Endovascular treatment of post-thrombotic and non-thrombotic iliofemoral venous outflow obstructions with self-expanding nitinol stents

VASA ◽  
2018 ◽  
Vol 47 (4) ◽  
pp. 319-325 ◽  
Author(s):  
Anna K. Stuck ◽  
Thomas Reich ◽  
Rolf P. Engelberger ◽  
Tim Sebastian ◽  
Nils Kucher
Keyword(s):  
Endovascular Treatment ◽  
Endovascular Therapy ◽  
Iliac Vein ◽  
Duplex Sonography ◽  
Primary Patency ◽  
Secondary Patency ◽  
Venous Outflow ◽  
Stent Occlusion ◽  
Nitinol Stents

Abstract. Background: The aim of the study was to investigate venous patency and clinical outcomes for endovascular treatment of iliofemoral venous obstruction in patients with post-thrombotic syndrome (PTS) and non-thrombotic iliac vein lesion (NIVL) with dedicated self-expanding nitinol stents. Patients and methods: Data were collected from the prospective Swiss Venous Stent Registry, enrolling consecutive patients with a standardized follow-up procedure since January 2008. Patency was evaluated by duplex sonography and clinical outcome by various scores including the Villalta score at baseline, three, six, and 12 months, and then annually after endovascular therapy. Results: Overall, 93 patients (64 PTS, 29 NIVL) were analysed. Mean follow-up time was 20 ± 16 (range 3–70) months. A total of 11 (12 %) patients had a stent occlusion, all of which occurred in the PTS group, and 13 (14 %) patients had a symptomatic stent stenosis. Primary patency was 79 % (95 % CI 68–87 %) at 12 months and 72 % (95 % CI 59–82 %) at 24 months. In PTS patients, primary patency at 12 months was 75 % (95 % CI 61–84 %) vs. 89 % (95 % CI 63–97 %) in NIVL patients (p = 0.10). Secondary patency at 24 months was 94 % (95 % CI 84–98 %) in PTS and 100 % in NIVL, p = 0.19). Overall, 62 (67 %) patients were free from PTS at the latest follow-up with a Villalta score < 5 points. Predictive factors for the loss of primary patency were stents placed below the inguinal ligament (OR 2.59, 95 % CI, 0.99–6.84, p = 0.05). Conclusions: In symptomatic patients with chronic iliofemoral vein obstruction, endovascular therapy with self-expanding nitinol stents was associated with favourable patency rates and clinical improvement in the majority of patients.

scholarly journals Mid-term outcomes of endovascular treatment for symptomatic chronic mesenteric ischemia

2011 ◽  
Vol 1 (1) ◽  
pp. 2 ◽  
Author(s):  
Eva Schönefeld ◽  
Susanne Szesny ◽  
Konstantinos P. Donas ◽  
Georgios A. Pitoulias ◽  
Giovanni Torsello
Keyword(s):  
Endovascular Treatment ◽  
Mesenteric Ischemia ◽  
Primary Patency ◽  
Mesenteric Arteries ◽  
Primary Study ◽  
Symptom Improvement ◽  
Initial Symptom ◽  
Secondary Patency ◽  
Chronic Mesenteric Ischemia

The authors would present the mid-term outcomes with the use of stent-supported angioplasty in the treatment of symptomatic chronic mesenteric ischemia (CMI). The present study is a retrospective analysis of 36 patients undergoing endovascular treatment of symptomatic CMI, between November 2000 and September 2009. Primary study endpoints were defined as primary patency, periprocedural and midterm mortality and complications, and symptom improvement after intervention. Forty-one mesenteric arteries (77.3% stenotic and 22.7% occluded vessels) were treated in 36 patients with 42 stents. In 30 patients (83.3%) one visceral artery and in 6 cases (16.7%) two visceral arteries were treated. Overall mortality was 16.7% (n=6) after a 60-month follow-up (mean follow-up period 30.1 months). Two early (&lt;30-day) deaths were caused by visceral ischemia (n=2: 5.5%). Late death was procedure-related in one patient with re-occlusion of the superior mesenteric artery after 12 months. The other 3 patients died from non procedure-related causes; e.g. twice myocardial infarction. Initial symptom relief was observed in 29 patients (80.5%); 7 patients reported no change. Primary patency was 83.3% after 5 years and secondary patency was 90.5% (38 out of 42 stents) among all patients. Two conversions to open surgery were documented. First-line endovascular approach of CMI is a reasonable strategy. Close follow-up is mandatory due to symptom recurrence and restenosis.

