bluuebunny/crossref_metadata_2025 huggingface dataset:
A Porcine Model of Carotid Artery Thrombosis for Thrombolytic Therapy and Angioplasty: Application of PTFE Graft-Induced Stenosis
Authors: Lin Peter H. , Chen Changyi , Surowiec Scott M. , Conklin Brian , Bush Ruth L. , Chaikof Elliot L. , Lumsden Alan B. , Weiss Victor
Published: March 2015

Purpose:

To develop a porcine carotid artery thrombosis model for the evaluation of thrombolytic therapy and adjunctive angioplasty procedures.

Methods:

Bilateral carotid thrombosis was induced in 16 pigs using endothelial crush injury followed by external polytetrafluoroethylene (PTFE, 5 × 2 cm2) wrap placement to create segmental carotid stenosis. Light microscopy was used to examine thrombus composition. Selective carotid catheterization was performed via a femoral approach. Two hours following carotid artery occlusion, a urokinase (250,000 IU) and heparin (1000 U) solution was pulse-sprayed in 1 carotid artery while the contralateral vessel received the control saline vehicle. The efficacy of thrombolytic therapy was assessed using carotid arteriography and intravascular ultrasound. The feasibility and technical efficacy of balloon angioplasty within the carotid stenosis model were also evaluated.

Results:

Carotid artery occlusion occurred in 30 ± 6 minutes following endothelial injury plus PTFE wrap placement. Histological examination of carotid arteries showed endothelial irregularity with fibrin-rich and platelet-rich thrombus. Urokinase was effective in recanalizing all occluded arteries (100%), while the control saline vehicle showed no effective thrombolysis (p < 0.001). Angioplasty was successful in restoring normal diameter in all arteries (100%).

Conclusions:

This carotid artery thrombosis model, which incorporates intimal injury with segmental stenosis, is simple to create and reproducible. It provides not only a model for the evaluation of thrombolytic therapy but also a practical training tool for adjunctive endovascular interventions.
Endograft Exclusion of Residual Common Iliac Artery Aneurysms
Authors: Derom Alex , Vermassen Frank , Ongena Karin
Published: March 2015

Purpose:

To describe an endovascular approach for residual common iliac artery (CIA) aneurysm.

Methods and Results:

A residual CIA was discovered in a 73-year-old man during routine examination following straight interposition graft placement for a ruptured abdominal aortic aneurysm (AAA). An aortobifemoral bypass was performed with ligation of both aneurysmal iliac arteries. A year later, aneurysms of both CIA stumps were found. On each side, a Hemobahn stent-graft was percutaneously positioned from the external to the internal iliac artery via the superficial femoral artery. Control angiography at 2 months and spiral computed tomographic angiography at 6 and 18 months confirmed exclusion of the aneurysms and patency of the endoprostheses.

Conclusions:

Successful endovascular treatment of residual CIA aneurysm is possible with flexible stent-grafts.
Abciximab in Carotid Stenting for Postsurgical Carotid Restenosis: Intermediate Results
Authors: Schneiderman Jacob , Morag Benyamina , Gerniak Alexander , Rimon Uri , Varon David , Seligsohn Uri , Shotan Avraham , Adar Raphael
Published: March 2015

Purpose:

To report intermediate results of a pilot study in which the glycoprotein IIb/IIIa receptor antagonist abciximab was given to patients during percutaneous carotid stenting for recurrent internal carotid artery (ICA) stenosis. The objective was to prevent procedure-related cerebral embolic events and decrease the incidence of recurrent stenosis.

Methods:

Sixteen patients (9 women; mean age 66.5 years, range 39–78) with severe ICA recurrent stenosis (>80%) underwent balloon angioplasty and stenting. Before the procedure, abciximab was administered intravenously as a bolus (0.25 mg/kg) followed by a 12-hour continuous infusion (10 µg/min).

Results:

Fifteen patients received stents (14 Wallstent and 1 Strecker); 1 vessel was dilated with only 50% improvement in luminal diameter. Two stented arteries had residual stenosis (<30%) but satisfactory luminal diameter was achieved in the remaining 13 (81%) arteries. There were no neurological ischemic events during or following the procedure, nor were there any bleeding or peripheral vascular complications. Duplex surveillance studies up to 12 months revealed no significant recurrent stenosis in the treated vessels.

Conclusions:

The administration of abciximab in conjunction with percutaneous revascularization procedures for postsurgical carotid artery stenosis may reduce cerebral ischemic episodes. It may also attenuate restenosis in the treated artery.
Three-Dimensional Intravascular Ultrasound Assessment of Abdominal Aortic Aneurysm Necks
Authors: van Essen Jeroen A. , Gussenhoven Elma J. , Blankensteijn Jan D. , Honkoop Jan , van Dijk Lukas C. , van Sambeek Marc R.H.M. , van der Lugt Aad
Published: March 2015

Purpose:

To document the accuracy of an automated analysis system for measuring lumen diameter and neck lengths of abdominal aortic aneurysms (AAAs) from intravascular ultrasound (IVUS) images and to describe additional features associated with 3-dimensional (3D) IVUS imaging.

Methods:

Twenty-two aortic aneurysms were studied with IVUS. Lumen diameters obtained using the automated analysis system were compared with manual measurements from axial IVUS scans, as were neck lengths obtained using automated analysis versus those measured with the aid of a displacement sensing device. Automated analyses were repeated by a second observer. Agreement was expressed as the coefficient of variation (CV).

