bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortic Stent-Grafting with Transrenal Fixation: Use of Newly Designed Spiral Z-Stent Endograft
Authors: Kichikawa Kimihiko , Uchida Hideo , Maeda Munehiro , Ide Koichi , Kubota Yasushi , Sakaguchi Shoji , Nishimine Kiyoshi , Higashiura Wataru , Nagata Takeshi , Sakaguchi Hiroshi , Yoshioka Tetsuya , Ohishi Hajime , Ueda Takashi , Tabayashi Nobuoki , Taniguchi Shigeki 
Published: March 2015

Purpose: To evaluate the feasibility and efficacy of a newly designed stent-graft placed across the renal arteries for exclusion of abdominal aortic aneurysms (AAAs) with short or tortuous proximal necks. Methods: Among a group of AAA patients treated with endovascular grafting, 5 had tortuous proximal necks and 13 had necks <20 mm (mean 13 mm). In these 18 cases, a 2-to 3-cm uncovered segment of the stent-graft was placed transrenally using a catheter inserted into the renal artery as a guide for graft margin positioning. A newly designed stent-graft was constructed from a custom-made spiral Z-stent covered with a thin-walled Dacron material; the endografts were deployed through 16-F (aortoaortic model) or 18-F sheaths (bifurcated devices). Renal function was assessed by preoperative and postoperative measurement of urea nitrogen and creatinine. Aneurysm exclusion and renal artery patency were evaluated during follow-up using spiral computed tomography and angiography. Results: The stent-grafts were correctly placed at the intended site in all 18 patients. Renal function was not affected except transiently in 1 patient who developed bilateral renal artery stenoses 24 hours after the procedure; Palmaz stents were deployed in each renal artery to reestablish satisfactory blood flow. Of the 33 renal arteries crossed by the bare stent-graft segment, all were patent over a mean 14-month follow-up (range 7–24), including the patient with Palmaz stents implanted for postprocedural renal stenosis. Complete aneurysm exclusion was maintained in 15 (83%) of 18 patients; proximal leaks persisted in 3 patients, including 2 with severely angled proximal necks. Conclusions: Transrenal placement of the uncovered leading edge of custom-made spiral Z-stent—based endografts appears feasible and clinically effective in the treatment of AAAs with short or tortuous proximal necks.
A Porcine Model of Carotid Artery Thrombosis for Thrombolytic Therapy and Angioplasty: Application of PTFE Graft-Induced Stenosis
Authors: Lin Peter H. , Chen Changyi , Surowiec Scott M. , Conklin Brian , Bush Ruth L. , Chaikof Elliot L. , Lumsden Alan B. , Weiss Victor 
Published: March 2015

Purpose: To develop a porcine carotid artery thrombosis model for the evaluation of thrombolytic therapy and adjunctive angioplasty procedures. Methods: Bilateral carotid thrombosis was induced in 16 pigs using endothelial crush injury followed by external polytetrafluoroethylene (PTFE, 5 × 2 cm2) wrap placement to create segmental carotid stenosis. Light microscopy was used to examine thrombus composition. Selective carotid catheterization was performed via a femoral approach. Two hours following carotid artery occlusion, a urokinase (250,000 IU) and heparin (1000 U) solution was pulse-sprayed in 1 carotid artery while the contralateral vessel received the control saline vehicle. The efficacy of thrombolytic therapy was assessed using carotid arteriography and intravascular ultrasound. The feasibility and technical efficacy of balloon angioplasty within the carotid stenosis model were also evaluated. Results: Carotid artery occlusion occurred in 30 ± 6 minutes following endothelial injury plus PTFE wrap placement. Histological examination of carotid arteries showed endothelial irregularity with fibrin-rich and platelet-rich thrombus. Urokinase was effective in recanalizing all occluded arteries (100%), while the control saline vehicle showed no effective thrombolysis (p < 0.001). Angioplasty was successful in restoring normal diameter in all arteries (100%). Conclusions: This carotid artery thrombosis model, which incorporates intimal injury with segmental stenosis, is simple to create and reproducible. It provides not only a model for the evaluation of thrombolytic therapy but also a practical training tool for adjunctive endovascular interventions.
Endograft Exclusion of Residual Common Iliac Artery Aneurysms
Authors: Derom Alex , Vermassen Frank , Ongena Karin 
Published: March 2015

