bluuebunny/crossref_metadata_2025 huggingface dataset:
Fatal Pericardial Tamponade after Wallstent Implantation for Malignant Superior Vena Cava Syndrome
Authors: Martin Matthias , Baumgartner Iris , Kolb Martin , Triller Jürgen , Dinkel Hans-Peter
Published: March 2015

Purpose:

To report a rare, fatal complication of superior vena cava Wallstent implantation.

Case Report:

A 59-year-old man presenting with superior vena cava syndrome caused by small-cell lung cancer underwent stent implantation of 2 kissing Wallstents >1.5 cm above the right atrium. Despite correct stent deployment, vessel perforation occurred in a section not encased by tumor, which led to fatal pericardial tamponade shortly after the procedure. Autopsy revealed perforation of a stent strut through the caval wall into the pericardial space. Anatomical and methodological reasons are discussed.

Conclusions:

The interventionist should be aware of this rare complication. Alternative stent designs avoiding the sharp ends of Wallstents and Palmaz stents should be considered.
Outcome of Abdominal Aortic Endografting in High-Risk Patients: A 4-Year Single-Center Study
Authors: Verzini Fabio , Cao Piergiorgio , Zannetti Simona , Parlani Gianbattista , De Rango Paola , Maselli Agostino , Lupattelli Luciano , Parente Basso
Published: March 2015

Purpose:

To evaluate feasibility, safety, and effectiveness of endovascular abdominal aortic aneurysm (AAA) repair in patients whose fitness for surgery is questionable.

Methods:

Between April 1997 and December 2001, 389 consecutive patients underwent endovascular AAA repair. Of these, 51 (13.1%) were ASA grade IV. The perioperative and late outcomes of this group were compared to the remaining 338 patients with ASA grades <IV. Failure of AAA exclusion was defined as late conversion to open repair, AAA rupture, increased aneurysm diameter, or persisting graft-related endoleak. Gender, age, ASA grade IV, EUROSTAR class E, and AAA diameter were examined by logistic regression analysis for their influence on perioperative death, survival, and failure of AAA exclusion.

Results:

Four (7.8%) perioperative deaths occurred in the ASA IV group compared to 1 (0.3%) in the ASA <IV group (p=0.001). Median follow-up was 22 months (range 1–56). Failure of AAA exclusion occurred in 3 (5.9%) patients in ASA IV group and in 25 (7.4%) in ASA 0.05). Actuarial survival at 30 months was 62.9% in ASA IV group and 88.0% in ASA <IV group (p=0.001, log-rank test). There were no independent predictors for failure of AAA exclusion; ASA IV was independently associated with perioperative mortality (HR 17.8; 95% CI 1.6 to 188; p=0.016).

Conclusions:

Endovascular AAA repair in ASA IV patients is feasible and effective in preventing AAA rupture in the mid term. High-risk patients experience a worse prognosis than their good-risk counterparts. An individualized approach in selecting high-risk patients for endoluminal repair is mandatory.
Neurological Outcomes after Carotid Stenting Protected with the NeuroShield Filter Compared to Unprotected Stenting
Authors: Macdonald Sumaira , McKevitt Fiona , Venables Graham S. , Cleveland Trevor J. , Gaines Peter A.
Published: March 2015

Purpose:

To compare outcomes for two nonrandomized cohorts of patients with high-grade carotid disease who underwent either unprotected carotid stenting or stent implantation protected by the NeuroShield filter.

Methods:

Under this protocol, symptomatic patients with carotid stenoses >70% or asymptomatic patients with bilateral carotid stenoses who were being evaluated for coronary artery bypass grafting were eligible for carotid stenting. Between December 1998 and November 2001, 75 consecutive patients (57 men; median age 67 years range 45–85) underwent carotid stenting without cerebral protection; concurrently, 75 carotid stent procedures protected with the NeuroShield filter were performed in 73 patients (51 men; median age 66 years, range 47–83). A neurologist reviewed all patients before and after treatment. The groups were comparable for age, sex, and symptoms, but the protected group had a higher proportion of postsurgical restenoses (14.7% versus 1.3%; p=0.003). Outcome measures included death and neurological events at 24 hours and 30 days.

Results:

There were minor technical difficulties in 12 of the protected group, but none were clinically relevant. The procedural all-stroke/death rates in the unprotected versus protected groups, respectively, were 5.3% (4/75) and 2.7% (2/75; p=0.681), while the disabling stroke/death rates were 4% (3/75) and 1.3% (1/75; p=0.620). At 30 days, the all-stroke/death rates were 10.7% (8/75) in the unprotected group and 4.0% (3/75) in the protected group (p=0.117); the death/major-disability-from-stroke rates were 6.7% (5/75) and 2.7% (2/75), respectively (p=0.442).

Conclusions:

Filter-related complications are well tolerated. Neuroprotection devices have the potential to reduce the procedural neurological event rate. Larger series and/or randomized trials are required for further evaluation.
Correlation of Periprocedural Systolic Blood Pressure Changes with Neurological Events in High-Risk Carotid Stent Patients
Authors: Howell Marcus , Krajcer Zvonimir , Dougherty Kathy , Strickman Neil , Skolkin Mark , Toombs Barry , Paniagua David
Published: March 2015

Purpose:

To examine retrospectively the magnitude of change in systolic blood pressure (SBP) during carotid artery stenting and its relationship to neurological events.

Methods:

In a 5-year period ending October 2000, 60 patients (36 men; mean age 67 ± 9 years) were enrolled in a study to evaluate stenting in symptomatic or asymptomatic high-risk patients with ≥70% carotid artery stenosis. The majority (48, 80%) of the patients were symptomatic. Five patients with bilateral lesions were treated in staged procedures. Sixteen (25%) of the 65 lesions were postsurgical stenoses and 12 (18%) were secondary to neck radiation therapy.

