Outcome of Femoral Angioplasty/Stenting Procedures in Different Ethnic Groups in England: A Retrospective Analysis of Hospital Episode Statistics and Review of Literature

Purpose Various studies, mainly from North America, report worse outcomes in ethnic minority populations submitted to revascularization for peripheral arterial disease (PAD). Limited nationwide data in relation to ethnicity are available from Europe. Objective The objective of the study is to compare the outcomes of femoral angioplasty/stenting procedures among different ethnic groups in England during the 10-year period from 2006 to 2015. Materials and Methods The “Hospital Episode Statistics” database has been searched using International Classification of Diseases, Tenth Revision ( ICD-10) codes to identify all cases of femoral angioplasty or stenting from English NHS Hospitals between January 1, 2006, and December 31, 2015. Subsequent mortality, second open or endovascular infrainguinal procedures, and major amputations on the same side within 2 years after the first procedure have been recorded. Patients were broadly categorized according to ethnicity as whites, Asians, and blacks. Chi-square test was used to demonstrate significant differences among ethnic groups and odds ratios (ORs) were calculated using white ethnic group as reference. Results A total number of 70 887 femoral endovascular procedures were recorded in patients from the 3 ethnic groups. Two-year mortality in whites, Asians, and blacks was 18.3%, 22.1%, and 19.5% (p<0.001); rates of second endovascular procedure were 12.1%, 13.1%, and 13.5% (p=0.24); rates of open infrainguinal procedure were 5.6%, 4.5%, and 8.0% (p<0.001); and rates of major amputation were 4.8%, 4.1%, and 7.0% (p<0.001), respectively. Mortality was higher in Asians (OR=1.26, 95% confidence interval [CI]=1.10-1.45, p<0.01) compared with whites. On the contrary, blacks underwent more open arterial operations (OR=1.48, 95% CI=1.19-1.83, p<0.01) and more amputations (OR=1.49, 95% CI=1.18-1.87, p<0.01). There were no significant differences in the rates of second endovascular procedures. Conclusion Two-year mortality after femoral angioplasty/stenting is higher in Asians, whereas risk of limb loss is higher in blacks compared with whites. Reasons of these ethnic differences in outcomes following femoral endovascular procedures for PAD merit further study.

Retrograde Superior Mesenteric Artery Stenting in Case of SMA Shuttering

This case describes a patient who underwent endovascular repair for an extent V thoracoabdominal aneurysm with planned coverage of the celiac artery. Following deployment of the stent graft, the superior mesenteric artery was shuttered, and the patient subsequently developed signs and symptoms of bowel ischemia. The patient underwent successful retrograde open superior mesenteric artery stenting with resolution of her symptoms. Although retrograde open mesenteric artery stenting (ROMS) has been primarily shown to be effective in acute mesenteric ischemia, this case demonstrates that ROMS can be used as a salvage option for shuttering during endovascular procedures.

Cerebral abscess secondary to embolization of arteriovenous malformation: A case report and literature review

Background: Infectious complications of the central nervous system secondary to endovascular procedures have rarely been reported. However, the number of complications has grown exponentially owing to the popularization of these procedures. The success rate of these procedures varies with the pathology, the patient, and surgical performance. Although brain abscesses have been extensively reported, their presence after endovascular procedures has not been described in detail in the literature. We present a case of brain abscess induced by embolization of an arteriovenous malformation (AVM), discuss the main indications, techniques, procedural complications, and review the associated literature. Case Description: A 13-year-old boy presented to us with a history of hemorrhagic stroke secondary to a cerebral AVM rupture. He underwent incomplete AVM resection (2014), with subsequent incomplete embolization (2017), and permanence of the endovenous catheter as a procedural complication. Physical examination revealed purulent exudate through the cervical surgical wound. We performed cervicotomy to remove the catheter but had no success in removing the intracranial material segment. The patient was subsequently diagnosed with a brain abscess (2018) and treated with antibiotics. Our team performed resection of the residual AVM, abscess, and the catheter-associated with the region. Conclusion: The patient showed significant clinical improvement after surgical resection of the malformation. No residual lesions were observed in the imaging examinations. Further, we reviewed the literature to find other cases of similar complications and their association with the endovascular procedure. We did not find complications in patients younger than the one presented in this case. Factors such as incomplete embolisation increase the risk of unfavourable outcomes.

Epidemiological Analysis of Lower Limb Revascularization for Peripheral Arterial Disease over 12 years in the Public Health System in Brazil

Objectives: Worldwide, peripheral arterial disease (PAD) is a disorder with high morbidity, affecting more than 200 million people. Our objective was to analyse the surgical treatment for PAD performed in the Unified Health System of Brazil over 12 years based on publicly available data. Methods: The study was conducted with data analysis available on the DATASUS platform of the Brazilian Health Ministry, assessing procedure technique distribution throughout the years, mortality and cost. Results: A total of 129,424 procedures were analysed (either for claudicants or critical ischemia, proportion unknown). The vast majority of procedures were Endovascular (65.49%), with a tendency for increase in this disproportion (p<0.001). There were 3,306 in-hospital deaths (mortality of 2.55%), with lower mortality in the Endovascular group (1.2% vs. 5.0%, p=0.008). The overall governmental investment for these procedures was U$ 238,010,096.51, and Endovascular Procedures were on average significantly more expensive than Open Surgery (U$ 1,932.27 v. U$ 1,517.32; p=0.016). Conclusions: In the Brazilian Public Health System, lower limb revascularizations occurred with gradual growing frequency between 2008 and 2019. Endovascular procedures were vastly more common, and related to lower in-hospital mortality rates, but higher procedural costs.

