bluuebunny/crossref_metadata_2025_split huggingface dataset:
Technological Advances in the Design of Catheters and Devices Used in Renal Artery Interventions: Impact on Complications
Authors: Zeller Thomas , Frank Ulrich , Müller Christian , Bürgelin Karlheinz , Schwarzwälder Uwe , Sinn Lutz , Horn Barbara , Roskamm Helmut , Neumann Franz-Josef 
Published: March 2015

Purpose: To analyze the impact of technical improvements in stent devices and guiding catheters (e.g., reduced device diameter, increased flexibility) on the complication rates associated with percutaneous renal artery interventions. Methods: During a 5-year period (1997–2001), 268 consecutive patients (178 men; mean age 67±9 years) had 370 atherosclerotic renal artery stenoses (RAS) ≥70% treated with angioplasty/stenting in 320 procedures. The guiding catheter technique was used routinely until 2000; in 2001, a guiding sheath was used in 29% of cases. From 1997 to 2000, sealing devices were frequently used for sheath removal; during the last year, the sheaths were removed using the Femostop device. Results: In 320 interventions, 32 (10%) complications occurred, with a decreasing frequency during the last 2 years (1996/97: 13% [7/53]; 1998: 16% [9/57]; 1999: 15% [11/74]; 2000: 4% [3/70]; 2001: 3% [2/66]). There were 21 (6.6%) local complications, including 4 cases requiring permanent hemodialysis after the intervention and 11 (3.4%) access site complications. No procedure-related death occurred. During the study period, the average sheath diameter was reduced from 8.15±0.76 F to 6.15±0.63 F (p<0.05). Mean procedural time was reduced from 42±13 minutes to 23±11 minutes (p<0.05). The initial heparin dose was reduced from 10,000 to 5000 units. Conclusions: In parallel with the use of more flexible catheters and premounted stents of lower profile, the complication rate of renal angioplasty/stenting of atherosclerotic RAS has been reduced significantly during a 5-year period.
Carotid Revascularization Using Endarterectomy or Stenting Systems (CARESS): Phase I Clinical Trial
Authors: McKinlay Sonja ,   CARESS Steering Committee
Published: March 2015

Purpose: To determine whether carotid stenting with embolic protection is equivalent to carotid endarterectomy (CEA) in a broad risk population of patients with symptomatic and asymptomatic carotid stenosis. Methods: A prospective, multicenter Phase I trial was conducted comparing standard CEA to carotid stenting systems (CSS) in patients with symptomatic (≥50%) and asymptomatic (≥75%) carotid stenosis. Patients were enrolled using selection criteria reflective of broad clinical practice. The enrollment ratio at each clinical site was designed to be 2:1 (CEA to CSS) to achieve a planned enrollment of 450 patients: 300 in the CEA arm and 150 in the CSS cohort, which would ensure adequate precision with a coefficient of variation ≤0.35. The primary endpoint for comparison was 30-day all-cause mortality and nonfatal stroke. Results: Between April 2001 and December 2002, 14 clinical sites enrolled 439 patients, of which 397 (247 men; mean age 71 years, range 44–89) were treated: 254 with CEA and 143 patients with CSS (ratio 1.8 to 1.0). More than 90% of patients had >75% stenosis; ∼68% of patients were asymptomatic. There were no significant differences in baseline patient characteristics between the treatment groups with the exception of a more frequent history of prior CEA (30% CSS versus 11% for CEA, p<0.0001) and prior carotid stent placement in the CSS group (6% versus 0% for CEA, p = 0.0002). There was no significant difference in the 30-day combined all-cause mortality and stroke rate by Kaplan-Meier estimate between CEA (2%) and CSS (2%). There was no significant difference in the secondary endpoint of combined 30-day all-cause mortality, stroke, and myocardial infarction between CEA (3%) and CSS (2%). Conclusions: This study suggests that the 30-day risk of stroke or death following carotid stenting with cerebral protection is equivalent to standard carotid endarterectomy in a broad risk population of patients with carotid stenosis.
Angioplasty/Stenting of the Superior Mesenteric Artery and Celiac Trunk: Early and Late Outcomes
Authors: AbuRahma Ali F. , Stone Patrick A. , Bates Mark C. , Welch Christine A. 
Published: March 2015

