Percutaneous Transluminal Stenting Research Articles

Endovascular intravascular intervention for central venous stenosis in maintenance hemodialysis patients: a retrospective observational study

BackgroundThe number of people undergoing maintenance hemodialysis is increasing rapidly worldwide. Central vein stenosis (CVS) is a common vascular complication in undergoing hemodialysis, especially those with a history of catheterization. This study aimed to investigate the characteristics of CVS and the clinical effectiveness of percutaneous transluminal angioplasty (PTA) alone and sequential percutaneous transluminal stenting (PTS) in hemodialysis patients with CVS.MethodsA retrospective analysis of 26 cases of endovascular intervention for CVS using PTA alone or sequential PTS was performed. The characteristics of CVS and the clinical effectiveness of these procedures were evaluated.ResultsThis study included 26 hemodialysis patients who presented with symptomatic CVS. Of these 26 patients, 53.85% were male, and their mean age was approximately 54.96 years. All the patients had a history of catheter placement or pacemaker implantation. The incidence of brachiocephalic vein stenosis was significantly higher than that of subclavian vein stenosis (46.16% vs. 26.92%). Based on the degree of stenosis and elastic retraction, these patients were administered PTA alone or sequential PTS. There was no difference in patient age, hemodialysis time, catheter retention time, or stenosis length between the PTA alone and sequential PTS groups. However, the degree of venous stenosis in the PTS group was more severe than that in the PTA alone group. The primary patency rates in the sequential PTS and PTA alone groups were 94.12% and 100% at 3 months; 88.24% and 88.89% at 6 months; 75.00% and 85.71% at 9 months; and 66.67% and 71.43% at 12 months, respectively. It is worth noting that for 7 patients with complete occlusion of the brachiocephalic vein, we used sharp recanalization technology and stenting placement, with patency rates of 85.71% and 71.43% at 6 and 12 months, respectively.ConclusionsPTA alone is recommended for patients with less than 50% central venous elastic retraction, while sequential PTS is recommended for patients with ≥ 50% central venous elastic retraction. PTA and PTS are safe and effective methods for the treatment of CVS in patients undergoing hemodialysis.

The Current Status of Endovascular Treatment for Extracranial Vertebral Artery Stenosis in Japan: A Subanalysis of the Japanese Registry of Neuroendovascular Therapy 4.

Endovascular treatment (EVT) is a potential therapeutic option for extracranial vertebral artery (VA) stenosis; however, its efficacy or optimal procedures remain unknown. This study aimed to investigate the recent status of EVT for extracranial VA stenosis in Japan using a nationwide registry. We conducted a post hoc analysis of the Japanese Registry of Neuroendovascular Therapy 4 that enrolled patients who underwent EVT at 166 hospitals in Japan from 2015 to 2019. The outcomes of this study were as follows: procedural success indicating that the planned procedure was completed, modified Rankin Scale (mRS) score at 30 days, and procedure-related complications evaluated according to the procedure during EVT (percutaneous transluminal angioplasty vs. stenting and with or without the use of embolic protection devices [EPDs]). Of 308 eligible patients, 301 (95%) were treated for atherosclerotic stenosis, predominantly by stenting (74%). EPDs were used in 43%, primarily with the distal balloon (63%). The proportion of procedural success was 98%. Functional independence (mRS of 0-2) at 30 days was achieved in 80% of the total cohort, and there were no differences between patients treated with or without stenting or EPDs (74% vs. 82%, p = 0.12, and 80% vs. 80%, p = 0.93). Procedural complications occurred in 28 (9.1%) patients similarly in each group, with distal embolism and vessel dissection being common. In conclusion, EVT is a reasonable option for extracranial VA stenosis as a daily clinical practice. This study emphasizes the potential of EVT in managing extracranial VA stenosis and the need for further research to refine treatment strategies.

Successful treatment of chronic venous in-stent restenosis using a Phoenix atherectomy device.

