Application of the Double Series Filter Technique for the Treatment of Acute Inferior Vena Cava Filter-Mediated Thrombosis.

BACKGROUND: In this study, we examined the safety and effectiveness of removing inferior vena cava (IVC) filters with residual acute thrombosis after endovascular therapy. METHODS: A retrospective chart review of 712 patients who underwent retrievable IVC filter implantation between July 2018 and December 2022 was conducted. Residual thrombosis with the IVC filter occurred in 18 patients, and the volume of residual acute thrombosis in the IVC filter exceeded 1 mL in all cases. Angiography was performed to evaluate the size of the residual thrombosis and its position with respect to the filter. The double series filter technique (first filter, infrarenal IVC filter; second filter, suprarenal IVC filter) was used to remove the filter and thrombosis. We summarize the diagnosis, treatment, and surgical experience of these patients. RESULTS: In this study, 16 of 18 patients (88.9%) demonstrated residual thrombosis in the IVC filter. One patient (5.6%) demonstrated thrombosis located both inside and floating above the filter, and one patient (5.6%) demonstrated thrombosis located both inside and underneath the filter. The technical success rate of double series IVC filter retrieval was 100%. Seventeen patients (94.4%) underwent single-stage suprarenal IVC filter retrieval, and one patient (5.6%, 1/18) underwent two-stage retrieval. In terms of residual thrombosis removal, 14 patients (77.7%) achieved complete removal and 4 patients (22.3%) achieved partial removal. Residual thrombosis could not be removed through the sheath in one patient, so femoral vein thrombectomy was performed. No other procedure-related complications were observed. The median follow-up time was 22.5 ± 6.8 months. No recurrence of thrombus symptoms was reported, and B ultrasound and computed tomography demonstrated smooth blood flow in the IVC, renal veins, and pulmonary artery. CONCLUSIONS: For patients with residual acute thrombosis on the IVC filter and in whom there was absence of a more appropriate treatment after percutaneous mechanical thrombectomy or catheter-directed thrombolysis therapy, the double series IVC filter technique was a safe approach to improve the IVC filter retrieval rate in the early stage, as well as for simultaneous residual thrombus removal.

Efficacy and safety analysis of AcoStream thrombus aspiration device in the treatment of acute superior mesenteric artery embolism.

OBJECTIVE: Acute superior mesenteric artery embolism is a life-threatening disease caused by the abrupt interruption of mesenteric blood circulation, and the prognosis is very poor. Several studies have confirmed the efficacy and safety of percutaneous mechanical thrombectomy in acute superior mesenteric artery embolism, however, there are currently no literature reports on the latest percutaneous mechanical thrombectomy device-AcoStream™. In the present report, we summarize a series of cases and share our surgical experiences. METHODS: The clinical data of 10 patients (six men and four women, mean age 77.6 ± 7.4 years) with acute superior mesenteric artery embolism treated by AcoStream™ in our center from December 2022 to December 2023 were retrospectively analyzed. Based on the literature, we summarized the diagnosis, therapy, and surgical experience of acute superior mesenteric artery embolism. RESULTS: Percutaneous mechanical thrombectomy was performed for all the patients. The success rate of surgery reached 100% and no perioperative complications occurred. Abdominal pain was significantly relieved and the abdominal signs gradually disappeared in eight patients, while the other two patients still complained of abdominal pain during hospitalization, and eventually, they underwent resection of necrotic bowel. All the patients' symptoms were significantly relieved and they were smoothly discharged from the hospital. CONCLUSIONS: As shown in the present study, percutaneous mechanical thrombectomy using AcoStream™ is minimally invasive, safe, and efficient in the initial stage of acute superior mesenteric artery embolism. We believe that percutaneous mechanical thrombectomy can be a promising alternative in selected cases.

Hemodynamic analysis of thoracic endovascular aortic repair with left subclavian artery reconstructed by chimney stent.