Purpose: To describe an endovascular approach for residual common iliac artery (CIA) aneurysm. Methods and Results: A residual CIA was discovered in a 73-year-old man during routine examination following straight interposition graft placement for a ruptured abdominal aortic aneurysm (AAA). An aortobifemoral bypass was performed with ligation of both aneurysmal iliac arteries. A year later, aneurysms of both CIA stumps were found. On each side, a Hemobahn stent-graft was percutaneously positioned from the external to the internal iliac artery via the superficial femoral artery. Control angiography at 2 months and spiral computed tomographic angiography at 6 and 18 months confirmed exclusion of the aneurysms and patency of the endoprostheses. Conclusions: Successful endovascular treatment of residual CIA aneurysm is possible with flexible stent-grafts.
Abciximab in Carotid Stenting for Postsurgical Carotid Restenosis: Intermediate Results
Authors: Schneiderman Jacob , Morag Benyamina , Gerniak Alexander , Rimon Uri , Varon David , Seligsohn Uri , Shotan Avraham , Adar Raphael 
Published: March 2015

Purpose: To report intermediate results of a pilot study in which the glycoprotein IIb/IIIa receptor antagonist abciximab was given to patients during percutaneous carotid stenting for recurrent internal carotid artery (ICA) stenosis. The objective was to prevent procedure-related cerebral embolic events and decrease the incidence of recurrent stenosis. Methods: Sixteen patients (9 women; mean age 66.5 years, range 39–78) with severe ICA recurrent stenosis (>80%) underwent balloon angioplasty and stenting. Before the procedure, abciximab was administered intravenously as a bolus (0.25 mg/kg) followed by a 12-hour continuous infusion (10 µg/min). Results: Fifteen patients received stents (14 Wallstent and 1 Strecker); 1 vessel was dilated with only 50% improvement in luminal diameter. Two stented arteries had residual stenosis (<30%) but satisfactory luminal diameter was achieved in the remaining 13 (81%) arteries. There were no neurological ischemic events during or following the procedure, nor were there any bleeding or peripheral vascular complications. Duplex surveillance studies up to 12 months revealed no significant recurrent stenosis in the treated vessels. Conclusions: The administration of abciximab in conjunction with percutaneous revascularization procedures for postsurgical carotid artery stenosis may reduce cerebral ischemic episodes. It may also attenuate restenosis in the treated artery.
Three-Dimensional Intravascular Ultrasound Assessment of Abdominal Aortic Aneurysm Necks
Authors: van Essen Jeroen A. , Gussenhoven Elma J. , Blankensteijn Jan D. , Honkoop Jan , van Dijk Lukas C. , van Sambeek Marc R.H.M. , van der Lugt Aad 
Published: March 2015

Purpose: To document the accuracy of an automated analysis system for measuring lumen diameter and neck lengths of abdominal aortic aneurysms (AAAs) from intravascular ultrasound (IVUS) images and to describe additional features associated with 3-dimensional (3D) IVUS imaging. Methods: Twenty-two aortic aneurysms were studied with IVUS. Lumen diameters obtained using the automated analysis system were compared with manual measurements from axial IVUS scans, as were neck lengths obtained using automated analysis versus those measured with the aid of a displacement sensing device. Automated analyses were repeated by a second observer. Agreement was expressed as the coefficient of variation (CV). Results: Twenty proximal aortic, 6 distal aortic, and 3 iliac necks were available for analysis. Comparison between automated analysis and manual measurements for lumen diameter revealed a difference of 0.45 ± 0.42 mm (mean ± SD, Pearson's r = 0.99, p < 0.001, CV = 2.1%) and a difference of 0.05 ± 0.12 cm (r = 0.99, p = 0.04, CV = 4.1%) for neck length. Interobserver difference for lumen diameter was 0.13 ± 0.66 mm (r = 0.99, p < 0.001, CV = 3.4%) and 0.05 ± 0.11 cm for length measurements (r = 0.99, p = 0.02, CV = 3.5%). The 3D IVUS imaging facilitated the identification of neck configuration. Conclusions: Automated analysis of IVUS images allows accurate measurement of the lumen diameter of proximal and distal AAA necks and gives length measurements comparable to those of manual analysis. Longitudinal display of IVUS images aids in the elucidation of neck anatomy.
A Simple Technique to Improve the Accuracy of Proximal AAA Endograft Deployment
Authors: Broeders Ivo A.M.J. , Blankensteijn Jan D. 
Published: March 2015

