Journal of Endovascular Therapy最新文献

{"title":"External Validation of Fully-Automated Infrarenal Maximum Aortic Aneurysm Diameter Measurements in Computed Tomography Angiography Scans Using Artificial Intelligence (PRAEVAorta 2).","authors":"Johannes Hatzl, Christian Uhl, Alexandru Barb, Daniel Henning, Jonathan Fiering, Edris El-Sanosy, Philippe W M Cuypers, Dittmar Böckler","doi":"10.1177/15266028241295563","DOIUrl":"https://doi.org/10.1177/15266028241295563","url":null,"abstract":"<p><strong>Purpose: </strong>This study investigates the accuracy of fully-automated maximum aortic diameter measurements in abdominal aortic aneurysm (AAA) patients using artificial intelligence software (PRAEVAorta 2, Nurea, Bordeaux, France).</p><p><strong>Materials and methods: </strong>This is a multicenter, retrospective validation study using prospectively collected data from the Zenith alpha for aneurysm Repair Registry (ZEPHYR). Automated measurements of PRAEVAorta 2 are compared with measurements of an internationally recognized core laboratory (Syntactx, New York, New York State). The reviewers at the core laboratory were measurement technologists trained to and utilizing established measurement standards, overseen by vascular surgeons and radiologists. The data set comprised 871 computed tomography angiography scans from the ZEPHYR registry with 347 patients who underwent endovascular aneurysm repair (EVAR) with the Zenith Alpha Endovascular Abdominal Graft (Cook Medical, Bloomington, Indiana) in Germany, Belgium, and The Netherlands between 2016 and 2019.</p><p><strong>Results: </strong>The analysis demonstrated excellent correlation of the measurements (r=0.97) with an intraclass correlation (ICC) of 0.972 (95% confidence interval [CI]=0.968-0.976) across all scans. For preoperative computed tomography (CT) scans, ICC was 0.953 (95% CI=0.941-0.963), and for postoperative scans, ICC was 0.979 (95% CI=0.975-0,983), respectively. In total, 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference. In total, 10% of scans demonstrated obvious segmentation errors, mainly due to failure in detecting vessel segments (renal arteries, aortic bifurcation) or due to mis-detecting the outer border of the AAA (duodenum, inferior vena cava, aortic branches) and were excluded from the analysis.</p><p><strong>Conclusion: </strong>In this study, the maximum AAA diameter could be accurately measured fully-automatically by PRAEVAorta 2 (Nurea) in most cases demonstrating that artificial intelligence (AI) software could serve as an important adjunct for research and clinical practice. However, critical review of the generated reports by an experienced observer and cautious use is warranted to identify flawed segmentations.</p><p><strong>Clinical impact: </strong>This multicenter, retrospective validation study assessed the accuracy of fully-automated maximum infrarenal aortic aneurysm diameter measurements. It was demonstrated, that 95.4% of measurements were within the clinically acceptable range of 5 mm in absolute difference, positioning the software as a potential adjunct for clinical practice and research. It is also highlighted however, that critical review of the measurements is obligatory, due to a 10% segmentation error rate.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241295563"},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631831","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":"Multidisciplinary Approach to Direct Segmental Artery Revascularization to Prevent Spinal Cord Ischemia Associated With Endovascular Thoracoabdominal Aortic Repair.","authors":"Anand V Ganapathy, Alexander D DiBartolomeo, William J Mack, Gregory A Magee, Nadiya Atai, Joseph N Carey, Jonathan J Russin, Sukgu M Han","doi":"10.1177/15266028241294216","DOIUrl":"https://doi.org/10.1177/15266028241294216","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;Despite advances in complex endovascular aortic repair techniques, spinal cord ischemia (SCI) remains a devastating complication following endovascular thoracoabdominal aortic repairs. Novel strategies to preserve key intercostal/lumbar arteries have been described. We report our early results of patients who underwent direct intercostal/lumbar artery revascularization using endovascular incorporation of fenestrations/branches or extra-anatomic approaches for fenestrated-branched endovascular aortic repairs (FBEVARs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;A retrospective review of consecutive patients who underwent FBEVAR with intercostal/lumbar artery revascularization from 2018 to 2022 was performed. Patient characteristics, intraoperative details, and outcomes including SCI and branch occlusions were evaluated.