Int J Angiol
· 2024 Jun · PMID 38846994
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Over the last 20 years, there has been a progressive increase in the incidence of pulmonary embolism (PE) diagnosis in the United States, Europe, and Australia. Increased use of computed tomography pulmonary angiography...Over the last 20 years, there has been a progressive increase in the incidence of pulmonary embolism (PE) diagnosis in the United States, Europe, and Australia. Increased use of computed tomography pulmonary angiography has likely contributed in part to this rising incidence. However, it is pertinent to note that the burden of comorbidities associated with PE, such as malignancy, obesity, and advanced age, has also increased over the past 20 years. Time-trend analysis in North American, European, and Asian populations suggests that mortality rates associated with PE have been declining. The reported improved survival rates in PE over the past 20 years are likely, at least in part, to be the result of better adherence to guidelines, improved risk stratification, and enhanced treatment. Factors contributing to the development of venous thromboembolism (VTE) include stasis of blood, hypercoagulability, endothelial injury, and inflammation. In 70 to 80% of cases of PE, the thrombi embolizes from the proximal deep veins of the lower extremities and pelvis. Strong risk factors for VTE include lower extremity fractures and surgeries, major trauma, and hospitalization within the previous 3 months for acute myocardial infarction or heart failure with atrial fibrillation. Acute PE causes several pathophysiological responses including hypoxemia and right ventricle (RV) failure. The latter is a result of pulmonary artery occlusion and associated vasoconstriction. Hemodynamic compromise from RV failure is the principal cause of poor outcome in patients with acute PE.
Int J Angiol
· 2024 Jun · PMID 38846993
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Pulmonary embolism is a major cause of mortality worldwide. In this historical perspective, we aim to provide an overview of the rich medical history surrounding pulmonary embolism. We highlight Virchow's first steps tow...Pulmonary embolism is a major cause of mortality worldwide. In this historical perspective, we aim to provide an overview of the rich medical history surrounding pulmonary embolism. We highlight Virchow's first steps toward understanding the pathophysiology in the 1800s. We see how those insights inspired early attempts at intervention such as surgical pulmonary embolectomy and caval ligation. Those early interventions were refined and ultimately led to the development of inferior vena cava filters, the earliest clinical applications of anticoagulation, and even apparently disparate medical advances such as the successful development of cardiopulmonary bypass. We also see how the diagnosis of pulmonary embolism has evolved from rudimentary monitoring of vitals and symptoms to the development of evermore sophisticated tests such as contrast tomography angiography and echocardiography. Finally, we discuss current approaches to diagnosis, classification, and myriad treatments including anticoagulation, thrombolysis, catheter-directed interventions, surgical embolectomy, and extracorporeal membrane oxygenation guided by Pulmonary Embolism Response Teams.
Int J Angiol
· 2024 Jun · PMID 38846992
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In efforts to decrease the mortality on the waiting list for lung transplantation, alternatives to increase the donor pool have been explored. Caution must be used when accepting donor lungs with pulmonary embolism (PE),...In efforts to decrease the mortality on the waiting list for lung transplantation, alternatives to increase the donor pool have been explored. Caution must be used when accepting donor lungs with pulmonary embolism (PE), as prior evidence has shown mixed results after transplantation of donor lungs with PE. However, the mere diagnosis of PE on imaging should not be the sole reason for the exclusion of these donors for transplant, and they should be reviewed as any other donor. A comprehensive evaluation should be performed for every donor, with a special focus on abnormalities of gas exchange and gross pathologic characteristics during procurement.
