bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular Repair Reduces Early and Late Morbidity Compared to Open Surgery for Abdominal Aortic Aneurysm
Authors: Arko Frank R. , Hill Bradley B. , Olcott Cornelius , Harris E. John , Fogarty Thomas J. , Zarins Christopher K.
Published: March 2015

Purpose:

To compare systemic complications between standard surgery and endovascular repair of abdominal aortic aneurysms (AAA) for both primary and late secondary procedures.

Methods:

At a single center between July 1993 and May 2000, 297 patients (255 men; mean age 73.4 ± 8.1 years, range 50–93) were treated with open surgical repair; beginning in 1996, 200 (166 men; mean age 73.6 ± 8.0 years, range 45–96) patients were treated with the AneuRx stent-graft. In a comparison of the cohorts, which were similar in terms of age, gender, and aneurysm diameter, the main outcomes were early major systemic morbidity following the primary procedure to treat the aneurysm and late (>30 days) organ system morbidity for any secondary procedures.

Results:

Mean length of follow-up for open patients was 20.1 ± 17.1 months (range 1–150) compared to 12.4 ± 9.6 months (range 1–60) after endovascular repair (p<0.05). There were 36 (12.1%) systemic complications after the primary open surgery and 15 (7.5%) after endovascular repair (p=NS). There were 43 (14.5%) combined primary and secondary morbidities in the open surgery group versus 15 (7.5%) for patients undergoing endovascular repair (p<0.01). The need for invasive procedures to treat these primary and secondary systemic complications was 4 times greater in the open group (17, 5.7%) than in endograft patients (3, 1.5%) (p<0.05). After secondary procedures (32 in the open group and 30 in the endovascular patients) for graft-related complications, there were 7 (21.9%) adverse events in the open group versus none (0%) for endograft patients (p<0.01). Hospital lengths of stay following both primary and secondary procedures were lower for the endograft patients (p<0.01 and p<0.001, respectively).

Conclusions:

Endovascular stent-graft repair compared to open surgery has reduced the early and late morbidity by half. Complications that require invasive or secondary surgical procedures and hospitalization are reduced with endovascular repair.
Endovascular Repair of Acute AAAs under Local Anesthesia with Bifurcated Endografts: A Feasibility Study
Authors: Verhoeven Eric L.G. , Prins Ted R. , van den Dungen Jan J.A.M. , Tielliu Ignace F.J. , Hulsebos Robin G. , van Schilfgaarde Reinout
Published: March 2015

Purpose:

To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting.

Methods:

Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms. Complications and outcome of endovascular repair were evaluated; mortality was compared to a contemporaneous surgical cohort.

Results:

Seven (23%) of 31 patients having a standard surgical procedure died in the study period compared to 1 (6%) of 16 patients undergoing endovascular repair (following conversion to surgery because of calcified access vessels). Twelve (75%) of the endovascular repairs were performed under local anesthesia; no complications with this mode of anesthesia were encountered. The median duration of the endovascular procedures was 110 minutes (range 75–240); median blood loss was 250 mL (range 100–2800 mL). Only 4 patients required blood transfusion, and only 8 patients required admission to the intensive care unit. There were 3 postoperative complications (1 ischemic colitis, 1 renal failure, 1 groin hematoma). During follow-up, 3 endograft patients received stent-graft extensions in uneventful procedures. Two patients died at 9 and 16 months from cardiac causes.

Conclusions:

This study demonstrates the feasibility and possible advantages of endovascular repair under local anesthesia in selected acute AAA patients. Further studies are needed to prove the advantages over open repair.
Stent-Graft Migration after Endovascular Repair of Abdominal Aortic Aneurysm
Authors: Kalliafas Stavros , Albertini Jean-Noel , Macierewicz Jan , Yusuf Syed W. , Whitaker Simon C. , Davidson Ian , Hopkinson Brian R.
Published: March 2015

Purpose:

To report the incidence of graft migration in patients after endovascular repair of abdominal aortic aneurysms (AAA) and assess the significance of neck diameter changes in patients with and without suprarenal stent implantation.

Methods:

The medical records and imaging studies of 176 consecutive patients (175 men; median age 71 years, range 48–88) who had endovascular AAA repair with the Nottingham aortomonoiliac system were reviewed. The following parameters were recorded: preoperative neck diameter and length, presence of intraoperative and late graft migrations, time to onset of late migration, length of late migration, and neck diameter changes in patients with documented late graft migration. The patients were divided into 2 groups based on the placement of an endograft with or without suprarenal bare stent fixation. Median follow-up was 15 months (range 1–48).

Results:

There were 15 (8.5%) graft migrations (6 intraoperative and 9 late). Of those, 14 (10.9%) were in the 128-patient infrarenal fixation group and 1 (2.1%) in the 48-patient suprarenal stent group. Median neck diameters on preoperative and postoperative computed tomography scans in patients with late migration were 22.2 mm and 23.0 mm, respectively (p>0.05). The median time to graft migration was 14 months after the original operation (range 6–36).

Conclusions:

Distal device migration occurred frequently with the Nottingham system. Late graft migration was not associated with neck enlargement. Endografts with a suprarenal stent may have a decreased incidence of graft migration.
Factors and Forces Influencing Stent-Graft Migration after Endovascular Aortic Aneurysm Repair
Authors: Mohan Irwin V. , Harris Peter L. , van Marrewijk Corine J. , Laheij Robert J. , How Thien V.
Published: March 2015

Purpose:

To assess and validate the clinical features predisposing to stent-graft migration and to calculate the distal displacement forces exerted at the proximal fixation site following endovascular aortic aneurysm repair (EVAR).

