bluuebunny/crossref_metadata_2025_split huggingface dataset:
Subclavian Stent Implantation to Alleviate Coronary Steal through a Patent Internal Mammary Artery Graft
Authors: Diethrich Edward B. , Cozacov Juan C. 
Published: March 2015

Purpose: Interventional techniques are rapidly supplanting conventional surgical therapies for the treatment of brachiocephalic occlusive disease. Although coronary-subclavian steal has been successfully alleviated with subclavian angioplasty, we report the first use of a Palmaz stent in the left subclavian artery (SCA) of a patient with a compromised left internal mammary artery (IMA) graft. Methods and Results: A 65-year-old male patient had undergone triple coronary artery bypass grafting in 1992, but 6 months later, severe narrowing occurred in two of the saphenous vein grafts, and arteriography identified a high-grade stenosis in the SCA supplying the left IMA graft to the left anterior descending coronary artery. Following balloon dilation of one saphenous vein graft stenosis, the left SCA was stented primarily with a P3008 Palmaz stent. Normal hemodynamics were restored, and the patient has been free of coronary steal symptoms for over 1 year. Conclusion: This case illustrates yet another aspect to the usefulness of intravascular stents in restoring and maintaining in flow to bypass grafts.
Aortic Aneurysm Morphology for Planning Endovascular Aortic Grafts: Limitations of Conventional Imaging Methods
Authors: Beebe Hugh G. , Jackson Tonya , Pigott John P. 
Published: March 2015

Purpose: To test whether conventional computed tomography scanning (CT) and contrast aortography (CA) provide adequate data for planning endovascular aortic grafting by measuring 33 parameters in patients having both imaging examinations for evaluation of abdominal aortic aneurysms (AAA). Methods: Fifty consecutive patients with AAA (41 men, 9 women; average age 65 years) had CT and CA (mean 26 days between exams). The data collected and analyzed included: 8 sites of diameter, 4 lengths, 6 angles, and 15 other dimensional measurements. Results: Conflicts between CA and CT data were common. Eighteen patients appeared to have a distal cuff by CA but not by CT. Proximal neck length could not be assessed by CT in 5 and had a difference between CA and CT > 1 cm in 25 patients. CA overestimated neck length in 11 patients. Common iliac artery angulation > 60° occurred unilaterally in 27 patients and bilaterally in 5. Seven patients had both iliac aneurysm and > 60° iliac angulation. Thirteen patients had one or more iliac aneurysms (> 2 cm) shown by CT but not by CA. Conclusions: For endovascular graft planning: (1) more detailed measurement is required than for traditional surgery; and (2) conventional CT and CA are complementary imaging studies, but each has important limitations.
Closure of a Popliteal Arteriovenous Fistula Using an Autologous Vein-Covered Palmaz Stent
Authors: Dorros Gerald , Joseph George 
Published: March 2015

Purpose: To report the use of autologous vein to cover a stainless steel stent designated for repair of a traumatic popliteal arteriovenous (AV) fistula. Methods and Results: Autologous cephalic vein was harvested to cover a Palmaz biliary stent selected to close a traumatic popliteal AV fistula that persisted despite reparative attempts with balloon occlusion and coil embolization. The vein-covered stent was delivered percutaneously and deployed, successfully obliterating the vascular communication. Patency of the popliteal artery was documented arteriographically at 5 months, and symptomatic improvement continues at 10 months. Conclusion: The simplicity of this percutaneous approach and the use of autologous vein to cover endovascular prostheses create the possibility for evaluating this technique in myriad anatomical situations.
Magnetic Resonance Acquisition to Determine the Lumen Length of a Tortuous Phantom Aorta
Authors: Liu Yu , Sampson Cynthia , Dorros Gerald , Wann L. Samuel , Parodi Juan 
Published: March 2015

