CVIR Endovascular最新文献

Background: Genicular artery embolization (GAE) is an emerging, effective pain treatment for symptomatic knee osteoarthritis. A potential concern of this procedure is non-target embolization of cutaneous and subcutaneous vessels, which can lead to severe skin complications such as necrosis. To mitigate this risk, some operators use periarticular cooling with the rationale of inducing vasoconstriction. The vasoconstrictive effect on non-target subcutaneous vessels caused by cooling has, however, not yet been objectively demonstrated. This study aims to provide the first objective evidence for this common safety maneuver.

Methodology: This retrospective analysis is based on a cohort of 36 patients (39 knees). The study evaluated a total of 49 selective angiographies of medial or lateral genicular arteries, which were stratified based on the presence of a superficial blush. Three cohorts were defined for comparison: 1) The Cooling Cohort, comprising 20 angiographies (from 10 knees) that showed a blush and were treated with periarticular cooling. 2) The Blush-Control Cohort, consisting of 18 angiographies (from 18 knees) with a blush but without a cooling maneuver. 3) The No-Blush Control Cohort (11 knees). The blush area on DSA was quantitatively analyzed for both groups with a superficial blush; in the Cooling Cohort, the area was compared before and after the intervention, while the baseline blush was quantified for the Blush-Control Cohort. Skin-related adverse events were systematically recorded and compared at the patient level across all three cohorts.

Results: The application of periarticular cooling resulted in a significant reduction in the mean blush area from 464.8 ± 447.6 mm² to 240.1 ± 208.2 mm² (p = 0.012), corresponding to an average reduction of 73.8% (p = 0.0006). Patients receiving cooling showed significantly fewer skin alterations than the blush-control group [median score 1 vs 2, p = 0.0174].

Conclusion: Periarticular cooling is a simple, non-invasive, and effective technique that significantly reduces quantifiable non-target cutaneous perfusion during GAE. Our work provides objective evidence supporting its use as a standard safety-enhancing maneuver to minimize the risk of skin-related complications.

Background: Endovascular therapy (EVT) has become a key revascularization strategy for patients with chronic limb-threatening ischemia (CLTI), especially in cases involving infrapopliteal (IP) chronic total occlusions (CTOs), which are often challenging to treat using standard antegrade approaches alone. Trans-collateral angioplasty (TCA) is a retrograde technique that accesses the distal true lumen via collateral vessels when conventional methods are unsuccessful. However, clinical evidence regarding the efficacy and safety of TCA remains insufficient. This study aimed to evaluate the efficacy and safety of TCA as a retrograde approach during EVT for IP CTO lesions.

Results: This retrospective single-center study included 44 IP CTO lesions in patients who underwent TCA between January 2020 and December 2022, after excluding 18 lesions treated solely with the pedal-plantar loop technique. The mean patient age was 78.8 years, and 81.8% had diabetes, 79.5% had chronic kidney disease, and 31.8% were on dialysis. EVT success was achieved in 95.5% (95% CI: 84.9-98.7) of lesions. TCA alone achieved lesion crossing in 70.5% (95% CI: 55.8-81.8), while distal puncture was required in 13.6% (95% CI: 6.4-27.0) of cases. Various crossing techniques, including the rendezvous technique and reverse subintimal tracking, were conducted. Collateral vessel-related complications occurred in 11.3% (5 lesions; 95% CI: 5.0-24.6), including injury in 6.8%, and occlusion and spasm in 2.3%. No vessel dissections occurred. The overall incidence of perioperative complications within 30 days was 20.5% (95% CI: 11.3-34.2), most commonly gastrointestinal bleeding and stroke. At one year, the rate of freedom from target lesion revascularization was 45.4%, and amputation-free survival was 84.0%.

Conclusions: Our findings suggest that TCA can be a feasible and relatively safe retrograde strategy for complex IP CTO lesions when antegrade wiring fails. It is associated with high procedural success and a low incidence of collateral vessel-related complications, supporting its use in selected cases of CLTI.

Background: Post-operative portal vein stenosis/occlusion is a relatively common and life-threatening condition. Clinical outcomes depend on the early diagnosis and the appropriate management.

Case presentation: A 78-year-old female developed portal vein high grade stenosis after resection of an ampullary cholangiocarcinoma. The patient presented with acute liver failure and impaired coagulation function. Imaging confirmed transient ischemic changes of the hepatic parenchyma. Salvage attempt with a portal venous stent was decided to prevent irreversible liver damage. The procedure was successful with a satisfactory clinical outcome.

Conclusions: The paper offers a summary of the clinical benefit from percutaneous portal venous stent placement in case of post operative high grade portal vein stenosis in a patient with acute liver failure.

