bluuebunny/crossref_metadata_2025_split huggingface dataset:
Open Subintimal Angioplasty of the Superficial Femoral and Distal Arteries
Authors: Balas Panagiotis , Pangratis Nicolas , Ioannou Nikos , Milas Photis , Klonaris Christos , Masouridou Efi 
Published: March 2015

Purpose: To describe an open approach to subintimal angioplasty. Technique: Through a subinguinal incision and arteriotomy over the superficial femoral artery origin, the opening of a subintimal channel is created surgically. The subintimal plane is advanced distally with a guidewire, and this neolumen is expanded with sequential balloon dilations. The atherosclerotic core is dissected proximally in the common femoral artery and tacked down to ensure inflow. A patch graft closes the arteriotomy. Conclusions: Open subintimal angioplasty is a simple, minimally invasive alternative treatment for complete SFA occlusion. Long-term follow-up in a large group of patients will be necessary to determine the durability of the false arterial lumen.
First-Generation Aortic Endografts: Analysis of Explanted Stentor Devices from the EUROSTAR Registry
Authors: Guidoin Robert , Marois Yves , Douville Yvan , King Martin W. , Castonguay Martin , Traoré Amidou , Formichi Maxime , Staxrud Lars Erik , Norgren Lars , Bergeron Patrice , Becquemin Jean-Pierre , Egana Jose M. , Harris Peter L. 
Published: March 2015

Purpose: To examine the structure and healing characteristics of chronically implanted Stentor endografts that were explanted due to migration, endoleak, thrombosis, or aneurysm expansion. Methods: The devices were harvested following reoperation (n = 5) or autopsy (n = 1) with implantation times ranging from 13 to 53 months. Structural modifications to the metal components were examined using radiography, endoscopy, and magnetic resonance imaging (MRI). Specimens taken from components of the modular stent-grafts were examined histologically and with scanning electron microscopy (SEM) to assess healing behavior. Physical and chemical stability of the nitinol wires and woven polyester graft material was evaluated using SEM and electron spectroscopy for chemical analysis. Results: Although the endografts were retrieved for a variety of reasons, they exhibited similar healing and structural modifications. The woven polyester sleeve showed evidence of yarn shifting and distortion, yarn damage, and filament breakage leading to the formation of openings in the fabric. The luminal surface endografts showed incomplete healing characterized by a poorly organized, nonadherent thrombotic matrix of variable thickness. Radiographic and endoscopic observations indicated that structural failure of the grafts, particularly in the main aortic component, was related to severe compaction and dislocation of the metallic frame due to suture breaks. Corrosion marks were observed on some nitinol wires in all devices. Chemical analysis and ion bombardment of the nitinol wires revealed that the surface concentrations of titanium and nickel were not homogenous. The first layer was composed of carbon or organic elements, followed by a stratum of highly oxidized titanium with a low nickel concentration; the titanium-nickel alloy lay beneath these layers. Conclusions: Although the materials selected for construction of endovascular grafts appears judicious, the assembly of these biomaterials into various interrelated structures within the device requires further improvement.
Cerebrospinal Fluid Drainage to Reverse Paraplegia after Endovascular Thoracic Aortic Aneurysm Repair
Authors: Tiesenhausen Kurt , Amann Wilfried , Koch Günter , Hausegger Klaus A. , Oberwalder Peter , Rigler Bruno 
Published: March 2015

Purpose: To report a case of endovascular descending thoracic aortic aneurysm (TAA) repair in which delayed-onset paraplegia was reversed using cerebrospinal fluid (CSF) drainage. Methods and Results: A 74-year-old patient with a 6.0-cm TAA underwent endovascular stent-graft repair that involved overlapping placement of 3 Talent devices to cover the 31-cm-long defect. Twelve hours later, a neurological deficit occurred manifesting as left leg paralysis with paresis on the right. After urgent intrathecal catheter placement and drainage of cerebrospinal fluid for 48 hours, the neurological deficit resolved. The patient's clinical condition was normal and endoluminal exclusion of the TAA remained secure at 8-month follow-up. Conclusions: This case demonstrates the potential therapeutic role for CSF drainage to reduce the complications of spinal cord injury after endovascular thoracic aneurysm repair.
Aortic Aneurysm Size and Graft Behavior after Endovascular Stent-Grafting: Clinical Experiences and Observations over 3 Years
Authors: Schunn Christian D. , Krauss Martin , Heilberger Peter , Ritter Wolfgang , Raithel Dieter 
Published: March 2015

