Journal of Endovascular Therapy最新文献

{"title":"Patterns of Angiographic Remodeling Following Foot Vein Arterialization.","authors":"Roberto Ferraresi, Alessandro Ucci, Michael C Siah, Daniel A van den Heuvel, Fabrizio Losurdo, Steven Kum","doi":"10.1177/15266028251383413","DOIUrl":"10.1177/15266028251383413","url":null,"abstract":"<p><strong>Objective: </strong>Foot vein arterialization (FVA) in no-option patients with chronic limb-threatening ischemia (CLTI) provides promising rates of limb salvage and wound healing; however, the precise mechanisms underlying tissue perfusion after FVA are not fully understood. In most cases, FVA creates an arterialized circuit confined inside the foot vein fortress (FVF) upon initial completion. Over the following weeks to months, FVA facilitates a process of vascular remodeling leading to tissue perfusion. The primary objective of this study is to describe a novel classification system of the angiographic patterns of vascular remodeling observed in FVA and to hypothesize their pathophysiology and implications for limb salvage.</p><p><strong>Methods: </strong>This is a retrospective observational case series. We included no-option CLTI patients who underwent clinically-successful FVA (defined as achieving limb salvage with complete wound healing) and clinically-driven angiographic studies during follow-up. We identified 6 types of vascular remodeling: type 0, the arterialized circuit is confined inside the FVF; type 1, expansion of the arterialized circuit into venous systems outside the FVF; type 2, wound-related vascular remodeling leading to wound blush (WB); type 3, venous-arterial fistulas recruiting hibernated arterial segments; type 4, self-pruning of venous outflow; and type 5, promotion of collateral vessel growth with reconstitution of a new calf/foot distribution system.</p><p><strong>Results: </strong>Nineteen patients (12 with hybrid, and 7 with totally percutaneous FVA) were evaluated. The acute result of FVA showed a type 0 pattern in 13 patients (68.4%) and type 1 pattern in 6 (31.6%). During follow-up, patients required 43 new clinically-driven angiographic studies (mean 2.3/patient). The average time between initial FVA and subsequent angiographic studies was 164 ± 325.2 days (2-1895). In the 43 follow-up angiograms, the following pattern distribution was observed: type 0 pattern in 5 (11.6%), type 1 in 29 (67.4%), type 2 in 18 (41.9%), type 3 in 10 (23.3%), type 4 in 4 (9.3%), and type 5 in 7 (16.3%).</p><p><strong>Conclusion: </strong>Vascular remodeling after FVA is a complex process involving multiple pathophysiological mechanisms, resulting in various angiographic patterns. Recognizing these patterns may aid clinicians in developing targeted treatments to enhance FVA efficacy and improve clinical outcomes.Clinical ImpactThis study introduces the first classification of angiographic patterns of vascular remodeling following foot vein arterialization (FVA), addressing the significant unpredictability of clinical outcomes despite high technical success in no-option CLTI patients. The primary clinical impact is providing a standardized framework to monitor and interpret the complex FVA maturation process. By recognizing the temporal evolution of these distinct patterns, clinicians can identify patients with suboptimal ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"2621-2632"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145373275","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":"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":"2204-2213"},"PeriodicalIF":1.8,"publicationDate":"2026-10-01","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":"Comparing Manual and Semi-Automatic AI-Based Methods for Aortic Landing Zone Assessment for Endovascular Treatment of Thoracic Aortic Aneurysm.","authors":"Luca Battaglia, Giovanni Spinella, Marco Magliocco, Bianca Pane, Giovanni Pratesi, Ferdinando Auricchio, Michele Conti","doi":"10.1177/15266028261479284","DOIUrl":"https://doi.org/10.1177/15266028261479284","url":null,"abstract":"<p><strong>Purpose: </strong>Accurate assessment of aortic landing zones (LZs) is essential for planning thoracic endovascular aortic repair (TEVAR). Manual measurements, while the clinical standard, are time-consuming and prone to inter-operator variability. This study evaluates the reliability of an artificial intelligence (AI)-based tool for standardized LZ assessment.</p><p><strong>Material and methods: </strong>A retrospective clinical data set of 35 patients was analysed using manual and an AI-assisted methods for evaluating key geometric parameters relevant to TEVAR planning: diameters at the endpoints of the proximal and distal aneurysm (P0, D0) and at the ends of the LZs (P2, D2), conicity indices (TR_P, TR_D), and lengths (L_PLZ, L_DLZ) of the proximal and distal LZs. Agreement was assessed using intraclass correlation coefficients (ICCs). The data set was stratified according to the anatomical zones of Ishimaru (Group A = 0, 1, and 2 and Group B = 3) to evaluate the influence of the anatomical location of the PLZ on the evaluation and the concordance of the method.