International Angiology最新文献

{"title":"The rheolytic thrombectomy AngioJet™ is a safe and technically feasible method for treating acute and sub-acute occluding lesions in the visceral arteries.","authors":"Bachar Al Haj, Imam T Ritonga, Martin J Austermann, Marco V Usai","doi":"10.23736/S0392-9590.24.05326-4","DOIUrl":"https://doi.org/10.23736/S0392-9590.24.05326-4","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study is to evaluate the safety and feasibility of the AngioJet™ device in the endovascular treatment of visceral ischemia with stenotic or occlusive lesions.</p><p><strong>Methods: </strong>Retrospective analysis of patients treated for visceral artery occlusion with thrombectomy using the AngioJet™ (Boston Scientific, MA, USA). Inclusion criteria: patients with stenotic or occluding lesion in visceral arteries including renal and mesenteric arteries, who received endovascular treatment with AngioJet™.</p><p><strong>Results: </strong>Eighteen patients with acute and sub-acute visceral arteries occlusions underwent endovascular thrombectomy. In twelve cases the procedure was successful, and the patients were discharged with patent target arteries. Four cases required re-intervention and two cases ended with a fatal complication. The technical and clinical success rate in our study was 88,9% (sixteen out of eighteen), these patients were discharged from hospital with patent target arteries.</p><p><strong>Conclusions: </strong>The thrombectomy using the AngioJet™ device is an effective and feasible method for the treatment of stenotic or occluding lesions of the visceral arteries with rapid post-interventional clinical improvement and minimal adverse events.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142715979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of arterial hypertension in patients with peripheral arterial disease.","authors":"Pavel Poredoš, Dimitri P Mikhailidis, Kosmas I Paraskevas, Aleš Blinc, Pier L Antignani, Agata Stanek, Armando Mansilha, Matija Cevc","doi":"10.23736/S0392-9590.24.05242-8","DOIUrl":"10.23736/S0392-9590.24.05242-8","url":null,"abstract":"<p><p>Hypertension is a major risk factor for peripheral arterial atherosclerotic disease (PAD). Hypertension deteriorates arterial wall function and the morphology of all layers of arteries. Endothelial cell injury enhances permeability and promotes migration of cholesterol and monocytes into the vessel wall. Increased blood pressure (BP) through hyperplasia of smooth muscle cells initiates remodeling of the arterial wall that increases peripheral resistance. Further, hypertension, particularly in patients with dyslipidemia, provokes atherosclerosis in different vascular territories, including the lower legs. Guidelines recommend treatment of hypertension in patients with PAD to reach the target BP of <130/80 mmHg. However, systolic BP (SBP) <120 mmHg may worsen oxygen delivery to the diseased leg and is related to a higher rate of cardiovascular (CV) events. Therefore, there is a J-shape relationship between SBP and the rate of primary outcomes. Any class of antihypertensive drugs, including beta-blockers, can be used for the treatment of hypertension in patients with PAD. Angiotensin converting enzyme (ACE) inhibitors may have some additional benefit over other antihypertensive drugs including improvement of perfusion of the diseased leg and are recommended even in patients with critical limb ischemia. In conclusion: hypertensive patients with PAD are at increased risk for CV events and treatment of raised BP is indicated, but SBP <120 mmHg and DBP <70 mmHg may contribute to adverse limb outcomes and other CV events. Consequently, PAD patients may require a different BP target than those without PAD.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for the treatment of recurrent varicose vein disease arising from the saphenofemoral junction or the great saphenous vein: a systematic review and meta-analysis.","authors":"Alkis Bontinis, Vangelis Bontinis, Georgios Koudounas, Argirios Giannopoulos, Christos Karkos, Dimitrios Virvilis, Angeliki Chorti, Kiriakos Ktenidis","doi":"10.23736/S0392-9590.24.05323-9","DOIUrl":"10.23736/S0392-9590.24.05323-9","url":null,"abstract":"<p><strong>Introduction: </strong>We investigated the safety and feasibility of the available interventions in the treatment of recurrent varicose vein disease.</p><p><strong>Evidence acquisition: </strong>A systematic search on Medline, Scopus, and Web of Science for articles published by August 2024 was performed. Primary endpoints included duplex ultrasonography (DUS)-identified recurrence and clinical recurrence.