Safety Of Endovascular Interventions Research Articles

Outcomes of endovascular management of the aorta in connective tissue disorders

Abstract Background Endovascular management of type B aortic dissection has been well established and accepted in the community. However, due to the lack of information on long-term outcome, endovascular management remains controversial in the setting of connective tissue disorders such as Marfan syndrome. Although surgical repair is recommended in type B aortic dissection with connective tissue disorders, recent studies demonstrated both feasibility and safety of endovascular interventions in those patients at least short term. Purpose Single centre experience and documentation of long-term outcomes after endovascular management of aortic conditions in patients with connective tissue disorders. Methods All patients with genetic confirmation of connective tissue disorders who underwent endovascular repair of the thoracic aorta were identified and evaluated retrospectively. Perioperative, procedure-specific and follow-up data were extracted from medical records of a structured surveillance program. Results Between 2002 and 2020, 18 patients were identified having undergone TEVAR procedures and protocol follow-up. The median age was 35.5 (IQL 30.0 – 42.7), and 12 (66.7%) were males; median ACEF II score was 0.6 (IQL 0.5 – 0.925). This cohort comprised 15 (83.3%) patients with genetically confirmed Marfan syndrome, two (11.1%) with Loeys-Dietz, and one (5.6%) with Ehlers-Danlos syndrome. Of these, 13 (72.2%) patients had undergone aortic root or aortic root/ascending aorta replacement independently in the past. The indication for a TEVAR procedure was seen in one case for degenerative aneurysmal disease (5.6%), in one case for elephant trunk stenosis (5.6%), in five cases for residual aortic dissection (27.8%), and in 11 cases for new type B dissection (61.1%). The most frequently used stent-graft was Valiant™ (Medtronic) in 10 cases (55.6%), followed by TAG® (Gore®) in four cases (22.2%), Zenith® (COOK®) in two cases (11.1%), and for Relay® (Bolton) and Sinus-XL® (Optimed) in one case each (5.6%). The average total covered length was 192.2±40.2 mm. Median follow-up duration was 77.5 months (IQR 35.8 - 131); three (16.7%) cases revealed failure of TEVAR and led to conversion to open surgery. Two patients (11.1%) had died including one patient in the perioperative phase. At the last follow-up, complete thrombosis of the false lumen was observed in 14 cases (82.3%), and 15 cases (88.2%) showed no aortic expansion or progression during the follow-up period resulting in an overall endovascular success rate of 72.2%. Conclusion Thoracic endovascular aortic repair can be performed for selected patients with connective tissue disorders at relatively low long-term mortality and morbidity. With improved devices and technical skills, mid- and long-term surveillance revealed promising outcomes and a low rate of aneurysmal degeneration. Structured surveillance remains crucial to detect emerging late complications and to accumulate more long-term data. Funding Acknowledgement Type of funding sources: None.

Role and outcome of endovascular procedures in patients with buerger’s disease with critical lower limb ischemia

Objective To assess the effectiveness, feasibility, and safety of endovascular intervention in patients who presented with Buerger’s disease with infrainguinal critical lower limb ischemia. Patients and methods This is a prospective study that was conducted on 52 patients who presented with Buerger’s disease who underwent percutaneous transluminal angioplasty. Clinical outcomes and limb salvage rates were reported at 1, 3, and 6 months following the intervention. Results The study was conducted on 52 patients, comprising 50 males and two females. The age varied between 25 and 55 years. The clinical outcome showed 73.1% technical success by endovascular intervention, with 53.8% patency rate after 1 month (P=0.001) and 86.3% limb salvage rate (P Conclusion Endovascular treatment of patients with Buerger’s disease is an effective, safe, and feasible method and shows high limb salvage rates and clinical improvement.

Prophylaxis of Ischemic Damage to the Ovaries, Taking Into Account Peculiarities of Blood Supply to the Uterus During Endovascular Treatment of Le Yo Fibroids

SUMMARY Uterine arteries embolization (UAE) is one of the modern trends in the treatment of uterine bleeding caused by uterine leiomyomas (UL). However, unfavourable results of this method of treatment are observed in 10–15% of cases. This is primarily concerned with the emerging ischemia of ovarian tissue after embolization.Material and methods Complex examination and treatment was performed in 48 patients admitted with UL complicated by the development of uterine bleeding. Patients with UL were divided into two groups. In the Group I of patients (n=29) standard embolization was performed, while the patients of the Group II (n=19) with diagnosed interarterial utero-ovarian anastomosis underwent separating technique of UA occlusion using different types of emboli.Results and discussion The features of the uterine blood supply in patients with UL were analyzed from the perspective of the effecacy and safety of endovascular intervention. A methodology of staged EUA was developed, which involved the staged aortography of the infrarenal aorta (for visualization of the ovarian arteries); pelvic arteriography (for evaluating the vascular anatomy of the pelvis and identifying utero-ovarian intearterial anastomoses); selective arteriography followed by UAE first with cylindrical emboli, and then with standard emboli in the form of microspheres. The application of the developed technique did not show dysfunction of the ovaries in both the short and long-term follow-up period up to 18 months in the Group II.Conclusion The separating UA occlusion is a safe and effective way of preventing ischemic damage in the presence of signoficant utero-ovarian inter-arterial nastomoses.

Endovascular treatment of iliac and common femoral arteries disease by the transradial access: A prospective, feasibility study.

