Purpose
To evaluate the effect of percutaneous transluminal angioplasty (PTA) on haemodialysis fistulas utilising drug-coated balloons with plain balloon vessel preparation (DCB).
Materials and ...Methods
In the study group, 31 patients (16 men; mean age 62.8 ± 17.2 years) with failing arteriovenous fistulas were treated, with DCB, and compared with a control group (31 patients; 15 men; mean age 67.0 ± 8.44 years), in which only plain balloon PTA was performed. All stenoses were dilated with regular PTA balloons. After achieving haemodynamic success (< 30% residual stenosis), drug-coated balloons were used for drug administration in the study group. The follow-up intervals were 6, 12 and 24 months. Target lesion primary patency, primary assisted patency and secondary patency were compared. The statistical significance was set at 0.05.
Results
Target lesion primary patency was compared in both groups and was significantly higher in the study group (DCB) at 6 months (90.3 vs. 61.3%;
p
= 0.016), 12 months (77.4 vs. 29%;
p
= 0.0004) as well as 24 months (45.2 vs. 16.1%;
p
= 0.026). Kaplan–Meier survival curves also showed a significant difference for target lesion primary patency (534.2 vs. 315.7 days;
p
= 0.0004). There were no significant differences in target lesion primary assisted patency and in secondary patency. However, only 38.7% of patients in the study group were treated twice or more versus 80.6% in the control group (
p
= 0.002).
Conclusion
DCB increases target lesion primary patency during the first 24 months and decreases the rate of reinterventions.
We discuss a rare case of Stanford type A aortic dissection (TAAD) occurring several months after endovascular aneurysm repair (EVAR) of the abdominal aortic and the common iliac artery (CIA) ...aneurysms. The patient underwent urgent surgery for TAAD treatment but died on the table due to intractable bleeding. We conclude that TAAD was likely unrelated to the initial EVAR procedure but rather to atherosclerosis, hypertension, and prior aortic valve replacement. Only a few cases in the literature report TAAD and total collapse of the abdominal aortic stent graft.
Drug-coated balloon angioplasty may present an efficient alternative to traditional balloon angioplasty and stenting, which suffer from high rates of restenosis and increased risk of stent fractures ...in the anatomically unfavorable regions, such as the superficial femoral artery in the adductor canal. Although pseudoaneurysms are the most common vascular access site complications, they are considerably rarer at the site of the endovascular treatment. They can be caused by several mechanisms, including stent fractures, usage of oversized balloons, high-pressure inflations, and infections. In addition, paclitaxel, the drug released from drug-coated balloons, may also play a significant role in the formation and exacerbation of pseudoaneurysms. The exact pathophysiology remains unclear, but it may be due to a combination of paclitaxel's suppression of neointimal healing and immune response, cytotoxic properties, and hypersensitivity-related inflammation.
Abdominal aortic injury (AAI) due to blunt trauma is rare and is often complicated by thrombosis within the true and false lumens and sometimes aortic rupture. No standard guidelines for treatment ...are available. We present the case of a 44-year-old female patient with posttraumatic dissection of the abdominal aorta, which was referred to our institution for endovascular aortic repair (EVAR). The patient was referred to our institution after emergency surgery following blunt abdominal trauma due to a car accident. Initial computed tomography (CT), performed at the referring hospital, showed multiple bone injuries with pneumothorax, liver and spleen lacerations, and rupture of the anterior abdominal wall with mesenteric injury and active intraperitoneal extravasation of contrast media from visceral arteries. Initial CT also showed dissection of the distal part of the abdominal aorta. Due to hemodynamic instability, emergency surgery was performed for intraperitoneal injuries. Control computed tomography angiography (CTA) after surgery confirmed a dissection of the distal part of the abdominal aorta at the level of the bifurcation protruding into the right common iliac artery with partial thrombosis of the right iliac artery and no active extravasation of the contrast media at the level of the aorta. An aberrant left renal artery was also identified. A hemodynamically stable patient was transferred to our institution for emergency EVAR which was performed without intraprocedural complications. Control CTA after EVAR showed a good result of the procedure with minimal type 2 endoleak and no extravasation. EVAR can also be used to treat AAI without active extravasation to prevent future total rupture of the aortic wall.
