206 results found
Hamady M, McCafferty I, 2021, The rocky road to recognizing interventional radiology as a full clinical speciality, CVIR Endovascular, Vol: 4
Morgan RA, Loftus I, Ratnam L, et al., 2021, Clinical experience with a shape memory polymer peripheral vascular embolisation plug: a case series, CVIR Endovascular, Vol: 4
Background: Shape memory polymers are materials that are manufactured in a certain shape, can be stored in a temporary deformed shape, and then return to – or remember – their original shape upon exposure to external stimuli such as temperature and moisture. This property lends itself to application in endovascular medical devices. Peripheral vasculature embolisation devices incorporating this novel technology have become commercially available and this case series, where the data were collected as part of a post market registry, outlines initial clinical experience with these novel devices. Results: Eight cases are described in this series. The disease state/conditions for which embolisation was indicated were right common iliac artery aneurysms (n = 3), a type II endoleak into the thoracic aorta following thoracic endovascular aneurysm repair (n = 1), a left inferior gluteal artery aneurysm (n = 1), left internal iliac artery aneurysms (n = 2), and a case of splenomegaly, where splenectomy was planned after the embolisation procedure (n = 1). Target arteries were 5–10 mm in diameter. In each case, at least one IMPEDE Embolization Plug (IMP-Device) of an appropriate diameter was used. All procedures were technically successful and target vessel thrombosis was achieved in all cases. Follow-up imaging available during the 45–90-day data collection timeframe showed sustained vessel occlusion. This case series includes examples of situations commonly encountered when embolising the peripheral vasculature, namely, the use of one or multiple devices in a single vessel and in combination with the use of other embolic devices (e.g., microcoils, gelatin sponge, and PVA particles) in the same case. There were no adverse events related to the specific use of the device. Conclusions: This small series illustrates the safety and efficacy of this novel sponge-based embolic device for the embolisation of small and medium sized arte
Hanna L, Abdullah A, Gibbs R, et al., 2021, Technical Note: Left Subclavian Artery Scallop Endografts to Facilitate a Proximal Landing Zone and Upper Extremity Access for Branched Endovascular Aortic Repair of Type II Thoracoabdominal Aortic Aneurysms., Cardiovasc Intervent Radiol
PURPOSE: To describe the dual purpose of left subclavian artery (LSA) scallop endografts to create the proximal landing zone (PLZ) and facilitate antegrade left-sided upper extremity access for branched endovascular aortic repair (BEVAR) of Type II thoracoabdominal aneurysms (TAAA) with a short PLZ. TECHNIQUE: Three patients with an inadequate (< 20 mm) PLZ underwent a 2-stage repair of Type II TAAA. Following femoral cut-down, a custom-made LSA scallop endograft was deployed into zone 2 to create the PLZ and maintain perfusion to the LSA. In a second procedure 36-96 days after insertion of the scalloped thoracic stent-graft, a branched abdominal stent-graft was subsequently deployed to dock into the proximal scallop endograft as the second stage. Via a left axillary conduit, a 12Fr sheath was used to cannulate the LSA scallop to facilitate selective catheterisation of antegrade branch cuffs and renovisceral target vessels, and insertion and deployment of bridging stents. The LSA scallop was also used to selectively catheterise and stent the perfusion branches via left-sided brachial puncture that were left open in each of the three cases 8-14 days after the second procedure to minimise the risk of spinal cord ischaemia. There were no neurological or endoleak complications. CONCLUSION: LSA scallop endografts are a feasible and useful adjunct to create the PLZ and to provide antegrade access for visceral stenting of branches and target vessels through the LSA scallop in branched endovascular repair of Type II TAAA with short PLZ.
