bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.