bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical treatment of varicose veins and venous malformations in Klippel–Trenaunay syndrome
Authors: Malgor Rafael D , Gloviczki Peter , Fahrni Jennifer , Kalra Manju , Duncan Audra A , Oderich Gustavo S , Vrtiska Terri , Driscoll David 
Published: March 2015

Background Klippel–Trenaunay syndrome (KTS) is a mixed mesenchymal malformation characterised by varicose veins, venous and capillary malformations, and hypertrophy of soft tissue and bone. The purpose of this study was to evaluate the surgical outcomes in KTS patients to provide standards for comparison with endovenous therapy. Methods The clinical data of consecutive patient with KTS who underwent open venous surgical treatment between January 1987 and December 2008 were reviewed. Demographics, clinical presentation, operative data, and clinical outcomes were recorded. Follow-up information was obtained from the medical records, mailed questionnaires and phone calls. Descriptive statistics, the Kaplan–Meier method and Log-rank statistics were used where appropriate. Results Twenty-seven females and 22 males, (mean age 26.5 years, range 7.7–55.8) were included in this study. All had varicose veins, 36 (73%) had limb hypertrophy, and 33 (67%) had capillary malformations, with two of three clinical features present in all. The most frequent symptom was pain (N = 43, 88%). Forty-nine patients underwent operations on 53 limbs. Stripping of the GSV, small and accessory saphenous and lateral embryonic veins was performed in 17 (32%), 10 (19%), 9 (17%), and 15 (28%) limbs, respectively. Two patients developed deep vein thrombosis, one had pulmonary embolism (PE), and one patient had peroneal nerve palsy. Freedom from disabling pain at 1, 3 and 5 years was 95%, 77% and 59%, respectively, and freedom from secondary procedures was 78% at 3 years, and 74% at 5 years. At the last follow-up visit, the venous clinical severity score had decreased from 9.48 ± 3.27 to 6.07 ± 3.20 (P < 0.001). Conclusions In selected symptomatic patients with KT syndrome, open surgical treatment is safe and durable. Three-fourths of the patients remain free of disabling pain at five years, but secondary procedures are required in one-fourth of the patients. These data can serve as standards for comparison of endovenous therapy for KT syndrome.
Quantitative volumetric analysis of head and neck venous and lymphatic malformations to assess response to percutaneous sclerotherapy
Authors: Alexander Matthew D , McTaggart Ryan A , Choudhri Omar A , Pandit Rajul P , Wu Allison , Ross Michael , Do Huy M 
Published: March 2015

Background Venous and lymphatic malformations of the head and neck can be successfully treated with percutaneous sclerotherapy. Purpose To examine the utility of three-dimensional volumetric analysis to assess these lesions and their response to therapy. Material and Methods Prospectively maintained procedure records were retrospectively reviewed to identify all patients with vascular malformations who underwent percutaneous sclerotherapy. Clinical data were used to classify lesions by apparent size and degree of visible physical asymmetry due to the lesions. Lesion volume was calculated using magnetic resonance images. Cohen’s weighted kappa coefficients were calculated to assess both intra- and inter-rater agreement. Pearson coefficients were calculated to identify correlation between clinical and volumetric measures, both at initial diagnosis and following treatment. Results Thirty-seven patients with head and neck venous or lymphatic malformations underwent 55 treatment sessions. Cohen’s weighted kappa coefficients were 0.84 and 0.77 for intra- and inter-rater agreement, respectively. Clinical size did not significantly correlate with measured volume at diagnosis (ρ = 0.08, P = 0.57). For lymphatic malformations, total lesion volume correlated with volume of macrocystic components (ρ = 0.47, P < 0.01). Total volume reduction significantly correlated with clinical response grade (ρ = 0.46, P = 0.02). For lymphatic malformations, reduction of volume of the macrocystic component significantly correlated with clinical response grade (ρ = 0.44, P = 0.03). Conclusion Changes in calculated volume corresponded to clinical measures of treatment response. Variability of qualitative approaches to lesion analysis may have led to the lack of correlation between initial size of a lesion based on clinical measures and calculated volume. Future research should include quantitative metrics to augment qualitative clinical results.
Abnormal inhibition-excitation imbalance in migraine
Authors: Nguyen Bao N , McKendrick Allison M , Vingrys Algis J 
Published: March 2015

