Invasive Endovascular Treatment Research Articles

Splenic Artery Aneurysm Occlusion by Overlapping Gore® Viabahn® Endoprosthesis Devices

The first lienal artery aneurysm was discovered and described for the first time in 1770 by the Frenchman Beaussier during an autopsy. It was first visualised using X-rays in 1920 by the physicians Akbulut and Otan. The first surgical treatment of a splenic artery aneurysm was performed by sur-geons MacLeod and Maurice in 1940. The first minimally invasive endovascular therapies using coils, stents or a combination of the two devices for minimally invasive treatment of aneurysms of the lienal artery were reported in 1990, 1994 and 1995 (1,2,3). 63-year-old patient with a known aneurysmal arteriopathy of the thoracic aorta in the sense of an aortic dissection in coexistence with a 2.2 cm splenic artery aneurysm discovered by chance in the vascular surgery department of the Bürgerspital Solothurn. The interdisciplinary consensus primarily favoured vascular surgery or minimally invasive transcatheter treatment to eliminate the splenic artery aneurysm. The dissected thoracic aortic aneurysm detected in the pre-interventional CT of the thorax and abdomen, extending into the abdominal aorta, (Fig. 1) should only be treated with minimally invasive endovascular treatment using EVAR after stenting of the lienal artery aneurysm detected by CT (Fig. 9, 10, 11). A reverse therapeutic sequence would have allowed access to the lienal artery aneurysm only by fenestration of the EVAR. For the treatment of our patient's wide-neck aneurysm, the use of a Viabahn was chosen from the many known and proven occlusion materials as a significantly less invasive alternative to surgical treatment of the aneurysm by interdisciplinary consensus. Due to a technical complication during the deployment of the first vial, a two-stage angiographic therapeutic intervention was necessary.

Endovascular Treatment of Hepatic Artery Pseudoaneurysm after Pancreaticoduodenectomy: A Literature Review

Pancreaticoduodenectomy (PD) is a complex surgical procedure performed in patients with periampullary tumors located within the pancreatic head, the papilla of Vater, the distal common bile duct, and the duodenum. In advanced tumors, the operative technique involves the need for dissection and divestment of the arteries located within the pancreaticoduodenal field, including the common hepatic artery (CHA) and the proper hepatic artery (PHA) and its branches. The second most important cause of post-PD visceral aneurysms is irritation of the peri-pancreatic arterial wall by pancreatic juice in a postoperative pancreatic fistula (POPF). Hepatic artery pseudoaneurysm (HAP) is a very dangerous condition because it is usually asymptomatic, but it is a rare and potentially lethal pathology because of the high risk of its rupture. Therefore, HAP requires treatment. Currently, selective celiac angiography is the gold-standard diagnostic and therapeutic management for postoperative bleeding and pseudoaneurysm in patients following PD. Open surgery and less invasive endovascular treatment are performed in patients with HAP. Endovascular treatment involves transarterial embolization (TAE) and stent graft implantation. The choice of treatment method depends on the general and local conditions, such as the patient’s hemodynamic stability and arterial anatomy. In patients in whom preservation of the flow within the hepatic artery (to prevent hepatic ischemia complications such as liver infarction, abscess, or failure) is needed, stent graft implantation is the treatment of choice. This article focuses on a review of two common methods for endovascular HAP treatment. In addition, risk factors and diagnostic tools have been described.

APOLLO: advanced magnetic probes for minimally invasive endovascular interventions.

APOLLO: advanced magnetic probes for minimally invasive endovascular interventions.

Transradial access for the endovascular treatment of intracranial aneurysms using the Woven EndoBridge device: A systematic review and pooled analysis.

