Journal of Endovascular Therapy最新文献

{"title":"Total Iodine Contrast-Free Protocol in Complex Endovascular Aneurysm Repair.","authors":"Roberto Falso, Sara Speziali, Rosella Di Domenico, Brigida Biancofiore, Marta Panella, Giulia Landini, Elena Giacomelli, Aaron Thomas Fargion, Walter Dorigo, Raffaele Pulli","doi":"10.1177/15266028251344793","DOIUrl":"https://doi.org/10.1177/15266028251344793","url":null,"abstract":"<p><strong>Objectives: </strong>Contrast-induced nephropathy is still a big issue related to using iodine contrast medium in patients with renal impairment undergoing complex endovascular aneurysm repair such as fenestrated or branched endovascular aneurysm repair (F/BEVAR). Although the use of carbon dioxide being well investigated in literature for standard EVAR, there are a few evidence about its use in F/BEVAR. The potential damage to kidneys is not only related to the procedure alone but also to the need to perform computed tomography angiography in the preoperative and postoperative period. With the aim to reduce the damage to renal function in patients with preexisting renal impairment, we report our experience of a total iodine contrast-free protocol in 6 patients with chronic kidney disease (stages from 3 to 5) who require a complex endovascular aneurysm repair due to an aneurysmatic disease of the thoracoabdominal aorta.</p><p><strong>Materials and methods: </strong>Six consecutive patients with chronic kidney disease underwent F/BEVAR at our institution following a total iodine contrast-free protocol, from perioperative period to follow-up. These patients were preoperatively evaluated with duplex ultrasounds and plain-computed tomography scan to perform proper reconstruction with dedicated 3D software. All the procedures were carried on with CO<sub>2</sub> as contrast medium. During follow-up, every patient underwent plain-computed tomography scan at 1 month and then duplex ultrasound evaluations.</p><p><strong>Results: </strong>Technical success was achieved in all cases. There were no aneurysm or procedure-related complications related to the use of CO<sub>2</sub> in the perioperative period. At 6 months, in each case, the sac was stable and no endoleak were found. Serum creatinine and estimated glomerular filtration rate values were similar to preoperative ones both in the perioperative period and during follow-up.</p><p><strong>Conclusions: </strong>The total iodine contrast-free protocol showed its feasibility and safety to carry on complex endovascular procedures in patients affected by chronic kidney disease from stages 3 to 5 and concomitant aneurysmatic disease of the thoracoabdominal aorta. This protocol could also avoid further deteriorations of renal function that could lead those patients to hemodialysis. A large cohort of patient and an extended follow-up are required in the future to achieve more accurate data.Clinical ImpactThis study aims to evaluate an iodine-contrast-free protocol for patients with chronic kidney disease undergoing complex endovascular aortic repair, such as FEVAR or BEVAR. The use of this protocol may help preserve renal function and prevent further deterioration in patients at high risk for acute kidney injury or hemodialysis. Although the literature describes the role of CO<sub>2</sub> as a non-nephrotoxic contrast agent, there are no reported experiences involving both preoperative and postoperat","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344793"},"PeriodicalIF":1.7,"publicationDate":"2025-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Curated Treatment of a Young Woman With Marfan Syndrome: Elective Open Ascending Repair to Emergent Thoracoabdominal Endovascular Repair.","authors":"Rohini J Patel, Eugene Golts, Andrew R Barleben","doi":"10.1177/15266028251344802","DOIUrl":"https://doi.org/10.1177/15266028251344802","url":null,"abstract":"<p><strong>Background: </strong>Hereditary aortopathies traditionally require open repair when significant pathologies arise. Open provides the most durable outcome for nominally a younger patient population that can tolerate larger procedures well. In certain situations, literature has described proceeding with endovascular repair in patients with known hereditary aortopathies.