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Among 317 patients who underwent FBEVAR during the study period, 12 patients were included. Aortic pathologies consisted of degenerative aneurysms (33%), postdissection aneurysms (33%), extensive penetrating aortic ulcers with intramural hematoma (25%), and visceral patch pseudoaneurysm (8%). Full thoracoabdominal coverage was required in 8 patients and supraceliac coverage &gt;10 cm was required in 4. Nine patients received endovascular incorporation, including directional branches (5/9), unstented fenestrations (2/9), and stented fenestration (2/9). Three patients received extra-anatomic subcutaneous femoral-to-radicular artery bypass using a composite graft of polytetrafluoroethylene (PTFE) and venous conduit. Our institutional SCI prevention protocol, consisting of prophylactic cerebral spinal fluid drain (CSFD) for high-risk patients, hemodynamic augmentation, and oxygen supplementation, was followed. Prophylactic CSFD was placed in 9 patients. One patient had unsuccessful drain placement attempts. The other 2 patients had previous unsuccessful attempts at CSFD placement. Median number of target vessels for FBEVAR was 4 with fluoroscopy time 66±31 minutes, contrast usage 109±51 ml. There were no in-hospital mortalities. Tarlov grade II SCI (ASIA grade D) were seen in 2 patients (1 endovascular and 1 extra-anatomic bypass), which resolved before discharge. At mean follow-up of 472±447 days, 3 patients had thrombosed intercostal/lumbar branches (1 extra-anatomic bypass and 2 endovascular branches) with no new SCI symptoms.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In patients at high risk for SCI undergoing FBEVAR, direct revascularization of an intercostal or lumbar artery is feasible using endovascular or extra-anatomic bypass approach. Further studies are planned to identify key contributing segmental arteries and optimization of revascularization strategies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical impact: &lt;/strong&gt;This study demonstrates the feasibility of Endovascular and extra-anatomic bypass to preserve segmental artery flow, aimed at reducing the risk of spinal cord ischemia during e","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241294216"},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631893","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":"Dynamic Morphology of Dilated Ascending Aorta and its Implications for Proximal Landing During Thoracic Endovascular Aortic Repair.","authors":"Denis Skrypnik, Moritz S Bischoff, Katrin Meisenbacher, Matthias Hagedorn, Samuel Kilian, Fabian Rengier, Florian Andre, Dittmar Böckler, Henning Steen","doi":"10.1177/15266028241292462","DOIUrl":"https://doi.org/10.1177/15266028241292462","url":null,"abstract":"<p><strong>Introduction: </strong>To improve the outcomes of thoracic endovascular aortic repair (TEVAR), we investigated the dynamic morphology of dilated and nondilated ascending aortas (AAs) to determine whether an appropriate proximal landing zone for TEVAR exists if the middle AA is dilated.</p><p><strong>Materials and methods: </strong>Patients with dilated (diameter 40-50 mm) and nondilated (<40 mm) AAs underwent electrocardiogram-gated computed tomography angiography of the entire AA in the systolic and diastolic phases. For each plane of each AA segment, the maximal and minimal diameters in systole and diastole were recorded.</p><p><strong>Results: </strong>A total of 105 patients were enrolled (54% male; median age: 80 years [IQR 78-85]). A total of 35 patients were included in the dilated AA group (DG), and 70 patients were included in the nondilated AA group (n-DG). The aortic planes of the AA segment at the sinotubular junction (STJ) showed a more oval-shaped morphology compared with the distal planes of the same segment (the differences between the maximum and minimum diameters were 8.9% to 9.4% and 4.8% to 5.6%, respectively). If the mid-ascending aorta was dilated, the aortic segment at the STJ showed a more pronounced reversed-funnel 3D morphology, with a 14% (IQR 11%-19%) difference in diameters between the proximal and distal segmental planes shown in the n-DG and 18% (IQR 16%-22%, p<0.001) in the DG.</p><p><strong>Conclusion: </strong>If the middle AA is dilated, it is considered unsuitable to perform TEVAR using conventional endografts without additional proximal fixation in the aortic segment at the STJ due to its pronounced reversed-funnel segmental morphology. By contrast, the aortic segment at the brachiocephalic trunk seems to be promising for performing TEVAR using an endograft of the appropriate size and conformability. Moreover, endograft sizing using the average aortic diameter instead of the maximal AA diameter in an oval-shaped aortic plane morphology should be considered.</p><p><strong>Clinical impact: </strong>If the middle ascending aorta is dilated, it is considered unsuitable to perform TEVAR with a proximal landing in the aortic segment at the sinotubular junction due to its pronounced reversed-funnel segmental morphology and high risk of type Ia endoleak and endograft migration. By contrast, the aortic segment at the brachiocephalic trunk seems to be promising for performing TEVAR due to its moderate funnel morphology using an endograft of appropriate size and conformability.