bluuebunny/crossref_metadata_2025 huggingface dataset:
Inspired and Inspiring Textile Designers
Authors: Strickfaden Megan , Stafiniak Lesley , Terzin Tomislav
Published: March 2015

This paper reports a study that investigated the synergies of influence (that which shapes the context for creative ideas) and inspiration (that which inspires the content) during the creation process of ten seasoned textile designers towards a better understanding of creativity. The behaviors and rhythm of textile designers were mapped using participant observation with multiple methods including field observation, capturing visual records using video equipment and photography, note taking, auditory records using mp3 recorders, and conducting informal dialogue during studio sessions. The results provide detailed interpretive information in the form of themes focused on understanding how they used and transformed inspirational sources towards the completion of their projects and how designers use their personal thesauruses through their sociocultural capital as influences. No two designers used and transformed inspirational sources in exactly the same way, yet each designer exhibited multiple methods of transformation by including an element of inspiration in their design process. Four separate themes emerged when we looked at how the designers used their personal thesauruses as influences. These themes were: (a) connections made to their sociocultural capital and through research, (b) narratives found or told to focus their projects, (c) emotions related to their attachments and reactions, and (d) design elements they referenced that aided in their decision making. Our rich descriptions of when and how often influence and inspirational sources play into the creative and problem-solving processes are a step toward a better understanding of creativity as a dynamic, complex, and diverse endeavor.
Euro 2012 in Poland: Recalibrations of statehood in Eastern Europe
Authors: Cope Benjamin
Published: March 2015

This article argues that the organisation of Euro 2012 in Poland is an extension and intensification of wider tendencies in the reconfigurations of statehood occurring in Eastern Europe. Contrary to free market mantras, the case of the Euro reveals ‘actually existing neoliberalism’ as involving a vital role for the state, but one where statehood is stretched in different, often incompatible, directions. The configurations of deregulation and reregulation involved reveal an emergent scalar hierarchy of monopoly manipulation and collusions, the outcomes of which are new patterns of spatial differentiation. The analysis of Euro 2012 helps to piece together the contradictory features of statehood as they emerge both in relation to, and as an element actively involved in, producing this configuration. Such research is important both for a view of the further transformations of statehood in Eastern Europe and also to ask what light the evolutions of statehood in Eastern Europe, as evidenced in the organisation of Euro 2012, throw on the turbulent realignments of the international configuration currently underway, particularly in terms of an ambivalent role of the notion of Europe.
Towards Understanding Employability in the Indian Context
Authors: Pandit Shilpa Ashok , G. Preethi , Wallack Dave C. , C. Vijayalakshmi
Published: March 2015

The article reports a year-long study to systematically understand ‘employability’ as a social psychological construct and its linkages with various person centred attributes and choice of career tracks. To that end, the article is divided into three sections. The first section analyses the Indian context of the demographic dividend and higher education and locates the construction of employability within it. The second section reports the rationale, the method and the results. Finally, the article concludes with the discussion of results and implications.

 Employability has a duality associated with it. It is a construct that, on one hand, is sensitive to macro variables like the state of the economy, the access to education and finance and sector-wise trends. On the other hand, employability may also be related to the person-centred variables like effectiveness and hope. The recruitment process can be seen as a site of this interaction between structural trends and agentic competencies. Through understanding the duality of structure and agency can we centre the debate on employability, skewed away from economic and sociological factors to psychological ones. This article is an attempt in that direction.

 In the present study, based on preliminary field research, six career tracks were identified. 643 students from final/pre-final semesters in colleges and employed cohort from Thanjavur and Chennai in Tamil Nadu, were administered psychological instruments regarding personal effectiveness and attribution to success and failure. Additionally, students were tested before and after the placement season to cross-validate whether they got employed or not.

 The model was tested using binomial logistic regression analysis. Results indicate that the employed cohort both as students and recently employed displayed significantly different internal and external attribution to success and failure and personal effectiveness than the non-employed cohort. Implications, limitations and future research questions are discussed.
Fear of Negative Evaluation as a Mediator of the Relation between Academic Stress, Anxiety and Depression in a Sample of Ghanaian College Students
Authors: Nonterah Camilla W. , Hahn Nathasha C. , Utsey Shawn O. , Hook Joshua N. , Abrams Jasmine A. , Hubbard Rebecca R. , Opare-Henako Annabella
Published: March 2015

This study examined the mediator effects of the fear of negative evaluation (FNE) on the relation between academic stress and psychological symptoms in a sample of Ghanaian college students (N = 431). A multi-step structural equation modelling (SEM) procedure was used to test the specified mediator model and several fit indices were calculated to assess how well the model fit the data. In addition, path coefficients were calculated to determine whether mediation had been established. The results indicated that the specified model produced a good fit to the data. Moreover, the findings revealed that FNE partially mediated the relation between academic stress and the psychological symptoms of anxiety and depression. Implications for the study’s findings are discussed and recommendations for future research are presented.
Book Review: Keun Lee. 2013. Schumpeterian Analysis of Economic Catch-up: Knowledge, Path-creation and Middle-Income Trap
Authors: Kaur Manjinder
Published: March 2015

