bluuebunny/crossref_metadata_2025 huggingface dataset:
An Exploratory Investigation of Quality of Life in Adult Liver Transplant Recipients
Authors: Bean Kathy B.
Published: January 2017

Quality of life is an important outcome indicator of experiences associated with liver transplantation. Unfortunately, quality of life has been defined in many different ways, causing confusion and misconceptions among practitioners, researchers, policy makers, and patients. This exploratory qualitative study was initiated to gain greater understanding regarding the adult transplant recipients' experiences with liver transplantation in order to direct future studies with this population and to assist in selection of a relevant quality of life survey tool for quantitative investigation. Twelve informants (7 women, 5 men) shared their experiences in face-to-face interviews conducted by the researcher. Analysis of these interviews reveals the importance of physiologic, psychological, social, spiritual, family, and socioeconomic aspects of quality of life for liver transplant recipients.
Advanced Practice Organ Procurement Techniques: Insertion of Thoracic Catheters
Authors: Powner David J.
Published: January 2017

Advanced practice coordinators who perform procedures that may be associated with complications must be proficient at treating those untoward events. This discussion reviews the diagnosis of a pneumothorax as a complication of insertion of a central venous catheter and mechanical ventilation. The method for inserting the Wayne Pneumothorax Set thoracic catheter is presented. This and similar commercially available catheters may also be used to evacuate a pleural effusion or nonclotted blood from the thorax for diagnostic purposes or when treating hypoxemia. It is essential for organ procurement organizations to provide appropriate training and quality assurance programs to ensure safe practice.
Evaluation of the Electronic Version of the Questionnaire for Lung Transplant Patients
Authors: Dabbs Annette De Vito , Johnson Bruce A. , Wardzinski W. Todd , Iacono Aldo T. , Studer Sean M.
Published: January 2017

Context

Recent modifications to the QLTP (Questionnaire for Lung Transplant Patients), including changing items from dichotomous to multiple dimension scaling, adding psychological symptoms, and converting to an electronic format (e-QLTP), made it necessary to reevaluate its reliability, validity, recipient satisfaction, and feasibility of administering the e-QLTP in the clinical setting.

Purpose

To report the final modifications, psychometric properties, recipient satisfaction, and feasibility of administering the e-QLTP, a patient report outcome measure of symptoms and activity tolerance.

Methods

Sixty lung recipients completed the original QLTP and the e-QLTP and rated their satisfaction with the e-version during a routine posttransplant evaluation; 65% (38 of 60) also completed a retest version. Correlations were computed for retest stability, concurrent validity between versions of the QLTP, and construct validity among the subscales of the e-QLTP and forced expiratory volumes in 1 second. Using the After Scenario Questionnaire, participants rated their satisfaction with the ease, amount of time, and support information when completing the e-QLTP.

Results

The e-QLTP and subscales were internally consistent (α=.73-.90) and stable (intraclass correlations = .47-.93). Significant correlations ( P = .001) were found between the e-QLTP and the original QLTP ( r=0.53–0.56) and between the e-QLTP subscales and forced expiratory volumes in 1 second ( r = 0.51–0.53). The overall mean satisfaction score was 1.27 (± 0.47).

Conclusions

The e-QLTP is a reliable and valid measure of physical and psychological symptoms after lung transplantation. It is feasible to complete in the clinical setting and recipients are highly satisfied with its use. Its computerized functionality enhances assessment and management of symptoms over time.
Further Exploration: Maturity and Adherence in Adolescent and Young Adult Heart Transplant Recipients
Authors: Lawrence Kathy , Stilley Carol S. , Olshansky Ellen , Bender Ann , Webber Steven A.
Published: January 2017

Context

Pediatric transplant clinicians note high rates of nonadherence with medications, appointment keeping, and laboratory tests and high rates of engagement in high-risk behaviors among older adolescents and young adult recipients. The caregivers also report symptoms of identity confusion, social immaturity, and failure to appreciate consequences of risky behavior among recipients.

Objective

To build on an earlier study that identified developmental characteristics that distinguish poor from good adherers.

Design

Qualitative methods were used to explore key themes identified in the first study with heart transplant recipients and their significant others.

Results

This research confirmed the themes of developmental maturity suggested by the first study: good adherers were able to integrate the transplant into sense of self, become independent adults, and achieve normalcy; poor adherers continued to “push away” the transplant experience and worried that they would never be normal. The good adherers, their parents, and friends had views of relationships that were congruent, acknowledging difficulties, discussing them, and moving toward mutual satisfaction. The poor adherers, their parents, and friends expressed incongruent views of the relationships, avoiding discussion of problems and idealizing relationships.