The Woven EndoBridge (WEB) device is a minimally invasive endovascular treatment option for patients with cerebral aneurysms. Transradial access (TRA) is a technique that involves accessing the arterial system through the radial artery in the wrist rather than the femoral artery in the groin. Several studies have investigated the use of TRA for WEB device deployment in treating intracranial aneurysms. A systematic review was conducted to evaluate the TRA for WEB device deployment in treating intracranial aneurysms. The databases PubMed, Cochrane, Embase, Scopus, and Web of Science were searched. To reduce the risk of bias, this systematic review only included studies reporting on using TRA in WEB device deployment for intracranial aneurysm treatment with a minimum of four patients. In this systematic review, 186 patients were included across five studies, with TRA used in 183 cases analyzed. The study population had a higher proportion of females (n = 118%-69%) than males, with a mean age of 62years old. Among the aneurysms treated, 46 were ruptured, and 119 were located at bifurcation sites, with a mean maximum diameter/width of 6.6mm and mean height of 5.9mm. Adjunctive coiling was used in three cases, and adjunctive stenting was used in nine cases. In two cases, conversion to a femoral artery access was necessary. The available results suggest TRA with the WEB device is a safe and effective alternative. However, using TRA versus TFA should be individualized based on patient factors and operator experience.

Clinical Case of IVUS-Guided Coronary Artery Stenting in a Patient with Chronic Renal Failure

Introduction. An expanding number of indications for PCI in patients with coronary heart disease and severe concomitant pathology are accompanied by a growing number of patients with chronic renal failure. Contrast-induced nephropathy (CIN) is recognized as a severe complication, aggravating the course of the underlying disease, and, moreover, reducing the life expectancy of the patients. Modern intravascular imaging technologies are widely implemented in real clinical practice of endovascular surgery. In the context of increasing number of PCI performed in patients with severe concomitant pathology, the IVUS-guidance will improve the quality of stenting, and, importantly, lessen the risks of CIN due to the reduction in contrast volume. Materials and methods. The paper presents a clinical case of IVUSguided stenting of the right coronary artery without contrast agent in a patient with chronic kidney disease and the following diagnosis: “Coronary heart disease. Effort angina, class III (dyspnea as anginal equivalent). Balloon angioplasty and stenting of circumflex artery and LAD. Hyperlipidemia 2a. Atherosclerosis of the aorta, brachiocephalic and coronary arteries. Stage 3 hypertension. Controlled Hypertension. Level IV CVD risk. Type 2 diabetes mellitus. Target glycated hemoglobin is less than 7.5%. Grade 2 obesity, exogenous-constitutional. Renal microlithiasis. CKD stage 4 (GFR 29 ml/min/1.73m2). Cerebrovascular disease. Chronic cerebral ischemia.” Results and discussion. In the described clinical case, a complete myocardial revascularization was achieved using IVUS-guidance and minimal amount of contrast agent in a patient with severe CKD. The advantage of minimally invasive endovascular interventions in a complex category of patients, demonstrated by the case, implies expanded possibilities for providing high-tech care to patients with significant limitations in the use of contrast agents due to severe CKD with a high risk of CIN. Conclusion. Today, an increasing number of X-ray operating rooms in Russia are equipped with intravascular technologies, ensuring their wider use. The skills and knowledge in using IVUS imply rare application of contrast agents, thereby lessening the risk of CKD and, as a consequence, improving the prognosis of patients with reduced renal function and high risk of CKD.

Assessment of the Quality and Reliability of Information on YouTube Regarding Angiography and Angioplasty.

Introduction Angiography is a method for defining the inner vessel wall and demonstrating flow through the lumen by detecting contrast injection into a blood vessel and projecting it onto a sequence of X-rays. This method is used to image the anatomical and architectural aspects of the vascular system. By employing balloon dilatation and the implantation of stents to widen the stenosed arteries, angioplasty is a form of minimally invasive endovascular treatment used to treat cardiovascular diseases and their consequences. People frequently rely on YouTube as a resource for awareness-raising and marketing activities. Animations and visual explanations can help patients understand the risks and benefits of procedures. Aims To assess the quality and reliability of the information on YouTube about angiography and angioplasty. We assessed quality using the GQS (Global Quality Scale) and reliability via the reliability score. Methodology This is an observational, cross-sectional study without the requirement of an ethics committee. It includes a questionnaire with predetermined criteria like time since upload, popularity, or type of uploader. The study assesses YouTube videos that include criteria using GQS and reliability scores. Responses recorded in Google Sheets were transferred to Microsoft Excel (Redmond, USA). Statistical analysis was performed using IBM Corp. Released 2012. IBM SPSS Statistics for Windows, Version 21.0. Armonk, NY: IBM Corp.All six authors assessed 10 YouTube videos using specific keywords. The study includes videos that meet the inclusion criteria. Videos that did not include the inclusion criteria were excluded. Results After applying inclusion/exclusion criteria, 57 out of 60 videos were included. Of the total videos analyzed, the majority were uploaded by various hospitals and people other than doctors and healthcare organizations. About 78.95% of the videos described the reason for angiography/plasty, followed by the anatomical area involved and the pre-procedural preparation phase. There is a significant increase in the GQS score and reliability score among the videos uploaded by doctors, hospitals, healthcare organizations, and other groups. Conclusions Verified health information should be uploaded responsibly by doctors, hospitals, healthcare organizations, or other agencies on social media like YouTube in a manner that is easy to understand, has a high GQS, and has a high reliability score, as it would make it simpler for the general population or viewers to have access to important health-related content they can rely on. Videos should advise the viewers to contact their doctors for all queries regarding the diagnosis or treatment of their health concerns.

