bluuebunny/crossref_metadata_2025 huggingface dataset:
Biocompatibility and Biostability of Metallic Endovascular Implants: State of the Art and Perspectives
Authors: Thierry Benjamin , Tabrizian Maryam
Published: March 2015

This work was partly supported by the Natural Science and Engineering Research Council (NSERC) of Canada.

More than a million metallic endovascular devices are implanted each year, but the quest for the perfect material continues. The importance of interfacial properties in the overall biocompatibility of metals and alloys has been recognized for a long time. In particular, these properties modulate the hemocompatibility of devices in contact with blood and, in turn, strongly influence implantation outcomes. In this article, the relative properties of metallic materials commonly used in endovascular applications are reviewed. Particular emphasis is given to the corrosion behavior of metallic endovascular materials and the specific surface treatments used in the production processes. Issues relative to corrosion assays will also be reviewed in terms of their relevance to in vivo applications. The potential adverse effects of degradation products with respect to endovascular applications will be described. Finally, this review addresses future perspectives of metallic devices in endovascular procedures in view of the recent promises of antiproliferative strategies that are likely to profoundly modify current procedures.
Transbrachial Stenting of a Critical Ostial Arteria Lusoria Stenosis
Authors: Basile Antonio , Lomoschitz Fritz , Lammer Johannes
Published: March 2015

Purpose:

To report the endovascular treatment of a critical ostial stenosis in an aberrant right subclavian artery (ARSA), a rare embryologic anomaly of the aortic arch.

Case Report:

A 76-year-old woman presented with acute ischemia of her right forearm. Her medical history was notable for hyperlipidemia but otherwise negative for risk factors of atherosclerosis. Color-coded duplex ultrasonography revealed occlusion of the distal brachial and cubital artery, poststenotic flow in the distal subclavian and axillary artery, and reversal of flow in the right vertebral artery. The patient underwent contrast-enhanced multidetector computed tomography of the thorax, which revealed the presence of an ARSA with a calcified, high-grade ostial stenosis. The lesion was successfully stented via a brachial access.

Conclusions:

Endovascular treatment of an ostial stenosis in an aberrant right subclavian artery is feasible by means of transbrachial approach.
Hyperperfusion Syndrome of the Deltoid Muscle after Subclavian Artery Angioplasty and Stenting
Authors: Klocker Josef , Chemelli Andreas , Bodner Gerd , Gschwendtner Andreas , Perkmann Reinhold , Tauscher Thomas , Jaschke Werner , Fraedrich Gustav
Published: March 2015

Purpose:

To report a case of hyperperfusion syndrome of the deltoid muscle after percutaneous transluminal angioplasty of a symptomatic high-grade subclavian artery stenosis.

Case Report:

Immediately after balloon dilation of a left-sided subclavian artery stenosis, a 53-year-old man developed severe ipsilateral shoulder pain and swelling. Computed tomographic angiography revealed no extravasation or hematoma. Sonography showed massive edema and increased anteroposterior diameter of the left deltoid muscle (3.5 cm compared to 2.0 cm on the right). Hyperperfusion syndrome was suspected, and decompression by anterolateral fasciotomy was performed. Subsequently, both pain and swelling decreased. At day 3, the skin incision, which was temporarily covered with a synthetic skin substitute, was sutured; the wound healed uneventfully. Two weeks after surgery, both muscle strength and shoulder movements showed no restrictions.

Conclusions:

Hyperperfusion syndrome after endovascular treatment of subclavian artery stenosis should be considered in the differential diagnosis of atypical muscle pain in the upper extremity. It may present as a compartment syndrome requiring surgical decompression.
Endoprosthetic Treatment of a Mycotic Superficial Femoral Artery Aneurysm
Authors: Callaert Joren R.G. , Fourneau Inge , Daenens Kim , Maleux Geert , Nevelsteen André
Published: March 2015

Purpose:

To describe the successful stent-graft exclusion of a mycotic aneurysm of the superficial femoral artery.

Case Report:

A 78-year-old man presented with Salmonella arteritis and the formation of a mycotic false aneurysm of the superficial femoral artery. Antibiotics were administered; the aneurysm was excluded using 2 Hemobahn stent-grafts, and the surrounding hematoma was drained. One year postoperatively, there are no clinical or biochemical signs of infection. Ultrasound examination does not show any fluid around the patent stent-graft.

Conclusions:

Stent-graft placement might be an alternative to traditional surgery in selected cases of mycotic aneurysm.
Delayed Diagnosis of Leiomyosarcoma of the Common Femoral Artery after Endovascular Repair
Authors: Porcellini Massimo , D'Armiento Francesco Paolo , Spinetti Fabio , Anniciello Annamaria , Bracale Giancarlo
Published: March 2015

Purpose:

To describe a unique case of misdiagnosed leiomyosarcoma of the common femoral artery presenting with signs and symptoms of high-grade stenosis, which was treated with stent placement.

Case Report:

A 31-year-old woman with a history of diabetes and hyperlipidemia had recurrent claudication and showed significant in-stent restenosis of the common femoral artery in a postoperative angiogram at 5 months. The patient's clinical stage remained unchanged after repeat percutaneous intervention, and leiomyosarcoma was diagnosed from surgical specimens. The patient underwent resection and repair of the involved artery. She has survived 30 months with no further evidence of local recurrence or systemic metastatic disease.

Conclusions:

Endovascular repair may cause a long delay in the diagnosis of an arterial leiomyosarcoma mimicking peripheral occlusive disease.
Surgical Removal of Self-Expanding Stents from the Carotid Artery: Does the Type of Stent Make a Difference?
Authors: Shaw Palma M. , Ohki Takao , Veith Frank J. , Dadian Nishan
Published: March 2015

Purpose:

To evaluate the degree of difficulty in surgically removing 2 different stent models placed in the canine carotid artery.

