CVIR Endovascular最新文献

Background: Endovascular therapy (EVT) for the aortoiliac (AI) artery using the transradial approach (TRA) has become increasingly common with the availability of radial-specific devices. However, the feasibility of treating AI chronic total occlusion (CTO) via the TRA remains unclear.

Methods: This was a single-center, retrospective study. From October 2019 to November 2024, among 105 cases of AI CTO treated with EVT, 46 procedures performed via the TRA were analyzed. The primary endpoint was clinical success. The secondary endpoints were 12-month freedom from clinically driven target lesion revascularization (CD-TLR), successful antegrade guidewire passage, procedure time, need for femoral sheath insertion, and procedural or perioperative complications.

Results: The mean age was 74.4 ± 9.2 years. Mean lesion length was 121.9 ± 44.1 mm, and 80.4% were classified as Trans-Atlantic Inter-Society Consensus II type C/D. The left radial approach was used in 91.3% of cases. Stent implantation was successful in all patients. Bare nitinol stents were used in 78.3% and covered stents in 21.7%. Intravascular ultrasound was used in 97.8% of procedures. The TRA alone was performed in 34.8%, the TRA with sheathless femoral access in 13.0%, and femoral sheath insertion in 52.2%. The 12-month rate of freedom from CD-TLR was 94.7%. Mean procedure time was 97.2 ± 52.3 min. Successful antegrade guidewire passage was achieved in 56.5%. Procedural and perioperative complications each occurred in 6.6%. No cases of radial artery occlusion, cerebral infarction, or blue toe syndrome were observed. In the multivariable analysis, common-to-external iliac artery CTO (adjusted odds ratio 0.09, 95% confidence interval 0.02-0.53, p = 0.008) and common femoral artery involvement (adjusted odds ratio 0.05, 95% confidence interval 0.006-0.39, p = 0.005) were independently associated with unsuccessful antegrade guidewire passage.

Conclusion: EVT for AI CTO via the TRA is feasible and achieves high procedural success; however, many cases required an additional bidirectional approach using the transfemoral route.

Background and objectives: Managing hemoptysis can be challenging due to recurrences after different treatment methods. This study aimed to assess the efficacy and long-term outcomes of bronchial artery embolization (BAE) in controlling hemoptysis and improving patient survival.

Methods: In this prospective cohort study, patients with hemoptysis undergoing BAE between August 2017 and August 2022 were enrolled and prospectively followed. Clinical characteristics, underlying etiologies, complications, and post-procedural recurrences were prospectively recorded during a 1- to 4-year follow-up period. The survival for each factor was graphed in subgroups by the Kaplan-Meier (KM) curve and presented the estimation of the hazard ratio (HR) with 95% confidence interval (CI) from the univariate Cox proportional hazard (PH) model.

Results: A total of 297 patients (32% female, 58% with massive hemoptysis) were included. The mean survival time (MST) for all-cause mortality was 35.9 months (95% CI 33.6-38.3) and for hemoptysis-related death was 45.1 months (95% CI 43.8-46.4). The overall recurrence rate was 14.6% at 1-month post-BAE, decreased to 5.7% by the 9th month, and rose again to approximately 20% during long-term follow-up. Recurrence was significantly 71% higher in patients with non-massive hemoptysis (46.6%) compared with those with massive hemoptysis (33.8%, OR = 1.71, 95% CI 1.05-2.80, P = 0.03).

Conclusions: BAE effectively controls life-threatening hemoptysis with favorable long-term survival and acceptable recurrence rates. Optimized management of the underlying pulmonary disease may further improve BAE outcomes and reduce recurrence risk.

Spontaneous hepatic haemorrhage is a rare and potentially fatal condition. This case describes a 78-year-old woman on rivaroxaban who presented with haemodynamic shock due to a spontaneous subcapsular liver haematoma with capsular rupture and pseudoaneurysm formation. Imaging revealed multiple abnormal vessels without a single bleeding point. Transarterial embolisation with Gelfoam was performed, achieving haemostasis without significant hepatic infarction. The patient remained stable post-procedure, with normalisation of liver function tests and no underlying liver neoplasm on follow-up imaging. This case underscores the importance of early diagnosis and multidisciplinary intervention. Temporary embolic agents such as Gelfoam offer effective haemostasis with lower risk of long-term hepatic injury in patients with diffuse microvascular disruption.

