bluuebunny/crossref_metadata_2025 huggingface dataset:
Thrombus Characterization with Intravascular Ultrasound: Potential to Predict Successful Thrombolysis
Authors: Kwan Damon , Dries Andrew , Burton Tamara , Bhandari Guru , Young Daniel , Green Richard , Ouriel Kenneth , Greenberg Roy K.
Published: March 2015

Purpose:

To define analysis methods using radiofrequency (RF) data from intravascular ultrasound (IVUS) to characterize thrombus so that the success or failure of thrombolysis can be predicted.

Methods:

Experimentation was done in 2 phases: first, 40 clots created from platelet-rich (n = 20) and platelet-poor (n = 20) plasma were imaged with 20 and 30-MHz IVUS probes. The digitized RF signals were analyzed to determine the attenuation and slope of attenuation characteristics as a reference standard for the second part of the study. In this phase, 20 perfusion trials were performed with 10 platelet-rich and 10 platelet-poor samples in an in vitro arterial perfusion model; the composition of the samples was blinded during interrogation with IVUS. Alteplase (0.1 mg) was then infused directly into the thrombus for 1 hour; restoration of flow and amount of lysis were quantified.

Results:

Significant differences were detected for the integrated attenuation value (p<0.001) between platelet-poor and platelet-rich clots interrogated with a 30-MHz probe, but no differences were noted using the 20-MHz catheter. However, both transducers were capable of differentiating platelet-rich and platelet-poor clots using a slope of attenuation analysis, which was successful in identifying all 20 (100%) of the blinded clots in the in vitro model. The speed and completeness of lysis were significantly higher (p<0.05) for platelet-rich (78%) than platelet-poor (21%) clots.

Conclusions:

IVUS preprocessed imaging is capable of differentiating various types of thrombus. This information can be used to predict the success or failure of pharmacological lysis techniques.
Deep Circumflex Iliac Artery as a Cause of Type II Endoleak
Authors: Teh Lip Gen , van Schie Greg , Sieunarine Kishore
Published: March 2015

Purpose:

To report a collateral pathway involving the deep circumflex iliac artery causing a type II endoleak following endoluminal exclusion of an abdominal aortic aneurysm (AAA).

Case Report:

A 75-year-old man was investigated for a persistent type II endoleak 2 years after endovascular AAA repair with a Zenith Trifab stent-graft. Angiography revealed contrast in the sac from a lumbar artery fed via a collateral of the deep circumflex iliac artery. The lumbar artery was embolized with coils, but an endoleak persisted and is being followed.

Conclusions:

This collateral pathway is easily missed during angiography for endoleaks and should be considered where an endoleak is suspected but cannot be found.
Percutaneous Treatment of Placenta Percreta Using Coil Embolization
Authors: Dinkel Hans-Peter , Dürig Peter , Schnatterbeck Peter , Triller Jürgen
Published: March 2015

Purpose:

To report the use of embolotherapy to avoid hysterectomy in rare placenta percreta.

Case Report:

A pregnant 34-year-old woman (gravida 3, para 2) was admitted with premature rupture of membranes and vaginal bleeding in the 32nd week. Prenatal B-mode and Doppler ultrasound revealed marked hypervascularity of the placenta with disruption of the uterine-bladder interface consistent with placenta percreta. Since the patient insisted on uterine preservation, uterus and placenta were left in situ after caesarean section, which was followed by coaxial microcoil embolization of 6 pelvic arteries and postoperative methotrexate administration. Three months later, the patient had severe bleeding from the retained placenta, possibly under the influence of anticoagulation administered for pulmonary embolism. Emergent hysterectomy was performed.

Conclusions:

Coil embolization may avoid immediate hysterectomy and reduce peri-delivery blood loss in placenta percreta. However, retained placenta poses a serious risk, even after months, and secondary hysterectomy should be performed as an elective procedure after embolization.
A Comparison of Balloon-Mounted and Self-Expanding Stents in the Carotid Arteries: Immediate and Long-Term Results of More Than 500 Patients
Authors: Wholey Michael Henry , Wholey Mark Henry , Tan Walter A. , Eles Gustave , Jarmolowski Chester , Cho Simon
Published: March 2015

Purpose:

To compare the rates of neurological complications and restenosis for balloon-mounted (BM) versus self-expanding (SE) stents deployed in the extracranial carotid arteries.

Methods:

Among 513 patients (312 men; mean age 71.3 years, range 27–91) who underwent carotid artery stent placement, 496 received 520 stents. The patients were followed with periodic duplex ultrasound examinations; angiography was performed whenever the duplex scan identified a >50% stenosis or symptoms warranted investigation. Periproce-dural data on complications were analyzed on an intention-to-treat basis, while intermediate-term neurological complications were compared in stented patients.

Results:

In the periprocedural period, there were 19 (3.7%) transient ischemic attacks, 10 (1.9%) minor strokes, 6 (1.2%) major strokes, and 8 (1.6%) deaths among the 513 patients. Five (1.0%) of the deaths were related to neurological complications (3.9% all stroke/neurological death rate). Among the 496 patients receiving 247 (48%) BM stents and 273 (52%) SE stents in 518 arteries, the all stroke/neurological death rates were 3.6% and 4.0%, respectively (p>0.05). During a mean follow-up of 20.6 months (range to 5.6 years), the 3-year freedom from all fatal and ipsilateral nonfatal strokes excluding the 30-day periprocedural period was 95.0% for BM stents and 95.2% for SE devices. Vessel patency (>50%) at 3 years was 92.0% in the population: 96.3% for BM stents and 83.7% for SE stents (p=0.0422).

