bluuebunny/crossref_metadata_2025 huggingface dataset:
Vibrational Angioplasty in the Treatment of Chronic Femoropopliteal Arterial Occlusions: Preliminary Experience
Authors: Michalis Lampros K. , Tsetis Dimitrios K. , Katsamouris Asterios N. , Rees Michael R. , Sideris Dimitris A. , Gourtsoyiannis Nicholas C.
Published: March 2015

Purpose:

To evaluate the safety and efficacy of vibrational angioplasty in chronic femoropopliteal arterial occlusions.

Methods:

Six patients (5 men; ages 52 to 84 years) with peripheral arterial occlusive disease were treated percutaneously using vibrational angioplasty to recanalize the lesion. Three occlusions ranging from 10 to 15 cm long were in the superficial femoral artery (SFA), while 3 other diffusely diseased popliteal arteries were occluded distally (length from 3.5 to 4.5 cm). Vibrational angioplasty using coronary equipment was applied to assist passage of a coronary guidewire, which was followed by conventional angioplasty. Follow-up surveillance featured periodic physical examination, ankle brachial index measurements, and duplex scanning.

Results:

In all 6 cases, recanalization of the occlusions was successful and without complications. The time to cross the occlusions with the wire ranged from 20 to 25 minutes for the SFA lesions and from 4 to 10 minutes for the popliteal occlusions. Two SFA occlusions were treated with stent implantation. Over a follow-up of 3 to 9 months, all treated vessels were patent. In 3 patients with skin ulcers, healing of the ulcers was observed.

Conclusions:

Vibrational angioplasty using coronary guidewires seems to be a promising ancillary technique in the management of chronic femoropopliteal arterial occlusions.
Recombinant Tissue Plasminogen Activator versus Urokinase for Local Thrombolysis of Femoropopliteal Occlusions: A Prospective, Randomized Multicenter Trial
Authors: Mahler Felix , Schneider Ernst , Hess Hans
Published: March 2015

Purpose:

To report the outcome of a prospective, randomized, open multicenter trial comparing (1) the effects of local thrombolysis with recombinant tissue plasminogen activator (rtPA) or urokinase (UK) and (2) 2 administration techniques.

Methods:

Two hundred thirty-four patients with thromboembolic occlusions in 223 native femoral or popliteal arteries (95%) and 11 bypass grafts (5%) were randomized to rtPA (n = 124) or UK (n = 110) administered either through an endhole catheter (Hess technique) in 81 patients or a microporous balloon catheter (Schneider technique) in 153 patients. When lysis was incomplete, additional catheter interventions were applied to achieve patency. Results were analyzed by fluoroscopy during intervention and by angiography evaluated by independent experts blinded to the methods applied.

Results:

The only significant difference between rtPA and UK was found at the end of lysis using the Hess technique. Complete reperfusion (TIMI grade 3) was produced in 60% of patients by rtPA versus 37% by UK (p = 0.045). By both techniques TIMI grade 3 was achieved in 62% with rtPA and in 50% with UK (p = 0.18). Independent of delivery technique, thrombolytic agent, or additional catheter interventions, TIMI grade 3 was achieved in 81% and angiographic patency in 88%. Primary patency at 6 months was 66%, which was increased by secondary interventions to 75%. Major amputations were performed in 6%, all in patients with initial Fontaine stage III/IV ischemia.

Conclusions:

With local thrombolysis alone, rtPA appears to be more effective than UK; however, additional catheter interventions further improved patency, abolishing the difference between the lytic agents.
Ultrasound and Fluoroscopic-Guided Angioplasty over the Aortic Bifurcation in a Patient with Previous Severe Reaction to Contrast Medium
Authors: Cook Christopher , Rees Michael
Published: March 2015

Purpose:

To describe a case of ultrasound and fluoroscopic-guided angioplasty necessitated by a patient history of allergic reaction to contrast medium.

Case Report:

A 60-year-old man with intermittent right leg claudication had a focal >70% stenosis in the right external iliac artery that was amenable to balloon dilation; however, the patient reported a severe reaction to radiographic contrast medium 10 years previously. Angioplasty was begun with transaortic access to the iliac artery lesion under fluoroscopic guidance only. On-table duplex imaging confirmed the lesion site and reference diameters for balloon selection. The balloon was filled with contrast medium to provide rapid positioning under fluoroscopy. An on-table postangioplasty duplex scan showed improvement in the lumen contour and confirmed a reduction in the peak systolic velocity. At the 1-year follow-up, the patient reports no symptoms referable to the treated segment.

Conclusions:

The combination of ultrasound and fluoroscopy facilitated quick and efficient balloon dilation of an isolated iliac lesion without the use of any contrast medium.
Benefits of Cerebral Protection during Carotid Stenting with the PercuSurge GuardWire System: Midterm Results
Authors: Henry Michel , Henry Isabelle , Klonaris Christos , Masson Isabelle , Hugel Michéle , Tzvetanov Kiril , Ethevenot Gérard , Le Borgne Edmond , Kownator Serge , Luizi François , Folliguet Bernard
Published: March 2015

Purpose:

To examine the possible beneficial effect of a new cerebral protection device based on balloon occlusion of the distal internal carotid artery (ICA) and debris aspiration for patients undergoing carotid artery stenting (CAS).

Methods:

One hundred and eighty-four CAS procedures were attempted under cerebral protection using the PercuSurge GuardWire system in 167 patients (129 men; mean age 70.5 ± 9.2 years, range 40–91)). The lesions were mainly atherosclerotic, and half (n = 93) were asymptomatic. Eighteen restenotic and 7 post-radiation stenoses were also treated.

