Journal of Endovascular Therapy最新文献

{"title":"Detecting Mitochondrial Oxygen Tension as a Measure of Local Tissue Oxygenation in Patients With Peripheral Arterial Disease Before and After Endovascular Therapy.","authors":"Abdallah H A Zaid Al-Kaylani, Richte C L Schuurmann, Riemer H J A Slart, Reinoud P H Bokkers, Jean-Paul P M de Vries","doi":"10.1177/15266028251344791","DOIUrl":"https://doi.org/10.1177/15266028251344791","url":null,"abstract":"<p><strong>Introduction: </strong>Assessment of mitochondrial oxygen tension (mitoPO₂) is a novel technique for measuring skin perfusion. It is based on the oxygen-dependent quenching of delayed fluorescence of 5-aminolevulinic acid (5-ALA), known as the protoporphyrin IX-triple state lifetime technique. This study aimed to determine the tolerability and feasibility of measuring mitoPO₂ in the lower limbs of patients with peripheral arterial disease (PAD) undergoing endovascular therapy. In addition, the study investigated the changes in mitoPO₂ pre- and postoperatively.</p><p><strong>Materials and methods: </strong>This prospective single-center study included patients with Rutherford stage 4 to 6 scheduled for endovascular therapy. Plasters containing 5-ALA were placed over the tibia and at the lower lateral leg 12 hours before the operation. 5-ALA tolerability was assessed by noting the occurrence of related side effects during application, measurements, and in the 48 hours after removal of the plaster. MitoPO₂ was measured immediately before and after the operation over the tibia at the anterior tibialis muscle and the lateral side of the lower leg, and was followed by transcutaneous oxygen pressure and ankle-brachial index measurements.</p><p><strong>Results: </strong>Ten patients were included in this study. No side effects or adverse events related to 5-ALA were observed. One patient reported weak itching within 48 hours after removing the 5-ALA plaster. MitoPO₂ measurements were feasible in all patients at the tibia and lower leg, but were not feasible on the dorsum of the foot. Postoperatively, a significant drop in mitoPO₂ was detected at the tibia. No significant difference was found in mitoPO₂ levels pre- and postoperative at the lower lateral leg. For transcutaneous oxygen pressure, no significant differences were detected postoperatively.</p><p><strong>Conclusions: </strong>5-ALA is tolerable and safe in patients with PAD. MitPO₂ measurements at the tibia and lower lateral leg are feasible and capable of detecting changes in perfusion following endovascular therapy. Further research is needed with larger cohorts and longer follow-up to investigate the relationship between mitoPO₂, oxygen supply, and tissue regeneration.Clinical ImpactThis study demonstrated the feasibility and safety of mitochondrial oxygen tension (mitoPO₂) measurement using 5-aminolevulinic acid (5-ALA) for assessing local skin perfusion in patients with peripheral arterial disease (PAD) undergoing endovascular therapy. Changes in mitoPO₂ post-intervention suggest sensitivity to real-time microvascular and physiological alterations. This technique could potenitally improve overall patient outcomes and wound healing by enhancing patient stratification, treatment planning, perioperative monitoring, and postoperative follow-up.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344791"},"PeriodicalIF":1.7,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144318548","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":"Aortic Coarctation With Type B Aortic Dissection: A Systematic Review and Report of 2 Cases.","authors":"Mauricio Gonzalez-Urquijo, Leopoldo Marine, Jose Francisco Vargas, Gabriel Seguel, Diego Soto V, Michel Bergoeing, Francisco Valdes","doi":"10.1177/15266028251344799","DOIUrl":"https://doi.org/10.1177/15266028251344799","url":null,"abstract":"<p><strong>Purpose: </strong>A systematic review of patients with aortic coarctation (CoA) and concomitant type B aortic dissection (TBAD) is presented; additionally, 2 cases of our own experience are reported.</p><p><strong>Materials and methods: </strong>Following the PRISMA guidelines, databases were search for all articles or abstracts written in English published until May 2024. Mesh terms used included \"aortic coarctation\" in combination with \"aortic dissection,\" \"type B aortic dissection,\" and \"TBAD.\"</p><p><strong>Results: </strong>A total of 121 studies were screened, 19 full-length articles, and 1 abstract were included for analysis. Adding our own 2, a total of 22 cases were analyzed. The median age was 39 years (range: 25-64 years). Eighteen (81.8%) patients were male. Fourteen (63.6%) patients underwent open surgery. One (4.5%) patient underwent hybrid repair. Five (22.7%) patients underwent endovascular repair, including these 2 cases. Two (9%) patients were managed conservatively. The complication rate was 9% (n=2). There were no reported deaths, and the median follow-up period was 11.5 months (range: 6-48 months).