Journal of Endovascular Therapy最新文献

{"title":"Prospective Cohort Study of a Treatment Strategy for a Combination of the Left Common Iliac Vein Compression Stenosis and Pelvic Venous Insufficiency.","authors":"Sergey G Gavrilov, Igor S Lebedev, Alexey V Vasilyev, Dmitry A Churikov, Nadezhda Yu Mishakina, Alexander V Alenichev","doi":"10.1177/15266028241271736","DOIUrl":"10.1177/15266028241271736","url":null,"abstract":"<p><strong>Purpose: </strong>To develop a strategy for the iliac vein stenting in patients with a combination of the left common iliac vein (LCIV) compression stenosis and pelvic venous insufficiency (PVI).</p><p><strong>Methods: </strong>This prospective comparative cohort study included 55 patients with hemodynamically significant LCIV stenosis out of 285 females with PVI screened in 2014-2022. All 55 patients underwent duplex ultrasound, multi-detector computed venography, ovarian venography, and multiplanar pelvic venography. Patients underwent LCIV stenting or the left gonadal vein (LGV) embolization as the primary intervention. The endpoints (chronic pelvic pain [CPP] relief, patency of stents, and reduction in pelvic venous reflux [PVR]) were evaluated 1 and 10 days, as well as 1, 6, and 12 months after the procedure. All patients received antithrombotic therapy after the interventions.</p><p><strong>Results: </strong>The primary LCIV stenting was performed in 49 patients and resulted in the CPP relief in 69.4%, pain reduction from 7.9±1.3 to 1.7±1.1 visual analog scale (VAS) scores (p=0.005), and substantial reduction of PVR in LGV (from 4.3±0.6 seconds to 1.9±0.3 seconds, p=0.003). The LGV embolization as the second stage of treatment was performed in 30.6% of patients with the LGV reflux greater than 5 seconds as a possible cause for the CPP persistence. The primary LGV embolization failed in 100% of patients (no changes in CPP and PVR). The LCIV stenting at the second stage resulted in the CPP relief within 10 days and the pelvic venous reflux (PVR) reduction. There were no complications of stenting, and the patency of stents in the follow-up period was 100%. Postembolization syndrome occurred in 9.5% of patients. No thromboses of the veins of the pelvis and lower extremities were identified.</p><p><strong>Conclusion: </strong>Treatment of patients with a combination of LCIV compression and PVI involves staged endovascular interventions: the LCIV stenting should be considered the first-line treatment, while the LGV embolization is performed when the PVI symptoms persist for more than 6 months and is not acceptable as the first-line treatment.Clinical ImpactThe developed strategy of endovascular treatment for the combination of left common iliac vein (LCIV) and pelvic venous insufficiency (PVI) provides an effective elimination of chronic pelvic pain (CPP) and reflux in the pelvic veins and avoids unnecessary embolizations of the gonadal veins, thereby eliminating possible risks related to complications of embolization. The use of antithrombotic therapy is an effective and safe approach for preventing venous thromboembolic events after endovascular interventions.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"363-373"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001194","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":"Solving Intraoperative Complications During Endovascular Repair of Late Contained Ruptured Aortic Pseudoaneurysm After Surgical De-coarctation: Case Report and Systematic Review of Literature.","authors":"Paolo Righini, Daniela Mazzaccaro, Marina Galligani, Matteo Giannetta, Francesco Secchi, Mario Carminati, Giovanni Nano","doi":"10.1177/15266028231177047","DOIUrl":"10.1177/15266028231177047","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Aim: &lt;/strong&gt;We present a case of successful endovascular repair of late ruptured aortic anastomotic pseudoaneurysm following previous left subclavian artery-descending thoracic aorta bypass and concomitant emergency thoracic endovascular aortic repair (TEVAR) of complicated endovascular aortic de-coarctation never previously described is also presented. A review of the intraoperative, 30-day, and follow-up morbidity, mortality, and complications of TEVAR as endovascular treatment of late aneurysm/pseudoaneurysms after surgical aortic de-coarctation was also performed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The systematic review was performed