Conclusions:

The rate of neurological complications following carotid stenting has been relatively low overall, and no differences were found relative to the type of stent deployed. Vessel patency was excellent at 3 years, with slightly better patency in BM stents, but because of their vulnerability to compression, they will not replace SE stents.
Cytokine Activation and Intestinal Mucosal and Renal Dysfunction are Reduced in Endovascular AAA Repair Compared to Surgery
Authors: Junnarkar Sameer , Lau Luk Louis , Edrees Waleed K. , Underwood David , Smye Michael G. , Lee Bernard , Hannon Raymond J. , Soong Chee V.
Published: March 2015

Purpose:

To compare endovascular (EVR) to open repair (OR) of abdominal aortic aneurysm (AAA) for cytokine activation, changes in the intestinal mucosal barrier, and renal dysfunction.

Methods:

In a prospective nonrandomized study, 15 patients admitted to a university hospital for elective infrarenal AAA repair (8 OR and 7 EVR) were recruited. Intestinal permeability was assessed preoperatively (PO), at day 1 (D1), and at day 3 (D3) after surgery using the lactulose/mannitol differential excretion (LMR) test. Renal damage was assessed from measurements of the urinary albumin:creatinine ratio (ACR); cytokine activation was based on the urinary concentration of tumor necrosis factor receptor p55 (TNF-Rp55) at the same time points. Serum creatinine and urea concentrations were measured preoperatively and daily for 5 days postoperatively.

Results:

A significant increase in LMR was found in the OR group at D1 and D3 compared to PO (p<0.05). The LMR increase at D3 was significantly greater in the OR group (p<0.01). A significant difference was observed in the percentage rise in ACR on D1 in the OR group compared to the EVR group (p<0.005). The urinary TNF-Rp55 concentration was significantly elevated in the OR group at D1 (p<0.05) and D3 (p<0.05) compared to baseline; in the EVR group, it was elevated at D1 (p<0.05) compared to PO. The difference was also significant for this marker between the 2 groups at D1 (p<0.01). No significant change was observed in the serum creatinine or urea concentrations in either group perioperatively

Conclusions:

Endovascular AAA repair is associated with less cytokine production and less intestinal and renal dysfunction compared to the open approach.
Contrast-Enhanced Ultrasound Imaging for Aortic Stent-Graft Surveillance
Authors: Giannoni Maria Fabrizia , Palombo Giovanni , Sbarigia Enrico , Speziale Francesco , Zaccaria Alvaro , Fiorani Paolo
Published: March 2015

Purpose:

To compare unenhanced and enhanced ultrasound imaging to computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) for surveillance of aortic endografts.

Methods:

Thirty consecutive patients (29 men; mean age 69 years, range 50–82) who underwent endovascular aortic aneurysm repair agreed to participate in a follow-up program. Patients underwent CTA (26/30) or MRA (4/30), plain abdominal radiography, and unenhanced and enhanced ultrasound examinations at 3, 12, and 24 months to evaluate aneurysm diameter, endoleaks, and graft patency. The accuracy of ultrasound was compared with CTA or MRA as the reference standards.

Results:

Twenty-six patients reached the 24-month assessment (mean follow-up 30 months, range 6–60). All endoleaks detected by CTA or MRA were confirmed by enhanced ultrasound; the aneurysm diameter in these patients remained unchanged or increased. In patients without endoleaks on any imaging method, the sac diameter remained unchanged or decreased. Endoleaks disclosed by enhanced ultrasound alone, all type II, numbered 16 at 3 months, 6 at 12 months, and 3 at 24 months. In this group, the aneurysm diameter remained unchanged or increased. Enhanced ultrasound yielded 100% sensitivity in detecting endoleaks, but compared with CTA and MRA, all endoleaks detected by enhanced ultrasound alone were false positives (mean specificity 65%). Nevertheless, because changes in the postoperative aneurysm diameter were similar in patients with endoleaks detectable on CTA/MRA and on enhanced ultrasound (“true positives”) and in those with endoleaks detectable only on enhanced ultrasound (“false positives”), some endoleaks were possibly “true positive” results.

Conclusions:

Enhanced ultrasound is a useful method in the long-term surveillance of endovascular aortic aneurysm repairs, possibly in association with CTA or MRA. Enhanced ultrasound also seems able to identify endoleaks missed by other imaging techniques, but this conclusion awaits further investigation.
IVUS Guidance of Thoracic and Complex Abdominal Aortic Aneurysm Stent-Graft Repairs Using an Intracardiac Echocardiography Probe: Preliminary Report
Authors: Zanchetta Mario , Rigatelli Gianluca , Pedon Luigi , Zennaro Marco , Ronsivalle Salvatore , Maiolino Pietro
Published: March 2015

Purpose:

To report our learning experience using an intracardiac echocardiography (ICE) probe to guide endovascular aortic procedures.

Methods:

Between November 1999 and July 2001, 17 patients (12 men; mean age 73.1 ± 2.3 years) underwent endovascular repair of 9 thoracic, 6 complex abdominal, and 2 thoracoabdominal aortic aneurysms. The most suitable dimensions and configuration of the stent-graft were based on preoperative computed tomographic (CTA) or magnetic resonance (MRA) angiography. Intraoperative intravascular ultrasound (IVUS) imaging was obtained using a 9-F, 9-MHz ICE probe, 110 cm in length, inserted through a 10-F, 55° precurved long polyethylene sheath.

