Journal of Endovascular Therapy最新文献

{"title":"Randomized Prospective Comparative Study of Mechanical Thrombectomy by Rotarex® Device Versus Catheter-Directed Thrombolysis in the Management of Acute Thrombotic Lower Limb Ischemia Without Motor Deficit.","authors":"Sherif O Elkerdawi, Mostafa S Abdelbary, Mohamed A Rizk, Hossameldin Ibrahim, Karim El-Awady","doi":"10.1177/15266028251363509","DOIUrl":"https://doi.org/10.1177/15266028251363509","url":null,"abstract":"<p><strong>Background: </strong>Acute limb ischemia (ALI) is a serious condition leading to amputation and mortality.</p><p><strong>Patients and methods: </strong>This prospective randomized study included 50 patients with thrombotic ALI treated at 2 hospitals between September 1, 2021, and August 31, 2023. Patients were randomly assigned using a double-blind method into Group A (<i>n</i> = 25), treated with percutaneous mechanical thrombectomy (PMT), and Group B (<i>n</i> = 25), receiving catheter-directed thrombolysis (CDT).</p><p><strong>Results: </strong>The mean age was 67.16 ± 9.56 years in Group A and 56.88 ± 11.38 years in Group B (<i>P</i> = .001), though gender distribution was comparable. Diabetes mellitus (DM) was the most prevalent risk factor (88% in Group A, 72% in Group B), followed by hypertension (68%) in Group A and smoking (56%) in Group B, with no significant differences between groups. Superficial femoral artery and popliteal artery occlusions were the most common findings (68% and 56% in Group A, 72% and 68% in Group B). Retrograde contralateral femoral access was used in 60% of Group A and 56% of Group B. The technical success rate showed a tendency to be higher but did not reach statistical significance in Group A (96%) than in Group B (80%). Perioperative complications occurred in 8% of patients in both groups, with Group A experiencing 1 vessel perforation and 1 distal embolization, while Group B had 1 intracranial hemorrhage and 1 pseudoaneurysm. The 30-day mortality rate was 0% in Group A and 8% in Group B (not statistically significant). Primary patency rates at 1 month were 84.0% in Group A and 81% in Group B, decreasing to 62.5% and 55.6% at 1 year, respectively. Group A had 1 below-knee amputation and no above-knee amputations, whereas Group B had 2 below-knee and 3 above-knee amputations.</p><p><strong>Conclusion: </strong>PMT appeared to have a tendency toward higher technical success and lower amputation rates, with a safety profile similar to CDT, though these differences were not statistically significant. Its single-session approach and potential for reduced bleeding risk might offer some advantages, while CDT generally requires prolonged infusion.Clinical ImpactThis randomized study suggests that percutaneous mechanical thrombectomy (PMT) using the Rotarex®️ device may offer advantages over catheter-directed thrombolysis (CDT) in selected patients with acute thrombotic lower limb ischemia without motor deficit. PMT achieved rapid revascularization in a single session with a tendency toward higher technical success and fewer amputations, while maintaining a safety profile comparable to CDT. By potentially reducing treatment time, bleeding risk, and the need for intensive monitoring, PMT could represent a valuable addition to current endovascular practice. Larger multicenter studies with longer follow-up are warranted to confirm these findings and guide future clinical adoption.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363509"},"PeriodicalIF":1.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976887","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 CLTI Paradigm Shift: Implications for Clinical Trial Design and Endpoints in Endovascular Management of Infrapopliteal Disease.","authors":"Jihad A Mustapha, Rita Jacob, Larry E Miller, Constantino S Pena, Amjad AlMahameed, Eric J Dippel, Robert E Beasley, Bret N Wiechmann","doi":"10.1177/15266028251363541","DOIUrl":"https://doi.org/10.1177/15266028251363541","url":null,"abstract":"<p><p>The evolution from critical limb ischemia to chronic limb-threatening ischemia (CLTI) necessitates a reevaluation of clinical trial endpoints. Traditional measures like hemodynamic indices and lesion patency inadequately reflect CLTI complexity or patient-centered outcomes. This article explores the limitations of conventional endpoints and proposes a modified definition of clinically-driven target lesion (TL) revascularization (CD-TLR) that addresses inflow, TL, and outflow disease. By incorporating a more comprehensive assessment of vascular health and prioritizing patient-relevant outcomes, this modified CD-TLR definition may better