bluuebunny/crossref_metadata_2025 huggingface dataset:
Results of Autopsy 7 Months after Successful Endoluminal Treatment of an Infrarenal Abdominal Aortic Aneurysm
Authors: McGahan Timothy J. , Berry Gerald A. , McGahan Sarah L. , White Geoffrey H. , Yu Weiyun , May James
Published: March 2015

Purpose:

To report the results of a postmortem examination in a patient who died of unrelated causes 7 months following endoluminal treatment of an infrarenal abdominal aortic aneurysm (AAA).

Methods:

As part of an FDA Phase I pilot study, a 73-year-old man underwent successful endoluminal exclusion of an infrarenal AAA using a 9-cm-long endograft (Endovascular Grafting System). Seven months later, he succumbed to complications of a spontaneous esophageal rupture. At autopsy, the aorta was dissected in situ by a vascular surgeon and pathologist before being explanted in order to examine the wound healing characteristics at the aorta-endograft interface. Particular attention was also directed to the hooks composing the attachment system at each end of the endograft.

Results:

Macroscopic and microscopic examination revealed that the graft had completely excluded the aneurysm sac from the circulation and was incorporated into the aortic wall at the proximal neck and distal cuff. A smooth pannus of endothelial cells covered the proximal end of the endograft at the areas of contact with the aorta, while microscopic examination of the distal end of the graft revealed poorly formed, fibrinous pannus. The neointima deep to the endothelium consisted of a collagenous matrix containing myofibroblasts and histiocytes, providing evidence of healing between the endograft and aorta. Both renal arteries were clear of the proximal end of the endograft, but a previously unrecognized right lower pole renal artery with an extremely caudal origin was excluded from the aortic lumen. Each hook of the attachment system was seen protruding through the adventitia of the aorta. There was no evidence of trauma to the aortic wall or the surrounding tissues caused by these hooks.

Conclusion:

There appears to be evidence that an endoluminally placed aortic graft may be incorporated by the host aortic tissue.
Determining Light Dose for Photodynamic Therapy of Atherosclerotic Lesions in the Yucatan Miniswine
Authors: Hsiang York N. , Todd Mary E. , Bower Robert D.
Published: March 2015

Purpose:

To determine the light dose required for photodynamic therapy of atherosclerotic lesions in the miniswine.

Methods:

Aortic atherosclerosis was created in seven Yucatan miniswine by a combination of balloon endothelial injury and 2% cholesterol and 15% lard for 7 weeks. Six animals received the photosensitizer PhotofrinR 2.5 mg/kg, while an additional swine received no drug. After 24 hours, the abdominal aorta was exposed and the aorta opened longitudinally in each animal. Three 1-cm spots were illuminated with energy densities of 60, 120, and 240 J/cm2 from an argon-pumped dye laser tuned to 630 nm with a laser output of 1 W. Four weeks later, the animals were killed, abdominal aortae removed, and intimal thickness determined by morphometry.

Results:

The percentage intimal thickness (mean ± SD) was 36.7 ± 27.1, 9.1 ± 5.0, and 6.4 ± 8.1 for the three energy densities, respectively. Although both 120 and 240 J/cm2 energy densities produced significant (p < 0.05) reduction in atheroma, considerable damage to the underlying media was also observed in the 240 J/cm2 group.

Conclusions:

A Photofrin dose of 2.5 mg/kg and 120 J/cm2 light are necessary for adequate ablation of atheroma while avoiding extensive medial damage.
Utility of Intravascular Ultrasound in Carotid Stenting
Authors: Wilson Eric P. , White Rodney A. , Kopchok George E.
Published: March 2015

Purpose:

To illustrate the utility of intravascular ultrasound (IVUS) imaging during endoluminal interventions in the carotid artery.

Methods and Results:

A patient with symptomatic internal carotid artery occlusive disease was treated with balloon angioplasty and evaluated with both angiography (interpreted as a widely patent outcome) and IVUS, which identified a residual 70% cross-sectional area stenosis. A stent was placed across the lesion, producing a 70% increase in the lumen as documented by IVUS in comparison to the cross-sectional area of the reference vessel. Postprocedural angiography of the stented segment showed only an approximate 20% increase in diameter.

Conclusions:

This study highlights the utility of IVUS for accurate assessment of angioplasty outcome and for quantitative assessment of luminal volume following intervention and stent placement. The case emphasizes the need for IVUS as an integral part of the procedure to ensure adequate treatment and to accurately document the residual lesion for assessment of recurrence phenomena at follow-up.
Recurrent Carotid Disease: Optimum Technique for Redo Surgery
Authors: Raithel Dieter
Published: March 2015

Carotid restenosis has been a well-recognized, though not well-understood, long-term complication of carotid endarterectomy. Various factors contribute to recurrent stenosis, but the chief cause is technical faults during the primary procedure. Redo endarterectomy or graft reconstruction are the traditional and most effective procedures for treating symptomatic or high-grade (> 80%) asymptomatic restenotic lesions.

To reduce the potential for carotid restenosis, eversion endarterectomy is recommended as the technique of choice for de novo carotid disease treatment. Angioscopy is useful in detecting correctable technical errors that could predispose to restenosis.
Three-Year Experience with the White-Yu Endovascular GAD Graft for Transluminal Repair of Aortic and Iliac Aneurysms
Authors: White Geoffrey H. , Yu Weiyun , May James , Waugh Richard , Chaufour Xavier , Harris John P. , Stephen Michael S.
Published: March 2015

Purpose:

To report a > 3-year experience with a modular, balloon-expandable endovascular graft used for aneurysm exclusion in the aorta and other arteries.