Abstract 1122‐000080: Remote Learning for Neuroendovascular Procedures During the COVID‐19 Pandemic

Introduction : Telemedicine coupled with teleproctoring have been a novel practice in the last months given the restrictive mobilization orders worldwide due to the COVID‐19 pandemic, generating the impossibility to travel and learn new techniques or bring a proctor to perform procedures on‐site. Previous papers have reported the benefits of remote proctoring for endovascular procedures using online platforms, whereas others proposed the use of more simple platforms and applications for telemedicine such as Zoom Ò , WhatsApp Ò or Google Glass Ò . Our study aimed to describe our experience in the implementation of remote learning for endovascular treatment of vascular lesions using a multicamera system streamed by a web‐based platform. Methods : Endovascular treatment of aneurysms, arteriovenous malformations, and chronic subdural hematomas were streamed through a multicamera system installed in the angiosuite and shared via Zoom® platform. Four main cameras projected the angiography monitors, the operator’s hands and the overview of the room. Results : Eleven cases were performed. Aneurysms, arteriovenous malformations and chronic subdural hematomas were treated by endovascular means. Preoperative angiographic setup, intraoperative endovascular technique and postoperative management were discussed during the live streaming. No technical problems were reported. Conclusions : Remote learning with online platforms is nowadays an important tool but not a substitute to hands‐on learning for endovascular procedures. We recommend its implementation during the COVID‐19 pandemic as a temporary substitute especially for trainees who do not have access to advanced endovascular interventions.

A comparative propensity-adjusted analysis of microsurgical versus endovascular treatment of unruptured ophthalmic artery aneurysms

OBJECTIVE Ophthalmic artery (OA) aneurysms are surgically challenging lesions that are now mostly treated using endovascular procedures. However, in specialized tertiary care centers with experienced neurosurgeons, controversy remains regarding the optimal treatment of these lesions. This study used propensity adjustment to compare microsurgical and endovascular treatment of unruptured OA aneurysms in experienced tertiary and quaternary settings. METHODS The authors retrospectively reviewed the medical records of all patients who underwent microsurgical treatment of an unruptured OA aneurysm at the University of California, San Francisco, from 1997 to 2017 and either microsurgical or endovascular treatment at Barrow Neurological Institute from 2011 to 2019. Patients were categorized into two cohorts for comparison: those who underwent open microsurgical clipping, and those who underwent endovascular flow diversion or coil embolization. Outcomes included neurological or visual outcomes, residual or recurrent aneurysms, retreatment, and severe complications. RESULTS A total of 345 procedures were analyzed: 247 open microsurgical clipping procedures (72%) and 98 endovascular procedures (28%). Of the 98 endovascular procedures, 16 (16%) were treated with primary coil embolization and 82 (84%) with flow diversion. After propensity adjustment, microsurgical treatment was associated with higher odds of a visual deficit (OR 8.5, 95% CI 1.1–64.9, p = 0.04) but lower odds of residual aneurysm (OR 0.06, 95% CI 0.01–0.28, p < 0.001) or retreatment (OR 0.12, 95% CI 0.02–0.58, p = 0.008) than endovascular therapy. No difference was found between the two cohorts with regard to worse modified Rankin Scale score, modified Rankin Scale score greater than 2, or severe complications. CONCLUSIONS Compared with endovascular therapy, microsurgical clipping of unruptured OA aneurysms is associated with a higher rate of visual deficits but a lower rate of residual and recurrent aneurysms. In centers experienced with both open microsurgical and endovascular treatment of these lesions, the treatment choice should be based on patient preference and aneurysm morphology.

Epistaxis etiology and treatment

Epistaxis occurs in approximately 60% of the general population. Every tenthperson requires treatment in a hospital setting. Epistaxis occurs in all age groups,reaching its peak in children around 10 years of age and in adults around 80years of age. The frequency and intensity of epistaxis are anatomically based onnumerous vascular connections. The cause of epistaxis in most cases can bedetermined on the basis of a detailed history and physical examination. Thereare a number of treatments available for nose bleeds. From widely availablemethods such as nasal tamponade to more advanced endovascular procedures.

New possibilities for testing direct arterial liver perfusion after liver transplantation

The aim of the study was to show new promising possibilities of direct perfusion test for the transplanted liver.Materials and methods. We have performed 246 liver transplantations (1998–2020). Since 2015 arterial complications were detected in 24 (23%) patients after 105 transplantations complicated by liver hypoperfusion: splenic artery steal syndrome (n = 8), hepatic artery thrombosis (n = 7), combination of hepatic artery stenosis and steal syndrome (n = 6), hepatic artery stenosis (n = 3). Endovascular interventions were performed in these cases for revascularization. Direct perfusion test was performed in 8 patients.Results. The liver perfusion index increased from 0.27 (0.13–0.45) to 0.62 (0.33–0.89) after endovascular procedures. Sufficient perfusion was ≥0.65.Conclusion. Direct liver perfusion test makes possible to identify and objectify graft blood supply, timely and adequate correction, and reduces the risk of developing biliary ischemic complications.