bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved Respiratory Function and Analgesia Control after Endovascular AAA Repair
Authors: Boyle Jonathan R. , Thompson Jonathan P. , Thompson Matthew M. , Sayers Robert D. , Smith Graham , Bell Peter R.F.
Published: March 2015

Purpose:

Endovascular abdominal aortic aneurysm (AAA) repair has been proposed as a minimally invasive alternative to conventional surgery and may offer significant advantages in respiratory function and analgesic requirements due to the absence of an abdominal incision.

Methods:

Respiratory function and analgesic requirements were quantified in 22 age-matched patients undergoing aneurysm repair under general anesthesia. Twelve patients underwent endovascular aneurysm repair, while 10 AAA patients had conventional surgery. One endovascular patient required conversion to conventional repair.

Results:

The endovascular group required postoperative artificial ventilation for a shorter time (6 versus 21 hours, p < 0.05) and had lower PCA (patient-controlled analgesia) morphine consumption (41 versus 133 mg, p < 0.05) than the conventional group. The endovascular group also had significantly better forced expiratory volume and forced vital capacity at both 3 and 5 days when expressed as percentages of the preoperative values (p < 0.05).

Conclusions:

Endovascular AAA repair attenuates respiratory dysfunction associated with conventional surgery and reduces perioperative analgesia requirements.
The Need for Clinical Trials of Endovascular Abdominal Aortic Aneurysm Stent-Graft Repair: The EUROSTAR Project
Authors: Harris Peter L. , Buth Jacob , Mialhe Claude , Myhre Hans O. , Norgren Lars
Published: March 2015

EUROSTAR(EUROpean collaborators on Stent-graft Techniques for abdominal aortic Aneurysm Repair) was established for the purpose of combining and studying data on endovascular abdominal aortic aneurysm (AAA) repair. EUROSTAR is independent of any commercial interest and has as its ultimate goal an independent, scientifically reliable assessment of endovascular AAA grafting. A standardized case record form is used for data collection and transmission, and the database is maintained in a central registry office. A comprehensive set of clinical, imaging, technical, and laboratory data obtained at initial admission and follow-up are recorded; these data are analyzed periodically and reports generated on the collated experience.

As a first priority, an observational study without controls was initiated in July 1996 to address the issues of procedural safety, device durability, and long-term effect upon the aneurysms. Several ancillary studies have been initiated, including a “Retrieval and Analysis Study” for the evaluation of explanted devices. While a randomized study does not seem feasible at present, this may be organized at the appropriate time when the devices and techniques become more standardized.
Endoluminal Graft Exclusion of a Proximal Para-Anastomotic Pseudoaneurysm following Aortobifemoral Bypass
Authors: White Rodney A. , Donayre Carlos E. , Walot Irwin , Wilson Eric , Jackson George , Kopchok George
Published: March 2015

Purpose:

To describe a case of endoluminal graft exclusion of a proximal para-anastomotic pseudoaneurysm that occurred 17 years following aortobifemoral bypass for occlusive disease.

Methods and Results:

The lesion was found on abdominal ultrasound examination as part of a work-up for acute abdominal pain and upper gastrointestinal bleeding in a 67-year-old male. A 5-cm saccular pseudoaneurysm was confirmed by preintervention aortography and spiral computed tomography (CT) scanning. Because of the patient's acute symptoms and high-risk medical condition (cardiomyopathy), he was deemed a candidate for endoluminal bypass. At the time of intervention, intravascular ultrasound (IVUS) interrogation identified a 3.5-cm-long separation of the existing aortic graft from the proximal aortic stump with a large pseudoaneurysm. The lesion was isolated and repaired by placement of an aortic-to-right iliac endoluminal bypass, ligation of the left limb of the aortofemoral graft, and femorofemoral bypass to restore blood flow to the lower extremities. Spiral CT scans at 48 hours and 3 months following the procedure confirmed complete isolation of the lesion.

Conclusions:

This case illustrates the feasibility of endografting for repair of aortic para-anastomotic pseudoaneurysms, and it also highlights the potential role of IVUS imaging in endoluminal graft deployment.
Shortening of Endografts during Deployment in Endovascular AAA Repair
Authors: White Geoffrey H. , May James , Waugh Richard , Harris John P. , Chaufour Xavier , Yu Weiyun , Stephen Michael S.
Published: March 2015

Purpose:

To evaluate the incidence and extent of length changes during implantation of endovascular grafts in a prospective study of patients undergoing endovascular abdominal aortic aneurysm (AAA) repair.

Methods:

Data regarding the occurrence of intraoperative technical difficulties and device complications were recorded prospectively for the Vanguard or AneuRx self-expanding, bifurcated endovascular grafts in 64 patients (56 males; mean age 75 years). Graft length was measured in the sheath system before deployment and again immediately after deployment by fluoroscopic comparison to a graduated marking catheter.

Results:

Graft shortening ≥ 15 mm was documented in 22 (56%) of 39 Vanguard cases and 11 (44%) of 25 AneuRx endografts. Additional extension grafts were required to correct endoleak caused by inadequate graft length in 9 (14%) patients, but no conversion to open repair was necessary.