Keun Lee. 2013. Schumpeterian Analysis of Economic Catch-up: Knowledge, Path-creation and Middle-Income Trap. Cambridge: Cambridge University Press, pp. xxiii + 273. £35.
Feelings and Intersubjectivity in Qualitative Suicide Research
Authors: Boden Zoë V. R. , Gibson Susanne , Owen Gareth J. , Benson Outi
Published: March 2015

In this article, we explore how feelings permeated our qualitative research on suicide. Drawing on phenomenological theory, we argue for the epistemic and ethical importance of the feelings that emerge through research encounters, considering them to be embodied, intersubjective, and multilayered, and requiring careful interpretation through a “reflexivity of feelings.” We sketch a tentative framework of the ways that we experienced feelings in our research and give three in-depth examples to illustrate some of the different layers and types of feelings we identified. We reflexively interpret these feelings and their role in our analysis and then discuss some of the ethical and methodological issues related to examining feelings in suicide research, and research more generally.
Improving Palliative Care Team Meetings
Authors: Brennan Caitlin W. , Kelly Brittany , Skarf Lara Michal , Tellem Rotem , Dunn Kathleen M. , Poswolsky Sheila
Published: March 2015

Increasing demands on palliative care teams point to the need for continuous improvement to ensure teams are working collaboratively and efficiently. This quality improvement initiative focused on improving interprofessional team meeting efficiency and subsequently patient care. Meeting start and end times improved from a mean of approximately 9 and 6 minutes late in the baseline period, respectively, to a mean of 4.4 minutes late (start time) and ending early in our sustainability phase. Mean team satisfaction improved from 2.4 to 4.5 on a 5-point Likert-type scale. The improvement initiative clarified communication about patients’ plans of care, thus positively impacting team members’ ability to articulate goals to other professionals, patients, and families. We propose several recommendations in the form of a team meeting “toolkit.”
Recovery of Activities of Daily Living Among Older People One Year After Hip Fracture
Authors: Córcoles-Jiménez María Pilar , Villada-Munera Ascensión , del Egido-Fernández María Ángeles , Candel-Parra Eduardo , Moreno-Moreno Mónica , Jiménez-Sánchez María Delirio , Piña-Martínez Antonio
Published: March 2015

This article aims to determine the functional recovery of older people, who were previously independent in activities of daily living (ADLs) and without cognitive impairment, in the year following a fall-related hip fracture. A cohort study was carried out among patients admitted to University General Hospital of Albacete (Spain). Consecutive sampling was performed. Variables included demographic, habitual residence, type of hip fracture, mental status (Short Portable Mental Status Questionnaire [SPMSQ] Pfeiffer), and independence in ADLs (according to the Barthel Index [BI]) prior to the fall and after the fracture. For 205 patients, 1 year after surgery, the mean BI score was 78.09 ( SD = 25.13); (vs. 90.02 before the hip fracture), 59% showed urinary continence (vs. 79%), and 65% walked without assistance (vs. 82%). Regarding predictors of recovery, results indicate that patients who are older, who suffer complications after hospital discharge, or who reside in nursing homes experience poorer recovery in ADLs. Only 47.9% of the patients regained prior levels of autonomy 1 year after surgery.
A Tipping Point for “Totally Evidenced Policing”
Authors: Sherman Lawrence W.
Published: March 2015

Increasing numbers of police professionals have decided to practice evidence-based policing. Yet many of these “early adopters” encounter opposition from their colleagues. Advocates of evidence-based policing (EBP) increasingly ask whether, or how, an entire agency can be transformed at about the same time, rapidly creating a “tipping point” for “totally evidenced” policing—defined as a steady growth of evidence-based decisionmaking on as many practices as possible. Such tipping points may require (1) a powerful advocate for EBP; (2) an “evolutionary” dimension to add on to any “smothering paradigm” that resists the addition of evidence to decision-making; and (3) strong external demands for change. Several attempts to create “totally-evidenced” decisions across entire agencies are under way. This article describes a hypothesis for how they might succeed, consisting of a 10-point plan to be implemented simultaneously.
Evidence-Based Triage in Prosecuting Arrestees
Authors: Neyroud Peter
Published: March 2015

Growing efforts in the United Kingdom to establish “triage” programs at the police gateway to the criminal justice system have met mixed success. This article reviews the evaluations of these programs, most of which use clinical rather than actuarial models of forecasting risk. Drawing on a recent experiment in diverting low-risk defendants from prosecution in Birmingham, this article suggests the design and implementation of an actuarial approach to risk assessment that would provide an evidence-based triage tool for processing arrestees in police stations.
Gastric Malignant Peripheral Nerve Sheath Tumor
Authors: Kim Eun Young , Lee Sung Hak , Yoo Han Mo , Song Kyo Young , Park Cho Hyun
Published: March 2015

Gastric malignant peripheral nerve sheath tumors (MPNSTs) are sarcomas arising within a peripheral nerve. Gastric MPNSTs are extremely rare with only a few cases. We herein describe the case of a 48-year-old man with a gastric MPNST for the first time in Korea, which was diagnosed histopathologically after surgery. The patient underwent curative subtotal gastrectomy with D1+ lymph node dissection and Billroth-II reconstruction. The postoperative recovery was uneventful, and he has had no recurrence until now. The ideal adjuvant treatment protocol is yet to be decided due to the relatively limited number of cases of these tumors previously reported.
Two-dimensional nonlinear shear waves in materials having hexagonal lattice structure
Authors: Porubov AV , Berinskii IE
Published: March 2015