Although endovascular treatment of venous obstruction with percutaneous transluminal angioplasty (PTA) and stenting is a safe and effective alternative to conservative treatment, the overall prevalence of in-stent restenosis (ISR) remains high in this patient population. This study reports a novel treatment option for patients with chronic ISR (C-ISR). At our center, all patients with ISR were treated based on the time since the initial intervention. Acute in-stent restenosis (A-ISR) was preferably treated with catheter-directed thrombolysis or a pharmacomechanical peripheral thrombectomy device and PTA. Selected patients with chronic ISR (C-ISR) (greater than 30 days) were treated with a catheter- guided unidirectional atherectomy in addition to PTA, under the assumption of a non-thrombotic mechanism in the development of C-ISR. We demonstrate a safe and practical treatment option for chronic ISR using a catheter- guided technical approach with the Phoenix atherectomy device in four patients. Technical success was achieved in every case, and mid-term patency was restored in three out of four patients. Restenosis following venous stenting is highly complex. Patients must be treated individually, with a focus on anticoagulation and antiplatelet therapy regimens, as well as the appropriate interventional treatment. Catheter- guided atherectomy is a viable option for this heterogeneous group of patients. Further studies are required to understand the etiology of chronic ISR.

Percutaneous transluminal angioplasty and stenting (PTAS) in patients with symptomatic intracranial vertebrobasilar artery stenosis (IVBS)

BackgroundApproximately 20% of all transient ischaemic attacks (TIAs) and ischaemic strokes occur within the posterior circulation, with vertebrobasilar stenosis identified as the cause in roughly 25% of the cases. Studies...

Graft survival after percutaneous transluminal renal stenting for transplant renal artery stenosis (TRAS) is worse compared to matched cadaveric grafts without TRAS

Objectives Transplant renal artery stenosis (TRAS) is now recognized as a curable disease with a good prognosis if intervention occurs in the early stage. However, the mid-term outcomes of TRAS when treated by percutaneous transluminal angioplasty with stent placement have yet to be fully elucidated. The purpose of this study was to compare mid-term graft and patient survival of TRAS group with a control group. Patients and methods Ninety-two patients were diagnosed of TRAS between January 2016 and January 2022 in our center. Fifty-six pairs of recipients with grafts from the same donor were selected as a study group with TRAS and a control group without TRAS, respectively. All donor kidneys were from deceased organ donation rather than living donors. The primary endpoints were graft and patient survival. The secondary outcomes were changes in renal graft function. Results The mean follow-up time for the TRAS group was 43.6 months, while the mean follow-up time for the control group was 45.3 months. In the TRAS group, the age of patients ranged from 11 to 62 years with 39 males and 17 females. In the control group, the age of patients ranged from 18 to 67 years with 40 males and 16 females. In the TRAS group, there were more patients with diabetic nephropathy as the primary renal disease compared to the control group (5/56 vs 0/56), and the incidence of acute rejection was higher in the TRAS group than in the control group (12/56 vs 3/56). Eight patients in the TRAS group and one patient in the control group experienced graft loss (p = .019). Four patients in the TRAS group and four patients in the control group died with functional renal allograft during the follow-up time (p = .989). The levels of eGFR did not differ significantly between the two groups in the first three years after kidney transplant (p > .05). Patients in the TRAS group had worse graft functionality (eGFR, 44.96 ± 18.9 vs 54.9 ± 19.6 mL/min) in the fourth year when compared with the control group (p = .01). Conclusions The graft function deteriorated faster, and graft survival was lower in the TRAS group treated by stent placement when compared with a control group without TRAS over the mid-term.

Clinical efficacy of endovascular revascularization combined with vacuum-assisted closure for the treatment of diabetic foot.

The diabetic foot is a common cause of disability and death, and comorbid foot infections usually lead to prolonged hospitalization, high healthcare costs, and a significant increase in amputation rates. And most diabetic foot trauma is complicated by lower extremity arteriopathy, which becomes an independent risk factor for major amputation in diabetic foot patients. To establish the efficacy and safety of endovascular revascularization (ER) combined with vacuum-assisted closure (VAC) for the treatment of diabetic foot. Clinical data were collected from 40 patients with diabetic foot admitted to the Second Affiliated Hospital of Soochow University from April 2018 to April 2022. Diabetic foot lesions were graded according to Wagner's classification, and blood flow to the lower extremity was evaluated using the ankle-brachial index test and computerized tomography angiography of the lower extremity arteries. Continuous subcutaneous insulin infusion pumps were used to achieve glycemic control. Lower limb revascularization was facilitated by percutaneous tran-sluminal balloon angioplasty (BA) or stenting. Wounds were cleaned by nibbling debridement. Wound granulation tissue growth was induced by VAC, and wound repair was performed by skin grafting or skin flap transplantation. Of the 35 cases treated with lower limb revascularization, 34 were successful with a revascularization success rate of 97%. Of these, 6 cases underwent stenting after BA of the superficial femoral artery, and 1 received popliteal artery stent implantation. In the 25 cases treated with infrapopliteal artery revascularization, 39 arteries were reconstructed, 7 of which were treated by drug-coated BA and the remaining 32 with plain old BA. VAC was performed in 32 wounds. Twenty-four cases of skin grafting and 2 cases of skin flap transplantation were performed. Two patients underwent major amputations, whereas 17 had minor amputations, accounting for a success limb salvage rate of 95%. ER in combination with VAC is a safe and effective treatment for diabetic foot that can significantly improve limb salvage rates. The use of VAC after ER simplifies and facilitates wound repair.