</p><p><strong>Results: </strong>Artificial intelligence-assisted and manual measurements showed strong agreement, with ICC values consistently >0.75. No significant differences were observed in TR_D between groups (2.2% vs 3.5%, <i>P</i> = .691). However, TR_P showed a trend towards higher proximal conicity in Group A vs Group B (-10.6% vs 0.8%, <i>P</i> = .086), with reduced agreement in Group B (ICC = 0.62).</p><p><strong>Conclusions: </strong>Artificial intelligence-assisted methods showed high concordance with manual measurements for most aortic LZ parameters. However, anatomical complexity, especially near zone 0, can affect agreement, particularly in evaluating aortic neck conicity. These findings highlight the importance of considering anatomical variability when validating AI-assisted tools for clinical planning.Clinical ImpactThis study shows that AI-assisted, centreline-based assessment of aortic landing zones can be integrated into routine TEVAR planning, providing diameters, lengths and conicity indices that agree closely with manual measurements while reducing operator dependency and post-processing time. For clinicians, this translates into faster, standardised and reproducible sizing, less variability between observers and centres, and better-supported decisions on endograft oversizing. The innovation lies in coupling deep-learning segmentation with automated detection of the maximum-area cross-section and of a fixed 25 mm sealing zone along the inner curvature. The reduced agreement observed in anatomically complex arch zones indicates where expert review remains indispensable.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261479284"},"PeriodicalIF":1.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149117700","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":"International European Expert Consensus on the Use of Shockwave Intravascular Lithotripsy in Iliac Arteries: A Modified Delphi Study.","authors":"Athanasios Saratzis, Stefano Fazzini","doi":"10.1177/15266028261489153","DOIUrl":"https://doi.org/10.1177/15266028261489153","url":null,"abstract":"<p><strong>Purpose: </strong>To establish pan-European expert consensus on the use of Shockwave intravascular lithotripsy (IVL) for endovascular treatment of calcified iliac steno-occlusive disease and to develop a pragmatic, expert-derived treatment algorithm.</p><p><strong>Materials and methods: </strong>A modified Delphi process comprised an initial workshop, 2 anonymous online surveys and a final workshop. Experts were purposively identified through professional networks using prespecified procedural-volume and IVL-experience criteria. Round 1 combined closed questions with unrestricted free text; thematic and framework analysis informed refinement, separation or removal of candidate items for round 2. Agreement was reported as the proportion supporting each statement, with consensus defined a priori as ≥70%.</p><p><strong>Results: </strong>Twenty-six experts completed round 1 and 17 completed round 2 (65% retention); reasons for non-participation in round 2 were not collected. Vascular surgeons comprised 65% of the round 1 panel, and approximately 65% of participants practised in Italy. Sixteen final statements achieved 73% to 100% agreement. Key items supported computed tomographic angiography with duplex ultrasound (100%), planned rather than bailout IVL use (100%), calcium burden as the principal determinant (93%), and selective rather than routine intravascular imaging (93%). The final workshop approved the algorithm; item-level agreement is displayed within it.</p><p><strong>Conclusion: </strong>This modified Delphi study provides a structured expert consensus and algorithm for Shockwave IVL in iliac arteries. It is an expert-opinion framework that should complement, not replace, patient-specific clinical judgement, device instructions for use and local guidance, and it requires prospective external validation.Clinical ImpactThis pan-European modified Delphi study reports expert-agreed statements on planned Shockwave IVL use, imaging, technique, adjunctive treatment and follow-up in calcified iliac disease. The algorithm displays the agreement strength for each recommendation and can support structured multidisciplinary decision-making where comparative evidence is limited. It represents expert opinion rather than a guideline. The algorithm should be applied alongside clinical judgement and device instructions for use. The consensus identified calcium definition, comparative IVL effectiveness assessment, and research priorities in this area.