Purpose: The BIONETIC-I trial aimed to evaluate the safety and effectiveness of the cobalt chromium Dynetic-35 stent, used in conjunction with the Passeo-35 Xeo peripheral dilation catheter, for treating atherosclerotic lesions in iliac arteries of patients with peripheral artery disease (PAD).

Materials and methods: This international, multi-center, prospective, single-arm study enrolled 160 subjects with 212 lesions across six European countries. The primary endpoint was a composite of major adverse events (MAE) at 12 months, including device- or procedure-related death within 30 days, clinically driven target lesion revascularization (cdTLR), and major index limb amputation. Secondary endpoints included technical and procedural success, cdTLR rate, mortality, major amputation rate, primary patency, and changes in PAD-related parameters.

Results: The patients (61.9% male, median age 65 years) presented with predominantly calcified lesions (90.1%) and high-grade stenosis (average 85.5%), with 12.5% having CLTI. The 12-month MAE rate was 3.5% (97.5% upper confidence limit: 7.2%), significantly non-inferior to the pre-specified performance goal (p < 0.0001). Secondary endpoints showed favorable 12-month outcomes, including a low cdTLR rate (2.0%), robust core lab-reported primary patency (93.1%), and significant improvements in PAD-related parameters such as Ankle-Brachial Index, Rutherford classification, and Walking Impairment Questionnaire. Subgroup analysis revealed no differences in MAEs between patients with severe/moderate and mild/no calcification, with notable improvements in functional measures for those with severe/moderate calcification.

Conclusion: The balloon-expandable cobalt chromium stent Dynetic-35 demonstrated safety and effectiveness in treating iliac arteries at the 12-month timepoint, showing promising results across various patient subgroups, including those with calcified lesions.

Level of evidence: Level 2, therapeutic study.

Trial registration: ClinicalTrials.gov, NCT04830228. Registered 31 March 2021, https://clinicaltrials.gov/ct2/show/NCT04830228 .

Purpose: To determine whether there is a significant decrease in intimal hyperplasia post percutaneous transluminal angioplasty (PTA) of AV access stenosis. Comparing drug-coated balloon (DCB) angioplasty with plain uncoated balloon (PUB) angioplasty by examining B-mode ultrasound measurements of percentage intimal medial thickening (%IMT) in stenotic lesions pre and post PTA.

Methods: One hundred ninety-one consecutive PTA procedures for AV access dysfunction were screened retrospectively for inclusion. Those procedures where there was an ultrasound prior to and following PTA with measurements of IMT were included.

Results: Ninety-nine stenotic lesions were included in a total of 87 patients. A total of 26/99, 26%, were treated by DCB angioplasty, and a total of 73/99, 74%, were treated by PUB angioplasty. The difference between the pre-PTA and post-PTA %IMT was calculated and defined as the delta-%IMT for each group. There was a greater reduction in %IMT in the DCB group (mean delta-%IMT =  - 22.35%) when compared with the PUB group (mean delta-%IMT =  - 5.94%), p = 0.0005. Delta-%IMT for those lesions where there was a baseline pre-PTA %IMT of greater than 25% was examined. The mean delta-%IMT reduced in the PUB group from - 5.94% to - 2.20% and remained similar in the DCB group at - 20.05%, p = 0.0003. A Kaplan-Meir survival analysis examining primary patency over 24 months did not demonstrate any significant difference between the 2 groups.

Conclusion: The statistically significant decrease in %IMT post PTA using a DCB compared with PUB angioplasty appears to demonstrate an anti-proliferative drug effect on lesion intimal hyperplasia. However, this did not translate into a sustained difference in target lesion primary patency.

Background: Genicular artery embolization (GAE) is an emerging, minimally invasive therapy for refractory knee osteoarthritis (OA), targeting pathological synovial hypervascularization. While technically well established in typical anatomy, rare congenital anomalies such as popliteal artery (PA) agenesis present unique procedural challenges and demand careful adaptation of endovascular technique.

Case presentation: A 56-year-old woman with refractory right knee OA and polymyalgia rheumatica presented with persistent pain despite extensive medical and surgical therapies. Angiography revealed complete absence of the PA, with distal lower limb perfusion entirely maintained through a dense network of arterial anastomoses. Detailed angiographic assessment and superselective catheterization allowed targeted embolization of hypervascular synovial branches while preserving critical collaterals. The procedure was technically successful and uneventful, providing substantial pain relief within two weeks, maintained at 3, 6, and 12 months. At 18 months, symptoms recurred and repeat GAE was considered. However, the symptoms resolved spontaneously, and no further embolization was required. Only mild swelling on exertion persisted. At the two-year follow-up, the patient reported sustained pain relief without further interventions.

