Patient-specific risk factors for reintervention following primary endovascular treatment of iliac artery disease.

OBJECTIVE: Predictive models for reintervention may guide clinicians to optimize selection, education, and follow-up of patients undergoing endovascular iliac revascularization. Although the impact of lesion- and device-related characteristics on iliac restenosis and reintervention risk is well-defined, data on patient-specific risk factors are scarce and conflicting. This study aimed to explore the value of patient-related factors in predicting the need for clinically driven target-vessel revascularization (CD-TVR) in patients undergoing primary endovascular treatment of iliac artery disease. METHODS: Consecutively enrolled patients undergoing endovascular revascularization for symptomatic iliac artery disease at a tertiary vascular referral center between January 2008 and June 2020 were retrospectively analyzed. Primary and secondary outcomes were CD-TVR occurrence within 24 months and time to CD-TVR, respectively. Patients who died or did not require CD-TVR within 24 months were censored at the date of death or at 730 days, respectively. Multiple imputation was used to account for missing data in primary analyses. RESULTS: A total of 1538 iliac interventions were performed in 1113 patients (26% females; 68 years). CD-TVR occurred in 108 limbs (74 patients; 7.0%) with a median time to CD-TVR of 246 days. On multivariable analysis, increasing age was associated with lower likelihood of CD-TVR (odds ratio [OR], 0.64; 95% confidence interval [CI], 0.50-0.83; P = .001) and decreased risk of CD-TVR at any given time (hazard ratio [HR], 0.66; 95% CI, 0.52-0.84; P = .001). Similarly, a lower likelihood of CD-TVR (OR, 0.75; 95% CI, 0.59-0.95; P = .017) and decreased risk of CD-TVR at any given time (HR, 0.73; 95% CI, 0.58-0.93; P = .009) were observed with higher glomerular filtration rates. Lastly, revascularization of common vs external iliac artery disease was associated with lower likelihood of CD-TVR (OR, 0.48; 95% CI, 0.24-0.93; P = .030) and decreased risk of CD-TVR at any given time (HR, 0.48; 95% CI, 0.25-0.92; P = .027). No associations were observed between traditional cardiovascular risk factors (sex, hypertension, higher low-density lipoprotein cholesterol, higher hemoglobin A1c, smoking) and CD-TVR. CONCLUSIONS: In this retrospective cohort study, younger age, impaired kidney function, and external iliac artery disease were associated with CD-TVR. Traditional markers of cardiovascular risk were not seen to predict reintervention.

Upside-down positioning of a peri-interventional cava filter during endovascular thrombectomy of a septic superior vena cava thrombosis.

A 43-year-old male patient with advanced colon carcinoma presented with disseminated staphylococcus aureus bacteremia and central venous catheter associated septic thrombosis of the superior vena cava. Despite appropriate antimicrobial therapy and surgical debridement of distant foci, bacteremia persisted, so an endovascular thrombectomy was performed. Contrary to the usual application, the Capturex® peri-interventional cava filter was positioned upside down, in the direction of the blood flow, in the superior vena cava to prevent septic embolism during mechanical thrombectomy. The wall-adherent septic thrombus was mechanically detached using a RAT fragmentation basket® followed by Aspirex® rotational thrombectomy. Final phlebography showed complete thrombus removal. Small thrombus fragments could be demonstrated in the filter after retrieval. The adapted technique of a reverse positioning of the Capturex® filter in the superior vena cava seems feasible and effective.

Cone-Beam CT-assisted navigation for endovascular treatment of erection-related artery stenosis in patients with erectile dysfunction.

BACKGROUND: Angioplasty and stenting have emerged as endovascular treatment options for arteriogenic erectile dysfunction over the past few years. Considerable anatomical variation of the erection related pelvic arteries can be challenging during these procedures, leading to time-consuming repetitive super-selective angiograms for navigation. TECHNIQUE: We report a novel technique of using C-arm Cone-Beam CT and vessel navigation software to facilitate super-selective catheterization. CONCLUSION: Cone-Beam CT-guided navigation for vascular assessment of arteriogenic ED is an optional approach compared to exclusive angiographic assessment. Compared to CT angiography, C-arm Cone-Beam CT offers benefits regarding usage of contrast media and radiation exposure. It has the advantage to combine imaging with endovascular procedures in a single session, reduces time to target navigation in complex pelvic arteries anatomy and may increase therapy safety in endovascular treatment of ED.

Catheter Directed Thrombectomy Under Temporary Catheter Based Filter Protection in Renal Vein Thrombosis and Contraindication to Anticoagulation.