Predicting postoperative delirium after percutaneous transluminal angioplasty and stenting in patients with intracranial atherosclerotic stenosis

ABSTRACT Objective Known as a major surgical complication, postoperative delirium (POD) has not been well studied in patients with intracranial atherosclerotic stenosis (ICAS). This study aimed to investigate the correlation between perioperative clinical characteristics and the occurrence of POD. Methods Patients’ demographic characteristics and perioperative testing data were collected. Binary logistic regression was conducted for assessing related risk factors. A nomogram was developed to predict the occurrence of POD after percutaneous transluminal angioplasty and stenting (PTAS) in patients with ICAS. Results The occurrence of POD in this study was 30.67%. Among all the clinical and laboratory characteristics in patients, age (OR = 1.234, 95%CI = 1.004–1.517, p = 0.046), gender (OR = 5.676, 95%CI = 1.028–31.334, p = 0.046), preoperative MMSE scores (OR = 2.298, 95%CI = 1.005–5.259, p = 0.049), the degree of stenosis (OR = 6.294, 95%CI = 1.043–37.974, p = 0.045), operating time (OR = 1.088, 95%CI = 1.023–1.157, p = 0.006), and HbA1c levels (OR = 2.226, 95%CI = 1.199–4.130, p = 0.011) were the independent risk factors. Conclusion Male patients with advanced-age, lower preoperative MMSE scores, severe stenosis, longer operating time, and higher HbA1c levels are closely related to POD after PTAS. Fully perioperative assessments may play an important role in predicting the occurrence of POD.

#2169 Transplant renal artery stenosis in recipients with resistant arterial hypertension

Abstract Background and Aims Transplant Renal Artery Stenosis (TRAS) is a vascular complication after kidney transplantation. It worsens the prognosis of the graft and the patient's life. The aim was to study the incidence of TRAS as a cause of resistant arterial hypertension in kidney transplant recipients in the Republic of Belarus and the efficiency of its endovascular treatment. Method The study included 187 kidney transplant recipients. Blood pressure of 72 (38.5%) patients was less than 130/80 mmHg without taking antihypertensive drugs. Arterial hypertension was diagnosed in 115 (61.5%) recipients. The study included clinical, laboratory and instrumental methods (24-hour blood pressure monitoring, Doppler ultrasound, graft scintigraphy with captopril). Results 31 (16.6%) recipients needed to take one antihypertensive drug, 43 (23.0%)—2 drugs, 41 (21.9%)—3 or more. 17 (9.1%) recipients did not have target blood pressure correction while taking more than 4 antihypertensive drugs. There was decreased blood flow in the graft artery with a peak systolic velocity > 200 cm/s in 14 (7.5%) cases. These patients were submitted to the graft nephroscintigraphy with caplopril where 8 grafts (4.3%) were diagnosed signs of TRAS. These recipients were submitted to the renal angiography with the injection of 150 (100; 200) ml of contrast agent. 5 (2.7%) recipients were diagnosed with hemodynamically significant TRAS of more than 70 (65; 75) % and received percutaneous transluminal angioplasty and stenting. All these patients had a decrease of glomerular filtration rate and resistant arterial hypertension before operation. The average age of the patients with TRAS was 57.4 ± 11.0 years, the period after transplantation was 11 ± 3 months. Their blood tests did not show dyslipidemia, but 4 out of 5 cases had diabetes mellitus. Their postoperative period had no complications. The patient was placed on dual antiplatelet therapy with aspirin and clopidogrel. There was an increase in glomerular filtration rate by 27 ± 7 ml/min/1.73 m2 and a decrease in systolic blood pressure by 40 (40; 45) mm Hg in the early postoperative period. Graft artery stenting allowed reducing the number of antihypertensive drugs to one tablet in 4 out of 5 patients. Conclusion Transplant Renal Artery Stenosis is a rare but significant complication of the late postoperative period that may cause resistant hypertension in kidney transplant recipients. Timely identification and stenting of the graft artery improves the graft functioning and reduces blood pressure.

