bluuebunny/crossref_metadata_2025_split huggingface dataset:
Acute Renal Failure after Redo Thoracoabdominal Aortic Aneurysm Repair in a Patient with a Solitary Kidney: Successful Percutaneous Treatment
Authors: Yue Robin L. , Collins Tyrone J. , Sternbergh W. Charles , Ramee Stephen R. , White Christopher J. 
Published: March 2015

Purpose: To report the successful percutaneous treatment of renal artery stenosis that precipitated renal failure following surgical repair of a thoracoabdominal aortic aneurysm (TAAA). Methods and Results: A 70-year-old woman with a solitary kidney became anuric 2 hours after urgent repair of a symptomatic true aneurysm of the Carrel patch from an 8-year-old TAAA repair. After medical treatment failed, aortography was performed, identifying complete occlusion of the solitary renal artery. Balloon dilation and implantation of a Palmaz stent restored renal perfusion and improved function. At 6-month follow-up, she was normotensive and her creatinine within normal limits. Conclusions: Renal artery stenosis or occlusion is a treatable cause of acute renal failure after TAAA repair. Percutaneous treatment options are likely to be better tolerated than surgical revascularization in this patient population.
Percutaneous Profundaplasty in the Treatment of Lower Extremity Ischemia: Results of Long-term Surveillance
Authors: Silva Jose A. , White Christopher J. , Ramee Stephen R. , Collins Tyrone J. , Jenkins J. Stephen , Sabet Sameh , Shamaileh Qasem , Vivekananthan Krishnamoorthy 
Published: March 2015

Purpose: To assess the procedural and long-term clinical outcomes of balloon angioplasty of the profunda femoris artery in patients with severe limb ischemia. Methods: Thirty-one consecutive patients were evaluated for severe ischemia in 32 limbs: 13 (41%) were categorized Fontaine class 2B, and 19 (59%) were class 3 or 4. The superficial femoral artery was occluded in 20 (62%) limbs; an additional vessel was treated in 22 (69%) limbs. Results: Procedural success was achieved in 91% (31/32) of limbs. The ankle-brachial index increased from 0.5 ± 0.2 at baseline to 0.7 ± 0.2 after intervention (p < 0.01). In-hospital limb salvage was 94% (30/32), and in-hospital event-free survival was 90% (28/31). At a mean follow-up of 34 ± 20 months, no additional amputations were necessary; 3 patients required repeat revascularization, and 5 patients died. Freedom from revascularization was 88% in the 25 survivors. At follow-up, 88% of the patients had Fontaine class 1 or 2A symptoms, and only 12% had Fontaine class 2B or higher (p < 0.001 compared with baseline). Conclusions: These data suggest that percutaneous profundaplasty is safe, effective, and may be considered as an alternative to surgical therapy in patients with anatomically suitable lesions.
Seat Belt Aorta: Endovascular Management with a Stent-Graft
Authors: Fontaine Arthur B. , Nicholls Steven C. , Borsa John J. , Hoffer Eric , Bloch Robert D. , Kohler Ted 
Published: March 2015

Purpose: To report the endovascular treatment of a relatively uncommon type of deceleration injury to the abdominal aorta. Case Report: A 21-year-old backseat passenger was wearing a single lap belt without shoulder harness when the car was involved in a collision. He sustained a transverse (Chance) fracture of the third lumbar vertebra and a circumferential dissection of the infrarenal abdominal aorta with pseudoaneurysm. As an interim measure while a stent-graft was obtained, a Wallstent was deployed to tack down the dissection and prevent distal embolization. Thirty-six hours later, an AneuRx endograft was successfully implanted inside the Wallstent to seal the pseudoaneurysm. The patient's recovery was uneventful, and the endograft remains secure and the pseudoaneurysm excluded at 10 months after the accident. Conclusions: Endovascular repair of “seat belt aorta” is a minimally invasive, straightforward method of management for this type of aortic injury. The potential for infection in a contaminated peritoneal cavity and the long-term outcome of this treatment have not been determined.
Early Clinical Experience with Color Three-Dimensional Intravascular Ultrasound in Peripheral Interventions
Authors: Irshad Khalid , Reid Donald B. , Miller Peter H. , Velu Raj , Kopchok George E. , White Rodney A. 
Published: March 2015