Methods:

In 5 dogs, each carotid artery was stented with a braided Elgiloy self-expanding stent (BESES) on one side and a surface-spanning micro stent (SSMS) on the other. After 4 weeks, an arteriogram was obtained, and the stents were removed via direct surgical exposure. The minimum lengths of the skin incisions and arteriotomies, the ease of stent removal, and the presence of a distal intimal flap were recorded.

Results:

Stent deployment and removal were successful in each animal, but there was a substantial difference in the ease of removal. The BESES could be removed in a strand-by-strand fashion via a more proximal, smaller arteriotomy compared to the SSMS (8.8±1.3 versus 37.2±4.7 mm, p<0.01). Furthermore, a smaller skin incision (3.85±0.9 versus 9.75±0.5 cm, p<0.01) was required for the BESES. There was no distal flap formation following BESES removal, whereas SSMS removal produced a large distal flap in each artery (p<0.01).

Conclusions:

Although rare, restenosis after stenting occurs, and surgical repair may become necessary in some patients. Each stent has inherent advantages and disadvantages, but the braided Elgiloy self-expanding stent lends itself to easier surgical removal, which may have important clinical implications, especially when used in the carotid artery.
Percutaneous Management of Concomitant Post-Traumatic High Vertebrovertebral and Caroticojugular Fistulas Using Balloons, Coils, and a Covered Stent
Authors: Duncan Ian C. , Fourie Pieter A.
Published: March 2015

Purpose:

To describe the endovascular management of vertebrovertebral and caroticojugular fistulas in the same patient using a combination of endovascular techniques including covered stent placement in the high extracranial internal carotid artery.

Case Report:

A 22-year-old man presented with ipsilateral vertebrovertebral and caroticojugular fistulas at the C1 level several weeks after sustaining a solitary penetrating knife injury below the right ear. The right vertebral artery was sacrificed after a failed endovascular attempt to close the vertebrovertebral fistula. The caroticojugular fistula was treated with a self-expanding covered stent (Wallgraft) with exclusion of the fistula and preservation of flow through the carotid artery.

Conclusions:

Preservation of the extracranial arteries should be the preferred goal of treatment in traumatic extracranial arteriovenous fistulas. The use of covered stents in the extracranial vessels can accomplish this goal.
Iohexol-Induced Neutrophil Myeloperoxidase Release and Activation upon Contact with Vascular Stent-Graft Material: A Mechanism Contributing to the Postimplantation Syndrome?
Authors: Videm Vibeke , Ødegård Asbjørn , Myhre Hans Olav
Published: March 2015

Purpose:

To investigate whether the contrast medium iohexol alone or in combination with vascular stent-graft material induces neutrophil degranulation.

Methods:

Human whole blood or isolated human neutrophils were incubated with or without iohexol and vascular stent-graft material. Samples were also drawn from 5 patients undergoing diagnostic angiography using iohexol. Myeloperoxidase and lactoferrin concentrations were determined by enzyme immunoassays.

Results:

Both in vitro and in the patients, iohexol induced neutrophil degranulation with considerable individual variation in dose sensitivity and timing. The in vitro effect was independent of the type of anticoagulant used (ethylenediamine tetra-acetic acid, heparin, lepirudin). Experiments using isolated neutrophils showed that degranulation was independent of complement activation or platelet-derived mediators. The dose for maximal response varied from 5 to 50 mg I/mL (10.7–107.6 mg/mL iohexol). In vitro, vascular stent-graft material alone did not induce neutrophil degranulation. As compared to iohexol alone, incubation with iohexol and vascular stent-graft material in combination substantially increased the release of myeloperoxidase.

Conclusions:

Iohexol induces neutrophil degranulation, which is greatly enhanced when combined with vascular stent-graft material. Thus, iohexol-induced neutrophil activation may contribute to an inflammatory response following stent-graft implantation. We speculate that neutrophil activation during other procedures combining catheters and iohexol (e.g., angiography) may induce inflammation, which might have detrimental effects.
Initial Clinical Experience with Percutaneous Atherectomy in the Infragenicular Arteries
Authors: Zeller Thomas , Frank Ulrich , Bürgelin Karlheinz , Schwarzwälder Uwe , Flügel Peter-Christian , Neumann Franz-Josef
Published: March 2015

Purpose:

To evaluate the efficacy and safety of a new atherectomy device for the treatment of infragenicular lesions in arteries with a reference diameter of at least 2.5 mm.

Methods:

Twenty-seven below-the-knee lesions in 17 patients (12 men; mean age 69±12 years) with chronic peripheral arterial occlusive disease were treated with directional atherectomy. The target lesion was in the popliteal artery (segment 3) in 2 (7%) cases, the tibioperoneal trunk in 12 (44%), the peroneal artery in 8 (30%), the anterior tibial artery in 2 (7%), and the posterior tibial artery in 3 (11%). Six (22%) of the lesions were in-stent stenoses. The mean diameter stenosis was 87%±9%, and the mean lesion length was 34±24 mm.

