bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Endograft Support Alter the Rate of Aneurysm Sac Shrinkage after Endovascular Repair?
Authors: Rhee Robert Y. , Garvey Laura , Missig-Carroll Nita , Makaroun Michel S.
Published: March 2015

Purpose:

To test the hypothesis that stent-graft support influences sac shrinkage independent of endoleak rates after endovascular repair of abdominal aortic aneurysms (AAA).

Methods:

Ninety AAA patients underwent treatment with bifurcated endoluminal devices at our institution between October 1996 and February 1999. Fifty-two patients were treated using a nonsupported (NS) Ancure endograft and 38 using a fully supported (FS) Excluder endograft. Computed tomographic (CT) scans were obtained during the first postoperative month and at 6, 12, and 24-month intervals. Aneurysm diameter was measured as the minor axis of the largest AAA axial slice on the CT scan. Six, 12, and 24-month sac sizes were compared to the first postoperative evaluation.

Results:

Successful endoluminal graft placement was accomplished in all patients. The two groups were matched for age, anatomical criteria, and comorbidities except for baseline AAA size: the mean diameter was 5.4 cm in the NS group and 5.0 cm for the FS group (p<0.01). Endoleak rates were 25% (13/52) in the NS group and 18% (7/38) in the FS group (p<0.05) at 1 month. All endoleaks that did not resolve spontaneously at 6 months were treated. Initial endoleak status did not affect the sac shrinkage rates at the 12 and 24-month evaluations. At 2 years, the NS group had greater shrinkage of the sac (1.2 cm) versus the FS cohort (0.3 cm, p<0.05). In addition, more patients in the NS group had sac shrinkage >5 mm (83% versus 18%, p<0.05).

Conclusions:

Despite a higher endoleak rate, the nonsupported Dacron Ancure endografts were associated with greater sac shrinkage at up to 24 months following implantation.
Modeling Endoleaks and Collateral Reperfusion following Endovascular AAA Exclusion
Authors: Chong Chuh K. , How Thien V. , Gilling-Smith Geoffrey L. , Harris Peter L.
Published: March 2015

Purpose:

To investigate the effect on intrasac pressure of stent-graft deployment within a life-size silicone rubber model of an abdominal aortic aneurysm (AAA) maintained under physiological conditions of pressure and flow.

Methods:

A commercial bifurcated device with the polyester fabric preclotted with gelatin was deployed in the AAA model. A pump system generated physiological flow. Mean and pulse aortic and intrasac pressures were measured simultaneously using pressure transducers. To simulate a type I endoleak, plastic tubing was placed between the aortic wall and the stent-graft at the proximal anchoring site. Type II endoleak was simulated by means of side branches with set inflow and outflow pressures and perfusion rates. Type IV endoleak was replicated by removal of gelatin from the graft fabric.

Results:

With no endoleak, the coated graft reduced the mean and pulse sac pressures to negligible values. When a type I endoleak was present, mean sac pressure reached a value similar to mean aortic pressure. When net flow through the sac due to a type II endoleak was present, mean sac pressure was a function of the inlet pressure, while pulse pressure in the sac was dependent on both inlet and outlet pressures. As perfusion rates increased, both mean and pulse sac pressures decreased. When there was no outflow, mean sac pressure was similar to mean aortic pressure. In the presence of both type I and type II endoleaks, mean sac pressure reached mean aortic pressure when the net perfusion rate was low.

Conclusions:

In vitro studies are useful in gaining an understanding of the impact of different types of endoleaks, in isolation and in combination, on intrasac pressure after aortic stent-graft deployment.
Cine MRI Assessment of Aortic Aneurysm Dynamics before and after Endovascular Repair
Authors: Vos A.W. Floris , Wisselink Willem , Marcus J. Tim , Vahl Anco C. , Manoliu Radu A. , Rauwerda Jan A.
Published: March 2015

Purpose:

To evaluate stent-graft and aneurysm wall motions during the cardiac cycle using cine magnetic resonance imaging (MRI) to identify mechanisms of long-term failure of endovascular aneurysm repair (EVAR).

Methods:

Prior to and after EVAR in 7 patients with abdominal aortic aneurysms (AAA), 12 MRI images per cardiac cycle were acquired in transverse, sagittal, and coronal planes of the aneurysm. Two independent observers blinded to the aim of the study manually traced stent-graft and aneurysm wall contours. Translation was defined as the maximal displacement of the contours in the peak-systolic image compared to the end-diastolic image. Aneurysm wall motions before and after repair were compared. Stent-graft and aneurysm configuration changes during the cardiac cycle were evaluated. The relation between translation and the degree of angulation of the stent-graft was calculated.

Results:

The anteroposterior translation of the aneurysm decreased from a median 1.05 mm (range <0.5–1.29) before EVAR to within pixel size (<0.5 mm) after EVAR (p=0.04). The cranial-caudal translation of the aneurysm increased from a median 1.01 mm (range <0.5–1.51) before to 1.69 mm (range 1.1–1.99) after EVAR (p=0.02). In 4 stent-grafts, bending during cardiac systole was observed at the site of maximal angulation of the device. In transverse sections, 2-dimensional pulsatile wall motion of the aneurysm was 0.25 cm2 (range 0.07–0.29) before and 0.17 cm2 (range 0.07–0.42) after EVAR (p=0.79). No pulsatility of the stent-graft itself was observed. The correlation coefficient between angulation of the stent-graft and the increase in cranial-caudal translation after EVAR was 0.67 (p>0.05).

