CVIR Endovascular最新文献

Rationale and objectives: Emergency embolization is a cornerstone in the management of active bleeding and vascular lesions at risk of bleeding. This study aims to provide a comprehensive overview of emergency embolization technical modalities in a large cohort of patients, with a focus on embolic agent selection depending on vessel and lesion characteristics.

Materials and methods: This retrospective study included consecutive patients who underwent emergency embolization procedures in an interventional radiology department between 2022 and 2024. Data collection included precise type specifications and quantity of embolic agents, diameter and location of targeted vessel, vascular-type lesions, etiology, and technical success rate.

Results: A total of 304 patients (320 procedures, 465 artery embolizations) were analyzed. Most target arteries measured 1.0-1.9 mm in diameter (42.6%). For arteries < 1 mm (13.8%), liquid agents were preferred (46.7%), whereas coils were the most widely used in larger vessels. In active bleeding (32.7%), liquid agents (38.6%) and coils (37.3%) were the most commonly used. For spontaneously resolved bleeding lesions and pseudoaneurysms (33.1% and 14.2% of lesions, respectively), coils were widely used (34.9% and 50.8%, respectively). Coil use was associated with the highest procedural cost. Technical success was achieved in 99.1% of procedures.

Conclusion: In emergency embolization, small-caliber vessels (1.0-1.9 mm) were the most frequently targeted. In cases of active bleeding, liquid embolic agents were favored, with high technical success. Notably, a substantial proportion of lesions were identified on CT without ongoing bleeding at the time of embolization.

Level of evidence: Level 4, Case Series.

The use of paclitaxel-coated devices (PCDs) in peripheral arterial disease continues to generate interest and controversy. The PCD journey to date has been a story of highs and lows. The recently published SWEDEPAD 1 and 2 trials have rekindled discussion regarding efficacy and a potential link to mortality.

Introduction: Due to several issues with endovascular treatment of intracranial symptomatic atherosclerotic disease (ICAD), international guidelines recommend drug therapy as first-line treatment since almost 10 years. Regardless of this, endovascular ICAD treatment has meanwhile progressed, significantly reducing periprocedural complication rates. However, early in-stent restenosis (ISRS) remains, so far, unchallenged. Cardiologists had been at a similar point in the evolution of cardiac artery stenting and challenged ISRS through drug-eluting stents (DES). Therefore, 90d results and restenosis rates of patients treated with DES versus bare-metal stents (BMS) were compared to determine whether DES could also solve the neurovascular problem.

Methods: All endovascular ICAD treatments in 2014-2022 at a single institution through DES were retrospectively compared to all BMS-treatments in regards to periprocedural complications and ISR rates. Perioperative procedures and drug regimen were comparable for all patients, follow-up was carried out 90 days after treatment through digital subtraction angiography, clinical status was recorded by a board certified neurologist.

Results: Fifty-two patients were treated for ICAD with DES, 26 patients received ICAD-treatment with BMS. Patients' demographics and comorbidities were comparable. The periprocedural and ISR-rates were significantly lower in DES compared to BMS.

Discussion: The lower periprocedural complication rate may be due to less complexity of the DES system, while lower ISR in the DES group may be connected to reduced endothelium irritation and proliferation through the eluted sirolimus.

Conclusion: In the population studied, DES achieved equal to better results in comparison to BMS. This study supports a re-evaluation of the role of endovascular ICAD-treatment as first line therapy in the light of the most recent developments on knowledge and techniques.

Background: Endovascular therapy (EVT) for aortoiliac (AI) disease has shown favorable outcomes with recent advances in technology. Furthermore, the transradial approach (TRA) has emerged as a less invasive alternative to transfemoral access, improving patient comfort. However, data on CS implantation using the TRA remain limited.

Case presentation: We report two cases in which a VIABAHN® VBX-CS (W.L. Gore & Associates, Flagstaff, AZ, USA) were successfully deployed for AI disease using the TRA. In both cases, a 6-Fr transradial guiding sheath was used. The CSs were advanced and accurately deployed using a TRA without complications. The completion of the angiography confirmed the proper expansion and positioning of the CS. Both patients were discharged uneventfully without access-site complications.

Discussion: These cases demonstrate the feasibility and safety of AI balloon-expandable CS implantation using the TRA. The evolution of the device has enabled the delivery of relatively large CS using the TRA, expanding the applicability of this less invasive technique.

