bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of Popliteal Artery Aneurysms with the Hemobahn Stent-Graft
Authors: Tielliu Ignace F.J. , Verhoeven Eric L.G. , Prins Ted R. , Post Wendy J. , Hulsebos Robin G. , van den Dungen Jan J.A.M.
Published: March 2015

Purpose:

To report a prospective study to ascertain the results of popliteal aneurysm treatment with a self-expanding stent-graft.

Methods:

In a recent 3-year period, 21 patients (18 men; median age 67 years, range 52–82) with 23 popliteal aneurysms were treated with Hemobahn stent-grafts. Follow-up evaluation included duplex scanning, ankle-brachial index (ABI) measurements, and radiographic examination of the knee. Outcome measures were occlusion of the stent-graft and limb loss.

Results:

Technical success in placing the stent-graft and excluding the aneurysm was 100%. An additional vascular intervention was performed in the same session in 5 (24%) cases. In the other 16 patients, local anesthesia was used in 10 (63%). During a median follow-up of 15 months (range 2–37), 5 (22%) of 23 stent-grafts occluded, resulting in a cumulative patency of 74%. All occlusions occurred within 6 months after the intervention; 2 were successfully recanalized, and none of the 3 patients with persisting occlusion required an amputation.

Conclusions:

The results of this study suggest that endovascular stent-graft repair of popliteal artery aneurysms is feasible. Midterm patency rates are lower compared to traditional surgical repair.
Endovascular Aortic Biopsy in the Diagnosis of Takayasu Arteritis
Authors: Morrissey Nicholas J. , Goldman Jeffrey , Fallon John T. , Faries Peter L. , Marin Michael L. , Hollier Larry H.
Published: March 2015

Purpose:

To use a minimally invasive approach to obtain biopsy specimens of the aorta to confirm the diagnosis of Takayasu arteritis and formulate a therapeutic plan.

Case Report:

A 17-year-old woman with lower extremity claudication and a normal erythrocyte sedimentation rate had magnetic resonance angiography, which suggested stenotic lesions of the infrarenal aorta and left renal artery. An endovascular biopsy of the aortic lesion was performed under local anesthesia, retrieving sufficient tissue to make the diagnosis of Takayasu arteritis. The patient was discharged the same day.

Conclusions:

Endovascular aortic biopsy may be useful in diagnosing Takayasu arteritis and guiding the clinician toward the proper mode of treatment.
Intrahepatic Aneurysmal Portohepatic Venous Shunt: Embolization with a Tissue Adhesive Solution
Authors: Fanelli Fabrizio , Marcelli Giulia , Bezzi Mario , Salvatori Filippo Maria , Rossi Michele , Rossi Plinio , Passariello Roberto
Published: March 2015

Purpose:

To report the endovascular treatment of an intrahepatic portosystemic venous shunt (IPSVS) using a tissue adhesive solution.

Case Report:

A 40-year-old woman without diagnosed liver disease presented for evaluation of vague abdominal pains. A latent portosystemic encephalopathy was diagnosed only during hospitalization, when ultrasound examination disclosed a venous-venous right hepatic communication. The patient was treated with selective percutaneous embolization using a tissue adhesive after blocking the lesion's venous inflow and outflow tracts. The result was excellent, and the patient recovered completely in a few days. After 5 months, the patient is asymptomatic and event-free.

Conclusions:

Large IPSVS may be successfully treated percutaneously using a tissue adhesive solution, avoiding a more invasive procedure.
A Modular Multi-Branched System for Endovascular Repair of Bilateral Common Iliac Artery Aneurysms
Authors: Abraham Cherrie Z. , Reilly Linda M. , Schneider Darren B. , Dwyer Shelley , Sawhney Rajiv , Messina Louis M. , Chuter Timothy A.M.
Published: March 2015

Purpose:

To describe a modular stent-graft for cases of bilateral common iliac aneurysm.

Technique:

The aortic aneurysm is repaired using a standard bifurcated modular system (Zenith). A modified bifurcated component is deployed with its trunk in one limb of the original aortic stent-graft, its long limb in the external iliac artery, and its short limb in the iliac aneurysm just above the internal iliac orifice. A flexible extension is introduced from the right brachial artery and used to bridge the gap between the short limb of the modified bifurcated component and the left internal iliac artery.

Conclusions:

Endovascular repair of bilateral iliac aneurysm is feasible using a modular stent-graft with separate branches to the internal and external iliac arteries.
Alternative Method of Rapid Drying Vascular Specimens for Scanning Electron Microscopy
Authors: Slížová DáŠa , Krs Otakar , PospíŠilová Blanka
Published: March 2015

Purpose:

To report the use of hexamethyldisilazane (HMDS) as an alternative to critical point drying for preparing stented canine peripheral vessels for scanning electron microscopy (SEM).

Technique:

Vascular specimens were fixed in 4% formaldehyde overnight, dehydrated in a graded ethanol series, followed by immersion in 100% hexamethyldisilazane. After air drying, the specimens were mounted on stainless steel stubs, coated with gold, and examined in the SEM. The electron micrographs were of high quality, showing the layers of the vascular wall and the incorporated stent covered by a neointimal layer. The micrographs were comparable to corresponding histological sections, but detailed endothelial patterns were more visible.

