CVIR Endovascular最新文献

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.

Purpose: To evaluate the safety and effectiveness of microfibrillar collagen paste (MCP), coils, and coils combined with gelatin sponge for transhepatic access tract embolization following portal vein islet cell transplant.

Methods: A retrospective review was conducted at a single institution between January 2008 and October 2024, including 20, 28, and 21 consecutive islet cell transplant procedures requiring transhepatic access embolization with MCP, coils, and coil plus gelatin sponge, respectively. All procedures were performed via a right portal vein branch. MCP was performed using Avitene (BD). The average number of coils required in the coil plus gelatin sponge and coil-only groups were 1.8 and 1.6 coils per procedure, respectively. All patients were placed on therapeutic anticoagulation during the procedure and for at least two weeks post-transplant. Medical records were reviewed to compare laboratory results, portal venous pressures, post-procedure liver ultrasounds, and 30-day hemorrhagic events across the three groups.

Results: All procedures were technically successful. However, one instance of coil migration into a portal vein branch occurred in the coil plus gelatin sponge group (1/28, 3.5%). Baseline hemoglobin, platelet counts, and partial thromboplastin time did not differ significantly between groups (p > 0.05). A statistically significant lower international normalized ratio (INR) was observed in the MCP group compared to the gelatin sponge and coil-only groups (1.0 vs. 1.1 vs. 1.1, p = 0.0036 and 0.004). No statistically significant differences were found in hemoglobin changes, post-transplant portal venous pressures, or post-embolization hemorrhagic events (p > 0.05). One patient in the coil plus gelatin sponge group developed a large subcapsular hematoma (1/27, 3.7%), while another in the MCP group experienced a large right hemothorax (1/20, 5.0%).

Conclusion: MCP, coils, and coil plus gelatin sponge are similarly effective for transhepatic access closure following islet cell transplant in anticoagulated patients. However, coil embolization may require multiple coils and carries a risk of migration.

Introduction: The field of interventional radiology (IR) has witnessed rapid advancements, with an increasing emphasis on complex and high-risk procedures. Increasingly, new IR treatments are becoming both available and indicated for patients with complex comorbidities. As a result, anaesthetic expertise has become essential to ensure patient safety, optimise procedural outcomes, and manage perioperative complications. Despite this growing demand, dedicated anaesthetic teams in IR remain limited, which leads to concerns regarding patient safety and procedural efficiency.

Methods: A comprehensive literature search was conducted across multiple databases, including PubMed, Embase, and the Cochrane Library, to identify studies published up to September 2024 that examined the expanding scope of IR, with a focus on the increasing need for anaesthetic support. This commentary draws on the existing literature to discuss the interaction between anaesthesia and interventional radiology, with particular attention to procedural sedation, pain management, and the care of high-risk patients. This commentary also evaluates workforce limitations, logistical challenges, and potential benefits of increased anaesthetic involvement in IR.

Findings: Existing literature demonstrates the significant benefits of anaesthetic involvement in IR. The presence of an anaesthesiologist was associated with reduced procedural risks, enhanced patient satisfaction, and quicker postoperative recovery times. Despite these benefits, many IR departments remain under-resourced in terms of dedicated anaesthetic staff. Furthermore, training programmes for anaesthesiologists rarely focus on the unique demands of IR, creating a gap in specialist care. The growing complexity and risk associated with IR procedures underscore the need for expanded anaesthetic support in this field. Hospitals and healthcare systems should prioritise the integration of anaesthetic teams into IR, investing in specialist training and workforce expansion. Doing so can improve patient outcomes and the overall efficiency of IR procedures, reducing procedural risks, increasing patient satisfaction, and facilitating quicker postoperative recovery times.