Methods:

The customized White-Yu Endovascular GAD Graft, a woven polyester prosthesis with an intrinsic Elgiloy wire graft attachment system along the body of the graft, is a flexible endograft design available in straight, tapered, and bifurcated versions that can be delivered transluminally through 18F to 24F sheaths.

Results:

Since July 1993, 93 patients have received the White-Yu endograft for treatment of 76 abdominal aortic, 3 thoracic aortic, 13 iliac, and 1 popliteal aneurysms. Of the 79 aortic procedures, 39 involved straight tube grafts, 20 were tapered aortoiliac models, and 20 were bifurcated devices. Success rates for tube grafts were 81% in the abdominal aorta and 100% for the thoracic aorta; 5 primary endoleaks (14%) and 2 conversions to surgery (5.6%) occurred with this graft type. Aortoiliac grafts were deployed successfully in 95% (19/20) of cases with 1 conversion (5%) due to thrombosis. Seventy-five percent of the bifurcated endograft procedures were successful, with 4 conversions (20%) for technical failures and 1 graft thrombosis. Four additional endografts were deployed to treat two primary and two secondary endoleaks in tube graft patients. Two access-related arterial injuries were treated surgically. There was one case of embolus to the distal femoral artery but no microembolization. Overall perioperative (30-day) mortality was 3.1%. Over a mean 18-month follow-up (range 2 to 39), no late graft thrombosis, stenosis, or graft migration has been seen on CT scans or X ray. Endoleak has not been detected in any aortoiliac or bifurcated graft. Aneurysm size has diminished consistently in successfully treated cases.

Conclusions:

The White-Yu endograft appears to offer a safe, efficacious, and minimally invasive means of excluding aneurysms from the circulation. Improvements in patient selection, surgical techniques, and equipment have reduced the incidence of endoleak and conversion to open repair over the course of the evaluation.
Endoluminal Repair of Abdominal Aortic Aneurysms: Strengths and Weaknesses of Various Prostheses Observed in a 4.5-Year Experience
Authors: May James , White Geoffrey H. , Yu Weiyun , Waugh Richard , Stephen Michael S. , Sieunarine Kishore , Chaufour Xavier , Harris John P.
Published: March 2015

Purpose:

To summarize the results of endovascular abdominal aortic aneurysm (AAA) treatment using several endograft designs over a 4.5-year experience and offer comparisons on the various devices.

Methods:

From May 1992 to August 1996, 121 AAA patients meeting the criteria for an endoluminal repair were treated with 1 of 5 endograft designs in three configurations. The endografts were implanted in the operating room under fluoroscopic control. Follow-up included contrast-enhanced computed tomography within 10 days of operation, 6 months postoperatively, and annually thereafter.

Results:

Endografts were successfully deployed in 106 patients (88%). Fifteen cases were converted to open repair. Six procedure-related deaths occurred within 30 days owing to myocardial infarction (3), combined renal failure and septicemia (2), and multisystem failure (1). There were 36 local/vascular complications (30%) and 18 systemic/remote complications (15%). Of the 121 patients undergoing endoluminal AAA repair, 93 (77%) are currently alive and well with their AAAs excluded from the circulation.

Conclusions:

Trends in endoluminal AAA repair and prosthetic design point toward simpler devices and earlier treatment of smaller aneurysms once the long-term outcome of aortic endografting has been determined.
Biological Responses to Endovascular Treatment of Abdominal Aortic Aneurysms
Authors: Norgren Lars , Swartbol Paul
Published: March 2015

Purpose:

To review the findings of two studies investigating the apparent differences in inflammatory responses demonstrated in patients undergoing endovascular as opposed to classic surgical treatment of abdominal aortic aneurysms (AAAs).

Methods:

The clinical course of seven patients treated with an endoluminal procedure (AAA-E) and seven patients undergoing conventional surgery (AAA-C) were compared (all men; ages 52 to 80 years). Blood samples were taken pre-, intra-, and postoperatively for up to 7 days. Inflammatory responses were assessed from measurement of interleukins (IL)-1 β, IL-6, IL-8, and tumor necrosis factor (TNF-α); complement proteins C1q, C4, C5a, and terminal complement complexes, C5b-C9; and C-reactive proteins. Granulocyte and monocyte surface adhesion molecule expression was determined indirectly using a panel of monoclonal antibodies against CD11a, CD11b, CD11c, CD18, and L-selectin in donor white blood cells exposed to patient plasma.

Results:

In six of the AAA-E patients, blood pressure decreases were recorded during the introduction of the device. Elevated body temperature was sustained for 2 to 5 days postoperatively in the AAA-E group. IL-6 levels were significantly higher in AAA-C patients (p < 0.0005), while TNF-α release was recorded in the AAA-E group only. CD11b, CD11c, and CD18 molecules on both granulocytes and monocytes were significantly upregulated 60 minutes after the endovascular procedure compared to conventional surgery.

Conclusions:

Endovascular aortic aneurysm repair apparently induces a significant inflammatory response, mainly involving TNF-α release, which differs from open AAA repair. These inflammatory responses, which may be related to the observed intraprocedural blood pressure decreases, could be caused by cell activation arising from intra-aneurysmal device manipulation.
Aortomonoiliac Endovascular Grafting: Difficult Solutions to Difficult Aneurysms
Authors: Thompson Matthew M. , Sayers Robert D. , Nasim Ahktar , Boyle Jonathan R. , Fishwick Guy , Bell Peter R.F.
Published: March 2015

Purpose:

To describe a refined technique for aortomonoiliac endograft exclusion of abdominal aortic aneurysms (AAAs).

