Journal of Endovascular Therapy最新文献

{"title":"Electrosurgical In Situ Fenestration of Aortic Endograft.","authors":"Martina Bastianon, Davide Esposito, Caterina Melani, Endri Sila, Giuseppe Baldino, Giovanni Pratesi","doi":"10.1177/15266028251320871","DOIUrl":"https://doi.org/10.1177/15266028251320871","url":null,"abstract":"<p><strong>Purpose: </strong>Endovascular interventions have become the primary choice for treating complex aortic pathologies, particularly with the use of fenestrated and branched endografts. However, limitations, such as manufacturing time have restricted their applicability in urgent situations. This has led to explore alternative off-the-shelf solutions, including in situ fenestration. Within this technical note, we describe technical aspects of in situ fenestration using electrosurgical guidewire, in both antegrade and retrograde approaches, explaining advantages and limitation compared with other in situ fenestration techniques.</p><p><strong>Technique: </strong>The technique involves standard main body endograft deployment followed by targeted in situ fenestration using an electrified guidewire. Two illustrative cases are presented to demonstrate the technical aspects and clinical outcomes of this procedure.</p><p><strong>Conclusion: </strong>Electrosurgical in situ fenestration emerges as an effective technique for urgent treatment of complex aortic diseases. Further research is warranted to validate its safety and durability in larger patient cohorts.</p><p><strong>Clinical impact: </strong>Electrosurgical in situ fenestration allows to expand the feasibility of complex endovascular repairs in emegency settings. Electrosurgical in situ fenestration combines the benefits of thermal methods, offering broad availability and lower costs. Compared to other in situ fenestration techniques, the proposed technology allows for the creation of extremely small fenestrations with minimal and precise tissue disruption.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251320871"},"PeriodicalIF":1.7,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Videolaparoscopic-Guided Saccography and Direct Sac Embolization After Standard EVAR.","authors":"Luca Mezzetto, Lorenzo Grosso, Mario D'Oria, Jacopo Weindelmayer, Simone Giacopuzzi, Giovanni De Manzoni, Gian Franco Veraldi","doi":"10.1177/15266028251320805","DOIUrl":"https://doi.org/10.1177/15266028251320805","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;The occurrence of type II endoleak (T2EL) presents a significant challenge in standard endovascular aneurysm repair (EVAR), with ongoing debate in the literature regarding its optimal management. Although spontaneous resolution has been observed in many cases, intervention is often required to prevent progressive sac enlargement and rupture. Various approaches have been described, including translumbar, transarterial, and transcaval embolization, as well as direct sac puncture. The aim of this study is to evaluate the role of videolaparoscopic-guided saccography and direct sac embolization (ViSE) in patients with sac enlargement following EVAR.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A prospectively maintained registry of patients undergoing standard EVAR between 2016 and 2022 at our institution was retrospectively reviewed. Exclusion criteria included concomitant computed tomography (CT)-diagnosed type I endoleak or type III endoleak (T1EL or T3EL), less than 6 months of follow-up, or no available imaging study for review. A nidus posterior to the main body of endograft and a hostile abdomen (severe obesity body mass index [BMI] &gt;35 kg/m&lt;sup&gt;2&lt;/sup&gt;, previous open surgery, or history of peritonitis) were considered contraindications to ViSE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 259 standard EVAR procedures were performed during the study period, with 63 patients (24.3%) identified as having T2EL, 26 underwent endovascular treatment for significant sac growth during follow-up; 14 of these patients received ViSE (5.4%) and were included in the study. The median procedure time and median fluoroscopic time were 140 (interquartile range [IQR]=105-150) and 40.5 (IQR=31-45) minutes, respectively. Technical success was achieved in 12 of 14 patients (87%). In 7 patients (50%), the inferior mesenteric artery (IMA) was ligated. An occult T1EL or T3EL endoleak was revealed in 5 patients (35%), requiring an immediate or staged adjunct procedure. After a median follow-up of 32.4 months (IQR=25.3-51.7), 2 patients presented sac growth and required surgical conversion. None of the patients died due to aortic-related causes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Videolaparoscopic-guided saccography and direct sac embolization may be considered a valid alternative in patients with T2EL and sac growth. In our early experience, it has proven to be safe and effective in treating the nidus and IMA, and identifying hidden T1EL or T3EL.