Vascular And Endovascular Surgery[JOURNAL]
Sun
200 papers
A Systematic Review of Transcarotid Approach for Endovascular Aortic Repair in Treating Aortic Disease.
Shi H, Guo X, Su C … +6 more , Huang H, Chen Y, Zhang J, Zhang B, Feng X, Shen Z
Vasc Endovascular Surg · 2025 Aug · PMID 40278166 · Publisher ↗
PurposeThe purpose of this study is to evaluate the feasibility, efficacy, and safety of transcarotid approach endovascular aortic repair (EVAR) in patients where conventional femoral access is not possible.Materials and...
PurposeThe purpose of this study is to evaluate the feasibility, efficacy, and safety of transcarotid approach endovascular aortic repair (EVAR) in patients where conventional femoral access is not possible.Materials and MethodsA systematic review of all articles discussing transcarotid approach EVAR published in the PubMed, Embase, Ovid, Web of Science, and Cochrane Library databases were conducted. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsIn accordance with the inclusion criteria, 17 articles discussing transcarotid approach EVAR were retrieved, encompassing 18 patients. Among these patients, 6 patients were related to ascending aortic disease, including 4 cases of pseudoaneurysms, 1 case of penetrating ulcer, and 1 case of dissection. 9 patients had descending aortic disease, comprising 6 aneurysms, 2 penetrating ulcers, and 1 pseudoaneurysm. There were 3 cases of abdominal aortic disease, including 2 aneurysms and 1 endoleak. Among these patients, 10 cases had access through the left common carotid artery, and 8 cases had access through the right common carotid artery. One patient experienced spinal cord ischemia and subsequently died of multi-organ failure caused by acute pancreatitis. Additionally, there was one case of minor embolization in the nonsurgical carotid supply area. No cerebral infarctions were observed in the vascular territory of the ipsilateral carotid artery at the surgical approach site.ConclusionsResearch on transcarotid approach EVAR is limited and predominantly consists of case reports, with a notable absence of randomized controlled trials. This systematic review suggests that transcarotid approach EVAR may be a viable alternative for selecting patient groups when the conventional femoral artery approach is not feasible. These findings indicate that this method is associated with a relatively manageable perioperative complications and mortality rates.
Endovascular Treatment of Common Iliac Aneurysm After Aortobifemoral Bypass: Banana Technique and Shape Memory Polymer Plug Embolization.
Asensio S, Brizuela JA, Revilla A … +3 more , Fernández-Bello S, Taylor JH, San Norberto EM
Vasc Endovascular Surg · 2025 Aug · PMID 40276939 · Publisher ↗
This case report aims to present a new endovascular technique for arterial embolization using a relatively recently developed endovascular device, Shape Memory Polymer (SMP) Embolization Plug (IMPEDE, Shape Memory Medica...
This case report aims to present a new endovascular technique for arterial embolization using a relatively recently developed endovascular device, Shape Memory Polymer (SMP) Embolization Plug (IMPEDE, Shape Memory Medical). A 66-year-old man presented an asymptomatic common iliac aneurysm with a maximun diameter of 4.4 cm and a previous aorto-bifemoral bypass. An embolization of the common iliac artery aneurysm with 5 units of IMPEDE-FX Rapid Fill (12 mm, Shape Memory Medical) and revascularization from external iliac artery to internal iliac artery through a banana technique with an auto-expandable covered stent (Viabahn 10 × 100 mm, Gore) was performed. The experience obtained after the use of this device has allowed us to increase the therapeutic arsenal for high volume aneurysm embolization.
Suspected Paclitaxel Allergy Following Angioplasty With a Drug-Coated Balloon.
Haffler Z, Endean E
Vasc Endovascular Surg · 2025 Aug · PMID 40268278 · Publisher ↗
PurposePaclitaxel is a chemotherapeutic agent which may be administered locally to an arterial lesion via a drug-coated balloon or drug-eluting stent. We report an allergic reaction to locally administered paclitaxel.Cas...
PurposePaclitaxel is a chemotherapeutic agent which may be administered locally to an arterial lesion via a drug-coated balloon or drug-eluting stent. We report an allergic reaction to locally administered paclitaxel.Case SummaryA 75 year-old woman underwent a right external iliac to superior mesenteric artery bypass and presented a year later with evidence of iliac artery stenosis, which was repaired via angioplasty and stenting. Two years later, the patient presented again with restenosis. She underwent balloon angioplasty of affected vessels with an IN.PACT Admiral® 6 × 40 drug-coated (Paclitaxel) balloon. The patient presented to her local hospital a week later with severe pruritis and a rash, for which she received a dose of parenteral steroid. Despite the patient's denial of changes in medication or environmental changes, she continued to experience hypersensitivity symptoms which required recurrent courses of oral prednisone, diphenhydramine, and cetirizine before finally resolving.ConclusionTo our knowledge, a severe allergic reaction to paclitaxel has not been reported when administered locally using either a drug-coated balloon or a drug-eluting stent. This case emphasizes that severe allergic reactions can occur. Because the drug is embedded in the arterial tissue, it cannot be easily removed, and such allergic reactions should be treated with systemic corticosteroids and antihistamines. The allergic reaction should be self-limited as the drug is eliminated over time.
