Journal of Endovascular Therapy最新文献

{"title":"Penetrating Chest Injury With a Crossbow Arrow.","authors":"Pablo Marques de Marino, Francesco Pollari, Caroline Eckrich, Eric L Verhoeven, Markus Preclik","doi":"10.1177/15266028251326468","DOIUrl":"https://doi.org/10.1177/15266028251326468","url":null,"abstract":"","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251326468"},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular Treatment of Abdominal Aorto-Caval Fistula With Occluder Devices: Case Report and Systematic Literature Review.","authors":"Claudio Bianchini Massoni, Laura Pauletti, Andrea Andreone, Luigi Vignali, Anna Fornasari, Antonio Freyrie, Paolo Perini","doi":"10.1177/15266028251324801","DOIUrl":"https://doi.org/10.1177/15266028251324801","url":null,"abstract":"<p><p>Aortocaval fistula (ACF) is a life-threatening condition secondary to abdominal aortic aneurysms (AAA) rupture or previous trauma/intervention. The treatment of ACF by an occluder device deployment is a rare but increasingly common approach. We report a case of ACF secondary to ruptured AAA treated with an occluder device after endograft deployment. A 66-year-old male was treated in an emergent setting for a ruptured AAA with ACF deploying aorto-bi-iliac endograft. At 3-month computed tomography angiography (CTA), the persistence of aorto-caval communication and the increased sac reperfusion (type II endoleak) from the lumbar and inferior mesenteric artery were detected. Under local anesthesia and through percutaneous left brachial arterial access and percutaneous right femoral venous access, a 7-mm Amplatzer Septal Occluder was deployed with the \"left\" atrial end in the aneurysmal sac and the \"right\" atrial end in the inferior vena cava. The adjunctive embolization of the aneurysmal sac was performed. The post-procedural CTA and 6-month contrast-enhanced ultrasound confirmed the disappearance of endoleak and the exclusion of ACF. A systematic review of the literature according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was conducted regarding the use of occluder devices to treat ACF (PROSPERO; CRD42024512167). Including the current case, 10 patients (male 100%; age range 24-74 years) in 10 publications were found. ACF after trauma and after AAA rupture was described in 6 and 4 patients, respectively. Occluder device deployment was a primary procedure in 6/10 cases and a secondary intervention in 4/10 cases. Different types of occluder devices (vascular 4/10, atrial septal 3/10, duct 2/10, ventricular septal 1/10) were used. Technical success was 100%, with no intraoperative complications. Postoperative complications occurred in 2/10 patients (vascular plug migration and iliac deep vein thrombosis). Three out 10 patients required reintervention within 30 days for persistent patency of ACF (1 endovascular abdominal aneurysm repair, 1 re-embolization of fistula with coils, 1 patient underwent adjunctive septal occluder device and iliolumbar embolization). In 8/10 patients (length of follow-up: 1-80 months), no residual arterio-venous communication. In 3 patients with AAA, aneurysm shrinkage occurred in 3/3 patients, with type II endoleak in 1 case. Although a scarce number of patients are available in the literature, occluder device deployment into abdominal arterio-venous fistula is feasible. For a traumatic ACF, the occluder device deployment could be proposed as the primary treatment, while, after a ruptured AAA, endograft deployment is mandatory.Clinical ImpactThe use of occluder device for the occlusion of an aorto-caval fistula (ACF) is an off-label technique reported in literature. The technical success mainly depends from the type of deployed occluder device. This treatment should be p","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251324801"},"PeriodicalIF":1.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143674585","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":"Drug Eluting Stents Below the Knee: Patency, Amputation-Rate, and Mortality-A Systematic Review of the Literature.","authors":"Marco Suriano, Imam T P Ritonga, Konstantinos P Donas, Martin J Austermann, Marco Virgilio Usai","doi":"10.1177/15266028251324809","DOIUrl":"https://doi.org/10.1177/15266028251324809","url":null,"abstract":"<p><strong>Background: </strong>Numerous meta-analyses and multicenter randomized controlled trials have demonstrated that drug-eluting stents (DES) offer superior outcomes in terms of primary patency and limb salvage compared to other endovascular modalities such as balloon angioplasty and bare metal stents. This review aims to systematically analyze the literature on the clinical outcomes of DES for the treatment of infrapopliteal arterial occlusions.