Outpatient Percutaneous Endovascular Abdominal Aortic Aneurysm Repair: A Single-Center Experience.

PURPOSE: To evaluate the safety of outpatient percutaneous endovascular abdominal aortic repair (PEVAR) versus inpatient PEVAR without or with adjunct procedures. MATERIALS AND METHODS: Between January 2012 and June 2019, a cohort of 359 patients comprising 168 (46.8%) outpatients and 191 (53.2%) inpatients who had undergone PEVAR were enrolled. All the patients were asymptomatic but had indications for endovascular aortic repair, ie, fit for intravenous anesthesia and anatomically feasible with standard devices. Patient sex, age, comorbidities, smoking status, type of anesthesia, adjunct procedures, type of graft device, operative times, mortality, complications, and readmissions were analyzed. RESULTS: Median follow-up period was 16.5 months (interquartile range, 9-31 months). Except for a higher percentage of tobacco use (42.6% vs 28.8%; P = .04), dyslipidemia (39.7% vs 19.2%; P < .01), and use of local anesthesia (99.4% vs 82.2%; P < .01) in the outpatients, there was no significant difference in the type of graft and adjunct procedures used. No outpatient mortality occurred. There was no difference in the number, severity, and onset of complications (all P > .05). Outpatient unexpected same-day admission, 30-day readmission, and emergency department visit rates were 4.8%, 2.4% (P = .13), and 10% (P < .01), respectively. Operative times for outpatient PEVAR without adjunct procedures were shorter (P < .01). CONCLUSIONS: Outpatient PEVAR can be performed with a safety profile similar to that of inpatient PEVAR. The unexpected same-day admission, 30-day readmission, and emergency department visit rates were low. The outpatient PEVARs without adjunct procedures took less time.

Non-contrast-enhanced magnetic resonance angiography of facial arteries for pre-operative evaluation of vascularized submental lymph node flaps.

BACKGROUND: The aim of this study was to compare non-contrast-enhanced 3D phase contrast magnetic resonance angiography (3D PC-MRA) and conventional intravenous administration of contrast media, i.e., contrast-enhanced MRA (CE-MRA), to evaluate the courses of facial arteries for the preparation of vascularized submental lymph node flap (VSLN flap) transfer. METHODS: The head and neck regions of 20 patients with limb lymphedema were imaged using a 3 T MRI scanner. To improve the evaluation of facial artery courses, MRA was fused with anatomical structures generated by high-resolution T1-weighted imaging. The diagnostic and image qualities of facial arteries for VSLN flap planning were independently rated by two radiologists. Interobserver agreement was evaluated using Cohen's kappa. Differences between 3D PC-MRA and CE-MRA in terms of the diagnostic quality of facial arteries were evaluated using McNemar's test. RESULTS: Cohen's kappa indicated fair to good interobserver agreement for the diagnostic and image qualities of the bilateral facial arteries. No significant difference in terms of the diagnostic quality of the left and right facial arteries between 3D PC-MRA and CE-MRA, respectively, was identified. CONCLUSIONS: Non-contrast 3D PC-MRA is a reliable method for the evaluation of facial artery courses prior to VSLN flap transfer and could serve as an alternative to CE-MRA for patients with renal insufficiency or severe adverse reactions to contrast media.

Transarterial embolization of a large high-flow right renal arteriovenous fistula using stents and an across-stent wire-trapping technique.

Renal arteriovenous fistulas (AVFs) are rare vascular abnormalities. Their high-flow nature may result in increased cardiac output and lead to heart failure. Transcatheter endovascular management of renal AVFs with various embolization materials has been the treatment of choice in recent years. Embolization of large renal AVFs poses a risk of embolization through the AVF to the pulmonary circulation. Herein, we present the case of a patient whose large high-flow renal AVF was treated by a novel method involving the use of a bare stent and detachable metallic coils-called a wire-trapping technique-as well as compare this method with vascular plugs.

Diameter change of common femoral arteries after percutaneous endovascular aortic repair with the use of the preclose technique.

OBJECTIVE: One of the major concerns regarding the preclose technique is its influence on the diameter of the accessed common femoral artery (CFA). The aim of our study was to evaluate the CFA diameter change after percutaneous endovascular aortic repair (PEVAR) with the use of the preclose technique. METHODS: From February 2012 to September 2013, 192 patients who underwent PEVAR with the preclose technique were reviewed. The patients were followed postoperatively with computed tomographic angiography 1, 6, and 12 months after PEVAR, and only those with complete computed tomography studies were included. For each access site, the inner diameter (ID) and outer diameter (OD) of the CFA were measured, and the diameters at various time periods were compared. In addition, the patient cohort was divided into four subgroups according to two parameters: the sheath size (12-16F and 18-24F) and the number of closure devices used for the preclose technique (two devices, more than two devices). The differences in diameter change between the subgroups were analyzed. The significance of the diameter change and the influences of the two parameters were analyzed statistically with the use of the paired t-test, one-way analysis of variance, and two-way analysis of variance. RESULTS: Fifty-eight patients fulfilled the study criteria. No significant influence on the ID of the accessed CFAs was observed at baseline and 1, 6, and 12 months (9.0 ± 1.75 mm, 9.1 ± 1.70 mm, 8.9 ± 1.72 mm, and 9.0 ± 1.68 mm, respectively). By contrast, a significant increase in initial OD occurred 1 month after PEVAR but gradually decreased in size in the following 11 months (13.0 ± 2.37 mm, 16.4 ± 3.44 mm, 14.2 ± 3.06 mm, and 13.5 ± 2.42 mm, respectively). Both the sheath size and the number of closure devices significantly affected the OD change (P < .001 and P = .037, respectively). The effect produced by the number of closure devices extended to 6 months after PEVAR, but the effect of the sheath size ceased before that time. CONCLUSIONS: This study demonstrates that PEVAR with the use of the preclose technique does not influence the ID of the accessed CFA, whereas the OD changes gradually over 1 year. These results may indicate that future endovascular interventions can be performed with the use of the same access without the risk of vascular narrowing.