reflect modern CLTI management strategies and improve clinical relevance of trial results in this challenging patient population.Clinical ImpactThe evolution from CLI to CLTI requires reassessing how we measure treatment success in clinical trials. This review identifies why traditional endpoints like hemodynamic indices, lesion patency, and CD-TLR may not adequately inform clinical decision-making. The importance of measuring outcomes that directly impact patient quality of life will help clinicians better evaluate and apply clinical trial results. An emphasis on limb salvage, wound healing, and functional outcomes, rather than surrogate endpoints alone, will lead to more informed treatment decisions and improved CLTI management strategies.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363541"},"PeriodicalIF":1.5,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977019","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":"Respiration-Induced Displacements of Abdominal Aortic Branches-An MRI Study.","authors":"Hossam I Shaabi, Nicla Settembre, Jacques Felblinger, Maya Delbany, Damien Mandry, Serguei Malikov","doi":"10.1177/15266028251363487","DOIUrl":"https://doi.org/10.1177/15266028251363487","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Introduction:&lt;/b&gt; The endovascular surgical approach provides a minimally invasive treatment of abdominal aortic aneurysms with less perioperative morbidity. This technique depends heavily on imaging to diagnose, plan surgical treatment, conduct the surgical procedure, and follow-up with patients. Image fusion technique was proposed to decrease radiation and injected contrast exposure; however, the accuracy of image fusion still needs to be improved. One of the major causes of this inaccuracy is the displacement of visceral arteries during respiration. &lt;b&gt;Objective:&lt;/b&gt; To analyze the physiological respiration-induced movements of the abdominal aortic side branches. &lt;b&gt;Materials and Methods:&lt;/b&gt; Thirty healthy volunteers were studied using noncontrast-enhanced MRI. Images were acquired in expiratory and inspiratory forced breath-holds. The displacements were studied by calculating 3-dimensional expiration-inspiration vectors of measured points; diaphragmatic domes, origins of the celiac trunk (CTA), superior mesenteric artery (SMA), right renal artery (RRA), and left renal artery (LRA) as well as the kidneys hila. &lt;b&gt;Results:&lt;/b&gt; For all measured points, the superior-inferior displacements were the most important component of movement vectors, and they were statistically significant. The right hemidiaphragm moved by 33.35 mm &lt;i&gt;P&lt;/i&gt; &lt; .001, the left hemidiaphragm by 32.4 mm &lt;i&gt;P&lt;/i&gt; &lt; .001, the right kidney moved by 19.56 mm &lt;i&gt;P&lt;/i&gt; &lt; .001, the left kidney moved by 23.64 mm &lt;i&gt;P&lt;/i&gt; &lt; .001, the origin of CTA moved by 3.41 mm &lt;i&gt;P&lt;/i&gt; &lt; .001, the origin of SMA moved by 3.54 mm &lt;i&gt;P&lt;/i&gt; &lt; .001, the origin of RRA moved by 3.03 mm &lt;i&gt;P&lt;/i&gt; &lt; .001, and the origin of moved LRA by 3.17 mm &lt;i&gt;P&lt;/i&gt; &lt; .001. &lt;b&gt;Conclusion:&lt;/b&gt; We found significant displacements of abdominal aortic branches from forced expiratory to forced inspiratory position. There is a positive correlation between diaphragmatic movement and all visceral arteries orifices displacements; however, this correlation is not high enough to be relayed upon for image fusion correction. Considering only the level of diaphragm to predict the level of abdominal branches origins is insufficient to correct image fusion inaccuracy. We suggest using a dynamic preoperative study as fusion model. Finally, this analysis protocol should be reapplied to a sample of patients with abdominal aneurysm to evaluate respiration-induced movements of the abdominal aortic side branches in pathological condition.Clinical ImpactAlthough it is known that visceral arteries move with respiration, the specific patterns and influencing factors remain unclear. No large-scale studies have quantified this motion under physiological conditions, and current understanding relies mainly on anatomical assumptions rather than detailed evidence.Understanding and predicting this movement has clear clinical implications. Accurate characterization of respiratory-induced arterial motion could improve image registration and fusi","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363487"},"PeriodicalIF":1.5,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976944","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 Predictive Value of