Success Rate Of Endovascular Treatment Research Articles

Role of Retrograde Tibiopedal Access in Limb Salvage in Patients with Critical Lower Limb Ischemia

AbstractThe aim of this study was to assess the efficacy and safety of retrograde tibiopedal access as an alternative approach in cases of critical limb ischemia (CLI) when antegrade access has failed. A prospective study was conducted that included patients with CLI who underwent tibiopedal access after failed antegrade recanalization from January 2018 to June 2022. Follow-up was conducted at 6, 12, and 24 months. The primary outcomes evaluated were technical success rate and primary patency. Secondary outcomes included complication rate, mortality rate, and limb salvage rate (LSR). Forty-eight patients had CLI and Trans Atlantic Inter-Society Consensus infrainguinal lesions. The retrograde approach was used through the anterior tibial artery in 28 patients (58%), the posterior tibial artery in 18 patients (37.5%), and the peroneal artery in 2 patients (4.5%). Technical success was achieved in 90% of patients (43 patients). There was a significant increase in the anklebrachial index after the procedure with a mean follow-up of 22 months. Twenty-two months primary patency rate was 85.2%, while secondary patency rate was 100% and LSR was 96%, respectively. There was no mortality in the series. Retrograde tibiopedal approach is an alternative option for managing peripheral arterial disease and CLI. This method offers another means of crossing lesions when antegrade access failed, and the intervention can be completed either in an antegrade or retrograde approach. As the retrograde approach does not impact access site, considered a feasible safe treatment alternative which increase the success rate of endovascular treatment.

Impact of Venous Collaterals on Clinical Outcomes in Paget–Schroetter Syndrome

PurposeTo characterize the degree of venous collateralization before and after endovascular therapy and determine the effect of collateralization on success of thrombolysis and rate of repeat intervention in patients with Paget–Schroetter syndrome. Materials and MethodsA single-center retrospective study of 37 extremities in 36 patients (mean age, 32.64 y; range, 15–72 y; 24 men) with PSS treated with endovascular therapy from 2007 through 2017 was conducted. Venograms at presentation, after lysis, postoperatively, and at each repeat intervention were graded for venous stenosis, thrombus burden, and collateralization on a 5-point scale. Collateralization was classified as high-grade (9 extremities) or low-grade (28 extremities) based on grading of the venograms at presentation. ResultsPrimary technical success rate for endovascular treatment was 100%. Eighty-six percent of patients (32 of 37) underwent thrombolysis, 91% (34 of 37) underwent mechanical thrombectomy, and 83% (30 of 37) underwent balloon angioplasty. Overall primary patency rate was 50% at 12 months. The repeat intervention rate within 12 months was significantly higher for extremities with high- vs low-grade collateralization (89% vs 43%; P = .016). There was a significant decrease in the median grade of collateral severity after initial intervention (2 vs 1; P = .044) and 1 day postoperatively (2 vs 1; P = .040) vs the venogram at presentation. ConclusionsSeverity of venous collateralization on the venogram at presentation of patients with PSS does not appear to affect success of endovascular therapy but may predict long-term patency of affected extremities. Patients in this cohort with severe collateralization on presentation were more likely to need repeat intervention.

Favorable Outcome of Endovascular Treatment for Intracranial Aneurysms: A Single-Center Study in Thailand.