Genetic Diagnosis and Combinational Treatment With Pharmacomechanical Thrombectomy and Transjugular Intrahepatic Portosystemic Shunt for Non-cirrhotic and Non-malignant Portal Vein Thrombosis.
Chen F, Xiong QG, Lu F … +3 more , Luo ZJ, Luo W, Zhou W
Vasc Endovascular Surg · 2025 Aug · PMID 40227156 · Publisher ↗
ObjectiveThis study aimed to evaluate the potential role of the whole-exome sequencing (WES) technique in screening pathogenic genes of non-cirrhotic and non-malignant portal vein thrombosis (PVT) and the clinical effica...
ObjectiveThis study aimed to evaluate the potential role of the whole-exome sequencing (WES) technique in screening pathogenic genes of non-cirrhotic and non-malignant portal vein thrombosis (PVT) and the clinical efficacy of AngioJet-assisted pharmacomechanical thrombectomy (PMT) with transjugular intrahepatic portosystemic stent shunt (TIPS) to treat this disease.Methods16 patients with acute non-cirrhotic and non-malignant PVT were retrospectively analyzed. 14 patients received genetically diagnosed using the WES technique, ten patients received PMT with or without TIPS and 6 cases received anticoagulation alone. Changes in clinical symptoms, and recanalization of the portal vein (PV) were also recorded.Results4 patients (28.6%) had JAK2 V617 F mutation, 4 patients (28.6%) had PROC mutations, 3 patients (21.4%) had SERPINC1mutations. Among patients treated with anticoagulation alone, 5 patients (83.3%, 5/6) developed cavernous transformation of PV and one patient with JAK2 V617 F mutation achieved complete recanalization of PV. One patient treated with PMT without TIPS developed PV cavernous transformation, eight patients (80%) treated with PMT and TIPS achieved complete or partial recanalization of PV. Three patients who developed intestinal necrosis all had SERPINC1 mutations and one of them died of intestinal necrosis. No recurrence was found during follow-up (1-36 months).ConclusionsThe WES technique offers a promising way to screen for thrombophilia in patients with non-cirrhotic and non-malignant PVT. Patients with SERPINC1 mutations are more inclined to develop intestinal necrosis than others. PMT combined with TIPS provides a safe and effective therapeutic alternative.
Sapheno-Femoral Junction Aneurysm: Single Centre Experience With Technical Notes and Histological Analysis.
Bucalossi M, Caggiati A, Carotti S … +4 more , Nevi L, Mariani F, Bissacco D, Mancini S
Vasc Endovascular Surg · 2025 Aug · PMID 40227069 · Publisher ↗
ObjectiveAn aneurysm is a localized dilation of a blood vessel, commonly referring to the arterial system, but venous aneurysms, especially in the lower limbs, are significant and often underreported vascular conditions....
ObjectiveAn aneurysm is a localized dilation of a blood vessel, commonly referring to the arterial system, but venous aneurysms, especially in the lower limbs, are significant and often underreported vascular conditions. This study focuses on superficial venous aneurysms at the sapheno-femoral junction (SFJ), categorized as Type IA and IB.Materials and MethodsEleven patients (5 females, 6 males; mean age 50 years) with venous masses were identified after negative hernia evaluations. Diagnosis was established through clinical examination and duplex ultrasound, confirming SFJ dilation with specific inclusion criteria. Surgical excision was performed, followed by follow-up assessments up to 5 years.ResultsAll patients underwent successful surgical excision. No major complications occurred, and all patients ambulated immediately post-surgery. Five years post-operation, there were no inguinal recurrences, and residual great saphenous vein remained patent and continent. Histopathological analysis revealed wall thinning, reduced smooth muscle and elastic fibers, and fibrous connective tissue predominance.ConclusionSuperficial venous aneurysms at the SFJ are rare but can be effectively managed through surgical excision. With appropriate diagnosis and intervention, the risk of complications is minimal, supporting the need for awareness and accurate classification in clinical practice.
Incidence of Perioperative Outcomes After Carotid Revascularization With Special Emphasis on Myocardial Infarction - A Systematic Review With Meta-Analysis of Randomized Control Trials.
Valaki P, Moulakakis KG, Mylonas S … +3 more , Karathanos C, Batzalexis K, Giannoukas A
Vasc Endovascular Surg · 2025 Aug · PMID 40156572 · Publisher ↗
Background and AimThe aim of this study is to estimate the incidence of periprocedural outcomes after carotid revascularization with special emphasis on myocardial infarction and assess the safety of carotid artery stent...