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical impact: &lt;/strong&gt;Videolaparoscopic-guided saccography and direct sac embolization (ViSE) represent a valuable option for managing type II endoleak (T2EL) with sac enlargement after EVAR. This approach allows precise treatment of the nidus and the inferior mesenteric artery while also identifying undetected type I and III endoleaks that may require further intervention. By integrating ViSE into clinical practice, physicians can improve diagnostic accuracy and expand treatment strategies","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251320805"},"PeriodicalIF":1.7,"publicationDate":"2025-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143517179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Vitro Investigation of Microcatheter Behavior During Microsphere Injection in Transarterial Radioembolization.","authors":"Tess Josien Snoeijink, Jan Lucas van der Hoek, Hadi Mirgolbabaee, Tristan Gerard Vlogman, Joey Roosen, Johannes Frank Wilhelmus Nijsen, Erik Groot Jebbink","doi":"10.1177/15266028251318953","DOIUrl":"https://doi.org/10.1177/15266028251318953","url":null,"abstract":"<p><strong>Purpose: </strong>To experimentally investigate the behavior of a clinically used microcatheter during transarterial radioembolization (TARE) microsphere injection in a successively bifurcating <i>in vitro</i> model.</p><p><strong>Materials and methods: </strong>A symmetrical phantom was developed which bifurcated 3 times into 8 outlets. A blood-mimicking fluid was pumped through the phantom using a physiological representative waveform. Holmium-165 microspheres were injected in a pulsed manner at 3 different locations using a standard microcatheter and a rigid counterpart with same dimensions as a control. Motion of the catheter was studied with a top- and side-view camera on the phantom. Microspheres were collected at each outlet and their distribution over the 8 outlets was analyzed.</p><p><strong>Results: </strong>Due to the pulsatile flow in the phantom, strengthened by the pulsatile microsphere injection, the clinical catheter showed maximum displacements of 0.87 mm within a vessel with a diameter of 3.6 mm. This motion resulted in a different microsphere distribution for the clinical catheter compared with the rigid counterpart (75.9% vs 49.4% of the microspheres went to outlet 1-4, respectively).</p><p><strong>Conclusion: </strong>In this <i>in vitro</i> model, the motion of the clinical catheter affected distribution of microspheres. Since the pulsatile administration of microspheres resulted in increased motion of the clinical catheter, standardizing microsphere administration could be beneficial to reduce interprocedural differences in TARE.</p><p><strong>Clinical impact: </strong>Our study demonstrated that microsphere distribution during transarterial radioembolization (TARE) is affected by catheter motion. Furthermore, increased catheter motion was observed as a result of the injection profile. Predictive tools such as the contrast CBCT and scout dose use different injection profiles compared to therapeutic TARE injections, potentially altering catheter tip behaviour and microsphere distribution, which could compromise their predictive values. Additionally, current TARE microsphere injection guidelines provide limited details, which may lead to variability across institutes and interventional radiologists. Standardizing injection techniques could reduce catheter motion variability and may facilitate more consistent and predictable microsphere distribution patterns.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251318953"},"PeriodicalIF":1.7,"publicationDate":"2025-02-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484581","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gore Tag Thoracic Branch Endoprosthesis in Acute Aortic Syndromes: A Case Series.","authors":"Andrea Spertino, Simona Marrocco, Marco Zavatta, Francesco Squizzato, Michele Piazza, Michele Antonello","doi":"10.1177/15266028251318957","DOIUrl":"https://doi.org/10.1177/15266028251318957","url":null,"abstract":"<p><strong>Clinical impact: </strong>The GORE TAG Thoracic Branch Endoprosthesis (TBE) represents an interesting novelty in the management of thoracic aortic pathologies, particularly in urgent settings where left subclavian artery (LSA) coverage is required. By eliminating the need for additional LSA revascularization procedures, this device aims to reduce procedural complexity, operating time, and the risk of complications associated with traditional methods. Clinicians can achieve effective treatment with a single, off-the-shelf device, improving both patient outcomes and procedural efficiency. This case series highlights the potential of an off-the-shelf single-branched thoracic endograft in urgent settings.