Methods:

Demographic, anatomical, and graft-related features from 2862 patients were analyzed in a regression model to identify variables associated with stent-graft migration, which was defined as device movement >5 mm or considered significant by the investigator. Using the principles of continuity and momentum, a mathematical model of blood flow was created. The pulse pressure, proximal aortic and distal iliac diameters, and the degree of iliac angulation were varied in the calculations, and the distal displacement force exerted at the proximal fixation site was calculated.

Results:

Ninety-nine patients developed stent-graft migration, which was clinically relevant in 85 (3.0%). Hypertension (p=0.015), smoking (p=0.009), maximal aortic diameter (p=0.004), and distal transverse aortic diameter (p=0.03) correlated with migration in the univariate analysis, but iliac angulation did not quite achieve significance (p=0.06). On multivariate analysis, current smoking, hypertension, distal transverse aortic diameter, maximum common iliac diameter, and increasing proximal graft size were significantly associated with stent-graft migration. The mathematical model calculated the distal displacement force exerted on the proximal fixation site of the stent-graft and validated the clinical findings. The ratio of graft-diameter change from proximal aorta to distal iliac influenced the greatest increase in the displacement force.

Conclusions:

The mathematical model validated hypertension, aneurysm morphology, and endograft size as clinical factors significantly associated with stent-graft migration. These findings may have important implications for the choice and design of future stent-grafts.
Successful Treatment of Aortic Endograft Thrombosis with Rheolytic Thrombectomy
Authors: Krajcer Zvonimir , Gilbert Jerry H. , Mortazavi Kathy Dougherty Ali , Strickman Neil
Published: March 2015

Purpose:

To report the benefits of rheolytic thrombectomy for treating aortic endograft thrombosis.

Methods:

Of 40 patients who received the Ancure bifurcated endograft to treat abdominal aortic aneurysm (AAA) during a 9-month period, 6 (15%) patients (6 men; mean age 62.6 years, range 53–77) developed thrombosis of the endograft at an average of 9 weeks (range 1–20 months). Five patients were taking aspirin, and 3 were on warfarin therapy for atrial fibrillation. Immediately after angiography, rheolytic thrombectomy was used to remove the thrombus, followed by adjunctive procedures to treat the underlying pathology.

Results:

Causes were kinking or extrinsic compression of the graft limb in 5 cases and thrombosis of the surgical closure site in a common femoral artery. Mechanical thrombectomy was successful in restoring circulation in all cases; thrombolysis was used in 1. All 6 patients had additional stents placed in the graft limbs, re-establishing patency. There was no mortality or recurrent thrombosis in a follow-up that has extended to 26 months, but 1 patient required additional stenting for subsequent focal kinking of a graft limb above the previously implanted stent.

Conclusions:

Rheolytic thrombectomy can safely and effectively treat endograft thrombosis after endovascular AAA repair. Additional thrombolytic agents, angioplasty, and stenting may be needed to correct the underlying causes of the thrombosis. Prophylactic stenting of iliac limbs at the time of implantation in patients with complex anatomy may prevent thrombosis of unsupported bifurcated endografts.
Aortomonoiliac Stent-Grafts for Abdominal Aortic Aneurysm Repair: Association with Iliofemoral Crossover Grafts
Authors: Pereira Adamastor Humberto , Sanvitto Paulo Cesar , de Souza Gilberto Gonçalves , Costa Luiz Francisco , Grudtner Marco Aurélio
Published: March 2015

Purpose:

To analyze the outcome of endovascular exclusion of abdominal aortic aneurysm (AAA) using aortomonoiliac stent-grafts.

Methods:

Fifty-seven consecutive patients (49 men; median age 70, range 56–89) with AAA >5 cm were treated in a 6-year period with the conical ELLA stent-graft. Forty-two (73.9%) patients were classified ASA (American Society of Anesthesiologists) IV and 6 as ASA V. In the majority of cases, the implantation procedure featured device delivery through the external iliac artery, transrenal placement of a bare stent in selected cases, and an iliofemoral crossover graft through a prevesical tunnel.

Results:

Successful deployment was achieved in 56 (98.2%) patients. Mean time to discharge was 8.7 days (range 2–125). Two patients died in the 30-day period. Nine endoleaks occurred in 8 (14%) patients; 4 required further intervention. Mean follow-up was 35.3 months (range 1–66), during which 5 patients died from unrelated causes. No late endoleak, graft occlusion, device twisting/migration, or aneurysm rupture was observed. No correlation between type I endoleaks and unfavorable proximal neck or iliac artery anatomical characteristics could be found. Primary technical and clinical success rates were 86.0% and 94.7%, respectively.

Conclusions:

In this approach, the crossover graft remains in a retropubic space and consequently does not have all the disadvantages of a subcutaneously placed prosthesis. The results achieved in this group of high-risk patients support recommendation of this technique as a simple and safe alternative to bifurcated systems.
Buttress Technique to Insure Accurate Placement of AneuRx Stent-Grafts in Patients with Complex Anatomy
Authors: Krajcer Zvonimir , Strickman Neil , Dougherty Kathryn , Howell Marcus H.
Published: March 2015

Purpose:

To describe a technique that prevents caudal displacement of the AneuRx stent-graft during removal of the nose cone and runners.

Technique:

The buttress technique uses a 16-F sheath positioned from the contralateral femoral approach at the inferior edge of the endograft's main body to provide safe retraction of the runners and the nose cone and accurate endograft deployment.

