Endovascular Interventional Procedures Research Articles

Carotid Endarterectomy With Shunt for Preoperative or Intraoperative Indication Is Associated With Increased Rate of Stroke

Carotid endarterectomy (CEA) is performed frequently both with and without the use of shunting, and previous studies have shown similar 1% to 2% rates of stroke with both techniques in asymptomatic patients. The rate of stroke when shunting is performed for a preoperative or intraoperative indication remains understudied. We aimed to evaluate the rate of stroke by shunt indication and to compare this cohort with routine shunt and no shunt cohorts in a large national registry. The Vascular Quality Initiative CEA registry was used to identify patients undergoing CEA for asymptomatic carotid stenosis from 2013 to 2019. Exclusion criteria included symptomatic patients (defined as ipsilateral transient ischemic attack or stroke within 6 months of operation), concomitant coronary intervention, proximal or distal endovascular intervention, and urgent or emergent procedures. Categorical variables were analyzed using χ2 test, and continuous variables were analyzed using analysis of variance. Multivariable logistic regression was used to evaluate demographic and perioperative predictors of stroke. There were 69,903 CEAs identified, which consisted of 33,459 without shunt, 31,711 routine shunts, 1369 shunts for preoperative indication, and 3364 shunts for intraoperative indication patients. The cohort with shunt for preoperative indication was more likely to be male, to be transferred from an outside hospital, and to have contralateral internal carotid artery (ICA) occlusion. In addition, the cohorts with shunt for indication had slightly increased procedure length, rates of re-exploration at time of initial operation, and protamine use (Table I). The rate of stroke was increased in shunt for preoperative and intraoperative indication cohorts (no shunt, 0.8%; routine shunt, 0.9%; preoperative indication, 1.8%; intraoperative indication, 1.3%; P < .01). On multivariable analysis, both shunt for preoperative indication and shunt for intraoperative indication are associated with stroke. Other perioperative and demographic variables associated with stroke include hypertension, any prior neurologic event, contralateral ICA occlusion, completion angiography, postoperative hemodynamic instability requiring intravenous medications, and re-exploration at the time of initial operation (Table II). The proportion of shunt for preoperative indication varies by region (East, 1.4%; North, 2.2%; South, 1.5%; West, 4.3%; P < .01). Regional variation is present in preoperative indication for shunt as the proportion of patients with contralateral ICA occlusion or >60% contralateral ICA stenosis varied widely (East, 55.3%; North, 62.9%; South, 52.2%; West, 47.6%; P < .01). CEA with shunt for preoperative or intraoperative indication is associated with increased rates of stroke, even in asymptomatic patients, suggesting a high-risk cohort that is poorly defined by registry data. Identifying this cohort may alter the risk-benefit ratio of the operation and inform clinical decision-making.Table IDemographic characteristics, preoperative workup, and intraoperative variablesDemographic characteristicsNo shunt (n = 33459)Routine shunt (n = 31711)Shunt: Preop indication (n = 1369)Shunt: Intraop indication (n = 3364)PAge, years (SD)70.7 (8.7)71.0 (8.8)70.4 (9.1)71.1 (8.9)<.01Sex (male)20263 (60.6)18715 (59.0)876 (64.0)1918 (57.0)<.01Comorbidities HTN29950 (89.5)28615 (90.2)1236 (90.3)3079 (91.5)<.01 CAD9092 (27.2)9061 (28.6)404 (29.5)926 (27.6)<.01 CHF3659 (10.9)3637 (11.5)157 (11.5)391 (11.6).15 Diabetes11988 (35.8)11881 (37.5)508 (37.1)1280 (38.0)<.01 Current Smoker7976 (23.8)8043 (25.4)330 (24.1)885 (26.3)<.01 ESRD352 (1.1)366 (1.2)16 (1.2)49 (1.5).16 ASA Class ≥45539 (16.6)6026 (19.0)274 (20.0)605 (18.0)<.01 Lived at Home33178 (99.2)31343 (99.1)1346 (98.4)3313 (98.5)<.01 Transfer OSH383 (1.1)341 (1.1)35 (2.6)46 (1.4)<.01Neurologic History Ipsi Neuro Event >6 months1891 (5.7)1803 (5.7)147 (10.8)214 (6.4)<.01 Ipsi Stroke >6 months1110 (3.3)1075 (3.4)103 (7.5)138 (4.1)<.01 Contra CEA5213 (15.6)5169 (16.3)156 (11.4)528 (15.7)<.01 Contra ICA Occlusion937 (2.8)1620 (5.2)370 (27.4)336 (10.3)<.01 Ipsi Stenosis ≥70%30362 (92.1)28306 (91.3)1232 (91.4)2932 (90.2)<.01 Contra Stenosis ≥70%6116 (18.6)5888 (19.0)314 (23.3)624 (19.2)<.01 Anatomic High Risk1433 (4.3)1232 (3.9)53 (3.9)147 (4.4).06Operative Factors Procedure Length (SD)114 (44)112 (42)122 (44)121 (43)<.01 Protamine23494 (70.2)21643 (68.3)985 (72.0)2581 (76.8)<.01 Patch27831 (83.3)30607 (96.5)1289 (94.2)3165 (94.1)<.01 Re-explore at Initial Operation459 (1.4)390 (1.2)19 (1.4)72 (2.1)<.01ASA, American Society of Anesthesiologists; CAD, coronary artery disease; CHF, congestive heart failure; Contra, contralateral; ESRD, end stage renal disease requiring dialysis; HTN, hypertension; ICA, internal carotid artery; Ipsi, ipsilateral; Neuro, neurologic event >6 months from procedure; OSH, outside hospital; SD, standard deviation. Open table in a new tab Table IIMultivariable logistic regression: strokeStrokeOdds ratio (OR)95% Confidence intervalPP2Y12 Inhibitor0.640.53-0.77<.01Male Gender0.810.69-0.96.02Shunt for Intraop Indication1.431.02-2.01.04Shunt for Preop Indication1.611.05-2.53.03Completion Angiogram1.691.22-2.35<.01Hypertension1.701.20-2.40<.01Contralateral ICA Occlusion1.781.34-2.38<.01Any Prior Neurologic Event1.931.63-2.29<.01Postop IV Medication for Hemodynamic Instability3.432.91-4.05<.01Re-explore at Initial Operation9.5411.31-17.08<.01 Open table in a new tab