Conclusions:

After EVAR, increased longitudinal translation of both the aneurysm and stent-graft was observed, indicating downward pulling forces at the proximal fixation site. Secondly, increased bending was seen at the site of maximal angulation, which implies a risk of metal fatigue and fabric damage at sites of stent-graft angulation.
Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: Logistics and Short-Term Results
Authors: Resch Timothy , Malina Martin , Lindblad Bengt , Dias Nuno V. , Sonesson Björn , Ivancev Krassi
Published: March 2015

Purpose:

To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of our short-term results.

Methods:

Between 1997 and July 2002, 21 patients with rAAA underwent endovascular repair according to our protocol and were followed prospectively. A retrospective analysis was also conducted of 23 rAAA patients treated with open repair from January 2001 through June 2002. Procedural and clinical data from this sample were compared to 14 contemporaneous emergent EVAR cases and analyzed to determine why the open repair patients were not treated with an endovascular approach.

Results:

Among the 21 patients treated with emergent EVAR since the beginning of this protocol, 6 (29%) procedures were performed under local anesthesia and 6 were performed percutaneously. Thirty-day mortality was 19%. In the comparison of 14 emergent EVAR cases to 23 open rAAA repairs, the mean duration of symptoms prior to intervention was 12 hours for the EVAR patients and <1 hour for OR patients. No significant difference was found in operating time, but the EVAR group had significantly less blood loss (p=0.0001) and transfusion needs (p=0.02); duration of intensive care unit stay was significantly shorter in the EVAR group (p=0.02). Thirty-day mortality was 29% (4/14) for EVAR and 35% for OR (8/23) (p>0.05). Reasons for not performing EVAR were unavailability of adequate equipment (n=11) or trained staff (n=7), hemodynamically unstable patient (n=2), mycotic aneurysm (n=2), and unfavorable anatomy in a 60-year old patient with a <5-mm-long, sharply angled infrarenal neck.

Conclusions:

Endovascular repair of ruptured aortic aneurysms is feasible, and short-term results are promising. Good logistics, adequate training of physicians and staff in an elective setting, and versatile endografts are prerequisites for this type of treatment program.
Endovascular Stent-Graft Repair of Ruptured Aortic Aneurysms
Authors: Scharrer-Pamler Reinhard , Kotsis Thomas , Kapfer Xaver , Görich Johannes , Sunder-Plassmann Ludger
Published: March 2015

Purpose:

To demonstrate the endovascular approach to the management of ruptured abdominal aortic aneurysms (AAA).

Methods:

From 1995 to 2001, 24 patients (21 men; mean age 69 years, range 26–92) underwent emergency endovascular treatment for ruptured AAA. The average interval between onset of symptoms and admission to the hospital was 8.0 hours; the mean time between admission and the operation was 2.3 hours. No suprarenal occluding catheter was used. The stent-graft configurations were 19 bifurcated, 4 tube, and 1 aortomonoiliac.

Results:

Stent-graft placement was successful in 23 (96%) cases. Failed limb extension deployment prompted conversion to open surgery in the remaining patient. One case was converted to open surgery. Mean duration of treatment was 122 minutes. Three (12.5%) patients died in-hospital. The median hospital stay was 12 days. The rate of endoleaks (all type I) was 16.7%. The overall technical success rate was 77%. The 3-year actuarial survival rate was 75%.

Conclusions:

Our experience shows excellent results in emergency patients with ruptured AAAs treated with endovascular surgery. In order to verify these promising results, a broader-scale clinical study must be conducted.
Anatomical Suitability of Ruptured Abdominal Aortic Aneurysms for Endovascular Repair
Authors: Rose Daniel F.G. , Davidson Ian R. , Hinchliffe Robert J. , Whitaker Simon C. , Gregson Roger H. , MacSweeney Shane T. , Hopkinson Brian R.
Published: March 2015

Purpose:

To assess the anatomical suitability of ruptured abdominal aortic aneurysms (AAA) for emergency endovascular repair.

Methods:

All cases (46 patients [35 men; mean age 74 years, range 54–85]) in which computed tomographic angiography (CTA) confirmed AAA rupture over a 5-year period at our university hospital were reviewed for anatomical suitability for endovascular repair. Measurements were made by a radiologist experienced in anatomical assessment of CT criteria for elective endovascular aneurysm repair (EVAR).

Results:

The mean aneurysm neck length was 18 mm (range 0–59); 17 were conical, 13 straight, 4 barrel, and 6 reverse conical. Six cases had no proximal neck. Overall, 37 (80%) patients were unsuitable for EVAR according to our criteria. Nearly half the patients (22, 48%) had ≥2 adverse features. Unsuitable neck morphology (35, 76%) was the primary reason for exclusion, but CIA aneurysm (10, 22%) and EIA tortuosity (7, 15%) were secondary adverse features.

Conclusions:

With current stent-graft design, the majority of ruptured abdominal aortic aneurysms are anatomically unsuitable for endovascular repair.
Endoluminal AAA Repair Using Intravascular Ultrasound for Graft Planning and Deployment: A 2-Year Community-Based Experience
Authors: Slovut David P. , Ofstein Lewis C. , Bacharach J. Michael
Published: March 2015

Purpose:

To examine the effectiveness of intravascular ultrasound (IVUS) and digital subtraction angiography (DSA) for preoperative planning and intraoperative deployment of stent-grafts to treat abdominal aortic aneurysms.

