CVIR Endovascular最新文献

Background: Central venous access catheter (CVC) devices are a critical part of care in patients with a variety of treatment needs but are not without complications.

Case presentation: A 5-year-old male child with a background of autosomal recessive nephrotic syndrome developed a septic right atrial thrombus related to his dialysis line. Mechanical thrombectomy and line removal was complicated by tract haemorrhage, requiring the integrated management of thrombosis and haemorrhage. Haemostasis was achieved with combination of compression and sealing of the subcutaneous tract.

Conclusion: This case provides an excellent example of tract haemorrhage demonstrated fluoroscopically. We discuss the available treatment options, which may need to be employed in urgent or emergent fashion, in paediatric patients with differing physiological reserves.

Background: Obesity is a global pandemic affecting more than 1 billion people worldwide and a leading cause of preventable death. Left gastric artery embolisation to inhibit ghrelin secretion, a hormonal driver of appetite, has been proposed as a potentially safer treatment for obesity than surgery. This study describes the incidence of anatomical variation, gastric artery anastomoses, collateral supply and vessel lengths, diameters and angles of origin relevant to embolisation of the LGA in the EMBIO cohort of obese patients.

Results: Arterial phase CT scans (n = 90) were performed as part of screening for the EMBIO trial. 62 participants (69%) had conventional coeliac and hepatic artery anatomy. 14 participants (16%) had left hepatic arterial supply originating from the LGA. The most common LGA branching pattern (37%) was for the first branch to supply the cardia / gastro-oesophageal junction and then for the LGA to split into two main branches supplying the gastric fundus. 34% had a left- right gastric artery anastomosis visible on CT. The LGA was the dominant artery supplying the gastric fundus in 51% with supply from multiple arteries, most frequently the LGA and short gastric arteries (27%), seen in the other participants.

Conclusion: This study presents detailed analysis of the arterial anatomy relevant to performing successful and safe embolisation of the LGA for treatment of obesity and acute haemorrhage.

Purpose: Conventionally, the treatment of carotid artery disease customizes stents to the vessel diameter. The design of the CGuard stent and its nitinol shape memory allow for a wide operational range and minimal residual radial force. This pilot study assesses the feasibility and clinical outcomes of the 10-mm CGuard stent in a one-size-fits-all sizes protocol.

Materials and methods: The study is a multicenter, prospective cohort study involving 226 consecutive patients with symptomatic or asymptomatic carotid artery stenosis, with an indication for revascularization. All patients received the 10-mm CGuard stent, irrespective of the carotid artery reference diameter, and were grouped into three categories based on the reference vessel diameter. Endpoints included procedural success and incidence of major adverse cardiovascular events (MACE) at 30 days and 1 year.

Results: The study achieved 100% technical success, with an average residual stenosis of 8.41%. Clinical success was 98.7%. During in-hospital observation, one patient experienced a major ipsilateral stroke (0.4%), and two patients had transient ischemic attacks (TIAs) (0.8%). At the 30-day follow-up, there were one death and one case of re-occlusion which was asymptomatic. No differences between the three groups were found regarding technical or procedural success, residual stenosis, complications, TIAs, MACEs, or patency rates. No events occurred between the 30-day and 1-year follow-up, maintaining the MACE rate at 1.5%. ICA and ECA patency rates at 1 year were 99% and 99.4%, respectively, indicating mid-term treatment effectiveness.

Conclusion: This pilot study demonstrates that the one-size-fits-all approach using a 10-mm CGuard stent to treat carotid artery stenosis provides minimal residual radial force with optimal stent apposition. The one-size-fits-all approach with CGuard stent is feasible, safe, and effective. Further studies for confirmation are guaranteed.

Background: Uterine artery embolization (UAE) is a recognized treatment for symptomatic fibroids, but its impact on fertility remains controversial. This study aimed to assess live birth rates, pregnancy outcomes, and obstetric complications in patients attempting pregnancy after UAE.

Materials and methods: We conducted a retrospective monocentric study including women aged 18-45 years treated by UAE for symptomatic fibroids between June 2007 and March 2021. Patients who attempted pregnancy post-procedure were identified and analyzed. The primary outcome was the live birth rate; secondary outcomes included pregnancy rate and obstetric complications. Statistical analyses were performed according to the STROBE guidelines.

Results: Among 210 included patients, 46 attempted pregnancy (22%). The mean age of this fertility population was 40 years. Thirteen women (28%) began at least one pregnancy after UAE, resulting in 12 births overall in 9 mothers. All live births were delivered via cesarean section, and no fatal obstetric complications occurred in this cohort. The miscarriage rate (23%) and other obstetric outcomes were consistent with general population trends for similar age groups. UAE demonstrated high symptom resolution, with 70% of patients requiring no further interventions for fibroids.

