Academic Day Presentations on 18.05.2024 by Department of Imaging Sciences and Interventional Radiology(ISIR)
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Item Long term outcomes of TEVAR for Thoracic Aneurysms - A single center study(SCTIMST, 2024-05-18) Apratim Roy ChaudharyAims and objective: Thoracic Aortic Aneurysm (TAA) involves Ascending Aorta (40%) followed by DTA (35%), Aortic Arch (15%) and Thoraco-abdominal aneurysms(10%). TEVAR (Thoracic Endovascular Aneurysm Repair) is the standard of care for DTA and arch aneurysm, having mortality and morbidity advantages over surgical repair. Thoracic aortic diameter >5.5 cms, saccular aneurysm, growth of aneurysm >1 cm/year and symptomatic/ ruptured aneurysm were indications for repair. Existing literature shows excellent short term outcome of TEVAR for arch and DTA aneurysms, however literature regarding long term (>10 years) outcomes of TEVAR are scarce. Results: Technical success rate was 99%. Incidence of intra-procedural Type I endoleak was <10 % cases. On table aneurysm rupture/ dissection was seen in <2% cases. Neurological complications of embolic stroke and post-procedural para-plegia was seen in <5% cases. On long term CT follow-up, aneurysm sac regression was seen in about 70% cases, Type II endoleak and delayed Type I endoleak were observed in around 10% and 5% of cases respectively. Larger aneurysm size, Zone 0 proximal landing and increased aortic tortuosity were predictors of endoleak and re-intervention. Emergency TEVAR was associated with increased incidence of endoleak, neurological complications and mortality. Conclusions: TEVAR has a favourable outcome with respect to aneurysm sac regression. Our study is one of the first studies in the country, assessing the long term outcomes of TEVAR for arch and DTA aneurysms.Item Determinants of technical success and mid-term patency rates of endovascular recanalization of thoracic central venous obstruction in patients on renal replacement therapy: A single-centre study(SCTIMST, 2024-05-18) Jayakrishnan, RAim: To evaluate the factors affecting the technical success and patency rates of endovascular recanalization of thoracic central venous obstruction. To evaluate the differences in patency rates between various anatomical segments of stenosis of the thoracic central veins. A single centre Prospective study was conducted to include 72 patients of chronic kidney disease presenting with features of thoracic central venous obstruction and undergoing primary endovascular treatment from January 2018 to May 2023. Patient demographics, symptoms, existing co-morbid conditions, lesion location, history of previous jugular or subclavian catheter insertions were documented. Periodic follow-up was done as part of institutional protocol at 1, 3, 6, 12 months. Technical success was defined as residual stenosis <30%. Tapered beak morphology of venous obstruction p=0.05) and long segment occlusion (p=0.05) (defined as more than 5cm in the study) were associated with technical failure. Zones prone for extrinsic compression (from clavicle, first rib, and aorta in the retrosternal space) were a significant predictive factor of poor primary patency (p<0.01). In the two-year follow-up of venous stents, a higher number of stent restenosis was noted at the site of extrinsic compression in the costoclavicular space. Location of the stenosis/ occlusions in the areas of extrinsic compression was a significant negative predictor of patency. Majority of the stent restenosis occurred at the sites of extrinsic compression by the first rib.Item Efficacy of infrapopliteal angioplasty on wound healing in patients with diabetic foot ulcer(SCTIMST, 2024-05-18) Venkata Subbaih, AWound healing in patients with diabetic foot ulcer is influenced by the interplay of adequate glycemic control, infection, microangiopathy and vascular compromise. The WIFI (Wound Ischemia Foot Infection) score helps identify patients likely to benefit from endovascular revascularisation. It is therefore important to evaluate and identify the clinico-radiological factors affecting early wound healing. After taking approval from the institutional ethical committee, 107 patients with non-healing diabetic foot ulcer for more than 6 weeks and presenting to interventional radiology or vascular surgery out-patient clinic were prospectively enrolled. Patients with glycosylated hemoglobin levels more than 9 and WIFI score of more than or equal to 3 were excluded from the study. Patients with inline flow in a minimum of at least one infrapoliteal vessel were excluded from the study. Data on demographic, clinical, biochemical, imaging and angiographic data were collected and recorded in excel sheet. Technical success was defined as establishment of inline flow in atleast one of the infrapopliteal vessel. Clinical success was defined as healing of wound within 3 months of revascularisation. Data from the clinical follow-up and doppler assessments till 1 year at 3 monthly interval was recorded. Absence of recent history of smoking, adequate glycemic control and higher number of revascularized target vessels are associated with reduced incidence of major adverse limb events. However, poor glycemic control and wound infection are associated with delayed wound healing despite achieving technical success.