Amiras D, Hurkxkens TJ, Figueroa D, et al., 2021, Augmented reality simulator for CT-guided interventions, EUROPEAN RADIOLOGY, ISSN: 0938-7994
Hanna L, Abdullah A, Kashef E, et al., 2021, Four-year results of the Bolton relay proximal scallop endograft in the management of thoracic and thoracoabdominal aortic pathology with unfavorable proximal landing zone., J Vasc Surg
BACKGROUND: Thoracic endovascular aortic repair with a scallop design (scallop-TEVAR) is a useful treatment strategy to extend the proximal landing zone (PLZ), while maintaining perfusion to one or more of the supra-aortic trunks (SATs) when treating aortic pathology with an unfavorable PLZ. The durability of this approach with the Bolton Relay scallop endograft (Terumo Aortic, Sunrise, Fla) has not been established. METHODS: A retrospective review of prospectively collected data on consecutive patients that received scallop-TEVAR in zones 0 to 2 at a tertiary aortic unit was undertaken. The main outcome was durability, characterized by survival estimates, freedom from reintervention to the thoracic aorta and PLZ, migration and aneurysm sac regression. RESULTS: Between 2009 and 2019, 38 patients (71% male; median age, 70 years) underwent scallop-TEVAR for thoracic aortic pathology (n = 28, 74%) or as a part of thoracoabdominal aneurysm repair (n = 10 [26%]). The use of scallop-TEVAR significantly extended the PLZ (median, 5 mm preoperative PLZ vs 26 mm extended PLZ; P = .0001). A total of 41 SATs were perfused with a scallop, including the left subclavian artery (n = 25), left common carotid artery (n = 6), neo/innominate artery (n = 4), left subclavian artery, and vertebral artery (n = 1), innominate artery, and left common carotid artery (n = 2) in conjunction with 15 extra-anatomical bypasses. The PLZ was at Ishimaru zone 0 and 1 in 6 cases (16%), respectively, and zone 2 in 26 cases (68%). Technical success was 98%. The 30-day mortality was 5% (2/38; 1 death from myocardial infarction and 1 from multiorgan failure). A minor stroke occurred in three patients (8%) and temporary spinal cord ischemia in two patients (5%). The median follow-up was 4.5 years (range, 0-10.53 years) during which two patients (5%) developed type Ia endoleak and required intervention to the PLZ (one from device-related migra
Piffaretti G, Czerny M, Riambau V, et al., 2021, Endovascular repair of ascending aortic diseases with custom-made endografts., Eur J Cardiothorac Surg, Vol: 59, Pages: 741-749
OBJECTIVES: The aim of this article is to report the mid-term results of ascending thoracic endovascular aortic repair using a custom-made device (CMD). METHODS: This was a retrospective study performed at tertiary centres. Nine patients considered unfit for open surgery received elective total endovascular repair of the ascending aorta with a Relay® (Terumo Aortic, Sunrise; FL, USA) CMD: pseudoaneurysn (n = 5), localized dissection (n =3) and contained rupture (n = 1). RESULTS: Primary clinical success was achieved in all patients with no major complications and no early conversion to open surgery. All patients were discharged home and independent: median length of stay was 7 days (interquartile range, 6-18). No patient was lost to follow-up at a median 26 months (interquartile range, 12-36). Three patients died 2, 6 and 24 months after intervention; 1 was aorta related (late aorto-atrial fistula due to infection that required open surgery). At the last follow-up available, no endoleaks, migrations, fractures or ruptures were observed in the remaining 6 patients. CONCLUSIONS: Ascending thoracic endovascular aortic repair with Terumo Aortic CMDs was technically feasible, effective and safe in very selected lesions. CMDs showed good ascending aorta conformability with different configurations and diameters, and satisfactory mid-term durability as shown by both structural integrity and aortic lesion exclusion.