Results:

Twenty proximal aortic, 6 distal aortic, and 3 iliac necks were available for analysis. Comparison between automated analysis and manual measurements for lumen diameter revealed a difference of 0.45 ± 0.42 mm (mean ± SD, Pearson's r = 0.99, p < 0.001, CV = 2.1%) and a difference of 0.05 ± 0.12 cm (r = 0.99, p = 0.04, CV = 4.1%) for neck length. Interobserver difference for lumen diameter was 0.13 ± 0.66 mm (r = 0.99, p < 0.001, CV = 3.4%) and 0.05 ± 0.11 cm for length measurements (r = 0.99, p = 0.02, CV = 3.5%). The 3D IVUS imaging facilitated the identification of neck configuration.

Conclusions:

Automated analysis of IVUS images allows accurate measurement of the lumen diameter of proximal and distal AAA necks and gives length measurements comparable to those of manual analysis. Longitudinal display of IVUS images aids in the elucidation of neck anatomy.
A Simple Technique to Improve the Accuracy of Proximal AAA Endograft Deployment
Authors: Broeders Ivo A.M.J. , Blankensteijn Jan D.
Published: March 2015

Purpose:

To report a technique for overcoming the positioning errors caused by angulation and rotation of the proximal aortic neck when anteroposterior fluoroscopic imaging is used during endograft deployment.

Technique:

Aortic neck angulation and rotation were measured preoperatively using spiral computed tomographic angiography in sagittal and axial projections. Before proximal graft deployment, the proximal end of the endograft was centered in the field of view, and the position of the C-arm was adjusted to the aortic neck angulation. Using this technique, optimal positioning of the endograft relative to the true position of the renal arteries can be achieved.

Conclusions:

C-arm angulation and rotation is helpful in facilitating perfect positioning for an optimal seal between the endograft and the infrarenal aortic neck.
Popliteal Artery Aneurysms: Is Endovascular Reconstruction Durable?
Authors: Rosenthal David , Matsuura John H. , Clark Michael D. , Kirby Lemuel B. , Knoepp Louis F.
Published: March 2015

Purpose:

To describe an endovascular method of performing femoropopliteal in situ saphenous vein (SV) bypass and popliteal artery aneurysm (PAA) embolization.

Methods:

Twenty-two patients underwent PAA operations. Twelve patients had conventional SV bypasses with PAA proximal and distal ligation, whereas 10 underwent PAA embolization and an endovascular in situ SV bypass (EISB). The endovascular procedure was performed using an angioscopically guided side branch coil occlusion system. The PAAs were coil embolized under fluoroscopic surveillance.

Results:

No deaths or wound complications occurred in the EISB group. The mean hospital length of stay (LOS) was 2.1 days. Seven EISB procedures were performed through 2 incisions, whereas 3 operations required an additional incision. One graft occluded at 3 months. All PAAs remained occluded by color-flow ultrasonography at follow-up ranging from 4 to 23 months (mean 13.6); cumulative primary patency was 89%. In the conventional bypass group, no deaths occurred, but 3 (25%) patients had wound complications. The mean LOS was 6.2 days, and 1 graft occluded, giving an 86% cumulative primary patency at 42 months.

Conclusions:

This minimally invasive technique obviates an extensive incision to harvest the SV and ligate the PAA proximally and distally. If long-term endovascular bypass graft patency and PAA occlusion rates prove to be similar to open operative results, the benefits of reduced wound complications, decreased hospital LOS, and increased health care savings support further investigation of this endovascular approach for the treatment of PAA.
Hybrid Open-Endoluminal Technique for Repair of Thoracoabdominal Aneurysm Involving the Celiac Axis
Authors: Lawrence-Brown Michael , Sieunarine Kishore , van Schie Greg , Purchas Stephen , Hartley David , Goodman Marcel A. , Prendergast Frank J. , Semmens James B.
Published: March 2015

Purpose:

To describe a technique combining endoluminal and open approaches for the repair of thoracoabdominal aneurysms involving the celiac axis.

Case Report:

Two patients with type I thoracoabdominal aneurysm and suboptimal cardiac reserve underwent transluminal stent-graft implantation. To achieve satisfactory distal seal, the caudal end of the endograft was circumscribed with a Dacron band that was sutured to the aorta and endograft through a midline incision. The patent celiac artery in both patients was ligated to stop retrograde filling of the aneurysm sac. The patients developed no problems perioperatively, and exclusion of the aneurysms was confirmed by follow-up imaging. Three years after endografting, both patients had excluded aneurysms without evidence of endoleak or device migration.

Conclusions:

This combined approach is another treatment option for thoracic aneurysms that have an anatomically suitable proximal attachment zone with a compromised distal neck.
Endoluminal Aortic Grafting with Renal and Superior Mesenteric Artery Incorporation by Graft Fenestration
Authors: Anderson John Lennon , Berce Michael , Hartley David E.
Published: March 2015

Purpose:

To explore the use of juxta- and suprarenal aortic segments for endograft fixation in abdominal aortic aneurysm (AAA) patients and to develop methods of graft implantation that use endograft fenestrations to preserve renal and visceral vessel perfusion.

Methods:

From August 1998 to May 2000, 13 AAA patients with unsuitable infrarenal aortic necks were treated with custom-designed endovascular grafts employing the juxta- and suprarenal aortic segments for proximal sealing. Flow to 33 renal and superior mesenteric arteries was maintained via graft fenestrations that were aligned by use of radiopaque graft markers. The fenestration-orifice interface for renal arteries was secured with modified balloon-expandable stents.

Results:

All fenestrated grafts were deployed as planned, and all target vessels (33/33) were preserved. Two patients did not receive any stents, one being the first in the series and another who had incorporation of a renal accessory artery only. Without the use of transgraft stenting, 5 renal arteries would have been occluded by the endograft or poorly perfused. Procedural success was 100%. No conversion to open operation or graft-related complications occurred. There was no primary endoleak in any patient by angiographic criteria. Two patients required additional surgical procedures related to access vessels. Periprocedural mortality at 30 days was nil. Follow-up ranging from 3 to 24 months on all patients has not demonstrated any proximal or distal endoleaks. One stented renal vessel has occluded; all other arteries remain patent at last examination.