Conclusions:

If accurate deployment of the stent-graft according to the manufacturer's directions is not possible, this buttress technique can insure proper positioning. It adds no additional time or equipment to the procedure, and it appears to be a safe and easily applied maneuver.
In Vitro Comparison of Four Cerebral Protection Filters for Preventing Human Plaque Embolization during Carotid Interventions
Authors: Müller-Hülsbeck Stefan , Jahnke Thomas , Liess Carsten , Glass Christoph , Paulsen Friedrich , Grimm Jan , Heller Martin
Published: March 2015

Purpose:

To evaluate in an in vitro bench-top model the efficacy of 4 filtration devices designed for cerebral protection during carotid angioplasty.

Methods:

Embolization during carotid angioplasty was simulated with human plaque material (8 to 12 particles weighing 6.02 ± 0.10 mg) in an open flow model with the aortic arch and carotid bifurcation made from elastic silicone tubes and saline used as the fluid medium. The 500 to 1500-µm particles were injected into the internal carotid artery (ICA) in front of the test protection device, which was deployed 5 cm distal to the bifurcation. Particles getting past the protection device or flowing into the external carotid artery (ECA) were caught in 100-µm filters and weighed. Ten trials were made on each of 4 devices: Angioguard, FilterWire EX, TRAP, and NeuroShield. All were deployed according to the manufacturers' directions except the FilterWire, which was manually repositioned in all tests to eliminate a gap between the filter and the tube wall.

Results:

The lowest weight of missed particles in the effluent was obtained with the NeuroShield (0.05 ± 0.04 mg, 0.8% of injected particle weight) and FilterWire (0.08 ± 0.05 mg, 1.3%; p=0.254 compared to NeuroShield, p=0.006 versus TRAP). The weight of particles missed by the TRAP device (0.16 ± 0.06 mg, 2.6%; p<0.001 versus NeuroShield and Angioguard, p<0.05 compared to Filter Wire) was higher, and the largest amount of missed particles was observed with the Angioguard filter (0.27 ± 0.06 mg, 4.4%; p<0.001 compared to all). NeuroShield and FilterWire were significantly different (p<0.001) compared to Angioguard and TRAP in a pairwise analysis. No embolization into the ECA occurred.

Conclusions:

In vitro, none of the tested devices had the ability to completely prevent embolization into the ICA. Comparing current designs, the NeuroShield filter and the FilterWire EX captured the highest percentage of human particles in this in vitro model, probably due to their larger filter volume.
Unprotected Carotid Artery Stenting Compared to Carotid Endarterectomy in a Community Setting
Authors: Madyoon Hooman , Braunstein Eric , Callcott Frank , Oshtory Meherji , Gurnsey Lynne , Croushore Linda , Macbeth Andrew
Published: March 2015

Purpose:

To evaluate the feasibility and safety of carotid artery stenting (CAS) performed by a dedicated multidisciplinary team in a community hospital.

Methods:

Forty-nine patients (30 men; mean age 74.3 ± 7.4 years, range 51–88) with 14 symptomatic and 35 asymptomatic >50% carotid stenoses were enrolled into the study and treated with self-expanding stents without cerebral protection. The patients were evaluated at 30 days for death, neurological sequelae, and length of stay. A contemporaneous group of 140 patients (80 men; mean age 72.3 ± 7.7 years, range 43–89) undergoing carotid endarterectomy (CEA) was used for comparison of the outcome measures. Owing to crossover of failed CAS patients to the CEA group, the data were analyzed according to intention-to-treat and treatment-received.

Results:

The only difference in baseline characteristics between the treatment and control groups was the greater frequency of bilateral disease in the CEA group (p=0.009). The CAS procedures were successful in 47 (96.0%) patients; 2 access failures were converted to endarterectomy, and 1 access-site pseudoaneurysm was treated surgically. There were no deaths or myocardial infarctions in either group. In the CAS group, there were no major and only 2 (4.1%) minor strokes compared to 4 (2.9%) major and 4 (2.9%) minor strokes in the CEA group (p>0.05). Median LOS was significantly lower in the CAS group (p<0.0001).

Conclusions:

Careful case selection and multidisciplinary collaboration facilitate the safe performance of carotid stenting in a community setting with acceptable early results.
Complications after Endovascular Repair of Type B Aortic Dissection
Authors: Pamler Reinhard S. , Kotsis Thomas , Görich Johannes , Kapfer Xaver , Orend Karl-Heinz , Sunder-Plassmann Ludger
Published: March 2015

Purpose:

To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection.

Methods:

Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals.

Results:

Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23).

Conclusions:

Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.
Side-Branched Modular Endograft System for Thoracoabdominal Aortic Aneurysm Repair
Authors: Bleyn Jacques , Schol François , Vanhandenhove Inga , Vercaeren Peter
Published: March 2015

Purpose:

To describe a side-branched modular endograft system that provides adequate visceral artery perfusion with perfect seal during thoracoabdominal aortic aneurysm (TAAA) repair.

Case Report:

A 76-year-old man with a 57-mm TAAA involving the celiac artery was treated with a customized Talent endograft consisting of a 46-mm × 18-cm stented main body and a 6-mm × 30-mm nonstented Dacron side branch. The graft was delivered through a surgical exposure of the left common femoral artery. A 6-mm × 10-cm Hemobahn stent-graft was introduced in the 30-mm side branch from the aorta to the celiac trunk through a long 8-F sheath via the left brachial artery. The patient recovered uneventfully except for a mild reactive inflammatory syndrome. Postoperative computed tomography demonstrated total exclusion of the TAAA sac and good antegrade perfusion of the celiac and superior mesenteric arteries, which has been maintained at the 6-month follow-up.

