The Accuracy and Reliability of Automated Oscillometric Measurement of Ankle-Brachial Index in the Diagnosis of Peripheral Artery Disease.

BACKGROUND: Comparing the accuracy and reliability of ankle-brachial index (ABI) measured by an oscillometric device with the Doppler method in peripheral arterial disease (PAD). METHODS: 122 patients admitted to the department of interventional radiology with PAD were studied. ABI was measured with the 2 methods in random order. After excluding the inconclusive results, Doppler ABIs were compared with the oscillometric ABIs in each limb, the reliability was evaluated by intraclass correlation coefficient (ICC), and the accuracy and consistency were assessed by receiver operating characteristic curves and Bland-Altman method. RESULTS: In 122 patients (244 legs), 27 legs got inconclusive oscillometric results, 4 legs got inconclusive oscillometric and inconclusive dorsalis pedis artery Doppler results, 2 legs had oscillometric cuff pressure intolerance. Using Doppler ABI <0.9 as a diagnostic threshold, compared with the high Doppler ABI, oscillometric method had a sensitivity of 57.81%, a specificity of 95.18%, the ICC was 0.626 (95% confidence interval [CI]: 0.536-0.701), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Compared with the low Doppler ABI, oscillometric method had a sensitivity of 50.66%, a specificity of 98.31%, the ICC was 0.541(95% CI: 0.483-0.630), Bland-Altman method showed 11/211 (5.21%) difference points outside the 95% limits of agreement. Using 1.00 as the diagnostic threshold and considering error oscillometric results as abnormal ABIs, the sensitivity improved to 88.05% with high Doppler ABI and 81.42% with the low. CONCLUSIONS: The accuracy and reliability of oscillometric ABI in patients with PAD is unsatisfied, which makes it not suitable as an alternative method in clinic disease assessment. Using 1.0 as the ABI oscillometric threshold for PAD diagnosis can improve the diagnostic value.

Rheolytic thrombectomy using an AngioJet ZelanteDVT catheter or a Solent Omni catheter for patients with proximal vein thrombosis.

PURPOSE: The present study aimed to investigate the preliminary safety and efficacy of rheolytic thrombectomy (RT) using an AngioJet Zelante DVT catheter or a Solent Omni catheter for acute proximal deep vein thrombosis (DVT). MATERIAL AND METHODS: We conducted a retrospective review of 40 patients who were treated with an AngioJet RT between January 2019 and January 2021, and then the patients were divided into the ZelanteDVT group (n = 17) and the Solent group (n = 23). Data on demographics, clinical characteristics, 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%. The ZelanteDVT group had a shorter duration of RT and a higher primary RT success than the Solent group (all p < .05), and the percentage of adjunctive catheter-directed thrombolysis (CDT) was 29.4% in the ZelanteDVT group, which was significantly lower than the 73.9% in the Solent group (p = .010). The clinical success rates for the ZelanteDVT group and Solent group were 100% (17/17) and 95.7% (22/23), respectively, and these values were high in the two groups (p > .05). Apart from transient macroscopic haemoglobinuria occurring in all the patients during the first 24 hours post-RT, none of the patients in either group suffered other procedure-related adverse events or major complications. Minor complications included bleeding events in 21.7% (5/23) of the patients in the Solent group and one (5.9%) patient in the ZelanteDVT group (p > .05). At 6 months, the frequency of PTS was 5.9% (1/17) in the ZelanteDVT group and 17.4% (4/23) in the Solent group (p > .05). CONCLUSION: Both catheters are safe and effective in managing patients with proximal DVT, thus leading to improved clinical outcomes with few complications. The ZelanteDVT catheter was more effective than the Solent catheter in thrombectomy, thus allowing for faster extraction of the DVT with a shorter run time and lower proportions of patients with adjunctive CDT.

Angiojet pharmacomechanical thrombectomy versus anticoagulant therapy alone in massive cancer-associated thrombosis: a single centre retrospective cohort study.

The therapeutic regimen option for the cancer-associated thrombosis (CAT) patients is still a major clinical challenge. The present study aimed to investigate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) with AngioJet treatment compared with the conventional anticoagulation alone therapy in the patients with CAT. We retrospectively reviewed the patients who underwent PCDT and/or anticoagulation for the treatment of CAT between August 1, 2016 and March 1, 2022. Each patient was divided into the PCDT group or the anticoagulation alone group. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were reviewed. A total of 51 eligible patients were included, of whom 21 were in PCDT group (mean age, 60.1 ± 13.0 years; 52.4% male) and 30 in anticoagulation alone group (mean age, 66.6 ± 11.1 years; 50.0% male). No significant differences regarding age, sex, onset time, limb characteristics, cancer conditions or risk factors were detected (p > .05). After PCDT, grade III lysis was achieved in 8 and grade II lysis in 11 patients. Clinical success was achieved in 90.5% (19/21) patients. The symptoms of leg pain and swelling were significantly improved in both groups. Except for transient macroscopic hemoglobinuria occurring in PCDT group, none of all patients suffered from procedure-related and major complications. Minor complications such as bleeding events occurred in 23.8% (5/21) of patients in PCDT group compared with 10.0% (3/30) in anticoagulation alone group (p > .05). At the 6-month follow-up, iliofemoral patency was found an absolute risk reduction of 37.9% (70.0 vs. 32.1%) (95% CI: 1.183-4.008%; P = 0.010). The incidence of mild PTS was 5.0% (1/20) in PCDT group compared with 10.7% (3/28) in anticoagulation alone group (p > .05). The PCDT is a safe and effective modality in managing patients with CAT, leading to improved clinical outcomes with a low complication. The PCDT was more effective than anticoagulation alone in massive symptom relief and venous patency.