in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement and following PICO model. A literature search was conducted on MEDLINE, PubMed, EMBASE, Cochrane Library, Google Scholar, Science Direct, and Web of Science using the words \"tevar of late complication of aortic coarctation surgical repair\" and \"endovascular repair of anastomotic pseudoaneurysm in coarctation\" up to June 17, 2022. Data were extracted from study documents about study design, patient's demographics and comorbidities, details about primary surgical repair, type of late complication, time between open surgery and occurrence of complications, details of the secondary endovascular procedure with technical success, early, and follow-up mortality and morbidity.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 18 papers were included with 78 patients (48 men, 69.5%). The most frequent type of primary open surgical repair was patch aortoplasty (46, 58.9%). Focusing on aneurysm and pseudoaneurysm as late complications, most of the patients were asymptomatic (45, 57.7%). All patients underwent TEVAR, 14 of them (17.9%) in urgent/emergent setting. The technical success was 98.7%, with 1 intraoperative death due to rupture of the aorta. In total, 31 patients out of 78 (39.7%) showed different complications in the immediate postoperative time, with type II endoleak being the most observed (8/31, 25.8%). The mean follow-up time was about 2 years (26.5 months, range 3-92). Overall, 30-day mortality was 2.6%. Complications occurred in 30 patients (39.4%), 23 of them resolved during the follow-up period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;With the limit of low-quality data, TEVAR can be considered a safe and effective option for the treatment of late complications after open surgery for aortic coarctation, even in urgent settings.Clinical ImpactDifferent specialists have to face the technical complexities and risks related to treatment of late complications after surgical de-coartaction, which can be either surgical or endovascular, and depend on patient's ages. Although covered stents appear to have some protection from the development of stent fractures, doesn't provide complete protection from late aneurysm formation. In this setting, TEVAR may represent a valuable option, combining the advantages of ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"290-302"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9929535","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":"Comparative Long-Term Outcomes of Drug-Coated Balloons Alone Versus Combined Treatment with Rotational Atherectomy in the Treatment of Femoropopliteal Artery In-Stent Restenosis.","authors":"Vicente Molina Nácher, José C Roselló Paredes, Laura Gálvez Núñez, Eduardo Picazo Pineda, David Olmos Sánchez, Bader Al-Raies Bolaños, Francisco J Gómez Palonés, Prof Manuel Miralles Hernández","doi":"10.1177/15266028251329757","DOIUrl":"https://doi.org/10.1177/15266028251329757","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate and compare the efficacy and safety of drug-coated balloon angioplasty (DEB) versus rotational atherectomy combined with DEB (RA + DEB) in patients with in-stent restenosis (ISR) in the femoropopliteal territory.</p><p><strong>Methods: </strong>Retrospective multicenter observational study based on data from a prospective registry of patients with femoropopliteal stents treated between January 2017 and March 2022.</p><p><strong>Results: </strong>One hundred and six patients were included (53 in each group) with 3 years median follow-up. At 2 years, freedom from clinically driven target lesion revascularization (CD-TLR) was 87.1 ± 3.9% in the RA + DEB group compared to 75.5 ± 8.7% in the DEB group. At 5 years, the CD-TLR rates were 64.0 ± 9.4% in RA + DEB and 30.5 ± 10.6% in DEB (<i>P</i> = .036). Additionally, 5-year thrombosis-free survival was significantly higher in RA + DEB (74.6 ± 7.6%) compared to DEB (37.2 ± 10.5%, <i>P</i> = .026). There were no statistically significant differences in MALE between the treatment groups. In multivariable analysis, RA + DEB reduced TLR risk and improved assisted primary patency, while Tosaka 3 and lesion length predicted worse outcomes.