Late migration of a covered stent into the stomach after repair of a splenic artery pseudoaneurysm

We would like to report our experience of a rather rare complication that occurred in a 76-year old patient tree years after endovascular repair of a splenic artery pseudoaneurysm with a covered stent. Three years after stent insertion, the patient complained of mild abdominal pain and melena; it was revealed endoscopically that the covered stent has eroded the stomach wall and migrated into the stomach. The splenic artery is the most common location among the spectrum of potential presentation sites of visceral arteries aneurysms and pseudoaneurysms. Endovascular treatment with the use of coils or stents is the first option due to lower morbidity and mortality than open surgery. Endovascular repair may also lead to complications and patients need to be followed up in order to confirm aneurysm sealing, and exclude late complication. Minor stent graft migration may occur in the long term, however extra vascular migration is extremely rare

Percutaneous Treatment of Malignant Jaundice Due to Extrahepatic Cholangiocarcinoma: Covered Viabil Stent Versus Uncovered Wallstents

To compare clinical effectiveness of Viabil-covered stents versus uncovered metallic Wallstents, for palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, 60 patients were enrolled in a prospective and randomized study. In half of the patients a bare Wallstent was used, and in the other half a Viabil biliary stent. Patients were followed up until death. Primary patency, survival, complication rates, and mean cost were calculated in both groups. Stent dysfunction occurred in 9 (30%) patients in the bare stent group after a mean period of 133.1 days and in 4 (13.3%) patients in the covered stent group after a mean of 179.5 days. The incidence of stent dysfunction was significantly lower in the covered stent group (P = 0.046). Tumor ingrowth occurred exclusively in the bare stent group (P = 0.007). Median survival was 180.5 days for the Wallstent and 243.5 days for the Viabil group (P = 0.039). Complications and mean cost were similar in the two groups. Viabil stent-grafts proved to be significantly superior to Wallstents for the palliation of malignant jaundice due to extrahepatic cholangiocarcinoma, with comparable cost and complication rates. Appropriate patient selection should be performed prior to stent placement

Endovascular Treatment of Giant Visceral Aneurysms: An Overview

Giant visceral aneurysms (or pseudoaneurysms) are aneurysmal lesions of the splanchnic vessels that are larger than 5 cm in diameter. As with other visceral aneurysms, treatment may be either surgical or endovascular. Both treatments face challenges given the anatomical complexity of such lesions. However, in the era of novel tools and techniques that have been developed in this field, an increasing number of giant visceral aneurysms can now be treated using endovascular approaches. The purpose of this article is to offer an overview of the most current techniques and trends in the endovascular treatment of giant visceral artery aneurysms

Emerging Stent and Balloon Technologies in the Femoropopliteal Arteries

Endovascular procedures for the management of the superficial femoral (SFA) and popliteal artery disease are increasingly common. Over the past decade, several stent technologies have been established which may offer new options for improved clinical outcomes. This paper reviews the current evidence for SFA and popliteal artery angioplasty and stenting, with a focus on randomized trials and registries of nitinol self-expanding stents, drug-eluting stents, dug-coated balloons, and covered stent-grafts. We also highlight the limitations of the currently available data and the future routes in peripheral arterial disease (PAD) stent and balloon technology

Endovascular management of massive post-partum haemorrhage in abnormal placental implantation deliveries

Objectives: To retrospectively evaluate safety and efficacy of pelvic artery embolisation (PAE) in post-partum haemorrhage (PPH) in abnormal placental implantation (API) deliveries. Methods: From January 2009 to November 2013, 12 patients with API and intractable intraoperative PPH underwent PAE after caesarean delivery to control a haemorrhage (in four of these cases after hysterectomy). Arterial access was obtained prior to the delivery; PAE was performed in the obstetrics operating room by an interventional radiologist that was present with an interventional radiology (IR) team during the delivery. Results: PAE was successful in preventing bleeding and avoid hysterectomy in four cases (group A). Uterine atony and disseminated intravascular coagulation caused failure of PAE requiring hysterectomy in four patients (group B). PAE prevented bleeding post-hysterectomy in the remaining four cases (group C). Technical success (cessation of contrast extravasation on angiography or occlusion of the selected artery) was 100 %. Maternal and foetal mortality and morbidity were 0 %. Conclusions: PAE is a minimal invasive technique that may help to prevent hysterectomy and control PPH in API pregnancies without complications. Embolisation should be performed on an emergency basis. For such cases, an IR team on standby in the obstetrics theatre may be useful to prevent hysterectomy, blood loss and limit morbidity. Key Points: • Endovascular treatment is a validated technique in post-partum haemorrhage. • Abnormal placental implantation is a risk factor for post-partum haemorrhage. • We propose an interventional radiologist standby in the delivery room. © 2015, European Society of Radiology

Techniques and future perspectives for the prevention and treatment of endoleaks after endovascular repair of abdominal aortic aneurysms.

