Journal of Endovascular Therapy最新文献

{"title":"Endovascular Closure of an Acquired Vascular Fistula, an Uncommon Complication of a Tunneled Hemodialysis Catheter: A Case Report.","authors":"Carlos Ivan Soledispa-Suarez, Stephanie Susana Alberca-Bonilla","doi":"10.1177/15266028231161243","DOIUrl":"10.1177/15266028231161243","url":null,"abstract":"<p><strong>Purpose: </strong>The objective of this case is to report an endovascular occlusion of an acquired vascular fistula using an Amplatzer Vascular Plug II. Also, it is to review the available literature on risk factors, pathophysiology, and related management strategies about complications of the tunneled central venous catheter (TCVC).</p><p><strong>Case report: </strong>The case was a 40-year-old man with a chronic kidney disease (CKD) on dialysis and with a history of several previous TCVC placements, along with recurrent infections. The last TCVC developed a fistula between the superior vena cava and the right pulmonary artery, shown by computed tomography (CT). We decided to remove a long-term TCVC and occluded the fistula applying an endovascular embolic device, an Amplatzer Vascular Plug II, subsequently. The patient was given parenteral treatment during 10 days of hospitalization. Over 9 months of follow-up, the device was appropriately positioned and did not obstruct the vascular flow.</p><p><strong>Conclusion: </strong>Tunneled central venous catheters are frequently used for hemodialysis in patients in the last stage of CKD who do not have an arteriovenous fistula. Occasionally, delayed complications such as adherence or catheter migration occur. This case illustrates an endovascular treatment with excellent results and low risk of morbidity and mortality.</p><p><strong>Clinical impact: </strong>The purpose of this work is to present an endovascular occlusion by means of an Amplatzer® Vascular Plug II in a residual fistula. The endovascular way is decided in situations, for instance, once the cardiothoracic surgeons argue that the patient is not in general conditions to tolerate surgery, the surgical procedure would be complex, or, in a surgical approach with a difficult-to-resolve hemorrhage. We explain the technique and the materials we used for an excellent result and a low risk of complications. This case is intended to serve as an aid in the treatment of similar events.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1257-1261"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523248","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":"Persistent Sciatic Artery in Right Lower Extremity Complicated by Thrombosis: A Case Report.","authors":"Boyang Liu, Bingbing Hu, Fang Li, Zhenqi Min, Supeng Yuan, Xianpeng Dai","doi":"10.1177/15266028231163054","DOIUrl":"10.1177/15266028231163054","url":null,"abstract":"<p><strong>Purpose: </strong>Persistent sciatic artery (PSA) is a rare congenital vascular malformation with an incidence of approximately 0.025% to 0.04%. Persistent sciatic artery has major complications, such as aneurysms, thrombosis, and occlusion. Complications may lead to a range of serious clinical problems, and a timely diagnosis of this vascular variant is crucial to avoid life-threatening complications.</p><p><strong>Case: </strong>A 65-year-old man was admitted to the hospital with pain and chills in the right lower extremity for 2 months, which gradually worsened. This was accompanied by numbness in the right foot for the last 10 days. Computed tomography angiography showed that the right inferior gluteal artery and right popliteal artery of the right internal iliac artery were connected, which is considered a congenital developmental variant. This was complicated by multiple thromboses of the right internal and external iliac arteries, and the right femoral artery. After admission to the hospital, the patient underwent endovascular staging surgery to relieve numbness and pain in the lower extremities.</p><p><strong>Conclusion: </strong>Treatment strategies can be selected based on the anatomical characteristics of PSA and superficial femoral artery. Asymptomatic patients with PSA can be closely monitored. Surgery or individualized endovascular treatment plans should be considered for patients with aneurysm formation or vascular occlusion.