Laser enhanced high-intensity focused ultrasound thrombolysis: An in vitro study

This is the Published Version made available with the permission of the publisher. Copyright, Ecological Society of America.Laser-enhanced thrombolysis by high intensity focused ultrasound (HIFU) treatment was studied in vitro with bovine blood clots. To achieve laser-enhanced thrombolysis, laser light was employed to illuminate the sample concurrently with HIFU radiation, and ultrasound and laser parameters were optimized to achieve better thrombolysis efficiency. The results indicated that the thrombolysis efficiency increased when pulse length of HIFU wave, HIFU pressure, or laser fluence increases. Also, with the presence of laser, an enhanced effect of thrombolysis was observed.This study was supported in part byNIH Grant No. 1R03EB015077-01A1

Type II Endoleak Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm: Innovative Transgraft Approach to Contemporary Management

Elective endovascular aneurysm repair (EVAR) is the first-line therapeutic option for patients with infrarenal abdominal aortic aneurysm. However, endoleaks –– persistent blood flow outside the lumen of the stent graft (or endograft) but within the aneurysm sac or adjacent vascular segment being treated by the graft –– continue to be a persistent problem in the post-EVAR setting. The type II endoleak is the most common of these and can be a demanding challenge to address by standard endovascular techniques. Currently, two prominent endovascular techniques exist for the management of type II endoleaks: direct translumbar embolization and transarterial embolization. Both of these are fraught with their own limitations and complications. In this review, we describe the contemporary trends in management of type II endoleaks and introduce a novel endovascular technique to treat this challenging and common EVAR complication

National trends and variability of atherectomy use for peripheral vascular interventions from 2010 to 2019

OBJECTIVES: Small, older studies suggest atherectomy devices have become common in peripheral vascular interventions (PVI) despite the paucity of strong clinical guidelines. We analyzed the 10-year trends in the use of atherectomy for PVI across the United States and identified main predictors of atherectomy use. METHODS: Using the Vascular Quality Initiative Registry, we identified all patients who had endovascular PVI for occlusive lower-extremity arterial disease from 2010 to 2019. Procedures in which an atherectomy device was recorded as the primary or secondary device were classified as the atherectomy group. We calculated frequency of atherectomy use over time and across geographic regions. Using regression modeling, we identified factors that were independently associated with atherectomy use. RESULTS: There were 205,377 procedures on 152,693 unique patients. Over 10 years, 16.6% of PVI procedures used atherectomy, increasing from 8.5% in 2010 to 19.7% in 2019, P \u3c0.0001. Across 17 geographic regions, there was a significant difference in the prevalence of atherectomy use, ranging from 8.2% to 29%. The strongest predictor of atherectomy use was the procedure being done in an office setting (OR 10.08, 95% CI 9.17-11.09) or ambulatory center (OR 4.0, 95% CI 3.65-4.39) vs hospital setting. The presence of severe (OR 2.6, 95% CI 2.4-2.85) or moderate (OR 1.5, 95% CI 1.4-1.69) lesion calcification was also predictive of atherectomy use. Other predictors included elective status, insurance provider, lesion length, prior PVI, claudication symptoms, and diabetes mellitus. CONCLUSIONS: Atherectomy use in PVI significantly increased between 2010 and 2019. There is wide regional variability in the use of atherectomy that seems to be driven more strongly by non-clinical factors

Early thoracic endovascular aortic repair of uncomplicated type B thoracic aortic dissection: An aorta team approach

Background:Although uncomplicated Type B aortic dissection (uTBAD) is traditionally treated with optimal medical therapy (OMT) as per guidelines, recent studies, performed primarily in interventional radiology or surgical operating rooms, suggest superiority of thoracic endovascular aortic repair (TEVAR) over OMT due to recent advancements in endovascular technologies. We report a large, single-center, case control study of TEVAR versus OMT in this population, undertaken solely in a cardiac catheterization laboratory (CCL) with a cardiologist and surgeon. We aimed to determine if TEVAR for uTBAD results in better outcomes compared with OMT. Methods:This was a retrospective chart review of all patients with uTBAD during the last 13 years, with 46 cases (TEVAR group) and 56 controls (OMT group). Results:In the TEVAR group, the procedure duration of 2.5 hours resulted in 100% procedural success for stent placement, with 63% undergoing protective left subclavian artery bypass, 0% mortality or stroke, and a lower readmission rate (1 vs. 2%; p = 0.04 in early TEVAR cases), but a longer length of stay (12.9 vs. 8.5 days: p = 0.006). The risk of all-cause long-term mortality was markedly reduced in the TEVAR group (RR = 0.38; p = 0.01), irrespective of early (\u3c14 days) versus late intervention. On follow-up computed tomography imaging, the false lumen stabilized or decreased in 85% of cases, irrespective of intervention timing. Conclusion:TEVAR performed solely in the CCL is safe and effective, with lower all-cause mortality than OMT. These data, in collaboration with previous data on TEVAR in different settings, call for consideration of an update of practice guidelines

Effectiveness and safety of atherectomy versus plain balloon angioplasty for limb salvage in tibioperoneal arterial disease

Purpose: To evaluate the effectiveness and safety of atherectomy versus plain balloon angioplasty (POBA) for treatment of critical limb ischemia (CLI) due to tibioperoneal arterial disease (TPAD). Materials and methods: Patients enrolled in the Vascular Quality Initiative registry who had CLI (Rutherford class 4-6) and underwent atherectomy versus POBA alone for isolated TPAD were retrospectively identified. Of eligible patients, a cohort of 2,908 patients was propensity matched 1:1 by clinical and angiographic characteristics. The atherectomy group comprised 1,454 patients with 2,183 arteries treated, the POBA group 1,454 patients with 2,141 arteries treated. The primary study endpoint was major ipsilateral limb amputation. Secondary endpoints were minor ipsilateral amputations, any ipsilateral amputation, primary patency, target vessel revascularization (TVR), and wound healing at 12 months. Results: Median follow-up was 507 days, mean patient age was 69±11.7 years, and mean occluded length was 6.9±6.5 cm. There was a trend toward higher technical success rates with atherectomy than POBA (92.9% vs. 91.0%, respectively; P=0.06). Rates of major complications during the procedure were not significantly different. The 12-month major amputation rate was similar in the atherectomy and POBA groups (4.5% vs. 4.6%, respectively, P=0.92, OR 0.97, 95% CI 0.68-1.37). There was no difference in 12-month TVR (17.9% vs 17.8% P=0.97) or primary patency (56.4% vs 54.5% P=0.64) between the atherectomy and POBA groups. Conclusion: In a large, national registry, treatment of TPAD for CLI using atherectomy vs POBA showed no significant differences in procedural complications, major amputations, TVR, or vessel patency at 12 months