Del Toro Mijares R, Rojas Murguia A, Porres-Aguilar M
… +1 more, Mukherjee D
Int J Angiol
· 2024 Jun · PMID 38846991
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Venous thromboembolism (VTE) is a very frequent cardiovascular entity that encompasses deep vein thrombosis and pulmonary embolism (PE). This last entity represents a major cause of cardiovascular morbidity and mortality...Venous thromboembolism (VTE) is a very frequent cardiovascular entity that encompasses deep vein thrombosis and pulmonary embolism (PE). This last entity represents a major cause of cardiovascular morbidity and mortality. The incidence of PE and the rate of PE-related morbidity significantly increase with age, race, and underlying medical conditions, such as malignancy. Given the recent advances in diagnostic strategies and algorithms, patients can be risk assessed and treated promptly to avoid disease progression. Anticoagulation is the mainstay of treatment for acute PE that is not hemodynamically unstable. Direct oral anticoagulants, such as apixaban, rivaroxaban, or edoxaban, are currently the preferred agents for the treatment of patients who present with acute PE or for long-term treatment. Treatment duration should be continued for at least 3 months, and all patients should be assessed for extended duration of therapy based on the precipitating factors that led to the development of the VTE. Novel anticoagulant agents targeting factor XI/XIa are currently being investigated in phases 2 and 3 clinical trials, representing an attractive option in anticoagulation therapies in patients with VTE. For hemodynamically unstable patients, systemic thrombolysis is the treatment of choice, and it may also be of benefit-in reduced dose-for patients with intermediate to high risk who are at risk of hemodynamic collapse.
Int J Angiol
· 2024 Jun · PMID 38846990
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Pulmonary embolism (PE) is a common disease associated with significant morbidity and mortality. Despite the familiarity with this disease, the best treatment remains undefined. Traditionally, treatment of PE has involve...Pulmonary embolism (PE) is a common disease associated with significant morbidity and mortality. Despite the familiarity with this disease, the best treatment remains undefined. Traditionally, treatment of PE has involved a choice of anticoagulation, thrombolysis, or surgery. However, the debate over pharmacologic versus mechanical treatment of acute PE reared up again with the advent of user-friendly mechanical and aspiration thrombectomy technologies. This is especially true for submassive PE, which is an area for potential growth both for understanding the pathophysiology of the disease process and management. Multiple devices are available for treatment of PE. Understanding the risks and benefits of each device is paramount in the complex management of PE.
Lei K, DiCaro MV, Tak N
… +4 more, Turnbull S, Abdallah A, Cyrus T, Tak T
Int J Angiol
· 2024 Jun · PMID 38846989
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Inferior vena cava (IVC) filters and endovascular devices are used to mitigate the risk of pulmonary embolism in patients presenting with lower extremity venous thromboembolism in whom long-term anticoagulation is not a...Inferior vena cava (IVC) filters and endovascular devices are used to mitigate the risk of pulmonary embolism in patients presenting with lower extremity venous thromboembolism in whom long-term anticoagulation is not a good option. However, the efficacy and benefit of these devices remain uncertain, and controversies exist. This review focuses on the current use of IVC filters and other endovascular therapies in clinical practice. The indications, risks, and benefits are discussed based on current data. Further research and randomized controlled trials are needed to characterize the patient population that would benefit most from these interventional therapies.
Int J Angiol
· 2024 Jun · PMID 38846988
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Thromboembolic events are the third leading cardiovascular diagnosis following stroke and myocardial infarction. In the United States, 300,000 to 600,000 people per year are diagnosed with venous thromboembolism, either...Thromboembolic events are the third leading cardiovascular diagnosis following stroke and myocardial infarction. In the United States, 300,000 to 600,000 people per year are diagnosed with venous thromboembolism, either deep venous thrombosis or pulmonary embolism (PE). Of those patients, thousands die from PE despite heightened vigilance and improved therapies. Lung transplant recipients are at increased risk of developing PE due to multiple risk factors unique to this population. Additionally, the transplant recipients are more susceptible to morbid complications from PE. As a result, prevention, timely recognition, and intervention of PE in the lung transplant population are of the utmost importance.