</p><p><strong>Conclusions: </strong>RA combined with DEB offers advantages over DEB alone in femoropopliteal ISR, reducing reinterventions, enhancing assisted primary patency, and lowering thrombosis rates without increasing MALE.Clinical ImpactThis study addresses the current lack of long-term evidence on the treatment of femoropopliteal in-stent restenosis (ISR) using drug-coated balloons (DEB) alone versus DEB combined with rotational atherectomy (RA). Clinically, RA+DEB significantly reduces reinterventions and thrombosis, and improves assisted primary patency without increasing complications. For clinicians, this supports a more effective and durable option for complex ISR, particularly in occlusive or long lesions. The innovation lies in demonstrating the added value of vessel preparation with RA, offering a lesion-specific strategy in the absence of clear guideline recommendations.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251329757"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765645","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":"Sex-Related Outcomes in Asymptomatic Patients Undergoing Carotid Artery Stenting.","authors":"Claudio Desantis, Sergio Zacà, Paola Wiesel, Giovanni Mastrangelo, Raffaele Pulli, Domenico Angiletta","doi":"10.1177/15266028231172356","DOIUrl":"10.1177/15266028231172356","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Aim of the study was to evaluate the influence of sex in asymptomatic patients undergoing carotid artery stenting (CAS).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A retrospective observational study was conducted from January 2006 to December 2020. A total of 438 consecutive patients with asymptomatic carotid artery stenosis &gt;70% underwent transfemoral CAS and were stratified in males (M) and females (F). Periprocedural 30-day outcomes were: stroke, death, and myocardial infarction (MI). Follow-up outcomes were: death and stroke rates (primary) and freedom from restenosis (FFR) and reintervention rates (secondary). Follow-up data were analyzed at 1, 5, and 10 years. Data were analyzed with χ&lt;sup&gt;2&lt;/sup&gt; test and Fisher's exact test and follow-up outcomes with Kaplan-Meier curves. The log-rank test was used to determine differences between the groups and univariate analysis to identify the association between risk factors and intraoperative details with mortality and restenosis rates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 462 procedures were performed (M: n=321, 69.4%), in which 24 CAS were bilateral (5.5%). Mean age was 71.9±7.6 years (M: 72.1±7.8; F: 71.7±7.3). Periprocedural outcomes were: stroke rate 2.2% (n=10; M: n=5, 1.6%; F: n=5, 3.5%; p=0.176), mortality rate 0.6% (M: n=3, p=0.334), and stroke/death rate 2.8% (n=13; M: n=8, 2.5%; F: n=5, 3.5%; p=0.528); no cardiac events (MI) were recorded. A not-disabling (minor) stroke was detected in 3 males (0.9%), while a disabling (major) stroke was reported in 7 patients (1.7%) of whom 5 were ischemic events (M: n=2, 0.6%; F: n=3, 2.2%) and 2 were cerebral hemorrhages (F: 1.3%, p=0.046). Mean follow-up was 73.66±40.83 months (M: 72.66; F: 76.01; p=0.246). Overall survival rate was 96.1% (95% confidence interval [CI]: 93-98), 81.8% (95% CI: 77-86), and 45.5% (95% CI: 38-53) at 1, 5, and 10 years, respectively (p=0.236). The overall stroke rate was 0.3% (freedom from stroke [FFS]: 99.7%; 95% CI: 98-100), 0.9% (FFS: 99%; 95% CI: 98-100), and 4.3% (FFS: 95.7%; 95% CI: 89-98; M: n=6; F: n=2; p=0.774). Stroke-related mortality rate was 0.7% (FFS: 99.3%; 95% CI: 97-100) and 2.9% (FFS: 97.1%; 95% CI: 91-99) at 5 and 10 years, respectively, without differences between the groups (M: n=4; F: n=2; p=0.763). Overall FFR rate was 97.4% (95% CI: 95-99), 93.4% (95% CI: 90-96), and 89.5% (95% CI: 84-93; p=0.322). Two severe symptomatic restenosis (&gt;70%, M) required a new endovascular revascularization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The sex variable does not influence outcomes of CAS in asymptomatic patients at short- and long-term follow-up, although females show a worst incidence of periprocedural major strokes. Carotid artery stenting may be safely proposed when a careful patient selection is applied.Clinical ImpactThe sex variable has been advocated as a considerable factor that could influence the outcomes of transfemoral carotid artery stenting (CAS). Literature data","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"404-413"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9471467","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":"Systematic Review With Meta-Analysis of Endovascular Versus Open Repair of Abdominal Aortic Aneurysm Repair in the Young.","authors":"Nikolaos Kontopodis, Aikaterini Gavalaki, Nikolaos Galanakis, Michalis Kantzas, Christos Ioannou, George Geroulakos, John Kakisis, George A Antoniou","doi":"10.1177/15266028231179419","DOIUrl":"10.1177/15266028231179419","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate which treatment method for abdominal aortic aneurysm (AAA), endovascular or open repair, has better outcomes in young patients.