bluuebunny/crossref_metadata_2025 huggingface dataset:
Heme Oxygenase-1 Gene Promoter Microsatellite Polymorphism is Associated with Restenosis after Percutaneous Transluminal Angioplasty
Authors: Exner Markus , Schillinger Martin , Minar Erich , Mlekusch Wolfgang , Schlerka Gerald , Haumer Markus , Mannhalter Christine , Wagner Oswald
Published: March 2015

Purpose:

To determine if an association exists between postdilation restenosis and heme oxygenase-1 (HO-1), which is induced by balloon injury and inhibits neointimal formation through the action of endogenous carbon monoxide. A dinucleotide repeat in the promoter region of the HO-1 gene shows a length polymorphism that modulates the level of gene transcription.

Methods:

This cohort study included 96 consecutive patients (64 men; median age 69 years, interquartile range 60–75) who underwent successful balloon dilation in the femoropopliteal segment. Six-month patency was evaluated using oscillography, ankle-brachial index, and duplex sonography. The association of patency and the length of (GT) repeats in the HO-1 gene promoter was assessed in univariate and multivariate analyses.

Results:

Restenosis was found in 23 (24%) patients within the first 6 months. Patients with short (<25 GT) dinucleotide repeats in the HO-1 gene promoter on either allele had restenosis significantly less often than patients with longer (≥25 GT) dinucleotide repeats (p = 0.01). Multivariate analysis revealed a significantly reduced risk for restenosis in these patients compared to patients without the short allele (odds ratio 0.2, 95% CI 0.06 to 0.70, p = 0.007).

Conclusions:

Genetic risk factors for restenosis after percutaneous transluminal angioplasty have not been investigated. In this patient population, short repeat alleles of the heme oxygenase-1 gene promoter polymorphism were associated with reduced postdilation restenosis at 6 months. Upregulation of HO-1 may be an important protective factor after balloon angioplasty by inhibition of vascular smooth muscle cell proliferation.
Unusual Case of AneuRx Stent-Graft Failure Two Years after AAA Exclusion
Authors: Krajcer Zvonimir , Howell Marcus , Dougherty Kathy
Published: March 2015

Purpose:

To present a case of type-III endoleak due to separation of modular components and suture breakage after abdominal aortic aneurysm (AAA) repair with the AneuRx stent-graft.

Case Report:

A 58-year-old man with a 78-mm AAA underwent successful aneurysm exclusion with an AneuRx stent-graft in 1998. Because the bifurcated component migrated during deployment, an additional aortic cuff was deployed to extend the stent-graft proximally to just below the renal arteries. On routine evaluation with computed tomography at 2 years postimplantation, a type-III endoleak with anterior displacement of the stent-graft was discovered. Angiography revealed separation of the aortic cuff from the stent-graft body. The aneurysm, which had decreased to 70 mm at 6 months, had enlarged to 80 mm in diameter. The patient underwent surgical AAA repair with removal of the stent-graft. Macroscopic examination showed suture breakage and separation of the stent rings and the graft material.

Conclusions:

This late complication of the AneuRx endograft underscores the need for frequent imaging surveillance in all patients undergoing endoluminal AAA repair.
Restenosis after Percutaneous Transluminal Angioplasty in the Femoropopliteal Segment: The Role of Inflammation
Authors: Schillinger Martin , Haumer Markus , Schlerka Gerald , Mlekusch Wolfgang , Exner Markus , Ahmadi Ramazanali , Minar Erich
Published: March 2015

Purpose:

To determine the value of baseline C-reactive protein (CPR), fibrinogen, and white blood cell (WBC) counts in predicting 1-year patency after percutaneous transluminal angioplasty (PTA) in the femoropopliteal segment.

Methods:

In a retrospective cohort study, 168 consecutive patients (103 men; median age 70 years, interquartile range 61–77) who underwent successful PTA of the femoral and/or popliteal arteries were analyzed. Twelve-month patency was evaluated using oscillography, ankle brachial index, duplex sonography, and angiography. The predictive value of inflammatory markers was assessed in a multivariate model controlling for cardiovascular risk factors, technical success, and hemodynamic factors.

Results:

Transient WBC elevation was found 6 hours after PTA, but this returned to baseline after 24 hours. Fibrinogen was elevated at 24 hours. Duplex scanning disclosed restenosis in 66 (39%) patients within the first 12 months after PTA. Only residual postdilation stenosis (≥30%) in the target segment (odds ratio 3.6, p=0.001) and baseline CRP levels (odds ratio 4.2, p=0.02) were independent predictors of outcome; neither WBC counts nor fibrinogen levels at any time point was associated with restenosis.

Conclusions:

Primary technical success and postinterventional hemodynamic flow at the dilated segment seem to be more important for intermediate-term patency than atherogenic risk factors. The predictive value of preprocedural serum CRP levels on restenosis should be further investigated.
Congenital Vascular Malformations in the Hand and Forearm
Authors: Sofocleous Constantinos T. , Rosen Robert J. , Raskin Keith , Fioole Bram , Hofstee Dirk-John
Published: March 2015

Purpose:

To review a single-center experience in the management of symptomatic congenital vascular malformations of the hand and forearm with special attention to embolotherapy.

Methods:

A retrospective chart review was performed to identify patients with vascular malformations referred for arteriography and possible intervention between 1983 and 1998. Arteriography and venography were performed in all patients to differentiate between true high-flow arteriovenous malformations (AVM) and low-flow primary venous malformations (PVM). The clinical and radiological data, procedural results, and follow-up data were retrieved and reviewed.