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241292462"},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631827","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":"TIPS, a Trick for Transcaval TEVAR Access.","authors":"Toon Kuypers, Sabrina Houthoofd, Geert Maleux","doi":"10.1177/15266028241293016","DOIUrl":"https://doi.org/10.1177/15266028241293016","url":null,"abstract":"<p><strong>Purpose: </strong>We described an alternative access for thoracic endovascular aortic repair (TEVAR) deployment using a transjugular intrahepatic portosystemic shunt (TIPS) needle for gaining transcaval access to the abdominal aorta.</p><p><strong>Case report: </strong>A 63-year-old man presented with a penetrating atherosclerotic ulcer in the descending aorta. Traditional transfemoral and transaxillary access were not possible. A transcaval access was established using a TIPS needle to puncture from the caval vein to the aorta. Next, the access was gradually upsized until a 22 french large-bore transcaval access was achieved. Afterwards the thoracic endograft was positioned and deployed accustomed. The infrarenal aortocaval fistula was closed with a covered stent.</p><p><strong>Conclusion: </strong>When classic TEVAR access is not possible, transcaval access is a valuable and minimally invasive alternative access. We prefer the use of a TIPS needle for gaining access and use a covered stent for closing the aortic access site when possible instead of using electrified wires nor a transseptal occluder device. Preoperative planning remains key.</p><p><strong>Clinical impact: </strong>We discribe a transcaval access with a TIPS needle and closing of the aortocaval fistula with a covered stent. We are one of fiew reports of transcaval puncturing instead of using an electrified wire and the first using a TIPS needle for gaining transcaval access. We hope this case and our comments help other surgeons, radiologists and patients when they are in need of a transcaval access and contribute to a successful procedure.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241293016"},"PeriodicalIF":1.7,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142631901","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":"Diagnostic Value of Maximal Systolic Acceleration Measurements in the Follow-up of Complex Endovascular Aortic Repair: Illustration of a Concept.","authors":"Siem A Willems, Jeroen J W M Brouwers, Jaap F Hamming, Jan Willem Hinnen, Joost R van der Vorst, Jan van Schaik","doi":"10.1177/15266028241296490","DOIUrl":"https://doi.org/10.1177/15266028241296490","url":null,"abstract":"<p><strong>Purpose: </strong>After complex endovascular aortic repair (cEVAR), long-term surveillance is advocated to monitor for potential (stent-related) complications. Although various imaging modalities are used, computed tomography angiography remains the standard in current clinical practice worldwide. However, radiopaque markers can cause metal artifacts and scattering, hampering assessment of patency of side branches. The maximal systolic acceleration (ACCmax) is a relatively new duplex ultrasound (DUS) parameter measured distal to a stenosis, avoiding in-stent assessment and scattering. The aim of this article is to illustrate the potential diagnostic utility of the ACCmax after cEVAR and visceral artery stenting in general.</p><p><strong>Technique: </strong>The ACCmax is measured at the maximal slope of the upstroke during the systolic phase in arterial flow. By manually connecting 2 points, a tangent line is created in which the maximal acceleration is automatically calculated and expressed in m/s². A higher value reflects better arterial perfusion proximal to its measurement point. One measurement of a visceral artery takes about 5 minutes.</p><p><strong>Conclusion: </strong>ACC_max measurements can be a useful addition during DUS follow-up after cEVAR or visceral artery stenting, possibly decreasing radiation exposure, nephrotoxicity, and health care costs.</p><p><strong>Clinical impact: </strong>Long-term surveillance after complex endovascular aortic repair (cEVAR) is necessary to monitor for potential (stent-related) complications. Although CTA is the most common modality for imaging, metal artifacts and scattering can hamper the assessment of stent patency. The maximal systolic acceleration (ACCmax) is a duplex ultrasound based parameter that reflects arterial perfusion proximal to its measurement point. Due to its noninvasive nature, it can be a useful addition during follow-up after cEVAR or visceral artery stenting, possibly decreasing radiation exposure, nephrotoxicity and health care costs as well.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241296490"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606938","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 Repair of Aortic Arch Zones 0 to 2 Using Physician-Modified Endografts: A Systematic Review and Meta-Analysis.","authors":"Georgios I Karaolanis, Vladimir Makaloski, Silvan Jungi, Mevlut Celik, Michel J Bosiers, Drosos Kotelis","doi":"10.1177/15266028241292485","DOIUrl":"https://doi.org/10.1177/15266028241292485","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to collect all the available evidence concerning technical success and early and mid-term clinical outcomes of physician-modified endografts (PMEGs) for the treatment of aortic arch pathologies in zones 0 to 2.