the Peripheral Arterial Calcium Scoring System on Computed Tomography Angiography in Patients With Chronic Limb-Threatening Ischemia Undergoing Below-the-Knee Endovascular Interventions.","authors":"Michael J Nugteren, Çağdaş Ünlü, Olaf J Bakker, Koen M van de Luijtgaarden, Morsal Samim, Hester J Scheffer, Gert J de Borst, Constantijn E V B Hazenberg","doi":"10.1177/15266028251363475","DOIUrl":"https://doi.org/10.1177/15266028251363475","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Endovascular below-the-knee (BTK) revascularization is safe and effective in patients with chronic limb-threatening ischemia (CLTI), but outcomes depend on the severity of limb ischemia, anatomical pattern, comorbidity, and degree of vessel calcification. The most commonly used peripheral calcification score, the peripheral arterial calcium scoring system (PACSS), is angiography based and is therefore limited by low sensitivity and interobserver agreement. This study aimed to determine the prognostic value of the original and a modified PACSS (mPACSS) based on computed tomography angiography (CTA) imaging on short-term outcomes after BTK endovascular interventions.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;All consecutive patients included in the prospective Dutch Chronic Lower Limb-Threatening Ischemia Registry (THRILLER) between February 2021 and July 2023 who underwent CTA imaging within 6 months before the procedure were included. The mPACSS also takes calcification of the entire target vessel into account. Primary outcomes were limb salvage and amputation-free survival (AFS) at 3 months. Secondary outcomes were technical success, primary patency, and overall survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In total, 419 patients with 473 limbs were included (mean age 74.1 ± 10.2 years; 71.1% male). PACSS 4 was present in 39.7% of the limbs and associated with higher age and higher rates of hypertension, diabetes mellitus, cardiovascular morbidity, wound, ischemia, foot infection stage, global limb anatomic staging system stage and use of stents. In multivariable analysis, PACSS 4 was significantly associated with lower limb salvage (hazard ratio [HR] 2.75, 95% confidence intervals [CI] 1.49-5.08, &lt;i&gt;P&lt;/i&gt; = .001) and AFS (HR 1.64, 95% CI 1.07-2.53, &lt;i&gt;P&lt;/i&gt; = .025), as was mPACSS ≥5 (limb salvage: HR 2.22, 95% CI 1.88-5.46, &lt;i&gt;P&lt;/i&gt; = .015; AFS: HR 1.68, 95% CI 1.06-2.65, &lt;i&gt;P&lt;/i&gt; = .026). No significant differences were found in terms of technical success, primary patency, and overall survival.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Both PACSS and mPACSS scored on CTA imaging are significantly associated with 3-month limb salvage and AFS after BTK endovascular interventions.Clinical ImpactCurrent peripheral calcification scores are based on angiography and limited by a low sensitivity and minimal interobserver agreement. Scoring the original and modified peripheral arterial calcium scoring system (mPACSS) on computed tomography angiography (CTA) has proven to be more reliable and fast. Accordingly, this study shows that both PACSS and mPACSS scored on CTA are independent predictors of 3-month outcomes after below-the-knee interventions. This reinforces the importance of using a reliable peripheral calcification score in the preoperative assessment of CLTI patients eligible for revascularization. Future evaluations in larger cohorts with longer follow-up should investigate the PACSS and mPACSS in different clinical","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363475"},"PeriodicalIF":1.5,"publicationDate":"2025-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977042","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 Wharton's Jelly Mesenchymal Stem Cells in Critical Limb Ischemia.","authors":"Hao Liang, Bin Zhao, Yuanyuan Ren, Peng Li, Xiangchen Dai","doi":"10.1177/15266028251361770","DOIUrl":"https://doi.org/10.1177/15266028251361770","url":null,"abstract":"<p><p>Peripheral artery disease (PAD) is a chronic vascular condition, and patients in the advanced stages typically do not respond favorably to interventional or surgical approaches. Recent advancements in Wharton's jelly-derived mesenchymal stem cells (WJ-MSCs) fundamental research have produced promising data in the context of PAD management. As recent pilot studies have suggested WJ-MSCs efficacy in patients with end-stage PAD who lack alternative treatment option, WJ-MSCs may offer a novel therapeutic strategy for managing end-stage PAD. The abundance, ease of isolation, and absence of ethical concerns associated with WJ-MSCs facilitate