</p><p><strong>Case report: </strong>This case report describes the treatment of a 29-year-old female with a history of type A dissection previously treated with a valve sparing aortic root repair and a type B dissection with a thoracic endovascular aortic repair (TEVAR) 2 years prior. Genetic testing then confirmed Marfan's syndrome, and she was followed by vascular medicine specialists and optimized medically. Several other family members also tested positive and imaging revealed aortic abnormalities. She arrived at our institution endorsing severe nausea, vomiting, back, flank, and abdominal pain. She was found on imaging to have a rapidly degenerating type II thoracoabdominal aortic aneurysm (TAAA) with dissection. A multidisciplinary team evaluated the patient and working with cardiothoracic (CT) surgery, our initial plan was an open repair. Following admission to the ICU, her symptoms improved with tight blood pressure control; however, she rapidly clinically decompensated with worsening pain and hypotension the day prior to her planned open repair. A massive transfusion protocol was initiated and CT scan revealed more than a 1 cm growth and evolution of her dissection. At the time, the CT surgery group were in cases and could not free an attending, and therefore recommended that we temporize the situation with balloon control and a fenestrated repair. We emergently proceeded to the operating room and obtained balloon control prior to induction of anesthesia while the 4-vessel fenestrated/branched endograft (F/BEVAR) was constructed. Repair was carried out with a bifurcated graft into the bilateral iliac arteries. However, following the endovascular repair, the patient did not want to proceed with a large open surgery and was managed definitively with endovascular means and ultimately required reintervention for a type 3 endoleak (EL) (bridging TEVAR) and type 1B EL requiring hypogastric preservation to minimize spinal cord ischemia. CT scan prior to discharge revealed only a type 2 EL, and she was discharged home with full motor and sensory function. Approximately 1 year later, a CT scan revealed regression of the aneurysm near her visceral segment, but growth near the aortic bifurcation and a type 2 EL. This was treated with a trans-caval approach and embolization of several segmental branches and the aneurysm sac with thrombin and gelfoam. Subsequent CT scans over the next 2 years have shown continued sac regression.</p><p><strong>Conclusion: </strong>This case serves as an example that an endovascular repair may play a role in the emergent treatment of complex an","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344802"},"PeriodicalIF":1.7,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183674","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":"Application of Noncontrast CT-Derived Volume Rendering Imaging and IVUS in Zero-Contrast EVAR: A Novel Technique.","authors":"Yusuke Ki, Toru Kuratani, Tomoaki Kudo, Yuki Oga","doi":"10.1177/15266028251344788","DOIUrl":"https://doi.org/10.1177/15266028251344788","url":null,"abstract":"<p><strong>Background: </strong>Endovascular aneurysm repair (EVAR) is a minimally invasive treatment for abdominal aortic aneurysms. However, it poses challenges in chronic kidney disease (CKD) patients due to contrast-induced nephropathy (CIN). This case report presents a zero-contrast EVAR technique using noncontrast CT-derived volume rendering (VR) imaging and intravascular ultrasound (IVUS).</p><p><strong>Case presentation: </strong>An 80-year-old male with CKD G4 underwent zero-contrast EVAR. Preoperative noncontrast CT-generated VR images were utilized for both surgical planning and intraoperative 3D roadmap, while intraoperative IVUS was used to identify key vascular landmarks, such as the renal arteries and internal iliac arteries bifurcation. This combination enabled precise vascular mapping and device placement without contrast agents. Preoperatively, renal function was serum creatinine (Cr) 2.64 mg/dL and estimated glomerular filtration rate (eGFR) 19.0 mL/min/1.73 m², indicating a high risk of CIN. At 6-month follow-up, postoperative evaluation confirmed stable renal function (Cr 2.82 mg/dL, eGFR 17.7 mL/min/1.73 m²) with no evidence of endoleaks.</p><p><strong>Discussion: </strong>This case demonstrates the feasibility of zero-contrast EVAR using VR imaging and IVUS, mitigating CIN risks while maintaining accuracy. VR imaging enhanced intraoperative navigation with detailed visualization and color mapping of critical branches. IVUS complemented VR imaging by providing real-time spatial relationships.