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Joh JH. Novel Strategies for the Hostile Iliac Artery during Endovascular Aortic Aneurysm Repair. Vasc Specialist Int 2024; 40:8. [PMID: 38475895 DOI: 10.5758/vsi.230119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 03/14/2024] Open
Abstract
Successful endovascular aneurysm repair can be achieved with favorable aortic and iliac arterial anatomies. However, patients with challenging iliac anatomy, such as stenotic, calcified, tortuous arteries, or concomitant iliac artery aneurysms, are commonly encountered. Such a hostile iliac anatomy increases the risk of intraprocedural complications and worsens long-term outcomes. This review addresses various technical options for treating patients with a hostile iliac anatomy, including innovative endovascular solutions, physician-modified endografts, and hybrid procedures. These considerations demonstrate the wide scope of therapies that may be offered to patients with an unfavorable iliac anatomy.
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Affiliation(s)
- Jin Hyun Joh
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, Seoul, Korea
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Adams RC, Hegde S, Sutphin P, Iqbal S, Irani Z, Kalva SP. Use of Polyurethane-Covered Stents for Exclusion of Pulmonary Arteriovenous Malformations. Cardiovasc Intervent Radiol 2024; 47:360-365. [PMID: 38180506 DOI: 10.1007/s00270-023-03638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE To evaluate the safety, technical success and short-term effectiveness of polyurethane-covered stent (PK Papyrus, BioTronik, Berlin) in the treatment of pulmonary arteriovenous malformations (PAVMs) that are not amenable to embolotherapy. MATERIALS AND METHODS In this IRB-approved, retrospective study, data from patients who received polyurethane-covered stents for exclusion of PAVMs were analyzed. The study included 5 patients (all women) with a median age of 40 years (range 25-60). Patients presented with hypoxemia, TIAs, and/or epistaxis; 4 were confirmed to have HHT. All had multiple PAVMs diagnosed on chest CT and underwent embolization with other devices in addition to the polyurethane-covered stent. The indication for stent placement in all cases was a short and/or tortuous feeding artery. Safety was assessed by immediate or short-term complications, e.g., migration, stent thrombosis, and fracture. Technical success was defined as the ability to accurately place the stent at the intended location. Effectiveness was defined as successful exclusion of PAVM with no perfusion across the AVM. RESULTS Technical success of stent placement was 100%. AVM exclusion rate was 80% after single stent deployment; in the case of incomplete exclusion, success was achieved using an overlapping stent to completely cover a second feeding artery. During the median follow-up period of 5 months (range 2-10), all stents remained patent, and AVMs were excluded without other complications. CONCLUSION Exclusion of PAVMs with polyurethane-covered stents is technically feasible, safe, and shows short-term effectiveness for PAVMs with a short/tortuous feeding artery when traditional embolization techniques are not possible.
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Affiliation(s)
- Ryan C Adams
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA.
| | - Siddhi Hegde
- Abdominal Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Patrick Sutphin
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Shams Iqbal
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Zubin Irani
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
| | - Sanjeeva P Kalva
- Interventional Radiology Division, Radiology Department, Massachusetts General Hospital, Boston, MA, USA
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Nazari I, Zargar MA, Alavi SMA. Percutaneous transluminal angioplasty with stenting for transplant renal artery stenosis at the anastomosis site in a young female patient: A case report. Int J Surg Case Rep 2024; 115:109209. [PMID: 38194865 PMCID: PMC10819742 DOI: 10.1016/j.ijscr.2023.109209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/20/2023] [Accepted: 12/22/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Transplant renal artery stenosis (TRAS) is one of the major vascular complications and is mostly reported within six months following kidney transplant. CASE PRESENTATION The present case was a 16-year-old female whose blood urea nitrogen (BUN) and creatinine rose seven days after a kidney transplant. Ultrasound investigation revealed well-prefusion with a 90-degree angle anastomosis, apparent narrowing, and peak systolic velocity of 300 cm/s. Fourteen days after the transplant, with pre-and post-intervention hemodialysis and well hydration, an angiography with diluted iodinated contrast was done for the patient, which revealed >80 % narrowing at the anastomosis site. Percutaneous transluminal angioplasty (PTAS) with stenting was carried out for the patient, resulting in normal levels of BUN, creatinine, and urinary output. CLINICAL DISCUSSION While the patient did not have any risk factors for TRAS and was young, an early stenosis occurred in her left internal iliac artery one week after the kidney transplant. Due to the lower accuracy of CO2 angiography, diluted iodinated contrast angiography with well hydration and pre- and post-intervention dialysis was preferred. Endovascular treatment was preferred by the patient and attending physician due to possible adhesion and complications of open surgery and the possibility of arterial rupture. CONCLUSION Performing PTAS two weeks after the renal transplantation at the anastomosis site can be a treatment in patients with early TRAS. However, due to the higher risk of rupture at the anastomosis site, it should be carried out carefully and with consideration of the need for open surgery.
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Affiliation(s)
- Iraj Nazari
- Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Amin Zargar
- Department of General Surgery, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Shehab M, Thorbjørnsen K, Mani K, Björck M, Wanhainen A. Long Term Outcome After EndoVAC Hybrid Repair of Carotid Patch Infection. Eur J Vasc Endovasc Surg 2024; 67:352-353. [PMID: 37690491 DOI: 10.1016/j.ejvs.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Maysam Shehab
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden.
| | - Knut Thorbjørnsen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Gävle County Hospital, Gävle, Sweden
| | - Kevin Mani
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden
| | - Martin Björck
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Institute of Clinical Medicine, Tartu University, Tartu, Estonia
| | - Anders Wanhainen
- Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgical and Peri-operative Sciences, Surgery, Umeå University, Umeå, Sweden
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Pisano U, Stevenson K, Kasthuri R, Kingsmore D. Cephalic arch stenosis: an analysis of outcome by type of first intervention. CVIR Endovasc 2024; 7:13. [PMID: 38240913 PMCID: PMC10798936 DOI: 10.1186/s42155-023-00424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 12/21/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Cephalic arch stenoses (CAS) occur in near 70% of elbow arteriovenous fistulas. Percutaneous transluminal angioplasty (PTA) remains first-line treatment despite documented stent-grafts (SG) efficacy. The study aim is to report long-term outcomes based on initial treatment of CAS. METHODS Retrospective review of 12-year data in single tertiary centre. Outcomes included technical success, rupture rate, primary patency (PP), dialysis performance; categorical variables assessed via χ2 or Fisher's; nonparametric tests used for skewed data. Kaplan-Meier analysis used for PP and cumulative patency. Cox proportional hazard regression model to assess explanatory variables in PP. RESULTS One hundred one brachio- and radiocephalic fistulas with CAS were included. SG as first intervention had higher success than PTA (85% vs 61%, p = 0.003). Rupture occurred in 9/85 (10.6%) PTA vs 0% in SG (p = 0.046). In a subgroup with poor urea reduction rate (URR), both PTA and SG improved dialysis performance post-intervention (p = 0.002). SG demonstrated better PP than PTA (79,73,60% patency at 3, 6, 9 months; versus 71,51,47%; p = 0.195) and cumulative patency (73,61,61% at 1, 2, 3 years; versus 60,34,26%; p < 0.001). Of the variables analyzed, technical success of PTA was the only discriminating factor (coeff.-1.01; RR 35%, p = 0.035). Accesses that underwent secondary stenting performed better than primarily stented CAS (p = 0.01). CONCLUSIONS SG superiority is confirmed in CAS, particularly when angioplasty is unsuccessful. While PTA has short-lived benefits, it can improve dialysis performance. Other than higher success rate, primary CAS stenting did not have advantages compared to post-PTA stenting in our study. Other factors related to inflow, outflow, conduit characteristics are presumed to be involved in access longevity.
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Affiliation(s)
- Umberto Pisano
- Radiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK.
| | - Karen Stevenson
- Renal Transplant Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - Ram Kasthuri
- Radiology Department, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
| | - David Kingsmore
- Renal Transplant Surgery, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, 1345 Govan Road, Glasgow, G51 4TF, UK
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Quaretti P, Corti R, D'Agostino AM, Bozzani A, Moramarco LP, Cionfoli N. Covered stent assisted coil embolization of large Buhler aneurysm in setting of chronic celiac trunk occlusion. CVIR Endovasc 2024; 7:9. [PMID: 38198119 PMCID: PMC10781915 DOI: 10.1186/s42155-023-00416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The arc of Bühler (AOB) is a residual embryonal anastomosis between the celiac artery (CA) and the superior mesenteric artery (SMA). Although usually asymptomatic, it has clinical relevance when compensatory reverse flow between the SMA and the CA in response to celiac artery obstruction leads to aneurysm formation and bleeding. Endovascular coiling is the mainstay therapy because of the deep AOB retropancreatic location, which hinders open surgery. CASE PRESENTATION We herein report a case of a 2.8-cm AOB saccular aneurysm and LAM compression of celiac trunk in a 47-year-old man during rehabilitation following motorcycle trauma and vertebral surgery. The patient was considered unsuitable for surgery. Neither conventional coiling nor bare-metal stent and balloon-assisted techniques for coiling were suitable because of the wide necked saccular shape of AOB aneurysm interposed between the SMA and the floor of celiac trunk. To exclude the aneurysm from direct SMA inflow and permit safe and efficient coiling to rule out retrograde sac perfusion, a 9-mm polytetrafluoroethylene stent graft (Viabahn; Gore, Phoenix, AZ, USA) was positioned in the mesenteric artery, followed by antegrade periprosthetic high-density packed coiling of the aneurysm. The AOB remained excluded from mesenteric perfusion. The patient's clinical condition and abdominal contrast-enhanced multislice computed tomographic findings were unremarkable at the 9-year follow-up. CONCLUSION The 9 year long-term efficacy in our case raises the possibility that perigraft coiling following stent-graft deployment in the SMA may represent a valuable technical option for large Bühler aneurysms that are not amenable to stand-alone coiling.
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Affiliation(s)
- Pietro Quaretti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy.
| | - Riccardo Corti
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Mauro D'Agostino
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Antonio Bozzani
- Vascular and Endovascular Surgery Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Paolo Moramarco
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
| | - Nicola Cionfoli
- Interventional Radiology Unit, Fondazione IRCCS Policlinico San Matteo, V.Le Golgi 19, Pavia, 27100, Italy
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Larsen ASF, Aslam S, Holmen LO. Neointimal dissection - a rare complication to endovascular treatment in grafts and stent grafts. CVIR Endovasc 2023; 6:49. [PMID: 37870690 PMCID: PMC10593731 DOI: 10.1186/s42155-023-00401-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/12/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Neointima formation and hyperplasia in vascular grafts may lead to graft complications threatening the patency of the vascular reconstruction. A rare complication to endovascular treatment of grafts and stent grafts is dissection inside the graft. CASE REPORT We present here a case of a 69-year-old female with acute occlusion of the limb of an aorto-bifemoral graft for the third time, 16 years after the primary operation. As at the first two occasions, catheter-based intra-arterial thrombolysis was performed, but with residual stenosis inside the graft. During stent placement, dissection of the neointima or fibrin sheet occluded the inflow to the stent. The complication was resolved with placement of kissing stents. CONCLUSIONS It is important to recognize iatrogenic neointima dissection inside graft and stent grafts, as continued thrombolysis will not solve this, but increase the risk of hemorrhagic complications.