Methods:

A tapered aortomonoiliac graft was prepared from an 8-mm thin-walled expanded polytetrafluoroethylene tube graft predilated proximally to 35 mm and tapered distally to 15 mm. The proximal graft was sutured to a 5-cm-long, predilated Palmaz stent, which was mounted on a 30-mm balloon and backloaded into a 21F packaging sheath. With the patient under general anesthesia and both common femoral arteries exposed, the endograft was anchored in the infrarenal aorta and subsequently passed into one iliac system, where it was anastomosed to the iliac or femoral vessels. The contralateral common iliac artery was occluded, and an extra-anatomic, femorofemoral, or iliofemoral bypass grafting was performed.

Results:

Twenty of the 25 AAAs treated to date with this technique have been successful, with aneurysm exclusion achieved in 18 (2 minor distal endoleaks are scheduled for endovascular repair). The technical failures were analyzed, resulting in enhancements to the technique. Complications included 2 early (< 30 days) deaths, 1 case of minor embolization, 1 transient renal failure, 1 pulmonary embolus, and 1 wound infection. The only late complication was a graft infection localized to the groin.

Conclusions:

Aortomonoiliac endovascular aneurysm repair is effective in patients with AAAs involving the iliac arteries. Short-term results are acceptable, but long-term efficacy must be addressed before this procedure is widely adopted. Technical changes made in response to early learning curve problems have led to a safer, more reliable procedure.
The EVT Tube and Bifurcated Endograft Systems: Technical Considerations and Clinical Summary
Authors: Moore Wesley S.
Published: March 2015

Endovascular exclusion of abdominal aortic aneurysms (AAAs) is an investigational technique under scrutiny around the world. The tube and bifurcated versions of the Endovascular Grafting System (EGS) developed by Endovascular Technologies are the subjects of FDA-approved multicenter trials in the United States (US). Similar studies are under way in Europe, Australia, and the United Kingdom. This review details the implantation techniques for the EGS device and summarizes the important clinical findings published through 1996.

Although the EGS was voluntarily removed from the US trial when fractures were discovered in the graft attachment system, subsequent experience with the re-engineered EGS has been positive. Successfully implanted EGS tube grafts have been associated with aneurysm shrinkage after 1 year in AAAs initially excluded or with sealed endoleaks. Aneurysm enlargement has been seen in EGS tube grafts with persistent endoleak.
What are the Characteristics of the Ideal Endovascular Graft for Abdominal Aortic Aneurysm Exclusion?
Authors: Allen Robert C. , White Rodney A. , Zarins Christopher K. , Fogarty Thomas J.
Published: March 2015

Purpose:

To review the anatomic factors crucial to successful endoluminal abdominal aortic aneurysm (AAA) repair and propose an ideal endograft design for AAA exclusion.

Methods and Results:

The anatomic features of critical importance to endovascular AAA exclusion comprise remote arterial access, proximal and distal fixation sites, AAA morphology, and arterial wall pathology. When designing an aortic endograft, the major components to consider are stent selection, graft material, and the delivery system. The ideal endograft design must be sufficiently versatile to treat a broad range of patients. To meet this requirement, the endograft should display a high degree of dimensional adaptability. A modular bifurcated endograft design permits intraoperative customization to tailor the device to each patient's anatomy and pathology.

Conclusions:

The modular stent-graft concept addresses many of the important factors in the evolution toward an ideal aortic endograft. Extensive testing will be needed to determine if the bifurcated stent-graft described here is the optimal design for effective AAA exclusion.
Operative Repair for Aortic Aneurysms: The Gold Standard
Authors: Zarins Christopher K. , Harris E. John
Published: March 2015

Surgical treatment of abdominal aortic aneurysm (AAA) is being challenged by newer, minimally invasive therapies. Such new treatment strategies will need to prove themselves against concurrent results of standard operative AAA repair, within defined medical risk and aneurysm morphological categories. We review the natural history of AAAs, the medical risk levels for elective AAA repair, aneurysm morphology and its impact on operative mortality, the issue of high-risk patient treatment, and the current standard of care for AAAs based on single-center, multicenter, and population-based statistics. In good-risk patients, aneurysms > 5 cm in diameter are best treated by replacement with a prosthetic graft. Operative mortality should be < 5% and 1-year survival > 90%. Aortic endograft techniques must meet or exceed these standards if they are to supplant standard surgical repair.
Preoperative Sizing of Grafts for Transfemoral Endovascular Aneurysm Management: A Prospective Comparative Study of Spiral CT Angiography, Arteriography, and Conventional CT Imaging
Authors: Broeders Ivo A.M.J. , Blankensteijn Jan D. , Olree Marco , Mali Willem , Eikelboom Bert C.
Published: March 2015

Purpose:

To define the impact of spiral computed tomographic angiography (CTA) with image reconstruction on graft selection for Transfemoral Endovascular Aneurysm Management (TEAM) by comparing it to conventional computed tomography (CT) and contrast arteriography.

Methods:

Twenty-one candidates for TEAM were included. The diameters of the superior and inferior aneurysm necks and lengths between the graft attachment sites were measured using the three imaging techniques. These measurements and their consequences on graft selection were studied.