Conclusions:

There appears to be a high incidence of intraprocedural graft shortening with 2 current designs of self-expanding endoluminal grafts.
Longitudinal Aneurysm Shrinkage following Endovascular Aortic Aneurysm Repair: A Source of Intermediate and Late Complications
Authors: Harris Peter , Brennan John , Martin; Janis , Gould Derek , Bakran Ali , Gilling-Smith Geoffrey , Buth Jaap , Gevers Evelien , White Donagh
Published: March 2015

Purpose:

To report the incidence of delayed complications following endovascular abdominal aortic aneurysm (AAA) repair and the relationship of these sequelae to morphological changes in the sac and endograft.

Methods:

Twenty-six AAA patients treated with Vanguard endografts had completed ≥1-year follow-up. Postoperative angiograms and spiral computed tomographic (CT) scans with 3-dimensional reconstruction were compared to the 1-year images to determine morphological changes in the aneurysm sac and the endograft. These changes were then related to complications occurring between 1 and 12 months postoperatively in the study group.

Results:

Comparison of angiograms uncovered endograft buckling in 18 (69%) patients and acutely angled or kinked endografts in 10 (38%). Measurements from the CT scans found that undistorted endografts had a mean change in sac length of +6.6 mm. Mean sac length change in buckled endografts was −3.1 mm, while kinked endografts displayed a mean change of −6.2 mm (p < 0.002, Student's t-test). Five (19%) patients, all with distorted endografts, demonstrated late (1 to 12 months) complications (4 endoleaks and 1 graft limb thrombosis) owing to component separation, distal stent migration, and acute angulation. No movement in the proximal stent was observed. Elongation of the endograft (flow line measurement) was observed in one tube graft only.

Conclusions:

In this study, longitudinal shrinkage of the sac following endovascular aortic aneurysm repair led to buckling or kinking of the endograft within 1 year in 69% of patients. This appears to be an important source of delayed complications.
Percutaneous Transluminal Angioplasty of the Subclavian Arteries
Authors: Henry Michel , Amor Max , Henry Isabelle , Ethevenot Gérard , Tzvetanov Kiril , Chati Zukaï
Published: March 2015

Purpose:

To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement.

Methods:

Over a 9-year period, 113 patients (67 males; mean age 63 ± 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% ± 7.4% (range 70 to 100). Mean lesion length was 24 ± 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine.

Results:

Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]).

Conclusions:

Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.
Stents in the Treatment of Renal Artery Stenosis: Long-Term Follow-up
Authors: Henry Michel , Amor Max , Henry Isabelle , Ethevenot Gérard , Tzvetanov Kiril , Courvoisier André , Mentre Bernard , Chati Zukaï
Published: March 2015

Purpose:

To evaluate the role of percutaneous stenting in the treatment of renal arterial lesions after failure of balloon angioplasty.

Methods:

Two hundred ten patients (139 males; mean age 67.7 ± 9.9 years, range 27 to 87) had 259 balloon-expandable stents (165 Palmaz and 94 Renal Bridge stents) implanted in 244 renal artery stenoses (171 ostial and 73 nonostial lesions). The patients were suffering from intractable hypertension (n = 210) and/or renal dysfunction (n = 48). The majority of the lesions (n = 234) were atheromatous in origin. Stents were implanted for suboptimal balloon dilation (n = 182, 75%), restenotic lesions (n = 27, 11%), or dissection (n = 9, 4%); 26 (11%) ostial lesions were stented primarily. Mean lesion length was 11.9 ± 4.4 mm (range 5 to 30) and mean percent stenosis was 81.9% ± 8.25% (range 70 to 100).

Results:

Immediate technical success was 99% (241 of 244). Three (1.2%) major complications included one intraprocedural stent thrombosis, one arterial perforation manifesting as a perirenal hematoma 24 hours after the procedure, and one renal arterial rupture. Follow-up over a mean 25.4 ± 22.8 months (range 1 to 96) in 185 eligible patients (209 arteries) found 24 cases of restenosis (11.4%). Primary and secondary patencies for all lesions at 60 months were 79% and 98%, respectively, with no significant differences between ostial and nonostial lesions or stent types. Hypertension was reversed in 35 (19%), improved in 112 (61%), and remained unchanged in 37 (20%). Renal function was improved in 29% (14 of 48), unchanged in 67% (32 of 48), and worse in 4% (2 of 48).

Conclusions:

Renal artery stenting is safe, effective, and may be an alternative to surgery, particularly in ostial lesions. Our experience shows reduction in the restenosis rate compared to conventional angioplasty. All ostial stenoses should be stented.
Angioplasty of Lower Limb Arterial Stenoses under Ultrasound Guidance: Single-Center Experience
Authors: Ramaswami Ganesh , Al-Kutoubi Aghiad , Nicolaides Andrew N. , Dhanjil Surinder , Vilkomerson David , Ferrara-Ryan Michelle , Stansby Gerard
Published: March 2015

Purpose:

To examine the feasibility and utility of ultrasound-guided angioplasty for treating lower limb stenoses.

