Endovascular management of traumatic pseudoaneurysms

Abstract Background Pseudoaneurysms (PAs) caused by traumatic injury to the arterial vasculature have a high risk of rupture, leading to life-threatening hemorrhage and mortality, requiring urgent treatment. The purpose of this study was to determine the technical and clinical outcomes of endovascular treatment of visceral and extremity traumatic pseudoaneurysms. Methods Clinical data were retrospectively collected from all patients presenting for endovascular treatment of PAs between September 2012 and September 2018 at a single academic level one trauma center. Technical success was defined as successful treatment of the PA with no residual filling on post-embolization angiogram. Clinical success was defined as technical successful treatment with no rebleeding throughout the follow-up period and no reintervention for the PA. Results Thirty-five patients (10F/25M), average age (± stdev) 41.7 ± 20.1 years, presented with PAs secondary to blunt (n = 31) or penetrating (n = 4) trauma. Time from trauma to intervention ranged from 2 h - 75 days (median: 4.4 h, IQR: 3.5–17.1 h) with 27 (77%) of PAs identified and treated within 24 h of trauma. Average hospitalization was 13.78 ± 13.4 days. Ten patients underwent surgery prior to intervention. PA number per patient ranged from 1 to 5 (multiple diffuse). PAs were located on the splenic (n = 12, 34.3%), pelvic (n = 11, 31.4%), hepatic (n = 9, 25.7%), upper extremity/axilla (n = 2, 5.7%), and renal arteries (n = 1, 2.9%). Technical success was 85.7%. Clinical success was 71.4%, for technical failure (n = 5), repeat embolization (n = 1) or post-IR surgical intervention (n = 4). There was no PA rebleeding or reintervention for any patient after discharge over the reported follow-up periods. Three patients died during the trauma hospitalization for reasons unrelated to the PAs. Conclusions Endovascular treatment of traumatic visceral and extremity PAs is efficacious with minimal complication rates and low reintervention requirements.

Download Full-text

An International, Multicenter Retrospective Observational Study to Assess Technical Success and Clinical Outcomes of Patients Treated with an Endovascular Aneurysm Sealing Device for Type III Endoleak

Journal of Endovascular Therapy ◽

10.1177/15266028211031933 ◽

2021 ◽

pp. 152660282110319

Author(s):

Aleksandra C. Zoethout ◽

Shirley Ketting ◽

Clark J. Zeebregts ◽

Dimitri Apostolou ◽

Barend M.E. Mees ◽

...

Keyword(s):

Clinical Outcomes ◽

Clinical Success ◽

Technical Failure ◽

Technical Success ◽

Technical Success Rate ◽

Type Iii ◽

Type Iiia ◽

Postoperative Myocardial Infarction ◽

Type Ia

Introduction: Type III endoleaks post-endovascular aortic aneurysm repair (EVAR) warrant treatment because they increase pressure within the aneurysm sac leading to increased rupture risk. The treatment may be difficult with regular endovascular devices. Endovascular aneurysm sealing (EVAS) might provide a treatment option for type III endoleaks, especially if located near the flow divider. This study aims to analyze clinical outcomes of EVAS for type III endoleaks after EVAR. Methods: This is an international, retrospective, observational cohort study including data from 8 European institutions. Results: A total of 20 patients were identified of which 80% had a type IIIb endoleak and the remainder (20%) a type IIIa endoleak. The median time between EVAR and EVAS was 49.5 months (28.5–89). Mean AAA diameter prior to EVAS revision was 76.6±19.9 mm. Technical success was achieved in 95%, 1 patient had technical failure due to a postoperative myocardial infarction resulting in death. Mean follow-up was 22.8±15.2 months. During follow-up 1 patient had a type Ia endoleak, and 1 patient had a new type IIIa endoleak at an untreated location. There were 5 patients with aneurysm growth. Five patients underwent AAA-related reinterventions indications being: growth with type II endoleak (n=3), type Ia endoleak (n=1), and iliac aneurysm (n=1). At 1-year follow-up, the freedom from clinical failure was 77.5%, freedom from all-cause mortality 94.7%, freedom from aneurysm-related mortality 95%, and freedom from aneurysm-related reinterventions 93.8%. Conclusion: The EVAS relining can be safely performed to treat type III endoleaks with an acceptable technical success rate, a low 30-day mortality rate and no secondary ruptures at short-term follow-up. The relatively low clinical success rates, related to reinterventions and AAA enlargement, highlight the need for prolonged follow-up.