Purpose: To report a technique for overcoming the positioning errors caused by angulation and rotation of the proximal aortic neck when anteroposterior fluoroscopic imaging is used during endograft deployment. Technique: Aortic neck angulation and rotation were measured preoperatively using spiral computed tomographic angiography in sagittal and axial projections. Before proximal graft deployment, the proximal end of the endograft was centered in the field of view, and the position of the C-arm was adjusted to the aortic neck angulation. Using this technique, optimal positioning of the endograft relative to the true position of the renal arteries can be achieved. Conclusions: C-arm angulation and rotation is helpful in facilitating perfect positioning for an optimal seal between the endograft and the infrarenal aortic neck.
Popliteal Artery Aneurysms: Is Endovascular Reconstruction Durable?
Authors: Rosenthal David , Matsuura John H. , Clark Michael D. , Kirby Lemuel B. , Knoepp Louis F. 
Published: March 2015

Purpose: To describe an endovascular method of performing femoropopliteal in situ saphenous vein (SV) bypass and popliteal artery aneurysm (PAA) embolization. Methods: Twenty-two patients underwent PAA operations. Twelve patients had conventional SV bypasses with PAA proximal and distal ligation, whereas 10 underwent PAA embolization and an endovascular in situ SV bypass (EISB). The endovascular procedure was performed using an angioscopically guided side branch coil occlusion system. The PAAs were coil embolized under fluoroscopic surveillance. Results: No deaths or wound complications occurred in the EISB group. The mean hospital length of stay (LOS) was 2.1 days. Seven EISB procedures were performed through 2 incisions, whereas 3 operations required an additional incision. One graft occluded at 3 months. All PAAs remained occluded by color-flow ultrasonography at follow-up ranging from 4 to 23 months (mean 13.6); cumulative primary patency was 89%. In the conventional bypass group, no deaths occurred, but 3 (25%) patients had wound complications. The mean LOS was 6.2 days, and 1 graft occluded, giving an 86% cumulative primary patency at 42 months. Conclusions: This minimally invasive technique obviates an extensive incision to harvest the SV and ligate the PAA proximally and distally. If long-term endovascular bypass graft patency and PAA occlusion rates prove to be similar to open operative results, the benefits of reduced wound complications, decreased hospital LOS, and increased health care savings support further investigation of this endovascular approach for the treatment of PAA.
Hybrid Open-Endoluminal Technique for Repair of Thoracoabdominal Aneurysm Involving the Celiac Axis
Authors: Lawrence-Brown Michael , Sieunarine Kishore , van Schie Greg , Purchas Stephen , Hartley David , Goodman Marcel A. , Prendergast Frank J. , Semmens James B. 
Published: March 2015

Purpose: To describe a technique combining endoluminal and open approaches for the repair of thoracoabdominal aneurysms involving the celiac axis. Case Report: Two patients with type I thoracoabdominal aneurysm and suboptimal cardiac reserve underwent transluminal stent-graft implantation. To achieve satisfactory distal seal, the caudal end of the endograft was circumscribed with a Dacron band that was sutured to the aorta and endograft through a midline incision. The patent celiac artery in both patients was ligated to stop retrograde filling of the aneurysm sac. The patients developed no problems perioperatively, and exclusion of the aneurysms was confirmed by follow-up imaging. Three years after endografting, both patients had excluded aneurysms without evidence of endoleak or device migration. Conclusions: This combined approach is another treatment option for thoracic aneurysms that have an anatomically suitable proximal attachment zone with a compromised distal neck.
Endoluminal Aortic Grafting with Renal and Superior Mesenteric Artery Incorporation by Graft Fenestration
Authors: Anderson John Lennon , Berce Michael , Hartley David E. 
Published: March 2015