Outcomes of Fluoroscopy-Guided Percutaneous High Ligation of the Great Saphenous Vein Combined With Foam Sclerotherapy for Symptomatic Great Saphenous Veins.

PURPOSE: To evaluate the effectiveness and safety of fluoroscopy-guided percutaneous high ligation (FPHL) combined with fluoroscopy-guided foam sclerotherapy (FGFS) to treat varicose veins of the great saphenous veins (GSVs). MATERIALS AND METHODS: This was a retrospective study of 113 patients (mean age, 62.1 ± 10.8 years; 60 men) with varicose veins of the GSVs (133 limbs) that were treated with FPHL combined with FGFS between April 1 and October 31, 2019. Demographic and clinical data were collected from these patients before the FPHL procedure, after which FGFS was performed. The preterminal GSV was ligated percutaneously by a percutaneously-positioned polypropylene ligature under fluoroscopic guidance. The outcome of ligation was confirmed by venography. Then, foam sclerotherapy was performed under fluoroscopy. At 1-year follow-up, GSV occlusion was evaluated by ultrasound. The venous clinical severity scores (VCSSs) were compared between the preoperative and 1-year follow-up periods. RESULTS: The technical success rate was 100% (133 limbs). Complete 12-month follow-up was available for 112 limbs (84.2%) and 103 of these limbs (92.0%) remained occluded during this period. The VCSS improved from 4.71 ± 2.15 to 0.74 ± 0.60 (V = 6328, P < .001). During follow-up, there were 16 limbs with thrombophlebitis and 38 limbs with saphenous junction pain; these events were alleviated within 2 weeks of the procedure. There was no deep venous thrombosis or other severe adverse events. CONCLUSIONS: FPHL combined with FGFS to treat varicose veins in the GSVs achieved an occlusion rate of 92% and improved the clinical symptoms within 1 year; this minimally-invasive procedure was safe and effective.

Transcatheter Arterial Embolization with N-Butyl-2 Cyanoacrylate Glubran 2 for the Treatment of Acute Renal Hemorrhage Under Coagulopathic Conditions.

BACKGROUND: Transcatheter arterial embolization (TAE) for acute renal hemorrhage (RH) under coagulopathic conditions with N-butyl-2 cyanoacrylate (NBCA) is rarely described in the literature, and a consensus on the efficacy and safety of NBCA under this condition has not been reached. The present study aimed to evaluate the efficacy and safety of TAE using NBCA Glubran 2 in the treatment of acute RH under coagulopathic conditions. METHODS: Eight patients who underwent TAE with NBCA Glubran 2 for acute RH under coagulopathic conditions were collected. RESULTS: NBCA Glubran 2 was employed as the sole embolic material in 6 patients. In the remaining 2 patients, NBCA Glubran 2 was employed for secondary embolization. Under coagulopathic conditions, both technical success and clinical success were achieved in treating acute RH with NBCA Glubran 2 in all patients. During a mean follow-up time of 30.1 months, neither persistent nor recurrent active hemorrhage required a repeated endovascular or surgical treatment for hemostasis. No Glubran 2-related complications occurred. In addition, there was no significant difference between the evaluated glomerular filtration rate level before and after one week of Glubran 2 embolization (P = 0.88; CI, -32.4 to 37.4). CONCLUSIONS: TAE with NBCA Glubran 2 may be a safe alternative treatment for the management of RH under coagulopathic conditions. In particular, this method appears to be a potentially attractive alternative when conventional embolic materials fail in patients with ongoing hemodynamic instability or even under severe coagulopathic conditions.

Mechanical Thrombectomy Using Kissing Y-Solitaire as a Rescue Treatment for Refractory Acute Popliteal and Infrapopliteal Occlusion in Elderly Patients.

Six patients were included to retrospectively review the preliminary efficacy and safety of mechanical thrombectomy using kissing Y-Solitaire as a rescue treatment. This technique was performed following failed single Solitaire thrombectomy in 5 patients (5/6), and the remaining patient (1/6) underwent unsuccessful AngioJet thrombectomy (Boston Scientific, Marlborough, Massachusetts). The ranges of the target vessel clot length and diameter were 4.9-6.9 mm and 27-38 mm, respectively. Technical success was achieved in all patients (6/6). They (6/6) had notable acute limb ischemia (ALI) symptom relief after 1 or 2 passes of retrieval, and clinical success was achieved in all patients (6/6). No complications were observed other than reversible vasospasm in 1 patient (1/6). Amputation or death did not occur. Mechanical revascularization with the use of kissing Y-Solitaire seems to be a potentially rapid, safe, and effective modality for selected patients with refractory short-segment occlusion of ALI secondary to popliteal and infrapopliteal arteries.