Conclusions:

HMDS treatment and subsequent air drying provides good quality scanning electron micrographs that reveal both endothelial patterns and the layered architecture of stented vessels. The disadvantage of HMDS drying may be a shrinkage and distortion similar to other drying agents. Ease of handling, low cost, and a high rate of success are advantages that favor HMDS desiccation over other drying methods.
Multicenter Trial of the Jostent Balloon-Expandable Stent-Graft in Renal and Iliac Artery Lesions
Authors: Gaxotte Virginia , Laurens Brigitte , Haulon Stéphan , Lions Christophe , Mounier-Véhier Claire , Beregi Jean-Paul
Published: March 2015

Purpose:

To report the results of a multicenter feasibility study of the Jostent balloon-expandable stent-graft in the treatment of renal and iliac artery lesions.

Methods:

Twenty-three patients (17 men; mean age 62 years, range 38–80) with lesions in the renal (n = 12) or iliac arteries (n = 12) were enrolled in 6 centers over a 1-year period. Preprocedural computed tomography (CT) and angiography were performed in all patients. The Jostent device was implanted in the 24 arteries to treat 11 in-stent stenoses, 2 arterial ruptures, 2 aneurysms, 2 dissections, 2 ulcerated stenoses, and 5 chronic occlusions. Follow-up included color duplex ultrasound examination on the day after the procedure and at 6 months; patients with renal artery stent-grafts were also evaluated with CT angiography.

Results:

Twenty-seven stent-grafts were deployed successfully in the 24 (100%) arteries. Seven (30%) patients required adjunctive procedures to address 1 acute in-stent thrombosis, 2 dissections, and 4 in-stent residual stenoses. At 6-month follow-up, 2 (8.3%) restenoses occurred in the renal arteries; these were treated successfully using balloon angioplasty.

Conclusions:

These data suggest that a balloon-expandable stent-graft may be safe and useful in patients with selected peripheral indications.
The Role of Routine Angioscopy in Vascular Access Surgery
Authors: Hölzenbein Thomas J. , Miller Arnold , Gottlieb Michael N. , Gupta Sushil K.
Published: March 2015

Purpose:

The purpose of this retrospective study is to describe our techniques, review our experience, and determine the feasibility, safety, and role of the routine use of angioscopy during primary and revision vascular access surgery.

Methods:

Between February 1991 and October 1993, intraoperative angioscopy was routinely performed in 84 consecutive operations (51 patients) for vascular access surgery. We reviewed the videotaped recordings of the angioscopic studies together with the clinical data according to a predetermined protocol.

Results:

There were 43 primary procedures (36 autogenous arteriovenous fistulas and 7 bridge graft fistulas) and 41 revision procedures for failed vascular access (7 autogenous arteriovenous fistulas and 34 graft bridge fistulas). In 20.9% of the primary vascular access procedures, abnormal endoluminal findings were noted. Based on these findings, only one additional intervention was performed. In revision vascular access surgery, abnormal endoluminal findings were noted in 92.7%, resulting in additional surgical interventions in 65.9% of the procedures. In the revised synthetic bridge graft fistulas, stenosis of the mid-graft (n = 9) as a result of needle insertion for dialysis was more common than at venous anastomosis (n = 4). Detection and correction of endoluminal abnormalities resulted in a 30-day patency of 66.6% as opposed to 33.3% when none was detected (p ≤ 0.012, Fisher's exact test).

Conclusions:

Routine angioscopy is technically feasible and can be performed safely in anuric patients during vascular access surgery. It provides additional and useful intraoperative information that may significantly alter the surgical procedure. Routine angioscopy may also provide new insights into the pathophysiology of vascular access failure.
The Role of Endovascular Surgery in Carotid Restenosis
Authors: Pratesi Carlo , Credi Giovanni , Pulli Raffaele , Michelangnoli Stefano , Bertini Domenico
Published: March 2015

Purpose:

To report the immediate and long-term outcome of intraoperative balloon angioplasty for the treatment of recurrent disease in the internal carotid arteries (ICAs).

Methods:

Three patients (2 males, 1 female; ages 53 to 70 years) presented with > 80% restenotic lesions (bilateral in one patient) at the distal aspect of a previous carotid endarterectomy. Two patients exhibited hemianopia, while the third was asymptomatic but had a contralateral ICA occlusion. All four lesions appeared smooth and fibrous on ultrasonography and were located high in the ICA. The location and morphology of the lesions made balloon angioplasty a more potentially successful treatment option.

Results:

Through open access to the common carotid artery, the lesions were approached and dilated under fluoroscopic guidance with monitoring of evoked potentials. The lesions were successfully dilated as determined by control arteriography, and no complications were encountered. Over a follow-up period extending to 18 months in one patient and 24 months in the other two, ultrasound imaging and arteriography have shown no restenosis at any treatment site.

Conclusions:

Although caution is prudent when dealing with lesions in the cervical arteries, balloon angioplasty may have a role in treating surgically in accessible restenotic carotid lesions that demonstrate a low potential for embolic complications. More experience with this technique will be required before widespread application of balloon angioplasty in the cervical vessels can occur.
Percutaneous Peripheral Atherectomy Using the Rotablator: A Single-Center Experience
Authors: Henry Michel , Amor Max , Ethevenot Gérard , Henry Isabelle , Allaoui Mohamed
Published: March 2015

Purpose:

In order to assess the role of percutaneous peripheral rotational ablation using Rotablator™, 150 symptomatic patients (94 males, 56 females; mean age 73 ± 1 years, range 42 to 90) having 212 complex peripheral vascular lesions were treated.

