Abstract Fifteen years ago, endovascular recanalization of chronic total occlusion of the subclavian artery relied largely on coronary guidewires and conventional catheters. An early series achieved technical success in 46 of 56 patients (82.1%). Today, dedicated crossing wires, support catheters, improved imaging, and a wider choice of stents provide additional options for complex lesions. Yet published series report variable technical success and patency, and differences in patient selection and follow-up limit comparisons between treatment eras. This review revisits earlier techniques, examines what has changed in practice, and discusses persistent challenges, particularly heavily calcified and ostial occlusions near the vertebral artery. Technological progress has broadened treatment options, but its independent contribution to long-term outcomes remains uncertain.
Abstract Purpose To characterize the temporal dynamic and clinical remodeling of the Obsidio™ Conformable Embolic (Obsidio) post endovascular delivery using longitudinal quantitative CT volumetry and Hounsfield unit (HU) attenuation. Materials and methods This retrospective, single-center cohort study included 21 patients (30 vessels) embolized with Obsidio for acute hemorrhage or hypervascular tumor between 2023 and 2026. Patients had at least two follow-up computed tomography (CT) scans. The primary endpoint was the percent change in embolic cast volume and HU attenuation, measured using standardized Picture Archiving and Communication System (PACS) segmentation tools. Secondary endpoints included assessment for recanalization. Results All embolizations were technically successful (100%). On the first follow-up CT (median 12 days), the mean Obsidio volume was 89.33 ± 13.86% of the original volume ( p = 0.0002). On the second follow-up (median 36 days), the volume was 79.51 ± 19.76% of baseline volume ( p = 0.0004), representing 20.49% reduction. On third follow-up CT (median 76 days), volume was 85.2 ± 18.92% ( p = 0.047). On the fourth follow-up CT, volume was 66.76 ± 16.9% ( p = 0.0048). On the fifth follow-up CT, volume was 60.15 ± 3.15% ( p = 0.00001) The average volume reduction rate decelerated from 0.99%/day to 0.71%/day to 0.17%/day then stabilized at 0.2%/day. Concurrently, mean Hounsfield unit attenuation increased by 4.85% ( p = 0.06) on the second follow-up CT scan. No evidence of recanalization, distal embolization, or cast fragmentation was observed on any of CT scans. Conclusion The Obsidio embolic cast undergoes progressive reduction in volume and increase in HU attenuation over time without evidence of vessel recanalization. This temporal dynamic of Obsidio embolic is consistent with bioresorption of its gelatin and water components, supporting the concept of persistent occlusion via in vivo remodeling.
Abstract Background Prostate artery embolization (PAE) has emerged as a minimally invasive therapy which affords improvement in benign prostatic hyperplasia (BPH) symptoms and objective urinary parameters with a favorable adverse event (AE) profile. While PAE was recently included in the American Urological Association (AUA) Guidelines, guidance on its specific use-cases is limited. This study sought to answer remaining questions surrounding the safety and efficacy of PAE across different patient subpopulations where formal guidance for PAE is limited. Methods Three hundred two patients with BPH underwent PAE. Key baseline characteristics were gathered. Patients were compared from baseline to follow-ups with regards to (1) objective parameters, including maximum urinary flow rate (Q max ), post-void residual (PVR), and prostate specific antigen (PSA); (2) prostate volume; (3) BPH symptoms, including International Prostate Symptom Score (IPSS), IPSS Quality-of-Life (IPSS-QoL), and BPH Impact Index (BPH-II); (4) sexual symptoms, including the International Index of Erectile function (IIEF) and Male Sexual Health Questionnaire for Ejaculatory Function Short Form (MSHQ-EjD-SF); and (5) AEs. Additional sub-analyses were performed comparing the safety/efficacy of PAE across key sub-groups. Results PAE afforded significant improvement ( p < 0.05) in each subjective/objective BPH parameter and sexual function score at nearly all follow-up points. Specifically, IPSS improved by 12.3–13.8 points (52.8–59.2%); IPSS-QoL by 2.3–2.8 points (47.9–58.3%); IIEF by 3.2–5.7 points (15.6–27.8%); PSA by 1.5–2.0 ng/mL (15.6–28.5%); and prostate volume by 16.9%. Twelve (4.0%) AEs were