Early results of surgical and Endovascular intervention procedures in Lower extremity arterial disease

Objective : To assess the early results of surgical and endovascular intervention in peripheral arterial disease Materials and methods : Retrospectively, we analysed the early results of treatment of lower extremity arterial diseases, managed at our institute. Depending up on the lesion characters and the distal run-off as evident from imaging, patients underwent either surgical or endovascular intervention for their disease. Over a period of one-year form July 2018 to July 2019, twenty-two patients were managed in total. Nine of them underwent surgical bypass for either aortoiliac or femoro-popliteal lesions. Another thirteen patients underwent endovascular intervention for lesions at aorto-iliac, femoro-popliteal and “Below the Knee” lesions. Procedure related morbidity, procedural success rate, postoperative pain score, hospital stay, flow patency and symptomatic improvement at follow-up at three and six months were analysed. Results: The results were optimistic with ischemic ulcers showing signs of healing, patients symptomatically better with improved walking distance and relieved of rest pain. Due to a smaller study population, limited study time and the study itself being a non- randomised one, no intragroup comparisons were made. The procedural success was 100% for each group, no periprocedural morbidity. The hospital stay was 9 days for surgical aorto bifemoral bypass patients, 5.8 days for femoropopliteal patients. For those who underwent endovascular intervention, average hospital stay was 3.4, 2.5 and 3 days respectively for the aorto-iliac, femoropopliteal and “Below the Knee” level groups. The average pain score was 6.3 and 5.8 for surgical aortobifemoral bypass and femoropopliteal bypass. Pain scores for the endovascular intervention group was 4.4, 3.2 and 4.7 respectively for the aortoiliac, femoropopliteal and “Below the Knee” level groups. The improvement in the Rutherford gradings at six months were Aorto bifemoral Bypass (4.6 to 3.6), Femoro-popliteal (4.1 to 2.6) in the surgical group and Aortiliac (4.4 to 3.4), Femoropopliteal (4.2 to 2) and no change in the score for the “Below the Knee” group. At six-month follow-up, Doppler interrogation revealed a triphasic flow pattern in surgical and endovascular bypasses involving the aortoiliac and femoropopliteal segments. The doppler interrogation for the “Below the Knee” lesions at six-month follow-up was biphasic (n=3) to monophasic (n=1). Conclusion: Surgical bypass and endovascular intervention either as an independent treatment modality or in combination as a Hybrid procedure looks promising in the management of LEAD. Surgical bypass is no doubt morbid, but early results are satisfactory in terms of patency rates and clinical improvement. The early six months results of endovascular intervention, are particularly encouraging in the femoropopliteal segment with poor distal run off. The results are inconsistent for the “Below the Knee” segment disease. TASC II- A and B lesions are addressed by endovascular interventions, whereas TASC II- C and D lesions are addressed by surgical bypass. Multidisciplinary individualised treatment approach should be adopted in deciding which treatment to be provided for a particular patient based on clinical, imaging findings and institutional protocols