Results:

All but 2 (7%) of the lesions could be treated successfully (residual stenosis <30%) with the atherectomy catheter (93% technical success) using an average of 5±2 (range 1–10) passes of the device. Six lesions (22%) were treated after predilation and 21 (78%) with primary atherectomy. In 8 (30%) lesions, additional balloon angioplasty was performed. The 2 failures were in heavily calcified lesions through which the device could not pass despite predilation. The mean diameter stenosis after atherectomy was 14%±22% (range 0%–90%); after additional balloon angioplasty, the mean residual stenoses reduced to 12%±21% (range 0%–100%). One (6%) of the 2 patients who failed atherectomy sustained a thrombotic occlusion of the target vessel. This complication was treated successfully with local lysis, but the vessel reoccluded 3 days later; a stent was implanted. The mean ankle-brachial index increased from 0.50±0.27 to 0.86±0.40 before discharge.

Conclusions:

Below-the-knee native vessel lesions and in-stent restenoses with a diameter of at least 2.5 mm can be treated successfully and safely with this new atherectomy catheter. Additional balloon angioplasty was necessary in only a few cases.
Clinical Experience with Retrievable Günther Tulip Vena Cava Filters
Authors: Wicky Stephan , Doenz Francesco , Meuwly Jean-Yves , Portier François , Schnyder Pierre , Denys Alban
Published: March 2015

Purpose:

To report clinical experience with retrievable Günther Tulip filters from implantation to retrieval and their status in nonretrieved situations.

Methods:

Seventy-five Günther Tulip filter implantations were performed in 71 patients (43 women; mean age 55 years). Indications for filter placement were pulmonary embolism (PE) or iliofemoral deep vein thrombosis (DVT) in patients with a contraindication to anticoagulation (43, 61%) or perioperative PE prophylaxis (28, 39%) in patients with confirmed iliofemoral DVT. Retrieval procedures were planned for each patient. Patients with nonretrieved filters were followed with plain radiography and duplex sonography.

Results:

Technical success of filter insertion was 97.3% (73/75). Eighteen (25%) patients died from unrelated causes prior to retrieval attempts, and 6 other patients were too critically ill for a retrieval procedure. Of 49 (67%) planned retrieval attempts, 14 (19%) filters could not be removed owing to large trapped thrombi. The mean implantation period for the 35 (48%) retrieved filters was 8.2 days (range 1–13). Delivery tilt was observed in 12 (16%) filters and during retrieval attempts in 1 more case. For 9 nonretrieved filters, tilt and migration were observed in 22% at a mean follow-up of 30 months, but no venous thrombosis was assessed.

Conclusions:

Our data confirm the clinical efficacy of the Günther Tulip filter during implantation and the feasibility of its retrieval. Further long-term follow-up should be conducted on nonretrieved filters to confirm our results.
Endovascular Aortic Arch Reconstruction with Supra-Aortic Transposition for Symptomatic Contained Rupture and Dissection: Early Experience in 8 High-Risk Patients
Authors: Schumacher Hardy , Böckler Dittmar , Bardenheuer Hubert , Hansmann Jochen , Allenberg Jens-Rainer
Published: March 2015

Purpose:

To report our initial experience with total and subtotal endovascular aortic arch reconstruction combined with supra-aortic vessel transposition in high-risk patients and to present a new morphological classification of thoracic aortic lesions for patient and procedure selection.

Methods:

Among 80 patients treated with thoracic stent-grafts at our department between 1997 and 2003, 8 patients (6 men; mean age 71 years, range 45–81) unfit for open repair were not candidates for standard endovascular repair due to inadequate proximal landing zones on the aortic arch. Commercially available endografts (Excluder, Zenith, Endofit, Talent) were used to repair the arch after supra-aortic vessel transposition was performed. The endograft was implanted transfemorally or via an iliac Dacron conduit graft with standardized endovascular techniques and deployed during intravenous adenosine-induced asystole. The imaging data from all thoracic endograft patients was analyzed to classify thoracic and thoracoabdominal lesions according to a 4-level anatomical system.

Results:

Deployment success was 100% after staged supra-aortic vessel transposition, but 1 patient died of endograft-related rupture of the proximal aortic arch. There was no neurological complication. Mean follow-up was 16 months (range 1–36). Patency of all endografts and conventional bypasses was 100%, and no migration was observed. One minor type II endoleak was demonstrated.

Conclusions:

Initial results are encouraging for endovascular aortic arch repair in combination with supra-aortic transposition in selected high-risk patients with complex aortic pathologies.
Requirements for Quantitative Analysis of Intimal Reaction in Arteries Treated with Intraluminal Stents
Authors: Uurto Ilkka , Juuti Hanne , Parkkinen Jyrki , Kellomäki Minna , Keski-Nisula Leo , Nevalainen Timo , Törmälä Pertti , Salenius Juha-Pekka
Published: March 2015

Purpose:

To assess the reliability of quantitative histomorphometry measurements for the intimal reaction that occurs after intraluminal stenting in an animal model.

Methods:

Two self-expanding intravascular stents, a biodegradable poly-D/L-lactic acid (PLA) stent and a stainless steel Wallstent, were implanted in the common iliac arteries of a beagle dog. After 45 days, the histomorphometry of the stented iliac artery segments was quantitatively measured. The relative standard error (RSE) of the estimate was calculated, and the reliability of measurements for maximal (LDmax) and minimal (LDmin) luminal diameters and internal (IELT) and external (EELT) elastic lamina thicknesses was assessed.

Results:

The PLA stent required more measurements of variables from a single slide to ensure reliable (RSE<10%) results (1 for LDmax, 1 for LDmin, 8 for IELT, and 4 for EELT) compared to the Wallstent (1 for LDmax, 1 for LDmin, 2 for IELT, and 2 for EELT 2). The measured results were reliable for both stent materials when variables were measured from 2 slides of each segment (proximal/central/distal) of the stent.

