bluuebunny/crossref_metadata_2025 huggingface dataset:
Eligibility Rates of Ruptured and Symptomatic AAA for Endovascular Repair
Authors: Lee W. Anthony , Huber Thomas S. , Hirneise Christa M. , Berceli Scott A. , Seeger James M.
Published: March 2015

Purpose:

To determine the anatomical eligibility rate for endovascular repair of ruptured and symptomatic abdominal aortic aneurysms (AAA) using commercially available endografts.

Methods:

In a retrospective review, 28 preoperative computed tomographic (CT) scans were examined from among 83 patients who underwent surgical repair of a ruptured or acutely symptomatic AAA at a university-based tertiary care center during the past 10 years. The proximal aortic neck, aneurysm, and iliac dimensions were compared to corresponding measurements from 100 preoperative CT scans from patients who underwent elective repair of asymptomatic AAA. Based on expanded selection criteria for the 2 FDA-approved endografts (AneuRx and Ancure), eligibility rates for endovascular repair were compared between patients with ruptured/symptomatic and asymptomatic AAAs.

Results:

The proximal neck of the ruptured/symptomatic AAAs was on the average 2 mm larger in diameter (25 ± 4 versus 23 ± 3 mm, p=0.04) and 7 mm shorter (16 ± 10 versus 23 ± 14, p=0.017) than asymptomatic AAAs. The maximum AAA diameter was significantly larger in the ruptured/symptomatic group (64 ± 16 mm) than in the asymptomatic group (58 ± 11 mm, p=0.033). Of the 28 ruptured/symptomatic AAAs assessed morphologically, 13 (46%) were anatomically eligible for endovascular repair compared to 74 of the 100 asymptomatic AAAs (p=0.006). The main cause for exclusion was an unfavorable proximal neck, which was present in 15 (54%) of the 28 ruptured/symptomatic AAAs and in 24 (24%) of the 100 asymptomatic AAAs (p = 0.003).

Conclusions:

A significantly smaller proportion of patients presenting with ruptured/symptomatic AAA are anatomically eligible for endovascular AAA repair compared to patients with asymptomatic AAA due to unfavorable proximal neck anatomy.
Endovascular versus Conventional Open Repair of Acute Abdominal Aortic Aneurysm: Feasibility and Preliminary Results
Authors: van Sambeek Marc R.H.M. , van Dijk Lukas C. , Hendriks Johanna M. , van Grotel Martine , Kuiper Jan-Willem , Pattynama Peter M.T. , van Urk Hero
Published: March 2015

Purpose:

To evaluate the feasibility of endovascular treatment of acute abdominal aortic aneurysm (AAA) with commercially prepared bifurcated systems.

Methods:

From January through July 2001, 22 patients (17 men; mean age 73.6 years, range 59–89) were referred with an acute (symptomatic/ruptured) AAA. Six patients were treated with emergent open surgery because of hemodynamic instability, but the other 16 patients underwent computed tomographic angiography with multidirectional reconstruction. Six (27%) aneurysms were suitable for endovascular repair (EVR) and were successfully treated. Procedural variables, morbidity, and mortality were compared between the EVR group and 6 patients of equivalent hemodynamic status from among the conventionally treated patients.

Results:

There was no mortality in either group. The median aneurysm diameter in the EVR group was 63 mm (range 48–84) versus 80 mm (45–82) in the matched surgically treated AAAs (p=0.628). Procedural duration was 193 minutes (150–265) for the EVR group compared to 203 minutes (130–270) for the matched group (p=0.630). Median blood loss was significantly less (p=0.010) in the EVR group (125 versus 3400 mL). Median length of stay (LOS) in intensive care was 8 hours (0–21) versus 62 hours (48–112) for the surgical group (p=0.004). Hospital LOS was significantly reduced (p=0.024) for the EVR patients (7.5 [2–16] versus 15.5 [10–34] days).

Conclusions:

Endovascular treatment of acute aneurysm is feasible, and preliminary results are promising.
Colonic Infarction following Endovascular AAA Repair: A Multifactorial Complication
Authors: Hinchliffe Robert J. , Armon Matthew P. , Tse Chad Cheuk-Wa , Wenham Peter W. , Hopkinson Brian R.
Published: March 2015

Purpose:

To report a case of colonic infarction following endovascular abdominal aortic aneurysm (AAA) repair in a patient with both internal iliac arteries (IIA) unobstructed by the endograft.

Case Report:

A 73-year-old man presented with blue toes as a result of emboli from a 6.4-cm AAA. As he was medically at high risk for open repair and his aneurysm morphology was suitable for a modular bifurcated endovascular graft, a Zenith endograft was used to exclude the aneurysm. Twenty hours after the successful procedure, in which both IIAs were preserved, the patient regurgitated coffee-ground vomit; an upper gastrointestinal endoscopy found a small Mallory-Weiss tear and antral gastritis. A proton-pump inhibitor was begun, but his symptoms progressed. Laparotomy revealed transmural ischemia and infarction of the upper rectum, sigmoid, descending colon, and the splenic flexure; a colonic resection with formation of Hartmann's pouch and colostomy was performed. He made a slow but uncomplicated recovery.

Conclusions:

Colonic necrosis can complicate endovascular AAA repair even when both IIAs are preserved. Advantageously, the clinical signs of severe colonic ischemia in endograft patients are not obscured by aftereffects of a laparotomy.
Early Rupture of a Partially Treated Abdominal Aortic Aneurysm: Another Endovascular Lesson
Authors: Walker Stuart , Papavassiliou Vassilios , Fishwick Guy , Bell Peter R.F.
Published: March 2015

Purpose:

To report early rupture of a partially treated abdominal aortic aneurysm.

