Abstract Purpose To investigate the ability to salvage an acutely thrombosed dialysis access using rheolytic pharmacomechanical thrombectomy (PMT), the short- and medium-term patency rates and safety at a tertiary care hospital. Methods A retrospective review of all patients who underwent rheolytic PMT for a thrombosed arteriovenous fistula (AVF) or arteriovenous graft (AVG) from October 2020 to 2023 was performed. Primary patency was defined as the ability to successfully dialyze through the treated access site without further intervention. Secondary patency included patients who required additional interventions that enabled them to continue dialysis. Data analysis was conducted using SPSS for comprehensive statistical evaluation. Results A total of 37 thrombectomy procedures, involving 15 AVF and 22 AVG cases, were performed on 31 patients; 20 males and 11 females with a mean age of 62 ± 13 years. The average time from recognizing dialysis access site dysfunction to intervention was 2.6 ± 1.4 days. The mean total rheolytic PMT run time was 295 ± 119 seconds. Immediate technical success was defined as restoration of flow between the arteriovenous anastomosis and the central veins. Technical success was achieved in 91.9% (34/37) of thrombectomies. Clinical success was defined as the ability to achieve successful dialysis within 48 hours of the intervention. In total, 72.9% (27/37) of these cases achieved clinical success. Primary patency rates at 1, 3, and 6 months were 87.5, 78, and 46.9%, respectively. Secondary patency rates at 3, 6, and 12 months were 87.5, 66.7, and 58.3%, respectively. Angioplasty was performed in all procedures, and stent insertion was required in 13.5% (5/37) of thrombectomies. Conclusion This study adds to the evidence that rheolytic PMT is a safe and effective tool for AVF and AVG salvage. After an initial thrombosis, the chance of re-thrombosis within 12 to 24 months is high and teams looking after these patients should have a strategy for future dialysis access.

Abstract Objective This retrospective case series reports the 15-year experience of the endovascular management of mycotic aortic and iliac aneurysms (MAAs) at a tertiary referral center in the United Kingdom. Materials and Methods The patients were identified through advanced searches in picture archiving and communication system (PACS) and electronic patient records. Data were retrieved and recorded in a structured spreadsheet including demographic details, symptoms and comorbidities, endovascular techniques employed and graft types, as well as treatment outcomes including 30-day mortality, 1-, 3-, and 5-year survival, aneurysm resolution percentage, and rates of re-intervention and complications. Statistical Analysis Descriptive statistics summarized the demographic and clinical characteristics, presenting them as means for continuous variables and frequencies/percentages for categorical variables. Results Of the 15 included patients, 73.3% (11/15) and 26.7% (4/15) were males and females, respectively, with a mean age of 64 years. Imaging revealed diverse anatomical involvement, with MAA in the descending thoracic (6/15), suprarenal and juxtarenal (5/15), infrarenal (3/15), and common iliac arteries (1/15). The 30-day mortality rate was 6.7% (1/15), while 1-, 3-, and 5-year survival rates from time of initial intervention were 57.1% (8/14), 38.5% (5/13), and 30.8% (4/13), respectively, with 1 case only just having undergone 1-month follow-up (performed in July 2023). The average mycotic aneurysm size was 47 mm (range: 19–80 mm), of which 33.3% (5/15) presented with rupture. The average sac size reduction following treatment was 31%, with 5/15 cases demonstrating complete resolution. Four cases required re-intervention due to persistent endoleak, sac re-expansion secondary to delayed endoleak, or stent occlusion. Persistent or recurrent graft infection was observed in 53.3% (8/15) of cases. Two cases required surgical re-intervention for stent occlusion. Conclusion Our findings reinforce the role of endovascular interventions in MAA acute management, showcasing immediate survival benefits. Late complications and frequent re-interventions emphasize the importance of vigilant surveillance.