Discussion

Strategies for clinicians, family, and friends to increase maturity and independence among older adolescent and young adult heart transplant recipients are described.
Communication as a Predictor of Willingness to Donate One's Organs: An Addition to the Theory of Reasoned Action
Authors: Jeffres Leo W. , Carroll Jeanine A. , Rubenking Bridget E. , Amschlinger Joe
Published: January 2017

Fishbein and Ajzen's theory of reasoned action has been used by many researchers, particularly in regard to health communication, to predict behavioral intentions and behavior. According to that theory, one's intention is the best predictor that one will engage in a behavior, and attitudes and social norms predict behavioral intentions. Other researchers have added different variables to the postulates of attitudes and social norms that Fishbein and Ajzen maintain are the best predictors of behavioral intention. Here we draw on data from a 2006 telephone survey (N=420) gauging the awareness of an organ donation campaign in Northeast Ohio to examine the impact of communication on people's intentions. The current study supports the hypothesis that those who communicate with others are more likely to express a greater willingness to become an organ donor, but it expands the range of communication contexts. With demographics and attitudes toward organ donation controlled for, this study shows that communication with others about organ donation increases the willingness of individuals to have favorable attitudes about being an organ donor.
A Multidisciplinary Program to Educate and Advocate for Living Donors
Authors: Sites Anita K. , Freeman Jason R. , Harper Michael R. , Waters David B. , Pruett Timothy L.
Published: January 2017

Education is critical in decision making and the informed consent process in prospective living donors. Little has been written about how and what living donors should be taught. This article describes a multidisciplinary program for living donor education at the University of Virginia. The goals of the program are to impart information needed for prospective donors to make an informed decision and to independently evaluate donors' medical and psychosocial suitability. A partnership between the transplant department and an independent donor advocacy team establishes an environment conducive to education. By embracing independence, transparency, partnership, and advocacy, our program permits bidirectional education. This partnership facilitates unbiased understanding and appreciation of this education and considers each individual's unique circumstances when making informed decisions. Likewise, prospective donors educate the team about their circumstances, which helps the team safeguard the prospective donor and may enhance the safety of prospective donors and the perceived integrity of living organ donation.
Designing an Educational Strategy for Increasing Organ Donor Registration among Older Adults
Authors: Downing Kimberly , Jones Linda L.
Published: January 2017

Context

Older adults (50–70 years of age) have lower organ donor registration rates than younger adults. Despite recent increases in organ donation registration of adults 18 to 49 years of age, the increase in older adult registrations is less.

Objective

To use research results from surveys and focus groups to inform an educational strategy and design for the older adult population.

Design

Pooled survey data from 3 statewide random-digit dial telephone interview surveys of 6230 adults, including 2631 respondents age 50 or older, were used to identify barriers to organ donor registration and information needs of older adults compared with younger adults. Two focus groups with older adults were used to further identify barriers and to pilot test messages for an educational strategy for older adults.

Setting and Participants

Surveys were conducted with adults in Ohio. Focus groups were conducted in 2 major cities in Ohio with older adults, 50 to 70 years of age.

Results

Survey results indicate that older adults and younger adults differ on several factors regarding their beliefs, attitudes, and behavior concerning organ donation. Although older adults express positive attitudes toward donation, they often “opt out” from registering to be organ donors for age and health reasons. Focus groups show similar barriers to organ donor registration and indicate that brochures are a preferred way to educate older adults about organ donation.

Conclusion

Using research results to identify barriers and information needs of specific demographic groups is very important in designing a targeted educational strategy. An educational campaign addressing the concerns and information needs of this age group could increase organ donor registration.
Constantly Responsible, Constantly Worried, Constantly Blessed: Parenting after Pediatric Heart Transplant
Authors: Green Angela , Meaux Julie , Huett Amy , Ainley Kathy
Published: January 2017

Context

Very little research has focused on the long-term caregiving demands associated with parenting a child after a transplant or on the parents' perceptions of those demands.

Purpose

To describe parents' experiences parenting a school-aged child after heart transplant.

Design

Focused ethnography.

Participants and Setting

Eleven parents of children who had undergone heart transplant 2 or more years before the study were recruited from a large children's hospital.

Data Collection and Analysis

Parents were interviewed in a private location of their choice. Verbatim interview transcripts were analyzed by using content analysis and constant comparison.

Results

The parents described their experiences in positive terms, yet acknowledged hardships. Key themes included (1) constantly responsible, (2) constantly worried, (3) constantly blessed, and (4) coping with life. The identified themes provide direction for interventions to help parents cope with the experience of parenting a child after heart transplant.
Quality of Life in Caregivers Providing Care for Lung Transplant Candidates
Authors: Lefaiver Cheryl A. , Keough Vicki A. , Letizia Marijo , Lanuza Dorothy M.
Published: January 2017

Context

Caregivers are essential members of the health care team who provide care, valued at more than $250 billion each year, to millions of persons who require assistance with health and daily care. Patients with respiratory diseases who are waiting for a lung transplant are required to have an identified caregiver. The caregivers are rarely studied.

Objective

To explore the relationships among the health status of caregivers of lung transplant candidates, caregivers' reaction to caregiving, and caregivers' perceived quality of life.

Design

This descriptive study examined the quality of life of lung transplant caregivers from a multidimensional perspective.

Setting and Participants

Twenty-nine dyads of lung transplant candidates and their caregivers were recruited from a Midwestern medical center.

Measures

Data were collected by self-report: caregivers completed the Quality of Life Index, SF-12 health survey, Profile of Mood States-Short Form, and the Caregiver Reaction Assessment.