An asymptotic procedure is developed to obtain governing two-dimensional nonlinear equations as a result of the continuum limits of the original discrete hexagonal lattice model. Possible continualization is analyzed on the basis of linearized discrete equations. New weakly nonlinear continuum equations for plane and weakly transverse disturbed shear waves in a hexagonal lattice are obtained using different continuum limits. It is shown that nonlinear plane shear waves are described different from the model of isotropic continuum.
Differences in Psychiatric Problems and Criminality Between Individuals Treated With Central Stimulants Before and After Adulthood
Authors: Rasmussen Kirsten , Palmstierna Tom , Levander Sten
Published: March 2015

Objective: The evidence for central stimulant (CS) treatment in ADHD is strong in some respects but not with respect to unselected clinical material and long-term effects over the life course cycle. The objective of this study was to explore differences in vocational, psychiatric, and social impairment, including crime and substance abuse, among adults with ADHD, treated or not, with CS drugs before age 18. Method: A clinical population of men ( N = 343) and women ( N = 129) seeking CS treatment as adults was assessed within a specific program for such treatment. Clinical information and data collected by structured instruments were available. Results: Previously CS-treated persons had a lower frequency of problems (alcohol/substance abuse, criminality), and of certain psychiatric disorders (depressive, anxiety and personality ones). Most differences were substantial. Conclusion: The study supports the assumption that CS treatment during childhood/adolescence offers some protection against the development of a range of problems known to characterize adult ADHD patients.
Effective Police Homicide Investigations
Authors: Carter David L. , Carter Jeremy G.
Published: March 2015

At present, the average homicide clearance rate in the United States is approximately 65%, down roughly 15% from the mid-1970s. This research seeks to inform how police can best improve homicide clearance rates by identifying best practices in homicide investigations. To accomplish this goal, as part of a federally funded project, seven geographically representative law enforcement agencies were identified that had at least 24 homicides in 2011 and had a clearance rate of 80% or higher from which effective investigative practices could be gleaned. Qualitative findings indicate that a strong community policing presence, collaboration with external agencies, and an innovative culture facilitate high rates of homicide clearance. Implications for policy and future research are discussed.
What Is the Nature of Faking? Modeling Distinct Response Patterns and Quantitative Differences in Faking at the Same Time
Authors: Ziegler Matthias , Maaß Ulrike , Griffith Richard , Gammon Amy
Published: March 2015

Research trying to uncover the true nature of faking is currently dominated by two competing modeling approaches. One approach views faking as the manifestation of distinct and qualitatively different response patterns. Typically, mixed Rasch models are used within this approach. The alternative approach views faking as a continuous and quantitative variable resulting from the interaction between test taker personality and situational demands. Modeling techniques for this approach range from regression analyses to structural equation modeling. So far, there has been no study in which both modeling approaches have been applied within one data set. More importantly, so far there has been no methodological model in which both views of faking could have been modeled simultaneously. Within the present article such a modeling approach is introduced and applied to a data set of N = 497 applicants. By combining factor mixture modeling with a latent change score model, it was possible to test both views of faking within the same model. Findings support the view of faking mainly as a continuous and quantitative variable. Theoretical implications are discussed.
Microskin Grafting for Stable Vitiligo of the Penis and Vulva
Authors: Gupta Devendra Kumar , Devendra Shruti
Published: March 2015

Background:

The vitiligo of the penis and vulva is a difficult to treat region of the body where the existing surgical repigmentation methods usually do not give satisfactory results.

Objective:

This study was conducted to evaluate the efficacy of microskin grafting in stable genital vitiligo.

Methods:

Four male patients and 1 female patient were included in this study, and microskin grafting was performed in the stable vitiliginous areas of genitals under regional anaesthesia.

Results:

The microskin grafting technique has shown desired results at these sites with near total pigmentation and negligible donor area deformity.

Conclusion:

The microskin grafting for vitiligo is simple, reliable, and the most cost-effective technique of tissue grafting that has all the benefits of the latest cellular grafting techniques without its high cost and infrastructure.
I’d rather be nice than honest
Authors: Dahlgren Gro Helen , Hansen Håvard
Published: March 2015

The interaction between interviewer and respondent is one of the most significant sources to interviewer bias, with respondents often answering questions in a way they think is socially desirable. This bias, called the social desirability bias, has been studied in a variety of context and found to influence the validity of data collected. In this study, we examine whether the national identity of an interviewer will bias results in a survey on tourist destinations when there is a match between interviewer nationality and target destination. In a 2 × 2 between-subjects experiment, the main finding is that respondents will evaluate more positively an advertisement, the attractiveness, and the people from a country if interviewed by someone from that country compared to being interviewed by someone not from the target country. Our results imply that the practice of interviewing tourists while being at a destination, by a local or domestic interviewer, is a situation severely prone to biased results. Theoretical and managerial implications are offered based on these findings.
Understanding the concept of resilience in relation to looked after children: A Delphi survey of perceptions from education, social care and foster care
Authors: South Rebecca , Jones Fergal W , Creith Elaine , Simonds Laura M
Published: March 2015