Conclusions:

This study has demonstrated the ability to successfully place a multifenestrated endoluminal graft in an aortic aneurysm using juxta- and suprarenal aortic segments to obtain a satisfactory seal. Stenting of the fenestration—renal ostium junction has helped to maintain renal patency.
“Accordion” Deformity of a Tortuous External Iliac Artery after Stent-Graft Placement
Authors: Quinn Stephen F. , Kim Jinho , Sheley Robert C. , Frankhouse Joseph H.
Published: March 2015

Purpose:

To identify a complication of endograft deployment in aneurysmal iliac arteries.

Case Report:

A 71-year-old man was referred for endovascular treatment of a 60-mm diameter right common iliac artery aneurysm; however, deployment of a homemade covered stent (Palmaz-Schatz and polytetrafluoroethylene) induced shortening of the tortuous external iliac artery, causing an “accordion” deformity. The anomaly proved difficult to treat with serial Wallstent deployment, because the convolution tightened and migrated caudally with each stent deployed, threatening outflow. Finally, after 3 Wallstents were implanted, the contour of the external iliac artery was straight, and flow was unimpeded. However, 3 weeks later, the external iliac artery had recoiled to its original redundant appearance, but flow remained satisfactory. The aneurysm remains excluded, with satisfactory distal flow after 24 months.

Conclusions:

Implanting endografts in redundant, tortuous arterial segments may prove problematic, since induced straightening by the device precipitates kinking in the redundant system. Although treatment may be required in some situations, the vessels may return to a noncompressed state by removing the delivery system and guidewire.
Use of a Balloon-Expandable, Radially Reinforced ePTFE Endograft after Remote SFA Endarterectomy: A Single-Center Experience
Authors: Heijmen Robin H. , Teijink Joep A.W. , van den Berg Jos C. , Overtoom Tim Th.C. , Pasterkamp Gerard , Moll Frans L.
Published: March 2015

Purpose:

To report our experience with endovascular femoropopliteal bypass grafting using a distensible, radially reinforced polytetrafluoroethylene endograft combined with remote endarterectomy.

Methods:

Forty-one patients (33 men; mean age 70 years, range 45–79) with symptomatic femoropopliteal occlusive disease underwent remote endarterectomy of the superficial femoral artery (SFA) followed by implantation of a balloon-expandable Enduring endovascular graft. All patients entered an extensive surveillance program, including angiography and duplex scanning at regular intervals.

Results:

Endarterectomy and endograft implantation were ultimately successful in all patients; 5 (12%) technical difficulties occurred intraoperatively and were treated with additional endovascular techniques. Control angiography at 1 week postoperatively demonstrated a patent endograft in 39 (95%) patients. Mean ankle-brachial index increased significantly from 0.57 to 0.91 (p < 0.001). Including the 2 early failures, 18 occlusions were documented over a median 15-month follow-up (range 3–24), due mainly to significant stenosis at the proximal and distal anastomoses. In 8 of 10 successfully reopened and revised endografts, reocclusion occurred after a median interval of only 1.8 months. Life-table analysis revealed cumulative primary and secondary patency rates of 42% and 56%, respectively, at 18 months. In the last 12 cases, the proximal end of the graft was sutured end-to-end to the transected SFA, which improved the short-term secondary patency rate to 83%.

Conclusions:

Insertion of the Enduring endovascular graft following remote endarterectomy effectively results in a less invasive treatment for femoropopliteal occlusive disease. Additional technical refinements of the procedure may be required to avoid early procedure-and graft-related failures.
Quality of Life Assessment in Patients Undergoing Endovascular or Conventional AAA Repair
Authors: Aquino Rainier V. , Jones Mildred A. , Zullo Thomas G. , Missig-Carroll Nita , Makaroun Michel S.
Published: March 2015

Purpose:

To compare health-related quality of life outcomes in a cohort of abdominal aortic aneurysm (AAA) patients treated concurrently with either a conventional or endoluminal intervention.

Methods:

Between December 1997 and April 1999, 51 AAA patients treated by either open or endovascular techniques were enrolled in this prospective study. Conventional therapy was performed in 26 patients (19 men; mean age 70.4 ± 6.0 years) with anatomical features unsuitable for the endovascular approach. Twenty-five patients (23 men; mean age 70.7 ± 7.2 years) underwent endoluminal AAA exclusion using either the Ancure or bifurcated Enduring stent-grafts. The Medical Outcomes Study Short-Form 36-item health survey was administered preoperatively and at 1, 4, 8, and ≥52 weeks after discharge.

Results:

At 1 week, both groups showed significant reductions (p < 0.001) in mean scores compared to baseline in 4 dimensions (physical function, social function, role-physical, and vitality), but the decline was more pronounced in patients having open repair. Endoluminal patients returned to their baseline scores by the 4th postoperative week, whereas complete recovery to baseline in the conventional patients was delayed to the 8th week.

Conclusions:

Patients treated endoluminally exhibit better physical and functional scores as early as 1 week after discharge; they also return to baseline status significantly earlier than the conventional group. These findings document the perceived advantage of endovascular therapy over conventional AAA treatment.
Endovascular Repair of Occluded Subclavian Arteries following Penetrating Trauma
Authors: Strauss Dirk C. , du Toit Danie F. , Warren Brian L.
Published: March 2015

Purpose:

To describe the endovascular repair of 2 subclavian arteries occluded due to penetrating trauma.