OBJECTIVES: The purpose of this study was to investigate the hemodynamic consequences of thoracic endovascular aortic repair which reconstructed left subclavian artery by chimney stent (ch-TEVAR). METHODS: Two patients who underwent thoracic endovascular aortic repair (TEVAR) and left subclavian artery (LSA) reconstruction using chimney stents were selected. Preoperative and postoperative CTA images were collected to reconstruct hemodynamic models for comparing and analyzing blood pressure, blood flow velocity, and wall shear stress in the aortic arch and its major branches. Concurrently, morphological alterations and position of chimney stent were also assessed. RESULTS: After the reconstruction of LSA in ch-TEVAR, no endoleak was seen, but the stent in LSA was compressed. The blood flow velocity of the LSA increased and disordered, the pressure was reduced, and the WSS was increased. Even more, there were a large amount of turbulence found in the LSA of one case, and its LSA was blocked. CONCLUSION: Chimney stent reduces the occurrence of endoleak due to its excellent deformation ability, but the compressed stent has a greater impact on the hemodynamics of LSA and eventually leads to LSA occlusion; in order to keep the LSA unobstructed, it is necessary to pay attention to the position of the chimney stent and keep it straight and do not fold or twist. Chimney stent has little influence on the aortic arch and the rest of the aortic arch branches.

Use of the Amplatzer vascular plug to treat carotid body tumors extending to the skull base.

BACKGROUND: Carotid body tumors extending to the skull base are hypervascular tumors which are difficult to access using a traditional lateral cervical approach. Preoperative embolization can reduce intraoperative blood loss. CASE PRESENTATION: We report two patients with a carotid body tumor extending to the skull base who underwent preoperative embolization of the external carotid artery using an Amplatzer vascular plug. Two days after embolization, surgical resection was performed. Embolization was successful in both patients and resection proceeded smoothly. Both were discharged on postoperative day 9 without complications. The tumor in each patient was classified as Shamblin group III. Computed tomography angiography of the neck six months after surgery showed patency of the ipsilateral internal carotid artery and no tumor recurrence. CONCLUSION: Preoperative embolization of the external carotid artery using the Amplatzer vascular plug is safe and feasible for patients with carotid body tumors extending to the skull base.

Early and midterm outcomes of in situ fenestration via adjustable puncture needle for Ankura aortic stent graft: A single-center experience.

OBJECTIVES: An analysis was conducted to demonstrate early and midterm outcomes of using adjustable puncture needle-based in situ fenestration (ISF) technique for Ankura aortic stent graft to reconstruct the supra-arch branch in thoracic endovascular aortic repair (TEVAR). METHODS: A retrospective analysis of 68 cases of aortic lesions with insufficient proximal anchoring area admitted to our department from March 2017 to December 2021 was performed. In situ fenestration thoracic endovascular repair (TEVAR) was performed at the same time during the operation. Among them, there were fifty-eight cases of thoracic aortic dissection, seven cases of thoracic aortic aneurysm, and three cases of thoracic aortic ulcer. Intraoperative adjustable puncture with needle was used for the Ankura aorta stent graft to perform ISF and reconstruction of the supra-arch branch. RESULTS: The success rate of ISF was 94.1% (64/68). Only in four cases, attempts were made to create ISF in the left subclavian artery (LSA), and all the four were unsuccessful because of sharp and tortuosity angle. Among them, forty-four cases were only LSA fenestration, and one case was left common carotid artery (LCCA) fenestration + LSA embolism. LSA + left vertebral artery (LVA) fenestration was performed in two cases, LSA fenestration +LCCA chimney was performed in fourteen cases, LCCA + LSA fenestration + innominate artery (INA) chimney was performed in one case, and LCCA fenestration + INA chimney + LSA embolism was performed in two cases. The overall neurologic event rate was 3.1% (spinal cord ischemia 0, with stroke observed in two cases). Postoperatively, one patient (1.6%) died on the third day after TEVAR due to the retrograde dissections. There were four cases of endoleak (6.3%; three type I and one type II). The average follow-up was 29.2 ± 14.4 months, and no patient died during the follow-up period. Three cases of endoleak disappeared, and one case did not increase further. In addition, other two cases of retrograde dissections were observed at 3 and 5 months after TEVAR. Fortunately, they were scheduled for emergency surgery with ascending aorta replacement and improved well. There was only one case of LSA occlusion after ISF which was reconstructed by endovascular treatment. Two patients were found with distal stent graft-induced new entries (dSINE), and TEVAR was performed again during the follow-up period. CONCLUSION: Early and midterm outcomes demonstrated that ISF via the adjustable puncture needle device for the Ankura aorta stent graft is a feasible and effective treatment method, which can achieve high technical success and satisfactory short-term results.