Methods:

Duplex ultrasonography was employed to guide 55 balloon dilation procedures (27 iliac, 26 superficial femoral, 1 profunda, and 1 vein graft) with the help of a special ultrasound catheter (EchoMark). Ultrasound was used to determine balloon size, monitor guidewire passage, direct the dilation, and judge procedural success. Angiography was performed prior to the procedure to confirm preprocedural ultrasound findings and afterward to compare with duplex visual and hemodynamic parameters of success (peak systolic velocity ratio < 2.0).

Results:

The balloon size determined from duplex measurements correlated in all cases with sizes selected based on the angiographic image. Guidewire visualization was possible in 95% of the cases. Angioplasty using ultrasound alone was feasible in 84%; inability to obtain a satisfactory image owing to vessel tortuosity, calcification, and bowel gas accounted for the failures. Against the duplex success criterion, initial completion angiograms had an accuracy of 76%, sensitivity of 76%, and specificity of 100%. The additional time for ultrasound guidance averaged 42 ± 12 minutes for all cases.

Conclusions:

Our results show that ultrasound guidance is feasible in routine clinical practice. In this series of well-selected cases of arterial stenoses, angioplasty was performed safely using ultrasound guidance alone in over 80% of the cases. Fluoroscopic monitoring is needed when ultrasound visualization is suboptimal.
The Role of Carotid Duplex Ultrasound in Evaluating Plaque Morphology: Potential Use in Selecting Patients for Carotid Stenting
Authors: AbuRahma Ali F. , Covelli Michael A. , Robinson Patrick A. , Holt Steven M.
Published: March 2015

Purpose:

To study the role of duplex ultrasonography in evaluating plaque morphology and its correlation to neurological symptoms and cerebral infarctions on computed tomographic scans.

Methods:

The hospital records of 181 patients (107 males; average age 66 years, range 41 to 89) with > 50% carotid stenosis (29 bilateral lesions) who had undergone duplex ultrasonography, carotid arteriography, and cerebral computed tomography were studied retrospectively. Of 210 duplex examinations, 139 were appropriate for morphological analysis of surface characteristics and echogenicity.

Results:

Over half of the plaques examined had irregular surfaces (81, 58%) and displayed mixed (i.e., heterogeneous) echogenic patterns (74, 53%). Irregular (68 of 81, 84%) and heterogeneous (65 of 74, 88%) plaques were associated with ipsilateral neurological symptoms (p < 0.0001). Similarly, 44 (54%) of 81 irregular plaques and 42 (57%) of 74 heterogeneous plaques were found in patients with cerebral infarctions in the carotid territory (p < 0.0001).

Conclusions:

Heterogeneous and/or irregular plaques were more often associated with both neurological symptoms and infarctions than smooth or homogeneous plaques. These findings may have implications in patient selection for endoluminal therapy.
Duplex Features of Vein Graft Stenosis and the Success of Percutaneous Transluminal Angioplasty
Authors: Gonsalves Chip , Bandyk Dennis F. , Avino Anthony J. , Johnson Brad L.
Published: March 2015

Purpose:

To determine if criteria exist that are correlated to a successful outcome after balloon angioplasty for vein graft stenosis.

Methods:

During a 5-year period, duplex surveillance of 380 infrainguinal vein bypasses identified 76 hemodynamically failing grafts (87 stenoses) requiring intervention. Percutaneous transluminal angioplasty (PTA) was selected over surgical repair based on 3 criteria: time interval from primary grafting procedure, vein graft diameter, and stenosis length. The 28 (32%) stenoses (20 grafts) treated by PTA were used in a retrospective analysis to test if any variables favored a successful outcome. Patient and lesion characteristics, graft patency, and restenosis following PTA were correlated with duplex features of the stenosis recorded prior to, immediately after, and at 3- to 6-month intervals postprocedurally.

Results:

Lesion characteristics that correlated with a successful outcome were vein size ≥3.5 mm, lesion length < 2 cm, and appearance > 3 months after surgery. Conduit type, PTA site, patient demographics, and indication for bypass did not correlate with PTA durability. Nineteen lesions in 13 grafts met these criteria (group 1), while 9 stenoses in 7 grafts did not (group 2). Lesion severity based on duplex velocity measurements were similar in both groups before (p = 0.40) and after (p = 0.32) treatment. During the mean 21-month follow-up, group 1 grafts required less intervention (p = 0.035). At last follow-up, hemodynamic changes were durable in group 1 (p = 0.0068) but not in group 2 (p = 0.39).

Conclusions:

Selection of vein graft stenoses for treatment by PTA can be based on temporal and duplex data. PTA of short (< 2 cm) stenoses in good caliber veins (≥ 3.5 mm) appearing > 3 months after bypass placement was durable with a late intervention rate of approximately 10%. Direct surgical repair or replacement is recommended for early (< 3 months) and/or long segment stenoses that develop in small caliber conduits.
Subclavian Stents and Stent-Grafts: Cause for Concern?
Authors: Phipp Laura H. , Scott D. Julian A. , Kessel David , Robertson Iain
Published: March 2015

Purpose:

To report cases of stent and stent-graft fracture in the subclavian vessels.

Methods and Results:

Three patients with self-expanding stents of 3 different types in 1 subclavian artery and 2 subclavian veins presented with recurrent symptoms 6 months to 2 years after stenting. All devices showed signs of compression with stent fracture. The covered stent in the subclavian artery was excised. Of the 2 venous patients, 1 was treated with first rib resection and the other refused further treatment.