Conclusions:

We conclude that these preliminary measurements to estimate the reliability of quantitative histomorphometry measurements should be made and reported before final results are given.
Serial CT Volume and Thrombus Length Measurements after Endovascular Repair of Stanford Type B Aortic Dissection
Authors: Czermak Benedikt V. , Mallouhi Ammar , Perkmann Reinhold , Steingruber Iris E. , Waldenberger Peter , Neuhauser Beate , Fraedrich Gustav , Jung Tarzis , Jaschke Werner R.
Published: March 2015

Purpose:

To evaluate the outcome of stent-graft placement in Stanford type B aortic dissection using contrast-enhanced spiral computed tomographic (CT) measurements of true and false lumen volumes and thrombus length.

Methods:

Among 18 consecutive patients (13 men; mean age 60 years, range 44–79) who underwent endovascular repair of Stanford type B dissection, 12 completed at least a 12-month follow-up, which included CT measurements of true and false lumen volumes and thrombus lengths prior to discharge and at 6 and 12 months postimplantation. Volumes were assessed in 3 different aortic segments (A1, A2, A3) extending from the proximal attachment site of the prosthesis to the aortic bifurcation. In addition, thrombus length was measured to evaluate the influence of clot formation on outcome of the false lumen volume.

Results:

Mean follow-up was 27 months (range 12–60). Within 12 months, mean true lumen volumes showed statistically significant increases in the A1 (p<0.001) and A2 (p=0.003) segments; false lumen volumes showed a significant decrease in the A1 segment (p=0.002) but an insignificant increase in the A2 segment. No substantial volume changes were observed in the A3 segment. Extension of clot formation in the false lumen varied among patients and over time. Length of stent-grafts, percentage of stented dissection length, or visceral arteries originating from the false lumen did not significantly influence thrombus development, nor did these parameters or thrombus formation distal to the prosthesis have a relationship to false lumen volumes.

Conclusions:

Volumetric analysis after endovascular repair of Stanford type B dissection shows optimal technical outcome in the stented segment, whereas the false lumen in the segment immediately adjacent to the stent-graft seems to be a vulnerable area. Extension of clot formation beyond the endograft seems to be no reliable predictor of outcome.
Stent-Graft Placement in Atherosclerotic Descending Thoracic Aortic Aneurysms: Midterm Results
Authors: Czerny Martin , Cejna Manfred , Hutschala Doris , Fleck Tatjana , Holzenbein Thomas , Schoder Maria , Lammer Johannes , Zimpfer Daniel , Ehrlich Marek , Wolner Ernst , Grabenwoger Martin
Published: March 2015

Purpose:

To determine midterm durability and need for reinterventions after stent-graft placement in atherosclerotic descending thoracic aortic aneurysms.

Methods:

Fifty-four patients (38 men; mean age 68 years, range 33–87) underwent stent-graft repair of chronic atherosclerotic aneurysms of the descending thoracic aorta between November 1996 and December 2002. Acute aortic syndromes (type B aortic dissections, perforating ulcers, and traumatic dissections) were excluded from analysis. Two types of commercially available stent-grafts were used (Talent and Excluder).

Results:

The primary technical success rate was 94.4%. In-hospital mortality was 3.7% (2/54). No adverse neurological events were encountered. Of 3 (5.6%) early type I endoleaks, 2 (3.7%) required reintervention; the other type I endoleak closed spontaneously. Mean follow-up was 38 months (range 1–72) in the 52 surviving patients. Four (7.7%) type I, 7 (13.5%) type II, and 4 (7.7%) type III endoleaks were seen. Three 3 patients had additional treatment for endoleaks (proximal stenting [type Ia], open thoracoabdominal repair [type Ib], and embolization [type II]). Two of the 3 reinterventions were performed in the first year of follow-up. One additional patient with a type Ia endoleak not suitable for reintervention is under close observation. There were no differences in the number of endoleaks between the 2 types of stent-grafts. Three-year event-free survival was 63%.

Conclusions:

Midterm durability of endovascular stent-graft placement in atherosclerotic descending aortic aneurysms seems promising, as the rate of endoleaks requiring reintervention is acceptably low. In our series, endoleak formation occurred during the first year after stent-graft placement, so close follow-up of patients after aortic aneurysm repair is crucial. Further studies are warranted to evaluate long-term durability of this new treatment modality.
How Many Patients with Infrarenal Aneurysms are Candidates for Endovascular Repair? The Northern California Experience
Authors: Arko Frank R. , Filis Konstantinos A. , Seidel Scott A. , Gonzalez Jim , Lengle Steve J. , Webb Ron , Rhee John , Zarins Christopher K.
Published: March 2015

Purpose:

To determine how many patients with abdominal aortic aneurysms (AAA) meet the anatomical selection criteria for AneuRx stent-graft repair in community hospitals of Northern California.

Methods:

The records were reviewed of 220 AAA patients (171 men, 49 women) who were considered for endovascular repair by the treating vascular surgeon at 28 community hospitals in Northern California between January and October 2001. Contrast computed tomographic angiography (CTA) and selective arteriography were performed at each institution and reviewed by a centralized, independent image-reading center. Selection criteria determined by the manufacturer and published in the indications for use were applied to each set of imaging studies. The number of patients who met inclusion criteria were recorded, as were the anatomical characteristics of each aneurysm.