Purpose: To assess the long-term safety and efficacy of aortic endografts in terms of clinical outcome, continuing aneurysm exclusion, and changes of aneurysm size and graft configuration. Methods: Between August 1994 and July 1997, 190 patients (176 men; mean age 68.7 years, range 40–87) with aortic and aortoiliac aneurysms were treated with endovascular stent-grafts (Stentor, Vanguard, and EGS) in a tertiary care municipal hospital setting. Follow-up involved clinic visits every 3 to 6 months with contrast-enhanced computed tomography (CT), color duplex, and plain abdominal radiographs at regular intervals; angiography was used selectively. All data were collected prospectively and entered into a computerized database. Results: Implantation was possible in 188 (98.9%) patients. Early conversion to open surgical repair was required in 14 (7.4%) patients. Primary endoleaks were detected in 32 (16.8%) patients. Perioperative mortality was 0.53% (1/190). During follow-up, 17 (8.9%) additional patients were converted to open repair over a mean 20.9 months. Thirty-seven secondary procedures to treat endoleaks and pelvic outflow occlusions were performed in 30 (15.8%) patients. Changes in stent configuration suggestive of endograft disintegration were observed in 31 (29.8%) of 104 abdominal radiographs. Intraluminal layering of thrombus was seen on contrast-enhanced CT images in 20 patients. A significant trend (χ24 = 12.34, p < 0.025) toward aneurysm enlargement was seen in patients with persistent endoleaks at a mean 18-month follow-up. Conclusions: Although endoleaks after aortic stent-graft placement tend to cause ongoing aneurysm growth, we have also observed aneurysm shrinkage despite ongoing endoleak. The presence or absence of an endoleak in itself may be a poor predictor of successful stent-graft therapy. Lifelong surveillance is needed to assure successful aneurysm exclusion and stability or shrinkage of the aneurysm sac. Technical improvements in stent materials and design are necessary to guarantee long-term stability and safety of the device.
Can Preoperative Spiral CT Scans Alone Determine the Feasibility of Endovascular AAA Repair? A Comparison to Angiographic Measurements
Authors: Shin Chung K. , Rodino William , Kirwin Jon D. , Wisselink Willem , Abruzzo Fredrick M. , Panetta Thomas F. 
Published: March 2015

Purpose: To determine whether computed tomography (CT) alone can be used for excluding patients from endovascular repair for abdominal aortic aneurysms (AAA). Methods: Among 71 patients evaluated for endovascular AAA repair using spiral CT imaging and angiography, 31 were selected who had both studies performed within 6 months of each other using a graduated measuring catheter or guidewire. Measurements of aneurysm neck diameter, neck length, and infrarenal aortic length were made from the CT and angiographic images using handheld calipers with calibration markers as guides. Infrarenal aortic length and neck length were determined from CT images by multiplying the width of the cuts by the number of slices between the lowest renal artery and the aortic bifurcation or the top of the aneurysm, respectively. Results: CT neck diameter measurements differed significantly from the angiographic dimensions (6.3 ± 5.1-mm mean difference, p < 0.001). In the majority of patients (25, 81%), CT neck diameters were larger (mean 7.3 ± 3.8 mm). The mean difference in neck length measurements was 0.5 ± 15.9 mm (p = NS). Twenty-two (71%) patients had aortic length measurements that were longer on the angiogram (mean 15.4 ± 17.2 mm, p = NS). Five patients who would have been excluded as candidates based on overestimated CT neck diameter measurements subsequently underwent successful endovascular aneurysm repair. Conclusions: Considerable discrepancies exist between preoperative neck diameter and infrarenal aortic length measurements obtained from CT scans and angiograms used to evaluate candidates for endovascular aortic aneurysm repair. CT alone may not be adequate for predicting the feasibility of endovascular AAA repair.
A Narrow-Waisted Abdominal Aortic Aneurysm Complicating Endovascular Repair
Authors: Heijmen Robin H. , Nolthenius Rudolf P. Tutein , van den Berg Jos C. , Overtoom Tim Th.C. , Moll Frans L. 
Published: March 2015

Purpose: To present a case in which a narrow waist in an abdominal aortic aneurysm (AAA) complicated endovascular repair using a modular bifurcated stent-graft. Methods and Results: A 68-year-old man underwent endovascular repair of a 5.9-cm asymptomatic AAA with a self-expanding modular bifurcated stent-graft. After insertion and deployment of the stent-graft, the intraoperative completion angiogram disclosed unexpected incomplete deployment of the contralateral iliac limb due to a narrow waist in the aortic aneurysm. Subsequent angioplasty did not increase iliac stent-graft diameter. At follow-up, a tapered course of the contralateral iliac leg persisted, without hemodynamic significance. Conclusions: A narrow waist in an AAA may be considered an additional important anatomical characteristic in assessing suitability for endovascular repair.
Endovascular Treatment of Atherosclerotic Lower Limb Lesions Using a PTFE-Collared Stent-Graft
Authors: Lundquist Per Birger , Kalin Bo , Olofsson Pär , Swedenborg Jesper 
Published: March 2015