Purpose: Endovascular abdominal aortic aneurysm repair is a technique that requires an accurate measurement of the aneurysm's lumen length prior to the procedure. This study examines the accuracy of luminal length measurement in an aortic phantom using magnetic resonance angiography (MRA) axial source images. Methods and Results: Tortuous phantom aortas were constructed using water-filled plastic tubing (7 mm in diameter with lengths of 80 to 160 mm). The tubes were molded into three-dimensional “S” or “C” shapes that simulated the luminal course of a tortuous aorta. Phantoms were imaged at angles of 0°, 15°, 30°, and 45° to the image slice direction on a 1.5T Signa MR scanner using a transaxial two-dimensional time-of-flight (TOF) and a Tr weighted spin-echo acquisition. The luminal length of the phantom was calculated after establishing the lumen center coordinates in axial source images and then measuring the distance between two sequential slices using the Pythagorean theorem. The accuracy of this measurement in the phantom was 89% to 99.6%, proportional to the length of the tubing. Accuracy was not affected by angulation of < 45°. Conclusion: Two-dimensional TOF MRA source images can provide an accurate measurement of the phantom aorta's lumen length.
Superficial Femoral Endarterectomy with Intraarterial PTFE Grafting
Authors: Bray Alan E. 
Published: March 2015

Purpose: To report early experience with a new endovascular approach to treating occluded Wallstents™ in the superficial femoral artery (SFA). Methods and Results: A symptomatic female patient with a 20-cm SFA occlusion involving a 10-cm Wallstent placed 2 years previously was offered an endovascular intervention. However, when percutaneous recanalization techniques failed, a semiclosed endarterectomy was undertaken using a conventional ring stripper. Although the atherosclerotic core and stent were removed smoothly, a small perforation was seen in the distal SFA. To avoid surgical repair, the endarterectomized segment was lined endoluminally using a 3-mm diameter, thin-walled polytetrafluoroethylene graft. A 15-mm Palmaz stent was used for distal fixation, with a plasty procedure performed at the proximal arteriotomy. There were no postoperative complications, and the patient, who was discharged on the second day, remains asymptomatic with normal flow through the graft at 3 months. Conclusion: Newer endovascular techniques may be applied in concert with conventional semiclosed endarterectomy to successfully treat lengthy SFA occlusions, particularly those involving stents.
Bird's Nest Inferior Vena Caval Filter Migration into the Duodenum: A Rare Cause of Upper Gastrointestinal Bleeding
Authors: Al Zahrani Hasan Ali 
Published: March 2015

Purpose: To report the first case of a potentially catastrophic complication of vena caval interruption with a bird's nest filter. Methods and Results: A 55-year-old Saudi patient presented with hypovolemic shock from massive upper gastrointestinal hemorrhage. Endoscopy identified a metallic object penetrating the duodenum. Five years earlier, the patient had a bird's nest vena caval filter inserted for recurrent pulmonary embolism. During emergent laparotomy, a broken filter wire was found projecting into the duodenum, where it had induced three profusely bleeding ulcers. The wire was transected and the ulcers oversewn. A hook projecting from the inferior vena cava (IVC) was also cut flush with the vessel wall, but the IVC was not opened nor the filter replaced. The patient's postoperative course was complicated by deep venous thrombosis, but he recovered and is asymptomatic on warfarin anticoagulation after 1 year. Computed tomography (CT) at 1-year follow-up confirmed no further migration of the filter. Conclusion: This event reinforces the need to monitor patients with IVC filters over the long term, preferably using CT scanning, and to consider filter migration as a possible cause of upper gastrointestinal bleeding.
Stenting in the Carotid Artery: Initial Experience in 110 Patients
Authors: Diethrich Edward B. , Ndiaye Mouhamadou , Reid Donald B. 
Published: March 2015

