bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in Carotid Artery Flow Velocities after Stent Implantation: A Fluid Dynamics Study with Laser Doppler Anemometry
Authors: Greil Oliver , Pflugbeil Gottlieb , Weigand Klaus , Weiß Wolfgang , Liepsch Dieter , Maurer Peter C. , Berger Hermann
Published: March 2015

Purpose:

To study the influence of stent size and location on flow patterns in a physiological carotid model.

Methods:

Wallstents were positioned in silicon models of the carotid artery at various locations: 2 stents appropriately sized to the anatomy were placed in (1) the internal carotid artery (ICA) and (2) the ICA extending completely into the common carotid artery so as to cover the external carotid artery (ECA) orifice. Another 2 stents were placed in the ICA extending (1) partially and (2) completely into the bulb to simulate stent displacement and disproportion between stent size and the original vessel geometry. Measurements were performed with laser Doppler anemometry (LDA) using pulsatile flow conditions (Reynolds number=250; flow 0.431 L/min; ICA:ECA flow rate ratio 70:30) in hemodynamically relevant cross sections. The hemodynamic changes were analyzed with 1-dimensional flow profiles.

Results:

With the stent in the ICA, no changes of the normal flow profile were seen. For stents positioned in the ICA and extending partially or completely into the carotid bulb, the flow behavior was affected by the resistance of the stent to flow in the ECA. Hemodynamically relevant disturbances were seen in the ICA and ECA, especially in the separation zones (regions along the walls just after a bifurcation, bend, or curve). The ICA:ECA flow rate ratios shifted from 70:30 to 71.3:28.7 and from 70:30 to 75.1:24.9, respectively, in the 2 malpositioned stent models. With the stent placed in the ICA extending completely into the CCA, the ICA:ECA flow rate ratio shifted from 70:30 to 72.4:27.6. In this configuration, there were no notable flow changes in the ICA, but a clear diminishing of the separation zones in the ECA separation zones.

Conclusions:

Anatomically correct positioning of appropriately sized stents does not lead to relevant flow disturbances in the ICA. In the ECA, depending on the position, size, and interstices of the stent, the physiological flow was considerably disturbed when any part of the stent covered the inflow of the vessel. Disturbances were seen when the stent was positioned into the bulb. For clinical application, stent location and size must be carefully determined so that the stent covers the bifurcation completely or is in the ICA only.
Percutaneous Transluminal Angioplasty in the Treatment of Critical Limb Ischemia
Authors: Molloy Kevin J. , Nasim Akhtar , London Nick J.M. , Naylor A. Ross , Bell Peter R.F. , Fishwick Guy , Bolia Amman , Thompson Matthew M.
Published: March 2015

Purpose:

To assess the role of percutaneous transluminal angioplasty (PTA) to treat critical limb ischemia (CLI) and to relate the changing experience with endovascular treatment of this condition in a major vascular unit.

Methods:

A prospective study was performed involving 110 consecutive patients (57 women; mean age 76 years, range 57–99) undergoing balloon angioplasty for critical limb ischemia in 133 limbs. Outcome at 1 year was examined by case note review or questionnaire to determine survival, amputation-free survival, limb salvage, and CLI recurrence.

Results:

Technical success was achieved in 105 (79%) of 133 limbs; the overall complication rate was 20% (3.8% major, 16.2% minor). The median follow-up was 15 months (minimum 12). The 12-month limb salvage rate by life-table analysis was 88%. Patients with an initially successful angioplasty had an extremely good outcome (95% 1-year limb salvage). In contrast, the 28 patients with failed angioplasty fared very poorly; a major amputation was required in 10, and death occurred in another 9, leaving only 9 survivors with limbs intact at 1 year.

Conclusions:

The results of this study justify the continuing use of PTA as first-line treatment for critical limb ischemia.
Percutaneous Mechanical Thrombectomy for the Management of Venous Thoracic Outlet Syndrome
Authors: Schneider Darren B. , Curry Thomas K. , Eichler Charles M. , Messina Louis M. , Gordon Roy L. , Kerlan Robert K.
Published: March 2015

Purpose:

To describe the successful use of percutaneous mechanical thrombectomy as an adjunct to thrombolysis for acute subclavian vein thrombosis due to venous thoracic outlet syndrome

Case Report:

A 40-year-old man presented with arm swelling due to acute subclavian vein thrombosis and venous thoracic outlet syndrome. Percutaneous mechanical thrombectomy with the AngioJet device and thrombolysis were used to restore venous patency. Immediately following operative thoracic outlet decompression, the patient experienced rethrombosis, which was successfully treated using percutaneous mechanical thrombectomy. After 6 months, the patient remains symptom-free, with a patent subclavian vein by duplex ultrasonography.

Conclusions:

Thrombus debulking or removal with percutaneous mechanical thrombectomy devices may reduce the amount or duration of thrombolytic therapy required, making treatment of venous thoracic outlet syndrome safer. Moreover, patients with recurrent thrombosis after thoracic outlet decompression may be safely treated with percutaneous mechanical thrombectomy, even when thrombolytic therapy is contraindicated.
Infrainguinal Atherectomy Using the Auth Rotablator: Patency Rates and Clinical Success for 36 Procedures
Authors: Myers Kenneth A. , Denton Michael J.
Published: March 2015

Purpose:

To determine whether the Auth Rotablator device is suitable for endoluminal atherectomy for infrainguinal occlusive arterial disease.

Methods:

Two surgeons used the Auth Rotablator to perform 36 infrainguinal atherectomy procedures in 34 patients for severe intermittent claudication in 21, critical ischemia in 12, or graft stenosis in 3 limbs. There were 24 stenoses and 12 occlusions. Adjuvant balloon dilation was performed in 13 limbs and stenting in 5.