Results

Caregivers reported favorable levels of quality of life, physical health, and mood during the pretransplant waiting phase. However, problem areas for caregivers during this time included fatigue, depression, and the financial impact of the transplant. Data analyses indicated that depression, caregiver general health, impact on finances, and lack of family support had the greatest effect on caregivers' quality of life. Nurses are urged to recognize the role of caregivers in the transplant process, ask about and listen to caregivers' needs, and include caregivers in the plan of care.
Experience With a New Process—Condition T—for Uncontrolled Donation After Circulatory Determination of Death in a University Emergency Department
Authors: DeVita Michael A. , Callaway Clifton W. , Pacella Charissa , Brooks Maria Mori , Lutz John , Stuart Susan
Published: January 2017

Background:

In the United States, organ donation after circulatory death (DCD) determination is increasing among those who are removed from life-sustaining therapy but is rare when death is unexpected. We created a program for uncontrolled DCD (uDCD).

Methods:

A comprehensive program was created to train personnel to identify and respond quickly to potential donors after unexpected death. The process termed Condition T was implemented in the emergency department (ED) of 2 academic medical centers. All ED deaths were screened for uDCD potential. Eligible donors included patients with preexisting donor designation who received cardiopulmonary resuscitation, failed to respond, and were pronounced dead.

Results:

Over 350 nurses, physicians, perfusionists, organ procurement personnel, and administrators were trained. From February 2009 to June 2010, a total of 18 patients were potential Condition T candidates. Six Condition T responses were triggered. Three donors underwent cannulation, and 4 organs were recovered (3 kidney and 1 liver) from 2 donors. Time from Condition T trigger to perfusion with organ preservation solution ranged from 14 to 22.3 minutes. Perfusion duration was 197 and 221 minutes. No recovered organs were transplanted because biopsies showed prolonged warm ischemia.

Conclusions:

It is feasible to create a process to rapidly intervene in the ED for uDCD. However, no organ transplants resulted. The utility and sustainability of an uDCD program in this particular setting are questionable.
A Prospective Study of Depression and Weight Change After Kidney Transplant
Authors: Stanfill Ansley , Hathaway Donna , Bloodworth Robin , Cashion Ann
Published: January 2017

Context:

Kidney transplant recipients have great risk for gaining significant weight (upward of 10 kg) in the first year posttransplant. Clinical depression can occur in response to life situations and is associated with weight gain.

Objective:

To explore the association between demographic characteristics, weight change, and depression posttransplantation.

Design:

Secondary data analysis on longitudinal data collected for a larger observational study. Demographic characteristics, weight, and Center for Epidemiologic Studies Depression Scale (CES-D) data were obtained at baseline (BL) (time of transplantation), 6, and 12 months posttransplant. The CES-D scores were compared among time points using means, standard deviations, correlations, t tests, and chi-square as well as by multiple regression modeling.

Setting:

Regional transplant center in the mid-south United States.

Participants:

Forty-seven kidney transplant recipients (55% female, 57% African American, mean age 52.5 years). Weight change ranged from −18.1 to +24.8 kg.

Results:

In all, 62% reported baseline CES-D scores indicative of depression, with lower scores indicating less psychological distress at 6 and 12 months (47% and 49%, respectively). We found no significant differences among CES-D scores at any time point. Regression models found age, race, gender, and weight change to be predictive of CES-D scores at 6 months ( P = .04, R2 = .137). Age was the most influential ( P = .008), with older individuals more likely to obtain higher CES-D scores. Since the experience of depression is common at transplant and during the first year, it is important that transplant recipients be evaluated for depression early in the recovery period.
Integration of Clinical Examination, Self-Report, and Hair Ethyl Glucuronide Analysis for Evaluation of Patients With Alcoholic Liver Disease Prior to Liver Transplantation
Authors: Beckmann Mingo , Paslakis Georgios , Böttcher Michael , Helander Anders , Erim Yesim
Published: January 2017

Context:

A large proportion of liver transplants (LTXs) are performed due to alcoholic liver disease (ALD) in the final stage of organ insufficiency. In order to list patients for LTX, transplant centers commonly require 6 months abstinence from alcohol. However, significant differences have been reported between alcohol intake as indicated by self-report and biochemical markers of alcohol.

Objective:

In the present study, the usefulness of ethyl glucuronide analysis in hair (hETG) was examined during the evaluation procedure before listing patients with ALD for an LTX.

Design:

Cross-sectional survey.

Setting:

Psychosomatic evaluation.

Patients:

Seventy patients with ALD prior to listing for an LTX.

Interventions:

According to clinical assessment before listing patients with ALD (n = 233) for an LTX, hETG analysis was only performed in the patients who were assumed to deny or underreport their alcohol consumption (n = 70).

Main Outcome Measures:

The analysis of hETG by liquid chromatography–mass spectrometry, clinical interview.

Results:

By hETG analyses, 27 (38.6%) of the 70 patients tested positive for ongoing alcohol consumption.

Conclusions:

Selective use of hETG based on the clinical interview rather than widespread screening is a possible way to detect excessive alcohol consumption in patients with ALD in the transplant setting. The primary evaluation of a patient’s situation in its entirety should remain the superordinate standard procedure. An interdisciplinary approach to transplant candidates with an ALD is asked for.
Living Kidney Donors’ Information Needs and Preferences
Authors: Traino Heather M. , Nonterah Camilla W. , Gupta Gaurav , Mincemoyer Jodi
Published: January 2017

Introduction:

Past research suggests the information exchanged from transplant centers to potential living kidney donors is, in many cases, suboptimal. The purpose of this study was to assess donors’ perceptions of the information provided while considering living donation.