Results:

In a 15-year period, 39 patients (22 men; mean age 22.5 years, range 1–51) had symptomatic vascular lesions diagnosed in the forearm and hand: 21 AVMs, 17 PVMs, and one complex lesion with both AVM and PVM. Thirty-four (87%) lesions were treated with immediate technical success achieved in 31 (91%) cases; 5 (13%) lesions were not amenable to percutaneous treatment. There were no major complications, but 3 embolized AVMs had significant residual flow (81.6% technical success on intention to treat basis). Long-term follow-up ranging to 5 years was available in 26 of the 34 treated patients; the mean symptom-free period was 30 months for the AVM patients and 30.5 months for the PVM group, with an average of 1.5 and 1.2 embolization procedures, respectively.

Conclusions:

Vascular malformations of the hand and forearm are extremely rare lesions that demand a multidisciplinary approach for optimal diagnosis and management. Microembolotherapy with or without surgery has offered the highest level of safety and success to date.
Successful Stent-Graft Repair of a Vertebrojugular Arteriovenous Fistula
Authors: Rückert Ralph I. , Rutsch Wolfgang , Filimonow Sergej , Lehmann Rüdiger
Published: March 2015

Purpose:

To describe an apparently unreported endovascular means of treating a vertebral arteriovenous fistula (AVF) using a small-caliber stent-graft to permanently reconstruct the involved vessels.

Case Report:

A 13-year-old girl presented with tinnitus caused by a high-flow AVF between the right extracranial vertebral artery and deep jugular vein arising from repeated internal jugular vein catheterization. A 4-mm-diameter balloon-expandable Jostent coronary stent-graft was placed in the vertebral artery via a percutaneous femoral access, with immediate and complete obliteration of the AVF and resolution of the tinnitus. Follow-up duplex ultrasonography at 15 months demonstrated patency and luminal integrity of the vertebral artery.

Conclusions:

Vertebrojugular AVFs are rare and usually treated with transcatheter embolization techniques, but percutaneous repair using a small-caliber stent-graft appears feasible. This minimally invasive treatment might become the method of choice for AVFs in other small-bore vessels.
Type-II Endoleaks following Endovascular AAA Repair: Preoperative Predictors and Long-term Effects
Authors: Arko Frank R. , Rubin Geoffrey D. , Johnson Bonnie L. , Hill Bradley B. , Fogarty Thomas J. , Zarins Christopher K.
Published: March 2015

Purpose:

To determine the significance of persistent type-II endoleaks and whether they can be predicted preoperatively in patients with abdominal aortic aneurysms (AAA).

Methods:

The charts of all AAA patients treated with the AneuRx stent-graft at a single center from 1996 to 1998 were reviewed. Patients with <12-month follow-up or type-I endoleaks were excluded. The presence or absence of type-II endoleaks was determined from duplex imaging and computed tomographic angiography. Three groups were identified and compared: 16 patients with persistent type-II endoleaks (PE), 14 patients with transient type-II endoleaks (TE), and 16 patients with no endoleak (NE).

Results:

The groups did not differ with regard to age, preoperative comorbidities, follow-up time, and AAA neck diameter and length. AAA diameters were 57.1 ± 9.0 mm for NE, 63.4 ± 11.4 mm for TE, and 55.6 ± 4.2 mm for PE. The inferior mesenteric artery (IMA) was patent in 5 (31%) NE patients, 6 (43%) TE patients, and 13 (81%) PE patients (p < 0.01). The number of patent lumbar arteries visualized preoperatively was 0.5 ± 1.0 in NE, 1.3 ± 0.8 in TE, and 2.4 ± 0.6 in PE (p < 0.0001). Patent IMAs (RR 0.82, p<0.01) and >2 lumbar arteries (RR 0.40, p < 0.0001) were identified as independent preoperative risk factors for persistent endoleaks. There were no changes in mean diameter or volume in aneurysms with persistent endoleaks.

Conclusions:

No adverse clinical events were related to the presence of type-II endoleaks, but there was no decrease in aneurysm size in patients with persistent type-II leaks. Patients with a large, patent IMA, or >2 lumbar arteries on preoperative CT angiography are at higher risk for persistent type-II endoleaks.
Risk Stratification for Subclavian Artery Angioplasty: Is There an Increased Rate of Restenosis after Stent Implantation?
Authors: Schillinger Martin , Haumer Markus , Schillinger Sabine , Ahmadi Ramazanali , Minar Erich
Published: March 2015

Purpose:

To compare long-term patency after balloon angioplasty of stenotic or occluded subclavian arteries with and without adjunctive stenting and to identify independent risk factors for restenosis after balloon angioplasty.

Methods:

In a retrospective cohort study, 115 consecutive patients (65 women; mean age 60 years, interquartile range 53–68) who underwent PTA for atherosclerotic subclavian artery obstruction within a 15-year period were included. Among these, 26 (23%) consecutive patients had Palmaz stents routinely implanted since 1996. Follow-up investigation was performed in the year 2000. Patency during the median 44-month follow-up period (interquartile range 18–69 months, minimum 12) was evaluated by oscillography, blood pressure measurement, and color-coded duplex sonography. The predictive value of possible risk factors for restenosis was assessed in a multivariate model controlling for cardiovascular comorbidities and angiographic data.

Results:

PTA success was achieved in 98 (85%) patients, 72 (81%) of 89 undergoing angioplasty alone and all 26 with stents. Complete occlusion of the vessel and long lesions (≥2 cm) correlated with a lower success rate. One-year patency was 76% in unstented arteries and 95% in stented lesions due to better primary technical success, but at 4 years, the patency rates were 59% in arteries with stents and 68% in arteries without. Long lesions, residual stenosis after PTA, and stent implantation were independent predictors for restenosis after successful intervention.