Case Reports:

Two male patients were admitted with zone-I neck stab wounds. Both were hemodynamically stable and had absent pulses in the ipsilateral upper limb with decreased Doppler pressures. There were no signs of critical ischemia or active bleeding. On arteriography, complete occlusion of the second segment of the left subclavian arteries in both patients was demonstrated. Stent-graft repair and embolectomy under local anesthesia were successfully performed. No procedure-related complications occurred, and both patients were discharged after 2 days. At 1-year follow-up, stent-graft patency was demonstrated in both patients.

Conclusions:

Endovascular repair is a feasible and safe option in the management of occluded subclavian arteries due to penetrating trauma. This may represent another indication for stent-grafting in the expanding role of this technique.
Carotid Artery Stenting: Effect of Learning Curve and Intermediate-Term Morphological Outcome
Authors: Ahmadi Ramazanali , Willfort Andrea , Lang Wilfried , Schillinger Martin , Alt Elisabeth , Gschwandtner Michael E. , Haumer Markus , Maca Thomas , Ehringer Herbert , Minar Erich
Published: March 2015

Purpose:

To assess the impact of learning on the rate of success and complications of carotid stenting in a single-center, one-operator series and prospectively follow a patient cohort with regard to restenosis.

Methods:

In 303 patients (mean age 70 ± 8.8 years), 320 internal carotid arteries (ICA) were treated with carotid stenting for stenoses ≥70%. Four groups of 80 consecutive interventions were compared with regard to primary technical success and periprocedural complications. Stent patency in follow-up was assessed using duplex scanning.

Results:

Stenting was successful in 298 (93%) arteries. The combined neurological complications (transient ischemic attacks and all strokes) and 30-day death rate was 8.2% (n = 25), but the all stroke and 30-day death rate was 3.0% (n = 9). A significant reduction in the frequency of neurological complications after the initial 80 interventions was observed (p = 0.03), but technical success was not appreciably improved with increasing experience thereafter. Over a median 12 months (interquartile range 6 to 24), cumulative patency rates were 91%, 90%, and 91% at 6, 12, and 36 months, respectively.

Conclusions:

Elective carotid stenting can be performed with excellent technical success, an acceptable frequency of periprocedural complications, and good intermediate-term patency. However, our findings suggest that a larger number of interventions should be performed to overcome the negative effects of the initial learning phase.
Increased Flexibility of AneuRx Stent-Graft Reduces Need for Secondary Intervention following Endovascular Aneurysm Repair
Authors: Arko Frank R. , Lee W. Anthony , Hill Bradley B. , Cipriano Paul , Fogarty Thomas J. , Zarins Christopher K.
Published: March 2015

Purpose:

To evaluate the impact of a change in the manufacturing of the AneuRx stent-graft on the long-term results of endovascular abdominal aortic aneurysm (AAA) repair.

Methods:

The first 70 AAA patients treated with the AneuRx stent-graft between October 1996 and December 1998 were reviewed. The early stiff bifurcated design (STIFF) was used in 23 patients (mean age 71.7 ± 9.3 years, range 45–87) and the current flexible bifurcated design (FLEX) in 47 mean age 75.0 ± 7.3 years, range 61–96). Data on patient demographics, aneurysm morphology, technical success, complications, secondary procedures, and outcomes were compared using Kaplan-Meier estimates to evaluate patient survival and freedom from surgical conversion, rupture, and secondary interventions at 6, 12, and 24 months.

Results:

The 2 groups were equally matched with regard to age, preoperative comorbidities, proximal neck dimensions, and aneurysm diameter. Mean follow-up times were 22.42 ± 11.72 months (range 1–46) for the STIFF cohort and 18.08 ± 6.14 months (range 1–30) for the FLEX (p = 0.057). Eleven (48%) of 23 STIFF patients required secondary interventions versus 6 (13%) of 47 FLEX patients (p < 0.05). There were no ruptures. At the 24-month interval, survival estimates were 86% for STIFF and 76% for FLEX (p = NS); freedom from surgical conversion was 100% for STIFF and 97% for FLEX (p = NS) and freedom from secondary interventions was 18% for STIFF and 90% for FLEX (p < 0.05) at 24 months.

Conclusions:

The AneuRx stent-graft was effective in achieving the primary objective of preventing aneurysm rupture in all patients. However, increasing the flexibility of the bifurcated module significantly improved the primary success rate by reducing the need for subsequent secondary interventions.
“Seat Belt and Air Bag” Technique for Cerebral Protection during Carotid Stenting
Authors: Parodi Juan C. , Schönholz Claudio , Ferreira L. Mariano , Mendaro Esteban , Ohki Takao
Published: March 2015

Purpose:

To present a 2-device technique for cerebral protection during carotid stenting of the internal carotid artery (ICA) in patients with high-grade lesions, contralateral occlusion, and/or an aberrant or nonfunctioning circle of Willis.

Technique:

A reverse flow system (Parodi Anti-Embolism System [PAES]) is first placed with a 260-cm exchange wire in the common carotid artery 3 cm below the carotid bifurcation. Flow reversal is obtained by inflating the balloons in the external and common carotid arteries. Via an external connector, a guidewire and E-Trap filter are delivered to the distal ICA with active suction from a syringe on the PAES catheter. Once the filter is above the stenosis, the reversed flow is discontinued, and the procedure proceeds under cerebral protection with the filter.