</p><p><strong>Clinical impact: </strong>For the rare vascular variation of the PSA, clinicians must make a timely and accurate diagnosis. Ultrasound screening is essential, which requires experienced ultrasound doctors to be aware of vascular interpretation and develop personalized treatment plans for each patient. In this case, we adopt staged a minimally invasive intervention to solve the problem of lower limb ischemic pain for patients. This operation has the advantages of rapid recovery and less trauma, which has important reference significance for other clinicians.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1252-1256"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9205199","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":"Quantitative Techniques of Ultrasonography in the Assessment of Femoropopliteal Atherosclerotic Lesions Using Peak Systolic Velocity Ratio: Results From the TURN-UP Study.","authors":"Aiko Hayashi, Mitsuyoshi Takahara, Masahiko Fujihara, Yumiko Komiya, Shun Aoki, Mina Enoki, Takamitsu Miyauchi, Rika Tanimoto, Jun Fujisaki, Keisuke Ishida, Masayuki Yamasaki, Naoto Waratani, Harumi Kawaguchi, Terutoshi Yamaoka","doi":"10.1177/15266028231160636","DOIUrl":"10.1177/15266028231160636","url":null,"abstract":"<p><strong>Purpose: </strong>Duplex ultrasound (DUS)-measured peak systolic velocity ratios (PSVRs) are commonly used to evaluate arterial stenosis in lower extremity artery disease (LEAD). However, these measurement methods have not yet been standardized. This study aimed to reveal the influence of measuring methods on PSVR values.</p><p><strong>Methods: </strong>A 132 femoropopliteal lesions with PSVR ranging from 1.5 to 3.5 evaluated using method A (angle correction 60°, the direction of blood flow, the no or few atherosclerotic changes closest to the lesion proximal side was defined as the nonstenotic area) were included. The following 4 different methods were then compared with method A: method B, angle correction 45°; method C, angle correction 60° measured along the vessel wall; D, angle correction 60°, with the nonstenotic area the lowest peak systolic velocity area; and E, angle correction 60°, with the reference point fixed at 2 cm proximal to the target lesion area. The difference in PSVR values was analyzed using the Bland-Altman method.</p><p><strong>Results: </strong>The mean PSVR value measured by method A was 2.27±0.51, those measured by methods B, C, D, and E were 2.21±0.55, 2.31±0.66, 2.34±0.63, and 2.11±0.63, respectively. The 95% prediction intervals of the differences in PSVR measurements versus A were -0.64 to +0.53 for method B, -0.59 to +0.68 for method C, -0.77 to +0.91 for method D, and -1.12 to +0.79 for method E.</p><p><strong>Conclusion: </strong>PSVR values considerably differed between measuring methods. PSVR values by DUS are largely dependent on the measurement methods, which could considerably affect the judgment of LEAD.</p><p><strong>Clinical impact: </strong>Due to differences in several DUS measurement methods, the PSVR results could be changed. Therefore, to need further investigations and unification of measurement method.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1075-1080"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9117090","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 Results and Feasibility of Total Endovascular Aortic Arch Repair Using 3-Vessel Company-Manufactured and Physician-Modified Stent-Grafts.","authors":"K Benjamin Lee, Jesus Porras-Colon, Carla K Scott, Khalil Chamseddin, Mirza S Baig, Carlos H Timaran","doi":"10.1177/15266028231163069","DOIUrl":"10.1177/15266028231163069","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Total endovascular repair of aortic arch aneurysms is feasible in select patients. This study aims to evaluate the feasibility and early outcomes of total endovascular arch repair using 3-vessel company-manufactured devices (CMDs) and physician-modified endo grafts (PMEGs).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients unfit for open repair who underwent 3-vessel total arch repair at a single institution from 2018 to 2021 were reviewed. Patients received either 3-vessel inner-branch CMDs or PMEGs. Three-vessel designs were used to incorporate the innominate, left common carotid, and left subclavian arteries. The antegrade inner branches in both devices were accessed via right brachial or carotid approach. The left carotid was accessed via carotid cutdown or femoral approach. The left subclavian artery was accessed via transfemoral approach. The study endpoints included procedural technical success, patient survival, neurologic events, cardiac complications, reinterventions, and target artery patency.