Conclusion: Transradial CS treatment may be a promising procedure for AI lesions, offering both procedural safety and patient comfort.

Pulmonary sequestration (PS) is the second most common pulmonary congenital malformation, which involves non-functional lung tissue that lacks communication with the tracheobronchial tree and is supplied by aberrant systemic arteries, with venous drainage to either the pulmonary or systemic venous system. This anatomic malformation increases patients' risk of recurrent infection due to the lack of robust gas exchange. Hence, prompt intervention is warranted for favourable outcomes. Surgical resection is the gold standard treatment for PS. However, embolization of aberrant arteries prior to surgery is a promising adjunct to reduce the risk of intraoperative hemorrhage associated with the aberrant arterial supply. Here we report a case of a 47-year-old man with suspected symptomatic extralobar sequestration dual feeders from a subclavian common trunk with an anomalous pulmonary arterial connection. The patient underwent preoperative embolization of feeding and draining vessels using low-profile plug occluders. The patient tolerated embolization and surgical resection with < 50 ml blood loss. Two-month post-operative imaging demonstrated the stable position of plug occluders. This case highlights the role of preoperative embolization with low-profile plug occluders as a safe and effective strategy for achieving hemodynamic control and minimizing intraoperative bleeding risk in anatomically complex pulmonary sequestrations.

Background: To evaluate outcomes of Castor single-branched stent graft combined with in situ fenestration of the left subclavian artery for aortic arch disease.

Methods: A retrospective analysis of 30 patients undergoing TEVAR with Castor stent that was first implanted with the branch in the left common carotid artery (LCCA) followed by in situ fenestration of the left subclavian (LSA) between March 2022 and March 2024 was conducted. Perioperative and follow-up data were collected and analyzed.

Results: The study retrospective analysis of 30 patients comprised 16 (53.3%) with acute type B aortic dissections, 6 (20%) with thoracic aortic aneurysms, 2 (6.7%) with intramural hematoma, and 6 (20%) with penetrating aortic ulceration. The technical success rate was 96.7% (29/30). One patient required carotid-axillary bypass due to subclavian artery lateral wall opening. There were no cases of mortality, stroke, upper limb ischemia, paraplegia, or stent graft-induced new entry within the 30-day follow-up period. Median hospitalization was 11 (IQR, 9-14) days, with a median follow-up of 12 (IQR, 8-19) months. One patient (3.3%) suffered a fall-related cerebral hemorrhage unrelated to the procedure. Another (3.3%) developed left upper limb ischemia due to stent angulation, corrected with a cover stent. Subclavian artery patency was 96.6% (28/29), and carotid artery patency was 100%. No deaths, endoleaks, or stent migrations occurred.

Conclusion: The Castor stent combined with in situ fenestration is a feasible, effective, and safe strategy for aortic arch disease repair, especially in providing alternative approaches for aortic diseases that require reconstruction in both branches.

Background: Consistent with global trends, the incidence of placenta accreta spectrum (PAS) is increasing in Australia. Prophylactic internal iliac arterial balloon occlusion (PIIABO) is an endovascular intervention utilised to assist haemorrhage control during caesarean delivery in women with PAS, offering a potentially uterus-preserving alternative to hysterectomy. However, existing outcomes remain heterogeneous. This study aimed to evaluate the endovascular safety of PIIABO with immediate sheath removal in the management of PAS, with a secondary assessment of haemostatic and procedural outcomes.

Materials and methods: A 10-year retrospective, single-centre cohort study of all patients with suspected PAS who underwent PIIABO was conducted with data obtained from electronic medical records and Radiology Information System (RIS)/Picture Archiving and Communication System (PACS).

Results: Fifteen patients underwent PIIABO. The mean maternal age was 34.1 years, with a mean gravidity of 4.2 and a parity of 2.3; all had prior caesarean delivery and 93% had concurrent major placenta praevia (n = 14). Mean gestational age at delivery was 34.9 weeks. Diagnosis was established by MRI (n = 11, 87.5% concordance) and ultrasound (n = 4, 50% concordance). Twelve patients underwent hysterectomy, confirming 1 accreta, 3 increta, and 8 percreta; 3 patients preserved uterus, with intraoperative evidence of percreta (n = 2) or normal placentation (n = 1). Mean estimated blood loss was 2273 mL, and 11 patients received blood transfusions, including four who required ≥ 4 units of packed red blood cells. Mean balloon inflation time was 129.9 min, sheath dwell time 265.5 min, and operating theatre time 265.7 min. Mean dose-area product was 55.03 Gy.cm² with a mean fluoroscopy time of 10.7 min. Radiation exposure decreased by approximately 90% over the study period with increasing institutional experience. No endovascular complications or reinterventions occurred, and all mothers and neonates were discharged without long-term morbidity.

