Vascular Interventional Procedures Research Articles

Variation in the Branches of Arch of Aorta in Patients Undergoing Contrast Enhanced Multidetector Computed Tomography in a Tertiary Centre, Nepal

Introduction: Variations in the branching pattern of the Arch of Aorta (AoA) are common in patients undergoing contrast-enhanced Multidetector Computed Tomography, the identification of which is crucial in managing patients undergoing cardiovascular/neck surgeries and interventions.Methods: This prospective cross-sectional study involved 513 patients who were sent to the Department of Radiology for evaluation of various pathologies of chest and neck between August 2018 and July 2019. After approval from the Institutional Review Committee {Reference No: 11(6-11) E2/075/076}, contrast-enhanced computed tomography images were evaluated with variations in branches of the left-sided arch of the aorta and symptoms associated.Results: Variations in branches of the arch of aorta were seen in 69 (13.45%; 95% CI: 10.60%-16.71%) of cases, left common carotid artery and brachiocephalic trunk having common origin or common trunk was 51(9.94%). The mean age was 52.4±20 years (Range 3 months to 92 years) with male to female ratio of 1.3:1.Conclusions: Contrast-enhanced computed tomography is the modality of choice for the detection of the variations in branches of AoA, recognition of which is crucial in vascular intervention and surgical procedures to reduce the postoperative morbidity and mortality of the patients.

Two Rare Variations; Persistent Trigeminal Artery and Hypoplasia of the A1 Segment of the Anterior Cerebral Artery

The trigeminal artery, which is one of the major carotid-basilar anastomoses in the fetal period, regresses with the development of the posterior circulation in the prenatal period. In rare cases, when this regression does not occur but persists, it is called persistent trigeminal artery (PTA). Because of the association of the persistent trigeminal artery with many other cerebral vascular pathologies, it is of vital importance to identify it and know its imaging characteristics, especially in cases where vascular surgery or interventional procedures are planned. We report a case with PTA and hypoplasia of the A1 segment of the anterior cerebral artery (ACA) as an associated vascular anomaly. Magnetic resonance angiography (MRA) is a non-invasive method for the detection of PTA and other vascular anomalies.

Safety and learning curve of percutaneous axillary artery access for complex endovascular aortic procedures

BackgroundPercutaneous axillary artery access is increasingly used for large-bore access during interventional vascular and cardiac procedures. The aim of this study was to evaluate the safety and learning curve of percutaneous axillary artery access in patients undergoing complex endovascular aortic repair (fenestrated and branched endovascular aneurysm repair [FBEVAR]) requiring large-bore upper extremity access and to discuss best practices for technique and complication management. MethodsOne-hundred forty-six patients undergoing large-bore percutaneous axillary artery access during FBEVAR in a prospective, nonrandomized, Investigational Device Exemption study between September 2017 and January 2023 were analyzed. Ultrasound guidance and micropuncture were used to access the second portion of the axillary artery and 2 Perclose Proglide or Prostyle devices (Abbott Vascular) were predeployed before the insertion of the large-bore sheath. Completion angiography was performed in all patients to verify hemostatic closure. Axillary artery patency was also assessed on follow-up computed tomography angiography. Patient-related, procedural, and postoperative variables were collected and analyzed. ResultsOne-hundred forty-five patients underwent successful percutaneous axillary artery access; 1 patient failed axillary access and alternative access was established. The left axillary artery was accessed in 115 patients (79%), and the right axillary artery was accessed in 30 patients (21%). The largest profile sheath was 14 F in 4 patients (2.8%), 12F in 133 patients (91.7%), and 8F in 8 patients (5.5%). Ten patients (6.9%) required covered stent placement (Viabahn, W. L. Gore & Associates) for failure to achieve hemostasis; there were no conversions to open surgical repair. Additional adverse events included transient upper extremity weakness in two patients (1.3%) and transient upper extremity paresthesias in two patients (1.3%). Three patients (2%) suffered postoperative strokes, including one unrelated hemorrhagic stroke and two possibly access-related embolic strokes. On follow-up, axillary artery patency was 100%. There was a trend toward decreased closure failure over time, with seven patients (10%) in the early cohort and three (4%) in the late cohort. There was a significant negative correlation between the cumulative complication rate and the cumulative experience. ConclusionsLarge-bore percutaneous axillary artery access provides safe upper extremity large-bore access during FBEVAR, achieving successful closure in >90% of patients with a low incidence of access-related complications. There was a trend toward better closure rates with increasing experience, suggesting a learning curve effect. Application of best practices including ultrasound guidance and angiography may ensure safe application of the technique of percutaneous large-bore axillary artery access.