</p><p><strong>Methods: </strong>This study is a systematic review. Comprehensive searches were conducted in the MEDLINE, EMBASE, Ovid, Cochrane, DAR, and BVS databases. Eligible studies were those that reported outcomes of DES in the treatment of infrapopliteal arterial disease, with no restrictions on time frame, publication status, or language. The primary outcome assessed was the primary patency of the stent, while secondary outcomes included the rates of re-occlusion and mortality.</p><p><strong>Results: </strong>A total of 27 studies involving 2470 patients were included in the analysis, in which 1191 patients come from prospective multicenter studies. The mean age of the participants was 73.4 years. Approximately, 50% of the patients had diabetes mellitus and/or chronic renal failure, and 33.3% had heart disease. The fibular artery was the most frequently affected by stenosis, involved in 50.2% of cases, followed by the anterior tibial artery in 34.6% of cases and the posterior tibial artery in 15.2% of cases. The average patency rate following DES treatment was 72.2% at 12 months. The rate of re-occlusion was 21.6%, and the mortality rate was 16.6%. However, due to the heterogeneity of the sample and incomplete data, it was not possible to draw definitive correlations between patency, amputation rates, and mortality.</p><p><strong>Conclusion: </strong>This systematic review and analysis revealed significant limitations due to the heterogeneity of the sample and incomplete data, preventing a comprehensive stratification of the findings. As a result, we are not yet able to fully address the research questions posed. Further studies with extended follow-up periods are needed to standardize the treatment of infrapopliteal arterial occlusions and provide more definitive conclusions.Clinical ImpactThis review assessed the efficacy and safety of drug-eluting stents for below-the-knee lesions, showing promising patency and safety results. Their use in daily practice may aid in treating lesions prone to recoil and dissection after angioplasty. Despite some data inconsistencies, the findings remain encouraging. Drug-eluting stents demonstrated better outcomes than Bare-metal Stent, supporting their consideration in clinical practice for below-the-knee vascular treatment.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251324809"},"PeriodicalIF":1.7,"publicationDate":"2025-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665271","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":"Fenestrated Aortic Arch Endovascular Repair for Aortic Diseases Extending to Ishimaru Zones 2 and 3.","authors":"Petroula Nana, Giuseppe Panuccio, José I Torrealba, Fiona Rohlffs, Tilo Kölbel","doi":"10.1177/15266028251324826","DOIUrl":"https://doi.org/10.1177/15266028251324826","url":null,"abstract":"<p><strong>Introduction: </strong>Fenestrated endovascular aortic arch repair (fTEVAR) has been successfully used for the exclusion of aortic lesions extending to distal arch. This study aimed to present the outcomes of fTEVAR for the preservation of the left common carotid artery (LCCA) or left subclavian artery (LSA) in lesions extending to Ishimaru zone 2 and 3.</p><p><strong>Materials and methods: </strong>A single-center retrospective analysis of patients managed with fTEVAR for the preservation of the LCCA or LSA, between September 1st, 2011 and December 31st, 2023, was conducted, following the STROBE guidelines. Only preloaded fenestrated custom-made devices (Cook Medical, Bloomington, IN, USA) were used. Primary outcomes were technical success, mortality, and stroke at 30 days. Survival and freedom from secondary intervention were assessed using Kaplan-Meier estimates.</p><p><strong>Results: </strong>Seventy-five patients were included [72 years (IQR 13), range 48-86; 66.7% males]; 54 scheduled for LSA and 21 for LCCA preservation. Seven (9.3%) were treated urgently. Twenty-one (28.0%) presented with aortic dissection; 19 type B. Ishimaru zone 2 disease extension was recorded in 44 (58.7%) and zone 3 in 32 (42.7%). Debranching was performed in 22 patients: 81.8% LCCA-LSA bypass. Technical success was 93.3% with proximal landing to zone 0 in 18.7% cases, zone 1 in 70.7%, and zone 2 in 10.6%. Six (8.0%) deaths were recorded at 30-days and 4 (5.3%) strokes; 2 (2.7%) major. All strokes were diagnosed in patients with LCCA preservation. The multivariate analysis showed LCCA bridging (OR 0.2, 95% CI 0.08-0.3, p < 0.001) as independently related to stroke. The median follow-up was 12 months. The survival and freedom from secondary intervention were 85.2% [standard error (SE) 4.7%] and 75.0% (SE 6.5%) at 12 months, respectively.