bluuebunny/crossref_metadata_2025 huggingface dataset:
Mead and Park: A “Socio-Biographical” account of their becoming pragmatists, but developing opposing interactional viewpoints
Authors: Athens Lonnie
Published: March 2015

Although Robert Ezra Park and George Herbert Mead were both pragmatists, they became the progenitors of two alternative versions of interactionism. Mead developed his version on the basis of his principle of “sociality,” which subsequently became known as “symbolic interactionism.” Conversely, Park developed his opposing version later labeled “radical interactionism,” on the basis of the principle of “dominance.” To solve this mystery behind their development of divergent forms of interactionism, I examined their lives from a “socio-biographical” approach. This entailed my comparing the critical, formative social experiences that they had undergone from their early childhoods to the end of their academic careers. My comparisons uncovered some important similarities in their critical formative social experiences shedding light on why they became career-long pragmatists. Despite the significant overlaps found in their socio-biographies, however, crucial differences also surfaced that lead to their development of opposing forms of interactionism. The dissimilar critical formative social experiences that were found sprang from the starkly different paths that they followed toward becoming tenured, full professors at the University of Chicago. To oversimplify, Park followed a much more zigzagged, bumpier, and obstacle-ridden path than Mead to reach this destination.
Losartan treating podocyte injury induced by Ang II via downregulation of TRPC6 in podocytes
Authors: Chi-Xianggeng  , Hu-Bo  , Yu SY , Yin-Lianghong  , Meng-Yu  , Wang-Boxun  , Yang-Jinsheng  , Lin-Jiahui  , Huang-Dexu  , Chen-lanlan
Published: March 2015

Objective:

In this study, we investigated the molecule mechanisms of podocyte injury and proteinuria and the protective effects of losartan.

Methods:

This study set up three groups: a control group; an Ang II group (Ang II 10–6 mol/l, Sigma); and a losartan group (losartan 10–6 mol/l, Sigma). We used RT-PCR assay to detect TRPC6 mRNA expression, and Western blot to detect TRPC6 protein expression.

Results:

TRPC6 overexpression was the basic change of podocyte injury and proteinuria occurrence. Losartan can treat podocyte injury and proteinuria induced by Ang II via downregulation of TRPC6 in podocytes.

Conclusion:

These findings maybe provide an ideal drug target for the diagnosis and treatment of acquired glomerular diseases.
Care assistant experiences of dementia care in long-term nursing and residential care environments
Authors: Talbot Rebecca , Brewer Gayle
Published: March 2015

Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.
here:now – Conceptual model of the impact of an experiential arts program on persons with dementia and their care partners
Authors: Burnside Lee D , Knecht Mary Jane , Hopley Elizabeth K , Logsdon Rebecca G
Published: March 2015

Community-based arts programs for persons with dementia and their care partners hold tremendous potential for increasing cognitive, social, and creative engagement and improving quality of life for these dyads. This is a qualitative, grounded theory analysis of here:now, a joint arts engagement program for persons with dementia and their care partners that involves gallery tours and art classes. Twenty-one care partners and 13 persons with dementia completed in-depth, semi-structured telephone interviews approximately two weeks following participation in the program. The program was well received by both persons with dementia and care partners as evidenced by high levels of engagement, mindfulness, social connection, and positive interactions. Factors identified as important to the experience included the museum space itself, the facilitation process, and socialization with other participants. Results form the basis for a conceptual model for assessing outcomes of arts programming and highlight the unique position of museums to support persons with dementia and their care partners in the community.
Exploring the multinatural: mobilising affect at the red kite feeding grounds, Bwlch Nant yr Arian
Authors: Brettell Jonathan
Published: March 2015

Red kites are one of Britain’s rarest birds. Once extinct from England, Scotland and Northern Ireland, a few remained in the upland valleys of Wales. In Wales, there are now over 1,000 breeding pairs, with a successful reintroduction programme throughout the United Kingdom. Part of this success story has been the provision of feeding stations. This article seeks to explore the unfolding and infolding topological relations that ensue at the Bwlch Nant yr Arian feeding grounds, near Aberystwyth as a site-based ontology. The gatherings at this site compose an alluring spectacular display which is a charged, affective experience. Following this practise the meanings of feeding red kites has evolved and metamorphosed into something less about kite survival, and more of an environmental pedagogy. Intriguingly, this is driven not by leaflets, documents, devices or schooling, but by an encounter with charismatic nonhumans, difference, affect and experience. The research navigates and explores the natures of the event-site and elucidates an affective zone of emergence that materialises where diverse Umwelten overlap.
Vagaries of value at California State Parks: towards a geographical axiology
Authors: Hoskins Gareth
Published: March 2015

This article explores the vagaries of locating value in California’s state park system in general and Malakoff Diggins State Historic Park in particular. The practice of listing and delisting for purposes of preservation relies on accepting the premise that some places are inherently superior and more worthy of public esteem than others, and that such distinctions are detectable, indeed, measurable in gradations. In this article, I aim to undermine our confidence in these kind of valuations and the designations they proliferate through scrutiny of two occasions where value is ranked geographically. I compare Frederick Law Olmsted Jr’s 1928 statewide survey of California that identified land for acquisition as parks, with a 2011 deficit-reduction measure earmarking 70 specific state parks for closure. These two lists demonstrate how value is immanent to social relations. The article contributes to examinations of value within Human Geography by developing a relational axiology that attends to the materials, forces and practices that hold together when value becomes subject to a project of fixing. I challenge the exclusively positive conception of value in on-going policy work and outline how valuation as a technology works to produce the public in whose name it is performed. What kinds of justifications emerge when fine-grained negotiations about revenue streams come up against long-held principals about the importance of nature and cultural history? Geographical value, in the same way as any other kind of value, is not found but is made by the very act of its enunciation. Accepting this requires us to think more carefully about how and why value’s identification leads invariably to its uneven distribution.
The effects of temperature and driving current on the key parameters of commercially available, high-power, white LEDs
Authors: Yurtseven MB , Mete S , Onaygil S
Published: March 2015