Results:

The difference in length sizing between spiral CTA and arteriography never exceeded 1 cm; however, lengths measured by conventional CT scanning resulted in underestimation of graft length in 91% of patients. Graft diameters were chosen too small in 62% of the patients when based on arteriographic diameter measurements. A graft of similar diameter was selected by spiral CTA and conventional CT scanning in 81% of the patients, while minor oversizing by conventional CT scanning was found in 14%.

Conclusions:

Neither conventional CT scanning nor arteriography is adequate as a sole preoperative radiological investigation for TEAM graft sizing. Spiral CTA with image processing produces all information required for selection of tho-optimal graft size and should be regarded the method of first choice for this purpose.
Postoperative Color Flow Duplex Scanning in Aortic Endografting
Authors: Heilberger Peter , Schunn Christian , Ritter Wolfgang , Weber Sepp , Raithel Dieter
Published: March 2015

Purpose:

To report the feasibility and sensitivity of duplex sonography compared to computed tomography (CT) for aortic endograft follow-up surveillance.

Methods:

In a 26-month period, 113 aortic aneurysm patients received 79 tube and 34 bifurcated stent-grafts. Follow-up used contrast-enhanced CT scanning and duplex sonography with an intravenous ultrasound contrast agent (Levovist).

Results:

Eleven patients (9.7%) were converted to open repair; 1 died from hemorrhagic shock secondary to retroperitoneal hematoma. The mean follow-up time was 7.2 months (range 1 to 24), during which 5 patients died of unrelated causes. Sixteen primary (within 30 days) and 5 secondary endoleaks were detected by duplex after tube graft implantation. Among 5 endoleaks due to retrograde side-branch perfusion, 3 were detected only with contrast-enhanced duplex scanning. Iliac artery occlusion was also documented using duplex; however, 2 stent fractures could not be seen with ultrasound. Ten primary endoleaks were detected in bifurcated stent-graft patients. One endoleak originating from the distal iliac limb anchoring site was missed by duplex owing to bowel gas. Graft limb thrombosis was clearly identified by lack of a flow signal on duplex.

Conclusions:

Duplex sonography could be a valuable, reliable, and economical surveillance tool for endovascular aortic reconstructions. The adjunctive use of an intravenous ultrasound contrast agent increased the sensitivity for detecting endoleak to a level comparable to contrast-enhanced CT scanning. However, stent fractures may not be seen on ultrasound, and bowel gas can interfere with obtaining an adequate image.
Influence of Abdominal Aortic Aneurysm Size on the Feasibility of Endovascular Repair
Authors: Armon Matthew P. , Yusuf S. Waquar , Whitaker Simon C. , Gregson Roger H.S. , Wenham Peter W. , Hopkinson Brian R.
Published: March 2015

Purpose:

To assess the effect of abdominal aortic aneurysm (AAA) size on overall aneurysm morphology with special attention to possible relationships among various anatomic variables that determine the feasibility of endovascular repair.

Methods:

One hundred sixty-eight patients were assessed with spiral computed tomographic angiography to measure the length and diameter of the AAA, the proximal neck, and the common iliac arteries. Anatomic variables were correlated with aneurysm size using Spearman's rank order correlation coefficients (rs); comparisons among small, intermediate, and large aneurysms were made using the Chi-square test.

Results:

Correlations between aneurysm size and the anatomic variables above were weak. The strongest association was between aneurysm size and aortic length (rs = 0.41, p < 0.001). Subgroup analysis showed no difference in proximal neck length, neck diameter, or overall suitability for endovascular repair between aneurysms greater or smaller than 5.5-cm diameter. However, significantly more short (< 1.5 cm), wide (> 3 cm), and, hence, unsuitable proximal necks were found in patients with aneurysms > 7 cm in diameter (χ2 = 7.8, p < 0.01).

Conclusions:

Shortening and widening of the proximal neck seems to increase with aneurysm size but only after the aneurysm expands beyond 7 cm in diameter. Aneurysms with diameters in the 4.5- to 5.5-cm range are no more suitable for endovascular repair than those between 5.5 and 7 cm. The lack of any significant correlation between anatomic variables emphasizes the need for accurate preoperative assessment of the anatomy of each individual patient before endovascular repair.
Endoluminal Repair of Large Abdominal Aortic Aneurysms Using PTFE: A Feasibility Study
Authors: Adiseshiah Mohan , Bray Alan J. , Bergeron Patrice , Raphael Maurice J.
Published: March 2015

Purpose:

To investigate the feasibility of using predilated thin-wall polytetrafluoroethylene (PTFE) secured by extra-large Palmaz stents for endoluminal repair of abdominal aortic aneurysms (AAA).

Methods:

Thirty-two patients (26 males; aged 69 to 83 years) from three centers (two in Europe, one in Australia) were selected for endoluminal stent-grafting using predilated 8-mm PTFE graft material fitted with extra-large Palmaz stents at the terminal ends. Aortoaortic tube grafts were implanted in 12 patients, while the remainder received aortomonoiliac endografts and femorofemoral bypass. Follow-up at 5 days and then biannually was by contrast-enhanced computed tomography (CT) or duplex scanning.

Results:

There were 13 conversions to open surgery; three patients died within 30 days. Nineteen patients were discharged with functioning endografts within 5 days of treatment. Of these, two have had their grafts removed owing to infection in one and distal stent migration in the other. Two endoleaks have been detected in follow-up; one has been sealed by covered stenting. One twisted graft was repaired by Wallstent implantation. Seventeen patients remain well, one with persistent distal endoleak, but none shows an increase in AAA diameter on imaging over the 6- to 26-month (median 13) follow-up.