Background People with migraine show increased surround suppression of perceived contrast, a perceptual analogue of centre-surround antagonistic interactions in visual cortex. A proposed mechanism is that cortical ‘hyperexcitability’ or ‘hyperresponsivity’, a prominent theory in the migraine literature, drives abnormal excitatory-inhibitory balance to give increased local inhibition. The purpose of this cross-sectional study was to determine whether cortical hyperresponsivity and excitatory-inhibitory imbalance manifests in the visual cortical response of migraine sufferers. Methods Interictal steady-state visual evoked potentials (VEPs) in response to 0 to 97% contrast were recorded in 30 migraine participants (15 without aura, 15 with aura) and 21 non-headache controls. Monotonicity indices were calculated to determine response saturation or supersaturation. Contrast gain was modelled with a modified saturating hyperbolic function to allow for variation in excitation and inhibition. Results A greater proportion of migraine participants (43%) than controls (14%) exhibited significant VEP supersaturation at high contrast, based on monotonicity index (chi-square, p = 0.028). Supersaturation was also evident by the trend for greater suppressive exponent values in migraine compared to control individuals (Mann-Whitney rank sum, p = 0.075). Conclusions Supersaturation in migraine is consistent with excess excitation (hyperresponsivity) driving increased network inhibition and provides support for excitatory-inhibitory imbalance as a pathophysiological disturbance in migraine.
An Endoluminal Method of Hemorrhage Control and Repair of Ruptured Abdominal Aortic Aneurysms
Authors: Greenberg Roy K. , Srivastava Sunita D. , Ouriel Kenneth , Waldman David , Ivancev Krasnodar , Illig Karl A. , Shortell Cynthia , Green Richard M. 
Published: March 2015

Purpose: To report our initial experience with endovascular grafting to treat ruptured abdominal aortic aneurysms (AAAs). Methods: Three consecutive patients with severe comorbid illnesses and symptoms of aneurysm rupture and hemodynamic instability were treated with aortomonoiliac grafts. The Z-stent—based devices were implanted with the assistance of an occlusion balloon placed in the distal descending thoracic aorta. Results: All patients survived the procedure with successfully excluded AAAs. Two patients had relatively short hospital stays (4 and 14 days), while the third required prolonged treatment for pre-existing conditions. All patients required blood transfusions; 2 developed significant coagulopathies. Definitive management was delayed significantly by imaging protocols and graft construction. Conclusions: Endovascular repair of ruptured aortic aneurysms is feasible. Proximal aortic control is readily attainable with the use of an aortic occlusion balloon placed through the left axillary artery. The absence of a laparotomy, extensive retroperitoneal dissection, and aortic cross-clamping likely contributes to patient survival; however, the delay in operative therapy to obtain adequate imaging and construct an endograft could be a hindrance to the ultimate success of this approach. The concepts of alternative aortic imaging techniques and endograft design, construction, and storage must be addressed.
Matched-Pair Analysis of Conventional versus Endoluminal AAA Treatment Outcomes during the Initial Phase of an Aortic Endografting Program
Authors: Cohnert Tina U. , Oelert Frank , Wahlers Thorsten , Gohrbandt Bernhard , Chavan Ajay , Farber Alexander , Galanski Michael , Haverich Axel 
Published: March 2015

Purpose: To investigate whether endovascular stent-grafts implanted during the early phase of an aortic endografting program have advantages over conventional surgical procedures for treatment of infrarenal aortic aneurysm (AAA). Methods: In the first months of an endografting program, 37 patients (36 men; mean age 67.9 ± 7.1 years, range 55 to 86) underwent AAA repair with endovascular implantation of a Vanguard (n = 17) or Talent (n = 20) bifurcated stent-graft. Data collected during the perioperative period and in follow-up were compared retrospectively to a matched group of 37 elective surgical patients. Results: All endograft implantations were completed. Two type I and 6 type II endoleaks (21.6%) were seen postoperatively. Five type II sealed without intervention; 1 type I endoleak was corrected with an additional stent, but 1 type I and 1 type II endoleaks persisted despite attempts with coil embolization. Two (5.4%) endograft patients died during the perioperative period; however, this was not significantly different (p = 0.15) from the control group. In the mean follow-up of 12 ± 6 months for both groups, 1 (2.7%) late conversion was necessary at 2 years for aneurysm expansion in an endograft patient with an unsealed type I endoleak. Conclusions: In our learning curve experience with aortic endografting, postoperative morbidity and mortality were higher in endograft patients compared to conventionally treated controls. Only in the endograft group was reoperation required during follow-up. Careful monitoring with periodic imaging studies is mandatory after endoluminal AAA treatment.
Stent-Graft Treatment of a Common Carotid Artery Pseudoaneurysm
Authors: Simionato Franco , Righi Claudio , Melissano Germano , Rolli Antonio , Chiesa Roberto , Scotti Giuseppe 
Published: March 2015