High-power LEDs with high luminous efficacies, compact sizes, long lifetimes and a wide colour range, are rapidly taking the place of conventional light sources in general lighting applications. But these properties of high-power LEDs are dependent on temperature and driving current. In this study, 24 samples of commercially available, high-power, white LEDs were measurement for their electrical, optical and thermal characteristics as well as their efficiency, luminous flux, luminous efficacy, correlated colour temperature and colour rendering index over six temperature steps at three different driving currents. LED manufacturers' catalogues including such information will allow consistency between the design and application stages of an installation. Also, it will make the technical and economic optimization of luminaires using high-power LEDs easier.
Can Health Trainers Make a Difference With Difficult-to-Engage Clients? A Multisite Case Study
Authors: Bailey Di , Kerlin Lianne
Published: March 2015

A political attempt in the United Kingdom to address health inequalities in the past decade has been the government’s initiative to employ local health trainers (HTs) or health trainer champions (HTCs) to support disadvantaged individuals with aspects of their health-related behaviors. HT/HTCs provide health-related information and support to individuals with healthy eating, physical activity, and smoking cessation. They undertake community engagement and direct individuals to relevant health services. They differ in that HTs are trained to provide health interventions to individuals or groups and to make referrals to specialist health care services when necessary. This article provides an evaluation of HT/HTCs interventions across three sites, including one prison, one probation service (three teams), and one mental health center. An evaluation framework combining process and outcome measures was employed that used mixed methods to capture data relating to the implementation of the service, including the context of the HT/HTCs interventions, the reactions of their clients, and the outcomes reported. It was found that HT/HTCs interventions were more effective in the prison and mental health center compared with the probation site largely as a result of contextual factors.
Can Third-party Help Improve Data Quality in Research Interviews? A Natural Experiment in a Hard-to-study Population
Authors: Quetulio-Navarra Melissa , van der Vaart Wander , Niehof Anke
Published: March 2015

In some survey research settings, it may be not attainable or optimal to interview individual respondents without involving bystanders or third parties in the interview. Due to complex living circumstances or group culture, respondents may be helped by others in answering questions. However, this involvement of third parties raises questions about data quality and poses a challenge to the data collection process. Recognizing this, a natural field experiment was embedded in an urban resettlement study in the Philippines that allowed for spontaneous third-party help during certain parts of the interview. Using an event history calendar, data were gathered on numbers (of household-related transitions), names (of community leaders), and dates (years of public services). Quality of data was assessed and compared for the “ with help” and “ without help” conditions. The results showed that third-party help did not negatively affect data quality but rather improved it for most issues.
Transient Contrast Encephalopathy after Carotid Artery Stenting
Authors: Dangas George , Monsein Lee H. , Laureno Robert , Peterson Michael A. , Laird John R. , Satler Lowell F. , Mehran Roxana , Leon Martin B.
Published: March 2015

Purpose:

To report an unusual case of transient contrast encephalopathy arising after carotid artery stenting.

Case Report:

An 82-year-old right-handed man with a recent history of transient ischemic events was admitted to the hospital for evaluation of carotid artery disease. During cerebral angiography, which identified a 90% right internal carotid artery stenosis, the patient received 25 mL of an ionic, low-osmolar contrast agent (ioxaglate) in each carotid artery. The following day he underwent successful carotid stenting, during which 180 mL of ioxaglate were used. He developed rapidly worsening confusion and left hemiparesis on the table. Noncontrast computed tomography showed marked cortical enhancement and edema of the right cerebral hemisphere in the distribution of the right anterior and middle cerebral arteries. The patient improved rapidly and by day 2 was completely recovered; magnetic resonance imaging documented no cortical edema and normal sulci. One month after the procedure, he was well, with patent carotid arteries.

Conclusions:

Transient neurotoxicity after carotid interventions must be differentiated from massive cerebral infarction and hyperperfusion syndrome, but the prognosis is excellent. However, subsequent contrast studies in a patient with this complication should be undertaken with extreme caution.
Neutrophil Respiratory Burst Activity and Pro- and Anti-inflammatory Cytokines in AAA Surgery: Conventional versus Endoluminal Treatment
Authors: Parodi Juan C. , Ferreira L. Mariano , Fornari M. Cecilia , Berardi Vanina E. , Diez Roberto A.
Published: March 2015

Purpose:

To examine the inflammatory impact of endovascular and conventional surgery of abdominal aortic aneurysm (AAA) as assessed by the activation of neutrophils and serum levels of pro- and anti-inflammatory cytokines.

Methods:

Twenty-four patients undergoing AAA exclusion were treated with either endovascular (n = 14) or conventional (n=10) techniques. Clinical and hematological data, respiratory burst of neutrophils, and the expression of adhesion and activation molecules (CD18, CD11b, CD69, and HLA-DR) were analyzed by flow cytometry. The enzyme-linked immunosorbent assay technique was used to measure proinflammatory cytokine interleukin (IL)–8 and anti-inflammatory cytokines IL-1 receptor antagonist (IL-1RA) and transforming growth factor β1 (TGF-β1).