Results:

There were 2 (3%) minor and 2 (3%) major strokes (94% procedural success), of which 1 was fatal. Six (9%) transient neurological events were recorded during balloon inflation. The mean SBP change during or after stenting in 55 cases without neurological events was 34 ± 14 mmHg, while the patients with transient or permanent neurological events had significantly greater changes in SBP (107 ± 31 mmHg [p<0.003] and 134 ± 14 mmHg [p<0.001], respectively). Patients exhibiting neurological sequelae had significantly higher SBP before the procedure than those without complications (203 ± 30 versus 165 ± 23 mmHg, p<0.001). There were no neurological events in patients with a <50-mmHg change in SBP.

Conclusions:

Patients with severely elevated baseline SBP (>180 mmHg) may be at higher risk for hemodynamic instability and neurological events during carotid stenting. The greater the change in SBP, the more severe the neurological event seems to be, but further studies in a greater number of patients are needed to evaluate the potential causes of SBP fluctuations in an effort to avoid neurological events.
Endograft Therapy for Diseases of the Descending Thoracic Aorta: Results in 43 High-Risk Patients
Authors: Lepore Vincenzo , Lönn Lars , Delle Martin , Bugge Mogens , Jeppsson Anders , Kjellman Ulf , Rådberg Göran , Risberg Bo
Published: March 2015

Purpose:

To report an initial experience with endovascular stent-graft implantation for diseases of the descending thoracic aorta in high-risk patients.

Methods:

Forty-three patients (28 men; mean age 67 years, range 17–82) with 16 descending thoracic aortic dissections, 14 aneurysms, 7 contained ruptures, 3 mycotic aneurysms, 2 posttraumatic pseudoaneurysms, and an aneurysm of an anomalous right subclavian artery were treated between June 1999 and July 2001. Twenty-three (53%) patients were treated emergently.

Results:

There were no conversions to open repair, but 3 (7%) patients died during the first 30 days (pneumonia, multiorgan failure, and acute bowel ischemia). Thirteen (30%) patients suffered 18 major complications (8 strokes, paraplegia in 3, respiratory insufficiency in 6, and 1 renal failure). Of 7 (16%) endoleaks detected in the early postoperative period, 3 required additional stents, while the other 4 were treated conservatively. Follow-up, which averaged 19 ± 6 months (median: 13; range 0–34), was 100% complete. Five (12%) patients died: 3 of aortic rupture at 34, 47, and 139 days, respectively, and 2 from heart failure at 3 and 15 months, respectively. No late migration or endoleaks have been detected in the remaining 35 patients; however, 1 (2%) patient showed progressive aortic dissection proximal to the stent-graft. In all other cases, the size of the aneurysm or the false lumen was unchanged or diminished.

Conclusions:

Treatment of descending thoracic aortic diseases with an endovascular approach has acceptable early mortality and morbidity in high-risk patients. In selected cases, stent-grafts may afford the best therapy.
Arterial Stenting and Overdilation: Does it Change Wall Mechanics in Small-Caliber Arteries?
Authors: Vernhet Hélène , Demaria Roland , Juan Jean-Marie , Oliva-Lauraire Marie-Claire , Senac Jean-Paul , Dauzat Michel
Published: March 2015

Purpose:

To evaluate changes in arterial wall mechanics induced by stent overdilation in the rabbit aorta.

Methods:

Twenty New Zealand white rabbits had initial stent deployment (3-mm × 8-mm Multilink) at 10% overdilation. Group A (n=11) had no subsequent balloon expansion of the stent and Group B (n=9) had 30% overdilation of the stent. A noninvasive B-mode ultrasound examination coupled with image processing allowed the measurement of systolic and diastolic diameter and the calculation of diameter compliance (Cd) and distensibility coefficient (DC) as indexes of arterial wall biomechanics. Measurements were performed before stenting in the infrarenal aorta, after initial stenting, and after stent overdilation at 3 locations: upstream, at the stent level, and downstream from the stent.

Results:

Cd was significantly lower in the stented aorta after initial stenting (p<0.0001) and after stent overdilation (p<0.0001) than before stenting. At the stent level, Cd and DC were significantly lower than downstream (p<0.0001) or upstream (p<0.0001) from the stent after initial stenting, as well as after stent overdilation. Downstream from the stent, Cd and DC were significantly lower after stent overdilation than before stenting (p<0.05).

Conclusions:

Endovascular stenting of the rabbit aorta produces a significant decrease in arterial wall compliance and distensibility. Stent overdilation is responsible for a slight additional decrease of compliance downstream from the stent.
Multiple Stenting in Takayasu Arteritis
Authors: Gradden Craig , McWilliams Richard , Gould Derek , Williams Peter , Harris Peter
Published: March 2015

Purpose:

To illustrate the possible peri- and postprocedural complications of stent treatment for Takayasu arteritis and suggest ways of reducing these risks.

Case Report:

A 69-year-old woman with Takayasu arteritis had multiple stents implanted in the aortic arch (3 Memotherm) and main branches of the thoracic aorta (individual Corinthian stents in the subclavian and brachiocephalic arteries) following balloon dilation. She suffered reperfusion injury with cerebral hemorrhage following the procedure, preventing the use of anticoagulation or antiplatelet therapy. Further cerebral infarctions/hemorrhages over the ensuing months led to her death.