Purpose: To analyze the early results and durability of angioplasty/stenting of the superior mesenteric artery (SMA) and celiac trunk (CT). Methods: Twenty-two patients (19 women; mean age 69.2 years, range 52–88) with 24 symptomatic SMA or CT stenotic lesions were treated with dilation/stenting over a recent 4.5-year period. Two patients had lesions in both the SMA and CT treated. Clinical follow-up and duplex exams were done to evaluate long-term patency. Kaplan-Meier life-table analyses estimated the freedom from recurrent stenosis and recurrent symptoms, as well as survival rates. Results: The initial technical and clinical success rates were 96% (23/24) and 95% (21/22), respectively, with no perioperative mortality or major morbidity. During a mean follow-up of 26 months (range 1–54), the primary late clinical success rate was 61% (11/18; 4 lost to follow-up), and freedom from recurrent stenosis (≥70%) was 30% (6/20). The freedom from recurrent stenosis at 1, 2, 3, and 4 years were 65%, 47%, 39%, and 13%; freedom from recurrent symptoms was 67% at all 4 intervals. The survival rates were 93%, 93%, 80%, and 53% at 1 to 4 years, respectively. Conclusions: Angioplasty/stenting of SMA and CT stenoses has a high initial technical success rate and acceptable early and late clinical outcomes; however, it is associated with a high incidence of late restenosis based on strict Doppler criteria.
Incidence of Renal Infarctions after Endovascular AAA Repair: Relationship to Infrarenal versus Suprarenal Fixation
Authors: Böckler Dittmar , Krauss Martin , Mannsmann Ulrich , Halawa Mustafa , Lange Ralph , Probst Thomas , Raithel Dieter 
Published: March 2015

Purpose: To analyze the incidence and etiology of renal infarctions following endovascular abdominal aortic aneurysm (AAA) repair detected on computed tomography (CT) and determine any association with infrarenal versus suprarenal fixation. Methods: Between August 1994 and October 2001, 663 patients (604 men; mean age 68.5 years, range 40–98) underwent endovascular AAA repair with predominately bifurcated (505, 77%) stent-grafts. About a third (202, 30%) of the devices were deployed in a suprarenal position. Contrast-enhanced CT scans were performed on days 10, 90, and 365 after operation and then annually. Two radiologists blinded to procedural details compared the preoperative and postoperative scans to identify renal infarctions from inadvertent renal artery occlusion by the endograft. Only patients with inadvertent infarctions were analyzed relative to endograft fixation position and stent-graft type. Results: Mean follow-up was 37 months (range 0.1–75). Overall renal infarction rate was 11.9% (n=79); 23 (3.4%) patients suffered from limited, segmental infarction due to intentional covering of preoperatively diagnosed accessory renal arteries. Unintentional renal ischemia was identified in 56 (8.5%) patients. In this subgroup, 39 (19%) were observed in the 202 patients with suprarenal fixation versus 17 (3.7%) in the 461 stent-grafts positioned infrarenally (RR 3.35, 95% CI 2.20 to 5.04, p < 0.00001). There was a significant correlation between the incidence of infarction and the device type (14.3% for modular grafts versus 5.6% for unibody designs, p = 0.0002). Seventeen (2.6%) patients suffered from unilateral kidney loss, with dialysis required in 2 cases. Creatinine and urea showed no significant postoperative elevation in the overall patient population, but both levels were significantly (p < 0.02) elevated in patients with complete unilateral renal infarcts. Conclusions: Transrenal fixation of aortic endografts had a 3-fold higher risk for renal infarction in this large patient population. There is no significant difference for specific endografts, but modular designs were associated with a higher rate of renal infarction. The need to occlude preoperatively diagnosed accessory renal arteries with an endograft should be considered a contraindication for current available devices.
Coil Embolization of Iliac Artery Aneurysms Developing after Abdominal Aortic Aneurysm Repair with a Conventional Bifurcated Graft
Authors: Sakamoto Ichiro , Mori Masakazu , Nishida Akifumi , Fukushima Aya , Sueyoshi Eijun , Hazama Shiro , Eishi Kiyoyuki , Hayashi Kuniaki 
Published: March 2015

