CVIR Endovascular最新文献

Purpose: To evaluate the institutional cost-efficiency of paclitaxel drug-coated balloon (DCB; IN.PACT Admiral, Medtronic) versus plain balloon (PB) angioplasty for dysfunctional hemodialysis arteriovenous fistulas (AVFs) over 24 months, in order to inform resource allocation policy in a fixed-reimbursement system.

Materials and methods: This analysis uses clinical outcomes from a previously published single-center cohort of 62 patients (31 DCB, 31 PB) treated for dysfunctional AVFs. The paclitaxel DCB used in the cohort was IN.PACT Admiral (Medtronic). A detailed institutional micro-costing approach based on cost-recovery self-pay tariffs was applied to quantify direct procedural costs. Total mean cost per patient and cost per year of primary patency (CPYPP) were calculated, and a sensitivity analysis was performed to explore the impact of varying the DCB device price.

Results: The DCB group demonstrated higher mean target-lesion primary patency (1.46 ± 0.56 vs 0.86 ± 0.59 years) and required fewer AVF-related endovascular interventions per patient over 24 months (1.55 ± 0.81 vs 2.29 ± 0.94). Total mean cost per patient was lower with DCB (€8496.02 vs €11,324.55), resulting in a lower cost per year of primary patency (CPYPP €5819 vs €13,168). Sensitivity analysis suggested that this cost-saving profile remained robust across a wide range of DCB device prices.

Conclusion: Despite the higher device cost, DCB angioplasty appeared to be a cost-saving and clinically more effective alternative to PB angioplasty in this cohort. Lower overall institutional expenditure and reduced reintervention frequency support its consideration for integration into AVF maintenance protocols and value-based care pathways in similar fixed-reimbursement settings.

Gastric and esophageal variceal bleeding causes significant morbidity and mortality. TIPS creation is one of many methods to treat and reduce the risk of variceal hemorrhage. In such cases where TIPS cannot be created, percutaneous retroperitoneal splenorenal shunt (PRESS) creation serves as one alternative to decompress the portal venous system. This case highlights a case of PRESS creation from splenic vein to left adrenal vein as a method to decompress the splanchnic venous system in cases of chronic portal vein thrombosis with cavernous transformation when PVR-TIPS fails, with subsequent 6 month follow-up.

A pelvic arteriovenous malformation (AVM) is a rare congenital vascular anomaly that may cause relevant clinical symptoms. This systematic review synthesizes current evidence on diagnostic approaches, embolization techniques, and clinical outcomes for pelvic AVMs. A PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses)-compliant literature search identified 19 studies comprising 49 patients treated with embolization therapy. Venous approaches, including direct puncture of a dominant outflow vein (DOV), were most commonly performed. Coils were the primary embolic agent, frequently combined with adjunctive materials, reflecting substantial technical heterogeneity. Despite this variability, embolization achieved consistently high technical and clinical success rates with low complication rates over a mean follow-up of 21.1 months. Embolization therapy of DOV may be considered as first-line therapy for symptomatic pelvic AVMs, although future comparative studies are needed to guide standardized treatment strategies.

This retrospective study evaluates post-procedural symptom score changes after prostate artery embolization (PAE) with (Coil-out) and without (Standard) adjunctive prostate artery coiling after particle embolization. Changes in IPSS, QOL/Bother, and SHIM-IIEF V are reported at 1-5- and 9-15-month intervals. 573 procedures were reviewed, and 317 patients were included with a mean age of 72.1 years. Results favored the Standard group with greater IPSS reduction at 1-5 (-12.2 vs. -9.9, p = 0.018) and 9-15 months (-12.5 vs. -7.6, p = 0.018), and greater QOL/Bother improvement in the Standard group at 9-15 months (-2.8 vs. -1.8, p = 0.014). Procedure times were longer in the Standard group (186 vs. 173 min; p = 0.039), whereas fluoroscopy times were longer in the Coil-out group (48.3 vs. 44.8 min; p = 0.014). Though limited by retrospective nature and lack of longer-term follow-up, these results support particle embolization alone over adjunctive coil embolization for PAE.

Background: Drug-coated balloons (DCBs) have demonstrated effectiveness and safety in the treatment of dysfunctional arteriovenous fistulas used for hemodialysis in larger randomized studies; however, the patient and lesion profiles that have the best DCB outcomes remain undefined. Pivotal trials with core lab adjudication are ideal to generate hypotheses for future studies of intra-procedural characteristics given they include both site-reported and independently assessed data. The IN.PACT AV Access Trial randomized 330 patients 1:1 to treatment with a DCB (n = 170) or uncoated percutaneous transluminal angioplasty (PTA; n = 160). This exploratory post-hoc analysis investigated core lab adjudicated vessel sizing in the context of target lesion primary patency (TLPP) outcomes through 36 months. Participants were split into groups by median reference vessel diameter (RVD).

Results: The IN.PACT AV Access Trial randomized 330 patients 1:1 to treatment with a DCB (n = 170) or uncoated percutaneous transluminal angioplasty (PTA; n = 160). This exploratory post-hoc analysis investigated core lab adjudicated vessel sizing in the context of target lesion primary patency (TLPP) outcomes through 36 months. Participants were split into groups by median reference vessel diameter (RVD).

Conclusions: This post hoc analysis identified that intra-procedural sizing decisions have the potential to positively impact outcomes in patients with dysfunctional fistula lesions. These findings warrant further prospective evaluation to define optimal DCB sizing strategies.

Trial registration: NCT03041467 . Registered 25 April 2017.

Level of evidence: 3:

Introduction: Ongoing developments in interventional radiology have enabled the treatment of various musculoskeletal inflammatory disorders via super-selective embolization of abnormal areas of neovascularization. The current convention is to utilize vascular sheaths in these procedures. This study explored a single-center experience with a novel approach utilizing a sheathless microcatheter cannulation technique without the conventional vascular sheath.

Material and methods: A single-center retrospective chart review was conducted, including all eligible adult patients for whom a super-selective embolization was performed to treat an MSK inflammatory disorder between August 2024 and March 2025. The pre-procedural medical records and imaging were reviewed to determine satisfaction of inclusion criteria. The fluoroscopic images from the angiography suite and procedure notes were reviewed to determine technical success and immediate complications.

Results: Twenty-seven procedures were performed for 19 patients. The average age was 47.5 ± 10 years old. The majority of patients were female (13; 68.5%). The most common procedure indication was for treatment of plantar fasciitis with 14 procedures (51.9%). The embolic material of choice was imipenem-cilastatin in all but one procedure (26; 96.3%). The commonest microcatheter size was 1.7 French (21; 77.8%), and the preferred access vessel was the common femoral artery (17; 63%). The technical success rate was 100% without immediate complications. No major post-procedural complications were encountered. Only one minor access site hematoma complication was reported.

Conclusion: This novel sheathless microcatheter approach was found to be feasible, safe, and effective without major complications within our limited sample size.