</p><p><strong>Materials and methods: </strong>A systematic review was conducted to identify observational studies or randomized controlled trials (RCTs) that compared endovascular and open repair of intact AAA in young patients. MEDLINE, EMBASE, and CENTRAL were searched up to March 2022 using the Ovid interface. The risk of bias was assessed with the Newcastle-Ottawa scale (NOS), with a maximum score of 9, or version 2 of the Cochrane risk of bias tool. The certainty of evidence was assessed with the GRADE framework. Primary outcomes were perioperative, overall, and aneurysm-related mortality. Secondary outcomes were reintervention, hospital length of stay, and perioperative complications. Effect measures in syntheses were the odds ratio (OR), risk difference (RD), mean difference (MD), or hazard ratio (HR) and were calculated with the Mantel-Haenszel or inverse variance statistical method and random-effects models.</p><p><strong>Results: </strong>Fifteen observational studies and 1 RCT were included, reporting a total of 48 976 young patients. Definitions of young ranged from 60 to 70 years. The median score on the NOS was 8 (range: 4-9), and the RCT was judged to be high risk of bias. The perioperative mortality was lower after EVAR (RD: -0.01, 95% CI: -0.02 to -0.00), but the overall and aneurysm-related mortality was not significantly different between EVAR and open repair (HR: 1.38, 95% CI: 0.81 to 2.33; HR: 4.68, 95% CI: 0.71 to 31.04, respectively), as was the hazard of reintervention (HR: 1.50, 95% CI: 0.88 to 2.56). The hospital length of stay was shorter after EVAR (MD: -4.44 days, 95% CI: -4.79 to -4.09), and the odds of cardiac (OR: 0.22, 95% CI: 0.13 to 0.35), respiratory (OR: 0.17, 95% CI: 0.11 to 0.26), and bleeding complications were lower after EVAR (OR: 0.26, 95% CI: 0.11 to 0.64). The level of evidence was low or very low.</p><p><strong>Conclusion: </strong>Patient preferences and perspectives should be considered during shared decision-making process considering the available evidence. EVAR may be considered in young and fit patients with a suitable anatomy.</p><p><strong>Protocol registration: </strong>PROSPERO, CRD42022325051Clinical ImpactUncertainty surrounds the optimal treatment strategy for abdominal aortic aneurysm in young patients. Meta-analysis of some 48,976 young patients showed that endovascular aneurysm repair (EVAR) has a lower perioperative mortality and morbidity and a shorter hospital and intensive care unit stay than open surgical repair, but the overall and aneurysm-related mortality in the short to medium term are not significantly different between EVAR and open repair. EVAR can be considered in young patients.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"276-289"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9680403","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":"A Case of Complete Resolution of Cauda Equina Syndrome Caused by Extensive Iliocaval Thrombosis: The Role of Thrombolysis and Venous Stents.","authors":"Jay M Bakas, Diederik C Bijdevaate, Mandy N Lauw, Marie-Lise C van Veelen-Vincent, Marie Josee E van Rijn","doi":"10.1177/15266028231179596","DOIUrl":"10.1177/15266028231179596","url":null,"abstract":"<p><strong>Purpose: </strong>The cauda equina syndrome (CES) is a rare condition affecting less than 1 in 100,000 patients annually. Diagnosing CES is challenging because of its rare incidence, potentially subtle presentation, and various underlying etiologies. Vascular causes, such as inferior vena cava (IVC) thrombosis, are uncommon but should be considered, since timely recognition and treatment of deep vein thrombosis (DVT) as a cause of CES can avoid irreversible neurological damage.</p><p><strong>Case report: </strong>A 30-year-old male presented with partial CES caused by nerve root compression due to venous congestion from an extensive iliocaval DVT. He completely recovered after thrombolysis and stenting of the IVC. His iliocaval tract remained patent until the last date of follow-up at 1 year without signs of post-thrombotic syndrome. Broad molecular, infectious, and hematological laboratory tests did not reveal any underlying disease for the thrombotic event, particularly no hereditary or acquired thrombophilia.