Journal of Endovascular Therapy最新文献

{"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":"<p><strong>Objective: </strong>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).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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":"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":"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}

{"title":"Risk Factors and Perioperative Outcomes of Postimplantation Syndrome After Thoracic Endovascular Aortic Repair.","authors":"Nicola Leone, Luigi Alberto Maria Bartolotti, Mattia Migliari, Andrea Ferri, Giovanni Francesco Baresi, Francesco Andreoli, Giuseppe Saitta, Stefano Gennai","doi":"10.1177/15266028251325764","DOIUrl":"https://doi.org/10.1177/15266028251325764","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Postimplantation syndrome (PIS) is a systemic inflammatory response that occurs following abdominal endovascular aortic repair (EVAR) and thoracic EVAR (TEVAR). The main outcome was to individuate the incidence and risk factors of PIS after TEVAR. Its impact on the length of stay and clinical outcomes were secondary objectives.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;Three hundred sixty-nine consecutive TEVAR procedures performed between February 2010 and November 2022 were included in this retrospective cohort, observational, single-center study. Patients with proximal landing in zones 0 to 5 were enrolled. Data on comorbidities, previous aortic surgery and morphology, thoracic aorta coverage, stent-graft composition, intraoperative variables, and postoperative outcomes were collected. White blood cell (WBC) and C-reactive protein (CRP) serum levels were recorded preoperatively and 48 hours after TEVAR. PIS was defined as the concomitant presence of fever (tympanic temperature ≥38.0°C), CRP serum level &gt;0.7 mg/dl and evidence of pleural effusion on postoperative chest radiograph.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;PIS incidence in our cohort was 26.8%. PIS patients presented with a higher rate of hyperlipidemia (56.6% vs 44.8%, p = 0.045) than non-PIS patients. Stent-graft composition did not play a relevant role in eliciting PIS. PIS was a statistically significant factor in prolonging patients' stay (median 16.0 days vs 8.0 days, p &lt; 0.001, PIS and non-PIS patients). Thoracic aortic coverage &gt;150 mm (Odds Ratio (OR) 4.7, p = 0.004), coronary artery disease (OR 2.1, p = 0.028), and preoperative WBC count (OR 1.1, p = 0.047) were identified as risk factors for PIS, whereas previous aortic surgery (OR 0.5, p = 0.05) was highlighted as a protective factor. Thoracic aortic coverage was a significant risk factor for increased WBC and CRP levels (p &lt; 0.001).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;PIS incidence was 26.8% in our cohort. Thoracic aortic coverage, coronary artery disease, and preoperative WBC count were identified as risk factors for PIS after TEVAR, whereas previous aortic surgery was found to be a protective factor. PIS also appeared to have a significant impact on length of stay.Clinical ImpactThis study identified a significant occurrence of post-implantation syndrome (PIS) following TEVAR, affecting over 25% of patients and adversely affecting the duration of hospital stay. Stent graft material did not seem to influence the incidence of PIS. Thoracic aortic coverage, coronary artery disease, and preoperative white blood cell (WBC) count have been identified as risk factors, whereas previous aortic surgery has been found to serve as a protective factor, representing a novel finding in the literature. Further research is warranted to ascertain strategies for mitigating the incidence of PIS, considering the risk factors identified in both current and prior studies. In addition, it is necessary to evaluate ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251325764"},"PeriodicalIF":1.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702092","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 Inner Branches Technique Using a Thoracic Endograft for Urgent Thoracoabdominal Aneurysm Repair.","authors":"Grace Carvajal Mulatti, Tayrine Mazotti de Moraes, Miguel Godeiro Fernandez, Lucas Ruiter Kanamori, André Brito-Queiroz, Nelson De Luccia","doi":"10.1177/15266028251325075","DOIUrl":"https://doi.org/10.1177/15266028251325075","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a standardized technique for modifying a Valiant Captivia endograft using pre-cannulated inner branches (PCIBs) for the treatment of thoracoabdominal aortic aneurysms. This approach offers a practical solution in urgent cases where custom-made devices are unavailable.</p><p><strong>Technique: </strong>A Valiant Captivia endograft is modified by creating fenestrations using an ophthalmic cautery and preparing PCIBs with 7 mm Solaris stents for the visceral arteries. The graft is carefully planned to fit the delivery sheath, ensuring that inner branches can be accommodated. The stents are secured with 4.0 Ethibond sutures and marked with radiopaque coils for enhanced visibility. Guidewires (0.035″ for the superior mesenteric artery or celiac trunk, and 0.014″ or 0.018″ for the renal arteries) are prepositioned to facilitate vessel cannulation. Key steps, such as precise device selection, first bare stent stability, and sequential Rummel tourniquets placement, are employed to optimize re-sheathing and deployment.</p><p><strong>Conclusion: </strong>The Valiant inner-branch technique is highly reproducible, and physician-modified endograft techniques with PCIBs are a valuable tool for urgent thoracoabdominal aortic aneurysm repair.Clinical ImpactThis standardized technique for modifying the Valiant Captivia endograft with precannulated inner branches provides a reproducible solution for urgent thoracoabdominal aneurysm repair, representing an effective alternative when custom-made devices are unavailable.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251325075"},"PeriodicalIF":1.