Background and AimThe aim of this study is to estimate the incidence of periprocedural outcomes after carotid revascularization with special emphasis on myocardial infarction and assess the safety of carotid artery stenting (CAS) and carotid endarterectomy (CEA) through systematic review and meta-analysis.MethodsA multiple electronic search was performed in Medline (database provider PubMed), Web of Science Core Collection, EMBASE (database provider Ovid) and Cochrane Central Register of Controlled Trials databases for articles from 2000 up to 2023 reporting outcomes after carotid revascularization. Randomized control trials comparing the perioperative events (30-day results) after CAS and CEA stating the perioperative risk of myocardial infarction were included in the present meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of twelve randomized control trials (RCTs) with 11 153 patients were identified and considered eligible. The pooled risk of periprocedural stroke was found to be reduced after CEA compared to CAS [OR: 1.6, CI 95%:1.3-2.1, < 0.05], while PMI was found to be more frequent after CEA, favoring CAS [OR: 0.4, CI 95%: 0.2-0.7, < 0.05]. Periprocedural mortality was lower but not reaching statistical significance in the CEA compared to CAS [OR: 1.1, CI 95%: 0.6-2.1, = 0.68]. The pooled OR for composite endpoint of stroke, MI or death was in favor of CEA as safer treatment [OR: 1.3, CI 95%: 1-1.5, < 0.05].ConclusionsPMI risk was lower after CAS, although the currently available data do not demonstrate any increase in mortality rates.
The Impact of Intra-abdominal Cancer Stage on Outcomes after Abdominal Aortic Aneurysm Repair.
Lubitz AL, Lutzow LK, Beard J … +4 more , Schmieder F, Lu X, Zhao H, Oresanya L
Vasc Endovascular Surg · 2025 Aug · PMID 40155320 · Publisher ↗
ObjectiveA significant number of patients undergoing abdominal aortic aneurysm (AAA) repair have a prior diagnosis of cancer. Further information on outcomes following AAA repair in patients with recent intra-abdominal m...
ObjectiveA significant number of patients undergoing abdominal aortic aneurysm (AAA) repair have a prior diagnosis of cancer. Further information on outcomes following AAA repair in patients with recent intra-abdominal malignancy diagnosis could help guide decision making.MethodsWe used the 2005-2016 Surveillance, Epidemiology and End Results (SEER)-Medicare database to examine outcomes of AAA repair in patients with a recent intra-abdominal malignancy diagnosis. Patients who had undergone AAA repair within 2 years following a cancer diagnosis were included in the study and stratified by cancer stage. We used Kaplan-Meir curves and survival models to compare outcomes of AAA repair in patients with cancer to a cohort without cancer.ResultsWe identified 2614 patients with intra-abdominal malignancy and 2680 patients without cancer who had AAA repairs. Cancer stages were: 53% stage I, 31% stage II, 11% stage III and 5% stage IV. Cancer patients were less likely to undergo open repair (20% vs 28% < 0.001) or emergent repairs (15% vs 24% < 0.001). Survival 2 years after AAA repair was 81% for patients without cancer and 78% for the cancer cohort. 2-year mortality by cancer stage was 20% for stage I, 20% for stage II, 33% for stage III and 69% for stage IV cancer patients (AHR for 2-year mortality, Stage I 1.10 (95% CI 0.94-1.27), Stage II 1.25 (95% CI 1.05-1.50), Stage III 2.01 (95% CI 1.62-2.50), Stage IV 5.23 (95% CI 4.17-6.56)).ConclusionPatients with late-stage intra-abdominal malignancies had significantly poorer prognosis following repair of a synchronous AAA as compared to patients without cancer. This data could help inform decision making around the role of AAA repair in the setting of concomitant intra-abdominal malignancy.
Enhancing Routine Reporting of IVC Filters: An Interventionalist's Approach to Improving Patient Safety in an Underserved Urban Area.
Shahid MU, Kondoor V, Nirgudkar N … +4 more , Gantz O, Ippolito P, Shukla P, Kumar A
Vasc Endovascular Surg · 2025 Aug · PMID 40133037 · Publisher ↗
PurposeTo determine whether concurrent reporting and follow-up on diagnostic imaging could be used as an effective tool to raise IVC filter (IVCF) awareness in an underserved urban community. For this prospective study,...
PurposeTo determine whether concurrent reporting and follow-up on diagnostic imaging could be used as an effective tool to raise IVC filter (IVCF) awareness in an underserved urban community. For this prospective study, radiologists at our institution flagged plain-film and cross-sectional imaging in which an IVCF was identified from October 2018 to October 2019. For consent, a phone survey was conducted to assess the patient's knowledge and understanding related to IVC filter placement. Key data points on the survey included patients' awareness of filter presence, placement date, location, difference between filters, satisfaction regarding peri-procedural education, and plan for filter removal. Patients desiring further information were scheduled for follow-up in the Vascular Interventional Radiology clinic. 77 patients were identified with an IVC filter. 34 patients (15 males, 19 females; mean age 56y +/- 13.6 years) consented. 23.5% were unaware of their IVC filter. Of those aware, 61.5% were dissatisfied with their consultation/education during placement and 88% pursued further IR consultation indicating a desire to consult a clinician regarding their filter. During the study, 8 patients with IVCF (23.5%) were deemed no longer medically necessary; 6 underwent retrieval and 2 were pending at study conclusion. In underserved urban communities, patients with indwelling IVC filters may not have received appropriate follow-up instructions regarding filter retrieval or may be unaware they have one altogether. Diagnostic imaging is an effective tool to identify these patients, raise awareness, and improve retrieval of filters that are no longer indicated.