Percutaneous mechanical thrombectomy in the management of early acute superior mesenteric artery embolism.

PURPOSE: This study was performed to summarize our experience in the management of early-stage acute superior mesenteric artery embolism (ASMAE) by percutaneous mechanical thrombectomy (PMT). METHODS: The clinical data of 12 patients with early-stage ASMAE treated by PMT in our institution from November 2019 to September 2021 were retrospectively analyzed. The patients had no obvious evidence of bowel infarction as shown by peritoneal puncture and computed tomography angiography. Thrombectomy of the superior mesenteric artery was performed using a 6F AngioJet catheter. RESULTS: The emboli were completely removed in 10 (83.3%) patients. Six patients were treated only by the AngioJet device. The other six patients underwent combined treatment with a 6F multipurpose drainage catheter after PMT, including one patient who underwent simultaneous stent implantation. Two patients showed no significant improvement in their symptoms after the operation; one was found to have intestinal necrosis and underwent resection by exploratory laparotomy, and the other died of septic shock 3 days after PMT (further intervention had been discontinued because of complications with multiple underlying diseases). No other PMT-related complications occurred. Only one patient was found to have a pseudoaneurysm of the superior mesenteric artery 1 week after PMT and underwent resection by exploratory laparotomy. The 11 surviving patients were smoothly discharged from the hospital after their symptoms were relieved. At a mean follow-up of 13.2 months, computed tomography angiography showed smooth patency of the superior mesenteric artery. No patients developed serious symptoms during follow-up. CONCLUSIONS: PMT by the AngioJet device is a minimally invasive, safe, and effective technique to remove ASMAE. Early application of PMT can avoid acute intestinal necrosis. Combining the AngioJet device with a 6F multipurpose drainage catheter might be more helpful to remove residual emboli.

LncRNA FGD5-AS1 Promotes Abdominal Aortic Aneurysm Growth Through the Activation of MMP3 in Vascular Smooth Muscle Cells.

Long noncoding RNAs (lncRNAs) can serve as treatment targets for abdominal aortic aneurysms (AAAs). Nonetheless, the exact role of FGD5 antisense RNA 1 (FGD5-AS1) in AAAs is unclear. Therefore, this study investigated the contribution of FGD5-AS1 to AAA growth regulated by vascular smooth muscle cells (VSMCs) and its potential mechanisms. ApoE-/- mice were used to establish the angiotensin II (Ang II)-elicited AAA model. RNA pull-down assay and dual luciferase reporter assay (DLRA) in human VSMCs were used in examining the interactions between FGD5-AS1 and its downstream proteins or miRNA targets. FGD5-AS1 expression in the mouse Ang II perfusion group was dramatically increased relative to the PBS-infused group. In the mouse AAA model, FGD5-AS1 overexpression induced SMC apoptosis, thereby promoting AAA growth. miR-195-5p acts as a potential FGD5-AS1 downstream target, whereas FGD5-AS1 promotes MMP3 expression by inhibiting miR-195-5p expression, thereby inhibiting proliferation and promoting apoptosis of smooth muscle cells. LncRNA FGD5-AS1 is detrimental to the proliferation and survival of SMCs during AAA growth. Therefore, FGD5-AS1 could be a novel treatment target for AAA.

Application of Kissing Technique for the Treatment of Superior Vena Cava Syndrome.

BACKGROUND: Superior vena cava syndrome is a series of symptoms caused by compression of the superior vena cava and its main branches. Endovascular therapy is now widely accepted because it offers rapid, safe and effective relief of clinical symptoms. Few reports have described the application of kissing technique for the treatment of superior vena cava syndrome. In this report, we review a series of cases in which superior vena cava syndrome was treated by kissing technique and we share our experience. METHODS: Our institute treated 22 patients with SVCS by endovascular intervention from November 2016 to June 2021; among them, the kissing technique was used in 10 cases and achieved satisfactory results. This is a retrospective evaluation and analysis of 10 patients with superior vena cava syndrome who were treated by endovascular intervention using the kissing technique from May 2018 to April 2021 in Hwa Mei Hospital, University of Chinese Academy of Sciences. Based on literatures, we summarize the diagnosis, treatment, and surgical experience. RESULTS: All patients underwent the implantation of the kissing stents, and the technical success rate was 100%. The symptoms and signs of intravenous obstruction in all patients were alleviated or disappeared within 1-3 days after the procedure. During the follow-up period, 9 patients remained free from any clinical signs or symptoms, and 1 patient died 1 month after the procedure due to the progression of malignant tumors. CONCLUSIONS: As a palliative intervention, the kissing technique for the treatment of superior vena cava syndrome caused by malignant tumors is safe, rapid, and effective. Successful endovascular therapy can quickly relieve symptoms, improve the patient's quality of life, and provide more opportunities for subsequent antitumor treatment.