Results:

There was initial technical and anatomical success in 34 procedures (94%), and 24 technically successful procedures persisted at mean follow-up of 16.5 months, although 1 limb required major amputation. Three failures were due to stenosis requiring further intervention, and 9 were due to occlusion. Failure led to no further intervention in 2, amputation in 1, further endovascular intervention in 5, and open surgical reconstruction in 4 limbs. After further treatment, 29 limbs are patent with no return of symptoms, 3 are occluded, and 4 have required amputation, all for initial presentation with critical ischemia. Life-table analyses calculate primary and secondary patency rates of 61% and 67% and a clinical success rate of 56% at 12 months.

Conclusions:

Atherectomy using the Auth Rotablator provides acceptable results, but its role in comparison to other endovascular techniques is still to be defined.
Subclavian Stent Implantation to Alleviate Coronary Steal through a Patent Internal Mammary Artery Graft
Authors: Diethrich Edward B. , Cozacov Juan C.
Published: March 2015

Purpose:

Interventional techniques are rapidly supplanting conventional surgical therapies for the treatment of brachiocephalic occlusive disease. Although coronary-subclavian steal has been successfully alleviated with subclavian angioplasty, we report the first use of a Palmaz stent in the left subclavian artery (SCA) of a patient with a compromised left internal mammary artery (IMA) graft.

Methods and Results:

A 65-year-old male patient had undergone triple coronary artery bypass grafting in 1992, but 6 months later, severe narrowing occurred in two of the saphenous vein grafts, and arteriography identified a high-grade stenosis in the SCA supplying the left IMA graft to the left anterior descending coronary artery. Following balloon dilation of one saphenous vein graft stenosis, the left SCA was stented primarily with a P3008 Palmaz stent. Normal hemodynamics were restored, and the patient has been free of coronary steal symptoms for over 1 year.

Conclusion:

This case illustrates yet another aspect to the usefulness of intravascular stents in restoring and maintaining in flow to bypass grafts.
Aortic Aneurysm Morphology for Planning Endovascular Aortic Grafts: Limitations of Conventional Imaging Methods
Authors: Beebe Hugh G. , Jackson Tonya , Pigott John P.
Published: March 2015

Purpose:

To test whether conventional computed tomography scanning (CT) and contrast aortography (CA) provide adequate data for planning endovascular aortic grafting by measuring 33 parameters in patients having both imaging examinations for evaluation of abdominal aortic aneurysms (AAA).

Methods:

Fifty consecutive patients with AAA (41 men, 9 women; average age 65 years) had CT and CA (mean 26 days between exams). The data collected and analyzed included: 8 sites of diameter, 4 lengths, 6 angles, and 15 other dimensional measurements.

Results:

Conflicts between CA and CT data were common. Eighteen patients appeared to have a distal cuff by CA but not by CT. Proximal neck length could not be assessed by CT in 5 and had a difference between CA and CT > 1 cm in 25 patients. CA overestimated neck length in 11 patients. Common iliac artery angulation > 60° occurred unilaterally in 27 patients and bilaterally in 5. Seven patients had both iliac aneurysm and > 60° iliac angulation. Thirteen patients had one or more iliac aneurysms (> 2 cm) shown by CT but not by CA.

Conclusions:

For endovascular graft planning: (1) more detailed measurement is required than for traditional surgery; and (2) conventional CT and CA are complementary imaging studies, but each has important limitations.
Closure of a Popliteal Arteriovenous Fistula Using an Autologous Vein-Covered Palmaz Stent
Authors: Dorros Gerald , Joseph George
Published: March 2015

Purpose:

To report the use of autologous vein to cover a stainless steel stent designated for repair of a traumatic popliteal arteriovenous (AV) fistula.

Methods and Results:

Autologous cephalic vein was harvested to cover a Palmaz biliary stent selected to close a traumatic popliteal AV fistula that persisted despite reparative attempts with balloon occlusion and coil embolization. The vein-covered stent was delivered percutaneously and deployed, successfully obliterating the vascular communication. Patency of the popliteal artery was documented arteriographically at 5 months, and symptomatic improvement continues at 10 months.

Conclusion:

The simplicity of this percutaneous approach and the use of autologous vein to cover endovascular prostheses create the possibility for evaluating this technique in myriad anatomical situations.
Magnetic Resonance Acquisition to Determine the Lumen Length of a Tortuous Phantom Aorta
Authors: Liu Yu , Sampson Cynthia , Dorros Gerald , Wann L. Samuel , Parodi Juan
Published: March 2015

Purpose:

Endovascular abdominal aortic aneurysm repair is a technique that requires an accurate measurement of the aneurysm's lumen length prior to the procedure. This study examines the accuracy of luminal length measurement in an aortic phantom using magnetic resonance angiography (MRA) axial source images.

Methods and Results:

Tortuous phantom aortas were constructed using water-filled plastic tubing (7 mm in diameter with lengths of 80 to 160 mm). The tubes were molded into three-dimensional “S” or “C” shapes that simulated the luminal course of a tortuous aorta. Phantoms were imaged at angles of 0°, 15°, 30°, and 45° to the image slice direction on a 1.5T Signa MR scanner using a transaxial two-dimensional time-of-flight (TOF) and a Tr weighted spin-echo acquisition. The luminal length of the phantom was calculated after establishing the lumen center coordinates in axial source images and then measuring the distance between two sequential slices using the Pythagorean theorem. The accuracy of this measurement in the phantom was 89% to 99.6%, proportional to the length of the tubing. Accuracy was not affected by angulation of < 45°.