Methods:

Fifty percent of lesions were below the knee; 65% of patients had severe claudication, 11% moderate (24% were in stage III or IV Fontaine classification). The femoral lesions were significantly longer than those at other sites (5.7 ± 0.4 versus 2.9 ± 0.3 cm, p < 0.001). The mean length was 4.0 ± 0.2 cm (range 1 to 20). All the lesions were considered complex; 93% of the lesions were calcified, and 63% were located at a bifurcation. Complementary balloon dilation (percutaneous transluminal angioplasty [PTA]) was significantly (p < 0.001) more frequent in femoropopliteal lesions (70 PTAs in 86 femoral arteries, 10 PTAs in 19 popliteal arteries) than in distal leg lesions (14 in 106 arteries).

Results:

After Rotablator therapy alone, the percent stenosis decreased from 81.0% ± 0.8% to 18.0% ± 1.1%. The residual stenosis was greater at the femoral (44%) than at the distal level (19%) (p < 0.01). Adjunctive PTA (47 lesions) lowered residual stenosis to 10% at the femoral level and 3% at the distal level. Thirty-seven in traprocedural complications occurred (spasm, thrombosis, dissection, perforation, distal emboli, no reflow); seven procedures subsequently failed for an overall technical success of 97%. The mean follow-up period was 14.4 ± 1.0 months (range 1 to 51). Among 125 patients having a follow-up period > 4 months, 114 patients representing 163 lesions underwent angiography. One hundred twenty-three lesions (76%) were patent, and 40 lesions (24%) showed restenosis (> 50% luminal narrowing) of 82.0% ± 2.1. The restenosis rate was higher in femoral (36%) than in distal (21%) or popliteal arteries (7%). Restenosis was more frequent for all lesions > 7 cm (p < 0.001) and for both above- and below-knee locations: 55% versus 19% for < 7 cm at the femoropopliteal level (p < 0.03), and 80% versus 18% at the distal level (p < 0.01).

Conclusions:

In our experience, percutaneous peripheral rotational ablation has taken a pre-eminent position in the treatment of distal leg arteries, especially in complex lesions. Our results have led us to broaden its indications to complex vascular lesions ≤ 6 cm. In particular, the use of this technique for treatment of runoff vessels should improve the long-term patency of proximal PTA and bypass grafts. This device has become in dispensable in our laboratory, where Rotablator therapy comprises 15% of all PTA procedures.
Strecker Stents in the Femoropopliteal Arteries: Value of Duplex Ultrasonography in Restenosis Assessment
Authors: Bray Alan E. , Liu Wei G. , Lewis Warren A. , Harrison Catherine , Maullin Ann
Published: March 2015

Purpose:

Experience with Strecker stent implantation in the femoropopliteal arteries has been described; however, few of the reports were prospective studies, and none routinely used site-specific assessment methods for follow-up evaluation of stent patency. The purpose of this study was to evaluate 1-year Strecker stent patency using duplex ultrasound imaging to obtain a more precise delineation of stent restenosis than is possible with other noninvasive assessment modalities.

Methods:

A prospective study involved 52 patients with 57 sites treated by angioplasty and Strecker stent deployment in the femoropopliteal arteries. Assessment included clinical evaluation; ankle-brachial index (ABI) measurements at rest and after exercise; and duplex ultrasound imaging preprocedurally and at 3 and 12 months after the intervention.

Results:

All 74 stents were deployed successfully in the 35 occluded arteries and 22 stenotic lesions. Acute reocclusion occurred in 6 (10%). At 3 months, primary patency was 81% and secondary patency 84%. Mean (± SD) ABIs increased from 0.64 ± 0.15 at rest and 0.32 ± 0.17 after exercise to 0.89 ± 0.14 and 0.68 ± 0.23, respectively (p < 0.0001). At 12 months, primary patency was 79%, and secondary patency was 82%. Mean ABIs were 0.82 ± 0.15 at rest and 0.52 ± 0.22 after exercise at 12 months (p < 0.0001 compared with preprocedural ABIs). Analysis of the length of lesion treated showed better results with shorter diseased segments, but this was not statistically significant (p > 0.05). Better outcomes were also obtained when one stent was used rather than two stents at 12 months (p = 0.15), but there was no difference at 3 months (p = 0.3). Thirty-four percent of the stented segments progressed from < 20% stenosis at 3 months to > 50% stenosis at 12 months. Overall, 19 (43%) of 44 segments progressed from < 50% stenosis at 3 months to a > 50% stenosis at 12 months. Restenosis seen at 3 months generally was in the native artery just proximal or distal to the stent, but at 12 months, restenosis was mainly inside the stent.

Conclusions:

Strecker stents at 1-year demonstrated satisfactory patency in the femoropopliteal arteries when deployed for angioplasty salvage or recurrent disease. The 3- and 12-month evaluations obtained with duplex ultrasound provided site-specific hemodynamic data for stent assessment. Resting ankle pressures were a poor index of restenosis.
Transbrachial Endovascular Exclusion of an Axillary Artery Pseudoaneurysm with PTFE-Covered Stents
Authors: Marston William A. , Criado Enrique , Mauro Matthew A. , Keagy Blair A.
Published: March 2015

Purpose:

Endovascular exclusion of arterial injuries associated with arteriovenous fistulas and pseudoaneurysms has only recently been described using various stent-graft prostheses. This report details a transbrachial technique used to exclude an axillary artery pseudoaneurysm developing at the axillary anastomosis of an axillofemoral graft.