Case Report:

A 76-year-old man with a 6.4-cm abdominal aortic aneurysm had the main body of a bifurcated graft inserted into the aneurysm. However, it was not possible to cannulate the short cuff of the graft to deploy the contralateral limb, probably due to a proximal aortic stenosis compressing the stent-graft. The plan was for the patient to return on another date for a further attempt at recannulation; however, shortly after the patient was discharged, the aneurysm ruptured, necessitating conventional open repair, which the patient survived.

Conclusions:

Every effort should be made to complete endovascular treatment of abdominal aortic aneurysms at a single session.
Endovascular Exclusion of a Ruptured Pseudoaneurysm of the Infrarenal Abdominal Aorta Secondary to Pancreatitis
Authors: Hinchliffe Robert J. , Yung Ming , Hopkinson Brian R.
Published: March 2015

Purpose:

To report the successful repair of a ruptured pseudoaneurysm of the infrarenal abdominal aorta secondary to pancreatitis

Case Report:

A 47-year-old man was admitted with abdominal pain due to an acute exacerbation of chronic alcoholic pancreatitis. He was found to have an infrarenal abdominal aortic aneurysm, which was confirmed by spiral computed tomography (CT), but there had been no evidence of aneurysm formation on a scan performed 1 year previously. Persistent symptoms prompted a further CT scan 48 hours later; this revealed evidence of a ruptured infrarenal abdominal aortic pseudoaneurysm. The pseudoaneurysm was excluded using a Zenith aortomonoiliac endovascular graft. Recovery was uneventful, and the patient underwent pancreatic resection 6 months later. A duplex scan 10 months after endograft placement could not identify an aneurysm sac.

Conclusions:

In selected cases, endovascular repair provides a useful method of excluding ruptured aortic pseudoaneurysms due to pancreatitis. It allows hemorrhage control in a potentially infected operative field and permits elective pancreatic resection. Prolonged follow-up is mandatory to ensure there is no evidence of graft sepsis and that aneurysm exclusion is maintained.
Interventional Treatment of Traumatic Priapism
Authors: Görich Johannes , Ermis Cengiz , Krämer Stefan C. , Fleiter Thorsten , Wisianowsky Christian , Basche Steffen , Gottfried Hans-Werner , Volkmer Bjoern G.
Published: March 2015

Purpose:

To describe the effectiveness of transarterial embolization of traumatic priapism.

Methods:

Six patients ranging in age from 6 to 37 years with traumatic high-flow priapism underwent superselective embolization with gelatin sponges (n=3) or minicoils (n=3). Embolization was repeated up to 3 times.

Results:

Embolization was successful in all cases. In 2 patients, repeated embolization led to a flow reduction in the fistula, which spontaneously occluded a few days later. All patients experienced normal erections after intervention, and no side effects were observed.

Conclusions:

Transarterial superselective embolization is an effective and well-tolerated therapy in patients with traumatic priapism.
Management of Unexpected Balloon Rupture during Deployment of Balloon-Expandable Stents
Authors: Order Berndt M. , Müller-Hülsbeck Stefan
Published: March 2015

Purpose:

To describe a method for dealing with balloon rupture during stent deployment.

Technique:

A 10-mL Luer-Lock syringe containing contrast material and heparinized saline is used to re-expand a balloon ruptured during stent deployment, permitting maximum balloon expansion and successful initial stent-wall apposition. No adjunctive use of probing catheters or a power injector is necessary to achieve adequate stent expansion. Analysis of the rupture may identify procedural deficiencies that can be rectified.

Conclusions:

This technique is simple and timesaving, and interventionists should maintain vigilance when handling of balloon-expandable stents.
Gadodiamide as an Alternative Contrast Agent during Angioplasty in Patients with Contraindications to Iodinated Media
Authors: Zeller Thomas , Müller Christian , Frank Ulrich , Bürgelin Karlheinz , Sinn Lutz , Horn Barbara , Flügel Peter C. , Roskamm Helmut
Published: March 2015

Purpose:

To evaluate gadodiamide as an alternative contrast agent for peripheral and renal angioplasty in patients with contraindications to iodinated contrast media.

Methods:

Seventeen patients (10 men; mean age 74 years, range 68–83) with contraindication to iodinated contrast media were given gadodiamide as the contrast agent during peripheral and renal intra-arterial digital subtraction angiography (DSA) and subsequent percutaneous interventions (balloon angioplasty, stent placement).

Results:

The mean volume of gadodiamide used was 136 ± 46 mL (range 60–200). No serious side effects were observed, especially no change in renal or thyroid function; no exanthema or other allergic reactions were noted. In patients without renal artery intervention, serum creatinine at discharge remained unchanged (2.57 ± 1.43 mg/dL to 2.40 ± 1.28 mg/dL, p=NS). In patients undergoing angioplasty/stenting of renal artery stenoses, serum creatinine decreased significantly from 3.53 ± 1.75 mg/dL to 2.36 ± 1.15 mg/dL (p<0.01). All but 1 intervention was successful. Using a simple scoring system, 2 judges blinded to the contrast agent graded the quality of the peripheral DSAs as “good,” whereas renal DSA images were only “sufficient.”