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Affiliation(s)
- Anne Sofie F. Larsen
- Radiology Department, Ostfold Hospital Trust, PB 300, Kalnesveien 300, 1714 Gralum, Norway
| | - Shakil Aslam
- Surgery Department, Ostfold Hospital Trust, Gralum, Norway
| | - Lars Olaf Holmen
- Radiology Department, Ostfold Hospital Trust, PB 300, Kalnesveien 300, 1714 Gralum, Norway
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Kulka C, Lagrèze S, Verloh N, Doppler M, Hettmer S, Fichtner-Feigl S, Uller W. Controlled flow reduction of an iliacoportal shunt graft for portal vein arterialization in a pediatric patient. Pediatr Radiol 2023; 53:2305-2308. [PMID: 37612542 PMCID: PMC10562313 DOI: 10.1007/s00247-023-05733-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/25/2023]
Abstract
Portal vein arterialization is a rarely used, temporary surgical salvage solution to prevent biliary and hepatic ischemia and necrosis in acute liver de-arterialization. However, it can induce portal hypertension, causing increased morbidity and mortality. We report the case of a 5-year-old girl with portal hypertension and right ventricle volume overload following the creation of an iliacoportal shunt graft for portal vein arterialization due to vessel-adhering neuroblastoma. Partial shunt graft closure was accomplished by placing a stent graft in an hourglass configuration via the right femoral artery using two slender-sheaths in a line with the second more distal than the first. Subsequently, the patient's symptoms of right ventricle volume overload and portal hypertension decreased. In conclusion, endovascular reduction of elevated portal blood flow after portal vein arterialization is feasible, even in pediatric patients.
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Affiliation(s)
- Charlotte Kulka
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany.
| | - Susanne Lagrèze
- Department of General and Visceral Surgery, Medical Center Freiburg, University of Freiburg, Hugstetter Strasse 55, Freiburg, Germany
| | - Niklas Verloh
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Michael Doppler
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Simone Hettmer
- Department of Pediatrics and Adolescent Medicine, Division of Pediatric Hematology and Oncology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Fichtner-Feigl
- Department of General and Visceral Surgery, Medical Center Freiburg, University of Freiburg, Hugstetter Strasse 55, Freiburg, Germany
| | - Wibke Uller
- Department of Diagnostic and Interventional Radiology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
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El-Sayed T, Zahed A, McCaslin J, Bungay P, Williams R, Nandhra S. Incidentally Discovered Fractured Proximal Nitinol Ring in Fenestrated Anaconda Stent Graft Device: an Important Radiographic Finding. Eur J Vasc Endovasc Surg 2023; 66:601-602. [PMID: 37516381 DOI: 10.1016/j.ejvs.2023.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 07/03/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Tamer El-Sayed
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Asef Zahed
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - James McCaslin
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Peter Bungay
- Department of Radiology, Royal Derby Hospital, Derby, UK
| | - Robin Williams
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Sandip Nandhra
- The Northern Vascular Centre, Freeman Hospital, Newcastle upon Tyne, UK.
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Tomoi Y, Takahara M, Soga Y, Hata Y, Iida O, Yamaoka T, Hayakawa N, Fujihara M, Ando K. Clinical outcome of endovascular therapy using a VIABAHN VBX-covered stent for complex aortoiliac artery disease: the AVOCADO II study. Heart Vessels 2023; 38:1288-1297. [PMID: 37247091 DOI: 10.1007/s00380-023-02274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
Clinical trials have demonstrated the efficacy of a balloon-expandable covered stent (CS) for aortoiliac occlusive disease (AIOD). However, the real-world clinical outcomes and the underlying factors remain unclear. We assessed the clinical outcomes and factors associated with primary patency after implantation of a balloon-expandable CS for patients with complex AIOD. This prospective multicenter observational study enrolled 149 consecutive patients undergoing VIABAHN® VBX-CS (W.L. Gore & Associates, Flagstaff, AZ) implantation for complex AIOD (age, 74 ± 9 years; male, 74%; diabetes mellitus, 46%; renal failure on dialysis, 23%; chronic limb-threatening ischemia, 26%). The primary study endpoint was 1-year primary patency, and the secondary endpoints were procedural complications, freedom from occlusion, clinical-driven target lesion revascularization (CD-TLR), and surgical revision at 1 year. Risk factors for restenosis were explored using random survival forest analysis. The median follow-up period was 13.1 months (interquartile range 9.7-14.0 months). Procedural complications were observed in 6.7% of the patients. The 1-year primary patency was 94.8% (95% confidence interval 91.0-98.6%), while the 1-year freedom rate from occlusion, CD-TLR, and surgical revision rates were 96.5% (93.5-99.5%), 94.7% (90.9-98.6%), and 97.8% (95.4-100%), respectively. The presence of chronic total occlusion, aortic bifurcation lesion, the number of disease regions, and TASC-II classification was significantly associated with the restenosis risk. In contrast, the calcification severity, IVUS use, IVUS parameters were not associated with restenosis risk. We observed excellent 1-year real-world outcomes after implantation of a balloon-expandable CS for complex AIOD; only a few perioperative complications occurred.
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Affiliation(s)
- Yusuke Tomoi
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-0001, Japan.
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-0001, Japan
| | - Yosuke Hata
- Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Osamu Iida
- Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Chiba, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-0001, Japan
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Simmering JA, Zagers DA, Geelkerken RH, Kuipers H, te Riet o.g. Scholten GA, Reijnen MM, Slump CH. The influence of electrocardiogram-gated computed tomography reconstruction into 8 or 10 cardiac phases on cardiac-pulsatility-induced motion quantification of stent grafts in the aorta. JVS Vasc Sci 2023; 4:100131. [PMID: 38033397 PMCID: PMC10682660 DOI: 10.1016/j.jvssci.2023.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023] Open
Abstract
Objective The goal of this study was to determine to what extent aortic stent graft motion quantification is comparable between electrocardiogram (ECG)-gated computed tomography (CT) scans with reconstructions into 8 and 10 cardiac phases on CT scanners from two different vendors. Methods An experimental setup that induces motion of an aortic stent graft, according to a predefined aortic blood pressure wave, was placed in two CT scanners of different vendors. The stent graft motion was captured using an ECG-gated CT technique and quantified using dedicated analysis algorithms. The calculated motion amplitudes and total traveled path lengths of stent segmentations were compared between scans reconstructed into 8 and 10 phases and between the scanners, after validation with sensor measurements and repeated measurements. Results No difference in motion amplitudes in z-direction (craniocaudal direction) was observed between the reconstructions into 8 and 10 phases (0.02 mm; 95% confidence interval [CI], -0.01 to 0.05 mm; P = .358). The z-amplitudes differed by 0.04 mm (95% CI, 0.01-0.07 mm; P = .003) between the different CT scanners. Path lengths differed 0.07 mm (95% CI, 0.01-to 0.13 mm; P = .013) between the reconstructions into 8 and 10 phases and 0.13 mm (95% CI, 0.06-0.17 mm; P < .001) between the different scanners. Conclusions The motion amplitudes can accurately be compared between 8 and 10 phases and between the two scanners, without differences larger than the voxel size of 0.3 × 0.3 × 0.5 mm. Clinical motion analysis results of different ECG-gated CT scans and CT scanners can be compared up to the accuracy of the CT scan.
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Affiliation(s)
- Jaimy A. Simmering
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Deborah A. Zagers
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Robert H. Geelkerken
- Division of Vascular Surgery, Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Henny Kuipers
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Gerben A. te Riet o.g. Scholten
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Michel M.P.J. Reijnen
- Multi-modality Medical Imaging (M3i) Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
- Department of Surgery, Rijnstate, Arnhem, the Netherlands
| | - Cornelis H. Slump
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Tsuchida K, Kokaguchi K, Hasegawa T, Akamatsu D, Namiki K. Endovascular treatment for a ruptured lumbar artery aneurysm in a patient with neurofibromatosis type 1. J Vasc Surg Cases Innov Tech 2023; 9:101208. [PMID: 37799844 PMCID: PMC10547740 DOI: 10.1016/j.jvscit.2023.101208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 04/24/2023] [Indexed: 10/07/2023] Open
Abstract
The present medical case report describes successful endovascular treatment via stent graft and coil packing for a ruptured lumbar artery aneurysm in a 55-year-old woman with neurofibromatosis type 1. Although less common, vasculopathy, such as an aneurysm, stenosis, rupture, and arteriovenous fistula, have been reported and can be a cause of death for patients with this disorder. However, only a few cases of a ruptured lumbar aneurysm have been reported.
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Affiliation(s)
- Ken Tsuchida
- Division of Vascular Surgery, Osaki Citizen Hospital, Osaki, Japan
| | | | - Tetsuya Hasegawa
- Division of Diagnostic Radiology, Osaki Citizen Hospital, Osaki, Japan
| | - Daijirou Akamatsu
- Division of Vascular Surgery, Department of Surgery, Tohoku University Hospital, Sendai City, Japan
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13
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Hsieh MY, Lin PS, Liao MT, Lin L, Chen TY, Boon JC, Yang TF, Wu CC. A Randomised Trial Comparing Drug Coated Balloons and Conventional Balloons for the Treatment of Stent Graft Stenosis in Dialysis Vascular Access. Eur J Vasc Endovasc Surg 2023; 66:253-260. [PMID: 37209996 DOI: 10.1016/j.ejvs.2023.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/28/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
OBJECTIVE Previous studies on arteriovenous fistulas have demonstrated the potential benefit of drug coated balloons (DCBs) in maintaining the patency of dialysis access. However, stenoses involving stent grafts were excluded from these studies. Therefore, the aim was to evaluate the effectiveness of DCBs in treating stent graft stenosis. METHODS This was a prospective, single blinded, randomised controlled study. From March 2017 to April 2021, 40 patients with dysfunctional vascular access owing to stent graft stenosis were randomised to treatment with a DCB or conventional balloon. Clinical follow up was scheduled at one, three, and six months, and angiographic follow up was performed six months after the intervention. The primary outcome was angiographic late luminal loss at six months, and secondary outcomes included target lesion and access circuit primary patency at six months. RESULTS Thirty-six participants completed follow up angiography. The DCB group had a superior mean late luminal loss at six months compared with the control group (1.82 mm ± 1.83 mm vs. 3.63 mm ± 1.08 mm, respectively, p = .001). All 40 patients completed clinical follow up. The DCB group had a superior six month target lesion primary patency compared with the control group [hazard ratio (HR) 0.23, 95% confidence interval (CI) 0.07 - 0.71; p = .005). Additionally, the DCB group had a numerically higher six month access circuit primary patency rate than the control group, although the difference was not statistically significant (HR 0.54, 95% CI 0.26 - 1.11, p = .095). CONCLUSION Conventional balloon angioplasty is not durable in stent graft stenosis treatment. Treatment with DCBs provides less angiographic late luminal loss and potentially superior primary patency of the target lesion than treatment with conventional balloons. [ClinicalTrials ID: NCT03360279.].
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Affiliation(s)
- Mu-Yang Hsieh
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Pei-Shan Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Min-Tsun Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Lin Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Tsung-Yan Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Jong-Chien Boon
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Ten-Fang Yang
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Taipei Medical University and Hospital, Taipei, Taiwan
| | - Chih-Cheng Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan; Institute of Biomedical Engineering, National Tsing-Hua University, Hsinchu, Taiwan; Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan; Centre of Quality Management, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan.