Conclusions:

Severe vascular disease of any cause confers a poor prognosis. Endovascular stenting may seem an attractive option for management of these patients, but there is often significant morbidity and mortality associated with the underlying disease as well as the stent.
Endovascular Stent-Graft Treatment of a Ruptured Thoracic Aortic Ulcer
Authors: Faries Peter L. , Lang Elvira , Ramdev Pranay , Hollier Larry H. , Marin Michael L. , Pomposelli Frank B.
Published: March 2015

Purpose:

To describe a ruptured ulcer of the descending thoracic aorta treated with an endovascular stent-graft deployed under transesophageal echocardiographic (TEE) guidance.

Case Report:

An 82-year-old man with severe chronic obstructive pulmonary disease and congestive heart failure presented with sharp pain in the back radiating to the left flank. Computed tomography (CT) and angiography demonstrated a penetrating ulcer of the descending thoracic aorta associated with aortic dissection commencing 6 cm from the origin of the left subclavian artery with extravasation of contrast outside the aortic wall. The patient remained symptomatic with a decrease in hematocrit from 36% to 23%. Endovascular repair was performed using self-expanding nitinol stents sutured to a 35-mm × 12-cm Dacron conduit. The device was deployed with a 24-F delivery system under TEE guidance and fluoroscopy. Successful exclusion of the ruptured ulcer was demonstrated by TEE Doppler, arteriography, and CT. The patient remains asymptomatic 18 months after the procedure with no CT evidence of endoleak.

Conclusions:

Endovascular stent-graft repair under TEE guidance assists in the oftentimes difficult treatment of ruptured penetrating thoracic aortic ulcer.
Stent-Graft Treatment of Penetrating Thoracic Aortic Ulcers
Authors: Kos Xavier , Bouchard Louis , Otal Philippe , Chabbert Valérie , Chemla Patricia , Soula Philippe , Meites Geneviève , Joffre Francis , Rousseau Hervé
Published: March 2015

Purpose:

To evaluate the efficacy of stent-graft placement for the treatment of penetrating thoracic aortic ulcers.

Methods:

Ten patients (7 men; mean age 73.8 years, range 69–79) were treated for penetrating thoracic aortic ulcers using Talent or Excluder stent-grafts. Preoperative examinations included computed tomographic angiography (CTA), transesophageal echography, and digital subtraction angiography (DSA). Follow-up included predischarge multimodal imaging and periodic CTA scans after discharge. Endoleaks, aortic diameter changes, and clinical complications were tracked.

Results:

Technical success was achieved in 100%, but 1 major neurological complication led to death 3 months after the procedure. Radiological follow-up detected 4 early endoleaks (3 type I and a type II), all of which spontaneously regressed, and 1 secondary type II endoleak. The mean aortic diameter decreased by 22% over a mean 9-month follow-up.

Conclusions:

Aortic ulcers are potentially lethal lesions. Considering its low morbidity and mortality, endovascular repair could widen the treatment options for these lesions.
Endovascular Repair for Acute Rupture of the Descending Thoracic Aorta
Authors: Alric Pierre , Berthet Jean-Philippe , Branchereau Pascal , Veerapen Reuben , Marty-Ané Charles Henri
Published: March 2015

Purpose:

To report the endovascular treatment of acute descending thoracic aortic rupture as an alternative to open surgery in high-risk patients.

Methods:

Between November 1999 and April 2001, 10 patients (7 men; median age 75 years) underwent endovascular stent-grafting of the descending thoracic aorta for acute rupture from an aneurysm (n = 7) or blunt trauma (n = 3). All patients were evaluated as high operative risk. The aortic rupture was associated with isolated mediastinal hematomas (n = 7), left hemothorax (n = 2), or aortobronchial fistula (n = 1). The Excluder Thoracic Endoprosthesis was used predominantly.

Results:

The mean interval to the endovascular repair was 45.3 ± 28.4 hours. All stent-grafts were successfully deployed. Two patients required common iliac artery access, and 2 needed covered stents for iatrogenic iliac artery rupture. There was 1 postoperative death (myocardial infarction) and no renal failure, neurological complications, embolization, stent-graft migration, or perigraft leak. One patient died 4 months later from an unrelated cause. At a mean follow-up of 7.9 ± 5.1 months, all aneurysms and rupture sites were excluded with no evidence of endoleak or hematoma.

Conclusions:

Endoluminal treatment is a feasible technique for the management of acute rupture of the descending thoracic aorta. Long-term studies are required to assess the effectiveness and durability of this technique in comparison to open repair.
Successful Endoluminal Repair of an Infected Thoracic Pseudoaneurysm Caused by Methicillin-Resistant Staphylococcus Aureus
Authors: Bell Rachel E. , Taylor Peter R. , Aukett Marion , Evans George H. , Reidy John F.
Published: March 2015

Purpose:

To report the successful endoluminal repair of an infected thoracic aneurysm secondary to methicillin-resistant Staphylococcus aureus (MRSA).

Case Report:

A 76-year-old man presented with an infected thoracic pseudoaneurysm 9 weeks after an elective infrarenal aneurysm repair. Blood cultures were positive for MRSA. Computed tomography (CT) showed an 11.5-cm false aneurysm of the descending thoracic aorta just proximal to the celiac axis. An Excluder stent-graft was used to successfully repair the lesion. Recovery was uneventful, and the patient was treated with linezolid for 6 weeks. Follow-up CT scans at 3 and 12 months confirmed exclusion of the aneurysm and progressive shrinkage of the aneurysm sac with no evidence of graft infection.

Conclusions:

Endoluminal repair is an alternative to open surgery for the treatment of infected aneurysms of the thoracic aorta.
Endovascular Management of Acute Carotid Artery Dissection with a Waxing and Waning Neurological Deficit
Authors: Sbarigia Enrico , Battocchio Cesare , Panico Maria A. , Zaccagnini Davide , Salvatori Filippo M. , Argentino Corrado
Published: March 2015

Purpose:

To evaluate the feasibility and efficacy of emergent carotid stenting for an acute internal carotid artery (ICA) dissection.

