Indigo aspiration thrombectomy for treating acute lower limb ischemia. Technical considerations

We have read with great interest the recently reported article by Lopez et al1 regarding their experience with Indigo System (IS; Penumbra, Alameda, Calif) aspiration thrombectomy for acute lower limb ischemia (ALLI) with a technical success rate of 52%. The study by Lopez et al1 is one of the first single-center experiences after the well-known PRISM trial.2 In the PRISM trial, the success of the procedures was reported using the Thrombolysis in Myocardial Infarction score,3 allowing for an objective evaluation. In contrast, Lopez et al1 selected the definition of technical success as blood flow restoration to the ischemic limb with <50% residual thrombus, and as they stated, this measurement could be perceived as subjective. The IS consists of an aspiration pump, five different aspiration catheters ranging from 3.4F to 8F, and a separator wire. These intrinsic characteristics lead to some technical considerations that were not described in their report, such as the type of device used in different vessels and whether they had used the separator wire. In our experience, the choice of the caliber of the CAT device is of crucial importance for clot removal and, in particular, in the femoral district in which a mismatch can be present between the vessel diameter and device size. Regarding the separator, our impression has been that it can help in the case of a larger clot by allowing for catheter patency during the aspiration maneuver. Another technical aspect we would like to focus on is the vascular access to be used: the antegrade or retrograde approach with short or long sheaths. We think that the antegrade common femoral artery approach, even for the CAT8 catheter, should be preferred when possible because it increases overall control of the endovascular devices. A main issue when treating patients with ALLI is symptom onset. Using the IS, we can observe the benefits of early treatment after symptoms have appeared. In conclusion, the IS device is very promising for treating ALLI; however, the optimal treatment time and standardization of the techniques should be determined

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 aneurysm

CIRSE Standards of Practice for the Endovascular Treatment of Visceral and Renal Artery Aneurysms and Pseudoaneurysms

Background: Endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms is an effective, minimally invasive treatment that has been successfully used since the early 1990s, with refined and expanded techniques and tools currently offering excellent outcomes. Due to increased detection of such lesions in recent years, many of which are asymptomatic, revision of the indications for intervention and the correct endovascular treatment approaches has become essential. Purpose: This document will presume that the indication for treatment is clear and approved by the multidisciplinary team and will define the standards required for the performance of each intervention, as well as their relative advantages and limitations. CIRSE Standards of Practice documents are not intended to impose a standard of clinical patient care, but recommend a reasonable approach to, and best practices for, the performance of the endovascular treatment of visceral and renal artery aneurysms and pseudoaneurysms. Methods: The writing group was established by the CIRSE Standards of Practice Committee and consisted of five clinicians with internationally recognised expertise in endovascular treatments. The writing group reviewed the existing literature on visceral and renal artery aneurysms and pseudoaneurysms, performing an evidence search using PubMed to identify publications in English and relating to human subjects from 1990 to 2022. The final recommendations were formulated through consensus. Results: Endovascular treatment has an established role in the successful management of visceral and renal artery aneurysms and pseudoaneurysms, and this Standards of Practice document provides up-to-date recommendations for its safe performance

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

How to manage the COVID-19 diffusion in the angiography suite. experiences and results of an Italian interventional Radiology Unit

Introduction: The management of the diffusion of Coronavirus disease 2019 (COVID-19) pandemic represents a massive problem for healthcare systems worldwide and Interventional Radiology (IR) is a fundamental hospital unit which must continue to provide its service. The aim of this article is to summarize the preventive measures taken in our IR unit and to report the results of these measures over a 7 weeks period. Material and Methods: Between the 25th of February, when we started to apply the recommended containing measures, and the 6th of April 2020, when all the IR staff started to undergo nasopharyngeal and oropharyngeal swabs screening, a total of 25 healthcare operators worked at our IR unit. Operators who, during this period, also worked in other hospital units such as diagnostic emergency department or other healthcare facilities, were excluded. Nasopharyngeal and oropharyngeal swabs screening and blood samples for specific SARS-CoV-2 IgG-IgM were retrospectively evaluated. Results: The overall procedures number decreased by a rate of 33% and twenty-three (16%) were performed in confirmed or strongly suspected COVID-19 patients. Two procedures were performed in non-suspected ones, who revealed positive in the following hospitalization days. Seventeen operators were included in the study. Only one of them resulted positive at the swabs, with an estimated infection rate in our IR unit of 6%. Specific SARS-CoV-2 IgG-IgM resulted negative in all the operators included. Conclusion: Our experience demonstrates that applying adequate measures to limit SARS-CoV-2 infection spread can efficiently reduce the viral transmission among IR healthcare workers

