Journal of Endovascular Therapy最新文献

{"title":"Association Between Wound Healing and the Japanese Below-the-Knee Chronic Total Occlusion Score in Patients With Chronic Limb-Threatening Ischemia After Endovascular Therapy.","authors":"Tomoya Fukagawa, Shinsuke Mori, Masahiro Yamawaki, Norihiro Kobayashi, Yoshiaki Ito","doi":"10.1177/15266028241296044","DOIUrl":"https://doi.org/10.1177/15266028241296044","url":null,"abstract":"<p><strong>Introduction: </strong>In the current study, we hypothesized that the Japanese below-the-knee chronic total occlusion score could be used to stratify the lesion difficulty of endovascular therapy for below-the-knee chronic total occlusion through angiographic evaluation. We thus aimed to evaluate the prognostic impact of the Japanese below-the-knee chronic total occlusion score in patients with chronic limb-threatening ischemia after successful endovascular therapy for below-the-knee chronic total occlusion.</p><p><strong>Methods: </strong>This was a retrospective, single-center observational study. We enrolled 139 consecutive patients with chronic limb-threatening ischemia (149 limbs), who underwent successful endovascular therapy for chronic total occlusion between February 2008 and December 2017. The Japanese below-the-knee chronic total occlusion score was assessed based on the definition of the target arterial path. The evaluation items were the rate of amputation-free survival and wound healing at 1 year, and the association between wound healing at 1 year and the Japanese below-the-knee chronic total occlusion score.</p><p><strong>Results: </strong>The rates of amputation-free survival and wound healing at 1 year were 88.0 and 56.4%, respectively. Multivariate Cox proportional hazard analysis identified direct flow to the wound (hazard ratio: 2.34, 95% confidence interval: 1.28-4.66; p<0.01); Wound, Ischemia, and foot Infection stages 1-3 (hazard ratio: 2.81, 95% confidence interval: 1.63-5.18; p<0.01); and a Japanese below-the-knee chronic total occlusion score ≤1 (hazard ratio: 1.70, 95% confidence interval: 1.02-2.98; p=0.04) to be predictors of wound healing.</p><p><strong>Conclusions: </strong>A Japanese below-the-knee chronic total occlusion score ≤1, direct flow to the wound, and Wound, Ischemia, and foot Infection stages 1-3 were found to be associated with wound healing after successful endovascular therapy for below-the-knee chronic total occlusion in patients with chronic limb-threatening ischemia.</p><p><strong>Clinical impact: </strong>This study was conducted to evaluate the prognostic impact of the Japanese below-the-knee chronic total occlusion (J-BTK CTO) score in patients with chronic limb-threatening ischemia (CLTI) after successful endovascular treatment (EVT). The results showed that the J-BTK CTO score not only evaluates the difficulty of EVT but also can predict limb prognosis. Using the J-BTK CTO score, it seems possible to predict the limb prognosis and make it useful in clinical practice.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631822","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":"Evaluation of the Validity of Anatomical Merkmal Method for Anterolateral Popliteal Puncture Technique.","authors":"Daisuke Yamazaki, Fumiaki Sasaki, Takahide Fujihashi, Hirokazu Amamizu, Toru Takahashi","doi":"10.1177/15266028241295917","DOIUrl":"https://doi.org/10.1177/15266028241295917","url":null,"abstract":"<p><strong>Clinical impact: </strong>This anatomical Merkmal method may facilitate anterolateral popliteal puncture.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631818","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":"Factors Associated With Adverse Outcomes Among Patients Undergoing Endovascular Revascularization for Iliac Artery Lesions TASC II A and B: A Single-Center Study.","authors":"Lam Van Nut, Le Duc Tin, Hoang Duc, Abdelrahman Sherif Abdalla, Patrick A Kwaah, Trang T B Le, Tran Thi Thuy Vy, Thoa Le, Pham Minh Anh, Do Kim Que, Nguyen Tien Huy","doi":"10.1177/15266028241296482","DOIUrl":"https://doi.org/10.1177/15266028241296482","url":null,"abstract":"<p><strong>Purpose: </strong>This prospective study from October 2016 to September 2020 aimed to identify the factors associated with non-revascularization and mortality rates in patients who underwent endovascular interventions for Trans-Atlantic Inter-Society Consensus (TASC) II A/B iliac artery occlusions at the Department of Vascular Surgery.</p><p><strong>Methods: </strong>Patients with TASC II A/B iliac artery occlusions who underwent endovascular intervention, including balloon angioplasty and stent placement, were included. The primary outcomes were factors associated with non-revascularization and mortality rate.