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A correction to this paper has been published: 10.1007/s00270-021-02862-w

The purpose of this paper is to describe a unique "eighth note" deformity of the autogenous radiocephalic fistula for hemodialysis and to retrospectively evaluate the efficacy and safety of its endovascular treatment. Over 3 years, a total of 808 patients and 558 autogenous radiocephalic fistulas were treated for vascular access dysfunction or thrombosis. These included 14 fistulas in 14 patients (9 men, 5 women; mean age, 58.2 +/- 2.8 years; range 27-79 years) whose fistulograms before treatment resembled a musical note, the eighth note. Endovascular treatment sought to remodel the deformed vascular access to a classic radiocephalic fistula and increase the number of cannulation sites available for hemodialysis. The technical and clinical success rates were each 92.8% (13/14). Fistula remodeling was successful in 13 patients. The postintervention primary patency was 100% at 90 days, 91.7 +/- 0.8% at 120 days, 78.6 +/- 13.9% at 180 days, 62.9 +/- 17.9% at 360 days, 31.4 +/- 24.0% at 540 days, and 0% at 720 days. The postintervention secondary patency was 100% at 90 days, 100% at 120 days, 100% at 180 days, 85.7 +/- 13.2% at 360 days, and 85.7 +/- 13.2% at 720 days. No major complications were noted. Minor complications were found in 71.4% of patients, all of which resolved spontaneously. In conclusion, endovascular treatment of fistulas with the eighth note deformity can effectively increase the number of available cannulation sites, facilitate fistula maturation, and facilitate thromboaspiration after fistula thrombosis.

This paper reports on the early and midterm results of endovascular treatment of acute carotid artery dissections, its specific problems, and its limitations. We encountered seven patients with symptomatic extracranial carotid artery dissection, three cases of which occurred after carotid endarterectomy, two after carotid angioplasty and stenting, and two after trauma. Balloon-expandable and self-expanding stents were placed using a transfemoral approach. Success in restoring the carotid lumen was achieved in all patients. No procedure-related complications occurred. All patients experienced significant clinical improvement while in the hospital and achieved complete long-term recovery. At follow-up (mean, 22.4 months), good luminal patency of the stented segments was observed. In conclusion, in this small series, primary stent-supported angioplasty seems to be a safe and effective strategy in the treatment of selected patients having acute traumatic extracranial carotid artery dissection, with excellent early and midterm results. Larger series and longer-term follow-up are required before definitive recommendations can be made.

Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.

This paper reports our experience with endovascular techniques for the retrieval of lost or misplaced intravascular objects. Over 12 years, 78 patients were referred for interventional retrieval of intravascular foreign objects. In this retrospective study, radiological procedure records and patients' medical records were reviewed to determine the exact removal procedure in every case, to report success rates, and to identify significant procedure-related complications. Written, informed consent was obtained from all patients prior to the intervention; this retrospective analysis was performed according to the guidelines of the Institutional Review Board. Thirty-six of seventy-eight foreign objects (46%) were located in the venous system, 27 of 78 (35%) in the right heart, and 15 of 78 (19%) in the pulmonary arteries. For foreign object removal, in 71 of 78 (91%) cases a snare loop was used, in 6 of 78 (8%) cases a sidewinder catheter combined with a snare loop was used, and in 1 case (1%) a sidewinder catheter alone was used for foreign object removal. In 68 of 78 (87%) cases, primary success was achieved. In 3 of 78 cases (4%), foreign objects were successfully mobilized to the femoral vessels and surgically removed. In 7 of 78 cases (9%), complete removal of the foreign object was not possible. In 5 of 78 cases (6%), minor complications occurred during the removal procedure. In conclusion, endovascular retrieval of lost or misplaced intravascular objects is highly effective, with relatively few minor complications. On the basis of our findings, these techniques should be considered as the therapy of choice.