</p><p><strong>Conclusion: </strong>The most comprehensive data on patients with CoA and TBAD is presented. The pathophysiology of this disorder remains uncertain. Both endovascular and open surgery have proven effective in treating these conditions with low complication rates. However, long-term outcomes remain undefined.Clinical ImpactThis systematic review provides the most comprehensive analysis of patients with concomitant aortic coarctation and type B aortic dissection to date, offering valuable insights into the demographics, treatment strategies, and outcomes of this rare condition. The findings suggest that both open and endovascular repair are viable treatment options with low complication rates. The absence of mortality in the analyzed cases highlights the feasibility of surgical intervention. However, with limited long-term follow-up, the durability of these treatments remains uncertain, emphasizing the need for further research to guide optimal management and improve long-term patient outcomes.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344799"},"PeriodicalIF":1.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303466","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":"Feasibility of Ultralow-Dose CT With Deep-Learning Reconstruction for Aneurysm Diameter Measurement in Post-EVAR Follow-Up: A Prospective Comparative Study With Conventional CT.","authors":"Keigo Matsushiro, Takuya Okada, Koji Sasaki, Tomoyuki Gentsu, Eisuke Ueshima, Keitaro Sofue, Katsuhiro Yamanaka, Masatoshi Hori, Masato Yamaguchi, Koji Sugimoto, Kenji Okada, Takamichi Murakami","doi":"10.1177/15266028251339345","DOIUrl":"https://doi.org/10.1177/15266028251339345","url":null,"abstract":"<p><strong>Purpose: </strong>We conducted a prospective study to evaluate the usefulness of ultralow-dose computed tomography (ULD-CT) with deep-learning reconstruction (DLR) compared with conventional standard-dose CT (SD-CT) for post-endovascular aneurysm repair (EVAR) surveillance.</p><p><strong>Materials and methods: </strong>We prospectively performed post-EVAR surveillance using ULD-CT at a single center in 44 patients after they had received SD-CT. The ULD-CT images underwent DLR, whereas the SD-CT images underwent iterative reconstruction. Three radiologists blinded to the patient information and CT conditions independently measured the aneurysmal sac diameter and evaluated the overall image quality. Bland-Altman analysis and a linear mixed-effects model were used to assess and compare the measurement accuracy between SD-CT and ULD-CT.</p><p><strong>Results: </strong>The mean CT dose index volume and dose-length product were significantly lower for ULD-CT (1.0 ± 0.3 mGy and 71.4 ± 26.5 mGy•cm) than that for SD-CT (6.9 ± 0.9 mGy and 500.9 ± 96.0 mGy•cm; p<0.001). The mean short diameters of the aneurysmal sac measured by the 3 observers were 46.7 ± 10.8 mm on SD-CT and 46.3 ± 10.8 mm on ULD-CT. The mean difference in the short diameter of the aneurysmal sac between ULD-CT and SD-CT was -0.37 mm (95% confidence interval, -0.6 to -0.12 mm). The intraobserver limits of agreement (LOA) for measurements by ULD-CT and SD-CT were -3.5 to 2.6, -2.8 to 1.9, and -2.9 to 2.3 for Observers 1, 2, and 3, respectively. The pairwise LOAs for assessing interobserver agreement, such as for the differences between Observers 1 and 2 measurements in SD-CT, were mostly within the predetermined acceptable range. The mean image-quality score was lower for ULD-CT (3.3 ± 0.6) than that for SD-CT (4.5 ± 0.5; p<0.001).</p><p><strong>Conclusion: </strong>Aneurysmal sac diameter measurements by ULD-CT with DLR were sufficiently accurate for post-EVAR surveillance, with substantial radiation reduction versus SD-CT.Clinical ImpactDeep-learning reconstruction (DLR) is implemented as a software-based algorithm rather than requiring dedicated hardware. As such, it is expected to be integrated into standard computed tomography (CT) systems in the near future. The ultralow-dose CT (ULD-CT) with DLR evaluated in this study has the potential to become widely accessible across various institutions. This advancement could substantially reduce radiation exposure in post-endovascular aneurysm repair (EVAR) CT imaging, thereby facilitating its adoption as a standard modality for post-EVAR surveillance.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251339345"},"PeriodicalIF":1.