Purpose: To report a case demonstrating successful endovascular treatment of a right common carotid artery pseudoaneurysm using a commercially prepared balloon-expandable covered stent. Methods and Results: A 50-year-old man was evaluated for syncopal episodes. He had a history of severe trauma sustained in a motor vehicle accident 3 years before symptom onset. Doppler ultrasound scanning detected a pseudoaneurysm at the origin of the right common carotid artery. The defect measured 25 mm × 20 mm with a 22-mm-long neck on angiography and computed tomography; there was no evidence of carotid stenosis or associated vascular pathology. Via a percutaneous femoral access, 2 Jostent peripheral stent-grafts were placed at the level of the aneurysm, safely achieving complete repair of the arterial wall defect. The patient was asymptomatic at his 12-month evaluation. Color flow duplex scans showed continued exclusion of the pseudoaneurysm. Conclusions: Wide-necked aneurysms in the extracranial carotid arteries may be treated with stent-grafts, which can achieve complete and permanent reconstruction of the arterial wall by excluding the aneurysm.
Vibrational Angioplasty and Hydrophilic Guidewires in the Treatment of Chronic Total Coronary Occlusions
Authors: Michalis Lampros K. , Rees Michael R. , Davis John A. S. , Pappa Eugenia C. , Katsouras Christos , Goudevenos John , Sideris Dimitris A. 
Published: March 2015

Purpose: To study the efficacy and safety of vibrational angioplasty versus hydrophilic guidewires for recanalizing chronic total occlusions (CTOs) of the coronary arteries. Methods: In a retrospective study, 99 patients with old (>3 months) CTOs resistant to conventional techniques were treated either with vibrational angioplasty (group A, n = 72) or 0.014-inch hydrophilic guidewires (group B, n = 27). The selection of the technique (vibrational angioplasty or hydrophylic guidewires) was dependent only upon device availability. A variety of guidewires were employed in conjunction with vibrational angioplasty. Results: The crossing success rates in groups A and B were 86.1% (62/72) and 55.5% (15/27) (p < 0.05), with final procedural success rates of 75% (54/72) and 44.4% (12/27) (p < 0.01), respectively. The main reasons for failure were inability to cross the lesion with a guidewire (10/18 in group A and 12/15 in group B) and large dissections resulting in vessel closure (2/18 in group A and 2/15 in group B). Three major complications were seen, 2 in group A and 1 in group B. Three vessel perforations were reported in group A. Both techniques needed prolonged fluoroscopy times. Conclusions: Vibrational angioplasty was more successful in treating CTOs compared to hydrophilic guidewires and had similar complication rates (most without clinical sequelae).
Symptomatic Subtotal Occlusion of the Innominate Artery Treated with Balloon Angioplasty and Stenting
Authors: Azzarone Matteo , Cento Maurizio , Mazzei Massimo , Tecchio Tiziano , Ugolotti Ugo 
Published: March 2015