Conclusions:

The subclavian vessels are prone to flexion during movement, and the vessels may be compressed by external structures, including the clavicle and first rib. Stents that have not been designed to withstand these forces may be damaged.
Abdominal Aortic Aneurysm Morphology in Candidates for Endovascular Repair Evaluated with Spiral Computed Tomography and Digital Subtraction Angiography
Authors: Resch Timothy , Ivancev Krassi , Lindh Mats , Nirhov Nick , Nyman Ulf , Lindblad Bengt
Published: March 2015

Purpose:

To analyze the morphology of abdominal aortic aneurysms (AAAs) and to study the usefulness of spiral computed tomography (CT) versus digital subtraction angiography (DSA) in the evaluation of patients for endovascular repair.

Methods:

Of 133 AAA patients (120 men, mean age 67 years, range 52 to 84) evaluated preoperatively with CT imaging, 77 endograft candidates (68 men) were also assessed with intra-arterial DSA. Arterial parameters were measured on axial CT scans and angiographic films for comparison.

Results:

Mean maximum AAA diameter was 58 ± 11 mm (range 39 to 95). Aneurysmal neck diameter was consistently smaller on DSA than on CT (20.7 ± 3.6 mm versus 23.0 ± 3.5 mm, p < 0.0001). The distance from the most distal renal artery to the aortic bifurcation was longer on angiography than on CT (mean difference 10.0 mm, p < 0.0001). There was a positive correlation between the maximum AAA diameter and the AAA length (r = 0.49, p < 0.0001) and an inverse relationship between the neck length and the neck diameter (r = −0.36, p < 0.0001). No correlation was found between the maximum AAA diameter and maximum iliac diameter, angulation, or length.

Conclusions:

AAA anatomy varies widely and independently of the aneurysm size. Therefore, the maximum size of the aneurysm is a poor predictor of whether or not an aneurysm is suitable for endovascular repair. The discrepancy between angiographic and axial CT measurements suggests that neither alone is sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure.
Mortality Rates following Endovascular Repair of Abdominal Aortic Aneurysms
Authors: Walker Stuart R. , Macierewicz Jan , MacSweeney Shane T. , Gregson Roger H. S. , Whitaker Simon C. , Wenham Peter W. , Hopkinson Brian R.
Published: March 2015

Purpose:

To present the perioperative and late mortality following endovascular repair (EVR) of abdominal aortic aneurysms (AAAs).

Methods:

Data were collected prospectively on 221 patients undergoing AAA EVR over a 4-year period (median 5-month follow-up). Patients were classified preoperatively as high risk with at least 1 of these features: serum creatinine > 150 μmol/L, ischemic heart disease or poor left ventricular function, respiratory function < 50% of predicted normal, ruptured or symptomatic AAA, contraindication to or failed open repair, and age > 80 years.

Results:

One hundred forty (63.3%) patients were classified as high risk, the most common criterion being cardiac disease (n = 96, 68.6%). There were 25 (11.3%) deaths in the 30-day perioperative period, 22 (15.7%) in the high-risk group compared to 3 (3.7%) in the acceptable-risk group (p = 0.02). The most common causes of perioperative death were multisystem organ failure and myocardial infarction. A further 21 (9.5%) late deaths occurred, 16 (11.4%) in the high-risk group and 5 (6.2%) in the acceptable-risk group (p > 0.1).

Conclusions:

The mortality of patients at acceptable risk undergoing EVR compares with the best published series for conventional open AAA repair. The perioperative and late mortality in the high-risk patients are substantially higher.
Quality Control during Endovascular Aneurysm Repair: Monitoring Aneurysmal Sac Pressure and Superficial Femoral Artery Flow Velocity
Authors: Treharne Gareth D. , Loftus Ian M. , Thompson Matthew M. , Lennard Nicola , Smith Julia , Fishwick Guy , Bell Peter R.F.
Published: March 2015

Purpose:

To use intraoperative aneurysmal sac pressure measurement and flow monitoring of the superficial femoral artery (SFA) to ensure complete exclusion of the aneurysm from the circulation.

Methods:

A 5F catheter was positioned in the aneurysmal sac of 15 consecutive patients undergoing endovascular aortomonoiliac aneurysm repair between February and September 1997. The catheter was connected to an external pressure transducer allowing pressure monitoring throughout the operation and for 24 hours postprocedurally. Flow velocity was monitored in the contralateral SFA by insonation with a 2-MHz Doppler ultrasound probe.

Results:

No technical defect was observed in the deployment of 10 endografts, which demonstrated marked reduction in sac pressure and good flow in the lower limb. The mean aneurysm pressure dropped from 123 to 57 mmHg after graft insertion. In 5 cases, monitoring detected problems during the endograft procedure. In 3, incomplete stent deployment was detected by a failure of sac pressure to fall following stent inflation and by the presence of flow in the contralateral femoral artery. In the other 2 cases, a distal endoleak was detected by direct injection of contrast into the sac.