Conclusions:

Endovascular treatment of TAAA is feasible with further technical refinements of available technology.
Vascular Endothelial Growth Factor (VEGF165) and its Influence on Angiogenesis versus Arteriogenesis in Different Vascular Beds
Authors: Nikol Sigrid , Pelisek Jaroslav , Engelmann Markus G. , Shimizu Masumi , Fuchs Alexandra , Golda Adam , Armeanu Sorin , Mekkaoui Choukri , Rolland Pierre H.
Published: March 2015

Purpose:

To use local gene delivery to determine any district-specific influence of vascular endothelial growth factor (VEGF165) on angiogenesis and arteriogenesis in arteries of distinct developmental origin.

Methods:

Coronary and peripheral arteries were chronically occluded in 30 Pietrain pigs using a percutaneous approach and blinded stent-graft. DNA was delivered to the adventitia in dosages corresponding to 10% of the body weight—adapted amount used in clinical trials. The coronary arteries in 12 animals and the peripheral arteries in 12 animals were treated or used as controls (no occlusion or occlusion with transfection of the β-galactosidase gene). Six additional animals were sacrificed at 1 or 3 weeks for expression analyses, while the other 24 animals were sacrificed at 5 months for expression analysis and histology. Angiography, polymerase chain reaction analyses, and immunohistochemistry were performed.

Results:

Expression of the VEGF gene was observed at 1 and 3 weeks following application, while transfected DNA was detected up to 5 months. New collaterals formed around occluded coronary arteries (2.63 ± 0.69 fold, p<0.05 versus 1.24 ± 0.40 fold for peripheral arteries), and angiographic arterial area increase was more pronounced in coronary (2.49 ± 0.59 fold, p<0.05) than peripheral arteries (1.49 ± 0.05 fold). There was no collateralization surrounding occluded peripheral arteries, but new arterial branches were seen (2.0 ± 0.28, p<0.05 versus 1.07 ± 0.31 for coronary).

Conclusions:

The response to VEGF, whether it is predominantly angiogenesis or arteriogenesis, is dependent on the target vessel. These observed differences in the behavior of arteries may be related to their differing developmental origins, which may have important implications for future therapeutic strategies using VEGF in different vessels.
Vibrational Angioplasty in the Treatment of Chronic Infrapopliteal Arterial Occlusions: Preliminary Experience
Authors: Tsetis Dimitrios K. , Michalis Lampros K. , Rees Michael R. , Katsamouris Asterios N. , Matsagas Miltiadis I. , Katsouras Christos S. , Sideris Dimitrios A. , Gourtsoyiannis Nicholas C.
Published: March 2015

Purpose:

To evaluate the safety and efficacy of vibrational angioplasty in chronic infrapopliteal arterial occlusions.

Methods:

Twelve patients (9 men, aged 54 to 90 years) with 13 below-knee arterial chronic total occlusions were treated percutaneously using vibrational angioplasty. The occlusions were located in the anterior tibial artery (n=5), the tibioperoneal trunk (n=4), the peroneal artery (n=1), the posterior tibial artery (n=1), and in both the tibioperoneal trunk and peroneal artery (n=2). The length of the lesions ranged from 5 to 14 cm.

Results:

Recanalization was successful in 12 (92.3%) lesions. In 1 case, the wire perforated the arterial wall; the procedure was abandoned without clinical sequelae. The time to cross the occlusions with the wire ranged from 6 to 19 minutes. No other complications were observed. Clinical follow-up ranged to 18 months. Ten patients with ulceration or gangrene demonstrated good wound healing, and pain was alleviated in all successfully treated patients.

Conclusions:

Vibrational angioplasty appears feasible as a means of safely recanalizing chronic total occlusions of the infrapopliteal arteries. Further experience should be acquired to assess its short- and long-term effects on this vascular territory.
Internal Iliac Aneurysm Rupture into the Rectum following Endovascular Exclusion: An Unusual Cause of Massive Lower Gastrointestinal Bleeding
Authors: Karkos Christos D. , Oshodi Taohid O. , Vimalachandran Dale , Abraham John S. , Adiseshiah Mohan
Published: March 2015

Purpose:

To report a rare iliorectal fistula following endovascular treatment of an internal iliac aneurysm.

Case Report:

A 76-year-old man developed lower gastrointestinal bleeding 3 months after successful endovascular exclusion of a left internal iliac aneurysm with coil embolization, attempted stent-grafting, ligation of the distal external iliac artery, and a femorofemoral crossover bypass. Aortography showed no clear intestinal bleeding point, but demonstrated recanalization and continued perfusion of the aneurysm. At laparotomy, an iliorectal fistula was detected. The common iliac artery was ligated proximally, the aneurysm sac was opened, and the back-bleeding internal iliac artery branches were oversewn. The rectum was closed primarily. He made an uneventful recovery.

Conclusions:

An iliorectal fistula is an extremely rare and unlikely complication of coil occlusion of an iliac aneurysm. A high index of suspicion for the diagnosis is of paramount importance. Periodic imaging in these patients is required to detect recanalization and continuing aneurysm expansion.
Perivascular Inflammatory Reaction to a Hemobahn Stent-Graft: Diagnosis with 3D MR Angiography
Authors: Juergens Kai Uwe , Tombach Bernd , Reimer Peter , Vestring Thomas , Heindel Walter
Published: March 2015

Purpose:

To present a rare perivascular inflammatory reaction to a commercially produced polytetrafluoroethylene-covered stent and demonstrate the utility of 3-dimensional (3D) magnetic resonance angiography (MRA) in the diagnosis of this phenomenon.