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251318957"},"PeriodicalIF":1.7,"publicationDate":"2025-02-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143484579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Patients With Chronic Obstructive Pulmonary Disease Preoperatively May Reduce Complications and Improve Outcomes in Infrainguinal Endovascular Revascularization.","authors":"Renxi Li, Rachel Silverman, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1177/15266028251320506","DOIUrl":"https://doi.org/10.1177/15266028251320506","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) and chronic obstructive pulmonary disease (COPD) are both systemic inflammatory diseases that may share similar pathophysiological pathways. Given their potential overlap, the impact of COPD on perioperative outcomes following infrainguinal endovascular revascularization warrants further examination. Therefore, this study aimed to analyze the 30-day postoperative outcomes for COPD patients after infrainguinal endovascular revascularization.</p><p><strong>Methods: </strong>Chronic obstructive pulmonary disease and non-COPD patients who underwent infrainguinal endovascular revascularization were identified in the ACS-NSQIP database from 2012 to 2022. Exclusion criteria included aged less than 18 years and emergency cases. A 1:1 propensity-score matching was used to match demographics, baseline characteristics, symptomatology, and anesthesia. Thirty-day postoperative outcomes were compared.</p><p><strong>Results: </strong>Of 24 223 patients who underwent infrainguinal endovascular revascularization, 2472 (10.21%) had COPD. All COPD patients were 1:1 propensity-score-matched to the non-COPD patients. Chronic obstructive pulmonary disease patients had higher risks of mortality (3.24% vs 2.18%, p=0.03), major adverse cardiovascular events (MACE) (3.48% vs 2.47%, p=0.04), pulmonary complications (3.24% vs 2.02%, p=0.01), and 30-day readmission (15.41% vs 13.23%, p=0.03). All other 30-day outcomes were comparable between the groups.</p><p><strong>Conclusion: </strong>Chronic obstructive pulmonary disease independently increases the risk of 30-day mortality and cardiopulmonary complications after infrainguinal endovascular revascularization. Identification and optimization of COPD patients before considering invasive treatment can be important for preventing complications. Patients may undergo mini-spirometry to screen for COPD. If identified, COPD patients may begin intensive inhalation therapy and medical treatment prior to the surgery.</p><p><strong>Clinical impact: </strong>Both PAD and COPD are systemic inflammatory diseases that may share similar pathophysiological pathways. This study analyzed the 30-day postoperative outcomes for COPD patients after infrainguinal endovascular revascularization. It was found that COPD independently increases the risk of mortality, cardiopulmonary complications, and 30-day readmissions. Identification and optimization of COPD patients before considering invasive treatment can be important for preventing complications in infrainguinal endovascular revascularization. Patients may undergo mini-spirometry to screen for COPD. If identified, COPD patients may begin intensive inhalation therapy and medical treatment prior to the surgery.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251320506"},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician-Modified Endografts for Non-deferrable Complex Abdominal Aortic Aneurysm Repair Using the Endurant Platform: Templates and Initial Results.","authors":"Francisco Álvarez Marcos, Andrés Reyes Valdivia, Mariano De Blas Bravo, Manuel Alonso Pérez","doi":"10.1177/15266028251318952","DOIUrl":"https://doi.org/10.1177/15266028251318952","url":null,"abstract":"<p><strong>Introduction and objectives: </strong>Complex abdominal aortic aneurysm (AAA) repair often requires the use of fenestrated and branched endografts, which can be influenced by factors such as device availability, cost, and operator expertise. This study aims to evaluate the preliminary results with physician-modified endografts (PMEGs) utilizing the Medtronic Endurant platform.