CVIR Endovascular最新文献

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.

Background: Thoracic endovascular aortic repair (TEVAR) has been a feasible treatment option since the first stent graft was approved by the FDA in 2005, and is now the recommended method for treating most descending aorta pathology in the current clinical practice guidelines. Indications for TEVAR include descending aorta aneurysms, traumatic aortic injury and pathology that presents as acute aortic syndrome. More often than not the lesion that needs to be excluded is quite close or contains the distal aortic arch, thus requiring the coverage of the left subclavian artery (LSA) origin, a practice that has been associated with severe complications. Contraindications to LSA coverage resulted in the development of various surgical and endovascular LSA revascularization techniques.

Materials and methods: Branched stent grafts containing a single branch for the LSA are a rapidly evolving technology regarding LSA reconstruction during TEVAR. The aim of this article is to demonstrate our center's experience using a novel off-the-shelf single-branched stent graft, the GORE® TAG® Thoracic Branch Endoprosthesis (TBE) (W. L. Gore & Associates, Inc, Flagstaff, Ariz, USA). The GORE® TAG® TBE is commercially available in Europe since early 2024. We have so far, since February 2024, treated 12 patients using this endograft, successfully treating all types of aortic lesions.

Conclusions: Branched TEVAR is becoming a feasible option for treating descending aorta pathology, without covering the LSA. Moreover, the development of off-the-shelf branched stent grafts, enables physicians to treat patients in the emergency setting, aside from planned procedures.

Background: Iatrogenic superior gluteal artery injury (SGA) following bone marrow biopsy is rare but potentially life-threatening. Due to the deep intrapelvic location of the vessel, conventional management with manual compression or surgical repair is challenging. Traditional management via endovascular coil embolization requires arterial access and vessel sacrifice. Case presentation We present a case of SGA injury resulting from a bone marrow biopsy in a patient with suspected T-cell lymphoma. The injury was successfully managed using a 6 french Angioseal closure device applied directly through the biopsy puncture site in the gluteal region, with the patient maintained in the lateral decubitus position. The approach achieved immediate hemostasis while preserving arterial patency.

Conclusion: This represents the first reported use of an Angioseal device for direct percutaneous treatment of iatrogenic SGA injury. This technique offers an effective hemostasis and vessel preservation, expanding the interventional radiology's armamentarium.

Background: Obesity is a global health challenge, leading researchers to explore innovative treatments. Bariatric arterial embolization (BAE), which blocks blood flow to parts of the stomach, shows promise for weight management by affecting hunger hormones like ghrelin. This study aimed to compare the efficacy and safety of n-butyl-2-cyanoacrylate (NBCA) and microspheres in suppressing weight gain and ghrelin expression after BAE in a swine model.

Materials and methods: Fifteen healthy juvenile male farm pigs were randomly allocated into three groups: NBCA embolization (n = 5), microsphere embolization (n = 5), and a control group (n = 5). Embolization targeted the right, left, and short gastric arteries. Weight and fasting plasma ghrelin levels were monitored weekly for 16 weeks. Gastric endoscopy was performed 1 and 4 weeks post-BAE, and each animal's ghrelin-expressing cells in the stomach's fundus, body, and antrum were analyzed.

Results: By week 16, the NBCA group showed lower weight gain (58.4 ± 17.8%) compared to that in the microsphere (114.0 ± 0.0%; P < .001) and control groups (123.9 ± 18.1%; P < .001). The NBCA group had lower mean ghrelin-expressing cell densities in the gastric fundus (P < .001), body (P = .002), and antrum (P = 0.003) compared to those in the control group, and lower ghrelin-expressing cell densities in the fundus compared to those in the microsphere group (P < .001). Endoscopy at 1-week post-BAE revealed gastric ulcers in 2 pigs in the NBCA group (40%) and all pigs (100%) in the microsphere group, which healed by week 4; no ulcers were found in the control group.

Conclusions: In a swine model of bariatric arterial embolization, NBCA was more effective than microspheres in reducing weight gain and ghrelin expression in the stomach fundus, indicating its potential for managing obesity through BAE.

Background: Prostate artery embolization (PAE) requires a careful understanding of pelvic arterial anatomy and identifying prostatic artery variants. Pre-procedure CTA and intra-procedural cone beam CT are traditional means of planning and performing PAE, with the latter providing guidance for embolization. Photon counting detector (PCD) CT enables ultra-high spatial resolution (UHR) whole-body imaging. For PAE, we obtain a single UHR PCD CT arterial phase acquisition, which provides both detailed pre-procedure pelvic arterial anatomic information and a dataset for 2D (angiographic) to 3D (CTA) fusion for intra-procedural guidance during PAE using embolization guidance software in the angiography suite.

