bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical treatment of varicose veins and venous malformations in Klippel–Trenaunay syndrome
Authors: Malgor Rafael D , Gloviczki Peter , Fahrni Jennifer , Kalra Manju , Duncan Audra A , Oderich Gustavo S , Vrtiska Terri , Driscoll David
Published: March 2015

Background

Klippel–Trenaunay syndrome (KTS) is a mixed mesenchymal malformation characterised by varicose veins, venous and capillary malformations, and hypertrophy of soft tissue and bone. The purpose of this study was to evaluate the surgical outcomes in KTS patients to provide standards for comparison with endovenous therapy.

Methods

The clinical data of consecutive patient with KTS who underwent open venous surgical treatment between January 1987 and December 2008 were reviewed. Demographics, clinical presentation, operative data, and clinical outcomes were recorded. Follow-up information was obtained from the medical records, mailed questionnaires and phone calls. Descriptive statistics, the Kaplan–Meier method and Log-rank statistics were used where appropriate.

Results

Twenty-seven females and 22 males, (mean age 26.5 years, range 7.7–55.8) were included in this study. All had varicose veins, 36 (73%) had limb hypertrophy, and 33 (67%) had capillary malformations, with two of three clinical features present in all. The most frequent symptom was pain (N = 43, 88%). Forty-nine patients underwent operations on 53 limbs. Stripping of the GSV, small and accessory saphenous and lateral embryonic veins was performed in 17 (32%), 10 (19%), 9 (17%), and 15 (28%) limbs, respectively. Two patients developed deep vein thrombosis, one had pulmonary embolism (PE), and one patient had peroneal nerve palsy. Freedom from disabling pain at 1, 3 and 5 years was 95%, 77% and 59%, respectively, and freedom from secondary procedures was 78% at 3 years, and 74% at 5 years. At the last follow-up visit, the venous clinical severity score had decreased from 9.48 ± 3.27 to 6.07 ± 3.20 (P < 0.001).

Conclusions

In selected symptomatic patients with KT syndrome, open surgical treatment is safe and durable. Three-fourths of the patients remain free of disabling pain at five years, but secondary procedures are required in one-fourth of the patients. These data can serve as standards for comparison of endovenous therapy for KT syndrome.
Quantitative volumetric analysis of head and neck venous and lymphatic malformations to assess response to percutaneous sclerotherapy
Authors: Alexander Matthew D , McTaggart Ryan A , Choudhri Omar A , Pandit Rajul P , Wu Allison , Ross Michael , Do Huy M
Published: March 2015

Background

Venous and lymphatic malformations of the head and neck can be successfully treated with percutaneous sclerotherapy.

Purpose

To examine the utility of three-dimensional volumetric analysis to assess these lesions and their response to therapy.

Material and Methods

Prospectively maintained procedure records were retrospectively reviewed to identify all patients with vascular malformations who underwent percutaneous sclerotherapy. Clinical data were used to classify lesions by apparent size and degree of visible physical asymmetry due to the lesions. Lesion volume was calculated using magnetic resonance images. Cohen’s weighted kappa coefficients were calculated to assess both intra- and inter-rater agreement. Pearson coefficients were calculated to identify correlation between clinical and volumetric measures, both at initial diagnosis and following treatment.

Results

Thirty-seven patients with head and neck venous or lymphatic malformations underwent 55 treatment sessions. Cohen’s weighted kappa coefficients were 0.84 and 0.77 for intra- and inter-rater agreement, respectively. Clinical size did not significantly correlate with measured volume at diagnosis (ρ = 0.08, P = 0.57). For lymphatic malformations, total lesion volume correlated with volume of macrocystic components (ρ = 0.47, P < 0.01). Total volume reduction significantly correlated with clinical response grade (ρ = 0.46, P = 0.02). For lymphatic malformations, reduction of volume of the macrocystic component significantly correlated with clinical response grade (ρ = 0.44, P = 0.03).

Conclusion

Changes in calculated volume corresponded to clinical measures of treatment response. Variability of qualitative approaches to lesion analysis may have led to the lack of correlation between initial size of a lesion based on clinical measures and calculated volume. Future research should include quantitative metrics to augment qualitative clinical results.
Abnormal inhibition-excitation imbalance in migraine
Authors: Nguyen Bao N , McKendrick Allison M , Vingrys Algis J
Published: March 2015

Background

People with migraine show increased surround suppression of perceived contrast, a perceptual analogue of centre-surround antagonistic interactions in visual cortex. A proposed mechanism is that cortical ‘hyperexcitability’ or ‘hyperresponsivity’, a prominent theory in the migraine literature, drives abnormal excitatory-inhibitory balance to give increased local inhibition. The purpose of this cross-sectional study was to determine whether cortical hyperresponsivity and excitatory-inhibitory imbalance manifests in the visual cortical response of migraine sufferers.

Methods

Interictal steady-state visual evoked potentials (VEPs) in response to 0 to 97% contrast were recorded in 30 migraine participants (15 without aura, 15 with aura) and 21 non-headache controls. Monotonicity indices were calculated to determine response saturation or supersaturation. Contrast gain was modelled with a modified saturating hyperbolic function to allow for variation in excitation and inhibition.

Results

A greater proportion of migraine participants (43%) than controls (14%) exhibited significant VEP supersaturation at high contrast, based on monotonicity index (chi-square, p = 0.028). Supersaturation was also evident by the trend for greater suppressive exponent values in migraine compared to control individuals (Mann-Whitney rank sum, p = 0.075).

