Development of a scoring system to predict endovascular crossing of femoropopliteal artery chronic total occlusions: the endo VAscular CROSsing score for chronic total occlusions (EVACROSS-CTO).

Objectives: To develop a predictive score for the prediction of successful endovascular crossing in femoropopliteal artery chronic total occlusions (CTOs).

Methods: In this retrospective study, 84 patients were divided 70%:30% into a training and a testing cohort. Parameters such as cap morphology, side branches, bridging collaterals, flush occlusion, and length were derived from preprocedural CT angiography.

Endovascular treatment of upper limb phlegmasia cerulea dolens in a hemodialysis patient.

Phlegmasia cerulea dolens (PCD) is a rare but limb-threatening complication of deep vein thrombosis. A 72-year-old hemodialysis male patient presented with upper limb PCD. The patient underwent hemodialysis via a permanent hemodialysis central venous catheter (HD-CVC) while a new brachial-cephalic AVF was created 1 month ago.

Utility of Dual-Energy Computed Tomography in lesion characterization and treatment planning for peripheral Chronic Total Occlusions: A comprehensive analysis of crossing difficulty.

Purpose: To investigate whether Dual-Energy Computed Tomography (DECT) could be useful in the lesion characterization and endovascular treatment planning of symptomatic patients with peripheral arterial disease (PAD) due to Chronic Total Occlusions (CTO).

Materials And Methods: Between 2018 and 2022, 60 symptomatic patients (52 male, age 71 years) with peripheral arterial CTO underwent DECT angiography before percutaneous endovascular treatment. Patients were classified, according to guidewire crossing difficulty into four categories, which were subsequently correlated with DECT values, including Dual Energy Index (DEI) and Effective Z (Zeff).

Concomitant vascular and orthopedic trauma: 10 points to consider.

Although vascular injuries complicate only 1-2% of patients with orthopedic trauma, they may be encountered in a much higher rate of around 10 % in injuries around the knee and elbow joints following both fractures and dislocations. In case of vascular involvement, specific diagnostic and therapeutic challenges arise and there is a higher risk for significant morbidity (i.e.

Technical challenges during emergent endovascular aneurysm repair with the ALTO system.

Introduction: Ruptured abdominal aortic aneurysms (AAAs) pose an immediate threat for patient's life and endovascular repair (EVAR) is currently the preferred treatment modality in the presence of suitable anatomy. This is determined based on the requirements of each endograft as described in the instructions for use (IFU). The new ALTO system (Endologix, Irvin, CA, U.

Central venous catheters: Which, when and how.

Short-term or long-term CVCs are now considered the standard of practice for the administration of chemotherapy, fluid therapy, antibiotic therapy, and parenteral nutrition. Central venous access catheters are broadly divided into tunneled or non-tunneled catheters. Tunneled catheters can be further subdivided into totally implanted and totally not implanted devices.

Effect of Sac Asymmetry, Neck and Iliac Angle on the Hemodynamic Behavior of Idealized Abdominal Aortic Aneurysm Geometries.

Background: Abdominal aortic aneurysms (AAAs) are currently treated based on the universal maximum diameter criterion, but other geometric variables may play a role in the risk of rupture. The hemodynamic environment inside the AAA sac has been shown to interact with several biologic processes which can affect prognosis. AAA geometric configuration has a significant impact in the hemodynamic conditions that develop, which has only been recently realized, with implications for rupture risk estimations.

Management of Inadvertent Arterial Catheterization during Central Venous Catheter Placement: A Case Series.

Percutaneous central venous catheterization, although a widely used technique in ICU patients worldwide, is not devoid of complications even under real-time ultrasound guidance. Arterial puncture is a well-recognized complication, while unintended subclavian or carotid artery cannulations during attempted central venous catheterization are infrequent, but documented complications with potentially deleterious consequences. Recently, endovascular balloon tamponade has emerged as the preferred initial approach to repair inadvertent arterial cannulations.

Dual-Energy Computed Tomography as an Adjunct in the Evaluation of Peripheral Chronic Total Occlusions: A Feasibility Study.

This study investigated the role of dual-energy computed tomography (CT) for lesion characterization in patients with peripheral arterial disease manifesting with chronic total occlusions (CTOs). Forty-one symptomatic patients with CTOs underwent dual-energy CT angiography before endovascular treatment. The lesions were subsequently analyzed in a dedicated workstation, and 2 indexes-dual-energy index (DEI) and effective Z (Z)-were calculated, ranging from 0.

Late Neck Related Adverse Events are Rare Among Patients with Wide Aortic Neck Undergoing Endovascular Aneurysm Repair with the Ovation Endograft.

Background: Patients with wide aortic necks undergoing Endovascular Aneurysm Repair (EVAR) have been shown to be at a higher risk for neck-related complications. We aim to examine outcomes of EVAR with an endograft exerting minimal outward pressure (Ovation-Endologix) in patients with a large baseline neck diameter.

Methods: We performed a retrospective single center study, including consecutive patients undergoing EVAR with the Ovation system from May 2011 to April 2021.

Perfusion imaging techniques in lower extremity peripheral arterial disease.

Lower limb peripheral arterial disease (PAD) characterizes the impairment of blood flow to extremities caused by arterial stenoses or occlusions. Evaluation of PAD is based on clinical examination, calculation of ankle-brachial index and imaging studies such as ultrasound, CT, MRI and digital subtraction angiography. These modalities provide significant information about location, extension and severity of macrovasular lesions in lower extremity arterial system.

Direct Iliac Vein Stenting in Phlegmasia Cerulea Dolens Caused by May-Thurner Syndrome.