</p><p><strong>Results: </strong>A total of 133 patients were enrolled in this study. Univariable analysis revealed significant associations between non-revascularization and diabetes (hazard ratio [HR]=2.61, 95% confidence interval [CI], p=0.03), chronic kidney disease (HR=16.2, 95% CI, p=0.01), and severe calcifications (HR=8.56, 95% CI, p<0.001). Subsequent multivariable analysis confirmed the significance of these factors, showing HRs of 3.04 (95% CI, p=0.02), 13.12 (95% CI, p=0.03), and 8.62 (95% CI, p<0.001), respectively. The overall mortality rate observed was 20.3%. Severe calcifications emerged as a significant risk factor for mortality in both univariable (HR=2.47, 95% CI, p=0.02) and multivariable (HR=3.01, 95% CI, p<0.001) analyses.</p><p><strong>Conclusion: </strong>Severe calcifications correlate with non-revascularization and mortality, while comorbidities like diabetes mellitus and chronic kidney disease are also associated with non-revascularization. Recognizing these identified factors holds substantial promise in enhancing patient selection and procedural approaches, potentially bolstering the success rates of endovascular interventions. However, further research aimed at comprehending the underlying mechanisms and devising strategies to mitigate these risks is imperative for continued improvement in patient outcomes.</p><p><strong>Clinical impact: </strong>The study provides valuable insights into patient selection and procedural planning for endovascular interventions in TASC II A/B iliac artery occlusions. Identifying severe calcifications, diabetes, and chronic kidney disease as key risk factors for non-revascularization and mortality equips clinicians with essential predictive tools, potentially improving outcomes by tailoring treatment approaches. The innovation lies in highlighting the impact of comorbidities and calcification severity, offering a pathway to refine patient eligibility criteria and optimize procedural decisions. This underscores the importance of further research to develop strategies that mitigate these risk factors and enhance intervention success rates.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631877","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":"External Validation of Fully-Automated Infrarenal Maximum Aortic Aneurysm Diameter Measurements in Computed Tomography Angiography Scans Using Artificial Intelligence (PRAEVAorta 2).","authors":"Johannes Hatzl, Christian Uhl, Alexandru Barb, Daniel Henning, Jonathan Fiering, Edris El-Sanosy, Philippe W M Cuypers, Dittmar Böckler","doi":"10.1177/15266028241295563","DOIUrl":"https://doi.org/10.1177/15266028241295563","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the accuracy of fully-automated maximum aortic diameter measurements in abdominal aortic aneurysm (AAA) patients using artificial intelligence software (PRAEVAorta 2, Nurea, Bordeaux, France).</p><p><strong>Materials and methods: </strong>This is a multicenter, retrospective validation study using prospectively collected data from the Zenith alpha for aneurysm Repair Registry (ZEPHYR). Automated measurements of PRAEVAorta 2 are compared with measurements of an internationally recognized core laboratory (Syntactx, New York, New York State). The reviewers at the core laboratory were measurement technologists trained to and utilizing established measurement standards, overseen by vascular surgeons and radiologists. The data set comprised 871 computed tomography angiography scans from the ZEPHYR registry with 347 patients who underwent endovascular aneurysm repair (EVAR) with the Zenith Alpha Endovascular Abdominal Graft (Cook Medical, Bloomington, Indiana) in Germany, Belgium, and The Netherlands between 2016 and 2019.</p><p><strong>Results: </strong>The analysis demonstrated excellent correlation of the measurements (r=0.97) with an intraclass correlation (ICC) of 0.972 (95% confidence interval [CI]=0.968-0.976) across all scans. For preoperative computed tomography (CT) scans, ICC was 0.953 (95% CI=0.941-0.963), and for postoperative scans, ICC was 0.979 (95% CI=0.975-0,983), respectively. In total, 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference. In total, 10% of scans demonstrated obvious segmentation errors, mainly due to failure in detecting vessel segments (renal arteries, aortic bifurcation) or due to mis-detecting the outer border of the AAA (duodenum, inferior vena cava, aortic branches) and were excluded from the analysis.</p><p><strong>Conclusion: </strong>In this study, the maximum AAA diameter could be accurately measured fully-automatically by PRAEVAorta 2 (Nurea) in most cases demonstrating that artificial intelligence (AI) software could serve as an important adjunct for research and clinical practice. However, critical review of the generated reports by an experienced observer and cautious use is warranted to identify flawed segmentations.