Purpose: To report early clinical experiences with color 3-dimensional intravascular ultrasound (3-D IVUS) in assisting peripheral interventions. Technique: A 3.5-F, 20-MHz IVUS catheter that utilizes ChromaFlo computer software to demonstrate blood flow in color was evaluated in over 100 peripheral interventions. ChromaFlo captures up to 30 conventional IVUS frames every second and generates “realtime” imaging. The software compares sequential axial IVUS images and interprets any differences in the position of echogenic blood particles, which are displayed as colorized flow in axial or 3-D renderings. Conclusions: ChromaFlo-enhanced IVUS demonstrates colorized blood flow inside the vessel lumen, which is helpful in distinguishing echolucent disease from luminal blood flow and can also be used to perform peripheral interventions in patients with renal failure or allergy, avoiding the use of contrast media.
Embolization via Collateral Circulation during Carotid Stenting with the Distal Balloon Protection System
Authors: Al-Mubarak Nadim , Vitek Jiri J. , Iyer Sriram , New Gishel , Leon Martin B. , Roubin Gary S. 
Published: March 2015

Purpose: To describe a potential route for embolization to the middle cerebral artery (MCA) during carotid stenting with the distal balloon protection system. Case Report: An 82-year-old man with symptomatic severe carotid artery stenosis underwent elective carotid stenting with distal-balloon protection. Despite complete occlusion of the distal internal carotid artery, frequent emboli were detected in the ipsilateral MCA by transcranial Doppler (TCD) during the procedure. Intracranial angiography, performed during the distal-balloon protection, revealed filling of the MCA through collaterals from the ipsilateral external carotid artery. The procedure was successfully completed without complications. The patient remains asymptomatic at 6 months. Conclusions: During carotid stenting with distal-balloon protection, asymptomatic embolization into the ipsilateral MCA may occur through collateral circulation. The clinical significance of these emboli is uncertain.
Macroporous Polyester—Covered Stent in an Experimental Abdominal Aortic Aneurysm Model
Authors: Soula Philippe , d'Othée Bertrand Janne , Otal Philippe , Amin Chauki , El Khoury Joe , Delisle Marie-Bernadette , Cérène Alain , Joffre Francis , Rousseau Hervé 
Published: March 2015

Purpose: To validate a recently described animal model of abdominal aortic aneurysm (AAA) and to assess a new macroporous polyester—covered stent for endovascular AAA exclusion. Methods: Twenty adult sheep had AAAs surgically created by replacing a segment of the infrarenal aorta with an autologous jugular venous graft. Three months later, surviving animals underwent percutaneous implantation of macroporous polyester—covered nitinol stents; 3 animals with untreated AAAs served as controls. Follow-up surveillance included spiral computed tomography at 1 month and digital subtraction angiography at 3 and 6 months. Endografted animals were sacrificed at 1, 3, and 6 months after implantation; specimens from all animals were examined grossly and microscopically. Results: Seven (35%) animals died within 24 hours of causes related to the technique; 1 animal developed paraplegia and was sacrificed on day 1. Three (25%) animals died of spontaneous aneurysm rupture at <10 days, and 6 received the stent-graft at 3 months. The macroporous cover did not prevent continued perfusion of the sac early after stent-graft deployment, but all aneurysms were excluded on the 1-month CT. Conclusions: Spontaneous AAA rupture occurred earlier and was not as frequent as previously described for this model. Implantation of the covered stent was feasible, but aneurysm exclusion was not immediate.
Evaluation of Endovascular Techniques for Creating a Porcine Femoral Artery Occlusion Model
Authors: Nikol Sigrid , Armeanu Sorin , Engelmann Markus G. , Pelisek Jaroslav , Fuchs Alexandra , Zähringer Christian , Bartoli Jean-Michel , Mesana Thierry , Rolland Pierre H. 
Published: March 2015

Purpose: To determine the optimal endovascular approach to achieve long-term occlusion of large arteries, while preserving the integrity of periarterial tissue, in an animal model of ischemia. Methods: Femoral artery occlusions were created in 16 pigs using detachable balloons, coils, or blinded stent-grafts. Feasibility, safety, primary and long-term success, and the degree of neovascularization were determined over a 6-month period by serial angiography and histological analyses. Four animals served as untreated controls. Results: Overall primary success for all occlusion devices was 100%. The 6-month occlusion rate using detachable balloons or coils was 33% and 0%, respectively; however, all arteries occluded with blinded stent-grafts remained obstructed to the end of the study. There was no significant difference in capillary densities and collateralization of periarterial areas when occluded arteries were compared with nonoccluded controls in the same animal. No increase in collateralization was observed following endovascular arterial occlusion. Conclusions: Percutaneous insertion of blinded stent-grafts easily, safely, and reliably creates long-term arterial occlusion in pigs, which may make this a more appropriate model for studying the effects of angiogenic factors in vivo.
Endovascular Repair of an Innominate Artery True Aneurysm
Authors: Puech-Leão Pedro , Orra Hussein Amim 
Published: March 2015