Results:

The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, interrogation with the ICE probe visualized the aortic arch and descending thoracoabdominal aorta without position-related artefacts and identified the sites of stent-graft fixation. After stent-graft deployment, visualization with the ICE probe detected the need for additional procedures in 8 patients, including 2 incompletely expanded thoracic grafts, which were treated with adjunctive balloon angioplasty. In 1 patient, ICE probe interrogation determined that the lesion was inappropriate for endovascular exclusion.

Conclusions:

ICE probe interrogation provides accurate information on the anatomy of thoracic and abdominal aortic aneurysms and allows rapid identification of attachment sites and stent-graft characteristics. It might be considered as a valid imaging modality for monitoring all phases of endovascular procedures.
Preoperative Embolization of Collateral Side Branches: A Valid Means to Reduce Type II Endoleaks after Endovascular AAA Repair
Authors: Bonvini Robert , Alerci Mario , Antonucci Francesco , Tutta Paolo , Wyttenbach Rolf , Bogen Marcel , Pelloni Angelo , von Segesser Ludwig , Gallino Augusto
Published: March 2015

Purpose:

To report the results of preprocedural embolization of collateral branches arising from abdominal aortic aneurysms (AAA) scheduled for endovascular repair.

Methods:

Twenty-three consecutive AAA patients (all men; mean age 73 years, range 56–82) had coil embolization of patent lumbar and inferior mesenteric arteries (IMA) in a staged procedure prior to endovascular repair. Embolization with microcoils was attempted in 37 of the 52 identified lumbar arteries and 14 of 15 inferior mesenteric arteries. Follow-up included biplanar abdominal radiography, spiral computed tomography, and duplex ultrasonography at 1, 30, 90, and 180 days after the stent-graft procedure and at 6-month intervals thereafter.

Results:

Successful embolization was obtained in 24 (65%) of lumbar arteries, while all 14 (100%) IMAs were occluded with coils. No complication was associated with embolotherapy. Over a mean 17-month follow-up of 22 patients (1 intraoperative death), there was only 1 (4.5%) type II endoleak from a patent lumbar artery, with no sac expansion after 2 years. There were 4 (18%) type I and 1 (4.5%) type III endoleaks.

Conclusions:

The embolization of side branches arising from an infrarenal aortic aneurysm before endovascular repair is feasible, with a high success rate; this maneuver may play a relevant role in reducing the rate of type II endoleak, improving long-term outcome.
Angioplasty and Elective Stenting of De Novo versus Recurrent Femoropopliteal Lesions: 1-Year Follow-up
Authors: Schillinger Martin , Mlekusch Wolfgang , Haumer Markus , Sabeti Schila , Ahmadi Ramazanali , Minar Erich
Published: March 2015

Purpose:

To investigate patency rates after percutaneous transluminal angioplasty (PTA) and PTA plus elective stenting in de novo versus recurrent femoropopliteal lesions.

Methods:

The data were collected from a prospective registry including 533 consecutive patients (284 men; median age 71 years, interquartile range [IQR] 72–78) with severe claudication (n=387) or critical limb ischemia (n = 146) who underwent femoropopliteal percutaneous interventions during a 36-month period. PTA was used to treat 357 de novo and 99 recurrent lesions; PTA plus elective stent implantation was performed in 58 de novo and 19 recurrent lesions. Patients were followed for a median 12 months (IQR 7–14) using color duplex sonography. Rates of restenosis (≥50%) were compared by multivariate analysis.

Results:

Overall primary technical success was achieved in 517 (97%) patients; 31 (6%) periprocedural complications were encountered. Restenosis occurred in 213 (40%) patients after a median 6 months (IQR 4–7). Twelve-month patency after PTA was 61% in de novo and 33% in recurrent lesions (p<0.0001). Patients with recurrent lesions had a 2.3-fold increased adjusted risk for restenosis after PTA (95% confidence interval 1.7 to 3.2). Twelve-month patency after stenting was 58% in de novo and 52% in recurrent lesions (p=0.9). In patients with de novo lesions, patency rates after PTA and stent were similar (p=0.8); however, in patients with recurrent lesions, elective stenting performed better (p=0.05).

Conclusions:

Recurrent stenosis after prior femoropopliteal balloon angioplasty is an independent risk factor for restenosis; these lesions exhibit disappointing patency after repeated PTA. Stent implantation may improve intermediate-term results in these patients.
Endovascular Brachytherapy after Percutaneous Transluminal Angioplasty of Recurrent Femoropopliteal Obstructions
Authors: Zehnder Thomas , von Briel Christian , Baumgartner Iris , Triller Jürgen , Greiner Richard , Mahler Felix , Do Dai-Do
Published: March 2015

Purpose:

To test the preventive effect of endovascular brachytherapy (EVBT) on restenosis following secondary angioplasty in patients with presumed neointimal restenosis in the femoropopliteal segment.