Methods:

One hundred seventy patients (143 men; mean age 73.6±7.2 years, range 51–89) underwent successful DSA and IVUS to determine suitability for stent-graft repair. Patients subsequently received the AneuRx (n=157) or Ancure (n=13) device; intraprocedural IVUS was used to survey the proximal endograft for proper apposition to the aortic wall.

Results:

Reliable preoperative IVUS measurements were obtained in all patients. Plaque morphology was assessed in 140 (82.3%) aortic necks; in 36 (25.7%), preoperative IVUS showed high-grade atherosclerotic plaque in the nonaneurysmal abdominal aortic neck. The procedure was successful in 168 (98.8%) cases (1 [0.6%] acute conversion and 1 access failure). There were 2 (1.2%) periprocedural deaths related to bowel ischemia. Four (2.3%) patients developed graft occlusion/kinking and 2 (1.2%) developed renal failure requiring dialysis within 30 days. Multivariate logistic regression analysis revealed that female gender (p=0.0247), a short nonaneurysmal aortic neck (p=0.0185), and presence of high-grade atherosclerotic plaque (p=0.0185) correlated with major acute complications. Over a mean 10.4-month follow-up (range 1–25), 11 patients died of unrelated causes; there was no known AAA rupture or device failure. The Kaplan-Meier estimate of survival at 1 year was 91.0%±2.8%. Sixteen (9.4%) patients underwent 17 secondary procedures for endoleak or graft limb occlusion at a mean 5.4 months after stent-graft repair (freedom from secondary intervention at 1 year 86.5%±3.2%).

Conclusions:

Our findings suggest that IVUS may identify patients at increased risk of major adverse complications following endovascular repair. The combination of IVUS and DSA for endoluminal stent-graft planning and placement provides excellent short- and mid-term patient outcomes.
Contemporary Management of Acute Aortic Dissection
Authors: Greenberg Roy K. , Haulon Stéphan , Khwaja Jamal , Fulton Gregory , Ouriel Kenneth
Published: March 2015

The development of endovascular techniques has introduced a new dimension to the management of acute aortic dissection. Conventional therapy has traditionally been relegated to patients who experience severe clinical sequelae; unfortunately, clinicians have not been able to accurately predict the clinical consequences of a dissection. However, recent attention to true and false lumen characteristics, the distal extent of the dissection, and branch vessel involvement has demonstrated that these independent predictors of outcome can serve as surrogate indications for endovascular or surgical treatment. We review the path-ophysiological mechanisms associated with the sequelae of aortic dissection and summarize the treatment paradigms we have developed.
Endovascular Treatment of Acute Complications Associated with Aortic Dissection: Midterm Results from a Multicenter Study
Authors: Beregi Jean-Paul , Haulon Stéphan , Otal Philippe , Thony Frédéric , Bartoli Jean-Michel , Crochet Dominique , Lacombe Pascal , Bonneville Jean-François , Besse Francis , Douek Philippe , Heautot Jean-François , Rousseau Hervé ,   For the Société Française d'Imagerie Cardio-Vasculaire (SFICV) Research Group on Aortic Dissection
Published: March 2015

Purpose:

To evaluate endovascular procedures in the management of acute ischemic complications and rupture of the false lumen in aortic dissections.

Methods:

Data on patients with aortic dissection and noncardiac acute complications (peripheral ischemia or thoracic aortic rupture) treated with endovascular techniques were collected from 10 institutions and retrospectively analyzed. From March 1997 to January 2000, 58 patients (50 men; mean age 59.6±12.8 years) were treated for 19 (33%) type A and 39 (67%) type B dissections. Twelve (21%) patients had thoracic aortic rupture; 46 (79%) patients had one or more peripheral ischemic complications that included bowel pain (19, 41%), anuria associated with acute renal insufficiency (18, 39%), lower limb ischemia (15, 33%), and/or uncontrolled hypertension with renal ischemia (14, 30%).

Results:

In the thoracic rupture cohort, all 12 patients were treated successfully with stent-grafts; one distal endoleak required a secondary procedure. There were 2 (12%) periprocedural deaths; one patient developed transient paraplegia after a secondary surgical procedure. In the 46 patients treated with stent implantation, fenestration, or both for peripheral ischemic symptoms, 44 (96%) had patency restored to the malperfused vessel. Eight (17%) patients died within 30 days. Over a mean follow-up of 8.2±8.9 months, the false lumen had thrombosed in 7 (70%) of the stent-graft patients. In the 38 surviving ischemic patients, the diameters of the true and false lumens and maximum transverse aorta all increased; only 4 (11%) had total thrombosis of the false lumen.

Conclusions:

Endovascular treatment of noncardiac acute complications associated with aortic dissection has favorable early and midterm outcomes.
Midterm Outcomes of Thoracic Aortic Stent-Grafts: Complications and Imaging Techniques
Authors: Chabbert Valérie , Otal Philippe , Bouchard Louis , Soula Philippe , Van Tuan Tran , Kos Xavier , Meites Geneviève , Claude Conil , Joffre Francis , Rousseau Hervé
Published: March 2015

Purpose:

To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance.

Methods:

Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters.

Results:

The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25–46 months), the aortic diameters decreased for all patients without endoleak (p<0.001). In the diameter/area subgroup analyses, only the traumatic rupture cohort demonstrated significant decreases in all 4 measurements. CTA and MRA measurements correlated well, but chest radiography was superior to both for visualizing stent-graft shape. In terms of endoleak detection, MRA missed only 1 (12.5%) endoleak (type II) seen on CTA; there were no false positive results with MRA.