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Tokuda Y, Terazawa S, Yoshizumi T, Ito H, Banno H, Mutsuga M. Hybrid Repair of Extensive Aortic Arch Aneurysms: Outcomes of Isolated Frozen Elephant Trunk Repair and of Elephant Trunk with Second Stage Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2023; 66:284-285. [PMID: 37187285 DOI: 10.1016/j.ejvs.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/20/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Yoshiyuki Tokuda
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Sachie Terazawa
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tomo Yoshizumi
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ito
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Banno
- Department of Vascular Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masato Mutsuga
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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15
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Khatri S, Epstein S, Kashfi S, Oza P. Iatrogenic subclavian artery rupture: A unique case report on balloon occlusion. Int J Surg Case Rep 2023; 109:108508. [PMID: 37454550 PMCID: PMC10384228 DOI: 10.1016/j.ijscr.2023.108508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Inadvertent subclavian artery puncture during attempted central venous catheterization can be devastating. Percutaneous stent grafting, closure devices and conventional surgery have been described to effect repair. Balloon occlusion has also been described and often recommended. Numerous publications advise use of balloon expanded to no less than the diameter of the punctured artery. CASE PRESENTATION We describe the case of a 21 year-old male whose right subclavian artery was inadvertently punctured after central-line removal. Our balloon when expanded was purposely slightly smaller than the inner arterial diameter. Balloon occlusion nevertheless alone sufficed to effect closure and repair. CLINICAL DISCUSSION When the expanded balloon surpasses the diameter of the subclavian artery, it is expected that blood flow to the upper extremity will be cut off. Presently, there is a lack of definitive data concerning the maximum duration for balloon inflation that could lead to upper extremity ischemia. However, in this particular case, there was a temporary reduction in vertebral artery flow, while the flow in the carotid and axillosubclavian arteries remained rapid and uninterrupted. To our understanding, only one other case documents the use of a balloon shorter than the vessel diameter. CONCLUSION In specific scenarios, it is advisable to consider the use of smaller balloon diameters to effectively stop extravasation while ensuring adequate perfusion to the brain and hand. While alternative approaches such as open repair, and stent graft procedure have been reported for repairing subclavian artery rupture, balloon tamponade provides interventional radiologists with a distinct technical advantage.
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Affiliation(s)
- Shivam Khatri
- CUNY School of Medicine, New York, NY 10031, United States of America.
| | - Steven Epstein
- Interventional and Vascular Radiologist, Department of Radiology, St. Barnabas Hospital, Bronx, NY 10457, United States of America
| | - Simon Kashfi
- Division of Internal Medicine, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Hempstead, United States of America
| | - Parind Oza
- Division of Vascular Surgery, Department of Surgery, St. Barnabas Hospital, Bronx, NY 10457, United States of America
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van der Krogt JM, van Erp AC, Smorenburg SP, Willems MC, Nederhoed JH. Endovascular Graft Suprarenal Bare Metal Stent Separation After Endovascular Aneurysm Repair: Case Reports and Literature Review. EJVES Vasc Forum 2023; 60:28-32. [PMID: 37577155 PMCID: PMC10415614 DOI: 10.1016/j.ejvsvf.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 06/05/2023] [Accepted: 06/29/2023] [Indexed: 08/15/2023] Open
Abstract
Objective Suprarenal bare metal stent separation is a rare complication after endovascular aneurysm repair. In this report, two new cases of this type of device failure are presented and the literature is reviewed to identify similar cases and evaluate associated clinical characteristics. Methods A literature search was conducted in March 2022 using PubMed, Embase, and The Cochrane Library, with MeSH terms including aortic aneurysm, stents, and device failure. Two authors independently selected studies eligible for inclusion. Results Twelve patients with endovascular graft suprarenal bare metal stent separation were identified. Endovascular aneurysm repair (EVAR) devices were implanted between May 1996 and November 2017. Suprarenal bare metal stent separation was detected after a median duration of five years post-operatively. Conclusion Endovascular graft suprarenal bare metal stent separation demands a high level of awareness. A better understanding of the involved failure mechanisms and associated risk factors is required to further optimise EVAR follow up protocols.
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Affiliation(s)
| | - Anne C. van Erp
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Stefan P.M. Smorenburg
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | | | - Johanna H. Nederhoed
- Department of Surgery, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
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Patel RK, Alagapan A, Tripathy T, Vats P, Rangarh P, Mohanty S, Sathia S. Lower extremity pseudoaneurysms and their interventional radiological management: a pictorial review. Emerg Radiol 2023:10.1007/s10140-023-02151-8. [PMID: 37335348 DOI: 10.1007/s10140-023-02151-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
Lower extremity pseudoaneurysms (PsAs) are mostly developed after traumatic or iatrogenic injury to the arteries. Unless treated, they can be complicated by adjacent mass effects, distal embolism, secondary infection, and rupture. Imaging helps in the diagnosis and planning of therapeutic intervention. Ultrasonography (USG) is often diagnostic, while CT angiography aids in vascular mapping required for intervention. Image-guided therapy offers to manage these pseudoaneurysms in a minimally invasive approach, obviating the need for surgery. A smaller, superficial, and narrow-necked PsA can easily be managed with local USG-guided compression or thrombin injection. When the percutaneous approach is not a feasible option, PsA from expendable arteries can also be managed with coiling or glue injection. Wide-necked PsA from an unexpendable artery necessitates stent graft placement, although coiling of the neck may be a viable and cheaper alternative for a long- and narrow-necked PsA. Presently, vascular closure devices are also used to seal a small arterial rent through a direct percutaneous approach. This pictorial review entails various techniques to deal with lower extremity pseudoaneurysms. An idea about the various intervention radiological approaches will help in choosing appropriate methods to tackle lower extremity pseudoaneurysms.
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Affiliation(s)
- Ranjan Kumar Patel
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
| | - Alamellu Alagapan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019
| | - Taraprasad Tripathy
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India, 751019.
| | - Prayas Vats
- Department of Interventional Radiology, Fortis Hospital, Shalimar Bagh, New Delhi, India
| | - Pulkit Rangarh
- Department of Vascular and Interventional Radiology, Asian Institute of Medical Sciences, Uttar Pradesh, Faridabad, India
| | - Satyapriya Mohanty
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
| | - Siddharth Sathia
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Bhubaneswar, India, 751019
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Znaniecki Ł, Tarnawski J, Żegleń B, Dymecki M, Gniedziejko M, Wojciechowski J. Surgical repair of a symptomatic celiac artery aneurysm with resection and end-to-end anastomosis. J Vasc Surg Cases Innov Tech 2023; 9:101197. [PMID: 37305359 PMCID: PMC10250160 DOI: 10.1016/j.jvscit.2023.101197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/30/2023] [Indexed: 06/13/2023] Open
Abstract
A true aneurysm of the celiac artery is a rare form of a visceral aneurysm, constituting ∼4% of visceral aneurysms. Mortality in ruptured cases is high; thus, early recognition and treatment are crucial. Recent guidelines suggest endovascular therapy; however, numerous complications are associated with endoluminal treatment. Open repair in select cases, using an individualized strategy fit for the patient's anatomy still provides excellent early and long-term results. Our patient was treated with open surgical resection and end-to-end anastomosis of the celiac and common hepatic arteries. A 43-month follow-up computed tomography angiogram revealed excellent hepatic artery patency and no pseudoaneurysm formation.
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Affiliation(s)
- Łukasz Znaniecki
- Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jakub Tarnawski
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Bartosz Żegleń
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Dymecki
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Michał Gniedziejko
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
| | - Jacek Wojciechowski
- Students’ Scientific Circle of Vascular Surgery, Department of Cardiac and Vascular Surgery, Medical University of Gdańsk, Gdańsk, Poland
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19
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Lopes A, Gouveia e Melo R, Leitão J, Mendonça C, Moutinho M, Mendes Pedro L. The fate of spinal arteries after the stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair technique: a case series. J Vasc Surg Cases Innov Tech 2023; 9:101183. [PMID: 37274437 PMCID: PMC10238459 DOI: 10.1016/j.jvscit.2023.101183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/28/2023] [Indexed: 06/06/2023] Open
Abstract
Objective We evaluated the patency of the spinal arteries (intercostal and lumbar) after the STABILISE (stent-assisted balloon-induced intimal disruption and relamination in aortic dissection repair) technique. Methods A retrospective analysis of all patients with aortic dissection treated with the STABILISE technique between April 2018 and July 2021 was performed. Imaging analysis of the spinal cord vascular supply was accomplished using multiplanar and maximum intensity projection reconstructed images of pre- and postoperative computed tomography angiograms at 1 month, 12 months, and annually thereafter. Results Twelve patients were treated for complicated aortic dissection. Primary technical success was 100% and mid-term clinical success, at a mean follow-up of 27 ± 12 months, was 90%. No cases of spinal cord ischemia were identified. One patient died after 1 year (non-aortic related), and one patient was lost to follow-up. A significant decrease was found in the mean number of patent spinal arteries in the stent graft area at 1 month (P < .001), 1 year (P < .001), and 2 years (P = .004). However, no significant reduction was found in the number of spinal arteries in either the bare metal stented or nonstented aorta (P > .05). Conclusions Use of the STABILISE technique decreased intercostal artery patency in the thoracic stent graft area, but spinal artery patency was not significantly affected by the bare metal stent nor its aggressive ballooning. These findings constitute a step toward a better understanding of the safety of this technique.
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Affiliation(s)
- Alice Lopes
- Heart and Vessels Division, Vascular Surgery Department, Hospital de Santa Maria, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center, University of Lisbon, Lisbon, Portugal
| | - Ryan Gouveia e Melo
- Heart and Vessels Division, Vascular Surgery Department, Hospital de Santa Maria, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center, University of Lisbon, Lisbon, Portugal
| | - João Leitão
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- General Radiology Department, Hospital de Santa Maria, Lisbon, Portugal
| | - Carlos Mendonça
- General Radiology Department, Hospital de Santa Maria, Lisbon, Portugal
| | - Mariana Moutinho
- Heart and Vessels Division, Vascular Surgery Department, Hospital de Santa Maria, Lisbon, Portugal
| | - Luís Mendes Pedro
- Heart and Vessels Division, Vascular Surgery Department, Hospital de Santa Maria, Lisbon, Portugal
- Faculty of Medicine, University of Lisbon, Lisbon, Portugal
- Cardiovascular Center, University of Lisbon, Lisbon, Portugal
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Rudolph C, Lindberg BR, Resch T, Mani K, Björkman P, Laxdal EH, Støvring H, Beck HM, Eriksson G, Budtz-Lilly J. Scandinavian trial of uncomplicated aortic dissection therapy: study protocol for a randomized controlled trial. Trials 2023; 24:217. [PMID: 36949478 PMCID: PMC10035204 DOI: 10.1186/s13063-023-07255-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Contemporary management of uncomplicated type B aortic dissections (uTBAD) is based on the acuity and various morphological features. Medical therapy is mandatory, while the risks of early thoracic endovascular aortic repair (TEVAR) are balanced against the potential for rupture, complex surgery, and death. Improved aortic morphology following TEVAR is documented, but evidence for improved overall survival is lacking. The costs and impact on quality of life are also needed. METHODS The trial is a randomized, open-label, superiority clinical trial with parallel assignment of subjects at 23 clinical sites in Denmark, Norway, Sweden, Finland, and Iceland. Eligibility includes patients aged ≥ 18 with uTBAD of < 4 weeks duration. Recruited subjects will be randomized to either standard medical therapy (SMT) or SMT + TEVAR, where TEVAR must be performed between 2-12 weeks from the onset of symptoms. DISCUSSION This trial will evaluate the primary question of whether early TEVAR improves survival at 5 years among uTBAD patients. Moreover, the costs and the impact on quality of life should provide sorely needed data on other factors that play a role in treatment strategy decisions. The common Nordic healthcare model, with inclusion of all aortic centers, provides a favorable setting for carrying out this trial, while the robust healthcare registries ensure data validity. TRIAL REGISTRATION ClinicalTrials.gov NCT05215587. Registered on January 31, 2022.