Emerging Hypertension in Young Adults: A Detailed Case Report on Takayasu Arteritis in a 29-Year-Old Female from South India

Abstract Introduction: Takayasu arteritis is a rare vasculitic disorder predominantly affecting young women, characterized by inflammation of the aorta and its major branches usually seen in the East Asian population. Due to its varied clinical presentation, early diagnosis remains challenging, necessitating a high index of suspicion. Case Report: A 29-year-old South Indian female presented with exertional dyspnea to the emergency department and was initially diagnosed and treated as middle lobe pneumonia. Further physical and laboratory evaluations done at that time were unremarkable. Following successful treatment, she remained largely asymptomatic and sought evaluation at the local clinic due to elevated blood pressure detected during home monitoring. On work up of hypertension Echocardiography was done which showed unusual wall thickening of the ascending aorta and mild aortic regurgitation .CT aortogram was then done which revealed aortic thickening and left renal artery stenosis. Confirmation of takayasu arteritis was achieved through PET-CT imaging at a higher tertiary care centre, leading to initiation of immunosuppressive therapy and subsequent percutaneous transluminal angioplasty stenting of the left renal artery. Conclusions: A high index of suspicion is crucial in young females with unusual presentations especially in the South Indian population where the disease is not prevalent. Due to financial constraints it is very likely that appropriate imaging is not done in cases where takayasu arteritis is not suspected by the treating physician. Lack of appropriate work up of hypertension can result in missed diagnoses which can lead to potentially disastrous side effects to the disease Keywords: Takayasu arteritis, young female, vasculitis, immunosuppressive therapy, angioplasty.

Hemorrhagic pericardial tamponade in a hemodialysis patient with catheter-related superior vena cava syndrome: a case report

BackgroundIatrogenic complications of endovascular treatment for central venous stenosis have not yet been reported. Here we present a case of a patient on maintenance hemodialysis who developed catheter-related superior vena cava syndrome and subsequently suffered from hemorrhagic pericardial tamponade after undergoing percutaneous transluminal angioplasty and stenting.Case presentationA 72-year-old male patient presented with uremia, and had been receiving maintenance hemodialysis for the past five years. The patient initially presented with dysfunction of the dialysis catheter (a cuffed tunneled double-lumen catheter in the right internal jugular vein). Imaging examination revealed a segmental occlusion of the superior vena cava stretching from the distal end of the dialysis catheter up to right atrium entrance, apparent compensatory dilatation of the azygos vein, and abundant subcutaneous collaterals. The patient underwent percutaneous transluminal balloon dilatation and stenting (covered stent) of the superior vena cava in the Cath Lab. During the procedure, with forceful advancement of the guidewire, it was observed to progress for a distance before a “smoke” appeared, and an outward spillage of contrast agent was visible, which suggested a possible vessel puncture leading into the mediastinum. Unfortunately, postoperative hemorrhagic pericardial tamponade occurred and the patient developed cardiogenic shock. He experienced symptoms included chest tightness and breath shortness with a recorded blood pressure of 84/60mmHg. After draining 600 ml of bloody fluid through pericardiocentesis, the patient’s symptoms alleviated and his condition improved.ConclusionsThe case emphasizes the need for increased attention to iatrogenic endovascular injuries during catheter placement and endovascular treatment, such as causing pericardial hemorrhage leading to cardiac tamponade.

Has collateral blood flow any effect on restenosis rate? Our experience.