Purpose: To describe endovascular repair of a large aneurysm of the innominate artery in a patient with episodes of transient cerebral ischemia. Case Report: A 44-year-old man with a history of transient hemiparesis and aphasia demonstrated a large mass in the upper right hemithorax on chest radiography. Systolic brachial pressure in the right arm was 100 mm Hg versus 130 mm Hg in the left. Imaging disclosed a large 12-mm-diameter aneurysm involving the brachiocephalic trunk 1 cm above its origin and the first portion of the right subclavian artery, which was occluded after the dilated segment. The aneurysm was treated with a tapered endograft made from polyester graft attached to a Palmaz stent inserted via a carotid artery arteriotomy. The distal end of the graft was anastomosed to the common carotid artery. Completion angiography showed exclusion of the aneurysm, which has been confirmed by imaging at 21 months. After 2 years, the patient is free from neurological symptoms and has a strong carotid pulse; no arm claudication developed. Conclusions: Endovascular correction of innominate artery aneurysms is feasible whenever there is an adequate proximal neck for attachment. In these cases, thoracotomy may be avoided.
Intentional Left Subclavian Artery Occlusion by Thoracic Aortic Stent-Grafts without Surgical Transposition
Authors: Hausegger Klaus A. , Oberwalder Peter , Tiesenhausen Kurt , Tauss Josef , Stanger Olaf , Schedlbauer Peter , Deutschmann Hannes , Rigler Bruno 
Published: March 2015

Purpose: To report the consequences of endoluminal deployment of stent-grafts in the thoracic aorta with intentional occlusion of the left subclavian artery. Case Reports: Three patients with an aortic type-B dissection and 1 with a thoracic aneurysm were treated endoluminally with Talent stent-grafts implanted over the ostium of the left subclavian artery without prior surgical subclavian-carotid transposition. The primary intimal tears were sealed and the degenerative aneurysm excluded; blood pressure in the left arm was significantly diminished immediately after the stent-graft was released, but adequate collateral retrograde perfusion via the left vertebral artery was apparent in all patients. No neurological deficit and no symptoms of left arm ischemia were observed in a follow-up that ranged from 14 to 20 months. Conclusions: Our limited experience shows that occlusion of the left subclavian artery with a stent-graft is well tolerated. If ischemic symptoms occur, a transposition procedure can be performed on an elective basis.
Micromovements at the Aortic Aneurysm Neck Measured during Open Surgery with Close-Range Photogrammetry: Implications for Aortic Endografts
Authors: Flora Harpaul S. , Woodhouse Neil , Robson Stuart , Adiseshiah Mohan 
Published: March 2015

Purpose: To describe the motion of abdominal aortic aneurysm (AAA) as a first step toward determining if stent-graft migration may be due to propulsive movements at the neck. Method: In an initial laboratory validation test, a silicone AAA model was imaged with a stereo-pair configuration of calibrated digital cameras using retro-reflective and ink dot surface targets. This technique was then applied to 4 aneurysm necks imaged at open surgery. In each case the paired images were measured and analyzed to produce sequences of accurate three-dimensional (3-D) surface models of the anterior aspect of the aortic neck. Engineering techniques were used to visualize and identify differences between the generated surfaces, allowing changes in shape of the aortic wall to be determined. Results: The correlation between stereoscopic digital imaging with electronic caliper measurements of linear dimensions was accurate, irrespective of the type of surface targets used ( r2 = 0.98). The AAA neck demonstrated complex 3-D movements that ranged from 1.0 to 1.5 mm in the radial direction to 0.6 to 1.0 mm along the longitudinal axis, with a 0.44 to 0.59-mm rotational component (p < 0.05). Conclusions: This pilot study raises questions about the validity of accepted models of arterial wall movements and compliance in which rotation has not been described. The technique used to measure dynamic neck morphology appears promising as a means to further define the mechanical parameters of the human aorta, which may assist in designing stent-grafts.
Penetrating Atherosclerotic Ulcer of the Aorta
Authors: Samal Aditya K. , White Christopher J. , Kot James B. 
Published: March 2015