Conclusion: Fertility may be preserved in a subset of women with complex surgical histories or high-risk surgical profiles undergoing UAE for symptomatic fibroids.

Trial registration: NCT05271981.

Background: Vascular Ehlers-Danlos syndrome is a rare connective tissue disorder characterised by arterial fragility, predisposing patients to life-threatening vascular complications. Endovascular aneurysm management in these individuals poses significant challenges due to their delicate vasculature and limited surgical options. This case report highlights the novel use of a direct percutaneous transhepatic approach for aneurysm coiling in a patient with a rapidly expanding hepatic artery aneurysm, demonstrating an innovative solution to a complex vascular emergency.

Case presentation: A 17-year-old male with a known diagnosis of vascular Ehlers-Danlos syndrome presented with a perforated sigmoid colon. After undergoing a midline exploratory laparotomy, imaging revealed a rapidly expanding 50-mm aneurysm in his common hepatic artery. Traditional endovascular coiling was infeasible due to significant proximal stenosis, creating similar limitations for vascular reconstruction and liver transplantation. The multidisciplinary team opted for a direct transhepatic approach to coil the aneurysm. The patient recovered without complications, and follow-up imaging confirmed haemodynamic stability and adequate liver perfusion.

Conclusions: This case highlights the importance of an integrative multidisciplinary approach in managing complex vascular emergencies and successfully demonstrates how a direct percutaneous transhepatic approach can serve as a valuable reference for similar cases, expanding the repertoire of endovascular interventional radiology techniques for challenging pathologies.

Purpose: Balloon dilatation has remained relatively underutilized despite its emerging potential for hemodialysis catheter removal. This case series revisits balloon-assisted retrieval to showcase its effectiveness in retrieving long-term port-a-caths complicated by fibrotic encapsulation, calcification, and stenosis.

Materials & methods: Endoluminal balloon-assisted retrieval was utilized in 12 cases with retained port-a-cath catheters after gentle traction failed to remove the indwelling 8 French catheter due to complex intravascular fibrotic adhesions and calcifications. Under fluoroscopic guidance, a non-compliant angio-balloon was advanced over a guidewire through the externally accessible central venous catheter. Once the balloon reached the distal segment of the tubing, it was sequentially inflated in a retrograde manner within the catheter's lumen to disrupt the surrounding adhesions.

Results: Balloon-assisted retrieval was successfully performed in all 12 cases, allowing for the complete removal of the indwelling catheter via gentle traction despite significant fibrotic encapsulation, calcification, and stenosis. Minimal blood loss was observed, and no further complications were reported.

Conclusion: This case series revisits endoluminal balloon dilatation, an emerging technique for removing hemodialysis catheters, to demonstrate its application and efficacy in retrieving long-term port-a-cath catheters complicated by fibrotic encapsulation, calcification, and stenosis. This technique should be regarded as a primary retrieval option for retained port-a-caths in instances of severe fibrosis and calcification.

Level of evidence: Level 4, case series.

Extracranial arteriovenous malformations (AVMs) are high-flow vascular malformations that are challenging entities to treat and are primarily managed with embolization alone. Single-stage embolization and resection is a technique occasionally used for treating intracranial arteriovenous malformations. This manuscript describes combined embolization and surgical resection for localized superficial extracranial AVMs by presenting three cases from our experience. A retrospective review of the medical records of patients in this series including clinical notes, procedural imaging, and follow-up documentation was performed. A total of three AVMs near the antecubital fossa, deltoid, and forehead were embolized and resected. There was no evidence of recurrence on follow-up imaging, and no complications were observed, specifically, overlying skin injury. Embolization and resection of localized superficial extracranial AVMs with overlying skin changes offer an alternative treatment option to existing paradigms.

Purpose: Refractory ascites (RA) is a rare but poorly understood complication following liver transplantation (LT). It is often associated with portal hyperperfusion, potentially driven by splenic hyperafflux. In such cases, splenic artery embolization (SAE) has been proposed as a minimally invasive and cost-effective therapeutic option to reduce splanchnic inflow and alleviate symptoms.

Materials and methods: This retrospective study analyzed patients who underwent LT between August 2010 and September 2023 at IRCCS Azienda Ospedaliera-Universitaria di Bologna and were subsequently diagnosed with refractory ascites. Embolization of the splenic artery was performed using coils or plugs of variable caliber. Laboratory assessments included bilirubin, albumin, alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and international normalized ratio (INR). Additionally, Child-Pugh and MELD scores were recorded. The severity and evolution of ascites were monitored through serial ultrasonographic follow-ups.