Results:

All patients, most of whom had normal cytokine values before surgery, were successfully treated. No significant changes were found in surface antigens. Basal respiratory burst was quite heterogeneous; in all cases respiratory burst activity decreased after surgery and remained low throughout the observation period. Despite marked interpatient differences, IL-1RA and IL-8 increased after surgery, whereas TGF-β1 decreased, although the variation achieved statistical significance only in the conventional group. Elevated IL-1RA returned to normal within 48 hours in the endoluminal group, whereas the level remained high in the conventional group in the last sample.

Conclusions:

Despite heterogeneity before surgery, the respiratory burst decreased for most of the patients regardless of the approach, and both techniques increased IL-1RA. Although both procedures seemed to decrease TGF-β1, the difference was significant only with the conventional approach. IL-1RA levels fell toward basal values quicker in the endograft patients, suggesting that the endoluminal approach was less aggressive.
Endovascular Repair of AAA Rupture 20 Months after Endoluminal Stent-Grafting
Authors: Ramaiah Venkatesh G. , Thompson Charles S. , Rodriguez-Lopez Julio A. , DiMugno Leanne , Olsen Dawn , Diethrich Edward B.
Published: March 2015

Purpose:

To demonstrate the feasibility of endovascular repair of a ruptured abdominal aortic aneurysm (AAA) previously treated with an endoluminal stent-graft.

Case Report:

An 84-year-old man with a 9.5-cm AAA underwent endoluminal repair with an Endologix stent-graft, but a type I endoleak was detected postprocedurally. The patient was discharged and lost to follow-up. Twenty months later, he suffered an aneurysm rupture, which was repaired using endovascular techniques. Although he had a postoperative course complicated by aspiration pneumonia and renal failure, he recovered fully and was discharged from the hospital with no evidence of endoleak on the postprocedural imaging studies.

Conclusions:

Late ruptures after endoluminal AAA stent-grafting can be successfully treated with endovascular techniques.
Abdominal Pain and Hemoperitoneum: Sole Presenting Symptoms for “Leaking AAA” after Endovascular Repair
Authors: White Rodney A. , Donayre Carlos E. , Walot Irwin , Kopchok George , Woody Jonathan
Published: March 2015

Purpose:

To describe an unusual presentation of impending aortic endograft rupture and successful endovascular rescue.

Case Report:

A 77-year-old man with an enlarging aortic aneurysm was treated with a Talent bifurcated endoprosthesis; a moderate endoleak that appeared to be related to either proximal or distal fixation sites was noted in the body of the aneurysm. The patient was observed for 1 month, and repeat imaging demonstrated persistent endoleak without major increase in the aneurysm diameter. Another examination was scheduled for 3 months hence, but, 2 months later, the patient presented with abdominal pain and a hemoperitoneum. A proximal extension cuff resolved the leak and led to resolution of the hemoperitoneum.

Conclusions:

A leaking aneurysm can be repaired using endovascular techniques in patients with an existing endograft. The need for frequent imaging surveillance of patients with endoleak is underscored.
Common Iliac Artery Access during Endovascular Thoracic Aortic Repair Facilitated by a Transabdominal Wall Tunnel
Authors: Macdonald Sumaira , Byrne Dominique , Rogers Paul , Moss Jonathan G. , Edwards Richard D.
Published: March 2015

Purpose:

To describe a technique for common iliac artery (CIA) access during endovascular aortic aneurysm repair when unfavorable angulation between the CIA and the delivery sheath precludes direct arterial access.

Technique:

After retroperitoneal exposure of the CIA, a puncture site is chosen inferolateral to the surgical incision, and an 18-G trocar/cannula is advanced in alignment with the CIA through the anterior abdominal wall or skin of the upper thigh into the retroperitoneal space. Serial dilatation is performed over a guidewire placed through the cannula to create the subcutaneous tract. The trocar/cannula is replaced over the wire, and the CIA is punctured under direct vision. The guidewire is then advanced into the proximal aorta. A CIA arteriotomy is performed and the delivery system introduced over the guidewire through the tunnel into the iliac artery.

Conclusions:

Retroperitoneal exposure of the CIA with tunneled transabdominal wall delivery of the stent-graft avoids both external iliac artery injury and creation of a temporary access conduit in patients with iliac tortuosity and/or occlusive disease.
Endovascular Repair as First-Choice Treatment for Anastomotic and True Iliac Aneurysms
Authors: Curti Tiziano , Stella Andrea , Rossi Cristina , Galaverni Cristina , Saccà Antonino , Resta Francesco , D'Addato Massimo
Published: March 2015

Purpose:

To report our experience with the endovascular repair of iliac aneurysms secondary to aortoiliac bypass grafting.

Methods:

Thirteen patients (12 men; age range 62–86 years) with histories of aortoiliac reconstructions were treated with endovascular stent-grafts for 11 false and 2 true iliac aneurysms that averaged 5.2 cm in diameter (range 3.0–7.0). Via a percutaneous access and 9-F or 12-F sheaths, Passager or Wallgraft stent-grafts were delivered to exclude the aneurysms.

Results:

Twelve (92%) of 13 interventions were completed satisfactorily; 1 procedure for a true iliac aneurysm was converted to traditional bypass grafting. Two patients underwent additional surgical procedures. The average hospital stay for the patients with endovascular repairs only was 3 days (range 2–5). After a mean follow-up of 28 months (range 17–40), no complication or endoleak has been detected in any patient, and all endografts are patent.