Conclusions:

The combination of 2 existing cerebral protection devices could, at least in theory, achieve what neither of them could independently. The “seat belt and air bag” approach may represent the ideal means of treating ICA stenoses in patients with a nonfunctioning circle of Willis.
Wallgraft Endoprosthesis for the Percutaneous Treatment of Femoral and Popliteal Artery Aneurysms
Authors: Howell Marcus , Krajcer Zvonimir , Diethrich Edward B. , Motarjeme Amir , Bacharach Michael , Dolmatch Bart , Walker Craig
Published: March 2015

Purpose:

To evaluate the safety and efficacy of the Wallgraft Endoprosthesis for the treatment of femoropopliteal artery aneurysms.

Methods:

From October 1997 to April 2000, 17 patients (13 men; mean age 73.5 ± 7.1 years) with 7 femoral and 13 popliteal artery aneurysms underwent percutaneous aneurysm exclusion using the Wallgraft Endoprosthesis as part of a larger clinical trial. The mean aneurysm diameters were 37.6 ± 12.9 mm and 22.3 ± 8.7 mm, respectively.

Results:

Acute procedural success was 100% for femoral aneurysms and 92.3% (12/13) in the popliteal artery owing to one endoleak that resolved after 1 month. There were no complications, and the mean length of stay was 2.2 ± 3.8 days. Six-month and 1-year aneurysm exclusion rates were 100% for both locations, but 4 (31%) popliteal stent-grafts thrombosed in follow-up. Three were recanalized, but the fourth underwent bypass grafting after 3 thrombotic episodes. The 1-year primary and secondary patency rates were both 100% for the femoral aneurysms and 69% and 92%, respectively, for popliteal repairs. No procedure or device-related deaths occurred.

Conclusions:

Treatment of aneurysms in the femoropopliteal segment appears to be safe and effective with the Wallgraft Endoprosthesis, although longer follow-up in a larger patient group will be needed to determine this technique's potential versus surgical repair.
A Useful Endovascular Technique for Treating Modular Limb Disconnection in a Bifurcated Stent-Graft
Authors: Brouard Remi , Otal Philippe , Soula Philippe , Chabbert Valérie , Chemla Patricia , Leger Philippe , Joffre Francis , Rousseau Hervé
Published: March 2015

Purpose:

To report a technique for treating a type III endoleak owing to disconnection of an iliac graft limb from a modular aortic stent-graft.

Technique:

A hydrophilic guidewire is introduced via a homolateral femoral access and passed through the thrombosed iliac extension. Once the errant graft limb is recanalized, wire exchange for an extra stiff guidewire facilitates passage of an angioplasty balloon into the stent. Inflated under low pressure, the balloon is used to push the thrombosed limb retrograde into the aneurysm sac. With the aortoiliac axis restored, a new covered stent can be deployed.

Conclusions:

This approach is one of several that may be used to treat a type III endoleak arising from a disconnected and occluded stent-graft limb. It avoids the bleeding complications of thrombolysis and restores the aortoiliac axis so that another stent-graft may be implanted to re-exclude the aneurysm.
Outcome of Conservative versus Interventional Treatment of Subclavian Artery Stenosis
Authors: Schillinger Martin , Haumer Markus , Schillinger Sabine , Mlekusch Wolfgang , Ahmadi Ramazanali , Minar Erich
Published: March 2015

Purpose:

To compare the outcome of conservative treatment versus percutaneous transluminal angioplasty (PTA) of subclavian artery stenosis in terms of long-term hemodynamic and symptomatic outcome in a retrospective, nonrandomized study.

Methods:

Within a 14-year period, 295 consecutive inpatients were treated for subclavian artery stenosis. Excluding 21 (7%) surgical cases, the remaining 274 patients were treated either conservatively (n = 165) or with PTA (n = 109). Medical history, physical findings, and sonographic and angiographic data were recorded from the medical records of the 223 (81%) patients who were followed until the year 2000; 166 patients were then reinvestigated with oscillography, Doppler measurements, and duplex sonography. Outcomes of conservative versus interventional therapy were analyzed based on the intention to treat principle.

Results:

After a median 42-month follow-up (interquartile range 18–85), patients treated with PTA had a 60% risk reduction for hemodynamic subclavian stenosis compared to conservative treatment (adjusted hazard ratio 0.4, 95% confidence interval 0.2–0.6, p<0.0001). However, the risk of having a symptomatic stenosis at the time of follow-up did not differ between the treatment groups (p=0.3).

Conclusions:

Endovascular revascularization improves the long-term hemodynamic outcome in patients with subclavian stenosis, but many conservatively treated patients become asymptomatic during follow-up. Interventional treatment may be considered primarily for patients with severe symptoms of vertebrobasilar insufficiency, critical ischemia, or peripheral emboli.
Use of the Parodi Anti-Embolism System in Carotid Stenting: Italian Trial Results
Authors: Adami Carlo A. , Scuro Alberto , Spinamano Luca , Galvagni Elisabetta , Antoniucci Davide , Farello Gian A. , Maglione Franco , Manfrini Stefano , Mangialardi Nicola , Mansueto Gian C. , Mascoli Francesco , Nardelli Ettore , Tealdi Domenico
Published: March 2015

Purpose:

To investigate the safety and efficacy of the Parodi anti-embolism system (PAES) in establishing flow reversal in the internal carotid artery (ICA) as a means of protecting against embolic phenomena during carotid stenting.

Methods:

Seven centers participated in a nonrandomized, prospective trial of carotid angioplasty and stenting under PAES protection in 30 patients (22 men; mean age 72 years, range 49–88) with 15 symptomatic (>70%) and 15 asymptomatic (>80%) stenotic ICAs. Safety was defined as achieving sufficient brain oxygenation during flow reversal as determined by level of awareness and motor control. The presence of new or enhanced neurological deficits and death were endpoints. Performance was based on angiographic evidence of successful retrograde flow.