Methods:

From March 1997 through May 2000, 100 patients (58 men; mean age 70 years, range 45–87) with postangioplasty femoropopliteal segment restenoses were enrolled and randomized to treatment with repeat angioplasty and EVBT (n = 51) or to angioplasty alone (n=49) as control. The groups were similar with regard to demographics and lesion characteristics. High-dose-rate EVBT was performed with 192Ir irradiation without a centering device (12 Gy for a reference vessel radius of 3 mm and a 2-mm reference depth). Primary endpoint in the 1-year follow-up was recurrent obstruction >50% documented by duplex ultrasound; the secondary endpoint was clinical improvement.

Results:

Only 44 (86%) of 51 patients received adequate EVBT due to technical failure, so the 7 failures were included with the controls in the per-protocol adherence analysis. At 1 year, the patients receiving EVBT had a restenosis rate of 23% (10/44), which differed significantly (p<0.028) from the 42% (23/56) rate in controls. Clinical results tended to be better with EVBT, but differences did not achieve statistical significance.

Conclusions:

EVBT without a centering device reduced restenosis significantly in patients with recurrent stenosis after angioplasty, which confirms previous results in primary long-segment femoropopliteal obstructions.
Safety of Limited Supplemental Iodinated Contrast Administration in Azotemic Patients Undergoing CO2 Angiography
Authors: Dowling Kyran , Kan Herman , Siskin Gary , Stainken Brian , Ahn Jiyong , Herr Allen , Darling R. Clement
Published: March 2015

Purpose:

To determine if limited doses of iodinated contrast significantly worsen the underlying renal insufficiency that had warranted the use of CO2 for diagnostic angiography.

Methods:

The records of 122 consecutive patients who had undergone CO2 angiography for peripheral vascular disease at our institution over a 5-year period were reviewed. The volume and type of iodinated contrast and the volume of CO2 administered were recorded. Serum creatinine measurements obtained before angiography and from 2 to 3 days after angiography were recorded.

Results:

One hundred patients had pre-angiography and post-angiography creatinine levels available for analysis (51 CO2 only, 49 CO2 with iodinated contrast). The average pre-treatment creatinine level was 2.8±1.5 mg/dL (range 1.8–6.6) for the CO2 only group and 3.0±1.4 mg/dL (range 1.8–8.2) for the CO2 plus iodinated contrast group (p=0.46). After angiography, the mean change in creatinine was +0.17±0.87 mg/dL for the CO2 only group and +0.03±0.98 mg/dL in the CO2 plus contrast group (p=0.27). Complications included 1 patient with a failing renal transplant who received iodinated contrast and ultimately required return to hemodialysis. A second patient had a transient 1-mg/dL rise of creatinine but did not require dialysis.

Conclusions:

This study supports the relative safety of CO2 angiography with the limited used of iodinated contrast supplementation for diagnostic studies or interventions in azotemic patients with peripheral vascular disease.
The Trellis Thrombectomy System in the Treatment of Acute Limb Ischemia
Authors: Kasirajan Karthikeshwar , Ramaiah Venkatesh G. , Diethrich Edward B.
Published: March 2015

Purpose:

To report the use of a new percutaneous mechanical thrombectomy device in the treatment of acute limb-threatening ischemia.

Technique:

The Trellis Thrombectomy System is a 7-F drug dispersion catheter that features a treatment segment isolated by proximal and distal occlusion balloons, which help prevent distal embolization and systemic release of the infused thrombolytic agent. After inflating the distal balloon, the thrombolytic agent is infused and held at the target site by inflation of the proximal balloon. An oscillating dispersion wire optimizes dispersal of the thrombolytic agent as the thrombus is mechanically fragmented. The liquefied thrombus is then aspirated. Four consecutive patients with acute lower extremity ischemia secondary to bypass graft thrombosis were treated with the Trellis thrombectomy catheter. Overall, 95% of thrombus was successfully removed from the treatment zone, with no device-related complications. Only one patient required adjunctive thrombolytic therapy after thrombectomy with the Trellis device.

Conclusions:

The Trellis thrombectomy device is a safe and effective technique to isolate the infused thrombolytic agent in association with mechanical fragmentation for rapid blood flow restoration.
Early Experience with a Rotational Thrombectomy Device for Treatment of Acute and Subacute Infra-Aortic Arterial Occlusions
Authors: Zeller Thomas , Frank Ulrich , Bürgelin Karlheinz , Müller Christian , Flügel Peter , Horn Barbara , Schwarzwälder Uwe , Neumann Franz-Josef
Published: March 2015

Purpose:

To evaluate a rotational thrombectomy device in the treatment of acute and subacute/chronic thrombotic infra-aortic occlusions of native vessels and bypass grafts.

Methods:

From July 2000 to February 2002, 98 patients (65 men; mean age 66±9 years, range 47–90) with 100 thrombotic occlusions (mean age of occlusion 31±33 days, range 0–140) measuring an average of 21±11 cm long (range 2–40) were treated with rotational thrombectomy (Rotarex). There were 33 acute (≤14 days) thrombotic/embolic native artery occlusions (group I), 58 subacute/chronic (>14 days) native artery occlusions (group II), and 9 acute bypass graft occlusions (group III).

Results:

The device activation time was 4.9±1.4 minutes, during which 4.0±1.4 passes of the device were performed. The amount of aspirated fluid was 240±119 mL. Slightly less than half the arteries (48%) were stented. Primary success (residual stenosis <30%) was achieved in 92% (94% for group I, 93% for group II, and 78% for group III; 100% for the ipsilateral approach, 56% for the crossover approach). Among the 18 complications, 3 were serious (2 amputations after unsuccessful intervention and 1 death); there were 8 vessel perforations and 7 cases of peripheral embolization. Thirty-day survival and limb salvage was 88% for group I, 100% for group II, and 66% for group III.