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Nine patients underwent treatment. Four patients were treated with PMEGs, and 5 with CMDs. Procedural technical success was 100%. There were no in-hospital deaths. There were no strokes, transient ischemic attacks, myocardial infarction, or spinal ischemia in the perioperative period. Major adverse events occurred in 3 patients (33%). Two (22%) vascular access complications and one (11%) acute kidney injury occurred. One (11%) patient required early reintervention for an access complication. The median follow-up period was 358 days (CMD, 392 days; PMEG, 198 days). There was a late reintervention and conversion to open repair at 142 days of follow-up in a patient with a PMEG that developed an aortic infection, leading to death on postoperative day 239. The mean length of stay was 7±4 days. Computed tomography imaging obtained during the immediate postoperative period revealed endoleak in 6 (66%) patients, out of which 5 resolved spontaneously and 1 required reintervention via left subclavian artery stenting. Target artery patency was 100% at the end of the follow-up period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Three-vessel total endovascular aortic arch repair using a CMD or PMEG is feasible with optimal early outcomes. Physician-modified stent-grafts are a feasible option for patients who do not meet anatomic criteria for CMDs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical impact: &lt;/strong&gt;Management of aortic arch disease remains a significant challenge in vascular surgery. This study showcases the feasibility and safety of using a total endovascular approach to repair the aortic arch, which could potentially reduce morbidity and mortality associated with traditional surgical approaches. The results suggest that this minimally invasive technique could be an alternative treatment option for high-risk patients and could significantly improve outcomes for those requiring aortic arch repair. Overall, this study represen","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1197-1207"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552197/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9192573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Percutaneous Access Via Large-Bore Sheaths (22-26F Diameter) in Endovascular Therapy.","authors":"Bartosz Rylski, Zeynep Berkarda, Friedhelm Beyersdorf, Stoyan Kondov, Martin Czerny, Jarosław Majcherek, Marcin Protasiewicz, Artur Milnerowicz","doi":"10.1177/15266028231161490","DOIUrl":"10.1177/15266028231161490","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the closure success rate's outcomes with suture-mediated vascular closure device Perclose ProGlide in patients undergoing aortic or iliac artery endovascular repair using large delivery systems (>21F).</p><p><strong>Materials and methods: </strong>We screened all the patient records in aortic databases at 2 centers who had undergone vascular interventions via ProGlide for percutaneous femoral access >21F between 2016 and 2020. Patients were divided into 2 groups according to the delivery system size: large (L) (22F-23F) and extra-large (XL) (24F-26F). Demographics, anatomical details, and outcome of percutaneous access were evaluated.</p><p><strong>Results: </strong>Included were 239 patients: 121 in the L group and 118 the XL group. Intraprocedural conversion to open surgery because of bleeding was necessary in 2% L and 6% XL patients (p=0.253). Severe femoral artery calcification was the sole risk factor for converting to open surgery (odds ratio=23.44, 95% confidence interval=1.49-368.17, p=0.025). In all, 2% of L and 3% of XL (p=0.631) did require late percutaneous intervention due to stenosis (all treated with balloon angioplasty). Overall, 3% developed pseudoaneurysm treated conservatively in all except one patient requiring surgical repair. Hematoma and groin infection were observed in 9% and 1%, respectively; none required surgical therapy.</p><p><strong>Conclusion: </strong>A femoral arterial defect after accessing the artery via a large bore sheath (22F-26F) can be closed successfully with ProGlide in more than 90% of patients. Severe femoral artery calcification is a risk factor for conversion to open surgery caused by bleeding.</p><p><strong>Clinical impact: </strong>This study adds evidence on efficacy of accessing the artery via a large bore sheath (22-26F) secured by ProGlide. In more than 200 patients conversion to open surgery was necessary in only 4%. Severe femoral artery calcification was the sole risk factor for converting to open surgery. Our findings encourage physicians to choose the percutaneous access even in patients requiring the use of large bore sheath.