Outcome of endovascular revascularisation in patients with acute obstructive mesenteric ischaemia - a single-centre experience

Abstract. Summary: Background: Acute embolic or thrombotic mesenteric ischaemia (AMI) is a rare but life-threatening clinical condition. Despite diagnostic and therapeutic advances, the mortality rate remains high, between 60 % and 90 %. Over the last years revascularisation was increasingly performed by endovascular techniques. The aim of this study was to retrospectively analyse the clinical outcome of catheter-directed thrombolysis (CDT) and aspiration thrombectomy (AT) in patients with AMI with regard to technical success, intervention-related complication rate, need for secondary abdominal surgery, clinical course and 30-day mortality rate. Patients and methods: Thirteen patients (4 men, 9 women; mean age 74.5 ± 17 years) with 12 embolic and one thrombotic occlusion of the superior mesenteric artery (SMA) underwent emergent endovascular revascularisation of SMA. Clinical data including all imaging reports, laboratory analysis and follow-up data were derived from the electronic patient file and images were reviewed on a Picture Archiving and Communication System. Results: Eleven patients (n = 11; 84.6 %) underwent CDT and AT, and two patients (n = 2; 15.4 %) had AT alone. Technical success with complete restoration of SMA perfusion was achieved in 38.5 % (n = 5). Adjunctive angioplasty ± stenting was mandatory in 2 patients. Overall, the intervention-related complication rate was 38.5 %. In total, 46.2 % (n = 6) clinically improved following the intervention, while 38.5 % required explorative laparotomy after the intervention, with 2 colectomies and 2 small bowel resections. Overall, the 30-day mortality rate was 30.8 %. Conclusions: Endovascular revascularisation with CDT in combination with AT is feasible, with a technical success rate of 38.5 % (n = 5). Endovascular revascularisation was beneficial for 46.2 % (n = 6) of the patients, who clinically improved following the intervention. The need for secondary explorative laparotomy was rather low, with 38.5 % (n = 5) of the patients. The 30-day-mortality remains high with 30.8 %.

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Transbrachial angiography: an effective and safe approach

VASA ◽

10.1024/0301-1526.33.4.231 ◽

2004 ◽

Vol 33 (4) ◽

pp. 231-234 ◽

Cited By ~ 13

Author(s):

Basche ◽

Eger ◽

Aschenbach

Keyword(s):

Image Quality ◽

Success Rate ◽

Complication Rate ◽

Low Risk ◽

Retrospective Evaluation ◽

Technical Success ◽

Technical Success Rate ◽

Transbrachial Approach ◽

Safe Approach

Background: Description of the technique of the transbrachial catheter diagnostics, retrospective evaluation of the technical success rate and the complications. Patients and methods: In a period of 8 years the transbrachial approach was used in 2555 patients, 1734 men and 821 women with an average age of 62.9 years. The investigation was done with outpatients in approximately 90% of the cases. Usually, the preferred arm was not punctured. For the diagnostics F4 and F5-catheter sheaths and selective catheter and/or plain catheters were used. Results: 12 times (0.47%) the investigation did not succeed technically. The image quality of the vascular representations was diagnostically sufficient. The total complication rate amounted to 0.47%. The following complications appeared: four dissections in the site of puncture, one embolism into arteries at the forearm, three transitory ischemic attacks, four haematoma at the site of puncture. Conclusions: The transbrachial catheter diagnostics is a little invasive, efficient and low-risk method, which is practicable in out-patients.

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Use and effectiveness of Pioneer re-entry device for subintimal true lumen re-entry: single-centre data and a review of the literature

CVIR Endovascular ◽

10.1186/s42155-021-00268-w ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Yvonne Tsitsiou ◽

Jadesola Ekpe ◽

Laura Harris ◽

Elika Kashef ◽

Mohamad Hamady

Keyword(s):