</p><p><strong>Conclusion: </strong>Timely recognition of venous thrombosis as a cause of CES is essential. This is the first case report of CES caused by an extensive iliocaval DVT successfully treated with thrombolysis and venous stenting with good resolution of DVT and CES.Clinical ImpactThis case-report describes a patient with cauda equina syndrome resulting from an extensive iliocaval deep vein thrombosis due to an underlying stenosis of the inferior vena cava. Thrombolysis and venous stenting succesfully restored venous patency and thereby relieved symptoms and signs of cauda equina syndrome, in addition to (long-term) therapeutic dose anticoagulation. It is important to timely recognize deep vein thrombosis as a cause of cauda equina syndrome and to consider endovenous treatment in a specialized center.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"524-528"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11898366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9590459","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}

{"title":"Mid-Term Outcomes of \"Complete Aortic Repair\": Surgical or Endovascular Total Arch Replacement With Thoracoabdominal Fenestrated-Branched Endovascular Aortic Repair.","authors":"Jesse Chait, Emanuel R Tenorio, Hidetake Kawajiri, Guilherme B B Lima, Nolan C Cirillo-Penn, Gabor Bagameri, Alberto Pochettino, Randall R DeMartino, Gustavo S Oderich, Bernardo C Mendes","doi":"10.1177/15266028231181211","DOIUrl":"10.1177/15266028231181211","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To describe a single-center experience of \"complete aortic repair\" consisting of surgical or endovascular total arch replacement/repair (TAR) followed by thoracoabdominal fenestrated-branched endovascular aortic repair (FB-EVAR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We reviewed 480 consecutive patients who underwent FB-EVAR with physician-modified endografts (PMEGs) or manufactured stent-grafts between 2013 and 2022. From those, we selected only patients treated with open or endovascular arch repair and distal FB-EVAR for aneurysms involving the ascending, arch and thoracoabdominal aortic segments (zones 0-9). Manufactured devices were used under an investigational device exemption protocol. Endpoints included early/in-hospital mortality, mid-term survival, freedom from secondary intervention, and target artery instability.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There were 22 patients, 14 men and 8 women with a median age of 72±7 years. Thirteen postdissection and 9 degenerative aortic aneurysms were repaired with a mean maximum diameter of 67±11 mm. Time from index aortic procedure to aneurysm exclusion was 169 and 270 days in those undergoing 2- and 3-stage repair strategies, respectively. The ascending aorta and aortic arch were treated with 19 surgical and 3 endovascular TAR procedures. Three (16%) surgical arch procedures were performed elsewhere, and perioperative details were unavailable. Mean bypass, cross-clamp, and circulatory arrest times were 295±57, 216±63, and 46±11 minutes, respectively. There were 4 major adverse events (MAEs) in 2 patients: both required postoperative hemodialysis, 1 had postbypass cardiogenic shock necessitating extracorporeal membrane oxygenation, and the other required evacuation of an acute-on-chronic subdural hematoma. Thoracoabdominal aortic aneurysm repair was performed with 17 manufactured endografts and 5 PMEGs. There was no early mortality. Six (27%) patients experienced MAEs. There were 4 (18%) cases of spinal cord injury with 3 (75%) experiencing complete symptom resolution before discharge. Mean follow-up was 30±17 months in which there were 5 patient deaths-0 aortic related. Eight patients required ≥1 secondary intervention, and 6 target arteries demonstrated instability (3 IC, 1 IIIC endoleaks; 2 TA stenoses). Kaplan-Meier 3-year estimates of patient survival, freedom from secondary intervention, and target artery instability were 78±8%, 56±11%, and 68±11%, respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Complete aortic repair with staged surgical or endovascular TAR and distal FB-EVAR is safe and effective with satisfactory morbidity, mid-term survival, and target artery outcomes.Clinical ImpactThe presented study demonstrates that repair of the entirety of the aorta - via total endovascular or hybrid means- is safe and effective with low rates of spinal cord ischemia. Cardiovascular specialists within comprehensive aortic teams at should feel confident that staged repair of th","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"503-512"},"PeriodicalIF":1.