Purpose: To explore the use of juxta- and suprarenal aortic segments for endograft fixation in abdominal aortic aneurysm (AAA) patients and to develop methods of graft implantation that use endograft fenestrations to preserve renal and visceral vessel perfusion. Methods: From August 1998 to May 2000, 13 AAA patients with unsuitable infrarenal aortic necks were treated with custom-designed endovascular grafts employing the juxta- and suprarenal aortic segments for proximal sealing. Flow to 33 renal and superior mesenteric arteries was maintained via graft fenestrations that were aligned by use of radiopaque graft markers. The fenestration-orifice interface for renal arteries was secured with modified balloon-expandable stents. Results: All fenestrated grafts were deployed as planned, and all target vessels (33/33) were preserved. Two patients did not receive any stents, one being the first in the series and another who had incorporation of a renal accessory artery only. Without the use of transgraft stenting, 5 renal arteries would have been occluded by the endograft or poorly perfused. Procedural success was 100%. No conversion to open operation or graft-related complications occurred. There was no primary endoleak in any patient by angiographic criteria. Two patients required additional surgical procedures related to access vessels. Periprocedural mortality at 30 days was nil. Follow-up ranging from 3 to 24 months on all patients has not demonstrated any proximal or distal endoleaks. One stented renal vessel has occluded; all other arteries remain patent at last examination. Conclusions: This study has demonstrated the ability to successfully place a multifenestrated endoluminal graft in an aortic aneurysm using juxta- and suprarenal aortic segments to obtain a satisfactory seal. Stenting of the fenestration—renal ostium junction has helped to maintain renal patency.
“Accordion” Deformity of a Tortuous External Iliac Artery after Stent-Graft Placement
Authors: Quinn Stephen F. , Kim Jinho , Sheley Robert C. , Frankhouse Joseph H. 
Published: March 2015

Purpose: To identify a complication of endograft deployment in aneurysmal iliac arteries. Case Report: A 71-year-old man was referred for endovascular treatment of a 60-mm diameter right common iliac artery aneurysm; however, deployment of a homemade covered stent (Palmaz-Schatz and polytetrafluoroethylene) induced shortening of the tortuous external iliac artery, causing an “accordion” deformity. The anomaly proved difficult to treat with serial Wallstent deployment, because the convolution tightened and migrated caudally with each stent deployed, threatening outflow. Finally, after 3 Wallstents were implanted, the contour of the external iliac artery was straight, and flow was unimpeded. However, 3 weeks later, the external iliac artery had recoiled to its original redundant appearance, but flow remained satisfactory. The aneurysm remains excluded, with satisfactory distal flow after 24 months. Conclusions: Implanting endografts in redundant, tortuous arterial segments may prove problematic, since induced straightening by the device precipitates kinking in the redundant system. Although treatment may be required in some situations, the vessels may return to a noncompressed state by removing the delivery system and guidewire.
Use of a Balloon-Expandable, Radially Reinforced ePTFE Endograft after Remote SFA Endarterectomy: A Single-Center Experience
Authors: Heijmen Robin H. , Teijink Joep A.W. , van den Berg Jos C. , Overtoom Tim Th.C. , Pasterkamp Gerard , Moll Frans L. 
Published: March 2015

Purpose: To report our experience with endovascular femoropopliteal bypass grafting using a distensible, radially reinforced polytetrafluoroethylene endograft combined with remote endarterectomy. Methods: Forty-one patients (33 men; mean age 70 years, range 45–79) with symptomatic femoropopliteal occlusive disease underwent remote endarterectomy of the superficial femoral artery (SFA) followed by implantation of a balloon-expandable Enduring endovascular graft. All patients entered an extensive surveillance program, including angiography and duplex scanning at regular intervals. Results: Endarterectomy and endograft implantation were ultimately successful in all patients; 5 (12%) technical difficulties occurred intraoperatively and were treated with additional endovascular techniques. Control angiography at 1 week postoperatively demonstrated a patent endograft in 39 (95%) patients. Mean ankle-brachial index increased significantly from 0.57 to 0.91 (p < 0.001). Including the 2 early failures, 18 occlusions were documented over a median 15-month follow-up (range 3–24), due mainly to significant stenosis at the proximal and distal anastomoses. In 8 of 10 successfully reopened and revised endografts, reocclusion occurred after a median interval of only 1.8 months. Life-table analysis revealed cumulative primary and secondary patency rates of 42% and 56%, respectively, at 18 months. In the last 12 cases, the proximal end of the graft was sutured end-to-end to the transected SFA, which improved the short-term secondary patency rate to 83%. Conclusions: Insertion of the Enduring endovascular graft following remote endarterectomy effectively results in a less invasive treatment for femoropopliteal occlusive disease. Additional technical refinements of the procedure may be required to avoid early procedure-and graft-related failures.
Quality of Life Assessment in Patients Undergoing Endovascular or Conventional AAA Repair
Authors: Aquino Rainier V. , Jones Mildred A. , Zullo Thomas G. , Missig-Carroll Nita , Makaroun Michel S. 
Published: March 2015

