CVIR Endovascular最新文献

Purpose: The aim of this systematic review and meta-analysis was to identify the technical and clinical outcomes of stent-graft implantation in patients with hepatic artery bleeding.

Materials and methods: The PubMed database was searched for publications between 2000 and March 2025 evaluating patients treated with stent-graft implantation for hepatic arterial hemorrhage. The outcome measurements were technical (successful hemostasis with stent-grafts) and clinical success (no rebleeding from hepatic arteries), early mortality, and stent-graft patency during follow-up. A modified Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included publications. An individual patient data meta-analysis was performed using the chi-square test or Fischer exact test to identify predictors of stent-graft patency.

Results: In total, 351 patients from 22 studies were included. The mean NOS score was 5.4 ± 0.95. Most patients (n = 323) had bleeding after surgery. The technical success rate of stent-graft placement was 94.3%. Patients with technical failure were managed either by surgery (n = 10) or coil embolization of the hepatic artery (n = 10). Rebleeding from hepatic arteries was seen in 24 patients with a clinical success rate of 92.7%. The early mortality rate was 15.6%. Follow-up showed stent-graft patency in 76.5% (202 of 264) of the cases. Most of the stent-graft occlusions (51/62, 82.2%) were asymptomatic. No significant difference was seen in the rate of stent-graft patency between patients receiving acetylsalicylic acid or not, or dual antiplatelet treatment or not. Overlapping stent-grafts (p = 0.009) were significant risk factors for stent-graft occlusion.

Conclusion: Stent-graft implantation in hepatic arterial bleeding is associated with high technical and clinical success rates. Despite the considerable rate of stent-graft occlusion during follow-up, occlusion is mostly asymptomatic, probably due to collateral development.

Background: Prostate artery embolization (PAE) is an established treatment option for benign prostatic hyperplasia (BPH). Variations in prostatic artery (PA) origins can present significant technical challenges.

Case presentation: An 86-year-old male with recurrent bladder cancer and persistent gross hematuria post-TURBT presented for PAE. Intra-procedural angiography revealed a prostatic artery branching from an aberrant obturator artery that originated from a trifurcation of the common femoral artery. PAE was successfully performed with contralateral access and particle embolization. The patient's hematuria resolved within 3 days, and his IPSS decreased by 10 points at follow-up.

Conclusion: This case highlights a markedly rare variant of the prostatic artery arising from the common femoral artery, emphasizing the need for careful pre-procedural planning and vigilance during PAE to avoid complications.

Purpose: Hepatic artery stenosis (HAS) is a serious complication of liver transplantation (LT), with no established guidelines for choosing between percutaneous transluminal Angioplasty (PTA) and stent. This study compared their outcomes to inform clinical practice.

Materials and methods: We searched PubMed, SCOPUS, Cochrane library, and Web of Science for studies comparing PTA and stenting in HAS patients after LT. The primary outcome was primary patency rate. Secondary outcomes included technical success, major complications, Hepatic artery thrombosis (HAT) incidence, reintervention rates, and time to recurrent HAS. We also conducted a subgroup analysis based on major complication types, specifically artery dissection and rupture.

Results: Nine observational studies, including 325 patients with HAS after LT, were analyzed, with 140 treated with PTA alone and 197 with stents. No significant differences were found between stenting and PTA in primary patency rates at 6 months, 12 months, and the end of follow-up, as well as in technical success, major complications, artery dissection, artery rupture, and HAT incidence. However, stenting was significantly associated with a lower reintervention rate (RR = 0.57, 95% CI [0.36, 0.89], P = 0.01) and a longer time to recurrent HAS compared to PTA (MD = 36.42, 95% CI [14.14, 58.70], P = 0.001).

Conclusion: Both PTA and stenting show similar primary patency and safety for HAS after LT. However, stenting offers lower reintervention rates and longer recurrence-free intervals, suggesting better long-term outcomes. Treatment selection should be individualized, considering anatomical factors, stenosis morphology, and operator expertise.

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.