Conclusions

Supersaturation in migraine is consistent with excess excitation (hyperresponsivity) driving increased network inhibition and provides support for excitatory-inhibitory imbalance as a pathophysiological disturbance in migraine.
Melding Service Learning and Leadership Skills Development
Authors: Lester Scott W.
Published: March 2015

The author presents keys to designing a class that successfully melds service learning and student leadership development. These prescriptions are based on the lessons learned over 8 years of teaching a class titled “Community Leadership.” This class emphasizes experiential learning and revolves around service learning projects. The article begins by describing the theoretical foundations that informed the decision making during the ongoing development of this class. Next, the planning process that occurred prior to the initial offering of the course is discussed. Feedback from researching other leadership programs, conversations with local community leaders at the outset, and feedback elicited from project liaisons and student participants in subsequent years highlighted the biggest challenges associated with facilitating student leadership development in a service learning context, informed ongoing course adjustments, and shaped the evolution of the class. The connections between the multi-source feedback, class refinements, and suggested keys to success are reviewed.
Combined effect of a nanoemulsion of d-limonene and nisin on Listeria monocytogenes growth and viability in culture media and foods
Authors: Maté Javier , Periago Paula M. , Palop Alfredo
Published: March 2015

The present work evaluated the antibacterial effect of nanoemulsions from natural compounds d-limonene and nisin against Listeria monocytogenes in tryptic soy broth growth medium, chicken broth, and vegetable cream. Experiments were performed by means of optical density growth curves and studies of viability in culture media and foods. Stability of nanoemulsions was evaluated by a Mastersizer 2000 equipment. Results showed greater effectiveness when applying d-limonene in form of nanoemulsion than when applying it directly, and when using both compounds together, both directly and in the form of nanoemulsion. Concentration of L. monocytogenes decreased at least in three log cycles in all the culture media and foods used within the first 90 min after the addition of the natural antimicrobials combined in form of nanoemulsion. Moreover, the growth of L. monocytogenes was inhibited with the combination of antimicrobials in the four weeks that the experiment lasted. Nanoemulsion technology would solve present problems of solubility and stability of oily antimicrobials in the food industry.
Still childless at the age of 32: An investigation of predictors in 22-year-old women and men
Authors: Nilsen Anne Britt Vika , Waldenström Ulla , Espehaug Birgitte , Schytt Erica
Published: March 2015

Aim: The aim of this study was to investigate if family background and attitudes in early adulthood contribute to postponement of parenthood. Postponement of parenthood is associated with increased need for artificial reproductive techniques, increased risk for adverse pregnancy outcomes and reduced fertility rates. Methods: This was a cohort study including 1000 women and men aged 22 years from the Swedish Young Adult Panel Study. Questionnaire data were linked to information from the Swedish Total Population Register 10 years later. Logistic regression analyses were conducted. Results: Background factors associated with being childless were: being second-generation Polish or Turkish (odds ratio [OR] 1.5; 95% confidence intervals [CI] 1.2–2.0), growing up in a large city (OR 1.5; 95% CI 1.1–2.0), well-educated mother (OR 1.5; 95% CI 1.1–1.9) or father (OR 1.4; 95% CI 1.1–1.9), no siblings (OR 1.9; 95% CI 1.1–3.2), living in parental home (OR 2.2; 95% CI 1.6–3.1), less than good assessment of own mother (OR 1.8; 95% CI 1.2–2.7) or father (OR 1.4; 95% CI 1.0–1.9) as a parent, and less than satisfactory relationship with own mother (OR 1.5; 95% CI 1.1–2.1). Attitudes associated with being childless were: not enjoying children (OR 2.7; 95% CI 2.0–3.6), finding that one could be satisfied in life without being a good parent (OR 2.3; 95% CI 1.7–3.0) and not assuming that one will have children in the future (OR 2.9; 95% CI 2.1–3.9). Conclusions: The findings suggest that postponement of parenthood to the age of 32 could partly be explained by family background and negative or ambivalent attitudes to children and parenthood in early adulthood.
How participants in arguments challenge the normative position of an opponent
Authors: Reynolds Edward
Published: March 2015

This article describes a device used to challenge a target’s normativity in the course of an argument, a members’ method employed in arguments in public places. In this device, participants seek to challenge their opponent’s normativity by implying that the target of the device is not adhering to a norm mutually agreed-to in the earlier preparatory phases of the device. A pre-challenge phase poses an ‘enticing interrogative’, a question that fails to take for granted common-sense features of the target as a resource for obtaining a pre-figured reply. The resulting challenge phase implies that on the basis of the pre-challenge, the target is failing to adhere to some norm required of them by means of category or general membership. This article describes the way in which with this device parties to an argument may manufacture challenge an opponent’s normativity.
Animosities in Yugoslavia before its demise: Revelations of an opinion poll survey
Authors: Perunovic Sreca
Published: March 2015

Contrary to the widespread opinion that hatred and mutual dislike among various ethnic groups was a chief characteristic of Yugoslavia and was at the bottom of the country’s destruction, the ethnic distance survey conducted in 1990 indicates that Yugoslav society was a community with a generally low level of ethnic animosities. The results demonstrate the huge discrepancy between what most Yugoslav citizens felt and needed, and what political elites and nationalist intellectuals claimed “their people” wanted and needed in the 1990s. Many scholars have not incorporated or noticed the difference.
What’s in a click? A social semiotic framework for the multimodal analysis of website interactivity
Authors: Adami Elisabetta
Published: March 2015