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Affiliation(s)
- Claudina Rudolph
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Beate Rikken Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Timothy Resch
- Department of Vascular Surgery, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kevin Mani
- Section of Vascular Surgery, Department of Surgical Sciences, University of Uppsala, Uppsala, Sweden
| | - Patrick Björkman
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital, Helsinki, Finland
| | - Elín Hanna Laxdal
- Department of Vascular Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - Henrik Støvring
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Henriette Margrethe Beck
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Gunnar Eriksson
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Budtz-Lilly
- Division of Vascular Surgery, Department of Cardiovascular Surgery, Aarhus University Hospital, Aarhus, Denmark.
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21
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Miura K, Komiya T, Matsushime S, Oka N, Kamo K. Stent graft placement for traumatic lumbar artery injury in which coil embolization is not feasible. Trauma Case Rep 2023; 43:100774. [PMID: 36699716 PMCID: PMC9867970 DOI: 10.1016/j.tcr.2023.100774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Lumber artery injuries are anatomically difficult to treat surgically, and coil embolization is a first-line treatment option for them. In some cases, however, there is not enough space for coil embolization, for which stent graft placement can be an alternative therapy. We report a case of traumatic lumbar artery injury in which stent graft placement was performed due to lack of space for coil embolization.
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Affiliation(s)
- Koji Miura
- Corresponding author at: Department of Emergency Medicine, Kurashiki Central Hospital, 1-1-1 Miwa, Kurashiki 710-8602, Japan.
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22
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Primrose CW, Arestis N. Accessory Right Hepatic Artery Pseudoaneurysm Resulting in Biliary Obstruction. Case Rep Gastroenterol 2023; 17:346-355. [PMID: 38033393 PMCID: PMC10684257 DOI: 10.1159/000535039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 11/02/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Visceral pseudoaneurysms are prone to rupture and can cause mass effect on surrounding structures, with extrinsic compression on the biliary tree being a rare but challenging complication. Case Presentation We report a case of a 48-year-old man with a history of alcohol excess who presented acutely unwell with jaundice. Imaging revealed a pseudoaneurysm of the accessory right hepatic artery extending into an adjacent pancreatic pseudocyst, leading to common bile duct compression. Successful management included pseudoaneurysm exclusion with a stent graft and concurrent alleviation of the biliary obstruction. Conclusion Managing pancreatic pseudocysts with biliary compression becomes complicated when an accompanying pseudoaneurysm is present, elevating the associated risk. In this case, stent graft exclusion of the pseudoaneurysm was the chosen approach to preserve arterial flow with potential for long-term patency. Delayed pseudoaneurysm diagnosis underscores the importance of comprehensive assessment in complex presentations, such as jaundiced alcoholic patients, where the possibility of pancreatitis episodes necessitates evaluation of the visceral vasculature for pseudoaneurysms.
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Affiliation(s)
- Colin William Primrose
- Department of Interventional Radiology, Queen Elizabeth University Hospital, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Nikolas Arestis
- Department of Radiology, Forth Valley Royal Hospital, NHS Forth Valley, Larbert, UK
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23
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Weissler EH, Hammill BG, Armstrong JL, Vekstein AM, Chodavadia P, Long CA, Roe M, Hughes GC. Association Between Device Type and Type IIIb Endoleaks Following Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2023; 65:112-119. [PMID: 36209962 DOI: 10.1016/j.ejvs.2022.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 08/24/2022] [Accepted: 10/02/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Endoleaks following thoracic endovascular aortic repair (TEVAR) can lead to the need for re-intervention and aortic rupture. Given the recent recall of a specific thoracic stent graft type due to concerns about type IIIb endoleak (T3bE), in which blood leaks through the stent graft fabric, the aim was to characterise patterns of T3bEs among available TEVAR devices. METHODS Reports related to thoracic stent grafts in the Food and Drug Administration's (FDA) Manufacturer and User Facility Device Experience (MAUDE) database between 2010 and 2020 were reviewed. Proportional reporting ratios (PRRs) and chi squared tests were used to assess for the presence of a signal of association between device type and T3bE. A PRR > 2 and chi squared value > 4 with three or more reports overall constituted a signal of association. The institutional database of patients undergoing TEVAR for thoracic aneurysms since 2002 was also queried for T3bE. RESULTS There were 7 328 MAUDE reports available for analysis. When analysing T3bEs in the MAUDE database, the lowest PRR was 0.36 (95% confidence interval [CI] 0 - 1.03 in Gore CTAG, nine T3bE among 1 328 reports) and the highest was 2.07 (95% CI 1.72 - 2.42 in Medtronic Valiant, 64 T3bE among 2 520 reports). The T3bE chi squared value for Medtronic Valiant was 17.3. The relationship between Medtronic Valiant and T3bE was ascertainable by MAUDE data as early as 2013. Among 542 TEVARs for an aneurysm indication at Duke University Hospital since 2002, there were eight T3bEs - all in devices with sutured on graft material. CONCLUSION The Medtronic Valiant device met criteria for association with type IIIb endoleaks in the FDA's MAUDE database and met those criteria as early as 2013. A possible relationship between woven graft fabric and T3bEs is supported by the observation that all types of T3bE that occurred among a large number of TEVARs at the institution followed placement of grafts with sutured on woven fabric.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Jenna L Armstrong
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Andrew M Vekstein
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Parth Chodavadia
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Chandler A Long
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | | | - G Chad Hughes
- Division of Cardiovascular and Thoracic Surgery, Duke University School of Medicine, Durham, NC, USA.
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Rodrigues DVS, Frazao VHA, de Araujo Junior RT, Schmitt LG. Endovascular repair of ruptured external iliac artery pseudoaneurysm and arteriovenous fistula using reversed bell-bottom technique. J Vasc Surg Cases Innov Tech 2023; 9:101087. [PMID: 36747599 DOI: 10.1016/j.jvscit.2022.101087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Pseudoaneurysm and arteriovenous fistula can occur after iatrogenic trauma or penetrating injuries. Endovascular treatment is a minimally invasive method used to manage these complex vascular injuries. We have described the case of a 27-year-old male patient who had presented with progressively increasing pain and swelling of the left inguinal region after a gunshot injury 5 years earlier. The bell-bottom technique was used in a reversed fashion to exclude the pseudoaneurysm and treat the arteriovenous fistula, achieving symptom resolution without complications.
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25
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Kim MK, Kim JG, Kim CS, Park KB, Yang SS, Park YJ. Repeated Pseudoaneurysm after Endovascular Repair of Popliteal Aneurysm due to Graft Disintegration and Fabric Tear. Vasc Specialist Int 2022; 38:31. [PMID: 36510690 DOI: 10.5758/vsi.220035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/29/2022] [Accepted: 10/04/2022] [Indexed: 12/15/2022] Open
Abstract
Endovascular repair of popliteal artery aneurysms (PAA) using a stent graft is suitable for patients with favorable anatomy. In the domestic situation where Gore Medical withdrew, we report two cases of unusual complications of pseudoaneurysm after endovascular repair of PAA. A 44-year-old male with a history of bypass surgery for a PAA presented with recurrent vein graft pseudoaneurysm. Endovascular treatment using a domestic stent graft was performed. However, pseudoaneurysm developed due to the graft fabric tear 1 month later, requiring surgical removal. In another case, an 84-year-old female presented with acute limb ischemia related to PAA. Endovascular aneurysm repair with the same domestic stent graft was performed. However, stent graft failure occurred 2 years later and the patient underwent open surgical repair. There was a graft fabric disintegration. When proper endovascular device is not available, open surgical treatment is the best option for treating PAA.
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Affiliation(s)
- Min-Kyu Kim
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun-Gon Kim
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cho-Shin Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Yeungnam University Medical Center, Daegu, Korea
| | - Kwang-Bo Park
- Department of Radiology, Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shin-Seok Yang
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yang-Jin Park
- Division of Vascular Surgery, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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26
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Mandigers TJ, Trimarchi S, Van Herwaarden JA, Piffaretti G. The ongoing dynamic interaction between thoracic stent grafts and the aorta demands knowledge and further optimalization. Eur J Cardiothorac Surg 2022; 63:6968980. [PMID: 36610455 DOI: 10.1093/ejcts/ezad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Affiliation(s)
- Tim J Mandigers
- Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Santi Trimarchi
- Department of Vascular Surgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.,Clinical and Community Sciences Department, Università degli Studi di Milano, Milan, Italy
| | | | - Gabriele Piffaretti
- Vascular Surgery-Department of Medicine and Surgery, University of Insubria, Varese, Italy
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27
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Ćeranić D, Nikolić S, Lučev J, Slanič A, Bujas T, Ocepek A, Skok P. Fatal bleeding due to an aorto-esophageal fistula: A case report and literature review. World J Clin Cases 2022; 10:11493-11499. [PMID: 36387793 PMCID: PMC9649541 DOI: 10.12998/wjcc.v10.i31.11493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/27/2022] [Accepted: 09/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Aorto-esophageal fistula is an extremely rare cause of acute upper gastrointestinal bleeding (UGIB).
CASE SUMMARY We present a case of an 80-year-old woman with esophageal cancer who was admitted to our department with hemorrhagic shock due to UGIB. During the diagnostic procedure, emergency computed tomography angiography was performed and confirmed aorto-esophageal fistula. Interventional radiologists inserted a stent graft into the aorta, successfully closing the fistula. Unfortunately, the patient later died of heart failure following irreversible hemorrhagic shock. Autopsy confirmed the aorto-esophageal fistula, which formed 1 cm below the distal edge of the stent previously inserted into the esophagus for a malignant stricture.
CONCLUSION There are very rare causes of UGIB. Although clinical decisions are made during the diagnostic workup of these patients, we must be aware of the limitations of various therapeutic options, even the most contemporary.
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Affiliation(s)
- Davorin Ćeranić
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Sara Nikolić
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Jernej Lučev
- Department of Radiology, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Aleš Slanič
- Department of Radiology, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Tatjana Bujas
- Department of Pathology, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Andreja Ocepek
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Pavel Skok
- Department of Gastroenterology, Internal Medicine Clinic, University Medical Centre Maribor, Maribor 2000, Slovenia
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28
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Pacini D, Murana G. Novel hybrid graft for acute type A repair: advance mastering of dissection stenting. Eur J Cardiothorac Surg 2022; 62:6661345. [PMID: 35971687 DOI: 10.1093/ejcts/ezac408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Davide Pacini
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine, DIMES, University of Bologna, Bologna, Italy
| | - Giacomo Murana
- Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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29
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Kato T, Fuke M, Nagai F, Nomi H, Kanzaki Y, Yui H, Maruyama S, Nagae A, Sakai T, Saigusa T, Ebisawa S, Okada A, Motoki H, Kuwahara K. Successful endovascular treatment with a stent graft for chronic deep vein thrombosis with multiple arteriovenous fistulas: a case report. J Med Case Rep 2022; 16:257. [PMID: 35778762 PMCID: PMC9250182 DOI: 10.1186/s13256-022-03480-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Deep vein thrombosis with arteriovenous fistulas is rare, with few therapeutic options available for chronic-phase deep vein thrombosis. Moreover, the effectiveness of endovascular treatment for chronic-phase deep vein thrombosis with arteriovenous fistulas has not been established. We describe herein a case of successful endovascular treatment for chronic deep vein thrombosis with multiple arteriovenous fistulas. Case presentation We describe the case of a 72-year-old Asian woman who had begun experiencing left leg swelling and intermittent claudication 2 years prior. Enhanced computed tomography revealed left common iliac vein occlusion with vein-to-vein collateral formation and several arteriovenous fistulas. Angiography and ultrasound showed the arteriovenous fistulas to run from the common and internal iliac arteries to the external iliac and superficial femoral veins. We opted against surgical repair for the arteriovenous fistulas due to their complex nature and complicated morphology. Since her condition was progressive, endovascular treatment with a stent graft was performed for the deep vein thrombosis, after which her symptoms gradually improved. Four months following the procedure, enhanced computed tomography confirmed remarkable reduction of the vein-to-vein collaterals and arteriovenous fistulas. Conclusions In the present case, enhanced computed tomography with a stent graft was effective in improving symptoms. This strategy may therefore be a treatment option for intractable chronic deep vein thrombosis with arteriovenous fistulas.