Results:

The mean aneurysm size in the 220 patients was 55.3±0.7 mm. Among these patients, 122 (55%) were judged to be candidates for endovascular repair and 98 (45%) were considered ineligible. The primary anatomical reason for ineligibility was a short infrarenal neck in 43 (44%) patients, followed by a large proximal neck diameter (25, 25%), iliac aneurysms (10, 10%), extremely tortuous or calcified neck (7, 7%), iliac occlusion (6, 6%), and small distal aortic bifurcation and accessory renal arteries (5, 5%). Four (4%) patients were classified as non-candidates due to poor quality imaging. There was no difference in aneurysm diameter (54.0±0.8 versus 57.1±1.2 mm, p=NS) or age (72.2±1.2 versus 74.6±2.2 years, p=NS) between candidates and non-candidates. However, proportionally more men (60%) than women (39%) were eligible for endovascular repair with the AneuRx stent-graft (p<0.05). All 122 patients who were considered candidates for endovascular repair were treated, with successful stent-graft placement achieved in 121 (99%).

Conclusions:

Fifty-five percent of patients considered for endovascular AAA repair in community hospitals in Northern California met the anatomical selection criteria for the AneuRx stent-graft. Men appeared to be twice as likely to meet the eligibility requirements as women. Unfavorable infrarenal neck anatomy was the primary exclusion criterion for endovascular repair in this community setting.
Endoluminal Stent-Graft Repair of Aortobronchial Fistulas: Bridging or Definitive Long-Term Solution?
Authors: Böckler Dittmar , Schumacher Hardy , Schwarzbach Matthias , Ockert Stefan , Rotert Harald , Allenberg Jens-Rainer
Published: March 2015

Purpose:

To describe our experience with endoluminal stent-graft repair of aortobronchial fistulas (ABF) and to analyze midterm results focusing on late chronic graft infections, secondary conversion, and survival.

Methods:

The records of 8 patients (6 men; mean age 69 years, range 28–88) treated between March 1997 and October 2003 for traumatic and postsurgical ABFs were reviewed. Seven presented with hemoptysis and 1 with hemorrhagic shock. According to the severity of emergency, patients underwent computed tomography, angiography, bronchoscopy, and transesophageal echocardiography. Preoperatively, no clinical signs of infection were evident. Two different stent-graft models (Talent and Excluder) were implanted using standard endovascular techniques.

Results:

Procedural and clinical success was achieved in all patients. Paraplegia, secondary intervention, conversion, or procedure-related death was not observed. Mean follow-up was 30 months (range 0.6–77). One patient with a postsurgical ABF (Dacron tube graft) successfully treated with an Excluder stent-graft died 13 months later from hemorrhage secondary to aortoesophageal fistula repair procedures. A second patient died from pneumonia after 42 months. A third patient, in whom 2 Talent stent-grafts had been implanted to treat an ABF from the false lumen of a type B dissection, died 7 months later from massive hemorrhage.

Conclusions:

Endoluminal stent-grafting of ABF is feasible and the preferred method of treatment. Secondary conversion due to endograft infection is not absolutely mandatory, but close surveillance is necessary.
Prophylactic Stenting of the Inferior Vena Cava before Transcatheter Embolization of Renal Cell Carcinomas: An Alternative to Filter Placement
Authors: Zamora Carlos Armando , Sugimoto Koji , Mori Takeki , Taniguchi Takanori , Tsurusaki Masakatsu , Izaki Kenta , Yamaguchi Masato , Sugimura Kazuro
Published: March 2015

Purpose:

To report the use of the self-expanding Wallstent as an alternative to prophylactic inferior vena cava (IVC) filter placement before embolization of renal carcinomas with tumor thrombus.

Case Reports:

Two patients, a 71-year-old man and an 88-year-old woman, were diagnosed with extensive tumor infiltration of the IVC secondary to renal cell carcinomas. Prophylactic placement of an IVC filter before transcatheter embolization was unsuccessful in both cases; a reduced space for deployment would have left part of the filter inside the right atrium. Instead, a Wallstent was used to constrain the tumor thrombus against the vessel wall and, at the same time, protect the patency of the contralateral kidney. Adequate patencies were confirmed 9 months after stenting in the first patient and after 19 days in the second patient. There were no clinical manifestations of pulmonary embolism.

Conclusions:

Wallstent implantation is an alternative prophylactic measure before transarterial embolization of renal carcinomas if IVC filters cannot be placed.
History and Current Status of Endovascular Management for the Extracranial Carotid and Supra-Aortic Vessels
Authors: Wholey Mark H. , Wholey Michael H.
Published: March 2015

Few procedures in the history of medicine have been more controversial than carotid artery stenting (CAS) for the management of carotid artery occlusive disease. Introduced just as the randomized trials were establishing carotid endarterectomy as the gold standard for carotid interventions, CAS has finally reached the point in its development when dedicated stenting systems are being tested in randomized clinical trials. Assisted by the concomitant use of distal protection devices, CAS has shown equipoise with endarterectomy in terms of safety at 30 days. This review summarizes the completed and ongoing CAS trials and the applications of endovascular techniques in the supra-aortic vessels.
A Decade of Thoracic Endografting: Planning the Next 10 Years…
Authors: Abul-Khoudoud Omran , Criado Frank J.
Published: March 2015

Endovascular repair has emerged as a very important treatment modality in the management of a host of serious and relatively frequent thoracic aortic diseases. This minimally invasive approach is certain to revolutionize the entire field of thoracic aortic surgery in the near future. The technologies, however, can still be considered as a “work in progress.” Future refinements, which should be available within the next 1 to 2 years, will address some of the most important needs as yet unmet today: lower profile (<22 F) delivery systems, greater device flexibility, no longitudinal metal bars, and precise deliverability and deployment characteristics that will be conducive to optimal success and safety, especially in the region of the aortic arch.
Advances in Endovascular Techniques to Treat Failing and Failed Hemodialysis Access
Authors: Tynan-Cuisiner Gerlinde , Berman Scott S.
Published: March 2015