Sokolowski C, Al-Saghir T, Lee YS
… +2 more, Ceniza N, Baciewicz F
Int J Angiol
· 2026 Mar · PMID 41705081
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Severe mitral annular calcification (MAC) presents a surgical challenge due to the complexity of disease and the risk of valve replacement. There have been a variety of techniques to combat this risk including edge-to-ed...Severe mitral annular calcification (MAC) presents a surgical challenge due to the complexity of disease and the risk of valve replacement. There have been a variety of techniques to combat this risk including edge-to-edge repair, collar-enforced prosthesis, and pericardial patch techniques. This report highlights a case in which a novel reproducible surgical technique was used to prevent perivalvular leak with mitral valve replacement. This technique may add to surgeons' repertoire in addressing patients with MAC concentrated on the posterior annulus.
Hashemi A, Serati A, Ahmadieh A
… +3 more, Khalilipur E, Ghaffari L, Movahed MR
Int J Angiol
· 2025 Sep · PMID 40771286
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Carotid artery stenting is increasingly performed among patients with proper indications for carotid artery revascularization. It has a low complication rate with a short recovery time. In this case, we report a new comp...Carotid artery stenting is increasingly performed among patients with proper indications for carotid artery revascularization. It has a low complication rate with a short recovery time. In this case, we report a new complication due to unintended stent deployment in the external carotid artery covering the ostium of the internal carotid artery requiring penetration and stenting of the deployed Wallstent wall to advance the second stent in the proper position in the internal carotid artery.
Int J Angiol
· 2025 Jun · PMID 40365157
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The success of revascularization in the total occluded coronary lesion with dense thrombus burden is important for the short- and long-term prognosis of patients with acute ST-segment elevation myocardial infarction (STE...The success of revascularization in the total occluded coronary lesion with dense thrombus burden is important for the short- and long-term prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI). In these lesions, stenting without dispersing the thrombus can increase the success of revascularization without fatal complications. The aim of this case is to demonstrate the newly developed thrombus-demarcated stenting with dual-contrast imaging approach after unsuccessful predilatation in a late-inferior STEMI. In centers where optical coherence tomography is not available, this technique can be used as an alternative.
Int J Angiol
· 2024 Feb · PMID 38352641
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A new index called the acute-to-chronic (A/C) glycemic ratio has been proposed to better represent the true acute glycemic rise in people with acute disease. However, there has been no previous study investigating the re...A new index called the acute-to-chronic (A/C) glycemic ratio has been proposed to better represent the true acute glycemic rise in people with acute disease. However, there has been no previous study investigating the relationship between A/C glycemic ratio and SYNTAX score in patients with diabetic acute coronary syndrome (ACS). The aim of this study is to evaluate the role of A/C glycemic ratio in predicting coronary artery disease severity and SYNTAX score in diabetic patients presenting with ACS. The study included 131 consecutive patients hospitalized for ACS in our hospital, previously diagnosed with diabetes and undergoing percutaneous coronary intervention. The relationship between A/C glycemic ratio and SYNTAX score calculated at the time of admission was determined in univariate and multivariate linear regression analyses. The sample size was divided into three parts (T1, T2, and T3) according to the admission blood glucose (ABG)/estimated average glucose (eAG) ratio. When ABG/eAG and SYNTAX scores were compared, there was no significant difference between the T1 and T2 groups, but a significant increase was found in the T3 group compared with the other two groups (T1: 14.26, T2: 14.77, T3: 24.41; < 0.001). When multivariate modeling was performed with the two or three most relevant variables (age, estimated glomerular filtration rate [eGFR], and ABG/eAG ratio), the upper tertile of the ABG/eAG variable was correlated with the severity of coronary atherosclerosis and higher SYNTAX score. This study shows that there is a significant relationship between higher ABG/eAG ratio and higher SYNTAX score in diabetic patients presenting with ACS.
Dwiputra B, Santoso A, Purwowiyoto BS
… +4 more, Radi B, Pandhita BAW, Fatrin S, Ambari AM
Int J Angiol
· 2024 Feb · PMID 38352637
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Omega-3 supplementation has a controversial role in the secondary prevention of cardiovascular diseases. Despite large clinical trials published over the years, the evidence of omega-3 in preventing cardiovascular diseas...Omega-3 supplementation has a controversial role in the secondary prevention of cardiovascular diseases. Despite large clinical trials published over the years, the evidence of omega-3 in preventing cardiovascular diseases, especially coronary heart disease, is still inconclusive. However, recent clinical trials using higher dose of omega-3 or highly purified esters of omega-3 shows promising result, with reduction in cardiovascular death and incidence of cardiovascular disease. This review aims to summarize the possible mechanism of omega-3 in preventing cardiovascular disease and future directions of research regarding the benefit of omega-3 in cardiovascular disease.