There has been a surge of interest regarding the application of resilience theory in childcare practice and how resilience can be promoted among vulnerable children, in particular, looked after children. However, little is known about how people working with looked after children understand the concept of resilience. This study aimed to explore how social workers, teachers and foster carers, working with looked after children, understand resilience and whether there is consensus as to what constitutes resilience. The study also sought to explore whether there are differences in how resilience is constructed across these groups. In total, 106 participants took part in a Delphi survey (34 teachers, 36 foster carers, 36 social workers). There was moderate consensus that resilience related to survival, coping and a sense of self-worth. Resilience was not considered a panacea but a concept that also had limitations. Participants understood resilience in ways that were both similar and different to existing conceptualisations within the literature. However, there were many aspects of resilience for which there was no consensus or significant difference of opinion between the participant groups. The need for further training and research is discussed, in order to support attempts to promote resilience among looked after children.
Rwandan developmental ‘social engineering’: What does it imply and how is it displayed?
Authors: Hasselskog Malin
Published: March 2015

Rwandan development policy is frequently referred to as ‘social engineering’. As this concept is not analytically clear and carries negative connotations, this article elaborates on its meaning. An analytical framework is developed and applied to selected Rwandan policies and programmes, as depicted in government documents, academic writing and field work. The analysis points to far-reaching social engineering in terms of visionary design, depoliticized managerialism, firm and partly coercive implementation, state–population separation and paternalism. In the conclusion, impressive results as well as problematic aspects are discussed, as are the negative connotations and the legitimate use of social engineering.
Book Review: Scott, M. 2014: Media and Development
Authors: Foyer Chantal
Published: March 2015

Scott, M. 2014: Media and Development. London: Zed Books. 240 pp. £14.99 paperback. ISBN: 9781780325507.
Activation of renin–angiotensin–aldosterone system (RAAS) in the lung of smoking-induced pulmonary arterial hypertension (PAH) rats
Authors: Yuan Yi-Ming , Luo Li , Guo Zhen , Yang Ming , Ye Ren-Song , Luo Chuan
Published: March 2015

Objectives:

To explore the role of the renin–angiotensin–aldosterone system (RAAS) in the pathogenesis of pulmonary arterial hypertension (PAH) induced by chronic exposure to cigarette smoke.

Methods:

48 healthy male SD rats were randomly divided into four groups (12/group): control group (group A); inhibitor alone group (group B); cigarette induction group (group C); cigarette induction + inhibitor group (group D). After the establishment of smoking-induced PAH rat model, the right ventricular systolic pressure (RVSP) was detected using an inserted catheter; western blotting was used to detect the protein expression of angiotensin-converting enzyme-2 (ACE2) and angiotensin-converting enzyme (ACE); expression levels of angiotensin II (AngII) in lung tissue were measured by radioimmunoassay.

Results:

After six months of cigarette exposure, the RVSP of chronic cigarette induction group was significantly higher than that of the control group; expression levels of AngII and ACE increased in lung tissues, but ACE2 expression levels reduced. Compared with cigarette exposure group, after losartan treatment, RVSP, ACE and AngII obviously decreased ( P<0.05), and ACE2 expression levels significantly increased.

Conclusion:

Chronic cigarette exposure may result in PAH and affect the protein expression of ACE2 and ACE in lung tissue, suggesting that ACE2 and ACE play an important role in the pathogenesis of smoking-induced PAH.
Living the lessons of action: An interview with Patricia Maguire*
Authors: Horwitz Julie , Howton Amy
Published: March 2015

This article highlights an interview conducted with Patricia Maguire. Her words are used to exemplify her beliefs about critical reflection, listening, and committing to the difficult work of action research.
Stent-Graft Treatment of Dissecting Aneurysm in Association with Aortic Intramural Hematoma: When Should the Procedure Be Performed?
Authors: Ide Koichi , Kichikawa Kimihiko , Uchida Hideo , Nagata Takeshi , Higashiura Wataru , Sakaguchi Shoji , Kubota Yasushi , Nishimine Kiyoshi , Ohishi Hajime
Published: March 2015

Purpose:

To report 2 cases of stent-graft implantation for localized dissecting aneurysm during the conservative treatment of aortic intramural hematoma.

Case Reports:

One patient underwent stent-graft implantation for 2 localized dissecting aneurysms about 23 months after symptom onset. Computed tomography (CT) 1 year after the procedure demonstrated aneurysm shrinkage. In the other patient, a localized dissecting aneurysm was treated about 3 months after symptom onset, even though the intramural hematoma had not resolved. CT scanning 3 months after the procedure demonstrated aneurysm shrinkage, but also revealed poor attachment of the distal stent-graft to the aortic wall due to subsequent resolution of the hematoma.

Conclusions:

Endograft implantation for treatment of localized dissecting aneurysm associated with aortic intramural hematoma should probably not be performed before the hematoma has completely resolved.
Endovascular Management of Visceral Artery Aneurysm
Authors: Kasirajan Karthikeshwar , Greenberg Roy K. , Clair Daniel , Ouriel Kenneth
Published: March 2015

Purpose:

To retrospectively review our experience with visceral artery aneurysms (VAAs) treated with percutaneous coil embolization techniques.