Purpose: To describe a case of penetrating atherosclerotic ulcer of the aorta with a review of its natural history, diagnosis and management. Case Report: An elderly patient with a history of hypertension presented to the emergency room with the sudden onset of severe chest pain radiating to the back. The electrocardiogram showed left ventricular hypertrophy; the chest radiograph revealed mediastinal widening. Computed tomography was suspicious for a mediastinal hematoma without aortic dissection. Transesophageal echocardiography was also negative for dissection. An aortogram revealed a penetrating atherosclerotic ulcer of the descending thoracic aorta. The patient underwent successful resection and repair of the lesion. Conclusions: Penetrating atherosclerotic ulcer of the aorta is a potentially lethal lesion that must be promptly diagnosed and treated.
Vibrational Angioplasty in the Treatment of Chronic Femoropopliteal Arterial Occlusions: Preliminary Experience
Authors: Michalis Lampros K. , Tsetis Dimitrios K. , Katsamouris Asterios N. , Rees Michael R. , Sideris Dimitris A. , Gourtsoyiannis Nicholas C. 
Published: March 2015

Purpose: To evaluate the safety and efficacy of vibrational angioplasty in chronic femoropopliteal arterial occlusions. Methods: Six patients (5 men; ages 52 to 84 years) with peripheral arterial occlusive disease were treated percutaneously using vibrational angioplasty to recanalize the lesion. Three occlusions ranging from 10 to 15 cm long were in the superficial femoral artery (SFA), while 3 other diffusely diseased popliteal arteries were occluded distally (length from 3.5 to 4.5 cm). Vibrational angioplasty using coronary equipment was applied to assist passage of a coronary guidewire, which was followed by conventional angioplasty. Follow-up surveillance featured periodic physical examination, ankle brachial index measurements, and duplex scanning. Results: In all 6 cases, recanalization of the occlusions was successful and without complications. The time to cross the occlusions with the wire ranged from 20 to 25 minutes for the SFA lesions and from 4 to 10 minutes for the popliteal occlusions. Two SFA occlusions were treated with stent implantation. Over a follow-up of 3 to 9 months, all treated vessels were patent. In 3 patients with skin ulcers, healing of the ulcers was observed. Conclusions: Vibrational angioplasty using coronary guidewires seems to be a promising ancillary technique in the management of chronic femoropopliteal arterial occlusions.
Recombinant Tissue Plasminogen Activator versus Urokinase for Local Thrombolysis of Femoropopliteal Occlusions: A Prospective, Randomized Multicenter Trial
Authors: Mahler Felix , Schneider Ernst , Hess Hans 
Published: March 2015

Purpose: To report the outcome of a prospective, randomized, open multicenter trial comparing (1) the effects of local thrombolysis with recombinant tissue plasminogen activator (rtPA) or urokinase (UK) and (2) 2 administration techniques. Methods: Two hundred thirty-four patients with thromboembolic occlusions in 223 native femoral or popliteal arteries (95%) and 11 bypass grafts (5%) were randomized to rtPA (n = 124) or UK (n = 110) administered either through an endhole catheter (Hess technique) in 81 patients or a microporous balloon catheter (Schneider technique) in 153 patients. When lysis was incomplete, additional catheter interventions were applied to achieve patency. Results were analyzed by fluoroscopy during intervention and by angiography evaluated by independent experts blinded to the methods applied. Results: The only significant difference between rtPA and UK was found at the end of lysis using the Hess technique. Complete reperfusion (TIMI grade 3) was produced in 60% of patients by rtPA versus 37% by UK (p = 0.045). By both techniques TIMI grade 3 was achieved in 62% with rtPA and in 50% with UK (p = 0.18). Independent of delivery technique, thrombolytic agent, or additional catheter interventions, TIMI grade 3 was achieved in 81% and angiographic patency in 88%. Primary patency at 6 months was 66%, which was increased by secondary interventions to 75%. Major amputations were performed in 6%, all in patients with initial Fontaine stage III/IV ischemia. Conclusions: With local thrombolysis alone, rtPA appears to be more effective than UK; however, additional catheter interventions further improved patency, abolishing the difference between the lytic agents.
Ultrasound and Fluoroscopic-Guided Angioplasty over the Aortic Bifurcation in a Patient with Previous Severe Reaction to Contrast Medium
Authors: Cook Christopher , Rees Michael 
Published: March 2015