Purpose: To assess the feasibility of a polytetrafluoroethylene-collared (PTFE) endoluminal graft in the treatment of lower limb atherosclerosis. Methods: We designed an endograft using a 3-mm-diameter balloon-expandable PTFE graft with terminal Palmaz stents placed on the outside of the graft, folding the PTFE back over the stents to form a collar at each end. Under protocol, this device was implanted in 8 symptomatic patients with lower limb ischemia. The lesions, ranging from 4 to 20 cm long, were located in the superficial femoral artery (n = 5), femoropopliteal segment (n = 1), and common (n = 1) and external (n = 1) iliac arteries. The device required a 14-F introducer system. Results: Graft lengths varied from 4 to 35 cm. Implantation was successful in all cases, but procedural complications occurred in 4 patients (2 access site hematomas, 1 leading to endograft occlusion; 1 arterial injury, and 1 distal thromboembolism). At a mean 14-month follow-up, 5 endografts were patent (2 after reintervention for restenosis or thrombosis). The common iliac endograft and 2 superficial femoral artery devices occluded after 3, 2, and 12 months, respectively. Conclusions: Although this endoluminal graft system is technically feasible and showed encouraging intermediate-term patency in a small pilot study, the early and late complications identified several shortcomings of this design, which needs refinement.
Stent-Graft Treatment for Bleeding from a Presumed Aortoenteric Fistula
Authors: Grabs Anthony J. , Irvine Craig D. , Lusby Robert J. 
Published: March 2015

Purpose: To describe a technique for the endovascular treatment of aortoenteric fistula. Methods and Results: A 67-year-old man who had undergone aortobi-iliac grafting for aneurysmal disease 8 years previously presented with life-threatening upper gastrointestinal hemorrhage. Endoscopy after resuscitation did not identify the source of the bleeding. Computed tomographic (CT) scanning and angiography revealed pseudoaneurysm formation at the upper anastomosis 1 cm below the renal arteries. Measurements were taken for endovascular repair. Uncomplicated emergency aortic endografting for exclusion of the pseudoaneurysm was performed using a 28-mm × 3.75-cm AneuRx device. Gastrointestinal hemorrhage ceased. CT scanning at 6 months confirmed the absence of a pseudoaneurysm, and the patient remains symptom free at 18 months. Conclusions: Endovascular treatment of aortoenteric fistula may represent a technique for treating gastrointestinal hemorrhage and for lessening the morbidity and mortality of open repair.
Endovascular Repair of an Innominate Artery False Aneurysm following Blunt Trauma
Authors: Axisa Benedict M. , Loftus Ian M. , Fishwick Guy , Spyt Tom , Bell Peter R. F. 
Published: March 2015

Purpose: To describe a case of endovascular graft exclusion of an innominate artery pseudoaneurysm arising from blunt trauma. Methods and Results: A 21-year-old patient was admitted following a major road accident. Computed tomography (CT) and aortography on admission disclosed an isolated innominate artery pseudoaneurysm. The lesion was stable, so an elective endoluminal repair was undertaken once the patient was treated for his other injuries. The right carotid artery was exposed and controlled, and the aneurysm was excluded by transluminal implantation of a customized stent-graft consisting of predilated polytetrafluoroethylene graft material covering a balloon-expandable Palmaz stent. A CT scan at 1 month and duplex scans at 6-month intervals documented good stent-graft positioning and aneurysm exclusion over a period of 18 months. Conclusions: This case illustrates the potential durability of endoluminal repair of innominate artery lesions and highlights the potential role of this minimally invasive alternative to surgery in these clinical situations.
Aortic Stent-Grafts in Patients with Renal Transplants
Authors: Sawhney Rajiv , Chuter Timothy A. M. , Wall Susan D. , Reilly Linda M. , Kerlan Robert K. , Canto Catherine J. , Jean-Claude Jessie , Faruqi Rishad M. 
Published: March 2015

