Patients Undergoing Balloon Angioplasty Research Articles

Pulmonary Flow Management by Combination Therapy of Hemostatic Clipping and Balloon Angioplasty for Right Ventricular-Pulmonary Artery Shunt in Hypoplastic Left Heart Syndrome.

Controlling pulmonary blood flow in patients who have undergone Norwood palliation, especially early postoperatively, is challenging due to a change in the balance of systemic and pulmonary vascular resistance. We applied a combination therapy of clipping and balloon angioplasty for right ventricle-pulmonary artery (RV-PA) shunt to control pulmonary blood flow, but the influence of the combination therapy on the PA condition is uncertain. Retrospectively analysis was conducted of all infants with hypoplastic left heart syndrome who had undergone Norwood palliation with RV-PA shunt at Okayama University Hospital from January 2008 to September 2022. A total of 50 consecutive patients underwent Norwood palliation with RV-PA shunt in this study period. Of them, 29 patients underwent RV-PA shunt flow clipping, and the remaining 21 had unclipped RV-PA shunt. Twenty-three patients underwent balloon angioplasty for RV-PA shunt with clips. After balloon angioplasty, oxygen saturation significantly increased from 69 (59-76)% to 80 (72-86)% (p < 0.001), and the narrowest portion of the clipped conduit significantly improved from 2.8 (1.8-3.4) to 3.8 (2.9-4.6) mm (p < 0.001). In cardiac catheterizations prior to Bidirectional cavo-pulmonary shunt (BCPS), there were no significant differences in pulmonary-to-systemic flow ratio (Qp/Qs), ventricular end-diastolic pressure, Nakata index, arterial saturation, mean pulmonary artery pressure and pulmonary vascular resistance index. On the other hand, in Cardiac catheterizations prior to Fontan, Nakata index was larger in the clipped group (p = 0.02). There was no statistically significant difference in the 5-year survival between the two groups (clipped group 96%, unclipped group 74%, log-rank test: p = 0.13). At least, our combination therapy of clipping and balloon angioplasty for RV-PA shunt did not negatively impact PA growth. Although there is a trend toward better but not statistically significant difference in outcomes in the clipped group compared to the non-clipped group, this treatment strategy may play an important role in improving outcomes in hypoplastic left heart syndrome.

Safety and efficacy of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis

Objective: To investigate the efficacy and safety of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis. Methods: A retrospective analysis was carried out on 46 patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis who received endovascular treatment at the Strategic Support Force Medical Center from January 2015 to August 2022. Twenty-seven patients underwent balloon angioplasty alone and 19 patients underwent acute stent implantation. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of the responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality of the two groups were evaluated. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in the acute stenting group was slightly higher than that in the balloon angioplasty group (16/19 vs. 81.5%), but the difference was not statistically significant (P>0.05). Besides, there was no significant difference in the median of mRS between the acute stenting group [3.0(0, 4.0)] and the balloon angioplasty group [4.0(1.0, 5.0)] 90 days after operation (P>0.05). In terms of safety, the incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusions: The effect of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis is not inferior to that of balloon angioplasty, and it does not increase the risk of intracranial bleeding complications.

May Thurner Syndrome: Diagnostic and Therapeutic Outcomes in an Institutional Setting

