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Background The novel low-profile p48 flow diverter has been designed to treat aneurysms on small vessels of 1.75–3mm. We report our first clinical experiences.Methods Between March 2018–January 2020, 22 patients with 25 aneurysms were treated with the p48 in 3 centers. One patient had 3 aneurysms covered by one p48 and one patient had 2 aneurysms. There were 5 men, 17 women, with a mean age of 55 years (median 59, range 29–73 years).Results In 25 aneurysms, 24 p48 flow diverters were placed. In 1 patient additional coils were placed in the aneurysm. Procedural vessel rupture by the micro guidewire occurred in 2 patients and vessel rupture during p48 balloon dilatation occurred in 1 patient. Overall, the permanent morbidity rate was 13.6% (3 of 22, 95%CI 3.9–34.2%) and mortality was 4.5% (1 of 22, 95%CI <0.01–23.5%). Most complications were procedure-related and not device-specific. Of 22 patients with 25 aneurysms treated with p48, 18 patients with 20 aneurysms had angiographic follow-up after 5–18 months. Of 19 aneurysms, 10 were occluded and 7 showed a remnant. Two aneurysms were open after 6 months. Three aneurysms were still not occluded after 12, 14, and 18 months and these 3 were retreated. Retreatment rate was 16% (3 of 19) and the adequate occlusion rate was 90% (17 of 19).Conclusions Treatment of aneurysms in small-caliber vessels with the p48 is feasible and effective but is not without complications. More data is needed to establish indications, safety, and efficacy more accurately.

Background and purpose Flow diverters are increasingly used to treat intracranial aneurysms. We report the safety and efficacy of the p64 flow diverter, a resheathable and detachable device for intracranial aneurysms.Materials and methods We retrospectively reviewed 108 patients with 109 aneurysms treated with the p64 between March 2014 and July 2019. There were 87 women and 21 men, mean age 57 years. Of 109 aneurysms, 74 were discovered incidentally, 12 were symptomatic, 18 were previously treated, and five were ruptured dissection aneurysms. A total of 10 aneurysms were located in the posterior circulation. The mean aneurysm or remnant size was 8.1 mm.Results Hemorrhage by perforation with the distal guidewire occurred in two patients with permanent neurological deficits in one. In one patient, acute in-stent occlusion caused infarction with a permanent deficit. Permanent morbidity was 1.9% (2 of 108, 95%CI 0.1–6.9%); there was no mortality. During follow-up, three in-stent occlusions occurred, all asymptomatic. There were no delayed hemorrhagic complications. At six months, 77 of 96 aneurysms (80.2%) were completely occluded, and at last follow-up, this increased to 93 of 96 aneurysms (96.9%). In-stent stenosis at any degree occurred in 11 patients, progressing to asymptomatic complete occlusion in one. In the other patients, stenosis resolved or improved at further follow-up.Conclusion The p64 offers an effective and safe treatment option. Aneurysm occlusion rate was 97% at last follow-up, mostly achieved with a single device. There were no delayed hemorrhagic complications. Delayed in-stent stenosis infrequently progresses to occlusion but remains a matter of concern.

Abstract.: A patient with hereditary hemorrhagic telangiectasia and diffuse intrahepatic arteriovenous fistulas developed secondary high-output ventricular failure and pulmonary hypertension. A serial staged hepatic arterial coil embolization was performed with long-term resultant haemodynamic and clinical improvement. The methods of this procedure and related complications are discussed.

Objectives:to identify risk factors for complications following endovascular repair of abdominal aortic aneurysms (AAAs). Materials and methods:endovascular AAA exclusion was attempted in 64 patients. Patient characteristics, anatomic features of the aneurysm, operative technical aspects, and the experience of the teams were correlated with mortality, occurrence of endoleak, and other complications. Perioperative complications were graded following the recommendations of the Ad Hoc Committee on reporting standards. For the assessment of correlation between risk factors and outcomes a logistic regression analysis was used. Results:complications were observed in 43% of the procedures and were classified as mild (24%), moderate (55%) or severe (21%). American Society of Anaesthesiology (ASA) risk class 3 or 4, and advanced age were independent risk factors for perioperative death and complications. Adjuvant procedures or overstenting of the renal arteries with the uncovered part of the stent were not associated with increased risk of complications. Nevertheless, in four of 24 overstented renal orifices, a renal infarction or ischaemia of the kidney was observed on a postoperative CT scan. Advanced experience was associated with less complications, less endoleaks, and shorter operating time.Conclusions:high age and medical co-morbidity were associated with increased risk for perioperative complications and death. Additional perioperative procedures are usually well tolerated. With greater experience in endovascular AAA grafting the incidence of complications and endoleaks decreased.