Restenosis is one of the important factors affecting the effectiveness of percutaneous transluminal angioplasty and stenting in the treatment of intracranial atherosclerotic stenosis. We aimed to clarify whether recruitable collateral flow could cause restenosis in patients treated with percutaneous transluminal angioplasty and stenting. Our study retrospectively analyzed patients with symptomatic severe intracranial atherosclerotic stenosis (≥70%) who underwent percutaneous transluminal angioplasty and stenting. We enrolled 28 patients with restenosis and 71 patients without restenosis. We analyzed baseline data, perioperative events, and follow-up results of patients in the two groups. Binary logistic regression analysis was used to identify restenosis predictors. For preoperative stroke, the restenosis group had a greater likelihood of having a previous stroke (89.3%), which was less prevalent in the non-restenosis group (66.2%) (P = 0.020). The restenosis group had a higher rate of re-stroke (21.4 vs. 4.2%, P = 0.022). After binary logistic regression analysis, collateral circulation and residual stenosis were independent risk factors of restenosis, with overall risk (95% confidence intervals) of 5.034 (1.484-4.066, P < 0.001) and 1.064 (1.006-1.125, P = 0.030), respectively. Restenosis risk increased 1.456-fold for each collateral circulation grade increase. However, for each 1% increase in residual stenosis, restenosis risk increased by 5.9% (P = 0.03). The chance of restenosis is minimal when the residual stenosis rate after percutaneous transluminal angioplasty and stent implantation is 15.85%. Good collateral circulation was significantly associated with restenosis in patients undergoing intracranial angioplasty, the residual stenosis rate tends to be 15.85% to reduce restenosis risk. Compared to patients with restenosis, those without restenosis have a low stroke risk during follow-up.

Assessment of Efficacy and Complications of Endovascular Interventions for Critical Limb Ischemia in Germany: A Nationwide Study.

Endovascular interventional radiological procedures have become the mainstay for the treatment of critical limb ischemia (CLI) due to arterial stenosis or occlusion. Open surgical or endovascular procedures, such as percutaneous transluminal angioplasty (PTA) or stenting can be used as a treatment strategy. The aim is to evaluate the success and major complication rates of interventional radiology treatments for CLI in Germany in 2021, and to compare these results with internationally published data. Data for PTA and stenting in CLI for 2021 was obtained from the quality management system of the German Society of Interventional Radiology (DeGIR). 16 393 PTA procedures, 701 stenting procedures, and 8110combined procedures were documented for 2021. Data was analyzed for technical and clinical success rates, as well as major complication rates documented mainly as major bleeding, distal embolization, and aneurysm formation. PTA had technical and clinical success rates of 96.3 % and 92.33 %, respectively. Stenting had technical and clinical success rates of 98.7 % and 96.15 %, respectively. PTA and stenting combined had success rates of 98.71 % and 96.91 %, respectively. The major complications were mainly: major bleeding (PTA: 0.40 %; stenting: 1.28 %; PTA and stenting: 0.54 %), distal embolization (PTA: 0.48 %; stenting: 1 %; PTA and stenting: 0.96 %), and aneurysm formation (PTA: 0.19 %; stenting: 0.43 %; PTA and stenting: 0.19 %). All procedures showed high technical and clinical success rates, while the complication rates were low. Interventional radiologists in Germany perform effective and safe treatment for CLI, achieving outcomes that tend to surpass internationally published data. · German interventional radiologists provide safe and effective critical limb ischemia treatment.. · Major complications occurred at maximum in 1.28 % of cases.. · Outcomes tend to surpass international data, indicating strong performance.. · Bastian M, Scheschenja M, Wessendorf J et al. Assessment of Efficacy and Complications of Endovascular Interventions for Critical Limb Ischemia in Germany: A Nationwide Study. Fortschr Röntgenstr 2024; 196: 1161 - 1165.

Clinical outcome of percutaneous angioplasty and covered stent placement for treatment of left brachiocephalic vein obstruction in hemodialysis patients.

Left brachiocephalic vein (LBV) obstruction is a common complication in patients undergoing hemodialysis. This study aimed to compare the clinical characteristics and outcomes of patients with LBV obstruction who underwent percutaneous angioplasty or stenting. We performed a retrospective study of 67 hemodialysis patients with LBV stenosis or occlusion who underwent percutaneous transluminal angioplasty (PTA; n = 25) or percutaneous transluminal stenting (PTS; n = 42). We compared the clinical characteristics, lesion features, and patency between the two groups of patients. The average age, sex, smoking history, body mass index, obstruction period, comorbidities, and clinical manifestations were comparable between the PTA and PTS groups. Prior ipsilateral catheterization was less common in the PTS group than in the PTA group (14.3% vs 36.0%, p < 0.05). Smaller sized balloons were used in the PTS group than in the PTA group (p < 0.05). The overall primary patency rates were similar between the two groups, whereas the secondary patency rate in the PTS group was higher than that in the PTA group (p < 0.05). The average age, sex, smoking history, body mass index, obstruction period, prior ipsilateral catheterization, comorbidities, and types of lesions were comparable between patients with or without restenosis, while patients with restenosis had a higher percentage of high venous pressure than those without restenosis (87.5% vs 60.5%, p < 0.05). The primary patency rates were similar in the angioplasty and the stenting groups. Stenting has a significantly higher secondary patency rate than angioplasty alone for treating LBV obstruction and is required more commonly in patients without prior ipsilateral catheterization.