Introduction: May-Thurner syndrome (MTS), a chronic compression of left common iliac vein (CIV) against the lumbar vertebrae by overlying common iliac artery is an underappreciated contributor to left leg deep venous thrombosis. Even though the estimated prevalence of MTS is high in left-leg deep vein thrombosis (DVT) cases per autopsy studies, the clinical association remains low. Since the screening for MTS in patients with recurrent left-leg DVTs is not a common practice, diagnosis can either be incidental or a combination of clinical presentation and objective testing. Diagnosis is challenging via ultrasound (US) due to the deep anatomical location of iliac veins; therefore, invasive imaging including Contrast venography (CTV) is needed for confirmation. The management of MTS has been reformed over the years with the advances in minimally invasive therapeutic tools. We sought to review the management and outcomes of the MTS adult population by conducting a retrospective review to identify all adult cases of MTS at our academic safety net hospital between 2010 and 2022. Methods: Data was extracted and analyzed for baseline parameters including age, gender, ethnicity, and body mass index (BMI). Presenting symptoms, imaging used for MTS diagnosis (including US Doppler, magnetic resonance venography or CTV), and interventional approaches (catheter or systemic thrombolysis, thrombectomy, balloon angioplasty and/or stent placement) were additionally documented. SAS v9.4 (Cary, NC) was used for statistical analysis. Results: A total of 19 cases, predominantly females 68% (13/19), with a median age of 48 years and a mean BMI of 28.84 kg/m 2 diagnosed with MTS were identified. The predominant initial presentation was left lower extremity edema and pain 36% (7/19) later found to have a DVT, followed by non-healing venous ulcer 15% (3/19) and pelvic congestion syndrome 0.05 % (1/19). Whereas 42% (8/19) of the patients were diagnosed with MTS while undergoing evaluation for chronic and recurrent DVTs. All patients were diagnosed following CTV using transvenous pressures with the formation of collateral veins and a pressure gradient of more than 2 mm Hg across iliofemoral stenosis at rest. Sixteen patients (84%) underwent endovascular stent placement, while one patient underwent Balloon Angioplasty only. One patient refused any intervention for MTS however underwent great saphenous vein ablation for chronic venous wounds. In view of anticoagulation therapy, the initial choice in the most cases was low molecular weight heparin (LMWH), which was later transitioned to other choices, 81 % (10/16) were switched to direct oral anticoagulants, (apixaban= 10, rivaroxaban=3) due to ease of administration and compliance, while 19 % (3/16) were continued on LMWH for patient preference and pregnancy. Post-intervention complications consisted of stent failure in 25% (4/16) patients; related to stent thrombosis and Post-thrombotic Syndrome (PTS) in 12.5 % (2/16) patients. No bleeding complications were seen post any case of endovascular stent placement. Conclusion: This review was a highly educational experience giving us insight into this unacknowledged syndrome. Multiple factors could be contributing to this underdiagnosis, including invasive gold standard imaging for MTS, more easily recognizable risk factors for DVTs that can overshadow MTS, and a smaller number of data and studies. Some authorities have advocated a need to rule out MTS in young women with acute left lower extremity DVT, a clear female predominance was also noted (68%) in our analysis. Post-stent placement, systemic anticoagulation for 3-6 months is recommended, in our review, all patients (100%) who underwent stent placement were started on anticoagulation for at least 3 months. A small sample size, patients lost to follow-up (poor outcomes and complications could have been missed) and a single institutional review were some limitations of our study, however with a rare disease such as MTS with 2-3% prevalence it is difficult to conduct a large size, multi- institutional analysis. This study contributes to the limited literature available on MTS.

Delayed Migration of Tapered Open-Cell Design Carotid Stent: A Case Report.

We present a case of delayed migration of an open-cell design carotid stent, which is a rare complication following carotid artery stenting (CAS). A 65-year-old patient with carotid artery stenosis underwent CAS with an open-cell stent, initially achieving successful deployment. However, 4 months later, the stent migrated and resulted in restenosis. The patient underwent balloon angioplasty and received an additional stent, leading to improved blood flow. The rarity of stent migration, particularly in the absence of risk factors, highlights the need for clinicians to be vigilant and consider early imaging follow-up for patients at risk of this complication after CAS.

Restenosis Rate and Reinterventions after Aortic Arch Repair in Infants

The aim. This study aims to determine the reintervention rate in infantsundergoing aortic arch repair and to analyze risk factors and evaluate the results of reinterventions.&#x0D; Materials and methods. This retrospective study examines 445 infants with aortic arch hypoplasia who under-went aortic arch reconstruction between 2011 and 2019. The study included only patients with two-ventricle physiology and subsequent two-ventricle repair. Techniques for primary repair included extended end-to-end anastomosis (n = 348), end-to-side anastomosis (n = 611), autologous pericardial patch repair (n = 16).&#x0D; Results. The overall mortality in the entire study group was 3.3 %. Follow-up period ranged from 1 month to 9.4 years (mean 2.8 ± 2.5 years). Restenosis at the site of aortic arch repair was identiϐied in 47 (10.5 %) patients. Of these, 12 patients underwent surgical reconstruction of the aortic arch, 27 patients underwent balloon angioplasty, and in 8 patients both methods were used. Freedom from reintervention was 89.4 % at 1-year follow-up and 87.5 % at 4-year follow-up. The most determining factorsfor restenosis were related to hypoplastic proximal aortic arch and body weight less than 2.5 kg.&#x0D; Conclusions. Surgical treatment of aortic arch hypoplasia in newborns and infants is effective and shows good immediate and long-term results. Anatomical correction of reobstruction at the level of the aortic arch is safe with both endovacular and surgical methods with low mortality and incidence of repeated interventions. Identified risk factors for mortality and recurrent aortic arch interventions help to improve the treatment of aortic arch hypoplasia in patients under 1 year of age.

