Endologix Unibody Endograft performance in Aortoiliac occlusive disease

The field of endograft manufacture and design has been an active one with improved performance and lower profile devices under continuous development. A multicenter retrospective review was conducted to evaluate safety, efficacy and early patency rates of the 17Fr ipsilateral, 9Fr contralateral Endologix AFX unibody endograft in the treatment of aortoiliac occlusive disease and recently published in the European Journal of Vascular and Endovascular Surgery.

91 patients were treated for aortoiliac occlusive disease. Patients with concomitant aortic aneurysm were excluded. Mean follow up was 22.2 months. Technical success was 100%. Complication rate was 22% with 1 mortality in the 30 day follow up period from extensive pelvic thromboembolism. At 1 year 73% of patients experienced improvement in Rutherford stage of -3 or greater compared with baseline. At all points primary patency were >90%, assisted patency rates were >98% and secondary patency rates were 100%.

Commentary:

Use of the AFX unibody stent-graft had a high rate of technical success and a low morality rate. Patency rates were comparable to with open aortobifemoral bypass, kissing stent and CERAB techniques. This study is the largest so far in the evaluation of the AFX unibody graft performance. Notably 82% of patients treated in this study had baseline TASC D disease making the already favorable patency data arguably even more so. 41% of these cases were done percutaneously with hemostasis achieved using the Proglide (Abbott Vascular, Abbott Park, IL, USA). Although the authors indicate that the use of re-entry devices was not necessary, they say these may be helpful to obtain femoral-femoral wire access in some cases. It is not clear what proportion of aortoiliac lesions were successfully crossed in an intraluminal position and which if any required subintimal angioplasty (SIA). Furthermore if there were lesions which required SIA it is unclear if these were included.

Although the complication rate was high (22%) none of the complications appear to be device related. The majority of the complications appear to be related to the open femoral access utilized in 59% of cases. The incidence of groin related complications in this study is comparable with that found in open surgical repair and may reflect that this subset of patients is exposed to the same risks found in open surgery. Overall, this manuscript serves as continued support in using the Endologix device in cases of aortoiliac occlusive disease in which the cranial extent of occlusion makes kissing stents unfavorable.

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Maldonado TS, Westin GG, Jazaeri O, et al. Treatment of aortoiliac occlusive disease with the Endologix AFX unibody endograft. Eur J Vasc Endovasc Surg. May 2016. doi: 10.1016/j.ejvs.2016.04.003

Post Author:
Marco Ugas, MD
University of Virginia
PGY-5 Radiology Resident

SIR 2016 Vancouver: Early Career Section "Exploring IR" Session

Seeking questions for the "In Your Experience" Panel

During the 2016 Annual Scientific Meeting in Vancouver, BC, the Early Career Section will be hosting the several meetings and events focused on addressing the needs and interests of young professionals. One of these meetings is a session in SIR targeted toward Interventionalists early on in their career.

The "In Your Experience" Panel will feature panelists that have extensive experience in both the private practice setting and academics. They will be giving answers to questions provided by YOU. Did you ever wonder how they managed to maintain a strong presence in the PVD space without alienating their vascular surgery colleagues? How did they maintain a close relationship with diagnostic radiology during years that their interventional practice was not profitable? What would they be worried about if they were just starting their career?

Exploring IR

Saturday, April 2, 2016
3:30- 5:30 pm

· Participating in Clinical Research – Wael Saad, MD, FSIR
· Developing & Maintaining a Referral Base – Elizabeth B. Spencer MD, FSIR
· Dealing with Complications and malpractice – John Cardella, MD, FSIR
· Business of Medicine – What you need to know as an early IR – Katherine Krol, MD, FSIR
· Transitioning from MSC to RFS and ECS – Geogy Vatakencherry, MD
· Value SIR offers young IR’s - Alan Matsumoto, MD, FSIR

“In Your Experience” Expert Panel

Panelists:

· Bayne Selby, MD
· Parag Patel, MD, FSIR
· Keith Sterling, MD, FSIR
· James Benenati, MD, FSIR
· Anne Roberts, MD, FSIR

This is your chance to ask the tough questions to a group of well-respected interventional radiologists. Anytime between now and March 25th , submit any questions toccouture@sirweb.org and come to the session to hear the answers by our expert panel.

Cryoneurolysis in Peripheral Neuropathic Pain

Neuropathic pain is a growing problem as the population ages and the prevalence of diabetes increases. Multiple methods of have been employed to treat neuropathic pain, including medical therapies, local anesthetics, and more invasive procedures such as spinal cord stimulators and neurolysis. Investigators from SUNY Stony Brook evaluated the use of ultrasound guided cryotherapy in this difficult patient population. Patients were selected based on inclusion criteria such as: failure of a first or second line therapy, evaluation by a pain physician before initiating therapy, and a history of response to nerve blocks. Exclusion criteria included an inability to participate in follow up assessments of pain levels. In total, 22 patients underwent ablation and were followed at 1 week and 1, 3, 6, 9, and 12 month intervals. Of these patients, 11 required repeat cryoneurolysis within 12 months of the initial procedure. The average pain score before treatment was 8.3 +/- 1.9. Pain scores after treatment were 2.3 +/- 2.5 at 1 month, 3.2+/- 2.5 at 3 months, 4.7 +/- 2.7 at 6 months, and 5.1 +/- 3.7 at 12 months. In addition to these findings, the study concluded that the regeneration of the treated nerve was related to ablation time. For example, authors found that 1 minute of ablation time corresponded to 1 month of time for nerve regeneration.

Commentary:

This study presents cryotherapy as an effective and safe alternative to other treatment methods for neuropathic pain. This technique provides statistically significant pain relief for the patients at every time point examined. Additional studies will be required for further evaluation of this technique, including future prospective studies to determine optimal ablation time and treatment intervals. Although the study is limited by sample size, number of ablations during the evaluation period, and concomitant pain management therapy, the results are quite promising given the positive response to therapy and the superior safety profile of cryoneurolysis compared to alternative invasive therapies for the treatment of neuropathic pain.




Click here for abstract

Yoon JHE, Grechushkin V, Chaudry A, Bhattacharji P, Durkin B, Moore W. Cryoneurolysis in Patients with Refractory Chronic Peripheral Neuropathic Pain. J Vac Interv Radiol 2016; 27:239-243.

Post Author:
Brian Gardner, MD
VIR Pathway Resident at University of Virginia