A comparison of patient dose and occupational eye dose to the operator and nursing staff during transcatheter cardiac and endovascular procedures

The number and complexity of transcatheter procedures continue to increase, raising concerns regarding radiation exposure to patients and staff. Procedures such as transaortic valve implantations (TAVI) have led to cardiologists adopting higher dose techniques, such as digital subtraction angiography (DSA). This study compared the estimated patient and occupational eye dose during coronary angiography (CA), percutaneous coronary intervention (PCI), TAVI workups (TWU), TAVI, endovascular aneurysm repairs (EVAR), and other peripheral diagnostic (VD) and interventional (VI) vascular procedures. A quantitative analysis was performed on patient dose during 299 endovascular and 1498 cardiac procedures. Occupational dose was measured for the cardiologists (n = 24), vascular surgeons (n = 3), scrub (n = 32) and circulator nurses (n = 35). TAVI and EVAR were associated with the highest average dose for all staff, and significantly higher patient dose area product, probably attributable to the use of DSA. Scrub nurses were exposed to higher average doses than the operator and scout nurse during CA, VD and VI. Circulating nurses had the highest average levels of exposure during TAVI. This study has demonstrated that EVAR and TAVI have similar levels of occupational and patient dose, with a notable increase in circulator dose during TAVI. The use of DSA during cardiac procedures is associated with an increase in patient and staff dose, and cardiologists should evaluate whether DSA is necessary. Scrub nurses may be exposed to higher levels of occupational dose than the operator.

Expected changes in physician outpatient interventional practices as a result of coronavirus disease 2019 and recent changes in Medicare physician fee schedule

ObjectiveWe examined the economic and practice effects of the coronavirus disease 2019 (COVID-19) pandemic and decreased Medicare physician payments on outpatient vascular interventional procedures. MethodsA 21-point survey was constructed and sent electronically to the physician members of the Outpatient Endovascular and Interventional Society and the American Vein and Lymphatic Society. The survey responses were converted to a Likert scale and statistical analyses performed to examine the associations between the response variables and the characteristics and practice patterns of the physician respondents. ResultsA total of 165 physicians responded to the survey, of whom 33% were vascular surgeons, 18% were radiologists, and 15% were general surgeons. For slightly more than one half (55%), their interventional practice was limited to the office setting, with the remainder also performing procedures in an office-based laboratory (OBL), ambulatory surgery center (ASC), or hospital. Almost all respondents had performed superficial venous interventions, with slightly more than one third also performing either deep venous procedures and/or peripheral arterial interventions. The COVID-19 pandemic had affected 98% of the practices, with a staff shortage reported by 63%. The most-established physicians, those with the longest interval since training completion, were the least likely to have experienced staff shortages. Almost all (94%) the respondents expected that the recent Medicare payment changes will have a negative effect on their practice. Physicians with only an office-based practice were less likely to add a physician associate compared with those with an OBL (P = .036). More than one quarter reported that it was likely they would close or sell their interventional practice in the next 2 years and 43% reported they were planning to retire early. The anticipated ameliorative responses to the decreased Medicare physician payments included adding wound care (24%) or other clinical services (36%) to their practices, with the alternatives considered more by younger physicians (P = .002) and nonsurgeons (P = .047). Only 10% expected to convert their practices to an ASC or hybrid ASC/OBL (16%). ConclusionsThe emotional and economic effects of the COVID-19 pandemic and the decreased Medicare physician reimbursement rates for vascular outpatient interventionalists have been significant. Even greater challenges for the financial viability of office practices and OBLs can be expected in the near future if additional further planned cuts are put into effect.

Assessment of Clinical Outcomes Following Lower Extremity Bypass and Percutaneous Revascularization: Should we be Following Ankle Brachial Indexes or Asking Our Patients?

Patients with peripheral arterial disease (PAD) will undergo lower extremity bypass (LEB) and percutaneous vascular intervention (PVI) procedures to prevent limb loss and improve physical function. The success of revascularization has traditionally relied on assessing the ankle brachial index (ABI) but has not considered patient-reported outcomes (PROs). We aimed to determine how physical function PROs (PF-PROs) correlate with the ABI after LEB and PVI procedures.