Rate of reinterventions and restenosis after aortic arch repair in Infants

Restenosis after aortic arch repair is well known complication in infants. The purpose of this study is to identify the reintervention rate in infants with aortic arch repair. Cohort retrospective study of 200 infants with aortic arch hypoplasia who did aortic arch reconstruction between 2010 and 2021. The procedures for primary repair included extended end-to-end anastomosis (n = 175) and autologous pericardial patch repair (n = 25). The overall mortality in the entire study group was 4.7 %. Follow-up period ranged from 5 month to 10 years (mean 2.2 ± 2.3 years). Restenosis at the site of aortic arch repair was identified in 60 (14.3 %) patients. Furthermore 15 patients underwent surgical reconstruction of the aortic arch, 30 patients underwent balloon angioplasty, and in 4 patients both methods were used. In conclusions surgical treatment of aortic arch hypoplasia in infants is effective and shows good immediate and long-term results.

MO775: Vacuum-Assisted Thromboaspiration with Indigo System After Acute Arteriovenous Fistula Thrombosis: Monocentric Experience of an Innovative Interventional Approach

Abstract BACKGROUND AND AIMS Arteriovenous fistula (AVF) must be the first choice where eligible and a prompt approach within 48–72 h should be performed in case of acute AVF failure in order to maintain the patency of the vascular access. Evaluation of the most appropriate de-clotting technique must be made considering the patient's comorbidity, AVF characteristics and absolute, relative and temporary contraindications to each kind of corrective intervention. The outcome is different between the multiple methods and nowadays mechanical thromboaspiration (MT) seems to be an innovative and promising approach. METHOD A total of 9 AVF of 9 chronic haemodialysis patients with acute AVF failure were treated with MT between January 2019 and January 2022 and were retrospectively evaluated. MT was carried out via Indigo catheter (Penumbra Inc.), an aspiration system intended for the removal of emboli and thrombi from vessels through venipuncture of AVF/AVG: the continuous aspiration helps distinguish clots from normal blood flow; in case of resistant clots, separators of many sizes can be used at the tip of the catheter to facilitate their fragmentation and aspiration. Adjunctive procedures such as balloon angioplasty (used at all sites), local fibrinolysis, heparin infusion, or stents placement were considered. Technical success was defined by clot removal from AVF or AVG. Clinical success was defined by the restoration of thrill and bruit together with AVF usability after the procedure. Vascular access survival defined as AVF/AVG usability at 3 and 6 months was assessed. RESULTS Average age was 71.2 years; dialysis vintage was 93.4 months. Medium follow-up was 13.1 months. All patients needed placement of a temporary central venous catheter (CVC) and dialysis before the MT. Technical success was achieved in 100% of the procedures, clinical success was achieved in 88.9% of the MT (despite the technical success, in 1/9 patients AVF could not be used due to a severe residual venous stenosis). None reported peri-/intraprocedural complications. In 2/9 MT there was no use of anticoagulation; in 5/9 patients, a single unfractionated heparin bolus was used (2500 UI) during the manoeuvre; in 2/9 patients, a single 2500 UI bolus plus continuous intravenous infusion of unfractionated heparin was administered combined with local thrombolysis with urokinase: both patients needed blood transfusions after the manoeuvre, one of them reporting severe haemorrhage from AVF. As adjunctive procedures, 9/9 patients underwent balloon angioplasty; one of them needed stent placement over the venous stenosis. CVC was removed less than 48 h from the procedure in 5/9 patients (55.6%), in 3/9 patients it was removed after 48 h, while 1/9 patients maintained the temporary vascular access due to the lack of clinical success after MT. Double-needle puncture occurred after a medium time of 3.5 days. AVF survival at 3 months and 6 months was 66.6% (6/9 patients), while 3/9 patients faced AVF failure (1/3 patients deceased 2 months after the procedure with a functioning AVF, in 1/3 patients a relapse of AVG thrombosis occurred 2 months after the procedure, 1/3 never reached clinical success due to severe residual venous stenosis). At the time of study design, 3/9 patients resulted to be deceased due to causes unrelated to the procedure. (1/3 due to complications of abdominal surgery, 1/3 due to sepsis, 1/3 due to subarachnoid haemorrhage). CONCLUSION MT is an innovative yet functional and safe procedure that allows declotting of the thrombosed AVF while reducing or avoiding anticoagulation and/or surgery.