scholarly journals Simultaneous Hybrid Treatment of Multilevel Peripheral Arterial Disease in Patients with Chronic Limb-Threatening Ischemia

2021 ◽  
Vol 10 (13) ◽  
pp. 2865
Author(s):  
Felice Pecoraro ◽  
David Pakeliani ◽  
Salvatore Bruno ◽  
Ettore Dinoto ◽  
Francesca Ferlito ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Endovascular Treatment ◽  
Hybrid Approach ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Major Amputation ◽  
Primary Patency ◽  
Secondary Patency ◽  
Peripheral Arterial

Background: Hybrid treatments (HT) aim to reduce conventional open surgery invasiveness and address multilevel peripheral arterial disease (PAD). Herein, the simultaneous HT treatment in patients with chronic limb-threatening ischemia (CLTI) is reported. Methods: Retrospective analysis, for the period from May 2012 to April 2018, of patients presenting multilevel PAD with CLTI addressed with simultaneous HT. The outcomes of these interventions were measured the following metrics: early technical successes (within 30 days following treatment) and late technical successes (30 days or more following treatment) and included mortality, morbidity symptoms recurrence, and amputation. Survival and patencies were estimated. The median follow-up was 43.77 months. Results: In the 45 included patients, the HT consisted of femoral bifurcation patch angioplasty followed by an endovascular treatment in 38 patients (84.4%) and endovascular treatment followed by a surgical bypass in 7 patients (15.6%). Technical success was 100% without perioperative mortality. Eight (17.8%) patients presented early complications without major amputations. During the follow-up, seven (15.6%) deaths occurred and six patients (13.3%) experienced symptoms recurrence, with five of those patients requiring major amputation. An estimated survival time of 5 years, primary patency, and secondary patency was 84.4%, 79.2%, and 83.3% respectively. Conclusions: Hybrid treatments are effective in addressing patients presenting with multilevel PAD and CLTI. The common femoral artery involvement influences strategy selection. Larger studies with longer-term outcomes are required to validate the hybrid approach, indications, and results.

scholarly journals Management of endovascular treatment in spontaneous iliac artery dissections: Applications enabling classical surgery

2020 ◽  
Vol 28 (4) ◽  
pp. 601-608
Author(s):  
Fehim Can Sevil
Keyword(s):  
Endovascular Treatment ◽  
Iliac Artery ◽  
False Lumen ◽  
Arterial Occlusion ◽  
Primary Patency ◽  
Artery Dissection ◽  
Acute Ischemia ◽  
Entry Site ◽  
Stent Occlusion

Background: This study aims to investigate the effectiveness of endovascular applications for the treatment of spontaneous iliac artery dissections. Methods: The medical records of 13 patients (12 males, 1 female; mean age 67.9±5.7 years; range, 58 to 75 years) with spontaneous iliac artery dissection between January 2017 and December 2019 were retrospectively reviewed. The diagnosis of spontaneous iliac artery dissection was made based on contrast-enhanced computed tomography. Demographic and clinical characteristics of the patients, physical examination and imaging findings, and hybrid treatments applied during endovascular treatment were analyzed. Results: The mean follow-up was 12.5±1.1 (range, 6 to 16) months. Five patients received hybrid treatment during endovascular treatment. The re-entry site was closed by a patch plasty over the common femoral artery in one of these patients. Embolectomy was performed in the remaining four patients for the treatment of acute ischemia of the extremities. Since no patency could be achieved in two of the patients undergoing embolectomy, a femoropopliteal bypass was performed. The technical success and primary patency rates were 100%. No new false lumen formation, intra-stent occlusion or arterial occlusion was observed during the hospital stay and follow-up. Conclusion: Endovascular methods can be safely used in the treatment of spontaneous iliac artery dissections; however, hybrid treatments may be also required in selected cases. We believe that it is effective and safe to apply endovascular and hybrid treatments without preventing possible surgical treatments which may be required in the future.

Endovascular treatment for chronic atherosclerotic occlusive mesenteric disease: Is stenting superior to balloon angioplasty?