The CathCam: A Novel Angioscopic Solution for Endovascular Interventions.

Peripheral arterial diseases are commonly managed with endovascular procedures, which often face limitations in device control and visualization under X-ray fluoroscopy guidance. In response, we developed the CathCam, an angioscope integrated into an expandable cable-driven parallel mechanism to enhance real-time visualization, precise device positioning and catheter support for successful plaque crossing. The primary objective of this study was to assess and compare the performance of the novel CathCam with respect to conventional catheters and the CathPilot (i.e., CathCam without the angioscope), for applications in crossing chronic total occlusions (CTO). We first assessed the system in 3D-printed phantom models, followed by an ex vivo evaluation with CTO samples from a patient's superficial femoral artery. We measured and compared success rates, crossing times, and fluoroscopy times in both experiments. The CathCam demonstrated a 100% success rate in phantom experiments and a 75% success rate in ex vivo experiments with CTO samples, compared to conventional catheters, with 35% and 25% success rates, respectively. The average crossing times for the CathCam and the conventional catheter were 31s and 502s for the phantom experiments and 210s and 511s for the actual CTO lesions. The Cathcam also showed to be a reliable endovascular imaging approach in an in vivo experiment. Compared to conventional catheters, the CathCam significantly increased the success rate and reduced crossing and fluoroscopy times in both phantom and ex vivo setups. CathCam can potentially improve clinical outcomes for minimally invasive endovascular interventions by offering high-resolution real-time imaging alongside accurate device control.

IMPI: portable human-sized magnetic particle imaging scanner for real-time endovascular interventions

Minimally invasive endovascular interventions have become an important tool for the treatment of cardiovascular diseases such as ischemic heart disease, peripheral artery disease, and stroke. X-ray fluoroscopy and digital subtraction angiography are used to precisely guide these procedures, but they are associated with radiation exposure for patients and clinical staff. Magnetic Particle Imaging (MPI) is an emerging imaging technology using time-varying magnetic fields combined with magnetic nanoparticle tracers for fast and highly sensitive imaging. In recent years, basic experiments have shown that MPI has great potential for cardiovascular applications. However, commercially available MPI scanners were too large and expensive and had a small field of view (FOV) designed for rodents, which limited further translational research. The first human-sized MPI scanner designed specifically for brain imaging showed promising results but had limitations in gradient strength, acquisition time and portability. Here, we present a portable interventional MPI (iMPI) system dedicated for real-time endovascular interventions free of ionizing radiation. It uses a novel field generator approach with a very large FOV and an application-oriented open design enabling hybrid approaches with conventional X-ray-based angiography. The feasibility of a real-time iMPI-guided percutaneous transluminal angioplasty (PTA) is shown in a realistic dynamic human-sized leg model.

Acute mesenterial ischaemia: a contemporary view

During the COVID-19 pandemic, the incidence of acute mesenteric ischemia (AMI) increased to 10.9 per 100 000 population. Here we discuss causes, symptoms, current diagnosis and treatment of AMI.Frequently, such patients suffer from stenosis or occlusion of superior mesenteric artery accompanied by coronary artery disease, chronic heart failure, or chronic brain ischaemia. The main clinical symptom is constant abdominal pain which is sharp in case of mesenteric artery thrombosis or dull if thrombosis is restricted to the branch of superior or inferior mesenteric veins. Conventionally, the diagnosis of AMI is verified by multislice computed tomography angiography and contrast-enhanced multislice computed tomography. Timely diagnosis with emergency surgery reduces mortality from 90% to 30-50%. The best treatment outcomes are observed after early revascularizations and minimally invasive endovascular interventions.

