Journal of Endovascular Therapy最新文献

{"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":"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":"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}