Purpose:The purpose of this study is to collect the information on patients with intracranial aneurysm (IA) receiving endovascular management in Siriraj Hospital, Mahidol University, Thailand.Materials and Methods:We retrospectively reviewed data from patients with IA who underwent endovascular treatment from January 1997 through July 2013. We collected patients’ demographic data including age, sex, clinical presentations, and aneurysmal profiles, as well as endovascular treatment technique, complications, angiographic results, and regrowth rate. Treatment results included success rate, clinical findings during follow-up, and regrowth rate.Results:We reviewed data from 497 patients with 636 aneurysms (female:male ratio, 1.9:1; age range, 15–90 years; mean age, 59.18 years) and 69% presented with rupture. One hundred and twenty patients with 127 aneurysms received endovascular treatment. The most common location for endovascular treatment was the posterior communicating artery (15.8%), and endovascular techniques were used most often for posterior circulation and paraclinoid aneurysms. The success rate was approximately 99.2% with a 16.5% regrowth rate and no rebleeding. Regrowth rate did not correlate with immediate postoperative angiographic findings. We encountered 23 complications (18.1%); most commonly, intra-procedural rupture (7/23). Good outcomes occurred in approximately 95.9% of the patients.Conclusions:The success rate for endovascular treatment was >90%. Regrowth rate and clinical outcomes were within standard limits. Posterior circulation and paraclinoid aneurysms were our main targets. We tended to use fewer devices and simpler techniques to secure ruptured IA; however, the regrowth rate was similar to that using device-assisted techniques in other studies. We found no significant factors affecting regrowth rate, including immediate posttreatment angiographic results.

Endovascular treatment for hepatic vein-type Budd-Chiari syndrome: effectiveness and long-term outcome.

To determine the clinical effectiveness and long-term outcomes of endovascular treatment for hepatic vein (HV)-type Budd-Chiari syndrome (BCS). From June 2011 to August 2016, 68 consecutive patients with symptomatic HV-type BCS underwent endovascular treatment in our center. Data on the baseline characteristics, technical success, clinical success, and long-term outcomes were collected and analyzed retrospectively. The technical success rate of endovascular treatment was 100%. Fifty patients underwent HV recanalization, and 18 underwent accessory HV (AHV) recanalization. The clinical success rate was 95.6% (65/68). During a mean follow-up period of 29.4 ± 13.6months, 19 patients experienced re-obstruction of either the HV (n = 18) or the AHV (n = 1). The cumulative 1-, 2-, and 5-year primary patency rates were 80.0, 72.8, and 67.9%, respectively. The cumulative 1-, 2-, and 5-year secondary patency rates were 93.8, 90.3, and 82.9%, respectively. Univariate and multivariate analyses revealed that the independent predictor of a prolonged primary patency duration was recanalization of the AHV. Five patients died 1-28months (median, 15months) after treatment. The cumulative 1-, 2-, and 5-year survival rates were 96.9, 93.4, and 91.2%, respectively. There was no significant difference in survival between the HV and AHV recanalization groups. Endovascular treatment is effective for patients with HV-type BCS. It can result in excellent long-term patency and survival rates. If it is applicable, AHV recanalization should be considered prior to treatment in order to achieve a longer patency.

Percutaneous intervention for symptomatic central vein stenosis in patients with upper limb arteriovenous dialysis access

Central venous stenosis is an important hindrance to long-term maintenance of arteriovenous access in the upper extremities in dialysis patients. AimThe present study was done to determine feasibility and clinical success of endovascular approach for the treatment of symptomatic central venous stenosis associated with significant ipsilateral limb edema in dialysis patients with vascular access in the upper limb. MethodsA database of hemodialysis patients who underwent endovascular treatment for central venous stenosis from January 2014 to January 2017 at our institute was retrospectively reviewed. Follow-up was variable. ResultsThe study included ten patients (6 men and 4 women) with a mean age of 45.2 years, who underwent thirteen interventions during a period of 3 years. The technical success rate for endovascular treatment was 100%. One patient underwent primary PTA (percutaneous transluminal angioplasty). Seven patients underwent primary PTA and stenting. Three patients underwent secondary PTA. One among these patients underwent secondary PTA twice along with fistuloplasty. One patient underwent secondary PTA with stenting. No immediate complications were encountered during the procedure. Our study shows a primary patency rate of 67% and 33% at 6 months and 12 months for PTA with stenting. Our study also shows secondary or assisted primary patency of 75% at 6 months of follow-up. ConclusionsEndovascular therapy (PTA) with or without stenting for central venous stenosis is safe, with low rates of technical failure. Multiple additional interventions are the rule and long-term patency rate is not very good.