The presence of endoleaks remains one of the main drawbacks of endovascular repair of abdominal aortic aneurysms leading to the increase of the size of the aneurysmal sac and in most of the cases to repeated interventions. A variety of devices and percutaneous techniques have been developed so far to prevent and treat this phenomenon, including sealing of the aneurysmal sac, endovascular embolisation, and direct sac puncture. The aim of this review is to analyse the indications, the effectiveness, and the future perspectives for the prevention and treatment of endoleaks after endovascular repair of abdominal aortic aneurysms

Risk of Major Amputation Following Application of Paclitaxel Coated Balloons in the Lower Limb Arteries : A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Objective: There have been concerns about the long term safety of paclitaxel coated devices in the lower limbs. A formal systematic review and meta-analysis of randomised controlled trials (RCTs) was performed to examine the long term risk of major amputation using paclitaxel coated balloons in peripheral arterial disease (PAD). Method: This systematic review was registered with PROSPERO (ID 227761). A broad bibliographic search was performed for RCTs investigating paclitaxel coated balloons in the peripheral arteries (femoropopliteal and infrapopliteal) for treatment of intermittent claudication or critical limb ischaemia (CLI). The literature search was last updated on 20 February 2021 without any restrictions on publication language, date, or status. Major amputations were analysed with time to event methods employing one and two stage models. Sensitivity and subgroup analyses, combinatorial meta-analysis, and a multivariable dose response meta-analysis to examine presence of a biological gradient were also performed. Results: In all, 21 RCTs with 3 760 lower limbs were analysed (52% intermittent claudication and 48% CLI; median follow up two years). There were 87 major amputations of 2 216 limbs in the paclitaxel arms (4.0% crude risk) compared with 41 major amputations in 1 544 limbs in the control arms (2.7% crude risk). The risk of major amputation was significantly higher for paclitaxel coated balloons with a hazard ratio (HR) of 1.66 (95% CI 1.14 - 2.42; p = .008, one stage stratified Cox model). The prediction interval was 95% CI 1.10 - 2.46 (two stage model). The observed amputation risk was consistent for both femoropopliteal (p = .055) and infrapopliteal (p = .055) vessels. Number needed to harm was 35 for CLI. There was good evidence of a significant non-linear dose response relationship with accelerated risk per cumulative paclitaxel dose (chi square model p = .007). There was no evidence of publication bias (p = .80) and no significant statistical heterogeneity between studies (I-2 = 0%, p = .77). Results were stable across sensitivity analyses (different models and subgroups based on anatomy and clinical indication and excluding unpublished trials). There were no influential single trials. Level of certainty in evidence was downrated from high to moderate because of sparse events in some studies. Conclusion: There appears to be heightened risk of major amputation after use of paclitaxel coated balloons in the peripheral arteries. Further investigations are warranted urgently.Peer reviewe

Percutaneous use of ePTFE/FEP covered stents in the management of malignant biliary stenoses