</p><p><strong>Material and methods: </strong>We performed a systematic review to identify all the eligible studies that reported outcomes to the PMEGs for aortic arch pathologies in zones 0 to 2 and then conducted a qualitative synthesis and meta-analysis of the results. The main outcomes were technical success, mortality, stroke rate, bridging stents' complications, and reintervention rate. We estimated pooled proportions and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>A total of 134 study titles were identified by the initial search strategy, of which 14 (zone 0 n=6; zone 1 n=1; zones 1 t o2: n=7) were considered eligible for inclusion in the meta-analysis. A total of 777 patients (80% male; 62±6 years) were identified among the eligible studies. The pooled technical success for the PMEG in zone 0 was 96.6% (95% CI=93.9%-98.2%), whereas in zones 1 to 2 was 95.9% (95% CI=92.9%-97.6%). The pooled 30-day mortality was 4.6% (95% CI=2.0%-10%) and 4.3% (95% CI=2.2%-8.2%) for zones 0 and 1 to 2, respectively, whereas the prevalence of late mortality was 8.2% (95% CI=4.7%-14%) and 3.4% (95% CI=1.9%-6%). The pooled stoke rate was 3.7% (95% CI=2.1%-6.4%) in zone 0 and 2.7% (95% CI=1.4%-5%) in zones 1 to 2. The early reintervention rate was 3.5% (95% CI=1.5%-8.0%) and 4.2% (95% CI=2.4%-7.2%) for zones 0 and 1 to 2, respectively, whereas during the mean follow-up of 26 months was 8.5% (95% CI=3.0%-21%) and 1.9% (95% CI=0.8%-4.3%). The pooled bridging's stent instability was 3.9% (95% CI=1.1%-12.9%) in zone 0 and 3.2% (95% CI=1.8%-5.8%) in zones 1 to 2.</p><p><strong>Conclusions: </strong>Endovascular repair of aortic arch pathologies using PMEGs seems to present a satisfactory level of technical success and a low mortality rate. To attain clearer conclusions, further research employing randomized controlled trials, longer-term follow-up, and consistent reporting of results is warranted.</p><p><strong>Clinical impact: </strong>This systematic review and meta-analysis of observational studies analyzed the short- and mid-term outcomes of aortic arch aneurysm and/or dissection using physician-modified endografts. It separately examined the outcomes from zones 0 and 1-2 of the aortic arch. Fourteen studies (n=777 patients) were included. Overall technical success rates were 96.6% for zone 0 and 95.9% for zone 1-2. Regarding early mortality and stroke rates, no significant differences were observed, while late mortality was higher in patients in zone 0. The late reintervention rate favored patients treated with PMEGs in zone 1-2. The physician-modified technique appears to be an excellent and rapidly available alternative for the treatment of aortic arch diseases.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241292485"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142606939","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-Prediction Model of Restenosis after Endovascular Treatment for Peripheral Arterial Disease: A Systematic Review and Meta-analysis.","authors":"Xiaoyan Quan, Yang Liu, Huarong Xiong, Pan Song, Dan Wang, Xiaoyu Liu, Qin Chen, Xiaoli Hu, Meihong Shi","doi":"10.1177/15266028241289083","DOIUrl":"https://doi.org/10.1177/15266028241289083","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Peripheral artery disease (PAD) patients after endovascular treatment (EVT) have a relatively high restenosis rate. However, this risk can be mitigated through precise risk assessment and individualized self-management intervention plans. Moreover, the number of predictive models for restenosis risk in PAD patients after EVT is gradually increasing, yet these results of study exhibit certain discrepancies, raising uncertainties regarding the quality and applicability in clinical practice and future research.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to systematically evaluate risk-predictive models for restenosis in patients with PAD after EVT.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A systematic review and meta-analysis of predictive model construction and validation using observational studies was undertaken. The China National Knowledge Infrastructure, China Science and Technology Journal Database, Wanfang Database, SinoMed, PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to January 1, 2024. Two researchers independently conducted literature screening and data extraction, encompassing study design, data sources, outcome definition, sample size, predictive factors, model development, and performance. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used for risk of bias and applicability assessment of the models.