Purpose: During thoracic endovascular aortic repair for complicated Stanford type B aortic dissection, large bare stent placement for the abdominal aorta is sometimes necessary. In smaller abdominal aortic diameter cases, we used the stripped AFX aortic cuff as a scaffolding bare stent rather than the Zenith Dissection Endovascular Stent, which is a commercially available, large bare stent. In this study, we evaluated the feasibility of the stripped AFX aortic cuff and experiments were conducted to compare the stripped AFX and the Zenith Dissection Endovascular Stent.

Material and Method: The type B aortic dissection patients treated with thoracic endovascular aortic repair using stripped AFX at three institutions between January 2014 and December 2017 were retrospectively reviewed. Clinical data, including technical success, perioperative complication, and overall survival, were evaluated. The experiment assessed the chronic outward force that reflected the load acting on the artery wall from the stent.

Result: Eight cases (seven males) were reviewed. The median (interquartile range, IQR) age of the patients was 60 years (46.3-70.3). The technical success rate was 100%, and no perioperative complications were observed. The median (IQR) follow-up period was 28.9 months (17.5-31.5). During the follow-up, one patient died of septic shock unrelated to aortic events. The median (IQR) diameter of the stripped AFX on the last follow-up CT was 23.5 mm (21.9-25.0). The chronic outward force of the Zenith Dissection Endovascular Stent was two to three times that of the stripped AFX.

Conclusions: The stripped AFX aortic cuff is feasible and safe as a scaffolding stent during thoracic endovascular aortic repair for Stanford Type B aortic dissection.

Purpose: To investigate the midterm stent patency and patient prognosis after stenting for superior mesenteric artery malperfusion complicating with acute aortic dissection.

Material and Methods: Thirteen patients who underwent branch vessel stenting for superior mesenteric artery malperfusion between 2011 and 2021 in six institutions were retrospectively reviewed. By comparing pre- and postoperative computed tomography scans in the same plane, the length of the stent implanted in the superior mesenteric artery and the stent-to-vessel diameter ratio were measured. The technical and clinical success of stenting, midterm patient prognosis, and stent patency were evaluated.

Results: Superior mesenteric artery stenting was technically successful in 12 patients (92.3%). The mean length of the stents implanted in the superior mesenteric artery was 61.3 ± 39.4 mm (range, 14-127 mm). The mean proximal and distal stent-to-vessel diameter ratios were 1.02 ± 0.16 and 1.30 ± 0.42, respectively. A weak correlation was found between the length of the stents implanted in the superior mesenteric artery and the distal stent-to-vessel diameter ratio (R² = 0.34). Two major complications occurred, one of which resulted in death within 30 days, and 12 (92.3%) were clinically successful. Of these 12 patients, no recurrent intestinal ischemia occurred during the follow-up duration (mean, 45.2 months). Partial occlusion of the stent distal edge without intestinal ischemia was observed in one patient (distal stent-to-vessel diameter ratio = 2.33) 42 months after stenting. The overall survival rate and primary stent patency rate were 84.6% and 91.7%, respectively.

Conclusions: Midterm stent patency and survival after superior mesenteric artery stenting for malperfusion were acceptable.

Purpose: This retrospective study of patients with pulmonary arteriovenous malformations aims to assess the efficacy of embolization distal to the origin of the last normal branch of the pulmonary artery.

Material and Methods: A total of 30 consecutive patients with 38 untreated pulmonary arteriovenous malformations underwent coil embolization distal to the origin of the last normal branch of the pulmonary artery between September 2015 and October 2021. The median (interquartile range) age of patients (5 males, 25 females) was 59 years (50-68 years old), and the median (interquartile range) sizes of the feeding artery and sac were 2.9 mm (2.3-3.8 mm) and 6.7 mm (5.4-9.7 mm), respectively. The technical success rate, persistence rate, and treatment-related complications were evaluated. Technical success was defined as the inability to identify the draining vein on feeding arteriography after coil embolization. Persistence was assessed using time-resolved magnetic resonance angiography.

Results: Coil embolization was successful in all patients (100%). There was no persistence during a median (interquartile range) follow-up period of 23 months (10-45 months) for the 38 pulmonary arteriovenous malformations embolized with coils. No major complications were reported. Only minor complications following embolization occurred in 4 of 36 sessions, including local pain in 2 sessions (6%) and hemosputum in 2 sessions (6%).

Conclusions: Embolization distal to the origin of the last normal branch of the pulmonary artery is effective in preventing the persistence of pulmonary arteriovenous malformations.

An 87-year-old woman was hospitalized for liver abscesses and cholangitis due to common bile duct stones. She developed worsening anemia and abdominal pain. Contrast-enhanced computed tomography revealed an intrahepatic pseudoaneurysm and an arteriovenous fistula between the hepatic arteries and inferior vena cava. The initial endovascular treatment was transarterial embolization. The pseudoaneurysm was embolized with an N-butyl-2-cyanoacrylate mixture, and the inflow arteries of the arteriovenous fistula were embolized with microcoils. However, the residual perfusion of the arteriovenous fistula remained. A second endovascular treatment was performed using the transarterial and transvenous approaches. The inflow arteries were embolized using microcoils and gelatin sponges and the dominant outflow vein was embolized using microcoils, resulting in the disappearance of the perfusion in the arteriovenous fistula.

Purpose: Large-bore chest tube insertion is commonly performed using the trocar technique and blunt dissection; however, large-bore chest tube can cause severe visceral injury due to penetration, which is a life-threatening complication. Conversely, small-bore chest tubes can be safely inserted using the Seldinger technique; however, small-bore chest tubes are prone to blockage, especially in empyema cases. Therefore, this study aimed to demonstrate large-bore chest tube insertion using the Seldinger technique over two guidewires following image-guided puncture.

Material and Methods: We started performing large-bore chest tube insertion using the Seldinger technique over two guidewires following image-guided puncture in February 2022. Demographic data and procedural details, such as chest tube size, dilator size, procedure time, and type of image-guided puncture, of patients who underwent this procedure between February 2022 and March 2023 were retrospectively reviewed. Technical success was defined as the successful drainage of the pleural cavity.

Results: This method was used for performing ten procedures in nine patients who presented with empyema, pneumothorax, and pulmonary fistula. The insertion of a large-bore chest tube with a size ranging from 18- to 24-French was successfully performed in all cases without any complications. The median procedure time was 17.5 (first quartile-third quartile, 13.5-28.0) min.

Conclusions: Large-bore chest tube insertion using the Seldinger technique over two guidewires may be used as an alternative to conventional methods.