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693728","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":"Branched Endovascular Repair of Aortic Recoarctation and Postcoarctation Descending Thoracic Aortic Aneurysm With the Off-the-Shelf Thoracic Branch Endoprosthesis.","authors":"Jesse Chait, Jason H Anderson, Muhammed Varol, Allison K Cabalka, Bernardo C Mendes","doi":"10.1177/15266028251328459","DOIUrl":"https://doi.org/10.1177/15266028251328459","url":null,"abstract":"<p><p>Recurrent coarctation of the aorta (reCoA) can be treated via redo surgical or endovascular means with the latter option providing a shorter hospitalization, expedient recovery, and a lower incidence of early morbidity and mortality. A common barrier to endovascular repair with standard thoracic endografts is the proximity of the left subclavian artery (LSA) to the reCoA which has previously necessitated adjunctive open revascularization or additional off-label endovascular techniques. This case describes percutaneous endovascular repair of postsurgical reCoA and a poststenotic descending thoracic aortic aneurysm with an off-the-shelf thoracic branched endograft incorporating the LSA with successful resolution of aortic pressure gradient and complete aneurysm exclusion.Clinical ImpactThis case highlights the use of a commercially available, off-the-shelf endograft to treat thoracic aortic coarctation and associated aortic aneurysm. The paper highlights unique technical points for use of the Gore Thoracic Branch Endoprosthesis in the off-label treatment of thoracic aortic coarctation which is an ideal endovascular option for lesions in proximity to the left subclavian artery.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251328459"},"PeriodicalIF":1.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693717","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":"Rescue and Redeploy: Successful Valve-in-Valve Implantation After Transcatheter Aortic Valve Embolization.","authors":"Ahmad Abdelrehim, Ameer Abdelrahman, Ahmad Almagazzachi, Harit Desai, David Drucker","doi":"10.1177/15266028251325656","DOIUrl":"https://doi.org/10.1177/15266028251325656","url":null,"abstract":"<p><strong>Background: </strong>Pacing failure is a common cause of transcatheter aortic valve replacement (TAVR) malposition and embolization. Transcatheter aortic valve embolization that compromises aortic branches usually necessitates open surgery. However, a salvage technique can address this complication percutaneously.</p><p><strong>Case summary: </strong>We report a case involving a 26 mm Edwards transcatheter valve that was cephalically embolized during rapid pacing due to ventricular tachycardia with a single capture beat. The semiinflated embolized valve was successfully pulled back to a position just distal to the left subclavian artery. Subsequently, a second 26 mm valve was implanted through the embolized valve and deployed successfully in the correct position.</p><p><strong>Conclusion: </strong>Carefully pulling back the embolized transcatheter aortic valve (TAV) to the area distal to the left subclavian artery is a viable salvage technique for embolized TAV. Another attempt of TAVR through the embolized valve can be safely performed, with careful monitoring of left ventricular capture during rapid pacing.Clinical Impact<b>Question:</b> Can transcatheter aortic valve (TAV) embolization be solved percutaneously? <b>Findings:</b> The semi-inflated embolized valve was successfully pulled back to a position just distal to the left subclavian artery. Subsequently, a second 26 mm valve was implanted through the embolized valve and deployed successfully in the correct position. <b>Results:</b> Carefully pulling back an embolized TAV to the descending aorta is a viable salvage technique for managing embolized TAV.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251325656"},"PeriodicalIF":1.7,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143702079","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 Exclusion of a Refluxing Segment of Femoral Vein in Post-Thrombotic Syndrome, Characterized by a Vicious Shunt with the Main Upward Draining Pathway.","authors":"Paolo Zamboni, Giulia Baldazzi, Roberto Galeotti","doi":"10.1177/15266028251326767","DOIUrl":"https://doi.org/10.1177/15266028251326767","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a novel endovascular technique to treat ilio-femoral reflux in post-thrombotic syndrome (PTS). It consists of regulated exclusion of a femoral vein (FV) segment with indication based on Doppler ultrasound (DUS) scan and ascending and descending venogram.</p><p><strong>Technique: </strong>Through lower limb venous DUS, we identify a post-thrombotic refluxing FV, characterized by a duplicated FV and/or ascending collateral veins draining into a common trunk with a re-entry point into the refluxing FV itself. The above findings indicate a second-level venogram. If the descending phase confirms the FV reflux pattern, we perform an ascending venogram to confidently locate where the draining blood is shunted into the FV. We proceed with the scleroembolization of the segment below the shunt. The postoperative venogram documents the treated segment occlusion and the elimination of the reflux. We described 4 cases: 3 successful reflux eliminations and 1 case where we decided not to treat. Mean follow-up lasts 6.5 months with DUS showing the abolition of the reflux; the overall Villalta score, performed at the baseline and last follow-up visit, resulted statistically significant (p = 0.0087).</p><p><strong>Conclusion: </strong>Performing an endovascular regulated exclusion of FV refluxing segment opens a great scenario for PTS treatment; multicenter randomized trials are warranted.Clinical ImpactRecanalized post-thrombotic syndrome, with reflux involving the ilio-popliteal segments, affects the patient's life without any clear surgical indication. The proposed protocol and technique are based on performing a descending and ascending venogram to identify the point of femoral vein duplication. The regulated exclusion of the refluxing FV segment, below the duplication, by means of scleroembolization, allowed to permanent abolish the reflux. This novel technique is minimally invasive and presents great potential for treating a significant proportion of patients currently managed exclusively with conservative approaches.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251326767"},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143671711","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}