Conclusions:

Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.
Aortic Intimal Tears: Detection with Spiral Computed Tomography
Authors: Quint Leslie E. , Platt Joel F. , Sonnad Seema S. , Deeb G. Michael , Williams David M.
Published: March 2015

Purpose:

To determine the frequency, locations, and sizes of aortic intimal tears detected using spiral computed tomography (CT).

Methods:

CT scans (26 single detector and 26 multidetector studies) from 52 patients with an unoperated aortic dissection and a patent false lumen were evaluated on a workstation. The number, location, and size of aortic tears were recorded and compared between the following groups: acute and chronic dissection, type A and type B, and single detector and multidetector studies.

Results:

In 52 patients, 129 tears were identified (mean 2.48 per patient, median 2, range 1–7). There were no significant differences in the number or size of tears between the acute and chronic, the type A and type B, or the single detector and multidetector groups (p<0.05). The most common locations for tears were the descending aorta (57, 44%) and the juxtarenal region (26, 20%). Within the type B category, there was no significant difference in tear locations between the acute and chronic groups (p>0.05). The majority of tears (88, 68%) were <1 cm in each dimension. Tears in the thoracic aorta were significantly larger than abdominal aortic tears (p<0.05).

Conclusions:

All patients with an aortic dissection and a patent false lumen demonstrated one or more aortic intimal tears using spiral CT. Although most tears were small (<1 cm), they were usually easily visualized.
Endoluminal Repair of Mycotic Thoracic Aneurysms
Authors: Stanley Brendan M. , Semmens James B. , Lawrence-Brown Michael M.D. , Denton Michael , Grosser David
Published: March 2015

Purpose:

To report a series of endoluminally repaired mycotic thoracic aneurysms.

Case Reports:

Four patients with presumed mycotic aneurysms of the thoracic aorta were treated with endovascular grafts owing to overly high risk for open repair. All aneurysms were successfully excluded at the initial intervention. In one case, which required endograft fenestrations for the superior mesenteric and renal arteries, the patient died 53 days after the procedure, following graft migration and occlusion of major branch vessels. The other 3 patients remain alive and well at a mean follow-up of 16 months with no signs of ongoing sepsis.

Conclusions:

Endoluminal repair of thoracic mycotic aneurysms is technically feasible and, in association with long-term antibiotics, offers at least temporary protection against imminent rupture.
Distribution of Sac Pressure in an Experimental Aneurysm Model after Endovascular Repair: The Effect of Endoleak Types I and II
Authors: Xenos Eleftherios S. , Stevens Scott L. , Freeman Michael B. , Pacanowski John P. , Cassada David C. , Goldman Mitchell H.
Published: March 2015

Purpose:

To study in an experimental aneurysm model the differential distribution of strain/pressure (S/P) on the aneurysm wall before and after endograft exclusion and in the presence of individual type I and type II endoleaks.

Methods:

Two tapered elliptical Gore-Tex patches were sutured to an anterior and posterior longitudinal arteriotomy of an 8-mm Gore-Tex tube graft, thus creating a fusiform aneurysm. Two S/P transducers were placed at the proximal sac adjacent to the proximal neck, 2 at the site of the widest sac diameter, and 2 at the sac adjacent to the distal neck. The aneurysm, which was connected to a pulsatile pump system, was excluded using a 10-mm endograft. Type I and type II endoleaks were created and tested individually. S/P measurements were obtained at systemic systolic pressures (BP) of 80, 110, and 150 mmHg. Thrombosis of the sac contents was induced by injection of thrombin and calcium in the sac. Angiography was used to verify presence or absence of flow in the sac.

Results:

Aneurysm exclusion resulted in significant S/P reductions at all 3 BP levels versus prior to exclusion (p<0.05). Thrombus in the sac did not alter S/P in the excluded sac (p>0.05 for all 3 BP levels). In the presence of a proximal type I endoleak, S/P distribution was not uniform, and S/P at the proximal neck was close to S/P prior to exclusion (p>0.05 no graft versus type I endoleak for all 3 BP levels). This was also true in the presence of thrombus. With a type II endoleak, S/P was more evenly distributed and was not significantly elevated compared to the pressure without an endoleak (p>0.05, graft versus type II endoleak for all 3 BP levels). Thrombus had no effect on intrasac S/P with a type II endoleak. Intrasac S/P was significantly higher in the presence of a type I endoleak compared to a type II endoleak when BP=150 mmHg (p=0.008).

Conclusions:

Endovascular exclusion of an aneurysm results in uniform S/P reduction in the aneurysm sac. Type I endoleak, but not type II endoleak, results in significantly higher S/P in an area of the sac adjacent to the proximal neck. Thrombus does not result in significantly different S/P distribution in the aneurysm sac.
Can Intrasac Pressure Monitoring Reliably Predict Failure of Endovascular Aneurysm Repair?
Authors: Vallabhaneni Srinivasa R. , Gilling-Smith Geoffrey L. , Brennan John A. , Heyes Richard R. , Hunt John A. , How Thien V. , Harris Peter L.
Published: March 2015

Purpose:

To determine if pressure measured at a single location within aneurysm sac thrombus accurately reflects the force applied to the aneurysm wall and the risk of rupture by examining (1) if pressure is distributed uniformly within aneurysm thrombus, (2) the pressure transmission through aneurysm thrombus, and (3) the microstructural basis for pressure transmission.