Hybrid surgery for symptomatic chronic complete occlusion of the internal carotid artery: A case report

Currently, there are antiplatelet drugs, extracranial-intracranial (EC-IC) vascular bypass, carotid endarterectomy (CEA), endovascular intervention (EI), and other revascularization procedures for symptomatic chronic internal carotid artery occlusion (CICAO). In consulting the literature, we found that existing techniques for single treatments cannot achieve satisfactory results when there is a long segment occlusion with plaque attached to the intracranial segment and a short stump at the initial segment. We reported the case of a 50-year-old male patient with blurred vision, headache, and weakness in the right upper limb. After the exclusion of other neurological diseases, he was diagnosed with symptomatic CICAO; the occlusion segment was long and the stump was too short. We performed a novel hybrid surgery for the patient—a carotid endarterectomy combined with internal carotid artery stenting. After 6 months of follow-up, computed tomography angiography (CTA) confirmed that the left internal carotid artery was unobstructed, and the symptoms were relieved. A brief review of the literature is presented in addition to this report.

Implication of the inferolateral trunk of the cavernous internal CAROTID artery in cranial nerve blood supply: Anatomical study and review of the literature

The inferolateral trunk (ILT) is one of the two more common branches of the cavernous internal carotid artery (ICA). Its knowledge is important for skull base surgery and endovascular interventional procedures. The ILT is described with superior, anterior and posterior branch, which is the complete form. These branches vascularize the oculomotor, trochlear, trigeminal and abducens nerves into the cavernous sinus and superior orbital fissure (SOF) courses, and through the foramens rotundum and ovale.We performed 21 injected embalmed cadaveric dissections combined with six specimen tomodensitometry.The ILT originates from the horizontal ICA segment and passes above the abducens nerve. Three branches arise from the ILT between the cavernous ICA and the ophthalmic and maxillary nerves initial courses. The main differences with the literature are the number of branches and their cranial nerves’ blood supply. The more frequent ILT conformation is the incomplete form with anterior and posterior branch (13/21); the complete form is present in 5/13 sides (38%) and the ILT is in common with the meningohypophyseal trunk in 3/21 (14%) sides. The anterior branch always vascularizes the cranial nerves into the SOF course and most often the maxillary nerve through the foramen rotundum. The posterior branch always vascularizes the mandibular nerve through the foramen ovale course and sometimes the maxillary nerve. This study has demonstrated that there are anastomoses between these branches and arteries arising from the external carotid.This study explains why the sacrifice of a branch of the ILT does not implicate cranial nerve palsy.

Are complication rates lower with 4-Fr versus 6-Fr transfemoral arterial access \u2013 prospective audit at a single interventional radiology centre

BackgroundFemoral arterial access constitutes the first step in a significant proportion of interventional endovascular procedures. Whilst existing reports describe sheath size as an independent risk factor for bleeding complications in radial arterial access for coronary intervention, the influence of sheath size on overall complication rates and morbidity following femoral arterial access is not well described. This prospective single centre study reports our experience of vascular sheath size, patient and procedural factors in influencing complication rates following femoral arterial access. From April 2010 to May 2013, data was collected prospectively for all femoral arterial access procedures performed in the Interventional Radiology department of a tertiary hospital. For vascular sheath size <6-Fr, haemostasis was achieved by manual compression. For 6-Fr sheath size, a closure device was used in the absence of any contraindication.ResultsOf the 320 femoral access cases with eligible inclusion criteria, 52.5% had 4-Fr whilst 47.5% had 6-Fr vascular sheaths inserted. Overall post procedure complications rates were significantly higher following 6-Fr sheath (17/152 (11.2%)) versus 4-Fr systems (3/168 (1.8%)) (p=0.0007) mostly comprising self-limiting hematoma. There was no significant difference in major complications that required escalation of treatment.ConclusionNo significant difference has been demonstrated between the use of either sheath systems for major complications. The practical limitations of a smaller system, combined with existing body of evidence, may not justify the routine use of 4-Fr sheath systems as the primary sheath size for all endovascular procedures.