Conclusions:

Subclavian arterial stent implantation is associated with better 1-year patency than PTA due to improved technical success, but intermediate and long-term outcomes are less favorable, as instent restenosis frequently occurs.
Overlapping Stents for Treatment of a Dissecting Carotid Artery Aneurysm
Authors: Benndorf Goetz , Campi Adriana , Schneider Gerd Helge , Wellnhofer Ernst , Unterberg Andreas
Published: March 2015

Purpose:

To report the increased efficacy of oversized, overlapping stents to treat an internal carotid artery (ICA) dissecting aneurysm.

Case Report:

A 55-year-old woman presented with reduced consciousness, aphasia, and right-sided hemiplegia owing to an infarction of the left middle cerebral artery territory documented by computed tomography. Digital subtraction angiography disclosed an extracranial dissection of the left ICA with a pseudoaneurysm. Two self-expanding Wallstents were placed, bridging the dissected segment and overlapping at the level of the aneurysm neck. Immediate arteriography showed remarkably reduced filling of the pseudoaneurysm. Serial arteriograms performed 6 days and 9 and 20 months after stenting documented the disappearance of the pseudoaneurysm without appreciable intimal hyperplasia of the vessel wall.

Conclusions:

Reducing stent porosity by overlapping the devices causes significant hemodynamic changes inside the aneurysm sac, accelerating intra-aneurysmal thrombosis.
Catheter Modification for Easier Cannulation of the Carotid Artery during Angioplasty and Stenting
Authors: Houdart Emmanuel , Mounayer Charbel , Chapot René , Saint-Maurice Jean-Pierre , Merland Jean-Jacques
Published: March 2015

Purpose:

To present a modification of both the guiding catheter and stent delivery system to facilitate access into sharply curved supra-aortic vessels during carotid angioplasty.

Technique:

Access failures during carotid interventions typically occur because either the vessel origin is acutely angled or the stenosis is located proximal to the carotid bifurcation, limiting access to the external carotid artery. We directly catheterized the left common carotid artery or brachiocephalic trunk with a guiding catheter whose tip had been curved by steam-shaping. The tip of the stent delivery system also was molded into a curve by this process so it engaged the curved part of the guiding catheter without pulling it out of the vessel.

Conclusions:

This simple modification can improve the success rate of carotid cannulation via the femoral approach and does not seem to increase the risk of the intervention.
Intrarenal Color Duplex Examination of Aortic Endograft Patients with Suprarenal Stents
Authors: Kalliafas Stavros , Travis Simon J. , Macierewicz Jan , Yusuf Syed W. , Whitaker Simon C. , Davidson Ian , Hopkinson Brian R.
Published: March 2015

Purpose:

To report an experience using intrarenal color duplex ultrasonography (ICDU) to detect high-grade renal artery stenosis in patients who had endovascular repair of abdominal aortic aneurysm (AAA) with suprarenal stent fixation.

Methods:

Twenty-eight patients (25 men; mean age 71 years, range 58–83) who had endovascular AAA repair with suprarenal stenting at least 3 months prior to commencement of this study were screened with ICDU. Acceleration time (AT), peak systolic velocity (PSV), end diastolic velocity (EDV), and resistive index (RI) were measured. The Doppler waveform was quantitatively scored on a scale from 0 to 4. AT >0.07 seconds, RI <0.45, or a Doppler waveform score of 0 or 1 (indicating loss of early systolic peak) were indicative of high-grade renal artery stenosis.

Results:

Median follow-up was 15.5 months (range 3–34). ICDU was successful in 54 (98%) of 55 kidneys scanned. No AT values exceeded 0.07 seconds, all RIs were >0.45, and no waveforms had loss of early systolic peak, indicating that no patient had evidence of high-grade renal artery stenosis.

Conclusions:

ICDU is a simple and affordable method that seems well suited to periodic screening in patients with suprarenal stents. Longer follow-up with a larger number of patients is needed before definite conclusions can be drawn about the effect of suprarenal stenting on renal circulation.
Repair of Secondary Aortoesophageal Fistula by Endoluminal Stent-Grafting
Authors: Bond Stephen E. , McGuinness Catharine L. , Reidy John F. , Taylor Peter R.
Published: March 2015

Purpose:

To describe a case of secondary aortoesophageal fistula that was treated with an endoluminal stent-graft.

Case Report:

A 58-year-old woman presented with hematemesis and melena. In 1974 she had an interposition graft repair of an aortic transection sustained during a traffic accident. At the examination in 1998, angiography demonstrated a mechanical disruption of the proximal anastomosis forming an aortoesophageal fistula. A 28-mm × 3.75-cm AneuRx stent-graft was introduced via a right femoral arteriotomy and deployed across the defect. Follow-up CT scans at 18 months showed exclusion of the false aneurysm with no evidence of infection; the patient remains well at >2 years after stent-graft implantation.

Conclusions:

Endoluminal repair can be successful in achieving a satisfactory midterm outcome in cases of secondary aortoesophageal fistula.
Endovascular AAA Repair in a Patient with a Horseshoe Kidney and an Isthmus Mass
Authors: Toursarkissian Boulos , Mejia Alejandro , Wholey Michael H. , Lawler Marion A. , Thompson Ian M. , Sykes Mellick T.
Published: March 2015

Purpose:

To report the endovascular exclusion of an abdominal aortic aneurysm (AAA) in a patient with a horseshoe kidney and an isthmus mass with preservation of accessory renal vessels.