Results:

Technical success was 99.5%. All lesions were stented except 3 postangioplasty restenoses. Prophylactic occlusion during balloon dilation and stenting was well tolerated in 176 (95.7%) patients. Microscopic analysis of the aspirated blood showed different types of particles numbering between 7 and 145 per procedure with a mean diameter of 250 µm (56–2652 µm). The 30-day stroke and death rate was 2.7%: 3 periprocedural complications at <48 hours (1 major stroke and 2 transient ischemic attacks), 1 intracerebral hemorrhage at 3 days, and 1 death of cardiac failure at 3 weeks.

Conclusions:

This study yielded a favorably low rate of periprocedural embolic events comparable with standard CAS series. Protection devices may play an important role in future carotid interventions and expand the applicability of the procedure. Randomized studies (surgery versus CAS with and without cerebral protection) are awaited.
Endovascular Treatment of Visceral Artery Aneurysms
Authors: Gabelmann Andreas , Görich Johannes , Merkle Elmar M.
Published: March 2015

Purpose:

To review a 10-year experience with endovascular embolization of visceral artery aneurysms.

Methods:

Twenty-five patients (13 men; mean age 52.1 years, range 31–80) presented with VAAs of varying locations and etiologies: 10 splenic, 3 gastroduodenal, 2 pancreaticoduodenal, 3 hepatic, 3 superior mesenteric, 2 celiac, 1 left gastric, and 1 jejunoileal. Ten patients were asymptomatic; 7 aneurysms were ruptured. Transcatheter coil embolization was the treatment of choice in all patients.

Results:

Coil placement was initially (<7 days) successful in 23 (92%) patients. One superior mesenteric artery aneurysm remained perfused, and recurrent bleeding occurred 2 days after intervention in 1 case, but repeated embolization excluded the aneurysm. One patient with necrotizing pancreatitis died from sepsis 10 days after endovascular treatment and surgery (4% 30-day mortality). Long-term follow-up revealed excellent results after an average 48.7 months (range 14–75) with only 1 recurrence after 12 months.

Conclusions:

Embolotherapy is the treatment of choice in visceral artery aneurysms, regardless of etiology, location, or clinical presentation.
Noninvasive Diagnosis of Incomplete Endovascular Aneurysm Repair: D-Dimer Assay to Detect Type I Endoleaks and Nonshrinking Aneurysms
Authors: Serino Francesco , Abeni Damiano , Galvagni Elisabetta , Sardella Savino G. , Scuro Alberto , Ferrari Mauro , Ciarafoni Iole , Silvestri Lorena , Fusco Angelo
Published: March 2015

Purpose:

To test the hypothesis that D-dimer (D-D), a cross-linked fibrin degradation product of an ongoing thrombotic event, could be a marker for incomplete aneurysm exclusion after endovascular abdominal aortic aneurysm (AAA) repair.

Methods:

In a multicenter study, 83 venous blood samples were collected from 74 AAA endograft patients and controls. Twenty subjects who were >6 months postimplantation and had evidence of an endoleak and/or an unmodified or increasing AAA sac diameter formed the test group. Controls were 10 nondiseased subjects >65 years old, 18 AAA surgical candidates, and 26 postoperative endograft patients with no endoleak and a shrinking aneurysm. Blood samples were analyzed for D-D through a latex turbidimetric immunoassay. The endograft patients were stratified into 5 clinical groups for analysis: no endoleak and decreasing sac diameter, no endoleak and increasing/unchanged sac diameter, type II endoleak and decreasing sac diameter, type II endoleak and increasing/unchanged sac diameter, and type I endoleak.

Results:

Individual D-D values were highly variable, but differences among clinical groups were statistically significant (p < 0.0001). D-D values did not vary significantly between patients with stable, untreated AAAs and age-matched controls (238 ± 180 ng/mL versus 421 ± 400 ng/mL, p > 0.05). Median D-D values increased at 4 days postoperatively (963 ng/mL versus 382 ng/mL, p > 0.05) and did not vary thereafter if there was no endoleak and the aneurysm sac decreased. D-D mean values were higher in patients with type I endoleak (1931 ± 924 ng/mL, p < 0.005) and those with unchanged/increasing sac diameters (1272 ± 728 ng/mL) than in cases with decreasing diameters (median 638 ± 238 ng/mL) despite the presence of endoleak (p < 0.0005).

Conclusions:

Elevated D-D may prove to be a useful marker for fixation problems after endovascular AAA repair and may help rule out type I endoleak, thus excluding patients from unnecessary invasive tests.
“Pseudoendoleak”— Residual Intrasaccular Contrast after Endovascular Stent-Graft Repair
Authors: Lee W. Anthony , Rubin Geoffrey D. , Johnson Bonnie L. , Arko Frank , Fogarty Thomas J. , Zarins Christopher K.
Published: March 2015

Purpose:

To present a unique demonstration of postoperative perigraft contrast masquerading as an endoleak following endovascular abdominal aortic aneurysm (AAA) repair.

Case Report:

A 66-year-old man underwent endovascular stent-graft repair of a 4.6-cm infrarenal AAA. The procedure was uncomplicated, and intraoperative completion angiography demonstrated good proximal and distal fixation of the stent-graft without an endoleak. A spiral computed tomographic (CT) angiogram obtained on postoperative day 2 revealed a large amount of extrastent contrast along the posterior aspect of the aneurysm sac. This defect had the appearance of an endoleak, but it was also present on the noncontrast images. A color-flow duplex examination performed on the same day showed a widely patent stent-graft with no evidence of extrastent flow.

Conclusions:

Contrast trapped in the aneurysm sac during endovascular aneurysm repair may be misinterpreted as an endoleak on postprocedural CT scans. “Pseudoendoleaks” can be distinguished from true endoleaks by examination of prebolus, noncontrast CT images, as well as by duplex ultrasound scanning.
Partially Clipped Intracranial Aneurysm Obliterated with Combined Stent and Coil Implantation
Authors: Lylyk Pedro , Cohen José E. , Ferrario Angel , Ceratto Rosana , Miranda Carlos
Published: March 2015

Purpose:

To report a case of endovascular stent placement to assist stable coil deployment in a symptomatic, wide-necked, partially clipped aneurysm.