Conclusions:

Endovascular repair is an effective treatment for secondary aneurysms arising after aortoiliac surgery. It is less invasive and involves a shorter hospital stay. Endovascular repair should be the first choice treatment for iliac aneurysms.
Excimer Laser-Assisted Recanalization of Long, Chronic Superficial Femoral Artery Occlusions
Authors: Scheinert Dierk , Laird John R. , Schröder Malte , Steinkamp Herrmann , Balzer Joern O. , Biamino Giancarlo
Published: March 2015

Purpose:

To examine the safety and efficacy of excimer laser-assisted angioplasty (ELA) for recanalization of superficial femoral artery (SFA) occlusions.

Methods:

Data were analyzed from 318 consecutive patients (207 men; mean age 64.2 ± 10.7 years, range 33–91) who underwent ELA of 411 SFAs with chronic occlusions averaging 19.4 ± 6.0 cm in length. More than 75% of patients had severe claudication (category 3). Critical lower limb ischemia with rest pain or minor tissue loss was present in 6 and 15 patients, respectively. The mean ankle brachial index (ABI) before and after exercise was 0.62 ± 0.15 and 0.40 ± 0.18, respectively.

Results:

The initial attempt (crossover approach 89.7%, antegrade 6.6%, transpopliteal 3.6%) to cross the occlusion with an excimer laser catheter was successful in 342 (83.2%) of 411 limbs. A secondary attempt performed in 44 of 69 failed cases was successful in 30 limbs, increasing the technical success rate to 90.5% (372/411). Complications included acute reocclusion (4, 1.0%), perforation (9, 2.2%), and distal thrombosis/embolization (16, 3.9%). Postprocedurally, 219 (68.8%) patients were asymptomatic; mild (category 1) or moderate (category 2) claudication remained in 53 (16.6%) and 26 (8.2%) patients, respectively. The primary patency at 1 year was 33.6%. In the majority of patients, reocclusion was treatable on an outpatient basis. The 1-year assisted primary and secondary patency rates were 65.1% and 75.9%, respectively.

Conclusions:

Long SFA occlusions can be recanalized safely and successfully by ELA. However, to maintain patency and quality of life, intensive surveillance using objective testing followed by prompt repeat intervention are mandatory.
Balloon Angioplasty for Arteriovenous Graft Stenosis
Authors: Anain Paul , Shenoy Sadashiv , O'Brien-Irr Monica , Harris Linda M. , Dryjski Maciej
Published: March 2015

Purpose:

To retrospectively review the long-term outcome as well as the cost effectiveness of thrombolytic therapy and balloon angioplasty (TBA) versus surgical thrombectomy and balloon angioplasty (SBA) in the treatment of prosthetic dialysis access grafts.

Methods:

Between February 1996 and February 1999, 63 hemodialysis patients (35 women; mean age 62.2 years) were treated for 105 thromboses in 6-mm polytetrafluoroethylene straight or loop bridge arteriovenous grafts. Choice of treatment was at the discretion of the surgeon or interventional radiologist: either Fogarty balloon thrombectomy followed by balloon dilation of the venous anastomotic stenosis or urokinase thrombolysis followed by angioplasty.

Results:

Forty-eight SBAs and 55 TBAs were performed in 63 patients without complications. The primary patency rates in the entire cohort were 34%, 29%, and 17% at 1, 2, and 3 months, respectively. Primary patency after TBA was 29%, 18%, and 11%, and that for SBA, 45%, 45%, and 33% over the same time intervals. The mean graft survival was 10 days for TBA versus 31 days for SBA. Repeat angioplasty performed in 23 grafts produced secondary patency rates of 52% at 1 month, 34% at 3 months, and 5% at 5 months. The Medicare reimbursement for both treatments was identical ($1638 for TBA and $1670 for SBA).

Conclusions:

The poor patency rate and high cost of TBA and SBA suggests that these procedures should not be routinely used for salvage of thrombosed arteriovenous grafts with outflow stenosis. Patch angioplasty or creation of simultaneous temporary and new permanent accesses may be a more cost-effective approach in these patients.
Endovascular Treatment of Renal Artery Stenosis
Authors: Geroulakos George , Missouris Constantinos , Mitchell Adam , Greenhalgh Roger M.
Published: March 2015

Significant changes have occurred in the treatment of renal artery disease over the past few years. Although excellent clinical results can be obtained with surgery, percutaneous transluminal renal angioplasty has proved similarly efficacious and is now the treatment of choice for nonostial atherosclerotic stenoses and fibromuscular dysplasia. The introduction of stents has become a valuable adjunctive therapy for postangioplasty restenosis and dissection.
Preliminary Report of a New Approach to Sparing the Greater Saphenous Vein for Grafting: Valvuloplasty Combined with Axial Transposition of a Competent Tributary Vein
Authors: Yamaki Takashi , Nozaki Motohiro , Sasaki Kenji
Published: March 2015

Purpose:

To compare a new vessel-sparing technique combining valvuloplasty with axial transposition of a competent tributary vein versus single valvuloplasty for the treatment of greater saphenous vein (GSV) incompetence.