Clinical Indication ◽

Technical Failure ◽

Technical Success ◽

Single Centre ◽

Related Complication ◽

Subintimal Angioplasty ◽

Technical Success Rate ◽

Patient Demographics ◽

Vessel Lumen ◽

Diseased Vessel

Abstract Introduction During subintimal angioplasty (SIA), it is not always possible to re-enter the vessel lumen due to a variety of factors. Recanalization using hydrophilic wires and catheters alone, apart from its potential technical failure, is also limited by minimal control over the re-entry point. This is frequently well beyond the point of occlusion, thus often compromising important collaterals. In order to bypass the obstruction and attain controlled re-entry into the lumen of the diseased vessel, a re-entry device (RED) may be required. This paper assesses our centre’s experience with the safety and efficacy of the Pioneer re-entry system and systematically reviews the pertinent literature. Method A single centre retrospective study of subintimal angioplasty involving the use of the Pioneer Plus intravascular guided reentry catheter was performed. Patient demographics including age, gender, risk factors, comorbidities clinical indication and complications were recorded. Lesion characteristics, including location and severity of calcification were also assessed. A systematic literature review of all reported studies where the Pioneer RED was used for iliac and lower limb revascularization was conducted by 2 of the authors using the PubMed (MEDLINE) and EMBASE databases. Results The study comprised 30 cases. Technical success was 97%. A small, quickly resolved extravasation was the only device related complication. These results are in line with the systematic review which identified 16 studies using the Pioneer RED, reporting a technical success rate of 87.4–100% (median = 100%) and complication rate of 0–25.8% (median = 0%). However, due to heterogeneity in definitions of technical success, data was not pooled.

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TRIACCESS study: randomized comparison between radial, femoral and transpedal access for for percutanous supertfitial femoral artery angioplasty

European Heart Journal ◽

10.1093/ehjci/ehaa946.2380 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

Z Ruzsa ◽

A Csavajda ◽

M Deak ◽

P Sotonyi ◽

O.F Bertrand ◽

...

Keyword(s):

Success Rate ◽

Femoral Artery ◽

Complication Rate ◽

Randomized Study ◽

Technical Success ◽

Access Site ◽

Femoral Access ◽

X Ray ◽

Technical Success Rate ◽

Access Site Complication

Abstract Background Traditional access for the treatment of femoral artery lesions is the femoral artery (FA) approach, but radial (RA) and pedal access (PA) is an alternative access site. The aim of the study was to compare the success rate, complication rate of different access sites for the treatment of superfitial artery stenosis in a randomized study Methods 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral stenosis, via RA, FA and PA. Primary endpoint: technical success, rate of major and minor access site complications. Secondary endpoints: major adverse events (MAE), procedural factors, cross-over rate, and duration of hospitalization. Results Technical success was achieved in 96.6%, 100% and 100% patients in RA, FA and PA group (p=ns). Secondary access site was used in 30%, 3.3% and 30% in the RA, FA and PA access group (p<0.01). Stent implantation was done in the femoral artery in 26.6%, 58.3% and 71.6% cases in RA, FA and PA group (p<0.01). CTO recanalization was performed in 34/36 (100%), 30/30 (100%) and 45/45 (100%) cases successfully in RA, FA and PA group (p=ns). Contrast consumption, fluoroscopy and procedure time was not statistically different, but the X Ray dose was significantly lower in PA than in the RA and FA access group (63.1 vs 162 vs 153 Dyn). The cumulative rate of access site complications in the RA, FA and PA group was 3.3% (0% major and 3.3% minor), 15% (3.3% major and 11.6% minor) and 3.3% (0% major and 3.3% minor) (p<0.01), respectively. The cumulative incidence of MAE's at 6 months in the RA, FA and PA group was 8.3% vs 13.3% and 18.3%. (p<0.05) Conclusion Femoral artery intervention can be safely and effectively performed using radial, femoral and pedal access, but radial and pedal access is associated with less access site complication rate. Pedal access is associated with less X Ray dose than radial and femoral access. Funding Acknowledgement Type of funding source: None

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Fenestrated/Branched Endovascular Repair for Postdissection Thoracoabdominal Aneurysms: A Systematic Review with Pooled Data Analysis

Vascular and Endovascular Surgery ◽

10.1177/1538574420927131 ◽

2020 ◽

Vol 54 (6) ◽

pp. 510-518

Author(s):

Yuan He ◽

Senhao Jia ◽

Guoyi Sun ◽

Long Cao ◽

Xinhao Wang ◽

...