Case Report:

A 51-year-old man was admitted to our emergency department's stroke unit 1 hour after the onset of left hemiparesis. Computed tomographic and transcranial Doppler scans showed no pathological findings, but the color Doppler study detected a double lumen in the right carotid bifurcation extending to the proximal ICA. Within the first 2 hours after admission, the patient's neurological status began to fluctuate; the NIH Stroke Scale (NIHSS) and Rankin scores evaluated each hour after admission ranged from 0 to 12 and from 0 to 3, respectively. Emergency carotid angiography confirmed the dissection of the bulb and proximal right ICA, which prompted implantation of 2 Wallstents from the internal to common carotid artery. Forty-eight hours later, the patient was almost totally asymptomatic with an NIHSS score of 1 and a Rankin score of 0; he was discharged on postoperative day 3. At 3 months, the patient was free of neurological symptoms and the stented carotid artery was patent.

Conclusions:

In patients with fluctuating neurological signs and symptoms consistent with carotid artery dissection that are refractory to medical therapy, a stent can be placed to prevent permanent neurological deficits provided that the anatomical conditions are suitable.
Recurrent Vertebral Arteriovenous Fistula after Surgical Repair: Treatment with a Self-Expanding Stent-Graft
Authors: Surber Ralf , Werner Gerald S. , Cohnert Tina U. , Wahlers Thorsten , Figulla Hans R.
Published: March 2015

Purpose:

To describe successful endovascular repair of a recurrent vertebral arteriovenous fistula (AVF) after surgical correction.

Case Report:

A 42-year-old woman presented with recurrent dizziness, nausea, and headaches. A loud bruit in the right neck was present. Central venous catheter insertion had been done 1 year previously, creating an angiographically documented right-sided vertebral AVF that was successfully excluded by a surgical procedure. Four weeks later, the AVF reappeared. Successful endovascular repair with a self-expanding stent-graft was performed. Follow-up over 12 months was uneventful, with a patent vertebral artery and no recurrence of symptoms.

Conclusions:

Endovascular stent-graft repair is feasible and offers a therapeutic alternative in the treatment of vertebral AVF, in particular for recurrence after initial surgery. This minimally invasive method may become the treatment of choice in the management of such lesions, preserving patency of the vertebral artery.
Endovascular Management of Impending Carotid Rupture in a Patient with Advanced Head and Neck Cancer
Authors: Bates Mark C. , Shamsham Fadi M.
Published: March 2015

Purpose:

To describe an innovative endovascular technique combining a flexible self-expanding stent-graft to protect the common and internal carotid artery with selective coil embolization of the affected external carotid artery (ECA) branches.

Case Report:

A 42-year-old man presented with episodes of profuse but self-limited carotid hemorrhage from advanced squamous cell carcinoma of the neck. Despite invasion of the carotid sheath by the tumor, angiography confirmed the source of bleeding to be invasion of branches of the ECA. Successful coil embolization of the ECA and stent-graft isolation of the common/internal carotid arteries were performed. At 1-month follow-up, carotid angiography confirmed the complete occlusion of the ECA and patent stent-graft. There was no recurrent bleeding or neurological deficits at 6 months after the procedure.

Conclusions:

Stent-grafts in combination with coil embolization can be used to manage patients with impending carotid rupture secondary to head and neck cancer.
Regional Thrombolytic Therapy and Stent Implantation in an Acutely Occluded Aortobifemoral Bypass Graft
Authors: Anzuini Angelo , Chiesa Roberto , Airoldi Flavio , Gimelli Giorgio , Civilini Efrem , Dordoni Laura , Frigerio Silla , Moura Marcelo R.L. , Birnbaun Yochai , Colombo Antonio , Margonato Alberto , Briguori Carlo
Published: March 2015

Purpose:

To present a case highlighting the efficacy of local thrombolysis followed by stent implantation in acute occlusion of an aortobifemoral bypass graft.

Case Report:

A 47-year-old man was referred to our catheterization laboratory for acute bilateral limb ischemia occurring 18 hours after an aortobifemoral bypass procedure. Angiography documented total occlusion due to massive thrombosis of the grafts. After 24 hours of local thrombolysis, repeat angiography showed complete lysis of the thrombus and an intimal flap in the abdominal aorta. A Palmaz stent was successfully implanted to cover the flap and restore adequate flow. At 1 year, the patient remains asymptomatic, and angiography showed patency of both the stent and the grafts.

Conclusions:

Based on this patient's response, local thrombolysis followed by stenting may be a safe and effective alternative to reoperation for the treatment of acute graft thrombosis caused by an intimal aortic flap. More experience with this approach is necessary to determine if this is an acceptable and effective mode of treatment.
Remote Superficial Femoral Artery Endarterectomy and Distal Vein Bypass for Limb Salvage: Initial Experience
Authors: Rosenthal David , Wellons Eric D. , Matsuura John H. , Ghegan Mark , Shuler Frederick W. , Pallos L. Laszlo
Published: March 2015

Purpose:

To examine the results of remote superficial femoral artery endarterectomy (RSFAE) performed through a small groin incision in conjunction with distal saphenous vein (SV) bypass for limb salvage.

Methods:

A retrospective study was conducted of 21 patients (14 men; mean age 68.5 years, range 47–78) who underwent RSFAE and distal SV bypass between May 1998 and September 2001 for limb salvage. Thirteen had gangrene and 8 had rest pain. RSFAE was performed with the MollRing Cutter device through a femoral arteriotomy; the distal atheromatous plaque was “tacked up” with a stent. Distal SV bypass from the proximal popliteal artery was performed in situ in 7, from a transposed harvested vein in 8, or from a reversed graft in 6. All patients underwent follow-up examination with serial color-flow ultrasound scans.