Case Report:

A 48-year-old woman presented for endovascular treatment of a symptomatic posterior communicating artery aneurysm remnant that was surgically clipped 10 years ago. A 3.5-mm × 12-mm balloon-expandable stent was placed across the aneurysm orifice followed by complete obliteration of the remnant with coils implanted through the stent mesh. Digital subtraction angiography documented continued patency of the arterial lumen and complete obliteration of the aneurysm at 11 months.

Conclusions:

Partial aneurysm clipping may assist or complicate secondary interventional procedures and interfere with correct visualization of the neck. Stent placement obviates the need for the balloon-assist method of coil embolization for wide-necked aneurysm remnants, acting as a mechanical barrier to hold the coils in a very unfavorable anatomy.
Emergent Repair of a Ruptured Abdominal Aortic Aneurysm Using an AneuRx Stent-Graft
Authors: Kumar Vinay , Campbell Joe H. , Andy Orlando J. , Hatten Lewis E.
Published: March 2015

Purpose:

To report a case of ruptured abdominal aortic aneurysm (AAA) treated with a commercially available endoluminal graft.

Case Report:

Ruptured AAA was diagnosed in a 58-year-old man with lower abdominal pain, hypotension, and syncope. A contrast-enhanced computed tomographic (CT) scan confirmed the presence of a 7-cm ruptured infrarenal AAA associated with a large retroperitoneal hematoma. The aneurysm was successfully excluded with a bifurcated AneuRx stent-graft placed through a femoral approach in an emergent procedure. The patient was discharged on the third postoperative day. CT scans at 1 and 10 months demonstrated complete resolution of the retroperitoneal hematoma and continued exclusion of the aneurysm.

Conclusions:

The AneuRx stent-graft can be successfully applied for the treatment of a ruptured AAA in emergency situations.
CT-Guided Percutaneous Embolization of a Lumbar Artery Maintaining a Type II Endoleak
Authors: Schmid Roger , Gürke Lorenz , Aschwanden Markus , Stierli Peter , Jacob Augustinus Ludwig
Published: March 2015

Purpose:

To demonstrate the possibility of percutaneous embolization of a type II endoleak guided by computed tomographic (CT) fluoroscopy.

Case Report:

A type II endoleak maintained by a hypertrophic fourth lumbar artery failed to occlude spontaneously 7 months after stent-graft deployment for endovascular repair of an infrarenal abdominal aortic aneurysm. A percutaneous procedure was performed to eliminate the endoleak using needle puncture and embolization under CT fluoroscopic guidance. The sagittal diameter of the aneurysm sac, which had remained constant after initial endovascular exclusion, shrank from 5.2 to 4.8 cm in the 3 months following embolization.

Conclusions:

Percutaneous embolization of lumbar branches guided by CT fluoroscopy may be an alternative to other therapies for type II endoleaks.
Preoperative Duplex-Derived Parameters and Angioscopic Evidence of Valvular Incompetence Associated with Superficial Venous Insufficiency
Authors: Yamaki Takashi , Sasaki Kenji , Nozaki Motohiro
Published: March 2015

Purpose:

To determine if an association exists between duplex-derived parameters and intraoperative angioscopic findings of valvular incompetence.

Methods:

Preoperative duplex scanning and intraoperative angioscopy were performed on 153 limbs in 116 patients (84 women; mean age 53 years, range 24–79) with superficial venous incompetence (SVI). The duplex parameters of vein diameter at the saphenofemoral junction (SFJ), reflux duration, and peak retrograde reflux velocity at the SFJ were analyzed among SVI patients categorized by intraoperative angioscopy as type I (valves with elongated and atrophic cusps), type II (valves with expanded and depressed commissures with cusp changes), type III (cusps with other deformities), or type IV (absent valves).

Results:

There were 33 limbs with type I valves, 56 with type II, 25 with type III, and 39 with type IV. Among the 89 limbs with type I or II valves, 64 (71.9%) had a peak velocity <30 cm/s, while only a quarter of the limbs with type III or IV values had a velocity <30 cm/s. The majority of patients with types I or II valves had a vein diameter <0.9 cm (25 [75.8%] type I and 37 [66.1%] type II). The sensitivity, specificity, and predictive value for identifying type I and II valve lesions were maximized at 90.0%, 66.7%, and 77.8%, respectively, when vein diameter <0.9 cm was combined with a peak reflux velocity >30 cm/s.

Conclusions:

These data suggest that a combination of variables determined by preoperative duplex scans may correlate to the severity of valvular deformity determined by direct angioscopic inspection.
Predicting Spinal Cord Ischemia before Endovascular Thoracoabdominal Aneurysm Repair: Monitoring Somatosensory Evoked Potentials
Authors: Bafort Catherine , Astarci Parla , Goffette Pierre , El Khoury Gebrine , Guerit Jean-Michel , de Tourtchaninoff Marianne , Verhelst Robert
Published: March 2015

Purpose:

To present a method of predicting spinal cord ischemia before deployment of an endograft in the thoracoabdominal aorta.

Case Report:

A 76-year-old high-risk patient presented with an aneurysm of the distal thoracic and proximal abdominal aorta. An endovascular treatment was scheduled, but before deployment of the endograft, occlusion of the aneurysmal segment was monitored for 15 minutes using multilevel somatosensory evoked potentials (SEP). An external axillofemoral bypass was necessary during the test period to prevent distal ischemia; transesophageal echocardiography verified the absence of flow inside the aneurysm during occlusion. Because no SEP changes occurred during the 15-minute test, a 20-cm-long endograft was deployed. No postoperative neurological event was encountered, and the aneurysm has remained successfully excluded with shrinkage of the sac diameter by 1 cm at 6 months.