Treatment of Atherosclerotic Femoropopliteal Artery Disease with Supera Interwoven Nitinol Stent: A Real-World Study in China

To analyze the outcomes of Supera stent deployment in Chinese patients with atherosclerotic femoropopliteal artery (FPA) disease in a real-world setting. This retrospective cohort study collected and analyzed the medical records of 246 consecutive patients who received Supera stents for FPA disease at the China Academy of Chinese Medical Sciences Xiyuan Hospital between February 2017 and December 2019. All study patients underwent balloon angioplasty and were treated with Supera stents (Abbott Vascular, Santa Clara, CA, USA). The primary outcome was the rate of primary patency 12months after discharge. The analyses included 246 consecutive patients and 260 lesions. The mean±SD age was 73.2±9.9years and most patients (60.2%) were males. Of the 260 treated lesions, Supera stents were deployed in eight (3.1%) cases after a previous stent fracture. Critical limb ischemia was diagnosed in 87.3% of the limbs, and 84 (32.3%) and 83 (31.5%) cases were classified as TransAtlantic Inter-Society Consensus (TASC) C and D, respectively. Most of the lesions were in situ (80.8%) and located in the superficial femoral artery (45.0%) or the FPA (45.8%). The mean lesion length was 147.7mm. Nominal deployment (-10 to 10% compression) was the most common deployment scenario (84.1%). The 1-year primary patency rate was 80.6%. Lesions that occurred as restenosis (odds ratio [OR]:=3.34, 95% confidence interval [CI]: 1.03-10.85, P=0.045) or in-stent restenosis (OR:=2.88, 95% CI: 1.03-8.07, P=0.045) were independently associated with occlusion or stenosis after stent deployment. No stent fracture was observed in this study. Our study indicates that the use of Supera stents is feasible for the treatment of Chinese patients with FPA disease. The long-term results reveal high primary patency.

Association of periprocedural perfusion non-improvement with recurrent stroke after endovascular treatment for Intracranial Atherosclerotic Stenosis.

Predictors of recurrent stroke after endovascular treatment for symptomatic intracranial atherosclerotic stenosis (ICAS) remain uncertain. Among baseline characteristics, lesion features, and cerebral perfusion changes, we try to explore which factors are associated with the risk of recurrent stroke in symptomatic ICAS after endovascular treatment. Consecutive patients with symptomatic ICAS of 70-99% receiving endovascular treatment were enrolled. All patients underwent whole-brain computer tomography perfusion (CTP) within 3 days before and 3 days after the endovascular treatment. Baseline characteristics, lesion features, and cerebral perfusion changes were collected. Cerebral perfusion changes were evaluated with RAPID software and calculated as preprocedural cerebral blood flow (CBF) < 30%, time to maximum of the residue function (Tmax) > 6 s, and Tmax > 4 s volumes minus postprocedural. Cerebral perfusion changes were divided into periprocedural perfusion improvement (>0 ml) and non-improvement (⩽ 0 ml). Recurrent stroke within 180 days was collected. The Cox proportional hazards analysis analyses were performed to evaluate factors associated with recurrent stroke. From March 2021 to December 2021, 107 patients with symptomatic ICAS were enrolled. Of the 107 enrolled patients, 30 (28.0%) patients underwent balloon angioplasty alone and 77 patients (72.0%) underwent stenting. The perioperative complications occurred in three patients. Among CBF < 30%, Tmax > 6 s, and Tmax > 4 s volumes, Tmax > 4 s volume was available to evaluate cerebral perfusion changes. Periprocedural perfusion improvement was found in 77 patients (72.0%) and non-improvement in 30 patients (28.0%). Nine patients (8.4%) suffered from recurrent stroke in 180-day follow-up. In Cox proportional hazards analysis adjusted for age and sex, perfusion non-improvement was associated with recurrent stroke [hazards ratio (HR): 4.472; 95% CI: 1.069-18.718; p = 0.040]. In patients with symptomatic ICAS treated with endovascular treatment, recurrent stroke may be related to periprocedural cerebral perfusion non-improvement. http://www.chictr.org.cn. Unique identifier: ChiCTR2100052925.