Callosal mutism after AVM embolization in territoy of distal anterior cerebral artery branches

Introduction: Callosum mutism (CM) is a rare complication of neurosurgical procedures. There is no previous report of its ocurrence after interventional endovascular procedures for intracranial lesions. Material and method: We present a case of CM after embolization of anterior cerebral artery branches for treatment of a left frontal arterio-venous malformation (AVM). After reporting the particularities of clinical and radiological presentation of such case, we preform a critical literature review and discusses the clinical and ethiological aspects of CM as well as its differences in relation to other genders of speech disturbances (like aphasias). Finally we provide a brief overview about present available methods of cortical function monitoring emphasizing their utility in therapeutic endovascular procedures in eloquent areas. Result and conclusion: In literature, there are no previous report of CM as a complication of therapeutic angiographic procedures. Its exact pathophysiology is unknown. It is usually believed that this syndrome may appear after lesion of any of the components of the dentate-thalamic-cortical pathway, as well as supplementary motor area and mesolimbic regions involved in speech production. The diagnosis of CM must be considered after a clinical picture of speech deficit after therapeutic endovascualr procedures in territory of distal branches of anterior cerebral artery, specially of frontopolar (FpA branch) and anterior internal frontal (AIFA) branches.

In vivo and in vitro experimental studies of remote digital control endovascular robotic system in interventional angiography

Objective: To investigate the feasibility of the remote control endovascular robotic system in interventional angiography. Method: The endovascular robotic system Heifetz™ and the matched steerable catheter Mirage™ were used to cannulate all the target vessels in the vascular model and cerebral arteries originated from the aorta of Bama mini-pigs under fluoroscopic guidance. The technical success rate, cannulation time and exposure dose were all collected and compared with the result of using conventional techniques. Result: All the target vessels were successfully cannulated.The average cannulation time for the steerable catheter into left subclavian artery, left common carotid artery, brachiocephalic artery, right common carotid artery and right subclavian artery in the vascular model was (21.3±2.8)s, (28.8±5.2)s, (17.7±2.6)s, (31.5±5.1)s and (24.2±3.7) s, respectively, while the average exposure dose was (9.3±1.2)mGy, (12.4±2.2)mGy, (7.4±1.2)mGy, (14.2±2.5)mGy and( 10.4±1.9)mGy, respectively. The endovascular robotic system completed the cerebral angiography in Bama mini-pigs successfully. The average cannulation time for left innominate artery, right innominate artery, right subclavian artery, common internal carotid trunk, left internal carotid artery and right internal carotid artery was (41.5±6.8)s, (29.1±3.7)s, (40.7±5.5)s, (40.1±5.8)s, (59.6±9.0)s and( 60.3±10.1)s, respectively, while the average exposure dose was (40.6±6.5)mGy, (36.0±5.2)mGy, (39.8±6.1)mGy, (43.9±6.7)mGy, (51.0±7.4)mGy and( 50.1±7.8)mGy, respectively. There was no significant difference between robotic and conventional group in success rate, cannulation time and exposure dose. Conclusion: The remote digital control endovascular robotic system could cannulate the target vessel in both vascular model and complete the cerebral angiography in Bama mini-pigs, which shows the feasibility of using this robotic system in endovascular intervention procedures under remote control.

Acute management and outcomes of iatrogenic dissections during cerebral angiography

Background and purposeIatrogenic dissection is a known complication of cerebral angiography, but the clinical outcomes and optimal treatment of these patients is not well established. We sought to review our...