</p><p><strong>Conclusion: </strong>Patients treated by fTEVAR for diseases extending to zones 2 and 3 presented encouraging early outcomes. LCCA bridging seems to be independently related to higher stroke rate. Preservation of the LSA seems safe, without neurological consequences.Clinical ImpactFenestrated endovascular arch repair has been applied with acceptable mortality in distal aortic arch lesions. However, the published experience is limited. This retrospective study of 75 patients with disease extend to zones 2 and 3 showed encouraging early outcomes with 93.3% technical success, 8.0% mortality, and 5.3% strokes. The inclusion of the left common carotid artery to the repair was related to higher stroke rate, while the preservation of the left subclavian seems to have no neurological consequences.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251324826"},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659321","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":"ESAL: A Tool for the Explanatory Prediction of Loss of Patency Within 1 Year After Iliac Vein Stent Placement.","authors":"Chang Sheng, Baihong Pan, Pu Yang, Wei Wang","doi":"10.1177/15266028251325393","DOIUrl":"https://doi.org/10.1177/15266028251325393","url":null,"abstract":"<p><strong>Objective: </strong>Establish a predictive tool for assessing post-iliac vein stent placement (IVSP) patency loss within 1 year.</p><p><strong>Background: </strong>Post-IVSP stent surveillance is vital for detecting stent malfunction and guiding interventions. Despite extensive research on vascular patency after IVSP, individual risks for patency loss remain understudied.</p><p><strong>Materials and methods: </strong>We developed a predictive model for assessing patency loss risk within 1 year after IVSP using data from 162 patients. Cox regression and the Boruta method identified risk factors, leading to the construction of a random forest (RF) model. We validated the model's performance using testing data and developed a user-friendly risk tool, the Etiology-Stenosis-Age-Length (ESAL) Classification.</p><p><strong>Results: </strong>The RF model demonstrated excellent performance, with high sensitivity, specificity, and negative predictive value. Risk factors identified included younger age, post-thrombotic lesions, short-segment occlusions, and preoperative target lesion occlusion. Shapley Additive exPlanations analysis and Cox regression enhanced model interpretability.</p><p><strong>Conclusions: </strong>We present a novel, intuitive model for assessing patency loss risk after IVSP. The ESAL classification provides clinicians with a practical tool to identify high-risk patients. Future research should focus on larger, more representative cohorts to validate and refine the model.Clinical ImpactHow will this change clinical practice?The risk of iliac vein stent patency loss within one year post-placement can be predicted in advance.What does it mean for the clinicians?The newly introduced Etiology-Stenosis-Age-Length (ESAL) Classification offers clinicians a practical and user-friendly tool for identifying high-risk patients who may experience patency loss after iliac vein stent placement.What is the innovation behind the study?Researchers have successfully developed a predictive model for assessing the risk of iliac vein stent patency loss within one year post-placement.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251325393"},"PeriodicalIF":1.7,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143659250","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":"Association of Subclavian Artery Blood Flow with Stroke After Thoracic Endovascular Aortic Repair with Single-Branch Stent Graft.","authors":"Zhang Cheng, Liying Ma, Yiqi Jin","doi":"10.1177/15266028251326737","DOIUrl":"https://doi.org/10.1177/15266028251326737","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the stroke risk factors following thoracic endovascular aortic repair (TEVAR) with a single-branch stent graft.</p><p><strong>Materials and methods: </strong>We retrospectively analyzed 128 patients of acute aortic syndromes with inadequate proximal landing zones (PLZ) who underwent TEVAR from September 2019 to December 2023. Patient survival was evaluated using the Kaplan-Meier method, and the relationship between subclavian artery patency and stroke incidence was determined through Cox regression analysis.