Methods:

Semistructured telephone interviews conducted with 81 past living donors seen at 1 mid-Atlantic transplant center assessed the extent to which living kidney donors deemed Centers for Medicare and Medicaid Services (CMS)-mandated information useful to making a decision about donation and to which more information was or would have been desired before donating. Understanding of and satisfaction with the information was also assessed.

Results:

Participants were primarily white (67.9%), females (67.9%), with an average age of 57.8 years. Perceived usefulness ranged from a mean of 3.1 for the confidentiality of the transplant center’s communication to 4.1 for postoperative care and short-term medical risks of donation. Donors of minority descent as well as those with more education and less income found the information provided most useful. Few donors desired additional information about the right to opt out of (8.6%) or decline (13.6%) donation; however, most wanted more information regarding the risk of being refused health, disability and/or life insurance after donating (77.8%), and insurance coverage for future health problems (66.7%).

Discussion:

This study revealed limited usefulness of certain CMS-mandated topics and a desire for additional information about donation. Efforts to standardize the informed consent process should incorporate donors’ perspectives as to the specific topics, quantity of information, and the mode of communication found most useful when considering living donation.
The Relationship between Upper Extremity Strength and Instrumental Activities of Daily Living Performance among Elderly Women
Authors: McGee Corey W. , Mathiowetz Virgil
Published: January 2017

The purpose of this study was to assess the relationship between upper extremity strength and the ability to perform instrumental activities of daily living (IADL) independently and to explore how therapists might interpret the results of upper extremity strength evaluations among elderly women. Participants included 29 women (68 to 84 years old) who resided in assisted living facilities. Daily living performance was assessed using five subscales of the Multilevel Assessment Instrument. Grip, lateral pinch, and the strength of selected muscles of the elbow and the shoulder in the dominant upper extremity were tested. Shoulder abductor and external rotator strength were moderately correlated (rs = 0.50 and rs − 0.51, respectively) with IADL function. Shoulder external rotator strength was moderately correlated (rs = 0.55) and elbow extensor strength was fairly correlated (rs = 0.49) with participants' ability to grocery shop. Upper extremity strength measurements within normal limits are not necessarily predictive of IADL independence for elderly women, but measurements below normal limits may indicate IADL limitation. A positive screening result for shoulder weakness or upper extremity strength of more than two standard deviations below norms may warrant in-depth assessment of IADL performance. Alternatively, self-reported limitation in IADL independence may support the need for assessment of upper extremity strength.
Occupational Therapy at Home for Older Individuals with Mild to Moderate Cognitive Impairments and Their Primary Caregivers: A Pilot Study
Authors: Graff Maud J. L. , Vernooij-Dassen Myrra J. F. J. , Hoefnagels Willibrord H. L. , Dekker Joost , de Witte Luc P.
Published: January 2017

The objective of this pilot study was to explore the effects of occupational therapy on the performance of daily activities by older individuals with cognitive impairments and on the sense of competence of their primary caregivers. The design was a single group design. Older individuals with cognitive impairments and their primary caregivers were assessed prior to the first occupational therapy visit in hospital and after 5 weeks of occupational therapy at home. Participants were older individuals with mild to moderate cognitive impairments living at home (n = 12) and their primary caregivers (n = 12). These older clients with cognitive impairments and their primary caregivers received an occupational therapy intervention in hospital and at home after discharge in accordance with an occupational therapy guideline. This guideline is client-centered and makes use of collaborative, psychosocial, and environmental approaches. The main outcome measures were older clients' motor and process skills, initiative, need for assistance, self-perception in occupational performance, and satisfaction with this performance in daily activities and primary caregivers' sense of competence. The results of this study indicated that older clients' motor and process skills and self-perception in occupational performance improved and that they needed less help. The sense of competence of their primary caregivers also improved. This study provides preliminary evidence for the effectiveness of occupational therapy in older individuals with cognitive impairments and their primary caregivers, which should be tested in a randomized, controlled trial.
Dural Sinus Malformation with Dural Arteriovenous Fistula
Authors: Yau C. Kwong , Alvarez H. , Lasjaunias P.
Published: January 2017

A rare case of dural sinus malformation with dural arteriovenous fistula in an infant is presented. Presenting symptom was progressive macrocrania without hydrocephalus. A high flow arteriovenous of the sigmoid sinus associated with jugular bulb diaphragm was demonstrated. Reflux in the intracranial sinus was present. The shunt was successfully occluded by transarterial embolization. The natural history and treatment strategy are discussed.
Postoperative Intracranial Thrombolysis and Angioplasty
Authors: Levrier O. , Stordeur J.M. , Bruder N. , Manera L. , Bouillot P. , Raybaud C.H.
Published: January 2017