Compromiso peneano por embolización de cristales de colesterol secundaria a cateterismo cardiaco: primer reporte de caso en Latinoamérica

Of all the reported cases of cholesterol crystal embolisms, penile involvement is extremely rare. From 1982 to 2012, eight cases have been reported in the literature. The case is presented of a sixty year-old man, who underwent a percutaneous coronary angioplasty for an acute coronary event. Ten days after the procedure, he complained of an intense and painful ulcer on the penis. He also had discolored lesions on thighs, legs and plantar surface of the feet. Skin biopsy reported cholesterol crystals embolism. Penile involvement secondary to cholesterol crystal embolism is a rare complication in endovascular interventional procedures with severe atherosclerosis. It is estimated that this condition can be a predictor of morbidity and mortality in those patients.© 2014 Sociedad Colombiana de Urología. Published by Elsevier España, S.L. All rights reserved.

Workflow for the use of a high-resolution image detector in endovascular interventional procedures.

Endovascular image-guided intervention (EIGI) has become the primary interventional therapy for the most widespread vascular diseases. These procedures involve the insertion of a catheter into the femoral artery, which is then threaded under fluoroscopic guidance to the site of the pathology to be treated. Flat Panel Detectors (FPDs) are normally used for EIGIs; however, once the catheter is guided to the pathological site, high-resolution imaging capabilities can be used for accurately guiding a successful endovascular treatment. The Micro-Angiographic Fluoroscope (MAF) detector provides needed high-resolution, high-sensitivity, and real-time imaging capabilities. An experimental MAF enabled with a Control, Acquisition, Processing, Image Display and Storage (CAPIDS) system was installed and aligned on a detector changer attached to the C-arm of a clinical angiographic unit. The CAPIDS system was developed and implemented using LabVIEW software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF including: fluoroscopy, roadmap, radiography, and digital-subtraction-angiography (DSA). Using the automatic controls, the MAF detector can be moved to the deployed position, in front of a standard FPD, whenever higher resolution is needed during angiographic or interventional vascular imaging procedures. To minimize any possible negative impact to image guidance with the two detector systems, it is essential to have a well-designed workflow that enables smooth deployment of the MAF at critical stages of clinical procedures. For the ultimate success of this new imaging capability, a clear understanding of the workflow design is essential. This presentation provides a detailed description and demonstration of such a workflow design.

Experimental and theoretical performance analysis for a CMOS-based high resolution image detector.

Increasing complexity of endovascular interventional procedures requires superior x-ray imaging quality. Present state-of-the-art x-ray imaging detectors may not be adequate due to their inherent noise and resolution limitations. With recent developments, CMOS based detectors are presenting an option to fulfill the need for better image quality. For this work, a new CMOS detector has been analyzed experimentally and theoretically in terms of sensitivity, MTF and DQE. The detector (Dexela Model 1207, Perkin-Elmer Co., London, UK) features 14-bit image acquisition, a CsI phosphor, 75 µm pixels and an active area of 12 cm × 7 cm with over 30 fps frame rate. This detector has two modes of operations with two different full-well capacities: high and low sensitivity. The sensitivity and instrumentation noise equivalent exposure (INEE) were calculated for both modes. The detector modulation-transfer function (MTF), noise-power spectra (NPS) and detective quantum efficiency (DQE) were measured using an RQA5 spectrum. For the theoretical performance evaluation, a linear cascade model with an added aliasing stage was used. The detector showed excellent linearity in both modes. The sensitivity and the INEE of the detector were found to be 31.55 DN/µR and 0.55 µR in high sensitivity mode, while they were 9.87 DN/µR and 2.77 µR in low sensitivity mode. The theoretical and experimental values for the MTF and DQE showed close agreement with good DQE even at fluoroscopic exposure levels. In summary, the Dexela detector's imaging performance in terms of sensitivity, linear system metrics, and INEE demonstrates that it can overcome the noise and resolution limitations of present state-of-the-art x-ray detectors.