Endovascular revascularization strategies using catheter-based thrombectomy versus conventional catheter-directed thrombolysis for acute limb ischemia.

BACKGROUND: Acute limb ischemia (ALI) is an important clinical event threatening both life and the affected limbs, but the optimal treatment for ALI remains undefined. The aim of this study was to compare the safety and effectiveness of thrombectomy approaches via either catheter-based thrombectomy (CBT) or catheter-directed thrombolysis (CDT). METHODS: A total of 98 patients (mean age 69.7 years, 60 male) who underwent endovascular intervention for ALI from January 2015 to July 2019 were included. Of these, 57 were treated with primary CBT via a large-bore catheter, an AngioJet catheter or Rotarex catheter, and/or underwent low-dose CDT, and 41 were treated with primary CDT. The safety and effectiveness of CBT compared to conventional CDT and other various endovascular techniques were evaluated. RESULTS: More Rutherford IIb patients were treated with primary CBT (68.4%) than CDT (26.8%; P < .001). Patients who underwent primary CDT achieved a higher technical success rate than those who underwent primary CBT in a shorter procedure time (P < .001), whereas 42.1% of patients who underwent CBT did not need adjunctive CDT. The duration and dosage of adjunctive CDT in the CBT group were significantly decreased compared with those in the primary CDT group (both P < .001), and the CBT group achieved a shorter in-hospital length of stay (P < .001). Subgroup analysis revealed that patients treated with AngioJet and Rotarex catheters achieved slightly lower dosages, shorter CDT durations and shorter in-hospital stay lengths than those treated with large-bore catheters (P > .05). Clinical success was estimated to be achieved in 98.2% of patients who underwent CBT, which is similar to the 97.6% estimated in those who underwent primary CDT (P = 1.000), and this finding was similar among the CBT subgroups. Patients who underwent CBT had a higher procedure-related distal embolization rate and economic cost than those who underwent primary CDT (P < .05), but it had slightly fewer complications than those who underwent primary CDT (P = .059), especially minor complications (P = .036). The freedom from amputation at 6 and 12 months for CBT and CDT was assessed (93.0% vs 90.2% respectively, P = .625; 89.5% vs 82.9%, respectively, P = .34,). Comparable limb salvage was found for different techniques of large bore catheters, AngioJet catheters and Rotarex catheters. The Kaplan-Meier table analysis also showed similar limb salvage rates between groups. CONCLUSIONS: Endovascular treatment of ALI with the use of catheter-based therapies is an effective modality that can reduce the requirement for thrombolysis, with expected reductions in hemorrhagic complications, but at the risk of remediable distal emboli and increased economic cost. It has a similar clinical outcome to conventional CDT alone. Different CBT techniques have comparable efficacy but different adverse event profiles.

Rescue catheter-based therapies for the treatment of acute massive pulmonary embolism after unsuccessful systemic thrombolysis.

The management of acute massive pulmonary embolism (PE) patients who did not respond to systemic thrombolysis (ST) has not been well established. The present study aimed to investigate the safety and effectiveness of catheter-based therapies (CDT) in this condition. We conducted a retrospective study of PE patients after unsuccessful ST (UST) between January 2012 and January 2018. Massive PE was identified in 408 patients and treated with full-dose ST therapy. Thrombolysis at 36 h was judged to be unsuccessful in 52 patients. Four ineligible patients were excluded, and the remaining 48 patients underwent rescue CDT: 30 patients underwent thrombus fragmentation with a rotating pigtail catheter; 8 patients underwent Straub rotational thrombectomy; and 10 patients underwent AngioJet rheolytic thrombectomy. In total, 42 patients subsequently underwent CDT relative to reduced-dose thrombolysis. Pooled clinical success was achieved in 45 patients, and the time-to-clinical instability relief for CDT was short (i.e., 48 h). Clinical findings significantly improved with oxygen saturation and the shock index (p < 0.01). CDT resulted in a significant decrease in the right ventricular (RV)/left ventricular end-diastolic diameter ratio and the average number of patients with pulmonary hypertension (p < 0.01). None of the patients suffered major complications or procedure-related adverse events, and two patients experienced minor complications. During follow-up, RV function symptoms were uneventful. The present study found that CDT is a safe and effective modality for rescue management of massive PE in patients with clinical instability and RV dysfunction after UST, leading to improved clinical outcomes and RV function with a low complication rate.

Efficacy of stent-graft placement to salvage central vein stents with recalcitrant restenosis in patients with arteriovenous fistulas.