Conclusions:

The device is an easy-to-handle, useful tool for ipsilateral treatment of acute and subacute thrombotic arterial and bypass graft occlusions. The use of this device is limited by the 8-F diameter of the catheter and the limited capacity for crossover interventions.
Thrombolysis and Mechanical Fragmentation to Treat Massive Pulmonary Embolism in a Patient with an Anterior Communicating Artery Aneurysm
Authors: Kutlu Ramazan , Alkan Alpay , Kocak Ayhan , Sarac Kaya
Published: March 2015

Purpose:

To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm.

Case Report:

An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated.

Conclusions:

Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.
A Percutaneous Approach to Deep Venous Valve Insufficiency with a New Self-Expanding Venous Frame Valve
Authors: de Borst Gerrit J. , Teijink Joep A.W. , Patterson Marlowe , Quijano Tino C. , Moll Frans L.
Published: March 2015

Purpose:

To ascertain if a percutaneously delivered venous valve bioprosthesis (PVVB) can be implanted in the porcine venous system and function without complications.

Methods:

The PVVB is a glutaraldehyde-preserved, valve-bearing venous xenograft sutured inside a memory-coded nitinol frame (diameter 10, 12, or 14 mm). In 10 50-kg pigs, the external jugular vein was exposed, and a 16-F introducer sheath was positioned in the common iliac vein. One PVVB was inserted and deployed in each iliac vein under fluoroscopic control. After PVVB implantation, all animals were randomly given either vitamin K antagonists (1–2 mg/d) (group I) or a combination of aspirin (150 mg/d) and clopidogrel (75 mg/d) (group II), which were shown in a preliminary pilot study to be the most effective anticoagulation regimens in the pig model. Ascending and descending completion phlebograms were performed. PVVBs were evaluated with phlebography at 4 weeks to assess patency and competence; all PVVBs were explanted and processed for histological analysis.

Results:

In 8 animals, the PVVB was successfully deployed in both the left and right iliac veins. In 2 pigs, only 1 PVVB was inserted due to vascular anomalies. Completion phlebography demonstrated 18 patent and competent valves. At 2 weeks, bleeding complications occurred in 3 group I pigs; all 5 animals were terminated to prevent further complications. Of the 8 valves in this group, 7 were patent (3 competent) by phlebography; 1 PVVB had migrated due to known undersizing of the stent frame. At 4 weeks, group II (5 pigs, 10 valves) analysis revealed 5 patent (3 competent) valves; no bleeding complications occurred in this group. Histology showed thrombosis as the cause of occlusion in all 5 non-patent valves from group II.

Conclusions:

Deployment of a glutaraldehyde-fixed bovine vein sutured to a self-expanding nitinol stent in the porcine iliac vein is technically feasible. Development of a venous bioprosthesis that can be placed percutaneously may have important clinical applications as an endovascular treatment for chronic venous insufficiency when it is due to valvular incompetence.
Venous Function after Restoring Valve Competence of the Great Saphenous Vein
Authors: Danielsson Gudmundur , Jungbeck Christel , Peterson Karin , Norgren Lars
Published: March 2015

Purpose:

To measure changes in venous function after elimination of great saphenous vein reflux using endovenously-applied heat with a specially designed catheter.

Methods:

In a prospective clinical study, 13 patients (8 women; mean age 39 years, range 25–59) with symptomatic chronic venous insufficiency were treated for reflux at the saphenofemoral junction. A radiofrequency catheter (Restore) with expandable electrodes that shrinks the vein by controlled constriction of subendothelial collagen was used to restore valve competence. Extirpation of local varicosities was performed simultaneously. Main outcome was change in venous function as measured by plethysmography (foot volumetry) and change in diameter and reflux time at the saphenofemoral junction after 6 and 12 months.

Results:

Reflux in the greater saphenous vein was eliminated or reduced to below 0.5 seconds in all patients. The venous function was significantly improved after 6 months' follow-up, with decreased refilling rate/expelled volume related to foot volume (p=0.019). The patients were clinically improved, although only 7 (54%) were entirely free from reflux. Three (21%) patients had thrombus in the vein the day after the treatment, 2 at the treatment site and 1 at the entry site of the introducer. After 1 year, the patients are still satisfied with the results, although venous function is no longer significantly improved compared to baseline.

Conclusions:

It is possible to safely restore valvular competence by means of internally shrinking the vein diameter. The venous function is improved, although the vein has a tendency to increase in width with time; limited reflux reappears, with deterioration of venous function.
Color Doppler Ultrasound Guidance during Renal Angioplasty and Stenting
Authors: Cianci Rosario , Zaccaria Alvaro , Lai Silvia , Coen Giorgio , Mander Antonio , Manfredini Paolo , Minnetti Marco , Clemenzia Gianfranco , Fiorani Paolo
Published: March 2015

Purpose:

To investigate whether an imaging technique combining color Doppler ultrasonography and selective renal artery digital subtraction angiography reduces contrast requirements in patients with progressive renal insufficiency undergoing renal artery angioplasty and stenting.

Methods:

Eight patients (5 men; mean age 58 years) with renal artery stenosis and renal insufficiency underwent percutaneous transluminal angioplasty and stenting under color Doppler ultrasound guidance.

