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Purpose: To investigate and compare the physical properties of the new generation Gore VIATORR-Controlled Expansion Endoprosthesis (VCX) to those of the predecessor VIATORR stent in an in vitro experimental setup., Materials and Methods: A total of 12 stents (8 VCX; 4 VIATORR; GORE, USA) were examined. Radial resistive force (RRF) and chronic outward force (COF) were assessed using a radial force testing machine (RX-650, Machine Solutions Inc., USA). To assess the radial forces of the VCX above 8 mm, balloon expansion was performed between cycles., Results: All VCX stents show an abrupt decrease in COF at an external diameter of 8.3 mm; RRF decreases likewise at an external diameter of 8.5 mm. The predecessor VIATORR stent without the "controlled expansion" feature shows linear radial force reduction until full expansion at a diameter of 10 mm. The physical properties of the VCX can be altered by balloon modulation. Point of COF (RRF) reduction shifts to 8.5 mm (8.6 mm), 8.6 mm (8.8 mm) and 9.3 mm (9.6 mm) following modulation with a 8 mm, 9 mm and 10 mm balloon., Conclusions: The VCX shows an abrupt and disproportionate decrease in COF and RRF at an external diameter of 8.3 mm, thus passive expansion to its nominal diameter of 10 mm is not to be expected. By means of balloon dilatation the physical properties of the stent can be altered, enabling customized TIPS creation. The previous VIATORR stent shows continuous COF and RRF until total expansion., (© 2023. The Author(s).)

Purpose: To evaluate technical feasibility and safety of common endovascular visceral interventions using a vascular robotic platform through preclinical study., Material and Methods: The CorPath GRX Robotic System (Corindus Inc, Waltham, Massachusetts) was tested in an anesthetized pig for its ability to navigate various commercially available devices in the abdominal vasculature and to perform routine endovascular visceral procedures. After manually placing a guiding catheter in the celiac trunk, several visceral branches were probed with microcatheters and -wires under robotic assistance, and embolization with liquids (lipiodol), detachable coils and plugs were performed. Furthermore, the origin of the celiac trunk was stented before accessing the left hypogastric artery for pelvic embolization., Results: All procedures were performed with technical success and without any complications. Navigating the catheters and wires via the steering console proved intuitive. Coil, plug and stent deployment were exclusively controlled by remote with remarkable precision and stability., Conclusion: Robotic-assisted visceral embolization and stenting as well as pelvic embolization using the CorPath GRX System is feasible and safe. Application of the platform in the abdominal vasculature is demonstrated for the first time. Considering the precision and the potential for reducing the operator's radiation exposure, further research in this area is highly encouraged to enable translation into clinical practice., (© 2022. The Author(s).)

Purpose: The use of pharmacomechanical thrombectomy in patients with symptomatic iliofemoral deep venous thrombosis (DVT) not responsive to conservative treatment is under-investigated until now. This prompted us to review and analyze our results (technical/clinical outcome, complications) and compare them to the current literature., Materials and Methods: Between 2013 and 2019, 19 patients (14 women and 5 men; mean age: 41.2 years, SD: 18.2) with iliofemoral DVT and excessive pain not responsive to conservative treatment were treated with pharmacomechanical thrombectomy. Patients were followed up for 12 months. Demographics, technical success and clinical outcome data (pain score/Villalta score) were collected., Results: Thrombectomy ± thrombolysis was successful in all cases (n = 19). No major complications were observed. Eight out of nineteen cases developed hematoma at the sheath insertion site not requiring further treatment. Seven out of nineteen cases required additional continuous lysis for complete iliofemoral clot solution. All patients received balloon angioplasty to treat post-thrombotic strictures. In 16/19 cases, stents were placed to preserve iliofemoral caliber and maintain unrestricted iliac venous outflow. Three patients (16%) required re-intervention due to re-thrombosis or in-stent stenosis after 4, 14 days and 4 months, respectively. Symptoms could be improved temporarily or indefinitely in 19 out of 19 patients. 1 year following thrombectomy mean pain score was reduced by 87%, mean Villalta score was 2.6 (SD: 4), and iliofemoral veins were patent in 15/17 patients., Conclusion: In symptomatic patients with iliofemoral DVT, refractory to conservative treatment, catheter-directed thrombectomy enables rapid and long-lasting pain relief. High patency rates can be achieved in patients receiving PTA and venous stenting post-thrombectomy.

Purpose: Malignant obstructions of the inferior vena cava (IVC) are a common cause of the IVC syndrome. As reports on interventional treatment of malignant inferior caval obstructions are very sparse, the purpose of this study was to retrospectively assess the outcome of endovascular treatment of symptomatic, malignant IVC syndromes., Materials and Methods: Between 2000 and 2015, 19 patients (six women; mean age 59 years ± 14) received endovascular treatment of malignant IVC obstruction/occlusion. Patients' demographics as well as interventional and clinical outcome data were collected., Results: All 19 patients underwent stenting of the IVC. Technical success was 100%. Clinical success was 79% (15/19). Three patients (16%) required early re-intervention (days 1-8) due to stent compression. Three patients (16%) with initially good post-interventional results required late repeated intervention due to tumor progression, and repeated intervention could alleviate symptoms in all cases. Best results were achieved when choosing a stent diameter between 16 and 20 mm and a stent length approximately 15-20 mm longer than the lesion length. Too large stent diameters (>28 mm) can lead to stent compression, too small stent diameters (<14 mm) can lead to stent migration, and too short stent lengths can lead to a reoccurrence of symptoms with obstruction of a non-treated segment., Conclusion: Endovascular treatment of malignant IVC syndromes is a safe and effective approach enabling immediate relief of inferior inflow congestions. Recurrent venous obstruction is common but can be avoided when stent diameter and stent length are adapted to the degree of IVC compression as well as expected progression of the underlying malignancy.