Results:

The PAES was positioned in all 30 patients, but technical error and access-related difficulties prevented establishment of reversed flow in 2. Among the 28 (93%) patients treated under PAES protection, 1 patient developed aphasia after flow reversal, necessitating balloon deflation between subsequent stages of the procedure. Three other adverse events included 1 case of bradycardia and 2 cases of hypotension, with dysarthria and facial paresis in one and temporary loss of consciousness in the other. All events resolved with appropriate therapy, and there was no change from baseline in the neurological status or brain scans at 24 hours. There were no strokes or neurological deficits at 30 days.

Conclusions:

The PAES appears to be a safe and effective means of providing protection from embolic complications during carotid stenting.
Detection of Endoleak with Enhanced Ultrasound Imaging: Comparison with Biphasic Computed Tomography
Authors: McWilliams Richard G. , Martin Janis , White Donagh , Gould Derek A. , Rowlands Peter C. , Haycox Alan , Brennan John , Gilling-Smith Geoffrey L. , Harris Peter L.
Published: March 2015

Purpose:

To compare unenhanced and enhanced ultrasound imaging to biphasic computed tomography (CT) in the detection of endoleak after endovascular abdominal aortic aneurysm (AAA) repair.

Methods:

Fifty-three patients (44 men; mean age 70 years) were examined during 96 follow-up visits after endovascular AAA repair. All patients had color Doppler and power Doppler ultrasound studies performed before and after the administration of an ultrasound contrast agent. Biphasic (arterial and delayed) CT was performed on the same day, and the ultrasound and CT studies were independently scored to record the presence or absence of endoleak and the level of confidence in the observation.

Results:

The sensitivity of the ultrasound techniques to detect endoleak improved with the use of ultrasound contrast media, ranging from a low of 12% with unenhanced color Doppler to 50% with enhanced power Doppler. However, the enhanced power Doppler failed to detect 9 type II endoleaks identified by CT (86% negative predictive value for endoleak). There were only 2 graft-related endoleaks in the study; one was diagnosed from the ultrasound image, but the other had nondiagnostic ultrasound scans because of poor views.

Conclusions:

Ultrasound scanning with or without contrast enhancement was not as reliable as CT in diagnosing type II endoleak. CT imaging remains our surveillance modality of choice.
Hemorrhage from a Right Hepatic Artery Pseudoaneurysm: Endovascular Treatment with a Coronary Stent-Graft
Authors: Venturini Massimo , Angeli Enzo , Salvioni Marco , De Cobelli Francesco , Trentin Chiara , Carlucci Michele , Staudacher Carlo , Del Maschio Alessandro
Published: March 2015

Purpose:

To report a novel case demonstrating the successful endovascular treatment of a right hepatic artery pseudoaneurysm using a balloon-expandable coronary stent-graft.

Case Report:

A 60-year-old woman underwent surgical treatment for a Klatskin tumor, but her postoperative course was complicated by serious blood loss. An emergent celiac angiogram through a right transfemoral approach demonstrated a small iatrogenic pseudoaneurysm in the proximal right hepatic artery. A 7-F guiding catheter was positioned at the origin of the celiac trunk, and a Jostent coronary stent-graft mounted on a 2.7-F, 4-mm × 30-mm balloon catheter was successfully placed across the aneurysm neck. The final angiogram demonstrated total exclusion of the pseudoaneurysm with preservation of the arterial lumen. The hemodynamic condition of the patient became stable. At 12-month follow-up, duplex scanning confirmed regular right hepatic artery patency and absence of thrombotic tissue or signs of infection around the stent-graft.

Conclusions:

For hepatic artery pseudoaneurysms, endovascular repair using small covered stents may be a viable alternative to transcatheter embolization. The use of coronary instruments facilitates treatment of vascular lesions in small caliber visceral vessels.
Preliminary Observations on the Need for Control Angiography after Peripheral Endovascular Brachytherapy Using a Centering Balloon
Authors: Hofmann Wolfgang J. , Kopp Michael , Kofler Barbara , Ugurluoglu Ara , Kogelnik Dieter , Magometschnigg Heinrich
Published: March 2015

Purpose:

To examine the need for completion angiography after endovascular femoropopliteal brachytherapy using a centering catheter.

Methods:

Nine consecutive patients (7 men; mean age 68 years, range 53–79) were enrolled in a double-blinded multicenter randomized trial of endovascular brachytherapy after femoropopliteal balloon angioplasty. All patients underwent postdilation angiography, after which the centering catheter was placed in the dilated segment. The patients were randomized and transferred to the radiotherapy unit; the centering catheter was inflated only in patients randomized to receive brachytherapy (18 Gy of γ radiation delivered to the target site 2 mm from an iridium-192 source axis). Because the local ethics committee required angiography after any interventional procedure (not stipulated in the study protocol), our patients were taken back to the angiosuite for angiography.

Results:

There were no complications of angioplasty or centering catheter introduction. In the 5 patients randomized to brachytherapy, the median inflation time of the centering catheter was 12.1 minutes (range 9.1–13.3). The completion angiogram following brachytherapy showed peripheral embolization in 2 patients and lesion recoil that required redilation in another; all the complications were confined to the treatment group.

Conclusions:

Three of 5 patients who received brachytherapy via a centering catheter demonstrated sequelae on postradiation angiography. Therefore, as in any other peripheral vascular intervention, completion angiography after brachytherapy seems to be essential in preventing delayed diagnosis of procedural complications.
Endovascular Brachytherapy for Prevention of Recurrent Renal In-Stent Restenosis
Authors: Stoeteknuel-Friedli Sandra , Do Dai-Do , von Briel Christian , Triller Jürgen , Mahler Felix , Baumgartner Iris
Published: March 2015

Purpose:

To examine the ability of endovascular brachytherapy to prevent recurrent in-stent restenosis in patients at high risk for this complication.