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 4275 studies were retrieved, ultimately resulting in the inclusion of 7 articles comprising 7 predictive models for restenosis in PAD patients after EVT, with a restenosis incidence ranging from 21.8% to 39.7%. The total sample size of the included models ranged from 137 to 1578 cases, with logistic regression analysis being the most commonly used modeling method. All models were built using R software. Only 2 models underwent external validation, and the reported area under the curve ranged from 0.728 to 0.864. The summary area-under-the-curve statistic was 0.80 (95% confidence interval [CI], 0.74-0.86), with an approximate prediction interval of 0.80 (95% CI, 0.62-0.91) . The number of included predictive factors ranged from 3 to 10, with the most common factors being age, Trans-Atlantic Inter-Society Consensus Ⅱ classification, hypertension, diabetes, high-sensitivity C-reactive protein, and surgical approach. All studies exhibited high risk of bias, primarily attributed to inappropriate sources of data and poor reporting of the analysis domain.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Predictive models for restenosis after EVT in PAD patients demonstrate overall good predictive performance but are still in the developmental stage with higher risk of bias. Future studies should follow the TRIPOD statement, focusing on the development of new models with larger samples, rigorous study designs, and multicenter external validation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical impact: &lt;/strong&gt;This systematic review adheres","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241289083"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607047","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":"Real-World Performance of Excimer Laser Ablation Combined with Drug-Coated Balloon Versus Drug-Coated Balloon for the Treatment of Femoropopliteal In-Stent Restenosis Disease.","authors":"Hui Wang, Sensen Wu, Dikang Pan, Yachan Ning, Chun Sun, Jianming Guo, JinLan Jiang, Yongquan Gu","doi":"10.1177/15266028241288778","DOIUrl":"https://doi.org/10.1177/15266028241288778","url":null,"abstract":"<p><strong>Background: </strong>This study aims to assess the effectiveness and identify the risk factors associated with postoperative restenosis in patients with femoropopliteal in-stent restenosis (FP-ISR) disease treated with excimer laser ablation (ELA) combined with drug-coated balloon (DCB) versus DCB alone.</p><p><strong>Methods: </strong>This retrospective real-world study compares patients with FP-ISR treated with ELA + DCB versus DCB alone. Additionally, subgroup analysis was conducted for long-segment lesions (lesion length ≥200 mm) and Tosaka III lesions. Then Cox regression analysis was used to examine 24-month outcomes of target lesion revascularization and restenosis.</p><p><strong>Results: </strong>We found no significant differences in primary patency and freedom from clinically driven target lesion revascularization (CD-TLR) at 24 months between the ELA + DCB group (49 patients) and the DCB group (82 patients). In the subgroup analysis of long-segment lesions (target lesion length ≥200 mm), the results showed that ELA + DCB was superior to DCB at 24 months in terms of both primary patency (55.0% vs 35.3%; <i>P</i> = 0.048) and freedom from CD-TLR (77.8% vs 50.8%; <i>P</i> = 0.033). The 2 treatment methods did not show statistical significance in the subgroup analysis of Tosaka III patients. Target lesion length of ≥200 mm was found to have a significant association with restenosis (hazard ratio = 5.28; 95% CI, 2.48-11.23; <i>P</i> < 0.001) and freedom from CD-TLR (hazard ratio = 3.02; 95% CI, 1.02-9.30; <i>P</i> = 0.044) in the multivariate analysis.</p><p><strong>Conclusions: </strong>We do not have sufficient evidence to show a significant difference between ELA + DCB and DCB alone for FP-ISR. However, for patients with long-segment FP-ISR lesions, ELA + DCB may provide better long-term patency.</p><p><strong>Clinical impact: </strong>Our results suggest that for patients with long-segment (≥200 mm) FP-ISR, the efficacy of ELA combined with DCB may be superior to that of DCB alone. For patients with FP-ISR <200 mm, DCB alone may achieve satisfactory efficacy, thus reducing the medical burden on patients and allowing for the selection of more appropriate treatment options for different types of lesions.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241288778"},"PeriodicalIF":1.7,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607046","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":"Local Morphologic and Hemodynamic Analyses for the Prediction of Abdominal Aortic Aneurysm Rupture Based on Patient-Specific CTA and Computational Modeling.","authors":"Jian Wang, Bing Chen, Zhixuan Bai, Tingting Yang, Fan Gao","doi":"10.1177/15266028241285130","DOIUrl":"10.1177/15266028241285130","url":null,"abstract":"<p><strong>Objective: </strong>Extensive research has focused on the evaluation of rupture risks in abdominal aortic aneurysms (AAAs) through comprehensive morphologic and hemodynamic analyses, primarily considering the AAA as a whole entity. This study tried to identify the high-risk rupture sites of AAAs more precisely before the fatal process based on morphologic and hemodynamic analyses at the local segment.