</p><p><strong>Methods: </strong>Retrospective analysis of consecutive patients unsuitable for other techniques or custom-made devices, in which a PMEG Endurant was used for repair between 2021 and 2024. Bidimensional templates of the Endurant endograft were developed to ensure precise fenestration placement, which was confirmed intraoperatively with a 3D-printed aortic template. Endpoints were technical success, mortality, reinterventions, and target vessel patency.</p><p><strong>Results: </strong>Thirty-seven target vessels in 18 patients (mean age 79.4 ± 9 years, 94% male) were treated with Endurant main bodies (n=10, 55.6%), abdominal tubes (n=4, 22.2%), or aortic extensions (n=4, 22.2%). Mean aneurysm diameter was 70.0 ± 23 mm. Mean number of fenestrations was 2.1 ± 1 (33.3% 3-FEN or 4-FEN). The most frequent bridging stents were iCover (n=15, 40.5%), BeGraft (n=10, 27.0%), and VBX (n=9, 24.3%). Mean implantation time was 198.9 ± 90 minutes. Technical success was achieved in all but one case (n=17, 94%), with no 30 day mortality, no reinterventions, and 100% target vessel patency at a median follow-up of 10 months. Three patients (16.7%) died of non aortic-related causes. One residual type IA endoleak was adverted in computed tomography scan controls and was left untreated according to patient's decision.</p><p><strong>Conclusion: </strong>PMEG utilizing the Medtronic Endurant endograft, supported by bidimensional templates and 3D-printed confirmation models, provided safe and effective short-term outcomes for complex, non-deferrable AAA repair. Long-term data and a prospective study on PMEG with a standardized protocol would allow for evidence to arise on this technique, facilitating adequate comparisons with custom-made and off-the-shelf devices.</p><p><strong>Clinical impact: </strong>This short series highlights the initial outcomes of physician-modified endografts (PMEG) using the Medtronic Endurant platform. Dedicated 2D templates for all Endurant sizes are provided as supplementary material, offering valuable assistance to practitioners in the vascular community. A standardized modification protocol, based on these templates along with the double-check of a sterile 3D-printed model, has allowed to achieve satisfactory short term outcomes. These outcomes are comparable to those of custom-made devices, even in scenarios requiring non-deferrable repairs and involving challenging anatomic constraints, such as type 1A endoleaks.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251318952"},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiographic Characterization of Inferior Vena Cava and Its Reaction Following Filter Placement: A Single-Center Retrospective Study.","authors":"Maofeng Gong, Rui Jiang, Shaorui Xu, Zhengli Liu, Boxiang Zhao, Xu He, Jie Kong, Jianping Gu","doi":"10.1177/15266028251319137","DOIUrl":"https://doi.org/10.1177/15266028251319137","url":null,"abstract":"<p><strong>Objective: </strong>To classify the radiographic characterization of the inferior vena cava (IVC) diameter, as well as to quantitatively describe the dimensional alternations in response to variations in filter placement, using cross-sectional computer tomographic venography (CTV) imaging.</p><p><strong>Methods: </strong>A single-center retrospective study was conducted on eligible patients who underwent CTV of IVC both before and after the placement of spindle-shaped filters, from September 2018 to June 2023. Baseline data, IVC diameter and orientation <i>pre-</i> and <i>post</i>-filter placement, IVC enlargement rate, and related complications were analyzed.</p><p><strong>Results: </strong>A total of 70 eligible patients were included, 52 (74.3%) with type 1 IVC, 11 (15.7%) with type 2, 4 (5.7%) with type 3, 3 (4.3%) with type 4, and none with type 5. An accompanying morphological alteration turned IVC into a quasi-round shape with Lin CCC of 0.870, and orientation was significantly altered after filter placement. In patients with type 1, 3, and 4 IVCs, the mean diameter of the IVC increased almost 1.5-fold in the minor axis (95% confidence intervals [CIs]=-7.77 to -5.83, <i>p</i><0.001), while only a slight expansion of the major axis to its initial size (<i>p</i>>0.05). Greater IVC enlargement rate was seen in the diameter of the minor axis than in the major axis (95% CI=40.31 to 65.12, <i>p</i><0.001). Notably, regional clots around the filter were found in 22 (31.4%) patients. Among them, 14 (20.0%) were located on the anterior or posterior walls of caval minor axis, 5 (7.1%) in the lateral walls, and 3 (4.3%) in the central part of the IVC filter. Patients exhibited a higher incidence of clots on anterior and posterior walls compared to lateral wall (20.0% vs 7.1%, <i>p</i>=0.014).