Case Report:

Three weeks after percutaneous deployment of a Hemobahn stent-graft to treat a high-grade stenosis and aneurysm of the proximal left superficial femoral artery (SFA), a 70-year-old diabetic man developed fever, pain, and local swelling of the left thigh. Venous thrombosis was excluded by ultrasound imaging; a normal flow profile was seen in the left common and superficial femoral arteries. Blood analysis found elevated inflammatory markers. MRA revealed extensive soft-tissue edema and perivascular contrast enhancement around the left SFA, but the stent-graft was patent. The clinical symptoms resolved within 7 days after initiation of anti-inflammatory therapy. Follow-up MRA scans demonstrated significantly reduced inflammatory reaction over the next few months.

Conclusions:

Symptomatic perivascular inflammatory soft-tissue response to a stent-graft can be diagnosed with MR imaging studies.
Coil Embolization of an Aortic Arch False Aneurysm
Authors: Chapot René , Aymard Armand , Saint-Maurice Jean-Pierre , Bel Alain , Merland Jean-Jacques , Houdart Emmanuel
Published: March 2015

Purpose:

To report the endovascular occlusion of an anastomotic false aneurysm of the ascending aorta.

Case Report:

A 51-year-old patient developed an anastomotic false aneurysm at the level of the aortic arch after surgical replacement of the aortic root and arch for aortic dissection. The aneurysm expanded after 6 months and because of its saccular shape was treated by selective occlusion with detachable microcoils. Magnetic resonance angiography showed the stability of the occlusion after 2 years.

Conclusions:

Endovascular treatment with coils may be a good alternative to surgery for saccular anastomotic false aneurysms.
Intravascular Ultrasound—Guided Stenting for Chronic Abdominal Aortic Dissection
Authors: Giudice Rocco , Frezzotti Antonio , Scoccianti Marco
Published: March 2015

Purpose:

To describe how the combined use of duplex and intravascular ultrasound (IVUS) can assist in the evaluation and treatment of isolated abdominal aortic dissection without need for contrast angiography.

Case Report:

A 78-year-old man presented with intermittent bilateral buttock and thigh claudication. Duplex ultrasound and contrast-enhanced computed tomography (CT) confirmed a chronic dissection along 3 to 4 cm of the infrarenal abdominal aorta. During Extra Large Palmaz stent implantation, the procedure was based on IVUS images and fluoroscopy without angiography. Both duplex and IVUS images were critical in assessing the type and extent of the lesion to be treated, in guiding the procedure, and in assessing its satisfactory outcome.

Conclusions:

In selected cases, ultrasound-based imaging modalities can provide most of the information required to accomplish complex aortic procedures.
Percutaneous Infusion System for in Situ Thrombolysis in the Abdominal Aorta and Iliac Arteries
Authors: Viña Roberto Fernandez , Benetti Federico , Vrsalovick Francisco , Rizzardi José Luis , Petroni Danilo , de Zappetti Mariana , Zappetti Alejandro , Leeflang Stephen
Published: March 2015

Purpose:

To report successful treatment of an occluded aorta with a new percutaneous infusion system.

Case Report:

A 57-year-old man was admitted in severe pain with cyanosis and acrocyanotic pigmentation in the lower abdomen and limbs. The patient had symptoms of renal disease and severe oligoanuria. Ultrasound scanning detected no flow in the lower limbs, and angiography identified total thromboembolic occlusion of the aorta immediately below the origin of the renal arteries. A new Trellis percutaneous thrombolytic infusion system was used for controlled site-specific infusion and dispersion of streptokinase into the abdominal aorta and the iliofemoral arteries bilaterally with successful restoration of flow and no complications.

Conclusions:

The Trellis system is effective for rapid lysis of thrombotic emboli using low doses of lytic agents. The unique design of the Trellis allowed complete aspiration of the residual thrombus, thus avoiding adverse effects.
Initial Experience with Intentional Stent-Graft Coverage of the Subclavian Artery during Endovascular Thoracic Aortic Repairs
Authors: Görich Johannes , Asquan Yahia , Seifarth Harald , Krämer Stefan , Kapfer Xaver , Orend Karl-Heinz , Sunder-Plassmann Ludger , Pamler Reinhard
Published: March 2015

Purpose:

To investigate the extent to which clinical status is affected by covering the left subclavian artery (LSA) with stent-grafts in the thoracic aorta.

Methods:

Stent-graft reconstruction of the thoracic aorta was performed in 23 patients (20 men; mean age 50.8 years, range 17–77) for management of rupture (n = 11), type B dissection (n = 9), or aneurysm (n = 3). All patients had bilaterally equal systolic and diastolic blood pressures (141.3 ± 19.8 and 78.9 ± 11.0 mmHg, respectively). Twenty Gore TAG and 1 Talent thoracic endografts were used; 2 cases required a combination of prostheses. In all patients, the stent-graft was intentionally placed to cover the LSA. Follow-up included clinical examination with blood pressure measurements and computed tomography during the first postoperative week and at 3-month intervals thereafter.

