CVIR Endovascular最新文献

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.

Background: The aim of this study was to compare the use of combined fenestrated and bifurcated aortic endografts to the standard modular design including a proximal fenestrated and a distal, bifurcated endograft. The combined design allows for a modification of the procedure that may contribute to lowering the risk of damaging the target vessel stents and reducing the perioperative obstruction of the ipsilateral access vessel.

Methods: Consecutive patients treated with fenestrated aortic repair between December 2020 and December 2022 were included in this retrospective, single center study. Technical success was analyzed, including the integrity of the target vessel (TV) stents assessed on perioperative CT. Further, the duration during which the large introducer had to be kept in the access vessel was analyzed. Finally, we report technical data on the endograft design, adverse events and midterm results.

Results: Twelve patients were treated with a modular endograft (group A) and 13 patients with a combined endograft design (group B). Technical success was 100% in both groups, however there were 4 deformed target vessel stents in group A, none in group B. The duration of potential flow reduction due to a large introducer in the access vessel was significantly shorter in group B than group A (median 54 min vs. 109.5 min, p < 0.05). No adverse events were reported in any of the groups. The observation period was shorter in group B (median 18 months vs. 33 months, p < 0.05). Except for one case of aneurysm growth in group A, all other patients in both groups showed stable or decreased aneurysm size without TV occlusions.

Conclusions: The integration of the bifurcation on the fenestrated endograft may contribute to the prevention of damage of the TV stents and has potential to reduce the duration of perioperative limb obstruction.

Background: Endovascular stenting is widely accepted as the standard treatment for central venous obstruction syndromes such as superior vena cava (SVC) syndrome due to its demonstrated clinical efficacy and improved patient outcomes. However, its application in axillosubclavian vein thrombosis (ASVT) has been limited due to concerns about stent compression within the thoracic outlet. This report aims to evaluate the feasibility and safety of the off-label use of dedicated venous stents-engineered with enhanced mechanical features-as an alternative endovascular approach for the treatment of ASVT.

Methods: Thirty-eight patients (43 affected limbs) with symptomatic ASVT and no prior treatment or surgical decompression underwent endovascular placement of dedicated venous stents across the thoracic outlet with Abre Venous Stents (Medtronic, Dublin, Ireland), Venovo Venous Stents (BD, Franklin Lakes, NJ, USA), or Vici Venous Stents (Boston Scientific, Marlborough, MA, USA). Stents were extended peripherally to the subclavian or axillary veins and centrally to the brachiocephalic vein or SVC. Technical success was defined as successful stent deployment across the costoclavicular space, and clinical success as symptomatic improvement.

Results: Stent placement was technically successful in all 43 limbs (100%), with clinical improvement observed in 97.4% of patients. The one patient without clinical improvement experienced early thrombosis of the stent, requiring mechanical thrombectomy and additional stenting. Follow-up CT venography at a mean of 301.3 days demonstrated high primary stent patency rates (81.4%), with stent crushing observed in only 7.0% of limbs and no instances of stent fracture. Adverse events were limited, including two access site hematomas and one hypotensive episode, all of which resolved without evidence of long-term complications.

Conclusions: Our findings suggest that stenting across the thoracic outlet for the treatment of ASVT may be a viable option with the use of novel dedicated venous stents, potentially expanding treatment strategies for TCVO.

Background: Uterine artery embolization (UAE) has been a valid tool in the treatment of symptomatic uterine fibroids for a quarter of a century by now. This study aims to examine the impact of this treatment and its development since its introduction in Germany.

Materials and methods: All patients that received inpatient treatment for uterine fibroids (ICD-10 code D25) as primary diagnosis or the primary symptoms of hypermenorrhea/menorrhagia (N92) or dysmenorrhea (N94) with a secondary diagnosis of uterine fibroids from 2005 until 2023 were included. The data was obtained from the research data center of the German Federal Statistical Office. Basic demographic data and all encoded diagnostic and therapeutic procedures were collected and analyzed. Special focus laid on patients receiving either of the three invasive treatments: hysterectomy (HE), myomectomy (ME), and uterine artery embolization (UAE).