Carotid endarterectomy versus carotid stenting for asymptomatic carotid stenosis: Evaluating the overlapping meta-analyses of randomized controlled trials

BackgroundAsymptomatic carotid stenosis is associated with increased risk of ischemic stroke. The management of asymptomatic carotid stenosis ranges from open surgical approaches, minimally invasive endovascular interventions, and medical therapeutics. However, the research synthesis comparing these interventions, as shown by the scattered and overlapping published meta-analysis, has been inconsistent and non-comprehensive. MethodsUsing previously-employed methods, we searched for and compared published meta-analyses comparing carotid endarterectomy and carotid stenting. A comprehensive search was conducted for all relevant studies published until November 13th, 2021, using the following databases: PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, OVID, and Google Scholar. ResultsFive meta-analysis studies were included in this review. In summary, clinical findings were: carotid endarterectomy reduced the rate of ischemic stroke and stroke-related mortality, but led to a higher rate of intraoperative cranial nerve injury. There was no significant difference between carotid endarterectomy and carotid stenting in ipsilateral stroke and myocardial infarction events. ConclusionsThe clinical findings favor the carotid endarterectomy over the carotid stenting in terms of stroke incidence (overall and minor events) and stroke-related mortality rates. However, the carotid stenting was superior to the carotid endarterectomy in the events of cranial nerve injury during the intervention.

Results of treatment of acute arterial thrombosis in patients with severe course of coronavirus infection COVID-19

Acute arterial thrombosis against the background of the novel coronavirus infection COVID-19 is an unfavorable complication. The survival prognosis in this category of patients is much worse than in the rest of the patient population. The aim of the work is to compare the immediate results of various methods of treating acute arterial insufficiency in patients with the novel coronavirus infection COVID-19, complicated by the development of acute arterial thrombosis of various localizations. 42 clinical cases of treatment of acute arterial pathology in patients with confirmed COVID-19 infection were analyzed. The severity of the underlying disease was not considered as a criterion for exclusion from the study. Surgical treatment by open intra-arterial thrombectomy under local anesthesia was used in 9 patients. Endovascular balloon angioplasty of arteries followed by selective catheter-guided thrombolysis with alteplase was performed in 17 patients. Sixteen patients received systemic transvenous thrombolysis with the recombinant human tissue plasminogen activator alteplase at a dose of 100 mg. The development of arterial thrombosis against the background of the coronavirus infection is accompanied by a high risk of death in the absence of timely and active specialized care. In the study group, 18 patients (43 %) with acute arterial thrombosis associated with COVID-19 deceased; of these, eight patients underwent open thrombectomy, eight patients had systemic transvenous thrombolysis with alteplase, and two patients underwent endovascular balloon angioplasty with selective catheter-guided thrombolysis with alteplase. A favorable outcome of the disease was noted in 24 patients (57 %); of these, fifteen patients underwent endovascular balloon angioplasty with selective catheter-guided thrombolysis with alteplase, and 8 patients had systemic thrombolysis with alteplase. Optimal treatment results were achieved in the group of patients using minimally invasive endovascular treatment methods in combination with tissue plasminogen activator. In the group of non-transportable patients with grade 3 respiratory failure and high perioperative risks, positive results were achieved exclusively through the use of systemic transvenous thrombolysis. These data allow us to consider justified the use of options for systemic thrombolysis and selective catheter thrombolysis in combination with endovascular reconstruction as an alternative to «open» surgical methods for thevtreatment of acute arterial insufficiency against the background of COVID-19.

Invasive Diagnostic and Therapeutic Management of Cerebral VasoSpasm after Aneurysmal Subarachnoid Hemorrhage (IMCVS)-A Phase 2 Randomized Controlled Trial.