This article presents a social semiotic framework for the multimodal analysis of website interactivity. Distinguishing it from interaction, it defines interactivity as the affordance of a text of being acted (up)on, thus including hypertextuality. The author introduces the notion of ‘interactive sites/signs’ as the loci of interactivity in digital texts; these have a two-fold nature and a two-dimensional functioning. In their two-fold nature, they are both places enabling actions producing effects and forms endowed with meanings. Notwithstanding the non-direct correspondence between forms, actions and effects (which makes any specific association between the three significant within a webpage design), and in spite of their many possible forms (encompassing still and dynamic images, shapes and writing), a small range of actions can activate them (click/click+type/hover), producing a restricted set of textual effects (access/provide/transfer text). In their two-dimensional functioning, interactive sites/signs function both syntagmatically, on the page where they are displayed, in their relation with other co-occurring elements, and paradigmatically, opening to optional text realizations, hence in their relation with these. The framework adapts Halliday’s three metafunctions to the analysis of the two-fold nature and two-dimensional functioning of interactive sites/signs. It provides a fine-grained account of the interactive meaning potentials of digital texts, distinguishing between a text’s aesthetics of interactivity – as visually communicated before it is activated, performed and experienced – and its functionality, in the configuration of interactive possibilities offered by a page. Designed to complement the extant practices of text analysis of webpages, the framework can be used comparatively, as exemplified in its application to the analysis of two blog pages, and can provide a more refined assessment of the interactive meaning potential of a webpage than traditional methodologies such as content analysis.
Developing primary care occupational health services for informal sector workers in Thailand
Authors: Nilvarangkul Kessarawan , Arphorn Sara , Smith John F , Phajan Teerasak , Kessomboon Nusaraporn , Thaewnongiew Kesorn
Published: March 2015

This study demonstrates action research’s emancipatory traditions in enabling community stakeholders in rural Thai settings to increase self-reliance and collaboration in improving primary care occupational health services. Most of the Thai workforce are informal sector workers outside Thai labor law protections, health and safety regulatory frameworks, and without specific occupational health services to provide for work-related health needs. This project brought together community leader teams, village health volunteers and informal workers themselves to collaboratively develop community services for this underserved group. Significant changes were effected at community team level, with improvements in networking and community nurses’ health care for the workers and in their oversight and supervision of village health volunteers (VHVs) in the community. Most notably, VHVs’ self-confidence improved at providing illness prevention and health promotion support in workers’ homes and work settings congruent with their daily lifestyle and work schedules. Informal workers’ health self-care behaviors improved.
An Endoluminal Method of Hemorrhage Control and Repair of Ruptured Abdominal Aortic Aneurysms
Authors: Greenberg Roy K. , Srivastava Sunita D. , Ouriel Kenneth , Waldman David , Ivancev Krasnodar , Illig Karl A. , Shortell Cynthia , Green Richard M.
Published: March 2015

Purpose:

To report our initial experience with endovascular grafting to treat ruptured abdominal aortic aneurysms (AAAs).

Methods:

Three consecutive patients with severe comorbid illnesses and symptoms of aneurysm rupture and hemodynamic instability were treated with aortomonoiliac grafts. The Z-stent—based devices were implanted with the assistance of an occlusion balloon placed in the distal descending thoracic aorta.

Results:

All patients survived the procedure with successfully excluded AAAs. Two patients had relatively short hospital stays (4 and 14 days), while the third required prolonged treatment for pre-existing conditions. All patients required blood transfusions; 2 developed significant coagulopathies. Definitive management was delayed significantly by imaging protocols and graft construction.

Conclusions:

Endovascular repair of ruptured aortic aneurysms is feasible. Proximal aortic control is readily attainable with the use of an aortic occlusion balloon placed through the left axillary artery. The absence of a laparotomy, extensive retroperitoneal dissection, and aortic cross-clamping likely contributes to patient survival; however, the delay in operative therapy to obtain adequate imaging and construct an endograft could be a hindrance to the ultimate success of this approach. The concepts of alternative aortic imaging techniques and endograft design, construction, and storage must be addressed.
Matched-Pair Analysis of Conventional versus Endoluminal AAA Treatment Outcomes during the Initial Phase of an Aortic Endografting Program
Authors: Cohnert Tina U. , Oelert Frank , Wahlers Thorsten , Gohrbandt Bernhard , Chavan Ajay , Farber Alexander , Galanski Michael , Haverich Axel
Published: March 2015

Purpose:

To investigate whether endovascular stent-grafts implanted during the early phase of an aortic endografting program have advantages over conventional surgical procedures for treatment of infrarenal aortic aneurysm (AAA).

Methods:

In the first months of an endografting program, 37 patients (36 men; mean age 67.9 ± 7.1 years, range 55 to 86) underwent AAA repair with endovascular implantation of a Vanguard (n = 17) or Talent (n = 20) bifurcated stent-graft. Data collected during the perioperative period and in follow-up were compared retrospectively to a matched group of 37 elective surgical patients.