Results: One million one hundred sixty-four thousand five hundred sixty-six women were hospitalized in those 19 years with 91.7% receiving either HE, ME or UAE. There was a continuous decline in annual numbers of hospitalizations (-47.7%) and of HE (-55.5%) between 2005 and 2023. Constantly more than 99% of the treated women underwent surgery-contribution of UAE continuously remained below 1%. The highest number of UAE was conducted in 2012 with 568 treated women, followed by a continuous decline to 313 in 2023. The reference population of all women at the age of 30 to < 55 years in Germany decreased only slightly from 15,230,000 to 13,506,000 (-11.3%).

Conclusion: The numbers of inpatient invasive treatment continuously declined disproportionately to the demographic development. Despite excellent evidence, UAE is not used for treatment of symptomatic uterine fibroids to a relevant extent in Germany.

Proximal Interruption of the Pulmonary Artery (PIPA) is a rare congenital condition with an incidence of 1 in 200,000-300,000 individuals. We report the case of a 67-year-old woman with PIPA who presented with massive haemoptysis. Imaging revealed a small calibre right main pulmonary artery, absence of upper/middle lobe pulmonary arteries, and tortuous right systemic collateral arteries. A multidisciplinary meeting favoured bronchial artery embolisation over right pneumonectomy, due to the bleeding risk associated with extensive transpleural systemic collateral arteries. The patient underwent two staged bronchial artery embolisation and remained free of haemoptysis at the most recent 13-month follow-up. This case highlights the potential for bronchial artery embolisation to serve as a first-line treatment in managing PIPA, as a less invasive alternative to surgery.

Introduction: A varicocele is a venous dilatation due to valvular incompetence within the pampiniform plexus, affecting 10-20% of the population and found in 40% of men with primary infertility (Hum Reprod Update 7(1):59-64, 2001, Cochrane Database System Rev (3), 2004, Curr Urol 6(1):33-6, 2012, World J Men's Health 37(1):4, 2019). Varicocele associated pain occurs in 2-10% of cases (Hum Reprod Update 7(1):59-64, 2001, SpringerPlus 4:1-5, 2015). Treatment options include conservative management, percutaneous embolization, or surgery (Urology 72(1):77-80, 2008). In the literature, percutaneous embolization has a technical failure rate ranging from 0 to 13.9% and recurrence rates of around 13% (Cochrane Database System Rev 4(4):CD000479, 2021). This study evaluates the success and recurrence of percutaneous varicocele embolizations over fifteen years and compares the embolic materials used.

Methods: This was a retrospective study of all adult patients who underwent varicocele embolization performed from April 2008 to February 2023 in two tertiary centres. Data collected included patient age, procedure date, access site, side of occurrence, previous interventions, treatment method, need for re-intervention, and recurrence rates. We defined technical success as successful access to the gonadal vein and embolization of same with coil/sclerosant. We assessed clinical success through follow-up telephone consultations and ultrasound.

Results: The technical and clinical success rate was 96% and 93.75%, respectively. Of 225 patients, 3.12% had prior failed surgeries, all were treated successfully with IR, and only 0.89% required further surgical intervention. Patients reported recurrence rate of 25% of cases during telephone follow-up. However, the confirmed actual recurrence rate based on ultrasound was only 6.25%. The complication rate was low (1.78%), with no major events. Among patients treated for subfertility, 51.35% achieved successful conception following percutaneous embolization. Outcomes did not significantly differ based on the type of embolic material used.

Conclusion: Percutaneous embolization is a safe, effective, and durable treatment for varicocele, demonstrating high technical and clinical success regardless of embolic material used with a low recurrence rate over long-term follow-up. It remains effective even in cases of prior failed surgical repair and is associated with promising fertility outcomes. These findings support embolization as a first-line treatment in varicocele management.