Methods:

Patient records were retrospectively reviewed between 1988 and 1998 for VAA cases treated with catheter-based techniques. Nine patients (5 women; mean age 64 ± 11 years) with 12 (8 false and 4 true) VAAs were identified. The majority (67%) of these patients presented with symptoms of aneurysm rupture. The etiology of the aneurysm was iatrogenic in 4, pancreatitis in 4, and idiopathic in 4. Ten cases involved the hepatic artery; the other 2 aneurysmal arteries were the middle colic and the gastroduodenal. Selective and superselective catheter techniques were used to obtain access to the VAA. A variety of microcoils were delivered to entirely fill saccular aneurysms, whereas fusiform aneurysms were thrombosed by occluding the inflow and outflow vessels.

Results:

Aneurysm exclusion was achieved in 9 (75%) of the 12 cases. The 3 technical failures resulted from the inability to cannulate the aneurysm neck. Coil embolization of the neck of the aneurysm sac did not result in occlusion of the native vessel, with a single exception. No procedure-related complications or deaths were noted. All patients remained symptom free during a mean follow-up of 46.0 ± 29.6 months.

Conclusions:

Percutaneous transcatheter coil embolotherapy is an effective alternative to open surgery for the management of VAAs. This therapy may decrease the morbidity and mortality associated with an open surgical procedure in patients with ruptured aneurysms and pseudoaneurysms, selectively thrombosing the aneurysm while preserving flow in the native vessel.
Corroded Nitinol Wires in Explanted Aortic Endografts: An Important Mechanism of Failure?
Authors: Heintz Carsten , Riepe Gunnar , Birken Lars , Kaiser Edelgard , Chakfé Nabil , Morlock Michael , Delling Günter , Imig Herbert
Published: March 2015

Purpose:

To analyze surface alterations and fractures observed in the nitinol stent wires of explanted endovascular grafts used for treatment of abdominal aortic aneurysm.

Methods:

Twenty-one explanted Stentor devices and 1 Cragg stent were received from investigators in Germany and France. After macroscopy and photography, the explants were cleaned and the polyester coating removed. The frame was examined completely by stereomicroscopy, and irregularities were assayed by scanning electron microscopy and energy dispersive x-ray analysis (EDAX). The observed alterations were classified according to stereomicroscopic and electron microscopic morphology.

Results:

The mean implantation interval for the endografts was 29.1 ± 13.2 months (range 5–46). All examined explants, even those retrieved after only a few months in situ, showed pitlike surface damage 10–25 µm in diameter. Larger, irregularly shaped surface alterations were observed in ∼70% of the explants. Older explants (age >32 months) presented vast regions of decay, with bending of the wire and stress cracks in some areas. EDAX examination revealed decreased nickel concentration in the corroded regions.

Conclusions:

Corrosion of the nitinol wire in endovascular grafts is confirmed. Presumably, the observed pitting and irregularly shaped corrosion defects are the precursors of material failure. They weaken the thin wire, which leads to stress cracks and eventually fracture of the stent wire under circulatory pulsation. Cell-induced electrochemical corrosion and active cellular destruction of surfaces are well-known mechanisms that must be investigated for their possible roles in the corrosion of stent metals.
Endovascular Grafting of Traumatic Aortic Aneurysms in Contaminated Fields
Authors: Krämer Stefan , Pamler Reinhard , Seifarth Harald , Brambs Hans-Jürgen , Sunder-Plassmann Ludger , Görich Johannes
Published: March 2015

Purpose:

To evaluate the potential of endovascular stent-grafts to treat traumatic aortic lesions in contaminated areas.

Methods:

Four patients (3 women; ages 26–78 years) underwent stent-grafting to repair an aortic rupture sustained in a motorcycle accident, aortic lacerations secondary to surgical treatment of spondylitis in 2 patients, and an aortobronchial fistula following surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1 Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a transfemoral approach. Follow-up included erythrocyte sedimentation rate, white blood count, C-reactive protein, blood cultures, and computed tomography (CT).

Results:

The stent-grafts were successfully placed in all cases and excluded the aortic lesion. Under supportive antibiotic therapy, inflammation parameters returned to normal. CT imaging showed no evidence of paraprosthetic infection, nor were there any other complications over a follow-up that ranged from 3 to 34 months.

Conclusions:

Endovascular therapy may be an alternative in the acute management of aortic ruptures in the setting of infection. Long-term results are required for definitive evaluation of the method.
Intraoperative Proximal Endoleaks during AAA Stent-Graft Repair: Evaluation of Risk Factors and Treatment with Palmaz Stents
Authors: Dias Nuno V. , Resch Timothy , Malina Martin , Lindblad Bengt , Ivancev Krassi
Published: March 2015

Purpose:

To study factors that might contribute to intraoperative proximal type I endoleak and to evaluate the placement of giant Palmaz stents as a therapeutic option.

Methods:

Thirty-three patients (30 men; median age 72 years, range 50–85) with abdominal aortic aneurysms underwent implantation of fully supported Gianturco Z-stent—based endografts (12 custom-made aortomonoiliac and 21 bifurcated Zenith devices). Ten (30%) patients were treated for intraoperative proximal endoleaks. Stent-graft oversizing and neck angulation, length, and shape were compared between patients with and without leaks.