Jones B, Riga C, Bicknell C, et al., 2021, Robot-Assisted Carotid Artery Stenting: A Safety and Feasibility Study, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 44, Pages: 795-800, ISSN: 0174-1551
Mollier J, Patel NR, Amoah A, et al., 2020, Clinical, Imaging and Procedural Risk Factors for Intrauterine Infective Complications After Uterine Fibroid Embolisation: A Retrospective Case Control Study., Cardiovasc Intervent Radiol, Vol: 43, Pages: 1910-1917
INTRODUCTION: This was a retrospective case-control study at a single tertiary centre investigating all UFE procedures between January 2013 and December 2018 for symptomatic fibroids. The aim was to determine the clinical, imaging and procedural risk factors which impact upon the risk of post-uterine fibroid embolisation (UFE) intrauterine infection. Cases were patients which developed intrauterine infection post-procedure, and controls were the background UFE population without infection. METHODS: Clinical demographics, presenting symptoms, uterine and fibroid characteristics on imaging and procedural variants were analysed. A p value of less than 0.05 was considered statistically significant. The main outcome measures were presence of infection and requirement of emergency hysterectomy. RESULTS: 333 technically successful UFE procedures were performed in 330 patients. Infection occurred after 25 procedures (7.5%). 3 of these patients progressed to overwhelming sepsis and required emergency hysterectomy. Clinical obesity (BMI > 30) (OR 1.53 [1.18-1.99]) and uterine volume > 1000cm3 (2.94 [1.15-7.54]) were found to increase the risk of infection CONCLUSIONS: UFE is generally safe in patients with symptomatic fibroids. Obese patients (BMI > 30) and those with large volume uteri (> 1000cm3) are at slight increased risk of developing infection and require appropriate pre-procedural counselling, as well as careful post-UFE follow-up. BMI and uterine volume may be useful to assess before the procedure to help to determine post-UFE infection risk.
Makris GC, Burrows V, Lyall F, et al., 2020, Vascular and Interventional Radiology Training; International Perspectives and Challenges, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 44, Pages: 462-472, ISSN: 0174-1551
Cheung S, Rahman R, Bicknell C, et al., 2020, Comparison of manual versus robot-assisted contralateral gate cannulation in patients undergoing endovascular aneurysm repair, INTERNATIONAL JOURNAL OF COMPUTER ASSISTED RADIOLOGY AND SURGERY, Vol: 15, Pages: 2071-2078, ISSN: 1861-6410
Staniszewska A, Anwar M, Hamady M, et al., 2020, Hybrid repair of proximal subclavian artery transection, Trauma (United Kingdom), Vol: 22, Pages: 316-319, ISSN: 1460-4086
Although rare, subclavian artery injuries are associated with significant mortality and morbidity, with almost two-thirds of patients dying before reaching hospital. Recent advances in technology have resulted in increasing use of endovascular therapy in management of these injuries. In this report, we present a case of a successful hybrid repair of traumatic left proximal subclavian artery transection. The employment of an Amplatzer Vascular Plug to control a short proximal subclavian artery stump and subsequent ligation of the distal segment of subclavian artery with its anastomosis to the carotid artery resulted in excellent clinical outcome without performing a sternotomy in a young patient.
Hamady M, Bicknell C, 2020, Challenges of Total Endovascular Repair of Chronic Type B Aortic Dissection, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 43, Pages: 1735-1737, ISSN: 0174-1551
Johari NH, Hamady M, Xu XY, 2020, A computational study of the effect of stent design on local hemodynamic factors at the carotid artery bifurcation, Artery Research, Vol: 26, Pages: 161-169, ISSN: 1872-9312
Background: Previous clinical studies have shown that the incidence of restenosis after carotid and coronary stenting varies with stent design and deployment configuration. This study aims to determine how stent design may affect in-stent hemodynamics in stented carotid arteries by means of Computational Fluid Dynamics (CFD).Methods: A robust computational method was developed to integrate detailed stent strut geometry in a patient-specific carotid artery reconstructed from medical images. Three stent designs, including two closed-cell stents and one open-cell stent, were reproduced and incorporated into the reconstructed post-stent carotid bifurcation. CFD simulations were performed under patient-specific flow conditions. Local hemodynamic parameters were evaluated and compared in terms of Wall Shear Stress (WSS), Oscillatory Shear Index (OSI) and Relative Residence Time (RRT).Results: All simulated stent designs induced some degree of flow disruption as manifested through flow separation and recirculation zones downstream of stent struts and quantified by WSS-related indices. Compared to the simulated open-cell stent, closed-cell stents created slightly larger areas of low WSS, elevated OSI and high RRT, due to a greater number of stent struts protruding into the lumen.Conclusion: Detailed stent design and patient-specific geometric features of the stented vessel have a strong influence on the evaluated hemodynamic parameters. Our limited computational results suggest that closed-cell stents may pose a higher risk for in-stent restenosis (ISR) than open-cell stent design. Further large-scale prospective studies are warranted to elucidate the role of stent design in the development of ISR after CAS.