In a 1-year period, 14 patients with inoperable, biopsy-proven hepatocellular cacinoma (HCC) underwent 18 superselective catheterisations of the proper hepatic artery with combined injection of Cisplatin and Liodol. According to Okuda et al. [1], patients were classified into clinical Stages I (2), II (7) and III (5). All 5 Stage III patients died during follow-up. Distal superselective catheterisation of the proper hepatic artery, in order to avoid Lipiodol embolism to the gastroduodenal, gastric or other anastomotic arteries was possible with conventional diagnostic catheters use and inexpensive coaxial (5 cases) or, an easry-to-use an inexpensive coaxial catheterisation system (13 cases). Radiological follow-up was by means of computed tomography (CT) 24 h and 6 weeks after chemoembolisation. Further CT studies were performed depending on the patient's progress. Twelve patients had CT follow-up over at least 6 weeks. Hypervascular hepatocellular carcinomas tend to diminish in volume, especially those which retain Lipiodol after 6 weeks, and survival after intra-arterial chemotheraphy is shorter in patients with hypovascular tumours which do not retain Lipiodol. We have treated only a limited number of patients, but consider chemoembolisation okf inoperable HCC with Lipiodol and Cisplatin as useful treatment for Okuda Stage 1 and II patients, but not for those in Stage III. Hypervascularity and Lipiodol retention on follow-up CT could indicate a favourable prognosis.

The aim of our study was to evaluate the results of catheter-directed thrombolysis and complementary procedures to treat acute iliofemoral deep vein thrombosis (DVT). A total of 24 consecutive patients with acute iliofemoral DVT underwent intrathrombus drip infusion of alteplase (3 mg/h; mean dosage 86 mg, range 45–174 mg), while intravenous heparin (1000 U/h) was continued. Complementary procedures were hydrodynamic thrombectomy in 3 and primary insertion of a Wallstent in 9 patients. Patency of 19 thrombosed veins (79 %) was restored with prompt symptomatic relief. An underlying anatomical anomaly or lesion was present in 13 patients: iliac vein compression syndrome (n= 8), absent (n= 2) or obstructed (n= 1) vena cava or venous stenosis (n= 2). Ten of the abnormalities were unknown before lysis and eight were relieved by stent deployment. Puncture site bleeding was the only complication but led to transfusion in 6 patients (25 %). Symptomatic reocclusion occurred in 4 patients. Catheter thrombolysis of iliofemoral vein thrombosis revealed many anatomical abnormalities which may predispose to thrombosis and are often amenable to stenting.

The purpose of the study was to investigate whether visual inspection of maximum intensity projection (MIP) images is a reliable method for assessment of the severity of renal artery stenoses (RAS). Therefore, 20 RAS were investigated with helical CT. Native axial images and MIP images were analysed separately or in combination (“two-step method”). A phanton study was performed to investigate the influence of window setting on apparent stenosis severity. Accuracy for diagnosis of 50–69% and 70–99% RAS and the mean inter-observer agreement were 82.5%, 77.5% and 82.5% respectively, using study of MIP images alone, and 100%, 97.5% and 95% using the “two-step method”. The phantom study showed that the apparent severity of vascular stenoses on MIP images depends on the selected window centre values. It is concluded that combined evaluation of both MIP images and native axial images is more reliable than study of MIP images alone for assessing the severity of RAS.

Objectives:: Percutaneous treatment of iliac artery occlusive disease has replaced open vascular reconstruction for several indications. A balloon angioplasty with or without stent is not an option in the presence of infrainguinal extension of the disease. The authors describe a technique that allows the construction of an aorto- or iliofemoral graft through a single groin incision, using a 4 mm PTFE graft, anchoring it proximally with a Palmaz stent and dilating both to the desired diameter. Design:: Retrospective non-randomised study. Materials and Methods:: Nineteen procedures were performed in 16 patients mainly because of ischaemic rest pain, often with trophic skin changes or minor gangrene. Three patients had a bilateral procedure. Twelve patients had one or more associated procedures: 10 distal bypasses, one thrombectomy, one reimplantation of a distal bypass on the iliofemoral graft, one contralateral profundaplasty and two stents of the contralateral common iliac artery. Results:: Two patients died, one of small bowel ischaemia and the other of a myocardial infarction. During the mean follow-up of 8.8 months, two graft thromboses occurred. In another patient bilateral stenting of a residual stenosis was necessary. Conclusions:: Our experience shows that the reported technique is feasible. Whether the procedure is truly ''less invasive'' and the long-term results acceptable remains to be shown.

Color and duplex Doppler ultrasound and digital subtraction angiography were compared for the evaluation of graft patency of the gastroepiploic artery (GEA).