Developmental Anomalies of the Inferior Vena Cava and its Tributaries: What the Radiologist Needs to Know?

Inferior vena cava (IVC) can be involved by a wide gamut of developmental anomalies owing to its complex embryogenesis. Developmental anomalies of the IVC are not infrequent, seen in approximately 8.7% of the general population. Although most of the anatomical variations are asymptomatic, identification of these variations is important before planning any vascular surgery or interventional procedure in relation to the IVC to avoid inadvertent complications. Conventional venography has largely been replaced by noninvasive cross-sectional imaging modalities for detecting IVC abnormalities. Ultrasonography, often used for initial evaluation, is highly operator-dependent and the infrarenal part of IVC is often obscured by bowel gases. While magnetic resonance imaging is devoid of radiation risks, its use is limited due to limited availability and the frequent need for sedation. Computed tomography (CT) venography plays a pivotal role in the detection of these anomalies as it has an excellent spatial resolution along with availability of multiple postprocessing tools such as multiplanar reconstruction with generation of maximum intensity projection and volume-rendered images. This pictorial review focuses on the embryogenesis of IVC, various developmental anomalies of the IVC and its tributaries, their appearance on CT venography and conceivable clinical relevance.

Calibration Method of Projectional Geometry for X-ray C-arm Fluoroscopy Using Sinogram Data

X-ray imaging represents the most commonly used imaging modality in X-ray-guided vascular intervention procedures. Computed tomography (CT) data ensure that the procedure is performed accurately and safely by providing medical staff with positional information of the body part before starting the procedure. In particular, accurate geometric information of the imaging equipment is essential to accurately calculate the three-dimensional (3D) position of catheters used in delicate operations. However, it is difficult to gather this information before surgery. Therefore, this study proposes a novel calibration method that can be used immediately before a procedure and can guarantee the stability of the procedure. The calibration was performed without additional radiography using sinogram data obtained during the 3D CT imaging process, and both the accuracy and calculation time available in the vascular intervention theater were allowable. The experimental results show that the best angular conditions in terms of calculations and accuracy are between −40 and 40 degrees in angular range and 1.6 degrees in angular interval. Consequently, we achieved a calculation time of 2.92 s and an average accuracy of 0.36 mm, thus meeting our goal of accuracy below 1 mm within a minute of computational time.

Dexmedetomidine attenuates pneumocyte apoptosis and inflammation induced by aortic ischemia-reperfusion injury

ABSTRACT Objective Despite significant improvements in interventional vascular aneurysm repair procedures and intensive care patient management, there has been no significant decrease in mortality due to ruptured abdominal aortic aneurysm. Oxidative stress is known to play a key role in secondary organ damage due to infrarenal aortic clamping. The aim of this study was to examine the potential protective effect of the alpha-2 adrenergic receptor agonist dexmedetomidine (DMT) on aortic occlusion-induced lung injury. Methods Thirty Sprague Dawley rats were allocated into control, ischemia-reperfusion (IR), and IR+DMT groups randomly. Vascular clamps were attached to the abdominal aorta in the IR and IR+DMT groups. Two-hour reperfusion was established 1 h after ischemia. The IR+DMT group received a single intraperitoneal 100 µg dose of DMT 30 min before infrarenal abdominal aortic clamping. Results IR due to aortic occlusion led to apoptosis, widespread inflammation, alveolar septal wall thickening due to bleeding and vascular congestion were observed in both types I and II pneumocytes. Malondialdehyde levels increased while glutathione decreased. However, DMT was found to lower apoptotic pneumocytes, alveolar-septal thickness, hemorrhage, vascular congestion, and malondialdehyde levels, while glutathione levels in lung tissue increased. Conclusions This study is the first to address the effects of DMT on the lung in a ruptured abdominal aortic aneurysm model. Our findings suggest that the alpha-2 adrenergic receptor agonist DMT reduces oxidative stress and apoptosis, thus protecting against aortic occlusion-induced pulmonary injury.