Download Full-text

Endovascular treatment of obstructive iliac artery dissections

Acta Radiologica ◽

10.1080/02841850510021166 ◽

2005 ◽

Vol 46 (4) ◽

pp. 359-365 ◽

Cited By ~ 11

Author(s):

B. Önal ◽

E. T. Ilgit ◽

S. Akpek ◽

G. Erbas ◽

A. Akkaya

Keyword(s):

Endovascular Treatment ◽

Iliac Artery ◽

Clinical Success ◽

Symptom Relief ◽

False Lumen ◽

Complete Relief ◽

Technical Success ◽

Technical Success Rate ◽

Presenting Symptoms

Purpose: To report our results from a study of the endovascular treatment of flow restricting chronic atherosclerotic or catheter‐induced segmental iliac artery dissections with bare stents. Material and Methods: Thirty symptomatic patients with 32 lesions, including chronic atherosclerotic ( n = 21) and catheter‐induced ( n = 11) segmental arterial dissections, were treated with primary stenting. The common iliac artery was involved in 19 lesions and the external iliac artery in the remaining 13. Two patients had two lesions in the same vessel. Technical success was defined as restoration of the smooth contoured luminal patency with no more than 20% residual stenosis in diameter in atherosclerotic dissections associated with plaque formation or total obliteration of the false lumen in catheter‐induced dissections. Complete relief of, or marked improvements in, presenting symptoms, or at least single category improvement, was assessed for clinical success. Results: Technical success rate was 100%. No procedure‐related complications such as distal emboli or early occlusions were observed. Complete symptom relief was achieved in all patients with catheter‐induced dissection and in all but three cases with chronic spontaneous atherosclerotic dissection. In two cases, occlusion of the stents occurred during the follow‐up period. Clinical and radiological mean follow‐up for 24 months (range 3–55) revealed patency of all other stented segments. Cumulative primary patency rate was 97% over 12 months and 90% over 24 months. Conclusion: Endovascular treatment of chronic atherosclerotic and catheter‐induced short obstructive iliac arterial dissections with bare stents is safe and effective. Patency of the diseased arterial segment with a smooth lumen can be sustained for an extensive period.

Download Full-text

Safety and efficacy of EUS-guided pancreatic duct drainage in symptomatic main pancreatic duct obstruction: Is there still a place for surgery?

Endoscopy International Open ◽

10.1055/a-1302-1484 ◽

2021 ◽

Vol 09 (06) ◽

pp. E934-E942

Author(s):

Arthur Falque ◽

Mohamed Gasmi ◽

Marc Barthet ◽

Jean-Michel Gonzalez

Keyword(s):

Quality Of Life ◽

Minimally Invasive ◽

Success Rate ◽

Pancreatic Duct ◽

Main Pancreatic Duct ◽

Clinical Success ◽

Complication Rates ◽

Technical Success

Abstract Background and study aims In patients with symptomatic dilation of the main pancreatic duct (MPD) for whom endoscopic retrograde cholangiopancreatography (ERCP) is impossible, surgery has long been the only available treatment. EUS-PD is described as a minimally invasive alternative for ductal decompression surgery. We describe the results of our experience with it. Patients and methods This was a retrospective single-center study over 9 years. Twenty-seven patients, median age 61.8 years (range 36 to 85) who underwent EUS-PD for symptomatic MPD dilatation were included. The main objective was to evaluate the technical success (placement of a plastic stent between the stomach and the MPD). Secondary objectives were to document clinical success based on pain and quality of life (visual analogic scales and treatments) and complication rates, and to define a standardized management algorithm. Results The technical success rate was 92.5 %. The rate of minor adverse events was 21 % (4 cases of non-specific postoperative pain and two cases of delayed benign edematous pancreatitis). The clinical success rate was 88 %, and half of patients in whom the procedure was successful had "complete regression" of pain and half "partial regression." Median follow-up was 34.2 months (range 4 to 108). During follow-up, 74 % of patients reported improvement in quality of life and no patients required secondary surgery. Conclusion Provided it is performed in an expert center, EUS-PD is a minimally invasive, effective, and safe alternative to pancreatic surgical drainage in patients with symptomatic MPD dilatation with failure or in whom ERCP is impossible.

Download Full-text

Candy-Plug Generation II for False Lumen Occlusion in Chronic Aortic Dissection: Feasibility and Early Results

Journal of Endovascular Therapy ◽

10.1177/1526602819871613 ◽

2019 ◽

Vol 26 (6) ◽

pp. 782-786 ◽

Cited By ~ 7

Author(s):

Ahmed Eleshra ◽

Tilo Kölbel ◽

Nikolaos Tsilimparis ◽

Giuseppe Panuccio ◽

Martin Scheerbaum ◽

...