</p><p><strong>Results: </strong>Technical success rates for aortic dissection (AD), intramural hematoma (IMH), and penetrating aortic ulcer (PAU) were 98.3%, 100%, and 100%, respectively. There were no significant differences in surgery duration, hospital stay, stent length, and oversize across the groups. Over an 18-month follow-up, there were no significant differences in mortality, stroke incidence, or re-intervention rates among the groups. The rates of stroke post-treatment were 4.9% for AD, 11.8% for IMH, and 12.0% for PAU. Notably, subclavian artery stenosis increased the stroke risk by 37.94 times (hazard ratio, 37.94; 95% CI: 4.76-302.35; p < 0.001). Female patients had a 16.57-fold increased risk of stroke (hazard ratio: 16.57; 95% CI: 1.00-272.88; p = 0.049). In addition, each standard deviation increase in operation time raised the stroke rate by 1.03 times (hazard ratio: 1.03; 95% CI: 1.001-1.05; p = 0.003). Subclavian artery stenosis also significantly increased the risk of re-intervention by 44.14 times (hazard ratio: 44.14; 95% CI: 7.50-259.73; p < 0.001), with significant differences in re-intervention rates among the 3 groups, notably improved in the PAU group compared to the AD group (hazard ratio: 3.60; 95% CI: 1.01-12.82; p = 0.042).</p><p><strong>Conclusion: </strong>This study underscores the critical importance of maintaining subclavian artery branch patency post-TEVAR to mitigate stroke and re-intervention risks.Clinical ImpactThis study comprehensively investigates the risk of stroke following the reconstruction of subclavian artery branches during thoracic endovascular aortic repair (TEVAR). While previous literature has extensively documented stroke rates associated with the coverage of subclavian artery branches post-TEVAR, reports on stroke following single-branch stent placement are relatively scarce. By analyzing data from patients with inadequate proximal landing zones who received a single-branch stent, this study identifies potential risk factors for stroke and provides a new perspective on postoperative complications specifically related to subclavian artery reconstruction. Our findings significantly contribute to the literature by offering a novel approach to understanding complications after TEVAR, enhancing the precision of risk analysis for postoperative complications.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251326737"},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651673","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":"Comparison of Postoperative Outcomes Between Endovascular and Surgical Revascularization of the Left Subclavian Artery in Patients Undergoing Thoracic Endovascular Aortic Repair: Systematic Review and Meta-Analysis.","authors":"Noritsugu Naito, Hisato Takagi","doi":"10.1177/15266028251324804","DOIUrl":"https://doi.org/10.1177/15266028251324804","url":null,"abstract":"<p><strong>Background: </strong>This meta-analysis aimed to compare postoperative outcomes between endovascular and surgical revascularization of the left subclavian artery (LSA) in patients undergoing thoracic endovascular aortic repair (TEVAR).</p><p><strong>Methods: </strong>We performed a comprehensive search of the MEDLINE and EMBASE databases through February 2024. Pooled results were calculated, and subgroup analyses focused on the chimney technique for LSA revascularization. Kaplan-Meier curves for mid-term all-cause mortality were reconstructed by extracting time-to-event data from the included studies.</p><p><strong>Results: </strong>Twelve nonrandomized studies, including a total of 4158 patients, were analyzed. Procedural duration was significantly longer in the surgical revascularization cohort (p < 0.01). No statistically significant differences were found in other short-term outcomes between the 2 groups. However, subgroup analysis of studies focusing on the chimney technique showed that surgical revascularization was associated with a significantly lower rate of postoperative endoleak [odds ratio; OR (95% confidence interval; CI) = 0.17 (0.06-0.49), p < 0.01]. For mid-term outcomes, there were no significant differences in mortality [hazards ratio; HR (95% CI) = 1.25 (0.71-2.22), p = 0.44], aortic re-intervention rate [HR (95% CI) = 1.10 (0.49-2.47), p = 0.81], or LSA patency rate [HR (95% CI) = 1.24 (0.40-3.89), p = 0.71] between the 2 strategies. The follow-up endoleak rate tended to be lower in the surgical revascularization group [HR (95% CI) = 0.50 (0.24-1.03), p = 0.06], with a more pronounced trend in the subgroup analysis of studies exclusively employing the chimney technique [HR (95% CI) = 0.33 (0.10-1.02), p = 0.05], though the differences were not statistically significant. Reconstructed Kaplan-Meier curves for all-cause mortality indicated no significant difference in mid-term survival between the groups [HR (95% CI) = 0.94 (0.74-1.19), p = 0.60].