Case Report:

A 70-year-old man with a 5-cm AAA and renal cell carcinoma involving a horseshoe kidney was treated with an AneuRx bifurcated graft. Two accessory renal arteries believed to feed the isthmus mass were sacrificed, but 2 other accessory renal arteries from the left common iliac artery (CIA) were preserved by using an extension cuff to cover the aneurysmal left CIA distal to their origins. The right renal isthmus mass decreased in size on follow-up imaging. At 9 months, there was no endoleak evident on computed tomographic scans, and the aneurysm measured 4.8 cm.

Conclusions:

The presence of accessory renal arteries in AAA patients with horseshoe kidneys should not automatically exclude them from consideration for endovascular repair. Creative stent-graft arrangements can be a treatment option.
Predicting Renal Failure after Balloon Angioplasty in High-Risk Patients
Authors: Schillinger Martin , Haumer Markus , Mlekusch Wolfgang , Schlerka Gerald , Ahmadi Ramazanali , Minar Erich
Published: March 2015

Purpose:

To assess the incidence and predictors of acute renal failure after percutaneous transluminal angioplasty (PTA) in a cohort of patients with generalized atherosclerosis.

Methods:

A retrospective review of 213 consecutive patients (127 men; median age 71 years, interquartile range 63–77) undergoing femoropopliteal PTA was undertaken. Renal function was measured by creatinine clearance at baseline and 24 hours after the intervention; acute renal dysfunction was defined as ≥20% decrease of creatinine clearance. The predictive value of potential risk factors was determined in a multivariate model adjusting for comorbidities, pre-existing renal impairment, and angiographic data.

Results:

Overall serum creatinine values and creatinine clearance remained stable within 24 hours after PTA. Acute renal dysfunction occurred in 25 (12%) patients. Two (1%) patients developed oliguria; one required transient hemodialysis and developed persistent renal failure. Pre-existing impaired renal function (OR 12.2, p < 0.0001) and contrast dosage (OR 1.1, p = 0.03) were independent predictors of acute renal failure; hypertension (OR 7.9, p = 0.06) and congestive heart failure (OR 4.5, p = 0.06) were associated factors.

Conclusions:

While transient acute renal dysfunction occurs in ∼10% of patients with peripheral artery disease within 24 hours after angioplasty, persistent renal failure or end-stage renal disease is rare.
Endovascular Interventions on Persistent Sciatic Arteries
Authors: Gabelmann Andreas , Krämer Stefan C. , Wisianowski Christian , Tomczak Reinhard , Pamler Reinhard , Görich Johannes
Published: March 2015

Purpose:

To report our experience with interventional procedures used to treat complete and incomplete persistent sciatic arteries (PSA).

Case Reports:

Three female patients with PSAs displayed varying symptoms referable to this rare anatomical variant. In the first woman, a 1-year history of intermittent lower limb ischemia and an acute event prompted angiography, which demonstrated proximal occlusion of 2 crural vessels and a partially thrombosed sciatic artery aneurysm. To prevent further embolism, the aneurysm was excluded with a stent-graft. Endograft patency and aneurysm exclusion have been maintained up to 22 months. In a 41-year-old diabetic with chronic limb ischemia and digital gangrene, a flow-limiting stenosis of the sciatic artery was stented, restoring adequate pedal perfusion. The stent remained patent at the 18-month follow-up. The third patient suffered from a tumor-related pelvic hemorrhage originating from retrograde perfusion through the PSA, which had been ligated during previous surgery. Attempted embolization via a collateral connection between the incomplete PSA and the popliteal artery failed, and the patient died.

Conclusions:

Vasculopathies involving the sciatic artery are uncommon but may be amenable to interventional techniques, such as coil embolization and stent implantation. PSA aneurysm exclusion with a stent-graft may represent a new therapeutic alternative to standard surgery that obviates potential sciatic nerve damage, but the durability of the repair remains to be determined.
Utility of Duplex Surveillance following Iliac Artery Angioplasty and Primary Stenting
Authors: Back Martin R. , Novotney Michael , Roth Steven M. , Elkins Dan , Farber Steven , Cuthbertson David , Johnson Brad L. , Bandyk Dennis F.
Published: March 2015

Purpose:

To evaluate the clinical outcome and patency rates after iliac artery angioplasty and primary stenting using a noninvasive surveillance protocol that includes duplex ultrasonography.

Methods:

Sixty-seven patients (64 men; mean age 61 ± 9 years, range 45–83) underwent stenting of 84 iliac systems for claudication (63%), rest pain (9%), tissue loss (20%), or failing lower limb bypass graft (8%). The surveillance algorithm included aortoiliac duplex scanning within 1 month and serial limb pressure measurements and femoral artery waveform analyses during follow-up. Iliac systems with a peak systolic velocity >300 cm/s and velocity ratio >2.0 by duplex and/or symptomatic or hemodynamic deterioration were considered failing and an indication for angiography.

Results:

During intermediate-term follow-up ranging to 36 months (mean 12), life table primary, assisted primary, and secondary patency rates for the treated iliac systems were 78%, 90%, and 98%, respectively, at 18 months. Assisted primary iliac system patency at 18 months was significantly worse in the 20 (24%) limbs having an outflow bypass done with or prior to iliac stenting (83% versus 100% without bypass, p = 0.01). Indirect clinical indicators found 17 (20%) suspected failing iliac systems, in which duplex imaging correctly identified 5 of 6 recurrent iliac stenoses and facilitated secondary endovascular intervention. Three (4%) stent occlusions occurred in the treated iliac systems despite surveillance.

Conclusions:

Duplex surveillance after iliac stenting localizes failing inflow segments, optimizes assisted patency of the treated iliac system, and possesses greatest utility in patients with multilevel occlusive disease and outflow reconstructions.
Carotid Artery Stenting for Stenosis following Revascularization or Cervical Irradiation
Authors: Alric Pierre , Branchereau Pascal , Berthet Jean-Philippe , Mary Henri , Marty-Ané Charles
Published: March 2015

Purpose:

To assess the safety and efficacy of carotid artery stenting (CAS) for stenosis following revascularization or cervical irradiation.