Results:

All endograft implantations were completed. Two type I and 6 type II endoleaks (21.6%) were seen postoperatively. Five type II sealed without intervention; 1 type I endoleak was corrected with an additional stent, but 1 type I and 1 type II endoleaks persisted despite attempts with coil embolization. Two (5.4%) endograft patients died during the perioperative period; however, this was not significantly different (p = 0.15) from the control group. In the mean follow-up of 12 ± 6 months for both groups, 1 (2.7%) late conversion was necessary at 2 years for aneurysm expansion in an endograft patient with an unsealed type I endoleak.

Conclusions:

In our learning curve experience with aortic endografting, postoperative morbidity and mortality were higher in endograft patients compared to conventionally treated controls. Only in the endograft group was reoperation required during follow-up. Careful monitoring with periodic imaging studies is mandatory after endoluminal AAA treatment.
Stent-Graft Treatment of a Common Carotid Artery Pseudoaneurysm
Authors: Simionato Franco , Righi Claudio , Melissano Germano , Rolli Antonio , Chiesa Roberto , Scotti Giuseppe
Published: March 2015

Purpose:

To report a case demonstrating successful endovascular treatment of a right common carotid artery pseudoaneurysm using a commercially prepared balloon-expandable covered stent.

Methods and Results:

A 50-year-old man was evaluated for syncopal episodes. He had a history of severe trauma sustained in a motor vehicle accident 3 years before symptom onset. Doppler ultrasound scanning detected a pseudoaneurysm at the origin of the right common carotid artery. The defect measured 25 mm × 20 mm with a 22-mm-long neck on angiography and computed tomography; there was no evidence of carotid stenosis or associated vascular pathology. Via a percutaneous femoral access, 2 Jostent peripheral stent-grafts were placed at the level of the aneurysm, safely achieving complete repair of the arterial wall defect. The patient was asymptomatic at his 12-month evaluation. Color flow duplex scans showed continued exclusion of the pseudoaneurysm.

Conclusions:

Wide-necked aneurysms in the extracranial carotid arteries may be treated with stent-grafts, which can achieve complete and permanent reconstruction of the arterial wall by excluding the aneurysm.
Vibrational Angioplasty and Hydrophilic Guidewires in the Treatment of Chronic Total Coronary Occlusions
Authors: Michalis Lampros K. , Rees Michael R. , Davis John A. S. , Pappa Eugenia C. , Katsouras Christos , Goudevenos John , Sideris Dimitris A.
Published: March 2015

Purpose:

To study the efficacy and safety of vibrational angioplasty versus hydrophilic guidewires for recanalizing chronic total occlusions (CTOs) of the coronary arteries.

Methods:

In a retrospective study, 99 patients with old (>3 months) CTOs resistant to conventional techniques were treated either with vibrational angioplasty (group A, n = 72) or 0.014-inch hydrophilic guidewires (group B, n = 27). The selection of the technique (vibrational angioplasty or hydrophylic guidewires) was dependent only upon device availability. A variety of guidewires were employed in conjunction with vibrational angioplasty.

Results:

The crossing success rates in groups A and B were 86.1% (62/72) and 55.5% (15/27) (p < 0.05), with final procedural success rates of 75% (54/72) and 44.4% (12/27) (p < 0.01), respectively. The main reasons for failure were inability to cross the lesion with a guidewire (10/18 in group A and 12/15 in group B) and large dissections resulting in vessel closure (2/18 in group A and 2/15 in group B). Three major complications were seen, 2 in group A and 1 in group B. Three vessel perforations were reported in group A. Both techniques needed prolonged fluoroscopy times.

Conclusions:

Vibrational angioplasty was more successful in treating CTOs compared to hydrophilic guidewires and had similar complication rates (most without clinical sequelae).
Symptomatic Subtotal Occlusion of the Innominate Artery Treated with Balloon Angioplasty and Stenting
Authors: Azzarone Matteo , Cento Maurizio , Mazzei Massimo , Tecchio Tiziano , Ugolotti Ugo
Published: March 2015

Purpose:

To report the endovascular treatment of a subtotal occlusion of the innominate artery giving rise to subclavian steal syndrome.

Methods and Results:

A 60-year-old man in general good health was admitted to the hospital for sudden onset of amaurosis in the right eye. Thrombosis of the central retinal artery was diagnosed. Physical examination, color flow duplex imaging, and aortic arch angiography showed a subtotal occlusion of the innominate artery with right subclavian steal syndrome. One month later, balloon dilation and stenting of the innominate artery was performed through a right axillary access without cerebral protection. The innominate artery was recanalized with correction of the steal syndrome and restoration of the right radial pulse; no complications occurred. Twelve months later, color flow duplex sonography confirmed innominate stent patency and antegrade flow in the right vertebral artery.

Conclusions:

Our experience supports the view that percutaneous endovascular techniques are appropriate and are the preferred treatment for lesions of the supra-aortic vessels. Continued surveillance will determine their long-term durability.
Vascular Response in the Femoropopliteal Segment after Implantation of an ePTFE Balloon-Expandable Endovascular Graft: An Intravascular Ultrasound Study
Authors: van Sambeek Marc R.H.M. , Hagenaars Tjebbe , Gussenhoven Elma J. , Leertouwer Trude C. , van der Lugt Aad , Hoedt Marco T.C. , van Urk Hero
Published: March 2015

Purpose:

To use intravascular ultrasound (IVUS) to document changes in vascular dimensions after placement of a balloon-expandable endograft.