Cerebral vasospasm (CVS) is associated with delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (SAH). The most frequently used form of rescue therapy for CVS is invasive endovascular therapy. Due to a lack of prospective data, we performed a prospective randomized multicenter trial (NCT01400360). A total of 34 patients in three centers were randomized to invasive endovascular treatment or conservative therapy at diagnosis of relevant CVS onset. Imaging data was assessed by a neuroradiologist blinded for treatment allocation. Primary outcome measure was development of DCI. Secondary endpoints included clinical outcome at 6 months after SAH. A total of 18 of the 34 patients were treated conservatively, and 16 patients were treated with invasive endovascular treatment for CVS. There was no statistical difference in the rate of cerebral infarctions either at initial or at the follow-up MRI between the groups. However, the outcome at 6 months was better in patients treated conservatively (mRs 2 ± 1.5 vs. 4 ± 1.8, p = 0.005). Invasive endovascular treatment for CVS does not lead to a lower rate of DCI but might lead to poorer outcomes compared to induced hypertension. The potential benefits of endovascular treatment for CVS need to be addressed in further studies, searching for a subgroup of patients who may benefit.

Delayed Cerebral Ischemia after Aneurysmal Subarachnoid Hemorrhage: The Results of Induced Hypertension Only after the IMCVS Trial-A Prospective Cohort Study.

Delayed cerebral ischemia (DCI) is a predictor of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Treatment strategies vary and include induced hypertension and invasive endovascular treatment. After the IMCVS trial (NCT01400360), which failed to demonstrate a benefit of endovascular treatment for cerebral vasospasm (CVS) and resulted in a significantly worse outcome, we changed our treatment policy in patients with diagnosed CVS to induced hypertension only, and we present our prospective results in the subgroup of SAH patients meeting inclusion criteria of the IMCVS trial. All patients underwent screening for DIND when conscious and for CVS using CT-A/-P at day 6–8 after SAH. In the case of CVS, arterial hypertension was induced and continued until re-assessment. In total, 149 of 303 patients developed CVS. DCI developed in 35 patients (23.5%). In multivariate analyses, CVS was a predictor for the development of new infarctions. Poor admission status, re-bleeding before treatment, and DCI predicted poor outcome. The omittance of invasive endovascular rescue therapies in SAH patients with CVS, additional to induced hypertension, does not lead to a higher rate of DCI. Potential benefits of additional endovascular treatment for CVS need to be addressed in further studies searching for a subgroup of patients who may benefit.

Endovascular management of a congenital hepatic arterioportal malformation in a low resource setting

BackgroundArterioportal malformations, a rare type of vascular malformation, have significant associated morbidity and mortality. Management requires a carefully thought out approach by a multidisciplinary team. Low resource settings have an added challenge of limited treatment options and consumables.Case presentationWe report a case of a 14-month-old male with failure to thrive due to a congenital hepatic arterioportal fistula. He was successfully treated via an endovascular approach with metallic coil embolization.ConclusionHepatoportal fistula, a rare hepatic vascular malformation, has limited treatment options which can further be restricted by overall patient wellness. Minimally invasive endovascular treatment options can offer a high rate of success and reverse the morbidity associated with the disease as was seen with our case.

Understanding Thrombolysis: Improving Patient Care

<h3>Background Information</h3> Thrombolysis is a process used to break up abnormal blood flow in veins and arteries. Catheter-directed thrombolysis treats vascular blockages and improves blood flow by dissolving abnormal blood clots or by mechanically removing the clots using radiology imaging. Understanding the pathophysiology behind what is causing the thrombus in the patient is as important as managing the patient pre and post thrombolysis procedures. Catheter-directed thrombolysis is a minimally invasive endovascular treatment that is used as an adjunct to anticoagulation. This is a procedure that is performed in Interventional Radiology and the nurses that receive these patients need to understand how to manage them. These patients are often critical and need personalized care and close attention. <h3>Objectives of Project</h3> The purpose of this project is to educate nurses in Interventional Radiology (IR), Intensive Care Units (ICU), and other departments about the pathophysiology of the thrombolysis procedure, along with the preparation, management, and post-procedure care of patients undergoing thrombolysis. <h3>Process of Implementation</h3> The IR shared governance team recognized a gap in knowledge regarding Thrombolysis procedures and the care of patients post-procedure. Current evidence was reviewed and an educational Power Point was created. All members of the IR shared governance team reviewed and offered feedback. The IR Director also reviewed the Power Point for content. Education will be uploaded to the health system's education platform. <h3>Statement of Successful Practice</h3> At the conclusion of the education, learners will be able to describe thrombolysis and how the procedure is performed, define deep vein thrombosis and pulmonary embolism and several methods of treatment for both, and explain the care and management of the patient undergoing Thrombolysis. <h3>Implications for Advancing the Practice of Perianesthesia Nursing</h3> Nurses caring for these patients need to understand what to manage and report back to the physician such as changes in mental status, acute headache, nausea/vomiting, and any neurovascular changes. RNs also need to understand appropriate dosages and rates of thrombolytic agents as ordered by the physician in order to properly care for the patient.