</p><p><strong>Conclusions: </strong>This meta-analysis reveals comparable postoperative outcomes between surgical and endovascular LSA revascularization in patients undergoing TEVAR. However, the chimney technique was associated with a higher rate of postoperative endoleak.Clinical ImpactThis meta-analysis provides insights into the comparative effectiveness of surgical versus endovascular left subclavian artery (LSA) revascularization during thoracic endovascular aortic repair (TEVAR). While both techniques demonstrated comparable short- and mid-term outcomes, the chimney stent-graft technique showed a higher incidence of postoperative endoleak, suggesting a need for careful patient selection and follow-up. These findings will guide clinicians in optimizing LSA revascularization strategies and balancing procedural risks with postoperative outcomes in patients requiring LSA coverage during TEVAR.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251324804"},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651676","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":"Extraluminal Pelvic Vein Recanalization With Parallel Stents.","authors":"Jan Masek, Radovan Maly, Vendelin Chovanec, Jan Raupach","doi":"10.1177/15266028251321297","DOIUrl":"https://doi.org/10.1177/15266028251321297","url":null,"abstract":"<p><strong>Purpose: </strong>A chronically-occluded stent during a pelvic vein recanalization attempt was crossed extraluminally to create a new channel to bypass the affected segment after conventional methods failed.</p><p><strong>Case report: </strong>A 55-year-old male patient presented with recurrent acute deep vein thrombosis superimposed on a chronically-occluded older stent type 25 years after primary endovascular treatment. During the procedure, we used an unusual technique with extraluminal parallel stent insertion. Another recurrence 2.5 years later was treated with pharmacomechanical thrombectomy and stenting.</p><p><strong>Conclusion: </strong>Recanalization of venous stent occlusions often requires advanced techniques. The presented technique could be considered as an alternative approach in difficult cases. However, the level of reproducibility is currently unknown due to the lack of further data.Clinical ImpactVenous obstruction can manifest with chronic symptoms that affect daily activities and might cause severe disability. Advanced endovascular recanalization techniques have potential to improve quality of life in cases where other methods failed.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251321297"},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651640","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":"Effectiveness of 2D-DSA and 3D-DSA in the Evaluation of Iliac Vein Stenosis: A Multicenter Prospective Study.","authors":"Jianli Luan, Yubin Li, Ruipeng Zhang, Yan Gao, Heng Zhang, Jianlie Wu, Zhenyuan Zhao, Hongqiao Zhu, Mingjin Guo, Junjun Liu","doi":"10.1177/15266028251326768","DOIUrl":"https://doi.org/10.1177/15266028251326768","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;To compare the sensitivity of measuring iliac vein stenosis using two-dimensional digital subtraction angiography (2D-DSA) and three-dimensional digital subtraction angiography (3D-DSA), with multidetector computed tomography venography (MDCTV) as the reference standard.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Between January 2020 and January 2023, a total of 103 patients suffered from chronic venous insufficiency symptoms categorized as CEAP Level 3 or above were included from three centers. These patients were admitted to our hospital after abdominal vascular ultrasound and MDCTV positivity. During hospitalization, all patients underwent both 2D-DSA and 3D-DSA procedures simultaneously. Ensure double-blind and rigorous evaluation process when evaluating images. All patients were categorized into two groups based on the degree of CTV stenosis: Group A (50%-70%) and Group B (&gt;70%). Considering the morphology of iliac vein compression, all patients were categorized into three groups: central, lateral, and partial obstruction. Subsequently, the effectiveness analysis was performed for each diagnostic method based on the aforementioned classification.