Single Versus Double Antiplatelet Therapy in Patients Undergoing Endovascular Treatment With a Stent for an Iliac Occlusive Lesion.
Kobayashi T, Okazaki T, Okusako R … +2 more , Hamamoto M, Takahashi S
Vasc Endovascular Surg · 2025 Aug · PMID 40130909 · Publisher ↗
ObjectiveEndovascular treatment (EVT) for an aorto-iliac occlusive lesion is performed worldwide as first-line treatment. However, the choice of single antiplatelet therapy (SAPT) or double antiplatelet therapy (DAPT) af...
ObjectiveEndovascular treatment (EVT) for an aorto-iliac occlusive lesion is performed worldwide as first-line treatment. However, the choice of single antiplatelet therapy (SAPT) or double antiplatelet therapy (DAPT) after aorto-iliac revascularization is controversial. The purpose of the study was to assess clinical outcomes in patients with SAPT or DAPT after iliac EVT, using propensity score matching.MethodPatients who underwent EVT for a de-novo iliac occlusive lesion at a single center from 2017 to 2023 were analyzed retrospectively. Comparisons were made between SAPT and DAPT cases after propensity score matching. The primary endpoints of the study were freedom from restenosis and freedom from target lesion revascularization (TLR).ResultsA total of 150 patients underwent iliac EVT and received SAPT (n = 93) or DAPT (n = 57). The DAPT group had a significantly higher rate of coronary artery disease ( = .010). After matching, the differences in baseline and procedural details were diminished. The technical success rate of EVT, access site complications, and manual compression time did not differ between the groups. The median follow-up period was 33 (20-47) months. During follow-up, restenosis occurred in 11 cases (7%) and 10 cases (7%) underwent TLR. After matching, the 5-year freedom from restenosis did not differ significantly in the SAPT and DAPT groups (92% vs 90%, = .80). Freedom from TLR also did not differ between the groups ( = .80). There was a tendency for a lower incident rate of major bleeding in the SAPT group (7% vs 18% at 5 years, = .10).ConclusionsRetrospective analysis using propensity score matching showed that SAPT after iliac EVT resulted in similar freedom from restenosis and TLR compared with DAPT.
Hospital Volume and Social Determinants of Health Do Not Impact Outcomes in Fenestrated Visceral Segment Endovascular Aortic Repair for Patients Treated at VQI Centers.
Li RD, O'Meara R, Rao P … +4 more , Kang I, Soult MC, Bechara CF, Blecha M
Vasc Endovascular Surg · 2025 Aug · PMID 40127376 · Publisher ↗
ObjectiveThe purpose of this study is to investigate the impact of social determinants of health on access to high volume centers and clinical outcomes in fenestrated abdominal aortic endografting. Further, the effect of...
ObjectiveThe purpose of this study is to investigate the impact of social determinants of health on access to high volume centers and clinical outcomes in fenestrated abdominal aortic endografting. Further, the effect of center volume in fenestrated endografting on outcomes will be sought as this is ill defined. The data herein have the potential to affect referral patterns and locations of complex fenestrated aortic aneurysm care. If lower volume centers achieve equivalent outcomes to higher volume centers, then limiting access to a small number of centers may not be justified.MethodsVascular Quality Initiative (VQI) was utilized as the data source. Four adverse outcomes categories were investigated : (1) Lack of follow up data in the VQI database at 1 year postoperatively; (2) Thirty day operative mortality; (3) Composite perioperative adverse event outcome; and (4) Twelve month mortality. Social determinants of health exposure variables included rural status, non-metropolitan living area, highest and lowest decile and quintile area deprivation index, insurance status, and non-home living status. Designated categories were created for patients operated on in centers within the top 25% of case volume, centers in the bottom 25% of case volume, and in centers with less than 10 total fenestrated endograft cases. Univariable analyses were performed with Chi-squared testing for categorical variables and test for comparison of means. Multivariable binary logistic regression was performed to identify risks for the composite adverse perioperative event.ResultsThere was no statistically significant association with the composite adverse perioperative event category, 30-day mortality or 12-month mortality for any of the social determinants of health or center volume categories. Patients who live in rural areas ( = .029) and patients with Military/VA insurance ( < .001) were significantly more likely to be lost to follow up at their index VQI center at 1 year. When accounting for all standard co-morbidities, none of the following variables had any significant association with the composite adverse perioperative event on multivariable analysis: absolute center volume as an ordinal variable ( = .985); procedure at a bottom 25 percentile volume center ( = .214); procedure at a center with less than 10 total fenestrated cases in the database ( = .521); rural home status ( = .622); remote from metropolitan home status ( = .619); highest 10% ADI ( = .903); highest 20% ADI ( = .219); Lowest 10% of ADI ( = .397). The variables that had a statistically significant multivariable association with the composite adverse event were 3 or 4 visceral vessels stented vs 2 vessels ( < .001), baseline renal insufficiency ( < .001), female sex ( < .001), ESRD on dialysis ( = .002), and history of coronary revasculizaiton ( = .047). There was noted to be a statistically significant ( < .01) increase in 30 day mortality, composite adverse perioperative event, and 12 month mortality in moving from 2 to 3 to 4 fenestrated stented vessels. However, amongst patients who were treated with 3 and 4 vessel fenestrated stenting, patients treated at bottom 25 percentile centers and centers with less than 10 total cases did not experience a higher rate of composite adverse perioperative event, 30 day mortality, or 12 month mortality relative to top 25% volume centers indicating safety of these procedures in lower volume centers.ConclusionsSocial determinants of health and center volume do not impact outcomes in fenestrated visceral segment aortic endograft procedures performed at centers participating in the Vascular Quality Initiative. There is progressive morbidity and mortality in moving from 2 to 3 to 4 visceral stents and fenestrations, however lower volume centers within VQI achieve equivalent outcomes to high volume centers in performing 3 and 4 vessel visceral fenestrated stent cases. Female sex, ESRD, prior coronary revascularization, and baseline renal insufficiency portend an increased risk for perioperative morbidity for fenestrated visceral segment aortic endografting.
The Alpha to Omega of Dialysis Access: Arteriovenous Fistula and Graft (Part 1).
Ghasemi-Rad M, Trinh K, Ahmadzade M … +6 more , Agahi K, Jefferson X, Klusman C, Leon D, Wynne D, Cui J
Vasc Endovascular Surg · 2025 Jul · PMID 40123557 · Publisher ↗
Vascular access is a critical determinant of hemodialysis efficacy in patients with end-stage kidney disease (ESKD). The choice between arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) influences long-term d...
Vascular access is a critical determinant of hemodialysis efficacy in patients with end-stage kidney disease (ESKD). The choice between arteriovenous fistulas (AVFs) and arteriovenous grafts (AVGs) influences long-term dialysis outcomes, with AVFs offering superior patency but higher maturation failure rates and AVGs providing immediate usability at the expense of increased complications. Recent advancements in endovascular techniques and biomaterials have introduced novel approaches to optimizing vascular access. This review examines the latest evidence on AVF and AVG creation, focusing on factors affecting maturation, long-term patency, and emerging minimally invasive techniques, such as percutaneous AVF creation, to enhance hemodialysis access outcomes. A systematic review of current literature, clinical guidelines, and innovations in vascular access for dialysis patients was conducted. Emphasis was placed on comparative effectiveness studies, patency and complication rates, and new endovascular approaches. Data were sourced from clinical trials, registry reports, and systematic reviews evaluating AVF and AVG outcomes, as well as emerging endovascular fistula technologies. Key parameters such as patency rates, infection rates, thrombosis incidence, and maturation success were analyzed. Particular attention was given to procedural innovations, including bioengineered grafts and percutaneous fistula creation, assessing their impact on long-term dialysis access viability. AVFs maintain superior long-term patency but are hindered by primary failure rates, necessitating interventions for maturation. AVGs, while more prone to infection and thrombosis, offer a viable alternative when native vessels are unsuitable. Endovascular AVF creation has demonstrated high technical success and promising long-term outcomes, reducing the need for traditional surgical approaches. Advances in biomaterials and adjunctive pharmacologic therapies may further improve vascular access durability. Individualized vascular access planning remains essential to optimizing hemodialysis outcomes. The evolution of minimally invasive techniques, coupled with improved patient selection criteria and emerging biomaterials, offers new opportunities for enhancing dialysis access longevity. Future research should focus on refining endovascular approaches and integrating novel technologies to minimize complications and improve access patency.
Predicting Long-Term Survival after Endovascular Aneurysm Repair Using Machine Learning-Based Decision Tree Analysis.
Nishibe T, Iwasa T, Kano M … +4 more , Akiyama S, Fukuda S, Koizumi J, Nishibe M
Vasc Endovascular Surg · 2025 Aug · PMID 40123361 · Publisher ↗
ObjectiveEndovascular aneurysm repair (EVAR) has become a preferred method for treating abdominal aortic aneurysms (AAA) due to its minimally invasive approach. However, identifying factors that influence long-term patie...