Conclusions:

Measuring aneurysm pressure in combination with SFA Doppler flow monitoring can detect complications of endovascular aneurysm repair.
Histology and Electron Microscopy of Explanted Bifurcated Endovascular Aortic Grafts: Evidence of Early Incorporation and Healing
Authors: Shin Chung K. , Rodino William , Kirwin Jon D. , Ramirez Jose A. , Wisselink Willem , Papierman Gary , Panetta Thomas F.
Published: March 2015

Purpose:

To report an examination of explanted bifurcated endovascular aortic grafts for histologic evidence of early healing and incorporation.

Method:

Two bifurcated endovascular aortic grafts composed of polycarbonate urethane and Elgiloy wire were explanted 42 and 21 days after successful endovascular exclusion of abdominal aortic aneurysms. Both patients expired from causes unrelated to endograft deployment. The explanted devices were examined using immunohistochemical analysis and electron microscopy.

Results:

On explantation, both grafts appeared to have excluded the aneurysm with no evidence of endoleak, graft migration, or thrombosis. Histological examination showed numerous inflammatory cells and good ingrowth of tissue into the proximal 2 cm of the graft. Collagen and smooth muscle cells were evident in the proximal portion of the graft with only collagen in the distal segments. Neointimal formation was seen within the proximal 2 cm also, but not at the distal segments. Macrophages were present in the graft. Scanning electron microscopy showed an extensive matrix of fibers that most likely represented collagen.

Conclusions:

Bifurcated endovascular aortic grafts show inflammatory and mild foreign body reactions, collagen formation, and intimal ingrowth during healing. These findings are similar to some of the healing properties reported for sutured grafts, as well as other endovascular grafts.
Graft-Wall Endoleak 18 Months after Successful Endoluminal AAA Repair
Authors: Midorikawa Hirofumi , Hoshino Shunichi , Iwaya Fumio , Igari Tsuguo
Published: March 2015

Purpose:

To describe a case of graft-wall endoleak 18 months after successful endoluminal repair of an abdominal aortic aneurysm (AAA).

Methods and Results:

A 71-year-old man with infrarenal AAA was successfully treated with an endoluminal aortomonoiliac graft and femorofemoral crossover bypass with surgical ligation of the right external iliac artery. The stent-graft was made from 2 Gianturco Z-stents and a tapered thin-walled (0.1-mm) Dacron graft. Eighteen months after endografting, the patient complained of a pulsatile abdominal mass. Angiography and computed tomography showed graft-wall endoleak. Aneurysmectomy was performed, and the aneurysm was successfully replaced with a Y-shaped knitted Dacron graft. A hole in the graft wall was found 3 cm from the proximal edge of the stent-graft.

Conclusions:

This case suggests that the use of thin-walled graft material in endografts may not be sufficiently durable.
Immediate Stenting of Iliofemoral Occlusive Lesions: A Surgeon's Early Experiences
Authors: Cheng Stephen W.K. , Ting Albert C.W. , Lau Hung , Wong John
Published: March 2015

Purpose:

To report the early and midterm results of balloon angioplasty and immediate stenting of atherosclerotic iliofemoral lesions in an operating room setting.

Methods:

Sixty-one patients (41 men, mean age 70 ± 8 years, range 49 to 86) underwent balloon dilation and systematic stenting for 80 stenotic and occlusive lesions in the iliac (n = 47) and superficial femoral (n = 33) arteries in 72 limbs. One hundred two stents (63 VascuCoil, 33 Wallstent, and 6 miscellaneous) were placed. Patients were followed with serial duplex scans at 3-month intervals.

Results:

Initial technical success by intention-to-treat was 96.2% (77/80) (iliac: 100%, femoral: 90.9% [30/33]). There were 9 (11.3%) procedure-related complications and no deaths. Initial success by anatomic, hemodynamic, and clinical limb criteria were 100%, 95%, and 94.4%, respectively. Thirty procedures were performed for limb salvage with a success rate of 86.7%. Six patients (7 limbs) died during follow-up of unrelated causes. Fifty-nine (81.9%) limbs were available for duplex follow-up over a mean 17.7 months (range 3 to 37). Cumulative patency rates were 87.3% at 2 years for iliac stents and 66.6% at 18 months for femoral stents with an overall 2-year patency rate of 76.3%. The only independent risk factors affecting late patency were the site of angioplasty, stent diameter, lesion grade, and the preoperative ankle-brachial index. Stents placed with a diameter ≤ 5 mm and > 5 mm had 1-year patency rates of 51.0% and 97.6%, respectively (p = 0.004)

Conclusions:

Iliac and femoral angioplasty and immediate stenting have acceptable midterm patency rates. The patency of femoral stenting is inferior and is adversely affected by stents ≤ 5 mm in diameter.
Sequential Retroperitoneal Venous Hemorrhage and Embolism of an Angio-Seal Puncture Closure Device Complicating Iliac Artery Angioplasty
Authors: Tomlinson Mark A. , Beese Richard , Banwell Miles , Loosemore Tom , Buckenham Timothy M. , Dormandy John A.
Published: March 2015

Purpose:

To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma.

Methods and Results:

A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure.