Phlegmasia cerulea dolens (PCD) is an uncommon but potentially limb-threatening complication of acute deep vein thrombosis. A 56-year-old male presented with PCD. Color Doppler ultrasonography revealed extensive thrombosis of the left superficial and common femoral and external and common iliac veins.

Discrimination of High-Risk Type-2 Endoleak after Endovascular Aneurysm Repair through CT Perfusion: A Feasibility Study.

A type-2 endoleak after an endovascular aneurysm repair is the most prevalent type of endoleak, but as the clinical consequence of its diagnosis is uncertain, at present, management decisions are solely based on aneurysm sac growth. The aim of this study was to investigate the potential of various computed tomography perfusion parameters for their ability to distinguish high-risk type-2 endoleaks from low-risk type-2 endoleaks after an endovascular aneurysm repair.

The Use of a Suture Mediated Vascular Closure Device to Achieve Hemostasis following Arterial Access through Previously Implanted Synthetic Grafts.

Background: Percutaneous endovascular aneurysm repair (EVAR) and peripheral interventions using the Perclose Proglide suture mediated system has not been adequately studied in patients with synthetic grafts at access sites.

Methods: We report the use of the Perclose Proglide in 10 patients in whom previously inserted synthetic grafts in the groin were punctured for arterial access (5 for peripheral interventions and 5 undergoing EVAR). In patients undergoing peripheral interventions a single device was used, while in patients undergoing EVAR 2 devices were employed per access site.

Endovascular Treatment of Malignant Superior Vena Cava Syndrome through Upper-Limb Access: A Comparison between Venous-Dedicated and Conventional Stents.

Purpose: To retrospectively evaluate the technical and clinical outcomes of superior vena cava (SVC) stent placement through upper-limb venous access in malignant SVC syndrome (SVCS) and compare the efficacy of different nitinol stent types.

Materials And Methods: Between 2006 and 2018, 156 patients (132 male; mean age, 62 y; age range, 33-81 y) underwent SVC stent placement for malignant obstructions through upper-limb venous access with 1 of 3 types of nitinol stent: 1 venous-dedicated (Sinus-XL stent) and 2 non-venous-dedicated (E-Luminexx Vascular Stent and Protégé GPS). Cases of common femoral vein access or non-nitinol stents were excluded from further analysis.

Dynamic CT perfusion imaging for type 2 endoleak assessment after endograft placement.

Endovascular repair of abdominal aortic aneurysm is a widely performed treatment method due to its minimal invasiveness, reduced need for intensive care unit (ICU), shorter hospitalization and lower 30-day morbidity and mortality compared to open surgery. Endoleak is the drawback of this procedure and is considered the main culprit for re-interventions due to the risk of late aneurysm sac growth and rupture. Type 2 endoleak (T2EL) is the most common type of endoleak which is also the most controversial regarding its management.

Aggressive recurrence of Non-Hodgkin's Lymphoma after successful clearance of hepatitis C virus with direct acting antivirals.

The association of Non-Hodgkin lymphomas and Hepatitis C virus is well documented and antiviral treatments facilitate a virological and hematological response in the majority of HCV related Non-Hodgkin lymphomas. The recent years, direct acting antivirals have made cure possible almost for every HCV patient. Some concerns were raised as regards the frequency and the pattern of recurrence in HCV patients with HCC, treated with these agents.

Transcatheter arterial chemoembolization combined with radiofrequency or microwave ablation for hepatocellular carcinoma: a review.

Hepatocellular carcinoma (HCC) is the sixth most common type of malignancy. Several therapies are available for HCC and are determined by stage of presentation, patient clinical status and liver function. Local-regional treatment options, including transcatheter arterial chemoembolization, radiofrequency ablation or microwave ablation, are safe and effective for HCC but are accompanied by limitations.

The "Arm-to-Chest Tunneling" technique: A modified technique for arm placement of implantable ports or central catheters.

Purpose: Central venous catheters or "venous access devices" include totally implantable venous access devices or "ports," peripherally inserted central catheters, and tunneled lines. Venous access devices are now the standard of care in patients requiring long-term intravenous drug administration. Arm venous access device placement is a valuable option for vascular access yet often complicated or rendered practically impossible by the condition and size of peripheral veins.

CT Foot Perfusion Examination for Evaluation of Percutaneous Transluminal Angioplasty Outcome in Patients with Critical Limb Ischemia: A Feasibility Study.

Purpose: To evaluate foot perfusion in patients with critical limb ischemia (CLI) using quantitative perfusion multi-detector-row CT and estimate perfusion parameter changes before and after percutaneous transluminal angioplasty (PTA).

Materials And Methods: This prospective study investigated 13 patients (10 men; median age, 72 y; range, 51-84 y) with CLI who underwent CT foot perfusion examinations with a 128-slice dual-energy CT scanner 1 day before and 1 week after PTA. Key parameters such as permeability surface (PS), blood volume (BV), and blood flow (BF) were analyzed and compared statistically.

Occupational exposure during endovascular aneurysm repair (EVAR) and aortoiliac percutaneous transluminal angioplasty (PTA) procedures.

Objectives: The purpose of this study was to determine the radiation exposure of primary interventionalist's different body parts during endovascular aneurysm repair (EVAR) procedures and aortoiliac percutaneous transluminal angioplasty (PTA) procedures and to evaluate the efficacy of a radioprotective drape.

Methods: Occupational doses for 36 consecutive aortoiliac PTA procedures and 17 consecutive EVAR procedures were estimated using thermoluminescence dosimetry (TLD) chips (TLD-200, Hashaw, Solon, OH). Effective dose (ED) was calculated using the Niklason algorithm.