their potential clinical use. However, randomized, appropriately powered clinical trials are necessary to comprehensively assess their safety and effectiveness. This review aims to summarize the molecular and cellular mechanisms underlying the emerging role of WJ-MSCs in critical limb ischemia.Clinical ImpactThis review establishes Wharton's Jelly MSCs (WJ-MSCs) as a paradigm-shifting therapy for end-stage critical limb ischemia (CLI).This review pioneers a translational roadmap for WJ-MSCs in CLI by integrating molecular mechanisms, preclinical models, and clinical outcomes. It uniquely identifies anatomic sourcing heterogeneity as a critical efficacy variable and proposes combination therapy with revascularization.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251361770"},"PeriodicalIF":1.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976786","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":"Aortic Compliance: A Narrative Review.","authors":"Rajan A Ramdev, Andrew Matar, Carlos A Valdes, Shivam Patel, Bethelhem Tadesse, Marcelah I Chen, Meisam Asgari, Dean J Arnaoutakis, Jean Bismuth","doi":"10.1177/15266028251363468","DOIUrl":"https://doi.org/10.1177/15266028251363468","url":null,"abstract":"<p><p>Aortic compliance, the ability of the aorta to expand and recoil with each cardiac cycle, plays a crucial role in cardiovascular function and health. The present review explores the physiology of aortic compliance, evolution of various modalities and techniques to evaluate arterial stiffness, factors influencing compliance, and the clinical implications of aortic compliance when performing interventions on the aorta.Clinical ImpactA comprehensive understanding of endovascular approaches to the ascending aorta, including the aortic arch, is fundamental to evaluating the ongoing evolution of device technology and its integration with contemporary surgical strategies.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363468"},"PeriodicalIF":1.5,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976770","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":"Outcome of Embolization of an Endoleak Type 2 After Placement of an Endoprosthesis for an Infrarenal Aorta Aneurysm.","authors":"Mattice Steenbeke, Nathalie Moreels, Frank Vermassen, Peter Vanlangenhove, Laurens Hermie, Elisabeth Dhondt, Lynn Huyck, Luc Defreyne","doi":"10.1177/15266028251363477","DOIUrl":"https://doi.org/10.1177/15266028251363477","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to investigate the effect of transarterial (TA) and translumbar (TL) embolization of a type 2 endoleak (T2EL) after endovascular aneurysm repair (EVAR) of an infrarenal abdominal aortic aneurysm (AAA) on the evolution and rupture of the aneurysmal sac.</p><p><strong>Methods: </strong>A retrospective study was conducted including patients who underwent TA or TL embolization for a growing T2EL after EVAR from April 2001 to August 2022. Demographic data, used endograft, radiological data of the AAA and T2EL, embolization agents, techniques (TA or TL approach), and angiographical outcomes were collected from 48 patients with a total of 58 embolizations. The primary clinical outcome was rupture of the AAA. Secondary outcomes included T2EL recurrence, re-embolization of T2EL, aneurysm sac growth (≥5 mm), and mortality. Clinical success was defined as the absence of a 5 mm or greater increase in the aneurysm sac diameter.</p><p><strong>Results: </strong>After primary T2EL embolizations, an increase in aneurysm sac was seen in 56.5% (n = 26), stability in 30.4% (n = 14), and regression in 13.0% (n = 6). Recurrence of T2EL had a significant impact on clinical success. No difference in sac size or evolution after the TA and TL embolization was noted. Rupture was found in 4 patients, but in only 1 patient it was caused by an isolated T2EL. The effect of increase in aneurysm sac size on overall survival was not statistically significant. Additionally, no associations were observed between the outcome and clinical factors including gender, obesity, chronic obstructive pulmonary disease, diabetes, hypertension, hypercholesterolemia, smoking, technique, used embolic agents, and time from endoleak onset to embolization.