Purpose: To evaluate the efficacy of embolizing iliac artery aneurysms (IAAs) developing after abdominal aortic aneurysm (AAA) repair. Methods: The records of 6 patients (5 men; mean age 79 years, range 61–87) with unilateral (n = 3) or bilateral (n = 3) IAAs that had developed after AAA repair were reviewed. In all patients, the limbs of the bifurcated graft were anastomosed end-to-end or end-to-side with the external iliac arteries during AAA repair. Before embolization, superior mesenteric artery (SMA) arteriography was done in all patients to evaluate collateral pathways to the inferior mesenteric artery (IMA). Results: The unilateral IAAs were treated by proximal and distal embolization. In 2 patients with bilateral IAAs, SMA angiography showed sufficient collateral flow to the IMA, so the aneurysms were treated by proximal embolization and packing. In the other bilateral IAA case, the left 6-cm IAA was treated by proximal and distal embolization, while the contralateral 3-cm IAA was not embolized because angiography demonstrated inadequate collateral flow to the IMA, indicating a possible risk of colon ischemia if both IAAs were embolized. Immediate postprocedural angiography in all patients showed complete exclusion of the IAAs. Mild buttock claudication occurred in 1 patient. There were no episodes of rupture over a mean 46-month follow-up. Conclusions: Embolization is a safe and effective alternative to open surgery for the treatment of IAAs that develop after AAA repair. However, before embolization, angiographic evaluation of collateral pathways to the IMA is essential to reduce the risk of colon ischemia.
Internal Iliac Artery Occlusion Using a Stent-Graft Tunnel during Endovascular Aneurysm Repair: A New Alternative to Coil Embolization
Authors: Rajasinghe Hiranya A. , Pigott John P. , Kritpracha Boonprasit , Corbey Mary Jo , Beebe Hugh G. 
Published: March 2015

Purpose: To report a new endovascular technique for internal iliac artery (IIA) occlusion during stent-graft treatment in patients with aortoiliac aneurysm. Technique: Stent-grafts measuring 20 to 28 mm in diameter and 37.5 mm long were deployed at the iliac bifurcation to occlude the IIA at its origin. Subsequent deployment of an aortic bifurcation endograft with ipsilateral extension into the external iliac artery was through this iliac stent-graft tunnel. This approach has been used in 5 patients with abdominal aortic aneurysm and common iliac artery aneurysm (n = 4) or isolated iliac artery aneurysm. Proximal IIA occlusion was achieved in all cases with no distal type I endoleak. IIA patency on the side opposite to the tunnel procedure was preserved in each case. No patient described new onset of pelvic ischemic symptoms. Over a mean 10-month follow-up (range 1–12), there was no secondary procedure required for type I endoleak. Three patients had a CIA aneurysm diameter change of −1, −4, and 0 mm at 1 year. Conclusions: This new method for IIA occlusion at its origin without coil embolization may prove to be a useful adjunct to endovascular aortoiliac aneurysm repair. The technique is simple, rapid, and may minimize the risk of pelvic ischemia.
Heparin-Induced Thrombocytopenia and Graft Thrombosis following Endovascular Aneurysm Repair
Authors: Chuter Timothy A.M. , Pak Laura K. , Gordon Roy L. , Reilly Linda M. , Messina Louis M. 
Published: March 2015

Purpose: To report a case of heparin-induced thrombocytopenia (HIT) complicated by stent-graft thrombosis. Case Report: An 82-year-old woman underwent endovascular aortic aneurysm repair using a Zenith stent-graft. She returned 2 weeks later with an occluded graft limb, large quantities of thrombus lining the remainder of the stent-graft, thrombocytopenia, and antiplatelet antibodies. There were no signs of kinking or compression of the graft, nor was there any thrombosis of the native arteries downstream from the occluded graft limb. Thrombolysis restored graft patency. Anticoagulation was induced using hirudin and warfarin. The graft remains patent at 6-month follow-up. Conclusion: HIT is a rare cause of postoperative endograft thrombosis. In this case, the presumed source of the inciting heparin dosage was the stent-graft itself, which had been soaked in a concentrated heparin solution prior to insertion.
Endotension is Influenced by Aneurysm Volume: Experimental Findings
Authors: Gawenda Michael , Winter Stefan , Jaschke Gregor , Wassmer Gernot , Brunkwall Jan 
Published: March 2015

Purpose: To investigate in an in vitro model whether and to what extent pressure is influenced by aneurysm size. Methods: Latex aneurysms of 3 different volumes (24, 30, and 81 mL) were inserted into an in vitro circulation model. The systemic mean pressure (SPmean) was varied from 50 to 120 mmHg. The aneurysms were excluded using a woven polyethylene graft. Aneurysm sac mean pressure (ASPmean) was measured. Results: In the in vitro model, endovascular aneurysm repair created a closed chamber without endoleak but showed a relevant aneurysm sac pressure. At an SPmean of 80 mmHg, the ASPmean was 42.0 ± 0.6 mmHg in the 24-mL aneurysm, 40.5 ± 0.5 mmHg in the 30-mL model, and 19.3 ± 0.5 mmHg in the 81-mL aneurysm (p < 0.05). The ASPmean rose with increasing SPmean and was inversely dependent on the aneurysm volume. Conclusions: This in vitro model demonstrated that the sac mean pressure correlated to the systemic pressure and that a greater aneurysm volume reduced aneurysm sac pressure. These data highlight the need for further studies regarding endotension.
Non-Axisymmetrical (Life-Like) Abdominal Aortic Aneurysm Models: A Do-It-Yourself Approach
Authors: Chaudhuri Arindam , Ansdell Leslie E. , Richards Robin , Adiseshiah Mohan , Grass Anthony J. 
Published: March 2015