Surface and Event Characterization - Proximal Audio Sensing to improve Manual and Robotic Device Interventions

Abstract Minimal-invasive procedures come with significant advantages for the patient. They also come with problems as the navigation/guidance of the devices to a target location is either based on pre-operatively acquired images and then performed free-hand or is accompanied by intraoperative imaging such as MRI or CT that is expensive, complicated and produces artifacts. Using robotic systems for moving and guiding these interventional and therapeutic devices adds additional issues like lack of palpation sensation and missing tissue feedback. While it is possible to add sensors to the distal tip, this creates other obstacles concerning reduced functionality, cables, sterility issues and added complexity and cost. We propose to use a proximally attached audio sensor to record the tissue tool interaction and provide real-time feedback to the clinician. This paper reports on initial attempts to use this technology with robotic arms for surface characterization and interventional vascular procedures that gain increased attention in combination with robotic devices. In summary, Proximal Audio Sensing could be a versatile, cost-effective and powerful tool to guide minimally invasive needle interventions and enable (semi-) autonomous robot-assisted surgery.

Abstract 478: Role Of FXR1 And Senescence In Intimal Hyperplasia And Vascular Biology

Introduction: Despite the advent of stents, intimal hyperplasia subsequent to vascular interventional procedures remains a major obstacle. Vascular smooth muscle cells (VSMC) play a critical role in the pathogenesis of intimal hyperplasia; therefore regulation of VSMC gene expression is a logical intervention point. FXR1 is a muscle-enhanced RNA binding protein and expression is increased in injured arteries. We have shown that modulation of FXR1 levels affects stability and abundance of inflammatory transcripts in VSMC, suggesting that FXR1 is a negative regulator of inflammation. This drives our hypothesis that FXR1 is involved in mitigating vascular disease and regulating inflammatory and proliferative mRNA in VSMC. Approach/Results: We developed a novel VSMC-specific conditional knockout mouse (FXR1 VSMC/VSMC ). In a carotid artery ligation model of intimal hyperplasia FXR1 VSMC/VSMC mice, have significantly reduced neointima formation (p<0.001) post-ligation compared to controls. To determine the mechanism of these effects, we knocked down FXR1 in human VSMC and observed decreased proliferation (p<0.05) as well as increased beta galactosidase (p<0.05) and gamma H2AX (p<0.01) staining, indicative of senescence. Senescent cells exhibit a senescence associated secretory phenotype (SASP) with characteristic gene expression leading to increased inflammation in the tissue microenvironment. RIP-sequencing demonstrated that FXR1 interacts with transcripts involved in cell cycle control, and stability of these transcripts is decreased with FXR1 KO. qPCR analysis from FXR1 KO mouse VSMC show increased transcripts associated with senescence (p21, p16, p53) as well as increased SASP-associated mRNA. Furthermore, wild-type human VSMC cultured in conditioned media from cells transfected with FXR1 siRNA show increased SASP mRNA and increased proliferation compared with cells cultured in conditioned media from scrambled control cells. Summary & Conclusions: Our results are the first to suggest that in addition to destabilization of inflammatory transcripts, FXR1 may stabilize cell cycle related genes in VSMC, and absence of FXR1 leads to induction of a senescent phenotype, an increase in SASP genes, and reduction of intimal hyperplasia.

The Role of FXR1 and Senescence in Vascular Biology and Intimal Hyperplasia

IntroductionDespite the advent of stents, intimal hyperplasia subsequent to vascular interventional procedures remains a major obstacle to success. Vascular smooth muscle cells (VSMC) play a critical role in the development and pathogenesis of intimal hyperplasia indicative of restenosis; therefore regulation of gene expression in VSMC represents a logical intervention point to attenuate this syndrome. FXR1 is a muscle‐enhanced RNA binding protein and expression is increased in injured human and mouse arteries. We have shown that modulation of FXR1 levels affects abundance and stability of inflammatory transcripts in VSMC, suggesting that FXR1 is a negative regulator of inflammation. This drives our hypothesis that FXR1 is involved in mitigating vascular disease and acts as a crucial regulator of inflammatory and proliferative mRNA in VSMC.Approach/ResultsBecause FXR1 expression is increased in injured arteries, we have developed a novel VSMC‐specific conditional knockout mouse (FXR1VSMC/VSMC). In a carotid artery ligation model of intimal hyperplasia, FXR1VSMC/VSMC mice have significantly reduced neointima formation (p<0.001) post‐ligation compared to several controls. To determine the mechanism of these effects, we knocked down FXR1 in human VSMC by siRNA and observed decreased proliferation (p<0.05) as well as an increase in beta galactosidase (p<0.05) and gamma H2AX (p<0.01) staining compared with controls, indicative of senescence. Senescent cells exhibit phenotypic changes called the senescence associated secretory phenotype (SASP) with characteristic gene expression leading to increased inflammation in the tissue microenvironment. RIP‐sequencing demonstrated that FXR1 interacts with transcripts involved in cell cycle control, and RNA stability of these transcripts is decreased with FXR1 KO. qPCR analysis from FXR1 KO mouse VSMC show an increase in transcripts associated with senescence (p21, p16, p53) as well as an increase in SASP‐associated mRNA compared with controls. Furthermore, wild‐type human VSMC cultured in conditioned media from cells transfected with FXR1 siRNA show an increase in SASP mRNA and an increase in proliferation compared with cells cultured in conditioned media from cells transfected with a scrambled control.Summary & ConclusionsOur results are the first to suggest that in addition to destabilization of inflammatory transcripts, FXR1 may stabilize cell cycle related genes in VSMC, and absence of FXR1 leads to induction of a senescent phenotype, an increase in SASP gene expression, and reduction of intimal hyperplasia.