Conclusions:

These results represent the learning curves of three separate centers. Technical failure and complications were more common early in the study. Advantages of the technique include relative low cost and the ability to tailor the stent-graft to the individual aneurysm.
An Experimental Model for the Acute and Chronic Evaluation of Intra-Aneurysmal Pressure
Authors: Faries Peter L. , Sanchez Luis A. , Marin Michael L. , Parsons Richard E. , Lyon Ross T. , Oliveri Steve , Veith Frank J.
Published: March 2015

Purpose:

To develop an animal model for the acute and chronic monitoring of pressure within abdominal aortic aneurysms (AAAs) to be treated with endovascular grafts.

Methods:

A strain-gauge pressure transducer was placed within an AAA created from a prosthetic vascular graft. Prosthetic aneurysms were implanted into 17 canine infrarenal aortas. The intra-aneurysmal pressure was monitored and correlated with noninvasive forelimb sphygmomanometry for 2 weeks. After this time, an intravascular manometer catheter was passed into the aneurysm. Simultaneous pressure measurements were obtained using the implanted strain-gauge pressure transducer, the manometer catheter, and the forelimb sphygmomanometer. Angiography was performed to assess intraluminal morphology, aneurysm anastomoses, and adjoining aortic vessels. In addition, two control animals underwent intra-aneurysmal pressure monitoring after standard surgical aneurysm repair.

Results:

There was excellent correlation (r = 0.97) between the pressure measurements obtained with the implanted strain-gauge pressure transducer and the intravascular manometer. Close correlation was also observed between the implanted strain-gauge transducer and the forelimb sphygmomanometer (r = 0.88) during postprocedural monitoring. Intra-aneurysmal pressure was lowered dramatically by surgical exclusion (aneurysm: 15/5 ± 7/4 mmHg; systemic: 124/66 ± 34/17 mmHg; p < 0.001). The prosthetic aneurysms were successfully imaged with angiography.

Conclusions:

This animal model provides an accurate and reproducible means for measuring intra-aneurysmal pressure on an acute and chronic basis. It may be possible to use this model in the assessment of endovascular devices to determine their efficacy in reducing intra-aneurysmal pressure. Evaluation of complications associated with their use, such as patent aneurysm side branches, perigraft channels, and perianastomotic reflux, may also be possible.
Surgical Reconstruction of the Iliac Arteries Prior to Endovascular Aortic Aneurysm Repair
Authors: Chuter Timothy A.M. , Reilly Linda M.
Published: March 2015

Purpose:

To explore a method of combined endovascular/conventional treatment of abdominal aortic aneurysm (AAA), in which the iliac arteries are reconstructed by conventional surgical techniques to provide the anatomic substrate for subsequent endovascular repair of the aortic aneurysm.

Method:

A 77-year-old patient with severe cardiac disease was found to have a 6.5-cm AAA, bilateral common iliac artery (CIA) aneurysms, and diffusely narrowed, tortuous external iliac arteries. The left internal iliac artery was occluded. At operation, the right CIA was exposed through a transverse retroperitoneal incision under epidural anesthesia. An iliobifemoral bypass was constructed using a preformed bifurcated graft. A stent-graft was delivered through the right limb of the bifurcated iliobifemoral graft. The proximal end of the stent-graft was implanted in the neck of the aneurysm, and the distal end was deployed in the common trunk of the iliobifemoral graft, thereby excluding the AAA and both native iliac arteries from prograde arterial flow.

Results:

Completion angiography and follow-up contrast computed tomography showed the aneurysm to be excluded from the circulation. The patient was not intubated, was never hemodynamically unstable, and had aortic blood flow interrupted for no more than 20 seconds. In addition, he was able to resume his usual diet on the first postoperative day. He continues to be well and without evidence of endoleak at 6-month follow-up.

Conclusions:

This case demonstrates that iliac artery stenosis, tortuosity, and aneurysmal dilatation are not impediments to endovascular AAA exclusion. Any necessary surgical modifications of pelvic arterial anatomy can be performed before stent-graft insertion to minimize aortic occlusion time.
Endovascular Stents for Carotid Artery Occlusive Disease
Authors: Wholey Michael H. , Wholey Mark H. , Jarmolowski Chester R. , Eles Gustav , Levy David , Buecthel Jack
Published: March 2015

Purpose:

To study the feasibility and safety of endovascular stenting of cervical carotid artery stenosis.

Methods:

Between April 1994 and May 1997, 108 consecutive patients (58 men; mean age 70.1 years) with ≥ 70% carotid stenosis were treated with percutaneous stent implantation under a protocol that featured independent neurological review. Forty-four percent were asymptomatic. Over half the lesions (59%) were in the internal carotid artery; the mean stenosis was 86%. Palmaz stents were implanted without cerebral protection following preliminary balloon dilation; two Wallstents were used in long lesions.

Results:

Carotid stents were successfully placed in 108 of 114 (95%) lesions. Of the 6 technical failures, 5 were access related and 1 was due to seizures during balloon dilation. Two major (1.8%) and 2 minor (1.8%) strokes occurred (3.7% stroke rate for 108 patients; 3.5% in 114 procedures), all in symptomatic patients, one of whom died. There were 5 (4.4%) transient ischemic attacks and 2 (1.8%) brief seizure episodes during dilation. One patient died of a cardiac event on day 20. The all stroke or death rate was 5.3% based on 114 arteries at risk (5.6% in 108 patients). In the mean 6-month follow-up (range 1 to 36) of 97 eligible patients, 3 (3.1%) died from unrelated causes. There was 1 restenosis (1.0%) from a stent compression, which was successfully redilated. There were no neurological sequelae, cranial palsies, or cases of stent or vessel thrombosis in follow-up.