Conclusions:

For patients with contraindications to iodinated materials, gadodiamide may be a suitable alternative for renal or peripheral DSA followed by angioplasty.
The Zenith Aortic Stent-Graft: A 5-Year Single-Center Experience
Authors: Alric Pierre , Hinchliffe Robert J. , MacSweeney Shane T.R. , Wenham Peter W. , Whitaker Simon C. , Hopkinson Brian R.
Published: March 2015

Purpose:

To evaluate the efficacy and midterm results of the Zenith stent-graft in the treatment of abdominal aortic aneurysms (AAA).

Methods:

Since March 1994, 364 patients have undergone endovascular repair of infrarenal AAA. Of the 94 who were treated with the Zenith stent-graft from 1996 to 2002, 88 patients (82 men; mean age 72.6 ± 6.5 years, range 47–88) with at least 6-month follow-up were analyzed. Sixty-one (69.3%) patients were considered at high risk for intervention; 7 ruptured AAAs were treated emergently. In all, 68 (77.3%) bifurcated stent-grafts (including 18 TriFab systems) and 20 aortomonoiliac configurations were used. Cumulative data on endoleak, migration, secondary procedures, and survival were evaluated with Kaplan-Meier analyses.

Results:

Implantation success was 97.7%; 2 (2.3%) access-related failures were converted to open repair (1 immediate, 1 at 3 months). There were 3 (3.4%) graft limb thromboses (2 immediate, 1 late), 3 (3.4%) cases of colon ischemia due to embolization in 1 and hypogastric artery occlusion in 2, and 1 (1.1%) renal infarction due to embolism. Three (3.4%) patients died within 30 days. Eleven (12.5%) endoleaks and 1 (1.1%) late endograft migration were recorded. The 5-year cumulative endoleak and migration rates were 15% and 7%, respectively. Sixty-three (71.6%) patients did not present any complication related to the repair during a mean follow-up of 20.6 ± 14.9 months (range 6–68); notably, no complications were associated with the 18 TriFab systems. Six (6.8%) secondary procedures were performed (31% 5-year cumulative secondary procedural rate). All 6 (6.8%) aneurysm-related deaths (the 3 perioperative, 2 from late AAA rupture, and 1 during a secondary procedure) and 14 of 18 (20.4%) non-aneurysm—related deaths occurred in high-risk patients; the 5-year cumulative survival rates were 57% for any death and 92% for aneurysm-related deaths.

Conclusions:

The Zenith stent-graft appears both safe and effective in terms of midterm outcome of endovascular aortic aneurysm repair.
Treatment of Thoracic Aortic Dissection with Stent-Grafts: Midterm Results
Authors: Shim Won-Heum , Koo Bon-Kwon , Yoon Young-Sup , Choi Donghoon , Jang Yangsoo , Lee Do-Yun , Chang Byoung-Chul
Published: March 2015

Purpose:

To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta.

Methods:

Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 ± 13.7 years, range 32–82) with descending thoracic aortic dissection. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up.

Results:

Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the procedure. Over an average follow-up of 31.5 ± 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 patients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved.

Conclusions:

Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.
Renal Atrophy in Atherosclerotic Renovascular Disease: Gradual Changes 6 Months after Successful Angioplasty
Authors: Mounier-Véhier Claire , Haulon Stéphan , Lions Christophe , Devos Patrick , Jaboureck Olivier , Willoteaux Serge , Carré Alain , Beregi Jean-Paul
Published: March 2015

Objective:

To assess renal morphology using spiral computed tomographic angiography (CTA) before and 6 months after angioplasty of unilateral atherosclerotic renal artery stenosis (RAS).

Methods:

Spiral CTA scans from 14 hypertensive patients (7 men; mean age 57.4 ± 13.1 years) with significant RAS were performed before and 6 months after angioplasty; renal length, mean cortical thickness (MCT), cortical area (CA), and medullary length (ML) were measured from the axial slices in the 14 contralateral and 14 poststenotic then revascularized kidneys. Blood pressure, creatinine clearance, and number of antihypertensive drugs were analyzed.

Results:

At 6 months, the systolic blood pressure was significantly reduced (p=0.007), but the number of antihypertensive drugs and the creatinine clearance did not change significantly. Most morphological parameters before and after angioplasty were different in the contralateral versus poststenotic kidneys (renal length, p=0.01; MCT, p=0.01; ML, p=0.03; CA, p=0.008). After angioplasty, there was an 11% drop in cortical atrophy associated with a mean 4-mm increase in medullary length in the poststenotic/revascularized kidneys. The contralateral kidneys exhibited corticomedullary thinning after angioplasty.

Conclusions:

In atherosclerotic renal disease, cortical thinning could be a useful timesaving marker to assess the significance of the lesion and to evaluate associated distal lesions. The favorable blood pressure outcome supports the existence of reversible ischemic lesions, particularly in the medulla. Angioplasty appears to be useful for the poststenotic kidney, according to the morphological study.
Duplex Ultrasound—Guided Femoropopliteal Angioplasty: Initial and 12-Month Results from a Case Controlled Study
Authors: Ahmadi Ramazanali , Ugurluoglu Ara , Schillinger Martin , Katzenschlager Reinhold , Sabeti Schila , Minar Erich
Published: March 2015

Purpose:

To evaluate initial technical success, procedural complications, and 12-month patency of duplex-guided angioplasty compared to conventional fluoroscopically-guided procedures.

Methods:

One hundred four patients (65 men; mean age 69 years) who underwent duplex-guided femoropopliteal angioplasty were compared to 104 patients undergoing fluoroscopically-guide procedures who were matched for age, sex, baseline ankle-brachial index (ABI), and length and grade of lesion. Patients were followed for 12 months, and restenosis was assessed by ABI and duplex sonography.