Purpose: To evaluate the feasibility, safety, and efficacy of intravascular stents in the treatment of extracranial carotid artery occlusive disease. Methods: According to protocol, stent therapy was offered to symptomatic patients with ≥ 70% arteriographically defined carotid stenoses or ulcerative lesions and, after September 1994, to asymptomatic patients with ≥ 75% stenoses. From April 1993 to September 1995, 110 nonconsecutive patients (79 males; mean age 72 years, range 45 to 85) consented to participate in the study. The majority (79 [72%]) were asymptomatic. Lesions meeting the treatment criteria were in the proximal common (n = 3); mid common (n = 12); distal common (n = 8); internal (ICA) (n = 92); and external (n = 2) carotid arteries. Seven patients had bilateral ICA stenoses, and 17 patients were treated for postsurgical recurrent disease. The mean lesion length and diameter stenosis for all lesions were 12.4 ± 9.2 mm and 86.5% ± 10.6%, respectively. The procedures were performed either via direct percutaneous access to the cervical common carotid artery or through a retrograde femoral artery approach. Standard balloon dilation preceded deployment of balloon-expandable stents in most cases. No postprocedural anticoagulation was used (aspirin only). Results: In 110 patients (117 arteries) intended for treatment, 109 (99.0%) (116 arteries [99.1%]) were successfully treated with 129 stents (128 Palmaz, 1 Wallstent). One percutaneous procedure failed (0.9%) for technical reasons (stent could not be deployed) and was converted to carotid endarterectomy. Minor complications included 4 cases of spasm (successfully treated with papaverine); 1 flow-limiting dissection (stented); and 6 access-site problems. There were 7 strokes (2 major, 5 reversible) (6.4%) and 5 minor transient events (4.5%) that resolved within 24 hours. Three patients were converted to endarterectomy (2.7%) prior to discharge; 1 stroke patient expired (0.9%), and another patient died of an unrelated cardiac event in hospital. In the 30-day postprocedural period, 2 ICA stents occluded (patients asymptomatic). Clinical success at 30 days (no technical failure, death, endarterectomy, stroke, or occlusion) was 89.1% (98/110). Over a mean 7.6-month follow-up (range 2 to 31), no new neurological symptoms developed. Another stent occlusion at 2 months and one case of flow-limiting intimal hyperplasia at 7 months were detected on routine duplex scanning in asymptomatic patients. Life-table analysis shows an 89% cumulative primary patency rate. Conclusions: Based on this early experience, carotid stenting appears feasible from a technical standpoint, with good midterm patency. However, the incidence of neurological sequelae is a serious problem. Technical enhancements and a more aggressive antiplatelet regimen may have a positive impact on these events.
Recurrent Carotid Disease: Will Stents Be an Alternative to Surgery?
Authors: Bergeron Patrice , Chambran Pascal , Benichou Hubert , Alessandri Christian 
Published: March 2015

Purpose: To report the results of balloon angioplasty in recurrent carotid occlusive disease and evaluate the potential for stent implantation. Methods and Results: Between April 1991 and September 1995, 15 patients with carotid restenosis underwent 17 endoluminal procedures in 3 common carotid and 14 internal carotid arteries. Two postdilation complications (dissection and acute occlusion) required prompt stenting; one common carotid artery was stented for postdilation residual stenosis. One recurrent lesion was also stented 6 months after initial angioplasty. One stroke, 1 silent cerebral infarction, and 3 transient ischemic attacks occurred in the balloon angioplasty patients (33% neurological complication rate). The common carotid stent patient died 3 days postoperatively due to hyperperfusion syndrome. Long-term follow-up in two stent patients showed no restenosis at 18 and 48 months, respectively. The 11 balloon angioplasty patients likewise have not demonstrated restenosis. Conclusions: Balloon angioplasty alone appears too risky for treating recurrent carotid disease. Stents may offer a safer alternative, particularly when implanted primarily.
Ultrasound Imaging during Endovascular Abdominal Aortic Aneurysm Repair Using the Stentor Bifurcated Endograft
Authors: Lie Torgrim , Lundbom Jan , Hatlinghus Staal , Grønningsaeter Aage , Ommedal Steinar , Aadahl Petter , Sæther Ola D. , Myhre Hans O. 
Published: March 2015

Purpose: To evaluate different ultrasound modalities during implantation and follow-up of endovascular grafts for abdominal aortic aneurysm (AAA) exclusion. Methods: Between February 1995 and May 1996, 18 patients (14 men; aged 49 to 80 years, mean 67) were treated with endovascular intervention for infrarenal AAA. Seventeen patients received Mialhe Stentor bifurcated grafts, while one patient was treated with a straight graft for pseudoaneurysm. During and after the implantation, 3.25- and 5-MHz annular array ultrasound probes were used for transabdominal visualization of the endograft. Intravascular ultrasound was applied in combination with angiography for postoperative control. Results: Intraprocedurally, transabdominal two-dimensional (2D) ultrasound successfully monitored guidewire passage from the groin into the main part of the bifurcated endograft for implantation of the second limb. All implantation procedures were technically successful, but four endoleaks were identified intraprocedurally by 2D ultrasound and angiography. One healed spontaneously, two were treated with endovascular techniques at 1 and 4 months, and the last leak was scheduled for repair when the patient died of probable myocardial infarction at 2 months. During follow-up, 2D ultrasound successfully visualized all the endografts; no endoleaks were found in up to 18 months of surveillance. Conclusions: Transabdominal ultrasound imaging could be valuable in bifurcated endograft deployment both for guiding guidewire insertion and for controlling wire position before the second graft limb is connected to the main graft. Provided that satisfactory visualization of the entire endograft can be obtained, ultrasound examination may possibly replace arteriography and computed tomographic scanning as a follow-up investigation.
Successful Embolization of Persistent Endoleak from a Patent Inferior Mesenteric Artery
Authors: van Schie Greg , Sieunarine Kishore , Holt Mike , Lawrence-Brown Michael , Hartley David , Goodman Marcel A. , Prendergast Frank J. , Khangure Mark 
Published: March 2015