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 319-324 ◽  
Author(s):  
Daliri ◽  
Grunwald ◽  
Jobst ◽  
Szucs-Farkas ◽  
Diehm ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Patency Rate ◽  
Celiac Artery ◽  
Primary Patency ◽  
Secondary Patency ◽  
Chronic Mesenteric Ischemia ◽  
Primary Patency Rate ◽  
Secondary Patency Rate

Background: Endovascular treatment is an increasingly used therapeutic option in patients with chronic atherosclerotic occlusive mesenteric disease. Purpose of this study was evaluation of patency and mortality in patients treated with visceral artery percutaneous transluminal angioplasty (PTA) or stenting including follow-up. Patients and methods: A retrospective review of 17 consecutive patients (4 women, 13 men) with endovascular treatment for symptomatic chronic mesenteric ischemia from 1998 to 2004 was performed. Mean follow-up period was 42 months. Patient demographics, interventional details, primary and/or secondary patency and mortality were recorded. Cumulative mortality and patency rates were determined using Kaplan-Meier life table analysis. Results: Twenty-six interventions (PTA alone n = 13, PTA and stenting n = 13) were performed in 17 patients. Interventions were performed in the superior mesenteric artery (n = 13) and celiac artery (n = 13). The re-intervention rate was 30 % (6/26). Re-interventions were performed for the superior mesenteric artery (n = 4) and celiac artery (n = 2). Cumulative overall 1-year results were primary patency rate 81 %, secondary patency rate 94 %, and survival rate 82 %. Cumulative 10-year results were primary patency rate 73 %, secondary patency rate 94 %, and survival rate 65 %. The 10-year secondary patency rate was 100 % in patients post initial stenting and 86 % in patients post initial PTA. Conclusions: Long-term follow-up post endovascular treatment for chronic mesenteric ischemia demonstrated a considerable overall secondary patency rate of 94 %. However, the long-term secondary patency rate was higher in patients post initial stenting compared to PTA alone.

Midterm Outcomes on Primary Endovascular Treatment of 395 Aortoiliac Occlusive Disease Patients: A Single-Center Experience

Angiology ◽  
2021 ◽  
pp. 000331972199137
Author(s):  
Ender Özgün Çakmak ◽  
Emrah Bayam ◽  
Fatih Yilmaz ◽  
Muzaffer Kahyaoğlu ◽  
Mehmet Çelik ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Primary Patency ◽  
Occlusive Disease ◽  
Secondary Patency ◽  
Aortoiliac Occlusive Disease ◽  
Single Center Experience ◽  
Observational Cohort ◽  
Vascular Center

We report the results of endovascular treatment of Trans-Atlantic Inter-Society Consensus II (TASC) A&B, TASC C, and TASC D aortoiliac lesions in a single vascular center. In this retrospective, observational cohort study, we analyzed 395 patients (mean age 61.2 ± 9.0; 359 men) between January 2015 and December 2017. Technical success was achieved in 96.5%; in-hospital mortality was 1.2% (n = 5). Median follow-up was 36 months (range 24-49 months). After 1 and 5 years, the primary patency rates were 99% and 85% for TASC A&B, 90%, and 78% for TASC C, and 90% and 74% for TASC D. Secondary patency rates were 99% and 90% for TASC A&B, 98% and 65% for TASC C, and 97% and 65% for TASC D. Previous peripheral revascularization (hazard ratio: 1.76, 95% CI: 1.01-3.08, P = .04) was associated with decreased primary patency along with lower age, TASC C, and TASC D class. This analysis reported the acceptable effectiveness and safety of stenting for all types of aortoiliac occlusive disease in a modern setting, with few complications and excellent long-term primary and secondary patency rates.

scholarly journals Excellent long-term results with iliac stenting in local anesthesia for post-thrombotic syndrome

2015 ◽  
Vol 4 (9) ◽  
pp. 205846011559216 ◽  
Author(s):  
Lotte Klitfod ◽  
Sven Just ◽  
Pia Foegh ◽  
Niels Baekgaard
Keyword(s):  
Endovascular Treatment ◽  
Local Anesthesia ◽  
Symptom Relief ◽  
Iliac Vein ◽  
Primary Patency ◽  
Long Term Results ◽  
Compression Stocking ◽  
Post Thrombotic Syndrome