Conclusions:

An occlusion test to detect spinal cord ischemia before deployment of an endograft could be useful in lowering the risk of paraplegia associated with endovascular treatment of thoracoabdominal aneurysm.
Endoventricular Transplantation of Allogenic Skeletal Myoblasts in a Porcine Model of Myocardial Infarction
Authors: Dib Nabil , Diethrich Edward B. , Campbell Ann , Goodwin Noreen , Robinson Barb , Gilbert James , Hobohm Dan W. , Taylor Doris A.
Published: March 2015

Purpose:

To assess the technical feasibility of percutaneous endoventricular injection of skeletal myoblasts into an infarcted porcine myocardium.

Methods:

A skeletal muscle biopsy was obtained from a donor pig and processed for myoblast expansion in vitro. Myocardial infarction was induced in a host pig via fibrin coil placement in the left anterior descending artery. Four weeks later, electromechanical mapping of the left ventricle identified the infarction site, into which ∼200 million allogenic cells obtained from the muscle biopsy were directly injected (0.1 mL/injection at 25 sites) from inside the ventricular cavity via a needle injection catheter inserted through the femoral artery. Ten days after transplantation, the injected heart was evaluated histologically for the presence of myoblasts.

Results:

Electrocardiography, echocardiography, left ventricular angiography, and electromechanical mapping confirmed the myocardial infarction. During the cell transfer procedure, premature ventricular contractions confirmed needle placement in the endocardium. Histological evaluation of the host heart 10 days after cell transfer revealed living myoblasts and multinucleated myotubes in the infarcted region, indicating successful transplantation.

Conclusions:

Direct myoblast transplantation into infarcted porcine myocardium using an endoventricular injection was technically feasible. The results in this model show that transplanted myoblasts were able to survive for 10 days after transplantation.
Endoluminal Stent-Graft Repair of a Renal Artery Aneurysm
Authors: Bruce Michael , Kuan Yew-Ming
Published: March 2015

Purpose:

To present a renal artery aneurysm that was treated successfully by endoluminal grafting.

Case Report:

A 48-year-old woman presented with a 2.5-cm saccular left renal artery aneurysm. A Jostent coronary stent-graft was placed transluminally into the left renal artery via a femoral artery cutdown. After 12 months, renal function remained normal, and computed tomography revealed normal kidney perfusion with complete resolution of the renal artery aneurysm.

Conclusions:

The advances in endovascular stent-grafts will allow more visceral artery aneurysms to be treated with a minimally invasive approach.
Stent-Graft Repair of a Recurrent Popliteal Arteriovenous Fistula
Authors: Tielliu Ignace F.J. , Verhoeven Eric L.G. , Prins Ted R. , van Det Marc , van den Dungen Jan J.A.M.
Published: March 2015

Purpose:

To describe the successful endovascular treatment of a popliteal arteriovenous fistula with a stent-graft.

Case Report:

A 54-year-old man was referred to our hospital with a distal popliteal arteriovenous fistula following an arthroscopic meniscectomy 6 years earlier. Three surgical attempts to close the fistula were undertaken, but the fistula recurred. He now presented with symptoms of progressive venous hypertension with claudication, swelling of the leg, and ulceration at the ankle. The fistula was closed with a stent-graft deployed percutaneously. At 18 months, the patient is doing well; duplex evaluation has documented the patency of the popliteal artery and the stent-graft.

Conclusions:

Endovascular treatment of a popliteal arteriovenous fistula is an alternative to open surgical reconstruction. In this situation, after multiple failed surgical closures and in a leg with extensive venous hypertension, it may be the best treatment option.
Heme Oxygenase-1 Genotype is a Vascular Anti-inflammatory Factor following Balloon Angioplasty
Authors: Schillinger Martin , Exner Markus , Mlekusch Wolfgang , Ahmadi Ramazanali , Rumpold Helmut , Mannhalter Christine , Wagner Oswald , Minar Erich
Published: March 2015

Purpose:

To investigate the association of the heme oxygenase-1 (HO-1) genotype, which has potent anti-inflammatory capability, and the inflammatory response induced by balloon angioplasty.

Methods:

Three hundred seventeen patients (188 men; median age 70 years, range 57–77) undergoing femoropopliteal balloon angioplasty (n=150) or stenting (n=61) were evaluated for upregulation of the HO-1 genotype; 106 patients undergoing lower limb angiography served as controls. The acute phase reactants C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen were measured 24 and 48 hours postintervention and compared to baseline values. An association of the relative increase (Δ, %) of these inflammatory markers with short (<25) (GT)n dinucleotide repeats in the HO-1 gene promoter was assessed.

Results:

The HO-1 genotype was significantly associated with ΔCRP24 (p<0.0001), ΔCRP48 (p<0.0001), ΔSAA24 (p=0.02), and ΔSAA48 (p=0.006) after balloon angioplasty; Δfibrinogen showed no association. Patients with a higher ΔCRP48 after balloon angioplasty exhibited significantly reduced odds for the presence of short (<25) (GT)n repeats. The adjusted odds reduction in the multivariate model was 80% (p=0.002) in the third quartile of ΔCRP48 values and 90% (p=0.001) in the fourth quartile. No association of HO-1 genotype and inflammatory response was found 24 and 48 hours after stenting (p=0.3, p=0.5) or angiography (p=0.2, p=0.6).

Conclusions:

The HO-1 promoter genotype is independently associated with the inflammatory response seen after balloon angioplasty. Short alleles (<25 GT repeats) seem to be an intrinsic vascular anti-inflammatory factor.
Percutaneous Inferior Vena Cava—to—Portal Vein Shunt (PIPS) Using a Stent-Graft: Preliminary Results
Authors: Quinn Stephen F. , Sheley Robert C.
Published: March 2015

Purpose:

To present preliminary results of an inferior vena cava (IVC)–to—portal vein shunt (PIPS) that is created through the caudate lobe of the liver.