Conclusions:

The use of stents in the treatment of cervical carotid occlusive disease appears feasible, effective in the short term, and without excessive risk of periprocedural stroke.
Transcatheter Embolization of a Ruptured Superior Gluteal Artery Aneurysm: Case Report and Review of the Literature
Authors: McMillan William D. , Smith Norm D. , Nemcek Albert , Pearce William H.
Published: March 2015

Purpose:

To report the successful coil embolization of a true gluteal artery aneurysm and review therapeutic options for this rare condition.

Methods and Results:

A ruptured superior gluteal artery aneurysm in a symptomatic 80-year-old man was successfully thrombosed by embolization using a combination of Gianturco coils and helical platinum microcoils. Six-month computed tomography demonstrated persistent thrombosis of the aneurysm and resolution of the perivascular blood.

Conclusions:

This report offers support for the use of catheter-based techniques as an alternative to standard surgical repair of gluteal artery aneurysms.
Intravascular Stenting in the Superior Mesenteric Artery for Chronic Abdominal Angina
Authors: Busquet Jacques
Published: March 2015

Purpose:

Abdominal angina is an early clinical expression of occlusive mesenteric arterial insufficiency, a condition that requires aggressive treatment to prevent intestinal infarction. We report a case of chronic mesenteric ischemia in a young polyvascular man who had symptoms of abdominal angina.

Methods and Results:

An aortic angiogram revealed a significant ostial stenosis of the superior mesenteric artery (SMA) associated with an occlusion of the inferior mesenteric artery. After predilation of the ostial portion of the SMA, significant residual stenosis remained. A balloon-expandable Palmaz P154 stent was deployed, restoring adequate luminal dimensions and blood flow. The patient was discharged after 2 days and remains asymptomatic at 5 months.

Conclusion:

Intraluminal stenting for treatment of mesenteric ischemia represents a viable alternative to surgical revascularization in selected cases.
Rupture of the External Iliac Artery during Balloon Angioplasty: Endovascular Treatment Using a Covered Stent
Authors: Formichi Maxime , Raybaud Gilles , Benichou Hubert , Ciosi Godefroy
Published: March 2015

Purpose:

To report the emergent endovascular management of an external iliac artery (EIA) rupture after standard guidewire recanalization and balloon angioplasty.

Method and Results:

A 54-year-old diabetic male presented with an occlusion of the EIA associated with severe stenotic lesions of the femoral bifurcation. Guidewire recanalization of the lumen was followed by balloon angioplasty, but evidence of EIA rupture was detected on the intraoperative arteriogram. Temporary homeostasis was achieved using the angioplasty balloon, and a Cragg EndoPro System 1 stent-graft was inserted transluminally to repair the injury. At 18 months poststenting, routine color Doppler confirmed continued patency of the vessel repair.

Conclusions:

While rupture of the EIA during angioplasty usually demands open surgical correction, an endovascular procedure can provide a fast, efficient, and less aggressive method of treating this serious complication.
Tube Collapse and Valve Closure in Ambulatory Venous Pressure Regulation: Studies with a Mechanical Model
Authors: Raju Seshadri , Green Austin B. , Fredericks Ruth K. , Neglen Peter N. , Hudson C. Alexander , Koenig Keith
Published: March 2015

Purpose:

To determine the role of valve closure and column segmentation in ambulatory venous pressure regulation.

Methods:

Using a mechanical model consisting of a graduated adjustable valve and a collapsible tube, we studied the differential effects of valve closure and tube collapse on venous pressure regulation. By utilizing materials with differing wall properties for the infravalvular tube, the influence of wall property changes on tube function and pressure regulation was explored.

Results:

Valve closure, per se, does not cause venous pressure reduction. Collapse of the tube below the valve is the primary pressure regulatory mechanism. The nonlinear volume-pressure relationship that exists in infravalvular tubes confers significant buffering properties to the collapsible tube, which tends to retain a near-constant pressure for a wide range of ejection fractions, residual tube volumes, and valve leaks. Changes in tube wall property affect this buffering action, at both the low and high ends of the physiological venous pressure range.

Conclusions:

The valve and the infravalvular venous segment should be considered together in venous pressure regulation. Tube collapse of the segment below the valve is the primary pressure regulatory mechanism. An understanding of the hydrodynamic principles involved in pressure regulation derived from this model will provide the basis for construction of more complex models to explore clinical physiology and dysfunction.
Combined Operative and Endovascular Treatment of a Post-Traumatic Embolizing Aneurysm of the Subclavian Artery
Authors: Meyer Thomas , Merkel Susanne , Lang Werner
Published: March 2015

Purpose:

To describe a combined endovascular and surgical approach for an embolizing subclavian artery aneurysm as an alternative to conventional reconstructive surgery.

Methods and Results:

A 39-year-old woman presented with a post-traumatic aneurysm of the left subclavian artery and occlusion of the brachial artery due to embolization. Exclusion of the aneurysm was achieved by intraoperative implantation of a covered stent during simultaneous reconstruction of the brachial artery by a venous bypass graft. The patient is well and free of symptoms 24 months after the operation.