Safety and Efficacy of Intracoronary Brachytherapy Protocol for Resistant In-Stent Restenosis

The aim of our prospective study is to evaluate the safety and the long-term clinical efficacy of Intracoronary Brachytherapy (ICBT) for In-stent Restenosis utilizing a prespecified interventional and radiation protocol.Single center prospective analysis of patients undergoing ICBT with at least 2 prior layers of coronary stents compared to patients undergoing balloon angioplasty alone. Per our protocol, the first step is to perform an intravascular ultrasound (IVUS) study to evaluate the lesion for degree of calcification, etiology of ISR, length of the lesion and diameter of the vessel. Then, laser atherectomy is performed using 0.9, 1.4- or 1.7-mm catheters for 3 runs. Percutaneous transluminal coronary angioplasty (PTCA) of the culprit lesion with a 1:1 sized cutting balloon is performed. Then, ICBT is performed and IVUS is repeated to confirm appropriate MLA. Target Vessel Revascularization rates within one year of ICBT will be assessed. Periprocedural complications will be assessed for up to 72 hours. Side branch occlusion: > 50% stenosis of the side-branch of the target vessel during/immediately after completion of ICBT. Absence of TIMI III flow distally in the target vessel after ICBT will also be assessed.Results for our project are forthcoming however we have completed 32 brachytherapy treatments in our laboratory since 2016 and their results are presented herein. Significant side branch occlusion occurred in only 4 cases (13%). Distal slow flow or no flow occurred in 3 cases (9%). TIMI 3 flow was restored in all 3 cases. TVR occurred in only 3 cases (9%). Bleeding complications occurred in 3 cases, 2 patients had a hematoma and one had bleeding at the access site. Only one case required one unit of blood transfusion. Acute renal failure occurred in one case. There were no 30-day readmissions to our hospital for any of the patients who received ICBT. 30-day survival was observed in all 32 patients. The 8 patients who qualified for ICBT during the same time period of January 2016 to December 2020 but had PTCA alone or atherectomy and PTCA had TVR observed in 5/8 cases (63%); This was significantly higher than in those patients who underwent ICBT (P < .001). Side branch occlusion did not occur in any of the 8 cases. None of the cases had a distal slow flow or no flow phenomenon. None of the patients had acute renal failure. There were no 30-day readmissions and all of the patients survived to 30 days.In-stent restenosis of DES is an important clinical issue. Intracoronary brachytherapy is a safe and well tolerated treatment option that may serve as a form of therapy for high-risk patients with recurrent ISR of DES. At our high-volume institution we have created a systematic protocol for ICBT. We look forward to updating the clinical results from our prospective study.

THE ONE EXCESSIVE EXERCISE CAUSED PULMONARY EMBOLISM!

TOPIC: Pulmonary Vascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The annual incidence of upper extremity deep venous thrombosis (DVT) is 0.4 in 10,000 people annually accounting for 4-10% of all DVT. Upper extremity DVT is divided into primary and secondary. Around 80% of the cases consist of secondary DVT caused by indwelling catheters, cardiac hardwares, and cancer. One of the primary causes is Paget-Schroetter Syndrome. This is the development of upper extremity clot caused by strenuous activity like rowing, baseball, and heavy lifting. We present a young farmer with acute pulmonary thromboembolism due to Paget-Schroetter Syndrome. CASE PRESENTATION: A 26-year-old male farmer presented with right arm throbbing pain and edema for a week. It was aggravated by abduction and extension above 90 degrees and alleviated by resting. It was associated with weakness resulting in difficulty holding his phone or brushing his teeth. Vital signs were within normal limits. Physical examination significant for 1+ edema on the right upper extremity and right axilla. Pulses were 2+ in all extremities. Pain was reproducible on passive right arm abduction and extension. Chest CTA showed acute thrombus in the segmented vessel of the right lower lobe and pulmonary arterial segment of the right upper lobe. Right upper extremity venous Doppler showed acute occlusive deep vein thrombosis in the right subclavian, axillary, brachial veins. Venogram confirmed axillary vein occlusion. CTA of upper extremity showed focal concentric narrowing of right subclavian artery at the junction of right clavicle and right first rib. Patient underwent balloon angioplasty and catheter directed thrombolysis with EKOS. He was discharged on Rivaroxaban with plans for first rib resection on the outpatient setting. DISCUSSION: Paget-Schroetter syndrome (PSS) also known as Effort thrombosis is an acute thrombosis of the axillary-subclavian vein associated with strenuous activity. Those repetitive movements cause microtrauma on the subclavian vein endothelium triggering the coagulation cascade. This can be accompanied by venous stasis caused by anatomical thoracic outlet obstruction from cervical rib, scalenus tendon hypertrophy, or costoclavicular ligament. The major complication of this disease is Pulmonary Embolism which has been reported up to 10% of the presentations. CONCLUSIONS: It is important to identify PSS as the cause of PE, since it requires a more aggressive treatment beside anticoagulation, which includes catheter directed thrombolysis, thoracic outlet decompression, and physical therapy. Conservative management with anticoagulation by itself could lead to disability. Increasing awareness will ensure early recognition and proper treatment. REFERENCE #1: Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK. Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. West J Emerg Med. 2010;11(4):358-362. REFERENCE #2: Heil J, Miesbach W, Vogl T, Bechstein WO, Reinisch A. Deep Vein Thrombosis of the Upper Extremity. Dtsch Arztebl Int. 2017;114(14):244-249. doi:10.3238/arztebl.2017.0244 DISCLOSURES: No relevant relationships by Sarah Nuzzo, source=Web Response No relevant relationships by Joshuam Ruiz Vega, source=Web Response No relevant relationships by Amtul Shafi, source=Web Response