reported; no sexual/severe AEs were observed. PAE was safe and afforded significant improvement in subjective/objective BPH parameters in patients with: prostate volumes ≥ 80 mL; prior BPH surgery/intervention; higher medical comorbidity; pre-procedural catheter-dependent urinary retention; pre-procedural renal insufficiency; and pre-procedural hematuria. Conclusions PAE improved subjective/objective BPH parameters and sexual function. Further, it safely afforded significant improvement in subjective/objective BPH parameters in specific contexts/scenarios where current guidance for PAE is limited, including patients with larger prostates, prior BPH intervention, higher medical comorbidity, urinary retention, renal insufficiency, and hematuria. Altogether, PAE can be performed safely and effectively in several real-world contexts in which formal guidance for PAE is limited, and where it may offer unique advantages compared to surgical therapies. Trial registration Clinicaltrials.gov, NCT03052049. Registered 6 September 2017, https://clinicaltrials.gov/study/NCT03052049 ; Clinicaltrials.gov, NCT02026908. Registered 10 June 2019, https://cdn.clinicaltrials.gov/large-docs/08/NCT02026908/Prot_SAP_000.pdf .
Transurethral resection of bladder tumor (TURBT) can be technically challenging in patients with large bladder tumors because intraoperative bleeding may obscure the surgical field, prolong the procedure, and hinder complete tumor resection. Preoperative bladder artery embolization may reduce tumor vascularity and facilitate subsequent TURBT; however, comparative evidence regarding its perioperative benefits and safety remains limited. This study evaluated the perioperative outcomes of preoperative bladder artery embolization followed by TURBT within 24 h in patients with bladder tumors measuring ≥ 3 cm. Among 75 eligible patients, 27 underwent preoperative bladder artery embolization followed by TURBT and 48 underwent TURBT alone. Propensity score matching generated 17 matched pairs. Compared with the TURBT-alone group, the embolization group had significantly lower intraoperative blood loss (68.03 [56.68, 75.50] mL vs. 101.96 [93.62, 116.67] mL, P = 0.005) and shorter operation time (60.00 [49.00, 67.00] min vs. 80.00 [75.00, 87.00] min, P = 0.009). Postoperative hospital stay (7 [7, 8] days vs. 8 [8, 10] days, P = 0.035) and catheterization time (6 [6, 7] days vs. 8 [7, 8] days, P = 0.009) were also shorter in the embolization plus sequential TURBT group. For bladder tumors measuring ≥ 3 cm, bladder artery embolization followed by sequential TURBT within 24 h may reduce intraoperative blood loss, shorten operation time, and promote early postoperative recovery.
Abstract Purpose While femoral and radial artery access are routine for endovascular procedures, brachial artery access remains an important alternative in selected cases. This study aimed to evaluate the complication rate of percutaneous brachial artery access at a tertiary centre and identify potential risk factors for access-site complications. Materials and methods A retrospective review was performed of all procedures utilising percutaneous brachial artery access over a 12.5-year period. Patient demographics, sheath size, closure technique and complications were recorded. Complications were classified according to the CIRSE classification system. Results One hundred percutaneous brachial artery punctures were identified. Sheath sizes ranged from 3 to 9 Fr; the majority (57%) using 6 Fr. Most procedures (84%) were performed for aortic, mesenteric/renal, or peripheral arterial interventions. Overall, 23 complications occurred (23%), including 9 (9%) grade 3 complications requiring additional treatment. No convincing association was identified between complication rate and patient age, gender, or sheath size. Vascular closure devices were used in seven cases, five of which resulted in complications, including three grade 3 events. Conclusions The complication rate associated with brachial artery access in this series was higher than that reported in much of the published literature. These findings suggest that brachial artery access may be less safe than commonly perceived and that vascular closure devices should be used with caution, particularly given their off-label status for this access site. Standardised procedural protocols and post-procedural care pathways may help reduce complication rates. Broader auditing and reporting across centres are encouraged to better define best practice.