Keyword(s):

Data Analysis ◽

Mortality Rate ◽

Endovascular Repair ◽

Spinal Cord Ischemia ◽

Injury Rate ◽

Outcome Data ◽

Aortic Aneurysms ◽

Technical Success ◽

Technical Success Rate ◽

Pooled Data

Purpose: Patients who have survived an acute aortic dissection remain at risk for postdissection thoracoabdominal aortic aneurysms (PD-TAAAs). Fenestrated/branched endovascular repair for PD-TAAA is increasingly used in some high-volume centers, but outcomes are still limited because of the additional challenges compared to atherosclerotic thoracoabdominal aneurysms. This study was performed to evaluate the literature on fenestrated/branched endovascular repair for PD-TAAAs. Methods: PubMed, Embase, and the Cochrane Database were searched for relevant studies published until September 2019. Outcome data were extracted to evaluate the technical success, 30-day mortality, later survival, major complications, endoleaks, target vessel patency, and reintervention. Studies were analyzed in a pooled proportion meta-analysis. Results: In total, 143 patients from 4 studies were identified for the pooled data analysis. The pooled technical success rate was 98% (95% CI: 86%-100%). After the treatment, the overall estimated 30-day mortality rate was 3% (95% CI: 1%-8%), early spinal cord ischemia rate was 10% (95% CI: 4%-21%), early renal injury rate was 5% (95% CI: 1%-19%), endoleak rate was 33% (95% CI: 22%-47%), reintervention rate at a median follow-up of 22.5 months was 34% (95% CI: 27%-42%), and all-cause mortality rate was 12% (95% CI: 6%-24%). Conclusions: The use of fenestrated/branched stent grafts for the treatment of PD-TAAA appears generally feasible based on the limited literature, but endoleaks and reinterventions are frequent.

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Aspiration thrombectomy for the management of acute deep venous thrombosis in the setting of venous thoracic outlet syndrome

Vascular ◽

10.1177/1708538119895833 ◽

2019 ◽

Vol 28 (2) ◽

pp. 183-188

Author(s):

Katherine Teter ◽

Frank Arko ◽

Patrick Muck ◽

Patrick J Lamparello ◽

Minhaj S Khaja ◽

...

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Upper Extremity ◽

Thoracic Outlet Syndrome ◽

Technical Success ◽

Aspiration Thrombectomy ◽

Venous Involvement ◽

Acute Thrombosis ◽

Catheter Directed Thrombolysis

Objectives Venous thoracic outlet syndrome, known by the eponym Paget–Schroetter syndrome, is seen in healthy, young individuals with “effort-induced thrombosis.” Endovascular therapies, including catheter-directed thrombolysis, have been described in the acute management of the upper extremity deep venous thrombosis; however, we assessed the technical success of treating this entity using a mechanical aspiration thrombectomy system. Methods This was a multi-center retrospective review of patients with venous thoracic outlet syndrome with acute thrombosis treated with the Indigo continuous aspiration mechanical thrombectomy system. Charts from patients with venous thoracic outlet syndrome and acute deep venous thrombosis treated with this system at our institution along with three data sharing locations were reviewed for demographics, deep venous thrombosis risk factors, imaging modalities used for diagnosis, extent of axillosubclavian deep venous thrombosis, treatment details, adjunctive therapies, and complications. The primary outcome was technical success (resolution of >70% of thrombus). Results There were 16 patients (50% male) with a mean age of 33 years (range 17–69 years). Six patients had underlying venous thromboembolism risk factors including use of contraceptives ( n = 2), prior deep venous thrombosis ( n = 3), and known thrombophilia ( n = 1). Fifteen patients had complete venous occlusion, and the extent of venous involvement included subclavian ( n = 14), axillary ( n = 16), and brachial ( n = 7). The majority (81.25%) of patients were treated in a single setting, and technical success was achieved in all cases with the use of adjunctive therapies. Only three patients required additional overnight thrombolytic therapy. Conclusions The Penumbra Indigo system, often in combination with adjunctive catheter-directed thrombolysis and venoplasty, is a safe and effective device for the treatment of acute upper extremity deep venous thrombosis in the setting of Paget–Schroetter syndrome. No patients experienced central embolization or post-operative renal insufficiency. One-third of patients avoided any additional catheter-directed thrombolysis exposure, and technical success was achieved in all cases. A single bleeding complication was observed in a patient undergoing overnight adjunctive catheter-directed thrombolysis. All patients maintained patency until time of first rib resection.