</p><p><strong>Evidence synthesis: </strong>Twenty-eight studies, eleven describing endovenous thermal ablation (EVTA), four ultrasound-guided foam sclerotherapy (UGFS), and thirteen surgery (high ligation with or without stripping) encompassing 2228 limbs, were included. The overall DUS-detected recurrence estimate was 11.84% (95% CI: 7.15-17.40). EVTA displayed the lowest recurrence of 4.27% (95% CI: 0.37-10.75), followed by UGFS 11.19% (95% CI: 6.80-16.42) and surgery 23.27% (95% CI: 15.35-32.19). Statistically significant differences were observed between surgery and both EVTA (P<0.01) and UGFS (P=0.01). The overall clinical recurrence estimate was 24.91% (95% CI: 10.40-42.96) with EVTA portraying the lowest clinical recurrence of 2.37% (95% CI: 0.00-16.81), followed by surgery 31.08% (95% CI: 14.43-50.63). Subgroup analysis identified statistically significant differences between EVTA and surgery (P=0.01). Whereas non-statistically significant differences were identified between the included interventions regarding paresthesia and deep vein thrombosis (DVT), surgery exhibited higher wound infection estimates compared to EVTA of 0.00% (95% CI: 0.00-0.80) versus 4.34% (95% CI: 2.21-7.02, P<0.01). The pooled hematoma and lymphatic complication estimates for surgery were 5.04% (95% CI: 0.50-12.87) and 5.71% (95% CI: 2.91-9.22) respectively.</p><p><strong>Conclusions: </strong>This review demonstrated the superior efficacy of EVTA over surgery in treating recurrent varicose vein disease corroborating its use as the preferred treatment, when feasible. Additionally, UGFS displayed comparable outcomes to EVTA. The notable recurrence estimates associated with surgery call into question its suitability within this context.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142667844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Current evidence on the effectiveness and safety of oral anticoagulants in superficial venous thrombosis: a systematic review and meta-analysis.","authors":"Vito A Damay, Ignatius Ivan, Marc Vuylsteke","doi":"10.23736/S0392-9590.24.05309-4","DOIUrl":"https://doi.org/10.23736/S0392-9590.24.05309-4","url":null,"abstract":"<p><strong>Introduction: </strong>Previous studies suggest fondaparinux as an effective regimen for superficial venous thrombosis (SVT), but the inconvenience of prolonged parenteral injections has prompted investigations into oral anticoagulants (OACs). This study aims to evaluate the current evidence on the effectiveness and safety of OACs in the treatment of SVT.</p><p><strong>Evidence acquisition: </strong>Following the PRISMA 2020 guidelines, we conducted a systematic review and meta-analysis registered in PROSPERO (CRD42024535625). A comprehensive literature search was performed across multiple databases up to April 2024. Studies were included if they involved adult patients diagnosed with SVT, treated with OACs, and reported relevant efficacy and safety outcomes. Both randomized controlled trials (RCTs) and observational studies were considered. Data extraction and risk of bias assessments were independently performed by two authors.</p><p><strong>Evidence synthesis: </strong>The search identified 1531 studies, with six studies (three RCTs and three prospective cohort studies) meeting inclusion criteria. Meta-analysis for Rivaroxaban-treated group showed DVT occurrence was 1.30% (95% CI 0.17-3.07%), SVT extension was 0.32% (95% CI: 0.00-1.58%), SVT recurrence was 0.75% (95% CI: 0.00-3.30%), clinically relevant non-major bleeding was 1.95% (95% CI: 0.46-4.11%), minor bleeding was 5.68% (95% CI: 3.02-9.01%). These estimates were for patients treated with rivaroxaban 10-20 mg once daily over 42 days to 37 months. No major bleeding was reported with rivaroxaban 10 mg once daily.</p><p><strong>Conclusions: </strong>This systematic review and meta-analysis demonstrate that OACs, especially rivaroxaban, are effective and safe for the treatment of SVT. They offer a convenient alternative to parenteral anticoagulants, potentially improving patient compliance and outcomes. However, further large-scale studies are warranted to confirm these findings.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of light compression on chronic venous disease, edema and comfort in women during pregnancy and postpartum period: a prospective randomized study.","authors":"Aleksandra Frydrych-Szymonik, Katarzyna Ochałek, Agnieszka Jankowicz-Szymańska, Zbigniew Szyguła","doi":"10.23736/S0392-9590.24.05208-8","DOIUrl":"https://doi.org/10.23736/S0392-9590.24.05208-8","url":null,"abstract":"<p><strong>Background: </strong>Lower limb edema associated with venous disorders is an increasingly common problem in pregnant women. The study aimed to assess the use of compression class 1 (ccl1=18-21 mmHg) in lower limb edema and CVD prevention in pregnant and postpartum women.