Results:

In 9 cases, the endoleaks were successfully treated with intraoperative placement of Palmaz stents without complications. In 1 patient, a leak that was resolved intraoperatively with balloon dilation reappeared 1 month later; a Palmaz stent was deployed successfully. Stent-graft oversizing did not differ significantly between patients who developed proximal endoleaks and those who did not (median 4.0 mm in both groups, p = 0.47). Median neck length was 21.0 mm in patients with endoleak and 28.0 mm in those without (p > 0.99). Median neck angulation was 30° in both groups (p = 0.33), and the presence of a conical aneurysm neck was not significantly different (2/10 versus 6/23, p > 0.99). All aneurysms remained excluded at a median follow-up of 13 months (range 6–24).

Conclusions:

Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.
Percutaneous Techniques for Managing Maldeployed or Migrated Stents
Authors: Gabelmann Andreas , Krämer Stefan C. , Tomczak Reinhard , Görich Johannes
Published: March 2015

Purpose:

To report our experience in the percutaneous management of dislocated endovascular stents.

Methods:

During a 6-year period, 28 (2.7%) patients with a maldeployed or migrated endovascular stent (20 Palmaz, 5 Wallstent, 2 Memotherm, and 1 AVE) were recognized among 1021 patients undergoing noncardiac vascular stent procedures. Percutaneous stent management was performed using balloon catheters, gooseneck snares, grasping forceps, or additional stent implantation on the basis of the stent type, degree of expansion, mechanical characteristics, and location of the stent.

Results:

Three stents that embolized into the pulmonary artery were left in situ, but percutaneous management was successful in 23 (92%) of the remaining 25 dislocated stents (12 venous and 13 arterial stents). Twelve stents were repositioned in an alternate, stable position or the primarily intended location; 4 stents were anchored by a second stent, and 7 stents were removed percutaneously. In the 2 failed cases, the stents were retrieved using a minor surgical procedure. There were 2 minor groin hematomas but no secondary complications during a median follow-up of 26.2 months (range 1–62).

Conclusions:

Percutaneous management of migrated or maldeployed endovascular stents is highly effective with few complications. On the basis of our findings, these techniques should be considered the therapy of choice.
Intravascular Ultrasound Evidence for Stabilization of Compensatory Enlargement of the Femoropopliteal Segment after Endograft Placement
Authors: Hagenaars Tjebbe , Gussenhoven Elma J. , Athanassopoulos Petros , Pattynama Peter M.T. , van Sambeek Marc R.H.M.
Published: March 2015

Purpose:

To document whether the vasodilatory response seen at the anastomotic segment 6 months after placement of a balloon-expandable endograft in the femoropopliteal segment progresses between 6 and 24 months.

Methods:

Twelve patients (9 men; median age 65 years, range 47–75) treated with an investigational polytetrafluoroethylene (PTFE) endograft for obstructive disease of the femoropopliteal segment were studied with intravascular ultrasound (IVUS) immediately after placement and at 6 months (first follow-up period) and 24 months (second follow-up period). Matched IVUS cross sections derived from the endograft and the anastomotic segment were analyzed for changes in lumen (LA), vessel (VA), and plaque areas (PLA).

Results:

Five patients had complete IVUS surveillance at both the first (mean 8 months, range 7–9) and second (mean 25 months, range 23–26) follow-up periods; 1 patient was lost to follow-up during the second interval, and another 6 were excluded owing to graft occlusion (n = 4) or no IVUS surveillance available (n = 2) during the second follow-up period. Matched IVUS cross sections derived from the endograft showed no significant change in LA during both follow-up periods (–8% and +1%, respectively). There was no evidence for intimal hyperplasia or endograft recoil. During both follow-up periods, IVUS cross sections derived from the anastomotic segment revealed significant increases in LA (+37% and +8%, respectively) and VA (+26% and +6%, respectively) (both p < 0.05). The change in PLA during both follow-up periods was not significant (+13% and +3%, respectively).

Conclusions:

The PTFE endograft seems to inhibit both intimal hyperplasia and constrictive remodeling. The short-term (6-month) vascular dilatory response seen at the anastomotic segment tends to stabilize at 2 years. Therefore, this endovascular anastomosis acts as an “ideal” end-to-end anastomosis.
Noninvasive Evaluation of the Effectiveness of Endovascular AAA Exclusion
Authors: van der Laan Maarten J. , Teutelink Arno , Meijer Rudy , Wixon Christopher L. , Blankensteijn Jan D.
Published: March 2015

Purpose:

To evaluate the relationship between aneurysm sac pressure and endograft wall motion in vitro and in vivo and to compare this to sac volume changes after endovascular aneurysm repair.

Methods:

In a flow model of an aneurysm with a stent-graft in situ, sac pressure was incrementally increased by adding volume to an otherwise excluded sac; sac pressure waves were registered. Clinically, 43 patients who had unsupported endografts were monitored for stent-graft wall motion using electrocardiographically-guided M-mode ultrasonography. At 3 predetermined points in the cardiac cycle, 2 independent observers measured the maximal endograft diameter. Graft wall motion was then compared to changes in aneurysm thrombus volume (shrinking, static, growth) based on serial spiral computed tomographic angiography measurements.