The case study involves a patient presenting middle cerebral artery thrombosis, related to a severe vasospasm following subarachnoid hemorrhage due to aneurysm rupture. The patient was treated initially by surgical clipping of the left middle cerebral artery aneurysm. After surgery, the neurological status of the patient was normal. Six days later, the patient presented right hemiplegia and aphasia that were related to the proximal left middle cerebral artery thrombosis. Despite recent open-skull surgery, in situ thrombolysis using urokinase and antiplatelet antibodies (abciximab) was performed. The thrombosed artery was reopened and a severe vasospasm was observed. The vasospasm was treated by transluminal angioplasty. No intracranial hemorrhage was noted after thrombolysis and angioplasty, whereas subcutaneous hemorrhage around the scalp incision was observed. The patient recovered from motor and language impairment. The only long-term symptom was a mild dysorthographia. Balance of risk/benefit is discussed for such aggressive thrombolytic therapy. In this particular case, effectiveness and uneventful use of abciximab was demonstrated despite very recent brain surgery that was considered a formal contra-indication for the use of such a powerful thrombolytic drug.

Vessel thrombosis is an exceptional complication of cerebral vasospasm. In the early hours, intra-arterial thrombolysis may be considered, but recent intracranial surgery is usually an exclusion criterion to performing thrombolysis. We report the case of a patient who underwent thrombolysis and angioplasty in the postoperative period to treat this complication of vasospasm.
Tuberous Sclerosis Complex with an Unruptured Intracranial Aneurysm: Manifestations of Contiguous Gene Syndrome
Authors: Chen Y.L. , Luo C.B. , Hsu S.W. , Rodesch G. , Lasjaunias P.
Published: January 2017

With the advancement of molecular genetics, the deletion of the TSC2/PKD1 gene at chromosome 16p13.3 has been discovered to be responsible for the tuberous sclerosis complex sharing some of the clinical manifestations of autosomal dominant adult polycystic kidney disease such as multiple renal cysts and intracranial aneurysms. The unruptured aneurysm in tuberous sclerosis complex is far beyond the meaning it has in general population. The risk of aneurysmal hemorrhage in tuberous sclerosis complex may be higher than that in autosomal dominant adult polycystic kidney disease due to the synergistic effect of gene deletion and certainly much higher than that in the general population. For such high-risk patients with intracranial aneurysms doomed to subarachnoid hemorrhage, magnetic resonance angiography plays an important role in screening and follow-up, especially more critically for patients with contiguous gene syndrome. Endovascular coil embolization should be the first choice of treatment for unruptured intracranial aneurysms.
Endovascular Treatment of a Distal Aneurysm of the Superior Cerebellar Artery by Intra-Aneurysmal Injection of Glue
Authors: Leonardi M. , Simonetti L. , Andreoli A.
Published: January 2017

Aneurysms in the distal cerebellar arteries are rare events. They are associated with a poor prognosis, as surgery or embolisation with Guglielmi detachable coils (GDCs) is very difficult. The ability to treat them surgically depends on the location of the aneurysm, but surgery is considered difficult and is associated with a high morbidity/mortality rate.

Embolisation with GDCs may be difficult or impossible because of the distal location of the aneurysm or the unfavourable ratio between the size of the aneurysm and the size of the parent vessel.

We report our experience in one case treated with intra-aneurysmal injection of glue.

The aneurysm, located in the distal right superior cerebellar artery, was catheterized with a flow-guided microcatheter, and glue was slowly injected into the aneurysmal sac.

The treatment resulted in total occlusion of the aneurysm with preservation of the parent artery.
Utility of Balloon-Assisted Guglielmi Detachable Coiling in the Treatment of Cerebral Aneurysms
Authors: Mangiafico S. , Cellerini M. , Villa G. , Nistri M. , Pandolfo C. , Ammannati F. , Mennonna P. , Giordano GP
Published: January 2017

Balloon-assisted Guglielmi detachable coiling (BAGDC) is a new technical option developed to allow endovascular treatment of wide-necked aneurysms. Aim of the following work is to report a single center experience of BADGC of aneurysms with assessment of its efficacy and safety.

BAGDC of wide-necked aneurysms (SNR close to 1) was retrospectively evaluated in 37 patients (28 females, nine males, mean age: 56.6 yrs, range: 27–81 yrs) who underwent the procedure between january 1999 and january 2002 for a total of 45 procedures on 41 aneurysms. Twenty-nine patients presented with SAH from an acutely ruptured aneurysm.

In two patients BAGDC failed whereas 35 patients successfully underwent BADGC (39 aneurysms). Twenty-nine patients (31 aneurysms) were available for angiographic follow-up (mean: 10 mo, range: 3–24 mo). At the last angiographic follow-up 29/33 aneurysms (87%) resulted stable and occluded (22 aneurysms with dense and seven with loose packing of the sac and the neck), two aneurysms showed regrowth, one aneurysm showed a neck remnant and another one a sac and neck remnant. Complications directly related to the procedure occurred in five patients (three perforations, one thromboembolism, one femoral AV) with a mortality and morbility rate of 2.7 and 5.4 respectively.

BAGDC is a promising adjunct to treatment of wide-necked aneurysms broadening the spectrum of indications for endovascular treament of challenging aneurysms.
Glubran 2: A New Acrylic Glue for Neuroradiological Endovascular Use
Authors: Leonardi M. , Barbara C. , Simonetti L. , Giardino R. , Aldini N. Nicoli , Fini M. , Martini L. , Masetti L. , Joechler M. , Roncaroli F.
Published: January 2017

A new acrylic glue, Glubran 2, is now available on the European market. It bears the CE mark with several surgical indications and the specific indication for neuroradiological endovascular use. Despite this approval, to our knowledge its use is still limited to surgery and no injections have been made in human patients.