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261489153"},"PeriodicalIF":1.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082781","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":"Initial Application of Excimer Laser Atherectomy for Femoropopliteal Thromboangiitis Obliterans: Preliminary Results and Exploratory Comparison With Balloon Angioplasty.","authors":"Lefan Hu, Hui Wang, Hanyu Zhang, Tengfei Wang, Yongquan Gu, Jianming Guo","doi":"10.1177/15266028261487356","DOIUrl":"https://doi.org/10.1177/15266028261487356","url":null,"abstract":"<p><strong>Introduction: </strong>Long-segment femoropopliteal thromboangiitis obliterans (TAO) causes severe limb ischemia and remains challenging to treat, particularly given the poor distal runoff. Evidence regarding excimer laser atherectomy (ELA) for these complex lesions remains limited.</p><p><strong>Materials and methods: </strong>This single-center retrospective study included 50 male patients with Rutherford category 5 TAO and femoropopliteal occlusions treated between January 2016 and October 2024. The primary analysis focused on the ELA-assisted angioplasty cohort (n = 34), while patients treated with balloon angioplasty alone (n = 16) served as an exploratory comparator. Outcomes included technical success, perioperative complications, 12-month freedom from major adverse limb events (f-MALEs), primary patency, ulcer healing, and symptom improvement.</p><p><strong>Results: </strong>In the ELA cohort, technical success was achieved in 97.1% of patients, with no vessel perforation, clinically significant distal embolization, or acute limb ischemia. At 12 months, f-MALE, primary patency, and ulcer healing rates were 61.8%, 52.9%, and 79.4%, respectively. In the exploratory comparison, despite longer femoropopliteal lesions, ELA showed numerically higher f-MALE and primary patency rates than balloon angioplasty alone, although the overall between-group differences were not statistically significant. A post hoc 3-month landmark analysis suggested possible time-dependent separation of the f-MALE curves, but this finding was hypothesis-generating only. Exploratory secondary outcomes also suggested potentially more favorable pain-relief and ulcer-healing patterns with ELA. No clear incremental clinical benefit of drug-coated balloon use was observed in descriptive analyses.</p><p><strong>Conclusion: </strong>In this initial single-center experience, ELA-assisted angioplasty appeared feasible and procedurally safe for Rutherford category 5 femoropopliteal TAO. These encouraging findings support further prospective evaluation in larger cohorts.Clinical ImpactExcimer laser atherectomy (ELA) was associated with a high procedural success rate of 97.1% and no severe intraoperative or perioperative complications in this initial cohort. For clinicians, ELA may represent a feasible endovascular debulking option for selected patients with complex femoropopliteal thromboangiitis obliterans. Single-arm outcomes were encouraging regarding f-MALE, pain relief, and ulcer healing. Exploratory comparisons with percutaneous transluminal angioplasty alone suggested possible favorable clinical patterns, but these findings were not adjusted for multiple comparisons and require confirmation in larger prospective studies.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261487356"},"PeriodicalIF":1.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149082787","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":"Early and Mid-Term Outcomes of Zone 2 Thoracic Endovascular Aortic Repair With Open Left Subclavian Revascularization Versus Zone 2 Thoracic Branch Endoprosthesis.","authors":"Pedro J Furtado Neves, Hamza Hanif, Branson Taheri, Aline H Ishida, Eunsaem Cho, Muhammad Aftab, T Brett Reece, Emily A Malgor, Donald L Jacobs, Muhammad Ali Rana, Rafael D Malgor","doi":"10.1177/15266028261489513","DOIUrl":"https://doi.org/10.1177/15266028261489513","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The Gore TAG Thoracic Branch Endoprosthesis (TBE) was the first commercially available device designed for thoracic aortic repair to offer a fully endovascular alternative to open left subclavian artery (LSA) revascularization. In this study, we compared early and mid-term outcomes of zone 2 thoracic endovascular aortic repair (TEVAR) with open LSA revascularization and zone 2 TBE.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This retrospective analysis was conducted at 2 tertiary referral centers and included all consecutive patients who underwent zone 2 TEVAR with LSA revascularization and zone 2 TBE between 2011 and 2024. Patient characteristics, procedural details, and 1-month and 1-year outcomes were compared across cohorts. Statistical significance was set at &lt;i&gt;P&lt;/i&gt; &lt; .05.