Results:

The mean length of the endarterectomized SFA was 26.5 cm (range 12–40). There were no deaths, only 2 wound complications, and the mean hospital length of stay was 3.1 ± 0.6 days. The primary cumulative patency rate by life-table analysis was 71.4% with follow-up extending to an average of 12.4 months (range 1–18). There were 2 amputations for gangrene and 6 percutaneous procedures in 4 (19.1%) patients to maintain bypass patency, producing an assisted primary patency rate of 81.5%. The locations of the restenoses were evenly distributed along the endarterectomized SFA and SV graft.

Conclusions:

When adequate SV is not available, RSFAE with residual SV bypass is a safe and moderately durable procedure that may prove to be a useful adjunct for limb salvage, especially in the presence of foot infection, where an autogenous tissue bypass is preferred.
Aortoenteric Fistula Due to Endoleak Coil Embolization after Endovascular AAA Repair
Authors: Bertges Daniel J. , Villella Edward R. , Makaroun Michel S.
Published: March 2015

Purpose:

To report a late complication associated with embolization coils used to treat an endoleak after endovascular abdominal aortic aneurysm (AAA) repair.

Case Report:

A 79-year-old man with a 5.8-cm AAA underwent endovascular repair with an Ancure graft in 1997. A persistent type I endoleak was identified on serial postoperative computed tomographic scans. Three transarterial coil embolization procedures were performed to treat an endoleak from the proximal and right distal attachment sites with outflow by the inferior mesenteric and lumbar arteries. Coil embolization was ultimately successful in sealing the endoleak, and the AAA decreased in size. Four years later, the patient developed an aortoenteric fistula due to erosion of the metallic embolization coils into the duodenum. The endograft was explanted and an extra-anatomical bypass inserted.

Conclusions:

Coil embolization to treat endoleaks can, on rare occasions, be the cause of aortoenteric fistula. Lifelong follow-up of stent-graft patients is required.
Endovascular Treatment of an Aneurysmal Aberrant Right Subclavian Artery
Authors: Lacroix Valerie , Astarci Parla , Philippe Devaux , Goffette Pierre , Hammer Frank , Verhelst Robert , Noirhomme Philippe
Published: March 2015

Purpose:

To describe combined endovascular and surgical management of a complex aneurysmal aberrant right subclavian artery (RSA).

Case Report:

A 75-year-old obese man with severe chronic obstructive pulmonary disease was referred for treatment of a 6.8-cm aneurysm of an aberrant right subclavian artery. A stent-graft was deployed in the proximal part of the descending aorta to cover the origin of the dilated aberrant RSA, and then a venous carotid-subclavian bypass was made to restore blood flow in the right arm. In a second stage, the prevertebral segment of the aberrant RSA was embolized to avoid retrograde perfusion of the aneurysm.

Conclusions:

Combined endovascular and surgical treatment of an aneurysmal aberrant subclavian artery is feasible, safe, and effective. This less invasive approach could be the treatment of choice in high-risk patients.
Adjunctive Procedures for the Treatment of Proximal Type I Endoleak: The Role of Peri-Aortic Ligatures and Palmaz Stenting
Authors: Tzortzis Elias , Hinchliffe Robert J. , Hopkinson Brian R.
Published: March 2015

Purpose:

To investigate the feasibility, efficacy, and long-term effects of peri-aortic ligatures and Palmaz stenting used to treat proximal type I endoleak after endovascular repair (EVR) of abdominal aortic aneurysm (AAA).

Methods:

An 8-year single-center experience with proximal type I endoleak was reviewed; the records of the 55 identified cases were examined to ascertain the methods of treatment used. Among these, all 22 patients who were treated with peri-aortic ligatures and Palmaz stenting were segregated for analysis.

Results:

The 22 patients (14 men; mean age 74.6 years, range 66–85) with proximal type I endoleak (18 early, 4 late) selected for analysis underwent 23 secondary procedures: 15 involving peri-aortic ligatures and 8 Palmaz stent implantations. Of the 18 early endoleaks, 11 were treated intraoperatively and 7 were observed. Ten (45%) patients died within 30 days of endoleak treatment: 8 had early endoleaks. Five of the 10 deaths occurred in patients successfully treated with peri-aortic ligatures (3/10) or Palmaz stenting (2/7). The 12 (54%) surviving patients suffered no aneurysm-related deaths or secondary endoleaks over a median follow-up of 20 months (range 4–75)

Conclusions:

Endoleak is an important mode of failure after endovascular repair. Peri-aortic ligatures and Palmaz stenting are feasible techniques for the treatment of proximal endoleak; however, the perioperative mortality of peri-aortic ligatures was higher when compared with other less invasive techniques. In contrast to other therapeutic options, these methods are more effective in the short and medium term.
How to Exclude the Dilated False Lumen in Patients after a Type B Aortic Dissection? The Cork in the Bottleneck
Authors: Loubert Maartje C. , van der Hulst Victor P.M. , De Vries Cees , Bloemendaal Kees , Vahl Anco C.
Published: March 2015

Purpose:

To report techniques for excluding the dilated false lumen associated with chronic type B aortic dissection following placement of a stent-graft in the true lumen.

Case Reports:

Two patients underwent stent-graft implantation for a dilated false lumen after chronic aortic dissection, but the false lumen was not excluded from the circulation by this procedure. The false lumen was obliterated in one case with Greenfield filters and detachable balloons placed above a renal artery orifice that was perfused via the false lumen. This acted like “a cork in the bottleneck” to block retrograde flow into the thoracic portion of the false lumen above the blockade. In the other patient, an occluder device was used as the “cork.” In both cases, a good result was obtained. The occluder device is preferred because deployment is more controllable.