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9624648","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":"From Crisis to Cure: Endovascular Management of Rasmussen Pseudoaneurysm Presenting as Life-Threatening Hemoptysis.","authors":"Puneet Garg, Resham Singh, Aarushi Narwani","doi":"10.1177/15266028251331340","DOIUrl":"https://doi.org/10.1177/15266028251331340","url":null,"abstract":"<p><strong>Background: </strong>Rasmussen's pseudoaneurysm is a rare and potentially lethal pulmonary vascular complication of tuberculosis. It should be considered in the differential diagnosis of massive hemoptysis in patients known or suspected to have pulmonary tuberculosis. CT angiography is the first investigation to confirm the diagnosis and localize the bleeding source. Endovascular interventions remain the mainstay of treatment in Rasmussen's pseudoaneurysm, with common embolic agents such as glue, coils, and plugs.</p><p><strong>Case presentation: </strong>A 50-year-old female was diagnosed with pulmonary Koch's 6 years ago. She took antitubercular therapy for 6 months and was asymptomatic for the last 5 and ½ years. She presented with 2 episodes of massive hemoptysis for the previous 2 days. CT angiography in emergency showed cavitary changes in the left upper lobe with focal contrast-filled outpouching measuring 2 cm × 2 cm from the superior segmental branch of the left descending pulmonary artery. The patient was immediately posted for embolization of the pseudoaneurysm. She had another episode of massive hemoptysis on the cath lab table and went into class II hypovolemic shock. Immediate fluid resuscitation was done. Successful embolization of the pseudoaneurysm sac with glue with proximal coil embolization of the pulmonary artery branch was done.Clinical ImpactThis case highlights the efficacy of combined glue and coil embolisation for managing Rasmussen pseudoaneurysm-induced massive hemoptysis, offering a life-saving, minimally invasive alternative to surgery. It emphasises the importance of early diagnosis using cross-sectional imaging and prompt intervention by interventional radiologists. The technique's dual approach ensures secure embolisation and reduced recurrence risk. Clinicians should consider this approach in similar cases to minimise mortality and morbidity. This case report further underscores the role of multidisciplinary collaboration in achieving optimal patient outcomes in life-threatening hemoptysis.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251331340"},"PeriodicalIF":1.7,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755126","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":"Single-Disk's Plug-Based Embolization of Directional Branches During Urgent Complex Endovascular Aortic Aneurysm Repair.","authors":"Paolo Bonanno, Simone Cuozzo, Federica Donato, Francesco Grasselli, Maria Concetta Gugliotta, Giulia Proietti Silvestri, Raimondo Micheli, Paolo Ottavi","doi":"10.1177/15266028251322704","DOIUrl":"https://doi.org/10.1177/15266028251322704","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The introduction of off-the-shelf (OTS) multibranch stent-grafts represented an advancement in the endovascular treatment of thoraco-abdominal aortic aneurysms (TAAAs), particularly in urgent settings. In certain cases (e.g, target vessel [TV] occlusion), unused directional branches (DBs) require proper occlusion with a vascular plug to prevent type III endoleaks. However, no standardized technique for DB closure has been established. We aim to evaluate the safety, feasibility, time-effectiveness and cost-effectiveness of using single-disk vascular plug (Amplatzer Vascular Plug [AVP]) for DB closure during urgent branched endovascular aneurysm repair (B-EVAR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Retrospective analysis of 16 patients (16/101, 15.8%) undergoing urgent B-EVAR with OTS devices requiring intentional occlusion of at least 1 DB using vascular plug due