The objective of this paper is to present an alternative therapeutic approach for the treatment of patients with massive hemoptysis in whom bronchial and/or nonbronchial systemic arterial embolization is not possible. We describe a percutaneous procedure for pulmonary segmental artery embolization. Between May 2000 and July 2006, 27 adult patients with hemoptysis underwent percutaneous treatment at our department; 20 of 27 patients were embolized via bronchial and or nonbronchial systemic arteries and 7 patients were embolized via pulmonary artery. Femoral arterial access for systemic artery catheterization and femoral vein access for pulmonary arterial catheterization were used. Gelfoam particles and coils were used for embolization. In this study, we report on three cases of massive hemoptysis from a systemic arterial source in whom bronchial and/or nonbronchial arteries embolization was not possible. Percutaneous embolization via the pulmonary artery access was successful in all three patients. In conclusion, embolization via pulmonary artery is presented as an alternative approach for the management of hemoptysis in patients in whom bronchial arterial embolization is not possible.

Percutaneous atherectomy was first introduced as an alternative to balloon angioplasty (BA) in 1986 to improve the results that could be achieved with BA [1]. The advantages of atherectomy were the creation of a smooth luminal surface with less local thrombosis and the reduction of elastic recoil because the lumen can widen without stretching the arterial wall. In percutaneous atherectomy the atheromatous intima usually occurs with or without the media. The notion that the “bad” atheroma would be removed is also an appealing feature of this technique. Atherectomy can be divided into extirpative atherectomy, which means cutting and/or shaving and removing the atherosclerotic material from the patient, and ablative atherectomy, where the atheroma is fragmented with a high-speed device. The Simpson atherectomy catheter is an example of extirpative atherectomy, and the Kensey catheter and the rotablator are examples of ablative devices. The term “directional” means that the catheter removes one sector or direction of the vessel-wall atheroma. Eleven studies of the Simpson atherectomy device were published between 1988 and 1993. Excluding 2 studies that did not publish technical success, a total of 908 patients were reported. The technical success rate was reported at approximately 90%, and complications, mainly peripheral embolisation, were reported to be between 3% and 21% (median 4%). Six-month follow-up was available in eight reports, and patency by different definitions varied between 80% and 99%. Twelve-month follow-up of 71% to 94% was reported in only five reports. Only one article reported 24-month follow-up of a lager group of patients. The 24-months patency has since decreased to 37% [2]. The previous papers is typical for older interventional radiology (IR) publications concentrating on the technique but with less focus on long-term outcome or real evidence for effectiveness. In 1995, Vroegindeweij et al. [3] published data from a prospective randomized trial comparing BA with atherectomy. This is an example of probably the earliest randomized controlled trial (RCT) concerning peripheral interventional techniques. Although the total series is small (n = 73 patients), the outcome is clear and significant. Atherectomy does not result in improved clinical and hemodynamic outcome. Furthermore, atherectomy of segmental atherosclerotic femoropopliteal disease does not result in a better patency rate than BA; in patients with lesions longer than 2 cm, atherectomy results are significantly worse. So, the myth was busted and that was the end of directional atherectomy, one could say. However, it is well known that IR is a profession of the future, so we should never look back. Yes, directional atherectomy publications died out during the next 2 decades; then in approximately 2005, a well-orchestrated new directional atherectomy offensive began. The system was presented as “new” and promising. There was an early registry and enthusiastic presentations at many angioclubs, and IR meetings were held by small groups of physicians [4]. Again, directional atherectomy was booming once again. This time not only medical journals were involved, there was also a publication in the Wall Street Journal in August 2005: Physicians Testing SilverHawk Catheter Also Own Stock Options was the title of the warning article. Twelve doctors supplied information about the catheter’s effectiveness to a registry that the company used to evaluate the SilverHawk (EV3, USA)—its only product—and to promote it to other doctors. The article concluded with the warning that the results were anecdotal. By now (2008), new reports have shown that directional atherectomy, also performed with the “new” device, has no additional value to BA but moreover carries a high risk for peripheral embolization, which was not noted in the original registry [5–7]. Is the myth now finally busted? Some myths must be busted twice. However, in IR you never know.

