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Van Den Berg J.C.,Service of Interventional Radiology | Pedrotti M.,Service of Angiology | Canevascini R.,Service of Angiology | Chimchila Chevili S.,Service of Angiology | And 2 more authors.
Journal of Invasive Cardiology | Year: 2014

BACKGROUND: In-stent restenosis (ISR) after endovascular treatment of stenotic and occlusive disease of the infrainguinal arteries is still a clinical challenge. The purpose of this study is to evaluate the mid-term follow-up of a combination therapy using laser debulking and drug-eluting balloons for ISR. METHODS: A prospective cohort of 14 patients (10 female, 4 male) with clinically relevant (Rutherford 3-6) ISR who were treated with excimer-laser angioplasty and drug-eluting balloons and a clinical follow-up of at least 9 months was evaluated. RESULTS: Mean age was 78 ± 6.5 years (range, 67-88 years). The mean lesion length treated was 133.2 ± 107.2 mm (range, 10-380 mm). The mean time to occurrence of restenosis after initial treatment was 8.6 ± 4.7 months (range, 2-18 months). Technical success was 100%. Distal embolization occurred in 2 cases, and was treated successfully by endovascular means. No other periprocedural major adverse events occurred. All patients were available for clinical follow-up and 12 patients were available with Duplex follow-up. At a mean clinical follow-up of 19.1 ± 8.7 months (range, 9-38 months), 1 target lesion revascularization was seen (at 3 years after the ISR treatment). In the patients with critical limb ischemia (n ≤ 7), no major amputations were needed. Twelve patients had Duplex control (mean follow-up, 19.4 ± 9.4 months; range, 9-38 months). Binary restenosis (>50%) was seen in 1 case at 36 months; it was the same patient who had TLR. A 25%-50% stenosis was seen in 4 patients (mean follow-up, 25 months; range, 19-38 months). No sign of neointimal hyperplasia was demonstrated in 7 patients (mean follow-up, 14.3 months; range, 9-19 months). CONCLUSION: These mid- to long-term data compare favorably with results obtained with standard balloon angioplasty, cutting-balloon angioplasty, and balloon angioplasty using drug-eluting balloon. Longer follow-up and randomized trials are necessary to further define the role of combined excimer-laser debulking and drug-eluting balloon angioplasty in the treatment of ISR.

Lonn L.,Copenhagen University | Larzon T.,Örebro University | Van Den Berg J.C.,Service of Interventional Radiology
Journal of Cardiovascular Surgery | Year: 2010

In all fields of surgery there is a trend towards less invasive procedures reducing hospital stay, complications and mortality. Open surgery in the treatment of aortic diseases is gradually less applied, and instead endovascular aortic repair - EVAR - is a widely accepted treatment modality of today. The traditional approach in EVAR involves surgical exposure of the femoral arteries with bilateral groin incisions. Through the groin access, and under fluoroscopy, a special insertion sheath introducer is used to position a stent graft in the desired location with the patient in general or epidural anesthesia. The evolving stent-technology with smaller sheath sizes has broadened the scenario for alternative approaches for access and closure of the common femoral arteries. The following review presents an introduction on technical aspects of puncture of the femoral artery and closure of the arterial wall using percutaneous closure devices. We also aim to discuss three important approaches to expose and close the femoral arteries during endovascular aortic repair: The cut down approach, the true percutaneous technique, and the femoral fascial closure. Finally, factors important in the choice of techniques will be discussed in relation to early and late complications. We suggest that a percutaneous femoral approach should initially be considered for all endovascular aortic procedures, but with a low threshold to convert to traditional cut-down technique when complications such as bleeding, stenosis, ischemia, or femoral artery injury occur. The choice of the optimal femoral approach depends on the unique anatomy of each patient.

Vos J.A.,St Antonius Hospital | Van Werkum M.H.,St Antonius Hospital | Bistervels J.H.G.M.,St Antonius Hospital | Ackerstaff R.G.A.,St Antonius Hospital | And 2 more authors.
CardioVascular and Interventional Radiology | Year: 2010

The purpose of this study was to prospectively evaluate the incidence of retinal emboli during carotid angioplasty and stenting (CAS) and to correlate emboli with clinical findings and transcranial Doppler (TCD)-detected cerebral embolic load. Between 2001 and 2005, 33 CAS procedures in 32 patients (23 [72%] male, 19 [58%] symptomatic, mean age 72.5 years [range 54.6 to 83.9]) scheduled for CAS were included in this study. Bilateral fundoscopy with retinal photography was performed by an experienced ophthalmologist immediately before, immediately after (fundoscopy only), and 1 day after the procedure and again at long-term follow-up (mean 37 months). Visual field testing was performed before CAS and again at long-term follow-up. TCD-detected cerebral emboli were stratified to five procedural phases: wiring, predilatation, stent placement, postdilatation, and cerebral protection device (CPD) use (if applicable). To establish correlation between TCD data and retinal embolization, Mann-Whitney test was used, and P < 0.05 was considered statistically significant. All procedures were performed successfully. In five of 33 procedures (15%), new retinal emboli were found. Two of the procedures with emboli had small retinal infarcts. Three of five were performed using CPDs versus seven of 28 that had no retinal emboli (P = not significant). Two of four patients (50%) with previous radiation therapy to the neck had new retinal emboli versus three of 29 patients (10%) who had no previous radiation therapy (P = 0.038). None of the other patient characteristics was associated with retinal embolization. In 30 (91%) of patients with an adequate acoustic temporal window for TCD monitoring, there was no statistically significant correlation between TCD data and the incidence of retinal emboli. No visual field defects were found. On long-term follow-up, all retinal emboli and retinal infarcts had resolved. Retinal embolization during CAS is not uncommon, and it occurs in both protected and unprotected procedures. Most retinal emboli are clinically silent. © 2009 Springer Science+Business Media, LLC and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE).

