CVIR Endovascular最新文献

Background and aims: Transjugular intrahepatic portosystemic shunt (TIPS) is an effective method for reducing portal hypertension in patients with decompensated cirrhosis. However, portal vein puncture is associated with a steep learning curve. Conventional "blind" puncture methods are often imprecise, carry a high risk of complications, and require significant radiation exposure. To increase puncture accuracy, we developed an intravascular navigational ultrasound (IVNU) system. This study aimed to evaluate the feasibility, efficacy, and safety of IVNU for portal vein puncture during TIPS procedures.

Methods: In the in vitro experiment, we performed punctures using IVNU in four isolated porcine livers. Subsequently, in the in vivo animal study, eight Bama swine (Sus scrofa) were randomly assigned to undergo TIPS using either IVNU (experimental group) or conventional "blind" puncture with the RUPS100 COOK kit (control group).

Results: In our in vitro experiment, the IVNU system successfully punctured each lobe. In our in vivo study, all the procedures successfully established portosystemic shunts. The IVNU group exhibited significantly fewer punctures (1.8 ± 0.4 vs. 4.2 ± 1.1), shorter procedure times (32.5 ± 4.2 min vs. 58.7 ± 6.5 min), shorter fluoroscopy times (8.1 ± 1.3 min vs. 20.4 ± 2.1 min), and lower radiation doses (579.5 ± 45.9 mGy vs. 1305.7 ± 50.4 mGy) than the control group (all P < 0.01). Puncture-related complications were also significantly reduced in the IVNU group.

Conclusions: These findings indicate that IVNU significantly improves portal vein targeting success, reduces the risk of puncture-related complications and radiation exposure, and decreases procedure time, offering clinicians an optimized solution for TIPS creation.

Background: Slow-flow vascular malformations are persistent congenital vascular lesions that progressively disrupt tissue structure and function, often causing pain, swelling, and esthetic concerns. Despite the availability of surgical and sclerotherapy-based interventions, treatment outcomes are often unsatisfactory, with high rates of recurrence and resistance. The aim of this study was to prospectively evaluate the safety and effectiveness of bleomycin electrosclerotherapy in reducing lesion volume, alleviating symptoms, and improving clinical outcomes in 33 patients with slow-flow vascular malformations resistant to previous treatments. The prospective design allowed real-time observation of patients' responses to therapy, while the longitudinal follow-up, beginning with recruitment in 2020 and continuing through the end of 2024, allowed comprehensive monitoring of outcomes.

Results: After one treatment session, 33 of 35 (94.3%) lesions demonstrated symptomatic improvement, and all lesions (n = 35/35, 100%) showed a reduction in volume. Average volume decreased from 1781.1 to 1335.0 mL (25.0%) after one session and 1189.13 mL (33.24%) after final treatment. Mild adverse events, including redness (n = 4) and swelling (n = 25), resolved within 4 weeks. Skin changes like hyperpigmentation (n = 3) and livid discoloration (n = 4) could be observed for longer periods of time.

Conclusions: Bleomycin electrosclerotherapy demonstrated high effectiveness and safety for treating slow-flow malformations, establishing it as a promising therapeutic option even for lesions that have responded insufficiently to previous treatment attempts.

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.