Results:

Color Doppler ultrasound imaging yielded the information necessary for verifying catheter position, stent placement and expansion, and hemodynamics after revascularization. The combined imaging technique considerably reduced contrast requirements to only 10 mL in each case. No worsening of renal function was seen in any patient.

Conclusions:

The combined imaging procedure uses low doses of contrast agent and is especially suited to patients with renal dysfunction undergoing percutaneous renal revascularization.
Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer (Onyx)
Authors: Lupattelli Tommaso , Abubacker Ziyad , Morgan Robert , Belli Anna-Maria
Published: March 2015

Purpose:

To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent.

Case Report:

A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion.

Conclusions:

The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.
Endovascular Treatment of a Recipient Celiac Trunk Stenosis after Orthotopic Liver Transplantation
Authors: Yilmaz Saim , Çeken Kağan , Gürkan Alihan , Erdoğan Okan , Demirbaş Alper , Kabaalioğlu Adnan , Sindel Timur , Lüleci Ersin
Published: March 2015

Purpose:

To present the successful endovascular treatment of a severe recipient celiac trunk stenosis that led to allograft ischemia following liver transplantation.

Case Report:

A 56-year-old woman underwent orthotopic liver transplantation because of hepatitis C—induced cirrhosis. After the operation, routine hepatic Doppler ultrasonography showed a tardus parvus flow pattern in the hepatic artery, suggesting an impending hepatic artery thrombosis. Digital subtraction angiography (DSA), however, showed severe stenosis of the recipient celiac trunk and moderate splenic artery steal. The stenosis was dilated and stented in the same session. The postprocedural DSA showed good dilation of the lesion with immediate improvement of hepatic opacification. Follow-up Doppler ultrasound scans showed normal flow patterns in the hepatic artery at 3 and 6 months.

Conclusions:

In the presence of a tardus parvus flow pattern on Doppler ultrasound after liver transplantation, the possibility of an undetected recipient celiac stenosis should be considered in the differential diagnosis. Such lesions can successfully be treated with angioplasty and stenting.
Mediastinal Bronchial Artery Aneurysm Treated with a Stent-Graft
Authors: Kasashima Fuminori , Endo Masamitsu , Kosugi Ikuko , Matsumoto Yasushi , Abe Yoshinobu , Sasaki Hisao , Sanada Junichiro , Matsui Osamu
Published: March 2015

Purpose:

To report a rare case of mediastinal bronchial artery aneurysm successfully treated with an endovascular stent-graft.

Case Report:

A 79-year-old man with a history of tuberculosis was admitted to our hospital complaining of worsening hoarseness. Examination revealed a large mediastinal bronchial artery aneurysm located near the origin of the artery. Since neither surgical intervention nor transcatheter embolization was feasible, an endovascular stent-graft repair was performed using a newly developed stent-graft constructed from a nitinol stent and a thin membrane of polyester. Postprocedural angiography showed satisfactory exclusion of the aneurysm. The patient made an uneventful recovery. The 18-month computed tomographic scan documented continued exclusion of the aneurysm, with no evidence of endoleak, graft thrombosis, or migration.

Conclusions:

When conventional procedures are too complicated for bronchial artery aneurysms, endovascular stent-graft repair can be a useful approach.
Endovascular Treatment of an Acute Superior Mesenteric Artery Occlusion following Failed Surgical Embolectomy
Authors: Yilmaz Saim , Gürkan Alihan , Erdoğan Okan , Sindel Timur , Çeken Kağan , Lüleci Ersin
Published: March 2015

Purpose:

To present the successful primary stenting of a superior mesenteric artery (SMA) occlusion following failed surgical embolectomy.

Case Report:

A 65-year-old woman with a history of atrial fibrillation underwent surgical embolectomy of an acute embolic occlusion of the superior mesenteric artery (SMA). The following day, symptom recurrence suggested reocclusion, which was confirmed with emergent arteriography. Two balloon-expandable stents were deployed primarily, which ameliorated the patient's symptoms. Follow-up angiography at 3 months showed continued SMA patency, with no evidence of distal embolization or restenosis. The patient remains asymptomatic at 9 months after the stent procedure.

Conclusions:

Although more experience is required, primary stenting may be a valuable alternative in the treatment of acute SMA occlusions, in particular, for reocclusions after failed surgery.
Endoluminal Grafting for Percutaneous Aneurysm Exclusion in an Aortocoronary Saphenous Vein Graft: The First Clinical Experience
Authors: Heuser Richard R. , Reynolds Glenn T. , Papazoglou Constantine , Diethrich Edward B.
Published: March 2015

Purpose:

Aneurysms develop only rarely in aortocoronary saphenous vein grafts (SVGs), and the usual treatment is surgical replacement of the diseased segment. However, in patients at appreciable risk for redo surgery, alternative therapies are desirable. We report the first compassionate use of a percutaneously delivered endoluminal graft (ELG) for internal exclusion of an SVG aneurysm.

Methods:

A 47-year-old male with two coronary bypass procedures and SVG angioplasty presented with an 8-mm diameter aneurysm lying between 80% and 70% stenotic lesions in an SVG to the obtuse marginal branch. The risks of a third bypass operation were considerable, so the decision was made to attempt internal exclusion of the SVG aneurysm.