Results:

Technical success was achieved in 88 (84.6%) patients from the duplex-guided group and in 102 (98.1%) control patients (p=0.001). Periprocedural complications occurred in 12.5% (n=13) and 18.3% (n=19), respectively (p=0.4). Contrast-induced transient renal impairment was observed in 7 (6.7%) patients in the fluoroscopic group. One hundred (96.1%) patients in the duplex and 102 (98.1%) patients in the fluoroscopic group completed the 12-month follow-up. Restenosis was found in 35 (39.8%) patients of the duplex group and in 38 (37.2%) patients of the fluoroscopic group (p=0.8).

Conclusions:

Technical success of duplex-guided procedures was significantly lower compared to fluoroscopic angioplasty; complications and 12-month patency were similar with both techniques. Duplex-guided angioplasty may be a feasible alternative, particularly for patients at high risk for contrast-induced complications.
Percutaneous Transluminal Laser Angioplasty versus Balloon Dilation for Treatment of Popliteal Artery Occlusions
Authors: Steinkamp Hermann J. , Rademaker Jürgen , Wissgott Christian , Scheinert Dierk , Werk Michael , Settmacher Utz , Felix Roland
Published: March 2015

Purpose:

To compare the immediate results, complication rates, and long-term outcomes of percutaneous transluminal laser angioplasty (PTLA) versus balloon dilation alone in the treatment of popliteal artery occlusions.

Methods:

In a prospective nonrandomized study conducted between December 1994 and June 2000, 215 symptomatic patients with unilateral popliteal occlusions were treated with either dilation alone (88 patients: 52 men; mean age 62 years, range 48–83) or PTLA (127 patients: 70 men; mean age 64 years, range 49–86) using a 308-nm excimer laser followed by dilation. The average occlusion length was 10.4 cm (range 3–14).

Results:

PTLA was successful in recanalizing 105 (82.7%) arteries, while the recanalization rate for dilation alone was only 70.4% (62/88; p=0.045). After a mean follow-up of 36 months (range 6–52), the primary and secondary patency rates were 21.7% and 50.8%, respectively, in patients with PTLA and 16.3% and 35.2% in the angioplasty group (p=0.762). The complication rates associated with both techniques were similar.

Conclusions:

Although initial recanalization may be better with PTLA, it does not appear to add any long-term benefit over balloon dilation alone.
Endovascular Treatment of a Multimorbid Patient with Late AAA Rupture after Stent-Graft Placement: 1-Year Follow-up
Authors: Teufelsbauer Harald , Prusa Alexander M. , Prager Manfred , Thurnher Siegfried , Lammer Johannes , Hölzenbein Thomas , Kretschmer Georg , Huk Ihor , Polterauer Peter
Published: March 2015

Purpose:

To report successful endovascular management of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 40 months after primary stent-grafting.

Case Report:

A 64-year-old man presented with hypotension, severe back pain, and abdominal distension. Immediate computed tomography revealed a proximal type I endoleak due to distal migration of the stent-graft with subsequent rupture of the aneurysm. The patient was hemodynamically unstable, and open surgery was refused because of severe comorbidities that were the indications for initial endovascular repair. The diameter of the proximal aneurysm neck required the use of a thoracic stent-graft that was overly long, which led to occlusion of the contralateral stent-graft limb supplying not only the left leg but also a left kidney transplant. A crossover bypass was implanted to revascularize both.

Conclusions:

Minimally invasive strategies, even when challenged by complex vascular reconstructions, offer the possibility of managing ruptured aortic aneurysms in patients unsuitable for open surgery.
Aortic Stent-Graft Infection Due to a Presumed Aortoenteric Fistula
Authors: Kar Biswajit , Dougherty Kathy , Reul George J. , Krajcer Zvonimir
Published: March 2015

Purpose:

To report a case of late stent-graft infection with aortoenteric fistula.

Case Report:

A 76-year-old Colombian man received an AneuRx stent-graft for a 5.5-cm infrarenal AAA. The aneurysm sac progressively shrank until 22 months postoperatively, when an increase in diameter was noted on magnetic resonance imaging without evidence of endoleak or air in the sac. Two months prior, the patient had developed fever and an elevated white blood cell count; he underwent a 6-week course of intravenous antibiotics. Shortly thereafter, the fever recurred, along with progressive weight loss, which prompted admission. The computed tomographic scan showed no evidence of endoleak, but gas collection was seen anteriorly in the sac; aspirated material was positive for a variety of organisms. At surgery 23 months after stent-graft implantation, pronounced inflammatory reaction and scarring were seen around the graft in conjunction with evidence of a healed duodenal perforation, suggestive of an aortoenteric fistula. The excised stent-graft was intact; no deterioration was seen. The patient had a protracted recovery but has been afebrile and asymptomatic >1 year after stent-graft explantation

Conclusions:

Close surveillance after endovascular AAA repair is essential to detect late leaks, secondary migration, endotension, structural failure, and infection with or without aortoenteric fistula.
Acute Thrombotic Subclavian Artery Occlusion Treated with a New Rotational Thrombectomy Device
Authors: Zeller Thomas , Frank Ulrich , Bürgelin Karlheinz , Sinn Lutz , Horn Barbara , Roskamm Helmut
Published: March 2015

Purpose:

To report the use of a new rotational thrombectomy device for percutaneous thrombectomy of an acutely occluded subclavian artery.