INTRODUCTION: A 55 year old man who suffered from recurrent traumatic multi-organ bleeding presented with deterioration in kidney function and pulmonary embolism caused by a newly diagnosed renal vein thrombosis during hospitalisation. REPORT: Complete clot removal was performed successfully by catheter directed aspiration. Thrombotic emboli were captured in a temporary filter device. A post-interventional computed tomography scan showed full restoration of the occluded renal vein. DISCUSSION: Use of a temporary catheter based vena cava filter (Capturex) during catheter directed thrombectomy is safe and should be considered to prevent thrombo-embolism in selected cases when any rheolytic therapy is contraindicated.

Selective Arterial Embolizations of Renal Angiomyolipomas Using 96% Ethanol: A Case Series of 5 Patients.

Angiomyolipomas are rare benign tumors of the kidneys, with a risk of spontaneous hemorrhage including severe retroperitoneal bleedings. In this study, we report clinical outcomes of 5 patients who underwent 8 embolization sessions using 96% ethanol, as there is scarce data using this embolic agent for this indication. The primary angiographic success could be achieved in all but 1 lesion, which was not accessible due to vasospasm of the supplying vessel. Therapeutic success could be demonstrated in all treated cases for which follow-up imaging was available (n = 3). In 1 complex patient, a mildly reduced renal function, as well as a new onset of arterial hypertension was detected after treatment. Nontarget embolization of vital kidney tissue was demonstrated in another patient; it remained asymptomatic. Embolization therapy using 96% ethanol is an optional method to treat renal angiomyolipomas.

Farbkodierte Duplexsonografie der Gefässe in der Praxis: Pitfalls.

Color Doppler ultrasound is the diagnostic cornerstone of vascular assessment. Almost all arteries and veins of the human body are accessible to this diagnostic imaging, which as a result is very often used as first-line diagnostic test. Recent technological developments in high-end ultrasound machines enable us to optimize image quality in color-coded duplex ultrasound of arteries and veins. To obtain an optimal instrument setting, all relevant adjustments of imaging must be considered. In B-Mode ultrasound, the basic vascular imaging method, the most important settings to optimize are ultrasound frequency, gain, dynamic range, and focus, whereas color Doppler depends on angle supersonic sounding and its application in clinical practice. Most mistakes in measuring blood flow velocities, a frequent cause of misinterpretation, result from insufficient angle correction. Cardiac pathologies may result in typical changes of arterial and venous Doppler curves.

[Vascular Color-Coded Duplex Ultrasound in Practice: Artifacts]. / Farbkodierte Duplexsonografie der Gefässe in der Praxis: Artefakte.

Vascular Color-Coded Duplex Ultrasound in Practice: Artifacts Abstract. Ultrasound artifacts are technical phenomena which may cause diagnostic mistakes and do not correlate with the real target organ. These optical and acoustic phenomena of color-coded duplex ultrasound are very common in the real world and may lead to misinterpretations and diagnostic errors. The twinkling artifact, for example, imitates high-flow velocities and turbulences, which may lead to the misdiagnosis of a high-grade stenosis or of vascularization. Mirror image artifacts may irritate the sonographer and cause an impression of an additional - really not existing - vessel. The "seagull cry", whose origin is not well understood, is usually found in the region of a high-grade stenosis.

Detection of hypofibrinolysis in stable coronary artery disease using the overall haemostatic potential assay.

INTRODUCTION: Patients with stable coronary artery disease (CAD) are at risk of arterial thrombosis causing myocardial infarction. Detection of global haemostatic markers of hypercoagulability and hypofibrinolysis may be important for risk stratification and individualised treatment. We examined overall haemostatic potential (OHP) and thrombin generation in a group of stable CAD patients. We also sought to investigate associations between fibrinolytic inhibitors and abnormal global fibrinolysis in these patients. MATERIALS AND METHODS: Blood samples were collected from 56 patients defined by coronary anatomy as symptomatically stable CAD. Medications were recorded. Samples were analysed using the global coagulation assays OHP and thrombin generation (calibrated automated thrombogram, CAT), platelet aggregometry measured by Multiplate®, and levels of plasminogen activator inhibitor-1 (PAI-1) antigen measured by ELISA. Results were compared with a reference group of healthy controls. RESULTS: Stable CAD patients displayed increased fibrin and thrombin generation and impaired fibrinolysis (decreased overall fibrinolytic potential, OFP, and increased clot lysis time) compared with healthy controls. No effect of antiplatelet agents or other medications on these parameters was observed using platelet-poor plasma. After multivariate adjustment, OFP of healthy individuals was significantly associated with fibrinogen, but in CAD patients PAI-1 became an important determinant. CONCLUSIONS: Hypercoagulability of plasma is observed in stable CAD, with both increased thrombin generation and reduced fibrinolytic potential making a significant contribution. The OHP assay may provide a simple method of identifying hypercoagulability in individual patients.