2-Methoxyestradiol inhibits carotid artery intimal hyperplasia induced by balloon injury via inhibiting JAK/STAT axis in rats.

Intimal hyperplasia (IH) is a common complication of vascular interventional procedures that leads to narrowing of the vessel lumen. 2-Methoxyestradiol (2ME), an estrogen metabolite, has numerous pharmacological actions, including vasoprotective and antiproliferative activities. The present study aimed to evaluate the potential of 2ME, prepared as a self-nanoemulsifying drug delivery system (SNEDDS), to inhibit IH induced by balloon injury (BI) in the rat carotid artery. The prepared 2ME SNEDDS had a particle size of 119 ± 2.3 nm and a zeta potential of -7.1 ± 1.4 mV. Animals were divided into 5 groups, namely control, sham, BI, BI + 2ME (100 μg/kg), and BI + 2ME (250 μg/kg). The obtained data indicated that 2ME significantly inhibited IH as indicated by the histological and morphometric assessment of the intima, media and lumen areas. This was associated with enhanced expression of Bax and inhibited expression of Bcl2 mRNA. Furthermore, 2ME exhibited significant antioxidant properties as evidenced by prevention of malondialdehyde accumulation as well as superoxide dismutase and catalase enzymatic exhaustion. In addition, 2ME showed significant anti-inflammatory actions as it significantly inhibited vascular content of interleukin-6, tumor necrosis factor-alpha, and nuclear factor-κB. The observed vasoprotective activities of 2ME were accompanied by inhibition of Janus kinase/signal transducers and activators of transcription (JAK/STAT) protein expression. In conclusion, this study revealed that 2ME ameliorates balloon injury-induced IH in rats via suppressing JAK/STAT axis. This may help to develop new strategies to combat IH.

ROLE OF ENDOVASCULAR INTERVENTIONAL RADIOLOGY IN CHRONIC KIDNEY DISEASE PATIENTS: SINGLE CENTRE EXPERIENCE

BACKGROUND AND AIMS: To study different vascular interventional procedures done in patients with chronic kidney disease (CKD) and End Stage Renal Disease (ESRD) patients and management of vascular pathologies using interventional procedures wherever applicable. METHOD: A retrospective study of CKD/ESRD patients referred to the department of Interventional Radiodiagnosis for undergoing hemodialysis related or renal diagnostic/therapeutic interventions during 12 months period. In our study of 60 patie RESULTS: nts following procedures were performed,16 patients underwent central venous angioplasty for central venous stenosis,10 patients underwent permcath insertion for hemodialysis,9 patients underwent stulography/stuloplasty,15 patients underwent renal artery angiography/angioplasty of the native and transplant kidney respectively,8 underwent embolization for post biopsy vascular complication and 2 patients underwent Trans jugular kidney biopsy. The individual most common procedure in our hospital was central venousplasty (16 patients), however combined most common procedure was for establishing dialysis access (19 patients, stulography/stuloplasty and permcath insertion) Interventional CONCLUSIONS: Radiology has a major role in management of CKD/ESRD patients as described in this study done in a tertiary care centre.

Clopidogrel Use and CYP2C19 Genotypes in Patients Undergoing Vascular Intervention Procedure: A Hospital-Based Study.