Conclusion:

Two-dimensional TOF MRA source images can provide an accurate measurement of the phantom aorta's lumen length.
Superficial Femoral Endarterectomy with Intraarterial PTFE Grafting
Authors: Bray Alan E.
Published: March 2015

Purpose:

To report early experience with a new endovascular approach to treating occluded Wallstents™ in the superficial femoral artery (SFA).

Methods and Results:

A symptomatic female patient with a 20-cm SFA occlusion involving a 10-cm Wallstent placed 2 years previously was offered an endovascular intervention. However, when percutaneous recanalization techniques failed, a semiclosed endarterectomy was undertaken using a conventional ring stripper. Although the atherosclerotic core and stent were removed smoothly, a small perforation was seen in the distal SFA. To avoid surgical repair, the endarterectomized segment was lined endoluminally using a 3-mm diameter, thin-walled polytetrafluoroethylene graft. A 15-mm Palmaz stent was used for distal fixation, with a plasty procedure performed at the proximal arteriotomy. There were no postoperative complications, and the patient, who was discharged on the second day, remains asymptomatic with normal flow through the graft at 3 months.

Conclusion:

Newer endovascular techniques may be applied in concert with conventional semiclosed endarterectomy to successfully treat lengthy SFA occlusions, particularly those involving stents.
Bird's Nest Inferior Vena Caval Filter Migration into the Duodenum: A Rare Cause of Upper Gastrointestinal Bleeding
Authors: Al Zahrani Hasan Ali
Published: March 2015

Purpose:

To report the first case of a potentially catastrophic complication of vena caval interruption with a bird's nest filter.

Methods and Results:

A 55-year-old Saudi patient presented with hypovolemic shock from massive upper gastrointestinal hemorrhage. Endoscopy identified a metallic object penetrating the duodenum. Five years earlier, the patient had a bird's nest vena caval filter inserted for recurrent pulmonary embolism. During emergent laparotomy, a broken filter wire was found projecting into the duodenum, where it had induced three profusely bleeding ulcers. The wire was transected and the ulcers oversewn. A hook projecting from the inferior vena cava (IVC) was also cut flush with the vessel wall, but the IVC was not opened nor the filter replaced. The patient's postoperative course was complicated by deep venous thrombosis, but he recovered and is asymptomatic on warfarin anticoagulation after 1 year. Computed tomography (CT) at 1-year follow-up confirmed no further migration of the filter.

Conclusion:

This event reinforces the need to monitor patients with IVC filters over the long term, preferably using CT scanning, and to consider filter migration as a possible cause of upper gastrointestinal bleeding.
European Carotid Angioplasty Trial
Authors: Sivaguru Arulmaran , Venables Graham S. , Beard Jonathan D. , Gaines Peter A.
Published: March 2015

The Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS) is an international multicenter randomized trial, the primary aims of which are: (1) to determine the risks and benefits of carotid and vertebral artery transluminal angioplasty; and (2) to compare these with surgical treatment (carotid endarterectomy) or best medical treatment. Through the end of October 1995, 193 patients have been randomized (90 at our center). In this article, the rationale for the trial, its design and protocol, and the experience of our institution within the trial will be discussed.
Stenting in the Carotid Artery: Initial Experience in 110 Patients
Authors: Diethrich Edward B. , Ndiaye Mouhamadou , Reid Donald B.
Published: March 2015

Purpose:

To evaluate the feasibility, safety, and efficacy of intravascular stents in the treatment of extracranial carotid artery occlusive disease.

Methods:

According to protocol, stent therapy was offered to symptomatic patients with ≥ 70% arteriographically defined carotid stenoses or ulcerative lesions and, after September 1994, to asymptomatic patients with ≥ 75% stenoses. From April 1993 to September 1995, 110 nonconsecutive patients (79 males; mean age 72 years, range 45 to 85) consented to participate in the study. The majority (79 [72%]) were asymptomatic. Lesions meeting the treatment criteria were in the proximal common (n = 3); mid common (n = 12); distal common (n = 8); internal (ICA) (n = 92); and external (n = 2) carotid arteries. Seven patients had bilateral ICA stenoses, and 17 patients were treated for postsurgical recurrent disease. The mean lesion length and diameter stenosis for all lesions were 12.4 ± 9.2 mm and 86.5% ± 10.6%, respectively. The procedures were performed either via direct percutaneous access to the cervical common carotid artery or through a retrograde femoral artery approach. Standard balloon dilation preceded deployment of balloon-expandable stents in most cases. No postprocedural anticoagulation was used (aspirin only).

Results:

In 110 patients (117 arteries) intended for treatment, 109 (99.0%) (116 arteries [99.1%]) were successfully treated with 129 stents (128 Palmaz, 1 Wallstent). One percutaneous procedure failed (0.9%) for technical reasons (stent could not be deployed) and was converted to carotid endarterectomy. Minor complications included 4 cases of spasm (successfully treated with papaverine); 1 flow-limiting dissection (stented); and 6 access-site problems. There were 7 strokes (2 major, 5 reversible) (6.4%) and 5 minor transient events (4.5%) that resolved within 24 hours. Three patients were converted to endarterectomy (2.7%) prior to discharge; 1 stroke patient expired (0.9%), and another patient died of an unrelated cardiac event in hospital. In the 30-day postprocedural period, 2 ICA stents occluded (patients asymptomatic). Clinical success at 30 days (no technical failure, death, endarterectomy, stroke, or occlusion) was 89.1% (98/110). Over a mean 7.6-month follow-up (range 2 to 31), no new neurological symptoms developed. Another stent occlusion at 2 months and one case of flow-limiting intimal hyperplasia at 7 months were detected on routine duplex scanning in asymptomatic patients. Life-table analysis shows an 89% cumulative primary patency rate.