</p><p><strong>Conclusion: </strong>In this retrospective study, 1 AAA rupture was attributable to an isolated T2EL out of 48 patients, with a clinical success rate of 43.5%.Clinical ImpactAlthough the impact of a type 2 endoleak (T2EL) on the outcome of an endovascular repaired abdominal aortic aneurysm is not yet clarified, in daily practice, the endovascular embolization is considered as a safe and effective option. Elimination or reduction of the volume of the endoleak can be obtained and can probably prevent aortic rupture, which is reassuring for the treating physician and the patient. The embolization of the T2EL reduces the need for extra imaging or hospitalizations, lowers the risk of complications and minimizes healthcare costs. This study contributes to the knowledge and treatment of T2EL, supporting clinicians in making better informed decisions, ultimately optimizing patient care. Moreover, this research found no outcome differences between the embolization techniques.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363477"},"PeriodicalIF":1.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144976928","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 Endovascular Therapy Using Excimer Laser Atherectomy for Complex Femoropopliteal In-Stent Restenosis Lesions.","authors":"Kazunori Horie, Mitsuyoshi Takahara, Shin Takiuchi, Shin Okamoto, Naoki Yoshioka, Nobuhito Kaneko, Kenji Ogata, Yoshiaki Shintani, Takuya Haraguchi, Kuniyasu Ikeoka, Tomoko Kobayashi, Kenji Suzuki, Kuniyoshi Fukai, Yuki Shima, Masahiro Iiya, Norio Tada, Osamu Iida","doi":"10.1177/15266028251363466","DOIUrl":"https://doi.org/10.1177/15266028251363466","url":null,"abstract":"<p><strong>Purpose: </strong>The guidelines recommend excimer laser atherectomy (ELA) for in-stent restenosis (ISR) lesions in femoropopliteal arteries. However, its efficacy is still unknown in ISR related to scaffolds other than bare-metal stent (BMS). This study aimed to evaluate the 1-year clinical outcomes in patients with femoropopliteal ISR lesions treated with endovascular therapy (EVT) using ELA.</p><p><strong>Materials and methods: </strong>This retrospective multicenter registry analyzed patients who presented with peripheral artery disease caused by femoropopliteal ISR lesions undergoing EVT with ELA between 2020 and 2024. The primary outcome was re-restenosis 1-year following EVT.</p><p><strong>Results: </strong>Overall, consecutive 166 patients with femoropopliteal ISR lesions were enrolled. The rates of in-stent occlusion and ISR related to scaffolds other than BMS were found in 88.6% and 52.4% of the lesions, respectively. Technical success was achieved in 83.7%. The 1-year Kaplan-Meier estimate of freedom from re-restenosis was 67.6% (95% confidence interval [CI] 60.0-75.5). The primary-assisted patency and secondary patency rate was 72.7% (95% CI 65.8-80.3) and 81.5% (95% CI 76.6-88.0), respectively. In the multivariate analysis, slow flow observed in the completion angiography of EVT (adjusted hazard ratio, 2.32; <i>P</i> = .024) and chronic renal failure requiring dialysis (1.72; <i>P</i> = .036) were independently associated with re-restenosis risk. The accumulation of these factors was associated with a lower rate of freedom from re-restenosis; Kaplan-Meier estimates of the rates were 46.6% in subgroups with 1 or 2 risk factors, whereas it was 77.8% in the absence of risk factors. The Kaplan-Meier estimate shows a comparable primary patency rate between ISR related to BMS and drug-eluting stent at 1 year.</p><p><strong>Conclusion: </strong>ELA provided acceptable technical success in current femoropopliteal ISR lesions; however, the long-term result was clinically suboptimal.Clinical ImpactThis retrospective multicenter registry enrolled 166 patients with in-stent restenosis/in-stent occlusion lesions in femoropopliteal arteries treated with endovascular therapy using excimer laser atherectomy. The technical success rate was acceptable at 83.7%; however, 1-year estimate of freedom from restenosis was clinically suboptimal at 67.6%. The multivariate analysis showed incomplete antegrade blood flow and dialysis-dependent chronic renal failure were independently associated with re-restenosis risk.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363466"},"PeriodicalIF":1.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144977027","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-Coated Balloon Versus Plain Balloon Angioplasty for the Treatment of Dysfunctional Dialysis Access: A Systematic Review and Meta-analysis.","authors":"Qianqian Zhang, Deshuang Zou, Wenqiong Mao, Xing Su, Jingzhen Li","doi":"10.1177/15266028251359499","DOIUrl":"https://doi.org/10.1177/15266028251359499","url":null,"abstract":"<p><strong>Background: </strong>The optimal treatment for dysfunctional dialysis access between drug-coated balloon angioplasty (DCBA) and plain balloon angioplasty (PBA), including standard balloon angioplasty (SBA) and high-pressure balloon angioplasty (HPBA), remains unclear. This study aims to compare the efficacy and safety of DCBA and PBA.