</p><p><strong>Conclusion: </strong>The combination of VR imaging and IVUS offers a viable alternative for zero-contrast EVAR, particularly in patients contraindicated for contrast agents. This renal-sparing technique expands EVAR options for high-risk populations.Clinical ImpactThis case presents a novel approach to zero-contrast endovascular aneurysm repair (EVAR) by combining non-contrast CT-derived volume rendering (VR) imaging and intravascular ultrasound (IVUS). This technique provides a renal-sparing solution for patients with chronic kidney disease (CKD) at high risk of contrast-induced nephropathy (CIN). By enabling accurate vascular mapping and device placement without contrast agents, procedural safety is enhanced. The innovation lies in integrating VR for visualization and IVUS for real-time intraluminal assessment, ensuring precision while avoiding contrast-related risks. This method may expand EVAR options and improve outcomes in CKD patients unsuitable for traditional contrast-based imaging.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251344788"},"PeriodicalIF":1.7,"publicationDate":"2025-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144144262","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":"Atherectomy and Intravascular Lithotripsy Provide Comparable Outcomes for Common Femoral Artery Atherosclerotic Disease: A Systematic Review With Meta-analysis.","authors":"Nicolas Bouchareine, Guillaume Daniel, Sonia Ramos-Pascual, Kinga Michalewska, Bethany Grew, Mo Saffarini, Pierre-Jules Delannoy, Mathias Montveneur","doi":"10.1177/15266028251335174","DOIUrl":"https://doi.org/10.1177/15266028251335174","url":null,"abstract":"<p><strong>Objective: </strong>To identify, synthesize, and critically appraise the published studies reporting outcomes of atherectomy and/or intravascular lithotripsy (IVL) for symptomatic common femoral artery (CFA) atherosclerosis and therefore provide support in clinical decision-making.</p><p><strong>Design: </strong>Systematic review with meta-analysis.</p><p><strong>Data sources and review methods: </strong>This review was registered in PROSPERO and followed the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A search was performed on MEDLINE and Embase. Inclusion criteria were prospective or retrospective comparative or non-comparative studies and research letters, published between Jan 01, 2000 and Dec 01, 2023, written in English or French, that reported on adults with symptomatic atherosclerotic stenosis or occlusion, localized within the CFA, treated with atherectomy and/or IVL. Study and lesion characteristics, clinical and technical outcomes were extracted independently by 2 reviewers, and data were pooled for 5 selected outcomes. Risk of bias was assessed with Mixed Methods Appraisal Tool (MMAT).</p><p><strong>Results: </strong>Sixteen studies (13 on atherectomy, 960 limbs; 3 on IVL, 66 limbs) were included. Both atherectomy and IVL had good outcomes in terms of technical success (96% vs 97%), proportion of bailout stenting (6% vs 8%), freedom from target lesion revascularization (TLR; 90% vs 91%), and limb salvage (97% vs 95%). IVL tended to have more perioperative complications than atherectomy (16% vs 10%). Five studies on atherectomy and 2 studies on IVL met all 7 MMAT criteria, 4 studies on atherectomy met 6 criteria, while 4 studies on atherectomy and 1 study on IVL met 4 or 5 criteria.</p><p><strong>Conclusion: </strong>Atherectomy and IVL can have equally good short- to mid-term outcomes for the treatment of symptomatic CFA atherosclerosis in terms of technical success, as well as freedom from TLR and limb salvage. Although these findings suggest that the choice between atherectomy and IVL for CFA atherosclerosis can be at the discretion of the clinician, further studies with longer follow-up are needed to formulate clinical recommendations.Clinical ImpactThis systematic review with meta-analysis can help clinicians to make evidence-based choices between endovascular treatments for common femoral artery (CFA) atherosclerosis. It shows that atherectomy and intravascular lithotripsy (IVL) have equally good short- to mid-term outcomes in treating CFA atherosclerosis, both in terms of technical success, as well as limb salvage and freedom from target lesion revascularization. These findings suggest that the choice between atherectomy and IVL for CFA atherosclerosis can be at the discretion of the clinician, however, further studies with longer follow-up are needed to formulate clinical recommendations.