Endovascular therapy for complex ostial vertebral artery stenosis

Objective To investigate the characteristics of endovascular intervention to treat complex ostial vertebral artery stenosis. Methods The 56 patients of complex ostial vertebral artery stenosis were summarized with endovascular treatment by vascular surgery at Xuanwu Hospital of Capital Medical University from 2013 Jun to 2015 Jun. The lesion features of the cases, the success rate of endovascular treatment, relief of postoperative symptoms, and the patency rate were analyzed. Results The complex of vertebral artery lesion was divided into three types: Type Ⅰwas the almost occlude lesion of vertebral artery, Type Ⅱ was the stenting of ostial vertebral artery need upper limb artery approach, and Type Ⅲ was the ostial vertebral artery lesion combined with the subclavian artery stenosis or occlusion. The success rate of endovascular treatment was 92.9%. Postoperative symptom improvement rate was 56.5%. The patency rate was 88.5% after 1 year. Conclusions Predilation could improve the stent success rate to the almost occlude lesion of vertebral artery. Upper limb artery approach could improve the stent success rate of vertebral artery. The vertebral artery should be protected during the procedure of the subclavian artery stenting. Key words: Vertebrobasilar insufficiency/SU; Angioplasty; Vascular surgical procedures; Stents

Endovascular treatment of central venous obstruction as a complication of prolonged hemodialysis - Preliminary experience in a tertiary care center.

Background:Central venous disease is a serious complication in patients undergoing hemodialysis, often presenting with symptoms of venous hypertension. Treatment is aimed to provide symptomatic relief and to maintain hemodialysis access site patency.Aim:To describe our initial experience in the endovascular treatment of central venous stenosis or obstruction in patients undergoing hemodialysis.Settings and Design:This was a retrospective study carried out in a tertiary care center. Study duration was 24 months. Follow-up was variable.Materials and Methods:Eleven patients of chronic renal failure undergoing hemodialysis presented with central vein stenosis or obstruction having ipsilateral vascular access, between July 2012 and July 2014. All the patients underwent endovascular treatment and were analyzed retrospectively.Results and Conclusion:A total of 11 patients (4 male and 7 female) underwent 18 interventions for 13 stenotic segments during a time period of 2 years. Eight stenotic segments were in brachiocephalic vein, three in subclavian vein, and two in axillary veins. The technical success rate for endovascular treatment was 81.8%. Two patients underwent percutaneous transluminal angioplasty (PTA) alone and presented with restenosis later. Balloon angioplasty followed by stenting was done in seven patients, two of which required reintervention during follow-up. We found endovascular treatment safe and effective in treating central venous disease.

The Antegrade Approach Using Transbrachial Access Improves Technical Success Rate of Endovascular Recanalization of TASC C-D Aortoiliac Occlusion in Case of Failed Femoral Access

Technical success rates of endovascular recanalizations for Trans-Atlantic Inter-Society Consensus (TASC) C-D chronic occlusions are highly variable and depend on the characteristics and sites of the lesions as well as on the operator experience. We hypothesized that an antegrade approach via transbrachial access could improve the technical success rate of endovascular treatment of TASC C-D occlusions in case of failed femoral access. From January 2010 to December 2012, all patients with symptomatic chronic TASC C-D aortoiliac occlusion were treated with an endovascular-first approach. Recanalization was first attempted using a femoral access. In case of failure, an antegrade approach using a transbrachial access was performed. Patient characteristics, anatomic details, procedural data, and immediate outcomes were prospectively recorded. During the study period, 73 patients (99 arteries) were included. Twenty-seven (37%) patients had TASC C occlusions including 11 bilateral common iliac artery occlusions and 16 external iliac artery (EIA) occlusions involving the common femoral or the internal iliac arteries. Forty-six (63%) patients had TASC D occlusions including 10 aortoiliac occlusions, 31 unilateral occlusions of both common and EIAs, and 5 bilateral EIA occlusions. Technical success with femoral access has been obtained in 53 arteries. An antegrade approach via transbrachial access allowed technical success in the other arteries, except in 7 arteries. Overall technical success rate was 93%, and 2 complications were related to the brachial accesses including 1 thrombosis and 1 pseudoaneurysm both requiring a reintervention. Brachial access for TASC C-D aortoiliac chronic occlusion improves the technical success rate without the need for reentry devices.