Results:

After coverage of the LSA by the stent-graft, systolic pressure fell by a mean 48.3 ± 23.4 mmHg. In 4 cases of proximal endoleak, however, systolic pressure fell by only 25.0 ± 15.0 mmHg. Twenty (78.5%) patients reported no complaints during a mean follow-up of 12.1 ± 7.3 months. Postinterventional complaints reported by 3 patients included exercise-dependent paresthesias; nonexercise-dependent, intermittent, and completely reversible dizziness; and a temperature difference between the upper extremities with no decrease in strength.

Conclusions:

Covering the LSA is generally well tolerated by patients and increases the landing zone for the placement of thoracic stent-grafts. Long-term studies, however, must investigate the hemodynamic effects of this procedure on the vertebrobasilar circulation.
Emergency Endovascular Treatment of Thoracic Aortic Rupture in Three Accident Victims with Multiple Injuries
Authors: Nio Denise , Vos Patrick M. , de Mol Bas A.J.M. , Ponsen Kees J. , Reekers Jim A. , Balm Ron
Published: March 2015

Purpose:

To report an experience with emergency endovascular treatment of traumatic thoracic aortic ruptures in multi-injured patients.

Case Reports:

Three victims of motor vehicle accidents with multiple head, chest, and abdominal injuries in addition to fractures were treated urgently for thoracic aortic lacerations with transluminal placement of an endovascular graft during the initial emergent laparotomy. In all cases, ruptured visceral organs were treated first and the abdomen closed. Femoral artery access was gained through a cutdown, and the endografts were delivered with no systemic heparinization. The endovascular component of the surgical session took ∼50 minutes. All patients survived to discharge. Two patients are alive at 5 and 12 months with sustained endovascular exclusion of the pseudoaneurysm, but one patient with severe brain damage died 9 months after treatment from respiratory insufficiency.

Conclusions:

Acute endovascular treatment of thoracic aortic ruptures is feasible and has the advantage of avoiding thoracotomy in otherwise severely injured patients.
Emergency Stent-Graft Placement for Impending Rupture of the Descending Thoracic Aorta
Authors: Nesser H. Joachim , Eggebrecht Holger , Baumgart Dietrich , Ebner Christian , Gschwendtner Manfred , Barkhausen Jörg , Erbel Raimund , Nienaber Christoph A.
Published: March 2015

Purpose:

To present initial experience with emergent stent-graft placement for impending rupture of the descending thoracic aorta.

Case Reports:

Intramural hematoma (IMH) of the descending thoracic aorta was diagnosed by transesophageal echocardiography and computed tomography in 3 patients with acute onset of severe thoracic pain. Because of signs of impending rupture, e.g., pleural effusion, sustained pain, or transadventitial bleeding, the patients underwent emergency stent-graft placement, which was successful in all cases. No procedure-related complications were observed. Follow-up to 18 months has revealed no evidence of endoleak, and all patients remain free of symptoms.

Conclusions:

Emergency stent-graft placement may be a promising alternative to conventional surgery in patients with impending aortic rupture due to IMH.
Endovascular Exclusion of Leaking Thoracic Aortic Aneurysms
Authors: Woody Jonathan D. , Walot Irwin , Donayre Carlos E. , Eugene John , Carey Joseph S. , White Rodney A.
Published: March 2015

Purpose:

To describe the endovascular exclusion of leaking thoracic aortic aneurysms (TAA).

Case Report:

Two elderly patients with leaking TAAs who were at high risk for surgical intervention were transferred to our institution for possible endovascular treatment. Both patients underwent successful endovascular exclusion of the leaking TAAs using multiple stacked AneuRx thoracic endoprostheses. One patient remains alive and well at 1 year with an excluded aneurysm; the other patient died from heart failure 2 months after endografting.

Conclusions:

While the early results of the endovascular exclusion of leaking TAAs are promising, the use of thoracic endoprostheses remains investigational.
Angiographic Description of Blunt Traumatic Injuries to the Thoracic Aorta with Specific Relevance to Endograft Repair
Authors: Borsa John J. , Hoffer Eric K. , Karmy-Jones Ryad , Fontaine Arthur B. , Bloch Robert D. , Yoon Justin K. , So Coralli R. , Meissner Mark H. , Demirer Seher
Published: March 2015

Purpose:

To describe the precise anatomical location and extent of injury (based on angiography) in a series of patients with blunt thoracic aortic injury (BTAI) and evaluate the findings relative to the potential for endograft repair.

Methods:

Thoracic aortograms from 50 trauma patients (37 men; mean age 37 years, range 13–87) with BTAI were retrospectively reviewed. Parameters important for endograft repair were recorded, including the length of the pseudoaneurysm, the distance between the origin of the most distal arch vessel and the pseudoaneurysm, the diameter of the aorta both above and below the pseudoaneurysm, and finally, the curvature of the aorta in the vicinity of the pseudoaneurysm.

Results:

The mean distance from the left subclavian artery to the superior aspect of the injury measured 5.8 mm along the lesser curve and 14.9 mm along the greater curve. The mean length of the injury was 17.0 mm and 26.0 mm along the lesser and greater curves, respectively. The mean aortic diameter adjacent to the injury measured 19.3 mm. The mean degree of curvature of the aorta over the length of the injury was 27.2°, with a mean radius of curvature of 32.6 mm at the superior aspect of the injury and 39.3 mm inferiorly.

Conclusions:

In most cases of BTAI, the location of the injury will necessitate covering the origin of the left subclavian artery if endovascular repair is to be performed. The curvature of the aorta in the region predisposed to these injuries requires that the endograft be very flexible and/or precurved.
Regression of a Descending Thoracoabdominal Aortic Dissection following Staged Deployment of Thoracic and Abdominal Aortic Endografts
Authors: White Rodney A. , Donayre Carlos , Walot Irwin , Lee James , Kopchok George E.
Published: March 2015

Purpose:

To describe the successful endovascular repair and regression of an extensive descending thoracoabdominal aortic dissection associated with thoracic and abdominal aortic aneurysms.