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Safety and Efficacy of Totally Percutaneous Access Compared With Open Femoral Exposure for Endovascular Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/1526602816689679 ◽

2017 ◽

Vol 24 (2) ◽

pp. 246-253 ◽

Cited By ~ 15

Author(s):

Zhanjiang Cao ◽

Weiwei Wu ◽

Keqiang Zhao ◽

Junlai Zhao ◽

Yu Yang ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Meta Analysis ◽

Endovascular Aneurysm Repair ◽

Procedure Time ◽

Technical Success ◽

Safety And Efficacy ◽

Technical Success Rate ◽

Percutaneous Access ◽

Aneurysm Repair

Purpose: To compare the safety and efficacy of percutaneous (PEVAR) vs open femoral access (OFA) techniques for endovascular aneurysm repair (EVAR). Methods: A systematic review of English-language articles (Medline, EMBASE, and Cochrane databases) between January 1999 and August 2016 returned 11 studies including 1650 patients with 2500 groin accesses eligible for the meta-analysis. Data extracted from each study were synthesized to evaluate technical success rates, procedure time, and complications for the 2 access approaches. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The quality of individual studies was evaluated based on the Newcastle-Ottawa scale. Results: The mean technical success rate in the PEVAR group was 94.5% (785/831). The overall OR was 0.38 (95% CI 0.12 to 1.18, p=0.09), indicating no significant difference between the methods. The procedure time in PEVAR was shorter than OFA (mean difference −24.52, 95% CI −46.45 to −22.60, p<0.001). Overall, the total complication rate was 15.3% in the OFA group vs 7.8% in the PEVAR group (OR 0.52, 95% CI 0.37 to 0.73, p<0.001). The meta-analysis identified significant differences between groups for all complications (p<0.001) and the following individual adverse events: wound infection (OR 0.28, 95% CI 0.10 to 0.81, p=0.02), pseudoaneurysm (OR 8.07, 95% CI 1.54 to 42.32, p=0.01), seroma (OR 0.10, 95% CI 0.02 to 0.55, p=0.008), and lymphocele or lymph leak (OR 0.19, 95% CI 0.04 to 0.92, p=0.04). Conclusion: PEVAR had a similar technical success rate, shorter procedure time, and lower complication rate compared with OFA. Thus, percutaneous access appears to be the preferential approach for EVAR. However, larger and randomized studies are needed to draw definitive conclusions.

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Analysis of internal spermatic vein embolization through catheter versus laparoscopic high ligation in treatment of left varicocele

Vascular ◽

10.1177/1708538120923548 ◽

2020 ◽

Vol 28 (5) ◽

pp. 583-590

Author(s):

Ye-Xiang Jing ◽

Rui-Hua Wang ◽

Zhao-Xuan Liu ◽

Qing-Yi Meng

Keyword(s):

