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Objectives Chronic total occlusion (CTO) of the EVAR graft is a rare and serious complication. Traditionally, surgical intervention with prosthetic graft replacement or bypass graft implantation is performed. However, there are limited data in endovascular era. Methods We present a case of a 68-year-old male with a history of late EVAR graft occlusion treated with multiple surgical interventions (femorofemoral crossover, extra-anatomic bypass surgery, and thrombectomy) five years ago. Color Doppler ultrasound (CDUS) and computed tomography (CT) angiography revealed thrombosis of the entire bypass graft. Endovascular recanalization and remodeling of the abdominal stent graft CTO was performed with a combination of bare stents and stent grafts. Rupture of the stent graft occurred on the right limb. A second covered stent was placed. Results At 12-month follow-up, the patient was symptom free. Color Doppler ultrasound surveillance showed patent aortic stent graft and downstream arteries. Conclusions Endovascular recanalization of aortic stent graft CTO is a viable option in patients with failed bypass graft.

OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of transhepatic pharmacomechanical thrombectomy of symptomatic acute portomesenteric venous thrombosis. MATERIALS AND ME...

Purpose To evaluate the feasibility and technical outcomes of retrograde access via occluded pedal arteries in endovascular treatment of critical limb ischemia (CLI) when the conventional antegrade approach fails. Materials and Methods One hundred fifty-one patients with CLI (age 69 y ± 10.5; 116 men) who were not surgical candidates and were treated via retrograde pedal access between January 2016 and January 2018 were evaluated retrospectively. Seventy patients in whom retrograde access was performed through occluded arteries constituted the occluded group, and 81 patients who were treated via retrograde access from patent arteries constituted the nonoccluded group. Pedal access success, lesion crossing success, angiographic success, overall technical success, and procedure-related complications were evaluated and compared between groups. Results Pedal access success (74 of 78 vs 83 of 87 attempts; P = .873) and lesion crossing success (64 of 78 vs 77 of 87 lesions; P = .340) were comparable between subgroups. Angiographic success (54 of 78 vs 77 of 87 lesions; P = .012) and overall technical success (48 of 70 vs 72 of 81 patients; P = .004) rates were lower in the occluded group. Procedure-related complications were similar between groups (P = .096). Conclusions Retrograde pedal access from occluded pedal arteries is a feasible option when an antegrade approach fails in endovascular treatment of CLI. Although it has lower technical success, its use enables angiosome-directed therapy and has the potential to improve the outcomes of the procedure.

Background Hepatic arterioportal fistulas are rare, abnormal, direct communications between hepatic artery and portal venous system. Treatment options shifted from surgery to endovascular interventions. Catheterization may be challenging. We report a case of a hepatic arterioportal fistula treated successfuly with Amplatzer Vascular Plug II via percutaneous transhepatic hepatic artery access after failed transfemoral approach. Case presentation 58 year old woman presented with right heart failure, kidney insufficiency and massive ascites related to portal hypertension caused by hepatic arterioportal fistula. She had a history of previous abdominal surgery. Colour Doppler ultrasound and computed tomography revealed a giant portal vein aneurysm related to large hepatic areterioportal fistula. Endovascular treatment was planned. Catheterization of the hepatic artery could not be realized due to severe tortuosity and angulation of the celiac artery and its branches. Access to the hepatic artery was obtained directly via percutaneous transhepatic route and fistula site was embolized with Amplatzer Vascular Plug II and coils. Immediate thrombosis of the aneurysm sac and draining portal vein was observed. Patients clinical status improved dramatically. Conclusion Transcatheter embolization is the first choice of the treatment of hepatic arterioportal fistulas but the type of the therapy should be tailored to the patient and interventional radiologist should decide the access site depending on his own experience if the routine endovascular access can not be obtained.

Purpose We aimed to determine the safety and effectiveness of percutaneous endobiliary radiofrequency ablation of malignant biliary obstructions with a temperature-controlled radiofrequency ablation device. Methods In this single center retrospective study, a total of 62 consecutive patients with malignant biliary obstruction were evaluated. Thirty patients who underwent endobiliary radiofrequency ablation with metallic stent placement were in the study group and 32 patients who underwent only metallic stenting were in the control group. Outcomes of this study were technical success, complications related to the procedure, stent patency, and overall survival. Results All procedures were technically successful in both groups. There was no procedure-related mortality in either group. Procedural complication rates were similar between the groups. Although statistically not significant, the only two major complications (hemobilia requiring endovascular treatment) were in the control group. Median primary stent patency was significantly longer in the study group than in the control group (223 days vs. 158 days; P = 0.016). Median survival rates were also longer in the study group (246 days vs. 198 days; P = 0.004). Conclusion Percutaneous endobiliary radiofrequency ablation is safe and feasible with this novel radiofrequency ablation device in patients with malignant biliary obstruction. Percutaneous endobiliary radiofrequency ablation has a potential to improve both stent patency and survival.