Purpose: The definition of the role of ePTFE/FEP metallic covered endoprostheses in the palliation of malignant jaundice. Methodology: in the feasibility study 36 patients with malignant jaundice were included in which an ePTFE/FEP covered endoprosthesis was deployed (fully covered or with side holes) in the prospective randomized study. 72 patients were included, 46 were affected by pancreatic cancer and 26 by cholangiocarcinoma with survival perspective more than three months. A randomized comparison between the ePTFE/FEP covered stent was made and a) a nitinol bare metal endoprosthesis for the patients with pancreatic cancer and b) a stainless steel alloy bare metal stent for the patients with cholangiocarcinoma results there was a statistical significant difference in the dysfunction the patency and the ingrowth rate between the fully covered ePTFE/FEP stents and the stents with side holes there was no difference in the survival and complications rate there was a statistical significant difference between the dysfunction the patency and the ingrowth rate between the covered and the uncovered stents in the groups that were studied there was no difference in the survival and complication rate conclusions the ePTFE/FEP membrane seems able to prevent from ingrowth the patients that would benefit from the ePTFE/FEP device are the patients with pancreatic cancer and the patients with bismuth type I cholangiocarcinoma that are likely to survive more than three months.Στόχος: Ο προσδιορισμός της χρήσης των επικαλυμμένων με ePTFE/FEP μεταλλικών ενδοπροθέσεων στις κακοήθεις στενώσεις των χοληφόρων. Μεθοδολογία: Κατά την μελέτη σκοπιμότητας. Μελετήθηκαν 36 ασθενείς με κακοήθους αιτιολογίας στένωση των χοληφόρων στους οποίους τοποθετήθηκαν ePTFE/FEP ενδοπροθέσεις με η χωρίς πλάγιες οπές. Στόχος ήταν η αξιολόγηση της ασφάλειας του υλικού, ο καθορισμός της δυνατότητας της μεμβράνης επικάλυψης να περιορίσει το ingrowth, ο προσδιορισμός των ασθενών εκείνων που χρίζουν περαιτέρω μελέτης καθώς και ο προσδιορισμός της πιθανής συσχέτισης των αποτελεσμάτων με το είδος της νεοεξεργασίας κατά την προοπτική τυχαιοποιημένη μελέτη. Μελετήθηκαν 72 ασθενείς με αδενοκαρκίνωμα της κεφάλης του παγκρέατος (46) και χολαγγειοκαρκίνωμα (26) και προοπτική επιβίωσης άνω του τριμήνου στους οποίους τοποθετήθηκαν με τυχαιοποιημένο τρόπο είτε μια επικαλυμμένη ePTFE/FEP ενδοπρόθεση είτε μια μη επικαλυμμένη ενδοπρόθεση. Υπόθεση της μελέτης ήταν ότι η ePTFE/FEP επικαλυμμένη ενδοπρόθεση θα επιμηκύνει το χρόνο βατότητας προσφέροντας μικρότερο αριθμό επανεπεμβάσεων και ανάλογες επιπλοκές με τις μη επικαλυμμένες. Αποτελέσματα: Τα αποτελέσματα της μελέτης σκοπιμότητας ανέδειξαν ότι σημειώθηκε στατιστικά σημαντική διαφοροποίηση ανάμεσα στο χρόνο βατότητας, το ποσοστό δυσλειτουργίας και το ποσοστό της διήθησης δια του πλέγματος των πλήρως επικαλυμμένων ενδοπροθέσεων έναντι των ενδοπροθέσεων με οπές. Δεν διαπιστώθηκε διαφοροποίηση ανάμεσα στα ποσοστά τεχνικής επιτυχίας επιβίωσης είδους και αριθμού των επιπλοκών. Τα αποτελέσματα της προοπτικής μελέτης ανέδειξαν ανάλογη τεχνική επιτυχία και επιπλοκές στις δυο ομάδες. Σημειώθηκε στατιστικά σημαντική διαφοροποίηση ανάμεσα στο ποσοστό δυσλειτουργίας, την διάρκεια της βατότητας και το ποσοστό του ingrowth των επικαλυμμένων έναντι των μη επικαλυμμένων. Η επιβίωση των ασθενών που έλαβαν την επικαλυμμένη ενδοπρόθεση ήταν μεγαλύτερη έναντι των ασθενών που έλαβαν την μη επικαλυμμένη χωρίς όμως στατιστικά σημαντική διαφοροποίηση. Συμπεράσματα: η ePTFE/FEP μεμβράνη επικάλυψης μοιάζει ικανή να αποτρέψει την διήθηση δια του πλέγματος. Οι ασθενείς εκείνοι που χρίζουν την τοποθέτηση ePTFE/FEP επικαλυμμένης ενδοπρόθεσης είναι οι ασθενείς με αδενοκαρκίνωμα της κεφαλής του παγκρέατος και προοπτική επιβίωσης άνω του τριμήνου και οι ασθενείς με χολαγγειοκαρκίνωμα σταδίου Ι σύμφωνα με την κατηγοριοποίηση κατά bismuth και προοπτική επιβίωσης άνω του τριμήνου