Recurrence Rate ◽

Complication Rate ◽

Treatment Cost ◽

Operative Time ◽

Laparoscopic Group ◽

High Ligation ◽

Technical Success ◽

Technical Success Rate ◽

Hospitalization Time ◽

Significant Difference

Objective Varicocele is a common disease in young and middle-aged men. This study aims to compare the efficacy of internal spermatic vein embolization of left varicocele versus laparoscopic high ligation. Methods From January 2017 to September 2018, a total of 69 varicocele patients were admitted and given the opportunity to choose the treatment option. Among these, 26 patients were treated with sclerosing agent injection, while 43 patients underwent laparoscopic surgery. They were followed up for 12 months after surgery, and the technical success rate, recurrence rate, complication rate, cost, operative time, and hospitalization time with regard to these two methods were analyzed. Results All patients completed the medical procedures. There was no recurrence in patients in the sclerotherapy group during the follow-up period; however, the complication rate was 19.2%. Furthermore, the operative time, hospitalization time, and cost of treatment were 31.1 ± 11.1 min, 1.2 ± 0.49 days, and 9613.11 ± 895.97 Yuan, respectively. In the laparoscopic group, 9 patients underwent laparoscopic bilateral high ligation, while 34 patients received treatment on the left side alone. The recurrence rate of left varicocele was 4.7% and the complication rate was 44.2%. Furthermore, the operative time, hospitalization time, and treatment cost were 50.4 ± 14.48 min, 4.0 ± 2.02 days, and 10,948.29 ± 2547.00 Yuan, respectively. Moreover, there were statistically significant differences ( P < 0.05) in operative time, hospitalization time, and treatment cost. Patients in the sclerotherapy group had an advantage with respect to the overall complication rate when compared with patients from the laparoscopic group ( X2 = 4.448, P < 0.05), and there was a statistically significant difference in hydrocele ( X2 = 4.555, P < 0.05). However, there was no significant difference in the recurrence rate between these two groups ( X2 = 1.245, P > 0.05). Conclusion Patients who underwent sclerotherapy showed a higher technical success rate, a lower recurrence rate, fewer complications, and shorter hospitalization time compared to those treated with laparoscopic ligation. Transcatheter sclerosing agent injection may be a preferable treatment option for patients with unilateral varicocele.

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Endovascular recanalization for symptomatic non-acute middle cerebral artery occlusion: proposal of a new angiographic classification

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2020-016692 ◽

2020 ◽

pp. neurintsurg-2020-016692

Author(s):

Feng Gao ◽

Xu Guo ◽

Ju Han ◽

Xuan Sun ◽

Zhenhua Zhou ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Success Rate ◽

Complication Rate ◽

Type I ◽

Technical Success ◽

Technical Success Rate ◽

Endovascular Recanalization ◽

Mca Occlusion ◽

Perioperative Complication

BackgroundEndovascular recanalization for medically refractory non-acute middle cerebral artery (MCA) occlusion remains a clinical dilemma, and limited data are available. We report the multicenter clinical results of endovascular recanalization for symptomatic non-acute MCA occlusion and propose a new angiographic classification to explore which subgroups of patients are most suitable for this treatment.MethodsFrom January 2015 to December 2019, 50 consecutive patients who underwent endovascular recanalization for recurrent symptomatic non-acute MCA occlusion were analyzed retrospectively. All patients were divided into three types according to the angiographic classification. The technical success rate, periprocedural complications, rate of stroke or death within 30 days, and follow-up results were evaluated.ResultsThe overall technical success rate was 84.0% (42/50). The perioperative complication rate was 14.0% (7/50), and the rate of stroke or death within 30 days was 12.0% (6/50). The revascularization success rate was higher in patients with type I occlusion than in those with type II or type III occlusion (95.5%, 83.3%, and 60%, respectively; p=0.014), and the opposite was true for the perioperative complication rate (4.5%, 11.1%, and 40.0%, respectively; p=0.013). The median clinical follow-up period was 13.4 months (IQR 12.5–15.6), and the rate of stroke or death beyond 30 days was 8.3%.ConclusionsEndovascular recanalization for non-acute MCA occlusion is technically feasible in reasonably selected patients, especially type I patients, and has potential as an alternative option for patients with recurrent stroke or transient ischemic attack in the short term despite optimal medical therapy.

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Use of microspheres in embolization for unruptured renal angiomyolipomas

Open Medicine ◽

10.1515/med-2021-0280 ◽

2021 ◽

Vol 16 (1) ◽

pp. 655-659

Author(s):

Masashi Shimohira ◽

Keiichi Nagai ◽

Kengo Ohta ◽

Yusuke Sawada ◽

Taku Naiki ◽

...