Keyword(s):

Aortic Dissection ◽

Clinical Success ◽

False Lumen ◽

The Other ◽

Type I ◽

Technical Success ◽

Chronic Aortic Dissection ◽

Early Results ◽

Aortic Remodeling

Purpose: To present the early results of false lumen (FL) occlusion in chronic aortic dissection using the Candy-Plug generation II (CP II), which has a self-closing fabric channel that obviates the need for separate occlusion of its center. Materials and Methods: Fourteen consecutive patients (mean age 60±11 years; 10 men) with persistent FL backflow and aneurysm formation at the thoracic segment in chronic aortic dissection underwent thoracic endovascular aortic repair (TEVAR) with FL occlusion using the refined CP II. Primary endpoints were technical success (successful deployment) and clinical success (no FL backflow at the CP II level). Secondary endpoints included 30-day mortality and morbidity and aortic remodeling during follow-up. Results: Technical success was 100%. One patient required additional intraprocedural FL embolization at the CP II level due to persistent FL backflow on final angiography (clinical success 93%), though there was no flow through the CP II center. There were no intraprocedural complications. Immediate complete FL occlusion was achieved in 12 patients; the other 2 required reintervention. One had contrast enhancement in the distal FL proximal to the CP II and was treated with coil embolization. The other patient had persistent type I endoleak at the level of the left subclavian artery (LSA) and underwent left carotid–LSA bypass and proximal stent-graft extension. One patient died due to retrograde type A aortic dissection that was not related to CP II placement. Over a mean 8-month follow-up (range 3–12), 9 patients had computed tomography angiography; 8 patients had evidence of aortic remodeling, while 1 aneurysm sac was stable. Conclusion: The CP II reduces the number of procedural steps and offers good seal, with minimal morbidity and mortality and a high rate of aortic remodeling.

Download Full-text

Rheolytic Thrombectomy Using AngioJet ZelanteDVT Catheter or Solent Omni Catheter for Treatment of Patients with Proximal Vein Thrombosis

10.21203/rs.3.rs-1073588/v1 ◽

2021 ◽

Author(s):

Maofeng Gong ◽

Guanqi Fu ◽

Zhengli Liu ◽

Yangyi Zhou ◽

Jie Kong ◽

...

Keyword(s):

Clinical Success ◽

Successful Outcome ◽

Success Rates ◽

Technical Success ◽

Bleeding Events ◽

Vein Thrombosis ◽

Rheolytic Thrombectomy ◽

Deep Vein ◽

Clinical Characteristic

Abstract Purpose The present study aimed to investigate the preliminary safety and efficacy of rheolytic thrombectomy (RT) using AngioJet ZelanteDVT catheter or Solent Omni catheter for acute proximal deep vein thrombosis (DVT).Material and Methods We conducted a retrospective review of 40 patients who treated by AngioJet RT divided into ZelanteDVT group (n=17) and Solent group (n=23) from January 2019 to January 2021. Data of demographics, clinical characteristic, technical success, clinical success, complications, and early follow-up were analysed.Results No significant differences regarding demographics were detected (all p >.05). The technical success rates were both 100%. ZelanteDVT group had a shorter duration time of RT and a higher primary RT success than those of Solent group (all p <.05), and percentage of adjunctive CDT was 29.4% in ZelanteDVT group, significantly lower than that was 79.3% in Solent group (p =.010). The successful outcome for ZelanteDVT group and Solent group were 100% (17/17) and 95.7% (22/23), both high in the two groups (p >.05). Except for transient macroscopic hemoglobinuria occurred in all patients at the first 24 hours post-RT, none suffered other procedure-related adverse events or major complications in both groups. Minor complications presented as bleeding events occurred in 21.7% (5/23) patients of Solent group, and one (5.9%) patient in Zelante DVT group (p >.05). At 6-month, the frequency of PTS was 5.9% (1/17) in ZelanteDVT group compared with 17.4% (4/ 23) in Solent group (p >.05).Conclusion Both catheters are safe and effective for the management of patients with proximal DVT, leading to improved clinical outcomes with low complication. Zelante-DVT catheter offered more powerful thrombectomy over Solent catheter, allowing for faster extraction of the DVT with shorter run time and lower adjunctive CDT.