Purpose: To describe a case of ultrasound and fluoroscopic-guided angioplasty necessitated by a patient history of allergic reaction to contrast medium. Case Report: A 60-year-old man with intermittent right leg claudication had a focal >70% stenosis in the right external iliac artery that was amenable to balloon dilation; however, the patient reported a severe reaction to radiographic contrast medium 10 years previously. Angioplasty was begun with transaortic access to the iliac artery lesion under fluoroscopic guidance only. On-table duplex imaging confirmed the lesion site and reference diameters for balloon selection. The balloon was filled with contrast medium to provide rapid positioning under fluoroscopy. An on-table postangioplasty duplex scan showed improvement in the lumen contour and confirmed a reduction in the peak systolic velocity. At the 1-year follow-up, the patient reports no symptoms referable to the treated segment. Conclusions: The combination of ultrasound and fluoroscopy facilitated quick and efficient balloon dilation of an isolated iliac lesion without the use of any contrast medium.
Benefits of Cerebral Protection during Carotid Stenting with the PercuSurge GuardWire System: Midterm Results
Authors: Henry Michel , Henry Isabelle , Klonaris Christos , Masson Isabelle , Hugel Michéle , Tzvetanov Kiril , Ethevenot Gérard , Le Borgne Edmond , Kownator Serge , Luizi François , Folliguet Bernard 
Published: March 2015

Purpose: To examine the possible beneficial effect of a new cerebral protection device based on balloon occlusion of the distal internal carotid artery (ICA) and debris aspiration for patients undergoing carotid artery stenting (CAS). Methods: One hundred and eighty-four CAS procedures were attempted under cerebral protection using the PercuSurge GuardWire system in 167 patients (129 men; mean age 70.5 ± 9.2 years, range 40–91)). The lesions were mainly atherosclerotic, and half (n = 93) were asymptomatic. Eighteen restenotic and 7 post-radiation stenoses were also treated. Results: Technical success was 99.5%. All lesions were stented except 3 postangioplasty restenoses. Prophylactic occlusion during balloon dilation and stenting was well tolerated in 176 (95.7%) patients. Microscopic analysis of the aspirated blood showed different types of particles numbering between 7 and 145 per procedure with a mean diameter of 250 µm (56–2652 µm). The 30-day stroke and death rate was 2.7%: 3 periprocedural complications at <48 hours (1 major stroke and 2 transient ischemic attacks), 1 intracerebral hemorrhage at 3 days, and 1 death of cardiac failure at 3 weeks. Conclusions: This study yielded a favorably low rate of periprocedural embolic events comparable with standard CAS series. Protection devices may play an important role in future carotid interventions and expand the applicability of the procedure. Randomized studies (surgery versus CAS with and without cerebral protection) are awaited.
Endovascular Treatment of Visceral Artery Aneurysms
Authors: Gabelmann Andreas , Görich Johannes , Merkle Elmar M. 
Published: March 2015

Purpose: To review a 10-year experience with endovascular embolization of visceral artery aneurysms. Methods: Twenty-five patients (13 men; mean age 52.1 years, range 31–80) presented with VAAs of varying locations and etiologies: 10 splenic, 3 gastroduodenal, 2 pancreaticoduodenal, 3 hepatic, 3 superior mesenteric, 2 celiac, 1 left gastric, and 1 jejunoileal. Ten patients were asymptomatic; 7 aneurysms were ruptured. Transcatheter coil embolization was the treatment of choice in all patients. Results: Coil placement was initially (<7 days) successful in 23 (92%) patients. One superior mesenteric artery aneurysm remained perfused, and recurrent bleeding occurred 2 days after intervention in 1 case, but repeated embolization excluded the aneurysm. One patient with necrotizing pancreatitis died from sepsis 10 days after endovascular treatment and surgery (4% 30-day mortality). Long-term follow-up revealed excellent results after an average 48.7 months (range 14–75) with only 1 recurrence after 12 months. Conclusions: Embolotherapy is the treatment of choice in visceral artery aneurysms, regardless of etiology, location, or clinical presentation.