Methods and Results:

Thin-walled polytetrafluoroethylene was expanded with an angioplasty balloon catheter and used to cover standard Palmaz stents. Two covered stents were delivered under fluoroscopic guidance via open brachial artery access to the site, resulting in complete exclusion of the pseudoaneurysm. Follow-up duplex scanning confirmed aneurysm exclusion 3 months postprocedure.

Conclusions:

This technique can be applied in arteries of different sizes and lengths, using currently available materials. However, the long-term behavior of these devices in the arterial tree must be determined before their widespread use can be recommended for most indications.
Endoluminal Grafting for Aneurysmal and Occlusive Disease in the Superficial Femoral Artery: Early Experience
Authors: Diethrich Edward B. , Papazoglou Konstantine
Published: March 2015

Purpose:

To examine whether endoluminal grafts (ELGs) of radially expandable polytetrafluoroethylene (PTFE) can successfully form durable internal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the femoropopliteal (FP) arteries.

Methods:

Under protocol, implantation of an unpredilated PTFE tube ELG anchored with Palmaz stents using a low-profile percutaneous delivery system was attempted in 50 symptomatic patients for a variety of pathologies: (1) restenosis; (2) complex lesions unlikely to be treated successfully with other endoluminal therapies; (3) acute angioplasty failure; and (4) aneurysms. There were 37 occlusions, 14 stenoses, and 2 long, combined stenoticaneurysmal lesions in 47 native arteries, 5 FP grafts, and 1 femorotibial (FT) vein graft. Thirty-two percent of the patients had ≤ 1 vessel runoff. The average lesion length was 20.4 ± 11.4 cm (range 1.5 to 40), and the mean preoperative ankle-brachial index (ABI) at rest was 0.53 ± 0.14.

Results:

In a 20-month period through April 1995, 50 patients (34 males, 16 females; mean age 69.5 years, range 45 to 87) underwent 54 procedures in 53 limbs; 55 ELGs were successfully deployed in 51 limbs; 2 patients were converted to FP bypass owing to technical problems (96% procedural success). There were 18 inhospital complications: 1 distal wire dissection repaired with an additional ELG; 2 hematomas requiring surgical repair; 1 graft collapse; 1 pseudoaneurysm at the site of a mid-ELG leak; 7 minor access sequelae; and 6 acute ELG thromboses, 4 treated with lytic therapy and balloon dilation, 1 with open thrombectomy, and 1 with bypass grafting. The mean postoperative ABI was 1.01 ± 0.10. During the 30-day postprocedure period, 2 ELGs rethrombosed and 2 other limbs (3 ELGs) occluded; 1 thrombosis and 1 rethrombosis were lysed successfully, but the other 2 patients had an FP bypass. Over the mean 8.3 ± 5.5 month follow-up, 6 additional ELGs occluded and 1 reoccluded; 4 were successfully treated by endovascular techniques for a primary patency of 72% and secondary patency of 84% by life-table analysis.

Conclusions:

Endovascular grafting is a conceptually attractive technique that has the potential to expand the current boundaries of interventional treatment. This preliminary experience attests to the feasibility and safety of ELG deployment in the superficial femoral arteries. Whether such a device can match the durability of classical revascularization techniques remains to be determined in clinical trials when device configurations and deployment techniques have been standardized.
Use of Polyetherurethane to Improve the Biocompatibility of Vascular Stents
Authors: Fontaine Arthur B. , Passos Susan Dos , Spigos Dimitrios , Cearlock Jody , Urbaneja Alberto
Published: March 2015

Purpose:

To investigate potential differential growth of neointima following overdilating arterial trauma with polyetherurethane-coated versus bare metalìc stents in swine.

Methods:

Twelve specially constructed tantalum stents, 6 coated with polyetherurethane block copolymer and 6 uncoated, were overdilated by 25% in 12 normal renal arteries of six swine. The stents were harvested 8 weeks after implantation and prepared for histologic examination. Neointimal thickness was quantified and analyzed for significant differences between coated and uncoated prostheses.

Results:

All specimens demonstrated fractures of the internal elastic lamina consistent with vascular injury. There was significantly less neointimal formation (0.0001 < p < 0.05) in coated specimens as compared to uncoated controls in each test animal.

Conclusion:

The vascular response to overdilating stent trauma appears to be moderated with the use of polyetherurethane block copolymer as compared to control.
The Mollring Cutter™ Remote Endarterectomy: Preliminary Experience with a New Endovascular Technique for Treatment of Occlusive Superficial Femoral Artery Disease
Authors: Ho Gwan H. , Moll Frans L. , Joosten Paul Ph.A. Hedeman , van de Pavoordt Eric D.W.M. , Overtoom Tim Th.C
Published: March 2015

Purpose:

To evaluate the feasibility and efficacy of the Mollring Cutter™ remote endarterectomy (EA) technique in the treatment of occlusive superficial femoral artery (SFA) disease.

Methods:

A new device was developed to perform remote EA of occluded SFAs through a single groin incision. The technique initially uses a conventional ring stripper, which is exchanged for a double-ring cutter that transects the distal atheroma core. The entire core and cutter are removed simultaneously, and a Palmaz stent is implanted to secure the distal intimal flap.