PurposeClopidogrel is widely used in coronary artery, peripheral arterial, and cerebrovascular disease. We aimed to study the association of the CYP2C19 phenotype with cardiovascular outcomes and interventional procedures in a hospital-based population.Patients and MethodsThis cross-sectional, retrospective study enrolled patients with prior exposure to clopidogrel at the Taichung Veterans General Hospital (TCVGH) using data extracted from the Taiwan Precision Medicine Initiative (TPMI). Data on the CYP2C19 phenotype, drug-prescription profile, comorbidities, vascular intervention procedures, and hospitalization due to acute myocardial infarction (AMI) or stroke of clopidogrel users were analyzed.ResultsFrom the 32,728 patients in the TCVGH-TPMI cohort, we selected 2687 clopidogrel users. A total of 400 (14.9%) clopidogrel poor metabolizers (PMs), 1235 (46.0%) intermediate metabolizers (IMs), and 1052 (39.2%) extensive metabolizers (EMs) were identified. The predominant loss-of-function allele is *2. In 2687 patients with clopidogrel exposure, the CYP2C19 PM phenotype was unassociated with hospitalization due to AMI or stroke after adjusting for comorbidities and carotid angiographies. Among the 1554 clopidogrel users who underwent cardiovascular intervention, 193 (12.4%) received two or more types of interventional procedures. Compared with non-PMs, patients with the PM phenotype had a higher risk of multiple carotid interventions (OR: 3.13, 95% CI: 1.19–8.22).ConclusionIn this hospital-wide cohort, 8.2% were clopidogrel users, of which 14.9% were CYP2C19 PMs. The result of this study does not support universal genotyping of CYP2C19 in all clopidogrel users to identify risks for stroke and AMI. CYP2C19 PMs are more likely to undergo multiple carotid interventions than non-PMs. Prospective studies to investigate the association of the CYP2C19 genotype and carotid interventions and outcomes are needed to validate our results.

Abstract 13125: The Role of FXR1 and Cellular Senescence in Vascular Pathology

Introduction: Despite the advent of stents, intimal hyperplasia subsequent to vascular interventional procedures remains a major obstacle to success. Vascular smooth muscle cells (VSMC) play a critical role in the development and pathogenesis of intimal hyperplasia indicative of restenosis; therefore regulation of gene expression in VSMC represents a logical intervention point to attenuate this syndrome. FXR1 is a muscle-enhanced RNA binding protein and expression is increased in injured human and mouse arteries. We have shown that modulation of FXR1 levels affects abundance and stability of inflammatory transcripts in VSMC, suggesting that FXR1 is a negative regulator of inflammation. This drives our hypothesis that FXR1 is involved in mitigating vascular disease and acts as a crucial regulator of inflammatory and proliferative mRNA in VSMC. Approach/Results: Because FXR1 expression is increased in injured arteries, we have developed a novel VSMC-specific conditional knockout mouse (FXR1 VSMC/VSMC ). In a carotid artery ligation model of intimal hyperplasia, FXR1 VSMC/VSMC mice have significantly reduced neointima formation (p<0.001) post-ligation compared to several controls. To determine the mechanism of these effects, we knocked down FXR1 in human VSMC by siRNA and observed decreased proliferation (p<0.05) as well as an increase in beta galactosidase (p<0.05) and gamma H2AX (p<0.01) staining compared with controls, indicative of senescence. Senescent cells exhibit phenotypic changes called the senescence associated secretory phenotype (SASP) with characteristic gene expression leading to increased inflammation in the tissue microenvironment. RNA sequencing demonstrated a decrease in abundance of cell cycle control genes. This was validated by actinomycin D RNA stability assays, and further qPCR analysis showed an increase in abundance of SASP-related mRNA with FXR1 depletion. VSMC knockout of FXR1 via Cre adenovirus in mouse cells validated these results. Summary & Conclusions: Our results are the first to suggest that in addition to destabilization of inflammatory transcripts, FXR1 may stabilize cell cycle related genes in VSMC, and absence of FXR1 leads to induction of a senescent phenotype and reduction of intimal hyperplasia.