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Affiliation(s)
- Tamon Kato
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan.
| | - Megumi Fuke
- Division of Cardiovascular Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Fumio Nagai
- Department of Plastic and Reconstructive Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidetomo Nomi
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Yusuke Kanzaki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hisanori Yui
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Shusaku Maruyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayumu Nagae
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Takahiro Sakai
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Tatsuya Saigusa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Soichiro Ebisawa
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Ayako Okada
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hirohiko Motoki
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Koichiro Kuwahara
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
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30
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Scheurig-Münkler C, Zerwes S. [Isolated iliac artery aneurysm : Clinical background and interventional treatment strategies]. Radiologe 2022; 62:607-613. [PMID: 35503119 DOI: 10.1007/s00117-022-01002-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Isolated iliac artery aneurysms are less frequent than abdominal aortic aneurysms, with the same, predominantly atherosclerotic-degenerative etiology, but patients present more frequently with symptoms or at the stage of rupture. The majority of those affected are men over the age of 65. The ideal imaging technique for diagnosis, treatment planning and follow-up is computed tomography (CT) angiography. Below a diameter of 4 cm, the risk of rupture is 6.3%, and then increases significantly with increasing diameter. Today, treatment is recommended from a size of 3.5 cm at the earliest. THERAPY Because of the lower mortality, endovascular therapy is the leading treatment for the elective and emergency situation. The quality of the landing zones, which are important for sealing, is decisive for elimination of the aneurysm. The elimination is carried out by means of stent grafts, often in combination with embolization. Due to the risk of buttock claudication and erectile dysfunction, the preservation of ipsilateral pelvic perfusion is recommended in cases of insufficient collateralization. Special iliac branch devices or various parallel endograft techniques are available for this purpose. FOLLOW-UP The main problem of endovascular treatment are endoleaks and the associated need for reintervention. Imaging control by means of CT angiography is crucial for timely endoleak detection, especially in the early phase.
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Affiliation(s)
- C Scheurig-Münkler
- Klinik für Diagnostische und Interventionelle Radiologie und Neuroradiologie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland.
| | - S Zerwes
- Klinik für Gefäßchirurgie und endovaskuläre Chirurgie, Universitätsklinikum Augsburg, Stenglinstr. 2, 86156, Augsburg, Deutschland
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Takahashi S, Nishibe T, Kano M, Akiyama S, Iwahashi T, Ogino H. Type IIIb endoleak due to stent suture line fabric breakage in the Endurant stent graft: a case report. Surg Case Rep 2022; 8:72. [PMID: 35438327 PMCID: PMC9018899 DOI: 10.1186/s40792-022-01415-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/03/2022] [Indexed: 11/25/2022] Open
Abstract
Background Early type IIIb endoleak is a very rare complication of endovascular aneurysm repair (EVAR). Case presentation An 87-year-old man was diagnosed with infrarenal abdominal aortic aneurysm. The patient underwent EVAR using the Endurant stent graft. Postoperative color duplex ultrasound revealed a regular row of pulsatile blood flow from the main body and left leg. The blood flow appeared to be bleeding from the stent suture lines because of its regularity. Type IIIb endoleak was suspected due to stent suture line fabric breakage but was not treated surgically or endovascularly because of the patient’s poor general health status. Six months later, contrast-enhanced CT demonstrated a deformation and enlargement of the aneurysm sac as well as an oozing of the contrast medium on the main body and left limb. Thereafter, he died of a subdural hematoma due to a fall. Autopsy showed no visible abnormal erosion or holes on the graft fabric, suggesting that suture line fabric breakage may have existed during the manufacturing process. Conclusions Although rare, type IIIb endoleaks can occur even in the perioperative period after EVAR. Early type IIIb endoleaks may not resolve spontaneously and should be treated promptly, if possible. Supplementary Information The online version contains supplementary material available at 10.1186/s40792-022-01415-8.
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Affiliation(s)
- Satoshi Takahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan.
| | - Masaki Kano
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Shinobu Akiyama
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
| | - Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160-0023, Japan
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32
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Kopjar T. Vascular anastomosis device to facilitate aortic arch vessel reconstruction. Eur J Cardiothorac Surg 2022; 62:6556266. [PMID: 35355057 DOI: 10.1093/ejcts/ezac225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Tomislav Kopjar
- Department of Cardiac Surgery, University of Zagreb School of Medicine, Zagreb, Croatia
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33
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Sliman H, Eitan A, Shiran A, Zafrir B, Jaffe R. Transbrachial Secondary Vascular Access in Transcatheter Aortic Valve Replacement Procedures: A Single-Centre Retrospective Analysis. Heart Lung Circ 2022; 31:1023-1028. [PMID: 35277348 DOI: 10.1016/j.hlc.2022.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/30/2021] [Accepted: 01/27/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Transfemoral transcatheter aortic valve replacement (TAVR) procedures require secondary vascular access for inserting accessory catheters and performing percutaneous repair of femoral artery injury. Use of the transbrachial approach for secondary vascular access in TAVR procedures has not been reported. METHODS This study identified 48 patients at the current institution who had undergone transfemoral TAVR utilising transbrachial secondary vascular access. Efficacy and safety of this strategy for achieving a successful totally percutaneous procedure were examined. Study endpoints were occurrence of vascular complications and bleeding related to transbrachial access, as well as periprocedural and 1-year mortality. RESULTS Mean patient age was 80±7 years and Society of Thoracic Surgeons Predicted Risk of Mortality score was 10.6±3.1. Sizes of sheaths inserted into the brachial artery were 6 Fr (85%), 8 Fr (2%), and 9 Fr (13%). Transbrachial access was used for delivering stent grafts to the femoral artery in 13% of the patients, inflation of an occlusive balloon within the iliac artery in 10%, and treatment of iatrogenic femoral artery stenosis in 2%. Successful valve replacement was achieved in all cases. Brachial sheaths were removed by manual compression following administration of protamine sulfate. There were no major access site complications or VARC-3 type ≥2 bleeding related to the brachial vascular access. Brachial artery occlusion occurred in two patients (4%) who underwent surgical vascular repair. Two (2) additional patients developed mild arm ischaemia, which was treated conservatively. Periprocedural mortality was 0% and early mortality was 8%. CONCLUSIONS Transbrachial secondary access in TAVR procedures was feasible and enabled percutaneous vascular repair in cases of femoral artery injury.
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Affiliation(s)
- Hussein Sliman
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Amnon Eitan
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Avinoam Shiran
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Barak Zafrir
- Department of Cardiology, Carmel Medical Center, Haifa, Israel
| | - Ronen Jaffe
- Department of Cardiology, Carmel Medical Center, Haifa, Israel.
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Parra JR, Bertino FJ, Shin DS, Chick JFB, Koo KSH, Monroe EJ. Portomesenteric and portosystemic venous reconstructions in children using balloon-expandable endoprostheses. Pediatr Radiol 2022; 52:493-500. [PMID: 34751814 DOI: 10.1007/s00247-021-05229-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/24/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Portomesenteric and portosystemic venous occlusive disease may lead to portomesenteric hypertension, variceal bleeding, ascites and hypersplenism. Data regarding endovascular reconstructive strategies in children, however, are limited. OBJECTIVE To report technical success, outcome and patency of portomesenteric and portosystemic venous reconstruction using VIABAHN VBX balloon-expandable endoprostheses in pediatric patients. MATERIALS AND METHODS Five pediatric patients (median age: 15 years, range: 4-18 years), including 3 (60%) boys and 2 (40%) girls, with portomesenteric or portosystemic venous occlusion or recurrent stenosis, underwent balloon-expandable stent graft reconstruction. Presenting symptoms included acute variceal bleeding, without (n = 2, 40%) or with (n = 1, 20%) splenomegaly, and transfusion-dependent chronic melena (n = 1, 20%). One patient was asymptomatic (n = 1, 20%). Preprocedural imaging included Doppler ultrasound and contrast-enhanced computed tomography (CT) in all patients. Initial imaging showed 4 (80%) occlusions and 1 (20%) recurrent stenosis greater than 50%. Technical aspects of the reconstructions, technical successes, clinical outcomes and adverse events were recorded. Technical success was defined as completion of stent graft reconstruction. Adverse events were categorized according to Society of Interventional Radiology criteria. Clinical success was defined as resolution of the presenting symptoms and/or prevention of portal hypertensive sequela. RESULTS Venous reconstruction was technically successful in all five patients. Stent graft locations included the main portal vein in 2 (40%), the superior mesenteric vein in 1 (20%), autologous Meso-Rex shunt in 1 (20%) and splenocaval shunt in 1 (20%). Six stent grafts were placed (two stent grafts placed in a single patient). Stent grafts had a median diameter of 7 mm (range: 6-10 mm) and a median length of 59 mm (range: 19-79 mm). Median fluoroscopy time was 36.6 min (range: 13.4-95.8 min) and median air kerma was 301.0 mGy (range: 218.0-1,148.2 mGy). No adverse events occurred. Median clinical follow-up was 18 months (range: 6-29 months). Median imaging follow-up was 17 months (range: 2-29 months). Clinical success was achieved in all patients and maintained during the follow-up period. One patient required follow-up intervention with superior mesenteric vein side extension with a self-expanding bare metal stent due to perigraft stenosis detected on CT 3 months after stent placement. There were no stent graft occlusions. CONCLUSION Portomesenteric and portosystemic venous reconstruction using balloon-expandable stent grafts in pediatric patients was feasible and clinically successful in this preliminary experience. Additional studies are warranted.
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Affiliation(s)
- Jorge R Parra
- College of Osteopathic Medicine, Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - Frederic J Bertino
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA
| | - David S Shin
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA
| | - Jeffrey Forris Beecham Chick
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA.,Department of Radiology, Section of Vascular and Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Kevin S H Koo
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Washington, Seattle, WA, USA.,Department of Radiology, Section of Vascular and Interventional Radiology, Seattle Children's Hospital, Seattle, WA, USA
| | - Eric J Monroe
- Department of Radiology, Section of Vascular and Interventional Radiology, University of Wisconsin, Madison, WI, USA. .,Department of Radiology, Section of Vascular and Interventional Radiology, American Family Children's Hospital, 1675 Highland Ave., Madison, WI, 53792, USA.
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35
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Cha JG, Lee SY, Hong J, Park JM, Lim KH, Kim D. Traumatic iliac vein rupture managed using a bare-metal stent. Trauma Case Rep 2022; 37:100589. [PMID: 35005165 PMCID: PMC8718966 DOI: 10.1016/j.tcr.2021.100589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/28/2022] Open
Abstract
Iliac vein rupture resulting from blunt trauma is rare but can be fatal and challenging to diagnose despite thorough clinical investigation and image workup. Here, we present a case of traumatic iliac vein rupture managed by emergent endovascular repair using a bare-metal stent. Low pressure traumatic venous rupture is different from arterial rupture, and a bare-metal stent can be a sufficient tool to control bleeding.