Vertebral artery course variation leading to an insufficient proximal anchoring area for thoracic endovascular aortic repair.

BACKGROUNDS: We aimed to demonstrate the feasibility of thoracic endovascular aortic repair for type B aortic dissection in patients with an insufficient proximal anchoring area due to the vertebral artery originating from the aortic arch. METHODS: In this study, we report two patients with type B aortic dissection who were complicated with left vertebral artery course variation. Specifically, the left vertebral artery originated from the aortic arch. In these patients, the anchoring area (<15 mm) was not sufficient between the left vertebral artery and the ruptured aortic dissection. RESULT: We reconstructed the left vertebral artery during horacic endovascular aortic repair. Both patients recovered well and were discharged without any adverse events. CONCLUTION: Our experience shows that horacic endovascular aortic repair is feasible in patients with type B aortic dissection who have an insufficient proximal anchoring area due to the left vertebral artery originating from the aortic arch.

Acute Pancreatitis: A Rare Complication After Percutaneous Mechanical Thrombectomy of Portal Vein Thrombosis.

BACKGROUND: Acute pancreatitis caused by Percutaneous Mechanical Thrombectomy treatment is extremely rare, and so far, no clinical report involving portal veins has been reported. In the article, we summarize this unusual case and share our experience. METHODS: Percutaneous mechanical thrombectomy was performed for the patient who was diagnosed with portal vein thrombosis. Postoperatively, the patient was complicated by acute pancreatitis and received a series of medical treatments. RESULTS: During the first month of follow-up, the patient was free of any clinical symptoms or signs. CONCLUSIONS: When performing percutaneous mechanical thrombectomy therapy, it is crucial to grasp the time limit strictly, strengthen perioperative rehydration and urine alkalinization to prevent massive hemolysis and subsequent complications. Early detection and the early administration of therapy for this potentially severe complication are essential for obtaining a good prognosis.

Spontaneous Spinal Subdural Hematoma after Percutaneous Mechanical Thrombectomy Combined with Catheter-Directed Thrombolysis for Deep Venous Thrombosis: A Case Report.

BACKGROUND: Percutaneous mechanical thrombectomy combined with catheter-directed thrombolysis is one of the most important methods for deep venous thrombosis treatment. Spontaneous spinal subdural hematoma is a remarkably rare complication in the thrombolysis process with catastrophic consequences, as shown in this case report. METHODS: Percutaneous mechanical thrombectomy, percutaneous angioplasty, and catheter-directed thrombolysis were performed for the patient. Postoperatively, the patient was diagnosed with spontaneous spinal subdural hematoma and received a series of medical treatments and surgical interventions. RESULTS: The patient was still paraplegic and incontinent at the postoperative 7-month follow-up. CONCLUSIONS: Neurologic symptoms must be monitored carefully both during and after the thrombolysis procedure. The onset of spinal neurologic deficits in any patient must raise the suspicion that a spinal subdural hematoma has occurred. Surgical decompression beyond 24 hr may cause permanent neurological damage.

[Efficacy of percutaneous mechanical thrombectomy combined with percutaneous transluminal angioplasty in treatment of iliofemoral deep vein thrombosis].