Purpose: To compare health-related quality of life outcomes in a cohort of abdominal aortic aneurysm (AAA) patients treated concurrently with either a conventional or endoluminal intervention. Methods: Between December 1997 and April 1999, 51 AAA patients treated by either open or endovascular techniques were enrolled in this prospective study. Conventional therapy was performed in 26 patients (19 men; mean age 70.4 ± 6.0 years) with anatomical features unsuitable for the endovascular approach. Twenty-five patients (23 men; mean age 70.7 ± 7.2 years) underwent endoluminal AAA exclusion using either the Ancure or bifurcated Enduring stent-grafts. The Medical Outcomes Study Short-Form 36-item health survey was administered preoperatively and at 1, 4, 8, and ≥52 weeks after discharge. Results: At 1 week, both groups showed significant reductions (p < 0.001) in mean scores compared to baseline in 4 dimensions (physical function, social function, role-physical, and vitality), but the decline was more pronounced in patients having open repair. Endoluminal patients returned to their baseline scores by the 4th postoperative week, whereas complete recovery to baseline in the conventional patients was delayed to the 8th week. Conclusions: Patients treated endoluminally exhibit better physical and functional scores as early as 1 week after discharge; they also return to baseline status significantly earlier than the conventional group. These findings document the perceived advantage of endovascular therapy over conventional AAA treatment.
Endovascular Repair of Occluded Subclavian Arteries following Penetrating Trauma
Authors: Strauss Dirk C. , du Toit Danie F. , Warren Brian L. 
Published: March 2015

Purpose: To describe the endovascular repair of 2 subclavian arteries occluded due to penetrating trauma. Case Reports: Two male patients were admitted with zone-I neck stab wounds. Both were hemodynamically stable and had absent pulses in the ipsilateral upper limb with decreased Doppler pressures. There were no signs of critical ischemia or active bleeding. On arteriography, complete occlusion of the second segment of the left subclavian arteries in both patients was demonstrated. Stent-graft repair and embolectomy under local anesthesia were successfully performed. No procedure-related complications occurred, and both patients were discharged after 2 days. At 1-year follow-up, stent-graft patency was demonstrated in both patients. Conclusions: Endovascular repair is a feasible and safe option in the management of occluded subclavian arteries due to penetrating trauma. This may represent another indication for stent-grafting in the expanding role of this technique.
Carotid Artery Stenting: Effect of Learning Curve and Intermediate-Term Morphological Outcome
Authors: Ahmadi Ramazanali , Willfort Andrea , Lang Wilfried , Schillinger Martin , Alt Elisabeth , Gschwandtner Michael E. , Haumer Markus , Maca Thomas , Ehringer Herbert , Minar Erich 
Published: March 2015

Purpose: To assess the impact of learning on the rate of success and complications of carotid stenting in a single-center, one-operator series and prospectively follow a patient cohort with regard to restenosis. Methods: In 303 patients (mean age 70 ± 8.8 years), 320 internal carotid arteries (ICA) were treated with carotid stenting for stenoses ≥70%. Four groups of 80 consecutive interventions were compared with regard to primary technical success and periprocedural complications. Stent patency in follow-up was assessed using duplex scanning. Results: Stenting was successful in 298 (93%) arteries. The combined neurological complications (transient ischemic attacks and all strokes) and 30-day death rate was 8.2% (n = 25), but the all stroke and 30-day death rate was 3.0% (n = 9). A significant reduction in the frequency of neurological complications after the initial 80 interventions was observed (p = 0.03), but technical success was not appreciably improved with increasing experience thereafter. Over a median 12 months (interquartile range 6 to 24), cumulative patency rates were 91%, 90%, and 91% at 6, 12, and 36 months, respectively. Conclusions: Elective carotid stenting can be performed with excellent technical success, an acceptable frequency of periprocedural complications, and good intermediate-term patency. However, our findings suggest that a larger number of interventions should be performed to overcome the negative effects of the initial learning phase.