Degache F, Mak W, Calanca L
… +2 more, Mazzolai L, Lanzi S
Int J Angiol
· 2024 Feb · PMID 38352636
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Patients with symptomatic peripheral artery disease (PAD) have been shown to present balance disorders and a history of falling, which are associated with functional and daily life impairments. Although postural control...Patients with symptomatic peripheral artery disease (PAD) have been shown to present balance disorders and a history of falling, which are associated with functional and daily life impairments. Although postural control improvement is an important outcome, the benefits of supervised exercise training (SET) on postural control have been seldom investigated in these patients. This article investigates the effects of SET on traditional measures of postural control and on stabilogram-diffusion analysis (SDA) parameters in patients with symptomatic PAD. Patients with symptomatic chronic lower limb claudication were investigated. All subjects who completed the 3-month multimodal SET program and postural control assessment before and after SET were included. Center of pressure trajectory analysis and SDA parameters were investigated using a posturographic platform. Patients were instructed to stand on the platform and maintain balance to their best ability. Treadmill pain-free (PFWD) and maximal (MWD) walking distances were also assessed prior and following SET. Forty-four patients with PAD (65.2 ± 9.8 years, 34% women) were investigated. All postural control parameters were unchanged following SET, except the length of center of pressure displacement as a function of the surface of center of pressure trajectory (LFS), which was significantly increased (before SET: 1.4 ± 0.4; after SET: 1.5 ± 0.5; = 0.042). PFWD (before SET: 103.5 ± 77.9 m; after SET: 176.8 ± 130.6 m; ≤ 0.001) and MWD (before SET: 383.6 ± 272.0 m; after SET: 686.4 ± 509.0 m; ≤ 0.001) significantly improved following SET. The increased LFS suggests a better postural control accuracy following SET in patients with symptomatic PAD.
Cédric S, Lijckle VL, Nick S
… +2 more, Anne M, Inge F
Int J Angiol
· 2024 Feb · PMID 38352635
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Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality. Classification methods differentiate into patients with rest pain or with ischemic ulcers. No distinction is made between the pre... Chronic limb-threatening ischemia (CLTI) is associated with high morbidity and mortality. Classification methods differentiate into patients with rest pain or with ischemic ulcers. No distinction is made between the presence or absence of rest pain in patients with ischemic ulcers. Our aim is to determine any differences in outcome between these subdivisions so we can improve preoperative counseling and risk assessment. This multicenter retrospective cohort study included all patients revascularized for a first episode of CLTI between 2013 and 2018. The cohort was divided in three groups: patients with solely rest pain (RP), solely ischemic ulcers (IU), and patients with both rest pain and ischemic ulcers (RP + IU). Baseline characteristics, morbidity, and mortality were analyzed. A total of 624 limbs in 599 patients were included: 225 (36.1%) in the rest pain group, 169 (27.1%) in the ischemic ulcers group, and 230 (36.2%) in combined group. Amputation rates were higher in the combined group at 6 months. Mortality rates were significantly higher in the ischemic ulcers group and the combined group at 6 months and 1 year. Patients with solely rest pain have significantly lower mortality rates in comparison to patients with ischemic ulcers. Rest pain did not affect mortality rates in patients with ulcers. There was a higher amputation rate in patients with combined rest pain and ischemic ulcers because the presence of rest pain CLTI patients had a significant negative effect on amputation risk. A separate subdivision for patients with combined ulcers and rest pain is indicated.