Purpose: To report the successful endovascular occlusion of a persistent endoleak owing to collateral perfusion in a 1-year-old bifurcated aortic endograft. Methods and Results: An 81-year-old man underwent endovascular repair of a 5.5-cm abdominal aortic aneurysm (AAA) with a bifurcated stent-graft in 1995; collateral perfusion of the excluded aneurysm by retrograde filling of the patent inferior mesenteric artery (IMA) was noted postoperatively. At his 1-year follow-up, the mid-sac endoleak persisted on contrast-enhanced computed tomography. Using the superior mesenteric artery for access, the stump of the IMA was successfully embolized with glue. Conclusions: This case, which highlights the importance of documenting a patent IMA prior to AAA endografting, illustrates one option for the management of persistent collateral perfusion of endovascularly excluded aneurysms.
Acute Inflammatory Reaction Associated with Endoluminal Bypass Grafts
Authors: Hayoz Daniel , Do Do-Dai , Mahler Felix , Triller Jürgen , Spertini François 
Published: March 2015

Purpose: Nonspecific inflammatory reactions characterized by local tenderness, fever, and flu-like discomfort have been seen in patients undergoing endoluminal graft placement in the abdominal aorta or the femoral arteries. We undertook a study to assess the clinical and laboratory parameters of this inflammation. Methods: Ten patients with femoropopliteal artery (n = 9) or aortic (n = 1) lesions were treated with EndoPro System 1 stent-grafts made of nitinol alloy and covered with a polyester (Dacron) fabric. Eleven patients implanted with a bare nitinol stent served as the control group. Results: In the stent-graft group, four patients showed clinical signs of acute inflammation manifested by fever and local tenderness. Three of these patients suffered thrombosis of the stent-grafts during the first month of follow-up. Plasma levels of interleukin-1β and interleukin-6 in all stent-graft patients were markedly increased 1 day after intervention (7.3 ± 2.8 versus 90.2 ± 34.1 pg/mL and 15.6 ± 5.8 versus 175.5 ± 66.3 pg/mL, respectively; p < 0.01). This was followed by an increase in fibrinogen (3.0 ± 0.2 versus 5.0 ± 0.2 g/L; p < 0.05) and C-reactive protein (14.6 ± 3.3 versus 77.5 ± 15.0 mg/L; p < 0.01) at 1 week. No direct correlation between the inflammatory markers and symptoms could be found. In vitro analysis showed that individual components of the stent-graft did not activate human neutrophils, whereas the intact stent-graft itself induced a marked neutrophil activation. Conclusions: The component of the self-expanding stent-graft responsible for the nonspecific inflammatory reaction was not identified in this study. It is likely that the stent-graft itself or some as yet unrecognized element of the device other than the Dacron fabric or metal alloy may be a potent in vivo inducer of cytokine reaction by neutrophils.
Peripheral Atherectomy with the Pullback Atherectomy Catheter: Procedural Safety and Efficacy in a Multicenter Trial
Authors: White Christopher J. ,   PAC Investigators
Published: March 2015