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303467","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":"The Fate of False Lumen in Type B and Residual Type A Aortic Dissection Using the Candy-Plug Technique: A Systematic Review and Meta-Analysis.","authors":"Georgios I Karaolanis, Konstantinos Kotopoulos, Rosalinda D'Amico, Drosos Kotelis, Edin Mujagic, Vladimir Makaloski","doi":"10.1177/15266028251344808","DOIUrl":"https://doi.org/10.1177/15266028251344808","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We performed a systematic review and meta-analysis to evaluate the technical and clinical success of false lumen occlusion with the Candy-plug (CP) technique in patients with type B and residual type A aortic dissection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A systematic search of all the literature reported until November 2024 was performed according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The pooled technical and clinical success and corresponding 95% confidence intervals (CIs) were estimated using fixed or random effect methods.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 106 study titles were identified by the initial search strategy, of which 6 were considered eligible for inclusion in the meta-analysis. A total of 128 patients (83% male) were identified among the eligible studies. The pooled technical and clinical success rate among the studies were 96% (95% CI, 88-98) and 76% (95% CI, 58-88) respectively. The technical success for custom-made manufacturing device (CMD) was 98.5% (95% CI, 92-99; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0%; p=0.78, 2 studies) while for the physician modified CP technique (pmCP) technique was 92.7% (95% CI, 77-98; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0%; p=0.79, 4 studies). Overall, false lumen thrombosis rate was 71% (95% CI, 55-83): 80% (95% CI, 57-92; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0%; p=0.90, 2 studies) for CMD while for the pmCP technique was 63% (95% CI, 27-88; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0%; p=0.99, 4 studies). The pooled aortic remodeling rate was 50% (95% CI, 33-66): 63.2% (95% CI, 52.7-72.5; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=69%; p=0.68, 2 studies) for CMD, while for the pmCP technique was 35.9% (95% CI, 17-54%; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=39%; p=0.17, 4 studies). The incidence of CP related reinterventions were 7.1% [11.5% for CMD (95% CI, 0.3-8.4; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0%; p=0.09, 2 studies) and 5.1% for pmCP (95% CI, 1.3-18; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0%; p=0.96, 4 studies)] and 12.8% [4.5% for CMD (95% CI, 0.3-39; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=69%; p=0.68, 2 studies), while for the pmCP technique was 4.6% (95% CI, 0.9-19; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=0%; p=0.90, 4 studies)] in the early and late period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;CP technique appears to be a promising solution demonstrating high technical success, false lumen thrombosis, and aortic remodeling rate. However, the clinical success rate tends to be lower. Life-long and strict follow-up of these patients may be necessary to monitor CP-related complications, given the limited data on the long-term durability of these devices.Clinical ImpactThis study provides detailed information on a physician-modified candy plug technique in patients with patent False lumen in Type B or residual Type A aortic dissection. As the custom-made candy plug devices have been developed, the delivery time for them varies between countries and vascular surgery services, making the planning of the procedure difficult, especially in symptomatic patients or ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344808"},"PeriodicalIF":1.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303468","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":"The Terumo Aortic Global Endovascular Registry: A Multiarm, Multicenter, Open Label, Prospective Observational Registry to Obtain Safety and Performance Data on off-the-Shelf and Custom-Made Stent-Grafts.","authors":"Michel M P J Reijnen, Bartosz Rylski, Antoine Millon, Robert H Geelkerken, Alexander Hyhlik-Dürr, Arjan W J Hoksbergen, Pierfrancesco Veroux, Ernst Weigang, Jörg Tessarek, Vincent Riambau","doi":"10.1177/15266028251344790","DOIUrl":"https://doi.org/10.1177/15266028251344790","url":null,"abstract":"<p><strong>Background: </strong>Approval of medical devices is typically based on data from relatively small clinical studies with a highly selected patient population. Postmarket surveillance is required by regulatory bodies after approval to collect and evaluate experience gained from real world use in larger and unselected populations. Terumo Aortic is a manufacturer of off-the-shelf and custom-made stent-grafts for endovascular repair of thoracic and abdominal aortic pathologies and is assessing device performance in a large registry.