Real-world Data of Antithrombotic Therapy in Neuroendovascular Therapy: Analysis of JR-NET 4.

As the number of neuroendovascular therapies in Japan increases, the current trends in periprocedural antithrombotic therapy must be understood.We retrospectively analyzed data on periprocedural antithrombotic therapy in the Japanese Registry of Neuroendovascular Therapy (JR-NET) 4, a nationwide survey carried out in Japan between January 2015 and December 2019. Details on antithrombotic therapy in neuroendovascular therapy for ruptured cerebral aneurysms, unruptured cerebral aneurysms, and percutaneous transluminal angioplasty or stenting were collected from the JR-NET 4 database. These data were analyzed and compared with those from the JR-NET 2 (January 2008 to December 2009) and JR-NET 3 (January 2010 to December 2014). A total of 36,560 cases were analyzed in the JR-NET 4. The frequency of preprocedural dual antiplatelet therapy (DAPT) significantly increased from the JR-NET 2 to 4 (48.1%, 53.4%, and 62.3%, respectively; P < 0.001), whereas the frequency of monotherapy significantly decreased (15.7%, 13.9%, and 8%, respectively; P < 0.001). Postprocedural antiplatelet therapy exhibited similar trends, and postprocedural anticoagulant therapy was discontinued. Particularly, heparin use significantly decreased from the JR-NET 2 to 4 (23.4% vs. 12.7% vs. 7.9%, respectively; P < 0.001). In terms of periprocedural complications, the incidence of ischemic complications increased from the JR-NET 3 to 4 (5.8% vs. 6.2%; P = 0.05). In the JR-NET 4, severe adverse events and hemorrhagic and all complications were significantly more frequent in the preprocedural triple or more therapy group.The rate of postprocedural anticoagulant therapy decreased, whereas that of antiplatelet therapy increased. Overall, in Japan, periprocedural DAPT has become increasingly common.

Percutaneous Transluminal Angioplasty (PTA) and Stent Implantation in Hemodialysis Patients with Central Venous Stenosis:A Study of Outcomes

BACKGROUND: Central venous stenosis and occlusion are serious complications that can arise from central venous catheterization in hemodialysis patients, leading to significant difficulties in the dialysis process. Common clinical manifestations include swelling in the arm or neck on the affected side and compromised hemodialysis access. To address this issue, percutaneous balloon angioplasty and stent implantation have emerged as potential solutions to maintain vein patency. However, there is a need to evaluate the efficacy of these interventions over an extended period to determine their long-term benefits. This study aimed to monitor the patency status periodically, starting at 1st Month, followed by assessments at 3rd Month, 6th Month, and finally, the 12th Month. METHODS: This single-center observational study focused on endovascular interventions performed on hemodialysis patients with central venous stenosis or occlusion.Participants included end-stage renal failure patients undergoing hemodialysis who exhibited clinical signs of central venous stenosis or occlusion. Data were collected from 60 patients, consisting of 42 males (70%) and 18 females (30%), with an average age of 46.19±13.21 years. The affected sites of central vein stenosis or occlusion were distributed as follows: 13 cases in the innominate veins, 25 cases in the superior vena cava, 18 cases in the brachiocephalic vein, and 10 cases in the subclavian vein. Some patients had multiple site occlusions, while others experienced occlusion of AV fistula. RESULTS: Of the 60 endovascular procedures performed, only one case did not achieve technical success, resulting in an overall success rate of 96.4%. Stent implantation was carried out in only four patients. No significant procedure-related complications were encountered, and all patients were able to undergo hemodialysis after the initial intervention. The primary patency rates for PTA at 1, 3, 6, and 12 months were 96%, 92%, 88%, and 86%, respectively. As for stent implantation, the primary patency rates at 1, 3, 6, and 12 months were 100%, 98%, 98%, and 98%, respectively. Assisted primary patency rates for PTA at 1, 3, 6, and 12 months were 2%, 6%, 11%, and 14%, respectively. During the 12-month follow-up, 10 reinterventions were performed, with three patients requiring more than two reinterventions. CONCLUSION: The study's findings demonstrate that endovascular interventions, such as percutaneous balloon angioplasty and stent implantation, are highly effective in managing central venous stenosis or occlusion in hemodialysis patients. These interventions showed a remarkable success rate and a minimal occurrence of procedure-related complications. Particularly, stent implantation consistently exhibited 100% primary patency at all evaluated time points. While the assisted primary patency rates for PTA were relatively lower, the overall need for reinterventions remained low, emphasizing the long-term benefits of these procedures. Based on these promising results, endovascular interventions can be considered as a viable and efficient option for the management of central venous stenosis or occlusion in hemodialysis patients, offering improved hemodialysis access and ensuring enhanced patient outcomes.