Purpose: To report the initial results of a newly designed catheter for percutaneous circumferential atherectomy in patients with lower extremity atherosclerotic occlusive disease. Methods: The Pullback Atherectomy Catheter (PAC) is an over-the-wire device that circumferentially debulks atherosclerotic lesions in peripheral arteries up to 6 mm in diameter. Pullback atherectomy with or without adjunctive balloon angioplasty was attempted in 190 patients (246 lesions) with lower extremity lesions ≤ 7.0 cm in length and a diameter stenosis > 50%. Results: Angiographic success was accomplished in 95% (234/246) of the of the lesions attempted. The baseline ankle-brachial index rose from 0.61 ± 0.20 to 0.83 ± 0.20 (p < 0.001) at 24 hours after the procedure. There were no major complications (distal emboli, dissection, thrombosis, or perforation requiring surgical correction) attributable to pullback atherectomy. Conclusions: The acute results of pullback atherectomy demonstrate an extremely high technical success rate and an excellent safety record for lower extremity percutaneous revascularization. The catheter facilitates debulking longer lesions, but it is limited to small-diameter (≤ 6 mm) peripheral vessels.
The Hydrolyser Thrombectomy Catheter: A Single-Center Experience
Authors: Henry Michel , Amor Max , Henry Isabelle , Tricoche Olivier , Allaoui Mohamed 
Published: March 2015

Purpose: To present a single-center experience with a mechanical hydrodynamic thrombectomy system (Hydrolyser) in native arteries, veins, and bypass grafts. Methods: The Hydrolyser is a 7F, double lumen, over-the-wire thrombectomy catheter. The device was used in 41 patients (22 males; mean age 68 years, range 40 to 90), with recent thromboses (aged 1 to 30 days, mean 8.7 ± 8.5), measuring from 4 to 35 cm long (mean 17.7 ± 9.5). The occlusions were located in native lower limb arteries (n = 28), bypass grafts (n = 8), superior venae cavae (n = 2), axillary vein (n = 1), and pulmonary arteries (n = 2). Results: Immediate technical success (residual clot < 50% of lumen diameter) was achieved in 34 patients (83%): 22/28 native arteries (78%), 7/8 bypass grafts (87%), and all pulmonary arteries, superior venae cavae, and the axillary vein. The 7 failed patients were treated surgically (bypass graft or Fogarty balloon). Adjunctive procedures were used to maximize luminal diameter: angioplasty (n = 29, with 13 immediate stent implantations), thromboaspiration (n = 17), and thrombolysis (n = 10). One case of distal embolism was the only complication (treated by thromboaspiration). At 30 days, 30 (73%) vessels remained patent. Conclusions: The Hydrolyser system is a promising concept for percutaneous thrombectomy. It is a quick, reliable, efficient device that may offer an alternative to thrombolysis and surgical thrombectomy.
Stenting of the Renal Artery to Improve Renal Function Prior to Thoracoabdominal Aneurysm Repair
Authors: Sullivan Timothy M. , Hertzer Norman R. 
Published: March 2015

Purpose: To report the successful staged treatment of a patient with a thoracoabdominal aortic aneurysm (TAA), who presented with renal insufficiency attributable to renal artery stenosis. Methods and Results: A 66-year-old woman with a 6-cm Crawford type IV TAA presented with uncontrolled hypertension (240/130 mmHg), worsening congestive heart failure, and progressive renal insufficiency (serum creatinine 3.8 mg/dL) caused by renal artery stenosis to a solitary functioning kidney. Renal artery stenting restored normal renal and pulmonary function, and elective TAA repair 6 weeks after percutaneous stenting was uneventful. Restenosis (50% diameter reduction) in the renal artery was found 10 months later and treated with repeat dilation. Secondary patency was maintained at follow-up 21 months after redilation. Conclusions: It appears feasible to use preliminary renal artery stenting to reduce operative risk in TAA surgical candidates with renal insufficiency secondary to renal artery stenosis.
Endovascular Grafting of a Popliteal Aneurysm Using the Saphenous Vein
Authors: Puech-Leão Pedro , Kauffman Paulo , Wolosker Nelson , Anacleto Alexandre Maiera 
Published: March 2015

Purpose: To report the successful endovascular exclusion of a popliteal aneurysm using a saphenous vein stent-graft. Methods and Results: A 1.9-cm popliteal aneurysm in a 75-year-old man was excluded by an endovascular stent-graft constructed from a segment of a greater saphenous vein to which a Palmaz stent was attached at its proximal end. The operation was performed through an open posterior approach to the distal popliteal artery. The stent-graft was introduced in retrograde fashion and passed up to the superficial femoral artery, where the proximal stent was deployed. Distally, a conventional anastomosis was performed with standard suture technique. Follow-up at 2 months shows continued exclusion of the aneurysm and patency of the bypass. Conclusions: Saphenous stent-grafting is a promising technique in the less invasive treatment of popliteal aneurysms. Further experience and longer follow-up are required before this technique can replace open surgery in clinical practice.