Methods:

In 55 patients with GSV incompetence, 29 of 57 limbs were treated by angioscopic valvuloplasty of the subterminal valve alone, whereas the remaining 28 limbs underwent angioscopic valvuloplasty combined with axial transposition of a competent tributary vein identified preoperatively by duplex scanning. After angioscopic valvuloplasty in the latter group, the competent tributary vein was exposed and cut 1.5 cm distal to its insertion point on the GSV. The transected vein was anastomosed end to side to the GSV, which was ligated between the tributary insertion site and the anastomosis. Changes in venous hemodynamics, including venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF), were analyzed by use of air plethysmography.

Results:

In the 1-year follow-up, no venous thrombosis was detected in either group. In the valvuloplasty-only group, 22 (75.9%) limbs exhibited reflux in the proximal GSV; recurrent varicose veins were detected in 5 (17.2%) limbs. In contrast, only 2 (7.1%) limbs showed reflux in the valvuloplasty + transposition group. There were no significant differences in EF and RVF between the groups before or after the operation, although a significant difference was seen in VFI at 1 year (p = 0.005, Wilcoxon rank sum test).

Conclusions:

Valvuloplasty combined with tributary vein transposition gives a better result than valvuloplasty alone at 1 year. This new treatment option may be useful for both reducing the rate of varicose veins and sparing the GSV for grafting.
Traumatic Subclavian Artery Pseudoaneurysm: Periprocedural Salvage of Failed Stent-Graft Exclusion Using Coil Embolization
Authors: Watelet Jacques , Clavier Eric , Reix Thierry , Douvrin Françoise , Thomas Pascale , Testart Jacques
Published: March 2015

Purpose:

To report the exclusion of a subclavian pseudoaneurysm by a combination of covered stent implantation and coil embolization.

Case Report:

A 30-year-old man presented with a posttraumatic pseudoaneurysm of the left subclavian artery. A covered Jostent was inserted via a percutaneous femoral approach and deployed in the injured subclavian artery. Because of tapering of the artery proximally, apposition of the covered stent to the arterial wall was insufficient, leading to persistent filling of the pseudoaneurysm. Exclusion of the pseudoaneurysm was achieved by coil embolization through a gap between the stent-graft and the arterial wall.

Conclusions:

This report illustrates that successful endovascular treatment of a left subclavian pseudoaneurysm may require a combination of catheter-based techniques.
Stent-Related Iliac Artery and Iliac Vein Infections: Two Unreported Presentations and Review of the Literature
Authors: Dosluoglu H. Haldun , Curl G. Richard , Doerr Ralph J. , Painton Frederick , Shenoy Sadashiv
Published: March 2015

Purpose:

To discuss the presentation, diagnosis, and treatment of stent-related infections on the basis of 2 new cases and historical review.

Case Reports:

Two previously unreported cases of vascular stent infection are presented with a summary of cases from the literature. One case involved an iliac artery stent infection secondary to a remote bacteremia 6 months after stent placement. The other case was an early iliac vein stent infection, a previously unreported site of this complication. Both cases were diagnosed by use of computed tomography and were treated surgically after medical management failed. Both patients survived.

Conclusions:

A high index of suspicion is necessary for the diagnosis of stent infections, and an aggressive treatment is usually necessary for survival. Prophylactic antibiotics should definitely be considered in cases involving repeat interventions and prolonged catheterization, as well as before bacteremia-inducing therapies.
Therapeutic Embolization of Idiopathic Renal Arteriovenous Fistula Using the “Stop-Flow” Technique
Authors: Mansueto Giancarlo , D'Onofrio Mirko , Minniti Salvatore , Ferrara Rosa Maria , Procacci Carlo
Published: March 2015

Purpose:

To present a case of massive idiopathic arteriovenous fistula (AVF) successfully treated with an endovascular procedure.

Case Report:

A 42-year-old woman with microscopic hematuria was found to have a massive idiopathic renal AVF. Percutaneous embolization was undertaken using a dual approach to deliver an occluding balloon through the draining vein and an arterial access to selectively catheterize the aneurysmal afferent artery. With the balloon inflated to interrupt flow (“stop-flow” technique), acrylic glue was delivered precisely to occlude the lesion. Duplex scans at 12 months have documented continued complete occlusion of the anomalous communication.

Conclusions:

The dual arterial and venous approach with the “stop-flow” technique makes it possible to successfully treat idiopathic AVFs that have constant high-flow connections.
Protected Renal Stenting with the PercuSurge GuardWire Device: A Pilot Study
Authors: Henry Michel , Klonaris Christos , Henry Isabelle , Tzetanov Kiril , Le Borgne Edmond , Foliguet Bernard , Hugel Michele
Published: March 2015

Purpose:

To evaluate the feasibility and safety of renal artery angioplasty and stenting utilizing a distal protection device to reduce the risk of intraprocedural atheroembolism.

Methods:

Twenty-eight hypertensive patients (18 men; mean age 71.3 ± 8.6 years, range 49–87) with atherosclerotic renal artery stenosis (4 bilateral) underwent angioplasty and stenting with distal protection in 32 renal arteries (29 ostial lesions). The lesion was crossed with a GuardWire temporary occlusion balloon, which was inflated to provide parenchymal protection. Generated debris was aspirated and analyzed. Blood pressure and serum creatinine levels were followed.