Download Full-text

Long-Term Management of Recurrent Cholecystitis after Initial Conservative Treatment: Endoscopic Transpapillary Gallbladder Stenting

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2018/3983707 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Hideki Kamada ◽

Hideki Kobara ◽

Naohito Uchida ◽

Kiyohito Kato ◽

Takayuki Fujimori ◽

...

Keyword(s):

High Risk ◽

Acute Cholecystitis ◽

Success Rate ◽

Clinical Success ◽

Clinical Success Rate ◽

Technical Success ◽

Technical Success Rate ◽

High Risk Patients ◽

Risk Patients

Background. Endoscopic transpapillary gallbladder stenting (ETGBS) is an effective procedure for treating high-risk patients with acute cholecystitis and severe comorbidities. However, the efficacy of ETGBS for recurrent cholecystitis (RC) remains unclear. This study aimed to explore its efficacy in patients with RC for whom cholecystectomy is contraindicated because of its high surgical risk.Methods. Data on 19 high-risk patients who had undergone ETGBS for RC after initial conservative therapy in our institution between June 2006 and May 2012 were retrospectively examined. The primary outcome was the clinical success rate, which was defined as no recurrences of acute cholecystitis after ETGBS until death or the end of the follow-up period. Secondary outcomes were technical success rate and adverse events (AEs).Results. The clinical success rate of ETGBS was 100%, the technical success rate 94.7%, and AE rate 5%: one patient developed procedure-related mild acute pancreatitis. The clinical courses of all patients were as follows: four died of nonbiliary disease, and the remaining 15 were subsequently treated conservatively. The median duration of follow-up was 14.95 months (range 3–42 months).Conclusions. ETGBS is an effective alternative for managing RC in high-risk patients with severe comorbidities.

Download Full-text

The Evaluation of Aortic Diameter Changes During Long-Term Follow-Up After Endovascular Treatment of Acute Blunt Traumatic Thoracic Aortic Injuries

Vascular and Endovascular Surgery ◽

10.1177/1538574418765385 ◽

2018 ◽

Vol 52 (5) ◽

pp. 335-343 ◽

Cited By ~ 6

Author(s):

Federico Fontana ◽

Edoardo Macchi ◽

Filippo Piacentino ◽

Larissa Nocchi Cardim ◽

Giuseppe De Marchi ◽

...

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Mean Value ◽

Aortic Diameter ◽

Long Term Results ◽

Technical Success ◽

Long Term Follow Up ◽

Aortic Injuries

Purpose: To evaluate the variations in aortic diameters and long-term results in patients who underwent thoracic endovascular aortic repair (TEVAR) for acute blunt traumatic thoracic aortic injuries (BTTAIs). Materials and Methods: We retrospectively evaluated 23 patients with a mean age of 39 years (range: 17-74 years) who underwent TEVAR for BTTAI between October 2000 and November 2014. All of the patients underwent computed tomography angiography (CTA) before hospital discharge as a baseline imaging for the subsequent follow-up examinations. The technical success, overall survival, and complications were evaluated. Furthermore, the aortic diameters outside of the stent-graft (1 cm proximal and 1 cm distal to the stent-graft) and the aortic diameters within the stent-graft (2 cm distal to the proximal end and 2 cm proximal to the distal end) were assessed. The diameters at baseline on CTA were compared with those of the latest available follow-up examination. Results: Technical success was 100% with a mean follow-up of 65.4 months (range: 12-171 months). No death was registered, and 2 (8.7%) of 23 endograft-related complications (1 stent-graft distal infolding and 1 endoleak 2 and 4 months after the procedure, respectively) were observed. An increase in aortic diameter either proximal or distal to the stent-graft (mean value 0.7 and 0.5 mm, respectively) or within the stent-graft (mean value of 0.5 mm for both proximal and distal diameters) was registered (mean follow-up at 65.4 months, range: 12-171 months). Conclusion: Aortic dilatation following TEVAR for BTTAI is minimal during long-term follow-up. Endovascular treatment represents a durable and safe option in acute BTTAIs.

Download Full-text

Patency of endoscopic ultrasound-guided gastroenterostomy in the treatment of malignant gastric outlet obstruction

Endoscopy International Open ◽

10.1055/a-1214-5659 ◽

2020 ◽

Vol 08 (09) ◽

pp. E1194-E1201 ◽

Cited By ~ 1

Author(s):

Janine B. Kastelijn ◽

Leon M.G. Moons ◽

Francisco J. Garcia-Alonso ◽

Manuel Pérez-Miranda ◽

Viliam Masaryk ◽

...