Methods:

Thirteen patients (9 men; mean age 62 years, range 47–75) treated with an investigational polytetrafluoroethylene endograft for obstructive disease of the femoropopliteal segment were studied with IVUS immediately after endograft implantation and at follow-up. Corresponding IVUS cross sections were analyzed for changes in lumen, vessel, and plaque areas seen inside the endograft, in the anastomotic segment, and in the remote arterial segment.

Results:

A mean 6-month (range 1.5–9) follow-up was completed in 12 patients. Matched IVUS cross sections derived from within the endograft (n = 12) and at the endograft edges (n = 23) showed no change in lumen area (LA) in 17, reduction in 11, and dilatation in 7. Median changes within the endograft (+3%) were not significant (p = 0.28) and no neointima was found. Cross sections obtained at the anastomotic segment revealed a significant increase in LA (85%, p < 0.001), which was associated with a significant increase in both vessel area (VA) (42%, p < 0.001) and plaque area (PLA) (15%, p = 0.003) area. In the remote arterial segment, the change in LA was minimal (6%, p = 0.07), as were changes in the VA (9%, p = 0.04) and PLA (10%, p = 0.07).

Conclusions:

Following endograft placement, luminal changes within the endograft, at the endograft edges, and at the remote arterial segments were minimal. Intimal hyperplasia was not observed in the endograft. The distinct LA increase at the anastomotic segments was determined by the extent of VA and PLA change.
Treatment of Catheter-Induced Iliac Artery Injuries with Self-Expanding Endografts
Authors: Scheinert Dierk , Ludwig Josef , Steinkamp Herrmann J. , Schröder Malte , Balzer Joern O. , Biamino Giancarlo
Published: March 2015

Purpose:

To evaluate the efficacy of fabric-covered endoprostheses for percutaneous repair of traumatic iliac artery lesions.

Methods:

Among 47 patients treated for catheter-induced iliac artery injuries, 20 (42%) patients (13 men; mean age 58 ± 10 years, range 41–76) presented with acute (n = 7) or subacute (n = 13) lesions considered inappropriate for bare stent implantation (17 dissecting aneurysms, 2 perforations, and 1 traumatic arteriovenous fistula). The self-expanding Cragg EndoPro System I or Passager devices were deployed percutaneously to exclude the defects.

Results:

Immediate exclusion of the lesion was achieved in all 20 cases; there were no major procedural complications. However, within 24 hours after implantation, fever (n = 11, 55%) and elevations in white blood cell count (n = 10, 50%) and C-reactive protein (n = 13, 65%) were seen in the majority of patients, which prolonged hospitalization in this group (8.4 versus 4.2 days). During a median 21-month follow-up (range 5–31), 2 angiographically documented restenoses at the outlet of the endografts were treated successfully with balloon angioplasty, achieving primary and secondary patency rates of 87% and 100%, respectively.

Conclusions:

Early model stent-grafts provided a safe and effective endovascular treatment for iliac perforations and large arterial dissections, showing a high mid-term patency rate. However, postimplantation syndrome appears to occur frequently with this type of Dacroncovered nitinol device.
Endovascular Repair of a Presumed Aortoenteric Fistula: Late Failure Due to Recurrent Infection
Authors: Chuter Timothy A.M. , Lukaszewicz Gregory C. , Reilly Linda M. , Kerlan Robert K. , Faruqi Rishad , Sawhney Raj , Wall Susan D. , Canto Catherine , LaBerge Jean M. , Gordon Roy L. , Messina Louis M.
Published: March 2015

Purpose:

To describe a case of presumed aortoduodenal fistula that was treated by endovascular implantation of a stent-graft.

Methods and Results:

A 76-year-old man was transferred from another hospital where he had been treated for upper gastrointestinal hemorrhage over a 2-month period. Ten years previously, he had undergone aortobifemoral bypass, the right limb of which recently thrombosed. At the time of transfer, computed tomographic scanning showed a large false aneurysm between the aorta and the duodenum. Endoscopy disclosed mucosal erosions in the fourth portion of the duodenum. Following implantation of 2 overlapping stent-grafts, the bleeding ceased and the false aneurysm disappeared. At no time did the patient have a fever. The patient initially did well, but 8 months after treatment, he presented with fever and chills. Recurrent infection had caused erosion of the aorta so that a large portion of the stent-graft was visible from the duodenum. The infected graft and stent-grafts were removed in a two-part operation, from which the patient recovered satisfactorily.

Conclusions:

Endovascular stent-grafts may have a role to play in the management of aortoduodenal fistula, if only as a temporary measure to control bleeding.
Abdominal Aortic Aneurysm Rupture following Endoluminal Graft Deployment: Report of a Predictable Event
Authors: White Rodney A. , Donayre Carlos , Walot Irwin , Stewart Mark
Published: March 2015

Purpose:

To describe the predictability of an abdominal aortic aneurysm (AAA) rupture secondary to a type II endoleak following stent-graft exclusion.

Methods and Results:

An 81-year-old man with an enlarging AAA underwent endovascular repair using an AneuRx aortic stent-graft, but a type II endoleak fed by an accessory renal artery was detected at postprocedural computed tomography (CT). Surveillance CT scans at 6 and 16 months showed an increase in the aneurysm diameter and endoleak volume, but the patient refused advised treatment to close the leak. He suffered a fatal aneurysm rupture 24 months after endografting. Retrospective analysis of CT data documented progressive aneurysm enlargement that correctly predicted the rupture.