During the decade since JEVT was inaugurated, we have witnessed the growing application of endovascular techniques for arteriovenous (AV) access in parallel with the evolution of endovascular therapy for arterial pathology. To date, few if any technologies have compared with balloon angioplasty for treating venous anastomotic stenosis, the most common cause of access failure. Only one device, which incorporates the principles of access graft design and self-expanding stent technology, has been uniquely conceived for this pathology. The encapsulated polytetrafluoroethylene stent-graft has achieved reasonable preliminary results, but randomized data is forthcoming. Technology to clear the clot from a thrombosed graft continues to evolve, but will never be as cost-effective as simple balloon thrombectomy. However, the pressure placed on providers to perform all percutaneous interventions and move away from open techniques continues to fuel interest in this component of treatment. Finally, the pursuit of a completely percutaneous AV access continues. As with endovascular procedures in general, whether or not the procedure is cost-effective or time-consuming seems to take a back seat to the all-percutaneous approach that so many seem to converge upon. Moreover, as most autogenous fistulas and AV grafts can be created with minimal incisions under local anesthesia, the pursuit of a completely percutaneous access system seems more like an academic exercise than a practical application of technology. We must try and avoid the tendency to “minimize invasiveness” with technology that is maximally intensive (and expensive), such as limiting ourselves to only percutaneous methods. Given the increasing pressure to have an all autogenous access program, current techniques that apply well in prosthetic grafts will need to be modified to accommodate the different biology of a native fistula. Clearly, the enlarging end-stage renal disease population will continue to provide endovascular specialists with clinically challenging problems requiring new and revolutionary technology.
Development of Vascular Biology over the past 10 Years: Heme Oxygenase-1 in Cardiovascular Homeostasis
Authors: Ohta Kunio , Yachie Akihiro
Published: March 2015

The study of vascular biology has provided strong evidence for the role that free radical attack plays in the pathogenesis of cardiovascular diseases. The endothelial cell (EC) dysfunction that results from exposure to oxidative stresses, such as oxidized LDL, influences vascular cell gene expression, promoting smooth muscle cell (SMC) mitogenesis and apoptosis. These factors also play an important role in atherogenesis, which is attenuated by antioxidants. Thus, antioxidants are important to understanding the pathophysiology of cardiovascular diseases and to constructing an effective treatment strategy for these patients. Over the last decade, there has been a tremendous interest in the biology of heme oxygenase-1 (HO-1), which exhibits antioxidant effects in various forms of tissue injury. Moreover, the reaction is also the major source of carbon dioxide (CO) in the body, which is a physiologically important gaseous vasodilator that inhibits SMC proliferation. Thus, HO-1–derived products provide various mechanisms to maintain cardiovascular homeostasis. We review recent work on the cellular and molecular biological aspects of the HO/CO system in vascular pathophysiology.
Vascular Imaging: An Unparalleled Decade
Authors: Reid Allan W. , Reid Donald B. , Roditi Giles H.
Published: March 2015

Vascular imaging techniques, such as catheter angiography, ultrasound, computed tomography (CT), and magnetic resonance (MR), have all undergone unprecedented innovation and incredible technological leaps in the last 10 years. Ultrasound, CT, and MR have progressed in acquisition speed, resolution, and accuracy to the point that they have now supplanted the former mainstay, invasive catheter-based angiography, despite the advent of digitized angiographic image recording. This review explores the advantages and shortcomings of each technique and how they have changed the diagnosis and assessment of the cardiovascular system for endovascular intervention.
The Excimer Laser: Science Fiction Fantasy or Practical Tool?
Authors: Biamino Giancarlo
Published: March 2015

Nearly 20 years ago, in vitro experiments left no doubt about the fact that laser light can ablate atherosclerotic plaque. The initial enthusiastic results with the technology, particularly in coronary arteries, were followed by reports showing unacceptably high restenosis and complication rates. These poor results were due to the premature application of an underdeveloped technology, a lack of understanding of laser/tissue interaction, and the use of incorrect lasing techniques. Consequently, and without discrimination, all lasers were banned from the catheterization laboratories for nearly a decade. Technological enhancements of the excimer laser, combined with refined catheter lasing techniques, resulted in greater debulking of atherosclerotic material in long superficial femoral artery occlusions. These results triggered the application of the excimer laser technique as an atherectomy tool in more complex lesions below the knee. The multicenter Laser Atherectomy for Critical Ischemia study clearly demonstrated that the excimer laser technology resulted in limb salvage rates >90% in patients with critical limb ischemia (CLI). Furthermore, new clinical results indicate that the excimer laser is very effective in dissolving thrombotic obstructions, redirecting this technology to the coronary field.

The results of the excimer laser in CLI validate the role of the cool laser in treating complex peripheral vascular disease. The results suggest a larger indication for this technology and support a more aggressive use of these interventional techniques in the treatment of this large patient cohort. However, all lasers are not equally effective in debulking atherosclerotic material. Only the athermic process associated with the excimer laser produces a safe and effective endovascular ablation of obstructive atherosclerotic and/or thrombotic material. The appropriate and safe utilization of the equipment and lasing techniques, combined with correct indications and patient selection, will contribute to the successful application of laser-assisted atherectomy in complex peripheral and coronary artery obstructive disease. Unfortunately, little consistent scientific data has been generated to convince the interventional community of the usefulness of excimer laser ablation.
Influence of Pulmonary Status and Diabetes Mellitus on Aortic Neck Dilatation following Endovascular Repair of Abdominal Aortic Aneurysms: A EUROSTAR Report
Authors: Diehm Nicolas , Hobo Roel , Baumgartner Iris , Do Dai-Do , Keo Hak-Hong , Kalka Christoph , Dick Florian , Buth Jaap , Schmidli Juerg
Published: March 2015

Purpose:

To elucidate the association of impaired pulmonary status (IPS) and diabetes mellitus (DM) with clinical outcome and the incidences of aortic neck dilatation and type I endoleak after elective endovascular infrarenal aortic aneurysm repair (EVAR).