Results:

Immediate technical success was 100%. All lesions were stented, either directly (14 ostial lesions), after predilation (15 ostial lesions), or owing to suboptimal angioplasty (3 nonostial lesions). Visible debris was aspirated from all patients. Mean particle number and diameter were 98.1 ± 60.0 per procedure (range 13–208) and 201.2 ± 76.0 µm (range 38–6206), respectively. Mean renal artery occlusion time was 6.55 ± 2.46 min (range 2.29–13.21). Mean follow-up was 6.7 ± 2.9 months (range 2–17). Systolic and diastolic blood pressure declined from 167.0 ± 15.2 and 103.0 ± 12.0 mm Hg, respectively, to 154.7 ± 12.3 and 93.2 ± 6.8 mm Hg after the procedure. The mean creatinine level dropped from 1.34 ± 0.35 mg/dL preprocedurally to 1.22 ± 0.36 mg/dL at 24 hours and remained constant. At 6-month follow-up, renal function did not deteriorate in any patient, whereas 5 patients with baseline renal insufficiency improved after the procedure.

Conclusions:

These preliminary results suggest the feasibility and safety of distal balloon occlusion during renal interventions to protect against atheroembolism. This technique's beneficial effects should be evaluated by randomized studies.
Intravascular Ultrasound—Guided Renal Artery Stenting
Authors: Dangas George , Laird John R. , Mehran Roxana , Lansky Alexandra J. , Mintz Gary S. , Leon Martin B.
Published: March 2015

Purpose:

To evaluate the clinical outcomes of patients undergoing renal artery stenting with intravascular ultrasound (IVUS) guidance and compare measurements between IVUS and angiography.

Methods:

One hundred thirty-one patients (71 women; mean age 71 ± 8 years) underwent IVUS-guided Palmaz stent implantation in 153 stenotic renal arteries at a single center. The indications for stenting were uncontrolled hypertension (102, 77.9%), renal insufficiency (10, 7.6%), and both conditions (19, 14.5%). The majority of lesions were ostial (114, 74.5%); the remainder occupied the proximal renal artery (39, 25.5%). The mean lesion length and diameter stenosis were 6.5 ± 3.0 mm and 74% ± 10%, respectively, as measured by angiography. Data were recorded in a pre-specified database; angiographic and IVUS images were analyzed at dedicated core laboratories and compared.

Results:

Angiographic success was achieved in all patients, but IVUS indicated the need for additional intervention in 36 (23.5%) cases. There was strong correlation between the angiographic and IVUS measurements of lesion length ( r = 0.60, p < 0.0001) and pre-/postprocedural minimal luminal diameter ( r = 0.72 and 0.63, respectively; p < 0.0001). The mean contrast volume was 74 ± 18 mL per case. In-hospital renal failure occurred in 8 (6.1%) patients; 2 (1.5%) required transient hemodialysis. At a mean 15-month follow-up, patients were treated with fewer antihypertensive medications (p = 0.05), and systolic and diastolic arterial blood pressures had decreased (p = 0.001); no significant change was noted in serum creatinine.

Conclusions:

IVUS-guided stenting facilitates safe renal artery revascularization. IVUS imaging may complement angiography in certain cases, which should be studied further in prospective studies with iodinated or noniodinated contrast agents.
Failed AAA Endograft Exclusion Due to Type II Endoleak: Explant Analysis
Authors: White Rodney A. , Walot Irwin , Donayre Carlos E. , Woody Jonathan , Kopchok George E.
Published: March 2015

Purpose:

To report the patient history and analysis of an explanted modular bifurcated endograft that was implanted to exclude an abdominal aortic aneurysm (AAA).

Case Report:

An 80-year-old man with a 6-cm AAA underwent uneventful endovascular implantation of a bifurcated AneuRx stent-graft. His postprocedural clinical course was uneventful, although persistent contrast enhancement of the aneurysm remained via the inferior mesenteric artery (IMA). By 6 months, an endoleak connecting to the lumbar and mesenteric arteries became apparent. Over the ensuing 12 months, the endoleak and aneurysm enlarged; branch artery embolization was attempted in 4 percutaneous procedures. Despite successful IMA occlusion, the aneurysm continued to increase in diameter and volume, necessitating conversion to a conventional bypass at 20 months. Analysis of the explanted specimen revealed an intact endograft with fibrous incorporation of the stent framework at the proximal and distal fixation sites only; no incorporation of the endograft was noted within the aneurysm. The feeding channel for the endoleak was not identified.

Conclusions:

Serial imaging is a vital component of endograft surveillance, and persistent type II endoleaks that cannot be completely embolized endanger the longevity of the aneurysm exclusion. Explant analysis can play an important role in understanding the mechanisms of endograft failure.
Healing Response of Normal Canine Aorta and Iliac Artery to a Nitinol Stent Encapsulated in Carbon-Lined ePTFE
Authors: Woody Jonathan D. , Nishanian Gary , Kopchok George E. , Kim Nam I.I. , Donayre Carlos E. , White Rodney A.
Published: March 2015

Purpose:

To evaluate the healing response of normal canine arteries to a self-expanding nitinol stent encapsulated in carbon-lined expanded polytetrafluoroethylene (ePTFE).

Methods:

Twenty-eight dogs were divided into aortic (n = 18) or iliac (n = 10) groups. In the latter, 2 animals were assigned to implantation intervals of 7, 30, and 90 days, respectively; 4 were designated for 180-day implantation. Half of the animals in each subgroup received a second overlapping stent-graft in one iliac artery. In the aortic cohort, 6 animals were assigned to the 180-day implantation group (2 with dual devices) and 3 to each of the others (1 dual implantation in each group). The devices were evaluated with angiography and intravascular ultrasound at implantation and explantation. After harvesting and gross examination, the specimens were examined microscopically and with scanning electron microscopy.