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251335174"},"PeriodicalIF":1.7,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Profunda Femoral Artery Retrograde Puncture in Complex Revascularization of Ileo-Femoral Chronic Total Occlusions.","authors":"Lorenzo Patrone, Edoardo Pasqui, Giambattista Parlani, Alexandre Araujo Pereira, Bhaskar Purushottam, Gianmarco de Donato, Gioele Simonte, Raphael Coscas","doi":"10.1177/15266028251338835","DOIUrl":"https://doi.org/10.1177/15266028251338835","url":null,"abstract":"<p><strong>Introduction: </strong>The profunda femoral artery (PFA) puncture is generally fraught with risk of bleeding and iatrogenic damage, leading to possible impaired flow in such a valuable artery. However, the PFA represents a potential retrograde path to the common femoral artery (CFA) due to its usual good size and convenient location. Since endovascular treatment of the CFA and its bifurcation is gaining popularity, this study intends to report the use of PFA access in complex revascularizations.</p><p><strong>Materials and methods: </strong>This is a retrospective multicenter registry on PFA retrograde approaches, including 15 cases in which this access was used during challenging recanalizations of iliac and femoral chronic total occlusions (CTO). This access was performed as a bailout in 11 cases (73.3%). The puncture's technical success and the diseased segments' recanalization were achieved in all cases. Hemostasis was done by intraluminal balloon inflation (9/15, 60%), external manual compression (4/15, 26.7%), or closure device deployment (2/15, 13.3%). No complications related to the access were noted.</p><p><strong>Conclusion: </strong>This series represents the largest cohort of patients who underwent retrograde PFA puncture for iliac and femoral CTO crossing. It shows how different clinical and anatomical settings may suit this endovascular approach, making it a safe alternative that vascular specialists should be aware of.Clinical ImpactRetrograde puncture of the profunda femoral artery (PFA) could represent a strategic approach during complex iliac and femoral endovascular revascularizations and total endovascular femoral reconstruction. This article presents 15 cases of PFA retrograde puncture and conveys technical tips for performing this maneuver correctly and avoiding potential risks at the level of this vessel. Surgeons and interventionalists should be aware of this possibility, especially with the increasing number of total endovascular treatments of the femoral bifurcation.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251338835"},"PeriodicalIF":1.7,"publicationDate":"2025-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103045","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":"Sirolimus-Eluting Resorbable Magnesium Scaffold for the Treatment of Patients With Infrapopliteal Arteries Disease: Three-Year Results.","authors":"Adeline Demierre, Rolf P Engelberger, Daniel Hayoz, Daniel Périard","doi":"10.1177/15266028251339356","DOIUrl":"https://doi.org/10.1177/15266028251339356","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Symptomatic infrapopliteal arterial disease often requires challenging endovascular interventions. Percutaneous transluminal angioplasty with stent placement to settle residual stenosis or dissections remains the standard of care for infrapopliteal endovascular intervention. Concerns have been raised about permanent artery rigidification by stainless steel stents. Drug-eluting resorbable scaffolds combine the mechanical support in the acute phase and the delivery of an antirestenotic drug overtime, then fully resorb leaving the vessel free from permanent metallic implant. This study investigated the performance of the Magmaris sirolimus-eluting resorbable magnesium scaffold (RMS) in the management of infra-popliteal, severely diseased leg arteries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;This investigator-initiated single-center retrospective study, analyzed all patients with symptomatic peripheral arterial occlusive disease (Rutherford class of symptoms 2-5) treated with the Magmaris RMS from 2016 to 2023, for the treatment of infrapopliteal arterial lesions with postangioplasty 50% or more residual stenosis. Technical success, degree of residual stenosis after scaffold implantation, incidences of target lesion primary patency, clinically driven target lesion revascularization (CDTLR), major limb amputation, and all-cause mortality are provided up to 36 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Hundred eleven patients (69.4% male, age 79 ± 10) were treated with 141 Magmaris RMS for infrapopliteal lesions (92.3% proximal third of leg). Target lesions had a mean degree of stenosis of 92%, with 52.2% of occlusion and 58.5% of moderate or severe calcification. The mean degree of stenosis after angioplasty remained 60.1% ± 15.8% and fell to 4.8% ± 9.6% after scaffold implantation. Freedom from CDTLR was 95.5%, 93.4%, 90.4%, and 87.9% at 6, 12, 24, and 36 months. Freedom from limb major amputation was 98.2%, 98.1%, 96.4%, and 95.5% and mortality was 7.6%, 10.6%, 24.2%, and 28.8% at 6, 12, 24, and 36 months.