OBJECTIVE: To evaluate the clinical efficacy of percutaneous mechanical thrombectomy (PMT) combined with percutaneous transluminal angioplasty (PTA) in the treatment of iliofemoral deep vein thrombosis. METHODS: Ninety-four patients with iliofemoral deep vein thrombosis were identified in this retrospective study in our institution from November 2015 through December 2017. Patients were divided into two groups:PMT+PTA group (n=50) and PMT only group (n=44). Clot lysis rates, the retrieving and the embolism of the interior vena cava filter, as well as the incidence of complications were compared between two groups. The changes of serum creatinine, lactate dehydrogenase and hemoglobin were also measured perioperatively. RESULTS: All procedures were completed successfully. The average clot lysis rate was higher and the procedure time was shorter in PMT+PTA group than those in PMT group (both P<0.01). No significant differences were found in the rates of venous stenosis, catheter-directed thrombolysis and stent placement between two groups (all P>0.05). The interior vena cava filter was taken out in 82.0% (41/50) patients of PMT+PTA group and 81.8% (36/44) patients of PMT group (P>0.05). There were no significant differences of the changes in serum creatinine, lactate dehydrogenase and hemoglobin (all P>0.05). In PMT+PTA group, symptomatic pulmonary embolism and puncture bleeding occurred in 1(2.0%) and 2(4.0%) patients, while in PMT group, it was 0 and 2(4.5%), respectively (P>0.05). CONCLUSIONS: PMT combined with PTA is more effective than PMT alone for the treatment of iliofemoral deep vein thrombosis with less procedure time and without more incidence of pulmonary embolism.

[Comparison of mechanical thrombectomy with transcatheter thrombolysis for acute iliac femoral venous thrombosis].

OBJECTIVE: To compare the efficacy of mechanical thrombectomy with transcatheter thrombolysis in the treatment of acute iliac femoral venous thrombosis. METHODS: The clinical data of 170 patients with acute iliac venous thrombosis treated in Ningbo No.2 Hospital from September 2015 to September 2017 were retrospectively reviewed. Among them, 94 cases were treated with AngioJet mechanical thrombolysis or additional thrombolysis for residual thrombus (PMT group) and 76 cases were treated with catheter-directed thrombolysis(CDT group). After thrombolytic treatment if there was stenosis of iliac vein, the transluminal angioplasty was also performed. The clearance of thrombus and safety were evaluated and compared between two groups. RESULTS: In PMT group there were 86 cases (91.5%) with grade Ⅲ, 5 cases (5.3%) with grade Ⅱ, 3 cases (3.2%) with grade Ⅰ clearance of thrombus; while in CDT group, there were 63 cases (82.9%) with grade Ⅲ, 7 cases (9.2%) with grade Ⅱ and 6 cases (7.9%) with grade Ⅰ clearance of thrombus (P>0.05). The differences of diameter of two lower extremities 15 cm above knee after treatment in PMT and CDT groups were (2.3±0.9) cm and (2.5±1.1) cm, respectively (P>0.05). The time of thrombolysis in group PMT was significantly shorter than that in group CDT[(2.6±1.2) d vs. (5.3±1.5) d, P<0.05]. The dosage of urokinase in PMT group was significantly lower than that in CDT group[(15.0±5.0)×105 U vs. (26.5±7.5)×105 U, P<0.05]. Hemoglobin decrease was observed in both groups, which was more significant in PMT group (P<0.01). During the following period, there was no significant difference in the incidence of recurrence and post-thrombosis syndrome in two groups (all P>0.05). CONCLUSIONS: Both PMT and CDT have good thrombus clearance effect in the treatment of acute iliac femoral venous thrombosis, however, PMT has the advantages of short thrombolytic time and less urokinase.

[Long-term efficacy of percutaneous mechanical thrombectomy combined with stent implantation in treatment of acute iliofemoral venous thrombosis].

OBJECTIVE: To evaluate the long-term efficacy of percutaneous mechanical thrombectomy (PMT) combined with stent implantation in treatment of acute iliofemoral vein thrombosis. METHODS: Seventy patients with acute iliac vein thrombosis were treated with PMT combined stent implantation in Ningbo No.2 Hospital from November 2015 to November 2017. During the follow-up, the improvement of blood flow was evaluated, the occurrence of post-thrombotic syndrome was assessed by the Villalta rating scale, and the stent patency was examined with lower extremity ultrasound or angiography. RESULTS: The blood flow was significantly improved after procedure in all 70 patients, including 62 cases (88.6%) of grade Ⅲ clearance, 5 cases (7.1%) of grade Ⅱ clearance, and 3 cases (4.3%) of grade Ⅰ clearance. No significant complications occurred during the treatment. The patients were followed up for (15.0±2.5) months. During the follow-up, 64 patients (91.4%) had unobstructed stents, and 9 patients (12.8%) had post-thrombotic syndrome. CONCLUSIONS: PMT combined with stent implantation is effective in the treatment of acute iliac vein thrombosis with a high medium-and long-term stent patency rate.