Case Report:

A 71-year-old woman with a history of multivessel coronary disease complained of sudden onset of pain at rest and paleness of the left arm. Duplex ultrasound showed a localized thrombotic occlusion of the postvertebral subclavian artery and another at the bifurcation of the brachial artery. After angiographic confirmation, the subclavian artery was recanalized with an 8-F Rotarex device via a percutaneous transfemoral access; the bifurcation of the brachial artery was recanalized by local thrombolysis (50 mg rtPA) because the thrombectomy device was too short to reach the occlusion. Follow-up examinations up to 1 year have shown normalized perfusion of the left arm.

Conclusions:

This new thrombectomy device is a useful tool for the percutaneous treatment of acute occlusion in the brachiocephalic arteries.
Magnetic Resonance Imaging versus Multislice Computed Tomography of Thoracic Aortic Endografts
Authors: Merkle Elmar M. , Klein Stefan , Wisianowsky Christian , Boll Daniel T. , Fleiter Thorsten R. , Pamler Reinhard , Görich Johannes , Brambs Hans-Jürgen
Published: March 2015

Purpose:

To compare the potential of magnetic resonance imaging (MRI) to multislice computed tomography (CT) for evaluating stent-graft placement in the thoracic aorta.

Methods:

Susceptibility artifacts in 2 different stent-graft systems (Talent and Excluder) were evaluated in vitro in 2 angulations (straight and 33° curved) using 3 different MRI gradient echo sequences (True FISP, 2-dimensional FLASH, and 3-dimensional Turbo FLASH). The size of the stent-related artifact was measured, and the relative stent lumen was calculated. In vivo stent demarcation, stent patency, and additional findings were determined in 13 patients (3 Talent, 9 Excluder, and 1 combined) and compared to CT findings.

Results:

In vitro, both endograft systems proved to be MR compatible, with the relative stent lumen value ranging from 82% to 100% in the straight configuration; in a curved model, the relative stent lumen value ranged from 56% to 92% with the 3D Turbo FLASH sequence, which provided the smallest susceptibility artifacts. The Excluder endoprosthesis caused significant signal inhomogeneity within the stent in a curved configuration. In vivo, MRI and multislice CT showed similar results, with CT imaging slightly superior in stent demarcation and MRI better in demonstrating thrombus. CT beam hardening artifacts were pronounced in the Talent system, while the Excluder device caused significant signal inhomogeneity within the stent on magnetic resonance angiography.

Conclusions:

Multislice CT and contrast-enhanced MRI are fast, reliable means of providing all relevant information for surveillance of fully MR-compatible stent-grafts in the thoracic aorta.
Transesophageal Echocardiographic Guidance of Thoracic Aortic Stent-Graft Implantation
Authors: Schütz Wolfram , Gauss Albrecht , Meierhenrich Rainer , Pamler Reinhard , Görich Johannes
Published: March 2015

Purpose:

To evaluate the efficacy of intraoperative transesophageal echocardiography (TEE) as an adjunctive measure in guiding the implantation of endoluminal stent-grafts in the thoracic aorta.

Methods:

TEE was used in 21 of 30 patients (27 men; median age 70 years; range 19–77) undergoing implantation of Excluder or Talent stent-grafts for management of 11 type B aortic dissections, 7 thoracic aortic aneurysms, 2 traumatic thoracic aortic ruptures, and an aortic coarctation. We evaluated the ability of TEE to provide evidence of (1) correct placement of the guidewire within the true lumen, (2) reduction in blood flow in the false lumen following stent deployment, and (3) early complications.

Results:

Definite identification of the true lumen and a reliable evaluation of the position of the stent-graft guidewire during advancement were possible in all patients. Reduction of blood flow within the false lumen following deployment of the stent-graft was visualized in >70% of patients with aortic dissection. In the patient with aortic coarctation, TEE recognized the acute onset of aortic dissection following stent dilation, which resulted in immediate management with an additional stent.

Conclusions:

The intraoperative use of TEE in the implantation of stent-grafts in the thoracic aorta is not significantly invasive and is easily employed. It permits excellent evaluation of the correct placement of the stent guidewire and, in patients with aortic dissection, intraoperatively visualizes effective blood flow reduction in the false lumen following stent-graft deployment. Its ability to recognize early complications may indicate the need for additional maneuvers during the surgical procedure.
Technical Strategies to Expand Stent-Graft Applicability in the Aortic Arch and Proximal Descending Thoracic Aorta
Authors: Criado Frank J. , Barnatan Marcos F. , Rizk Youssef , Clark Nancy S. , Wang Cecilia F.
Published: March 2015

The endovascular repair of thoracic aortic pathology is on an evolutionary threshold, as advancing technologies and techniques combine to offer the interventionist expanded treatment opportunities. A variety of maneuvers are recommended to address the landing zone limitations to thoracic endografting imposed by the arch vessels: transostial bare stent placement, intentional occlusion of the arch vessel origin, vessel transposition, and bypass grafting. These adjunctive techniques can help us extend the option of a minimally invasive treatment to a greater number of patients with severe thoracic aortic lesions and comorbidities that place them at high risk for standard surgical intervention.
Salvage of an Acutely Ruptured Thoracic Aortic Aneurysm during CPR
Authors: Larzon Thomas , Jansson Håkan , Holmström Björn , Lund Philip , Norgren Lars , Arfvidsson Berndt , Berggren Lars , Nydahl Anders , Eriksson Tomas , Jonsson Thomas , Stenberg Björn
Published: March 2015

Purpose:

To report the successful endovascular treatment of a ruptured thoracic aortic aneurysm during cardiopulmonary resuscitation.