To report feasibility and safety of endovascular interventions on iliac and common femoral arteries, using the transradial access (TRA). 100 consecutive patients (19 women; mean age 71, range 37-90years) with critical limb ischemia (30%) or claudication, and TASC A-D lesions in iliac or common femoral arteries, were prospectively enrolled, from January 2013 to June 2015, to be treated via the TRA. Exclusion criteria included no palpable radial arteries (RA) and the presence of a fistula for hemodialysis. Patients were evaluated for procedural technical success, in-hospital complications, and 30days clinical success (defined as improvement of at least one grade in the Rutherford classification of symptoms). A total of 131 iliac and common femoral arteries lesions were treated (58 in common iliac arteries, 38 in external iliac arteries and 35 in common femoral arteries). Ninety-two stents were deployed in 58 patients. Procedural technical success was achieved in 91% of the lesions; with 95% technical success rate in common iliac arteries, 87% in external iliac arteries and 89% in common femoral arteries; with 72% technical success rate in occlusions and 98% in stenosis. No in-hospital complications were observed. At 30days, 93 patients (93%) had an improvement of at least one category in the Rutherford classification of symptoms (clinical success rate 93%); 12 patients (12%) had an asymptomatic occlusion of the RA. TRA can be used to treat iliac and common femoral arteries lesions with a high grade of technical success and a low rate of complications.

Abstract TP12: Safety of Endovascular Intervention for Acute Stroke in Patients on Anticoagulation

Background and Purpose: Current guidelines recommend against IV tPA use in patients on warfarin with INR > 1.7, recent use of novel oral anticoagulants (NOACs), or current therapeutic parenteral anticoagulation. These patients are sometimes considered for endovascular thrombolysis, however there is limited data on the safety of this approach. We sought to assess the safety of endovascular intervention in these patients. Methods: We performed a multicenter retrospective study to identify consecutive patients undergoing endovascular intervention for acute ischemic stroke while on therapeutic anticoagulation (defined as warfarin use with INR > 1.7, heparin with elevated PTT, or recent LMWH or NOAC use). The primary outcome measure was symptomatic ICH (sICH) using the NINDS definition. We compared the observed rate of sICH to risk-adjusted published historical control rates of sICH after IV tPA using weighted averages of the Hemorrhage after Thrombolysis (HAT) and Multicenter Stroke Survey (MSS) prediction scores. Results: Of 82 cases, mean age was 73 ± 15 years, 46% were female, and median NIHSS was 19 (IQR 14-22). Anticoagulation consisted of warfarin (n=43, mean INR 2.3), IV heparin (n=19), NOACs (n=17), and LMWH (n=3). Any ICH on follow-up CT was present in 26 (32%) patients, and sICH in 7 (8.5%, 95% CI 4.2-16.6) patients. All 7 sICH occurred in patients on warfarin. Severe systemic bleeding occurred in 1 patient. At discharge, 10% subjects returned home, 44% went to an acute rehabilitation facility, 27% to a nursing facility, and 19% had died. Predicted sICH rate for the cohort based on HAT and MSS scoring was 12% and 7% respectively. Conclusions: Endovascular intervention in subjects on therapeutic anticoagulation appears reasonably safe, with a sICH rate similar to patients not on anticoagulation receiving IV tPA.

Endovascular Mechanical Thrombectomy for the Treatment of Acute Ischemic Stroke Due to Arterial Dissection

Arterial dissections account for 2% of strokes in all age groups, and up to 25% in patients aged 45 years or younger. The safety of endovascular intervention in this patient population is not well characterized. We identified all patients in the Merci registry - a prospective, multi-center post-market database enrolling patients treated with the Merci Retriever thrombectomy device - with arterial dissection as the most likely stroke etiology. Stroke presentation and procedural details were obtained prospectively; data regarding procedural complications, intracerebral hemorrhage (ICH), and the use of stenting of the dissected artery were obtained retrospectively. Of 980 patients in the registry, ten were identified with arterial dissection (8/10 ICA; 2/10 vertebrobasilar). The median age was 48 years with a baseline NIH stroke scale score of 16 and median time to treatment of 4.9 h. The procedure resulted in thrombolysis in cerebral ischemia (TICI) scores of 2a or better in eight out of ten and TICI 2b or better in six out of ten patients. Stenting of the dissection was performed in four of nine (44%). The single complication (1/9; 11%) - extension of a dissected carotid artery - was treated effectively with stenting. No symptomatic ICH or stroke in a previously unaffected territory occurred. A favorable functional outcome was observed in eight out of ten patients. Despite severe strokes on presentation, high rates of recanalization (8/10) and favorable functional outcomes (8/10) were observed. These results suggest that mechanical thrombectomy in patients with acute stroke resulting from arterial dissection is feasible, safe, and may be associated with favorable functional outcomes.

Interventional Stroke Therapies in the Elderly: Are We Helping?

It is unclear whether endovascular therapies for the treatment of AIS are being offered or are safe in older adults. The use and safety of endovascular interventions in patients older than 75 years of age were assessed. A retrospective review of patients with AIS 75 years or older (n = 37/1064) was compared with a younger cohort (n = 70/1190) by using an established data base. Admission and discharge NIHSS scores, rates of endovascular treatment, SICH, in-hospital mortality, and the mBI were assessed. Rates of endovascular treatments were significantly lower in older patients (5.9% in the younger-than-75-year versus 3.5% in the older-than-75-year cohort, P = .007). Stroke severity as measured by the NIHSS score was equivalent in the 2 age groups. The mBI at 12 months was worse in the older patients (mild or no disability in 52% of the younger-than-75-year and 22% in the 75-year-or-older cohort, P = .006). Older patients had higher rates of SICH (9% in younger-than-75-year versus 24% in the 75-year-or-older group, P = .04) and in-hospital mortality (26% in younger-than-75-year versus 46% in the 75-year-or-older group, P = .05). Patients older than 75 years of age were less likely to receive endovascular treatments. Older patients had higher rates of SICH, disability, and mortality. Prospective randomized trials are needed to determine the criteria for selecting patients most likely to benefit from acute endovascular therapies.