Retrograde catheterization of the SMA on a B-EVAR – Case report

Alternative Approach for Endovascular Treatment of Aortic Aneurysms

Evaluation of false lumen occluders implanted in the abdominal aorta false lumen

Endovascular treatment of thoracoabdominal aortic aneurysms

Retrograde Femoral Access Flipped Antegrade Technique and its Effect on Patient Outcomes Following Lower Extremity Angiography.

Branched devices for thoracoabdominal aneurysm repair: Early experience

Open repair of thoracoabdominal aortic aneurysm is connected with high mortality and morbidity. On the other hand, endovascular treatment of thoraco-abdominal aneurysms, which started 10 years ago, reduced perioperative mortality and morbidity. However, it results in a high level of late complications. It seems that an interesting solution to the problem is a hybrid procedure, which allows late complications to be reduced with acceptable levels of operative mortality and morbidity. This case report presents the use of a hybrid procedure in treatment of symptomatic thoraco-abdominal aneurysm in a patient with prior abdominal aortic reconstruction. In the first stage the patient underwent open revascularization of visceral vessels of the aorta. One week later a thoraco-abdominal stent-graft was implanted. The perioperative and postoperative period was uncomplicated. Two months after the second intervention the patient returned to work. Control imaging conducted 30 and 90 days after the procedure confirmed patency of all revascularized vessels and did not reveal any graft-related complications. The hybrid procedure seems to be an interesting alternative for open and endovascular repair of thoraco-abdominal aneurysms because it combines the advantages of open and endovascular repair. It also gives an opportunity to perform the procedure within a reasonable period of time from diagnosis of symptomatic thoraco-abdominal aneurysm.

Failure of Sandwich Technique for Thoracoabdominal Aneurysm Treated with Custom-Made Fenestrated Endograft

Systematic review and meta-analysis of published studies on endovascular repair of thoracoabdominal aortic aneurysms with the t-Branch off-the-shelf multibranched endograft

Present and Future of Branched Stent Grafts in Thoraco-abdominal Aortic Aneurysm Repair: A Single-centre Experience

To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.

Outcomes and complications after fenestrated-branched endovascular aortic repair

Endovascular treatment of thoracic aortic diseases: Combined experience from the EUROSTAR and United Kingdom Thoracic Endograft registries

Endolymphatic Thoracic Duct Stent-Graft Reconstruction for Chylothorax: Approach, Technical Success, Safety, and Short-term Outcomes

Background: Endovascular interventions are a standard treatment approach for patients suffering chronic limb threatening ischemia. This approach however can be complicated in some cases owing to difficult anatomy of the lesion that hinders successful crossing and recanalization of the diseased artery. Hence retrograde access and recanalization technique was described and used. Aims and Objectives: The aim of this study was to assess the procedural success, periprocedural complications and evaluate the safety of retrograde popliteal access for SFA and iliac lesions and tibial and pedal access for difficult tibial lesions. Materials and Methods: This is a case series of 60 patients who underwent percutaneous retrograde access (SFA, popliteal, tibial, pedal) for the recanalization of difficult lesions (aorto-iliac, SFA, tibial) between November 2018 to December 2022. We analyzed the technical success and number of periprocedural complications following successful revascularization through a prospective, nonrandomized, single–center, observational study conducted at Jain Institute of Vascular Sciences, Bengaluru, Karnataka, India. We have also analyzed safety of retrograde access and hemodynamic success (based on post-operative ABI improvement) following revascularization. Results: Of the 60 cases, retrograde access was successfully performed in all 60 patients, SFA in 3.3% (n=2), popliteal in 30% (n=18) (3 were primary PA retrograde access and remaining 15 were secondary), ATA was utilized in 35% (n=21), PTA in 20% (n=12), DPA in 6.7% (n=4) and peroneal in 5% (n=3). Technical success was achieved in 92% (n=55). Hemodynamic success was achieved in 75% (n=45). The recorded complication rate was 8.3% which included perforation of artery in 3% (n=2), iatrogenic AV fistula in 1.7% (n=1), arterial thrombosis in 1.7% (n=1) and peri-operative death in 1.7% (n=1). Conclusions: Hence, we recommend that retrograde access angioplasty is a safe and effective approach for revascularization when antegrade access fails and should be considered after proper anatomic evaluation, under US or fluoroscopic guidance.

Objective: To investigate the safety and effectiveness of Neuroform Atlas stent-assisted coiling in the endovascular treatment of intracranial aneurysms. Methods: This was a retrospective, single-center observational study of 77 patients who underwent endovascular treatment of intracranial aneurysms using the Neuroform Atlas device at the Department of Neurology, People's Liberation Army General Hospital from July 2020 to May 2022. There were 34 males and 43 females, with a median (range) age of 59 (23-81) years. The degree and effect of aneurysm embolization were evaluated by modified Raymond grading post procedure and after 6 months. Complications occurring during the perioperative period were recorded. Vaso computed tomography was performed immediately after the operation to assess stent opening and adherence. Digital subtraction angiography was performed 6 months after discharge and the aneurysm was classified as cured, stable, or recurrent. Results: A total of 87 Atlases were successfully released in 77 cases. Angiography performed immediately after the embolization revealed 19 (24.7%) modified Raymond grade Ⅰ, 10 (13.0%) grade Ⅱ, and 48 (62.3%) grade Ⅲa cases. Three perioperative complications were observed including thrombotic events in 2 cases and stent migration in 1 case. A follow-up angiogram was available for 47 aneurysms, and showed that modified Raymond grade Ⅰ occlusion was achieved in 38 (80.9%) cases, grade Ⅱ in 2 (4.3%) cases, and grade Ⅲa in 7 (14.9%) cases. At the 6-month follow-up, 38 patients were cured and 7 were stable, whereas 2 patients experienced a recurrence of aneurysm. Stenosis of the parent artery occurred in 3 (6.4%) cases, including 2 at the head and 1 inside the stent. Conclusions: The results of this preliminary study suggest that Neuroform Atlas stent-assisted coiling has a high occlusion rate and low incidence of complications in the endovascular treatment of aneurysms. However, the effectiveness of this procedure for large aneurysms and long-term outcomes require further investigation.