Results: A total of 12 patients met the inclusion criteria. No severe complications related to the procedure were observed. Among them, 9 patients (75%) experienced complete resolution of ascites and normalization of liver function within 9 months post-procedure. Three patients (25%) died during follow-up due to transplant-related complications unrelated to SAE in the first month after the procedure.

Conclusion: SAE is an effective treatment option for patients with refractory ascites following LT. The procedure resulted in significant improvement in ascites control and liver function in most patients. Good patient selection is essential for a good procedure outcome. Further research with larger patient cohorts and longer follow-up is needed to validate these results.

Level of evidence: Level 3.

Purpose: Determining the safety of Optical Coherence Tomography (OCT) and Fractional Flow Reserve (FFR) in Percutaneous Transluminal Angioplasty (PTA) for below-the-knee vascular disease.

Materials and methods: In this prospective single-center non-randomized trial, patients who underwent PTA for below-the-knee vascular disease with lesions no longer than 3 cm were included. Based on digital subtraction angiography (DSA) using iodine contrast agent, the physician was asked to estimate the diameter of the target vessel and degree of stenosis of the target lesion. The investigated tools are OCT, which is an intravascular imaging technique using near-infrared light and iodine contrast agent to visualize the vessel wall, and FFR, which measures the pressure gradient along a stenosis in a hyperemic state. The primary outcomes were the safety and feasibility of performing these measurements. OCT and FFR measurements were conducted before and after PTA. Physicians were not allowed to interpret study measurements during the procedure, as the safety and feasibility of these novel techniques have not yet been proven. To assess the secondary outcomes, physicians interpreted the measurements after the procedure to determine whether OCT or FFR would have changed intra-operative decision-making such as not performing PTA, the use of other balloons or stents, and additional revascularization based on the OCT and FFR measurements.

Results: Ten patients were included. The target lesion was significant in nine patients based on angiography, who were therefore treated. Seven patients were treated with PTA using plain-old-balloon and two patients were treated using atherectomy devices. No complications occurred during or after the procedures and measurements were successfully conducted in all patients. Overall, OCT and FFR would have led to a change in intra-operative decision-making in 7 patients. Estimation of the diameter of the target vessel varied from the value measured with OCT with more than 0.5 mm in 4 cases. FFR measurements demonstrated target lesions to be hemodynamically insignificant in 6 cases, while it showed target lesions to remain hemodynamically significant despite treatment in 3 cases.

Conclusion: OCT and FFR are feasible to use in below-the-knee PTA and may cause significant alterations in perioperative decision-making by providing previously unavailable information on lesion size and morphology and hemodynamic significance.

Objectives: To evaluate clinical presentation, imaging features, embolization techniques and their outcome for acquired uterine vascular anomalies (UVA) related to obstetric events.

Materials and methods: Thirteen women (mean age = 34; range = 20-40 years) who had undergone interventional radiological treatment of UVAs between 2013 and 2024 were retrospectively analyzed. All patients had a history of an obstetric event. They presented with ongoing postpartal vaginal blood losses (n = 11) or were asymptomatic (n = 2). Fertilization had been performed by intracytoplasmic sperm injection (ICSI) in 3/13 women. 7/13 women had delivered healthy babies. 6 women had surgical, drug-induced or missed abortions. Postpartum dilatation and curettage had been performed in 4 women. The delay between the obstetric/gynecological event and the radiological intervention ranged from 19 to 193 days (median = 49 days). Long-term follow-up was available in 12/13 patients (median FU = 2.4 years). Unilateral selective transcatheter embolization was performed in 7/12 patients (n-Butyl-Cyanoacrylate-Lipiodol mixture [BCAL], n = 5; trisacryl gelatine particles, n = 2); Bilateral uterine artery embolization was performed in 5/12 women (unilateral BCAL combined with contralateral particles in 3/12, or bilateral gelatine sponge slurry in 2/12). In one patient percutaneous direct injection of BCAL into a uterine artery branch pseudoaneurysm was performed.

Results: Primary clinical success without complications was achieved in 10/13 interventions. Re-embolization was successful in the 3 patients with ongoing bleeding despite uterine artery embolization. Follow-up information was available in 12/13 patients (median FU = 2.4 yrs). The pregnancy rate after embolization was 8/12women with a birth rate of 6/8 pregnancies.

Conclusion: Embolization of acquired UVAs is an effective and safe treatment. Preservation of uterine function for future pregnancy after uterine transarterial embolization seems warranted.