Results:

In the in vitro model, as the sac was incrementally pressurized, the initially static pressure waveform changed to a more dynamic waveform identical to that of the systemic pressure. Additionally, graft wall motion was noted visually when the pressure exceeded 40 mm; it became increasingly vigorous at higher pressures. The 0.13-cm wall motion in the growth group (n=5) was significantly larger than the 0.04 cm in the static group (n=19; p=0.012) and the 0.03 cm in the shrinking group (n=19; p=0.002). No significant difference was found between the static and the shrinking groups (p=0.209).

Conclusions:

Increases in sac pressure are reflected as increased wall motion in unsupported endografts. Clinically, increased endograft wall motion can be demonstrated by M-mode ultrasound; in growing aneurysms, the significant change in wall motion may suggest increased sac pressures as the etiology of the aneurysm growth.
Three-Dimensional Rotational Angiography in Peripheral Endovascular Interventions
Authors: van den Berg Jos C. , Moll Frans L.
Published: March 2015

Purpose:

To demonstrate the feasibility and applicability of 3-dimensional rotational angiography (3D-RA) in the assessment of candidates for endovascular treatment of occlusive or aneurysmal arterial disease.

Technique:

In 3D-RA, a continuous rotation of the fluoroscopic tube around the region of interest is made while intra-arterial contrast is continuously infused. The area of interest is placed in the isocenter in both frontal and lateral planes. Images are acquired at a rate of 12.5 frames per second at a rotation speed of 30° per second. Injection protocols are adjusted according to the anatomical location. The acquisition takes 8 seconds and yields 100 contrast-enhanced cinefluoroscopic images that are automatically reconstructed within 5 minutes to yield a 3D volume that can be rotated and viewed in any direction. Measuring the diameter of the target vessel and length of the lesion can be performed in the same session. An initial evaluation of this technique in 101 patients with known peripheral vascular disease yielded diagnostically adequate images preprocedurally while adding a maximum of only 10 minutes to the endovascular procedure: 5 minutes for reconstruction and another 2 to 5 minutes for measurements, which were made without difficulty in all cases. 3D-RA aided in selection of the optimal fluoroscopic tube angulation for the endovascular procedures and provided assessment of the interventional results comparable to angiography.

Conclusions:

Our preliminary experience suggests that 3D-RA appears to be a valid tool in the pre- and periprocedural assessment of patients treated endovascularly for both aneurysmal and occlusive peripheral arterial diseases.
Healing of Carotid Stents: A Prospective Duplex Ultrasound Study
Authors: Willfort-Ehringer Andrea , Ahmadi Ramazanali , Gschwandtner Michael E. , Haumer Angelika , Heinz Gottfried , Lang Wilfried , Ehringer Herbert
Published: March 2015

Purpose:

To study the dynamics of carotid stent healing over a 2-year period using duplex ultrasound imaging.

Methods:

One hundred twelve patients with 121 successfully stented carotid arteries were examined with color-coded duplex ultrasound the day after the stent procedure and at 1, 3, 6, 12, and 24 months in follow-up. The maximal thickness and echogenicity of the layer between the stent and the perfused lumen (SPL) were evaluated. Echogenicity was classified as echogenic if the SPL layer was clearly detected in B mode and echolucent if the SPL layer was barely visible in B mode, its border defined by assistance of color-coded flow.

Results:

At day 1, an echolucent SPL layer with a median thickness of 0.7 mm was interpreted as a thrombotic layer, which decreased at 1 month to practically zero (i.e., not detectable). In follow-up, increases in thickness (mainly up to 6 months) and echogenicity (up to 12 months) of the SPL layer were interpreted as neointimal ingrowth. At 3, 6, and 12 months, the median maximal thickness of the SPL layer was 0.5 mm, 0.9 mm, and 1.0 mm, respectively, whereas the percentage of patients with an echogenic SPL layer was 27% (32/119), 56% (66/117), and 95% (105/110), respectively, at the same time intervals. No further change was observed at the 24-month examination.

Conclusions:

Three phases of carotid stent incorporation are defined: (1) an early unstable period soon after stent placement with an echolucent (thrombotic) SPL layer, (2) a moderately unstable phase with ingrowing neointima (1–12 months), and (3) a stable phase from the second year on. These data may indicate the need for different intensities of therapy and surveillance intervals.
Emergent Endovascular Treatment of a Spontaneous Internal Carotid Artery Dissection with Pseudoaneurysm
Authors: Tseng Albert , Ramaiah Venkatesh , Rodriguez-Lopez Julio A. , Perkowshi Paul E. , Del Santo Peter B. , Gowda Ramesh G. , Diethrich Edward B.
Published: March 2015

Purpose:

To report the use of a coronary stent-graft for the endovascular treatment of a spontaneous internal carotid artery (ICA) dissection complicated by a large pseudoaneurysm.

Case Report:

A 68-year-old man presented to an outside hospital with complaints of headache, severe left-sided neck pain, fever, chills, and vomiting. Contrast-enhanced computed tomography revealed a large (3.5×3 cm) extracranial aneurysm of the left ICA. The patient was emergently transferred to our facility for endovascular treatment of the carotid aneurysm. Via a percutaneous access in the right common femoral artery, 2 Jostent coronary stent-grafts were deployed across the aneurysm with no evidence of a residual pseudoaneurysm. The patient was hemodynamically stable throughout the procedure. Duplex examination at 9 months revealed no evidence of a residual pseudoaneurysm, dissection, or endoleak.