Rostampour S, Cleveland T, Haslam P, et al., 2020, Response of UK interventional radiologists to the COVID-19 pandemic – survey findings, CVIR Endovascular, Vol: 3, Pages: 1-5, ISSN: 2520-8934
BackgroundThe COVID-19 pandemic has had an unprecedented effect upon the National Health Service (NHS).Like other specialties, Interventional Radiology (IR) rapidly adapted to the evolving situation.Members of BSIR were surveyed to obtain a snapshot of the experiences of UK IRs in response to COVID-19.An electronic survey was compiled using Google Forms, approved by the BSIR Council Officers and distributedto BSIR members by email on 18thApril 2020.A total of 228 responses were received.The survey was open for a 14-day period and the data analysed in Microsoft Excel 365.The response rate was 29% (228/800).ResultsTwo thirds of respondents work in aTertiary unit and 33% deliver IR in a District Hospital.84% have a day-case facility. After the COVID-19 crisis, 81% of respondents were able to maintain 24-7 On-call service.59% of respondents had been required change their day to day practice to allow the on-call service to continue.55% of respondents were involved in providing a central line service.Of those questioned, 91% continued to offer endovascular services, 98% genitourinary and 92% hepatobiliary services, although a degree of service reduction was described. 38% have provided IR trainees with additional training material during this pandemic.ConclusionsThis survey has confirmed that the responses of UK IR departments to the COVID-19 crisis have ensured vital on-call and urgent services have continued, including ongoing availability of most IR sub-specialties.Availability of a day case facility has possibly influenced the positive response.
Anwar MA, Hamady M, 2020, Various Endoluminal Approaches Available for Treating Pathologies of the Aortic Arch, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 43, Pages: 1756-1769, ISSN: 0174-1551
Llewellyn O, Patel NR, Mallon D, et al., 2020, Uterine Artery Embolisation for Women with Giant Versus Non-giant Uterine Fibroids: A Systematic Review and Meta-analysis., Cardiovasc Intervent Radiol, Vol: 43, Pages: 684-693
BACKGROUND: Evidence supporting uterine artery embolisation (UAE) for giant fibroids (≥ 10 cm and/or uterine volume ≥ 700 CC) remains sparse. We performed a systemic review and meta-analysis of UAE outcomes for symptomatic giant versus non-giant fibroids. METHODS: The literature was systematically reviewed. Research studies of UAE as an adjunct to surgery, and those not using peri-operative MRI were excluded. Primary outcomes were fibroid size and uterine volume reduction, procedure time, length of hospital stay, reinterventions, patient symptom improvement/satisfaction and complications. RESULTS: We identified four observational studies (839 patients; giant = 163, non-giant = 676). Both groups demonstrated reduction in fibroid size and uterine volume after UAE, with equivocal difference in uterine volume reduction (Mean difference (MD) - 0.3 95% confidence interval (CI) - 3.8 to 3.1, p = 0.86) and greater reduction in non-giant dominant fibroid size (MD - 5.9 95% CI - 10.3 to - 1.5, p < 0.01). Giant fibroids were associated with 5.6 min longer mean operative time (MD 5.6 min 95% CI 2.6-8.6, p < 0.01) and 4.8 h longer mean hospital stay (MD 4.8 h 95% CI 1.1-8.6, p = 0.01). Patient symptoms/satisfaction outcomes were summarised, but too heterogeneous for meta-analysis. Major complication and reintervention rates were low, with a statistically higher rate of major complications (Odds ratio (OR) 4.7 95% CI 1.5-14.6, p < 0.01) and reinterventions (OR 3.6 95% CI 1.7-7.5, p < 0.01) in giant fibroids. CONCLUSIONS: Current evidence shows UAE is a safe and effective option to treat giant fibroids. However, the limited available data indicate a relatively higher risk of complications and reinterventions when compared with non-giant fibroids. Patients should be selected
Rostampour S, Hamady MS, Alsafi A, 2020, To Tweet or Not to Tweet? A Look at Radiology Societies' Use of Twitter, CARDIOVASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 43, Pages: 1070-1074, ISSN: 0174-1551