Purpose: To report the endovascular treatment of a subtotal occlusion of the innominate artery giving rise to subclavian steal syndrome. Methods and Results: A 60-year-old man in general good health was admitted to the hospital for sudden onset of amaurosis in the right eye. Thrombosis of the central retinal artery was diagnosed. Physical examination, color flow duplex imaging, and aortic arch angiography showed a subtotal occlusion of the innominate artery with right subclavian steal syndrome. One month later, balloon dilation and stenting of the innominate artery was performed through a right axillary access without cerebral protection. The innominate artery was recanalized with correction of the steal syndrome and restoration of the right radial pulse; no complications occurred. Twelve months later, color flow duplex sonography confirmed innominate stent patency and antegrade flow in the right vertebral artery. Conclusions: Our experience supports the view that percutaneous endovascular techniques are appropriate and are the preferred treatment for lesions of the supra-aortic vessels. Continued surveillance will determine their long-term durability.
Vascular Response in the Femoropopliteal Segment after Implantation of an ePTFE Balloon-Expandable Endovascular Graft: An Intravascular Ultrasound Study
Authors: van Sambeek Marc R.H.M. , Hagenaars Tjebbe , Gussenhoven Elma J. , Leertouwer Trude C. , van der Lugt Aad , Hoedt Marco T.C. , van Urk Hero 
Published: March 2015

Purpose: To use intravascular ultrasound (IVUS) to document changes in vascular dimensions after placement of a balloon-expandable endograft. Methods: Thirteen patients (9 men; mean age 62 years, range 47–75) treated with an investigational polytetrafluoroethylene endograft for obstructive disease of the femoropopliteal segment were studied with IVUS immediately after endograft implantation and at follow-up. Corresponding IVUS cross sections were analyzed for changes in lumen, vessel, and plaque areas seen inside the endograft, in the anastomotic segment, and in the remote arterial segment. Results: A mean 6-month (range 1.5–9) follow-up was completed in 12 patients. Matched IVUS cross sections derived from within the endograft (n = 12) and at the endograft edges (n = 23) showed no change in lumen area (LA) in 17, reduction in 11, and dilatation in 7. Median changes within the endograft (+3%) were not significant (p = 0.28) and no neointima was found. Cross sections obtained at the anastomotic segment revealed a significant increase in LA (85%, p < 0.001), which was associated with a significant increase in both vessel area (VA) (42%, p < 0.001) and plaque area (PLA) (15%, p = 0.003) area. In the remote arterial segment, the change in LA was minimal (6%, p = 0.07), as were changes in the VA (9%, p = 0.04) and PLA (10%, p = 0.07). Conclusions: Following endograft placement, luminal changes within the endograft, at the endograft edges, and at the remote arterial segments were minimal. Intimal hyperplasia was not observed in the endograft. The distinct LA increase at the anastomotic segments was determined by the extent of VA and PLA change.
Treatment of Catheter-Induced Iliac Artery Injuries with Self-Expanding Endografts
Authors: Scheinert Dierk , Ludwig Josef , Steinkamp Herrmann J. , Schröder Malte , Balzer Joern O. , Biamino Giancarlo 
Published: March 2015

Purpose: To evaluate the efficacy of fabric-covered endoprostheses for percutaneous repair of traumatic iliac artery lesions. Methods: Among 47 patients treated for catheter-induced iliac artery injuries, 20 (42%) patients (13 men; mean age 58 ± 10 years, range 41–76) presented with acute (n = 7) or subacute (n = 13) lesions considered inappropriate for bare stent implantation (17 dissecting aneurysms, 2 perforations, and 1 traumatic arteriovenous fistula). The self-expanding Cragg EndoPro System I or Passager devices were deployed percutaneously to exclude the defects. Results: Immediate exclusion of the lesion was achieved in all 20 cases; there were no major procedural complications. However, within 24 hours after implantation, fever (n = 11, 55%) and elevations in white blood cell count (n = 10, 50%) and C-reactive protein (n = 13, 65%) were seen in the majority of patients, which prolonged hospitalization in this group (8.4 versus 4.2 days). During a median 21-month follow-up (range 5–31), 2 angiographically documented restenoses at the outlet of the endografts were treated successfully with balloon angioplasty, achieving primary and secondary patency rates of 87% and 100%, respectively. Conclusions: Early model stent-grafts provided a safe and effective endovascular treatment for iliac perforations and large arterial dissections, showing a high mid-term patency rate. However, postimplantation syndrome appears to occur frequently with this type of Dacroncovered nitinol device.
Endovascular Repair of a Presumed Aortoenteric Fistula: Late Failure Due to Recurrent Infection
Authors: Chuter Timothy A.M. , Lukaszewicz Gregory C. , Reilly Linda M. , Kerlan Robert K. , Faruqi Rishad , Sawhney Raj , Wall Susan D. , Canto Catherine , LaBerge Jean M. , Gordon Roy L. , Messina Louis M. 
Published: March 2015