Conclusions:

Type II endoleaks can lead to aneurysm rupture. Three-dimensional (3D) spiral CT angiography offers an opportunity to track endoleak volume and the effect of exposure to systemic pressure on the aneurysm sac.
Transrenal Fixation of Aortic Endografts: Intermediate Follow-up of a Single-Center Experience
Authors: Lobato Armando C. , Quick Rhonda C. , Vaughn Paul L. , Rodriguez-Lopez Julio , Douglas Myles , Diethrich Edward B.
Published: March 2015

Purpose:

To examine the fate of the renal ostia following transrenal fixation of endovascular aortic stent-grafts.

Methods:

Thirty-five patients (29 men; mean age 75 years) undergoing endovascular repair for abdominal aortic aneurysms (AAAs) had transrenal fixation of the uncovered proximal stent due to a short (<1.5 cm long) or conical neck or a periprocedural endoleak. Eighteen (51%) patients were hypertensive; 7 (20%) had renal artery stenoses (RAS). Outcome measures included blood pressure, serum creatinine, computed tomography, and renal artery duplex scans.

Results:

Two patients with ≥60% RAS had renal stents placed during the endograft procedure; the other 5 RAS patients were normotensive and their renal lesions were not treated. Overall technical success was 82.9% (29/35). One (2.9%) case was converted due to graft twisting. There were 5 (14.2%) early endoleaks. Transient postoperative creatinine elevations were observed in 5 (14.2%) cases. Over a median 11-month period (range 2–24), no secondary endoleaks or silent renal artery occlusions were seen. One normotensive patient with an untreated ≥60% renal lesion developed hypertension and severe stenosis (99%) at 4 months; stenting through the interstices of the transrenal stent was performed. No disease progression was seen in the other 6 RAS patients.

Conclusions:

In the intermediate period, transrenal fixation appears to have no adverse effects on renal blood flow. Moreover, in patients with no evidence of renal disease or preoperative RAS <60%, it does not precipitate or cause progression of renal stenosis. However, patients with preoperatively documented RAS ≥60% are a concern and mandate further study.
Effort Subclavian Vein Thrombosis: Evolution of Management
Authors: AbuRahma Ali F. , Robinson Patrick A.
Published: March 2015

Purpose:

To analyze changes in the management of effort subclavian vein thrombosis at our institution.

Methods:

Records of 23 patients with effort subclavian vein thrombosis treated over a 10-year period were analyzed to compare the results of conventional therapy (heparin/warfarin) used in the first half of this period to a multimodality treatment strategy (thrombolysis and other adjunctive treatment as indicated, e.g., first rib resection, angioplasty/stenting, and vein reconstruction). Diagnostic testing included duplex ultrasound and venography. All patients had at least 1-year follow-up.

Results:

Eight patients (7 men; mean age 34 years, range 15–54) had conventional treatment (group A) and 15 patients (14 men; mean age 36 years, range 17–55) had multimodality therapy (group B). Demographics and clinical characteristics were comparable for both groups. Initial thrombolysis was achieved in 14 (93%) group B patients; 10 received adjunctive treatment to relieve external compression or vein stenosis. Four patients had successful first or cervical rib resection and scalenectomy, and first rib resection followed by angioplasty/stenting was successful in 2. However, angioplasty and stenting alone failed in 2 patients, while venous reconstruction was successful in only 1 of 2 cases. Mean follow-up was 72 months in group A patients and 59 months in group B. One (13%) group A patient and 12 (80%) group B patients demonstrated total venous recanalization and symptom resolution (p = 0.003). Overall, clinical resolution (total and partial symptom relief) was achieved in 3 (38%) group A patients and 13 (87%) group B patients (p = 0.026).

Conclusions:

Initial lytic therapy followed by adjunctive treatment to relieve external venous compression or venous stenosis is effective in treating patients with effort subclavian vein thrombosis.
Safety, Efficacy, and Durability of Carotid Artery Stenting for Restenosis following Carotid Endarterectomy: A Multicenter Study
Authors: New Gishel , Roubin Gary S. , Iyer Sriram S. , Vitek Jiri J. , Wholey Mark H. , Diethrich Edward B. , Hopkins L. Nelson , Hobson Robert W. , Leon Martin B. , Myla Subbarao V. , Shawl Fayaz , Ramee Stephen R. , Yadav Jay S. , Rosenfield Kenneth , Liu Ming W. , Gomez Camilo R. , Al-Mubarak Nadim , Gray William A. , Tan Walter A. , Goldstein Jonathan E. , Stack Richard S.
Published: March 2015

Purpose:

To present the results of a multicenter registry established to collect data on carotid stent procedures in patients with restenosis following carotid endarterectomy.

Methods:

The procedural details, outcomes, and late follow-up results were collected from 14 centers in the United States. Thirty-day and late stroke and death rates were analyzed.

Results:

Three hundred and thirty-eight patients (201 men; 71 ± 8 years) underwent carotid stenting in 358 arteries. The average duration from carotid endarterectomy was 5.5 ± 7.3 years. Sixty-one percent of the patients were asymptomatic. The overall 30-day stroke and death rate was 3.7%. The minor stroke rate was 1.7% (6/358), and the major nonfatal stroke rate was 0.8% (3/358). The fatal stroke rate was 0.3% (1/358), and the nonstroke-related death rate was 0.9% (3/338). There was 1 (0.3%) fatal and 1 (0.3%) nonfatal stroke during the follow-up period. The overall 3-year rate of freedom from all fatal and nonfatal strokes was 96% ± 1% (±SE).