Conclusions:

Covered coronary stents may have a role in the treatment of spontaneous ICA dissection with pseudoaneurysm formation.
Covered Stents for True Subclavian Aneurysms in Patients with Degenerative Connective Tissue Disorders
Authors: Kasirajan Karthikeshwar , Matteson Brian , Marek John M. , Langsfeld Mark
Published: March 2015

Purpose:

To report the endovascular repair of rare true aneurysms of the subclavian artery in patients with degenerative connective tissue disorders.

Case Reports:

Two patients, one with Marfan syndrome and the other with idiopathic cystic medial necrosis, presented with 3 subclavian artery aneurysms. A Wallgraft and 2 Viabahn covered stents were used to successfully exclude these aneurysms. After 3 months, the Wallgraft thrombosed, but the contralateral Viabahn remained patent at the most recent examination 13 months after treatment. The other patient with the unilateral aneurysm had a patent Viabahn stent-graft at 10 months.

Conclusions:

Patients with degenerative connective tissue disorders may benefit from less invasive treatment with stent-grafts. The more flexible Viabahn stent-graft may be better able to adapt to arterial tortuosity. However, the long-term results of this new technique have not yet been established.
Iatrogenic Vertebral Arteriovenous Fistula Treated with a Hemobahn Stent-Graft
Authors: Priestley Rhyan , Bray Peter , Bray Alan , Hunter Jenny
Published: March 2015

Purpose:

To illustrate the utility of color flow duplex ultrasound (CFDU) in the diagnosis and stent-graft treatment of a rare arteriovenous fistula (AVF) involving the vertebral artery and vein.

Case Report:

An iatrogenic AVF involving the right vertebral artery and vein was diagnosed in a 45-year-old man using CFDU. Treatment was recommended due to the large volume of blood shunted through the fistula and the associated loud bruit. Endoluminal treatment involved deployment of a covered stent within the vertebral artery to exclude the fistula. Postoperative CFDU confirmed the success of the treatment.

Conclusions:

CFDU can be utilized to accurately diagnose unusual lesions, such as AVFs involving the vertebral artery. The technique is also useful in planning treatment and monitoring the durability of stent-grafts implanted to obliterate this type of defect.
Endovascular Treatment of External Iliac Artery Injuries after Hip Arthroplasty
Authors: Adovasio Roberto , Mucelli Fabio Pozzi , Lubrano Giovanni , Gasparini Cristiana , Belgrano Manuel , Griselli Filippo , Fancellu Giovanni
Published: March 2015

Purpose:

To report endovascular repair of injuries to the external iliac artery during hip surgery.

Case Reports:

Two elderly women with histories of chronically infected hip prostheses were found to have iatrogenic leaking pseudoaneurysms of the external iliac artery due to hip surgery trauma in the past. Both were treated successfully with a Jostent Peripheral Stent-Graft. The first patient died 17 months after treatment, and the second was well, with an excluded false aneurysm, at the 6-month follow-up.

Conclusions:

Stent-graft repair may be an appropriate and effective treatment for some traumatic arterial lesions.
Percutaneous Rheolytic Thrombectomy of Thrombosed Autogenous Dialysis Fistulas
Authors: Maleux Geert , De Coster Bruno , Laenen Annouschka , Vaninbroukx Johan , Meijers Björn , Claes Kathleen , Fourneau Inge , Heye Sam
Published: March 2015

Purpose: To retrospectively analyze the technical and clinical outcome of percutaneous rheolytic thrombectomy with the use of the AngioJet device in thrombosed autogenous arteriovenous dialysis fistulas. Methods: A cohort of 38 consecutive patients (24 men; mean age 70.7±13.8 years) presenting with 59 thrombotic events in 39 autogenous dialysis fistulas were retrospectively analyzed. The AngioJet rheolytic thrombectomy device was used in all cases. Adjunctive therapies, as well as procedure-related complications, were noted. Primary, assisted primary, and secondary patency of the autogenous fistulas was assessed along with factors potentially influencing patency. Results: Initial technical success to recanalize the efferent vein was 100% (n=59), and a successful postprocedure dialysis session was possible in 97% (n=57) of cases. Adjunctive procedures included percutaneous thromboaspiration (n=4, 7%), balloon angioplasty (n=59, 100%), and stent placement (n=16, 27%). Complications related to thrombectomy occurred in 3 (5%) procedures (distal arterial embolus). Primary, assisted primary, and secondary patency rates at 12 months were 56.1% (95% CI 42.8% to 75.2%), 61.6% (95% CI 48.6% to 74.7%), and 86.2% (95% CI 74.9% to 97.5%), respectively. Risk factors for early fistula occlusion were greater patient age (p=0.045), the age of the fistula (p=0.045), previous stent insertion (p=0.019), and an upper arm fistula (p=0.047). Conclusion: Percutaneous rheolytic thrombectomy of autogenous dialysis fistulas is effective in restoring patency and allowing subsequent hemodialysis. The complication rate is acceptably low, and the large majority of the fistulas are still used for hemodialysis at 1-year follow-up. Older fistulas and upper arm fistulas are at higher risk for early rethrombosis.