</p><p><strong>Clinical impact: </strong>This multicenter, retrospective validation study assessed the accuracy of fully-automated maximum infrarenal aortic aneurysm diameter measurements. It was demonstrated, that 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference, positioning the software as a potential adjunct for clinical practice and research. It is also highlighted however, that critical review of the measurements is obligatory, due to a 10% segmentation error rate.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631831","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":"Multidisciplinary Approach to Direct Segmental Artery Revascularization to Prevent Spinal Cord Ischemia Associated With Endovascular Thoracoabdominal Aortic Repair.","authors":"Anand V Ganapathy, Alexander D DiBartolomeo, William J Mack, Gregory A Magee, Nadiya Atai, Joseph N Carey, Jonathan J Russin, Sukgu M Han","doi":"10.1177/15266028241294216","DOIUrl":"https://doi.org/10.1177/15266028241294216","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Despite advances in complex endovascular aortic repair techniques, spinal cord ischemia (SCI) remains a devastating complication following endovascular thoracoabdominal aortic repairs. Novel strategies to preserve key intercostal/lumbar arteries have been described. We report our early results of patients who underwent direct intercostal/lumbar artery revascularization using endovascular incorporation of fenestrations/branches or extra-anatomic approaches for fenestrated-branched endovascular aortic repairs (FBEVARs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A retrospective review of consecutive patients who underwent FBEVAR with intercostal/lumbar artery revascularization from 2018 to 2022 was performed. Patient characteristics, intraoperative details, and outcomes including SCI and branch occlusions were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 317 patients who underwent FBEVAR during the study period, 12 patients were included. Aortic pathologies consisted of degenerative aneurysms (33%), postdissection aneurysms (33%), extensive penetrating aortic ulcers with intramural hematoma (25%), and visceral patch pseudoaneurysm (8%). Full thoracoabdominal coverage was required in 8 patients and supraceliac coverage &gt;10 cm was required in 4. Nine patients received endovascular incorporation, including directional branches (5/9), unstented fenestrations (2/9), and stented fenestration (2/9). Three patients received extra-anatomic subcutaneous femoral-to-radicular artery bypass using a composite graft of polytetrafluoroethylene (PTFE) and venous conduit. Our institutional SCI prevention protocol, consisting of prophylactic cerebral spinal fluid drain (CSFD) for high-risk patients, hemodynamic augmentation, and oxygen supplementation, was followed. Prophylactic CSFD was placed in 9 patients. One patient had unsuccessful drain placement attempts. The other 2 patients had previous unsuccessful attempts at CSFD placement. Median number of target vessels for FBEVAR was 4 with fluoroscopy time 66±31 minutes, contrast usage 109±51 ml. There were no in-hospital mortalities. Tarlov grade II SCI (ASIA grade D) were seen in 2 patients (1 endovascular and 1 extra-anatomic bypass), which resolved before discharge. At mean follow-up of 472±447 days, 3 patients had thrombosed intercostal/lumbar branches (1 extra-anatomic bypass and 2 endovascular branches) with no new SCI symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients at high risk for SCI undergoing FBEVAR, direct revascularization of an intercostal or lumbar artery is feasible using endovascular or extra-anatomic bypass approach. Further studies are planned to identify key contributing segmental arteries and optimization of revascularization strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical impact: &lt;/strong&gt;This study demonstrates the feasibility of Endovascular and extra-anatomic bypass to preserve segmental artery flow, aimed at reducing the risk of spinal cord ischemia during e","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631893","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":"Dynamic Morphology of Dilated Ascending Aorta and its Implications for Proximal Landing During Thoracic Endovascular Aortic Repair.","authors":"Denis Skrypnik, Moritz S Bischoff, Katrin Meisenbacher, Matthias Hagedorn, Samuel Kilian, Fabian Rengier, Florian Andre, Dittmar Böckler, Henning Steen","doi":"10.1177/15266028241292462","DOIUrl":"https://doi.org/10.1177/15266028241292462","url":null,"abstract":"<p><strong>Introduction: </strong>To improve the outcomes of thoracic endovascular aortic repair (TEVAR), we investigated the dynamic morphology of dilated and nondilated ascending aortas (AAs) to determine whether an appropriate proximal landing zone for TEVAR exists if the middle AA is dilated.