Methods:

Pressure within aneurysm thrombus was measured by direct puncture through the aneurysm wall at 121 sites in 26 patients during open abdominal aortic aneurysm repair. Measurements were taken prior to cross clamping and compared with intrasac pressure measured at 30 sites in 6 patients without aneurysm thrombus (controls). Transmission of pressure through aneurysm thrombus was further examined ex vivo by subjecting fresh thrombus to a pressure gradient in a custom-made pressure cell. Pressure transmission was correlated with matrix density as determined by light microscopy and image analysis.

Results:

Mean pressure within aneurysm thrombus was higher than mean systemic pressure in 11 patients, lower in 1, and identical in 9. In 5 patients, the pressure was greater than systemic in some areas of the thrombus but less in others. Sac pressure was identical to systemic pressure at all sites in the controls. In 12 thrombus specimens (6 patients) examined in the pressure cell, pressure transmission varied significantly between specimens, correlating directly with matrix density ( R2=0.747, p=0.001).

Conclusions:

Pressure transmission through aneurysm thrombus is variable and depends upon the microstructure of the thrombus. Pressure measured at a single location may not, therefore, accurately reflect the pressure acting on the aneurysm wall.
Two-Dimensional versus Three-Dimensional CT Scan for Aortic Measurement
Authors: Dillavou Ellen D. , Buck David G. , Muluk Satish C. , Makaroun Michel S.
Published: March 2015

Purpose:

To examine if 3-dimensional (3D) reconstructions of computed tomographic (CT) data, by imaging perpendicular to blood flow, can improve aortic diameter measurement accuracy over axial (2D) CT.

Methods:

Two independent, blinded observers used electronic calipers to measure the minor axis and the line perpendicular to it on 40 2.5-mm 2D CT scans from 31 patients. A circular electronic tool was used to estimate diameters on 3D reconstructions from the same 40 scans. Measurements of the aortic neck were obtained 5 mm below the renal arteries and the widest slice of the aneurysm was used to measure sac diameter. Only the minor axis was measured at the iliac arteries immediately above the left (LI) and right (RI) iliac bifurcations. Datasets were compared with an intraclass correlation coefficient (ICC), Bland and Altman variation assessments, and absolute differences.

Results:

ICC between 2D and 3D scans demonstrated high correlation with 2D minor axis measurements (neck=0.9282, sac=0.8956, RI=0.8755, LI=0.7381). 3D to 2D major axis correlation was lower (neck=0.6388, sac=0.8995). Variation between 3D and 2D minor axis measurements was low (0.51-mm average variation from the mean for the minor axis and 1.30-mm variation for the major axis). Average absolute difference between 3D and 2D diameters was 1.01 mm (minor axis) versus 2.61 mm (major axis). Interobserver correlation was highest for sac measurements both in 2D minor axis (ICC=0.8990) and 3D (ICC=0.9518).

Conclusions:

Minor axis measurements on axial CT scan can substitute for diameters obtained from 3D reconstructions in most clinical situations.
Survival after Stenting of Severe Atherosclerotic Ostial Renal Artery Stenoses
Authors: Zeller Thomas , Müller Christian , Frank Ulrich , Bürgelin Karlheinz , Schwarzwälder Uwe , Horn Barbara , Roskamm Helmut , Neumann Franz-Josef
Published: March 2015

Purpose:

To examine long-term survival after angioplasty and stenting of atherosclerotic renal artery stenosis (RAS).

Methods:

Over a 5-year period, 241 consecutive patients (153 men; mean age 67±9 years, range 44–84) were treated with angioplasty and stent implantation for 355 ostial renal stenoses >70%. The procedures were performed in standard fashion using a variety of stents. For survival analysis, the patients were divided into 3 groups based on baseline creatinine levels: group 1: 115 (48%) patients with normal renal function (creatinine <1.2 mg/dL); group 2: 93 (39%) patients with moderately impaired renal function (creatinine 1.2 to 2.5 mg/dL); and group 3: 33 (13%) patients with severely impaired renal function (creatinine >2.5 mg/dL).

Results:

All patients were treated successfully without any procedure-related mortality. The 30-day mortality was 0.4% (1/241). Twenty-two patients died during a follow-up of 27±15 months (range 1–60) (overall survival 91%). The causes of death were cardiac (congestive heart failure or myocardial infarction, 73%), stroke (13.5%), and malignant disease (13.5%). The survival rate was significantly lower (29.6%) in patients with a baseline serum creatinine >2.5 mg/dL (p<0.0001) than in groups 2 (89.1%) or 1 (95.4%). Long-term survival without hemodialysis or restenosis was 66.6% at 48 months. Independent predictors for a reduced survival were left ventricle function (HR 2.59, 95% CI 1.45 to 4.63, p=0.001 for each 15% incremental decrease), age (HR 1.13, 95% CI 1.03 to 1.25, p=0.011), and baseline renal function (HR 1.58, 95% CI 1.10 to 2.29, p=0.014).

Conclusions:

Survival after successful stenting for severe ostial RAS depends on baseline serum creatinine and left ventricle function. Efforts must be made to avoid the development of advanced ischemic nephropathy and congestive heart failure.
Percutaneous Stenting of Incidental Unilateral Renal Artery Stenosis: Decision Analysis of Costs and Benefits
Authors: Axelrod David A. , Fendrick A. Mark , Carlos Ruth C. , Lederman Robert J. , Froehlich James B. , Weder Alan B. , Abrahamse Paul H. , Stanley James C.
Published: March 2015

Purpose:

To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S).