Management of Benign Head and Neck Tumors

: Endovascular procedures for benign head and neck tumors include embolization, stenting, and balloon test occlusion. A transarterial (or endovascular) approach forms the mainstay of treatment for head and neck bleeding as well as for transarterial chemotherapy for head and neck neoplasms. A combination of percutaneous and transarterial approaches may be needed in the embolization of high-flow craniofacial vascular malformations (VMs) and hypervascular tumors. This is a review of the current clinical applications of a variety of percutaneous and endovascular interventional procedures of the extracranial head and neck. The tumors that require embolization in the head and neck most commonly include glomus tumors, angiofibromas, and meningiomas. Many other types of tumors that may also require preoperative embolization include the following: hypervascular metastases, esthesioneuroblastomas, schwannomas, rhabdomyosarcomas, plasmacytomas, chordomas, and hemangiopericytomas. The goal of tumor embolization is to selectively occlude the external carotid artery (ECA) feeders through intratumoral deposition of embolic material. The embolic agents in common use are polyvinyl alcohol (PVA), Embospheres (BioSphere Medical, Rockland, Mass), liquid embolic agents (glue, ethylvinyl alcohol copolymer [EVOH], or Onyx [ev3, Irvine, Calif]), gelatin sponge (Gelfoam; Phadia, Uppsala, Sweden), and coils. The embolization is ideally performed 24-72 hours before surgical resection to allow maximal thrombosis of the occluded vessels and prevent recanalization of the occluded arteries or formation of collateral arterial channels. Preoperative embolization is cost-effective and tends to shorten operation time by reducing blood loss and the period of recovery.

Editor's Choice - Use of Disposable Radiation-absorbing Surgical Drapes Results in Significant Dose Reduction During EVAR Procedures

Because of the increasing number of interventional endovascular procedures with fluoroscopy and the corresponding high annual dose for interventionalists, additional dose-protecting measures are desirable. The purpose of this study was to evaluate the effect of disposable radiation-absorbing surgical drapes in reducing scatter radiation exposure for interventionalists and supporting staff during an endovascular aneurysm repair (EVAR) procedure. This was a randomized control trial in which 36 EVAR procedures were randomized between execution with and without disposable radiation-absorbing surgical drapes (Radpad: Worldwide Innovations & Technologies, Inc., Kansas City, US, type 5511A). Dosimetric measurements were performed on the interventionalist (hand and chest) and theatre nurse (chest) with and without the use of the drapes to obtain the dose reduction and effect on the annual dose caused by the drapes. Use of disposable radiation-absorbing surgical drapes resulted in dose reductions of 49%, 55%, and 48%, respectively, measured on the hand and chest of the interventionalist and the chest of the theatre nurse. The use of disposable radiation-absorbing surgical drapes significantly reduces scatter radiation exposure for both the interventionalist and the supporting staff during EVAR procedures.

Management of Takayasu arteritis: a systematic review

Assessment of the pattern and extent of arterial involvement and measurement of current disease activity are essential for the management of Takayasu arteritis (TA). Since there is no completed, placebo-controlled, randomized clinical trial, the level of evidence for management of TA is low, generally reflecting the results of open studies, case series and expert opinion. The most commonly used agents include corticosteroids and conventional immunosuppressive agents such as MTX, AZA, MMF and LEF. In patients who remain resistant and/or intolerant to these agents, biologic drugs including TNF inhibitors, rituximab and tocilizumab seem to be promising. Antiplatelet treatment may also lower the frequency of ischaemic events in TA. In the presence of short-segment, critical arterial stenosis, balloon angioplasty or stent graft replacement may be useful. On the other hand, long-segment stenosis with extensive periarterial fibrosis or occlusion requires surgical bypass of the affected segment, which is clearly associated with superior results compared with endovascular intervention. As a general rule, both endovascular intervention and surgical procedures should be avoided during the active phase of the disease. Earlier diagnosis, better assessment of disease activity and future clinical trials will obviously improve the management of TA.

GW24-e2356 Approach to the synthesis of Hollow Magnetic nanoparticles used for long-acting and targeted contrast agents

ObjectivesVessels can be displayed clearly with contrast agents flashily but not long. However, continuous vascular imaging and less contrast agents would be beneficial to the patients undergoing interventional endovascular procedures,...

Anatomical variations of aortic arch branching: evaluation with computed tomographic angiography