Conclusions:

Carotid artery stenting can be performed in patients with restenosis following carotid endarterectomy with 30-day complication rates comparable to those of most published studies on repeat carotid endarterectomy. Results of late follow-up suggest that this technique is durable and efficacious.
Endovascular Repair of an Extracranial Internal Carotid Artery Aneurysm Complicated by Heparin-Induced Thrombocytopenia and Thrombosis
Authors: van Sambeek Marc R.H.M. , Segeren Christine M. , van Dijk Lukas C. , van Essen Jeroen A. , Dippel Diederik W.J. , van Urk Hero
Published: March 2015

Purpose:

To report the endovascular treatment of a symptomatic extracranial internal carotid artery (ICA) aneurysm that was complicated by heparin-induced thrombocytopenia and thrombosis.

Methods and Results:

After undergoing a coronary artery bypass graft procedure, a patient was diagnosed with a symptomatic, 3.5-cm ICA aneurysm by computed tomography and angiography. Via a semiclosed access, an Enduring vascular graft was inserted under controlled back bleeding from the ICA. The patient was recovering uneventfully when routine duplex scanning on the fifth postoperative day suggested multiple thrombi within the graft, which was confirmed by arteriography. Thrombectomy and local fibrinolysis were performed; however, the graft occluded the next day without causing neurological symptoms. Heparin-induced thrombocytopenia was diagnosed by enzyme-linked immunosorbent assay.

Conclusions:

Endovascular repair of high cervical extracranial ICA aneurysms is feasible, and protection against intracerebral embolization can be achieved using a semiclosed technique with controlled back bleeding from the ICA during endograft deployment. However, multiple thrombi or thrombotic occlusion during the postoperative period, particularly in a patient already sensitized to heparin, should direct attention toward possible heparin-induced thrombocytopenia.
Quality of Life before and after Endovascular and Open Repair of Asymptomatic AAAs: A Prospective Study
Authors: Malina Martin , Nilsson Marie , Brunkwall Jan , Ivancev Krasnodar , Resch Timothy , Lindblad Bengt
Published: March 2015

Purpose:

To assess how patients perceive health-related quality of life (HRQOL) after endovascular and open abdominal aortic aneurysm (AAA) repair.

Methods:

Forty-two consecutive patients (33 men; mean age 74 years, range 46–81) were assessed prospectively before and after elective endovascular (n = 21) and open (n = 21) AAA repair. Aneurysm morphology dictated the type of repair. The two patient groups were similar regarding age, gender, comorbidities, and cardiopulmonary function. Data concerning surgical trauma were compiled. The Nottingham Health Profile (NHP) score was used to assess the perceived HRQOL (criteria: pain, mobility, sleep, emotion, energy, and isolation) preoperatively and at 5, 30, and 90 days postoperatively. Specific treatment perception questions were added.

Results:

One patient from each group died, leaving 40 patients to complete the study. Two patients with open repair and 1 patient with endovascular repair were unfit to answer the questionnaire on day 5. The HRQOL improved at 3 months compared with the preoperative values (p < 0.05). No significant difference was found at any time between the open and endovascular groups regarding the NHP score, although the operative time, blood loss, analgesic use, and hospital stay were significantly in favor of endovascular repair. Reinterventions were required in 5 patients with endovascular and 2 patients with open repair.

Conclusions:

In general, 3 months after AAA repair, the perceived HRQOL seems better than before treatment. Perceived HRQOL is similar after endovascular and open AAA repair despite greater surgical trauma in open surgery. This may reflect the higher number of reinterventions following endovascular repair but also difficulties in defining HRQOL.
Suprarenal Mycotic Aneurysm Exclusion Using a Stent with a Partial Autologous Covering
Authors: Madhavan Prakash , McDonnell Ciaran O. , Dowd Mariana O. , Sultan Sherif A. H. , Doyle Maeve , Colgan Mary-Paula , McEniff Nial , Molloy Martin , Moore Dermot J. , Shanik Gregor D.
Published: March 2015

Purpose:

To report a combined endovascular and open technique to manage a suprarenal mycotic aortic aneurysm using a stent-graft partially covered with a section of autologous artery.

Methods and Results:

A 50-year-old was hospitalized for staphylococcal septicemia and severe back pain. A previously diagnosed 3-cm abdominal aortic aneurysm was found to have expanded 2 cm in 3 weeks. Aortography documented some periaortic thickening and 2 mycotic aneurysms, one posterior at the level of the superior mesenteric artery and the second at the aortic bifurcation. After intensive antibiotic therapy, an endovascular approach to exclude the suprarenal mycotic aneurysm was undertaken in tandem with surgical excision of the infrarenal aneurysm. The harvested right common iliac artery was used to partially cover a Palmaz stent, which was deployed under direct vision just above the renal artery ostia so that the covered portion of the stent excluded the aneurysm. A right axillofemoral bypass with a femorofemoral bypass completed the revascularization. Postoperatively, the patient developed renal failure, ischemic colitis necessitating a left hemicolectomy, and paraplegia. Although the patient is paralyzed, the aneurysm remains excluded with patent visceral vessels at 12 months following surgery. No organisms were grown from excised aortic tissue, and no signs of recurrent infection have been seen.