Отдаленные результаты первого опыта лечения мужчины с синдромом Мея–Тюрнера и варикозной болезнью вен органов малого таза

Recurrent and bilateral varicocele represent two least studied aspects of the disease. There is no recommendation in current urological and andrological guidelines in various countries on the diagnosis and treatment of such patients. The first experience of successful surgical treatment of a patient with recurrent varicocele due to May-Thurner syndrome is presented in this paper. The patient had a severe form of the disease and admitted with the varicocele recurrence after 5 previous intervention with chronic pelvic pain syndrome, erectile dysfunction, chronic calculous prostatitis and varicose veins of the pelvic organs. The patient underwent balloon angioplasty and stenting of the left iliac vein on 28th March, 2017 in the City hospital named after E.O. Mukhin. There was almost complete resolution of pelvic pain in the immediate postoperative period (within 1 hour). One week after surgery the patient noted a recovery of erection without any therapy. Three months later, a 45% reduction in the maximum diameter of the prostatic veins was noted according to transrectal ultrasound (TRUS) as well as a lack of antegrade blood flow according to the color Doppler TRUS at rest and during Valsalva's test. There was no deterioration of symptoms during follow-up. Overall, the venous blood flow in prostate was decreased which accompanied by the reducing in pain syndrome and restoration of sexual function without medical therapy. The reduction of diameter of testicular and epididymal varicose veins was seen 6 months after surgery. The diameter of veins of pampiniform plexus in supine position at rest was less than 2 mm. There was no retrograde flow neither in supine, nor in stand position during Valsalva maneuver. Thus, X-ray endovascular angioplasty and stenting of the iliac veins in case of arterio-venous crossing at the lower level is a pathogenetically justified and highly effective treatment of varicocele and varicose veins of the pelvic organs in men.

Endovascular Recanalization of Non-acute Symptomatic Middle Cerebral Artery Total Occlusion and Its Short-Term Outcomes.

Background and Purpose: The optimal treatment for patients with non-acute symptomatic middle cerebral artery (MCA) total occlusion and a high risk of recurrent ischemic stroke despite medical management is not well-established. We aimed to assess the feasibility, safety, and short-term outcomes of angioplasty and stenting for these patients.Methods: Data of 22 patients with non-acute symptomatic MCA total occlusion who have failed medical management and undergone endovascular recanalization were retrospectively collected in our prospective database. All occlusive lesions were predilated with conventional balloons, followed by paclitaxel-coated coronary balloon inflation or not, and then a remedial stenting was performed or not, depending on the discretion of the operator. The rate of successful recanalization, perioperative outcomes, and short-term outcomes, such as restenosis and stroke recurrence, was analyzed.Results: Successful recanalization was achieved in 95.5% of patients, with 14 patients undergoing balloon angioplasty and 7 patients undergoing remedial stenting. Seven patients developed perioperative complications, including one patient with persistent neurological deficit. Over a median clinical follow-up duration of 5.0 months, only one patient had recurrent ischemic symptoms attributed to the cessation of antiplatelet treatment owing to postoperative intracranial hemorrhage. The proportion of patients who achieved favorable clinical outcome (modified ranking scale score of 0–2) was 85.7%. Post-procedural repeat vascular imaging was performed at 4.5 ± 1.84 months, with nine and one patient undergoing cerebral angiography and magnetic resonance angiography, respectively. One (10%) artery presented with asymptomatic reocclusion.Conclusions: Angioplasty and stenting may be feasible for the patients with non-acute symptomatic atherosclerotic MCA total occlusive disease who have failed medical management.