Methods:

Thirteen renal stent patients (8 women; mean age 66 ± 8 years) with an initial (n=9) or recurrent (n=4) in-stent restenosis underwent redilation followed by high-dose-rate brachytherapy (12 Gy of γ radiation delivered to the target site 5 mm from an iridium-192 source axis).

Results:

The procedure was technically successful in 11 (85%) patients; in the other 2, the renal artery could not be accessed with the large sheaths required for brachytherapy. One patient with no clinical suspicion of restenosis died of an unrelated cause during the 1-year follow-up. Eight (80%) of 10 patients alive at 1 year had no in-stent restenosis apparent on duplex sonography or angiography. One of the postradiation recurrent restenoses was redilated, but the other patient was treated conservatively.

Conclusions:

Renal angioplasty followed by brachytherapy seems to be a feasible and efficient method to prevent recurrent in-stent restenosis in renal arteries at increased risk.
Balloon Angioplasty in Chronic Critical Limb Ischemia: Factors Affecting Clinical and Angiographic Outcome
Authors: Balmer Hannes , Mahler Felix , Do Dai-Do , Triller Jürgen , Baumgartner Iris
Published: March 2015

Purpose:

To assess factors that affect clinical and angiographic outcome in chronic critical limb ischemia (CLI) 12 months after primary, technically successful balloon angioplasty (BA) in infrainguinal arteries.

Methods:

Sixty consecutive patients (37 women; mean age 75 ± 10 years, range 53–99) with technically successful BA in 66 limbs were followed for 12 months or until death, for major amputation, or repeat target lesion revascularization (TLR). Assessment at baseline and 1 day and 12 months after BA or at an endpoint event, if feasible, was performed with angiography or duplex ultrasound (above-knee revascularization only). Mortality, limb prognosis, and restenosis rate were correlated with cardiovascular risk factors, hemodynamic measures, and angiographic features.

Results:

Mortality was 25% at 1 year; compared to survivors, nonsurvivors more often had coronary artery disease (93% versus 44% for survivors, p<0.001), bilateral CLI (60% versus 29%, p=0.033), and higher fibrinogen levels (5.1 g/L versus 4.3 g/L, p=0.049). CLI resolved in more than half (35, 53%) of the limbs without repeat TLR. The major amputation rate was 6%. Limb prognosis correlated with ankle pressures after BA. Restenosis rates were 65% at the femoropopliteal and 56% at the infrapopliteal level (NS); these correlated with the length of the treated arterial segment (8.7 cm with restenosis versus 4.0 cm without, p<0.001).

Conclusions:

High mortality in CLI was associated with an extensive, clinically manifest arteriosclerotic process and high fibrinogen levels. Limb prognosis and restenosis after BA were primarily influenced by local hemodynamic and technical factors. Despite considerable restenosis, more than 90% of survivors avoided major amputations.
Subintimal Angioplasty of Isolated Infragenicular Vessels in Lower Limb Ischemia: Long-term Results
Authors: Ingle Hemant , Nasim Ahktar , Bolia Amman , Fishwick Guy , Naylor Ross , Bell Peter R.F. , Thompson Matthew M.
Published: March 2015

Purpose:

To assess the outcome of subintimal angioplasty in treating isolated infragenicular arterial disease in patients with severe lower limb ischemia.

Methods:

A retrospective study reviewed 67 consecutive patients (39 men; mean age 76 years, range 41–96) who underwent infragenicular subintimal angioplasty between March 1997 and May 2000 for ischemia in 70 limbs. The median length of occlusion was 6 cm (range 1–10) in the below-knee popliteal arteries, 4 cm (range 1–4) in the tibioperoneal trunk, 21 cm(range 1–35) in the anterior tibial artery, 10 (1–30) in the posterior tibial artery, and 5 (range 1–20) in the peroneal artery.

Results:

The technical and clinical success rates were 86% and 80%, respectively. In the 10 (14%) patients with a technical failure, 3 underwent successful bypass, 4 had an amputation, 1 had a lumbar sympathectomy, and 2 were treated conservatively. Of the 4 (6%) limbs that did not achieve clinical success, 2 patients required femorodistal bypass and their ulcers improved; in the other 2, ulcerations did not heal completely. The cumulative limb salvage rate and freedom from critical limb ischemia (CLI) quantified by Kaplan-Meier life-table analysis were 94% and 84% at 36 months. Mortality rates were 19% at 1 year, 43% at 2 years, and 51% at 3 years. In a subgroup analysis, the rate of CLI was significantly lower in nondiabetics (4%) and than in diabetics (24%, p=0.02), but neither survival nor amputation rates were significantly different.

Conclusions:

Subintimal angioplasty is a safe and effective procedure for treating isolated crural vessels in patients with severe lower limb ischemia.
Arterial Perforation during Infrainguinal Lower Limb Angioplasty Does Not Worsen Outcome: Results from 1409 Patients
Authors: Hayes Paul D. , Chokkalingam Arun , Jones Robert , Bell Peter R.F. , Fishwick Guy , Bolia Amman , Naylor A. Ross
Published: March 2015

Purpose:

To assess the prevalence and clinical significance of arterial perforation during lower limb angioplasty and determine the outcome of patients suffering this complication.

Methods:

The radiology department records of 1409 patients (878 men; mean age 69.6 years) undergoing peripheral angioplasty in 1532 limbs between January 1996 and December 1998 were studied to identify patients with a perforated vessel.