Results:

An ELG composed of 2.0-mm diameter unexpanded PTFE graft material with Palmaz stents for fixation was delivered with a low-profile system, but a second ELG was necessary for complete exclusion of the aneurysmal sac. Both ELGs were dilated after initial deployment. The patient was discharged after 9 days without sequelae, and he remains asymptomatic with arteriographically documented ELG patency 5 months after treatment.

Conclusions:

In this patient with limited therapeutic options, percutaneous aneurysm exclusion in an SVG was effective in restoring a viable blood conduit. It remains to be seen if ELGs have a potential in aortocoronary SVGs.
Long-term Results with the Palmaz Stent in the Superficial Femoral Artery
Authors: Bergeron Patrice , Pinot Jean J. , Poyen Vincent , Benichou Huber , Khanoyan Patrick , Rudondy Philippe , Wang Yu , Chiarandini Stefano , El Hussein Radwan , Rieu Regis , Larroude Laurence , Pelissier Robert
Published: March 2015

Purpose:

Femoral stenting has demonstrated inconsistent and often disappointing long-term results. To compare our experience, we retrospectively analyzed a series of patients who had Palmaz balloon-expandable stents placed exclusively for superficial femoral artery (SFA) lesions.

Methods:

From January 1990 to November 1993, 39 patients were evaluated for claudication (79%) or critical ischemia in 42 limbs. The culprit lesions were confined to the SFA: 24 (57%) occlusions and 18 (43%) stenoses, including 3 restenotic lesions. Stenting was elective in 12 (29%) cases: the 3 restenoses and 9 chronic, calcified occlusions. The remaining stents were applied for postangioplasty residual stenosis or angioscopic findings of thrombogenic luminal irregularities. A total of 55 prostheses were successfully implanted. All patients were maintained on ticlopidine and followed by routine duplex scanning. Follow-up angiography was performed in 28 (72%) patients between 4 and 45 months.

Results:

In the postprocedural period, two acute thromboses (4.8%) occurred within 48 hours in patients who had long occlusions and poor runoff; no other major complications were encountered, for a clinical success rate of 95%. Follow-up evaluation ranged from 4 months to 4 years with a mean of 25 months. The restenosis rate was 19% (34% in occlusions; 10% in stenotic lesions, p = NS). At 24 months, cumulative primary patency was 77% and secondary patency 89%.

Conclusions:

Palmaz stents performed well in the SFA, demonstrating a low acute thrombosis rate and good long-term patency. The incidence of restenosis is likely to be greater in occlusions than in stenoses.
Intraoperative Digital Subtraction Angiography after Thromboembolectomy: Preliminary Experience
Authors: Crolla Rogier M.P.H. , van de Pavoordt Eric D.W.M. , Moll Frans L.
Published: March 2015

Purpose:

To evaluate the potential influence of intraoperative digital subtraction angiography (DSA) on surgical strategy after balloon thromboembolectomy for acute lower limb ischemia.

Methods:

Thirty-six consecutive patients with critical limb ischemia were treated with balloon catheter thromboembolectomy assessed by intraoperative digital subtraction angiography. The need for further intervention was determined by the surgeon based on the DSA information. Primary completion DSAs were made in every procedure; subsequent completion DSAs were performed after reinterventions at the discretion of the surgeon.

Results:

Initial treatment in this patient group consisted of 14 embolectomies and 26 thrombectomies. From the completion DSAs of these 40 procedures, a reintervention was judged necessary in 27 (68%). Of these 27 reinterventions, 17 underwent a secondary DSA; evidence supporting a third intervention was found in 11 (64%). Overall, a total of 69 DSAs were performed in these patients. Mortality was 22% (8 patients); 38% (5) in embolectomy patients and 13% (3) in the thrombectomy cohort. Eighty-eight percent of the embolectomy survivors had an uneventful recovery, while only 25% of the thrombectomy survivors experienced an uncomplicated follow-up. In one quarter of the surviving thrombectomy patients, a surgical revascularization resulted in limb salvage; in 45%, a major amputation was the outcome.

Conclusions:

In this study, the completeness of balloon catheter thromboembolectomy was assessed by intraoperative DSA. As a result, 68% of the procedures required one or more reinterventions for residual lesions. Intraoperative DSA is a simple and quick technique that may be a promising adjunct to intraoperative balloon thromboembolectomy.
Endovascular Techniques in Adult Aortic Coarctation: The Use of Stents for Native and Recurrent Coarctation Repair
Authors: Diethrich Edward B. , Heuser Richard R. , Cardenas Joseph R. , Eckert Jordon , Tarlian Henry
Published: March 2015

Purpose:

To report initial experiences with stent implantation in the treatment of native and recurrent aortic coarctation in adults.

Methods:

Two adult patients were diagnosed with aortic coarctation: in one, the native aorta was involved, and in the other, the stenosis involved a prior coarctation repair. Both patients were offered and selected angioplasty with possible stent implantation as an alternative to surgery.

Results:

In the patient with recurrent narrowing, thrombolysis and balloon dilation preceded the successful deployment of three Palmaz stents along the grafted segment. In the case of native disease, one Palmaz stent was implanted primarily at the site of a critical, focal stenosis. No complications were encountered, and recovery was uneventful. Follow-up at 12 and 6 months, respectively, showed sustained clinical improvement with resolution of symptoms and excellent hemodynamic values.