Preliminary results of pharmacomechanical thrombectomy for iliofemoral deep venous thrombosis: A single center experience

Our aim is to explain follow-up in patients treated with pharmacomechanical thrombectomy (PMT) followed by balloon angioplasty for lower extremity deep venous thrombosis (DVT). A total of 19 patients who underwent PMT for DVT were included in the study. The patients underwent PMT with the Cleaner device after insertion of vena cava filters. The mean age was 45 years (range 20-56). The lesions were on the right side in nine patients and on the left side in 10 patients. Complete thrombus removal was achieved in 14 patients and the remaining five patients underwent balloon angioplasty and stenting to achieve significant patency. In conclusion, our single-center experience with short-term results suggests that PMT with the Cleaner device can be used to successfully manage acute and sub acute DVT.

Pediatric Budd-Chiari Syndrome: A Case Series

To study the diagnostic methods and treatment outcomes in children with Budd- Chiari syndrome. Case records of 25 patients with Budd-Chiari syndrome were evaluated retrospectively. These patients were investigated with imaging techniques and underwent balloon angioplasty or surgical management. 21 patients underwent balloon angioplasty, of which 17 had good medium- to long-term results, while only one out of four patients who underwent a portocaval shunt survived. The balloon angioplasty has satisfactory outcome in the treatment of acute Budd-Chiari syndrome. In failed cases, the surgical therapy may be attempted, but the outcomes do not appear rewarding.

Outcomes of endovascular interventional therapy for primary Budd‑Chiari syndrome caused by hepatic venous obstruction

To date, interventional therapy for patients with Budd-Chiari syndrome (BCS) due to hepatic vein obstruction (HVO) has not been standardized in China. In Western countries, BCS primarily occurs due to thrombosis and the majority of patients receive thrombolysis. In China, BCS is mostly caused by the membranous occlusion of the HV or IVC. The present retrospective study evaluated the efficacy of recanalization techniques in patients with primary BCS due to HVO. The data of 69 patients with BCS due to HVO, who underwent endovascular therapy at 2 centers in China between December 2010 and December 2012, were analyzed. All of the patients underwent balloon angioplasty. In addition, 14, 6 and 5 patients received thrombolysis, endovascular stent and thrombolysis + endovascular stent, respectively. The overall technical success rate was 95.7% (66/69), and was comparable among the treatments. The HV pressure after the treatments was significantly lower compared with that prior to the procedures (23.3±6.9 vs. 46.5±8.6 cmH2O; P<0.001). The mean follow-up duration was 75 months (range, 60–84 months). During the 5-year follow-up, 10 patients (15.2%) had developed a recurrence of BCS-associated symptoms, of which 7 were successfully treated. The cumulative survival rates at 12, 36 and 60 months after endovascular interventional therapy (balloon angioplasty or combined treatment) were 98.5, 98.5 and 93.9%, respectively. After treatment by endovascular therapy, the patients with BCS caused by HVO had high survival rates and low recurrence rates in the short- and mid-term.

Abstract No. 677 Outback re-entry device for the treatment of central venous occlusion in hemodialysis patients

To report our institutional experience with the Outback re-entry device for the treatment of central venous occlusion in hemodialysis patients. Since January 2013, 8 consecutive patients (4 males and 4 females, mean age: 63.2 years) receiving hemodialysis underwent endovascular treatment for central venous occlusion using the Outback re-entry device after failed attempts of guidewire traversal. The patients had been referred for percutaneous angioplasty due to increased venous pressure during hemodialysis in 4 patients and upper extremity swelling in 4 patients. The mean age of their fistulas since creation was 21.3 months. Six patients had previously received endovascular treatment for malfunctioning fistulas. Occlusion sites were in the subclavian vein (n=4) and brachiocephalic vein (n=4). In all patients, the guidewire was passed into the subintimal plane but could not be re-directed into the distal true lumen. The Outback re-entry device was used as a bail-out measure with technical success in all cases. All patients underwent balloon angioplasty; 6 of them had provisional bare metallic stent placement due to elastic recoil. The fistulas were functionally restored and arm swelling was relieved in all cases. Excluding three patients who were lost to follow-up, the fistulas were functional up to a mean period of 8.3 months. During this time, 4 patients underwent repeated intervention. There were no complications related to the procedure. The Outback re-entry device is a feasible and safe bail-out option in patients who fail conventional techniques for wire traversal during endovascular treatment of central venous occlusion.