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

Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the Italian Societies of Vascular and Endovascular Surgery (SICVE) and Medical and Interventional Radiology (SIRM)

: The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suffering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the GRADE-SIGN version, and followed the instructions of the AGREE quality of reporting checklist. Clinical questions, structured according to the PICO (Population, Intervention, Comparator, Outcome) model, were formulated, and systematic literature reviews were carried out according to them. Selected articles were evaluated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. Overall, 79 clinical practice recommendations were proposed. Indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended

Guidelines on the diagnosis, treatment and management of visceral and renal arteries aneurysms: a joint assessment by the italian societies of vascular and endovascular surgery (siCVe) and medical and interventional radiology (sirM)

The objective of these Guidelines is to provide recommendations for the classification, indication, treatment and management of patients suf- fering from aneurysmal pathology of the visceral and renal arteries. The methodology applied was the grade-sigN version, and followed the instructions of the agree quality of reporting checklist. Clinical questions, structured according to the PiCo (Population, intervention, Com- parator, outcome) model, were formulated, and systematic literature reviews were carried out according to them. selected articles were evalu- ated through specific methodological checklists. Considered Judgments were compiled for each clinical question in which the characteristics of the body of available evidence were evaluated in order to establish recommendations. overall, 79 clinical practice recommendations were pro- posed. indications for treatment and therapeutic options were discussed for each arterial district, as well as follow-up and medical management, in both candidate patients for conservative therapy and patients who underwent treatment. The recommendations provided by these guidelines simplify and improve decision-making processes and diagnostic-therapeutic pathways of patients with visceral and renal arteries aneurysms. Their widespread use is recommended

Hepatocellular Carcinoma Drug-Eluting Bead Transarterial Chemoembolization (DEB-TACE): Outcome Analysis Using a Model Based On Pre-Treatment CT Texture Features

(1) Introduction and Aim: The aim of this study is to investigate the prognostic value, in terms of response and survival, of CT-based radiomics features for patients with HCC undergoing drug-eluting beads transarterial chemoembolization (DEB-TACE). (2) Materials and Methods: Pre-treatment CT examinations of 50 patients with HCC, treated with DEB-TACE were manually segmented to obtain the tumor volumetric region of interest, extracting radiomics features with TexRAD. Response to therapy evaluation was performed basing on post-procedural CT examination compared to pre-procedural CT, using modified RECIST criteria for HCC. The prognostic value of texture analysis was evaluated, investigating the correlation between radiomics features, response to therapy and overall survival. Three models based on texture and clinical variables and a combination of them were finally built; (3) Results: Entropy, skewness, MPP and kurtosis showed a significant correlation with complete response (CR) to TACE (all p < 0.001). A predictive model to identify patients with a high and low probability of CR was evaluated with an ROC curve, with an AUC of 0.733 (p < 0.001). The three models built for survival prediction yielded an HR of 2.19 (95% CI: 2.03-2.35) using texture features, of 1.7 (95% CI: 1.54-1.9) using clinical data and of 4.61 (95% CI: 4.24-5.01) combining both radiomics and clinical data (all p < 0.0001). (4) Conclusion: Texture analysis based on pre-treatment CT examination is associated with response to therapy and survival in patients with HCC undergoing DEB-TACE, especially if combined with clinical data