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Forty-six patients underwent zone 2 TEVAR with open LSA revascularization (group 1), and 40 patients underwent zone 2 TBE (group 2). The overall median age of the cohort was 67 years, and 66.3% of the patients were male. The mean total operative time and length of stay were significantly shorter in the zone 2 TBE group (144.3 ± 63.7 vs 341.8 ± 106.8 minutes, &lt;i&gt;P&lt;/i&gt; &lt; .001; 2.9 ± 2.1 vs 4.1 ± 2.8 days, &lt;i&gt;P&lt;/i&gt; = .025). Patients who underwent zone 2 TEVAR with LSA revascularization were more likely to experience major adverse events (MAEs) during the perioperative period (32.6% vs 12.5%, &lt;i&gt;P&lt;/i&gt; = .028). The median follow-up time was 37.2 months (interquartile range [IQR], 15.2-75.8) for group 1 and 14.2 months (IQR, 3.7-23.3) for group 2. Kaplan-Meier analyses showed comparable 1-year freedom from all-cause mortality, endoleak, and reintervention between groups. Both groups achieved excellent primary LSA patency rates at 1 year (group 1, 95.3%; group 2, 100%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Zone 2 TBE was associated with reduced perioperative morbidity and similar 1-year outcomes to those of zone 2 TEVAR with open LSA revascularization. These findings show that zone 2 TBE is a feasible option in anatomically suitable patients, with postoperative outcomes and LSA patency through 1 year comparable to zone 2 TEVAR, and is associated with a shorter length of stay. Further long-term investigations are required to validate the sustained safety and durability of TBE repair.Clinical ImpactThis two-center, real-world comparison shows that zone 2 thoracic endovascular aortic repair (TEVAR) with the Gore TAG Thoracic Branch Endoprosthesis (TBE) achieves technical success, left subclavian artery patency, and 1-year freedom from mortality, endoleak, and re-intervention comparable to zone 2 TEVAR with open left subclavian revascularization, while shortening hospital stay and reducing perioperative morbidity by avoiding cervical exposure and its transfusion, nerve, and lymphatic complications. For clinicians, TBE offers an off-the-shelf, percutaneous option for anatomically suitable patients with aneurysmal, dissection-related","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261489513"},"PeriodicalIF":1.8,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070436","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":"Simultaneous Versus Staged Surgery for Concomitant Abdominal Aortic Aneurysm and Gastrointestinal Malignancy: A Systematic Review With Meta-Analysis.","authors":"Aouatif Erasmia El Kanty, Islam Kourampi, Spyridon Giannopoulos, George Triantafyllou, Natasha Hasemaki, Michail Peroulis, Athanasios Katsargyris, Dimitrios Schizas","doi":"10.1177/15266028261487352","DOIUrl":"https://doi.org/10.1177/15266028261487352","url":null,"abstract":"<p><strong>Purposes: </strong>To conduct a systematic review of the literature and perform a meta-analysis to the concurrent occurrence of abdominal aortic aneurysm (AAA) and gastrointestinal (GI) cancer and compare the perioperative and long-term outcomes of simultaneous versus staged treatment strategies.</p><p><strong>Methods: </strong>A systematic review of the current literature from 1992 to 2025 was performed using PubMed, Embase, and Cochrane Central databases to identify studies reporting surgical treatment of patients with concomitant GI cancer and AAA.</p><p><strong>Results: </strong>Thirty-nine (39) articles including 641 patients were detected. Simultaneous surgery was performed in 247 patients, while staged surgery was performed in 394 patients. The average age of patients undergoing simultaneous surgery was 71.8 years (±6.4 years), while those undergoing staged surgery had an average age of 72.2 years (±4.2 years). In the simultaneous surgery group (SSG), 91 patients (36.8%) underwent AAA repair first, with 56 (22.7%) of them being open aortic repair (OAR) and 35 (14.2%) endovascular aneurysm repair (EVAR). The 30-day mortality showed no significant difference between patients treated in 1 or 2 stages. However, the 30-day complication rate was significantly higher in staged surgeries (STG) compared with SSG with an odds ratio of 0.37 (95% CI, 0.20-0.69, <i>P</i> = .011). Moreover, the outcomes did not differ statistically between the EVAR and OAR methods.