Results:

The 49 implanted devices (24 aortic and 25 common iliac) were all widely patent at explantation, save for 2 iliac stents that had moderate (<40%) stenosis. No neointima was present at the 7-day interval. All stents were covered by thin neointima (<150 µm) at 30 days. At 180 days, an endothelial lining was present in the proximal and distal segments of all stents; in 4 of the 6 aortic stents, this endothelial lining was complete, whereas none of the iliac devices had endothelium in the midsegment at 180 days. At 1 year, 2 of the aortic specimens had an incomplete endothelial lining, whereas the lining was complete in the third. There was no evidence of stent-graft migration or inflammation associated with any device.

Conclusions:

The carbon-lined ePTFE-encapsulated stent is a novel approach to arterial stenting. The progressive endothelialization and lack of inflammatory reaction may provide improved long-term patency. Further study of this stent-graft design is warranted.
Arterial Thrombus Dissolution in Vivo Using a Transducer-Tipped, High-Frequency Ultrasound Catheter and Local Low-Dose Urokinase Delivery
Authors: Atar Shaul , Luo Huai , Nagai Tomoo , Sahm Roger A. , Fishbein Michael C. , Siegel Robert J.
Published: March 2015

Purpose:

To examine the hypothesis that a transducer-tipped high-frequency ultrasound drug-delivery catheter may augment the thrombolytic effects of locally delivered low-dose urokinase and result in improved recanalization rates and reduced residual thrombotic burden.

Methods:

Thrombi were induced in situ bilaterally in 5- to 6-cm-long segments of the superficial femoral arteries in 9 dogs by intraluminal thermal damage and injection of thrombin. A transducer-tipped high-frequency local drug-delivery catheter was applied at 1.1 MHz and 0.6 W for 60 minutes to one superficial femoral artery segment, and an identical catheter with an inactivated ultrasound transducer was used to treat the contralateral control segment. Urokinase (5000 IU/kg) was delivered bilaterally into the thrombi during the treatment interval.

Results:

Angiography documented TIMI grade 2 or 3 flow in 9 (100%) segments in the ultrasound-treated group versus 6 (67%) of the controls (no ultrasound) (p = 0.058). Angiographically detected distal embolization was found in 2 ultrasound-treated segments compared with 5 controls (p = 0.02). Protruding or occlusive thrombi were seen angioscopically in 8 (89%) control segments but in only 1 (11%) of the ultrasound-treated arteries (p < 0.001). By histopathology, 7 (78%) segments in the control group had occlusive thrombi, whereas only 3 nonocclusive thrombi were found in the ultrasound-treatment group (p < 0.001).

Conclusions:

Catheter-delivered high-frequency ultrasound and local low-dose urokinase infusion is efficacious for the treatment of acute thrombotic occlusions as evaluated by angiography, angioscopy, and histopathology.
Pseudoaneurysm Formation at the Site of External Iliac Artery Stents: Percutaneous Stent-Graft Treatment
Authors: Scheinert Dierk , Ludwig Josef , Schröder Malte , Bräunlich Sven , Balzer Joern O. , Biamino Giancarlo
Published: March 2015

Purpose:

To present a patient who developed an asymptomatic large iliac pseudoaneurysm complicating stent-supported iliac artery recanalization.

Case Report:

The pseudoaneurysm was detected in an asymptomatic 69-year-old man during routine angiography 6 months after an uncomplicated procedure to implant 3 overlapping Palmaz stents in an occluded external iliac artery. There was no evidence of stent infection. During a second intervention, the pseudoaneurysm was successfully treated by percutaneous implantation of an EndoPro System I stent-graft. Contrast-enhanced spiral computed tomography at 6 and 12 months confirmed the durability of aneurysm exclusion and the patency of the endoprosthesis.

Conclusions:

Angioplasty-induced pseudoaneurysm is rare and usually asymptomatic, but elective percutaneous stent-graft repair should be considered as the first treatment option.
Endovascular Stent-Grafting in the Treatment of Superficial Femoral Artery Occlusive Disease
Authors: Bauermeister Günther
Published: March 2015

Purpose:

To explore the feasibility of using a flexible stent-graft in the treatment of superficial femoral artery occlusive lesions.

Methods:

Thirty-five patients (26 men; median age 65 years, range 41–85) with long-segment occlusions of the femoropopliteal arteries were treated with the Hemobahn endovascular prosthesis. The median occlusion length was 22 cm (range 4–40). Endografting was performed in conjunction with additional recanalization procedures as needed.

Results:

Primary recanalization and deployment of 47 Hemobahn endografts was successful in all cases; 12 patients had 2 devices implanted. The adjunctive recanalization techniques included balloon thrombectomy (n = 28), ring-stripper disobliteration (n = 7), local thrombolysis (n = 2), mechanical rotational thrombectomy (n = 2), local thromboendarterectomy and femoral bifurcation patch angioplasty (n = 14), iliac artery stenting (n = 3), and bypass grafting (n = 2). The median ankle-brachial index rose from 0.25 preoperatively to 0.87. Over an average 7-month follow-up (range 1–18), 10 (28.6%) occlusions occurred; 6 stent-graft thromboses were treated successfully with thrombectomy only. The other 4 occlusions were permanent. Life-table analysis documented cumulative primary and secondary patency rates of 73.2% and 82.6%, respectively, at 1 year.