The purpose of this study was to determine the effectiveness and permanency of stent-graft placement to salvage stents with recalcitrant restenosis due to central vein stenosis (CVS). Between May 2014 and February 2016, VIABAHN stent-grafts were deployed in patients with functioning arteriovenous (AV) fistulas who underwent previous bare metal stent (BMS) placement and had recalcitrant stent restenosis that did not respond to percutaneous transluminal angioplasty (PTA). Surveillance was carried out at 3, 6, 12, 18, and 24 months with diagnostic fistulography. Fourteen patients initially underwent 15 BMS placements. In the follow-up period (range, 118-976 days), patients presented with symptomatic venous hypertension; subsequently, a total of 52 unsuccessful repeat PTAs for BMS restenosis were undertaken, and the median primary access survival of PTAs was 66 ± 43 days. For salvage, 14 stent-grafts were placed in segments with recalcitrant restenosis of a CVS stent. Within 1.25 ± 0.72 days after stent-graft placement, patients who initially presented with symptomatic venous hypertension reported complete resolution. The median primary access survival (mean, 1183 ± 312 days) was longer than PTAs alone (P < .01). No major or minor complications were associated with stent-graft deployment or any of the subsequent interventions in the study period. The primary patency rate at 6, 12, and 18 months was 100%, and it was 85.7% at 24 months. The secondary access patency rate was 92.9% at 24 months. In conclusion, stent-graft placement to salvage CVS stents with recalcitrant restenosis in patients with AV fistulas is safe and effective if PTAs fails to maintain luminal patency.

Unveiling the Link: Minimum Inferior Vena Cava Diameter and Thrombosis Risk.

RATIONALE AND OBJECTIVES: This study aimed to investigate the relationship between minimum inferior vena cava (IVC) diameter magnification percentage and in-situ IVC thrombosis (iIVCT) after inferior vena cava filter (IVCF) placement in lower extremity deep vein thrombosis (LEDVT). METHODS: This was a single center retrospective study. Study sample consisted of patients with LEDVT who received computed tomography venography of IVC both before and after IVCF placement between January 2019 and October 2023. A propensity score matching (PSM) was also used in covariates including age, hypertension, and thrombus limbs. Multivariate Cox regression analyses were performed to mitigate the impact of selection bias and control for potential confounding variables. The incremental changes associated with minimum IVC diameter magnification percentage and iIVCT were evaluated with restricted cubic spines (RCS). RESULTS: 113 LEDVT patients (age 58.8 ± 17.8 years, 57.5% male) were included. Multivariate Cox regression analyses revealed a significant positive association between the minimum IVC diameter magnification percentage and the incidence of iIVCT after adjusting for the age, hypertension, and thrombus limbs (adjusted hazard risk [HR] = 1.02, 95% CI, 1.01 to 1.02, p < .001), suggesting minimum IVC diameter magnification percentage was an independent risk factor for iIVCT. Moreover, after using PSM, the association remained significant (HR=1.01, 95% CI, 1.01 to 1.02, p < .001). RCS analysis showed a non-linear dose-response association (s-shaped fitting curve) between minimum IVC diameter magnification percentage and iIVCT risk (nonlinear p = .041). The fitting curve indicated a threshold effect (overall p = .005), with a smaller magnification percentage being negatively associated with the incidence of iIVCT, presenting continuously decreasing HR at levels of magnification percentage < 37.3%. CONCLUSION: A decreasing minimum IVC diameter magnification percentage is consistently associated with a decreasing risk of iIVCT following IVCF placement when the percentage is < 37.3%, indicating that it is a protective factor against iIVCT incidence. WHAT THIS PAPER ADDS?: This single-center retrospective study, which designed to investigate the relationship between minimum inferior vena cava diameter magnification percentage and in-situ inferior vena cava thrombosis (iIVCT) following inferior vena cava filter (IVCF) placement in lower extremity deep vein thrombosis in 113 patients, demonstrated that decreasing minimum IVC diameter magnification percentage is consistently associated with a decreasing risk of iIVCT following IVCF placement when the percentage is < 37.3%, indicating that it is a protective factor against iIVCT incidence.

AngioJet rheolytic thrombectomy coupled with dose-reduced rt-PA for massive inferior vena cava filter-related thrombosis: A single-center retrospective study.

OBJECTIVE: To evaluate the efficacy and safety of AngioJet rheolytic thrombectomy (ART) coupled with dose-reduced rt-PA, compared to catheter-directed thrombolysis (CDT) alone, for the treatment of massive inferior vena cava filter (IVCF)-related thrombosis. METHODS: We conducted a retrospective analysis of 40 patients who received either ART or CDT alone as the first-line endovascular therapy (ET) between January, 2016 and September, 2022. The data on demographics, clinical characteristics, technical success, clinical success, complications, and early follow-up were reviewed. RESULTS: Of the 40 included patients, 24 received ART and 16 received CDT alone. The demographics, presentation, lesion characteristics, comorbidities and risk factors were comparable (all p > .05). Technical success rates were 100% in both groups. The total CDT time and infusion agent dosage were lower in the ART group than those in the CDT group (both p < .05). At the end of CDT, clinical success was 81.8% in the ART group, which was slightly higher than that of 70.8% in the CDT group (p > .05). At the 6-month follow-up, the incidences of recurrent thrombosis in the two groups were 6.9% and 15.8%, respectively, and the incidence of post-thrombotic syndrome was 10.3% and 21.1%, respectively. However, these differences were not statistically significant (p > .05). No major complications were noted in either group, ART seemed to have slightly higher risk of transient macroscopic hemoglobinuria and recoverable acute kidney injury, but with a lower minor bleeding incidence when compared with CDT alone (4.2 vs. 31.3%, p < .05). CONCLUSIONS: ART or CDT alone as the first-line ET for IVCF-related thrombosis has comparable outcomes but with different adverse event profiles. Both modalities are safe and effective in patients with massive IVCF-related thrombosis.