</p><p><strong>Materials and methods: </strong>Patients with dilated (diameter 40-50 mm) and nondilated (<40 mm) AAs underwent electrocardiogram-gated computed tomography angiography of the entire AA in the systolic and diastolic phases. For each plane of each AA segment, the maximal and minimal diameters in systole and diastole were recorded.</p><p><strong>Results: </strong>A total of 105 patients were enrolled (54% male; median age: 80 years [IQR 78-85]). A total of 35 patients were included in the dilated AA group (DG), and 70 patients were included in the nondilated AA group (n-DG). The aortic planes of the AA segment at the sinotubular junction (STJ) showed a more oval-shaped morphology compared with the distal planes of the same segment (the differences between the maximum and minimum diameters were 8.9% to 9.4% and 4.8% to 5.6%, respectively). If the mid-ascending aorta was dilated, the aortic segment at the STJ showed a more pronounced reversed-funnel 3D morphology, with a 14% (IQR 11%-19%) difference in diameters between the proximal and distal segmental planes shown in the n-DG and 18% (IQR 16%-22%, p<0.001) in the DG.</p><p><strong>Conclusion: </strong>If the middle AA is dilated, it is considered unsuitable to perform TEVAR using conventional endografts without additional proximal fixation in the aortic segment at the STJ due to its pronounced reversed-funnel segmental morphology. By contrast, the aortic segment at the brachiocephalic trunk seems to be promising for performing TEVAR using an endograft of the appropriate size and conformability. Moreover, endograft sizing using the average aortic diameter instead of the maximal AA diameter in an oval-shaped aortic plane morphology should be considered.</p><p><strong>Clinical impact: </strong>If the middle ascending aorta is dilated, it is considered unsuitable to perform TEVAR with a proximal landing in the aortic segment at the sinotubular junction due to its pronounced reversed-funnel segmental morphology and high risk of type Ia endoleak and endograft migration. By contrast, the aortic segment at the brachiocephalic trunk seems to be promising for performing TEVAR due to its moderate funnel morphology using an endograft of appropriate size and conformability.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631827","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":"TIPS, a Trick for Transcaval TEVAR Access.","authors":"Toon Kuypers, Sabrina Houthoofd, Geert Maleux","doi":"10.1177/15266028241293016","DOIUrl":"https://doi.org/10.1177/15266028241293016","url":null,"abstract":"<p><strong>Purpose: </strong>We described an alternative access for thoracic endovascular aortic repair (TEVAR) deployment using a transjugular intrahepatic portosystemic shunt (TIPS) needle for gaining transcaval access to the abdominal aorta.</p><p><strong>Case report: </strong>A 63-year-old man presented with a penetrating atherosclerotic ulcer in the descending aorta. Traditional transfemoral and transaxillary access were not possible. A transcaval access was established using a TIPS needle to puncture from the caval vein to the aorta. Next, the access was gradually upsized until a 22 french large-bore transcaval access was achieved. Afterwards the thoracic endograft was positioned and deployed accustomed. The infrarenal aortocaval fistula was closed with a covered stent.</p><p><strong>Conclusion: </strong>When classic TEVAR access is not possible, transcaval access is a valuable and minimally invasive alternative access. We prefer the use of a TIPS needle for gaining access and use a covered stent for closing the aortic access site when possible instead of using electrified wires nor a transseptal occluder device. Preoperative planning remains key.</p><p><strong>Clinical impact: </strong>We discribe a transcaval access with a TIPS needle and closing of the aortocaval fistula with a covered stent. We are one of fiew reports of transcaval puncturing instead of using an electrified wire and the first using a TIPS needle for gaining transcaval access. We hope this case and our comments help other surgeons, radiologists and patients when they are in need of a transcaval access and contribute to a successful procedure.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631901","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}