Results:

Twenty-six consecutive patients with disabling claudication or critical ischemia were treated for long segment occlusions (n = 23) and multiple stenoses (n = 3). Patients were evaluated on the intention-to-treat basis. Clinical and anatomic success was achieved in all 26 SFAs. Average length of the endarterectomized segments was 29.9 cm (range 23 to 41). Technical problems were encountered intraoperatively in four patients, including one who required a second incision at the distal SFA to retrieve a broken ring. Recovery was uneventful in all patients. At up to 6-month follow-up, one reocclusion has been seen at 5 months.

Conclusions:

Based on this early experience, remote EA with the Mollring Cutter appears to be a feasible and effective method for treating occlusive SFA disease. Obviating the need for a second incision at knee level, this technique offers a less invasive approach that should facilitate postoperative recovery and earlier discharge.
A Prospective Study of Changes in Morphology and Dimensions of Abdominal Aortic Aneurysms following Endoluminal Repair: A Preliminary Report
Authors: May James , White Geoffrey H. , Yu Weiyun , Waugh Richard C. , Stephen Michael S. , Harris John P.
Published: March 2015

Purpose:

The aim of this prospective study was to analyze early changes in morphology and dimensions of abdominal aortic aneurysms (AAA) following endoluminal repair.

Methods:

Forty-two of 62 patients undergoing endoluminal repair of AAAs between May 1992 and November 1994 were potentially available for follow-up at 6 months or longer after operation. After excluding patients with failed endoluminal repairs, patients who died within 6 months of operation, and patients with anastomotic aneurysms, a study group of 30 patients remained. Contrast-enhanced computed tomography (CE-CT) was performed preoperatively, within 10 days of operation, and at 6 and 12 months postprocedure. Based on the postoperative CE-CT findings, patients were divided into two groups: those with no extravasation of contrast into the aneurysmal sac (group I; n = 26), and those in which there was contrast extravasation (“leak”) into the aneurysmal sac (group II; n = 4).

Results:

The mean maximum diameters of AAAs in group I diminished progressively at 6 and 12 months, while those in group II increased. Twenty-three (88%) patients in group I had decreased diameter of AAA, while all patients in group II had progressive increase in AAA diameter. Patients who had an increase in AAA diameter had a significantly higher incidence of leak compared with those who had a decrease in diameter (p = 0.001).

Conclusions:

The majority of AAAs in which the sac has been excluded from the general circulation diminish in size following successful endoluminal repair. An increase in size occurs in those AAAs in which a communication exists between the aortic lumen and the sac. These results suggest that successfully excluded AAAs that continue to increase in size should be suspected of having an undetected leak.
Local Anesthesia in Carotid Angioplasty
Authors: Alessandri Christian , Bergeron Patrice
Published: March 2015

Purpose:

To determine the safety and efficacy of local anesthesia for percutaneous carotid angioplasty and stenting performed via a direct common carotid access.

Methods:

Deep cervical plexus blockade was used for anesthesia in 22 of 32 patients (26 males; mean age 66 years) undergoing percutaneous carotid balloon angioplasty and/or stenting via direct carotid puncture. Local anesthesia was selected according to patient preference (n = 9); advanced age (n = 4); ischemic heart disease (n = 4); intended extracorporeal circulation for unstable angina (n = 3); and an incompetent circle of Willis (n = 2). The technique involved injection of bupivacaine hydrochloride along the C2, C3, and C4 transverse processes. No superficial cervical plexus blockade was used.

Results:

No complications of anesthesia were observed, though there were cases in which surgery became necessary under local anesthesia for angioplasty-related complications. These conversions were accomplished without difficulty.

Conclusions:

Cervical nerve blockade appears to be a safe and effective anesthetic method for endovascular carotid interventions performed percutaneously through direct carotid puncture.
Imaging Modalities for Aortic Endografting
Authors: Beebe Hugh G.
Published: March 2015

One of the most fundamental and influential differences between conventional surgery and endovascular grafting for aortic aneurysm is the central role of imaging in every aspect of management. This review summarizes five imaging techniques for aortic endografting: intravascular ultrasound, contrast angiography, conventional computed tomography (CT), spiral CT with image processing, and magnetic resonance angiography (MRA).

External ultrasound and intravascular ultrasound have important relevance to endovascular aortic surgery. Artifacts of arteriography include magnification, thrombus effect, foreshortening of tortuosity, loss of luminal detail, parallax error, and projection errors. Conventional CT scans have artifacts and difficulties also. Diameter measurement by CT suffers from methodology errors and observer variability. If conventional CT and angiography are used for endovascular aortic graft planning, both should be obtained since neither alone provides sufficient data.

The use of spiral CT scanning and computerized image processing has clearly aided the preoperative definition of aneurysm morphology both in terms of dimensional accuracy and by adding diagnostic information. MRA is capable of producing three-dimensional images, axial sections, and longitudinal projections in any plane. It can detect blood flow without contrast medium, but gadolinium enhances MRA by avoiding the “signal dropout” artifact.