Conclusion:

The positive outcome in these early cases supports further evaluation of the efficacy of adjunctive or primary stenting for treatment of native or recurrent aortic coarctation in adults.
Early Experience with the Sydney and EVT Prostheses for Endoluminal Treatment of Abdominal Aortic Aneurysms
Authors: May James , White Geoffrey H. , Yu Weiyun , Waugh Richard C. , Stephen Michael S. , McGahan Timothy J. , Harris John P.
Published: March 2015

Purpose:

The aim of this study was to report early experiences with the Sydney and Endovascular Technologies (EVT) prostheses for the treatment of abdominal aortic aneurysms (AAA) deemed suitable for endoluminal tube graft repair.

Methods:

Consecutive endoluminal tube graft repairs were analyzed over the first 12 months in which the Sydney and EVT prostheses were used. Patients eligible for the EVT prosthesis had type I AAAs: a proximal neck length ≥ 2 cm, a distal cuff length ≥ 1.5 cm, and nontortuous iliac arteries ≥ 8 mm. Selection criteria for the Sydney device were more liberal and included AAAs that had distal cuffs < 1.5 cm. During the study period, 28 of 91 patients evaluated for AAA repair were thus selected for endoluminal grafting: 18 patients received the Sydney endograft and 10 the EVT device. Medical comorbidities were present in slightly less than one third of patients in both groups. Contrast-enhanced computerized tomography (CT) was performed preoperatively, within 10 days of operation, and at 6 and 12 months postprocedure.

Results:

All endografts were successfully deployed in both groups. Postprocedural CT scans revealed incomplete aneurysm exclusion in four patients with the Sydney endograft. Subsequent deployment of a second endograft sealed these “leaks” in two cases; the other two were converted to open repair (89% clinical success). No leaks were seen with the EVT device. Local/vascular complications occurred in 33% of the Sydney group compared with 20% for the EVT device (p = 0.001); systemic sequelae were more common in the EVT group (30% versus 17% in the Sydney cohort, p = 0.002). There were no deaths within 30 days; three late deaths were not procedure related.

Conclusion:

AAAs that are suitable for endoluminal tube graft repair may be treated with a high rate of initial success with either the Sydney or EVT prostheses. More liberal selection criteria may increase the likelihood of local/vascular complications.
Angioscopic Evaluation of an Endoluminal Aortic Graft: The First Clinical Experience
Authors: Hill Bradley B. , Neville Richard , Hyde Gordon L. , Kuo Chien-Suu , Diethrich Edward B.
Published: March 2015

Purpose:

Balloon aortoscopy has been described for viewing aortic endoluminal anatomy and guiding aortic stent placement in animals. We report the first clinical use of this technique to visually inspect the proximal portion of a 1-year-old endovascular aortic graft, its proximal fixation stent, and its relationship to the renal arteries.

Methods:

The aortoscope is a modified fiber-optic endoscope that is fitted over the lens with a transparent, saline-filled balloon for blood displacement. Its performance was evaluated in a 62-year-old woman who had a Parodi-type Dacron/modified Palmaz stent endoluminal graft implanted to exclude an infrarenal aortic aneurysm in 1994. One year later, during an angioplasty procedure for symptomatic left subclavian and left common iliac artery stenoses, the 1-year-old endoluminal graft was inspected with the balloon-tipped angioscopic assembly.

Results:

Introduced via the left brachial artery, the aortoscope provided a panoramic view of the endoluminal surface through the solution-filled balloon. The endoluminal aortic graft was clearly identified, as were both renal artery orifices proximal to the graft. The surface of the proximal stent was smooth and without exposed metal. No complications occurred with the angioscopy technique.

Conclusions:

Aortic angioscopy can be used to evaluate endoluminal aortic grafts and endoluminal anatomy. It provides clear, magnified views that may be useful for guiding precise placement and assessing the function and healing of endoluminal devices in the aorta.
A New Access Site Management Tool: The Angio-Seal™ Hemostatic Puncture Closure Device
Authors: Henry Michel , Amor Max , Allaoui Mohamed , Tricoche Olivier
Published: March 2015

Purpose:

Given the increasing number of percutaneously applied endovascular therapies, the incidence of access-related vascular complications can be expected to rise, particularly in association with those techniques requiring large sheaths or anticoagulation. The need exists for a safe, easy to use, and effective hemostatic technique to replace the labor-intensive method of manual compression.

Methods:

A bioabsorbable, sheath-delivered vascular closure device (Angio-Seal™) has been developed that deposits a small collagen plug within the arterial wall to mechanically seal the puncture defect. An anchor connected by suture to the plug is first deployed in the arterial lumen and pulled flush against the interior arterial wall to guard against intraluminal deposition of the collagen.

Results:

The Angio-Seal device was deployed successfully in 80 (96%) of 83 attempts involving common femoral arteries accessed for peripheral angioplasty (n = 30), coronary angiography (n = 30), and coronary angioplasty (n = 16). Three popliteal artery access sites and one femoropopliteal bypass graft were also treated. Hemostasis was immediate in 78 cases (98%); 2 sites required a 5-minute manual compression to effect a secure seal. Three devices failed to deploy, and manual pressure was used to close the puncture. Nondeployment did not cause any sequelae, and no complications were encountered with the technique.

Conclusions:

This novel vascular closure device is quick (< 1 minute application time) and simple to use, providing a positive seal of common femoral artery puncture sites for both peripheral and coronary interventions. It appears to be a reliable alternative to standard manual hemostasis.