Purpose: To report the endovascular treatment of abdominal aortic aneurysms (AAA) in 2 patients with pelvic renal transplants. Methods and Results: Two men with multiple comorbidities and pelvic transplant kidneys underwent endovascular AAA repair using an aortomonoiliac system with femorofemoral bypass grafting. The arterial end-to-side anastomosis in both patients was to the external iliac artery. Tapered aortomonoiliac grafts were fashioned from Gianturco Z-stents covered with Dacron graft material and implanted with the distal attachment site in the iliac system ipsilateral to the transplant kidney arterial anastomosis. The body of the stent-graft was reinforcement with a Wallstent in each case before the contralateral common iliac artery was occluded and the cross-femoral bypass constructed. Both patients recovered uneventfully from the procedure and are free of endoleak or other complications related to their aneurysm repair at 7 and 34 months. Conclusions: The presence of a pelvic renal transplant in a patient undergoing endovascular AAA repair increases the complexity of procedural planning and endograft implantation, but a good outcome can be achieved.
Safety and Efficacy of High-Dose Adenosine-Induced Asystole during Endovascular AAA Repair
Authors: Kahn Ronald A. , Moskowitz David M. , Marin Michael L. , Hollier Larry H. , Parsons Richard , Teodorescu Victoria , McLaughlin Maryanne 
Published: March 2015

Purpose: To assess the safety and efficacy of high-dose adenosine administration to increase the precision of endovascular abdominal aortic aneurysm (AAA) repair using a balloon deployed stent-graft. Methods: From January 1997 to March 1999, 98 AAA patients (79 men; mean age 71 years, range 62–91) were treated with balloon-expandable stent-grafts under an approved protocol. After placing a temporary transvenous ventricular lead or an external transthoracic pacing electrode, adenosine (24 mg initially) was administered in an escalating dose fashion to induce at least 10 seconds of asystole, during which the proximal stent was expanded. Results: Adenosine dosages ranged from 24 to 90 mg (median 24 mg). Nine (9.2%) self-limiting cardiac events were observed: 2 (2.0%) episodes of transient myocardial ischemia, 2 (2.0%) cases of atrial fibrillation requiring cardioversion, 1 (1.0%) transient left bundle branch block lasting <10 seconds, and 4 (4.1%) prolonged periods of asystole requiring temporary pacemaker activation. There were no cases of bronchospasm or worsening obstructive pulmonary disease, and no patients required inotropic support after adenosine-induced asystole. Conclusions: Cardiac events following adenosine-induced asystole are infrequent, mild, and easily treated. The perioperative use of high-dose adenosine to ensure precise stent-graft placement appears to be a safe method of inducing temporary asystole during endovascular aortic repair.
Embolization of Type II Endoleaks Fed by the Inferior Mesenteric Artery: Using the Superior Mesenteric Artery Approach
Authors: Görich Johannes , Rilinger Norbert , Sokiranski Roman , Krämer Stefan , Schütz Ansgar , Sunder-Plassmann Ludger , Pamler Reinhard 
Published: March 2015

Purpose: To evaluate the use of a superior mesenteric artery (SMA) approach to embolize type II endoleaks arising from the inferior mesenteric artery (IMA). Technique: When reperfusion of the aneurysmal sac via the SMA occurs through the IMA, as shown by computed tomography (CT) and angiography, the IMA origin can be accessed via the marginal artery or the anastomosis of Riolan. The SMA is catheterized with a 5-F catheter, and a coaxial catheter is advanced to the leak to deliver 2- to 8-mm-diameter minicoils to embolize the IMA origin and entire aneurysmal sac. Embolization usually requires from 1 to 2 hours to complete. In our experience with this technique in 11 cases, complications have not occurred, and there has been only one very small residual leak that sealed the next day. Over a 24.5-month follow-up (range 12–39), the endoleaks have remained sealed according to serial color duplex scans. Conclusions: Successful percutaneous treatment of type II endoleak due to IMA inflow can be accomplished using an SMA access via the Riolan anastomosis or marginal artery. The procedure appears to be safe and has no adverse effects.
Endovascular in Situ Bypass Decreases Morbidity and Hospital Stay following Infrainguinal Arterial Reconstruction
Authors: Nelson Peter R. , Arous Elias J. 
Published: March 2015