</p><p><strong>Methods: </strong>A multiarm, multicenter, open label, prospective observational registry designed to obtain both short- and long-term safety and performance data on the use of standard and custom-made Terumo Aortic endovascular devices in patients with thoracic and abdominal aortic pathologies. Eligibility requirements are minimal, and a standard-of-care protocol will ensure real-world evidence is collected as far as 10 years.</p><p><strong>Discussion: </strong>Challenges to this research reflect its real-world nature such as differences in standard of care between centers and geographies, varying levels of experience and expertise with the devices or techniques, all-comer populations that may not always be comparable, and a design specifically limited to a single manufacturer. Advantages of this registry design include long-term follow-up, different modules to collect standardized outcomes across pathologies and global reach to reflect practice in many different geographies with a wide range of latest-generation endovascular devices.</p><p><strong>Conclusion: </strong>This protocol is a large endovascular registry of all aortic pathologies that are treated by both off-the-shelf and custom-made Terumo Aortic products. It is ambitious in scope and projection and will be part of an overall response involving patients, physicians, and manufacturers to answer the remaining questions of endovascular aortic repair, contribute to continuing improvement of the techniques and technologies, and present an accurate picture of outcomes with latest generation stent-graft devices.Clinical ImpactThis large, long-term registry will generate robust real-world evidence on the safety and performance of both standard and custom-made Terumo Aortic endovascular devices in treating thoracic and abdominal aortic pathologies. By including a broad, minimally selected patient population across diverse global centers, the study mirrors everyday clinical practice and helps bridge the gap between clinical trials and real-world outcomes. Its findings will inform clinical decision-making, support regulatory compliance, and guide ongoing device development. Ultimately, the registry aims to enhance patient care by improving the understanding of endovascular treatment effectiveness and long-term durability in heterogeneous populations.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344790"},"PeriodicalIF":1.7,"publicationDate":"2025-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144303469","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":"Primary Drug-Coated Balloon Versus Drug-Eluting Stent for Native Atherosclerotic Femoropopliteal Lesions: An Updated Systematic Review and Meta-Analysis.","authors":"Alessio Mario Cosacco, Gladiol Zenunaj, Pierfilippo Acciarri, Aaron Thomas Fargion","doi":"10.1177/15266028251344877","DOIUrl":"https://doi.org/10.1177/15266028251344877","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical outcomes after endovascular treatment of native femoropopliteal lesions with a drug-coated balloon (DCB) and drug-eluting stent (DES) as a primary option in patients with symptomatic peripheral artery disease.</p><p><strong>Materials and methods: </strong>A comprehensive literature search was performed through PubMed and Embase databases. Studies written in the English language and reporting a direct comparison of the outcomes between primary angioplasty with DCB and primary stenting with DES were included. The endpoints were considered the primary patency (PP), clinical-driven target lesion revascularization (cdTLR), major adverse limb events (free-MALE), and freedom from all-cause mortality.</p><p><strong>Results: </strong>Eleven studies were considered eligible for the metanalysis (3 randomized clinical trials and 8 cohort studies). Overall, 3231 femoropopliteal lesions in 3137 patients were included, with DCB and DES performed in 1951 and 1280 lesions, respectively. No differences were found in demographics, clinical limb presentation, lesions length [173.9±80.2 mm DES vs 195.1±103.3 mm DCB; odds ratio (OR) -2.44; 95% confidence interval (CI) -11.26 to 6.38; p=0.59] and total occlusions (OR 1.41; 95% CI 0.87-2.27; p=0.16). In the DCB group, there was a significant rate of adjunctive procedures such as atherectomy and bailout stenting OR 0.13 (95% CI 0.09-0.18; p<0.001). No differences among PP, cdTLR, free-MALE and freedom from all-cause mortality at 1 year for DCB and DES: OR 1.11 (95% CI 0.74-1.66, p=0.61); OR 1.01 (95% CI 0.72-1.41, p=0.97); OR 1.08 (95% CI 0.69-1.69, p=0.74) and OR 1.85 (95% CI 0.82-4.17, p=0.14) respectively. No differences were found at 2 years: OR 0.89 (95% CI 0.64-1.23, p=0.47); OR 0.79 (95% CI 0.49-1.27, p=0.32); OR 0.74 (95% CI 0.49-1.10, p=0.14); OR 1.21 (95% CI 0.75-1.96, p=0.44) respectively.