Methods:

Sixteen patients (13 men; mean age 50 years, range 32–63) were referred for PIPS procedures because of bleeding varices (n = 11), intractable ascites (n = 4), and hepatorenal syndrome (n = 1). The severity of liver disease was Child's B in 2 and Child's C in 14. The PIPS was created by a transhepatic puncture through the IVC and the portal vein; an endograft made of polytetrafluoroethylene sutured to a Palmaz stent was placed through a jugular approach.

Results:

In 13 (81%) patients, the portal vein—to—IVC tracts were successfully created. The postprocedural portal vein—IVC gradients varied from 1 to 9 mm Hg (mean 5). There were 2 deaths in the 30-day periprocedural period from adult respiratory distress syndrome and hepatorenal syndrome. A third patient died at 31 days from liver failure owing to continuing alcohol abuse. In addition, there was 1 case of peritoneal bleeding treated with blood product replacement. The follow-up period ranged from 14 to 671 days (mean 343). None of the patients treated for variceal bleeding had another bleeding episode, but 2 patients who had a PIPS procedure for refractory ascites did not benefit from the procedure. Postprocedure, 46% (6/13) of the patients had hepatic encephalopathy, which was unchanged from baseline. The primary and secondary patency rates at 365 days were 60% and 65%, respectively.

Conclusions:

The preliminary results using a stent-graft to create an IVC-portal vein shunt are encouraging and support further work to better determine the role of this procedure.
Virtual Angioscopy Using 3-Dimensional Rotational Digital Subtraction Angiography for Endovascular Assessment
Authors: Unno Naoki , Mitsuoka Hiroshi , Takei Yasutaka , Igarashi Tatsuya , Uchiyama Takashi , Yamamoto Naoto , Saito Takaaki , Nakamura Satoshi
Published: March 2015

Purpose:

To investigate the feasibility of 3-dimensional rotational digital subtraction angiography (3D DSA) and the creation of virtual angioscopic images from its data before and after endovascular treatment.

Technique:

Data sets from 3D DSA studies were used to create intraluminal images simulating angioscopy for 36 patients with arterial stenosis, aneurysm, or endoleak after stent-graft deployment. A biplanar DSA unit was used to acquire rotational angiography data, which was then processed with a surface-rendering technique to create maximum intensity projections, shaded surface displays, multiplanar reconstructions, and virtual angioscopy. 3D reconstructions were created in 2 minutes after angiography and provided realistic views adequate for vessel measurement, morphology assessment, and endoleak evaluation.

Conclusions:

3D DSA and virtual angioscopy are novel techniques that have been successful in recreating images of blood vessels immediately after angiography. These techniques could be useful as additional imaging modalities to complement computed tomography or magnetic resonance imaging in the evaluation of vascular diseases after endovascular therapy.
Type II Endoleak: Transperitoneal Sacotomy and Ligation of Side Branch Endoleaks Responsible for Aneurysm Sac Expansion
Authors: Hinchliffe Robert J. , Singh-Ranger Ravinder , Whitaker Simon C. , Hopkinson Brian R.
Published: March 2015

Purpose:

To demonstrate aneurysm sac expansion in the face of a type II endoleak and its treatment with open ligation of multiple side branch endoleaks.

Case Report:

An 81-year-old patient had undergone elective endovascular repair of a 6.3-cm infrarenal abdominal aortic aneurysm in September 1999. Routine spiral computed tomographic angiography at 10 months disclosed a type II endoleak; the aneurysm sac diameter had grown to 7.4 cm. Selective angiography revealed multiple lumbar endoleaks and a patent inferior mesenteric artery. Laparotomy and sacotomy was performed, confirming the presence of pulsatile type II endoleaks, which were ligated successfully. The patient made a full postoperative recovery.

Conclusions:

Type II endoleaks may cause aneurysm expansion. Open repair of multiple type II endoleaks is feasible and may be useful where endovascular or laparoscopic techniques are at high risk of procedural failure, such as multiple endoleak channels.
Carotid Artery Stenting in Older Patients: Is Age a Risk Factor for Poor Outcome?
Authors: Ahmadi Ramazanali , Schillinger Martin , Lang Wilfried , Mlekusch Wolfgang , Sabeti Schila , Minar Erich
Published: March 2015

Purpose:

To assess the impact of age on technical success and complications of carotid stenting in a prospective single-center cohort study.

Methods:

One hundred eleven consecutive patients (74 men; median age 70 years) with ≥70% symptomatic (n=33) or ≥90% asymptomatic (n=78) internal carotid artery (ICA) stenosis underwent carotid artery stent implantation. Primary technical success and periprocedural complications were compared in patients aged >75 years (n=28) to patients <75 years (n=83).

Results:

Patient groups below and above 75 years compared well with respect to baseline demographic and clinical data. Successful stenting was achieved in 108 (97%) patients. The combined neurological complication rate was 7% (n=8), with 1 (1%) major stroke, 1 (1%) minor stroke, and no 30-day mortality. Technical angiographic complications occurred in 8 (7%) patients. No significant differences between patients >75 years and those <75 years were observed for primary success rates (100% [28/28] versus 96% [80/83]; p=0.8), overall complications (14% [4/28] versus 16% [13/83]; p=1.0), neurological complications (7% [2/28] versus 7% [6/83]; p=1.0), or technical complications (7% [2/28] versus 4% [3/83]; p=0.6).