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"1173-1179"},"PeriodicalIF":1.7,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9147990","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":"Avoiding Aortic Valve Passage in Branched Arch Repair by Use of the Modified Balloon Nose Cone Technique.","authors":"Piotr Kasprzak, Waclaw Kuczmik, Karin Pfister, Fiona Rohlffs","doi":"10.1177/15266028241292466","DOIUrl":"https://doi.org/10.1177/15266028241292466","url":null,"abstract":"<p><strong>Purpose: </strong>To demonstrate the Modified Balloon Nose Cone Technique to avoid passage of the aortic valve in endovascular branched arch repair.</p><p><strong>Technique: </strong>The technique is demonstrated in a 54-year-old patient after previous open repair of the ascending aorta and mechanical aortic valve replacement due to type A aortic dissection. The delivery system of a custom-made stent-graft with 3 inner branches was modified by subtotally sawing off its nose cone. Using a right transaxillary access, a sheath was introduced over a through-and-through (TAT) wire exiting the left groin and meeting the branched stent-graft in a rendezvous fashion. A balloon was used to bridge the gap between both sheaths. Passing the innominate artery, both sheaths were pushed into the ascending aorta to establish a loop configuration of the balloon until the correct landing zone was reached. The main body was deployed, and the supra-aortic target vessels were connected. After the procedure, the mechanical aortic valve showed unimpaired function.</p><p><strong>Conclusion: </strong>The Modified Balloon Nose Cone Technique broadens the technical armamentarium in endovascular aortic arch repair offering a feasible solution to overcome the need of aortic valve passage. Especially patients with mechanical aortic valve could benefit from this method.</p><p><strong>Clinical impact: </strong>To describe the feasibility and safety of the Modified Balloon Nose Cone Technique in a severely comorbid patient with residual Type A aortic dissection and history of ascending aortic repair and mechanical replacement of the aortic valve to broaden the technical armamentarium in endovascular aortic arch repair offering a feasible solution to overcome the need of aortic valve passage.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241292466"},"PeriodicalIF":1.7,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774368","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 Use of Modified 3D-Printed Models for Precise Fenestrations in Physician-Modified Endografts to Treat Aortic Dissections Involving Visceral Branches.","authors":"Yihong Jiang, Hongji Pu, Jiahao Lei, Qiang Liu, Wenjun Wang, Yuliang Li, Wenbo Jiang, Xiaobing Liu, Xinwu Lu, Guang Liu","doi":"10.1177/15266028241292463","DOIUrl":"https://doi.org/10.1177/15266028241292463","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Purpose: &lt;/strong&gt;This study aims to summarize the experience and outcomes of using 3D printing technology to assist physician-modified fenestrated-branched endovascular aortic repair (PM-FBEVAR) in the treatment of thoracoabdominal aortic dissection involving visceral branches.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and methods: &lt;/strong&gt;From December 2018 to May 2023, clinical data of 48 consecutive patients (35 males; mean age, 62.9±11.57 years) from 3 hospitals with thoracoabdominal aortic dissection involving visceral branches were retrospectively analyzed. All patients underwent PM-FBEVAR assisted by modified 3D-printed models. The modified 3D-printed models were designed according to estimated aortic morphology after physician-modified endografts were implanted. These models were fabricated using polycaprolactone composite photosensitive resin and stereolithography technology. They were utilized for preoperative planning and guiding the modification of stent grafts to assist in the positioning of the fenestrations. Outcomes including technical success, 30-day mortality, major adverse events (paraplegia, respiratory failure, major stroke, myocardial infarction, acute kidney injury, bowel ischemia, and lower limb ischemia), target vessel-related outcomes (branch occlusion or stenosis, target vessel instability, endoleak), reintervention, and survival were analyzed. Follow-up was completed in all patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Technical success was achieved in 44 of 48 (91.67%) in patients and 178 of 182 (97.8%) in target vessels. The average operation time was 371.94±63.47 minutes, including a mean of 54.69±9.42 minutes for endograft customization and a mean of 211.92±55.44 minutes for endovascular operation. Perioperative major adverse events include 3 cases (6.25%) of acute renal injury and 1 case (2.08%) of transient paraplegia with no permanent neurological symptoms. The median follow-up was 24 (interquartile range, 12-30) months, and mortality was 0%. Seven endoleaks were detected during follow-up. One type Ic endoleak was managed with a reintervention procedure. One type IIIc endoleak spontaneously disappeared and the other type IIIc endoleak reduced. All 4 type II endoleaks remained stable during follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Rapid and accurate intraoperative fenestrations were achieved with the assistance of 3D printing for thoracoabdominal aortic dissection involving visceral branches. The modified 3D printing assisted PM-FBEVAR appears to be a safe and promising treatment option during early and mid-term follow-up.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Clinical impact: &lt;/strong&gt;This study highlights the use of modified 3D printed models to enhance the precision of fenestrations in physician-modified endografts for treating thoracoabdominal aortic dissection involving visceral branches. The innovation lies in creating patient-specific 3D models based on pre- and post-implantation anatomy, allowing clinicians to optimize fenestration ","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241292463"},"PeriodicalIF":1.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741292","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":"Acute Superior Mesenteric Artery Embolism With Infective Endocarditis: Is There a Role for Endovascular Treatment?","authors":"Xiaoxiang Zhou, Jiao Teng, Zhenjiang Li, Qinglong Zeng, Yangyan He, Yunjun He, Yilang Xiang, Ziheng Wu, Dongling Li, Lu Tian, Hongkun Zhang, Qianqian Zhu","doi":"10.1177/15266028241300927","DOIUrl":"https://doi.org/10.1177/15266028241300927","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this article is to report a case of acute superior mesenteric artery embolism due to infective endocarditis treated with endovascular therapy.</p><p><strong>Case report: </strong>A patient with infective endocarditis was admitted to the hospital with abdominal pain, and abdominal enhanced computer tomography showed acute superior mesenteric artery embolism. He underwent urgent percutaneous mechanical thrombectomy and stenting to open the superior mesenteric artery and restore blood supply to the intestine. However, 17 days after the endovascular treatment, a pseudoaneurysm formed next to the stent, which was eventually removed by open surgery. The patient's prognosis was good at the 1 year follow-up.</p><p><strong>Conclusion: </strong>Endovascular treatment of acute superior mesenteric artery embolism caused by infective endocarditis was able to rapidly restore the intestinal blood supply. However, the possibility of postoperative pseudoaneurysm needs to be guarded against.</p><p><strong>Clinical impact: </strong>This study will provide clinical treatment guidance for acute superior mesenteric artery embolism caused by infectious endocarditis. Endovascular treatment may rapidly alleviate intestinal ischemia and reduce the risk of intestinal necrosis, but it cannot completely eliminate infectious emboli, which may lead to further development of pseudoaneurysms.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241300927"},"PeriodicalIF":1.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741290","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":"Percutaneous Carotid Access in Endovascular Aortic Arch Repair: Initial Experience.","authors":"Angelos Karelis, Nivedita Mitta, Márton Berczeli, Björn Sonesson, Nuno V Dias","doi":"10.1177/15266028241292456","DOIUrl":"https://doi.org/10.1177/15266028241292456","url":null,"abstract":"<p><strong>Purpose: </strong>Direct percutaneous access to the carotid artery (diPerCa) during endovascular aortic arch repair (EVAAR) can potentially present a minimally invasive access with lesser local adverse events.