Methods:

In 164 European institutions participating in the EUROSTAR registry, 6383 patients (5985 men; mean age 72.4±7.6 years) underwent EVAR. Patients were divided into patients without versus with IPS or with/without DM. Clinical assessment and contrast-enhanced computed tomography (CT) were performed at 1, 3, 6, 12, 18, and 24 months and annually thereafter. Cumulative endpoint analysis comprised death, aortic rupture, type I endoleak, endovascular reintervention, and surgical conversion.

Results:

Prevalence of IPS was 2733/6383 (43%) and prevalence of DM was 810/6383 (13%). Mean follow-up was 21.1±18.4 months. Thirty-day mortality, AAA rupture, and conversion rates did not differ between patients with versus without IPS and between patients with versus without DM. All-cause and AAA-related mortality, respectively, were significantly higher in patients with IPS compared to patients with normal pulmonary status (31.0% versus 19.0%, p<0.0001 and 6.8% versus 3.3%, p=0.0057) throughout follow-up. In multivariate analysis adjusted for smoking, age, gender, comorbidities, fitness for open repair, co-existing common iliac aneurysm, neck and aneurysm size, arterial angulations, aneurysm classification, endograft oversizing >15%, and type of stent-graft, the presence of IPS was not associated with significantly higher rates of aortic neck dilatation (30.6% versus 38.0%, p>0.05) and did not influence cumulative rates of type I endoleak, endovascular reintervention, or conversion to open surgery (p>0.05). Similarly, the presence of DM did not influence the above-mentioned study endpoints.

Conclusion:

In contrast to observations regarding the natural course of AAAs, impaired pulmonary status does not negatively influence aortic neck dilatation, while the presence of diabetes does not protect from these dismal events after EVAR.
Virtual Histology Intravascular Ultrasound in Carotid Interventions
Authors: Irshad Khalid , Millar Samuel , Velu Raj , Reid Allan W. , Diethrich Edward B. , Reid Donald B.
Published: March 2015

Purpose:

To report early clinical experience with virtual histology intravascular ultrasound (VH IVUS) in carotid endoluminal repair.

Technique:

A 2.9-F, 20-MHz catheter that utilizes computer software to demonstrate the histological components of arteriosclerotic plaque was evaluated during carotid angioplasty and stenting. VH IVUS images were created following a pullback through the carotid stenosis and produced a color-coded map of the different histological constituents of the disease (dark green: fibrous, yellow/green: fibrofatty, white: calcified, and red: necrotic lipid core plaque).

Conclusion:

VH IVUS produces a color-coded map of the different histological components of artery plaque. It has the potential to predict how the plaque is likely to behave at the moment of endoluminal treatment.
Sirolimus-Elutin

g

versus Bare-Metal Low-Profile Stent for

R

enal

A

rtery

T

reatment (GREAT Trial): Angiographic Follow-up after 6 Months and Clinical Outcome up to 2 Years
Authors: Zähringer Markus , Sapoval Marc , Pattynama Peter M. T. , Rabbia Claudio , Vignali Claudio , Maleux Geert , Boyer Louis , Szczerbo-Trojanowska Malgorzata , Jaschke Werner , Hafsahl Geir , Downes Mark , Bérégi Jean-Paul , Veeger Nic J. G. M. , Stoll Hans-Peter , Talen Aly
Published: March 2015

Purpose:

To evaluate the patency of sirolimus-eluting stents (SES) compared to bare-metal stents (BMS) in the treatment of atherosclerotic renal artery stenosis (RAS).

Methods:

Between November 2001 to June 2003, 105 consecutive symptomatic patients (53 men; mean age 65.7 years) with RAS were treated with either a bare-metal (n=52) or a drug-eluting (n=53) low-profile Palmaz-Genesis peripheral stent at 11 centers in a prospective nonrandomized trial. The primary endpoint was the angiographic result at 6 months measured with quantitative vessel analysis by an independent core laboratory. Secondary endpoints were technical and procedural success, clinical patency [no target lesion revascularization (TLR)], blood pressure and antihypertensive drug use, worsening of renal function, and no major adverse events at 1, 6, 12, and 24 months.

Results:

At 6 months, the overall in-stent diameter stenosis for BMS was 23.9%±22.9% versus 18.7%±15.6% for SES (p=0.39). The binary restenosis rate was 6.7% for SES versus 14.6% for the BMS (p=0.30). After 6 months and 1 year, TLR rate was 7.7% and 11.5%, respectively, in the BMS group versus 1.9% at both time points in the SES group (p=0.21). This rate remained stable up to the 2-year follow-up but did not reach significance due to the small sample. Even as early as 6 months, both types of stents significantly improved blood pressure and reduced antihypertensive medication compared to baseline (p<0.01). After 6 months, renal function worsened in 4.6% of the BMS patients and in 6.9% of the SES group. The rate of major adverse events was 23.7% for the BMS group and 26.8% for the SES at 2 years (p=0.80).