Pseudoaneurysm as a rare complication in the treatment of superior mesenteric artery embolism via percutaneous mechanical thrombectomy: a case report.

Percutaneous mechanical thrombectomy is a safe and effective treatment for addressing thrombosis in various embolic diseases. In recent years, this approach has also been actively applied in the management of acute embolic occlusion of the superior mesenteric artery. A pseudoaneurysm as a complication of this operation is remarkably rare. This is the first case report of the diagnosis and treatment of a pseudoaneurysm that developed as a complication after the application of percutaneous mechanical thrombectomy via an AngioJet device for thrombolysis in the superior mesenteric artery.

Twelve-Month Results From the First-in-China Prospective, Multi-Center, Randomized, Controlled Study of the FREEWAY Paclitaxel-Coated Balloon for Femoropopliteal Treatment.

Background: Several paclitaxel-coated balloons have been proved to provide better efficacy results than uncoated balloons in femoropopliteal lesions. But the efficacy and safety of FREEWAY balloons have not been investigated in Chinese patients. This study aimed to evaluate the efficacy and safety performance of FREEWAY paclitaxel-coated balloons vs. uncoated balloons in Chinese femoropopliteal artery lesions. Methods: In this prospective multi-center randomized controlled FREEWAY-CHINA study, 311 patients with symptomatic lower limb ischemia (Rutherford category 2-5) and femoropopliteal lesions of 14 Chinese centers were randomly assigned in a 1:1 ratio to endovascular treatment with either FREEWAY paclitaxel-coated balloons or uncoated balloons (control). The primary endpoint was the 6-month clinically-driven target lesion revascularization (CD-TLR) rate. Secondary endpoints included the device and technical success rate, the ankle-brachial indexes (ABIs), Rutherford category change, the 6-month primary and secondary patency rates, severe adverse effects, and the 12-month CD-TLR rate. Results: The two groups were comparable in terms of their demographic and lesion characteristics. Patients' mean age was 70 years, and 70% were men. The mean lesion length was 71 mm. The 6-month CD-TLR rate was 2.6% in the FREEWAY group and 11.7% in the control group (P = 0.001). The 12-month CD-TLR rate was 2.7% in the FREEWAY group and 13.2% in the control group (P = 0.0005). Other endpoints, including patency rates, major adverse events, and ABI or Rutherford change, did not differ between the two groups. Conclusion: The FREEWAY balloon resulted in an effective decrease in CD-TLR rates and had similar safety results compared to the uncoated balloon in Chinese femoropopliteal artery patients at the 12-month follow-up appointment.

Docosahexaenoic acid inhibits vascular smooth muscle cell migration and proliferation by decreasing microRNA­155 expression levels.

Vascular smooth muscle cell (VSMC) hyperplasia is a common cause of carotid restenosis. In the present study, the potential protective effects of docosahexaenoic acid (DHA) in carotid restenosis and the underlying mechanism of its effects were examined. VSMCs were treated with DHA, a polyunsaturated ω­3 fatty acid. Cell migration and proliferation were assessed using wound healing and Cell Counting Kit­8 assays and by measuring Ki­67 protein levels. Additionally, the expression levels of microRNA­155 were determined by reverse transcription­quantitative PCR (RT­qPCR). The involvement of microRNA­155 in the regulation of migration and proliferation was evaluated by transfecting VSMCs with microRNA mimics and inhibitors. Moreover, the reversal of migration and proliferation after transfection of VSMCs with the microRNA mimics and subsequent treatment with DHA was investigated. A target gene of microRNA­155 was identified using RT­qPCR and luciferase assays. The migration and proliferation of VSMCs, as well as the expression of microRNA­155 was inhibited by DHA stimulation. MicroRNA­155 regulated the migration and proliferation of VSMCs. Finally, proliferation and migration of VSMCs were reduced following DHA treatment, which was mediated by an increase in the expression levels of microRNA­155. Suppressor of cytokine signalling 1 (Socs1) was the target gene of microRNA­155. In conclusion, DHA inhibited VSMC migration and proliferation by reducing microRNA­155 expression. This effect may be caused by the microRNA­155 target gene Socs1.