</p><p><strong>Methods: </strong>51 pregnant women (second trimester) were randomly recruited into either a study group CG with compression ccl1 or a control group NCG, both with physical activity (PA) recommendation. The assessment concerned venous system condition, limb size, and compression comfort. Edema was diagnosed as ≥10% measurement increase.</p><p><strong>Results: </strong>Venous reflux (8/22 CG, 1/16 NCG) and an onset of CVD (6/22 CG, 1/16 NCG) were diagnosed in the first measurement. After postpartum, a significant reduction of the great saphenous vein (GSV) diameter in the proximal part of the left lower limb in CG (P=0.014) and expansion of the small saphenous vein (SSV) in the proximal part of the left lower limb in NCG (P=0.028) were observed. An analysis of the limb sizes in the second measurement revealed a significant increase of all circumferences and volumes in the NCG, and of lower leg volumes in the CG. Edema was diagnosed in five women in the NCG in the second measurement. Consequently, compression was recommended for the new group (NCG+C), and a significant edema reduction (P=0.026) occurred in the third measurement.</p><p><strong>Conclusions: </strong>Compression ccl1 reduces the risk of edema, venous insufficiency, and improves women's quality of life during pregnancy and postpartum.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142568407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety of adjuvant open axillary access during complex thoracoabdominal aortic endovascular procedures.","authors":"Fabricio Barahona, Gaspar Mestres, Xavier Yugueros, Donovan Ruiz, Victoria Gamé, Daniel Gil-Sala, Carla Blanco, Vicente Riambau","doi":"10.23736/S0392-9590.24.05258-1","DOIUrl":"10.23736/S0392-9590.24.05258-1","url":null,"abstract":"<p><strong>Background: </strong>Endovascular treatment of aortic diseases with complex anatomy may require an additional upper extremity arterial access (like axillary access) for support during aortic navigation and allowing the use of larger sheaths for thoracoabdominal antegrade access. The objective of this study is to evaluate the safety of the open axillary approach as adjuvant access in complex thoracoabdominal aortic endovascular interventions.</p><p><strong>Methods: </strong>A monocentric retrospective study was performed, including all patients with a complex aortic endovascular procedure (fEVAR, bEVAR, chEVAR or TEVAR), elective or urgent, with open surgical exposure of the axillary artery as adjuvant access, between 2012 and 2022. Demographic data, diagnosis and urgency criteria, type of aortic intervention, size of axillary sheath, use of through-and-through maneuver, and features by computed tomography angiography (CTA) of the axillary artery and aortic arch were recorded. The appearance of local and aortic postoperative complications were described, and possible prognostic factors were analyzed.</p><p><strong>Results: </strong>Forty-eight patients (38 men) were included, median age 78 years (range 50-87), 33 with intact thoracoabdominal aneurysms, eight previous EVAR endoleaks and seven aortic aneurysm ruptures. 28 fEVAR/bEVAR, 17 chEVAR and three TEVAR procedures with axillary access were performed. Left infraclavicular axillary access was the most common approach (94%), along with a 12 French (F) median sheath (range 7-20). Eight (16.7%) local complications were identified: three bleedings, one hematoma, three focal dissections in the subclavian artery, and one brachial embolism, all successfully resolved. The only factor related to local complications was small axillary diameter (median 10.7 vs. 14.6 mm; P<0.001), a subclavian/sheath ratio less than one was associated to more local complications (P=0.02). Regarding aortic complications, two (4.1%) type B asymptomatic aortic dissections with left juxta-subclavian tear were found, attributed to local manipulation, occurring only in urgent procedures (P=0.032).</p><p><strong>Conclusions: </strong>The use of open axillary access as an adjuvant approach in complex aortic endovascular surgery, although it is very useful and usually safe, can be associated with subclavian or even aortic complications (not reported until now), especially in cases with small subclavian diameters and urgent cases.