P.142 Safety and Efficacy of Vascular Closure Devices in Interventional Radiological Procedures

Background: Vascular closure devices (VCDs) are routinely used in both neurovascular and vascular interventional procedures. The purpose of our study was to assess the safety and efficacy of the VCDs for diagnostic and therapeutic neurovascular and vascular procedures. Methods: The study was approved by the University of Manitoba research ethics board. A retrospective review was conducted of the database between January 2017 and December 2019. The data was collected from the Picture Archiving and Communication System (PACS) and collected in an excel spreadsheet. Patient demographics and clinical information was collected. Descriptive statistics and chi-squared tests were performed using STATA 13 software. A p<0.05 was considered significant. Results: VCD was used in a total of 2072 patients. VCDs were successfully deployed in 94% with 6% failure. Immediate perioperative complications were seen in 6.2% patients. The complication rates were significantly (p=0.025) associated with the type of procedure. Complications were seen significantly (p=0.044) higher in outpatients compared to inpatients and those from emergency room. Conclusions: VCDs were successfully deployed in 96VCDs were successfully deployed in 94% of the patient with 6% perioperative complications. Most of the complications were minor and complications were more commonly associated with outpatients procedures and with diagnostic vascular procedures.

A Vascular Intervention Assist Device Using Bi-Motional Roller Cartridge Structure and Clinical Evaluation.

Conventional vascular intervention procedures present issues including X-ray exposure during operation, and an experience-dependent success rate and clinical outcome. This paper presents a novel robotic system using modularized bi-motional roller cartridge assemblies for robotic vascular interventions, specifically percutaneous coronary interventions (PCIs). The patient-side robot manipulates instruments such as the guiding catheter, guidewire, balloon/stent catheter, and diagnostic sensor catheter via commands from the user interface device, which is controlled by the physician. The proposed roller cartridge assembly can accommodate instruments of various sizes with an active clamping mechanism, and implements simultaneous translation and rotation motions. It also implements force feedback in the physician-side system, to effectively monitor the patient-side system’s status. The positioning accuracy and precision in using the robotic system showed satisfactory performance in a phantom-based test. It was also confirmed, through animal experiments and a pilot clinical trial, that the system demonstrates feasibility for clinical use.

Analysis ofpredictiveandpreventivefactorsfor access complications associated with vascular closure devices in complicated endovascular procedures.

The main goal is to evaluate the effectiveness of angioseal and starclose vascular closure devices (VCDs) in high-risk patients under intensive anticoagulation who require therapeutic angiographic procedures and to discuss which factors are important in complications associated with VCDs. Medical records of the patients who underwent therapeutic complex interventional vascular procedures were reviewed retrospectively. One hundred sixty-six patients were divided into two groups regarding VCDs used for access-site closure after the procedure: group 1, (angioseal); group 2, (starclose). Data including patients' demographics and comorbidity information, procedural characteristics, and complications were analyzed. The device deployment success rate was 100%. For the procedural characteristics, there was no significant difference between the groups except access site (P = 0.016) and sheath size > 6F (P = 0.0001). No major complications had occurred in none of the patients. Minor complications including hematoma, access-site pain, and access-site infection, except prolonged hemostasis did not differ significantly between groups. The patients' demographic and periprocedural factors were not significantly correlated with the development of complications. Contrary to published reports, our study showed that demographic and periprocedural factors may not be responsible for the vascular access-site complications associated with VCDs.

In Vivo Usability Test of Vascular Intervention Robotic System Controlled by Two Types of Master Devices

Conventional vascular intervention (VI) procedures are typically performed manually under exposure to X-rays, whereby several problems are presented that need to be addressed owing to the patients and doctors being exposed to large amounts of radiation. In such cases, employing radiation protection units is not a long-term solution to avoid physical damage. Therefore, to overcome these issues, we propose a robotic VI system in this study. Moreover, we compare the extent of radiation exposure in the case of the conventional manual VI procedure with that in the case of the robotic procedure. The radiation exposure is then analyzed from the perspective of the doctor. Subsequently, the results of usability tests for two proposed master devices are presented in terms of the NASA task load index (NASA-TLX) and the system usability scale (SUS) score. To verify the effectiveness of the robotic VI system, animal experiments are conducted using a pig model. Among the two types of master devices tested with the proposed robotic VI system, the ergonomically designed 2-degree-of-freedom master device is found to be more effective than the joystick-type device in terms of the usability test scores. Hence, the proposed robotic VI procedure is shown to be advantageous in terms of reducing radiation exposure and improving usability.