Methods:

Twenty-two CAS procedures performed on 21 patients (20 men; mean age 69.3 years, range 58–87) from June 1997 to June 2000 were retrospectively reviewed. There were 5 radiation-induced carotid stenoses in 4 patients and 17 postsurgical restenoses. The mean interval between carotid revascularization and CAS was 48.1 months (range 6–264), while the elapsed time from irradiation to CAS was always >8 years (range 8–28). Seven patients screened during this period were excluded from CAS because of a duplex-defined >50% hypoechoic lesion and/or angiographic documentation of an irregular ulcerated stenosis.

Results:

Four Palmaz and 16 Wallstents were successfully deployed in 20 arteries; 1 access failure prompted conversion to surgery and a stent delivery failure resulted in 1 patient receiving balloon dilation only (technical success 91%). No complications were encountered in the periprocedural period, and no neurological events were observed during a mean follow-up of 16.6 months (range 3–36). One patient died at 20 months from an unrelated cause. One (4.8%) restenosis was detected after 1 year in the patient who did not receive a stent.

Conclusions:

CAS is a safe alternative to conventional surgery in patients with carotid artery stenosis following surgical revascularization or cervical irradiation provided preoperative testing excludes stenoses at risk for embolism.
Percutaneous Thrombin Injection of Carotid Artery Pseudoaneurysm
Authors: Holder Rebecca , Hilton Derek , Martin Janis , Harris Peter L. , Rowlands Peter C. , McWilliams Richard G.
Published: March 2015

Purpose:

To report the successful treatment of a carotid artery pseudoaneurysm by percutaneous thrombin injection.

Case Report:

A 71-year-old man with end-stage renal failure presented with acute left ventricular failure. The right common carotid artery (CCA) was punctured during attempted jugular line insertion, and he developed a large pseudoaneurysm connected to the CCA by a long, narrow neck. Ultrasound-guided compression was unsuccessful, so another technique was attempted. An occlusion balloon was inflated in the CCA at the neck of the aneurysm to avoid distal embolization, and 250 units of human thrombin were injected into the sac percutaneously; thrombosis was instantaneous. There were no procedural complications, and repeat ultrasound at 3 months showed resolution of the hematoma and no residual pseudoaneurysm. There were no neurological complications.

Conclusions:

Percutaneous thrombin injection may be a new and successful method of treating carotid artery pseudoaneurysms.
Renal Artery Aneurysm: Improved Renal Function after Coil Embolization
Authors: Tshomba Yamume , Deleo Gaetano , Ferrari Stefano , Marina Roberto , Biasi Giorgio M.
Published: March 2015

Purpose:

To describe a case of improved renal function and renovascular hypertension after percutaneous treatment of a renal artery aneurysm.

Case report:

A 72-year-old hypertensive woman with a hilar saccular aneurysm of the right renal artery underwent percutaneous coil embolization under local anesthesia. Four individual, soft, detachable platinum embolization coils were successfully inserted in the aneurysm with incomplete aneurysm exclusion. Nonetheless, the patient's blood pressure and renal function returned to normal. The arteriogram at 3 months demonstrated complete exclusion of the lesion and good renal perfusion. The patient remains normotensive with documented improved renal function at 18 months after treatment.

Conclusions:

Superselective coil embolization is an effective treatment for renal artery aneurysms that display proper morphological features. The long-term outcome of this less invasive therapy still must be assessed, but it appears plausible that embolotherapy of renal artery aneurysms can correct secondary hypertension and deteriorating renal function.
Balloon Angioplasty and Stent Implantation Induce a Vascular Inflammatory Reaction
Authors: Schillinger Martin , Exner Markus , Mlekusch Wolfgang , Haumer Markus , Ahmadi Ramazanali , Rumpold Helmut , Wagner Oswald , Minar Erich
Published: March 2015

Purpose:

To investigate whether peripheral balloon angioplasty with and without stent implantation independently causes an inflammatory vascular response measured by serum acute-phase reactants.

Methods:

This was a prospective cohort study enrolled 388 consecutive patients (218 men; median age 70 years, interquartile range 59–76) with peripheral artery disease undergoing balloon angioplasty (n = 187), stent implantation (n = 140), and diagnostic angiography (control group, n = 61). C-reactive protein (CRP) measured by standard and high-sensitivity assays, serum amyloid A (SAA), fibrinogen, and white blood cell (WBC) count were obtained at baseline and at 8, 24, and 48 hours postintervention. Polynomial logistic regression analysis was used to assess the independent association of acute-phase reactants and the interventional group.

Results:

CRP levels measured by both standard and the high-sensitivity assays significantly increased after balloon angioplasty (standard CRP, p = 0.02; high-sensitivity CRP, p = 0.02) and stent implantation (standard CRP, p = 0.004; high-sensitivity CRP, p = 0.008) compared to the control group adjusting for age, sex, duration of fluoroscopy, volume of contrast, and periprocedural complications. SAA values differed only between the stent group and controls (p = 0.05). Fibrinogen and WBCs were not different among the 3 interventional groups.

Conclusions:

Balloon injury and stent implantation induce a vascular inflammatory response at the dilated vessel segment measurable by serum acute-phase parameters. The standard CRP assay is adequate to quantify acute-phase response in these patients.
Long-Term Results of Stenting for Chronic Iliac Artery Occlusion
Authors: Uher Petr , Nyman Ulf , Lindh Mats , Lindblad Bengt , Ivancev Krasnodar
Published: March 2015

Purpose:

To evaluate the long-term results of stent placement for chronic occlusions of the iliac arteries.