Endovascular therapy for Angio‐sealTM‐related acute limb ischemia: Perioperative and long‐term results

To investigate the perioperative and long-term outcomes of endovascular therapy for Angio-sealTM -related acute limb ischemia. Currently, limited data are available on the optimal treatment strategy for Angio-sealTM -related acute lower limb ischemia. The prospectively maintained patient database of our institution was retrospectively searched to identify all patients who developed acute lower limb ischemia after use of the Angio-SealTM and received endovascular treatment from January 2010 to February 2016. The clinical and follow-up data were evaluated. Thirty-two patients with Angio-SealTM -related acute limb ischemia underwent endovascular therapy, resulting in an approximated incidence of 0.29% of all implanted devices. The overall procedural success rate was 96.9%. With regard to the patients who underwent successful endovascular treatment, the culprit lesion was located in the common femoral artery in 22 (71.0%) cases, the femoral artery bifurcation in 3 (9.7%) cases and the superficial femoral artery in 6 (19.4%) cases. Ten (31.3%) patients had thrombosis in other distal lower limb arteries ipsilateral to Angio-sealTM use. Eighteen (58.1%) patients underwent balloon angioplasty alone, while nine (29.0%) patients underwent balloon angioplasty and thrombolysis, and four (12.9%) patients underwent stent implantation. One patient suffered from minor bleeding at the site of application of the Angio-sealTM . During an average of 43.5 ± 22.9 months of follow-up, three patients with symptomatic restenosis underwent a second successful balloon angioplasty and remained asymptomatic until the last follow-up. Balloon angioplasty with selective thrombolysis or stent placement was safe and effective, with a low incidence of complication and restenosis. © 2017 Wiley Periodicals, Inc.

Hybrid Therapy Using a Surgical Thrombectomy with a Balloon Angioplasty to Regain Thrombosed Dialysis Vascular Access-Clinical Case Series

Introduction: Thrombectomy is the most common surgical method used to re-establish thrombosed vascular access, particularly in hemodialysis patients. To achieve better patient outcomes and to improve the prognosis for surgical thrombectomy, fistulography with balloon angioplasty to assist during surgery has been introduced in recent years. Methods: In this study, the results of hybrid therapy in 53 patients with thrombosed vascular access were examined. The success rate for re-opening vascular access and dialysis success were recorded, immediately, and at 1 m and 6 m after the surgical procedure. Results: Of 53 patients, 40 patients underwent balloon angioplasty. The success rate in the first session of dialysis after surgery was 85%. At 1 m and 6 m, the dialysis success rates were 75% and 55%, respectively. Conclusion: The use of hybrid method to re-establish vascular access in hemodialysis patients was not only quite effective but also showed several advantages over other conventional methods. Using this method, possible thrombotic lesions were evaluated and corrected with balloon angioplasty. In addition to reducing the risk of recurrent path failure, all these procedures can be performed during one session in the operating room, which led to reductions in surgical and recovery time and costs for both the surgeons and the patients.

Intra-arterial injection of iloprost reduces the risk of early recoil after balloon angioplasty of below-the-knee vessels in patients with critical limb ischemia.

Previous studies demonstrated that early recoil is frequently observed in patients undergoing balloon angioplasty. The aim of this study was to evaluate the impact of intra-arterial administration of iloprost (Endoprost®, Italfarmaco S.p.A., Milan, Italy) on early elastic recoil after balloon angioplasty of below-the-knee (BTK) vessels in patients with critical limb ischemia (CLI). Between January 2015 and December 2015 32 patients with CLI underwent balloon angioplasty of at least one BTK vessel followed by intra-arterial administration of iloprost. Early elastic recoil was defined as residual lumen compromise >10%. Early elastic recoil was determined on the basis of minimal lumen diameter (MLD) measurements at baseline (MLDbaseline), immediately after BTK balloon angioplasty (MLDpostdilation), and 15 minutes thereafter (MLD15min). Patients were predominantly female (18/32, 56.2%) with a mean age of 79.6 years (range 68-87). Most of the patients were diabetics (25/32, 78.1%). An occlusion was present in 24 cases (75%). Mean BTK lesion length was 144.1 mm (range 22-320). Mean MLD measurements were 0.1 mm (range 0-0.5; MLDbaseline), 2.5 mm (range 1.9-3; MLDpostdilation), and 1.9 mm (range 0.7-3; MLD15min). Early elastic recoil was recorded in 14 patients (43.8%). The mean percentage of elastic recoil after 15 minutes was 21.4%. In our experience intra-arterial administration of iloprost reduces the risk of early elastic recoil after balloon angioplasty of BTK vessels in patients with CLI. Further analyses with larger population studies and randomized trials are needed to validate this therapeutic option.