</p><p><strong>Conclusions: </strong>Both approaches proved to be effective and safe for treating complex femoropopliteal lesions, with comparable clinical outcomes between the 2 groups. In the DCB arm, adjunctive procedures such as atherectomy and bailout stenting were required to optimize the results.Clinical ImpactThe introduction of drug-coated technologies, such as drug-coated balloons (DCBs) and drug-eluting stents (DESs), has significantly improved clinical outcomes for native femoropopliteal lesions. However, despite ongoing advancements in drug-coated device technology, the optimal treatment approach remains unclear due to limited comparative data in the literature. This meta-analysis aims to bridge this gap by reviewing current evidence, highlighting the latest developments, and providing valuable insights that may aid clinical decision-making in the management of native femoropopliteal lesions.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344877"},"PeriodicalIF":1.7,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144286993","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":"Corrigendum to \"A cost-consequence analysis comparing balloon-expandable covered stents for the management of aortoiliac occlusive disease\".","authors":"","doi":"10.1177/15266028251348788","DOIUrl":"https://doi.org/10.1177/15266028251348788","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251348788"},"PeriodicalIF":1.7,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144250618","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":"Endovascular Treatment of Abdominal Aortic Aneurysm Using a Branched Stent-Graft With Perfusion of the Adamkiewicz Artery.","authors":"Antoni Wołoszyn, Piotr Kasprzak, Małgorzata Toroń, Wacław Kuczmik","doi":"10.1177/15266028251344785","DOIUrl":"https://doi.org/10.1177/15266028251344785","url":null,"abstract":"<p><strong>Introduction: </strong>Exclusion of long aortic segments in the treatment of endovascular thoracoabdominal aortic aneurysms is associated with a higher risk of spinal cord ischemia. We present the successful implantation of a branch stent graft with perfusion of the great Adamkiewicz artery to diminish risk of paraplegia.</p><p><strong>Case description: </strong>An 81-year-old man was diagnosed with a perirenal aneurysm of the abdominal aorta (64 mm). Imaging examination revealed an Adamkiewicz artery with a diameter of 4.5 mm. Endovascular treatment was conducted using a customized branched stent graft with an additional branch to the Adamkiewicz artery, with access via the right femoral artery and the left axillary artery. After embolization of the inferior mesenteric artery, a stent graft was implanted, maintaining patency of the renal arteries, Adamkiewicz artery and visceral vessels.</p><p><strong>Discussion: </strong>This case demonstrates the effectiveness of personalized stent grafts adapted to the patient's anatomy. The stent graft used, with a branch to the Adamkiewicz artery, allowed the aneurysm to be excluded from the circulation while maintaining spinal cord perfusion.</p><p><strong>Conclusion: </strong>In our opinion, such a solution should be considered in cases of extensive aortic aneurysms involving the large Adamkiewicz artery treated with branched endovascular aneurysm repair.Clinical ImpactPresented case illustrates the potential of customized stent-grafts, which can be adapted to the patient's anatomy. Spinal cord ischemia remains a significant complication of endovascular repair of aortic aneurysms. A prosthesis providing adequate perfusion of the Adamkiewicz artery may prove an additional method of preventing paraplegia. There is a paucity of literature on the repair of aortic aneurysms with the implantation of branched stent grafts with a branch into the Adamkiewicz artery, which serves to highlight the innovation of our treatment. The presented case offers new insights into the prevention of paraplegia with branched endovascular aneurysm repair procedures.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344785"},"PeriodicalIF":1.7,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217428","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":"Comparing the Safety and Feasibility of Endovascular Therapy via Transradial and Transfemoral Approaches in Patients with Aortoiliac Occlusive Disease: A Propensity Score-Matched Analysis of the Nationwide Registry.","authors":"Kazunori Horie, Mitsuyoshi Takahara, Osamu Iida, Shun Kohsaka, Tatsuya Nakama, Toshiro Shinke, Norio Tada, Tetsuya Amano, Ken Kozuma","doi":"10.1177/15266028231187625","DOIUrl":"10.1177/15266028231187625","url":null,"abstract":"<p><strong>Purpose: </strong>Our objective was to evaluate the feasibility of performing endovascular therapy (EVT) for aortoiliac artery disease using transradial approach (TRA) as compared to transfemoral approach (TFA).