Methods:

Between October 1992 and December 1997, 73 patients (40 men; median age 64 years, range 42–89) with 76 occluded iliac arteries (33 common, 34 external, and 9 both vessels) were treated with percutaneous recanalization and stenting using a variety of self-expanding and balloon-expandable devices. Median occlusion length was 7 cm (range 1–14). Follow-up consisted of clinical assessment, ankle-brachial index measurement, and arteriography or duplex ultrasound when indicated.

Results:

Anatomical success was achieved in 74 (97%) limbs. Seven (10%) patients experienced major complications: 2 distal embolizations, 2 arterial ruptures, 1 myocardial infarction, 1 groin hematoma requiring surgery, and 1 contrast-induced nephropathy. There was no 30-day mortality. Over a median follow-up of 27 months (range 1–75), there was 1 early occlusion (≤30 days) and 16 late recurrent lesions (11 occlusions and 5 stenoses) at a median 6.2 months (range 1.4–30). The recurrent lesions were treated with endovascular techniques in 8 limbs and surgery in 7 limbs (5 after failed endovascular procedures); 1 patient died before retreatment, and 1 patient refrained from further intervention. Primary and secondary patencies were 79% and 87% at 1 year and 69% and 81% at 3 years, respectively.

Conclusions:

Stenting of chronic iliac occlusions is a safe and durable alternative to surgical treatment.
Renal Infarction following Endovascular Aortic Aneurysm Repair: Incidence and Clinical Consequences
Authors: Krämer Stefan C. , Seifarth Harald , Pamler Reinhard , Fleiter Thorsten , Bühring Julia , Sunder-Plassmann Ludger , Brambs Hans-Jürgen , Görich Johannes
Published: March 2015

Purpose:

To investigate the incidence of renal infarction following endovascular abdominal aortic aneurysm (AAA) repair, with particular emphasis on a comparison of suprarenal versus infrarenal endograft placement.

Methods:

Ninety-nine patients (92 men; average age 68 years) who had undergone endovascular AAA repair between July 1995 and July 1999 and who had at least 12 months' follow-up were studied with spiral computed tomographic scans to identify suprarenal endograft deployment and renal infarction.

Results:

Among the 193 renal arteries available for study, partial or complete transrenal endograft placement was found in 69 (36%). Sixteen (8.3%) renal infarctions were identified by the postoperative imaging studies. Perfusion of these kidneys was supplied by 6 (8.7%) of the 69 overstented renal arteries and 7 (5.6%) of the 124 uncovered arteries (p > 0.05). In the 3 other cases, intentional accessory renal artery occlusion by the stent-graft fabric led to frank segmental renal infarctions, which were visualized as territorial perfusion defects affecting up to 27% of the renal volume. In the other 13 infarcted kidneys, the punctate deficits involved <10% of the parenchymal volume. Renal retention values were unaffected in 15 (94%) of 16 patients.

Conclusions:

Documented renal infarctions following endovascular aortic stent-graft placement are not common and do not appear to be associated with suprarenal endograft fixation.
CT Artifacts of the Proximal Aortic Neck: An Important Problem in Endograft Planning
Authors: Kritpracha Boonprasit , Wolfe Jeremy , Beebe Hugh G.
Published: March 2015

Purpose:

To describe the imaging error introduced by noncircular abdominal aortic aneurysm (AAA) necks in axial and reformatted computed tomographic (CT) images and discuss the potential implications for aortic endografting.

Methods:

The records of 120 endograft patients with preoperative CT axial scans and subsequent 3-dimensional (3D) computerized reconstructions were reviewed. Maximum and minimum infrarenal aortic neck diameters were measured from axial CT scans and 3D reformatted slices at the same point on the vessel. Diameter measurements were made at the largest point within the 10-mm segment of vessel below the lowest renal artery. Excluded were aneurysms with proximal neck minimum diameters >30 mm, neck lengths <15 mm, or angulation >75° measured on the axial CT slice.

Results:

Measuring from reformatted CT slices, 86 (71.6%) cases had ≤2-mm differences between maximal and minimal neck diameters, comprising the “round neck” group A. In 34 (28.4%) cases, the neck was not round: 26 (21.7%) had diameter differences between 2 and 4 mm (group B) and 8 (6.7%) had a >4-mm difference (group C; range 4.1–8.1 mm). Although AAA diameter, neck length, and neck angle progressively increased as the difference between neck maximum and minimum diameters grew, i.e., greater eccentricity, these trends did not reach statistical significance. Mean infrarenal neck maximum diameter was significantly larger in group C (30.2 ± 3.4 mm) compared to groups A (23.0 ± 2.9 mm, p = 0.0002) and B (23.8 ± 3.6 mm, p = 0.0003). Hence, 28.4% of AAAs had a noncircular aortic neck of varying degree, and 6.7% had an eccentricity factor that may have clinical significance.

Conclusions:

This study confirms the importance of selecting an endoprosthesis sized 15% to 20% larger than the infrarenal aortic neck diameter. Three-dimensional reconstruction using reformatted CT slices perpendicular to the flow lumen is an important tool that offers enhanced accuracy of infrarenal aortic neck evaluation.
Fenestrated Stent-Graft for Traumatic Juxtahepatic Inferior Vena Cava Injury
Authors: Watarida Shoji , Nishi Takao , Furukawa Akira , Shiraishi Shoichiro , Kitano Haruhisa , Matsubayashi Keiji , Imura Masato , Yamazaki Michio
Published: March 2015

Purpose:

To report the use of a fenestrated stent-graft to manage a traumatic rupture of the juxtahepatic inferior vena cava (IVC).