Keyword(s):

Gastric Outlet Obstruction ◽

Endoscopic Ultrasound ◽

Palliative Treatment ◽

Clinical Success ◽

Outlet Obstruction ◽

Invasive Technique ◽

Technical Success ◽

Ultrasound Guided ◽

Malignant Gastric Outlet Obstruction

Abstract Background and study aims Endoscopic ultrasound-guided gastroenterostomy (EUS-GE) with a lumen-apposing metal stent (LAMS) is a novel, minimally invasive technique in the palliative treatment of malignant gastric outlet obstruction (GOO). Several studies have demonstrated feasibility and safety of EUS-GE, but evidence on long-term durability is limited. The aim of this study was to evaluate patency of EUS-GE in treatment of malignant GOO. Patients and Methods An international multicenter study was performed in seven centers in four European countries. Patients who underwent EUS-GE with a LAMS between March 2015 and March 2019 for palliative treatment of symptomatic malignant GOO were included retrospectively. Our main outcome was recurrent obstruction due to LAMS dysfunction; other outcomes of interest were technical success, clinical success, adverse events (AEs), and survival. Results A total of 45 patients (mean age 69.9 ± 12.3 years and 48.9 % male) were included. Median duration of follow-up was 59 days (interquartile range [IQR] 41–128). Recurrent obstruction occurred in two patients (6.1 %), after 33 and 283 days of follow-up. Technical success was achieved in 39 patients (86.7 %). Clinical success was achieved in 33 patients (73.3 %). AEs occurred in 12 patients (26.7 %), of which five were fatal. Median overall survival was 57 days (IQR 32–114). Conclusions EUS-GE showed a low rate of recurrent obstruction. The relatively high number of fatal AEs underscores the importance of careful implementation of EUS-GE in clinical practice.

Download Full-text

Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts

World Journal of Surgery ◽

10.1007/s00268-020-05754-1 ◽

2020 ◽

Vol 44 (12) ◽

pp. 4267-4274

Author(s):

Felice Pecoraro ◽

Ettore Dinoto ◽

Domenico Mirabella ◽

Francesca Ferlito ◽

Arduino Farina ◽

...

Keyword(s):

Endovascular Treatment ◽

Stent Graft ◽

Abdominal Aorta ◽

Infrarenal Aorta ◽

Acute Aortic Syndrome ◽

Technical Success ◽

Stent Grafts ◽

Femoral Access ◽

Persistent Symptoms

Abstract Introduction Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. Methods From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months. Results Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37–43; SE: 1.7) and 94% (CI: 37–44; SE: 1.7), respectively. Conclusions The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.

Download Full-text

Prolonged international normalized ratio and vascular injury at divisional level predict embolization failures of patients with iatrogenic renal vascular injuries

Scientific Reports ◽

10.1038/s41598-019-53561-z ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Shen-Yang Lee ◽

Mei-Lin Wang ◽

Yon-Cheong Wong ◽

Cheng-Hsian Wu ◽

Li-Jen Wang

Keyword(s):

Vascular Injury ◽

Clinical Success ◽

Arterial Embolization ◽

International Normalized Ratio ◽

Technical Failure ◽

Clinical Failure ◽

Technical Success ◽

Inadequate Information ◽

Renal Function Deterioration ◽

Renal Vascular

AbstractTranscatheter arterial embolization (TAE), as an alternative to surgery for iatrogenic renal vascular injury (IRVI), may have unsatisfactory outcomes. Nonetheless, there is inadequate information regarding the predictors of TAE outcomes for IRVI in the literature. The aim of this retrospective study was to investigate the predictors of TAE outcomes for IRVI. Of 47 patients, none had major complications, 17 (36.2%) patients had minor complications, and none suffered significant renal function deterioration after TAE. Technical success and clinical success were 91.5% and 93.6%, respectively. Technical failure was associated with older age, thrombocytopenia, prolonged international normalized ratio (INR) and divisional IRVI. Clinical failure was associated with kidney failure, use of steroids, prolonged INR, and divisional IRVI. In addition, prolonged INR was a significant predictor of technical failure. This implies that aggressive measures to control the INR prior to TAE are warranted to facilitate technical success, and technical success could then be validated on post-TAE images. Furthermore, divisional IRVI was a predictor of clinical failure. Thus, divisional IRVI should undergo surgery first since TAE is prone to clinical failure. The avoidance of clinical failure is validated if divisional IRVI does not need further intervention.

Download Full-text