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"404-410"},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"STABILISE for acute type B aortic dissection.","authors":"Tatiana Cotão, Joel Sousa, Armando Mansilha","doi":"10.23736/S0392-9590.24.05279-9","DOIUrl":"10.23736/S0392-9590.24.05279-9","url":null,"abstract":"<p><strong>Introduction: </strong>Stent-assisted, balloon-induced intimal disruption and relamination of aortic dissection (STABILISE) is an extended downstream endovascular management technique for acute type B aortic dissection (TBAD), that aimed to achieve complete aortic remodeling. This systematic review aimed to assess the early and mid-term clinical outcomes with STABILISE in the management of TBAD.</p><p><strong>Evidence acquisition: </strong>A literature search was performed on the Medline, Web of Science, Scopus, and SciELO databases, which returned 195 studies. Five studies were included. Data were extracted using predefined forms.</p><p><strong>Evidence synthesis: </strong>In total, one hundred patients with acute or subacute TBAD managed with STABILISE were included. All studies reported a technical success of 100%. Thirty-day mortality was estimated at 4% (4/100) with no further deaths documented during an estimated mean follow-up of 12.7 months (range 12-15 months). Five percent developed spinal cord ischemia and another 5% developed visceral artery occlusions. One case of aortic rupture during time of balloon inflation was reported. Rare complications included delayed retrograde dissection (1%), aortobronchial fistula (1%), and renal failure (1%). One case of disconnection between stent-graft and bare stent was documented. Six percent of patients developed endoleak, predominately type I. Overall re-intervention rate was 21%, as reported in all studies. Complete obliteration of the false lumen in the thoracic aorta was achieved in 99% of patients and in the abdominal aorta in 96% of patients.</p><p><strong>Conclusions: </strong>STABILISE technique carries promising early and mid-term outcomes with high technical success and low mortality and morbidity. Excellent results on complete false lumen obliteration were observed. However, the heterogeneity among available studies' methodology does not permit firm conclusions, and further prospective analyses are needed to study the long-term outcomes of STABILISE.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"411-420"},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful treatment of chronic venous in-stent restenosis using a Phoenix atherectomy device.","authors":"Fabian Linden, Thomas Mihu, Norbert Frey, Christian Erbel","doi":"10.23736/S0392-9590.24.05229-5","DOIUrl":"10.23736/S0392-9590.24.05229-5","url":null,"abstract":"<p><strong>Background: </strong>Although endovascular treatment of venous obstruction with percutaneous transluminal angioplasty (PTA) and stenting is a safe and effective alternative to conservative treatment, the overall prevalence of in-stent restenosis (ISR) remains high in this patient population. This study reports a novel treatment option for patients with chronic ISR (C-ISR).</p><p><strong>Methods: </strong>At our center, all patients with ISR were treated based on the time since the initial intervention. Acute in-stent restenosis (A-ISR) was preferably treated with catheter-directed thrombolysis or a pharmacomechanical peripheral thrombectomy device and PTA. Selected patients with chronic ISR (C-ISR) (greater than 30 days) were treated with a catheter- guided unidirectional atherectomy in addition to PTA, under the assumption of a non-thrombotic mechanism in the development of C-ISR.</p><p><strong>Results: </strong>We demonstrate a safe and practical treatment option for chronic ISR using a catheter- guided technical approach with the Phoenix atherectomy device in four patients. Technical success was achieved in every case, and mid-term patency was restored in three out of four patients.</p><p><strong>Conclusions: </strong>Restenosis following venous stenting is highly complex. Patients must be treated individually, with a focus on anticoagulation and antiplatelet therapy regimens, as well as the appropriate interventional treatment. Catheter- guided atherectomy is a viable option for this heterogeneous group of patients. Further studies are required to understand the etiology of chronic ISR.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"430-436"},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142286292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aorto caval fistulas.","authors":"Lazar B Davidovic, Igor B Koncar, Aleksa L Jovanovic, Marko V Dragas, Nikola S Ilic, Milos M Sladojevic, Andreja D Dimic, Filip B Petrovic","doi":"10.23736/S0392-9590.24.05221-0","DOIUrl":"10.23736/S0392-9590.24.05221-0","url":null,"abstract":"<p><strong>Background: </strong>The purpose of this paper is to examine and assess the outcomes following open repair in 39 patients who experienced aorto-caval fistula (ACF) resulting from the spontaneous rupture of an abdominal aortic aneurysm (AAA).