Vascular Access in Patients With Peripheral Arterial Disease Undergoing TAVR

КАРДИОЛОГИЯ УЗБЕКИСТАНА, Journal Year: 2023, Volume and Issue: 16(4), P. 396 - 411

Published: Jan. 18, 2023

Language: Английский

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Valve-in-Valve Transcatheter Aortic Valve Replacement: From Pre-Procedural Planning to Procedural Scenarios and Possible Complications

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(2), P. 341 - 341

Published: Jan. 7, 2024

Over the last decades, bioprosthetic heart valves (BHV) have been increasingly implanted instead of mechanical in patients undergoing surgical aortic valve replacement (SAVR). Structural deterioration (SVD) is a common issue at follow-up and can justify need for reintervention. In evolving landscape interventional cardiology, valve-in-valve transcatheter (ViV TAVR) has emerged as remarkable innovation to address complex challenges previously treated with SAVR rapidly gained prominence feasible technique especially high risk. On other hand, expanding indications TAVR progressively younger severe stenosis pose crucial question on long-term durability (THVs), might outlive valve. this review, we provide an overview role ViV failed BHVs, specific focus current clinical evidence, pre-procedural planning, procedural techniques, possible complications. The combination integrated Heart Team discussion growth curve makes it achieve best results avoid complications or put oneself ahead time from them.

Language: Английский

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Intravascular Iliac Artery Lithotripsy to Facilitate Aortic Endograft Delivery: Midterm Results of a Dual-Center Experience

Journal of Endovascular Therapy, Journal Year: 2024, Volume and Issue: unknown

Published: April 1, 2024

Purpose: To assess the feasibility and safety of intravascular lithotripsy (IVL) for enabling transfemoral abdominal (EVAR), thoracic (TEVAR), thoracoabdominal (BEVAR) endovascular aneurysm repair in patients with narrow calcified iliac arteries. Materials methods: Consecutive treated IVL severe narrowed access before EVAR, TEVAR, or BEVAR between November 2020 June 2022 were retrospectively evaluated. All anatomical characteristics acquired by multi-planar reconstruction preoperative computed tomography angiography (CTA). The hostility vascular accesses was classified based on Peripheral Arterial Calcium Scoring System (PACSS) severity score (CASS), a new considering both (calcium grade length, minimum lumen diameter [MLD], tortuosity index) aortic stent-graft (SG/MLD parameters. Primary endpoint technical success defined as successful endograft delivery deployment without rupture. Freedom from complications primary patency additionally analyzed. Results: Twenty-eight axes (8 bilateral) 20 (mean age 74.5±6.7 years) mean follow-up 26.5±6.2 (range 17–36) months. Ten underwent EVAR: 3 7 procedures. In 14 (70%), disease associated symptomatic aorto-iliac occlusive (AIOD), Rutherford class III to IV. PACSS IV 89% cases CASS 14±2) all cases. (SG) outer (5.60±1.65 mm) significantly larger 50% than MLD (3.96±1.20 mm), an SG/MLD index 1.50±0.51 (p<0.001). Technical 100%. No dissection, rupture, distal embolization occurred. One (3.4%) bail-out stenting necessary endoconduit after treatment. month CTA showed that postoperative luminal gain increased 93% An improvement 2 classes occurred AIOD 100% at last follow-up. Conclusions: This study shows valuable option treat arteries facilitate delivery. Further studies will be useful confirm these results. Clinical Impact this article, use artery is explored. presence calcifications still represents contraindication repair. Intravascular increases procedures, facilitating reducing risk rupture and/or dissections improving vessel compliance gain. novel preparation could alternative “paving cracking” conduits. describes classify calcifications, parameters profile endografts system.

Language: Английский

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Case Report: Intravascular Lithotripsy of Calcified Iliac Artery Disease to Facilitate Kidney Transplantation

Transplantation Proceedings, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 1, 2025

Language: Английский

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Advances in intravascular lithotripsy: mechanisms, devices, and clinical applications

Expert Review of Medical Devices, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 10