</p><p><strong>Conclusion: </strong>The morphology of IVC shifted toward an approximated as circles after filter placement, with greater diameter changes seen in the minor axis compared to the major axis, where filter-related thrombosis most occurs.</p><p><strong>Clinical impact: </strong>The findings of this study offer insights into the biomechanical interaction between the inferior vena cava (IVC) and spindle-shaped filters, highlighting the anisotropic dimensional changes triggered by filter placement. The pronounced expansion along the minor axis, where filter-related thrombosis was more frequently observed, underscores a previously underrecognized risk factor for post-implantation complications. These results indicate that perioperative optimization of IVC dimensions and vigilant post-placement monitoring are crucial for improving patient outcomes.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251319137"},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Local Versus General Anesthesia in Emergency Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm.","authors":"Renxi Li, Anton Sidawy, Bao-Ngoc Nguyen","doi":"10.1177/15266028251320516","DOIUrl":"https://doi.org/10.1177/15266028251320516","url":null,"abstract":"<p><strong>Background: </strong>While general anesthesia (GA) has been the common choice of anesthesia for patients undergoing endovascular aneurysm repair (EVAR), local anesthesia (LA) has been proposed as an effective alternative for eligible patients. However, the choice of anesthesia in emergency EVAR situations remains less explored. Therefore, this study aimed to perform a retrospective analysis to compare the 30-day outcomes of patients who underwent emergency infrarenal EVAR receiving either LA or GA.</p><p><strong>Methods: </strong>Patients who underwent emergency infrarenal EVAR were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted database from 2012 to 2022. Exclusion criteria included age less than 18 years, acute intraoperative conversion to open surgery, and intraoperative anesthesia conversion. The 1:1 propensity-score matching and multivariable logistic regression were separately used to balance preoperative factors between patients who received LA and GA. Thirty-day postoperative outcomes were examined.</p><p><strong>Results: </strong>There were 258 (14.58%) and 1512 (85.42%) patients who underwent emergency EVAR under LA and GA, respectively. After multivariable analysis, patients who were under LA had lower mortality (11.24% vs 13.96%, aOR=0.61, 95% confidence interval [CI]=0.395-0.944, p=0.03), pulmonary complications (10.85% vs 17.59%, aOR=0.495, 95% CI=0.322-0.76, p<0.01), renal complications (5.04% vs 7.47%, aOR=0.545, 95% CI=0.303-0.983, p=0.04), wound complications (0.39% vs 3.64%, aOR=0.089, 95% CI=0.012-0.649, p=0.02), and 30-day readmission (6.59% vs 11.24%, aOR=0.564, 95% CI=0.334-0.953, p=0.03). Moreover, patients under LA had shorter operative time (p<0.01) and shorter length of stay (p=0.02).</p><p><strong>Conclusion: </strong>The LA is associated with better 30-day outcomes in emergency infrarenal EVAR. Therefore, in emergency EVAR, it may be advisable to consider LA over GA for eligible patients. Prospective studies in the future can be warranted to further support this anesthesia practice.</p><p><strong>Clinical impact: </strong>The choice of anesthesia in emergency endovascular aneurysm repair (EVAR) remains unexplored. This study performed a retrospective analysis to compare the 30-day outcomes of patients who underwent emergency infrarenal EVAR receiving local anesthesia (LA) or general anesthesia (GA). After propensity-score matching/multivariable analysis to balance preoperative differences, patients under LA were found to have lower 30-day mortality, pulmonary, renal, and wound complications, 30-day readmission, shorter operative time, and shorter hospital stay. In emergency EVAR, it may be advisable to consider LA over GA for eligible patients. Prospective studies in the future can be warranted to further support this anesthesia practice.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251320516"},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469841","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fenestrated/Branched Physician-Modified Endovascular Grafts for Aortic Pathologies Involving the Aberrant Subclavian Artery.","authors":"Lu Yu, Xiaolang Jiang, Guanyu Qiao, Min Zhou, Weiguo Fu, Zhihui Dong","doi":"10.1177/15266028251320513","DOIUrl":"https://doi.org/10.1177/15266028251320513","url":null,"abstract":"<p><strong>Purpose: </strong>The case series aim to explore the feasibility and effectiveness of using fenestrated/branched physician-modified endovascular grafts (PMEGs) to treat aortic pathologies involving the aberrant subclavian artery (ASA).