Saal-Zapata G, Walker M, Cervantes-Medina R
… +1 more, Rodríguez-Varela R
Int J Angiol
· 2024 Feb · PMID 38352634
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This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian acade...This article assesses the association between anterior circulation morphometry and the presence of intracranial aneurysm using three-dimensional rotational angiography (3DRA). A retrospective analysis at a Peruvian academic medical center between December 2018 and February 2020 identified 206 patients with unruptured intracranial aneurysms and matched controls who underwent 3DRA. Angiographic images were obtained per standard of care, and measurements of the vasculature were performed using 3DRA vascular automated software. A total of 163 aneurysms and 43 control angiograms were evaluated. Women represented 82.5% of the cases and the mean age was 55.9 years (standard deviation ± 14.2). In multivariate analysis, five specific features were found to be statistically significant predictors for presence of an anterior circulation aneurysm: female sex (odds ratio [OR] = 2.71; = 0.048), C-shape of the middle cerebral artery (MCA) (OR = 2.73; = 0.018), distal internal carotid artery (ICA) diameter (OR = 3.42; = 0.012), ICA bifurcation angle (OR = 1.02; = 0.036), and length of the carotid siphon (OR = 1.08; = 0.047). Features detected on 3DRA suggest morphological characteristics of the ICA and MCA may be predictive for intracranial aneurysm. Our findings build from prior reports by demonstrating five specific patient and imaging features associated with anterior circulation aneurysms. While 3DRA is the standard of care in many settings, medical centers with resource limitations may not have access to this technique. The demographic and morphological features identified in our study may have correlates that if detected on contrast computed tomography or magnetic resonance imaging studies, may be used to help screen for a higher level of care in select patients.
Int J Angiol
· 2024 Feb · PMID 38352632
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The ambulatory selective varicose vein ablation under local anesthesia (ASVAL) method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests phlebectomy...The ambulatory selective varicose vein ablation under local anesthesia (ASVAL) method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests phlebectomy of superficial varicose reservoir as a primary treatment. To increase patient comfort, foam safety and cosmetic results, we used ASVAL with a mixed phlebectomy/foam technique on local anesthesia. Thirty consecutive patients treated with ASVAL phlebectomy-sclerofoam technique were reviewed retrospectively between December 2022 and April 2023. All patients were evaluated by clinical examination and duplex ultrasound (DUS); the main selection criteria were a minimal GSV insufficiency (main GSV < or = to 1 cm). Muller phlebectomy of tributaries at entry point in the saphenous trunk was performed; after 1 week, patients were checked for foam sclerotherapy of residual trunk. Under visual control, 0.5% polidocanol foam (from 5 to 10 cc. "Tessari Technique") was injected in visible veins and elastic compression with pad was applied for 1 week. Compression with Class I elastic stockings was prescribed, and patients were reviewed after 1 month. Postoperative complications included thigh hematoma in two patients, three thrombosis of injected trunk, and hyperpigmentation in three patients. No GSV thrombosis at DUS was recorded. In 27 patients, a satisfying cosmetic result was achieved, and in 3 patients a new foam session was needed. Phlebectomy/foam ASVAL technique is a safe, low-traumatic technique with no need of US guidance, with less risk of foam migrating in GSV, simple and inexpensive, for patients with less advanced GSV insufficiency.
Int J Angiol
· 2025 Jun · PMID 40365149
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We present a rare complication of Rotablator (Boston Scientific) atherectomy during percutaneous coronary intervention in a 67-year-old patient with a history of coronary artery disease and prior coronary artery bypass g...We present a rare complication of Rotablator (Boston Scientific) atherectomy during percutaneous coronary intervention in a 67-year-old patient with a history of coronary artery disease and prior coronary artery bypass graft (CABG) surgery. The fracture of the Rotablator drive shaft and retention of the Rotablator burr in the mid left anterior descending coronary artery posed significant challenges in patient management. This case demonstrates the successful extraction of the retained Rotablator burr using retrograde total occlusion recanalization and highlights the importance of understanding the potential complications and management strategies in complex interventional cardiology procedures.