Conclusions:

Elective carotid stenting can be performed safely in older patients with several comorbidities. Patient age does not seem to be an independent risk factor for poor outcome after endovascular treatment of internal carotid artery stenosis. Both Drs. Ahmadi and Schillinger contributed equally to the study.
Endoluminal Repair of Infrarenal AAA in the Presence of Aortic Dissection
Authors: Tefera Girma , Carr Sandra , Hoch John , Acher Charles W. , Turnipseed William D.
Published: March 2015

Purpose:

To report a challenging case of infrarenal abdominal aortic aneurysm (AAA) treated with a commercial stent-graft in the face of thoracoabdominal aortic dissection.

Case Report:

A 73-year-old patient was admitted because of acute descending thoracic and abdominal aortic dissection. He was also found to have an 8-cm infrarenal AAA. After initial medical management of the acute aortic dissection, the patient underwent endoluminal AAA repair with an AneuRx stent-graft. The completion angiogram showed that the graft was deployed in the false lumen; this complication was treated with fenestration of the intimal flap, establishing flow through both lumens. The patient's recovery was uneventful, and he was discharged on the fourth postoperative day. Follow-up at 1 year with computed tomographic angiography documented a stable descending thoracic aorta with a suggestion of a type II endoleak and no change in the aneurysm volume.

Conclusions:

This case illustrates the feasibility of endograft repair of infrarenal AAA with a modular stent-graft in the presence of aortic dissection extending below the renal arteries.
Early Ambulation after Diagnostic Angiography Using 4-F Catheters and Sheaths: A Feasibility Study
Authors: Dowling Kyran , Todd David , Siskin Gary , Stainken Brian , Dolen Eric , Sansivero Gail , Quarfordt Steven , Mitchell Nancy , Darling R. Clement
Published: March 2015

Purpose:

To assess the feasibility and safety of early ambulation in patients undergoing transfemoral diagnostic angiography using 4-F catheters or sheaths.

Methods:

In this prospective study approved by the institutional review board, patients undergoing diagnostic angiography were randomized to ambulate 3 or 6 hours after catheter or sheath removal. All patients were assessed for hematoma formation, pseudoaneurysm development, and other groin complications during the in-hospital recovery period and after 30 days. Patient satisfaction and comfort level were also assessed by survey.

Results:

Of 110 patients (66 men; mean age 64.9 ± 12.8 years) who participated in this study, 47 were randomized to the 6-hour (6-H) group and 63 to the 3-hour (3-H) group. In the 3-H and 6-H groups, respectively, a 4-F catheter was used in 45 (71%) and 35 (74%) patients and a 4-F sheath in 18 (29%) and 12 (26%). No clinically significant groin complications were encountered in either group. Moderate to severe discomfort was reported in 9 (16%) of the 56 patients responding to the discomfort survey in the 3-H group compared to 10 (26%) of the 38 in the 6-H survey respondents.

Conclusions:

It is feasible and safe to ambulate patients 3 hours after diagnostic angiography performed with a 4-F catheter with or without a 4-F sheath. Early ambulation of patients after angiography has the additional benefits of increasing patient satisfaction and resource utilization.
Trends in Endovascular Surgery Training
Authors: Kashyap Vikram S. , Ahn Samuel S. , Davis Michael R. , Moore Wesley S. , Diethrich Edward B.
Published: March 2015

Purpose:

To gather vascular surgery fellows' opinions on various issues related to endovascular surgery (EVS) over a 2-year period and analyze the responses to identify trends in EVS training.

Methods:

Vascular surgery fellows in 2 consecutive years were given a 2-page questionnaire inquiring about training protocols and local practice habits. Respondents included 64 vascular fellows from the academic year 1998–1999 (F98) and 52 vascular fellows from the academic year 1999–2000 (F99) (78% men in the entire population; mean age 34 years), representing a significant fraction of trainees in North America. Data from F98 and F99 were compared and analyzed.

Results:

The majority (66%) of vascular surgery fellows were trained at university hospitals and performed EVS at the time of the survey: 83% in the F98 class and 92% in the F99 group (p=0.17). Utilization rates among the 9 interventions surveyed ranged from angiography (83%) and angioplasty (77%) to intravascular ultrasound (33%) and atherectomy (15%). Performance of endovascular grafting significantly increased among trainees (50% versus 81%, p<0.005), while atherectomy and angioscopy decreased. EVS performed in the operating room with portable imaging equipment decreased (67% versus 42%, p=0.02) as access to the radiology and cardiology suites increased. In most communities (63%), radiology specialists performed most of the EVS procedures, but the portion of communities where vascular surgery performed the majority of EVS procedures increased from 20% to 35% (p=0.10) from F98 to F99. Responders (90%) believed that EVS would become a major component of vascular surgery and comprise 30% of their future practice. The proportion of fellows who believed they were sufficiently trained in endovascular techniques increased from 30% to 50% (p=0.04), with the remainder willing to devote a short period (<3 months) for further training.

Conclusions:

The vast majority of vascular trainees perform EVS and believe that it will have an increasing role in their practice. Trends include increased endovascular grafting and performance of EVS by vascular surgeons in interventional suites.
Endotension Distribution and the Role of Thrombus following Endovascular AAA Exclusion
Authors: Pacanowski John P. , Stevens Scott L. , Freeman Michael B. , Dieter Robert S. , Klosterman Lance A. , Kirkpatrick Stacy S. , Ragsdale John W. , Davis S. Elizabeth , Goldman Mitchell H.
Published: March 2015

Purpose:

To determine the pattern of strain and pressure transmitted to an aortic aneurysm wall before and after endovascular exclusion and to evaluate the role of sac thrombus on the conduction of pressure and wall strain.