ObjectiveEndovascular aneurysm repair (EVAR) has become a preferred method for treating abdominal aortic aneurysms (AAA) due to its minimally invasive approach. However, identifying factors that influence long-term patient outcomes is crucial for improving prognosis. This study investigates whether machine learning (ML)-based decision tree analysis (DTA) can predict long-term survival (over 5 years postoperatively) by uncovering complex patterns in patient data.MethodsWe retrospectively analyzed data from 142 patients who underwent elective EVAR for AAA at Tokyo Medical University Hospital between October 2013 and July 2018. The dataset comprised 24 variables, including age, gender, nutritional status, comorbidities, and surgical details. The decision tree classifier was developed and validated using Python 3.7 and the scikit-learn toolkit.ResultsDTA identified poor nutritional status as the most significant predictor, followed by compromised immunity, active cancer, octogenarians, chronic kidney disease, and chronic obstructive pulmonary disease. The decision tree identified 9 terminal nodes with probabilities of long-term survival. Four of these terminal nodes represented groups of patients with a high probability of long-term survival: 100%, 84%, 77%, and 60%, whereas the other 5 terminal nodes represented groups of patients with a low probability of long-term survival: 17%, 25%, 30%, 45%, and 47%. The model achieved a moderately high accuracy of 76.1%, specificity of 72.4%, sensitivity of 81.8%, precision of 65.2%, and area under the receiver operating characteristic curve of 0.84.ConclusionML-based DTA effectively predicts long-term survival after EVAR, highlighting the importance of comprehensive preoperative assessments and personalized management strategies to improve patient outcomes.
Iliac Artery Occlusion Following Iliac Vein Recanalization and Stenting in Two Patients.
Pennix T, Metwalli Z, Habibollahi P
Vasc Endovascular Surg · 2025 Jul · PMID 40116320 · Full text
Ileocaval venous thrombosis and outflow obstruction is a condition with many possible causes that typically presents with symptoms related to venous congestion or insufficiency. Recent device development and availability...
Ileocaval venous thrombosis and outflow obstruction is a condition with many possible causes that typically presents with symptoms related to venous congestion or insufficiency. Recent device development and availability of endovascular stenting and venoplasty for lifestyle-limiting symptoms refractory to conservative management has led to increased interest in these procedures. While several common complications of venous stent placement have been well-described, 1 uncommon and emergent complication is nearby arterial compression or occlusion. Here we present 2 cases of iliac artery occlusion occurring after iliac venous recanalization and stenting, and discuss possible factors that may contribute to this uncommon complication.
Single Center Experience of Isolated Mechanical Thrombectomy and Thromboaspiration in Cancer-Related Acute Iliofemoral Deep Vein Thrombosis.
Yiğit G
Vasc Endovascular Surg · 2025 Aug · PMID 40114410 · Publisher ↗
IntroductionIliofemoral deep vein thrombosis (IFDVT) and subsequent pulmonary embolism (PE) are an crucial cause of mortality in cancer patients. There is a lack of evidence on the results of mechanical thrombectomy and...
IntroductionIliofemoral deep vein thrombosis (IFDVT) and subsequent pulmonary embolism (PE) are an crucial cause of mortality in cancer patients. There is a lack of evidence on the results of mechanical thrombectomy and thromboaspiration (MTT) procedures performed on cancer patients. The aim of this research was to assess safety, efficacy, and clinical outcomes following MTT for cancer-related IFDVT patients.MethodsFrom July 2020 and April 2022, a total of 14 active cancer patients with symptomatic acute IFDVT were managed with MTT with Mantis device. Primary outcomes included overall survival, venous patency, major bleeding and minor bleeding. Secondary outcomes included duration in intensive care unit and hospital stay, complications, bleeding events, reocclusion and reintervention rates.ResultsIn twelve patients (85.7%), a significant early clinical improvement was found. Median intensive care unit (ICU) stay was 1 (range, 1-4) days, while the median hospital stay was 4 (range, 3-10) days. Recurrence of IFDVT was observed in 14.3% of cases (n = 2) in the study group. No re-intervention was performed in these patients. The overall survival for the study cohort was 85.7% at 6 months, and 71.4% at 12 months. Venous patency rate at 12-month follow-up control was 64.3%. There was a significant decrease in Villalta scores following the procedures ( < 0.0001). The overall procedural complication rate was 28.6%.ConclusionIn cancer patients, MTT promises to be a reliable and successful treatment for IFDVT considering the dramatic early symptomatic improvement, low reocclusion rates, acceptable procedure-related major complications, satisfactory patency rates, and improved patient quality of life.
The Use of Intravascular Ultrasound During Deep Venous Interventions in a Tertiary Care Center.
Ali SH, Rodriguez PP, Abualanain E … +7 more , Li Y, Khalil MS, Aboloyoun H, Perez Lozada JC, Aboian E, Attaran R, Ochoa Chaar CI
Vasc Endovascular Surg · 2025 Jul · PMID 40096827 · Publisher ↗
ObjectiveIntravascular ultrasound (IVUS) is the gold standard for diagnosing venous stenosis and sizing venous stents, yet its impact on thrombosis after deep venous interventions is not well-studied. This study evaluate...
