CVIR Endovascular最新文献

Background: Urethral bleeding can be related to iatrogenic and non-iatrogenic trauma; selective internal iliac angiography may identify contrast extravasation with or without a pseudoaneurysm at the level of the distal internal pudendal or bulbourethral artery. Here, we describe another, yet unreported vascular lesion of the bulbourethral artery related to urethral injury.

Case presentation: Two patients with a iatrogenic and non-iatrogenic urethral bleeding respectively are presented. Conservative management, including Foley catheter placement and endoscopic management were unsuccessful. Selective internal pudendal angiography revealed an arteriospongious fistula without clear contrast extravasation into the urethral lumen; super-selective embolization with microcoils and non-adhesive liquid embolics was safely performed and successfully stopped the bleeding. The postinterventional course was uneventful and both patients recovered without sequelae.

Conclusions: Traumatic urethral bleeding might be related to an arteriospongious fistula which can be successfully managed with super-selective coil and liquid embolic embolization.

Purpose: This study evaluates catheter failure rates between a helical-tip catheter and a traditional split-tip catheter among intensive care unit (ICU) patients undergoing tunneled dialysis catheter (TDC) placement.

Materials and methods: We analyzed 1734 TDCs placed over seven years in a retrospective fashion, focusing on 340 catheters used in an ICU setting. Of these, 112 were VectorFlow catheters (32.9%), and 228 were Ash-Split catheters (67.1%). Catheter failure rates due to malfunction or infection were assessed using Kaplan-Meier analysis, while contributing factors were evaluated using Cox proportional hazards modeling.

Results: Within 90 days, 34.8% of patients experienced catheter failure. The VectorFlow catheter demonstrated superior unassisted patency at 30, 60, 90, and 180 days compared to the Ash-Split catheter (87.4 ± 3.6%, 78.0 ± 5.1%, 75.1 ± 5.0% and 60.1 ± 8.2% compared with 75.0 ± 3.3%, 62.8 ± 4.1%, 60.7 ± 4.2% and 44.3 ± 5.5% respectively, P = 0.022). Adjusted hazard ratios indicated Ash-Split catheters were nearly twice as likely to fail according to both univariate (1.72, P = 0.024) and multivariate (1.89, P = 0.017) modeling.

Conclusion: The findings suggest that the VectorFlow catheter demonstrates significantly better primary unassisted patency over the Ash-Split design in ICU settings, supporting its preferential use.

Interventional Radiology (IR) has evolved far beyond its procedural roots, offering advanced treatments in oncology, vascular disease, and trauma. Its future, however, depends on deeper integration into clinical workflows, patient management, and multidisciplinary collaboration. Barriers such as limited participation in care teams, absence of outpatient consultation structures, and insufficient clinical training hinder IR's ability to fully own patient care, reducing visibility and delaying referrals. To reframe IR as a true clinical specialty, several actions are needed: expand integration through tumor boards, ward rounds, and follow-up clinics; strengthen patient-centered communication to support trust and informed consent; assume leadership roles to improve workflows, staffing, and institutional decision-making; reform training with broader clinical exposure, simulation, and standardized certification (e.g., EBIR); and establish structural consistency across departments to unify identity and foster collaboration. The future of IR lies in combining technical expertise with patient engagement, interdisciplinary cooperation, and clinical leadership-ensuring it becomes a central, not peripheral, force in modern healthcare. This review will explore the evolving role of interventional radiologists in patient management, with particular emphasis on their integration into hospital-based multidisciplinary teams. It will examine their participation in clinical decision-making, interprofessional communication, and strategies to enhance the visibility and recognition of IR among both patients and healthcare providers.

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.