Methods:

Three canine thoracic aortas were used to create abdominal aortic aneurysms (AAA). The segments were placed on a pulsatile pump system, and 8 strain transducers were positioned in the aneurysm sac. Baseline strain/pressure (S/P) was recorded in 1 animal, then the AAA was excluded with a stent-graft. Thrombin was injected into the sac, and strain/pressure was recorded at 7 systemic pressures (35 to 120 mmHg) over 6 hours. The thrombus was replaced with fibrin glue, and S/P was recorded over 4 hours. Additional trials using whole and 50% diluted unclotted blood were performed prior to sac thrombosis. Computed tomography and angiography were performed before and after aneurysm exclusion.

Results:

Pressure transmitted to the aneurysm wall decreased following stent-graft placement (p≤0.001). Strain/pressure was not distributed evenly in the sac (p≤0.05), and varying systemic pressures did not affect this distribution. Pressures near the stent-graft were higher than those laterally (p≤0.001) in all trials with interposed fresh thrombus and fibrin thrombus. The fibrin group had elevated baseline measurements, but correction for the elevated values did not influence the statistical significance (p≤0.001). Blood and fibrin thrombus reduced transmitted wall pressure to a similar degree. Overall S/P in the fluid-filled nonclotted sac was significantly lower (p≤0.001) than in the thrombus groups.

Conclusions:

Endovascular AAA exclusion reduced strain and pressure conducted to the aneurysm wall, and the distribution of transmitted pressure in the excluded sac without endoleak differed regardless of the sac contents. Fresh thrombus reduced transmitted S/P in all trials at all systemic pressures, as did fibrin thrombus but in a less predictable fashion.
Aneurysm Wall Stress and Tendency to Rupture are Features of Physical Wall Properties: An Experimental Study
Authors: Flora Harpaul S. , Talei-Faz Bijan , Ansdell Leslie , Chaloner Edmund J. , Sweeny Aaron , Grass Anthony , Adiseshiah Mohan
Published: March 2015

Purpose:

To use bench top techniques to examine the biophysical phenomena affecting the risk of abdominal aortic aneurysm (AAA) rupture relative to the physical properties of the aneurysm sac.

Methods:

Three latex AAAs with different wall elasticities were tested in a validated pulsatile flow model (PFM). Strain gauges were wired to each AAA model at the neck, inflection point, and at the maximum diameter. In initial studies, the influence of pressurization and the mechanical properties of AAA wall stress were evaluated. In subsequent studies, the latex AAAs were excluded with a tube graft and retested in the PFM. After creation of either a type I or II endoleak of known size and pressure, the systemic/intrasac pressure and the AAA wall stress were measured.

Results:

Each model had a complex wall-stress pattern comprising radial, longitudinal, and shear components. The peak wall stress at any point, in the presence of systemic pressurization or endoleak pressure, only reached 1% of the failure strength. In an AAA with a reinforced wall, the peak stress was significantly greater. Statistical analysis showed that wall strength contributed more significantly to wall stress than increasing pressurization within the AAA sac.

Conclusions:

AAA wall mechanics contribute more significantly to peak wall stress than pressure variations within the system. In particular, increased stiffness (analogous to collagen deposition) significantly increased peak wall stress, which was located at the inflection point rather than at the maximum diameter. Techniques to measure the AAA wall mechanics and the rate of deterioration may predict AAA rupture in the untreated state or in the presence of an endoleak following endovascular repair.
Accidental Small Bowel Perforation after Antegrade Femoral Artery Access for Percutaneous Thromboembolectomy and Angioplasty
Authors: Seyfarth Tobias , Baumgartner Iris , Triller Jürgen , Dinkel Hans-Peter
Published: March 2015

Purpose:

To report a rare complication of antegrade femoral access for percutaneous aspiration thromboembolectomy and transluminal angioplasty.

Case Report:

A 73-year-old obese woman underwent antegrade femoral aspiration thromboembolectomy for lower limb arterial embolism. Fifteen hours later, she presented with acute abdomen and decreased hemoglobin. Computed tomography showed small bowel obstruction, incarcerated femoral hernia, and free peritoneal air and fluid suggesting bowel perforation. Emergent laparotomy revealed an incarcerated, perforated femoral bowel loop and 4-quadrant peritonitis.

Conclusions:

Femoral hernia injury is an exceptional complication of vascular interventions. Knowledge of this potential hazard may help to avoid its occurrence.
Hematoma after Percutaneous Transpopliteal Stenting and Remote Suturing of the Popliteal Artery
Authors: Yilmaz Saim , Sindel Timur , Erdoğan Abdullah , Mete Atalay , Lüleci Ersin
Published: March 2015

Purpose:

To present a case of extensive thigh hematoma that developed after use of a percutaneous suturing device for retrograde popliteal artery puncture.

Case Report:

A 55-year-old woman underwent endovascular treatment for a short occlusion of the right superficial femoral artery via a retrograde popliteal approach, after which the puncture site was closed with a Closer suture-mediated device. Several hours later, massive hematoma of the right thigh developed, which was noticed only after the patient's leg became markedly swollen and hypotension developed.

Conclusions:

The use of a suture-mediated closure device for a retrograde popliteal artery puncture may not be recommended.
Impact of Cerebral Protection Devices on Early Outcome of Carotid Stenting
Authors: Castriota Fausto , Cremonesi Alberto , Manetti Raffaella , Liso Armando , Oshola Kareem , Ricci Enrico , Balestra Guido
Published: March 2015

Purpose:

To evaluate the impact of cerebral protection devices on the procedural safety and outcome of carotid stent procedures.

Methods:

From June 1997 to July 2001, 275 consecutive patients (208 men; mean age 71 ± 7.4 years) underwent percutaneous angioplasty and/or stenting of the extracranial carotid artery. In the first 125 (45.4%) patients, the procedures were performed without cerebral protection. After January 2000, protection devices were routinely used (150 [54.6%] patients), including the Angioguard filter, GuardWire occlusion system, TRAP Vascular Filtration System, EPI Filter Wire, NeuroShield, Parodi Anti-Embolism System, and Medicorp occlusive balloon.