Published: Feb. 25, 2025

Peripheral arterial disease (PAD) complicates endovascular interventions due to vascular calcifications, which compromise procedural success and long-term outcomes. Intravascular lithotripsy (IVL) represents a promising innovation modify calcified lesions with shockwaves, addressing unmet clinical needs. This review explores the mechanisms, devices, applications of IVL in PAD treatment. It highlights limitations conventional approaches (high-pressure balloons, specialty atherectomy), often result suboptimal lesion preparation complications. Particular emphasis is placed on combination atherectomy IVL, as well various devices available development, beyond those from Shockwave Medical. Additionally, we discuss future perspectives, including drug penetration enhancement issue post-IVL recoil. literature methodology, encompassing searches PubMed Embase, January 2008 December 2023, briefly outlined. offers safe, effective, innovative approach treating while preserving surrounding tissues. However, current evidence, mainly derived industry-funded studies, limited by heterogeneous calcification classifications lack outcome data. Independent research essential define IVL's role treatment algorithms, especially regarding its cost-effectiveness primary patency

Language: Английский

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Access Options for Transcatheter Aortic Valve Replacement

Journal of Clinical Medicine, Journal Year: 2025, Volume and Issue: 14(5), P. 1651 - 1651

Published: Feb. 28, 2025

Transcatheter aortic valve replacement (TAVR) was introduced in 2002 and has become integral the management of stenosis. As an alternative to surgical replacement, it relies heavily on safe access annulus for implantation a prosthesis. Throughout its development current practice, transfemoral (TF) arterial route retrograde delivery been primary approach. However, this is not appropriate all patients, which led multiple alternate options. This review discusses TAVR, followed by thorough discussion TF access. The commercially available products, preprocedural planning, closure techniques, procedural complications are discussed. We also describe various routes with particular emphasis most recently developed route, transcaval (TCv), focus indications, technical considerations, comparative outcomes. TAVR technology, availability expand, knowledge implementation utmost importance.

Language: Английский

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New Practices in Transcatheter Aortic Valve Implantation: How I Do It in 2023

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(4), P. 1342 - 1342

Published: Feb. 8, 2023

Transcatheter aortic valve implantation (TAVI) went through a huge evolution in the last decades. Previously performed under general anesthesia, with transoperative transesophageal echocardiography guidance and using cutdown femoral artery access, procedure has now evolved into minimalist approach, local conscious sedation, avoidance of invasive lines becoming new standards. Here, we discuss TAVI approach how incorporate it our current clinical practice.

Language: Английский

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Intravascular lithotripsy in peripheral lesions with severe calcification and its use in TAVI procedure – a meta-analysis

VASA, Journal Year: 2024, Volume and Issue: 53(4), P. 263 - 274

Published: June 27, 2024

Heavily calcified peripheral artery lesions increase the risk of vascular complications, constituting a severe challenge for operator during catheter-based cardiovascular interventions. Intravascular Lithotripsy (IVL) technology disrupts subendothelial calcification by using localized pulsative sonic pressure waves and represents promising technique plaque modification in patients with arteries.

Language: Английский

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Alternative Access for TAVR: Choosing the Right Pathway

Journal of Clinical Medicine, Journal Year: 2024, Volume and Issue: 13(12), P. 3386 - 3386

Published: June 9, 2024

Transcatheter aortic valve replacement (TAVR) has emerged as an alternative treatment option for patients with severe stenosis regardless of surgical risk, particularly in those a high and prohibitive risk. Since the advent TAVR, transfemoral access been standard care. However, given comorbidities anatomical limitations, proportion are not good candidates approach. Alternative access, including transapical, transaortic, transaxillary, transsubclavian, transcarotid, transcaval, can be considered. Each advantages disadvantages, so vascular route should tailored to patient’s characteristics. there is no standardized algorithm when choosing optimal access. In this review, we analyzed evolution current evidence most common TAVR proposed patient population.

Language: Английский

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Selective assisted intravascular lithotripsy for complex aorto-iliac calcific lesions

Vascular, Journal Year: 2024, Volume and Issue: unknown

Published: March 28, 2024

Background Intravascular lithotripsy has proven to be safe, less invasive, and effective for coronary peripheral arteries, the indication been extended aortic district but there is still little evidence in literature as only a few cases have described so far. Method We report case of intravascular infrarenal aorta due coral reef, chronic occlusion using single Shockwave M5 + balloon, followed by covered stent deployment. The bifurcation common iliac arteries presented hemodynamic calcific lesions, which were prepared singularly with before aorto-iliac stenting kissing configuration. length from arises inferior mesenteric lumbar was left uncovered preserving their patency. Result In this case, shockwave balloon sufficient treat successfully safely heavy lesions. At 1 6 months follow-up, patient had no clinical symptoms, ultrasound assessment showed triphasic waveform at femoral bilaterally confirmed patency grafts. Conclusion Selective assisted vessels possible, definitive outcomes yet supported literature.

Language: Английский

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