</p><p><strong>Methods: </strong>We reviewed the clinical records of all patients surgically treated with open repair for ACF at the Clinic for Vascular and Endovascular Surgery of the Serbian Clinical Center in Belgrade, Serbia, from January 2012 to February 2023. All of the patients in this series were consecutive and had aorto-caval fistula from AAA. No patients were excluded from the procedure due to the life-threatening nature of the state. A follow-up assessment was performed during the follow-up examination or by telephone interview with the patient or a family member.</p><p><strong>Results: </strong>All patients were male, with mean age 67.4±8.3 years (range: 52-83 years). The 30-day mortality rate in our cohort was 35.9%, with three (7.7%) intraoperative deaths, and 11 deaths in the postoperative period (28.2%). A total of 25 patients out of 39 (64.1%) in the original cohort have survived the surgery and the postoperative period and were followed-up for a total of 67.1 person-years. The mean follow-up was 3.7±2.2 years (range 0.25-8.4 years). Two patients (8.0%) died during the follow-up, 16 patients (64.0%) survived, and seven (28.0%) were lost to follow-up. The long-term mortality rate in the cohort that survived the postoperative period was 3.0/100 person-years.</p><p><strong>Conclusions: </strong>ACF caused by spontaneous AAA rupture into the inferior caval vein or iliac veins is a relatively rare, life-threatening condition which requires prompt treatment. An exact preoperative diagnosis is essential for perioperative strategy. As the comparison of our results with the results from contemporary literature indicates, wherever possible endovascular repair should be considered since it results might be superior to open repair.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"394-403"},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142153902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Superficial temporal artery access for transfemoral or transbrachial carotid artery stenting in selected patients considered unfit for carotid surgery.","authors":"Piotr Myrcha, Izabela Taranta, Włodzimierz Hendiger, João Rocha-Neves, Kosmas I Paraskevas, Peter Gloviczki","doi":"10.23736/S0392-9590.24.05231-3","DOIUrl":"10.23736/S0392-9590.24.05231-3","url":null,"abstract":"<p><strong>Background: </strong>Transfemoral (TFCAS) or transbrachial carotid artery stenting (TBCAS) is an alternative to carotid endarterectomy (CEA) for treatment of high-grade internal carotid artery (ICA) stenosis. A difficult aortic arch (i.e., type III or bovine arch) and/or a tortuous/stenosed common carotid artery (CCA) are potential reasons for technical failure. This study explores the benefits of superficial temporal artery access (STAA) in aiding TFCAS or TBCAS for patients with challenging anatomical conditions.</p><p><strong>Methods: </strong>Clinical data of patients who underwent TFCAS or TBCAS using STAA between January and November 2023 were prospectively collected. Demographics, comorbidities, clinical presentation, and imaging studies were reviewed. Primary outcomes included 30-day stroke/death and technical success. Secondary outcomes and causes of failures were assessed.</p><p><strong>Results: </strong>Ten patients (mean age: 74 [range: 66-84] years) with difficult aortic arch (N.=2), CCA tortuosity (N.=2), proximal CCA stenosis (N.=2), previous technical TFCAS failure (N.=2) and aortoiliac occlusive disease (AIOD) (N.=2) underwent TFCAS or TBCAS supported by STAA. Successful STAA was possible in eight patients (six facilitated TFCAS and two TBCAS. after TBCAS occurred TIA). In two cases STAA was not successful. There were no deaths or strokes within 30 days, transient ischemic attack (TIA) occurred in one patient. Follow-up Duplex ultrasound confirmed occlusion of the STA in all patients, without clinical consequences.</p><p><strong>Conclusions: </strong>This prospective study suggests that TFCAS/TBCAS supported by STAA is a viable and safe approach when traditional access methods are ineffective and transcarotid artery stenting in not available or not possible. Despite a 20% technical failure in the current series, this technique may be useful for challenging anatomy of the aortic arch, CCA stenosis and tortuosity, and AIOD. When feasible, STAA may be a promising adjunct to TFCAS/TBCAS.</p>","PeriodicalId":13709,"journal":{"name":"International Angiology","volume":" ","pages":"421-429"},"PeriodicalIF":1.5,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}