Methods:

The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death.

Results:

Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year.

Conclusions:

PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.
Restenosis after Femoropopliteal PTA and Elective Stent Implantation: Predictive Value of Monocyte Counts
Authors: Schillinger Martin , Exner Markus , Mlekusch Wolfgang , Haumer Markus , Sabeti Schila , Ahmadi Ramazanali , Schwarzinger Ilse , Wagner Oswald , Minar Erich
Published: March 2015

Purpose:

To investigate the association of baseline peripheral blood monocyte counts and restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA) and PTA plus elective stent implantation.

Methods:

Three hundred thirty consecutive patients (170 men; median age 71 years, interquartile range 61–78) with peripheral artery disease underwent femoropopliteal PTA (n=258) or PTA plus elective stent implantation (n=72). Multivariate Cox regression analysis was used to determine the predictive value of baseline peripheral blood monocyte counts on the rate of restenosis (≥50% luminal reduction) in follow-up.

Results:

Cumulative patency at 6 and 12 months was 55% and 39% after PTA and 70% and 41% after elective stenting, respectively (p=0.19). Pretreatment monocyte counts (in tertiles) were associated with restenosis after PTA (p=0.002) and stent implantation (p=0.02). Compared to patients with monocyte counts <0.3×109/L (lower tertile, n=128), patients with monocytes from 0.3 to 0.4×109/L (middle tertile, n=91) had a 1.8-fold increased adjusted risk for restenosis (95% CI 1.1 to 2.8, p=0.01). Patients with monocytes >0.4×109/L (upper tertile, n=87) had a 2.3-fold increased adjusted risk (95% CI 1.4 to 3.5, p<0.0001).

Conclusions:

Baseline monocyte counts were associated with restenosis after femoropopliteal PTA and elective stent implantation, suggesting that circulating monocytes play a pivotal role in the development of recurrent lumen narrowing.
Leucine 7 to Proline 7 Polymorphism of the Preproneuropeptide Y Gene is Not Associated with Restenosis after Coronary Stenting
Authors: Pesonen Ullamari , Koch Werner , Schömig Albert , Kastrati Adnan
Published: March 2015

Purpose:

To identify if an association exists between the leucine 7 (Leu7) to proline 7 (Pro7) polymorphism located in the signal peptide of the preproneuropeptide Y (preproNPY) gene and restenosis after coronary stenting. The Pro7 allele of the preproNPY gene affects the plasma levels of human neuropeptide Y, a potent mitogen of vascular smooth muscle cells.

Methods:

A population of 1850 consecutive patients with symptomatic coronary artery disease undergoing coronary stent implantation was enrolled in a study that featured angiography at 6 months and genotype determination. The primary endpoint was angiographically documented restenosis (≥50% diameter stenosis) at 6 months. The secondary endpoint was the clinical outcome at 1 year (death, myocardial infarction, target vessel revascularization). Genotyping was based on the polymerase chain reaction with fluorescent allele-specific oligonucleotide probes (TaqMan method).

Results:

The carrier frequency of the rare Pro7 allele was 6.2%. Baseline, lesion-related, angiographic, and procedural parameters were similar in the patients with the Leu7/Leu7 genotype and carriers of the Pro7 allele (i.e., subjects with genotype Leu7/Pro7 or Pro7/Pro7). Restenosis rates at 6 months did not differ significantly between the groups (33% versus 30%, p=0.54). In addition, no relationship of the polymorphism with the clinical outcomes at 1 year was observed.

Conclusion:

Our results suggest that the Leu7 to Pro7 polymorphism of the preproNPY gene is not associated with angiographic restenosis or adverse clinical events after stent placement in coronary arteries.
Endovascular Gamma Irradiation of the Iliac Arteries: 1-Year Results from a Clinical Safety and Feasibility Study
Authors: Walichiewicz Piotr , Piecuch Jerzy , Białas Brygida , Orkisz Witold , Fijałkowski Marek , Slosarek Krzysztof , Miszczyk Leszek
Published: March 2015

Purpose:

To estimate safety and feasibility of vascular brachytherapy in iliac arteries.

Methods:

Fourteen patients (11 men; mean age 56.7±9.9 years, range 44–81) with occlusive disease in 15 iliac arteries (7 external, 8 common) were treated with balloon dilation followed by irradiation from an iridium 192 source (15 Gy at 3 mm from the inner surface of the artery wall) applied with a PARIS centering catheter and bilateral 10-mm margins. Patients receiving stents for suboptimal angioplasty were prescribed a 6-month course of antiplatelet treatment with ticlopidine. Angiography was routinely scheduled for 6 months after intervention.

Results:

There were no complications of the angioplasty procedure or EVBT treatment; 7 patients received stents for dissection or residual stenosis. Mean follow-up was 12.4±6.0 months. At 6-month angiography, 1 (6.7%) restenosis in a common iliac artery stent was found. Another patient with a common iliac artery stent developed transient lower limb ischemia at 4 months, probably due to temporary suspension of antiplatelet treatment and distal disease.

Conclusions:

Brachytherapy in the iliac arteries appears to be feasible and safe; longer follow-up in more patients is needed to determine its clinical utility in the prevention of restenosis.
Wall Mechanics of the Stented Rabbit Aorta: Long-Term Study and Correlation with Histological Findings
Authors: Vernhet Hélène , Demaria Roland , Pérez-Martin Antonia , Juan Jean Marie , Oliva-Lauraire Marie Claire , Marty-Double Christiane , Sénac Jean Paul , Dauzat Michel
Published: March 2015

Purpose:

To evaluate long-term changes in arterial wall mechanics induced by stenting of the rabbit aorta.