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study suggests that the Magmaris RMS has adequate mechanical properties, drug elution, and resorption time to be safely applied to atherosclerotic infrapopliteal arteries with promising clinical results. These data show that metallic resorbable scaffold may constitute a valuable addition to current option for infrapopliteal arteries management.Clinical ImpactResorbable magnesium scaffold (RMS) are an innovation in the treatment of residual stenoses or dissections after angioplasty in the infrapopliteal arteries. They offer mechanical support and drug elution during the healing phase of the artery wall; and then disappear, leaving the artery free of any rigid implant, once the resorption is completed. RMS thus allow the restoration of artery motion and endothelial function. This study provides efficacy and safety information up to 3 years after RMS implantation in severe l","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251339356"},"PeriodicalIF":1.7,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144095471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Aortoiliac Artery Bifurcation Angle May Be a New Indicator for Predicting the Growth of Abdominal Aortic Aneurysm.","authors":"Xinghan Zhao, Qingpeng Song, Shuailiang Liu, Qingduo Zheng, Xuejun Wu","doi":"10.1177/15266028251339355","DOIUrl":"https://doi.org/10.1177/15266028251339355","url":null,"abstract":"<p><strong>Objectives: </strong>The aortoiliac artery bifurcation angle (AIABA) within abdominal aortic aneurysms (AAAs) may potentially influence subsequent aneurysm growth. The goal was to investigate the role of AIABA in AAA growth via contrast-enhanced CT.</p><p><strong>Methods: </strong>A total of 142 patients with AAAs who underwent contrast-enhanced CT at baseline and follow-up (minimum follow-up duration of 3 months) were included. The AIABA, proximal landing zone distance and maximal AAA diameter were measured via multiplanar reconstruction, and the growth rate of the aneurysms was calculated. Comprehensive statistical approaches were used to determine the relationships between AIABA and aneurysm growth.</p><p><strong>Results: </strong>Mean age of patients was 69.7 ± 8.3 years and 90.8% were men. AAAs with affected bifurcations had smaller bifurcation angles (53.3° ± 20.1° vs 61.1° ± 16.4°; p<0.05) and faster growth rates (3.28 ± 1.79 vs 2.14 ± 1.42 mm/year; p<0.05). Groups 1 to 6 of all AAAs were defined by the AIABA as follows: <30°, 31° to 45°, 46° to 60°, 61° to 75°, 76° to 90° and >90°. The growth rates of the AAAs in Groups 1, 2, 3, and 6 were 2.92-, 2.91-, 1.56-, and 3.48-fold greater than those in Group 5 (p<0.05) and were 2.62-, 2.60-, 1.39-, and 3.12-fold greater than those in Group 4 (p<0.05), respectively. According to both the univariate and multivariate analyses, the AIABA was independently negatively related to the aneurysm growth rate when the AIABA <90° (univariate analysis: r=-0.83, p<0.01; multivariate analysis: r=-0.89, p<0.01).</p><p><strong>Conclusion: </strong>AIABA is an independent predictor of AAA growth.Clinical ImpactThe aortoiliac artery bifurcation angle is an independent predictor of abdominal aortic aneurysm progression. Abdominal aortic aneurysm with an aortoiliac artery bifurcation angle < 45° or > 90° are likely to grow faster. Abdominal aortic aneurysms surveillance strategies based on diameter could be modified, a risky angle (< 45° or > 90°) of bifurcation should be considered even if the maximal diameter of the AAA is within the conventional safe range.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251339355"},"PeriodicalIF":1.7,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144081623","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":"Clinical Study of the Results of Sac Prefilling Performed to Prevent Type II Endoleaks After Endovascular Abdominal Aortic Aneurysm Repair.","authors":"Jia-Xin Wang, Zong-Wei Liu, Jian-Tao Zhang, Heng-Hao Zhu, Xin-Yuan Jiao, Jia-Yin Guo, Jia-Xue Bi, Xiang-Chen Dai","doi":"10.1177/15266028251335771","DOIUrl":"https://doi.org/10.1177/15266028251335771","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigated the effectiveness and safety of sac prefilling (SP) with fibrin glue and/or a coil to prevent type II endoleaks (T2ELs) after endovascular aneurysm repair. The main outcome measure was prevalence of incidence of T2ELs.