</p><p><strong>Conclusions: </strong>Simultaneous and staged approaches to the treatment of concomitant AAA and GI cancer showed no significant differences in short- or long-term mortality or disease-related complications. However, staged procedures were associated with a higher 30-day complication rate, suggesting that simultaneous management may be safer in selected patients, particularly with the use of open repair. Prospective multicenter studies are needed to establish clear treatment guidance for this complex patient population.Clinical ImpactPatients presenting with both an abdominal aortic aneurysm and gastrointestinal malignancy require coordinated decisions about the timing and sequence of treatment. This systematic review and meta-analysis aims to optimize the management of this complex population and bring together the available evidence comparing simultaneous and staged approaches. Given the retrospective nature and limited number of comparative studies, the findings should inform individualized, multidisciplinary planning rather than establish a preferred strategy for all patients. Clinicians should consider aneurysm-related risk, cancer urgency, patient fitness, and the potential consequences of delaying either treatment.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261487352"},"PeriodicalIF":1.8,"publicationDate":"2026-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149070423","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":"Methodological Quality and Overlap of Systematic Reviews Comparing Carotid Endarterectomy versus Carotid Artery Stenting in Symptomatic Contralateral Carotid Occlusion: An Overview of Reviews.","authors":"Matheus de Lima Ruffini, Adolfo Moraes de Souza, Enzo Gallardo Gomes, Giovanna Jost Tibolla, Laíse Pauletti Barp, Renno Magalhães Mendonça Vilela, Leonardo Januario Campos Cardoso, Pedro Rodrigues Vidor, Fabiano Reis, Juliana Ávila Duarte","doi":"10.1177/15266028261489512","DOIUrl":"https://doi.org/10.1177/15266028261489512","url":null,"abstract":"<p><strong>Background: </strong>Symptomatic contralateral carotid occlusion (CCO) is considered a high-risk scenario for carotid revascularization, yet the comparative evidence for carotid endarterectomy (CEA) versus carotid artery stenting (CAS) is largely derived from observational data and repeatedly synthesized in systematic reviews. This research aimed to assess reviews appraising the methodological quality of these evidence syntheses and quantify overlap of included primary studies.</p><p><strong>Methods: </strong>PubMed and Embase were searched (June 2025) for systematic reviews and meta-analyses comparing CEA versus CAS in adults with symptomatic CCO or reporting extractable symptomatic CCO subgroup data. Two reviewers independently screened studies, extracted data, and assessed methodological quality using AMSTAR-2. Overlap among primary studies across reviews was evaluated using the corrected covered area (CCA).</p><p><strong>Results: </strong>Nine systematic reviews and meta-analyses (published from 2008 to 2021) derived from 86 unique primary studies were included. Overall confidence in review findings was poor: 8 (88.9%) were rated critically low and 1 (11.1%) low by AMSTAR-2. Major limitations included lack of protocol transparency, incomplete reporting of search strategies, absence of excluded-study lists, and insufficient integration of risk-of-bias assessments into interpretation. Across the 86 unique primary studies, the overall CCA was 16.7%, indicating high overlap in the evidence base. Clinical outcome reporting was heterogeneous and often lacked extracted raw event rates. Across reviews, no consistent, methodologically robust superiority of CEA or CAS was demonstrated.</p><p><strong>Conclusions: </strong>The secondary evidence comparing CEA and CAS in symptomatic CCO is dominated by low-confidence reviews and overlapping assessed evidence from observational cohorts. Future comparative studies and systematic reviews should prioritize standardized outcome reporting, transparent methods, and explicit management of overlapping primary evidence.Clinical ImpactThis overview shows that existing comparisons of CEA versus CAS in symptomatic contralateral carotid occlusion rest on weak, repetitive evidence. Most reviews scored poorly on AMSTAR-2, and the same retrospective studies were reused across multiple reviews, so agreement between them does not mean the findings are truly confirmed. For clinicians, this means current data cannot support choosing one procedure over the other for this high-risk group. Decisions should still be based on the patient's anatomy, surgical risk, and the treating team's experience. Higher-quality, independent studies and more transparent reviews are needed to clarify this question.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261489512"},"PeriodicalIF":1.