Conclusions:

Based on this early experience, carotid stenting appears feasible from a technical standpoint, with good midterm patency. However, the incidence of neurological sequelae is a serious problem. Technical enhancements and a more aggressive antiplatelet regimen may have a positive impact on these events.
Recurrent Carotid Disease: Will Stents Be an Alternative to Surgery?
Authors: Bergeron Patrice , Chambran Pascal , Benichou Hubert , Alessandri Christian
Published: March 2015

Purpose:

To report the results of balloon angioplasty in recurrent carotid occlusive disease and evaluate the potential for stent implantation.

Methods and Results:

Between April 1991 and September 1995, 15 patients with carotid restenosis underwent 17 endoluminal procedures in 3 common carotid and 14 internal carotid arteries. Two postdilation complications (dissection and acute occlusion) required prompt stenting; one common carotid artery was stented for postdilation residual stenosis. One recurrent lesion was also stented 6 months after initial angioplasty. One stroke, 1 silent cerebral infarction, and 3 transient ischemic attacks occurred in the balloon angioplasty patients (33% neurological complication rate). The common carotid stent patient died 3 days postoperatively due to hyperperfusion syndrome. Long-term follow-up in two stent patients showed no restenosis at 18 and 48 months, respectively. The 11 balloon angioplasty patients likewise have not demonstrated restenosis.

Conclusions:

Balloon angioplasty alone appears too risky for treating recurrent carotid disease. Stents may offer a safer alternative, particularly when implanted primarily.
Ultrasound Imaging during Endovascular Abdominal Aortic Aneurysm Repair Using the Stentor Bifurcated Endograft
Authors: Lie Torgrim , Lundbom Jan , Hatlinghus Staal , Grønningsaeter Aage , Ommedal Steinar , Aadahl Petter , Sæther Ola D. , Myhre Hans O.
Published: March 2015

Purpose:

To evaluate different ultrasound modalities during implantation and follow-up of endovascular grafts for abdominal aortic aneurysm (AAA) exclusion.

Methods:

Between February 1995 and May 1996, 18 patients (14 men; aged 49 to 80 years, mean 67) were treated with endovascular intervention for infrarenal AAA. Seventeen patients received Mialhe Stentor bifurcated grafts, while one patient was treated with a straight graft for pseudoaneurysm. During and after the implantation, 3.25- and 5-MHz annular array ultrasound probes were used for transabdominal visualization of the endograft. Intravascular ultrasound was applied in combination with angiography for postoperative control.

Results:

Intraprocedurally, transabdominal two-dimensional (2D) ultrasound successfully monitored guidewire passage from the groin into the main part of the bifurcated endograft for implantation of the second limb. All implantation procedures were technically successful, but four endoleaks were identified intraprocedurally by 2D ultrasound and angiography. One healed spontaneously, two were treated with endovascular techniques at 1 and 4 months, and the last leak was scheduled for repair when the patient died of probable myocardial infarction at 2 months. During follow-up, 2D ultrasound successfully visualized all the endografts; no endoleaks were found in up to 18 months of surveillance.

Conclusions:

Transabdominal ultrasound imaging could be valuable in bifurcated endograft deployment both for guiding guidewire insertion and for controlling wire position before the second graft limb is connected to the main graft. Provided that satisfactory visualization of the entire endograft can be obtained, ultrasound examination may possibly replace arteriography and computed tomographic scanning as a follow-up investigation.
Successful Embolization of Persistent Endoleak from a Patent Inferior Mesenteric Artery
Authors: van Schie Greg , Sieunarine Kishore , Holt Mike , Lawrence-Brown Michael , Hartley David , Goodman Marcel A. , Prendergast Frank J. , Khangure Mark
Published: March 2015

Purpose:

To report the successful endovascular occlusion of a persistent endoleak owing to collateral perfusion in a 1-year-old bifurcated aortic endograft.

Methods and Results:

An 81-year-old man underwent endovascular repair of a 5.5-cm abdominal aortic aneurysm (AAA) with a bifurcated stent-graft in 1995; collateral perfusion of the excluded aneurysm by retrograde filling of the patent inferior mesenteric artery (IMA) was noted postoperatively. At his 1-year follow-up, the mid-sac endoleak persisted on contrast-enhanced computed tomography. Using the superior mesenteric artery for access, the stump of the IMA was successfully embolized with glue.

Conclusions:

This case, which highlights the importance of documenting a patent IMA prior to AAA endografting, illustrates one option for the management of persistent collateral perfusion of endovascularly excluded aneurysms.
Acute Inflammatory Reaction Associated with Endoluminal Bypass Grafts
Authors: Hayoz Daniel , Do Do-Dai , Mahler Felix , Triller Jürgen , Spertini François
Published: March 2015

Purpose:

Nonspecific inflammatory reactions characterized by local tenderness, fever, and flu-like discomfort have been seen in patients undergoing endoluminal graft placement in the abdominal aorta or the femoral arteries. We undertook a study to assess the clinical and laboratory parameters of this inflammation.

Methods:

Ten patients with femoropopliteal artery (n = 9) or aortic (n = 1) lesions were treated with EndoPro System 1 stent-grafts made of nitinol alloy and covered with a polyester (Dacron) fabric. Eleven patients implanted with a bare nitinol stent served as the control group.