</p><p><strong>Methods: </strong>We analyzed 9671 cases with symptomatic lower extremity artery disease due to aortoiliac occlusive disease (AIOD) treated using EVT from a Japanese Nationwide EVT Registry between January and December 2021. We compared the baseline characteristics, procedural information, and 30-day outcomes of patients who received EVT only via TRA (n=863 [16.9%]) and those only via TFA (n=4255 [83.1%]) by using propensity score (PS) matching, after excluding those who required regular dialysis, those who underwent hybrid surgeries, and those who received EVT through 2 or more approach sites.</p><p><strong>Results: </strong>After matching, the final study population consisted of 862 matched patients with similar baseline characteristics in each group. Technical success rate was comparable between the 2 groups (99.3% vs. 99.3%, p>0.99). No significant differences were observed with respect to the composite of all-cause death within 48 hours after EVT and post-procedural complications within 30 days, including severe bleeding that required transfusion, revascularization procedures, urgent surgeries, cerebral infarction, and major limb amputation (0.2% vs. 0.7%, p=0.29). Transradial approach was associated with shorter operation time (85 vs. 90 minutes, p=0.016), but longer fluoroscopy time (26 vs. 20 minutes, p<0.001) and higher contrast agent volume (80 vs. 75 mL, p<0.001).</p><p><strong>Conclusion: </strong>After PS matching, TRA showed the comparable rates of successful EVT and 30-day complications in patients with AIOD compared to TFA. Transradial approach was found to be safe and be a viable alternative of TFA for the treatment of AIOD.Clinical ImpactThe efficacy of transradial approach (TRA) is established in percutaneous coronary intervention; however, its safety and feasibility are unclear in endovascular therapy (EVT). We analyzed 9,671 cases with symptomatic aortoiliac occlusive disease treated using EVT from a Nationwide Registry to compare the 30-day outcomes of those who received EVT only via TRA (n = 863 [16.9%]and those only via TFA (n=4,255 [83.1%]) by using propensity score matching. Technical success rate (99.3% vs. 99.3%, p > 0.99) and 30-day complications (0.2% vs. 0.7%, p = 0.29) were comparable between the two groups. EVT via TRA could be performed safely.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"756-765"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9846322","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 Modification of a Custom-Made Fenestrated Endograft By Closure of a Fenestration With Bovine Patch.","authors":"D Becker, A Ali, C Prendes, K Stavroulakis, J Stana, N Tsilimparis","doi":"10.1177/15266028231187749","DOIUrl":"10.1177/15266028231187749","url":null,"abstract":"<p><strong>Purpose: </strong>Ruptured mycotic pararenal aortic aneurysms are rare and serious condition that requires prompt treatment. Open surgery with aortic resection and in-situ or extra-anatomic reconstruction is the standard treatment. The aim of this technical note is to report urgent endovascular treatment using a readily available custom-made device (created for another patient), with a back-table modification using pericardium patch and a new fenestration.</p><p><strong>Technique: </strong>In preoperative measurements on centerline-based workstation, aortic diameter in proximal and distal landing zone and target vessel position matched the measurements of graft plan of custom-made device (CMD) besides left renal artery. To address current patient`s anatomy, closure of the nonsuitable fenestration with pericardial patch and creation of new fenestration (1 cm above and 1:15 hours posterior to original fenestration) for the respective target vessel have been performed. Postoperative computed tomography angiography (CTA) scan showed complete exclusion of aneurysm, perfused target vessels, and no endoleak. Under resistance-based antibiotic therapy, the patient was asymptomatic and showed normal infection parameters in blood samples postoperatively.</p><p><strong>Conclusion: </strong>In the hands of an experienced endovascular aortic surgeon modification of a custom-made device is a quick and feasible technique in this emergency situation. Long-term follow-up must confirm the durability and reliability of this new technique.</p><p><strong>Clinical impact: </strong>The described technique of modification of a custom-made endograft can provide an alternative endovascular treatment option for urgent complex abdominal aortic pathologies. Compared to the current available treatment modalities, like physician modified endografts, off-the-shelf branched devices, parallel grafts and in-situ fenestration, it can save considerable time and provides reasonable sealing in ruptured cases. The technique offers a valuable add-on to the armamentarium of experienced endovascular physicians.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"645-652"},"PeriodicalIF":1.7,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12089663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9831443","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}