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Affiliation(s)
- Jung Guen Cha
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Sang Yub Lee
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Jihoon Hong
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Jong Min Park
- Department of Radiology, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Kyoung Hoon Lim
- Department of Surgery, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Republic of Korea
| | - Donghyeon Kim
- Department of Radiology, Gyeongbuk Regional Rehabilition Hospital, 120, Mirae-ro, Gyeongsan-si, Gyeongsangbuk-do, Republic of Korea
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36
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Shibata T, Kawaharada N, Yasuhara K, Naraoka S. Physician-modified stent graft with inner branches for treating ruptured thoracoabdominal aortic aneurysm. Eur J Cardiothorac Surg 2021; 61:952-954. [PMID: 34897396 DOI: 10.1093/ejcts/ezab543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 11/04/2021] [Accepted: 11/21/2021] [Indexed: 11/13/2022] Open
Abstract
Thoracoabdominal aortic aneurysm (TAAA) repair remains challenging in patients with high surgical risk. We report a case of TAAA in an 84-year-old woman with type Ib endoleak after thoracic endovascular aortic repair with coeliac artery coverage due to impending ruptured TAAA. A stent graft was assembled to create 3 fenestrations and sew 3 inner grafts for the superior mesenteric artery (SMA) and bilateral renal arteries. This stent graft system was inserted into the thoraco-abdominal aorta and partially unsheathed until the first inner branch endograft fully expanded. The wire was used to catheterize the stent graft, inner branch, and SMA from the left upper limb, and a bridge stent was deployed from the inner branch to the SMA. A similar procedure was performed for bilateral renal arteries. The stent graft system was fully unsheathed. Postoperative computed tomography angiography revealed no endoleak and good flow of the visceral artery. The use of the physician-modified inner branched endograft system described is feasible and can make TAAA endovascular repair simpler and safer.
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Affiliation(s)
- Tsuyoshi Shibata
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Japan
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Japan
| | - Kiyomitsu Yasuhara
- Department of Cardiovascular Surgery, Isesaki Municipal Hospital, Isesaki, Japan
| | - Syuichi Naraoka
- Department of Cardiovascular Surgery, Sapporo Medical University Hospital, Sapporo, Japan
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Haraguchi T, Kashima Y, Tsujimoto M, Watanabe T, Shitan H, Sugie T, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K, Fujita T. The "needle re-entry" technique for infrainguinal arterial calcified occlusive lesions. CVIR Endovasc 2021; 4:85. [PMID: 34894315 DOI: 10.1186/s42155-021-00274-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 11/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Vascular calcification is a predictor of poor clinical outcome during and after endovascular intervention. Guidewire crossing techniques and devices have been developed, but chronic total occlusions (CTOs) with severe calcification often prevent subintimal re-entry. We propose a novel guidewire crossing approach combined needle rendezvous with balloon snare technique, named the “needle re-entry” technique, for treatment of complex occlusive lesions. Main text A 73-year-old female with severe claudication in her right calf with ankle brachial index of 0.62, and a computed tomography angiogram showed a long occlusion with diffuse calcification in superficial femoral artery. She was referred to our department to have peripheral interventions. Since the calcified vascular wall of the lesion prevented the successful re-entry, the “needle re-entry” was performed. First, a retrograde puncture of the SFA, distally to the occlusion, was performed and an 0.018-in. guidewire with a microcatheter was inserted to establish a retrograde fashion. Second, an antegrade 5.0-mm balloon was advanced into a subintimal plane and balloon dilation at 6 atm was maintained. Third, an 18-gauge needle was antegradely inserted from distal thigh to the dilated 5.0-mm balloon. After confirming a balloon rupture by the needle penetration, we continued to insert the needle to meet the retrograde guidewire tip. Then, a retrograde 0.014-in. guidewire was carefully advanced into the needle hole, named the “needle rendezvous” technique. After further guidewire advancement to accomplish a guidewire externalization, the needle was removed. Finally, since the guidewire was passing through the 5.0-mm ruptured balloon, the balloon was withdrawn, and the guidewire was caught with the balloon and successfully advanced into the antegrade subintimal space, named the “balloon snare” technique. After the guidewire was advanced into the antegrade guiding sheath and achieved a guidewire externalization, an endovascular stent graft and an interwoven stent were deployed to cover the lesion. After postballoon dilation, an angiography showed a satisfactory result without complications. No restenosis, reintervention, and limb loss have been observed for one year follow-up period after this technique. Conclusions The “needle re-entry” technique is a useful guidewire crossing technique to revascularize femoropopliteal complex CTOs with severe calcification which prevent the achievement of guidewire crossing with the conventional procedures. Supplementary Information The online version contains supplementary material available at 10.1186/s42155-021-00274-y.
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Ueda T, Murata S, Tajima H, Saito H, Yasui D, Sugihara F, Mizushima S, Mine T, Kawamata H, Hayashi H, Kumita SI. Emergency endovascular treatment using a Viabahn stent graft for upper and lower extremity arterial bleeding: a retrospective study. CVIR Endovasc 2021; 4:83. [PMID: 34882296 PMCID: PMC8660932 DOI: 10.1186/s42155-021-00273-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A Viabahn stent graft (SG) is a heparin-coated self-expandable SG for lower extremity arterial disease that exhibits high flexibility and accuracy in the delivery system. This study aimed to evaluate the short-term efficacy and safety of emergency endovascular treatment (EVT) using a Viabahn SG for upper and lower extremity arterial bleeding (ULEAB). METHODS Consecutive patients with ULEAB who underwent emergency EVT using the Viabahn SG between January 2017 and August 2021 were retrospectively reviewed. The indications for EVT, location of artery, technical success, clinical success, limb ischemia, periprocedural complications, bleeding-related mortality, 30-day mortality, diameter of the target artery, diameter of the SG, neck length, rebleeding, endoleaks, and patency of the SGs at 1, 3, 6, and 12 months were evaluated. RESULTS EVT using the Viabahn SG was performed in 22 patients (mean age, 72.0 ± 13.0 years; 11 men) and 23 arteries (upper, 6; lower, 17). The indications for EVT were pseudoaneurysm (n = 13, 59.1%), extravasation (n = 9, 39.1%), and inadvertent arterial cannulation (n = 1, 4.3%). The anatomical locations of the 23 ULEAB injuries were the brachiocephalic (1 [4.3%]), subclavian (3 [13.0%]), axillary (1 [4.3%]), brachial (1 [4.3%]), common iliac (4 [17.4%]), external iliac (8 [34.8%]), common femoral (2 [8.7%]), superficial femoral (2 [8.7%]), and popliteal (1 [4.3%]) arteries. The technical and clinical success rates were 100%. The rates of limb ischemia, periprocedural complications, and bleeding-related mortality were 0%, whereas the 30-day mortality rate was 22.7%. The mean diameters of the arteries and SGs were 7.7 ± 2.2 and 8.9 ± 2.3 mm, respectively. The mean neck length was 20.4 ± 11.3 mm. No endoleaks or rebleeding occurred during the follow-up period (mean, 169 ± 177 days). Two SG occlusions without limb ischemia occurred in the external iliac and brachial arteries after 1 and 4 months, respectively. Subsequently, cumulative SG patency was confirmed after 1, 3, 6, and 12 months in 91.7%, 91.7%, 81.5%, and 81.5% of patients, respectively. CONCLUSIONS Emergency EVT using the Viabahn SG for ULEAB was effective and safe according to short-term outcomes. Appropriate size selection and neck length are important for successful treatment. SG patency was good after 1, 3, 6, and 12 months.
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Affiliation(s)
- Tatsuo Ueda
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan.
| | - Satoru Murata
- Center for Interventional Radiology, Teikyo University Chiba Medical Center, 3426-3 Anesaki, 299-0011, Ichihara City, Chiba, Japan
| | - Hiroyuki Tajima
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Saitama, 350-1298, Hidaka City, Japan
| | - Hidemasa Saito
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
| | - Daisuke Yasui
- Department of Radiology, Nippon Medical School Musashi Kosugi Hospital, 1-396 Kosugi-machi, Nakahara-ku, 211-8533, Kawasaki City, Kanagawa, Japan
| | - Fumie Sugihara
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
| | - Shohei Mizushima
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Chiba, 270-1694, Inzai City, Japan
| | - Takahiko Mine
- Department of Radiology, Nippon Medical School Chiba Hokusoh Hospital, 1715 Kamagari, Chiba, 270-1694, Inzai City, Japan
| | - Hiroshi Kawamata
- Department of Radiology, Yokohama Rosai Hospital, 3211 Kozukue-Cho, Kohoku-Ku, 222-0036, Yokohama City, Kanagawa, Japan
| | - Hiromitsu Hayashi
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
| | - Shin-Ichiro Kumita
- Department of Radiology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, 113-8603, Tokyo, Japan
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Shu X, Xu H, Wang E, Wang L, Guo D, Chen B, Fu W. Midterm Outcomes of an Adjustable Puncture Device for In Situ Fenestration During Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2021; 63:43-51. [PMID: 34750032 DOI: 10.1016/j.ejvs.2021.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/03/2021] [Accepted: 09/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the midterm outcomes of in situ fenestration (ISF) with an adjustable puncture device for aortic arch branch preservation during thoracic endovascular aortic repair (TEVAR). METHODS From October 2016 to April 2019, patients with complicated type B aortic dissection, thoracic aortic aneurysm > 5.5 cm in diameter, or aortic penetrating ulcer with a base > 20 mm or depth > 15 mm, who received TEVAR requiring a proximal sealing beyond zone 3 and underwent ISF using an adjustable puncture device, were included. After the procedure, patients were monitored at one, three, six, and 12 months, and annually thereafter. Peri-operative and follow up data were collected and analysed. RESULTS Fifty of 51 patients (98%) received successful ISFs. One, two, or three aortic arch branches were preserved in 44, six, and one patient, respectively. Intra-operatively, eight type Ia endoleaks and one type II endoleak were found on angiography. One patient died of cerebral hernia three days post-procedure from a severe stroke; one patient suffered from transient paraplegia but recovered in two weeks; one patient had a non-disabling stroke. The median follow up was 31 months (22.5 - 36.5 months). At six month follow up, all nine unmanaged endoleaks had disappeared. One new type Ia endoleak was identified in a patient at the one month follow up which resolved spontaneously one year later. All revascularised arteries were patent at the last follow up. No fractures, migrations, or bridging stent kinks were found. CONCLUSION In this largest mechanical based ISF study to date, an adjustable puncture device was shown to facilitate the procedure of ISF during endovascular repair of aortic diseases involving the aortic arch, with high success. The midterm outcome demonstrates the efficacy and safety of the device in assisting with preservation of aortic arch branches.
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Affiliation(s)
- Xiaolong Shu
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China; Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Houpu Xu
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China; Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Enci Wang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China; Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Lixin Wang
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China; Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Fudan University, Shanghai, China.
| | - Daqiao Guo
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Bin Chen
- Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Fudan University, Shanghai, China
| | - Weiguo Fu
- Department of Vascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, Xiamen, China; Department of Vascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China; Institute of Vascular Surgery, Fudan University, Shanghai, China.
