Intra-Sac Injection of Thrombin During Endovascular Aneurysm Repair to Remedy Type II Endoleak and Promote Sac Shrinkage.

PURPOSE: To evaluate the safety and effectiveness of intra-sac thrombin injection to remedy type II endoleaks (T2ELs) during endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: 224 cases abdominal aortic aneurysm (AAA) were treated with EVAR. For the 52 cases of intra-operative type II endoleaks and 8 cases of ruptured AAAs, after the grafts were deployed, thrombin was injected into the aneurysm sac through a preset catheter. The occurrence of endoleaks post-EVAR were followed up with by Computed Tomography (CT) angiogram. The diameter and the volume of the aneurysm sac were also measured. Endpoints included incidence of T2ELs, AAA sac shrinkage and re-intervention rate and all-cause mortality. RESULTS: The overall technical success rate was 100%. Fifty-two patients were followed up with for 9-56 (median 24) months. No serious complications were observed during follow-up. The incidence of endoleak was 5.8% (3/52) during follow-up. The maximum diameter of the aneurysm decreased from 61.1 ± 14.2 mm to 53.7 ± 10.6 mm, 47.9 ± 8.3 mm and 43.7 ± 7.2 mm (87.9%, 78.4% and 71.5% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively (P < .05). The volume of the aneurysm sac shrank from 236.2 ± 136.2 cm3 to 202.6 ± 114.1 cm3, 155.6 ± 68.4 cm3 and 129.7 ± 52.4 cm3 (85.8%, 65.9%, and 54.9% of pre-EVAR) at the 6-month, 1-year and 2-year follow-up, respectively (P < .05). The rate of various endoleaks was 5.8% (3/52) and the re-intervention rate was 1.9% (1/52) in this research. CONCLUSIONS: Clinical outcomes show that intra-sac injection of thrombin during EVAR is safe and may be effective in remedying small amount and low-velocity endoleaks and promoting shrinkage of the aneurysm sac.

One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device: Cohort study from East Asia.

OBJECTIVES: The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets. METHODS: Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed. RESULTS: The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively (t= 29.644, P= .000). CONCLUSIONS: In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.

[Relative factors of type II endoleak after endovascular aneurysm repair].

OBJECTIVE: To study the relative factors of type II endoleak after endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. METHODS: Twenty-eight cases of abdominal aortic aneurysms treated by EVAR were retrospectively analyzed. The characteristics of the inferior mesentery arteries (IMA), the arc Riolan and the lumbar arteries of the cases with or without type II endoleak were analyzed. RESULTS: Type II endoleak was found in 8 (28.6%) cases, of which, 2 were type IIa and 6 were type IIb. The diameter of the IMA originating part of the cases with type II endoleak [(4.03 ± 1.00) mm] was significantly bigger than that without endoleak [(2.89 ± 0.50) mm, P=0.007]. The number of the lumbar arteries originating from the aneurysm sac in cases with type II endoleak (3.4 ± 0.8) was significantly more than that without endoleak (1.9 ± 1.5, P=0.017). However, type II endoleak was irrelevant to the diameter of originating part of the lumbar arteries and the form of the arc Riolan. After the average 14.5 months follow-up, the aneurysm sac was found with shrinkage in 1 case, no change in 2 cases, and augment in 5 cases. Secondary transarterial embolization was performed for only 1 case. CONCLUSION: Type II endoleak was much easily found in cases with bigger diameter of originating part of the IMA, or in cases with more lumbar arteries originating from the aneurysm sac.

[Comparison of curative effect and thrombolysis time between r-tPA application and urokinase in the interventional thrombectomy and thrombolysis for acute and severe pulmonary embolism].

OBJECTIVE: To study the influence of r-tPA and urokinase in curative effect and thrombolysis time on patients with acute and severe pulmonary embolism after interventional thrombectomy. METHODS: After reviewing and analyzing the clinical data of 19 acute and severe pulmonary embolism patients, we classified them into two groups in accordance with the application of r-tPA and urokinase to compare the changes of their heart rate, blood pressure, pulmonary arterial pressure, arterial partial pressure of oxygen and hemachrome before and after thrombolysis, as well as the thrombolysis effect time the two groups took. RESULTS: The heart rate, blood pressure, pulmonary arterial pressure, arterial partial pressure of oxygen of the patients in both groups gained remarkable improvement after operation (P<0.05); the pulmonary arterial pressure of the r-tPA patient group dropped but not significantly compared with that before operation (P>0.05); the pulmonary arterial pressure of the urokinase patient group dropped significantly compared with that study before operation (P<0.05); the hemachrome of both patient groups did not significantly drop after operation (P>0.05); the thrombolysis effect time by adopting r-tPA was remarkably shorter than that caused in thrombolysis by adopting urokinase (P<0.05). CONCLUSION: Both r-tPA and urokinase are effective in interventional thrombolysis for acute and severe pulmonary embolism. However, r-tPA could significantly shorten the time caused in thrombolysis without increasing any bleeding risk.

[Successful endovascular repair of isolated iliac aneurysm and reserving the internal iliac artery with fenestrated covered stent].

Isolated iliac aneurysm is rare and difficult for surgery repair because it locates in the deep pelvis. Endovascular repair is preferred currently, and internal iliac artery is generally embolized in order to avoid the endoleak. Embolization of the internal iliac artery can lead to the complications such as buttock claudication, colon ischaemia and erectile dysfunction. Therefore, the antegrade flow of internal iliac artery should be reserved. One seventy-seven-year-old male patient with isolated left common iliac aneurysm, 30 mm in diameter, was successful endovascular repaired using fenestrated covered stent. At 1-month follow up, the patient was asymptomatic. Computed tomography scan shows the iliac aneurysm was completely excluded, and the antegrade flow of the left common, internal and external iliac arteries were normal.