Technology exists to provide new forms of imaging for endovascular surgery that combines three-dimensional models with on-line image data in a process called “data fusion.” This may offer improved ease and accuracy for conducting endovascular procedures in the future.
Endoleak as a Complication of Endoluminal Grafting of Abdominal Aortic Aneurysms: Classification, Incidence, Diagnosis, and Management
Authors: White Geoffrey H. , Yu Weiyun , May James , Chaufour Xavier , Stephen Michael S.
Published: March 2015

The inability to obtain or maintain a secure seal between a vessel wall and a transluminally implanted intra-aneurysmal graft is a complication unique to the evolving technique of endovascular aneurysm exclusion. Because the term “leak” has long been associated with aneurysm rupture, the term “endoleak” is proposed as a more definitive description of this phenomenon.

Embracing both persistent blood flow into the aneurysmal sac from within or around the graft (graft related) and from patent collateral arteries (nongraft related), endoleak can be classified as primary or secondary depending on the time of occurrence (within 30 days of implantation or following apparent initial seal, respectively).

Diagnostic techniques to detect endoleak include arteriography, intraprocedural pressure monitoring, contrast-enhanced computed tomography, abdominal X ray, and duplex scanning. Management strategies for endoleak range from observation with periodic imaging surveillance to correction by additional endoluminal or surgical procedures.

Standardization of the terminology describing this important sequela to endovascular aneurysm exclusion should facilitate uniform reporting of clinical trial data vital to the evaluation of this emerging technique.
Evaluation of Endovascular Abdominal Aortic Aneurysm Repair: Anatomical Classification, Procedural Success, Clinical Assessment, and Data Collection
Authors: Dorros Gerald , Parodi Juan , Schonholz Claudio , Jaff Michael R. , Diethrich Edward B. , White Geoffrey , Mialhe Claude , Marin Michael L. , Stelter Wolf-J. , White Rodney , Coppi Gioacchino , Bergeron Patrice
Published: March 2015

Purpose:

To detail a methodology for evaluation of endovascular abdominal aortic aneurysm (AAA) repair that has been achieved through consensus of an international multidisciplinary team of investigators.

Methods:

This schema features an anatomical classification for AAAs, a definition of procedural success, and a procedure for clinical assessment, as well as the necessary data collection forms. Patient data include demographics, procedural and clinical success, complications, and follow-up. Procedural details can be related to anatomic situations, comorbid processes, devices, and effective aneurysmal exclusion.

Results:

These data would allow assessment of the procedures, physician learning curves, procedural indications, techniques, methodologies, the relationship of indications to success and complications, devices and subsequent graft patency, and aneurysmal exclusion.

Conclusions:

The use of this standardized data collection system could enable physicians and industry to better understand endovascular AAA repair and ultimately improve patient care.
Abdominal Aortic Aneurysms: Experience with the Ivancev-Malmö Endovascular System for Aortomonoiliac Stent-Grafts
Authors: Ivancev Krassi , Malina Martin , Lindblad Bengt , Chuter Timothy A.M. , Brunkwall Jan , Lindh Mats , Nyman Ulf , Risberg Bo
Published: March 2015

Purpose:

To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair.

Methods:

From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Ivancev-Malmö system.

Results:

Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients.

Conclusions:

Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.
The Italian Trial of Endovascular AAA Exclusion Using the Parodi Endograft
Authors: Coppi Gioacchino , Moratto Roberto , Silingardi Roberto , Tusini Nicola , Vecchioni Roberto , Scuro Alberto , Stimamiglio Piero , Adami Carlo A.
Published: March 2015

Purpose:

To report the outcome of the prospective 11-center Italian Parodi Trial using straight and tapered endografts for the endovascular exclusion of abdominal aortic aneurysms (AAA).

Methods:

From April 1994 to July 1995, 27 patients were evaluated and selected for endovascular AAA exclusion. The Parodi devices were delivered through femoral arteriotomies using 18 to 22F introducers and deployed by balloon expansion of the terminal stents.

Results:

Of 27 cases attempted, 24 endografts (15 tube, 9 aortomonoiliac) were implanted (1 deployment and 2 access failures [11.1%] were converted). Three endoleaks (12.5%) were treated intraoperatively with covered stents, two successfully, and the third sealed within 30 days. Three (12.5%) of the 24 treated patients died in-hospital of device- (n = 2) and procedure-related (n = 1) causes; the remaining 21 patients were discharged within 8 days. Of the 8 aortomonoiliac grafts in follow-up, only 1 (12.5%) failed in the mean 23-month (range 18 to 30) follow-up; however, 4 (31%) of 13 tube graft patients were converted to surgery within 18 months. Of the 16 (66.7%) surviving endografts at 2 years, 6 (38%) showed no change in the AAA diameter, while 10 (62%) had shrunk.

Conclusions:

The tube graft was applicable in only about 5% of cases, and accurate endograft sizing and distal fixation were problematic. The aortomonoiliac design was not appealing to surgeons but fared better in the long term. Given the advent of newer endograft models, the Italian Parodi Trial has been terminated.
Endograft Repair of an Aortic Pseudoaneurysm following Gunshot Wound Injury: Impact of Imaging on Diagnosis and Planning of Intervention
Authors: White Rodney , Donayre Carlos , Walot Irwin , Kopchok George E. , Wilson Eric , Klein Stanley
Published: March 2015

Purpose:

To describe the endovascular treatment of a gunshot injury to the visceral aorta and the role of various imaging modalities in the staging and planning of the endograft procedure.