Conclusions:

Repeat operative trauma to the supraclavicular region was avoided by transluminal implantation of a covered stent-graft in combination with an axilloulnar bypass procedure for chronic embolic occlusion of the brachial artery.
Popliteal Artery Aneurysm Treated with a Minimally Invasive Endovascular Approach: An Initial Report
Authors: Rosenthal David , Atkins Colby P. , Shuler Frederick W. , Jerius Hilde S. , Clark Michael D. , Matsuura John H.
Published: March 2015

Purpose:

To report a minimally invasive approach to popliteal artery aneurysm (PAA) treatment.

Methods and Results:

A 48-year-old male with a 3-cm PAA was treated electively with an endovascular in situ saphenous vein bypass and transluminal antegrade coil embolization of the PAA prior to completion of the proximal anastomosis. Two short incisions at the anastomosis sites resulted in no wound complications, and the patient was discharged after 2 days. After 14 months of follow-up, the patient is asymptomatic with continued patency of the in situ bypass and occlusion of the PAA.

Conclusions:

This endovascular approach for minimally invasive femoropopliteal in situ saphenous vein bypass grafting appears feasible for treatment of PAAs. This method may reduce the rate of wound complications attending classic open in situ bypass grafts.
Biplane Color Flow Duplex Intravenous Intravascular Ultrasound for Arterial Visualization
Authors: Beebe Hugh G. , Assadnia Shahin , Kriegel Andrew V. , Salles-Cunha Sergio X.
Published: March 2015

Purpose:

To describe a feasibility study in a sheep model using an intravascular ultrasound (IVUS) instrument in an intravenous position to produce color flow, B-mode images of arterial segments along with Doppler blood flow velocities.

Methods:

Four healthy adult male sheep were anesthetized for surgical exposure of the right external jugular vein. A 9.0F sheath was also introduced in the common femoral artery for arteriography and device insertion. A 7.5-MHz ultrasound probe with 1-cm graduation markers was passed into the jugular vein. B-mode and color flow pictures were captured at aortic branches in cross and longitudinal sections. Length measurements between aortic branches and Doppler spectral velocities were obtained. Guidewire, balloon, and stent maneuvers were monitored by the stationary intravenous IVUS probe.

Results:

High-quality visualization of the entire abdominal aorta and its branches was achieved in all animals. With the probe stationary in the vena cava, a 1.5-cm linear segment of the aorta could be continuously observed in both B-mode and color flow ultrasound scans. Insertion and implantation of a Palmaz balloon-expandable stent was guided by intravenous IVUS alone. Selective catheterization of the right renal artery was followed visually by moving the intravenous IVUS probe sequentially.

Conclusions:

Intravenous IVUS appears feasible as a guidance and monitoring tool for endovascular interventions. While conventional IVUS provides only cross-sectional images in B-mode, intravenous IVUS captures color flow and Doppler velocity data as well. These added ultrasound modalities may offer potential advantages for guidance of endovascular procedures and endoleak detection.
Treatment of Traumatic False Aneurysm of the Thoracic Aorta with Endoluminal Grafts
Authors: Deshpande Arvind , Mossop Peter , Gurry John , Frydman Gary , Matalanis George , Walker Philip , Meckechnie Sunderland , Denton Michael
Published: March 2015

Purpose:

Traumatic false aneurysms of the thoracic aorta presenting at a time remote from the original injury are a rare but complex problem. The treatment of a traumatic false aneurysm by endovascular techniques may offer many advantages over conventional open surgery.

Methods and Results:

Two male patients presented with traumatic false aneurysm of the thoracic aorta after being treated emergently for visceral injuries from a gunshot wound in one and an automobile accident in the other. In both cases, the aneurysm was situated so that only the T11 intercostal artery would be sacrificed by endoluminal exclusion. Commercially available endoluminal stent-grafts (Talent) were deployed successfully. Recovery in both patients was rapid and uneventful with no neurological sequelae. Spiral computed tomographic scans at 1 year indicated sustained aneurysm exclusion and satisfactory endograft position.

Conclusions:

A customized endoluminal stent-graft can be used with great accuracy to exclude thoracic false aneurysms, avoiding the potential complexity and morbidity of an open thoracic approach.
The Effect of Angulation on Intravascular Ultrasound Imaging Observed in Vascular Phantoms
Authors: Geselschap Jim H. , Heilbron Mauricio J. , Hussain Farabi M. , Daskalakis Theodoros M. , Wilson Eric P. , Kopchok George E. , White Rodney A.
Published: March 2015

Purpose:

To quantify the error introduced by noncoaxial intravascular ultrasound (IVUS) imaging and to evaluate the use of a balloon-tipped catheter in compensating for intraluminal angulation and subsequent dimensional inaccuracy.

Methods:

The effect of noncoaxial IVUS imaging was investigated in both a polyvinyl chloride phantom and an in vitro canine aorta using a calibrated setup to measure angulation off axis. Imaging was performed at increasing angulation (creating an elliptical image) in both phantoms, with the transducer centered and off center. Diameters were compared to the original coaxial diameter, as well as calculated diameters based on specific angles off axis. The percentage change (error) was also calculated at these angles. The measurements were repeated using a balloon-tipped catheter to center the transducer.

Results:

The measured diameters and percentage changes compared closely with their calculated counterpart. Up to 25° off axis, the apparent increase in diameter measurement was nearly 10%. Angulation from 30° to 70° resulted in an increase of 15% to 192%. Use of the centering balloon reduced the amount of error by 70% to 85% but was limited to angles ≤ 25° due to the design of the test apparatus.

