			Home About us Contact

Endovascular Intervention (endovascular + intervention)

Distribution by Scientific Domains

Medical Sciences	100%

Selected Abstracts

Endovascular Interventions in Iliac and Infrainguinal Occlusive Artery Disease

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 6 2004
JOHANNES RUEF M.D., M.Sc.
Percutaneous endovascular procedures are increasingly applied to treat symptomatic peripheral occlusive artery disease. While the primary technical success and recanalization rates in iliac and infrainguinal interventions are high, differences in the long-term patency rates exist with respect to the anatomic localization, separating the iliac, femoropopliteal, and infrapopliteal arterial regions. In iliac arteries, even complex lesions can be recanalized with good long-term patency rates, especially when using self-expanding nitinol stents. In the infrainguinal arteries the method of choice is still under debate (e.g., balloon angioplasty vs stent implantation). A high restenosis rate represents one of the major limitations in femoropopliteal and infrapopliteal interventions. Therefore, additional methods and treatment strategies for peripheral interventions with the potential for future applications are under investigation and will be discussed such as drug-eluting stents, brachytherapy, subintimal angioplasty, laser angioplasty, atherectomy/thrombectomy, cutting balloon, polytetrafluoroethylene (PTFE)-covered stent grafts, biodegradable stents, and cryoplasty. The increasing amount of data on successful peripheral interventions supports the necessity to adapt and reevaluate the current consensus guidelines that were put together in 2000. [source]

MR imaging in assessing cardiovascular interventions and myocardial injury

CONTRAST MEDIA & MOLECULAR IMAGING, Issue 1 2007
Alexis Jacquier
Abstract Performing an MR-guided endovascular intervention requires (1) real-time tracking and guidance of catheters/guide wires to the target, (2) high-resolution images of the target and its surroundings in order to define the extent of the target, (3) performing a therapeutic procedure (delivery of stent or injection of gene or cells) and (4) evaluating the outcome of the therapeutic procedure. The combination of X-ray and MR imaging (XMR) in a single suite was designed for new interventional procedures. MR contrast media can be used to delineate myocardial infarcts and microvascular obstruction, thereby defining the target for local delivery of therapeutic agents under MR-guidance. Iron particles, or gadolinium- or dysprosium-chelates are mixed with the soluble injectates or stem cells in order to track intramyocardial delivery and distribution. Preliminary results show that genes encoded for vascular endothelial and fibroblast growth factor and cells are effective in promoting angiogenesis, arteriogenesis, perfusion and LV function. Angiogenic growth factors, genes and cells administered under MR-guided minimally invasive catheter-based procedures will open up new avenues in treating end-stage ischemic heart disease. The optimum dose of the therapeutic agents, delivery devices and real-time imaging techniques to guide the delivery are currently the subject of ongoing research. The aim of this review is to (1) provide an updated review of experiences using MR imaging to guide transcatheter therapy, (2) address the potential of cardiovascular magnetic resonance (MR) imaging and MR contrast media in assessing myocardial injury at a molecular level and labeling cells and (3) illustrate the applicability of the non-invasive MR imaging in the field of angiogenic therapies through recent clinical and experimental publications. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Intravascular ultrasound-guided central vein angioplasty and stenting without the use of radiographic contrast agents

JOURNAL OF CLINICAL ULTRASOUND, Issue 4 2008
Ray Matthews MD
Abstract Patients with contraindications to iodinated radiographic contrast agents present a significant challenge during endovascular intervention. A 46-year-old man with end-stage renal disease and a normally functioning left upper extremity arteriovenous fistula presented with severe left arm edema. The patient's history included repeated severe anaphylactoid reactions with severe respiratory distress upon exposure to iodinated contrast. In an attempt to avoid the use of iodinated contrast, angioplasty and stent placement of a severe central venous stenosis were performed using only fluoroscopy and intravascular sonography. In patients unable to receive iodinated contrast secondary to anaphylactoid reactions, intravascular sonography can be used to guide angioplasty and stenting of central venous stenosis. © 2008 Wiley Periodicals, Inc. J Clin Ultrasound, 2008. [source]

Proceedings of the TCT: Endovascular Interventional Care Evolves into Multidisciplinary Field

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2006
WILLIAM A. GRAY M.D.Article first published online: 25 MAY 200
The creation, and expansion, of the heretofore nonexistent field of endovascular intervention has progressed quickly over the past 10,15 years. In a relatively short period of time, it has been instrumental in transforming both the care of the vascular patient and the practice of vascular surgery and cardiology. [source]

Multi-detector CT angiography for lower gastrointestinal bleeding: Can it select patients for endovascular intervention?

JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 1 2010
PT Foley§
Summary This is a retrospective review of the results at our institution of using multi-detector CT angiography (CTA) to localise lower gastrointestinal (GI) bleeding. We hypothesised that in our patient population: (i) CTA was unlikely to demonstrate bleeding in patients who were haemodynamically stable; (ii) in haemodynamically unstable patients in whom CTA was undertaken, the results could be used to select patients who would benefit from catheter angiography; and (iii) in haemodynamically unstable patients in whom CTA was undertaken, a subgroup of patients could be identified who would benefit from primary surgical treatment, avoiding invasive angiography completely. A retrospective review was conducted of the clinical records of all patients undergoing CTA for lower GI haemorrhage at our institution between 1 January 2005 and 30 June 2007. Out of the 20 patients examined, 10 had positive CTAs demonstrating the bleeding site. Nine were haemodynamically unstable at the time of the study. Four patients with positive CT angiograms were able to be treated directly with surgery and avoided invasive angiography. Ten patients had negative CTAs. Four of these were haemodynamically unstable, six haemodynamically stable. Only one required intervention to secure haemostasis, the rest stopped spontaneously. No haemodynamically stable patient who had a negative CTA required intervention. CTA is a useful non-invasive technique for localising the site of lower GI bleeding. In our patient population, in the absence of haemodynamic instability, the diagnostic yield of CTA was low and bleeding was likely to stop spontaneously. In haemodynamically unstable patients, a positive CTA allowed patients to be triaged to surgery or angiography, whereas there was a strong association between a negative CTA and spontaneous cessation of bleeding. [source]

DAMAGE CONTROL SURGERY AND ANGIOGRAPHY IN CASES OF ACUTE MESENTERIC ISCHAEMIA

ANZ JOURNAL OF SURGERY, Issue 5 2005
Anthony J. Freeman
Background: Acute mesenteric arterial occlusion typically presents late and has an estimated mortality of 60,80%. This report examines the evolution of a novel management approach to this difficult surgical problem at a teaching hospital in rural Australia. Methods: A retrospective review of 20 consecutive cases that presented to Lismore Base Hospital, Lismore, New South Wales, between 1995 and 2003 was performed. Results: Of the 16 patients who were actively treated, 10 survived. Mortality was associated with attempting an emergency operative revascularisation and not performing a second-look laparotomy. All three patients who had a damage control approach at the initial operation survived and in four cases endovascular intervention successfully achieved reperfusion of acutely ischaemic bowel. Conclusions: Evidence from the series of patients described suggests that damage control surgery and early angiography improve survival in patients suffering acute mesenteric ischaemia. A damage control approach involves emergency resection of ischaemic bowel with no attempt to restore gastrointestinal continuity and formation of a laparostomy. Patients are stabilised in the intensive care unit (ICU) and angiography can be arranged to either plan a definitive bypass procedure or alternatively endovascular therapies can be carried out in an attempt to arrest gastrointestinal infarction. Definitive surgery is then considered after 2,3 days. This approach is particularly attractive if immediate specialist vascular expertise is not available. [source]

Antiplatelet therapy after endovascular intervention: Does combination therapy really work and what is the optimum duration of therapy?,,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue S1 2009
Richard V. Milani MD
Abstract The number of patients undergoing peripheral interventions has increased in recent years, highlighting the need for a safe and effective protective antithrombotic therapy. Platelet inhibition following coronary intervention is associated with a significantly reduced risk of graft occlusion, and has been acknowledged to be safe and effective in patients with peripheral arterial disease. Monotherapy with either aspirin or clopidogrel, reduces the rate of stroke, myocardial infarction, and cardiovascular death in patients suffering from peripheral arterial disease. Limited data from clinical trials investigating combination therapy of aspirin with ticlopidine or clopidogrel in patients undergoing endovascular interventions, have suggested the potential for a reduction in cardiovascular events. Nevertheless, the optimal duration of postintervention antiplatelet therapy remains to be defined. © 2009 Wiley-Liss, Inc. [source]

ENDOVASCULAR REPAIR OF POPLITEAL ARTERY ANEURYSMS: TECHNIQUES, CURRENT EVIDENCE AND RECENT EXPERIENCE

ANZ JOURNAL OF SURGERY, Issue 6 2006
Ray Siauw
Endovascular repair of popliteal artery aneurysms is a new technique, which has emerged as an alternative to open surgical bypass. However, evidence to support its use is limited. We present a review of current literature relevant to this technique. The MEDLINE search terms were popliteal artery, aneurysm, endovascular, endoluminal and stent. Fifty-eight articles were yielded, of which 21 were studies of endovascular repair by implantation of stent or stent graft of true aneurysms of the popliteal artery. There was only one randomized study. Small numbers of endovascular interventions are reported, with variations in study design and endovascular techniques. Long-term follow-up data is lacking; however, early results have been promising with high rates of initial treatment success. Early thrombosis of stent grafts occurs in approximately 10%, but this does not herald limb loss. Endovascular treatment offers potential benefits over traditional surgery, but needs to be studied further with a large-scale multicentre randomized trial. [source]