This study was designed to evaluate the behavior of Glubran 2 in endovascular injection in a simulation of brain AVM.

Six sheep were operated on opening a fistula between the right common carotid artery and the jugular vein. This fistula modifies blood flow in the skull base rete mirabilis, which then functions as an AVM. In two sheep, the rete mirabilis was occluded by injection of 1.5 ml of Histoacryl diluted 1:1 and 1:3 with Lipiodol. In two sheep, the rete was embolized by injection of 1.5 ml of Glubran 2 diluted 1:1 with Lipiodol. The last two sheep were embolized by injection of Glubran 2 diluted 1:3 with Lipiodol. The procedures were documented by DSA angiographic acquisitions and by fluoroscopic VHS. The sheep were killed immediately after the procedures and the rete mirabilis isolated for histologic examination.

Embolization was obtained with both kinds of glue. Glubran 2 diffuses in a very similar way to Histoacryl with an apparently more complete diffusion. Reflux in the ascending pharyngeal artery showed that Glubran 2 tended not to produce bubbles but diffused more homogeneously.

The subjective conclusion of this work is that Glubran 2 can be used in endovascular embolizations. Before approaching brain AVMs, a further study will investigate embolization of the external carotid territory.
MR Detection of Dilated Deep Medullary Veins in Intracranial Dural Arteriovenous Fistulas with retrograde Leptomeningeal Venous Drainage
Authors: Chan C.M. , Cheng K.M. , Cheung J.Y.L. , Lee F.W.T. , Tang K.W. , Tse C.H. , Chan S.C.H.
Published: January 2017

Patients with dural arteriovenous fistula (DAVF) are at higher risk of developing neurological deficits when there is retrograde leptomeningeal venous drainage. Our aim is to demonstrate the presence of dilated deep medullary veins in the brain on magnetic resonance imaging (MR) in this group of patients, and to assess their clinical significance. Nine patients with angiographically proven DAVF associated with leptomeningeal venous drainage who had MR before treatment were studied. MR was performed in at least two orthogonal planes before and after gadolinium administration. The dural fistula was located at the cavernous sinus in five patients, at the transverse-sigmoid sinus in three and at the tentorium in one. Dilated deep medullary veins were noted in six patients. Of these, four showed parenchymal abnormalities which included intracerebral haematoma, venous infarction, brain oedema and T2 hyper-intensity in brainstem. Venous varix was present in one patient. No neurological complication or parenchymal change was observed in the three patients without dilated deep medullary veins. Therefore, in patients with intracranial DAVF associated with leptomeningeal venous recruitment, the MR finding of dilated deep medullary veins suggests a more severe degree of venous hypertension and congestion in the brain. This subgroup of patients has a much higher chance of neurological complications and warrants urgent intervention.
Ruptured Anterior Spinal Artery Aneurysm Associated with Coarctation of Aorta
Authors: Jiarakongmun P. , Chewit P. , Pongpech S.
Published: January 2017

A 39-year-old man presented with acute headache and neck pain, followed by quadriparesis and quadriparesthesia, accompanied by urinary and bowel incontinence. Lumbar puncture showed subarachnoid haemorrhage. Angiogram via a right axillary approach revealed severe coarctation of the aorta, between the left common carotid artery and left subclavian artery. Multiple collateral circulation including an enlarged anterior spinal arterial axis bridging the stenosed arch provided collateral circulation to the abdominal aorta. A small lobulated aneurysm was seen at the radiculomedullary-anterior spinal artery junction from the right ascending cervical artery. This patient underwent successful surgical clipping of the aneurysm. Pathogenesis of the spinal arterial aneurysm associated with coarctation of the aorta is likely to result from the haemodynamic stress from collateral circulation through the anterior spinal axis rather than segmental arterial disease or angiodysplastic disease. Aneurysms of the spinal artery are rare but can be unusually found in association with SCAVMs, coarctation of aorta, Klippel-Trenaunay syndrome or more rarely with aortic arch interruption.
Rheolytic Thrombectomy of Acute Stent Thrombosis of Cervical Vertebral Artery
Authors: Feng L. , Mangla S. , Pile-Spellman J.
Published: January 2017

A new Xpeedior rheolytic thrombectomy catheter has been successfully used to extract thrombus from an acutely thrombosed vertebral artery stent without apparent distal embolism. The ease of use and the speed of thrombectomy suggest that this system may be useful for the treatment of acute ischemic stroke.
Endovascular Embolization to Control Life-Threatening Epistaxis Due to a Post Radiotherapy Pseudoaneurysm of the Maxillary Artery
Authors: Marcy P.Y. , Magné N. , Bailet C. , Poissonnet G. , Bensadoun R.J. , Demard F.
Published: January 2017