Case Report:

An 83-year-old man presented with acute chest pain and shortness of breath. A descending thoracoabdominal aortic dissection that extended from near the left subclavian artery (LSA) to the right common iliac artery was found on computed tomography. Separate aneurysms in the thoracic and abdominal aorta were also identified. Staged endovascular procedures were undertaken to (1) close the single entry site and exclude the aneurysm in the thoracic aorta with an AneuRx thoracic stent-graft, (2) exclude the abdominal aneurysm and distal re-entry site with a bifurcated AneuRx endograft, and (3) treat a newly dilated thoracic segment between the LSA and first thoracic stent-graft. At 1 year, the false lumen had completely disappeared, the thoracic aneurysm had collapsed onto the endograft, and the abdominal aneurysm had shrunk by 30%.

Conclusions:

The potential to treat extensive aortic dissections with the hope that they might regress is promising, but repair of highly complex lesions involving one or more aneurysms in addition to the dissection requires meticulous imaging studies both preoperatively and intraprocedurally.
Early and Late Functional Outcome Assessments following Endovascular and Open Aneurysm Repair
Authors: Arko Frank R. , Hill Bradley B. , Reeves Terrence R. , Olcott Cornelius , Harris E. John , Fogarty Thomas J. , Zarins Christopher K.
Published: March 2015

Purpose:

To compare early and late functional outcomes, as well as survival and recovery, following endovascular or open repair of abdominal aortic aneurysm (AAA).

Methods:

Between 1996 and 2000, 294 patients underwent AAA repair (141 open and 153 endovascular); 57 patients from each group had 12-month follow-up for functional outcome assessment. Recovery was measured as hospital length of stay, skilled nursing requirement, and hospital readmission within 1 year to determine cumulative hospital utilization. Early (<6 months) functional outcomes were measured by activity level and convalescence days following surgery. Late (>6 months) functional outcomes were measured as ambulation, independent living, and employment status pre- and postoperatively.

Results:

Operative mortality for open repair was 5 (3.5%) compared to 1 (0.6%) after an endovascular procedure (p<0.05). The endovascular group had a shorter hospital stay (2.8±2.8 versus 8.3±4.5 days) and fewer skilled nursing requirements (0% versus 26%; p<0.001). Cumulative hospital utilization over 12 months was 3.8 days for endovascular patients and 13.8 days for open repair (p<0.001). Recovery time was 99.3±84.1 days (range 14–365) in conventionally treated patients and 32.1 ±43.5 days (range 7–180) in the stent-graft group (p<0.001). At 6 months, 43 (75%) open and 54 (95%) endovascular patients had full recovery (p<0.01). Activity levels decreased in 13 (23%) open and 3 (5%) endovascular patients after surgery (p<0.01). There were no differences in ambulation, independent living, or employment status before and after treatment.

Conclusions:

Periprocedural survival following aneurysm repair is improved with endovascular grafting compared to open surgery, and recovery is more rapid, with a 78% reduction in total hospital days. Early functional outcomes are markedly improved with endovascular repair, while there is no difference in late functional outcomes between the procedures.
Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms
Authors: Sanada Junichiro , Matsui Osamu , Terayama Noboru , Kobayashi Satoshi , Minami Tetsuya , Kurozumi Masahiro , Ohtake Hiroshi , Urayama Hiroshi , Endo Masamitsu
Published: March 2015

Purpose:

To evaluate the clinical efficacy of a curved nitinol stent-graft for repair of thoracic aortic aneurysms.

Methods:

The Matsui-Kitamura stent-graft (MKSG), composed of a self-expanding nitinol stent and polyester fabric, was shaped to match the aortic curvature of 11 patients (6 men; mean age 72.6 years, range 33–90) with 6 true and 5 false aneurysms of the distal arch or proximal descending aorta. The delivery system was an 18 or 20-F J-shaped sheath combined with a preloader-type introducer. The original mean proximal neck length was 16.4 mm, but 4 patients received an axilloaxillary bypass to lengthen the neck. Although the mean corrected proximal neck length was 21.9 mm (overall), 5 cases still had proximal necks <15 mm long.

Results:

All curved MKSGs were successfully deployed in the correct position and fitted to the curvature of the aortic arch, achieving complete aneurysm exclusion in 8 (73%) cases. The other 3 repairs displayed early endoleaks; 1 received an additional MKSG, but the other 2 are being observed. Thirty-day mortality was 0%. One patient developed transient renal failure requiring hemodialysis; no neurological complications were observed.

Conclusions:

Endovascular repair of thoracic aortic aneurysms using curved MKSGs appears to be feasible and clinically effective. A tighter fit of the device to the curvature of the aortic arch may exclude distal arch aneurysms despite a short proximal neck.
Evaluation of Glycoprotein IIb/IIIa Inhibitors in Carotid Angioplasty and Stenting
Authors: Wholey Michael Henry , Wholey Mark Henry , Eles Gustave , Toursakissian Boulis , Bailey Steven , Jarmolowski Chester , Tan Walter A.
Published: March 2015

Purpose:

To review the immediate neurological and bleeding complications associated with the use of glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing extracranial carotid artery stent placement.