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Charchyan E, Breshenkov D, Belov Y. A new dissection-specific hybrid stent graft for patients with DeBakey type I aortic dissection. Eur J Cardiothorac Surg 2021; 61:596-604. [PMID: 34734250 DOI: 10.1093/ejcts/ezab441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES We present our first experience of using a new dissection-specific hybrid stent graft (SG) (the 'Soft Elephant Trunk') in the frozen elephant trunk technique, in patients with non-acute DeBakey type I aortic dissection. METHODS Between September 2016 and February 2021, patients with non-acute DeBakey type I aortic dissection underwent the frozen elephant trunk procedure at our centre using 3 SG types: group Z used stiff, distal Z-shaped nitinol SGs (E-Vita, Medtronic); group R used a stiff, ring-shaped nitinol SG (Thoraflex); and group S used a soft, distal dissection-specific SG. Predictors of distal SG-induced new entry were analysed. End points were hospital- and midterm-follow-up results. RESULTS The study comprised 109 patients with 46 (42.2%), 22 (20.2%) and 41 (37.6%) patients in groups Z, R and S, respectively. No significant differences were found in early outcomes. Freedom from distal SG-induced new entry was comparable in groups Z, R and S (68.9% vs 92.9% vs 100%, log-rank = 0.14). There was no significant difference in follow-up between the groups. Four-year survival rates were 80.44%, 71.59% and 95.06% in groups Z, R and S, respectively. On multivariable analysis, the presence of connective tissue disorders [hazard ratio (HR) = 5.62, P = 0.11] and SG diameter (HR = 1.37, P = 0.034) were strong predictors of distal SG-induced new entry. CONCLUSIONS Dissection-specific hybrid SG with a soft distal end is effective in patients with non-acute DeBakey type I aortic dissection. Compared to non-soft distal SGs, this can reduce the incidence of distal complications. Long-term outcomes are necessary to determine the potential advantages and disadvantages of the new prosthesis.
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Affiliation(s)
- Eduard Charchyan
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Denis Breshenkov
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
| | - Yuriy Belov
- Department of Aortic Surgery, Petrovsky National Research Centre of Surgery, Moscow, Russia
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Eitan A, Shiran A, Sliman H, Zafrir B, Jaffe R. Totally Percutaneous Transfemoral Transcatheter Aortic Valve Replacement Despite Failure to Deploy a Vascular Closure Device: A Single-Center Case Series. Heart Lung Circ 2021:S1443-9506(21)01234-8. [PMID: 34607752 DOI: 10.1016/j.hlc.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/27/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is preferably performed as a completely percutaneous procedure via transfemoral access. Suture-mediated vascular closure devices are deployed prior to sheath insertion (pre-closure). Inability to perform pre-closure may necessitate surgical vascular repair of the femoral artery. Patients at increased risk of vascular surgery complications may benefit from a percutaneous method for achieving access site haemostasis. Stent graft implantation is commonly used for treating access site injury following TAVR. This study assessed the feasibility of a strategy of planned stent graft implantation within the femoral artery for achieving access site haemostasis in patients undergoing transfemoral TAVR and in whom vascular pre-closure was not possible. METHODS A prospective institutional TAVR registry was retrospectively analysed and a cohort of patients were identified who were selected for transfemoral valve delivery and in whom pre-closure failed and access site haemostasis was achieved by stent graft implantation. RESULTS This strategy was used for achieving access site haemostasis in 11 patients (1.5% of 744 patients undergoing transfemoral TAVR). These patients were considered to be at increased risk of vascular surgery complications due to advanced age, frailty, comorbidities, or immobility. Stent graft implantation achieved access site haemostasis in all patients. During follow-up, 30-day mortality was zero, 1-year mortality was 27%, and none of the patients required additional vascular interventions. CONCLUSION The preliminary data suggest that planned stent graft implantation within the femoral artery may achieve access site haemostasis and enable a totally percutaneous TAVR procedure, despite failure to perform pre-closure with a suture-based vascular closure device.
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Gilbert J, Rai J, Kingsmore D, Skousen J, Ptohis N. First Clinical Results of the Merit WRAPSODY™ Cell-Impermeable Endoprosthesis for Treatment of Access Circuit Stenosis in Haemodialysis Patients. Cardiovasc Intervent Radiol 2021; 44:1903-1913. [PMID: 34514534 PMCID: PMC8626397 DOI: 10.1007/s00270-021-02953-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/20/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE This prospective, observational first in human study evaluated the safety and effectiveness of WRAPSODYTM Cell-impermeable Endoprosthesis (Merit Medical Systems, Inc.) in the treatment of arteriovenous fistula and arteriovenous graft access circuit stenosis. MATERIALS AND METHODS Investigators conducted a prospective analysis of 46 patients with access circuit stenosis from three centres. Treatment sites included the peripheral outflow veins (e.g. cephalic arch, basilic vein swing point; 16 fistula and 10 graft patients); the graft-vein anastomosis (9 patients); and the central veins (up to, but not including the SVC; 11 patients). Primary outcome measures included 30-day freedom from access circuit-related safety events and 30-day target lesion primary patency. Secondary outcome measures included procedural success; device- and procedure-related adverse events; target lesion primary patency; access circuit primary patency; and secondary patency. In-person follow-up was scheduled at 1, 3, 6, and 12 months. An independent data monitoring/clinical event committee adjudicated all reinterventions and device/procedure-relatedness for adverse events. RESULTS All initial procedures were successful. All but one patient was free from safety events through the first 30 days (97.8% (45/46)). This event was not device-related. Over the remainder of the study, one adverse event was adjudicated as possibly device-related. Six- and 12-month target lesion primary patency rates were 97.7% (42/43) and 84.6.% (33/39), respectively. Six- and 12-month access circuit primary patency rates were 84.4% (38/45) and 65.9% (29/44), respectively. CONCLUSION Results suggest that the study device is safe and effective for treatment of stenoses in the peripheral and central veins of arteriovenous access circuits. LEVEL OF EVIDENCE Level 2b, cohort study.
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Affiliation(s)
- James Gilbert
- The Oxford Transplant Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK.
| | - Jason Rai
- The Oxford Transplant Centre, Churchill Hospital, Old Road, Headington, Oxford, OX3 7LE, UK
| | | | - John Skousen
- Merit Medical Systems, Inc, South Jordan, Utah, USA
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Haraguchi T, Tsujimoto M, Kashima Y, Takeuchi T, Tadano Y, Hachinohe D, Kaneko U, Kobayashi K, Kanno D, Sato K, Fujita T. The "Needle bypass" technique: Percutaneous anatomical bypass with needle rendezvous for patients with peripheral arterial disease that have no other surgical options. CVIR Endovasc 2021; 4:66. [PMID: 34436700 PMCID: PMC8390632 DOI: 10.1186/s42155-021-00254-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ideal method for recanalization of complex peripheral lesions has not been determined, despite the use of the latest endovascular devices. We describe a novel method for a fully percutaneous anatomical bypass, named the "needle bypass" technique, for treatment of complex vascular lesions with failed previous surgical therapy. MAIN TEXT A 68-year-old male patient with chronic limb-threatening ischemia presented to our department. He previously had received surgical treatment 10 years prior that included the removal of the right distal common femoral artery and two surgical bypasses, an axillary-femoral bypass and an iliofemoral bypass, because he had repeated infections. He was referred to our center in order to have peripheral interventions. Since the previous conventional bridging/revascularization of the removed common femoral bifurcation had failed, the "needle bypass" technique was then used. With this novel technique, the tips of two percutaneous and bidirectional inserted needles were aligned ("needle rendezvous") for the externalization of a guidewire in a through-and-through manner. Once this was achieved, an endovascular stent graft and an interwoven stent were deployed to cover and connect the lesion. This new technique is a minimally invasive anatomical bypass that directly connects artery to artery without any disturbance of the venous flow, and this technique, as the only option available, was performed successfully in our no-option patient. CONCLUSIONS The "needle bypass" technique is an effective percutaneous treatment method in patients with no other surgical options.
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Affiliation(s)
- Takuya Haraguchi
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan. .,Department of Cardiology and Head of Peripheral Artery Disease Center, Sapporo Heart Center, North 49, East 16, 8-1, Higashi ward, 007-0849, Sapporo, Hokkaido, Japan.
| | | | | | | | - Yutaka Tadano
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | | | - Umihiko Kaneko
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Ken Kobayashi
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Daitaro Kanno
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Katsuhiko Sato
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
| | - Tsutomu Fujita
- Department of Cardiology, Sapporo Heart Center, Sapporo, Japan
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Gottardi R, Wyss TR, van den Berg JC, Rylski B, Berger T, Schmidli J, Czerny M. Current trends in reduction or elimination of the aortic impulse during stent-graft deployment and balloon moulding during thoracic endovascular aortic repair. Eur J Cardiothorac Surg 2021; 60:1466-1474. [PMID: 34368834 DOI: 10.1093/ejcts/ezab275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/03/2021] [Accepted: 04/29/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES A survey was performed to evaluate the methods used for reduction or elimination of the aortic impulse (REAI) to facilitate precise stent graft placement and balloon moulding during thoracic endovascular aortic repair (TEVAR). METHODS A total of 127 physicians (1 per hospital) were contacted and asked to fill out a short, comprehensive questionnaire on an internet-based platform. RESULTS Fifty physicians (39.4%) responded and completed the survey. Routine use of REAI for stent graft deployment is most frequently used in the ascending aorta and less frequently in the aortic arch and the descending aorta (86.4% vs 69.4% vs 56%). Some physicians based the decision of whether to use REAI on the type of stent graft in the respective location (13.6% vs 24.5% vs 24.0%). Stent-graft deployment without REAI, irrespective of the type of stent graft used, was never done in the ascending aorta (0.0%), in 3 centres in the aortic arch (6.1%) and in 10 centres in the descending aorta (20%). The REAI method most frequently used was dependent on the aortic segment (ascending aorta vs aortic arch vs descending aorta) rapid right ventricular pacing (90.9% vs 59.2% vs 28.0%), followed by pharmacological blood pressure reduction (13.6% vs 53.1% vs 64.0%) and venous inflow occlusion (13.6% vs 14.3% vs 4.0%), respectively. Tip capture and non-occlusive deployment systems were frequently quoted as reasons for not using REAI. CONCLUSIONS REAI is the fundament for TEVAR in all thoracic aortic segments, with a decline in usage from proximal (ascending) to distal (descending). Rapid right ventricular pacing is the preferred REAI method used in TEVAR. Most procedures are performed with the patient under general anaesthesia. The types of stent grafts and moulding balloons used have an impact on the use or non-use of REAI.
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Affiliation(s)
- Roman Gottardi
- Department of Cardiac, Thoracic and Vascular Surgery, Heart Center Lahr, Lahr, Germany.,Paracelsus Medical University, Salzburg, Austria
| | - Thomas R Wyss
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.,Department of Vascular Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Jos C van den Berg
- Centro Vascolare Ticino, Ospedale Regionale di Lugano, Lugano, Switzerland.,Department of Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad, Krozingen, Germany.,Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Tim Berger
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad, Krozingen, Germany.,Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Juerg Schmidli
- Department of Cardiovascular Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Martin Czerny
- Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad, Krozingen, Germany.,Albert Ludwigs University Freiburg, Faculty of Medicine, Freiburg, Germany
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Rotzinger D, Roumy A, Tozzi P, Qanadli SD. Acute post-traumatic rupture of the right pulmonary artery: a modern approach for a rare condition. Eur J Cardiothorac Surg 2021; 60:200. [PMID: 33550401 DOI: 10.1093/ejcts/ezab035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/05/2021] [Accepted: 01/13/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- David Rotzinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Aurélien Roumy
- Cardiovascular Surgery Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Piergiorgio Tozzi
- Cardiovascular Surgery Department, University Hospital of Lausanne, Lausanne, Switzerland
| | - Salah D Qanadli
- Department of Diagnostic and Interventional Radiology, University Hospital of Lausanne, Lausanne, Switzerland
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Vecsey-Nagy M, Szeberin Z, Csobay-Novák C. Unusual hybrid repair of a thoracoabdominal and mesenteric aneurysm with aberrant right hepatic artery. J Vasc Surg Cases Innov Tech 2021; 7:458-61. [PMID: 34278084 DOI: 10.1016/j.jvscit.2021.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/21/2021] [Indexed: 11/23/2022]
Abstract
Hybrid approaches for the treatment of thoracoabdominal aortic aneurysms that combine visceral debranching and endovascular repair are feasible alternatives to open surgery for certain high-risk patients. A 70-year-old man was admitted with a rapidly expanding thoracoabdominal aneurysm involving the superior mesenteric artery, associated with an aberrant hepatic artery. An iliovisceral debranching was performed, followed by the endovascular repair of the thoracoabdominal aorta with a standard thoracic device. The ostial aneurysm was excluded by retrograde implantation of a covered stent from the superior mesenteric artery. Such approach can be considered as a viable alternative in the management of complex thoracoabdominal aneurysms.