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041473","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":"Transradial Endovascular Treatment of Acute External Iliac Artery Rupture in Hemorrhagic Shock.","authors":"Shadi Halabi","doi":"10.1177/15266028261484774","DOIUrl":"https://doi.org/10.1177/15266028261484774","url":null,"abstract":"<p><p>Iliac artery rupture is a rare but life-threatening complication of transfemoral vascular procedures that typically requires urgent intervention. Traditional approaches use transfemoral or transbrachial access; however, transradial access may offer a safer alternative in selected patients. We report the case of a 68-year-old man with ST-segment elevation myocardial infarction and shock who underwent primary percutaneous coronary intervention via right radial access with intra-aortic balloon pump (IABP) support through the right femoral artery. Following staged coronary intervention and IABP removal, he developed profound hemorrhagic shock and cardiac arrest, raising suspicion for retroperitoneal hemorrhage secondary to iliac artery injury. A 6-Fr, 119-cm sheath was advanced from the left radial artery to the right common iliac artery, demonstrating active extravasation from the right external iliac artery. A 7 × 59-mm covered stent was successfully deployed, resulting in immediate cessation of bleeding and rapid hemodynamic improvement. This case demonstrates the feasibility of transradial endovascular treatment of acute external iliac artery rupture in hemorrhagic shock and highlights its potential as a bailout strategy.Clinical ImpactThis case expands the potential role of transradial access in the management of life-threatening iliofemoral vascular complications. The availability of long-shaft, low-profile peripheral devices now enables covered-stent delivery from the radial artery to the iliac circulation. Clinicians performing large-bore transfemoral procedures should consider transradial access as an alternative bailout strategy for the management of iliofemoral vascular complications when anatomy, equipment availability, and operator experience permit.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261484774"},"PeriodicalIF":1.8,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149041613","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":"Wallstent Deployment Challenges and Complications in Endovenous Management of Non-thrombotic May-Thurner Syndrome.","authors":"Mohamed Mosadak Zaied, Moaaz Kamal, Ehab Imam","doi":"10.1177/15266028261489161","DOIUrl":"10.1177/15266028261489161","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate Wallstent deployment challenges and complications during endovenous management of non-thrombotic May-Thurner syndrome (NT-MTS) and to define their underlying mechanisms and optimal management strategies.</p><p><strong>Methods: </strong>This prospective single-center cohort study included 38 patients with NT-MTS treated with left common iliac vein stenting. Deployment-related phenomena, including foreshortening, slipping, proximal compression, and migration, were systematically assessed. Clinical outcomes were evaluated using symptom assessment and visual analog scale (VAS). Follow-up included duplex ultrasonography up to 12 months.</p><p><strong>Results: </strong>A total of 41 Wallstents were deployed with 100% technical success. Foreshortening and varying degrees of stent slipping were consistently observed during deployment and were managed intra-procedurally. Proximal stent compression occurred in 2 cases (5.3%), whereas cranial and caudal migration each occurred in 1 case (2.6%). Both migration events were successfully managed using endovascular techniques without surgical intervention. Complete or partial VAS improvement was observed in 100% of symptomatic patients. All venous ulcers healed, with a mean healing time of 2.5 months. No stent thrombosis or reintervention was observed during 1-year follow-up.</p><p><strong>Conclusion: </strong>Wallstent deployment in NT-MTS is characterized by consistent, device-driven mechanical behavior, including foreshortening and slipping, which should be recognized as predictable rather than adverse events. Stent migration, although rare, is multifactorial and can be effectively managed using endovascular techniques. A behavior-based approach to Wallstent deployment may improve procedural control and clinical outcomes.Clinical ImpactThis study addresses the predictable mechanical behavior of Wallstents during treatment of May-Thurner syndrome and the technical challenges that may arise during deployment, as well as complications including cranial and caudal stent migration. Understanding these characteristics provides practical guidance for controlled stent deployment, including appropriate sizing, multiplanar venography, initiating deployment approximately 3 cm cranial to the intended landing zone, controlled release with repositioning when necessary, Complete lesion coverage with proximal extension a few millimeters above the IVC confluence and distal-to-proximal post-stent dilatation. The study also introduces a novel endovascular technique for managing a migrated Wallstent entirely within the IVC, allowing successful correction without aborting the primary procedure.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028261489161"},"PeriodicalIF":1.8,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149026673","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}