</p><p><strong>Methods: </strong>Computed tomography angiography of a specific AAA patient was conducted at the follow-up 4 months before rupture, 1 day before rupture, the day of the rupture, and 15 days after endovascular aortic repair. The evolution of local morphology and the hemodynamic characteristics at these critical timepoints were investigated based on patient-specific reconstructions and computational fluid dynamics.</p><p><strong>Results: </strong>The morphologic and hemodynamic parameters of the rupture region vary continuously in the process of AAA development and rupture. The surface area and volume of the rupture segment were gradually enlarged at the follow-up 4 months before rupture (47.33 cm²; 67.35 mL), 1 day before rupture (57.23 cm²; 85.24 mL), and on the day of the rupture (62.41cm²; 104.73ml). A prominent decrease in time-averaged wall shear stress and velocity for the rupture segment is observed. The percentages of the lowest time-averaged wall shear stress (<0.1 Pa) area are increased in the AAA region (20.42%, 33.85%, and 53.00%, separately).</p><p><strong>Conclusions: </strong>The results based on precisely rebuilt geometries for the complete follow-ups of patient-specific computed tomography angiography demonstrate that notable morphologic and hemodynamic evolutions have occurred in the local segment of the AAA, which was further proved at the rupture site. The significant changes occurring at the local segment may provide valuable information for the evaluation of aneurysm rupture risk and locate the most probable site of rupture.</p><p><strong>Clinical impact: </strong>Capturing the entire process of AAA rupture through CTA imaging is a rare occurrence in clinical practice. The evolution of morphology and hemodynamic characteristics observed in the illustrated results provides valuable insights for clinicians to monitor the state of AAA from a different perspective. These findings suggest that variations in morphology and hemodynamics within the local segment of the AAA might serve as an alternative approach for predicting the rupture risk of AAA.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241285130"},"PeriodicalIF":1.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584735","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 Application of DynaCT in the Study of Vascular Neointimal Hyperplasia Characteristics after Option Filter Placement.","authors":"Rui An, Yandong Cai, Tianyi Zhu, Ruijiao Gao, Yanrong Zhang, Liang Li, Pengkai Cao, Xiangdong Liu, Yunsong Li","doi":"10.1177/15266028241290467","DOIUrl":"https://doi.org/10.1177/15266028241290467","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to analyze neointimal hyperplasia of the inferior vena cava (IVC) after Option filter implantation by DynaCT and to provide a reference for the safety of effective neointimal hyperplasia cutting after long retrieval window filter implantation in vivo.</p><p><strong>Methods: </strong>Clinical data on 22 patients with Option filters were retrospectively analyzed. DynaCT was used to analyze the characteristics of neointimal hyperplasia after filter implantation, including the distribution of neointimal hyperplasia and the maximum thickness of the neointimal hyperplasia. Correlation analysis was performed between the measurement results and the number of times the inner membrane of the filter was cut during filter retrieval, and correlation analysis also was performed between the measurement results and the time of filter placement.</p><p><strong>Results: </strong>As measured by DynaCT, the neointimal hyperplasia after filter placement was located around the barbs of the filter plug, and the maximum neointimal hyperplasia thickness was located in the 1 to 5 points of the IVC. There was a linear trend between neointimal hyperplasia thickness of the IVC and filter neointimal cutting times by the retrieval catheter after filter placement. Correlation analysis showed a correlation coefficient of <i>r</i> = 0.609 (<i>P</i> = 0.003), indicating a significant correlation between the two. There also was a linear trend between neointimal hyperplasia thickness and implantation time. Correlation analysis showed that the correlation coefficient was <i>r</i> = 0.36 (<i>P</i> = 0.102), and the correlation between the two was not significant.</p><p><strong>Conclusion: </strong>Based on DynaCT, the characteristics of IVC neointimal hyperplasia after Option filter implantation were analyzed, and the cutting force and direction of neointimal hyperplasia could be controlled effectively and safely by changing the filter retrieval catheter.</p><p><strong>Clinical impact: </strong>we can effectively and safely cut the hyperplastic intima by modifying the filter retrieval catheter to control the cutting force and direction and provide a reference for the safe and effective retrieval of the long-retrieval-time window filter after implantation in the body.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241290467"},"PeriodicalIF":1.7,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584733","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}