Int J Angiol
· 2026 Jun · PMID 42137762
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Concurrent thrombus formation in both the arterial and venous systems is rare and present as a diagnostic challenge in these cases; therefore, we must explore various possible etiologies and mechanisms. Herein, we report...Concurrent thrombus formation in both the arterial and venous systems is rare and present as a diagnostic challenge in these cases; therefore, we must explore various possible etiologies and mechanisms. Herein, we report a case of concurrent chronic limb threatening ischemia (CLTI) and deep vein thrombosis (DVT) of a limb in a patient with systemic lupus erythematosus (SLE) and chronic heart failure who underwent laboratory examinations and multimodality imaging. A 37-year-old male presented with a complaint of pain and swelling of the lower left extremity since 21 days before admission. Echocardiography showed dilated all chambers with ejection fraction, moderate-to-severe pericardial effusion, and no intracardiac shunt. Doppler ultrasound of the lower extremities showed DVT at the left mid-femoral and popliteal vein, severe stenosis at the left dorsalis pedis artery, moderate stenosis of the left popliteal, anterior, and posterior tibial arteries, and soft tissue swelling in the tibial region. Computed tomography angiography showed significant stenosis of the left popliteal, anterior, and posterior tibial arteries. The patient was diagnosed with CLTI and DVT of the left inferior extremity, heart failure, SLE, and tuberculous meningitis on antituberculosis medication. Primary amputation was performed, and the patient was discharged uneventfully. Concurrent CLTI and DVT in the same limb caused by SLE and heart failure is a rare condition. In this case, the probable causes were hypercoagulable state and vasculitis. Despite exhaustive attempts, the exact mechanism was not fully elucidated in this patient. However, we excluded other possible causes that require specific intervention, such as intracardiac shunt or phlegmasia cerulea dolens.
Int J Angiol
· 2025 Jun · PMID 40365150
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Decubitis angina briefly refers to a pain occurring during the night or in recumbent position. Herewith, we present a case of decubitis angina occurring immediately after lying down in a patient with coronary artery dise...Decubitis angina briefly refers to a pain occurring during the night or in recumbent position. Herewith, we present a case of decubitis angina occurring immediately after lying down in a patient with coronary artery disease and aortic regurgitation. The patient was successfully treated by percutaneous coronary intervention. It should be kept in mind that early-onset chest pain immediately after lying down might be a sign of myocardial ischemia or acute coronary syndrome especially in the presence of coronary artery disease and aortic regurgitation.
Int J Angiol
· 2026 Jun · PMID 42344939
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Coronary artery fistulas (CAFs), rare anomalies of coronary vasculature, often remain asymptomatic but can lead to complications necessitating intervention. We report a case of a 79-year-old man presenting with chest pai...Coronary artery fistulas (CAFs), rare anomalies of coronary vasculature, often remain asymptomatic but can lead to complications necessitating intervention. We report a case of a 79-year-old man presenting with chest pain and dyspnea. Diagnostic workup revealed atrial fibrillation, severe mitral regurgitation, and a CAF connecting the circumflex artery to the left atrium. Given high surgical risk, percutaneous closure was chosen. Utilizing a closed-loop balloon-stent technique, a stent was positioned at the fistula's ostium, effectively ceasing flow. The patient was discharged after 5 days, reporting symptom relief at 3-month follow-up. Our experience demonstrates the feasibility and cost-effectiveness of this technique, which can be readily implemented using standard materials available in catheterization laboratories. The closed-loop balloon-stent method offers a compelling alternative to surgical closure, particularly in patients with elevated surgical risks. This technique holds advantages over other percutaneous methods, such as coil embolization or vascular plug, due to its simplicity, affordability, and lower risk of coronary thrombosis. In conclusion, percutaneous closure with the closed-loop balloon-stent technique presents a viable approach for managing symptomatic CAFs, offering an attractive option for patients with limited surgical options. This method's practicality and affordability render it an appealing alternative in appropriate cases, highlighting its potential to improve patient outcomes and enhance overall management strategies.