Methods and Results:

The bullet entered the aorta posteriorly beneath the origin of the superior mesenteric artery and traversed the wall in a tangential manner entering the lumen proximal to the renal arteries. Intravascular ultrasound (IVUS) imaging and spiral computed tomography (CT) identified the injury that the initial angiograms failed to demonstrate. Combined use of IVUS and CT imaging enabled observation of the evolution of a pseudoaneurysm until an interval when endograft exclusion was possible. A stent-graft was customized based on precise IVUS and CT dimensional data and implanted successfully through an arteriotomy in the common femoral artery 3 weeks after the initial injury. Three-month follow-up imaging demonstrated continued exclusion of the pseudoaneurysm, and the patient remains well at 16 months.

Conclusions:

IVUS and spiral CT scans were instrumental in identifying an arteriographically undetected aortic injury. The combined imaging modalities also helped determine the timing for the endovascular procedure and provided the precise measurements for device fabrication and deployment.
Percutaneous Endovascular Stent-Graft Repair of Iliac Artery Aneurysms
Authors: Dorros Gerald , Cohn Joel M. , Jaff Michael R.
Published: March 2015

Purpose:

To report a percutaneous technique for endovascular repair of iliac artery aneurysms using commercially available materials.

Methods:

Ten patients (9 males; mean age 65 ± 11 years) presented with 11 isolated iliac artery aneurysms; 3 patients were asymptomatic. Stent-grafts were customized for each patient from polytetrafluoroethylene grafts with Palmaz stents sutured at either end of the tube. The devices were delivered percutaneously through standard 14F sheaths and deployed by balloon dilation.

Results:

All iliac aneurysms were excluded without procedural incident. One patient with chronic renal insufficiency (baseline serum creatinine 1.9 mg/dL) experienced transient contrast-induced renal failure inhospital. The average hospital stay was 2.5 days (range 1 to 7). One vessel thrombosed 2 weeks following the procedure; the culprit stenosis at the site of arterial cannulation was dilated. One patient died of myocardial infarction at 6 weeks. The remaining eight grafts are patent and free of endoleak at a mean 14-month follow-up.

Conclusions:

This percutaneous technique appears to be an acceptable alternative to open surgical repair.
Recurrence of Pseudoaneurysm after Successful Embolization
Authors: Garby Karen B. , King Teresa S. , Tsai Fong Y.
Published: March 2015

Purpose:

To report the initial successful treatment of a hepatic pseudoaneurysm by a partially formed coil and subsequent recurrence secondary to coil migration and configuration change.

Methods and Results:

A 22-year-old man suffered a gunshot wound in the abdomen; a grade 4 liver laceration was identified and repaired. Eight days later, abdominal pain developed, and pseudoaneurysms were noted off both the superior and inferior branches of the right hepatic artery. Coil embolization was successful in occluding both defects; however, the inferior branch coil was incompletely formed. Twenty days later, symptom recurrence prompted angiography. The inferior branch coil had changed position and configuration, resulting in a larger pseudoaneurysm. Repeat embolotherapy was successful.

Conclusions:

The possible sequelae to maldeployed occluding coils must be considered even if the procedure appears successful. It may be advisable to place additional coils to more confidently occlude the pseudoaneurysm.
Stent-Graft Arteriovenous Fistula: An Endovascular Technique in Hemodialysis Access
Authors: Masuda Elna M. , Kistner Robert L. , Eklof Bo , Lipman Robert A. , Balkin Peter W. , Kamida Curtis B.
Published: March 2015

Purpose:

To determine the feasibility and safety of a new endovascular technique for creating an arteriovenous (AV) fistula utilizing catheter-directed techniques and stents.

Methods:

Stent-graft AV fistulas were offered on an experimental basis to 8 patients who had a history of multiple failed access procedures or very small arm veins unsuitable for standard vascular access techniques. The device consisted of a balloon-expandable Palmaz stent attached to the designated venous end of a polytetrafluoroethylene graft. The balloon-mounted stent-graft was inserted into the brachial vein through an arteriotomy and advanced over a guidewire into the axillary vein. After the stent-graft was deployed, the arterial anastomosis was completed in standard surgical fashion using an end-to-side anastomosis of the graft to the brachial artery.

Results:

The stent-graft was inserted successfully in all patients, but there were two early failures. The first resulted from a steal phenomenon secondary to high flows through the stent-graft, necessitating ligation of the fistula. Another stent-graft was placed too peripherally in the upper arm, and the stainless steel stent was crushed by external compression. Three of the 6 remaining grafts were patent for over 1 year, and 2 grafts are still functioning at 22 and 13 months.

Conclusions:

Endoluminal stent-grafts can be successfully inserted into the axillary vein for creation of an AV fistula and remain patent for 2 years or more. This method may be most useful in patients with very small, unusable arm veins or multiple failed AV grafts.
Emergent Endoluminal Repair of Delayed Abdominal Aortic Rupture after Blunt Trauma
Authors: Scharrer-Pamler Reinhard , Görich Johannes , Orend Karl H. , Sokiranski Roman , Sunder-Plassmann Ludger
Published: March 2015

Purpose:

To report the emergency repair of a traumatic abdominal aortic rupture using endoluminal techniques.

Methods and Results:

A 25-year-old female sustained multiple head, chest, and abdominal injuries in a motorcycle accident. Six days after emergency treatment (including splenectomy and repair of a superficial hepatic rupture and lacerations to the stomach, small bowel, and colon), she became hemodynamically unstable. A massive retroperitoneal hematoma had evolved from a distal aortic rupture. Owing to a hostile abdomen and possibility of bacterial contamination, a self-expanding stent-graft was inserted transfemorally to repair the aortic injury. The patient recovered uneventfully and continues in good health with a patent endograft repair 2 years after treatment.