Recently a few authors have reported experience regarding the safety and efficacy of planned combined subintimal arterial flossing with antegrade-retrograde intervention (SAFARI) in patients with critical limb ischemia (CLI) presenting long occlusions involving the popliteal trifurcation. Spinosa et al. described the use of this technique in 20 limbs (21 cases), with a limb salvage rate of 90% at 6 months. The authors concluded that the SAFARI technique can be useful for completing subintimal recanalization when there is failure to reenter the distal true lumen from an antegrade approach or when there is limited distal target artery available for reentry. Also, according to these authors the SAFARI technique improves technical success in the performance of subintimal recanalization, and limb salvage rates are comparable to those with antegrade subintimal recanalization [1]. Gandini et al reported the use of this novel technique in four out of 104 patients with CLI. In their paper those authors concluded that the SAFARI technique should be adopted as a ‘‘standard procedure’’ in CLI cases showing long occlusions involving the trifurcation and presenting risk of amputation [2]. While we agree with Spinosa et al. that the SAFARI technique should be adopted in the presence of failure to reenter the distal true lumen from an antegrade approach, we do not think that this technique should always be used as first choice in the presence of long occlusion involving the trifurcation. Indeed, the SAFARI technique is indubitably an attractive option but, in view of the limited number of cases reported in the literature, should not yet be regarded as a standard procedure. According to the literature [3–5], intraluminal or subintimal recanalization of long occlusions involving the popliteal trifurcation is normally achieved by the transfemoral approach. In the last 2 years more than 1000 diabetic patients with CLI have been successfully treated endovascularly at our two centers (Multimedica IRCCS, Milan, and Multimedica Santa Maria Hospital, Castellanza, Va.). In this large cohort of subjects the use of the SAFARI technique was deemed necessary in four cases only (one posterior tibial and three anterior tibial artery approaches) and, importantly, after unsuccessful repeated attempts at distal revascularization. To the present authors, direct puncture of the distal third of a calf artery is not free of serious complications, leading in certain instances to flowlimiting dissection (due to introducer sheath advancement or due to the puncture itself) as well as thrombosis of the accessed artery (mainly at the end of the intervention during manual compression of the puncture site). Also, as reported by Gandini et al., the ‘‘presence of ulcers at the entry zone is an important limitation to the performance of this type of approach.’’ Finally, this type of procedure is time-consuming, which is a main limitation in such critically ill patients (heart and renal comorbidities are often associated). In conclusion, at this moment in time the use of the SAFARI technique should not be regarded as the first option for the treatment of diabetic patients with CLI. In expert hands, however, it may be considered in selected cases, after unsuccessful attempts at revascularization from the femoral artery. Most importantly, when this novel approach is deemed necessary, surgical exposure rather T. Lupattelli (&) Department of Radiology and Interventional Radiology, Via milanese 300, Sesto San Giovanni, Milan 20099, Italy e-mail: tommasolupattelli@hotmail.com

Success of percutaneous transluminal angioplasty (PTA) in disorders other than atherosclerosis has been reported in recent papers. It has been stated, however, that the unique histopathology characteristic of Takayasu's arteritis may prevent a successful dilatation of the stenotic segments. In a recent case, however, PTA was successful in the treatment of bilateral renal artery stenosis secondary to Takayasu's arteritis. Although more time is needed to evaluate the long-term results of this nonsurgical treatment, it is evident that the stenotic lesions in Takayasu's disease are amenable to balloon dilatation. PTA should be attempted in such cases, and surgery should only be performed in case of failure.

Technical success in percutaneous transluminal coronary angioplasty (PTCA) is a function of patient selection, operator experience, and the capabilities of the angioplasty equipment employed. When unsuccessful PTCA occurs, it is the result of one of several factors: (1) a failure to cross the stenosis; (2) a failure to dilate the stenosis; (3) an ischemic complication; or (4) a late recurrence of the anginal syndrome. In this paper, we discuss the relative frequency of these types of failure, and the ways in which improvements in technique and/or equipment may be employed to improve the chance of a successful procedure.