Keyword(s):

Success Rate ◽

Complication Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Arterial Embolization ◽

Major Complication ◽

Shrinkage Rate ◽

Technical Success ◽

Technical Success Rate ◽

Major Complication Rate

Abstract Purpose To describe our initial experience with use of microspheres in transcatheter arterial embolization (TAE) for unruptured sporadic renal angiomyolipomas (AMLs). Materials and methods Seven consecutive patients with seven unruptured sporadic renal AMLs, 6 females and 1 male, with a median age of 45 years (range, 30–69 years), underwent TAE using microspheres between November 2016 and February 2020. We evaluated the technical success rate, complications related to the procedure, clinical success rate, and the shrinkage rate of renal AML. Technical success was defined as the completion of TAE. Clinical success was defined as presence of shrinkage of the renal AML after TAE. Results In all patients, TAE using microspheres was accomplished and technical success rate was 100% (7/7). Three patients exhibited slight pain, but it improved with only observation, and the minor complication rate was 43% (3/7) and major complication rate was 0% (0/7). After the TAE, shrinkage of renal AML was confirmed in 6 of 7 patients, and clinical success rate was 86% (6/7). The median of shrinkage rate was 47% (range, 26–83%) with a median follow-up period of 19 months (range, 4–30 months). Conclusion TAE using microspheres appears to be effective and safe for unruptured sporadic renal AMLs.

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Comparison of Ultrasound-Accelerated Versus Multi-Hole Infusion Catheter-Directed Thrombolysis for the Treatment of Acute Limb Ischemia

Vascular and Endovascular Surgery ◽

10.1177/1538574419861768 ◽

2019 ◽

Vol 53 (7) ◽

pp. 558-562 ◽

Cited By ~ 2

Author(s):

Jesse Chait ◽

Afsha Aurshina ◽

Natalie Marks ◽

Anil Hingorani ◽

Enrico Ascher

Keyword(s):

Success Rate ◽

Limb Ischemia ◽

Limb Loss ◽

Acute Limb Ischemia ◽

Technical Success ◽

Safety And Efficacy ◽

Technical Success Rate ◽

Infusion Catheter ◽

Catheter Directed Thrombolysis ◽

The Mean

Objective: Thrombolytic therapy is widely used in the treatment of arterial occlusions causing acute limb ischemia (ALI); however, knowledge regarding the efficacy of the different catheter systems available is scarce. The objective of this study was to compare the safety and efficacy of 2 catheter-directed infusion systems for intra-arterial thrombolysis in the setting of ALI. Methods: A retrospective analysis was conducted to study all catheter-directed thrombolysis procedures performed over 32 months in patients diagnosed with ALI. Patients with thrombosis in both native arteries and bypass grafts were included. Patients with contraindications to thrombolysis, or those receiving thrombolysis for deep venous thrombosis, were excluded. The duration of thrombolysis, amount of thrombolytic agent, and technical success rate were recorded. Technical success was defined as complete or near-complete resolution of thrombus burden, allowing for further intervention. Data were stratified to include location of thrombus, procedural complications, mortality, and rates of limb loss. Results: Ninety-one patients met inclusion criteria. Among them, Uni-Fuse and EKOS catheters were used in 69 and 22 patients, respectively. The mean age of the population was 71 (standard deviation [SD]: ±1.5) for patients treated with the EKOS catheter and 70 years (SD: ±2.6) for patients receiving thrombolysis with Uni-Fuse. There was no significant difference in the mean infusion duration (1.65 vs 1.9 days), volume of tissue plasminogen activator (44.6 vs 48.2 mg), or technical success rate (72% vs 86%) between the Uni-Fuse and EKOS cohorts ( P > .3). Furthermore, there was no difference in major limb loss or compartment syndrome between each group ( P > .4). The overall complication rate was 14% in both groups, with a 30-day mortality rate of 4% when treated with either catheter system. Conclusion: This study suggests that a standard multi-hole infusion catheter demonstrates similar clinical safety and efficacy as the ultrasound-accelerated EKOS system in the treatment of ALI.

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