</p><p><strong>Techniques: </strong>A retrospective review of consecutive EVAAR between January 2018 and January 2024, in a tertiary referral center, was performed to identify cases, in which diPerCa was used. Patients who were planned for EVAAR with no previous carotid intervention were included. A standardized technique was employed where an ultrasound-guided retrograde puncture of the carotid artery was performed with a micro-puncture set and a suture-mediated closure device (pre-closure technique). Of the 13 included patients, technical success was achieved in 12 (92.3%), with one intraoperative death unrelated to diPerCa. Major complications included one case of carotid pseudoaneurysm and one case of non-flow-limiting carotid dissection. Minor complications were unilateral recurrent laryngeal nerve palsy in one case and new-onset dizziness in one case. All carotid arteries remained patent without stenosis, with one case of non-progressing dissection noted at the conclusion of the mean follow-up of 22.5±2.4 months.</p><p><strong>Conclusion: </strong>Direct percutaneous carotid access with suture-mediated closure devices during EVAAR is feasible with acceptable results and low incidence of clinically relevant neurological and local complications. Further studies are needed to confirm these findings and evaluate long-term outcomes.</p><p><strong>Clinical impact: </strong>Direct percutaneous carotid access (diPerCa) during endovascular aortic arch repair (EVAAR) offers a minimally invasive alternative to retrograde access via open surgical exposure. This technique, supported by suture-based closure devices, demonstrates no stroke and low rates of local complications. Overall outcomes are promising, suggesting diPerCa as a feasible option for select patients. Further research is warranted to validate these findings and assess long-term outcomes.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241292456"},"PeriodicalIF":1.7,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142741291","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 Management of Aortic Rupture Secondary to Thoracolumbar Spine Fracture From a Domestic Fall: A Case Report and Clinical Challenges.","authors":"David Pakeliani, Liborio Ferrante, Giuseppe Indelicato, Silvana Tumbiolo, Maurizio Finocchiaro","doi":"10.1177/15266028241302683","DOIUrl":"https://doi.org/10.1177/15266028241302683","url":null,"abstract":"<p><strong>Purpose: </strong>Instances of aortic lesions combined with thoracolumbar spine fractures have been rarely described, primarily occurring in high-speed motor vehicle collisions and falls from heights.</p><p><strong>Case report: </strong>We present a unique case of a 71-year-old woman with a thoracic aortic rupture caused by a thoracolumbar spine fracture during an accidental domestic fall. She experienced an injury at the level of the celiac trunk on the posterior aspect of the aorta. Hemorrhagic shock and profound hemodynamic instability prompted the swift initiation of a percutaneous endovascular approach, involving the use of REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta) followed by the parallel graft technique in a sandwich configuration. Subsequently, thoracolumbar spinal fixation was carefully scheduled and performed 20 days after achieving clinical stabilization.</p><p><strong>Conclusions: </strong>This case underscores the importance of a multidisciplinary approach in managing complex aortic and spinal injuries. The combined use of REBOA and the sandwich graft technique can be life-saving in managing acute thoracic aortic injuries, allowing for the staged stabilization and repair of associated spinal fractures.</p><p><strong>Clinical impact: </strong>This case highlights a novel approach to managing a rare thoracic aortic rupture caused by an accidental domestic fall. The application of REBOA for immediate hemodynamic stabilization, combined with the use of a sandwich graft configuration, underscores the adaptability of advanced endovascular techniques in complex, life-threatening situations. These interventions demonstrate the importance of tailoring treatment strategies to individual patient needs, especially in cases involving atypical mechanisms of injury. The findings emphasize the value of early multidisciplinary collaboration and dynamic procedural planning, paving the way for improved outcomes and the refinement of clinical protocols in the management of similar trauma cases.</p>","PeriodicalId":50210,"journal":{"name":"Journal of Endovascular Therapy","volume":" ","pages":"15266028241302683"},"PeriodicalIF":1.7,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142734388","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}