Background Only 20% of iliac veins will recanalize on anticoagulation (AC) treatment alone and may, therefore, develop venous obstruction after iliofemoral deep venous thrombosis (DVT). A considerable number of these patients will suffer from post-thrombotic syndrome (PTS) leading to impaired quality of life in more than 50%. Endovascular treatment for iliac vein obstruction using stents is known to alleviate PTS symptoms in selected patients. Purpose To report the Danish long-term results of endovascular treatment with iliac stenting. Material and Methods From 2000 to 2013 consecutive patients were evaluated and 19 patients with severe venous claudication were identified and subsequently underwent angioplasty and stenting. AC treatment was prescribed for 6 months, and knee-high class II compression stocking recommended for 1 year. Scheduled follow-up was done in the outpatient clinic at 6 weeks, 3 months, and annually thereafter. Results Nineteen patients, all women, all with left-sided iliac vein obstruction, and all with severe PTS symptoms were included. The median follow-up time was 81 months (range, 1–146 months; mean, 69 months). Primary patency rate of the inserted iliac stent was 89% (17/19) and 16 patients (84 %) had almost or total symptom relief at follow-up. Conclusion Endovascular stenting of iliac obstruction in local anesthesia is minimally invasive and shows excellent long-term outcomes for patients suffering from PTS.

Mid-term outcome after endovascular therapy in the superficial femoral and popliteal artery using long stents

VASA ◽  
2012 ◽  
Vol 41 (1) ◽  
pp. 49-56 ◽  
Author(s):  
Schoenefeld ◽  
P. Donas ◽  
Schönefeld ◽  
Osada ◽  
Austermann ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Popliteal Artery ◽  
Primary Patency ◽  
Stent Fracture ◽  
Fracture Rate ◽  
Term Outcome ◽  
Technical Success Rate ◽  
Endovascular Interventions ◽  
Artery Disease

Background: Peripheral artery disease (PAD) affecting the femoropopliteal artery is treated by endovascular interventions [2, 5, 13] increasingly. Aim of the study was to evaluate mid-term efficacy and patency of long stents in the superficial femoral and popliteal artery. Patients and methods: Between September 2006 and September 2007 103 patients received 128 stents for endovascular treatment of femoropopliteal vascular stenosis or occlusion. Clinical and hemodynamic parameters were collected. Risk factors, popliteal involvement and TASC classification, were documented and evaluated. Results: Immediate outcome was satisfactory with a technical success rate of 100 %. After a mean follow-up period of 21 months, primary patency was 83.6 %. Potential risk factor analysis for restenosis and fracture demonstrated hypertension to have borderline significance (P = 0.06). In normotensive patients no restenosis occurred. Further pre-conditions, e.g. smoking, metabolic syndrome, age, gender and previous intervention did not show any influence on restenosis or stent fracture. TASC C and D lesion had similar patency rates compared to TASC A and B lesions. Most of the restenoses (13 out of 16) were observed within the first six months of follow-up. Six stent fracture were observed (4.7 %). Conclusions: Long stents had convincing results after endovascular treatment of the femoropopliteal PAD. The used stent was an efficacious endovascular tool for long athersclerotic lesions in the superficial femoral and popliteal artery. Fracture rate was low with an incidence of 4.7 %. Most restenoses occurred within the first six months so that careful follow-up would be necessary.

Clinical Experience with a New Nitinol Self-Expanding Stent in Peripheral Arteries

1996 ◽  
Vol 3 (4) ◽  
pp. 369-379 ◽  
Author(s):  
Michel Henry ◽  
Max Amor ◽  
Rafael Beyar ◽  
Isabelle Henry ◽  
Jean-Marc Porte ◽  
...  
Keyword(s):  
Long Term Results ◽  
Lesion Length ◽  
Secondary Patency ◽  
Peripheral Arteries ◽  
External Compression ◽  
Nitinol Stent ◽  
Nitinol Stents ◽  
The Mean

Purpose: To evaluate a new self-expanding nitinol coil stent in stenotic or occluded peripheral arteries. Methods: Seventy-three symptomatic patients (58 men; mean age 67 years) were treated with nitinol stents for lesions in the iliac artery (9 stenoses); superficial femoral artery (SFA) (39 stenoses, 6 occlusions); popliteal artery and tibioperoneal trunk (9 stenoses, 7 occlusions); and 3 bypass grafts. Mean diameter stenosis was 84.4% ± 9.9% (range 75% to 100%), and mean lesion length was 45 ± 23 mm (range 20 to 120 mm). Results: Eighty-eight 40-mm-long stents with diameters between 5 and 8 mm were implanted percutaneously for suboptimal dilation (n = 45); dissection (n = 21); and restenosis (n = 7). All stents but one were implanted successfully; the malpositioned stent was removed, and another stent was successfully deployed. There were 3 (4.1%) failures due to thrombosis at 24 hours. During the mean 16-month follow-up (range to 44 months), 4 restenoses (3 femoral, 1 popliteal) have occurred; 2 were treated with repeat dilation and 2 underwent bypass. Primary and secondary patency rates at 18 months were 87% and 90%, respectively, for all lesions (iliac: 100% for both; femoral: 85% and 88%; popliteal: 87% and 100%). Conclusions: This new nitinol stent seems to be safe and effective with favorable long-term results, even in distal SFA lesions and popliteal arteries. Its flexibility and resistance to external compression allow its placement in tortuous arteries and near joints.