Results:

Fifty-two (3.7%) perforations occurred. Patients with a perforation were significantly older (median 74.8 years versus 69.6, p=0.03) and were more likely to be diabetic (p=0.01). The median age of a smoker with a perforation was 68 years versus 78 years for nonsmokers (p=0.02). Among the perforations, 29 resolved without intervention, 6 required temporary balloon occlusion, 15 were coil embolized, and 2 needed both balloon and coil treatment. Twenty-four (46%) of the 52 patients had a clinically successful angioplasty despite the perforation. No patient needed further urgent intervention. Seven patients underwent subsequent surgery to treat the underlying vascular disease that had prompted treatment initially; no one was treated for complications of the perforation. Due to the more extensive nature of the procedure, subintimal angioplasty was associated with an unsurprising increase in the rate of perforation (RR, 2.06;95% CI, 1.19–3.56;p=0.01). In no case did the perforation prejudice the eventual outcome of the patient.

Conclusions:

Arterial perforation during angioplasty is more common in the elderly and in diabetics. The perforation itself does not influence the ultimate outcome of the case; rather, it is the underlying vascular pathology.
Short-term Results of Endovascular AAA Repair with the Excluder Bifurcated Stent-Graft
Authors: Pfammatter Thomas , Lachat Mario L. , Künzli Andreas , Baur Daniel R. , Koppensteiner Renate , Turina Marko , Blum Ulrich
Published: March 2015

Purpose:

To evaluate the safety and efficacy of endovascular abdominal aortic aneurysm (AAA) repair with a commercial modular stent-graft.

Methods:

Between February 1998 and May 2000, 66 consecutive patients (56 men; mean age 70 years, range 51–87) were recruited for a single-center study to examine the safety and efficacy of the Excluder stent-graft for endovascular AAA repair. The patients were predominantly asymptomatic (2 symptomatic) and categorized as ASA III or IV (62, 94%), with aneurysms that ranged from 35 to 89 mm in diameter (mean 56). Surveillance included clinical examination and computed tomographic aortography at discharge, 6 weeks, and at 6, 12, and 24 months.

Results:

All endoprostheses were implanted as intended, but 1 patient succumbed to an intraprocedural brainstem infarction (1.5% 30-day mortality rate). The major and minor morbidity rates were 21% and 4.5%, respectively. Primary technical success at discharge was 68% (45/66), largely as the result of a 30% (20/66) endoleak rate. The aneurysm exclusion rate at 30 days was 88%. During the mean 5.8-month follow-up, no device migration, limb kinking, aneurysm rupture, or limb thrombosis was observed.

Conclusions:

Endoluminal AAA repair with the bifurcated Excluder stent-graft is safe and efficacious in the short term. Longer surveillance will have to demonstrate if the excellent early results can be maintained over the years.
Early Postsurgical Carotid Restenosis: Redo Surgery versus Angioplasty/Stenting
Authors: AbuRahma Ali F. , Bates Mark C. , Wulu John T. , Stone Patrick A.
Published: March 2015

Purpose:

To compare the results of balloon angioplasty/stenting (BA/S) versus redo surgery in patients with early carotid restenosis.

Methods:

Sixty-one patients (35 women; mean age 69 years, range 46–82) with early restenosis (<24 months from the primary endarterectomy) in 63 carotid arteries were treated during a 5-year period; 41 patients (41 arteries) had redo surgery (group A) and 20 patients (22 arteries) had BA/S (group B). Patients were followed regularly with duplex ultrasound to detect ≥50% recurrent restenosis (RRS) after redo surgery or BA/S. Kaplan-Meier life-table analysis was used to estimate the stroke-free survival rates and freedom from ≥50% RRS.

Results:

The demographic and clinical characteristics were comparable for both groups, as were the perioperative stroke and death rates (2.4% and 0% for group A, respectively, versus 4.5% and 0% for group B, p=0.46). Group A had a 12% incidence of cranial nerve injury (all transient) versus 0% for group B (p=0.11); however, group B had a higher incidence of ≥50% RRS than group A (32% versus 0%, p=0.0003). The stroke-free survival rates for redo surgery at 6, 12, 24, 36, and 48 months were 100%, 100%, 100%, 100%, and 88% versus 95%, 95%, 84%, 84%, and 63% for BA/S (p=0.067). Redo surgery had a 100% freedom from ≥50% RRS at the same time intervals, while recurrent restenosis rates for the BA/S patients were 95%, 86%, 69%, 52%, and 52% (p<0.0001).

Conclusions:

BA/S and redo surgery have comparable stroke and death rates in the treatment of early RCS; however, redo surgery is associated with cranial nerve injuries (transient), while stent patients have a higher incidence of recurrent lesions. These considerations should be kept in mind when selecting the appropriate treatment for patients with early postsurgical restenosis.
Restenting for Subclavian In-Stent Restenosis with Symptomatic Recurrent Coronary-Subclavian Steal
Authors: Bates Mark C. , AbuRahma Ali F. , Stone Patrick A.
Published: March 2015

Purpose:

To determine whether restenting for recurrent coronary-subclavian syndrome is technically feasible, provides durable results, and is a reasonable alternative to surgery.

Case Report:

A 58-year-old woman with a left internal mammary artery (LIMA) bypass to the left anterior descending artery underwent angioplasty and stent placement for left subclavian stenosis and coronary-subclavian steal. Twenty-three months later, she returned with progressive angina and left arm claudication; heart catheterization demonstrated restenosis of the subclavian artery at the stent site with recurrence of the coronary-subclavian steal. Successful redo angioplasty and stenting resulted in normal antegrade flow through the LIMA graft. The patient has remained asymptomatic for 3 years without evidence of recurrent in-stent stenosis on serial noninvasive studies.

Conclusions:

Restenting is technically feasible and appears to be a durable response to subclavian in-stent restenosis in patients with coronary subclavian steal.