We report an unusual case (never described) of a false aneurysm of the maxillary artery following irradiation and biopsy that ruptured into the nasopharynx in an 34-year-old man who presented with severe epistaxis 15 months after radiation therapy of the nasopharynx (80 Gy). Angiography revealed a fusiform aneurysm of the second portion of the maxillary artery, which was successfully embolized but the patient died from a pseudomonas septicemia three months later. False aneurysms of the maxillary artery following irradiation are exceptional complications. Despite a successful endovascular treatment, the absence of collateral revascularization did not allow to complete healing of the radionecrotic pharyngeal area and led to a lethal septicemia.
Fatal Cardiovascular Collapse during Ethanol Sclerotherapy of a Venous Malformation
Authors: Chapot R. , Laurent A. , Enjolras O. , Payen D. , Houdart E.
Published: January 2017

We report a case of fatal cardiovascular collapse that occurred during Ethanol sclerotherapy of a venous malformation in a 21-year-old woman. The malformation was located on the anterior part of the thigh. Fifty ml of a mixture of Ethanol, Ethibloc and Lipiodol containing 35 ml of Ethanol (0.52 ml / kg) were injected under fluoroscopy. A major drop in arterial pressure was recorded after release of the tourniquet placed at the thigh root. The patient died after four hours of intensive cardiac reanimation. Her blood alcohol level was 0.4 g/l one hour after the end of the intervention. The cardiac toxicity of ethanol depends more on the potential acute venous contamination than on the blood alcohol concentration. The currently admitted “safety limit” of 1 ml/kg of bodyweight for ethanol sclerotherapy of venous malformations is certainly unsafe and must be redefined.
Permanent Inflammatory Effect of N-Butylcyanoacrylate on Vascular Wall Immunohistochemical Analysis
Authors: Talan-Hranilović J. , Rumboldt T. , Vučic M. , Rumboldt Z. , Beroš V. , Tonković V. , Lupret V.
Published: January 2017

We report a case of large intracranial pseudoaneurysm which spontaneously thrombosed one week after an attempt at embolisation. Thrombosis was probably induced by the flow arrest in the parent artery due to vasospasm caused by microcatheter/microguidewire manipulations.
Coil-Induced Perforation of Recently Ruptured Cerebral Aneurysm during Embolization
Authors: Akan H. , Belet U. , Enel A.
Published: January 2017

Most coil-induced aneurysmal ruptures during endovascular treatment occur in small, recently ruptured aneurysms, and after placement of at least one coil. In cases where the distal part of the microcatheter cannot move back due to its straightness and tightness, the last coil deployed may advance towards the aneurysmal wall through intercircles of deposited coils. To solve this problem, after complete occlusion of the sac is obtained, the microcatheter is slightly withdrawn until the tip of the catheter is placed in the neck, and then the neck is occluded with the appropriate coil.
Prenatal Diagnosis of Unusual Fetal Pial Arteriovenous Malformation
Authors: Auyeung K.M. , Laughlin S. , terBrugge K.G.
Published: January 2017

Cerebral arteriovenous malformations (CAVMs) are rarely diagnosed in utero. Most prenatal imaging of intracranial vascular malformations relates to Vein of Galen aneurysmal malformations (VGAMs) or Dural Arteriovenous Malformations (D-AVMs). We report a case of a fetal pial AVF with multiple fistulae and venous pouches, which appeared as an anechoic lesion on the prenatal ultrasound scan. The patient was asymptomatic with normal postnatal growth. No haemodynmaic disturbance was evident. Postnatal Computed tomography (CT), Magnetic Resonance Imaging (MRI) and catheter Digital Subtraction Angiography (DSA) confirmed the presence of a pial AVF. The angiographic findings and family history of nose bleeds suggests the diagnosis of Hereditary Hemorrhagic Telangiectasia. The largest AVF was embolized with tissue adhesive; the residual AVF subsequently removed by surgical excision.
Rebleeding and Ischemia after Acute Endovascular Treatment of Ruptured Dissecting Subarachnoid Vertebral Artery Aneurysms
Authors: Mangiafico S. , Padolecchia R. , Cellerini M. , Puglioli M. , Villa G. , Nistri M.
Published: January 2017

Dissection aneurysms of the vertebral artery represent 3.2% of all cerebral aneurysms and 28% of intracranial dissection aneurysms.

Dissection of the vertebral artery in its intracranial segment (V4) usually causes a subarachnoid hemorrhage (SAH) from subadventiatial extension of the vessel wall hematoma. Rarely (one case in seven), the symptomatology is characterized by brain stem ischemia from the vertebral artery and/or postero-inferior cerebellar artery occlusive dissection. The high rebleeding (18–33% with a 10+/-5 day interval between the first and the second bleeding) and mortality (>45%) rates 1, 13 of this disease prompt emergency treatment usually consisting in endovascular coiling of the dissection aneurysm and/or the dissected segment of the parent vessel.