Conclusions:

Intraoperative use of the Hemobahn endograft is feasible and effective in restoring adequate distal perfusion in the short term, especially when combined with conventional recanalization techniques.
Ischemic Transverse Myelopathy after Endovascular Repair of a Thoracic Aortic Aneurysm
Authors: Reichart Marjan , Balm Ron , Meilof Jan F. , de Haan Peter , Reekers Jim A. , Jacobs Michael J.H.M.
Published: March 2015

Purpose:

To report a dramatic complication after endovascular repair of a descending thoracic aortic aneurysm (TAA) and to present a classification system and possible methods to avoid spinal cord ischemia.

Case Report:

A 48-year-old man with a descending TAA between T5 and T9 was treated with endovascular stent-grafts. Fourteen hours after the operation, the patient developed partial transverse myelopathy at level T10. During emergency conversion to open surgery and implantation of a conventional tube graft, 3 intercostal arteries that had been covered by the stent-graft were revascularized. Postoperatively, the neurological deficit improved, and the patient was able to walk again. Methods to predict and possibly prevent the induction of spinal cord ischemia after endovascular repair of TAA are suggested.

Conclusions:

Endovascular repair of TAA may induce spinal cord ischemia; pre- and intraoperative assessment of involved intercostal arteries should be performed.
Long-Term Renal Function following Endovascular Aneurysm Repair with Infrarenal and Suprarenal Aortic Stent-Grafts
Authors: Alric Pierre , Hinchliffe Robert J. , Picot Marie-Christine , Braithwaite Bruce D. , MacSweeney Shane T.R. , Wenham Peter W. , Hopkinson Brian R.
Published: March 2015

Purpose:

To determine in a retrospective analysis the incidence of renal impairment (RI) following endovascular repair (EVR) of abdominal aortic aneurysm (AAA), to assess the morbidity and mortality in endograft patients with preoperative RI, and to examine the impact of suprarenal stent-grafts on renal function.

Methods:

From March 1994 to October 2001, 315 AAA patients (289 men; mean age 72.4±7.0 years) undergoing EVR were entered prospectively into a vascular registry. The patients received either an in-house custom-made stent-graft or one of several commercially made devices implanted with infrarenal or suprarenal fixation. Renal function was monitored by serum creatinine measurements prior to discharge and at 3, 6, and 12 months and annually thereafter. Preoperative RI was defined as a serum creatinine > 130 μmol/L and/or long-term dialysis. Postoperative RI referred to a >20% increase in the serum creatinine over baseline. Additional deterioration of renal function in patients with preoperative RI was referred to as postoperatively worsened RI.

Results:

Of the 315 patients treated, 220 (69.8%) were considered high risk (ruptured AAA or ASA grade III or IV). Sixty-nine (21.9%) patients had preoperative RI (6 [1.9%] on preoperative dialysis). A suprarenal stent-graft was used in 169 (53.7%) patients and infrarenal stent-graft in the remaining 146 (46.3%). The mean follow-up was 30.1 ±22.7 months. Postoperative RI occurred in 53 (16.8%) patients (24 [7.6%] transient, 29 [9.2%] persistent). Patients with preoperative RI had a significantly higher incidence of postoperatively worsened RI (37.7% versus 11.0%, p<0.0001) and a higher mortality related to RI (7.2% versus 1.6%, p=0.02). Suprarenal fixation had no influence on the incidence of RI, on perioperative mortality, or on mortality related to RI. The only significant predictive factor of postoperative RI was preoperative RI (risk ratio 5.09, 95% CI 2.38 to 10.87, p=0.0001).

Conclusions:

Endovascular AAA repair may lead to persistent postoperative RI in nearly 10% of cases, especially in patients with preoperative RI. Suprarenal stent-graft fixation does not seem to have any deleterious effect on renal function. Further long-term studies are required to confirm the innocuous nature of transrenal stent placement.
Does the Type of Endograft Affect AAA Volume Change after Endovascular Aneurysm Repair?
Authors: van der Laan Maarten J. , Prinssen Monique , Bertges Daniel , Makaroun Michel S. , Blankensteijn Jan D.
Published: March 2015

Purpose:

To compare thrombus volume changes in a longitudinal study over 2 years after endovascular aneurysm repair using the Ancure and Excluder endografts.

Methods:

In 2 institutions, all consecutive patients treated with a bifurcated Ancure or Excluder endograft were included in this retrospective comparison of computed tomographic angiography (CTA) data recorded and stored to disk postoperatively and at the 12 (12M) and 24-month (24M) follow-up examinations. In one institution, among 45 Ancure endograft patients, 35 (group A) had the 3 requisite scans available. In the second institution, 23 (group B) of 36 patients with the Excluder endograft were eligible for analysis. The proportional volume change was calculated at 12M and 24M and compared to the postoperative CT data. More than 10% shrinkage was considered significant.

Results:

In both groups, the median absolute volume changed significantly. In group A, significant shrinkage was found in 66% (23/35) at 12M and 74% (26/35) at 24M; in group B, 46% (10/23) had significant shrinkage at 12M as well as at 24M (p=0.027 for the difference between groups A and B at 24M). Statistical analysis of the proportional volume change showed a significant difference between the Ancure and the Excluder devices at 12M (p=0.009) and 24M (p=0.001). Multivariate analysis found aneurysm size (p<0.012) and endograft type (p=0.026) to be independently predictive of the absolute volume change.

Conclusions:

Sac volume shrinkage after endovascular aneurysm repair is less pronounced and less frequent with the Excluder endoprosthesis than with the Ancure endograft.