scholarly journals Two-stage forearm brachio-basilic loop arteriovenous graft for hemodialysis

2018 ◽  
Vol 146 (5-6) ◽  
pp. 316-319
Author(s):  
Branislav Donfrid ◽  
Olivera Lozance ◽  
Zvezdan Stefanovic ◽  
Aleksandar Jankovic ◽  
Nada Dimkovic
Keyword(s):  
Vascular Access ◽  
Brachial Artery ◽  
Duplex Sonography ◽  
Distal Region ◽  
Original Method ◽  
Late Complications ◽  
Primary Patency ◽  
Chronic Hemodialysis ◽  
Secondary Patency ◽  
Basilic Vein

Introduction. The autologous radio-cephalic arteriovenous fistula (AVF) is the best vascular access for patients on chronic hemodialysis. In some patients with inadequate blood vessels, it is necessary to create proximal AVF, or arteriovenous grafts. High percentage of primary graft failure is noted in cases where diameters of the brachial artery and the basilic vein are insufficient. The aim of this work was to introduce a new surgical technique for arteriovenous creation in patients with inadequate blood diameter. Case outline. The authors have proposed implantation of brachio-basilic polytetrafluoroethylene AV forearm loop graft in two acts. In the first act, the native brachio-basilic AVF was created in the distal region of the arm by side-to-end anastomosis. Three to four weeks after the first act, significant dilatation of brachial artery and basilic vein was noted (confirmed by the use of color duplex sonography technique). During the second act, polytetrafluourethylene graft was implanted by end-to-end anastomosis on the dilated basilica vein. Conclusion. AV graft that was created in two acts has sufficient blood flow without early or late complications. Primary patency was 30 months and secondary patency was 50 months. As an original method in the current literature, we recommend it in different clinical settings when there are no better alternatives for vascular access.

MILLER Banding Procedure for Treatment of Dialysis Access–Related Steal Syndrome, Pulmonary Hypertension, and Heart Failure

2021 ◽  
pp. 000313482110562
Author(s):  
Ahmad Alqassieh ◽  
Patrick B. Dennis ◽  
Veena Mehta ◽  
June Shi ◽  
Angello Lin ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Vascular Access ◽  
Primary Patency ◽  
Secondary Patency ◽  
Dialysis Access ◽  
Long Term Follow Up ◽  
Steal Syndrome

A Minimally Invasive Limited Ligation Endoluminal-assisted Revision (MILLER) banding procedure has been used for treating patients with dialysis access–related steal syndrome (DASS) and high-flow vascular access–related pulmonary hypertension (PHT) and heart failure (HF). We performed a retrospective analysis of patients undergoing the MILLER procedure performed for DASS, HF, and PHT from our Vascular Access Database from September 2017 to October 2019. Outcomes included primary patency of banding, primary assisted patency, and secondary patency, using time-to-event analyses with Kaplan-Meier curves and life tables to estimate 6- and 12-month rates. A total of 13 patients (6 men and 7 women, mean age 60 ± 14 years) underwent the MILLER procedure, 6 patients for DASS and 7 patients for pulmonary hypertension and heart failure (PHT/HF). Technical success was achieved in all patients. The longest duration of follow-up was 28 months (median 12 months [IQR 7, 19]). One patient died at 1 month after the intervention due to stroke. One patient developed access thrombosis of the graft 3 days after the procedure. Repeat banding was required in 1 patient 8 months after the first procedure. The 6-month primary patency rate of banding following this procedure was 83% while the 12-month rate was 66%. The 6- and 12-month secondary patency rates were 87% and 75%, respectively. The MILLER procedure can be performed for DASS and PHT/HF with improvement of symptoms and good long-term patency rates. Additional interventions to maintain patency and efficacy are required on long-term follow-up.

Sign in / Sign up

Export Citation Format

Share Document