Conclusions:

The error introduced by noncoaxial IVUS imaging can be significant and may be partially corrected by the use of a centering balloon. Further studies in the clinical application of a centering device are warranted.
Transluminal Stent-Graft Repair for Pseudoaneurysm of PTFE Hemodialysis Grafts
Authors: Rabindranauth Prem , Shindelman Larry
Published: March 2015

Purpose:

To report the use of endovascular techniques to treat two cases of nonanastomotic pseudoaneurysm of a bridge graft fistula (BGF).

Methods and Results:

Two men with fully functional polytetrafluoroethylene (PTFE) BGFs both presented with an enlarging mass adjacent to their arteriovenous shunt. The false aneurysm in both instances was located by ultrasound and confirmed by shunt angiography at the time of surgery. Both fistulas were repaired by transluminally introducing a stented graft composed of a balloon-expandable Palmaz stent covered with a PTFE graft. Completion arteriography confirmed normal flow through the graft with no communication between the lumen and the aneurysmal cavity. Both patients recovered without complications and were discharged on the day of the procedure. Follow-up data reveal that both fistulas remain fully functional up to 5 and 6 months, respectively.

Conclusions:

Endovascular repair using stent-grafts can be a safe and effective method of excluding pseudoaneurysms associated with PTFE BGFs.
Dilatation of the Infrarenal Aneurysm Neck after Endovascular Exclusion of Abdominal Aortic Aneurysm
Authors: Sonesson Björn , Malina Martin , Ivancev Krasnodar , Lindh Mats , Lindblad Bengt , Brunkwall Jan
Published: March 2015

Purpose:

To determine the fate of the infrarenal aneurysm neck and suprarenal aorta after endovascular exclusion of abdominal aortic aneurysms (AAAs).

Methods:

Thirty-four patients underwent endovascular AAA repair between January 1994 and December 1995 using custom-made stent-grafts constructed from polyester graft material and modified self-expanding Gianturco Z-stents sutured to the graft orifices. Thirty-one patients were available for follow-up. Pre- and postimplantation diameters were measured using spiral computed tomography in the infrarenal aneurysm neck and the suprarenal aorta at the level of the superior mesenteric artery (SMA).

Results:

The mean follow-up time was 25 months. There was a significant increase of the diameter of the infrarenal aneurysm neck (+ 1.65 mm, p = 0.002), but not in the aorta at the level of the SMA (+ 0.52 mm, p = 0.100). There was no difference in the change in diameter in the infrarenal neck in the group with a stent adjacent to the level of measurement (n = 20) compared with the group without an adjacent stent (n = 11, p = 0.790). There was no correlation between preimplantation size of the infrarenal neck and its diameter change (r = 0.14, p = 0.488). There was no correlation (r = 0.10, p = 0.603) or association (chi-square test, p = 0.211) between aortic diameter change at the level of the SMA and the infrarenal neck.

Conclusions:

This investigation shows a significant dilatation of the infrarenal aneurysm neck, but not in the suprarenal aorta, after endovascular AAA repair with this device. The clinical significance of these findings is unclear. Whether such a dilatation in the infrarenal aneurysm neck may affect the long-term attachment of stent-grafts remains to be shown in the future.
Experience with the Stentor Endograft at Four Italian Centers
Authors: Coppi Gioacchino , Pacchioni Roberto , Moratto Roberto , Gennai Stefano , Farello Gianantonio A. , Bergamaschi Gastone , Rabbia Claudio , Rossato Denis , Ponzio Federico , Stancanelli Vincenzo , Piccinini Elio
Published: March 2015

Purpose:

To report the outcome of an Italian multicenter trial of endovascular abdominal aortic aneurysm (AAA) exclusion using the Stentor device.

Methods:

Between April 1995 and July 1996, 66 patients (63 men; average age 69 years, range 53 to 84) with infrarenal AAAs meeting the inclusion criteria were enrolled. The average diameter of the aneurysm was 4.6 cm (range 4.2 to 7). Three (4.5%) of the 66 AAAs were anastomotic aneurysms.

Results:

Sixteen (25%) tubular and 50 (76%) bifurcated endograft procedures were attempted; 4 (6.1%) were converted and 1 terminated owing to technical faults with the bifurcated graft's second limb. One tube graft was too short and failed to exclude an anastomotic aneurysm. Sixty (91%) endograft procedures were completed successfully. Six (9.1%) vascular complications occurred, three in one patient who subsequently died of pulmonary embolism 72 hours postoperatively (1.5% mortality). There were four (6.1%) proximal endoleaks; two sealed spontaneously in < 1 month, and a third was converted (7.6% conversion rate). The fourth is being observed. Clinical success (aneurysm exclusion with no death or endoleak) at 30 days was 86.3% (57/66). In the 23-month follow-up of 57 eligible patients, 2 patients died of unrelated causes and 1 graft limb thrombosed, requiring a crossover femoral bypass. One patient was converted to surgical repair at 5 months postoperatively when increasing aneurysm size signaled an undisclosed endoleak (1.8% late conversion rate). Five other secondary endoleaks were treated with endovascular techniques.

Conclusions:

The Stentor was technically feasible in 10% to 40% of AAA candidates in this study, although deployment of the second limb was problematic in the bifurcated device. Introduction of the second-generation Vanguard endograft brought this study to an end.