CVIR Endovascular最新文献

The dilemma of interventional radiology is that being right does not automatically translate into getting it right. I found out, amid the turmoil following the publication of my book The Medical Omerta (published in Dutch) that there was a significant interest not only on social media but also in newspapers, radio, and television about uterine fibroid embolization. It seemed that all our efforts during the last 15 years to give this topic more public attention had completely failed, as the message about UFE being a proven alternative to hysterectomy came totally out of the blue for many women. A paper in 2019 about implementation of UFE in the Netherlands, less than 6%, was already a predictor of the bad news [1]. Here there is some similarity with other women-related IR procedure, which we have highlighted in our CVIR Endovascular special issue on women’s health [2].

My personal story about the failure to get UFE implemented in the Netherlands after our EMMY trial is only one chapter out of fourteen in my book, but the discussions about this chapter overshadowed all the other chapters. After the release of my book, women posted their personal, and always bad, experiences with hysterectomy on social media. It was interesting to see that the focus was on two aspects of the UFE saga. First was the complete absence of any information on UFE by the gynaecologists during consultation and second was the importance for many women to preserve their uterus to maintain fertility and as a crucial part of their femininity [3]. The fact that gynaecologists do not tell patients about UFE is well known worldwide and supported by many papers [4], but the high focus for women to preserve their uterus as a crucial part of their femininity came also to me as a total surprise. During the aftermath of my book release, the discussions with gynaecologists were mostly personal attacks on me in newspapers and on social media. One gynaecologist wrote in a newspaper interview that women were always very relieved, in his personal experience, to have their uterus removed which has given them so much trouble. He said that more than 80% of women in his practice choose to have their uterus removed instead of undergoing UFE. Of course, this was his personal male experience without any science to back it up.

What we have been showing with level 1 evidence and a 10-year follow-up is that UFE is a true alternative to hysterectomy for the endpoint quality of life. This is what I mean with Being Right based on scientific data, but unfortunately, we have not been able to Get it Right for the patients. In most European countries the number of UFE is between 0 and 6%, at the most. We have been following the endpoints of the gynaecologists by focusing on avoiding major surgery and shorter hospital stay, which is countered by gynaecologists with the argument that laparoscopic hysterectomy is also not major surgery and also requires only a one-day hospital stay. But w

Background: The BYCROSS™ device is a novel device intended for use in atherectomy of the peripheral arterial disease (PAD). With the BYCROSS™ atherectomy system, also prolonged calcifying lesions can be treated in a minimally invasive manner, which was previously reserved for bypass surgery. The aim of this study is to collect additional clinical data on safety and performance of the BYCROSS™ from patients undergoing revascularization of severely stenotic or occluded peripheral arterial vessels with the BYCROSS™.

Methods and design: This is an investigator-initiated national prospective multicenter observational study in patients with PAD. Sixty patients (20 per center) with PAD with stenosis higher than 80% or complete occlusion (de novo or recurrent stenosis) of vessels below the aortic bifurcation (min 3 mm vessel diameter) will be recruited. Three vascular surgery centers are participating in the study. The primary efficacy endpoint is procedural success, defined as passage of the occlusion through the BYCROSS device, and safety outcomes, explicated as freedom from device-related serious adverse events (SADEs). Secondary endpoints include primary and secondary patency rates, change in Rutherford classification, and freedom from amputation at 3 and 12 months.

Discussion: The BYCROSS atherectomy system may be a novel device for the minimally invasive treatment of prolonged calcified lesions previously reserved for bypass surgery. This national prospective multicenter observational study could represent another step in demonstrating the efficancy and safety of this device for treatment of PAD.

Trial registration: #DRKS00029947 (who.int). PROTOCOL APPROVAL ID: #22-0047(Ethics Committee at Ludwig-Maximilians-University Munich).

The technique and outcomes of pulmonary artery pseudoaneurysm (PAP) embolization was retrospectively evaluated in 13 patients undergoing 14 PAP embolizations between January 2014 and September 2023. The etiology of the PAP was iatrogenic (4/13), tumor (3/13), chronic lung (2/13), idiopathic (2/13) and mycotic (2/13). Clinical presentation was massive hemorrhage (6/13), incidental (4/13), and non-massive hemoptysis (3/13). The average PAP size was 13.5 mm. Coil embolization of the PAP sac was performed in all but two extenuating cases (11/13). Follow-up of 12 patients over an average 5.3-months showed persistent occlusion in all cases. There were no major adverse events attributed to the embolization. Five out of ten patients with procedures performed at least one year before this study were noted to be deceased after an average seven-month time. PAPs of various etiologies may be safely and effectively treated by occluding the aneurysm inflow, outflow, and sac.

Background: Although the candy-plug technique has been reported to be useful for the treatment of post-dissection aortic aneurysm, the stent graft needs be to customized to accommodate the size of vascular occluders.

Case presentation: We present a case of a persistent false lumen successfully treated with endovascular stent-graft and atrial septal defect occluder in a patient with Stanford Type B dissection. A covered stent graft was implanted into the false cavity through a distal rupture, and an atrial septal defect occluder was inserted into the covered stent to seal of the false cavity. Decreased aneurysmal diameter and false lumen thrombosis were noted by CT scan at 6-month follow-up.

Conclusions: Our case showed that combined use of a stent graft and atrial septal defect occluder is safe, technically feasible and effective in sealing of the false lumen in post-dissection aortic aneurysm patients with previously failed false lumen thrombosis.

Radial arterial lines are inserted in critically ill patients admitted to hospital intensive care units for continuous monitoring of their blood pressure. On removal the line can rarely become transected, potentially leading to thrombosis of the radial artery. Retrieval of the broken fragment can be achieved by open surgery, however other retrieval methods using ultrasound-guidance have been performed as they are considered safer and less invasive. We describe our technique of ultrasound-guided percutaneous retrieval of a broken non-radioopaque radial line in one patient, which involved the use of a microsnare. Under local anaesthesia and ultrasound guidance, a 6 Fr 5.5 cm short brite tip sheath was introduced into the radial artery, followed by a microsnare which was used to capture the arterial line, track the line back into the sheath and remove it uneventfully. The use of a microsnare under ultrasound-guidance is only one method to retrieve transected radial lines, with other interventional methods described in the literature. It enables a minimally invasive and safer approach to this potentially critical challenge and can help affected patients avoid open surgery to achieve the same management outcome.