Vascular calcification is a frequent complication of chronic kidney disease and end stage renal disease. In both the general population and patients with end stage renal disease, vascular ...calcification is related to arterial stiffness and is a predictor of cardiovascular morbidity and mortality. Various diagnostic methods are currently used to assess vascular calcification. There is a preference for simple, reliable methods that can be used in daily practice. Therefore, several imaging and laboratory methods are investigated. Twenty‐eight patients with mean age of 62 years on chronic hemodialysis were enrolled in the study. The mean duration of hemodialysis treatment was 70 months (range 3 to 350 months). Vascular calcification was assessed with coronary computed tomography and lateral lumbar, pelvic and hand radiographs. Vascular stiffness was evaluated using aortic pulse wave velocity and ankle‐brachial index measurements, and finally serum levels of fibroblast growth factor‐23 were followed. A statistically significant correlation was demonstrated between all the following parameters: coronary artery calcification score, aortic pulse wave velocity, abdominal aortic calcification score, simple vascular calcification scores in pelvis and hand. A statistically significant correlation of ankle‐brachial index >1.3 to coronary artery calcification score was found. There was no correlation between the previous parameters and fibroblast growth factor‐23. The results of our study indicate that simple imaging methods could provide confident vascular damage assessment and therefore potentially guide therapy adjustments. An association between fibroblast growth factor‐23 and the other diagnostic modalities in our study was not found.
Background: Complex renal artery aneurysms (RAA) involving major branches of renal artery are difficult to treat. Surgery may be associated with extensive invasiveness and morbidity in the context of ...major intra-abdominal surgery. Stentgrafts or selective coil embolization are contraindicated when large branches are involved in the aneurysmal sac. A case of the patient with complex renal artery aneurysm involving all major arterial branches treated with a new type of multilayer stent is described. Case report: A 56-year old woman whose right kidney had been removed five years before because of renal cell carcinoma was incidentally found to have a large (22 x 26 mm) saccular aneurysm in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent. Conclusion: New multilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case.
Bilhemia is a rare but potentially lethal condition representing abnormal communication and flow of bile into the bloodstream. We present a case of iatrogenic bilhemia after a percutaneous liver ...biopsy in a patient with cholangiocarcinoma. The bilio-venous fistula was visualized with percutaneous cholangiography and successfully embolized using coils and the liquid embolic agent Onyx. To our knowledge, this is the first report of using Onyx for the embolization of a bilio-venous fistula.Bilhemia is a rare but potentially lethal condition representing abnormal communication and flow of bile into the bloodstream. We present a case of iatrogenic bilhemia after a percutaneous liver biopsy in a patient with cholangiocarcinoma. The bilio-venous fistula was visualized with percutaneous cholangiography and successfully embolized using coils and the liquid embolic agent Onyx. To our knowledge, this is the first report of using Onyx for the embolization of a bilio-venous fistula.
Chronic kidney disease (CKD) is strongly associated with a high burden of cardiovascular morbidity and mortality. Therefore, we aimed to characterize the putative role of microRNAs (miR)s in uremic ...vascular remodelling and endothelial dysfunction.
We investigated the expression pattern of miRs in two independent end-stage renal disease (ESRD) cohorts and in the animal model of uremic DBA/2 mice via quantitative RT-PCR. Moreover, DBA/2 mice were treated with intravenous injections of synthetic miR-142-3p mimic and were analysed for functional and morphological vascular changes by mass spectrometry and wire myography.
The expression pattern of miRs was regulated in ESRD patients and was reversible after kidney transplantation. Out of tested miRs, only blood miR-142-3p was negatively associated with carotid-femoral pulse-wave velocity in CKD 5D patients. We validated these findings in a murine uremic model and found similar suppression of miR-142-3p as well as decreased acetylcholine-mediated vascular relaxation of the aorta. Therefore, we designed experiments to restore bioavailability of aortic miR-142-3p in vivo via intravenous injection of synthetic miR-142-3p mimic. This intervention restored acetylcholine-mediated vascular relaxation.
Taken together, we provide compelling evidence, both in humans and in mice, that miR-142-3p constitutes a potential pharmacological agent to prevent endothelial dysfunction and increased arterial stiffness in ESRD.
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•Blood miR-142-3p is associated with pulse-wave velocity in uremic patients.•miR-142-3p was associated with decreased vascular relaxation in uremic mice.•Injection of miR-142-3p mimic restored acetylcholine-mediated aortic relaxation.•miR-142-3p might prevent endothelial dysfunction and arterial stiffness in uremia.
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