Conclusions:

An occluder device may be used like a cork in a bottle to exclude the dilated false lumen in the thoracic aorta after a type B dissection.
Suprarenal Fixation: Effect on Blood Flow of an Endoluminal Stent Wire across an Arterial Orifice
Authors: Liffman Kurt , Lawrence-Brown Michael M.D. , Semmens James B. , Šutalo Ilija D. , Bui Anh , White Flyn , Hartley David E.
Published: March 2015

Purpose:

To investigate what effect, if any, the presence of a stent wire in front of a renal artery has on the volume flow rate of blood through the renal artery.

Methods:

Experimental, numerical, and analytical modeling methods were used to test 4 separate stent wire configurations: a stent wire across the center of an artery orifice, an off-center wire placed at one-quarter the arterial diameter, a V-shaped wire with its vertex at the center, and 2 stent wires at one-third-diameter spacing.

Results:

For all the configurations studied, the presence of stent wires has a minimal effect on the blood flow rate into an artery of ≥3-mm diameter, with most flow rates decreasing by around 1%. This is true provided that there is no buildup of material on the wire. When material buildup was “encouraged” to occur, then decreases in flow rate of up to 40% were observed. The numerical and analytical methods indicated that the flow rates would, in most cases, decrease by around 3% to 10%.

Conclusions:

A bare stent wire in front of a >3-mm-diameter artery decreases the flow rate minimally, providing there is no material on the wire. Although the numerical and analytical methods indicated a greater effect on flow, the approximations required for these 2 methods to obtain meaningful solutions suggest that the experimental results are the most accurate. Nonetheless, the analytical equations provided a useful approximation for determining the effect on blood flow due to the presence of a stent wire.
Immediate and Long-Term Outcome of Upper Extremity Balloon Angioplasty in Giant Cell Arteritis
Authors: Amann-Vesti Beatrice R. , Koppensteiner Renate , Rainoni Lisa , Pfamatter Thomas , Schneider Ernst
Published: March 2015

Purpose:

To review the immediate and long-term results of subclavian, axillary, and brachial artery balloon angioplasty (PTA) in giant cell arteritis (GCA).

Case Reports:

Four patients (3 men; mean age 65±8.9 years) with upper limb claudication due to GCA underwent PTA for 2 stenoses and 1 occlusion of the subclavian artery, 6 stenoses and 2 occlusions of the axillary artery, and 2 stenoses of the brachial artery. Patients received steroids prior to the intervention, and steroid treatment was continued for at least 2 years. All procedures were performed successfully with no residual stenosis. At follow-up after 2 years (n=2), 5 years (n = 1), and 10 years (n = 1), no significant recurrent stenoses were detected by duplex scanning.

Conclusions:

PTA is a safe and effective therapy for stenotic lesions and occlusions of the upper limb arteries due to GCA. The long-term results seem to benefit from postprocedural therapy with steroids and aspirin.
Abdominal Aortic Intramural Hematoma Related to Penetrating Ulcer: An Inappropriate Indication for Endovascular Repair?
Authors: Ventura Marco , Mastromarino Alessandro , Cucciolillo Lucia , Calvisi Giuseppe , Spartera Carlo
Published: March 2015

Purpose:

To present a rare case of abdominal aortic intramural hematoma with penetrating ulcer.

Case Report:

A 68-year-old hypertensive lady was admitted with chest pain. An echo Doppler abdominal study showed a 2.5-cm-diameter abdominal aorta with periaortic blood flow. Urgent computed tomography documented a 4-cm aneurysmal dilatation, 4 cm long, at the infrarenal level of the inferior mesenteric artery origin, which appeared on the angiogram as a very short lateral bleb. At elective open laparotomy, no true abdominal atherosclerotic aneurysm was found in the retroperitoneal space, but rather, an intramural hematoma with ulcer. An aortobi-iliac graft was inserted, and the patient was discharged with a good outcome. Histological examination of the explanted tissue confirmed adventitial calcifications, organized thrombus in the hematoma, and intimal neovascularization.

Conclusions:

Considering the pathology, this case was more appropriately treated with open surgery, although endovascular repair was not excluded as an option.
Iliac and Femoropopliteal Lesions: Evaluation of Balloon Angioplasty and Classical Surgery
Authors: Becquemin Jean-Pierre , Cavillon Alain , Allaire Eric , Haiduc Franck , Desgranges Pascal
Published: March 2015

Purpose:

The purpose of this study was to compare the characteristics of patients treated for atherosclerotic disease of the lower extremities with balloon angioplasty (BA) or classical surgery (CS) and to assess the outcome of both techniques.

Methods:

The records of 1364 patients who were treated with BA or CS for chronic lower limb ischemia between 1986 and 1993 were analyzed. Demographic features of patients, immediate and long-term survival, patency, and amputation rates were compared in both groups according to the level of the revascularization (iliac or femoropopliteal).

Results:

Patients undergoing BA were slightly younger (62.3 years versus 65.9 years for CS group; p = NS) and demonstrated symptoms consistent with less severe atherosclerotic disease (81% claudication in the BA group versus 48% in the CS patients; p < 0.001). At 30 days post-treatment in the BA and CS groups, respectively, there were 0.7% and 4% deaths (p < 0.01); 13% and 6% primary failures (p = 0.013); 13% and 6% secondary failures (p = 0.01); 0.3% and 12% general complications (p = 0.001); and 3% and 8% nonvascular complications (p = 0.007). At the iliac level, in the angioplasty (n = 134 limbs) and surgery (n = 721 limbs) groups, respectively, the mean age was 57.6 and 63.7 years (p < 0.01), and claudication was present in 91% and 72. Perioperative mortality was 0% and 1.9. The 4-year survival rates were 95% and 88%; patency was 70% and 79%; and the amputation rates were 0% and 5. At the femoropopliteal level, in the angioplasty (n = 138 limbs) and surgery (n = 656 limbs) groups, respectively, the mean age was 67.8 and 66.8 years (NS), and claudication was present in 69% and 28. Perioperative mortality was 0.9% and 5.5. The 4-year survival rates were 95% and 78%; and patency was 44% and 65. At 2 years, the amputation rates were 6% and 12.