Conclusion:

The angiographic outcome at 6 months did not show a significant difference between BMS and SES. Renal artery stenting with both stents significantly improved blood pressure. Future studies with a larger patient population and longer angiographic follow-up are warranted to determine if there is a significant benefit of drug-eluting stents in treating ostial renal artery stenosis.
Risk Factors for Perioperative Stroke during Thoracic Endovascular Aortic Repairs (TEVAR)
Authors: Feezor Robert J. , Martin Tomas D. , Hess Philip J. , Klodell Charles T. , Beaver Thomas M. , Huber Thomas S. , Seeger James M. , Lee W. Anthony
Published: March 2015

Purpose:

To determine the clinical and anatomical risk factors for cerebrovascular accidents (CVA) in patients undergoing thoracic endovascular aortic repair (TEVAR).

Methods:

Between September 2000 and December 2006, 196 patients (135 men; mean age 68.6±13.5 years, range 17–92) underwent TEVAR for a variety of aortic pathologies. The majority (156, 79.6%) were treated with the TAG stent-graft. Demographics, pathologies, intraoperative procedure-related measures, device usage, and postoperative outcomes were assessed. CVA was defined as a new focal or global neurological (motor or sensory) deficit lasting >48 hours associated with acute intracranial abnormalities on computed tomography or magnetic resonance brain imaging. Spinal cord ischemia was excluded. In a subset of patients with planned left subclavian artery (LSA) coverage and an incomplete circle of Willis or a dominant left vertebral artery, prophylactic carotid-subclavian bypasses were performed.

Results:

Nine (4.6%) patients suffered a CVA. Factors not predictive of a CVA on univariate analysis included aortic pathology, urgency of repair, ASA classification, type of anesthesia, blood loss, procedure time, and device used. Proximal extent of repair (with or without extra-anatomical revascularization) was significantly associated with a higher incidence of strokes (zones 0–2 versus 3–4, p=0.025). Five (55.6%) patients with a CVA had documented intraoperative hypotension (systolic blood pressure <80 mmHg). Additionally, while 2 patients had hemispheric infarcts, 5 had acute posterior circulation infarcts involving the cerebellum and brainstem; a single patient had both anterior and posterior circulation infarcts. Seven of the CVA patients had proximal coverage of the thoracic aorta in zones 0–2; of these, 6 had posterior circulation infarcts. Selective LSA revascularization based on preoperative cerebrovascular imaging resulted in lower rates of CVA (6.4% to 2.3%, p=0.30) and posterior circulation infarcts (5.5% to 1.2%, p=0.13).

Conclusion:

Proximal extent of repair may serve as a surrogate marker for greater severity of degenerative disease of the aortic arch. Avoidance of intraoperative hypotension and preservation of antegrade vertebral perfusion may be important in prevention of posterior circulation strokes.
Device-Specific Resistance to in Vivo Displacement of Stent-Grafts Implanted with Maximum Iliac Fixation
Authors: Murphy Erin H. , Johnson Eric D. , Arko Frank R.
Published: March 2015

Purpose:

To compare the in vivo device-specific downward displacement force of various externally supported endografts implanted with maximum iliac fixation.

Methods:

Twenty female sheep had aneurysms created with a graft patch in the infrarenal aorta. In 12 animals, a fully supported modular bifurcated stent-graft [AneuRx (n=4), Talent (n=4), or Zenith (n=4)] was deployed; in the other 8, a bifurcated aortic graft was surgically anastomosed to the infrarenal aorta. All grafts were displaced in vivo by applying downward traction to a guidewire brought out both femoral arteries. The peak force to cause initial stent-graft migration or disruption of the sutured anastomosis was recorded and compared.

Results:

There was no difference in animal size, aortic neck diameter or length, aneurysm size, or iliac artery diameter for animals receiving the AneuRx, Talent, or Zenith stent-grafts and those undergoing surgical repair. The mean length of iliac fixation was 31.0±0.3 mm, 30.8±0.5 mm, and 31.3±0.6 mm for the AneuRx, Talent, and Zenith devices, respectively (p=NS). Peak force to initiate migration was 30.2=5.5 N (range 25–38) for the AneuRx, 44.8±5.5 N (range 40–53) for the Talent, 46.7±5.4 N (range 38–55) for the Zenith, and 40.6±7.5 N (range 31–50) for the surgical anastomosis (p=0.01). There was no difference detected in the peak force to initiate migration between the suprarenally affixed Talent and Zenith stent-grafts and the surgical anastomosis (p=0.55).

Conclusion:

Devices with a suprarenal component require significantly greater force to cause downward displacement compared to infrarenal devices. The force required to displace a suprarenal device with maximal iliac fixation was equivalent to the force required to disrupt a surgical anastomosis.
Endovascular Treatment of Aneurysmal Deterioration in Peripheral Arterial Allografts
Authors: Castier Yves , Alsac Jean-Marc , Paraskevas Nikos , Francis Fady , Coppin Thierry , Cerceau Olivier , Leseche Guy
Published: March 2015

Purpose:

To report endovascular treatment of 2 patients with aneurysmal deterioration of peripheral arterial allografts.

Case Report:

Two men (65 and 64 years old) who had undergone an arterial allograft reconstruction for infection of prosthetic infrapopliteal bypass grafts 5 and 7 years ago, respectively, were diagnosed with asymptomatic aneurysmal deterioration of the allografts. Stent-graft repair was successful in both cases, completely excluding the aneurysms. At ≥1 year, continued aneurysm exclusion was confirmed by duplex scan, with no evidence of endoleak, migration, or stenosis.

Conclusion:

Endovascular treatment may be a useful therapeutic option when treating patients with late peripheral allograft deterioration.