</p><p><strong>Technique: </strong>We presented 3 cases with multiple anomalies and complications related to the ASA. Two patients had aberrant right subclavian arteries (ARSA) and developed aortic dissection spontaneously or iatrogenically after endovascular intervention for myocardial infarction. The third patient had an aberrant left subclavian artery (ALSA) together with a Kommerell's diverticulum (KD) arising from a right-sided aortic arch and developed an aortic dissection. In all 3 cases, an Ankura thoracic endograft (Lifetech, Shenzhen, China) was back-table modified by adding an inner branch and a fenestration for bilateral subclavian arteries, respectively. All procedures were successfully conducted, and all patients underwent 6-month follow-up courses, which were uneventful.</p><p><strong>Conclusion: </strong>Our case series demonstrate a feasible and less invasive therapeutic approach, which produces promising results in treating the aortic pathologies involving the ASA. Further studies and long-term follow-up are required to refine this technical approach and to validate its durability.</p><p><strong>Clinical impact: </strong>The case series illustrate a total endovascular approach to treat aortic arch pathologies involving the ASA, which is one of the most frequent aortic arch anomalies. The use of PMEGs allows meticulous subclavian artery reconstruction without significant trauma brought by traditional open or hybrid approach. Our cases suggest that using PMEGs for total endovascular management of patients with ASA is feasible and effective, and it may help streamline the treatment of complex aortic pathologies.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251320513"},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term Clinical Outcomes and Predictors of Type-III Endoleak in a Large Cohort of Patients Treated With Anatomically Fixed Stent Grafts Over 20 Years.","authors":"Nicola Leone, Francesco Andreoli, Giovanni Francesco Baresi, Andrea Ferri, Luigi Alberto Maria Bartolotti, Giuseppe Marcello Saitta, Roberto Silingardi, Stefano Gennai","doi":"10.1177/15266028251317910","DOIUrl":"https://doi.org/10.1177/15266028251317910","url":null,"abstract":"<p><strong>Objective: </strong>To assess the incidence, outcomes, and predictors of type III endoleaks (TIIIELs) in patients treated with different generations of Endologix unibody devices for abdominal aortic aneurysm (AAA).</p><p><strong>Methods: </strong>Patients treated with unibody endografts between 1999 and 2020 in a single unit were prospectively enrolled, retrospectively analyzed, and stratified according to device generation. The primary outcome was the incidence of TIIIEL in patients treated with unibody devices. Secondary outcomes included: (1) TIIIEL incidence among the different device generations; (2) comparison of type IIIa (TIIIaELs) and type IIIb endoleaks (TIIIbELs) incidence, treatment, and complications; (3) risk factor analysis for TIIIEL; (4) overall survival and survival free from TIIIEL.</p><p><strong>Results: </strong>A total of 872 patients who underwent endovascular aortic repair (EVAR) were analyzed. The cumulative incidence of TIIIEL was 4.8% (42/872). The incidence among different generations was 2.4% (10/414), 21.7% (15/69), and 4.6% (16/341), and 2.1% (1/48) for Powerlink, AFXs, AFXd, and AFX2. Freedom from TIIIEL by device generation was significantly lower in the AFXs group (p<0.001). Type III endoleaks was higher in urgent EVAR (p=0.011), large AAA (p<0.001), angulated and calcified necks (p=0.002), and when more than one modular component or non-proprietary extension was used (p<0.001). AFXs was found as independent risk factor for TIIIEL (hazard ratio [HR]=3.1, p=0.003), while the use of a single component decreased the risk (HR=0.3, p=0.005). Finally, every 10-mm increase in AAA diameter resulted in a 2-fold increase in TIIIEL risk (HR=2.0, p<0.001).</p><p><strong>Conclusion: </strong>The first generation of AFX endograft was associated with an increase in TIIIEL risk by 3.1 times, claiming a strict and careful follow-up in patients implanted with this device.</p><p><strong>Clinical impact: </strong>The old-generation of unibody endograft AFXs was associated with an increase in TIIIEL risk by 3.1 times. Angulated and calcified neck, large aneurysms and the use of nonproprietary graft extension were found as independent risk factors for TIIIEL. Patients implanted with these devices and with these anatomical features should be intensively monitored during follow-up.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251317910"},"PeriodicalIF":1.7,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}