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Bontinis V, Antonopoulos CN, Bontinis A, Sfyroeras GS, Kontopodis N, Ioannou CV, Ktenidis K, Geroulakos G. A systematic review and meta-analysis of the streamliner multilayer flow modulator stent for treatment of complex aortic lesions. J Vasc Surg 2021; 74:646-656.e9. [PMID: 34019986 DOI: 10.1016/j.jvs.2021.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 03/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We evaluated the safety and efficacy of multilayer flow modulator (MFM) stents (Cardiatis, Isnes, Belgium) for the treatment of complex aortic lesions. METHODS A systematic electronic research was conducted for studies reported from December 2008 to May 2020. Data extracted from 15 eligible case series (CS) were appropriately pooled and analyzed in a meta-analysis. The patient baseline characteristics were recorded, and 16 outcomes of interest were studied. The primary end points included 30-day all-cause and aneurysm-related mortality, aneurysm-related mortality at 1 year, vessel patency, and any endoleaks, ruptures, reinterventions, and aneurysm exclusion at the end of follow-up. RESULTS A total of 39 studies (15 CS and 24 case reports), involving 429 patients, met the inclusion criteria. Overall, 436 lesions were treated, and 1521 aortic branches were covered by the multilayer stent. The mean follow-up for the 15 CS with 404 patients was 14.6 months. Compliance with the instructions for use was reported by eight CS, with 75% of the procedures performed within the instructions for use. However, 41% of the patients reported by 12 CS had undergone a previous aortic intervention. The pooled 30-day all-cause and 30-day aneurysm-related mortality rates were 0.56% (95% confidence interval [CI], 0.00%-2.54%) and 0.00% (95% CI, 0.00%-0.80%), respectively. The pooled aneurysm-related mortality at 1 year of follow-up was 5.25% (95% CI, 0.07%-14.91%). The pooled vessel patency at the end of follow-up was 99.12% (95% CI, 97.73%-99.93%). The pooled reintervention and endoleak rates at the end of follow-up were 10.94% (95% CI, 3.64%-20.67%) and 10.70% (95% CI, 4.45%-18.66%), respectively. The crude spinal cord ischemia and renal failure rates were 0.69% and 1.8%, respectively. CONCLUSIONS The results from the present review and meta-analysis have indicated the safety and efficacy of MFM stents for treating challenging aortic pathologic lesions when used as first-line treatment and within the instructions for use. The almost zero pooled 30-day all-cause and aneurysm-related mortality rates combined with the low crude spinal cord ischemia and renal failure rates indicate the use of MFM stents is a good treatment option for complex aortic lesions in the short- and mid-term periods. The lack of long-term follow-up warrants further research concerning the efficacy of the device in the long term.
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Affiliation(s)
- Vangelis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece.
| | - Constantine N Antonopoulos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Alkis Bontinis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George S Sfyroeras
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital Heraklion, University of Crete Medical School, Heraklion, Greece
| | - Kiriakos Ktenidis
- Department of Vascular Surgery, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, Greece
| | - George Geroulakos
- Department of Vascular Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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Sénémaud J, Fadel G, Touma J, Tacher V, Majewski M, Cochennec F, Kobeiter H, Desgranges P. Initial Results of Antegrade Laser Fenestrations Using Image Fusion Guidance and Company Manufactured Stent Grafts in Complex Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2021; 62:204-213. [PMID: 33994306 DOI: 10.1016/j.ejvs.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 01/22/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE The aim was to describe initial outcomes of physician modified stent grafts using antegrade laser fenestrations and image fusion guidance (LEVAR) and company manufactured custom made (CM) stent grafts for the treatment of complex abdominal aortic aneurysms (CAAAs), thoraco-abdominal aortic aneurysms (TAAAs) and type I endoleaks (T1ELs). METHODS This was a retrospective single centre study. All LEVAR and Zenith (Cook) CM stent graft procedures between 1 January 2012 and 31 December 2018 were reviewed. Endpoints included intra-operative adverse events (IOAEs), in hospital mortality, re-interventions, target vessel patency, and 12 month outcomes (overall survival, freedom from re-intervention, target vessel patency). Outcomes at 12 months were estimated using the Kaplan-Meier method. RESULTS A hundred patients were identified and included in the study. All patients were deemed unfit for open repair. The cohort included 22 LEVAR and 78 CM stent grafts. LEVAR cases included painful aneurysms (n = 5), > 65 mm aneurysms (n = 10), anatomical constrains and/or presence of previous renal stents (n = 7) or cases declined by the manufacturer planning centre (n = 2). IOAEs were recorded in 41% of cases (n = 9) in the LEVAR group vs. 10% (n = 8, p = .002) in the CM group. The in hospital mortality rate in the LEVAR group was 9% (n = 2) vs. 4% (n = 3, p = .30) in the CM group. The median follow up duration was 22 months (7 - 38) in the LEVAR group and 28 months (11 - 78) in the CM group. The estimate of overall survival at one year was 91% in both groups. The freedom from re-intervention rate at one year was 58% in the LEVAR group vs. 87% in the CM group. The target vessel patency rates at one year were 95% in both groups. CONCLUSION In high risk patients deemed unfit for open repair, LEVAR may provide satisfactory 12 month overall survival and target vessel patency rates, though reported IOAE, mortality, and re-interventions rates were high thus requiring close and extensive follow up.
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Affiliation(s)
- Jean Sénémaud
- Centre Hospitalier Universitaire Henri Mondor, Department of Vascular Surgery, Créteil, France
| | - Guillaume Fadel
- Centre Hospitalier Universitaire Henri Mondor, Department of Vascular Surgery, Créteil, France
| | - Joseph Touma
- Centre Hospitalier Universitaire Henri Mondor, Department of Vascular Surgery, Créteil, France
| | - Vania Tacher
- Centre Hospitalier Universitaire Henri Mondor, Medical Imaging Service, Interventional and Therapeutic Vascular and Oncologic Radiology Unit, Créteil, France
| | - Marek Majewski
- Centre Hospitalier Universitaire Henri Mondor, Department of Vascular Surgery, Créteil, France
| | - Frédéric Cochennec
- Centre Hospitalier Universitaire Henri Mondor, Department of Vascular Surgery, Créteil, France
| | - Hicham Kobeiter
- Centre Hospitalier Universitaire Henri Mondor, Medical Imaging Service, Interventional and Therapeutic Vascular and Oncologic Radiology Unit, Créteil, France
| | - Pascal Desgranges
- Centre Hospitalier Universitaire Henri Mondor, Department of Vascular Surgery, Créteil, France.
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Shaalan WE, El Emam AA, Lotfy HI, Naga AR. One-year results of stent graft repair for carotid artery pseudo-aneurysm in patients with Behcet's disease. Vascular 2021; 30:518-523. [PMID: 33977801 DOI: 10.1177/17085381211013641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Behcet's disease is a multisystem disorder of unknown etiology with vascular complications. This study reviewed the mid-term outcome of Behcet's disease patients with carotid artery pseudo-aneurysms treated by endovascular stent-graft repair at our unit. METHODS During a period of 11 years, six cases were included. Postoperative ultrasound duplex results were recorded along with computed tomography angiography report done a year after intervention. RESULTS The mean age (±SD) was 38 (±5.2) years. The mean (±SD) pseudo-aneurysm size was 33 (±12.2) mm. Technical success was 83%; failed cannulation of the internal carotid artery was encountered in one case. On day 2 post-operative, a duplex ultrasound revealed complete exclusion and thrombosis of the false aneurysm in all cases. A year later, a computed tomography angiography revealed a primary patency rate of 80%, and only one case had a recurrent pseudo-aneurysm at the distal margin of the stent graft. All cases, however, had complete thrombosis in the pseudo-aneurysms lumen with a mean (±SD) regression in size of 18 (±6) mm. The mean (±SD) percentage of in-stent stenosis was 34.5% (±11.73%). CONCLUSIONS Stent graft repair for carotid artery pseudo-aneurysm in Behcet's disease patients might be the preferable first line of treatment since it had a high technical success and mid-term primary patency rates, with additional fact that it obviously avoids the hazardous complications of surgery.
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Affiliation(s)
- Wael E Shaalan
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
| | - Ali A El Emam
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
| | - Hassan I Lotfy
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
| | - Ahmad R Naga
- Alexandria Vascular Unit, Alexandria University, Alexandria, Egypt
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Simon B, Neubauer J, Schoenthaler M, Hein S, Bamberg F, Maruschke L. Management and endovascular therapy of ureteroarterial fistulas: experience from a single center and review of the literature. CVIR Endovasc 2021; 4:36. [PMID: 33864536 PMCID: PMC8053137 DOI: 10.1186/s42155-021-00226-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
Background Ureteroarterial fistula (UAF) is a rare but potentially life threatening disease. The aim of this study was to evaluate the outcome of endovascular therapy for UAF treatment. Methods This retrospective case series evaluates a single center experience of percutaneous stent graft (SG) angioplasty and/or coil embolization for UAF. Patient follow-up included technical and early clinical success, complications and revisional procedures. We also conducted a systematic review of the literature reporting on endovascular UAF management. Results We identified 17 UAF in 16 patients (12 male, 4 female, mean age 69.8 ± 11.3 years) who underwent endovascular UAF therapy at our tertiary hospital. All patients presented with hematuria. 5/17 (29.4%) presented with flank pain, in 7 (41.2%) cases patients were in hypovolemic shock. Risk factors of UAF included chronic indwelling ureteral stents in all fistulas, major pelvic surgery in 13 cases (76.5%). In 6 cases (35.3%) SG were placed from the common iliac artery (CIA) to the external iliac artery (EIA) following coil embolization of the proximal internal iliac artery (IIA). SG placement without previous coil embolization was performed in 10 fistulas (58.8%). In one case only coil embolization of the IIA was performed. Mean follow-up was 654 (range: 1–3269) days. All procedures were technically successful and no procedure related deaths occurred during follow-up. During the initial hospital stay hematuria disappeared in 14/17 cases (82.4%). Overall, four patients suffered recurrent hematuria, which in three cases resolved after a secondary intervention. One recurrent UAF related death occurred during follow-up 229 days after initial treatment. A total of 152 UAF cases were additionally analyzed from our systematic literature review: SG placement with or without embolization was performed in 140 cases (92.1%) while embolization alone was done in 12 cases (7.9%). Complications included UAF recurrence (18/152, 11.8%), SG thrombosis (7/140, 5%), and SG infections (5/140, 3.6%) with an overall complications rate of 13.8%. Five patients died due to UAF (3.3%). Conclusion Endovascular therapy offers high technical success rates and rapid bleeding control of UAF. Severe complications like SG occlusions or SG infections are rare but significant. Antibiotic treatment and single anti-platelet therapy improve SG durability as well as close and long follow-up to timely perform repeated endovascular or surgical treatment if necessary. Evidence-based medicine Level 4, case series.
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Affiliation(s)
- Bjoern Simon
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
| | - Jakob Neubauer
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin Schoenthaler
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Hein
- Department of Urology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lars Maruschke
- Department of Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Diagnostic Radiology, Pediatric Radiology and Interventional Radiology, St.-Josefs-Krankenhaus, Freiburg, Germany
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