Subcutaneously implanted port catheters are increasingly used in the management of long-term chemotherapy and provide great comfort to oncology patients. Although central venous ports are implanted with high technical success and low complication rates, catheter malposition may occur, resulting in port dysfunction. Various techniques exist for repositioning malpositioned catheters. This report describes the use of an artificial snare technique for the repositioning of a central venous port catheter that was identified as malpositioned six months following its insertion.

Background: Arteriovenous fistula (AVF) thrombosis remains a critical complication in hemodialysis (HD) patients, often leading to treatment delays and requiring urgent intervention. While endovascular therapy (EVT) is commonly employed, less invasive strategies such as percutaneous thrombolytic therapy are gaining attention due to their potential to restore patency and avoid more complex procedures. This study assessed the effectiveness of percutaneous thrombolytic therapy in acute AVF thrombosis and explored key predictors associated with the need for subsequent endovascular intervention.

Methods: This retrospective study included 42 patients who underwent ultrasound-guided percutaneous thrombolytic therapy using low-dose alteplase (3-5 mg). Technical and clinical success, complication rates, and the need for additional EVT were assessed. Statistical analyses including logistic regression and ROC analysis were used to determine independent predictors for EVT.

Results: The clinical success rate was 97.6%, with 69% of patients achieving AVF patency without EVT. Symptom duration emerged as the strongest predictor for EVT; patients with symptoms > 2.5 days had significantly higher EVT rates (p = 0.01). Each additional day of symptoms increased the odds of requiring EVT by 88.5% (OR = 1.885, p = 0.012). Female patients were also more likely to require EVT than males (p = 0.005). No significant associations were found for age, BMI, or fistula characteristics.

Conclusion: Percutaneous thrombolytic therapy is a highly effective and minimally invasive option for acute AVF thrombosis. Symptom duration > 2.5 days is a key threshold predicting the need for EVT, highlighting the critical importance of early intervention. These findings may inform clinical decision-making and optimize access salvage strategies in dialysis patients.

Purpose: This study aimed to reveal the impact of nodular calcification (NC) on restenosis risk in patients undergoing femoropopliteal drug-coated balloon (DCB) angioplasty for symptomatic atherosclerotic peripheral artery disease.

Methods: We retrospectively analyzed 568 patients who underwent endovascular therapy with DCB for de novo femoropopliteal lesions under intravascular ultrasound guidance between November 2017 and February 2021 at seven cardiovascular centers in Japan. Patients with lesions without calcification were excluded from the study. The patients were classified into two groups based on the presence or absence of NC: the NC [ +] group (n = 200) and the NC [-] group (n = 368). The main outcome was the primary patency at 3 years. Cox proportional hazards analysis was used to determine whether NC was an independent predictor of clinical outcomes.

Results: The 3-year primary patency rates were significantly lower in the NC [ +] group than in the NC [-] group (53.8% vs. 65.8%, p = 0.001). After multivariate analysis, the presence of NC was independently associated with restenosis risk; the adjusted hazard ratio was 1.61 (95% confidence interval 1.15 to 2.26, p = 0.006).

Conclusion: The NC is an independent predictor of restenosis in patients undergoing DCB angioplasty for femoropopliteal lesions. Patients with NC had a significantly lower primary patency, highlighting their negative impact on clinical outcomes. Further research is required to establish evidence-based strategies for managing calcified femoropopliteal lesions.

Background: Endovascular therapy (EVT) is a well-established revascularization strategy for patients with peripheral artery disease. However, achieving optimal wire crossing in complex chronic total occlusion lesions remains technically challenging. Intravascular ultrasound (IVUS)-guided wiring facilitates safer and more effective procedures. However, aligning IVUS findings with fluoroscopic imaging is challenging due to catheter rotation. We report a novel technique-termed the IDEAL technique-that leverages the deep vein as an anatomical landmark to correct IVUS rotational orientation.

Case presentation: A 76-year-old female presented with chronic limb-threatening ischemia in the right toe. Contrast-enhanced computed tomography revealed a chronic total occlusion in the right superficial femoral artery. EVT was performed via the right common femoral artery. IVUS revealed that the first guidewire had entered the subintimal space partway through its course. Using preprocedural computed tomography, the deep vein was identified and its clock-face position relative to the artery was determined. This anatomical landmark enabled correction of IVUS image rotation, allowing accurate re-direction of a second guidewire under fluoroscopic guidance, thereby successfully crossing into the intraplaque lumen.

Conclusions: The IDEAL technique quickly provides anatomical orientation by utilizing the deep vein as a landmark during IVUS-guided wiring-making it, quite literally, ideal.