Clinical Features and Endovascular Treatment of Visceral Artery Pseudoaneurysms

To analyze our experience with clinical features and endovascular treatment of visceral artery pseudoaneurysms (VAPAs). We performed endovascular treatments on 52 patients (34 men and 18 women) affected by VAPA. These cases were pseudoaneurysms of the celiac axis, superior mesenteric artery, and their branches. Endovascular treatments of VAPA using isolation techniques were performed after failure of conservative treatments. Follow-up was carried out via assessment of contrast-enhanced computed tomography or computed tomography angiography images. The initial technical success rate of endovascular treatment is 100% with only 4 patients rebled during 2-week follow-up. One patient among no rebleeding died of multisystem organ failure 28 days after intervention; thus, 30-day mortality rate was 1.9%. Four patients (7.7%) required secondary interventions because of rebleeding and were successfully treated by reintervention; however, one of the patients died from uncontrolled sepsis 39 days after reintervention. Postembolization syndrome developed in 3 patients (5.8%); one of these patients underwent splenectomy. During follow-up, no change of hepatic function was observed, no bowel ischemia was reported, and VAPA remained absent in all patients. Endovascular management is minimally invasive and highly successful in treating VAPA. It is particularly useful in poor surgical candidates.

Therapeutic Management of Hemorrhage from Visceral Artery Pseudoaneurysms after Pancreatic Surgery

IntroductionHemorrhage from pseudoaneurysms after pancreatic surgery is a rare but life-threatening and complicated complication. The study presents our experience to provide therapeutic management for this rare condition. MethodsBetween February 1994 and January 2011, 35 patients experienced hemorrhage from pseudoaneurysms in our hospital. Medical data of this rare complication were analyzed retrospectively. ResultsThe prevalence of hemorrhage from pseudoaneurysms was 3.2% (35/1,102). Sixteen patients (45.7%) experienced sentinel bleeding. Pancreatic fistula (74.3%) and intra-abdominal abscess (57.1%) were two common complications prior to hemorrhage. Of 35 patients, 20 underwent endovascular intervention, 14 received surgical re-laparotomy, and bleeding stopped spontaneously in one. The overall mortality rate was 22.9%. Technical success rate of endovascular treatment was 87%. There were significant differences in the mortality rate (10.0% vs 42.9%), operation time (72.8 vs 123.9 min), estimated blood loss (1,835 vs 3,000 ml), and intensive care unit stay (3.6 vs 8.6 days) between endovascular and surgical treatment. Mean follow-up was 19.2±17.0 (range, 5–63 months). ConclusionEndovascular intervention represents the first-line treatment for hemorrhage from pseudoaneurysms after pancreatic surgery. Endovascular embolization or stent-graft placement should be selected individually depending on the involved artery and its vascular anatomy.