Methods:

A retrospective review was performed of 550 patients (321 men; mean age 71.1 years, range 28–91) who underwent carotid artery angioplasty and stent placement. Glycoprotein IIb/IIIa inhibitors were given prophylactically along with heparin to 216 patients, whose outcomes were compared to a control group of 334 patients who received intravenous heparin alone. Primary endpoints were the immediate and 30-day neurological complications, including transient ischemic attacks (TIAs), minor and major strokes, and neurologically-related deaths. The secondary endpoint was any abnormal bleeding.

Results:

The all stroke/neurological death rate in 216 patients treated with heparin and GP IIb/IIIa inhibitors was 6.0% (13 events) compared 2.4% (8 events) in the 334 patients in the heparin-only control group (p = 0.0430). Two of the 4 neurologically-related deaths in the GP IIb/IIIa inhibitor group resulted from intracranial hemorrhages; there were no intracranial hemorrhages in the heparin-only group. There was 1 episode of extracranial bleeding in the GP IIb/IIIa inhibitor group treated with embolization. The incidences of significant puncture-site bleeding requiring transfusion were similar in the groups.

Conclusions:

Neurological complications following percutaneous carotid artery interventions have been relatively few. The neurological sequelae in carotid stent patients receiving glycoprotein IIb/IIIa inhibitors were more numerous and consequential, which suggests that the use of GP IIb/IIIa inhibitors in carotid stenting should be discouraged.
Stent-Graft Repair of a Mycotic Left Subclavian Artery Pseudoaneurysm
Authors: Sanada Junichiro , Matsui Osamu , Terayama Noboru , Kobayashi Satoshi , Minami Tetsuya , Chujo Tatsuya , Urayama Hiroshi
Published: March 2015

Purpose:

To report successful stent-graft treatment of a mycotic pseudoaneurysm of the left subclavian artery in an immunosuppressed patient.

Case Report:

A 17-year-old immunosuppressed woman undergoing treatment for recurrent leukemia developed persistent fever and 2 episodes of hemoptysis. A contrast-enhanced computed tomographic (CT) scan demonstrated a saccular aneurysm of the left subclavian artery, which was considered to be a mycotic aneurysm caused by erosive fungal infection from the lung. The pseudoaneurysm was treated with a homemade stent-graft consisting of a nitinol stent and a polyester fabric. A type II endoleak present at the end of the procedure appeared to have sealed spontaneously on the CT scan at 3 days. No neurological deficit or ischemic symptoms of the left arm were noted during the follow-up, which lasted until the patient died 11 months later after rejecting a second bone marrow transplant.

Conclusions:

Endovascular repair may be an alternative to open surgery for the management of mycotic aneurysms of the subclavian artery.
Endovascular Repair of a Ruptured Renal Artery Aneurysm
Authors: Schneidereit Nathan P. , Lee Shung , Morris D. Christopher , Chen Jerry C.
Published: March 2015

Purpose:

To describe the percutaneous treatment of a ruptured renal artery aneurysm (RAA) using a stent-graft.

Case Report:

An 86-year-old woman had sudden onset of right-sided back pain and a swollen left leg. Computed tomography disclosed a right retroperitoneal mass involving the kidney; the inferior vena cava was compressed, with thrombus in the left common iliac artery. There was a suggestion of RAA associated with contrast extravasation. Angiography confirmed a saccular aneurysm of the distal right main renal artery immediately proximal to the first segmental branch. A Jostent peripheral stent-graft was implanted with complete exclusion of the lesion. At 6-month follow-up, the patient remained asymptomatic, but there was a suggestion of in-stent restenosis, which is being followed closely.

Conclusions:

In elderly patients who are hemodynamically stable and have aneurysm anatomy that is suitable for stent-graft placement, the endovascular approach may allow rapid and definitive treatment of the hemorrhage.
Endovascular Therapy Combined with Immunosuppressive Treatment for Pseudoaneurysms in Patients with Behçet's Disease
Authors: Koo Bon Kwon , Shim Won-Heum , Yoon Young-Sup , Lee Byoung Kwon , Choi Donghoon , Jang Yangsoo , Lee Do-Yun , Chang Byung-Chul
Published: March 2015

Purpose:

To evaluate the feasibility, efficacy, and outcome of endovascular therapy combined with immunosuppression for the treatment of arterial pseudoaneurysms due to Behçet's disease.

Methods:

Eleven pseudoaneurysms (3 in the abdominal aorta, 3 in the subclavian artery, and individual lesions in the brachiocephalic artery, renal artery, common iliac artery, common carotid artery, and the descending thoracic aorta) in 9 patients with Behçet's disease were treated with 10 stent-grafts and 1 self-expanding stent. All patients with elevated erythrocyte sedimentation rate (ESR) were treated with immunosuppressive agents (azathioprine, prednisolone) before and after the procedure.

Results:

Endovascular treatment was successful in all cases, without major adverse events. The ESR was reduced from 42.7 ± 18.0 mm/h initially to 18.6 ± 12.6 mm/h after immunosuppressive therapy prior to endovascular repair. During follow-up (mean 24.1 ± 14.0 months, range 6–43), 8 of 11 lesions showed complete resolution. One stent-graft to treat a postsurgical recurrent carotid artery pseudoaneurysm was occluded, and an abdominal aortic pseudoaneurysm recurred; both patients stopped their medications. ESR during follow-up was 7.9 ± 4.5 mm/h.

Conclusions:

Endovascular treatment for pseudoaneurysms due to Behçet's disease is feasible and effective when disease activity is strictly controlled with immunosuppressive therapy.