Abstract Objective The aim of this study was to report the primary outcomes of a pilot study investigating the safety and efficacy of sirolimus drug-coated balloons (SELUTION) for endovascular postatherectomy treatment of native occluded femoropopliteal lesions in patients with chronic limb-threatening ischemia (CLTI). Materials and Methods This study analyzes a cohort of CLTI patients with femoropopliteal artery occlusions treated with combined rotational atherectomy and postatherectomy angioplasty using the SELUTION device. The primary outcome measures were amputation-free survival (AFS) defined as time to major limb (above ankle) amputation of the index leg or death from any cause. Secondary outcome measures included technical success, overall survival, major amputation of the index leg, major adverse limb event (MALE) defined as major amputation or any further major revascularization intervention of the treated segment during the follow-up period and primary patency at 12 months. Results Between April 2021 and January 2022, nine patients (mean age: 64.0 ± 8.4, 66.7% male) with femoropopliteal occlusive lesions (mean lesion length: 141.1mm, range: 40–400) were treated with the above-combined approach. Technical success was 100%. At 12 months, the AFS was 88.9%, with one death and zero major amputations (88.9% survival and 100% limb salvage, respectively); only two patients (22.2%) suffered a MALE; primary patency was 75%. No adverse events related to the sirolimus drug-coated balloon nor to the atherectomy device were observed. Conclusion Combining sirolimus drug-coated balloon and atherectomy for treatment of femoropopliteal occlusions in CLTI patients is a safe and effective approach achieving satisfactory patency and adverse event rates.

AbstractPercutaneous radiologic gastrostomies are traditionally done using a supracolic approach due to the perceived increased risk of postprocedural hemorrhage associated with an infracolic approach. Many interventional radiologists will decline attempts at placing a gastrostomy tube in situations of colonic interposition, requiring patients to undergo surgery. The goal of this review was to understand the safety and technique of infracolic gastrostomies to assess the validity of these concerns. There were 12 cases of infracolic gastrostomies identified across two retrospective studies and one case report. All gastrostomy tubes were inserted successfully with no abandoned procedures with the only minor variation in technique being that the colon was displaced superiorly as opposed to inferiorly like in the traditional supracolic approach. Across the two retrospective studies, the percentage of infracolic gastrostomies done during the study period was 1.18% (6 out of 508) and 0.43% (5 out of 1,156). There were no immediate postprocedural complications reported in the study done with six patients who underwent infracolic gastrostomies, but there were two deaths during the follow-up period, both of which were attributed to disease progression. In the study with five patients who had undergone infracolic gastrostomies, there was one minor complication of site soreness along with one case of death due to sepsis secondary to aspiration of the barium contrast used to delineate the colon prior to the procedure. This is a rare complication that can occur when a barium swallow is done, especially in this case where the patient was older and had comorbidities that increased the aspiration risk. Evidently, infracolic gastrostomies have been inserted in the past with minimal complications. However, due to the limited sample size, the safety of this technique cannot be established without future prospective studies.

Abstract Objective The aim of the study was to assess the safety and efficacy of endovascular management for postpancreaticoduodenectomy hemorrhage. Materials and Methods A retrospective analysis of patients who underwent endovascular management for hemorrhage after pancreatic surgery between January 2015 to December 2020 was performed. Patient demographics, clinical presentation, angiography findings, endovascular procedure, technical success, clinical success, and complications were assessed. Results Seventeen patients, comprising 14 (82.4%) males and 3 (17.6%) females, aged 37 to 68 years underwent endovascular management for postpancreatectomy hemorrhage. Patients presented with hemorrhage on their postoperative days 4 to 22 (mean: 9.8th day; median: 8th day); the presentation was with extraluminal hemorrhage in 11 patients (64.7%) and intraluminal hemorrhage in 6 patients (35.2%). The gastroduodenal artery (GDA) stump (10 patients, 58.8%) was the most commonly involved artery. The majority of cases were treated using coils as embolizing agents (13/17 patients, 76.5%). The technical and clinical success rates were 100%. The complication rate was 5.9% (1/17) and the mortality rate was 11.8% (2/17). The relaparotomy rate was 23.5% (4/17); however, none of the relaparotomy was for hemorrhage. Conclusion Endovascular treatment provides a minimally invasive, safe, and effective method for the management of pancreaticoduodenectomy hemorrhage.

AbstractUltrasound contrast agents have gained increasing popularity due to the high level of safety, real-time improved visualization, and ability to detect vascularity. As a result, contrast-enhanced ultrasound lends itself well to interventional radiology including in preprocedure assessment, intraprocedural guidance, and postprocedure evaluation. The authors aim to demonstrate the wide utility of contrast-enhanced ultrasound in both vascular and nonvascular intervention.