Conclusions:

RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.
Prevention of Spinal Cord Ischemia in an Ovine Model of Abdominal Aortic Aneurysm Treated with a Self-Expanding Stent-Graft
Authors: Beygui Ramin E. , Kinney Edward V. , Pelc Lorie R. , Krievins Dainis , Whittemore Joshua , Fogarty Thomas J. , Zarins Christopher K.
Published: March 2015

Purpose:

To present novel techniques to prevent spinal ischemia during aneurysm creation and chronic bifurcated stent-graft implantation in an ovine model of abdominal aortic aneurysm (AAA).

Method:

Experimental AAAs were created in 38 sheep. To prevent spinal ischemia, an internal aortic shunt was used during aneurysm creation. In the animals designated to receive bifurcated stent-grafts, a left external iliac-to-internal iliac bypass was performed to revascularize the caudal artery and prevent postdeployment spinal cord ischemia. Specimens were harvested at 1 week, 1, 3, and 6 months, and 1 year.

Results:

Aneurysms were successfully created without paralysis in 35 animals. Two died due to aspiration pneumonia. Of the 33 animals implanted with endografts, 16 (94%) of 17 with straight devices and 15 (94%) of 16 with bifurcated stent-grafts survived with well-functioning, patent stent-grafts. Paralysis developed in 2 animals after endografting due to technical failures.

Conclusions:

The use of an internal shunt during aneurysm creation and internal iliac-to-external iliac transposition prior to bifurcated stent-graft deployment prevented spinal ischemia in an ovine AAA model. Chronically deployed stent-grafts were well tolerated.
Intravascular Ultrasound—Guided Vena Cava Filter Placement
Authors: Oppat William Frank , Chiou Andy C. , Matsumura Jon S.
Published: March 2015

Purpose:

To report a technique for the insertion of an inferior vena cava (IVC) filter under intravascular ultrasound (IVUS) guidance.

Technique:

Using a Seldinger technique, a single groin puncture provides the access for IVUS interrogation of the IVC. After the anatomy is defined with IVUS, the same guidewire is used for percutaneous IVC filter insertion. Intraoperative fluoroscopy, used as a backup, corroborates the proposed insertion location before deployment of the device. Postoperative flat-plate abdominal radiographs are used to confirm satisfactory position. IVC filters have been successfully placed in 9 patients with no complications related to IVUS-guided insertion.

Conclusions:

Intraluminal IVC interrogation using IVUS is ideally suited for the proper deployment of an IVC filter. The deployment of IVC filters under IVUS has the potential to further simplify an established therapy for deep venous thrombosis and pulmonary embolism.
Deformation of Self-Expanding Stent-Grafts Complicating Endovascular Peripheral Aneurysm Repair
Authors: Sitsen M. Elske , Ho Gwan H. , Blankensteijn Jan D.
Published: March 2015

Purpose:

To demonstrate the deformation of self-expandable stents after endovascular repair of peripheral aneurysms.

Methods and Results:

The Corvita Endoluminal Graft was used to treat a traumatic false aneurysm of the right subclavian artery and a common iliac artery aneurysm in 2 patients. In the subclavian case, the stent-graft showed a “cigar-shaped” deformation with hemodynamically significant stenoses at the proximal and distal ends at 3 months. In the second case, the same type of deformity was noted only 1 day after implantation. Two months later, the stent-graft occluded, necessitating surgical repair.

Conclusions:

Both cases demonstrate the possibility of stent deformation of self-expanding stent-grafts implanted at arterial sites not subject to external compression.
Successful Wallstent Implantation for Extensive Iatrogenic Renal Artery Dissection in a Patient with Fibromuscular Dysplasia
Authors: Damaraju Srikanth , Krajcer Zvonimir
Published: March 2015

Purpose:

To describe a case of renal artery stenosis with fibromuscular dysplasia (FMD) and extensive iatrogenic dissection treated with Wallstent implantation.

Methods and Results:

An 83-year-old woman with a history of coronary artery disease and hypertension presented at another facility with exertional angina and poorly controlled hypertension. Renal arteriography uncovered a critical right renal artery stenosis with severe FMD. However, angioplasty resulted in extensive dissection of the renal artery, for which the patient was referred to our institution. The renal artery was recanalized via the left brachial approach with restoration of flow using a Wallstent and a Palmaz stent. The patient's blood pressure was controllable after this procedure, and follow-up duplex imaging with flow velocities at 6 months showed patent right renal artery stents.

Conclusions:

Owing to its length and flexibility, the Wallstent endoprosthesis was a useful treatment modality in this case of extensive renal artery dissection.
Endovascular Treatment of a Posttraumatic Femoral Vein—Profunda Femoris Artery Fistula
Authors: Deshpande Arvind , Denton Michael
Published: March 2015

Purpose:

To describe successful endovascular management of a posttraumatic arteriovenous fistula (AVF) when a covered stent is unavailable.

Methods and Results:

An AVF developed between the profunda femoris and the femoral vein in a 59-year-old man undergoing a total hip revision procedure. No covered stent being available, a Dacron plug was inserted on top of scaffolding created by a conventional stent and embolization coils. Successful control of hemorrhage and resolution of the AVF was documented. Pulmonary embolization was avoided by using this scaffolding technique.