Salim S, Locci R, Martin G, et al., 2020, Short- and long-term outcomes in isolated penetrating aortic ulcer disease, Journal of Vascular Surgery, Vol: 72, Pages: 84-91, ISSN: 0741-5214
BACKGROUND: The optimum management of isolated penetrating aortic ulceration (PAU), with no associated intramural hematoma or aortic dissection is not clear. We evaluate the short- and long-term outcomes in isolated PAU to better inform management strategies. METHODS: We conducted a retrospective review of 43 consecutive patients (mean age, 72.2 years; 26 men) with isolated PAU (excluding intramural hematoma/aortic dissection) managed at a single tertiary vascular unit between November 2007 and April 2019. Twenty-one percent had PAU of the arch, 62% of the thoracic aorta, and 17% of the abdominal aorta. Conservative and surgical groups were analyzed separately. Primary outcomes included mortality, PAU progression, and interventional complications. RESULTS: Initially, 67% of patients (29/43) were managed conservatively; they had significantly smaller PAU neck widths (P = .04), PAU depths (P = .004), and lower rates of associated aneurysmal change (P = .004) compared with those initially requiring surgery. Four patients (4/29) initially managed conservatively eventually required surgical management at a mean time interval of 49.75 months (range, 9.03-104.33 months) primarily owing to aneurysmal degeneration. Initially, 33% of patients (14/43) underwent surgical management; 7 of the 14 procedures were urgent. Of the 18 patients, 17 eventually managed with surgical intervention had an endovascular repair; 2 of the 17 endovascular cases involved supra-aortic debranching, six used scalloped, fenestrated, or chimney stents. The overall long-term mortality was 30% (mean follow-up, 48 months; range, 0-136 months) with no significant difference between the conservatively and surgically managed groups (P = .98). No aortic-related deaths were documented during follow-up in those managed conservatively. There was no in-hospital mortality after surgical repair. Of these 18 patients, two required reintervention within 30 days for t
Bjorck M, Earnshaw JJ, Acosta S, et al., 2020, Editor's Choice - European Society for Vascular Surgery (ESVS) 2020 Clinical Practice Guidelines on the Management of Acute Limb Ischaemia, EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, Vol: 59, Pages: 173-218, ISSN: 1078-5884
Alsafi A, Jenkins MP, Hamady MS, 2019, Use of Stent Grafts to Preserve a Large Inferior Mesenteric Artery during Endovascular Aortic Aneurysm Repair, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 30, Pages: 1980-1981, ISSN: 1051-0443
Hanna L, Gibbs R, Fadl A, et al., 2019, Midterm to long-term outcomes of scallop endografts in the management of aortic disease with unfavorable proximal landing zone in the arch, Fall Meeting of the Frank-J-Veith-International-Society / VEITH Symposium, Publisher: Elsevier, Pages: E145-E145, ISSN: 0741-5214
Rolls AE, Riga CV, Rahim SU, et al., 2019, The use of video motion analysis to determine the impact of anatomic complexity on endovascular performance in carotid artery stenting, JOURNAL OF VASCULAR SURGERY, Vol: 69, Pages: 1482-1489, ISSN: 0741-5214
Kousios A, Storey R, Troy-Barnes E, et al., 2019, Plasmacytoma-like post-transplant lymphoproliferative disease in a disused arterio-venous fistula: the importance of histopathology., Kidney International Reports, Vol: 4, Pages: 749-755, ISSN: 2468-0249
Common causes of swelling in arteriovenous fistulae (AVFs) include thrombosis, infection, aneurysm, and superior vena cava (SVC) obstruction secondary to previous dialysis vascular catheter use. Malignancies confined in AVFs are rare and have been described in case series and case reports, mostly in immunosuppressed patients.1 Patients who undergo transplantation frequently have functioning or nonfunctioning AVFs. The risk of malignancy is increased in this patient group and thus should be considered in patients presenting with symptomatic AVF. The most common histopathological diagnosis is angiosarcoma.1, 2 Plasmacytoma-like posttransplant lymphoproliferative disease (PTLD) confined in an AVF has not been previously described.