The aim of this study was to investigate the frequency and gender distribution of variations in the aortic arch branching pattern using 64-slice computed tomograhic angiography. A total of 1000 patients with a normal left-sided aortic arch who underwent computed tomographic angiography for various reasons were analysed retrospectively for the frequency of variation of aortic arch branching; the variations were categorised into seven types. Of the 1000 patients, 79.2% had a normal aortic arch branching pattern - type 1 - and 20.8% had variations. The frequency of type 2 variation - brachiocephalic and left common carotid arteries arising from the aortic arch in a common trunk - was 14.1%, that of type 3 - left vertebral artery originating from the aortic arch - was 4.1%, that of type 4 - coexistence of type 2 and type 3 - was 1.2%, that of type 5 - aberrant right subclavian artery - was 0.6%, that of type 6 - coexistence of aberrant right subclavian artery and bicarotid trunk - was 0.7%, and that for type 7 - thyroidea ima artery arising from the aortic arch - was 0.1%. The incidences of the variations of aortic arch branching were similar among males and females (20% versus 22.1%). The incidence of an aberrant right subclavian artery - type 5 and type 6 - was higher among females compared with males (2.5% versus 0.5), whereas the frequencies of the other variations were either equal or similar in both genders. Recognition of variations of aortic arch branching is important because they may cause symptoms due to tracheoesophageal compression or complications during surgical or endovascular interventional procedures of the aorta and its branches.

TCT-334 Fusion of a fullscale patient simulator with an endovascular simulator to improve quality of human factors trainings with cathlab teams

Interventional endovascular procedures are frequently associated with complications. The use of endovascular virtual reality simulators allow the training of procedural complications. Periprocedural complications can be only trained with additional use of a fullscale patient simulator. Until today

APPROACH TO THE SYNTHESIS OF HOLLOW MAGNETIC NANOPARTICLES USED FOR LONG-ACTING AND TARGETED CONTRAST AGENTS

ObjectivesVessels can be displayed clearly with contrast agents flashily but not long. However, continuous vascular imaging and less contrast agents would be beneficial to the patients undergoing interventional endovascular procedures,...

Patient Organ Radiation Doses During Treatment for Aneurysmal Subarachnoid Hemorrhage

The aim of this retrospective study was to estimate risk organ doses and to estimate radiation risks during the imaging work-up and treatment for aneurysmal subarachnoid hemorrhage (SAH). The imaging procedures comprised computed tomography and digital subtraction angiography studies for diagnosis or endovascular interventional procedures in 50 consecutive patients. Equivalent organ doses (H(T)) to skin, brain, eye lens, salivary glands, thyroid and oral mucosa were measured using thermoluminescence dosimeters in an anthropomorphic head phantom. Picture archiving and communication system (PACS) and radiological information system (RIS) records were analyzed and the frequency of each imaging procedure was recorded as well as the registered individual kerma-length product (P(KL)) and the kerma-area product (P(KA)). The doses were computed by multiplying the recorded P(KL) and P(KA) values by the conversion coefficients H(T)/P(KL) and H(T)/P(KA) from the head phantom. The mean fluoroscopy time, P(KL) and P(KA) were 38 min, 7269 mGy cm and 286 Gy cm(2), respectively. The estimated mean equivalent doses were as follows: skin 2.51 Sv, brain 0.92 Sv, eye lens 0.43 Sv and salivary glands 0.23 Sv. Maximum organ doses were 2.3-3.5 times higher than the mean. Interventional procedures contributed 66 % to skin dose, 55 % to brain dose and 25 % to eye lens dose. Of the patients with an estimated skin dose exceeding 6 Sv, only 1 developed temporary epilation. The risk for radiation-induced cancer for SAH patients is low (2-3 cases per 1,000 patients, of which 90 % are expected to be benign types) compared with the risk of tissue reactions on the head such as skin erythema and epilation (1 temporary epilation per 50 patients).

Urgent endovascular treatment of iatrogenic subclavian artery rupture: report of three cases.

The increased use of central venous catheters in modern medical practice has brought a proportional increase in the number of cases of iatrogenic vascular injuries. Concerning the subclavian artery, the site of the lesion and the vessel size demand urgent and effective treatment in order to obtain a favorable prognosis. It has been common practice for a long time to consider this type of lesion as a surgical emergency. Nevertheless, emerging endovascular interventional procedures appear to offer an alternative that is effective and safe as well. We hereby report three cases of subclavian artery injury, in which repair was achieved by endovascular approach with the placement of a cover stent. Hypovolemic shock (demonstrated in two patients) as well as brachial plexus palsy due to pseudoaneurysm of the subclavian artery (presented in another patient) were successfully managed by percutaneous brachial (in two patients) or right femoral (in the patient with the pseudoaneurysm) approach and placement of balloon expandable covered stents (4-9 mm x 38 mm). No procedure-related complications were observed. Short-term follow-up results in two of the three patients were quite satisfactory concerning patency.