CVIR Endovascular最新文献

Background: This report describes an embolization technique using a steerable sheath and an Amplatzer vascular plug 2 (AVP 2) to treat a wide-necked aneurysm located at the ostium of the renal artery. Given this particular location, directly attached to the aortic wall, similar to a saccular aneurysm of the abdominal aorta, stent placement or embolization using coils or liquid agents was not feasible.

Case presentation: A 45-year-old patient with a long medical history including heterozygous SC sickle cell disease, systemic lupus erythematosus, and a left iliac fossa kidney transplant presented with a partially thrombosed right renal artery aneurysm of 45-mm diameter. The aneurysm was located at the ostium of the renal artery that was occluded downstream. The aneurysm was directly attached to the aortic wall with a wide neck measured at 8 mm. Use of coils or liquid agents was not possible because of a very high risk of extra-target embolization. Lack of a patent right renal artery downstream precluded placement of a covered stent. Following multidisciplinary discussion, and due to the patient's high risk for aortic abdominal surgery, endovascular management with embolization was decided. Embolization was performed under local anesthesia, using fluoroscopic guidance and a cone-beam computed tomography three-dimensional road map. Following common right femoral artery access, a 7F steerable sheath was used to catheterize the aneurysm. An AVP 2 was then passed through the sheath in the aneurysm. Particular attention was paid to deploying the last disc of the AVP 2 in the aortic lumen to ensure closure of the aneurysm neck. Final aortic angiogram confirmed exclusion of the aneurysm. There were no intraoperative or postoperative complications. At computed tomography performed 7 months later, the AVP 2 remained in position, and the aneurysm was excluded and partially decreased in size.

Conclusions: In an anatomical presentation that was not a candidate for stent placement or classic embolization techniques, deployment of an AVP 2 using a steerable sheath successfully excluded the aneurysm. This procedure, performed under local anesthesia, obviated the need for abdominal aortic surgical repair or for an aortic stent graft.

Background: Intravascular lithotripsy (IVL) is an emerging technique for modifying heavily calcified arterial lesions, with primary application in peripheral arteries. We report the use of IVL for lesion preparation prior to stenting in a patient with severely calcified superior mesenteric artery (SMA) stenosis.

Case presentation: A 66-year-old man with type I adenocarcinoma of the esophagogastric junction (AEG Type I) and neoadjuvant FLOT chemotherapy was scheduled for Ivor Lewis esophagectomy. Preoperative CT angiography (CTA) revealed a high-grade ostial SMA stenosis due to extensive atherosclerotic calcification. To mitigate the risk of postoperative mesenteric hypoperfusion, percutaneous endovascular revascularization was performed. Following initial predilatation, IVL using a Shockwave 5.5 × 60 mm balloon catheter was employed for lesion preparation. Subsequently, an 8.0 × 24 mm balloon-expandable stent was successfully deployed with low-grade residual stenosis and no complications.

Conclusion: This case demonstrates that IVL represents a feasible and effective adjunct in the management of severely calcified visceral arterial lesions. It facilitates adequate lesion preparation and enables full stent expansion, even when the IVL balloon diameter is notably smaller than the stent diameter. This potentially represents a less traumatic approach to the vessel than alternative techniques. IVL may therefore be considered a therapeutic option in selected patients.

Background: This study evaluates the current evidence on the use of cone-beam computed tomography (CBCT) combined with advanced planning and guidance (APG) software in transarterial embolization for acute hemorrhage and reviews our institution's preliminary experience of use in emergency settings.

Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, SCOPUS, and Embase were searched to identify studies using CBCT with software for transarterial embolization of hemorrhage. Inclusion criteria focused on studies utilizing CBCT and APG software for hemorrhage management, with data extracted on demographics, hemorrhage locations, equipment/software specifications, technical success and procedural metrics. Additionally, we report a single-center review of patient outcomes using CBCT with multi-organ APG software (EmboASSIST with Virtual Injection, GE HealthCare, Chicago, IL, USA).

Results: Nine studies met the inclusion criteria, including 71 patients. The most common site of bleeding was the lower gastrointestinal (GI) tract (62%). The mean technical success rate of embolization utilizing CBCT with APG was 94.3% (range: 82-100%). Three studies reported procedure time (mean 98.9 min, range 50-146 min), and two studies reported fluoroscopy time (mean 27.1 min, range 25-29.1 min). In our initial experience, all six cases were technically successful with favorable outcomes.

Conclusions: CBCT with APG software is a feasible and effective tool for hemorrhage embolization in emergency settings. Its potential ability to improve bleeding detection compared to digital subtraction angiography (DSA) may lead to reduced procedure time, lower radiation exposure, and enhanced patient outcomes.

Systematic review registration: NIHR-PROSPERO CRD 42024619227.

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.