Case Report:

A 72-year-old woman with a type B aortic dissection treated conservatively for 8 years was referred for rupture of a 16-cm aneurysm of the descending thoracic aorta. During transfer to the operating room, the patient suffered cardiac arrest; cardiopulmonary resuscitation (CPR) was initiated. A few minutes later during CPR, the surgical procedure began with a cutdown of the right femoral artery and insertion of a guidewire and an aortic occlusion balloon, which was inflated at the origin of the left subclavian artery (LSA). Blood pressure was immediately measurable. By only partially deflating the occluding balloon, a thoracic stent-graft was advanced above it and deployed at the origin of the LSA while rapidly deflating and retracting the occluding balloon. Three stent-grafts were required to cover 27 cm of the descending aorta. The patient was partly ventilator dependent for 3 months due to a massive pleural hematoma that was not evacuated. At the 10-month follow-up, the patient is fully recovered without any sign of respiratory dysfunction or any other sequela. CT scans reveal that the massive hematoma is almost completely resolved.

Conclusions:

This case illustrates that optimal collaboration between anesthesiologists, interventional radiologists, and vascular surgeons with appropriate resources can significantly expand the possibilities of emergent treatment in the face of aortic rupture.
Delayed Complications after Endovascular AAA Repair in Women
Authors: Shames Murray L. , Sanchez Luis A. , Rubin Brian G. , Choi Eric T. , Geraghty Patrick J. , Flye M. Wayne , Thompson Robert W. , Sicard Gregorio A.
Published: March 2015

Purpose:

To assess whether women suffer more delayed complications or require more interventions after endovascular abdominal aortic aneurysm (AAA) repair.

Methods:

Over a 2-year period, 245 patients (203 men, 42 women) underwent endovascular repair with the AneuRx stent-graft at our institution. Baseline, operative, and follow-up data were reviewed and outcomes compared between men and women for complications or secondary procedures beyond the 30-day postoperative period.

Results:

The 42 (17.1%) women treated with the AneuRx graft experienced more technical complications (17% versus 8.3%; p<0.05) and acute conversions to open repair (6/7, 86%; p = 0.0005). At 30 days, systemic morbidity was significantly higher in women (26% versus 5.3%; p = 0.001.) However, mortality (2.3% versus 1.5%), length of hospital stay (2.6 versus 2.9 days), and major endoleaks at discharge (0% versus 1.6%) were similar. Over a mean follow-up of 11.3 months (range 1–26), graft limb occlusion occurred more frequently in female patients (12.2% versus 2.5%; p = 0.05), and secondary procedures were required in a significantly higher number of women (29% versus 9%; p<0.05). Three patients in each group (25% of women versus 17% of men) who had secondary procedures required additional interventions. Although not statistically significant, the mortality in women during follow-up was higher (9.7% versus 5%); 2 deaths were directly related to graft complications in the female group.

Conclusions:

Endoluminal AAA repair in women presents a technical challenge at the time of operation and may cause more frequent late complications, necessitating close post-procedural surveillance and prompt correction of complications to avoid potentially catastrophic outcomes. Reassessment of inclusion criteria for women may be necessary.
Elective and Emergent Endovascular Treatment of Subclavian Artery Aneurysms and Injuries
Authors: Schoder Maria , Cejna Manfred , Hölzenbein Thomas , Bischof Georg , Lomoschitz Fritz , Funovics Martin , Nöbauer-Huhmann Iris , Sulzbacher Irene , Lammer Johannes
Published: March 2015

Purpose:

To demonstrate our short and long-term results after transbrachial treatment of subclavian artery aneurysms and injuries with stent-grafts in elective and emergency settings.

Methods:

Ten of 12 consecutive patients (6 men; mean age 63.8 years, range 38–80) were treated electively with commercially prepared endografts delivered via a transbrachial access to repair a subclavian artery aneurysm (n = 3) or an injury from a misplaced central venous catheter (n = 7). Two patients required emergency treatment for a ruptured atherosclerotic aneurysm in one and an unintentional arterial puncture during placement of a central venous access in the other. Stent-graft patency during follow-up was assessed by physical examination with comparison of brachial blood pressures in all patients; computed tomography angiography (CTA) was performed in available patients.

Results:

Successful deployment of stent-grafts with sealing of the lesion was achieved in all cases. There were 2 (17%) procedural complications. One patient developed an access-site hematoma that required surgical revision. The second patient, who had a right subclavian injury, suffered an embolic cerebral infarction. The primary stent-graft patency during follow-up (mean 11.6 months) was 100%. CTA examinations in 7 patients at a mean 18 months showed strut dislocation at the thoracic outlet without luminal narrowing in 1 patient. A 50% intraluminal narrowing due to compression between the clavicle and the first rib occurred in another patient. Six patients with a mean follow-up of 23 months (range 0.3–4.5 years) are still alive with patent stent-grafts.

Conclusions:

Endovascular stent-graft treatment of subclavian artery aneurysms and injuries is a less invasive alternative to surgical repair. Long-term results must still be confirmed in further studies.
Suspected Pulmonary Artery Disruption after Transvenous Pulmonary Embolectomy Using a Hydrodynamic Thrombectomy Device: Clinical Case and Experimental Study on Porcine Lung Explants
Authors: Biederer Jürgen , Schoene Arne , Reuter Michael , Heller Martin , Müller-Hülsbeck Stefan
Published: March 2015

Purpose:

To use porcine lung explants for reconstructing possible situations in which a vessel wall disruption might have occurred in a patient suffering fatal hemoptysis after pulmonary embolectomy with a hydrodynamic thrombectomy device.