Conclusions: This case illustrates that GAE can be safely and effectively performed even in the presence of rare congenital vascular anomalies such as PA agenesis. Meticulous angiographic assessment, precise differentiation of synovial from distal perfusion territories, and a tailored embolization strategy are essential to achieve safe and durable outcomes in such anatomically challenging scenarios. This case report underscores the adaptability of endovascular techniques and expands the evidence base for GAE in patients with rare vascular variants.

Background: Portal vein (PV) stenosis (PVS) is a common issue after pediatric liver transplantation (LT) and may be associated with severe morbidity. The purpose of this retrospective matched cohort study was to compare graft and patient survival after percutaneous angioplasty (PTA) for PVS in pediatric patients under 7 years with a control cohort without PVS and a cohort with chronic portal vein thrombosis (PVT).

Methods: This study included 31 patients with PVS (intervention group) and 62 patients without PVS (control group). Furthermore, 9 patients with chronic PVT were evaluated (negative control group). Primary endpoints were graft and patient survival. Secondary endpoints were comparison of liver function and clinical course (signs of portal hypertension), procedure-related complications, and long-term patency after PTA.

Results: Graft survival was comparable between the intervention and control group (p = 0.380), with 7-year survival rates of 93% (95% confidence interval [CI]: 84%, 100%) and 88% (95% CI: 80%, 97%), respectively. Graft survival was significantly higher in the intervention group compared to the negative control group p = 0.032; 7-year graft survival was 75% (95% CI: 50%, 100%). Patient survival was significantly higher in the intervention group (p = 0.034), with a 100% 7-year survival rate (95% CI: 100%, 100%) compared to 86% (95% CI: 78%, 96%) in the control group. Survival was reduced in the negative control group compared to the intervention group (p = 0.053). Seven-year patient survival in the negative control group was 88% (95% CI: 67%, 100%). There was one minor procedure-related complication (1/31 [3%]); long-term patency was 100%.

Conclusions: Seven-year graft and patient survival after PTA for PVS were on par with that of patients without PVS. Graft survival was lower for patients with chronic PVT. Clinical course and liver function after PTA were comparable to patients without PVS. These findings, together with the low complication rate and high long-term patency, provide additional evidence supporting the efficacy of PTA in the management of PVS.

Background: After a gastric variceal rupture, clinical practice guidelines recommend either transjugular intrahepatic portosystemic shunt (TIPS) or balloon-occluded retrograde transvenous obliteration (BRTO) as interventional options for secondary prevention. This study aimed to generate and compare TIPS and BRTO costing data to calculate the secondary prevention cost following gastric variceal bleeding, to encourage consideration of resource cost within decision-making.

Methods: All costs were included for patients treated between 1 January 2017 and 1 January 2024. Data on procedure, non-procedure, and ward costs were collected. Ward costs were only calculated for elective admissions to reduce bias from inpatient emergency procedures. All costs were measured from a healthcare system perspective and included direct and indirect expenses where relevant. A 5% indexation for inflation was applied to non-fixed costs from 2017 to the 2024 cost year. The cost to prevent gastric re-bleeding was then calculated by adjusting the costing data generated based on existing outcome data in the literature, utilising the largest existing meta-analysis on the efficacy of TIPS and BRTO in preventing re-bleeding.

Results: There were 38 patients in the study cohort, with a mean age 56.8 years (SD 12.0), and 25 patients (66%) were male. TIPS was performed in 27 patients (71%). The TIPS and BRTO groups had similar mean age, proportion of male sex, CP grading, and proportions of elective admissions. The median total cost for TIPS was AUD$11,922 (range $6307-$53,432), while the median total cost for BRTO was AUD$3632 (range $1818-$5174), p < 0.001. The adjusted cost to prevent future gastric re-bleed using TIPS was AUD$14,803, while the cost to prevent re-bleed using BRTO was AUD$3896.

Conclusion: The cost magnitude of both TIPS and BRTO was both low in an Australian model, and both remain good options for patients. However, the use of BRTO was associated with significantly lower upfront procedural costs than for TIPS for secondary prevention of gastric variceal bleeding. Costs should form a key component of the value of IR to modern healthcare.