Case presentations: In six patients who underwent technically successful PAE via a left transradial approach, the pre-procedure diagnostic UHR pelvic PCD prostate CTA delineated bilateral prostatic artery origins and course in all cases, as confirmed with conventional angiograms. Further, registration of the UHR PCD CTA for embolization guidance was successful in all cases, augmenting vessel selection. No complication occurred.

Conclusion: UHR PCD CTA is a novel imaging technology that can provide detailed prostate arterial anatomic information for pre-procedure PAE planning. Further, this same UHR PCD CTA dataset can be used for intra-procedural embolization guidance using commercially available embolization guidance software.

Background: Bronchial artery embolisation (BAE) is considered the most effective non-surgical technique for management of moderate-massive haemoptysis. Associated risks include neurological compromise such as stroke and spinal cord ischaemia. We aim to evaluate post-procedural outcomes and complication rates.

Materials and methods: A single-centre retrospective observational study was conducted for BAE cases performed between January 2002-June 2022 in a London teaching hospital. Data was collected from electronic medical records and Picture Archiving Communications System (PACS). Primary outcomes were measured, and statistical analysis was performed to identify risk factors for haemoptysis recurrence.

Results: One hundred eleven patients underwent 141 procedures with technical success achieved in 87.8% and clinical success in 84.8%. The most common causes of haemoptysis were aspergilloma (24.8%), bronchiectasis (19.1%) and malignancy (11.3%). Haemoptysis recurrence occurred in 65 cases (46%) with 20 patients undergoing repeat embolisation. Aspergillosis, cystic fibrosis, and non-tuberculous pneumonia were identified as risk factors for recurrent haemoptysis (p < 0.005). Pre-procedure MDCTA did not improve technical success. The rate of stroke in the cohort was 6.4% (9 cases), which is more so than quoted in the literature. Four of these patients presented with apical cavitations secondary to infection (aspergilloma or bacterial pneumonia).

Conclusions: BAE is an effective endovascular treatment in patients with massive and recurrent haemoptysis. However, there is a well-documented risk of recurrent symptoms and early mortality, particularly in the setting of aspergilloma, cystic fibrosis and non-tuberculous pneumonia. The risk of stroke should not be underestimated. Patients should be counselled appropriately during informed consent prior to embarking on BAE.

Background: The authors report herein a rare case of an endovascular management of a giant subclavian artery pseudoaneurysm, revealed by a massive hemoptysis in a patient suffering from a Pancoast tumor.

Case presentation: The endovascular procedure consisted of covering the subclavian artery rupture site with a stent graft after occluding the proximal segments of the ipsilateral internal thoracic and vertebral arteries.

Conclusion: Subclavian artery rupture was effectively managed using endovascular techniques via radial access.

Background: This study evaluates one-year clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) placement using a middle hepatic vein (MHV) versus right hepatic vein (RHV) access. Primary end points were shunt patency and one-year survival. Secondary outcomes included incidence of de novo hepatic encephalopathy (HE) and recurrence of portal hypertension related complications such as ascites, hepatic hydrothorax, and gastrointestinal bleeding. While prior studies have examined portal vein target selection, the clinical relevance of hepatic vein choice remains understudied.

Methods: A retrospective chart review of adult patients who underwent TIPS using a Viatorr stent graft between January 2014 and December 2022 was conducted. Patients were included if the procedure used either RHV or the MHV. Intracardiac echocardiography (ICE) was employed to select a direct path from hepatic to portal vein. Shunts were dilated to 8 or 10 mm to achieve a post-procedural portosystemic gradient (PSG) ≤ 12 mmHg or a 50% reduction from baseline. Clinical and imaging data was analyzed to assess outcomes, stratified by hepatic vein of access.

Results: One-year survival (84% MHV vs 75% RHV, p = 0.2) and overall one-year patency rates (96% MHV vs 87% RHV, p = 0.5) were similar between the groups. However, MHV access significantly reduced de novo hepatic encephalopathy (30% MHV vs 62% RHV, p = 0.008) and moderate to severe cases (16% MHV vs 42% RHV, p = 0.017). Despite more frequent use of smaller diameter shunts (8 mm: 72% MHV vs 47% of RHV, p < 0.001), MHV access achieved similar post-TIPS portosystemic gradient reductions (Average Pre-TIPS gradient: 17 mmHg MHV & 17 mmHg RHV, p = 0.8; Average Post-TIPS gradient: 8 mmHg MHV & 7.5 mmHg RHV, p = 0.12). Hepatic vein choice did not affect outcomes for ascites, hydrothorax, or gastrointestinal bleeding.

Conclusion: MHV and RHV access routes provided similar patency, survival, and TIPS indication outcomes, but MHV access had decreased incidence of hepatic encephalopathy and achieved similar portosystemic gradient reduction while using a smaller diameter shunt. MHV may be a preferred option for patients at higher risk of developing hepatic encephalopathy.