ObjectiveIntravascular ultrasound (IVUS) is the gold standard for diagnosing venous stenosis and sizing venous stents, yet its impact on thrombosis after deep venous interventions is not well-studied. This study evaluates the impact of IVUS on outcomes of lower extremity deep venous interventions, hypothesizing improved results with its use.MethodsThis retrospective study analyzed consecutive patients undergoing deep venous lower extremity interventions, dividing them into two groups based on IVUS use. Patient characteristics and outcomes, including primary patency and symptomatic improvement, were compared.ResultsAmong 185 patients (75.7% with IVUS), those without IVUS had higher rates of COPD (16% vs 5%; = 0.045), chronic kidney disease (27% vs 5%; < 0.001), and hypercoagulable state (47% vs 19%; = 0.001). Non-IVUS patients more frequently presented with thrombotic disease (78% vs 40%; < 0.001), while IVUS patients were more likely to have edema (41% vs 31%; = 0.04) and receive stenting (92% vs 44%; < 0.001). Wallstent was the most commonly used stent in both groups. IVUS patients achieved higher technical success (99% vs 82%; < 0.001) and had fewer 30-day complications (7% vs 20%; = 0.022). Over a mean follow-up of 3.5 years, IVUS use was associated with greater symptom relief (50% vs 41%; < 0.001) and higher primary patency rates (83% vs 53%; < 0.001). Regression analysis showed that age, prior anticoagulant use, and thrombolysis were significantly associated with loss of patency, while IVUS showed a trend toward decreased loss of patency (HR = 0.6; = 0.244).ConclusionIVUS use during deep venous interventions is associated with fewer complications and improved primary patency rates, suggesting its utility in enhancing patient outcomes when complementing multiplanar venography.
The Alpha to Omega of Dialysis Access: Evaluation, Interventions, Innovations (Part 2).
Ghasemi-Rad M, Trinh K, Ahmadzade M … +6 more , Agahi K, Jefferson X, Klusman C, Leon D, Wynne D, Cui J
Vasc Endovascular Surg · 2025 Jul · PMID 40088198 · Publisher ↗
End-stage kidney disease (ESKD) is a growing global health concern, significantly impacting patient morbidity and mortality, particularly among patients on hemodialysis. Vascular access remains a major challenge, often l...
End-stage kidney disease (ESKD) is a growing global health concern, significantly impacting patient morbidity and mortality, particularly among patients on hemodialysis. Vascular access remains a major challenge, often limiting the effectiveness of hemodialysis and requiring strategic planning to optimize outcomes. This review examines the current evidence on vascular access for dialysis, with a focus on pre- and post-operative assessments, necessary interventions for complications, and innovations in vascular access materials and techniques. This is a literature review analyzing existing studies, clinical trials and guidelines to evaluate the different vascular access options, interventions, and emerging technologies in dialysis access. Findings highlight the importance of thorough preoperative assessment, including vascular imaging and patient-specific considerations, to optimize access placement. Postoperative assessments and early interventions are crucial in ensuring access longevity. Innovations such as drug-coated balloons, stent technologies, and biologically engineered grafts have improved patient outcomes and reduced complications. Strategic planning and advancements in vascular access technology play a critical role in improving dialysis efficiency and patient outcomes. Continued research and innovation are needed to refine vascular access techniques and address challenges associated with ESKD management.
Stent Graft Intervention in a Lumbar Artery Pseudoaneurysm Improved Cauda Equina Syndrome: A Case Report of Combined Embolization Strategy.
Murai Y, Nakashima K, Tamura Y … +1 more , Miyaji K
Vasc Endovascular Surg · 2025 Jul · PMID 40080149 · Publisher ↗
A lumbar artery pseudoaneurysm following a lumbar vertebral compression fraction is rare. Cauda equina syndrome due to spinal canal compression is a rarer complication of this pseudoaneurysm. Endovascular treatment, whic...
A lumbar artery pseudoaneurysm following a lumbar vertebral compression fraction is rare. Cauda equina syndrome due to spinal canal compression is a rarer complication of this pseudoaneurysm. Endovascular treatment, which involves embolization of the inflow and outflow vessels, is the first-line treatment for lumbar artery pseudoaneurysms. We report a case of a lumbar artery pseudoaneurysm with spinal canal compression that was treated with coil embolization of the outflow vessel and stent graft placement to occlude the inflow vessel. After treatment, the symptoms of cauda equina syndrome improved. Using a stent graft is particularly effective when the inflow vessel to be occluded is short and, combined with other endovascular therapies such as coil embolization, increases the potential for complete exclusion of a lumbar artery pseudoaneurysm.
Median Arcuate Ligament Syndrome Without Static Image Findings of Celiac Artery Compression: The Potential Existence of a Pure Neurogenic Subtype.