Zamir M, Jenkins M, Burfitt N, et al., 2019, Short-term and Midterm Results of Fenestrated Anaconda Endograft in Patients with Previous Endovascular Aneurysm Repair, JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY, Vol: 30, Pages: 546-553, ISSN: 1051-0443
Grover G, Perera AH, Hamady M, et al., 2018, Cerebral embolic protection in thoracic endovascular aortic repair, JOURNAL OF VASCULAR SURGERY, Vol: 68, Pages: 1656-1666, ISSN: 0741-5214
ffrench-Constant S, Weerakoon N, Amin R, et al., 2018, Dual-balloon assisted super-selective embolisation of high flow arterial venous fistula within a transplant kidney, CVIR Endovascular, Vol: 1, ISSN: 2520-8934
BackgroundIn this case report, we describe a novel application of the technique of ‘dual-balloon assisted’ cannulation and embolisation of a high flow arterial venous fistula (AVF) in transplant kidney, where attempts at standard and previously described embolisation techniques were proving difficult to achieve.Case presentationSeventy year old gentleman with renal transplant presenting with high output cardiac failure and deteriorating renal function. Angiography demonstrated high flow traumatic AV fistula within transplanted kidney, secondary to multiple biopsies. Attempts at guidewire and guiding sheath placement and stability for occlusion plug deployment were failing due to combination of very high back-flow pressures within the AVF and challenging vascular anatomy; with an aneurysmal, tortuous iliac artery as well as intra renal transplanted vessels. A combination of angioplasty and remodeling aortic balloons in the transplant artery and the host external iliac vein respectively, facilitated stabilization of guiding sheath and hence controlled delivery of an occlusion plug from the venous side of the fistula. The fistula was successfully embolised, leading to complete resolution of patient symptoms and improvement of renal function beyond his previous baseline.ConclusionsPercutaneous embolisation is an established technique to treat iatrogenic AVF in transplant kidneys. High flow pressure through an AVF, as demonstrated in this case, can cause difficulty and raise safety issues in accessing and embolising the AVF using previously described techniques. This case report describes an effective and novel application of the technique of using a second balloon in the host common iliac vein to; lower flow pressure, stabilise the guidewires during plug deployment and prevent displacement of wires and/or plug into the common iliac vein.
Kok HK, Rodt T, Fanelli F, et al., 2018, Clinical and endovascular practice in interventional radiology: a contemporary European analysis, CVIR ENDOVASCULAR, Vol: 1
Li MM, Hamady MS, Bicknell CD, et al., 2018, Flexible robotic catheters in the visceral segment of the aorta: advantages and limitations, JOURNAL OF CARDIOVASCULAR SURGERY, Vol: 59, Pages: 317-321, ISSN: 0021-9509
Rudarakanchana N, Hamady M, Harris S, et al., 2018, Early outcomes of patients transferred with ruptured suprarenal aneurysm or dissection, ANNALS OF THE ROYAL COLLEGE OF SURGEONS OF ENGLAND, Vol: 100, Pages: 316-321, ISSN: 0035-8843
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