</p><p><strong>Methods: </strong>First, this is a retrospective observational study on patients treated in our institution. Patients who underwent endovascular aneurysm repair between January 2017 and July 2022 were included and divided into the endovascular aneurysm repair and endovascular aneurysm repair with SP groups. Additionally, all patients were divided into high-risk (HR) and low-risk (LR) groups based on their risk for T2ELs. The prevalence of incidence of T2ELs at 1 year postoperatively was the main effectiveness index, and the colorectal ischemia complication rate was the main safety index.</p><p><strong>Results: </strong>A total of 431 patients were included in this clinical study. The endovascular aneurysm repair group and SP group comprised 383 patients and 48 patients, respectively. No statistically significant differences between these groups were observed. The HR group included 282 patients; 246 of these patients were in the HR endovascular aneurysm repair group, and 36 were in the HR SP group. The prevalence of incidence of T2ELs in the endovascular aneurysm repair group was higher than that of the SP group at 6 and 12 months postoperatively (15.4% vs 2.8% and 13.2% vs 0%); statistically significant differences between these groups were observed (p = 0.039 and p = 0.032). The postoperative follow-up period was 60 months. A Kaplan-Meier curve analysis indicated that the cumulative T2EL incidence rate of the endovascular aneurysm repair group was significantly higher than that of the SP group (p = 0.011). The LR group included a total of 149 patients; 137 of these patients were in the endovascular aneurysm repair group, and 12 were in the SP group. No statistically significant differences between these groups were observed.</p><p><strong>Conclusions: </strong>For patients with an abdominal aortic aneurysm who are at HR for T2ELs, SP could effectively, and safely prevent postoperative T2ELs.Clinical ImpactThis study points out that in patients with AAA, the sac prefilling technique is more suitable for patients with high-risk factors, so the operator should evaluate the patient's anatomical condition more thoroughly before EVAR.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251335771"},"PeriodicalIF":1.7,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059666","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":"Improved Endovascular Aortic Repair Durability in Patients Achieving Increased Shortest Apposition Length: A Multi-Centre Analysis.","authors":"Cas H F Hendricks, Richte C L Schuurmann, Bram Fioole, Rogier H J Kropman, Reinoud P H Bokkers, Lievay van Dam, Jan-Albert Vos, Jean-Paul P M de Vries","doi":"10.1177/15266028251338812","DOIUrl":"https://doi.org/10.1177/15266028251338812","url":null,"abstract":"<p><strong>Objective: </strong>Endovascular aortic repair (EVAR) for an aneurysm of the abdominal aorta (AAA) is associated with long-term complications, such as endoleaks, resulting in a significant re-intervention rate. This study investigates the prognostic value of (change of) proximal seal length on post-EVAR computed tomography angiography (CTA) for predicting type 1a endoleak. It further proposes a risk-stratified imaging follow-up algorithm.</p><p><strong>Design: </strong>Multicentre, retrospective, observational study of consecutive patients who underwent elective EVAR for infrarenal AAA between 2015 and 2018 at 3 high-volume hospitals in the Netherlands.</p><p><strong>Materials and methods: </strong>Aorta morphology and endograft position analysis was performed. Shortest apposition length (SAL) was measured on the first post-EVAR CTA and, if available, on the last CTA. Change of SAL through time was categorized as increasing, stable, or decreasing and correlated with type 1a endoleak and secondary interventions for endoleak. Kaplan-Meier analysis was used to calculate type 1a endoleak free and re-intervention-free survival.</p><p><strong>Results: </strong>Three hundred ten AAA patients with a median follow-up of 51 (Q1, 17; Q3, 71) months were included. A median SAL of 22.8 mm (Q1, 15.9; Q1, 30.4) was measured on the first post-EVAR CTA. In 168 of 310 patients (54%), a second post-EVAR CTA was available, in which 71 (42%) showed increasing SAL over time. No type 1a endoleak developed in the increasing SAL group, whereas 1 of 43 (2%) in the stable group and 10 of 54 (19%) in the decreasing group developed type 1a endoleak. Five years post-EVAR, type 1a endoleak-free survival was 100% in the increasing SAL group versus 97.1% in the stable SAL group (p=0.195), and 81.6% in the decreasing SAL group (p<0.001). The re-intervention for all types of endoleak-free survival was 100% in the increasing SAL group versus 84.6% in the stable SAL group (p<0.001), and 60.7% (p<0.001) in the decreasing SAL group.