Endovascular Grafts for Treatment of Traumatic Injury to the Aortic Arch and Great Vessels

Treatment of traumatic vascular injury using endovascular techniques has evolved as endovascular capabilities have advanced over the past several decades. Several endovascular techniques have been employed to address the challenges of traumatic arterial injury, including coil embolization and the use of stents, which may be either bare metal or covered with graft material. Compared with traditional surgical repair, endovascular stent grafting for the repair of traumatic arterial injury offers the advantage of decreased morbidity because a remote access site may be used, avoiding surgical dissection and lengthy operating times. A Medline (1995-2007) search was performed to find all studies discussing the use of endovascular means to treat supradiaphragmatic arterial trauma. In this review of 195 studies published between January 1995 and December 2007, the overall technical success rate of endovascular treatment of supradiaphragmatic arterial injury was 96.7%, and the complication rate was 6.4%. The results of this review suggest a potential morbidity and mortality benefit over traditional open repair; however, long-term data are lacking. Long-term follow-up for stent durability is of particular concern in the trauma population, which tends to comprise younger patients with minimal atherosclerotic disease. The success of endovascular techniques is also limited by the availability of skilled interventionalists, properly outfitted angiography suites, and suitable stent graft devices. Despite these challenges, the potential advantages of endovascular stenting make it a welcome addition to the armamentarium of the vascular interventionalist who treats arterial traumatic injuries.

Management of aneurysms involving branches of the celiac and superior mesenteric arteries: A comparison of surgical and endovascular therapy

Aneurysms involving branches of the superior mesenteric and celiac arteries are uncommon and require proper management to prevent rupture and death. This study compares surgical and endovascular treatment of these aneurysms and analyzes outcome. Patients at the Mount Sinai Medical Center in New York who were treated for aneurysms in the branches of the celiac artery and superior mesenteric artery were identified through a search of the institution's medical records and endovascular database. Patient demographics, history, clinical presentation, aneurysm characteristics, treatments, and follow-up outcome were retrospectively recorded. Significant differences between patients treated by surgical or endovascular therapy were determined by using Student's t test and chi2 analysis. Between January 1, 1991, and July 1, 2005, 59 patients with 61 aneurysms were treated at a single institution. Twenty-four patients had surgical repair, and 35 underwent endovascular treatment, which included coil embolization and stent-graft therapy. Splenic (28) and hepatic (22) artery aneurysms predominated. Eighty-nine percent of splenic artery aneurysms were true aneurysms and were treated by endovascular and surgical procedures in near equal numbers (14 and 11, respectively). Pseudoaneurysms were significantly more likely to be treated by endovascular means (P < .01). The technical success rate of endovascular treatment for aneurysms was 89%, and failures were successfully treated by repeat coil embolization in all patients who presented for retreatment. Patients treated by endovascular techniques had a significantly higher incidence of malignancy than patients treated with open surgical techniques (P = .03). Furthermore, patients treated by endovascular means had a shorter in-hospital length of stay (2.4 vs 6.6 days, P < .001). Endovascular management of visceral aneurysms is an effective means of treating aneurysms involving branches of the celiac and superior mesenteric arteries and is particularly useful in patients with comorbidities, including cancer. It is associated with a decreased length of stay in the elective setting, and failure of primary treatment can often be successfully managed percutaneously.

Commentary

To analyze our experience with clinical features and endovascular treatment of visceral artery pseudoaneurysms (VAPAs).We performed endovascular treatments on 52 patients (34 men and 18 women) affected by VAPA. These cases were pseudoaneurysms of the celiac axis, superior mesenteric artery, and their branches. Endovascular treatments of VAPA using isolation techniques were performed after failure of conservative treatments. Follow-up was carried out via assessment of contrast-enhanced computed tomography or computed tomography angiography images.The initial technical success rate of endovascular treatment is 100% with only 4 patients rebled during 2-week follow-up. One patient among no rebleeding died of multisystem organ failure 28 days after intervention; thus, 30-day mortality rate was 1.9%. Four patients (7.7%) required secondary interventions because of rebleeding and were successfully treated by reintervention; however, one of the patients died from uncontrolled sepsis 39 days after reintervention. Postembolization syndrome developed in 3 patients (5.8%); one of these patients underwent splenectomy. During follow-up, no change of hepatic function was observed, no bowel ischemia was reported, and VAPA remained absent in all patients.Endovascular management is minimally invasive and highly successful in treating VAPA. It is particularly useful in poor surgical candidates.