Case Report:

A 62-year-old man was involved in a traffic accident and hospitalized for severe right leg fractures. Computed tomography also uncovered liver contusion and retroperitoneal hematoma. The next day, he became hemodynamically unstable; a huge retroperitoneal hematoma had developed from a rupture of the juxtahepatic IVC. An emergent procedure to implant a self-expanding fenestrated stent-graft was successful in repairing the IVC injury and maintaining hepatic venous return. The patient recovered and continues in good health with a patent endograft 16 months after treatment.

Conclusions:

This experience supports the efficacy of fenestrated endograft implantation for emergent repair of IVC injuries, although proper facilities, an experienced interventional team, and an assortment of devices must be available.
Thromboembolic Complications after Endovascular Aortic Aneurysm Repair
Authors: Görich Johannes , Krämer Stefan , Tomczak Reinhard , Seifarth Harald , Merkle Elmar , Sunder-Plassmann Ludger , Orend Karl-Heinz , Ashquan Yahia , Pamler Reinhard
Published: March 2015

Purpose:

To evaluate the frequency and significance of thromboembolic complications following endovascular treatment of aortic aneurysms.

Methods:

One hundred seventy-four patients (153 men; mean 71.4 years, range 26–90) underwent endovascular repair of aneurysms of the thoracic (n = 38) or abdominal (n = 136) aorta using a variety of endografts. All patients were examined preprocedurally using 3-phase helical computed tomography (CT) to determine appropriate endograft size. To exclude the occurrence of infarction in parenchymal organs, the first postprocedural CT scan was compared with preoperative findings. Newly recognized perfusion deficits were taken as evidence of procedure-related infarction.

Results:

Infarctions were detected in 16 (9.2%) patients: 13 in the kidneys, 2 in the spleen, with 1 in the mesentery; only the mesenteric infarction was clinically symptomatic. Both splenic infarctions were associated with deployment of stent-grafts in the thoracic aorta (5.3% of the 38 patients), while the mesenteric and 13 renal infarctions were seen in patients with infrarenal abdominal aortic aneurysms (0.7% and 9.6%, respectively, of 136 patients). One patient experienced complete thromboembolic occlusion of a renal artery, which was partially recanalized with intraoperative lysis.

Conclusions:

Thromboembolic complications of endovascular aortic aneurysm repairs are not uncommon, and although usually asymptomatic, these sequelae have the potential to be life threatening. Perfusion abnormalities may respond to immediate lytic therapy with complete dissolution of the thrombus in certain isolated cases.
Endovascular AAA Repair: Classification of Aneurysm Sac Volumetric Change Using Spiral Computed Tomographic Angiography
Authors: Pollock John G. , Travis Simon J. , Whitaker Simon C. , Davidson Ian R. , Gregson Roger H. S. , Hopkinson Brian R. , Wenham Peter W. , MacSweeney Shane T.
Published: March 2015

Purpose:

To classify and analyze the volumetric changes seen on spiral computed tomographic angiography (CTA) following endovascular abdominal aortic aneurysm (AAA) repair.

Methods:

Fifty patients (46 men; mean age 71 years, range 51–83) with >1 year of imaging follow-up were retrospectively selected. The volume of the aneurysm sac was calculated on standard CT workstations to obtain plots of volume changes over time. For the purpose of this study, a 10% change in sac volume was considered significant.

Results:

Over a mean 32-month follow-up, 256 CTA scans were performed; initial mean sac volume was 259 mL and initial mean AAA diameter was 6.5 cm. Six distinct patterns of volume change were recognized: group Ia (28 patients, 56%): progressive reduction in aneurysm sac volume; group Ib (3 patients, 6%): transient initial increase then same as Ia; group II (4 patients, 8%): no significant change; group IIIa (5 patients, 10%): late increase in volume; group IIIb (8 patients, 16%): progressive increase in volume; and group IV (2 patients, 4%): late reduction in volume after secondary intervention. Group III changes were associated with endoleak types I and III (p<0.0001).

Conclusions:

This classification system of spiral CTA volumetric changes features 6 patterns with recognized clinical significance and predictive value for endoleaks. Group I is the ideal outcome when the aneurysm sac shrinks and often completely disappears, while group III is associated with types I and type III endoleak and should prompt further investigation. Long-term volumetric analysis of all patients is advised.
Emergency Endograft Placement for Recurrent Aortocaval Fistula after Conventional AAA Repair
Authors: Gandini Roberto , Ippoliti Arnaldo , Pampana Enrico , Marchetti Andrea Ascoli , Pistolese Giuseppe Raimondo , Simonetti Giovanni
Published: March 2015

Purpose:

To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula that recurred after conventional abdominal aortic aneurysm (AAA) repair.

Case Report:

A 67-year-old man was treated urgently for ruptured AAA with surgical placement of a 16-mm Dacron interposition graft. During the procedure, an aortocaval fistula was repaired primarily. The patient was discharged in satisfactory condition but returned 20 days later with dyspnea, bilateral perimalleolar edema, and a bruit in the mesogastric region. The high flow fistula was again present just above the aortic bifurcation at the distal anastomosis of the existing graft. The patient's condition deteriorated rapidly, so a bifurcated Vanguard stent-graft was deployed in an emergency procedure. Subsequent imaging confirmed satisfactory closure of the fistula. The patient was discharged 8 days after endograft placement, and he continues to be without signs of fistula recurrence at 2 years.