Association between Pfizer-BioNTech mRNA vaccine and myocardial infarction: clinical and angiographic insights.

With the widespread administration of the BioNTech mRNA-based COVID-19 vaccine, there is a need to evaluate its potential effects on cardiovascular health, particularly its association with myocardial infarction (MI). This study aimed to investigate the relationship between BioNTech vaccination and MI, as well as its impact on clinical and angiographic parameters. A retrospective analysis was conducted at the Eskisehir Osmangazi University, Eskisehir City Hospital, between April 2020 and May 2023 on a cohort of 1 151 patients hospitalised with MI. The patients were stratified into a BioNTech+ (vaccinated) and a BioNTech- (unvaccinated) groups. Medical records were reviewed for demographic information, clinical data and angiographic findings. Statistical analyses were performed, including logistic regression models adjusting for potential confounders. The BioNTech- group had a higher mean number of percutaneous transluminal coronary angioplasty procedures and stents compared to the BioNTech+ group. Haematological parameters and lipid profiles showed some discrepancies between the two groups. The BioNTech- group had higher white blood cell and platelet counts, while also exhibiting a higher mean low-density lipoprotein cholesterol level. The prevalence of co-morbidities and cardiovascular risk factors differed between the groups. This study found associations between the BioNTech vaccination and clinical and angiographic parameters in patients with MI.

Cardiac Catheterization in Port Harcourt: Initial Two Years’ Experience

Introduction: Cardiac catheterization for diagnostic and therapeutic purposes is now routinely done at the Save a Life Port Harcourt, since last two years. Also included are cardiac devices which include pacemakers, Implantable Cardiac Defibrillators and Cardiac Resynchronization Therapy. In this retrospective study, we review our initial two years’ experience of Cardiac Catheterization at the Save a Life Mission Hospital, Port Harcourt. Methods: This is a retrospective study over a period of two years, form 1st February, 2021 to 31st March, 2023. A total of 216 consecutive diagnostic and therapeutic cardiac catheterization including cardiac devices performed in Save a life Mission Hospital between 1st February 2021 to 31st March 2023 were evaluated. Among them 88; (40.7%) were coronary angiogram, 41 (18.98%) percutaneous transluminal coronary angioplasty (PTCA) and stenting, 59(27.3%) permanent pacemaker insertion, 29 (13.4%) Implantable cardioverter defibrillators, 14 (6.5%) cardiac resynchronization therapy and 26 (12.1%) with peripheral angiography. Six patients were referred for coronary artery bypass surgery. Vascular complications [groin hematoma] occurred in two patients (0.9%). Conclusion: Both diagnostic and therapeutic cardiac catheterization procedures are safe with very low risk of complications even in its initial experience. The optimate goal of these procedures is to ensure the safety of the patients.

Recurrent flash pulmonary edema in unilateral renal artery stenosis with contralateral kidney shrinkage: A case report.