Results:

In the stent-graft group, four patients showed clinical signs of acute inflammation manifested by fever and local tenderness. Three of these patients suffered thrombosis of the stent-grafts during the first month of follow-up. Plasma levels of interleukin-1β and interleukin-6 in all stent-graft patients were markedly increased 1 day after intervention (7.3 ± 2.8 versus 90.2 ± 34.1 pg/mL and 15.6 ± 5.8 versus 175.5 ± 66.3 pg/mL, respectively; p < 0.01). This was followed by an increase in fibrinogen (3.0 ± 0.2 versus 5.0 ± 0.2 g/L; p < 0.05) and C-reactive protein (14.6 ± 3.3 versus 77.5 ± 15.0 mg/L; p < 0.01) at 1 week. No direct correlation between the inflammatory markers and symptoms could be found. In vitro analysis showed that individual components of the stent-graft did not activate human neutrophils, whereas the intact stent-graft itself induced a marked neutrophil activation.

Conclusions:

The component of the self-expanding stent-graft responsible for the nonspecific inflammatory reaction was not identified in this study. It is likely that the stent-graft itself or some as yet unrecognized element of the device other than the Dacron fabric or metal alloy may be a potent in vivo inducer of cytokine reaction by neutrophils.
Peripheral Atherectomy with the Pullback Atherectomy Catheter: Procedural Safety and Efficacy in a Multicenter Trial
Authors: White Christopher J. ,   PAC Investigators
Published: March 2015

Purpose:

To report the initial results of a newly designed catheter for percutaneous circumferential atherectomy in patients with lower extremity atherosclerotic occlusive disease.

Methods:

The Pullback Atherectomy Catheter (PAC) is an over-the-wire device that circumferentially debulks atherosclerotic lesions in peripheral arteries up to 6 mm in diameter. Pullback atherectomy with or without adjunctive balloon angioplasty was attempted in 190 patients (246 lesions) with lower extremity lesions ≤ 7.0 cm in length and a diameter stenosis > 50%.

Results:

Angiographic success was accomplished in 95% (234/246) of the of the lesions attempted. The baseline ankle-brachial index rose from 0.61 ± 0.20 to 0.83 ± 0.20 (p < 0.001) at 24 hours after the procedure. There were no major complications (distal emboli, dissection, thrombosis, or perforation requiring surgical correction) attributable to pullback atherectomy.

Conclusions:

The acute results of pullback atherectomy demonstrate an extremely high technical success rate and an excellent safety record for lower extremity percutaneous revascularization. The catheter facilitates debulking longer lesions, but it is limited to small-diameter (≤ 6 mm) peripheral vessels.
The Hydrolyser Thrombectomy Catheter: A Single-Center Experience
Authors: Henry Michel , Amor Max , Henry Isabelle , Tricoche Olivier , Allaoui Mohamed
Published: March 2015

Purpose:

To present a single-center experience with a mechanical hydrodynamic thrombectomy system (Hydrolyser) in native arteries, veins, and bypass grafts.

Methods:

The Hydrolyser is a 7F, double lumen, over-the-wire thrombectomy catheter. The device was used in 41 patients (22 males; mean age 68 years, range 40 to 90), with recent thromboses (aged 1 to 30 days, mean 8.7 ± 8.5), measuring from 4 to 35 cm long (mean 17.7 ± 9.5). The occlusions were located in native lower limb arteries (n = 28), bypass grafts (n = 8), superior venae cavae (n = 2), axillary vein (n = 1), and pulmonary arteries (n = 2).

Results:

Immediate technical success (residual clot < 50% of lumen diameter) was achieved in 34 patients (83%): 22/28 native arteries (78%), 7/8 bypass grafts (87%), and all pulmonary arteries, superior venae cavae, and the axillary vein. The 7 failed patients were treated surgically (bypass graft or Fogarty balloon). Adjunctive procedures were used to maximize luminal diameter: angioplasty (n = 29, with 13 immediate stent implantations), thromboaspiration (n = 17), and thrombolysis (n = 10). One case of distal embolism was the only complication (treated by thromboaspiration). At 30 days, 30 (73%) vessels remained patent.

Conclusions:

The Hydrolyser system is a promising concept for percutaneous thrombectomy. It is a quick, reliable, efficient device that may offer an alternative to thrombolysis and surgical thrombectomy.
Stenting of the Renal Artery to Improve Renal Function Prior to Thoracoabdominal Aneurysm Repair
Authors: Sullivan Timothy M. , Hertzer Norman R.
Published: March 2015

Purpose:

To report the successful staged treatment of a patient with a thoracoabdominal aortic aneurysm (TAA), who presented with renal insufficiency attributable to renal artery stenosis.

Methods and Results:

A 66-year-old woman with a 6-cm Crawford type IV TAA presented with uncontrolled hypertension (240/130 mmHg), worsening congestive heart failure, and progressive renal insufficiency (serum creatinine 3.8 mg/dL) caused by renal artery stenosis to a solitary functioning kidney. Renal artery stenting restored normal renal and pulmonary function, and elective TAA repair 6 weeks after percutaneous stenting was uneventful. Restenosis (50% diameter reduction) in the renal artery was found 10 months later and treated with repeat dilation. Secondary patency was maintained at follow-up 21 months after redilation.

Conclusions:

It appears feasible to use preliminary renal artery stenting to reduce operative risk in TAA surgical candidates with renal insufficiency secondary to renal artery stenosis.
Endovascular Grafting of a Popliteal Aneurysm Using the Saphenous Vein
Authors: Puech-Leão Pedro , Kauffman Paulo , Wolosker Nelson , Anacleto Alexandre Maiera
Published: March 2015

Purpose:

To report the successful endovascular exclusion of a popliteal aneurysm using a saphenous vein stent-graft.

Methods and Results:

A 1.9-cm popliteal aneurysm in a 75-year-old man was excluded by an endovascular stent-graft constructed from a segment of a greater saphenous vein to which a Palmaz stent was attached at its proximal end. The operation was performed through an open posterior approach to the distal popliteal artery. The stent-graft was introduced in retrograde fashion and passed up to the superficial femoral artery, where the proximal stent was deployed. Distally, a conventional anastomosis was performed with standard suture technique. Follow-up at 2 months shows continued exclusion of the aneurysm and patency of the bypass.