Conclusions:

Patients treated by BA were younger, especially in the iliac group, and had less symptomatic lesions than patients treated with surgery. Surgery achieved a better long-term patency at the cost of a higher immediate complication rate and mortality. Whenever technically feasible, BA may be the better choice for initial therapy in appropriate patients suffering from chronic lower limb ischemia.
Endovascular Repair of an Ascending Aorta-to-Left Common Femoral Artery Graft with Aneurysmal Degeneration
Authors: Jaff Michael R. , Dorros Gerald , Kumar Krishna , Caballero Gerardo , Tector Alfred
Published: March 2015

Purpose:

To report the use of endovascular grafting to repair degenerative aneurysmal changes in an extra-anatomic bypass graft.

Methods:

A 14-year-old extra-anatomic ascending aorta-to-left common femoral bypass graft (“ventral aorta”) had undergone aneurysmal degeneration, producing symptoms of progressive claudication and local abdominal swelling. The aneurysmal graft dilatation began within the thoracic cavity and extended through the entire extraperitoneal abdominal segment. The option for minimally invasive repair using a customized stent-graft device was offered to the patient as an alternative to standard reoperation.

Results:

An 8-mm × 42-cm endovascular graft was constructed of polytetrafluoroethylene with 30-mm Palmaz stents sutured to each end. With balloon occlusion of antegrade and retrograde blood flow, the stent-graft was delivered retrograde through an incision in the distal end of the existing bypass graft. The device was successfully positioned and deployed with complete exclusion of the aneurysm. No complications occurred, and the patient's symptoms abated. Follow-up arteriography at 1 month showed a pseudoaneurysm at the distal graft incision site; surgical repair was necessary. At 6 months, angiography demonstrated continued patency of the extra-anatomic bypass graft.

Conclusions:

Intraluminal aneurysm exclusion techniques in degenerated extra-anatomic bypass grafts may evolve into a viable therapeutic alternative to complex reoperative surgery.
The Clinical Value of Three-Dimensional Intravascular Ultrasound Imaging
Authors: Reid Donald B. , Douglas Myles , Diethrich Edward B.
Published: March 2015

Two-dimensional (2D) intravascular ultrasound (IVUS) imaging can now be reconstructed into three dimensions from serial 2D images captured following a “pullback” of the IVUS catheter through the target site. Three-dimensional (3D) reconstructions provide “longitudinal” and “volume” images. The former is similar to an angiogram and can be examined in three dimensions by rotating the image around its longitudinal axis, providing clinically useful information during endovascular procedures. The volume view takes longer to create and is not an exact reconstruction, but it provides images that can be rotated into any spatial position. It visualizes the luminal aspect of the vessel particularly well.

The clinical value of 3D IVUS is in the diagnosis of vascular disease and the assessment of endovascular interventions. Three-dimensional IVUS, which provides better, more informative images than 2D IVUS, can be particularly useful intraprocedurally in detecting inaccurate deployment of intravascular stents and endoluminal grafts.
Carotid Endarterectomy: The Gold Standard
Authors: Zarins Christopher K.
Published: March 2015

Carotid endarterectomy has been firmly established as the gold standard of therapy for symptomatic and asymptomatic patients with severe carotid stenosis, provided surgical complication rates are within prescribed limits. The procedure-related risk of stroke/death should be < 3% in asymptomatic patients and < 6% in symptomatic patients. New investigational therapies such as balloon angioplasty and stenting for carotid stenosis should be evaluated against the same standard.
Results of Balloon Angioplasty in the Carotid Arteries
Authors: Kachel Reiner
Published: March 2015

Purpose:

To report the experiences to date with percutaneous transluminal angioplasty (PTA) of the carotid artery and other supra-aortic vessels. A new coaxial dilatation system for carotid angioplasty with temporary balloon occlusion to avoid cerebral embolization is presented.

Methods:

PTA was performed in 220 patients with 245 stenosed or occluded supra-aortic arteries; among these were 74 carotid stenoses in the proximal common (n = 5), distal common (n = 1), internal (n = 65), and external (n = 3) carotid arteries. Duplex and B-mode ultrasonography, computed tomography, magnetic resonance imaging, single-photon emission computed tomography, indium 111-labeled platelet scintigraphy, and/or angiography were used before and after PTA. Intravascular ultrasound imaging was also recently added for monitoring angioplasty results.

Results:

All patients but one with carotid lesions had symptoms of cerebrovascular insufficiency. Angioplasty was successful in 69 of the 74 carotid stenoses: proximal common (n = 5), distal common (n = 1), internal (n = 60), and external (n = 3). There were only 1 major (hemiparesis) and 2 minor complications. During the average 70-month observation period, restenosis has not occurred in any treated carotid artery. In a literature review of > 500 patients undergoing carotid angioplasty, the complication rate appears very low (mortality 0%; morbidity 2.1%) and comparable to that for carotid endarterectomy.

Conclusions:

Results of this review suggest that percutaneous transluminal angioplasty of the carotid artery is an effective alternative method to vascular surgery, particularly for patients with comorbidities that elevate the risks of surgery.
Carotid Angioplasty: Is it Safe?
Authors: Becquemin Jean-Pierre , Qvarfordt Peter , Castier Yves , Melliere Didier
Published: March 2015

For 15 years, balloon angioplasty has been cautiously applied to carotid artery occlusive lesions. Procedural results have, by and large, been satisfactory, but the potential for significant neurologic complications and a dearth of controlled studies with long-term follow-up have impeded the development of carotid angioplasty until recently.