Abdominal aortic aneurysms-open vs. endovascular treatment : Decision-making from the perspective of the vascular surgeon

In the last 20years, the treatment of abdominal aortic aneurysms has essentially evolved from surgical to minimally invasive endovascular treatment. There are still anumber of clinical situations that make surgical intervention useful or even necessary. This underlines the importance of interdisciplinary vascular centers for the treatment of complex aortic pathologies and their sequelae. In the following article, the arguments for the choice of procedure for the treatment of infrarenal aortic aneurysms are discussed and the recommendations of various guidelines are compared.

Functionalized Spiral‐Rolling Millirobot for Upstream Swimming in Blood Vessel

Untethered small robots with multiple functions show considerable potential as next‐generation catheter‐free systems for biomedical applications. However, owing to dynamic blood flow, even effective upstream swimming in blood vessels remains a challenge for the robot, let alone performing medical tasks. This paper presents an untethered millirobot with a streamlined shape that integrates the engine, delivery, and biopsy modules. Based on the proposed spiral‐rolling strategy, this robot can move upstream at a record‐breaking speed of ≈14 mm s−1 against a blood phantom flow of 136 mm s−1. Moreover, benefiting from the bioinspired self‐sealing orifice and easy‐open auto‐closed biopsy needle sheath, this robot facilitates several biomedical tasks in blood vessels, such as in vivo drug delivery, tissue and liquid biopsy, and cell transportation in rabbit arteries. This study will benefit the development of wireless millirobots for controllable, minimally invasive, highly integrated, and multifunctional endovascular interventions and will inspire new designs of miniature devices for biomedical applications.

Comparative assessment of risk of development of purulent septic infections in children after open and closed cardiac operations for congenital diseases

Purpose of the study. Comparative assessment of the incidence of nosocomial purulent-septic infections (PSI) in children after open and closed heart surgery for congenital defects.Materials and methods. 503 medical records of children after cardiac surgery were studied. GSI was identified according to epidemiological standard case definitions.Results. It turned out that the incidence rate of PSI in children after open heart surgery is an order of magnitude higher than after minimally invasive endovascular interventions. Hospital-acquired pneumonia most often occurs in children after operations.Conclusion. The increased incidence of PSI after open heart surgery, as compared to endovascular surgery, is due to a longer surgical intervention and the subsequent longer stay of patients in the intensive care unit, where such an epidemiologically significant procedure as artificial lung ventilation is performed.

Adjunct procedures for malperfusion syndrome in complicated acute type B aortic dissection

: Acute aortic dissection is a common and often fatal aortic emergency. Treatment of type Baortic dissection typically consists of medical therapy in the uncomplicated cases, with surgical therapy reserved for complicated aortic dissection. Surgical therapy has shifted from traditional open surgical intervention to less invasive endovascular surgical interventions as a first line option. Complicated aortic dissection often presents as visceral or lower limb malperfusion (LLM). Conventional therapy of complicated aortic dissection has been revascularization of the affected vascular bed. Recently, numerous clinical trials and retrospective series have shown that treatment of the proximal aortic entry tear combined with targeted revascularization of the ischemic vascular bed leads to improved short term and long-term patient outcomes. This article outlines the interventional approach to the patient with complicated aortic dissection.

Thoracic endovascular aortic repair in octogenarians: Palliative or curative?

As the life expectancy of our population continues to increase, surgical decision-making in vascular surgery has progressively become more complicated.1 In the past, many octogenarians and older patients were simply not offered major vascular surgery interventions because of prohibitive physiologic stress in the setting of poor health or frailty. Because of technological advances in our specialty, however, patients over the age of 80 years can now be offered less invasive endovascular treatment options to treat complex aortic conditions.