Conclusions:

Saphenous stent-grafting is a promising technique in the less invasive treatment of popliteal aneurysms. Further experience and longer follow-up are required before this technique can replace open surgery in clinical practice.
Carotid Plaque Characterization Using Digital Image Processing and its Potential in Future Studies of Carotid Endarterectomy and Angioplasty
Authors: Biasi Giorgio M. , Mingazzini Paolo M. , Baronio Lucia , Piglionica Maria Rosa , Ferrari Stefano A. , Elatrozy Tarek S. , Nicolaides Andrew N.
Published: March 2015

Purpose:

To corroborate the validity of a computerized methodology for evaluating carotid lesions at risk for stroke based on plaque echogenicity.

Methods:

The records of 96 carotid endarterectomy patients (59 men; median age 69.5 years, range 52 to 83) with stenoses > 50% were studied retrospectively. Forty-one patients (43%) had been symptomatic preoperatively. All patients had undergone computed tomography (CT) to detect infarction in the carotid territory and a duplex scan to measure carotid stenosis. Plaque echogenicity was analyzed by computer, expressing the echodensity in terms of the gray scale median (GSM). The incidence of CT-documented cerebral infarction was analyzed in relation to symptomatology, percent stenosis, and echodensity.

Results:

Symptoms correlated well with CT evidence of brain infarction: 32% of symptomatic patients had a positive CT scan versus 16% for asymptomatic plaques (p = 0.076). The mean GSM value was 56 ± 14 for plaques associated with negative CT scans and 38 ± 13 for plaques from patients with positive scans (p < 0.0001). However, there was no difference in the GSM value between plaques with > or < 70% stenosis. Furthermore, the incidence of CT infarction was 40% in the cerebral territory of carotid plaques with a GSM value < 50 and only 9% in those with a GSM > 50 (p < 0.001).

Conclusions:

Computerized analysis of plaque echogenicity appears to provide clinically useful data that correlates with the incidence of cerebral infarction and symptoms. This method of analyzing plaque echolucency could be used as a screening tool for carotid stent studies to identify high-risk lesions better suited to conventional surgical treatment.
Combined Surgical and Endovascular Removal of Thrombus Entirely Occluding a Bifurcated Aortic Stent-Graft
Authors: Rückert Ralph I. , Romaniuk Paul , Rogalla Patrik , Thieme Torsten , Umscheid Thomas , Stelter Wolf J. , Müller Joachim M.
Published: March 2015

Purpose:

To explore a method combining interventional, endovascular, and conventional surgical techniques for treating a completely occluded bifurcated stent-graft after endovascular aortic aneurysm repair.

Methods and Results:

A 60-year-old patient underwent endovascular repair of an abdominal aortic aneurysm (AAA) with a Talent bifurcated stent-graft. Five months later, after chronic thrombotic occlusion of the right iliac limb, he presented with acute occlusion of the entire stent-graft. Local intra-arterial infiltration thrombolysis successfully reconstituted flow through the main aortic segment and left iliac limb. With a combination of conventional surgical and intraoperative endovascular procedures, thrombectomy and recanalization of the right iliac limb was completed by stenting a severe stenosis of the proximal iliac limb.

Conclusions:

A combination of techniques may be essential for successful management of thrombotic complications after endovascular AAA repair.
Laparoscopic Aortic Aneurysm Resection
Authors: Edoga John K. , James Kevin V. , Resnikoff Michael , Asgarian Kourosh , Singh Deepak , Romanelli John
Published: March 2015

Purpose:

To describe a laparoscopic technique for resection of infrarenal abdominal aortic aneurysms (AAAs).

Methods:

The operation is based on the principle of retroperitoneal reinforced staple exclusion of the aneurysm sac with aortobifemoral or aortoiliac bypass using gas and gasless laparoscopic techniques. Patients were eligible for this procedure if their infrarenal AAAs (with or without iliac artery involvement) were considered appropriate for surgical resection; however, renal or other visceral arterial stenoses, aneurysmal disease requiring surgical treatment, and/or aneurysms of the hypogastric arteries excluded patients from laparoscopic AAA resection.

Results:

Of 31 candidates for this procedure, 9 were excluded owing to high surgical risk. Twenty-two patients (16 males; age range 62 to 88 years) were deemed appropriate for the laparoscopic procedure. Maximum aneurysm diameter ranged from 4.0 to 8.0 cm. The operation was completed successfully in 20 (91%) patients. Two (9%) deaths in high-risk patients admitted early to the study occurred within 30 days of surgery. The only major complication was an injured ureter, for which a nephrectomy was performed. Comparison to a historical cohort of conventionally treated patients showed that the study group needed less ventilator support, had shorter intensive care and hospital stays, and resumed diet earlier despite relatively prolonged anesthesia and aortic clamping times.

Conclusions:

The laparoscopic approach to infrarenal AAAs appears feasible, with several potential advantages in low- and moderate-risk patients. Once the technique is optimized, randomized prospective studies will be needed to verify the apparent benefits demonstrated by these initial patients.
Subfascial Perforator Vein Ablation: Comparison of Open versus Endoscopic Techniques
Authors: Sato Dean T. , Goff Charles D. , Gregory Roger T. , Walter Barry F. , Gayle Robert G. , Parent F. Noel , DeMasi Richard J. , Meier George H. , Wheeler Jock R.
Published: March 2015

Purpose:

To compare the outcomes and complications of open (OSPS) versus endoscopic subfascial perforator surgery (SEPS) for treatment of chronic venous insufficiency.