Characterization and risk factors of inferior vena cava thrombosis in situ detected by computed tomography venography following filter placement: A single-center retrospective cohort study.

OBJECTIVE: This study aimed to characterize radiographic characteristics on computed tomography venography and risk factors of inferior vena cava thrombosis (IVCT) in situ after retrievable vena cava filter (VCF) placement. METHODS: Between September 2018 and June 2023, a single-center retrospective cohort study was conducted in patients with or without IVCT in situ following VCF placement. Patient baseline demographics, presentation of lower extremity deep vein thrombosis (LEDVT), thrombus characteristics, concurrent pulmonary embolism, comorbidities and risk factors for LEDVT, and IVCT and VCF-related information were collected and analysed. Univariable analysis followed by multivariable analysis was performed to evaluate the odds ratio (OR) with a 95% confidence interval (CI). RESULTS: One hundred and seventeen eligible patients were included, regionally isolated filling-defect surrounding the support pillars of VCF and contacting inferior vena cava (IVC) wall on computed tomography venography images were identified, clots were more frequently found on the minor axis or anterior wall of IVC. Univariable analyses suggested that the incidence of IVCT in situ (31.6%, 37/117) was closely associated with age (P = .001), thrombus limb (left (P = .001) and bilateral side (P = .001)), hypertension (P = .008), filter shapes (P < .001), short IVC diameter (P = .009) or magnification percentage (P = .004), and long IVC diameter (P = .006). Multivariable analyses suggested that bilateral side LEDVT (OR, 4.92; 95% CI, 1.56-15.51; P = .007) and increased short IVC magnification percentage (OR, 1.01; 95% CI, 1.00-1.03; P = .013) statistically significant increase the IVCT in situ risk, whereas increased age (OR, 0.96; 95% CI, 0.94-0.99; P = .013) and short IVC diameter (OR, 0.87; 95% CI, 0.77-0.98; P = .026) were associated with decreased odds against IVCT in situ. CONCLUSIONS: IVCT in situ represents regionally isolated filling-defect at points of filter contact with IVC wall. Bilateral side LEDVT and increased short IVC magnification percentage may be potential risk factors impacting the occurrence of IVCT in situ, while increased age and short IVC diameter may decrease the incidence of IVCT in situ and seem to be protective factor against IVCT in situ emergence.

AngioJet rheolytic thrombectomy for the treatment of deep vein thrombosis in elderly patients: Increase the risk of acute kidney injury?

Objective: The objective of this study was to investigate the risk of acute kidney injury in elderly patients compared with nonelderly patients undergoing AngioJet rheolytic thrombectomy for treatment of acute deep vein thrombosis. Methods: A retrospective review of all patients who underwent AngioJet rheolytic thrombectomy for the treatment of acute deep vein thrombosis between November 1, 2014 and August 1, 2022 was conducted. Their baseline demographics, comorbidities, clinical characteristics, procedural details, and postoperative course were reviewed. Results: A total of 105 eligible patients were reviewed; 45 patients were in the elderly group, and 60 were in the nonelderly group. Except for age (p < 0.001), no significant differences regarding demographics were detected (p >0.05). Transient macroscopic hemoglobinuria occurred in all patients during the first 24 h post-AngioJet rheolytic thrombectomy. The overall morbidity of acute kidney injury in the two groups was 11.4%, and the nonelderly group had a similar rate of acute kidney injury (8.3%) to the elderly group (15.6%). None of the 12 patients progressed to dialysis within the postoperative period, and the mean acute kidney injury recovery time of the elderly group was 5.86 ± 1.57 days, which was longer than the 3.60 ± .89 days of the nonelderly group (p = 0.017). Conclusion: The use of AngioJet rheolytic thrombectomy for the treatment of patients with acute deep vein thrombosis is associated with a potential risk of acute kidney injury, which seems to have a comparable rate in elderly and nonelderly patients. acute kidney injury in the elderly group tends to need a longer recovery time, which requires postoperative vigilance for this population.

Catheter-based therapies and short-term outcomes in the oncological patients with acute inferior vena cava thrombosis: a single centre experience.