Conclusion: PIIABO with immediate sheath removal demonstrated favourable procedural outcomes and a low complication rate in patients with PAS, supporting its safe implementation within a multidisciplinary care pathway.

Background: Pelvic and groin lymphoceles and lymphatic leaks remain challenging postsurgical complications. Ethiodized-oil (lipiodol) lymphangiography has been increasingly utilized as a combined diagnostic and therapeutic modality, but published experience with lipiodol-only management in this setting is limited. While transnodal glue embolization is well established, evidence on its long-term outcomes and safety profile remains sparse, with particular concerns regarding the potential risk of lymphedema. These gaps highlight the need for further evaluation of lymphangiography alone as a minimally invasive treatment option.

Materials and methods: This retrospective study included patients who underwent lymphangiography between January 2019 and March 2023 for persistent symptomatic pelvic lymphoceles or groin lymphatic leaks. Imaging findings, drain output, prior interventions, and clinical outcomes were reviewed. Technical success was defined as adequate visualization of the targeted lymphatic vessels. Clinical success was defined as resolution or minimal residual leak without need for further treatment.

Results: Ten patients (5 males, median age, 69 years) underwent lymphangiography for pelvic lymphoceles (n = 7) or groin lymphatic leaks (n = 3). The median interval from surgery to INL was 67.5 days (range, 12-108). Three patients had previously undergone surgical interventions, and four patients had undergone sclerotherapy without clinical improvement before INL was performed. Technical success was achieved in all patients (100%) with identification of lymphatic leak in all patients. Clinical success was achieved in 7 patients (70%) following lymphangiography alone, with a median time to resolution of 5.5 days (range, 5-12 days) and no immediate adverse events.

Conclusions: Lymphangiography using ethiodized oil contrast is a safe, and potentially effective minimally invasive treatment for pelvic and groin lymphatic leaks. These findings support a stepwise management approach, using lymphangiography as a first-line intervention before escalating to intranodal glue embolization.

Purpose: Removal of an adhered indwelling catheter in a totally implantable venous access device (TIVAD) can occasionally be challenging, particularly after prolonged implantation. The purpose of this paper is to present a modified endovascular technique for difficult TIVAD removal and to highlight its clinical relevance in cases where the catheter is firmly adhered to the vessel wall, making standard removal methods challenging.

Materials and methods: Between December 2015 and April 2025, a total of 3347 TIVADs were implanted, and 367 removal procedures were conducted. Among these, 355 (96.7%) catheters were successfully removed using the standard technique. Three (0.8%) were removed using the push-in techniques, and one (0.3%) was removed using the contralateral pull-through combined with the sheath-twist technique. In 8 (2.2%), the ipsilateral pull-through technique was required after failure of the initial approaches. The ipsilateral pull-through technique was performed using an introducer sheath and a handmade loop-snare constructed from a guidewire and a seeking catheter. Patient characteristics and procedural data were collected for analysis.

Results: The ipsilateral pull-through technique was successfully used to remove difficult-to-remove TIVADs in 7 of 8 patients. In the remaining patient, the indwelling catheter was firmly adhered to the segment extending from the innominate vein to the superior vena cava, where antegrade flow was absent and numerous collateral vessels were present. Although the occlusion was successfully crossed, catheter removal was aborted due to severe pain and concerns about potential superior vena cava rupture. One procedure-related complication was observed: catheter fracture on follow-up computed tomography in one of the seven successful cases. No other complications were observed. The subclavian vein, innominate vein, and superior vena cava were patent on follow-up computed tomography performed for cancer evaluation. The median indwelling duration in this cohort was 2473 days (interquartile range [IQR], 2017-3002 days), and the median procedure time was 60 min (IQR, 45.8-74.8 min).

Conclusion: The ipsilateral pull-through technique is a useful method to detach adhered catheters during difficult TIVAD removal.

Level of evidence: Level 3, Retrospective Study.