to unavailable TVs or anatomical constraints. Amplatzer Vascular Plugs were deployed in 2 different techniques: with or without DB elongation with balloon-expandable stent-grafts. Technical success, clinical outcomes, side branches plugging time, and plug-constrained length after its deployment were assessed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Balloon-expandable stent-graft plus AVP were used to occlude 7 unused DBs (36.8%), whereas AVP without elongation was used in 8 (42.1%), with a median oversizing rate of 58.7%. The technical success rate was 100%, with no instances of plug migration or endoleak during a median follow-up of 20.9±14.4 months. Perioperative mortality rate was 25%, exclusively in patients with ruptured aneurysms. Clinical success was maintained in all patients, with no late reinterventions or DBs recanalization. Side-branch plugging time was significantly shorter when performed without elongation (3.9±0.6 vs. 6.4±1.3 minutes; &lt;i&gt;p&lt;/i&gt;=.0003). Despite greater oversizing, even without elongation, the mean plug-constrained length (15.1±4.5 mm) did not exceed the shortest DB, effectively reducing the risk of complications associated with increased plug-constrained length while ensuring proper and secure deployment.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Single-disk vascular plugs without DB elongation provide a safe, feasible, time-effective and cost-effective solution for DB closure during B-EVAR, with favorable outcomes and reduced procedural complexity, even in urgent setting. Multicenter studies are needed to validate these findings and establish standardized DB management techniques for challenging anatomical and urgent cases.Clinical ImpactOur study demonstrated the feasibility, safety, and time- and cost-effectiveness of single-disc vascular plug (AVP) embolization for directional branches during urgent or emergent branched endovascular aortic aneurysm repair using off-the-shelf devices, even without elongation using balloon-expandable stent-grafts. This technique simplifies the procedure, reducing complexity and potential complications. It is par","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251322704"},"PeriodicalIF":1.7,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732702","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":"Beyond the Blockage: A Comprehensive Analysis of Reperfusion Injury Across Different Organs Post Endovascular Stenting-A Case Series.","authors":"Yashaswi Singh, Anjali Sah, Rajendra Kumar Behera, Shivanand Gamanagatti, Manoj Kumar Nayak, Nihar Ranjan Dash, R K Yadav","doi":"10.1177/15266028251325988","DOIUrl":"https://doi.org/10.1177/15266028251325988","url":null,"abstract":"<p><p>Endovascular stenting has emerged as the gold standard for treating various occlusive vascular disorders. However, it has its own challenges. Reperfusion injury, a paradoxical tissue damage that occurs after the restoration of blood flow, is one such challenge seen with endovascular interventions. This case series presents three instances of reperfusion injury involving the carotid, superior mesenteric, and renal arteries following stenting procedures. Timely management with targeted interventions, including coil embolization and hemodynamic stabilization, was crucial in mitigating adverse outcomes. By examining these cases, this series highlights the importance of increased awareness, early recognition, and targeted interventions in order to optimize patient outcomes.Clinical ImpactReperfusion injury after endovascular stenting is a serious but often overlooked complication that can lead to life-threatening consequences. This case series highlights the need for early recognition, careful blood pressure control, and prompt intervention to prevent complications. By examining cases involving the carotid, renal, and superior mesenteric arteries, we emphasize the importance of close post-procedure monitoring and tailored treatment strategies. Raising awareness about this issue and developing better management guidelines can improve patient outcomes and make vascular interventions safer. Our findings reinforce the need for vigilance and proactive care in endovascular treatments.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251325988"},"PeriodicalIF":1.7,"publicationDate":"2025-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732607","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}