Conclusions:

This experience would support the efficacy of endograft implantation for emergent repair of trauma aortic injuries; however, proper facilities, an experienced interventional team, and an assortment of endografts and stents must be available.
Changes in Referral Practice, Workload, and Operative Mortality after Establishment of an Endovascular Abdominal Aortic Aneurysm Program
Authors: Boyle Jonathan R. , Thompson Matthew M. , Sayers Robert D. , Nasim Ahktar , Healey Patricia , Bell Peter R.F.
Published: March 2015

Purpose:

To determine the change in referral practice following establishment of an endovascular abdominal aortic aneurysm (AAA) program.

Methods:

A prospective audit of all elective admissions for AAA was established in January 1994 at the initiation of an endovascular AAA program. A comparison was made between this cohort and the elective AAA repairs performed between 1981 and 1993.

Results:

Since January 1994, 213 AAA patients (177 men; median age 73 years, range 54 to 88) have been referred for potential endovascular aneurysm repair. To date, 142 patients have undergone elective surgery (41 endovascular and 101 conventional). Between 1981 and 1993, 304 patients (255 men; median age 69 years, range 45 to 86) had elective aneurysm repair. Comparison of the two time periods has revealed significant increases in the number of tertiary referrals (41.8% versus 9.5%, p < 0.01), annual operations (50 versus 23, p < 0.05), and overall mortality (12% versus 6.7%, p < 0.05), the latter attended by a significant increase in cardiorespiratory comorbidity.

Conclusions:

The higher elective AAA mortality rate since the establishment of an endovascular program reflects a change in referral practice and may be directly attributable to an increase in the number of high-risk patients. An endovascular AAA program has clinical and financial implications for the hospital concerned.
Percutaneous Endoluminal Treatment of Iliac Occlusions: Long-Term Follow-up in 105 Patients
Authors: Henry Michel , Amor Max , Ethevenot Gérard , Henry Isabelle , Mentre Bernard , Tzvetanov Kiril
Published: March 2015

Purpose:

To evaluate the long-term results of percutaneous recanalization techniques in occluded iliac arteries.

Methods:

Percutaneous recanalization was attempted in 105 patients (97 men; mean age 56 years, range 34 to 80) with iliac occlusions using thrombolysis (n = 15), excimer laser (n = 4), mechanical thrombectomy (n = 16), balloon angioplasty alone (n = 23), and angioplasty plus stenting (n = 69). The majority of lesions (n = 72) were in the common iliac artery (CIA); 33 were in the external iliac artery (EIA).

Results:

The primary recanalization rate was 88% (92/105) independent of location (EIA: 90%, CIA: 86%) and lesion length, but dependent on age of thrombus (< 3 months: 100%, > 3 months: 79%, p < 0.02). Complications included 5 (4.8%) cases of distal embolism treated by thromboaspiration or Fogarty balloon embolectomy. Seven (6.7%) early thromboses were treated surgically. Primary and secondary patency rates were calculated at 6 years for all 105 cases and for the 92 recanalized lesions using life-table analysis. Overall, primary patency was 52% (CIA: 58%, EIA: 34%) and secondary 66% (CIA: 74%, EIA: 40%). Lesions < 6 cm had a primary patency of 70%, while those > 6 cm had a 31% rate (p < 0.01). Secondary patencies were 86% and 42%, respectively (p < 0.01). Among recanalized lesions, the primary patency was 61% (CIA: 69%, EIA: 38%) and secondary 77% (CIA: 88%, EIA: 45%; p < 0.05). Lesions < 6 cm had a primary patency rate of 72%, while longer lesions had a primary rate of 44% (p < 0.04); secondary patencies were 89% and 59%, respectively (NS). Primary patency without stent was 57% and with stent 65% (NS); secondary patency without stent was 71% and with stent 82% (NS).

Conclusions:

Percutaneous recanalization of iliac occlusions represents a true alternative to vascular surgery and a first-line treatment option. Stents have a tendency to improve long-term results and are recommended for routine use in chronic iliac occlusions.
Assessment of Apparent Vena Caval Penetration by the Greenfield Filter
Authors: Proctor Mary C. , Greenfield Lazar J. , Cho Kyung J. , Moursi Mohammed M. , James Eric A.
Published: March 2015

Purpose:

To examine and elucidate the mechanisms for apparent “penetration” by Greenfield vena caval filters.

Methods:

Two filters were placed in the inferior venae cavae (IVC) of four immature sheep and followed with cavography for 1 year. Two animals underwent computed tomography (CT) and laparoscopic examination. At necropsy, the vena cava and adjacent structures of all four animals were examined grossly and histologically.

Results:

Based upon cavography and CT imaging, all filters appeared to penetrate the vena cava at 12 months. However, at laparoscopy, no hooks or limbs were exposed, and the pericaval tissues remained intact; each hook or limb was within the adventitia or encapsulated in scar tissue. Histology of the tissue at the hook sites revealed remodeling of the intimal surface of the IVC and thinning of the adventitia.

Conclusions:

Based upon these data, we hypothesize that the vena cava gradually adapts by medial and adventitial thinning and myointimal remodeling to the radial force exerted by a filter. This process allows increase in the filter base diameter while maintaining the integrity of the cava and protecting adjacent structures.