Conclusions:

Dacron can be used for occlusion of a medium-sized artery in an emergency situation in selected cases.
Gain Correction for an X-ray Imaging System With a Movable Flat Panel Detector and Intrinsic Localization Crosshair
Authors: Park Yang-Kyun , Sharp Gregory C.
Published: March 2015

Gain calibration for X-ray imaging systems with a movable flat panel detector and an intrinsic crosshair is a challenge due to the geometry-dependent heel effect and crosshair artifact. This study aims to develop a gain correction method for such systems by implementing the Multi-Acquisition Gain Image Correction technique. Flood field images containing crosshair and heel effect were acquired in 4 different flat panel detector positions at fixed exposure parameters. The crosshair region was automatically detected using common image processing algorithms and removed by a simple interpolation procedure, resulting in a crosshair-removed image. A large kernel-based correction was then used to remove the heel effect. Mask filters corresponding to each crosshair region were applied to the resultant heel effect-removed images to invalidate the pixels of the original crosshair region. Finally, a seamless gain map was composed with corresponding valid pixels from the processed images either by the sequential replacement or by the selective averaging techniques developed in this study. Quantitative evaluation was performed based on normalized noise power spectrum and detective quantum efficiency improvement factor for the flood field images corrected by the Multi-Acquisition Gain Image Correction-based gain maps. For comparison purposes, a single crosshair-removed gain map was also tested. As a result, it was demonstrated that the Multi-Acquisition Gain Image Correction technique achieved better image quality than the crosshair-removed technique, showing lower normalized noise power spectrum values over most of spatial frequencies. The improvement was more obvious at the priori-crosshair region of the gain map. The mean detective quantum efficiency improvement factor was 1.09 ± 0.06, 2.46 ± 0.32, and 3.34 ± 0.36 in the priori-crosshair region and 2.35 ± 0.31, 2.33 ± 0.31, and 3.09 ± 0.34 in the normal region, for crosshair-removed, Multi-Acquisition Gain Image Correction-sequential replacement, and Multi-Acquisition Gain Image Correction-selective averaging techniques, respectively. Therefore, this study indicates that the introduced Multi-Acquisition Gain Image Correction technique is an appropriate method for gain calibration of an imaging system associated with a moving flat panel detector and an intrinsic crosshair.
Alzheimer’s Disease and the Elderly in Israel
Authors: Werner Perla , Friedland Robert P. , Inzelberg Rivka
Published: March 2015

With the continuing rise in the elderly population, Alzheimer’s disease (AD) and dementia represent an increasing public health concern worldwide. In recent years, research has focused on the relationship between AD and ethnicity. Israel, a multiethnic society, provides a natural laboratory for research on ethnicity and health. The largest ethnic group is that of Israeli Jews, followed by Arab citizens, mostly Arab Muslims, with smaller numbers of Arab Christians in addition to Druze, Circassians, and others. The aim of this review is to clarify ethnic differences in prevalence and risk factors for Alzheimer’s disease. We review available literature on ethnic differences in epidemiologic and risk factors for Alzheimer’s disease, including genetic differences as well as disparities in health access and quality of health services. We will conclude with research and policy implications.
An Integrative Approach Using Third-Generation Cognitive-Behavioral Therapies for Avoidant Personality Disorder
Authors: Chan Chi C. , Bach Patricia A. , Bedwell Jeffrey S.
Published: March 2015

Evidence-based practice emphasizes the integration of empirically supported treatments with clinical expertise and unique client characteristics. The present study describes an integrative approach using Acceptance and Commitment Therapy (ACT) and skills training adapted from Dialectical Behavior Therapy (DBT) to treat a client with avoidant personality disorder (AvPD), comorbid adjustment disorder, and self-injurious behavior. The process of matching the therapies to the client and specific techniques to symptoms and problem behaviors is described. Ongoing clinical measures indicated reductions in depression, hopelessness, and anxiety. Behavioral measures indicated remission of cutting behavior and increases in social and physical activities. Results from a 1-month follow-up suggested maintenance of gains and continued reduction in symptoms. The Minnesota Multiphasic Personality Inventory–2 (MMPI-2) profile at follow-up as compared with pre-treatment indicated significant decreases in the client’s experience and perception of her symptoms. Endorsements on the Acceptance and Action Questionnaire–II (AAQ-II) at mid-treatment and follow-up suggested that the client achieved greater psychological flexibility. This case serves as evidence that individuals with AvPD and significant symptoms of anxiety and depression can be receptive to, and can benefit from, the integration of third-generation cognitive-behavioral therapies.
Effects of the Four-Herb Compound ANBP on Wound Healing Promotion in Diabetic Mice
Authors: Hou Qian , He Wen-Jun , Chen Li , Hao Hao-Jie , Liu Jie-Jie , Dong Liang , Tong Chuan , Li Mei-Rong , Zhou Zhong-Zhi , Han Wei-Dong , Fu Xiao-Bing
Published: March 2015