Conclusions:

Stent-graft repair may be able to lessen the invasiveness and reduce the morbidity associated with treatment of mycotic aortic aneurysms.
Does Successful Embolization of Endoleaks Lead to Aneurysm Sac Shrinkage?
Authors: Ermis Cengiz , Krämer Stefan , Tomczak Reinhard , Pamler Reinhard , Kolokythas Orpheus , Schütz Ansgar , Wisianowsky Christian , Kapfer Xaver , Görich Johannes
Published: March 2015

Purpose:

To determine whether embolization of endoleaks after endovascular repair of aortic aneurysms is associated with a decrease in the diameter of the aneurysm.

Methods:

Fifteen patients (13 men; median age 76 years) demonstrated primary endoleaks persisting ≥ 3 months after endovascular abdominal aortic aneurysm repair with a variety of commercial endografts. In 8 patients, coil embolization failed to completely obliterate the leak, whereas embolotherapy proved successful in the remaining 7 patients. Surveillance of endoleaks and the effect of their embolization on aneurysm size were followed with serial computed tomographic (CT) scans. Follow-up after embolization extended for at least 12 months.

Results:

Patients with persistent leak exhibited a slight increase in mean aneurysm area from 21.41 ± 4.25 to 22.47 ± 6.70 cm2. Medians differed from 20.03 (range 16.59–28.73) to 23.03 (range 14.14–33.69) cm2 (p = 0.0078, 95% confidence interval [CI] = 0.0075 to 0.0081). Successfully treated patients, however, showed a mean decrease from 20.58 ± 3.63 (median 19.87) to 16.36 ± 6.46 cm2 (median 18.10) at 1 year (p = 0.0156, 95% CI = 0.0151 to 0.0160). The medians differed significantly between groups (p < 0.05).

Conclusions:

Persistent endoleaks after endovascular aortic aneurysm treatment led to an increase in the diameter of the aneurysm, whereas complete occlusion was associated with a significant decrease in aneurysm diameter.
Aneurysm Expansion and Retroperitoneal Hematoma after Thrombolysis for Stent-Graft Limb Occlusion Caused by Distal Endograft Migration
Authors: Resch Timothy , Lindblad Bengt , Lindh Mats , Brunkwall Jan , Ivancev Krassi
Published: March 2015

Purpose:

To describe a complication of thrombolytic therapy used to treat graft limb occlusion precipitated by distal migration and kinking of an abdominal aortic stent-graft.

Case Report:

A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woman was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up, she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated distally approximately 5 mm, and the left graft limb was occluded. Thrombolysis was initiated, but after approximately 8 hours, abdominal pain began. Emergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped; transfusions and thrombogenic drugs were given to restore hemodynamic stability. The aneurysm began to decrease in size. The occluded graft limb had been reopened by the lytic therapy, uncovering a stenosis in the native artery distal to the graft limb. Stent placement restored outflow. The retroperitoneal hematoma resolved over time, and the aneurysm sac shrank to its prelytic diameter. The patient is well with a functioning endograft 18 months after the occlusion (30 months after stent-grafting).

Conclusions:

Caution must be taken when using thrombolysis in patients with endovascular aortic grafts because unexpected bleeding complications might arise. Thrombectomy, femorofemoral bypass, or stent or stent-graft extensions might be safer alternatives for treating occluded stent-graft limbs.
Role of Duplex Imaging in Endovenous Obliteration for Primary Venous Insufficiency
Authors: Pichot Olivier , Sessa Carmine , Chandler James G. , Nuta Michel , Perrin Michel
Published: March 2015

Purpose:

To assess the role of duplex imaging in defining suitable pathological anatomy for endovenous obliteration and characterizing its treatment outcomes over time.

Methods:

Eighteen lower limbs in 17 patients (12 women; mean age 48 years; range 29– 74 years) presenting with varicose greater saphenous veins (GSVs) were treated with endovenous obliteration without adjunctive high ligation. Duplex imaging was used as an intraprocedural guidance tool for vein access and catheter positioning and for preprocedural evaluation and serial surveillance after the procedures.

Results:

In the 18 limbs, preprocedural duplex scanning defined reflux owing to incompetence of the terminal valve (n = 6), subterminal valve (n = 9), or truncal valve (n = 3). Duplex imaging facilitated percutaneous vein puncture and was essential in catheter positioning at the saphenofemoral junction (SFJ). At 1 week, the saphenous trunks of all 18 limbs were either shrunken and obliterated (n = 7) or occluded by thrombus without shrinkage (n = 11). By 6 months, 7 GSVs were no longer sonographically visible, 10 were shrunken and obliterated, and 1 had a segmental partial recanalization. In the 15 limbs with terminal or subterminal valve incompetence at 1 week, 5 had total SFJ obliteration, 4 had ≥1 patent tributaries draining directly into the femoral vein through an open SFJ, and 6 had ≥1 patent tributaries draining into an open SFJ through a short (<2 cm) proximal saphenous trunk. By 6 months, only 1 limb had total SFJ occlusion; the other 14 had at least 1 persistent or reopened tributary.

Conclusions:

Duplex scanning is indispensable for selecting patients, guiding the procedure, and defining the morphological maturation and hemodynamic changes that appear to characterize successful endovenous obliteration.