Conclusions:

Endograft treatment of vascular lesions in the acute setting is becoming more common as our experience with the devices grows. Endovascular repair of primary aortocaval fistulas appears to be an efficacious and minimally invasive means of dealing with these lesions in AAA patients.
Aortoesophageal Fistula Secondary to Mycotic Thoracic Aortic Aneurysm: Endovascular Repair and Transhiatal Esophagectomy
Authors: van Doorn Ruth C. , Reekers Jim , de Mol Bas A.J.M. , Obertop Huug , Balm Ron
Published: March 2015

Purpose:

To report a case of aortoesophageal fistula secondary to a mycotic thoracic aortic aneurysm (TAA) successfully repaired by stent-grafting of the descending thoracic aorta.

Case Report:

A 66-year-old woman with a recent history of hemicolectomy for colon cancer complicated by postoperative infection presented with midthoracic pain, fever, hoarseness, and blood chemistries consistent with an inflammatory process. Imaging showed a widened mediastinum and displacement of the trachea due to a mycotic thoracic aneurysm; endoscopy confirmed a large fistula in the esophageal wall. There was no active bleeding, so an Excluder thoracic endograft was positioned in the aortic arch, partially covering the left subclavian artery origin. Three days later, a transhiatal esophagectomy was performed. Intravenous antibiotic therapy was continued for 6 weeks. At 18 months, a minithoracotomy was performed because of extreme dyspnea. An aneurysm sac hygroma was drained in the thoracic cavity. At 2 years, the patient was well, and there were no signs of infection or dyspnea.

Conclusions:

Along with a transhiatal esophagectomy, we suggest that endovascular stent-grafting has a place as a minimally invasive technique in the treatment of aortoesophageal fistula secondary to aneurysm of the thoracic aorta.
Preventive Stent Placement for Renal Artery Stenosis Prior to Emergent Coronary Artery Bypass Grafting
Authors: Martin-Ucar Antonio E. , Patel Ramesh L.
Published: March 2015

Purpose:

To illustrate the benefits of treating severe renal artery stenosis in renally compromised patients prior to surgery for coronary artery disease.

Case Report:

A 63-year-old woman with unstable angina, severe coronary artery disease, and long-term severe renal impairment with a single functioning kidney underwent renal stent placement for high-grade renal artery stenosis prior to coronary artery surgery. The procedure improved her serum creatinine from 528 µmol/L at baseline to 385 µmol/L, and she subsequently underwent coronary artery bypass grafting without deterioration in her renal function. At 1 year, the patient has a serum creatinine of 400 µmol/L, and there is no evidence of in-stent stenosis.

Conclusions:

Percutaneous renal angioplasty or stenting prior to coronary surgery in patients with concomitant renal and coronary artery disease may reduce perioperative renal deterioration in this specific group of patients.
Covered Stent to Exclude Intravascular Thrombus
Authors: Liistro Francesco , Stankovic Goran , Di Mario Carlo , Montorfano Matteo , Briguori Carlo , Colombo Antonio
Published: March 2015

Purpose:

To describe the utility of stent-graft implantation to avoid distal embolization from a large thrombus-containing lesion.

Case Report:

A 67-year-old man was evaluated for recent onset of disabling left leg claudication. Angiography disclosed a mobile lobular mass occluding the left common iliac artery; irregular staining suggested an atherothrombotic lesion. Through a percutaneous ipsilateral access and an 8-F sheath, a balloon-expandable Jostent peripheral stent-graft was positioned with the distal edge immediately proximal to the internal iliac artery ostium. A prominent “waist” at the center of the balloon confirmed entrapment of the thrombotic mass. Completion angiography showed an optimal result with no residual stenosis or evidence of distal embolization. At 6-month follow-up, the patient was asymptomatic with angiographically documented luminal patency and no evidence of in-stent stenosis.

Conclusions:

Stent-graft implantation appears a viable treatment alternative for thrombus-containing lesions, particularly when the thrombotic material is localized or is in a large vessel.
The First 150 Endovascular AAA Repairs at a Single Institution: How Steep is the Learning Curve?
Authors: Lee W. Anthony , Wolf Yehuda G. , Hill Bradley B. , Cipriano Paul , Fogarty Thomas J. , Zarins Christopher K.
Published: March 2015

Purpose:

To determine whether increasing experience with endovascular abdominal aortic aneurysm (AAA) repair in a single institution will result in improved outcome.

Methods:

A retrospective review was undertaken of 150 consecutive cases of endovascular AAA repairs performed using the AneuRx device between October 1996 and April 2000 in a university-based medical center. The population was divided into early and late groups of 75 patients each. Endpoints included technical success; complications; early (≤30-day) morbidity, mortality and rupture; endoleak at discharge and at 1 month; early secondary intervention; proximal neck and iliac tortuosity; extender cuff placement; femoral reconstructions beyond primary repair; total fluoroscopy time; and contrast load.

Results:

Baseline patient and aneurysm characteristics were similar between the 2 groups. Technical success was 98.7%; 2 cases were converted intraprocedurally owing to difficult iliac access (early group) and a severely angulated proximal neck (late group). There was a tendency toward more frequent use of intraoperative proximal extender cuffs in the early group (12% versus 4% in the late group, p=0.13). Femoral reconstructions were more frequent in the early group (36% versus 19%, p<0.025). While total contrast volume was similar (111 ± 56 versus 105 ± 45 mL, p=NS), total fluoroscopy time was significantly reduced (p<0.05) between the early and late groups.

Conclusions:

With attention to detail and careful patient selection, successful endovascular AAA repair can be achieved with very few conversions and low perioperative mortality even during the center's early experience. Evidence indicates, however, that a learning curve definitely exists, as shown by fewer access site problems, more accurate device deployments, and decreased fluoroscopy times as proficiency is attained.