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;With MDCTV as the reference standard, in Group A, the sensitivity of 2D-DSA and 3D-DSA is 78.69% and 90.48%, respectively. In Group B, the sensitivity of 2D-DSA and 3D-DSA is 93.44% and 97.62%, respectively. In Group A, the accuracy of 3D-DSA is significantly higher than that of 2D-DSA (p = 0.019). However, there is no statistically significant difference in Group B (p = 0.360). The accuracy rates for central, lateral, and partial obstruction using 2D-DSA are, respectively, 77.55%, 69.70%, and 95.24%. The accuracy rates for central, lateral, and partial obstruction using 3D-DSA are, respectively, 93.88%, 93.94%, and 100%. In central group, the accuracy of 3D-DSA is significantly higher than that of 2D-DSA (p = 0.021). In lateral group, no significant difference was observed between the accuracy obtained by both methods (p = 0.011). Similarly, no significant difference was found in partial obstruction group (p = 1.000). During the angiography procedure using 3D-DSA, a significant reduction was observed in both contrast agent quantity and exposure time (p &lt; 0.05) without any apparent effects on renal function.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Regardless of the degree or type of iliac vein stenosis, 3D-DSA exhibits superior sensitivity compared to 2D-DSA for the diagnosis and evaluation of stenosis. Particularly in instances of noncentral stenosis, 3D-DSA outperforms 2D-DSA.Clinical ImpactThis will provide new insights for the clinical diagnosis and treatment of iliac vein compression syndrome (IVCS), significantly enhancing the diagnostic accuracy of IVCS. For clinicians, three-dimensional digital subtraction angiography (3D-DSA)offers a more comprehensive and detailed assessment in clinical practice, leading to more precise diagnosis and treatment o","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251326768"},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651638","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":"Utilizing CO₂ Cone Beam Computed Tomography for Post-Procedure Completion Control Following Fenestrated Endovascular Repair of Complex Aortic Aneurysm With a Standardized CO₂ Protocol.","authors":"Davide Esposito, Martina Bastianon, Caterina Melani, Gaddiel Mozzetta, Endri Sila, Fabio Grimaldi, Enrica Bosisio, Andrea Savio, Giuseppe Baldino, Giovanni Pratesi","doi":"10.1177/15266028251327041","DOIUrl":"https://doi.org/10.1177/15266028251327041","url":null,"abstract":"<p><strong>Purpose: </strong>To assess the feasibility and efficacy of a standardized CO₂ protocol and CO₂ cone beam computed tomography (CBCT) for procedural completion in fenestrated endovascular aneurysm repair (FEVAR) of complex aortic aneurysms in patients with chronic kidney disease (CKD).</p><p><strong>Materials and methods: </strong>Ten patients with complex aortic aneurysms and CKD (estimated glomerular filtration rate <90 ml/min) underwent FEVAR with custom-made fenestrated devices, using CO₂ as the primary contrast agent. Procedures were conducted in a hybrid operating room following a standardized CO₂ protocol with optimized injection parameters and visualization techniques to maximize CO₂ imaging efficacy. CO₂ CBCT was performed intraoperatively to verify stent graft deployment, bridging stent positioning, target vessel patency, and the presence of potential endoleaks.</p><p><strong>Results: </strong>All 10 procedures were completed successfully without intraoperative complications or CO₂-related adverse effects. Completion CO₂ CBCT provided clear visualization of visceral and renal vessels, and no significant endoleaks were detected. One procedure was entirely iodine contrast-free, while minimal iodine contrast was used in others to address diagnostic uncertainties. Postoperative renal function remained stable across all patients.</p><p><strong>Conclusion: </strong>CO₂ CBCT is a feasible and effective alternative for completion imaging in complex FEVAR procedures for patients with CKD, potentially reducing the need for iodine contrast and the associated risk of nephropathy. A standardized CO₂ protocol can enhance procedural safety. Further research with larger cohorts is needed to confirm these findings.Clinical ImpactCO₂ serves as the preferred contrast medium for the endovascular treatment of patients with iodine contrast allergies or those afflicted with chronic kidney disease (CKD) to preserve further renal deterioration. Ensuring protection from potentially harmful substances is paramount during endovascular repair in such patients. Equally crucial is performing the procedure safely through a standardized protocol and confirming its accuracy upon completion. Nevertheless, the possibility of employing CO₂ for cone beam computed tomography provides invaluable insights into procedural efficacy, thereby enhancing outcomes for CKD patients undergoing complex endovascular repair.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251327041"},"PeriodicalIF":1.7,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143651645","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}