OBJECTIVE: To investigate the safety and effectiveness of catheter-based therapy (CBT) using AngioJet rheolytic thrombectomy (ART) device or large lumen catheter (LLC) in the oncological patients with inferior vena cava thrombosis (IVCT). METHODS: This was a retrospective study including eligible patients with IVCT treated with CBT coupled with dose-reduced thrombolysis as the first-line treatment from February 1, 2015 to January 1, 2022. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were all reviewed. RESULTS: A total of 33 patients (mean age 58.8 years, 57.6% male) was included, of whom 17 patients underwent ART and 16 underwent LLC aspiration, the technical success rates were 100%. All patients subsequently underwent catheter-directed thrombolysis relative to reduced-dose thrombolysis. At the end of catheter-directed thrombolysis, clinical success was achieved in 26 (78.8%) patients. In the subgroup analysis, ART seemed to receive a slightly higher rate of thrombus removal Grade III (47.1% vs 12.5%, p = .057). The symptoms of leg pain and swelling post-treatment were significantly improved in both groups (p < .001). Except for transient macroscopic hemoglobinuria occurring in patients with ART, none of all patients suffered from procedure-related adverse events and major complications. Minor complications such as bleeding events occurred in 6.1% (2/33) of patients. At the 6 month follow-up, the incidence of recurrent thrombosis and mild post-thrombotic syndrome (PTS) were 9.7% (3/31) and 6.5% (2/31). CONCLUSION: CBT is a safe and effective modality for the management of IVCT in the oncological patients, leading to high levels of technical and clinical success, symptoms alleviation, as well as a low incidence of minor complication, mild PTS and recurrence. ADVANCES IN KNOWLEDGE STATEMENT: The available data and evidence of endovascular therapy (ET) on oncologic patients with IVCT remains insufficient. The purpose of present single center retrospective study including 33 oncological patients is to investigate the preliminary safety and efficacy of CBT using ART device or LLC. The results demonstrated that CBTs are safe and effective as an ET modality in majority of eligible patients with symptomatic acute cancer-associated IVCT, indicating high levels of technical and clinical success, symptoms alleviation, as well as a low prevalence of minor complication, mild post-thrombotic syndrome and recurrence. Furthermore, they have the advantages of accelerated reduction of thrombus burden in a moderate time, speedy restoration of blood flow, but at the risk of potentially increased economic cost. Notably, in the condition of parallel time and dosages of lytic agents, ART tends to achieve a slightly higher thrombus removal Grade III than LLCA.

Association Between Inferior Vena Cava-Involved Thrombosis, Severe Iliac Vein Stenosis, and Proximal Pulmonary Embolism in Patients With Deep Vein Thrombosis.

To investigate the possible risk factors for proximal pulmonary embolism (PE) in patients with lower extremity deep vein thrombosis (LEDVT). A single-center, retrospective cohort study was conducted. Consecutive patients diagnosed with unilateral LEDVT and confirmed PE by computed tomography (CT) pulmonary angiography and indirect CT venography between September 2015 and January 2022 were included. Patient demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed to determine the univariable and multivariable associations. The associations between thrombus location, stenosis, and proximal PE were assessed using a stratified analysis. A total of 115 eligible patients (60.08 ± 15.18 years, 59.1% male) were included. Of these patients, 40 (34.8%) were in the proximal PE group (proximal thrombus involved main or lobar pulmonary artery), and 75 (65.2%) were in the distal PE group (without main and labor pulmonary artery involvement). The univariable analysis showed that onset time of LEDVT symptoms ≤ 7 days (P = .041), inferior vena cava (IVC) involvement (P = .035), and severe iliac vein stenosis (IVS) (stenosis ratio > 61.3%) (P = .010) were associated with the occurrence of proximal PE. Further multivariant analysis showed that IVC involvement was associated with an increased odds of proximal PE (OR: 4.45, 95% CI: 1.083 - 18.248, P = .038), whereas severe IVS (stenosis ratio > 61.3%) was associated with a decreased odds of proximal PE (OR: 0.294, 95% CI: 0.110-0.783, P = .014). Among patients with unilateral LEDVT, IVC involvement increased the risk of proximal PE; patients with severe IVS (stenosis ratio > 61.3%) had a lower risk of developing proximal PE compared with distal PE; and severe IVS seemed to be a protective factor for proximal PE.

Endovascular Therapies Using Catheter-Based Thrombectomy or Catheter-Directed Thrombolysis for Acute Non-Cancer Associated Inferior Vena Cava Thrombosis: A Retrospective Cohort Study.