Methods:

Data were retrospectively collected on 25 patients who underwent 27 SEPSs from February 1996 to August 1997 and from 22 patients who underwent 29 OSPSs between March 1978 and May 1993. Outcomes were evaluated for postoperative complications, ulcer healing, recurrence, and venous dysfunction scores on the last follow-up for the SEPS group and at 1-year follow-up for the OSPS group.

Results:

The 2 groups were similar in age, sex, history of previous venous surgery, healed or active ulcers, etiology, deep venous incompetency, pathophysiology, and venous refill times. Eighteen (90%) of 20 active ulcers in the SEPS group healed with recurrences in 5 (28%) limbs at 7.5 ± 5.4-month follow-up. All 19 ulcers in the OSPS group healed, with recurrences in 13 (68%) limbs at 35 ± 35-month follow-up. Clinical venous dysfunction scores showed significant improvement following SEPS (10.0 ± 3.6 to 5.4 ± 4.1, p < 0.001) and OSPS (10.0 ± 3.2 to 6.7 ± 3.6, p < 0.001) with no significant difference between groups. Both groups also had significant improvement in anatomical and disability scores. There was no postoperative mortality in either group. The OSPS group had significantly more wound complications (45%) than the SEPS group (7%) (p < 0.005). The hospital stay and readmission rate for wound problems were also higher in the OSPS group.

Conclusions:

The early outcome showed equal improvement in clinical venous dysfunction scores in the 2 groups, but with significantly fewer complications in the SEPS group. Although the long-term durability of the endoscopic approach has not been determined, the short-term results would favor SEPS for treatment of severe venous insufficiency when perforator incompetence is a significant component.
Percutaneous Stenting of the Internal Carotid Artery: The European CAST I Study
Authors: Bergeron Patrice , Becquemin Jean-Pierre , Jausseran Jean-Michel , Biasi Giorgio , Cardon Jean-Marie , Castellani Lucien , Martinez Robert , Fiorani Paolo , Kniemeyer Peter
Published: March 2015

Purpose:

To report the results of a multicenter safety trial of percutaneous carotid stenting performed by vascular surgeons.

Methods:

Symptomatic or asymptomatic patients ≥ 65 years of age with internal carotid artery (ICA) stenoses ≥ 70% and ≤ 2-cm long were eligible for enrollment. The procedures were performed in an operating room with the choice of anesthesia and the percutaneous access site at the discretion of the surgeon. Only Palmaz stents were used.

Results:

From January 1, 1996 to December 31, 1997, 99 patients (74 men, mean age 70 years, range 51 to 94) were enrolled in the study. More than half (57 of 99 patients) were asymptomatic. The direct cervical approach was used predominantly (97%). Three (3%) cases were converted to surgery for inability to access the artery or deploy the stent (technical success 97%). No perioperative death or myocardial infarction was reported. Six (6%) procedural complications included 1 reversible arterial spasm, 2 dissections, 1 cervical hematoma, and 2 residual stenoses. One neurological event reversed within 7 days(1% minor stroke rate) and 4 (4%) transient ischemic attacks resolved within 24 hours. One (1%) asymptomatic early occlusion occurred 2 days postoperatively. No neurological event was observed in the 1- to 24-month follow-up (mean 13 months). Two (2%) patients died of nonprocedurally related causes. No stent compression was seen, but 1 asymptomatic occlusion and 3 asymptomatic, non-flow-limiting restenoses (2 < 40%, 1 at 60%) were found within 1 year (3% restenosis rate on an intention-to-treat basis). Patency was 98% at 1 year.

Conclusions:

The results of this trial support the contention that carotid stenting of short ICA lesions can be performed with a low neurological complication rate.
Endoluminal Repair of Aneurysms Containing Ostia of Essential Branch Arteries: An Experimental Model
Authors: Wisselink Willem , Abruzzo Frederick M. , Shin Chung K. , Ramirez Jose R. , Rodino William , Kirwin Jon D. , Panetta Thomas F.
Published: March 2015

Purpose:

To examine experimentally the feasibility of transfemoral endoluminal repair of aneurysms containing the ostia of essential branch arteries.

Methods:

In a canine model (n = 4), suprarenal aortic aneurysms were created by suturing an artificial patch onto an anterior arteriotomy. Following a 2-week recovery period, the dogs underwent endovascular exclusion of their aneurysms using an aortic stent-graft with separate renal artery branch grafts. Outcome was evaluated using angiography, intravascular ultrasound (IVUS), Doppler flow, invasive pressure monitoring, and autopsy, respectively.

Results:

Successful creation and subsequent endovascular exclusion of the aneurysm using aortic stent-grafts and separate bilateral renal artery stent-grafts was achieved in all trials. Angiographically, all aneurysms were excluded from aortic flow and all renal arteries were patent at completion of the procedure. With IVUS, good graft apposition and absence of perigraft flow were demonstrated in all animals. Mean pressure in the aneurysmal sac at completion of the procedure was 40 ± 7 mmHg, compared to a mean systemic blood pressure of 105 ± 8 mmHg (p < 0.05). At autopsy, no gross intimal damage was seen in the aorta or the renal arteries, and intact aortic grafts and branch grafts without twisting, coiling, or kinking were found in all trials.