Methods:

A 76-year-old woman with massive pulmonary embolism underwent transvenous pulmonary embolectomy using a 6-F AngioJet Xpeedior catheter according to manufacturer's instructions. While activating the device in the middle lobe artery (∼8 mm diameter), massive and ultimately fatal arterial bleeding occurred through the tracheal tube. Because no autopsy was authorized, an experimental study was designed to examine possible causes for the vessel disruption. Five fresh porcine heart-lung preparations were examined inside a dedicated chest phantom. Access to the pulmonary vessels was provided through catheters inside the right and left ventricular outlets. A low-flow circulation was maintained with an external pump. The 6-F AngioJet thrombectomy device was activated at 42 sites inside vessels from 2 to 10 mm in diameter; in one lung, 8 activations were made after deliberately withdrawing the guidewire.

Results:

Vessels >6 mm in diameter remained intact. Vessel wall disruption occurred in 4 of 7 vessels between 4 and 6 mm in diameter and in 13 of 14 segmental arteries <4 mm in diameter (regardless of whether or not a guidewire was used). The signs of vessel wall disruption included extravasation of contrast material, arteriovenous fistula, and laceration of distal airspaces with contrast inside the bronchus.

Conclusions:

The application of this system has to be considered potentially dangerous when activated inside vessels with diameters < 6 mm. The use of this device appears to be safe only inside main branches of the lung vessels at this time. Additional experiments will be required to substantiate these initial results.
Open Surgical versus Minimally Invasive in Situ Femorodistal Bypass: Long-term Results
Authors: Renken Nomdo S. , Wittens Cees H.A. , Pattynama Peter M.T. , Du Bois Nico A.J.J. , van Dijk Lukas C.
Published: March 2015

Purpose:

To compare long-term patency and limb survival rates for the classical in situ surgical bypass procedure versus a minimally invasive technique for femorodistal revascularization.

Methods:

From May 1992 to June 1994, a prospective multicenter study was undertaken at 4 centers to evaluate the open versus closed technique for femorodistal bypass grafting. Of 97 patients enrolled in the trial, 73 patients (49 men; mean age 71 years) were assigned to the long-term follow-up protocol and prospectively randomized to the open (n = 38) or closed (n = 35) procedure. The classical open technique is characterized by a long incision over the length of the bypass graft, while the minimally invasive procedure involves only two short incisions over each anastomosis site (the side branches are closed with a coaxial embolization catheter system). Graft patency was evaluated with duplex imaging periodically throughout the 4-year observation period.

Results:

There was no statistically significant difference between the treatment groups with respect to age, sex, hypertension, ischemic heart disease, or smoking. However, the open group had a significantly greater incidence of diabetes (p = 0.037). Over a median 4.7-year follow-up (range 0.3–6.4), 9 (12%) patients (3 open and 6 closed) were lost to follow-up: 2 died and 7 refused the duplex examination. No significant differences in 4-year patency, limb salvage, or survival was demonstrated between the open versus closed treatment groups; 4-year secondary patency was 62% versus 64%, respectively, and limb salvage was 72% versus 86%.

Conclusions:

The closed technique for femorodistal in situ bypass procedures yields favorable long-term outcomes compared to the traditional open technique.
Simple Technique to Decrease Total Clamping Time during Combined Iliac and Femoral Endovascular Procedures
Authors: Giudice Rocco , Scoccianti Marco
Published: March 2015

Purpose:

To describe an alternative method of gaining vascular access while preserving blood flow to the profunda femoral artery during combined iliac and superficial femoral artery (SFA) recanalization.

Technique:

A sheath is introduced through the occluded SFA to reduce the total ischemic time when both the external iliac artery and SFA are obstructed. After iliac stenting and remote endarterectomy of the SFA with stent-graft deployment, blood flow to the profunda is interrupted only briefly when the proximal anastomosis of the femoral endobypass is completed.

Conclusions:

Sheath insertion into the proximal portion of an occluded SFA can be an effective option in reducing ischemic time when dealing with combined iliac and femoral endovascular procedures.
Stenting for Pulmonary Artery Stenosis Due to a Recurrent Primary Leiomyosarcoma
Authors: Meckel Stephan , Buitrago-Téllez Carlos , Herrmann Richard , Jacob Augustinus Ludwig
Published: March 2015

Purpose:

To report stent implantation for a malignant obstruction within the pulmonary artery (PA) caused by a recurrent leiomyosarcoma in the pulmonary trunk.

Case Report:

A 62-year-old man with a non-metastatic primary leiomyosarcoma of the right PA underwent pneumectomy of the right lung and postoperative radiotherapy in 1994. Six years later, he presented with symptoms of progressive right ventricular dysfunction. Computed tomography (CT) identified a high-grade stenosis of the left PA due to recurrent tumor within the pulmonary trunk extending into the left PA. Transthoracic ultrasound documented severe pulmonary hypertension with a high pressure gradient across the stenosis. A stent was deployed percutaneously, successfully establishing PA patency. Pressure measurements showed a significantly reduced gradient across the stented area. In follow-up, the patient reported subjective improvement of symptoms; CT scans revealed a fully patent stent. His status remained stable 11 months after stent implantation.

Conclusions:

PA leiomyosarcoma is a rare and highly malignant tumor. In most cases, surgery can only prolong survival for the short term. Palliative interventional PA stenting performed under local anesthesia can offer improvement in quality of life by reducing excessive pulmonary hypertension.
Spontaneous Common Iliac Artery Dissection after Exercise
Authors: Teh Lip Gen , Sieunarine Kishore , van Schie Greg , Vasudevan Thodur
Published: March 2015

Purpose:

To review the clinical features and management of spontaneous iliac dissections.