Purpose: To report the early results of endovascular in situ saphenous vein bypass (EISVB) using side branch coil occlusion. Methods: Between September 1997 and November 1998, 25 patients (15 men; mean age 70.9 years, range 53–85) with lower limb ischemia were treated with endovascular femorodistal bypass. The saphenous vein was prepared using retrograde valvulotomy and endoscopic cannulation with coil occlusion of the side branches. Duplex graft surveillance was performed at 1, 3, 6, and 12 months. Results: The 25 EISVB procedures consisted of 15 femorodistal popliteal, 7 femorotibial, 2 femoroperoneal, and 1 femorodorsalis pedis in situ saphenous vein reconstructions. Mean operative time was 202 ± 40 minutes, mean number of side branch coils per case was 5.1 ± 1.3, and mean number of incisions per case was 2.9 ± 0.6. Mean hospital length of stay (LOS) was 35 ± 13 hours (1.4 ± 0.6 days); 19 (76%) patients were discharged on the first postoperative day. Short-term follow-up (mean 6.2 months, range 2–15) was notable for 2 graft thromboses and 1 graft stenosis; primary and secondary patency rates were 88% and 92%, respectively. Three asymptomatic, persistent arteriovenous fistulas discovered on routine duplex were ligated in the outpatient setting. Only 1 (4%) minor wound complication was encountered. Conclusions: EISVB provides early patency comparable to conventional in situ infrainguinal bypass. Its distinct advantages, however, are the ability to minimize incision length with resultant reductions in wound-related complications, hospital LOS, and recovery time. EISVB promises to be a useful adjunct in the approach to peripheral vascular insufficiency.
Intravascular Ultrasound Assessment of Iliac Stent Procedures
Authors: Navarro Felipe , Sullivan Timothy M. , Bacharach J. Michael 
Published: March 2015

Purpose: To determine whether intravascular ultrasound (IVUS) is more sensitive in identifying incomplete stent deployment or mechanical disruption compared to angiography. Methods: Over a 9-month period, 44 patients (25 men; mean age 63 years, range 36–88) treated for common or external iliac artery stenoses with balloon angioplasty and stenting underwent IVUS interrogation following completion arteriography. Results: One hundred nine stents were deployed in the 44 patients. Of these, 29 (27%) stents (in 45% of patients) were found by IVUS to be incompletely deployed or to have an associated mechanical disruption despite a normal completion arteriogram. Further treatment (repeat dilation or additional stenting) was performed in 28 cases; 1 hemodynamically insignificant dissection was not treated. Twenty-six (93%) of these interventions were successful as determined by IVUS; 2 underexpanded stents did not respond to redilation. Conclusions: Incomplete stent deployment or mechanical problems associated with stenting were common in this study, occurring in nearly half of the patients. IVUS has clinical utility in identifying incomplete deployment or mechanical problems in stents with an increased sensitivity compared to contrast angiography.
Stent Implantation for Mesenteric Bypass Graft Stenosis
Authors: Phipp Laura H. , Scott D. Julian , Kessel David , Robertson Iain 
Published: March 2015

Purpose: To present a case of symptomatic mesenteric bypass graft stenosis treated with Palmaz stent implantation. Methods and Results: A 65-year-old man with a history of mesenteric ischemia and superior mesenteric artery (SMA) occlusion presented with recurrent symptoms 3 years after Dacron graft revision surgery for occlusion of a venous aorto-SMA bypass graft. Graft thrombectomy revealed a tortuous segment of narrowed graft proximally, and a Palmaz stent was deployed across the defect. Adequate flow was restored through the conduit, and the patient has remained asymptomatic for 2 years. Conclusions: Mesenteric ischemia is a rare and potentially fatal condition requiring major vascular intervention. Revision surgery may be avoided by angioplasty and stent insertion across flow-limiting stenoses, even in prosthetic grafts.
Emergency Stent-Graft Repair of a Ruptured Hepatic Artery Secondary to Local Postoperative Peritonitis
Authors: Bürger Thomas , Halloul Zuhir , Meyer Frank , Grote Reinhard , Lippert Hans 
Published: March 2015

Purpose: To describe the use of a stent-graft for emergent repair of life-threatening hepatic artery hemorrhage. Methods and Results: A 57-year-old man with a 17-year history of myxoid liposarcoma underwent surgery for a recurrent abdominal mass. Multivisceral resection including a Kausch-Whipple procedure with an extended right hemicolectomy was performed. Three weeks later, an episode of gastrointestinal bleeding prompted surgical repair of the hepatic artery, which had been eroded by infection due to a leaking bilioenteric anastomosis. After 3 weeks of programmed abdominal lavage, bleeding recurred. Angiography documented another rupture of the proximal hepatic artery. After an unsuccessful attempt at coil embolization, a Hemobahn stent-graft was implanted percutaneously during simultaneous cardiopulmonary resuscitation. Hemostasis was secured, and the patient recovered. Over the 10-month follow-up, no bleeding or infection has been observed at the site of the repair, and flow through the hepatic artery endograft remains satisfactory. Conclusions: Percutaneous stent-graft placement can be employed for emergent treatment of visceral artery rupture in patients at high risk for conventional surgical repair.