Flash pulmonary edema is a critical medical condition characterized by sudden and severe fluid accumulation in the lungs, which poses an immediate and life-threatening emergency. This can arise from a variety of underlying causes. This manuscript presents a case of recurrent pulmonary edema that was successfully managed through the insertion of a renal artery stent. A 78-year-old woman visited the emergency room with recurrent acute dyspnea. Computed tomography renal angiography revealed renal artery stenosis of a single-functioning kidney. Flash pulmonary edema caused by renal artery stenosis of a functioning single kidney. Percutaneous transluminal angioplasty and stenting were performed for the renal artery stenosis. The patient's kidney function rapidly improved, and she has been free of flash pulmonary edema for 2 years. Flash pulmonary edema can have various causes and can immediately be a life-threatening emergency. However, it can be treated with percutaneous revascularization if it is caused by renal artery stenosis. This case report reinforces the importance of accurate and immediate diagnosis when dealing with flash pulmonary edema. This case emphasizes the potential therapeutic benefit of renal artery stenting in the management of flash pulmonary edema caused by renal artery stenosis in patients with a single-functioning kidney.

Preliminary application of three-dimensional venography and fusion navigation technique in May-Thurner syndrome

ObjectiveThe purpose of this study was to report a technique for intraprocedural guidance of endovascular iliac vein stenting procedures using three-dimensional (3D) venography images as an overlay on live biplanar fluoroscopy. MethodsUsing 3D venography and a fusion navigation technique, percutaneous transluminal angioplasty and stent placement were performed to evaluate the feasibility of using 3D venography images and the fusion navigation technique to treat MTS compared with traditional digital subtraction angiography. The general epidemiologic data (ie, age, gender), clinical manifestations (ie, major symptoms, affected extremity, CEAP [clinical, etiology, anatomy, pathophysiology] classification, comorbidity, stenosis rate), intraoperative findings (ie, stent type, stent count, stent to inferior vena cava distance, procedure time, radiation dose, contrast agent dosage), and postoperative recovery were obtained and analyzed. ResultsA total of 30 consecutive patients with symptomatic MTS from our institution were enrolled in the present study. Of the 30 patients, 12 (group A) were treated using 3D venography images and fusion navigation and 18 (group B) were treated with two-dimensional venography images during endovascular management. Significant differences were observed between the two groups with respect to the procedure time (64.42 ± 4.35 minutes vs 76.61 ± 3.47 minutes; P = .04), radiation dose (2152 ± 124.7 mGy vs 2561 ± 105.6 mGy; P = .02), and contrast agent dosage (71.42 ± 4.87 mL vs 86.17 ± 4.14 mL; P = .03). Conclusions3D venography and its fusion navigation technique can improve prediction of the coverage area of the stent. Its use can also shorten the procedure time and reduce the contrast agent dose and radiation exposure, making it a valuable tool for both the diagnosis and the treatment of symptomatic MTS.

Percutaneous transluminal angioplasty and stenting of post-irradiated stenosis of subclavian artery: A matched case-control study

BackgroundAlthough radiotherapy is common for head/neck and chest cancers (HNCC), it can result in post-irradiation stenosis of the subclavian artery (PISSA). The efficacy of percutaneous transluminal angioplasty and stenting (PTAS) to treat severe PISSA is not well-clarified. AimsTo compare the technical safety and outcomes of PTAS between patients with severe PISSA (RT group) and radiation-naïve counterparts (non-RT group). MethodsDuring 2000 and 2021, we retrospectively enrolled patients with severe symptomatic stenosis (>60%) of the subclavian artery who underwent PTAS. The rate of new recent vertebrobasilar ischaemic lesions (NRVBIL), diagnosed on diffusion-weight imaging (DWI) within 24 h of postprocedural brain MRI; symptom relief; and long-term stent patency were compared between the two groups. ResultsTechnical success was achieved in all 61 patients in the two groups. Compared with the non-RT group (44 cases, 44 lesions), the RT group (17 cases, 18 lesions) had longer stenoses (22.1 vs 11.1 mm, P = 0.003), more ulcerative plaques (38.9% vs 9.1%, P = 0.010), and more medial- or distal-segment stenoses (44.4% vs 9.1%, P<0.001). The technical safety and outcome between the non-RT group and the RT group were NRVBIL on DWI of periprocedural brain MRI 30.0% vs 23.1%, P = 0.727; symptom recurrence rate (mean follow-up 67.1 ± 50.0 months) 2.3% vs 11.8%, P = 0.185; and significant in-stent restenosis rate (>50%) 2.3% vs 11.1%, P = 0.200. ConclusionThe technical safety and outcome of PTAS for PISSA were not inferior to those of radiation-naïve counterparts. PTAS for PISSA is an effective treatment for medically refractory ischaemic symptoms of HNCC patients with PISSA.