Methods:

Eighteen New Zealand white rabbits had initial stent deployment (3×8 mm Multilink) at 110% of the pre-stenting abdominal aortic diameter. Group A (n=10) had no post-deployment stent expansion and group B (n=8) had 30% overdilation of the stent. A noninvasive B-mode ultrasound examination coupled with image processing allowed measurement of diameters at systole and diastole and the calculation of diameter compliance. Measurements were performed before stenting and compared to those recorded immediately after stenting and at 3 months at 3 locations: upstream from the stent, at the stent level, and downstream from the stent. Measurements were also compared among measurement sites. The pathological study included measurement of intimal thickening and calculation of an injury score.

Results:

At the stent level, diameter compliance was significantly lower after initial stenting and at 3 months than before stenting (group A: p<0.005; group B: p<0.001) and than downstream or upstream from the stent (group A: p<0.0001, group B: p<0.005). No significant difference in diameter compliance was found between groups A and B. In group B, intimal thickening and the injury score were greater than in group A (p<0.05 and p<0.0001, respectively).

Conclusions:

Endovascular stenting of the rabbit aorta impairs wall mechanics. Performing 30% overdilation of the stent does not worsen this impairment but induces greater in-stent intimal hyperplasia.
Trellis Thrombectomy System for the Treatment of Iliofemoral Deep Venous Thrombosis
Authors: Ramaiah Venkatesh , Del Santo Peter B. , Rodriguez-Lopez Julio A. , Gowda Ramesh G. , Perkowski Paul E. , Diethrich Edward B.
Published: March 2015

Purpose:

To describe the use of a new percutaneous mechanical thrombectomy device to clear thrombus from the iliofemoral vein.

Case Report:

A 52-year-old woman with non-Hodgkin's lymphoma presented to the emergency room with a posterior tibial vein deep vein thrombosis and a greater saphenous vein thrombosis. Heparin therapy caused the clot to propagate into the iliofemoral vein. Catheter-directed thrombolysis for 36 hours with 24 units of reteplase failed to clear the clot. The Trellis Thrombectomy System, a new percutaneous mechanical thrombectomy device, was used to deliver a low dose of reteplase into the clot. Complete clot lysis was achieved in 45 minutes using only 5 units of reteplase. The patient's symptoms resolved completely, and she continues to be asymptomatic at 6 months with no evidence of residual clot on duplex scans.

Conclusions:

The Trellis device may be used to rapidly clear thrombus from the iliofemoral vein with a low dose of thrombolytic agent.
Thrombolytic Therapy in the Setting of Arterial Line-Induced Ischemia
Authors: Geschwind Jean-François H. , Dagli Mandeep S. , Lambert Ew L. , Kobeiter Hicham
Published: March 2015

Purpose:

To evaluate the use of percutaneous transcatheter thrombolysis in the treatment of thrombosis due to radial artery cannulation.

Methods and Results:

Seven patients (4 women; age range 41–62 years) with symptomatic cannulation-induced thrombosis and failure to improve after systemic anticoagulation underwent 8 catheter-directed thrombolytic infusions at our institution over a 3-year period. Access was either antegrade through the brachial artery or retrograde through the femoral artery. Thrombolytic infusions with urokinase began 2 to 12 days (average 6) after removal of the radial artery catheter. The thrombolytic infusion was successful in 5 of 7 patients based on angiographic flow restoration with <20% residual thrombus and significant clinical improvement in the ischemia.

Conclusions:

When systemic anticoagulation has failed, percutaneous catheter-directed thrombolytic infusion appears to be effective in the treatment of most patients with severe ischemic hand symptoms due to thrombosis after radial artery cannulation.
The Case for Early Detection and Integrated Intervention in Patients with Peripheral Arterial Disease and Intermittent Claudication
Authors: Comerota Anthony J.
Published: March 2015

Peripheral arterial disease (PAD) is defined as atherosclerotic disease of the aorta and arteries of the lower extremities. The most frequent manifestations of ischemia occur in the lower extremity arteries, with intermittent claudication as the most common symptom. Intermittent claudication, which is characterized by temporary pain brought on by muscle exertion, is usually experienced in the calf muscles and typically subsides with rest. The atherosclerotic nature of PAD/intermittent claudication makes it an important predictor of risk for cardio- and cerebrovascular disease, as well as limb loss. Thus, active screening and early diagnosis of PAD/intermittent claudication, in addition to aggressive management that incorporates risk factor modification, exercise therapy, platelet inhibition and other appropriate pharmacotherapy, and potential lifestyle changes, play important roles in overall patient management. Pharmacotherapy with cilostazol has been shown to improve maximal and pain-free walking distances. Uncontrolled and severely debilitating intermittent claudication may require revascularization.
Percutaneous Retrograde Tibial Access in Limb Salvage
Authors: Botti Charles F. , Ansel Gary M. , Silver Mitchell J. , Barker Billie J. , South Sheila
Published: March 2015

Purpose:

To describe a novel technique for percutaneous retrograde access of the tibial vessels after antegrade access failure in patients with chronic limb-threatening ischemia.

Methods:

Six patients who had failed antegrade access to infrapopliteal occlusions had attempted retrograde tibial puncture and wire passage into the proximally patent vessel. Endovascular intervention was carried out utilizing standard techniques. The patients were followed for functional class and wound healing.