Herein we report our experience in endovascular coiling of acutely ruptured dissecting aneurysms of the vertebral artery dissection in V4 segment. We focus the discussion on the risk of rebleeding and the ischemic complications that my occur after endovascular or surgical treatment.
Simultaneous Cerebral Aneurysms and Carotid Disease Should the Symptomatic Lesion always be the first to be Treated?
Authors: Castro E. , Villoria F. , Fortea F. , Carrera J. , Mateo O. , Sanchez-Alarcos S. , Reparaz L.
Published: January 2017

Simultaneous presentation of carotid stenosis and cerebral aneurysms is rare and it is conventionally accepted that symptomatic lesions need to be treated first. Our purpose was to describe our experience in managing patients who simultaneously presented significant carotid stenosis and cerebral aneurysm.
Three-Year Retrospective Study of Complications Arising during Interventional Procedures
Authors: Leonardi M. , Cenni P. , Spagnoli M. , Simonetti L. , Raffi L. , Agati R.
Published: January 2017

This retrospective study aimed to assess the percentage of complications arising in our daily practice of interventional procedures, comparing our findings with those of leading international reference centers and accepted guidelines for endovascular treatment. During the three-year period considered (2000–2002), we performed 246 interventional procedures, divided into seven different pathological conditions: aneurysms, brain AVMs dural and carotid cavernous fistulae, spine-spinal cord tumours, head-neck tumours, carotid stenosis and thrombolysis.

Aneurysmal disease accounted for 45% of all endovascular procedures.

In conclusion, four periprocedural complications arose in the course of 246 procedures resulting in one death and three cases of permanent neurological deficit (2%).
Hereditary Haemorrhagic Telangiectasia Cerebrospinal Localization in Adults and Children
Authors: Mahadevan J. , Ozanne A. , Yoshida Y. , Weon YC , Alvarez H. , Rodesch G. , Lasjaunias P.
Published: January 2017

Cerebral arteriovenous malformations (CAVM) can be associated with Hereditary Haemorrhagic Telangiectasia (HHT), adominantly inherited vascular disorder with variable penetrance and expressivity. The presentation and angiographic features were analysed retrospectively. The purpose is to point to special groups of AVM patients within the overall CAVMs and to discuss the issue of screening.

We reviewed 34 cases of HHT -related CAVM from the data bank in Bicêtre from 1985–2003. In Spinal cor d AVM (SCAVM) there were 194 patients with 5 HHT. HHT was diagnosed when at least two criteria were met; cutaneous telangiectasia, epistaxis, visceral AVMs, angiographic findings of AVF and first degree family history.

Intracranial haemorrhage was the presenting symptom in 8.8% and the risk of haemorrhage in the natural history was 0.7% per year. The commonest angiographic features in adults are nidus (81.8%) and multiplicity (45.5%), while in the paediatric group venous ectasia and giant pouches (91.3%), AVF (69.6%) and multiplicity (52.2%). In spinal cor d lesions macrofistulas are demonstrated in 83% of HHT with no multiplicity.

HHT-related CAVMs present as multiple lesions, cortical in location, micro AVMs or AVF. HHT in SCAVM is expressed as single macro AVF, especially in the paediatric group. AVF in children are highly suggestive of HHT. We do not recommend screening in HHT adult patients for CAVM, while in the paediatric population, screening could be recommended at six months of age for cerebrospinal localization. These patients should be screened for Pulmonary AVF, which needs to be treated in priority.
Endovascular Coiling of Multiple (More Than Four) Intracranial Aneurysms
Authors: Kim Y.J. , Song K.Y.
Published: January 2017

The incidence of multiple intracranial aneurysms has been reported from 5% to 35%. But over four multiple aneurysms are extremely rare. Sometimes it is very difficult to draw a clear line between ruptured ones and unruptured others especially in multiple aneurysm cases with even distribution of subarachnoid haemorrhage on basal cistern. We present two cases of multiple aneurysms, more than four, which were successfully treated by endovascular coiling at the same time. Our experience suggests an endovascular procedure would be the gold standard of treatment for ruptured multiple intracranial aneurysms.
Local Hyperthermia Enhances Thrombosis in Aneurysms Containing Platinum Coils
Authors: Suzuki O. , Miyachi S. , Okamoto T. , Ito A. , Shinkai M. , Honda H. , Kobayashi T. , Negoro M. , Yoshida J.
Published: January 2017

Despite recent technical advances in embolization of cerebral aneurysms with platinum coils, some aneurysms eventually resulted in incomplete packing with remnant neck or dome filling. Such a situation with a remaining inflow zone may pose a risk of rupture and subsequent regrowth. Metals characteristically generate heat under high-frequency alternating magnetic fields (AMF). We used this property to induce local hyperthermia and promote thrombogenesis in incompletely packed aneurysms.

Glass model aneurysms packed with coils were subjected to AMF to investigate the correlation between weight of platinum and temperature elevation and the correlation between flow rates of water through the model and temperature elevation. Next, activated coagulation time (ACT) of blood obtained from dogs was studied at various temperatures. Finally, side-wall aneurysms created in the canine carotid artery using a venous patch were packed with platinum coils. Change in temperature and angiographic changes were investigated after AMF application.

In the glass model, the weight of platinum was correlated with elevation of temperature, and a negative logarithmic correlation was evident between flow rate and elevation of temperature. Elevation of blood sample temperature tended to shorten ACT. In canine carotid aneurysms, elevation of intra-aneurysmal temperature was confirmed and sufficient elevation of temperature was found to promote angiographically evident thrombogenesis of the remnant space after AMF application.

Local hyperthermia may be useful in completing luminal obliteration of aneurysms after coil embolization. It may particularly useful for ruptured aneurysms to prevent the early rerupture.