OBJECTIVE: To investigate the safety and effectiveness of catheter-based therapy (CBT) compared to conventional catheter-directed thrombosis (CDT) for non-oncological patients with inferior vena cava thrombosis (IVCT), as well to evaluate the differences between CBTs using AngioJet rheolytic thrombectomy (ART) and large lumen catheter aspiration (LLCA). METHODS: This retrospective single-center study included eligible patients with IVCT treated with CBTs coupled with/without CDT or CDT alone as the first-line treatment between January 3, 2015 and January 28, 2022. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were all reviewed. RESULTS: A total of 106 patients (128 limbs) were included, with 42 cases were treated with ART, 30 with LLCA, and 34 with CDT alone. Technical success rates were 100% (128/128), and 95.5% (84/88) limbs treated with CBT subsequently underwent CDT. The mean duration of CDT time and total infusion agent dosage in patients with CBTs were lower than those who underwent CDT alone (P < .05). Similarities were observed in ART compared to LLCA (P < .05). At the end of CDT, clinical success was achieved in 85.2% (75/88) of limbs treated with CBTs and 77.5% (31/40) of limbs with CDT alone, and 88.5% (46/52) in ART and 80.6% (29/36) in LLCA. The 12-month follow-up showed slightly lower incidences of recurrent thrombosis (7.7% vs 15.2%) and post-thrombotic syndrome (14.1% vs 21.2%), which persisted in patients who underwent ART compared to LLCA (4.3% vs 12.9% and 8.5% vs 22.6%). Patients who underwent CBTs tended to have lower minor complications (5.6% vs 17.6%) but were at higher risk of transient macroscopic hemoglobinuria (58.3% vs 0%) and recoverable acute kidney injury (11.1% vs 2.9%) compared to CDT alone. These findings were similar in ART compared to LLCA (2.4% vs 10.0%, 100% vs 0%, and 16.7% vs 3.3%, respectively). LLCA seemed to have more hemoglobin losses (10.50 ± 9.20 vs 5.57 ± 10. 42 g/L, P < .05). CONCLUSION: CBTs coupled with/without CDT are safe and effective in patients with IVCT, reducing the clot burden in a moderate time, restoring blood flow rapidly, minimizing thrombolytic drug requirement and lowering minor bleeding complication compared to CDT alone. ART and LLCA have comparable outcomes but with different adverse event profiles.

Relationship between vascular access and angulation of vena cava filter at placement and retrieval: a multicenter retrospective cohort study.

Background: Inferior vena cava (IVC) filters are commonly used intravascular devices designed to prevent fatal pulmonary embolism (PE), maintaining the IVC filter as centered as possible is fundamental for achieving its filtration function. Objective: This study aimed to characterize the tilt angles of IVC filter between the vascular access of internal jugular vein (IJV) and femoral vein (FV), as well as to identify factors associated with increased or decreased tilt angles between placement and retrieval. Design: This is a multicenter retrospective study. Methods: A multicenter retrospective study was conducted from October 2017 to March 2019. The primary outcome was the change in filter tilt between placement and retrieval. The secondary outcome was the identifications of factors associated with increased or decreased tilt angle. Relevant variables were analyzed using t-tests, Chi-square tests, Fisher's exact tests, while multivariate logistic regression analysis was used to determine risk factors. Results: A total of 184 eligible patients were included in this study. The IJV group had a lower likelihood of tilt angle over 10° at the time of placement compared to the FVs group (0% versus 12.5%, p = 0.040). Among the 171 patients with a mean dwell time of 22.1 days, the IJV group had a higher likelihood of tilt angle over 10° than the FVs group (10.3% versus 2.3%, p = 0.080). The use of FVs access at placement was associated with a higher difference between placement and retrieval filter tilt angles (p < 0.01). Multivariate logistic regression analysis showed that hypertension [odds ratio (OR) 0.668; 95% confidence interval (CI) 0.328-1.358, p = 0.265], cardiologic artery disease (OR 0.537; 95% CI 0.136-2.130, p = 0.377), cerebral venous disease (OR 0.555; 95% CI 0.186-1.651, p = 0.290), filter types (OR 1.624; 95% CI 0.851-3.096, p = 0.141), and IVC filter thrombosis (OR 1.634; 95% CI 0.804-3.323, p = 0.175) were not associated with increased filter tilt angle. Right side (OR 0.434; 95% CI 0.202-0.930, p = 0.032) or bilateral lower extremity deep vein thrombosis (LEDVT) (OR 0.383; 95% CI 0.148-0.995, p = 0.049) were identified as protective factors. Conclusion: IJV access was associated with a lower filter tilt angle at the time of placement, while FVs access was linked to a higher difference between placement and retrieval tilt angles. Right side or bilateral LEDVT were identified as protective factors against increased IVC filter tilt angle.

Incidence and risk factors for inferior vena cava filter thrombosis detected at time of filter retrieval in patients with lower extremity deep vein thrombosis: a multicenter retrospective cohort study.