Wound healing is a troublesome problem in diabetic patients. Besides, there is also an increased risk of postsurgical wound complications for diabetic patient. It has been revealed that traditional Chinese medicine may promote healing and inhibit scar formation, while the changes of morphology and physiology of wounds on such medicine treatment still remain elusive. In this study, we first used the ultralow temperature preparation method to produce mixed superfine powder from Agrimonia pilosa (A), Nelumbo nucifera (N), Boswellia carteri (B), and Pollen typhae (P), named as ANBP. Applying ANBP on 40 streptozotocin (STZ)-induced diabetic C57BL/6 mice (4-6 weeks, 20 ± 2 g), we observed that the wound healing process was accelerated and the wound healing time was shortened (14 days, P < .05). Pathological observation using hematoxylin–eosin staining indicated that inflammatory cells were reduced ( P < .05) while the thickness of granulation tissue and length of epithelial tongue were increased ( P < .05). The vascular density was increased on 7 and 14 days after ANBP treatment. Masson and Sirius red staining showed that, at the early stage of trauma, the expressions of Col I and Col III, especially Col III, were increased in the ANBP group ( P < .05). Studies in vitro demonstrated that tubular formation was significantly increased after ANBP treatment on human vascular endothelial cells in a dose-dependent way. Taken together, our studies revealed that ANBP treatment could accelerate wound healing, promote vascularization, and inhibit inflammation, suggesting the potential clinic application of ANBP for diabetes mellitus and refractory wounds.
Making Paradigms Meaningful in Mixed Methods Research
Authors: Shannon-Baker Peggy
Published: March 2015

While recent mixed methods publications advocate for researchers’ explicit discussion of their paradigmatic foundations, more guidance is needed regarding how these paradigms can be used. This article comparatively analyzes four major paradigmatic perspectives discussed in mixed methods literature: pragmatism, transformative-emancipation, dialectics, and critical realism. It offers a discussion of each perspective’s implications for mixed methods and how they can be used to influence research based on recent publications. While there are several similarities, such as emphasizing divergent results and allowing for researcher choice in methods, each perspective offers a unique set of advantages and disadvantages. Emphasizing how paradigms can be used then promotes more explicit engagement with them in future research.
Implementing Mexico’s “Narcomenudeo” Drug Law Reform
Authors: Beletsky Leo , Wagner Karla D. , Arredondo Jaime , Palinkas Lawrence , Magis Rodríguez Carlos , Kalic Nicolette , Natasha-Ludwig-Barron  , Strathdee Steffanie A.
Published: March 2015

In 2009, Mexico decriminalized small-scale drug possession, instituting drug treatment diversion in lieu of incarceration. To assess initial reform impact, our mixed methods study integrated a structured questionnaire with in-depth interviews assessing legal knowledge, police encounters, and risk behaviors among people who inject drugs (PWID) in Tijuana. Between 2010 and 2013, we recruited 737 adults; 32 participated in qualitative interviews. Only 11% reported being aware of the reform; virtually none experienced its operational components. Narratives underscored the law’s irrelevance to PWID; 699 (98%) saw police practice as generally inconsistent with formal law. Instead of treatment diversion, police encounters were associated with risk behaviors, including syringe sharing (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.09-1.46) and polydrug use (OR = 2.11; 95% CI = 1.38-3.22). As drug policy reforms gain global momentum, ancillary structural interventions are needed to improve their public health benefit.
Outcome of two types of surgical correction of the extra phalanx in triphalangeal thumb: is there a difference?
Authors: Zuidam J. M. , Selles R. W. , de Kraker M. , Hovius S. E. R.
Published: March 2015

The surgical strategy of treatment of the opposable triphalangeal thumb is correction of the radio-ulnar deviation, reduction of the additional length and joint stabilization. The commonest procedures are: (1) removal of the extra phalanx and stabilization of the remaining joint; and (2) a combined reduction osteotomy with resection of the distal joint followed by arthrodesis. We treated 20 patients (33 hands). In 17 hands the extra phalanx was removed, and in 16 hands we used the combined osteotomy procedure of distal joint removal and arthrodesis. None of the patients in either group had an unstable interphalangeal joint. The mean radial or ulnar deviation in the interphalangeal joint was 5° degrees and 9°, respectively. Mean active flexion in the interphalangeal joint was 35° and 46°, respectively, in the two groups. Results for both procedures are similar, for both objective measures and self-rated function and activities of daily living. Either surgical approach seems reliable.

Therapeutic, Level of evidence: Level III
La contribución de los Centros Colaboradores de la OMS/OPS en los avances de la promoción de la salud en América Latina
Authors: Arroyo Hiram V. , Mantilla Uribe Blanca P. , Contreras Rengifo Adolfo , Westphal Marcia F. , Mendes Rosilda
Published: March 2015

Los “Centros Colaboradores” de la Organización Mundial de la Salud (OMS) son instituciones designadas para prestar apoyo estratégico en el desarrollo de los objetivos y la ejecución de las actividades de la OMS, y para generar capacidad institucional en países y regiones. En las Américas existen ocho Centros Colaboradores directamente relacionados a la promoción de la salud. Cuatro centros se ubican en Norteamérica y los otros cuatro en América Latina. El propósito de este artículo es describir los Centros Colaboradores de la Región de América Latina. Los centros han sido importantes en el desarrollo de la agenda de promoción de la salud de la región, la consolidación de la estrategia de entornos saludables y el fortalecimiento de las redes académicas y profesionales de promoción de la salud.