OBJECTIVE. Metallic stenting of malignant biliary strictures is the preferred method of palliation, because most patients present when the condition is inoperable. Most metallic stents, however, are occluded 6-8 months after deployment. Intraductal radiofrequency ablation has been used in previous studies to improve stent patency. The purpose of this study was to assess a single-center experience with percutaneous intraductal microwave ablation of malignant biliary strictures. MATERIALS AND METHODS. In this retrospective case series study, data on 12 patients with malignant biliary obstruction who underwent percutaneous intraductal microwave ablation followed by metallic stenting were evaluated. Ablation procedures were performed with generator frequencies of 902-928 MHz, power set at 6-10 W, and ablation time of 60-90 seconds in a temperature-controlled manner with target temperature set at 80°C. RESULTS. Causes of malignant biliary obstruction were pancreatic carcinoma in four patients, gastric antrum carcinoma in three, cholangiocarcinoma in two, metastasis in two, and gallbladder carcinoma in one patient. Percutaneous intraductal microwave ablation and metallic stenting were performed successfully in all patients. There was no procedural mortality or major complication. The most common minor complication was abdominal pain. Biliary decompression was achieved in all patients at the end of the first month. The mean follow-up time was 9.4 months. The median primary stent patency period was 231 days. There were two stent occlusions due to sludge formation, and two patients died during follow-up. CONCLUSION. Percutaneous intraductal microwave ablation of malignant biliary strictures is safe and feasible. Prospective randomized controlled studies with long-term results are warranted to determine the effectiveness of this technique in lengthening the stent patency period.

Purpose To evaluate the safety, effectiveness, and outcomes of endovascular recanalization of chronic total occlusion (CTO) of the superficial femoral artery (SFA) in patients with critical limb ischemia (CLI) after failed surgical bypass graft. Methods Endovascular recanalization of SFA CTO was performed for 26 consecutive CLI patients with failed bypass grafts from 2016 to 2020. Patient demographics, bypass and lesion characteristics, procedural data, technical, and clinical outcomes were evaluated. Results The technical success rate was 96.2% (25/26). Retrograde arterial access was used in 16 (61.6%) patients. Additional tibial and iliac angioplasty was performed in 15 and 2 patients, respectively. Fifteen complications occurred in 10 patients, including thrombosis, embolism, vessel rupture, dissection, arteriovenous fistula, and pseudoaneurysm. Pain relief and wound healing were achieved in 22 patients. The primary, assisted primary, and secondary patency rates were 95.5%, 100%, and 100% at 6 months, 81.8%, 95.5%, and 100% at 12 months, and 76.7%, 82.7%, and 87.5% at 24 months, respectively. By univariate analysis, hyperlipidemia (hazard ratio = 7.82; 95% CI: 1.27–48.04, P = .026) was found to be the only significant risk factor related to primary patency loss. Amputation-free survival and limb salvage rates were 100% and 100% at 6 months, 100% and 100% at 12 months, and 87.1% and 93.8% at 24 months, respectively. Conclusions Endovascular recanalization of SFA CTO in CLI patients with graft failures is effective with high technical success rates. Acceptable limb salvage and amputation-free survival rates make this technique a reasonable alternative to repeat surgery for high-risk patients.

Renal artery aneurysms (RAAs) are rare, and exist in approximately 1% of the general population (Henke et al. 2001). RAAs can be detected as an incidental finding by various imaging examinations pe...

Aim: To evaluate prevalence of cerebral arterial variations in Turkish population and association of the variations with cerebral aneurysmsMaterials and Methods: Digital subtraction angiography of 640 consecutive patients between January 2011-December 2013 were evaluated retrospectively. Patients with aneurysms were compared with patients without aneurysm to determine the effect of variations. Comparisons were made using Chi square or Fisher exact test for categorical variables and Student's t test or Mann Whitney U test for continuous variables.Results: The most common variation in the anterior circulation was hypoplasia of anterior cerebral artery A1 segment and the most common variation in the posterior circulation was fetal origin of the posterior cerebral artery. Hypoplasia and aplasia of the anterior cerebral artery A1 segment was significantly more frequent in patients with anterior communicating artery aneurysms than the control group (p:0.001). Prevalence of azygos anterior cerebral artery variation was higher in distal anterior cerebral artery aneurysms than the control group (p 0.001). There was no association between bihemispheric anterior cerebral artery and anterior communicating artery aneurysms (p = 0.453). Similarly, no significant association of fetal origin of posterior cerebral artery with posterior communicating artery aneurysms was found (p = 0.133). Conclusion: Prevalence of cerebral arterial variations in this study were compatible with literature. Some variations may play a role in development of aneurysms by alterations in hemodynamics and increasing shear wall stress. Further larger studies are needed to clarify the relation between variations in cerebrovascular structure and aneurysm formation.