</p><p><strong>Materials and methods: </strong>A systematic review was conducted to identify randomized controlled trials (RCTs) comparing DCBA and PBA. Outcomes included target lesion primary patency (TLPP), access circuit primary patency (ACPP), target lesion revascularization (TLR), technical success, and all-cause mortality. A meta-analysis with a priori subgroup analysis (ie, DCBA vs HPBA and DCBA vs SBA) was performed using a random-effects model to calculate risk ratios (RRs) and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Twenty-five RCTs with a total of 2838 patients were included. DCBA showed higher TLPP at 6 months (RR: 1.27, 95% CI: 1.12-1.43, p<0.001) and 12 months (RR: 1.28, 95% CI: 1.13-1.45, p<0.001) than PBA. ACPP was also superior with DCBA at 6 months (RR: 1.25, 95% CI: 1.04-1.40, p=0.002) and 12 months (RR: 1.42, 95% CI: 1.23-1.65, p<0.001). However, no significant difference was found between DCBA and HPBA for TLPP (RR: 1.49, 95% CI: 0.83-2.67, p=0.181) and ACPP (RR: 1.30, 95% CI: 0.92-1.84, p=0.133) at 12 months. TLR was lower with DCBA at 6 months (RR: 0.60, 95% CI: 0.35-0.80, p=0.003) and 12 months (RR: 0.79, 95% CI: 0.68-0.93, p=0.005). No significant difference in the technical success rate and all-cause mortality was observed.</p><p><strong>Conclusions: </strong>DCBA improves TLPP and ACPP and reduces the TLR rate compared to PBA. However, it shows no significant advantage over HPBA in terms of TLPP and ACPP at 12 months. The technical success rate and all-cause mortality were similar between the 2 approaches.Clinical ImpactThis meta-analysis highlights the differential effectiveness of drug-coated balloon angioplasty (DCBA) compared with standard balloon angioplasty (SBA) and high-pressure balloon angioplasty (HPBA) in dysfunctional dialysis access. DCBA significantly improves primary patency and reduces revascularization rates compared to SBA, supporting its clinical utility. However, no clear advantage was found over HPBA at 12 months. These results suggest that while DCBA offers benefits over SBA, its added value over HPBA remains uncertain. Clinicians should consider individual patient factors and access characteristics when selecting the optimal angioplasty strategy.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251359499"},"PeriodicalIF":1.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144856874","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":"Emergency Endovascular Stent Grafting of an Innominate Vein Injury Causing Hemothorax: The Double Balloon on a Single Wire Technique.","authors":"Emanuele Barabino, Lucia Soresini, Francesco Petrocelli, Daniele Bianco, Paolo Di Donna, Giulio Bovio","doi":"10.1177/15266028251363454","DOIUrl":"https://doi.org/10.1177/15266028251363454","url":null,"abstract":"<p><strong>Purpose: </strong>The VIABAHN^® VBX is a versatile stent graft that can be overdilated by up to 30% of its nominal diameter. However, to reach its maximum diameter, the balloon must be exchanged for a larger one. This technical note aims to illustrate a technique designed to enhance accuracy during the deployment and overdilation of a VIABAHN VBX for treating an injury to the left innominate vein (LIV).</p><p><strong>Technique: </strong>Two venous accesses were established in the left arm and in the right femoral vein. Using a rendezvous technique, a hydrophilic guidewire was snared and externalized from the arm. The balloon-expandable stent was advanced through the brachial access, and the larger balloon from the femoral access, both on the same guidewire. The balloon-expandable stent was inflated to its maximum diameter. During the retraction of the first balloon, the larger balloon was then advanced within the stent graft to perform overdilation.</p><p><strong>Results: </strong>The defect in the LIV was sealed-off without stent-graft migration and the patient showed improvement in his clinical condition.</p><p><strong>Conclusion: </strong>The VIABAHN VBX is a valid option for treating injuries to the LIV. The double-balloon on a single wire (double-BLOW) technique may be an advantageous approach to prevent migration and enhance accuracy during deployment.Clinical ImpactThe double-BLOW technique offers improved stability and enhanced precision in deliver stent grafts and it might be useful when a larger balloon is required to perform over dilatation.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028251363454"},"PeriodicalIF":1.5,"publicationDate":"2025-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144805204","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}