</p><p><strong>Conclusion: </strong>Increasing SAL after EVAR for infrarenal degenerative AAA is an indicator of durable success without type 1a endoleak and endoleak-associated secondary intervention within 5 years. Decreasing SAL is associated with development of type 1a endoleak after EVAR. Evaluation of (change of) the proximal seal could be a valuable part of follow-up after EVAR.Clinical ImpactEvaluation of proximal seal length after endovascular aortic repair offers valuable prognostic information regarding the risk of type 1a endoleak. Implementation could refine current follow-up algorithms to better stratify patients who have a substantial risk of type Ia endoleak from patients who may benefit from limited image surveillance.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251338812"},"PeriodicalIF":1.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144047928","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":"Impacts of Thoracic Endovascular Aortic Repair and Thrombus Load on Aortic Radial Deformation.","authors":"Alexandra Hauguel, Johan Bondesson, Arshid Azarine, Kianosh Kasani, Abdul I Barakat, Stephan Haulon, Christopher P Cheng","doi":"10.1177/15266028251339347","DOIUrl":"https://doi.org/10.1177/15266028251339347","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Aortic stiffness and intraluminal thrombus at baseline have been suggested as potential determinants of the impact of aortic endovascular devices on aortic wall properties. We aim to assess the impact of the endograft and of thrombus load on aortic compliance through the assessment of changes in aortic radial deformation following thoracic endovascular aortic repair (TEVAR).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;The 3D geometric models of the aorta at peak systole and end diastole were constructed from both pre- and post-TEVAR 4D flow magnetic resonance imaging (MRI) of aortic aneurysm and dissection patients. Arclength, length-averaged curvature, and true- and whole lumen effective diameters and areas were assessed in different aortic segments (ascending aorta, endografted segment, and all aorta). Aortic radial deformation was defined as percentage change in aortic diameter from diastole to systole. Thrombus load was defined as thrombus volume divided by aortic volume. Spearman's coefficient (R) was calculated to assess linear correlations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The analysis was conducted on 14 patients/TEVAR procedures (n=7 aneurysms, n=7 dissections). Median time between pre- and postoperative MRI was 124.6 ± 81.7 days. Aortic radial deformation significantly decreased in the endografted segment (7.2% ± 3.6% vs 5.0% ± 2.0%, p&lt;0.05), whereas it significantly increased in the ascending aorta (6.2% ± 2.3% vs 14.4% ± 4.0%, p&lt;0.05). No significant impact was observed on axial deformation (length change) and bending pre-to-post-TEVAR in those 2 segments. Regarding changes in geometry, cardiac cycle-averaged ascending aortic diameter was found similar pre-to-post TEVAR (3.7 ± 0.3 cm vs 3.6 ± 0.4, p=0.23). Thrombus load at the level of the diseased thoracic aorta at baseline correlated strongly with the amplification in ascending aorta radial deformation (R=-0.80, R&lt;sup&gt;2&lt;/sup&gt;=0.64), and in an even more significant manner when excluding the 2 patients with a history of prosthetic ascending aorta replacement (R=-0.88, R&lt;sup&gt;2&lt;/sup&gt;=0.77).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Following TEVAR, aortic radial deformation, is reduced in the stented segment and amplified in the ascending aorta. Greater baseline thrombus load results in lower radial deformation amplification post-TEVAR. These findings highlight the benefit of thrombus load assessment pre-TEVAR and the need for increasing the compliance of future grafts to minimize its impact.Clinical ImpactFollowing thoracic endovascular aortic repair (TEVAR), aortic radial deformation, directly related to aortic compliance, is reduced in the stented segment, and amplified upstream in the ascending aorta, likely due to increased stiffness of the endograft, remodeling, and pressure pulse reflection. Thrombus load is found as an effective predictor of aortic radial deformation amplification following TEVAR. This highlights the benefit of thrombus assessment pre-TEVA","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251339347"},"PeriodicalIF":1.7,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993998","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}