This review of the literature chronicles the slow but steady evolutionary pace of carotid angioplasty from its beginnings in 1980 to today's shifting focus to the use of stents. Based on these existing reports and significant personal experience, the advantages and risks of endoluminal carotid interventions are enumerated, along with suggested criteria for the application of carotid angioplasty.
Endovascular Treatment of Abdominal Aortic Aneurysms: Lessons Learned
Authors: Parodi Juan Carlos , Barone Andrea , Piraino Ruben , Schonholz Claudio
Published: March 2015

The authors offer an overview of their 20-year involvement in the development of an endovascular graft for abdominal aortic aneurysm exclusion. Clinical experience gained throughout 6 years of clinical evaluation are reviewed, along with observations and insights on preoperative assessment, implantation techniques, and complications.
Two-Center German Experience with Aortic Endografting
Authors: Blum Ulrich , Voshage Götz , Beyersdorf Friedhelm , Töllner Dirck , Spillner Gerhard , Morgenroth Andreas , Nagel Gudrun , Schiensack Christian , Langer Mathias
Published: March 2015

Purpose:

To report the results of a two-center study of endovascular abdominal aortic aneurysm (AAA) exclusion using a polyester-covered nitinol stent-graft.

Methods:

Candidates were evaluated with arteriography and computed tomography. Criteria for endovascular therapy were a proximal aortic neck > 10 mm in length and < 25 mm in diameter, no bilateral internal iliac artery involvement in the aneurysm, no markedly tortuous common iliac arteries (CIAs) or CIAs < 7 mm in diameter, and no superior mesenteric artery occlusive disease. Patients were treated with the Mialhe Stentor and Vanguard stent-grafts in either tube or bifurcated versions.

Results:

Between August 1994 and November 1996, 149 patients (mean age 67 years, range 49 to 90) were admitted to the study. Overall primary technical success (aneurysm exclusion without endoleak) was 87% (130 patients): 78% (7 patients) for tube grafts and 88% (123 patients) for bifurcated endografts. The rate of local, remote, or systemic complications was 10.8%, with a 30-day mortality rate of 0.7%. During an average 13.5-month follow-up, there were no late deaths. Four of 20 endoleaks sealed spontaneously, 14 were treated with endoluminal techniques, and 2 remain untreated by patient request. Three graft limb thromboses occurred; one was treated surgically, one with lytic therapy, and one was untreated. Secondary patency was 96%.

Conclusions:

Endoluminal repair of infrarenal AAAs using straight or bifurcated grafts is a feasible alternative to conventional surgical repair. Longer follow-up and more experience with refined endograft models will elucidate the durability of this endovascular approach to treating AAAs.
Traumatic Carotid Artery Dissection and Pseudoaneurysm Treated with Endovascular Coils and Stent
Authors: Matsuura John H. , Rosenthal David , Jerius Hilde , Clark Michael D. , Owens David S.
Published: March 2015

Purpose:

To report a case of post-traumatic internal carotid artery dissection and pseudoaneurysm formation at the C-1 level successfully treated by a percutaneous endovascular technique.

Methods and Results:

A 20-year-old female presented 72 hours after a motor vehicle accident with incomplete occulosympathetic paresis (Horner's syndrome), carotidynia, and left-sided weakness. Arteriography confirmed the diagnosis of carotid dissection and an associated 1.5-cm × 2.5-cm pseudoaneurysm at the C-1 level. Neuroradiologists embolized the pseudoaneurysm with Guglielmi detachable coils and controlled the dissection with placement of a Wallstent.

Conclusions:

This report illustrates successful percutaneous endovascular treatment of a carotid dissection and pseudoaneurysm near the base of the skull.
Three-Year Experience with Modular Stent-Graft Devices for Endovascular AAA Treatment
Authors: Stelter Wolf , Umscheid Thomas , Ziegler Peter
Published: March 2015

Purpose:

To evaluate feasibility and present early results of endovascular abdominal aortic aneurysm (AAA) exclusion using modular stent-grafts.

Methods:

In a 3-year period ending July 1997, 201 patients were treated with self-expanding stent-grafts for AAAs with infrarenal necks ≥ 10 to 15 mm long and ≤ 32 mm wide; subtotal mural thrombus, calcification, and even angulation to some extent were acceptable, as were iliac arteries up to 18 mm wide. The patients were treated with either the Stentor/Vanguard device (178 cases) or the Talent endograft (23 cases). Follow-up on all patients was conducted at 3, 6, 12, 18, and 24 months.

Results:

The technical aneurysm exclusion rate was 89% (178/201). There were 18 primary endoleaks (9.0%; 2 proximal, 16 distal), 4 (2.0%) conversions to open surgery, and 1 (0.5%) failure to deploy the graft. Seven (3.5%) patients died in the perioperative period, 5 due to multiorgan failure early in the series and two of hemorrhagic complications. Five (2.5%) renal artery occlusions were encountered; in one case, the graft was removed after 3 weeks. Nineteen late endoleaks were found in follow-up, related primarily to the iliac limb graft extensions of the Stentor device, graft material problems, or unknown causes. To date, 10 primary and 13 secondary endoleaks have been treated endovascularly. Twenty (10.0%) graft-limb thromboses were treated either by thrombolysis, thrombectomy, or a femorofemoral bypass.

Conclusions:

Endovascular grafting is technically feasible and becomes easier with improvements of the introducer systems and the grafts. The seemingly high complication rate in this series is due to the liberal patient selection criteria.