Results:

The percutaneous procedures were effective in 273 (99.3%) patients. No death or major stroke occurred in either group. In the unprotected group, 5 (4.0%) complications occurred: 3 (2.4%) minor strokes, 1 (0.8%) transient ischemic attack (TIA), and 1 (0.8%) subarachnoid hemorrhage. In the patients treated under cerebral protection, there were 2 (1.3%) complications: 1 (0.7%) minor stroke and 1 (0.7%) subarachnoid hemorrhage. There were 4 (3.2%) periprocedural embolic complications in the unprotected group versus 1 (0.7%) in the protected patients.

Conclusions:

Our data suggest that percutaneous dilation and stenting of the carotid arteries protected by cerebral protection devices is feasible and effective. In a consecutive series, the use of the cerebral protection systems reduced the acute neurological event rate related to embolic complications by 79%.
Effect of Mesenteric Ischemia/Reperfusion on Spinal Cord Injury following Transient Aortic Occlusion in Rabbits
Authors: Morrissey Nicholas J. , Kantonen Ilkka , Liu Harry , Sidiqui Mohamed , Marin Michael L. , Hollier Larry H.
Published: March 2015

Purpose:

To investigate in a rabbit model if prolonged periods of mesenteric ischemia followed by reperfusion may affect the rate of neurological complications.

Methods:

An infrarenal aortic snare, which consisted of a Silastic vessel loop whose ends were passed through plastic tubing, was placed in 50 male New Zealand white rabbits. In 40 of these animals, a similar but smaller device was placed around the superior mesenteric artery (SMA); all devices were exteriorized to allow vessel occlusion in the awake animal. The aorta was occluded for 12 minutes in the 10 control and 40 experimental animals, but the experimental rabbits also had occlusion of the SMA for varying intervals: 10 minutes (group 1), 12 minutes (group 2), and 18 minutes (group 3). To assess the hemodynamic effects of aortic and aortic/SMA occlusion, select control and test animals had blood pressure and heart rate monitoring via indwelling carotid catheters during the occlusion periods. The animals were euthanized, and spinal cords from paralyzed and normal rabbits were examined histologically

Results:

Neurological deficit occurred in 20% of controls and in 70%, 80%, and 100% in the experimental groups, respectively. There were no significant differences in systemic blood pressure at any time point during occlusion and reperfusion in the monitored control or test animals. There was no evidence of thrombosis of spinal arteries on histological analysis, nor was there evidence of bowel infarction at the time of sacrifice in animals undergoing combined aortic/SMA occlusion.

Conclusions:

Mesenteric ischemia/reperfusion worsens the neurological outcome in animals undergoing transient aortic occlusion. This observation is independent of hemodynamic influences and not the result of spinal artery thrombosis.
Endovascular Repair of Recurrent Thoracoabdominal Aortic Aneurysm
Authors: Khoury Michael
Published: March 2015

Purpose:

To report the endovascular repair of a complicated, recurrent thoracoabdominal aortic aneurysm (TAAA) using stacked, customized stent-grafts.

Case Report:

A 75-year-old man was evaluated for an enlarging 7-cm suprarenal abdominal aortic aneurysm. The patient had repair of a distal TAAA in the past, as well as multiple visceral revascularizations from the infrarenal aorta. A 3-segment aortic endograft with proximal and distal extensions was delivered with the aid of a prosthetic conduit from the right common iliac artery to the end of the right renal artery; spinal fluid drainage was performed to mitigate paraplegia. The stent-graft components were serially deployed from the level of the left common carotid artery and ended with the bare springs of the distal extension covering the renal arteries. The patient was discharged but returned within a month for drainage of a purulent retroperitoneal hematoma. He has since resumed his preoperative activities and remains well with documented exclusion of the aneurysm and satisfactory visceral and distal perfusion at 21 months.

Conclusions:

This case illustrates that aortic endografting can be a viable option for the treatment of recurrent thoracoabdominal aortic aneurysms.
Thrombolysis of Occluded Synthetic Bypass Grafts in the Lower Limb: Technical Success and 1-Year Follow-up in 32 Patients
Authors: van Holten Jacqueline , van Dijk Lukas C. , van Sambeek Marc R.H.M. , van Urk Hero , van Overhagen Hans , Pattynama Peter M.T.
Published: March 2015

Purpose:

To evaluate prospectively the technical success and clinical outcome of thrombolysis for acute occlusion of synthetic arterial bypass grafts in the lower limb.

Methods:

Thirty-two consecutive patients (27 men; median age 65 years, range 41–80) with occluded polytetrafluoroethylene bypass grafts were treated with direct-catheter thrombolysis (100,000-IU bolus of urokinase with 100,000-IU/h infusion) followed by ancillary interventions to treat underlying stenosis whenever necessary. All patients received oral anticoagulation to maintain the international normalized ratio at 3.0 to 4.0. Clinical follow-up and duplex ultrasound examinations were performed at 3-month intervals up to 1 year.

Results:

Thrombolysis was technically successful in 27 (84%) patients; 3 of the 5 failed patients had amputations. Mean duration of urokinase therapy was 36±14 hours. In 18 patients, underlying stenoses (11 distal anastomosis, 5 proximal anastomosis, and 3 inflow) were treated, 15 by an endovascular procedure and 3 surgically. Four major complications occurred: groin hematoma, sepsis, transient renal dysfunction, and a hemorrhage at the proximal anastomosis after urokinase treatment. At 1 year, 21 bypass grafts had reoccluded (20% patency rate on intention-to-treat basis); 3 reocclusions resulted in amputation (overall 19% amputation rate).

Conclusions:

Thrombolysis in the setting of acute lower limb bypass graft occlusion is associated with good initial technical success rates and satisfactory clinical results. However, the re-occlusion rate within 1 year is high.