Background: Inferior vena cava filter (IVCF) thrombosis is an uncommon complication of IVCF utilization. The aims of this study were to investigate inferior vena cava (IVC) venography before filter retrieval to determine the incidence relative to filter dwell time and risk factors of IVCF thrombosis based on the clinical data and imaging findings in patients with lower extremity deep vein thrombosis (LEDVT). Methods: The clinical data from a multicenter randomized trial conducted between October 2017 and March 2019 were reviewed to determine the incidence of IVCF thrombosis in preretrieval venography and the associated risk factors. The correlation between filter dwell times (within 90 days) and incidence was assessed. Baseline demographics, LEDVT presentation, laboratory examination, thrombus characteristics, concurrent pulmonary embolism (PE), comorbidities and risk factors for LEDVT, and IVCF-relevant information were analyzed using the independent samples t-test, chi-squared test, Fisher exact test, and regression analysis to determine the univariable and multivariable associations in assessing the risk factors of IVCF thrombosis. Results: A total of 178 eligible patients were included, of whom 58 were in the IVCF thrombosis group and 120 were in the IVCF nonthrombosis group, and the mean filter dwell time was 22.07±27.91 days (range, 4-190 days). The overall incidence of IVCF thrombosis in patients with LEDVT who received IVCFs was 32.58% (58/178). The incidence of IVCF thrombosis was 35.25% (49/139) in the first 30 days after the IVCF placement and decreased to 22.73% (5/22) between 30 to 60 days of dwell time and to 18.18% (2/11) between 60 and 90 days of dwell time, indicating a decreasing trend within the first 90 days. The risk factors for the occurrence of IVCF thrombosis were concurrent PE [odds ratio (OR) =2.59; 95% confidence interval (CI): 1.27-5.28; P=0.01], rheumatic diseases of the immune system (OR =14.42; 95% CI: 1.52-136.41; P=0.02), IVC:filter radial ratio >0.587 (OR =0.25; 95% CI: 0.10-0.65; P<0.01), and percutaneous angioplasty (PTA) (OR =2.50; 95% CI: 1.09-5.70; P=0.03). Conclusions: The incidence of IVCF thrombosis at the time of filter retrieval appears to decrease with dwell time within 90 days. Concurrent PE, rheumatic diseases of the immune system, and PTA were taken into account as risk factors. An IVC:filter radial ratio of 0.587 was a protective factor against developing IVCF thrombosis. These findings require further validation in a well-designed study since the present study lacked a close follow-up.

Identification microenvironment immune features and key genes in elderly stroke patients.

BACKGROUND: The purpose of this study was to identify the signaling pathways and immune microenvironments related to elderly stroke patients. METHODS: We downloaded the public transcriptome data (GSE37587) from the gene expression omnibus and divided the patients into young and old groups and identified differentially expressed genes (DEGs). Gene ontology function analysis, Kyoto encyclopedia of genes and genomes pathway analysis, and gene set enrichment analysis (GSEA) were performed. A protein-protein interaction network was constructed and hub genes were identified. Gene-miRNA, gene-TF, and gene-drug networks were constructed using the network analyst database. The immune infiltration score was evaluated using single-sample gene set enrichment analysis GSEA, its correlation with age was computed and visualized using R software. RESULTS: We identified 240 DEGs, including 222 upregulated and 18 downregulated DEGs. Gene ontology enrichment was significantly enriched in response to the virus, type I interferon signaling pathway, cytological component, focal adhesion, cell-substrate adherents junction, and the cytosolic ribosome. GSEA identified the following mechanisms: heme metabolism, interferon gamma response, and interferon alpha response. Ten hub genes included interferon alpha-inducible protein 27, human leucocyte antigen-G, interferon-induced protein with tetratricopeptide repeats 2, 2'-5'-oligoadenylate synthetase 2, interferon alpha-inducible protein 6, interferon alpha-inducible protein 44-like, interferon-induced protein with tetratricopeptide repeats 3, interferon regulatory factor 5, myxovirus resistant 1, and interferon-induced protein with tetratricopeptide repeats 1. Quantitative analysis of immune infiltration showed that increased age was significantly positively correlated with myeloid-derived suppressor cells and natural killer T cells, and negatively correlated with immature dendritic cells. CONCLUSION: The present research could help us better understand the molecular mechanisms and immune microenvironment of elderly patients with stroke.

How to create a nervous system aneurysm model in canines? ligation of the lingual artery is a simple and effective method.

Background: The purpose of this research was to establish a safe, effective, and simple nervous system aneurysm model. This method could quickly and stably establish an exact canine tongue aneurysm model. This paper summarizes the technique and key points of the method. Methods: Under the condition of anesthesia by inhaling isoflurane with a mask, we punctured the femoral artery of the canine, and the tip of the catheter was placed in the common carotid artery for intracranial arteriography. The positions of the lingual artery, external carotid artery, and internal carotid artery were identified. Then, the skin near the mandible was cut according to the positioning and separated layer by layer until the bifurcation of the lingual artery and external carotid artery was exposed. The lingual artery were then sutured with 2-0 silk sutures approximately 3 mm from the external carotid/lingual artery bifurcation. The final angiographic review showed that the aneurysm model was successfully established. Results: The lingual artery aneurysm was successfully established in all 8 canines. All canines obtained a stable model of nervous system aneurysm and confirmed by DSA angiography. Conclusion: We have established a safe, effective, stable and simple method to establish a canine nervous system aneurysm model with controllable size. In addition, this method has the advantages of no arteriotomy, less trauma, constant anatomical location, and low risk of stroke.