Purpose: To describe a case of presumed aortoduodenal fistula that was treated by endovascular implantation of a stent-graft. Methods and Results: A 76-year-old man was transferred from another hospital where he had been treated for upper gastrointestinal hemorrhage over a 2-month period. Ten years previously, he had undergone aortobifemoral bypass, the right limb of which recently thrombosed. At the time of transfer, computed tomographic scanning showed a large false aneurysm between the aorta and the duodenum. Endoscopy disclosed mucosal erosions in the fourth portion of the duodenum. Following implantation of 2 overlapping stent-grafts, the bleeding ceased and the false aneurysm disappeared. At no time did the patient have a fever. The patient initially did well, but 8 months after treatment, he presented with fever and chills. Recurrent infection had caused erosion of the aorta so that a large portion of the stent-graft was visible from the duodenum. The infected graft and stent-grafts were removed in a two-part operation, from which the patient recovered satisfactorily. Conclusions: Endovascular stent-grafts may have a role to play in the management of aortoduodenal fistula, if only as a temporary measure to control bleeding.
Abdominal Aortic Aneurysm Rupture following Endoluminal Graft Deployment: Report of a Predictable Event
Authors: White Rodney A. , Donayre Carlos , Walot Irwin , Stewart Mark 
Published: March 2015

Purpose: To describe the predictability of an abdominal aortic aneurysm (AAA) rupture secondary to a type II endoleak following stent-graft exclusion. Methods and Results: An 81-year-old man with an enlarging AAA underwent endovascular repair using an AneuRx aortic stent-graft, but a type II endoleak fed by an accessory renal artery was detected at postprocedural computed tomography (CT). Surveillance CT scans at 6 and 16 months showed an increase in the aneurysm diameter and endoleak volume, but the patient refused advised treatment to close the leak. He suffered a fatal aneurysm rupture 24 months after endografting. Retrospective analysis of CT data documented progressive aneurysm enlargement that correctly predicted the rupture. Conclusions: Type II endoleaks can lead to aneurysm rupture. Three-dimensional (3D) spiral CT angiography offers an opportunity to track endoleak volume and the effect of exposure to systemic pressure on the aneurysm sac.
Transrenal Fixation of Aortic Endografts: Intermediate Follow-up of a Single-Center Experience
Authors: Lobato Armando C. , Quick Rhonda C. , Vaughn Paul L. , Rodriguez-Lopez Julio , Douglas Myles , Diethrich Edward B. 
Published: March 2015

Purpose: To examine the fate of the renal ostia following transrenal fixation of endovascular aortic stent-grafts. Methods: Thirty-five patients (29 men; mean age 75 years) undergoing endovascular repair for abdominal aortic aneurysms (AAAs) had transrenal fixation of the uncovered proximal stent due to a short (<1.5 cm long) or conical neck or a periprocedural endoleak. Eighteen (51%) patients were hypertensive; 7 (20%) had renal artery stenoses (RAS). Outcome measures included blood pressure, serum creatinine, computed tomography, and renal artery duplex scans. Results: Two patients with ≥60% RAS had renal stents placed during the endograft procedure; the other 5 RAS patients were normotensive and their renal lesions were not treated. Overall technical success was 82.9% (29/35). One (2.9%) case was converted due to graft twisting. There were 5 (14.2%) early endoleaks. Transient postoperative creatinine elevations were observed in 5 (14.2%) cases. Over a median 11-month period (range 2–24), no secondary endoleaks or silent renal artery occlusions were seen. One normotensive patient with an untreated ≥60% renal lesion developed hypertension and severe stenosis (99%) at 4 months; stenting through the interstices of the transrenal stent was performed. No disease progression was seen in the other 6 RAS patients. Conclusions: In the intermediate period, transrenal fixation appears to have no adverse effects on renal blood flow. Moreover, in patients with no evidence of renal disease or preoperative RAS <60%, it does not precipitate or cause progression of renal stenosis. However, patients with preoperatively documented RAS ≥60% are a concern and mandate further study.