Objective Obstruction of the venous pathways after Mustard repair for transposition of the great arteries is associated with an increased risk of arrhythmia and sudden death. The purpose of this study was to assess the effectiveness of the largest (tracheal 22 × 40 mm) Wallstents in treating baffle obstructions. Design Retrospective analysis of patients with stented venous pathways. Subjects Eleven patients with baffle obstruction after Mustard repair for transposition of the great arteries. Interventions Stenoses were dilated with an 18 or 20 mm balloon. However, recoil was noticed in 11 patients: immediately (n = 7) or on repeat angiography (n = 4). Eighteen stents were implanted (mean (SD)) 18 (3.3) years postoperatively. After dilatation a tracheal Wallstent (11.5 F) was deployed. Main outcome measures Relief of obstruction, haemodynamic improvement. Results In the inferior vena cava, 10 stents were deployed in seven baffle obstructions with an increase in diameter from 9.8 (2.4) mm to 16.5 (1.4) mm (p &lt; 0.01) and a mean (SD) pressure gradient decrease from 5.1 (3.6) mm Hg to 1.4 (2.0) mm Hg; in the superior vena cava, eight stents were implanted increasing the diameter from 9.1 (3.7) mm to 15.6 (3.8) mm (p &lt; 0.001) with a decrease in mean pressure gradient from 5.1 (2.7) mm Hg to 1.9 (1.5) mm Hg. No complications were experienced during implantation. No anticoagulation was prescribed. During follow up (1.7 (0.6) years; range, 0.9-2.6) no problems were noted; five patients were re-catheterised without change in measurements. There was no evidence of peal formation in any of the stents. Conclusion It is concluded that Wallstents are safe, easy to use, and effective in relieving baffle obstruction. Anticoagulation does not seem neccessary.

Le registre Diversion p64 est une série prospective, internationale, multicentrique dont le but est d’évaluer la sécurité et l’efficacité du dispositif p64 dans le traitement des anévrismes intracrâniens de la circulation antérieure.

Atherosclerotic stenosis involving the proximal portion of at least two visceral arteries usually causes symptoms of intestinal ischemia and can lead to massive bowel infarction and death. This report describes a case of chronic proximal occlusion of the superior mesenteric artery (SMA) in a 51-year-old man, successfully treated by local catheter-directed thrombolytic therapy, followed by balloon dilatation and stent placement of the residual atherosclerotic stenosis. At 3 months follow-up, the patient was free of symptoms. This case shows that local thrombolytic therapy, percutaneous transluminal angioplasty and stent placement can be useful in the treatment of chronic atherosclerotic occlusion of the proximal SMA.

Introduction/PurposeThe Pipeline™ Embolization Device (PED) is a flow-diverter available for treatment of intracranial aneurysms (IAs). We assessed the long-term safety and angiographic outcomes of a new generation of PED, Pipeline™ Flex Embolization Device with Shield Technology™ (Pipeline™ Shield). The Pipeline™ Shield device features the same implant and delivery system as the Pipeline™ Flex Embolization Device, but has been modified to include a surface synthetic biocompatible polymer to reduce the thrombogenicity of the braid surface.Materials and MethodsThe Pipeline Flex Embolization Device with Shield Technology (PFLEX) study is a prospective, single-arm, multicenter study for the treatment of unruptured IAs using Pipeline Shield. Patients with IA located in the internal carotid artery (ICA) up to the carotid terminus or vertebral artery segment up to and including the posterior inferior cerebellar artery were included. The primary study endpoint was the occurrence of major stroke in the territory supplied by the treated artery or neurological death at 1 year post-procedure. An independent Clinical Events Committee (CEC) adjudicated all adverse events. The study also assessed angiographic outcomes at 1 year post-procedure, and angiographic images in standard and working views that corresponded to the treatment angiograms were interpreted by an independent core radiology laboratory.ResultsFifty patients with 50 unruptured target IAs, 49 (98%) saccular and 1 (2%) fusiform, were treated. The mean age was 53.0±13.01 years, and 82% (41/50) of the patients were female. The mean target aneurysm diameter was 8.82±6.15 mm. Twenty-four aneurysms (48%) were small (<7 mm), 14 (28%) were medium (7–12 mm), 11 (22%) were large (13–24 mm), and 1 (2%) was giant (≥25 mm). Forty-seven (94%) aneurysms were located in the internal carotid artery, and 3 (6%) were located in the vertebral artery. Device deployment was successful in all patients. The mean number of Pipeline Shield utilized per aneurysm was 1.1±0.27. Complete wall apposition was achieved immediately post-procedure in 48 (96%) cases. No major strokes or neurological deaths were reported through 1 year post-procedure. There were 3 procedure-related, serious adverse events (headache, diplopia and retroperitoneal hematoma) and 1 device-related serious adverse event (intracranial arterythrombosis) observed through 1 year follow up. Complete aneurysm occlusion was achieved in 83.9% of target aneurysms at 1 year post-procedure. There were no reports of target aneurysm recurrence or retreatment.ConclusionsThe PFLEX study is the first prospective study to evaluate the use of the Pipeline Shield device. The results from the study are comparable to previously published results with the earlier generation devices, and demonstrate that the Pipeline Shield device is safe and effective for treatment of intracranial aneurysms.DisclosuresM. MartÍÁínez-galdÍÁíámez:2; C; Proctor and consultant for Medtronic. S. Lamin:2; C; Proctor and consultant for Medtronic. K. Lagios:None. T. Liebig:2; C; previously consulted and proctored for Covidien, Stryker, and MicroVention, and currently serves as a proctor and consultant for Sequent Medical.. E. Ciceri:None. R. Chapot:None. L. Stockx:None. S. Chavda:None. C. Kabbasch:None. G. Farago:None. H. Nordmeyer:None. T. Boulanger:None. M. Piano:None. E. Boccardi:2; C; receives honoraria from Medtronic and serves as a consultant for Medtronic.