Okita A, Yokoyama N
Vasc Endovascular Surg · 2025 Jul · PMID 40079656 · Publisher ↗
Symptomatic median arcuate ligament syndrome (MALS) is considered to be a diagnosis of exclusion, and there is no consensus about its diagnostic criteria. We present the case of a 39-year-old woman, who presented with pe...
Symptomatic median arcuate ligament syndrome (MALS) is considered to be a diagnosis of exclusion, and there is no consensus about its diagnostic criteria. We present the case of a 39-year-old woman, who presented with persistent epigastric pain. A computed tomography scan did not show external celiac artery (CA) stenosis. Ultrasonography showed that the peak systolic blood flow velocity of the CA in inspiration and expiration position was 1.13 m/sec and 2.16 m/sec, respectively. The difference in the angle between the aorta and CA between maximum inspiration and maximum expiration was >50°. Only the patient's physical findings were suggestive of MALS, as the ultrasonographic findings demonstrated normal flow without compression through the celiac axis. The patient underwent laparoscopic division of the median arcuate ligament (MAL), and her symptoms disappeared postoperatively. The pathophysiology of MALS remains unclear, and our case suggests the potential existence of a neurogenic subtype in which MAL compresses the celiac plexus, but not the CA.
Three-Year Outcomes of Chronic Total Occlusion (CTO) versus Non-CTO Femoropopliteal Lesions Treated With Atherectomy Followed by Drug-Coated Balloon Angioplasty.
Kamran H, Gokhale R, Halista M … +3 more , Telegina A, Bakirova Z, Babaev A
Vasc Endovascular Surg · 2025 Jul · PMID 40079622 · Publisher ↗
BackgroundEndovascular intervention of the femoropopliteal chronic total occlusions (CTOs) is technically challenging and associated with increased rates of treatment failure and complications. The long-term patency of C...
BackgroundEndovascular intervention of the femoropopliteal chronic total occlusions (CTOs) is technically challenging and associated with increased rates of treatment failure and complications. The long-term patency of CTOs of the femoropopliteal segment treated with contemporary tools, such as atherectomy and drug-eluting technology, is not well studied.MethodsWe performed a prospective, single-center analysis of 60 consecutive patients with femoropopliteal disease successfully treated with either directional or orbital atherectomy followed by paclitaxel drug-coated balloon (DCB). Endpoints of interest were freedom from restenosis and revascularization following atherectomy and DCB angioplasty. All patients underwent clinical and imaging evaluation for 3 years to identify evidence of target lesion restenosis (RS) and revascularization (TLR).ResultsThere were 26 patients with CTO and 34 patients with non-CTO lesions. Baseline demographic and clinical characteristics were similar between the CTO and non-CTO groups other than ankle-brachial indices (ABI, 0.73 ± 0.11 vs 0.88 ± 0.14, < 0.001). Kaplan Meier (KM) analysis for freedom from RS and TLR at 3 years was similar among the 2 groups (log rank p; 0.42, 0.69 respectively). Post-procedure, all patients had improvement of claudication, normalization of ABI indexes and duplex ultrasound velocities.ConclusionFreedom from target lesion restenosis and revascularization at 3 years were similar between CTO and non-CTO lesions treated with atherectomy followed by DCB angioplasty. These findings underscore the importance of optimal vessel preparation to achieve improved patency regardless of lesion morphology.
Endovenous Treatment for Great Saphenous Vein Insufficiency: A Comparative Study of Segmental Radiofrequency and 1470-nm Endovenous Laser.
Filippo MG, Harduin LO, Barroso TA … +3 more , de Almeida LC, Schanaider A, Espinosa G
Vasc Endovascular Surg · 2025 Jul · PMID 40078141 · Publisher ↗
PurposeThis study aims to evaluate recovery time, patient-centric postoperative outcomes, and the efficacy of endovenous laser ablation (LA) and radiofrequency ablation (RFA) in treating venous insufficiency associated w...
PurposeThis study aims to evaluate recovery time, patient-centric postoperative outcomes, and the efficacy of endovenous laser ablation (LA) and radiofrequency ablation (RFA) in treating venous insufficiency associated with great saphenous vein (GSV) reflux.MethodsIn this single-center, self-paired, randomized trial, 16 limbs from 8 patients with symptomatic bilateral GSV insufficiency were treated. LA was performed on one lower limb, and after 40 days, the contralateral limb was treated with RFA. For LA, we used a 1470-nm endolaser with radial fiber, and for RFA, the VNUS ClosureFast™ system. All patients were followed with clinical, radiological, and laboratory evaluations for 6 months postoperatively.ResultsBoth techniques showed similar postoperative pain scores, number of complications, time to return to work, and patient satisfaction scores. LA and RFA decreased the mean Venous Clinical Severity Score by the end of the study and achieved a 100% vein occlusion rate, along with a reduction in GSV size. Procedure time was significantly shorter with LA.ConclusionLA and RFA demonstrated similar recovery profiles, pain levels, and patient satisfaction outcomes, maintaining high efficacy in resolving venous insufficiency associated with GSV reflux.
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