Conclusions:

In an acute animal model, suprarenal aortic aneurysms can be excluded from the circulation with preservation of renal flow using an endoluminally placed aortic stent-graft with separate branch grafts.
Endotension after Endovascular Aneurysm Repair: Definition, Classification, and Strategies for Surveillance and Intervention
Authors: Gilling-Smith Geoffrey , Brennan John , Harris Peter , Bakran Ali , Gould Derek , McWilliams Richard
Published: March 2015

In the ongoing evolution of a categorization system for endoleak, the authors propose the term endotension to define persistent or recurrent pressurization of the aortic aneurysm sac after endovascular repair. Endotension is evidence that the aneurysm remains at risk of rupture and should, therefore, be considered an indication for secondary intervention. Management strategies and a grading system for endotension are offered.
Carotid Stenting with Cerebral Protection: First Clinical Experience Using the PercuSurge GuardWire System
Authors: Henry Michel , Amor Max , Henry Isabelle , Klonaris Christos , Chati Zukaï , Masson Isabelle , Kownator Serge , Luizy François , Hugel Michèle
Published: March 2015

Purpose:

To study the feasibility and safety of carotid angioplasty and stenting using a new cerebral protection device that temporarily occludes the distal internal carotid artery (ICA).

Methods:

Forty-eight high-risk patients (39 men, mean age 69.1 ± 8 years, range 54 to 86) with 53 ICA stenoses underwent percutaneous angioplasty and stenting via the femoral approach under cerebral protection afforded by a 0.014-inch GuardWire balloon occlusion device. Mean stenosis was 82.1% ± 9.65% (range 70 to 96) and mean lesion length was 16.0 ± 7.5 mm (range 6 to 50). Thirty-three (62%) lesions were calcified, and 38 (72%) were ulcerated. Thirty-two (60%) of the lesions were asymptomatic. With the occlusion balloon inflated in the distal ICA, the lesion was dilated and stented. The area was cleaned by aspiration and flushed via an aspiration catheter advanced over the wire. Blood samples were collected from the external carotid artery (ECA) and analyzed to measure the size and number of particles collected. Computed tomography and neurological examinations were performed the day after the procedure.

Results:

Immediate technical success was achieved in all patients with the implantation of 38 Palmaz stents, 8 Expander stents, and 11 Wallstents. Carotid occlusion was well tolerated in all patients but 1 who had multiple, severe carotid lesions and poor collateralization. Mean cerebral flow occlusion time was 346 ± 153 seconds during predilation and 303 ± 143 seconds during stent placement. Total mean flow occlusion time was 542 ± 243 seconds. One immediate neurological complication (transient amaurosis) occurred in a patient who had an anastomosis between the external carotid (EC) and ICA territories. Debris was removed in all patients with a mean 0.8-mm diameter catheter.

Conclusion:

Cerebral protection with the GuardWire device is easy, safe, and effective in protecting the brain from cerebral embolism. Larger studies are warranted.
Relocation of the Iliac Artery Bifurcation to Facilitate Endoluminal Treatment of Abdominal Aortic Aneurysms
Authors: Parodi Juan C. , Ferreira Mariano
Published: March 2015

Purpose:

To report a surgical technique to preserve the internal iliac arteries (IIAs) and facilitate endovascular repair of abdominal aortic aneurysms (AAAs) with extensive iliac artery involvement.

Technique:

A new iliac artery bifurcation is created surgically through an 8-cm lower left abdominal incision by implanting the IIA onto the distal external iliac artery either directly or by using a tube graft interposition. Careful technique is required to avoid embolic complications, but after relocating the bifurcation, aortic endografting can be performed, either simultaneously or staged, depending upon patient characteristics.

Conclusions:

Relocation of the iliac artery bifurcation appears to be a good alternative to preserve pelvic arterial flow in selected candidates for endoluminal AAA repair.
Endovascular Repair of Abdominal Aortic Aneurysm Using a Pararenal Fenestrated Stent-Graft
Authors: Faruqi Rishad M. , Chuter Timothy A. M. , Reilly Linda M. , Sawhney Rajiv , Wall Susan , Canto Catherine , Messina Louis M.
Published: March 2015

Purpose:

To report an unusual case of endovascular abdominal aortic aneurysm (AAA) exclusion in which a fenestrated stent-graft was used to seal a proximal Type I endoleak.

Methods and Results:

An 84-year-old man with a 6.0-cm AAA underwent an aortomonoiliac aneurysm exclusion procedure that was complicated by a proximal endoleak. Because the patient had no right kidney, an additional stent-graft was designed to cover the right renal artery stump while preserving left renal perfusion through a fenestration in the graft material. This approach was successful in obliterating the endoleak around the proximal attachment site, but flow through the lumbar arteries remained.

Conclusions:

The use of a fenestrated stent-graft is feasible, but the type of fenestration in this case has limited applicability owing to the rarity of patients with suitable anatomy.
Verbal Memory and Brain Aging
Authors: Libon David J. , Preis Sarah R. , Beiser Alexa S. , Devine Sherral , Seshadri Sudha , Wolf Philip A. , DeCarli Charles , Au Rhoda
Published: March 2015

Objective:

Analysis sought to determine whether Wechsler Memory Scale-Logical Memory (LM)-correct responses and errors were related to magnetic resonance imaging (MRI) brain volume measurements.

Methods:

The LM immediate (LM-I) and LM delay (LM-D) free recall correct responses and related and unrelated errors were scored. Principal components analysis yielded a 3-factor solution: LM-I and LM-D correct responses, LM-I and LM-D-unrelated errors, and LM-I/-D-related errors. The MRI total cerebral brain volume, frontal brain volume, temporal horn volume (THV), and white matter hyperintensities volume (WMHIV) were obtained.

Results:

Increasing THV (suggesting greater regional atrophy) was associated with lower scores on the LM-correct responses factor. Extensive WMHIV was associated with higher scores on the LM-related errors factor.

Conclusion:

These results suggest that LM-correct responses could relate to emerging brain alterations. Longitudinal research might enhance the sensitivity of this test to identify preclinical impairment and persons at risk of mild cognitive impairment and dementia.