In this randomized trial, patients undergoing hemodialysis who had native upper-extremity arteriovenous fistula stenosis received drug-coated or standard balloon angioplasty after initial successful ...transluminal angioplasty. The drug-coated balloon was superior to the standard balloon and was noninferior with respect to access circuit-related serious adverse events.
To review safety and feasibility in a single center using transradial access (TRA) for noncoronary interventions.
Retrospective analysis was performed of 946 patients evaluated for 1,531 consecutive ...TRA procedures from April 2012 to July 2015. Exclusion criteria included sheath > 6 F, Barbeau D waveform, radial artery (RA) diameter < 2 mm on ultrasound, history of severe aortic tortuosity or RA occlusion, and dialysis. TRA was attempted in 936 patients (62% men; median age, 62.4 y) who underwent 1,512 consecutive procedures (chemoembolization n = 485, yttrium-90 mapping n = 391 and infusion n = 293, renal/visceral intervention n = 172, uterine artery embolization n = 116, peripheral intervention n = 43, endoleak repair n = 10, and other n = 2). Patients were evaluated for complications during follow-up at ~30 days.
Technical success was 98.2% (1,485/1,512). Major complications (0.13%) included pseudoaneurysm (n = 1) and seizure (n = 1). Minor complications (2.38%) included hematoma/bleeding (n = 13), RA occlusion (n = 11), arm pain (n = 6), and RA spasm (n = 6). Univariate analysis demonstrated a lower rate of adverse events in African American patients (hazard ratio HR, 0.25; 95% confidence interval CI, 0.07-0.86; P = .027). Twenty-seven cases (1.8%) required crossover to transfemoral access (TFA). Crossover rates were higher in female patients (P = .0055), height < 1.7 m (P = .024), renal/visceral interventions (P = .0003), and endoleak interventions (P = .0357). Multivariate analysis demonstrated intervention type to be the only significant predictor of TFA crossover (renal/visceral HR, 4.48; 95% CI, 1.84-10.9; P = .001; endoleak repair HR, 9.54; 95% CI, 1.09-83.8; P = .042).
TRA was safe and well tolerated in a heterogeneous patient population across a range of peripheral vascular interventions.
Abstract
The SARS-COV-2/ COVID-19 pandemic created unique, once in a lifetime challenges for healthcare workers across the globe. One of the challenges specific to interventional radiology was the ...increased incidence of vascular thrombosis leading to urgent and emergent clinical patient management issues. Limited healthcare resources and complex clinical presentations required innovative solutions, and workflows to manage the increased burden on the healthcare providers.
Background The optimal treatment for critical limb ischemia remains controversial owing to conflicting conclusions from previous studies. Methods and Results We obtained administrative claims on ...Medicare beneficiaries with initial critical limb ischemia diagnosis in 2011. Clinical outcomes and healthcare costs over 4 years were estimated among all patients and by first treatment (endovascular revascularization, surgical revascularization, or major amputation) in unmatched and propensity-score-matched samples. Among 72 199 patients with initial primary critical limb ischemia diagnosis in 2011, survival was 46% (median survival, 3.5 years) and freedom from major amputation was 87%. Among 9942 propensity-score-matched patients (8% rest pain, 26% ulcer, and 66% gangrene), survival was 38% with endovascular revascularization (median survival, 2.7 years), 40% with surgical revascularization (median survival, 2.9 years), and 23% with major amputation (median survival, 1.3 years; P<0.001 for each revascularization procedure versus major amputation). Corresponding major amputation rates were 6.5%, 9.6%, and 10.6%, respectively ( P<0.001 for all pair-wise comparisons). The cost per patient year during follow-up was $49 700, $49 200, and $55 700, respectively ( P<0.001 for each revascularization procedure versus major amputation). Conclusions Long-term survival and cost in critical limb ischemia management is comparable between revascularization techniques, with lower major amputation rates following endovascular revascularization. Primary major amputation results in shorter survival, higher risk of subsequent major amputation, and higher healthcare costs versus revascularization. Results from this observational research may be susceptible to bias because of the influence of unmeasured confounders.
Objective There have been four eras in the development of endovascular aneurysm repair (EVAR): physician-made grafts, early industry devices, intermediary commercial endografts, and modern stent ...grafts. This study analyzes differences in outcomes between these four groups and the impact of device evolution and increased physician experience. Methods From 1992 to 2012, 1380 patients underwent elective EVAR. Fourteen different devices were used during this time. The four generations were defined as follows: era 1, all physician-made devices; era 2, June 1994 to June 2003; era 3, June 2003 to January 2008; and era 4, January 2008 to July 2012. Grafts used in each era were the following: era 1, physician made; era 2, early industry, such as EVT, Talent, AneuRx, Excluder, Quantum LP, Vanguard, Ancure, and Teramed; era 3, Talent, Endologix, Excluder, AAAdvantage, Zenith, and Aptus; and era 4, Zenith, Endurant, and Excluder. Results Mean age was 75.2 years, and 84.5% were men. Adjunctive procedures decreased from era 1 to era 2 ( P < .001) but rose again in eras 3 and 4 ( P < .001). Procedure times ( P < .001), blood loss ( P < .001), and length of stay ( P < .001) have decreased in eras 2, 3, and 4 compared with era 1. Major perioperative complications (era 1, 23%; era 2, 5.9%; era 3, 4.9%; and era 4, 4.7%; P < .001), abdominal aortic aneurysm-related perioperative mortality (era 1, 4.3%; era 2, 0.2%; era 3, 0.06%; and era 4, 0.5%; P < .001), and all-cause perioperative mortality (era 1, 7.7%; era 2, 1.9%; era 3, 1.5%; and era 4, 0.47%; P < .001) have also decreased in eras 2, 3, and 4 compared with era 1. Type I and type III endoleaks ( P < .001) and the need for reintervention ( P < .001) have decreased. Freedom from aneurysm-related mortality has significantly improved. Conclusions EVAR has evolved during the last 20 years, resulting in an improvement in efficiency, outcomes, and procedural success. The most significant advance is seen in the transition from era 1 to the later eras.
Several treatment options exist for acute intra-abdominal arterial thromboembolic events, including systemic thrombolytics, endovascular therapy, and less commonly surgery. A novel alternative ...treatment intervention for acute intra-abdominal arterial thrombus is the use of stent retriever (SR) devices, tools traditionally applied for treatment of acute vascular thrombosis in stroke patients. This brief report presents two cases of acute intra-abdominal arterial thrombosis successfully managed by deployment of SRs. Furthermore, it details the history, device mechanism, and design of SRs and describes cases in literature involving effective extracranial SR application.
The lack of consistent definitions and nomenclature across clinical trials of novel devices, drugs, or biologics poses a significant barrier to accrual of knowledge in and across peripheral artery ...disease therapies and technologies. Recognizing this problem, the Peripheral Academic Research Consortium, together with the U.S. Food and Drug Administration and the Japanese Pharmaceuticals and Medical Devices Agency, has developed a series of pragmatic consensus definitions for patients being treated for peripheral artery disease affecting the lower extremities. These consensus definitions include the clinical presentation, anatomic depiction, interventional outcomes, surrogate imaging and physiological follow-up, and clinical outcomes of patients with lower-extremity peripheral artery disease. Consistent application of these definitions in clinical trials evaluating novel revascularization technologies should result in more efficient regulatory evaluation and best practice guidelines to inform clinical decisions in patients with lower extremity peripheral artery disease.
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