Case Report:

A healthy 60-year-old competitive cyclist presented with acute onset of short-distance claudication following vigorous exercise. Angiography showed a dissection flap extending from the right common iliac artery to the external iliac artery. An uncovered stent was placed across the proximal entry site but did not obliterate the false lumen; open surgical intervention was required.

Conclusions:

Spontaneous dissection of the iliac artery is a rare but important condition to suspect in high performance athletes complaining of leg pain following exercise.
Internal Carotid Artery Pseudoaneurysms: Treatment with the Wallgraft Endoprosthesis
Authors: Kubaska Stephen M. , Greenberg Roy K. , Clair Daniel , Barber Gregory , Srivastava Sunita D. , Green Richard M. , Waldman David L. , Ouriel Kenneth
Published: March 2015

Purpose:

To report several cases illustrating the feasibility and mid-term efficacy of deploying a self-expanding stent-graft to treat traumatic ruptures, pseudoaneurysms, and a spontaneous dissection of the internal carotid artery (ICA).

Case Reports:

One patient suffered a stab wound and another developed a large pseudoaneurysm years after a gunshot to the neck. The third patient presented with a spontaneous rupture in the setting of fibromuscular dysplasia, and the final patient developed a pseudoaneurysm following carotid endarterectomy in an irradiated neck. All 4 patients were successfully treated with Wallgrafts deployed in the ICA using either an open carotid (first 3 cases) or percutaneous approach (fourth patient). There were no adverse neurological events. During a mean 16-month follow-up (range 6–24), duplex ultrasound and CT scanning found no evidence of restenosis, occlusion, or persistent perfusion of the pseudoaneurysm, which was noted to decrease in all cases.

Conclusions:

The thin-walled fabric of the Wallgraft appears capable of completely excluding the pseudoaneurysm, resulting in decreased aneurysm size overtime.
Ruptured AAA in a Patient with a Horseshoe Kidney: Emergent Treatment Using the Talent Acute Endovascular Aneurysm Repair Kit
Authors: Teijink Joep A.W. , Odink Henk F. , Bendermacher Bianca , Welten Rob J.T.J. , van Zanten G. Otto Veldhuijzen
Published: March 2015

Purpose:

To report emergent endovascular repair of a ruptured abdominal aortic aneurysm (AAA) in a patient with a horseshoe kidney.

Case Report:

A 78-year-old man with a horseshoe kidney presented with a contained rupture of a 72-mm AAA. After urgent computed tomographic angiography (CTA) documented the blood supply to the kidney and the suitability of the aneurysm for endovascular repair, the patient was given a local anesthetic. An aortomonoiliac stent-graft constructed from components provided in a Talent Acute Endovascular Aneurysm Repair Kit was inserted successfully. The procedure was completed with placement of a contralateral common iliac artery occluder and a femorofemoral bypass graft. No complications were encountered, and the patient was discharged with an excluded aneurysm on the fourth postoperative day. At 3 months, aneurysm exclusion was confirmed by CTA, and no endoleak was present; the retroperitoneal hematoma had disappeared. The patient remains in good general condition 8 months after treatment

Conclusions:

The advantages of endovascular aneurysm repair in the emergency setting can facilitate rapid recovery in patients with symptomatic or ruptured aneurysms, especially those having a horseshoe kidney.
False Aneurysms at Both Ends of a Descending Thoracic Aortic Stent-Graft: Complication after Endovascular Repair of a Penetrating Atherosclerotic Ulcer
Authors: Chen Fang Hong , Shim Won Heum , Chang Byung Chul , Park Sang Joon , Won Jong Yun , Lee Do Yun
Published: March 2015

Purpose:

To report the formation of false aneurysms at both ends of a stent-graft implanted in the descending thoracic aorta to repair a penetrating atherosclerotic ulcer.

Case Report:

A 66-year-old woman with a penetrating atherosclerotic ulcer was treated with a 34 × 70-mm homemade Gianturco-type stent covered with polytetrafluoroethylene graft. Four months later, she developed false aneurysms at both ends of the stent-graft. The patient refused further endovascular repairs, so the stent-graft was surgically removed and the aorta repaired.

Conclusions:

This case demonstrates an unusual complication that should be anticipated when a stent-graft is deployed in the acute phase of thoracic aortic ulcer or its variants.
Type a Aortic Dissection Developing during Endovascular Repair of an Acute Type B Dissection
Authors: Fanelli Fabrizio , Salvatori Filippo Maria , Marcelli Giulia , Bezzi Mario , Totaro Marco , Vagnarelli Simone , Dake Michael D. , Rossi Plinio , Passariello Roberto
Published: March 2015

Purpose:

To describe an extension of type B dissection into type A during endoluminal treatment of acute type B dissection.

Case Report:

A 57-year-old man with acute type B dissection underwent endovascular repair using 2 Excluder stent-grafts. Before releasing the second stent-graft, the patient complained of mild central chest pain, headache, and visual flashes, but no hemodynamic changes were noticed. An angiogram, performed soon afterwards, showed a retrograde extension of the dissection through the aortic arch involving both the left carotid artery and the ascending aorta. The procedure was completed, and the patient was transported to the operating room where the proximal ascending aorta was replaced. Spiral computed tomographic angiography performed 2 weeks after the procedure showed complete exclusion of the primary entry tear. At 6-month follow-up, the patient was asymptomatic; the left carotid artery dissection had disappeared.

Conclusions:

Endovascular repair of acute type B dissection is technically feasible, but longer experience will help prevent technical complications.