Results:

All six patients were successfully recanalized. Five patients experienced rapid and dramatic healing of wounds that had previously been refractory to conservative therapy. The other patient did not experience healing and ultimately died of progressive intractable congestive heart failure in the setting of a severe ischemic cardiomyopathy.

Conclusions:

Retrograde tibial access can be a valuable technique in the armamentarium of a peripheral interventionist treating patients with chronic critical limb ischemia.
Percutaneous Treatment of Long Superficial Femoral Artery Occlusive Disease: Efficacy of the Hemobahn Stent-Graft
Authors: Bray Peter J. , Robson William J. , Bray Alan E.
Published: March 2015

Purpose:

To assess the efficacy of the Hemobahn stent-graft in the percutaneous treatment of long occlusive lesions of the superficial femoral artery (SFA).

Methods:

Fifty-nine limbs in 54 patients (42 men; mean age 73.3±8.2 years, range 55.2–91.3) with 59 symptomatic SFA occlusions >10 cm in length were selected for percutaneous treatment with the Hemobahn stent-graft. The treated SFA was assessed for patency and degree of stenosis by color-flow duplex ultrasound prior to discharge and at 1, 3, and 6 months and yearly thereafter. The actuarial life-table method was used to derive primary and secondary patency rates.

Results:

Primary technical success was achieved in 56 (95%) of 59 limbs on an intention-to-treat basis (2 access and 1 device failures). In the first 30 days, 4 (6.8%) stent-graft thromboses and 5 (8.5%) minor technical difficulties occurred. Up to 1 year, there were 15 (25.4%) primary occlusions, 7 (11.9%) of which were associated with restenosis. Cumulative primary patencies were 88%, 67%, and 58% at 1, 6, and 12 months, respectively; secondary patencies were 92%, 82%, and 73% at the same intervals. There was no statistically significant difference (p<0.05) in patency (primary or secondary) with respect to presenting symptoms, lesion length, stent-graft length, or distal runoff.

Conclusions:

Symptomatic long occlusive lesions of the SFA treated percutaneously with the Hemobahn stent-graft achieved good outcomes initially with a low complication rate. Primary and secondary patencies were similar to those reported for open synthetic femoropopliteal bypass procedures.
Primary Stenting of Embolic Occlusions in Iliac Arteries
Authors: Yilmaz Saim , Sindel Timur , Lüleci Ersin
Published: March 2015

Purpose:

To present our experience with the use of primary stenting to treat embolic iliac artery occlusions.

Methods and Results:

Six patients (5 men; mean age 50.6±14.1 years range 37–72) underwent primary stenting for embolic occlusions lodged in the common iliac and/or external iliac arteries and were retrospectively evaluated. The probable reason for the embolism was atrial fibrillation in 4 patients and acute myocardial infarction in 2. In 5 patients, an additional embolus was demonstrated in the renal, mesenteric, popliteal, and middle cerebral arteries. Iliac emboli were treated with primary implantation of self-expanding stents followed by very low-pressure balloon dilation. In all cases, primary stenting was technically successful and provided immediate recanalization with elimination or reduction of symptoms. There was no procedure-related complication. During the mean 11-month follow-up (range 1–18), all stented iliac arteries remained patient. One patient died due to cerebral embolism at 21 months.

Conclusions:

Although this experience is limited, excellent midterm results suggest that primary stenting may be a valuable alternative in the treatment of embolic occlusions of the iliac arteries in selected cases.
Management of Mobile Floating Carotid Plaque Using Carotid Artery Stenting
Authors: Chakhtoura Elie Y. , Goldstein Jonathan E. , Hobson Robert W.
Published: March 2015

Purpose:

To present management techniques for dealing with mobile floating carotid plaque (MFCP), which represents an indeterminate risk of embolic cerebrovascular events.

Case Reports:

Two high-risk patients with a history of carotid endarterectomy were diagnosed with MFCP by duplex ultrasound scanning. One patient had a left hemispheric transient ischemic attack while the other was asymptomatic with a moderate stenosis. Both were successfully treated with carotid artery stenting, achieving complete coverage of the MFCP. Their outcomes were uneventful, and sustained patency of the stented arteries has been observed during an event-free survival of 32 and 44 months, respectively.

Conclusions:

Based upon the unique nature of these lesions and our satisfactory clinical results, we believe that carotid stenting may be a viable option for the treatment of MFCP.
Supported Endograft Limb Occlusion Likely Occurring Secondary to Hip Arthroplasty
Authors: Woo Edward Y. , Zabinski Stephen J. , Milner Ross , Fairman Ronald M.
Published: March 2015

Purpose:

To report an acute endograft limb occlusion immediately subsequent to a total hip replacement.

Case Report:

A 62-year-old man underwent successful placement of a bifurcated stent-graft for a 5-cm abdominal aortic aneurysm (AAA). Surveillance imaging documented a satisfactory outcome and no defects in the stent-graft. Three months after the endograft procedure, he underwent left total hip arthroplasty, at which time the left endograft limb acutely thrombosed. He was successfully treated with thrombectomy and dilation/stenting of the thrombosed graft limb.

Conclusions:

Patients with aortoiliac stent-grafts need careful surveillance around the time of a procedure that may require extreme manipulation of the pelvis and hips. Even fully supported, widely patent endograft limbs may be vulnerable to acute thrombosis in this setting.