Van Den Berg J.C.,Service of Interventional Radiology
Journal of Cardiovascular Surgery | Year: 2016

Atherectomy has been used as an adjunct therapy for balloon angioplasty and/or stent placement in the superficial femoral artery for many years, but has never gained global popularity in the treatment of peripheral arterial disease, most probably related to the conflicting results as published in the literature. Novel techniques that have been developed over the past years are yielding promising results in the infrainguinal region. Lhis paper will describe the added benefits of atherectomy as compared to plain old balloon angioplasty and bail-out bare-metal stenting, both in the treatment of primary lesions of the superficial femoral artery as well as in cases of in-stent restenosis. © 2016 EDIZIONI MINERVA MEDICA.

Van Den Berg J.C.,Service of Interventional Radiology
The Journal of cardiovascular surgery | Year: 2016

This manuscript will describe of the process of in-stent restenosis and the histopathological changes involved. Moreover, it will provide an overview of the current status of the literature of the various therapeutic options that are available for the treatment of in-stent restenosis.

Van Den Berg J.C.,Service of Interventional Radiology
Journal of Cardiovascular Surgery | Year: 2014

This paper will describe the technique of the treatment of in-stent restenosis of the infrainguinal arteries, using a combined technique of laser debulking followed by drug-eluting balloon angioplasty. The results of this technique from the literature will be discussed, and a comparison with other techniques that are currently used will be made.

Van Den Berg J.C.,Service of Interventional Radiology
Journal of Vascular Surgery | Year: 2010

Introduction: Acute leg ischemia is one of the most challenging and dangerous conditions in vascular surgical practice and carries a high risk of amputation and death when left untreated. This article provides an overview of the currently held opinions on the role of catheter-based thrombolytic therapy in patients with acute leg ischemia. Methods: A systematic review of literature from 1980 to 2009 was performed. The literature analyzed included randomized trials, large single-center case series, and review articles. Results: Three large randomized trials and 14 review articles were identified. Pharmacologic aspects and the results of thrombolytic therapy, as well as indications, contraindications, and complications are described. Conclusions: Catheter-directed thrombolysis can be considered a complementary and not a competing technology with surgical or percutaneous revascularization, with an acceptably low complication rate. © 2010 Society for Vascular Surgery.

Barbetta I.,Service of Interventional Radiology | Van Den Berg J.C.,Service of Interventional Radiology
Seminars in Interventional Radiology | Year: 2014

This article reviews the arterial access sites used in the treatment of peripheral arterial disease, including common femoral, superficial femoral, and popliteal arterial puncture. The optimal approach and techniques for arterial puncture will be described and technical tips and tricks will be discussed. An overview of the currently available vascular closure devices will also be presented. Indications, contraindications, and complications will be discussed. Results of the use of vascular closure devices compared with manual compression will be presented. © 2014 by Thieme Medical Publishers, Inc.

Engelberger S.,Service of Vascular Surgery | Van Den Berg Jc J.C.,Service of Interventional Radiology
Journal of Cardiovascular Surgery | Year: 2015

In the femoropopliteal segment, endovascular revascularization techniques have gained the role as a first line treatment strategy. Nitinol stent placement has improved the short- and midterm primary patency rates in most lesion types and is therefore widely applicated. Stenting has several shortcomings as in-stent restenosis, stent fractures and foreign material being left behind in the vessel. The concept of atherectomy is plaque debulking. This results in a potential reduction of inflation pressure requirements in angioplasty. Stent placement and consecutive in-stent restenosis may be avoided. In this non systematic literature review, the perfomance of different atherectomy techniques, such as direct atherectomy, orbital atherectomy, laser debulking and rotational atherectomy in the treatment of complex femoropopliteal lesions, including long lesions, moderately to heavily calcified lesions as well as occlusions and in-stent restenosis, has been analyzed.

Van Berg Den J.C.,Service of Interventional Radiology | Engelberger S.,Service of Vascular Surgery
Journal of Cardiovascular Surgery | Year: 2015

The objective of this article was to give a comprehensive overview over the different etiologies and the current techniques and results of endovascular treatment of aneurysms of the extracranial carotid artery. Extracranial carotid artery aneurysms are characterized by a low incidence but a high stroke rate in case of conservative management. Open surgical treatment has the disadvantage of a high percentage of postoperative cranial nerve injury and morbidity due to the cervical exposure. Endovascular treatment is attractive because of its less invasiveness. Due to the large variety of etiologies and different endovascular treatment approaches no comparative trials or even large retrospective studies do exist to determine the optimal treatment for the disease. This is a non-systematic review of clinical case series and retrospective analysis about endovascular treatment of extracranial carotid artery aneurysms in English literature.

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