Purpose: To construct life-like non-axisymmetrical abdominal aortic aneurysm models from latex. Technique: A computed tomographic 3-dimensional reconstruction of an actual abdominal aortic aneurysm was cast in plastic to provide a core for a “chemical metal” mould. The mould was then coated with nonadhesive prevulcanized dipping latex and cured to provide an idealized hollow reconstruction of the aneurysm. Conclusions: Chemical metal can be manipulated quite easily to make a mould of any required size or surface character, which then allows the manufacture of a well-matched latex model for biophysical studies of non-axisymmetrical abdominal aortic aneurysms.
Vascular Occlusion by Ruptured Balloon after Percutaneous Transluminal Angioplasty
Authors: Gahlen Johannes , Koeppel Thomas , Prosst Ruediger L. 
Published: March 2015

Purpose: To report a rare case of chronic vascular occlusion by an undetected ruptured balloon fragment following percutaneous transluminal angioplasty. Case Report: A 79-year-old man suffered from calf claudication 1 year after angioplasty for a short stenosis in the superficial femoral artery. During the femoropopliteal bypass operation, a ruptured angioplasty balloon was retrieved. Conclusions: Endovascular treatment of arterial lesions always requires thorough pre and postinterventional check of the applied instrumentation. A damaged catheter must initiate an immediate search for lost intravascular objects.
Diagnostic Value of CT Virtual Intravascular Endoscopy in Aortic Stent-Grafting
Authors: Sun Zhonghua , Winder R. John , Kelly Barry E. , Ellis Peter K. , Kennedy Peter T. , Hirst David G. 
Published: March 2015

Purpose: To investigate the diagnostic value of postprocessing techniques for 3-dimensional (3D) computed tomography (CT), with emphasis on CT virtual intravascular endoscopy (VIE), in patients with abdominal aortic aneurysms (AAA) treated with suprarenal stent-grafts. Methods: The preprocedural and postprocedural CT datasets from 47 AAA patients (40 men; mean age 75 years, range 61–87) undergoing aortic stent-grafting with suprarenal fixation were examined. The CT datasets were processed to create various 3D reconstructions: shaded surface display (SSD), maximum intensity projection (MIP), and VIE. Three independent radiologists assessed various diagnostic parameters for each 3D reconstruction method and compared them to axial CT images. Results: Scores for VIE reconstructions were inferior to axial CT images in the visualization of normal arterial branches, measurement of the aneurysm diameter and neck length, as well as assessment of vessel patency and presence of endoleaks. VIE was rated superior to axial CT and other 3D imaging methods in visualizing the configuration of stent struts relative to the aortic branch ostia and the number of stent wires crossing the ostia in >80% of cases. Conclusions: VIE was not found to play a role in most preoperative situations compared to axial CT images. However, VIE provided additional postgrafting information on the 3D relationship of the suprarenal stent struts to the aortic branch ostia (in particular the renal and superior mesenteric arteries). VIE findings might aid clinicians in accurately assessing the effect of suprarenal stent-grafting on the renal arteries.
Carotid Stenting for Radiation-Induced Extracranial Carotid Artery Occlusive Disease: Efficacy and Midterm Outcomes
Authors: Ting Albert C.W. , Cheng Stephen W.K. , Yeung Kai-Ming Au , Cheng Pui-Wai , Lui Wai-Man , Ho Pei , Tso Wai-Kuen 
Published: March 2015

Purpose: To investigate the immediate and midterm results of carotid stenting for severe radiation-induced extracranial carotid artery disease. Methods: Between April 1998 and May 2002, 16 patients (15 men; mean age 64±8 years, range 48–72) presented with 18 severe radiation-induced carotid stenoses in the internal carotid artery (n=3), common carotid artery (n=7), and both vessels (n=8). Thirteen (76%) patients were symptomatic; the mean degree of carotid stenosis was 85%±10% (range 70%–95%). An independent neurological specialist assessed perioperative neurological complications before and after treatment. The patients were followed prospectively for at least 12 months by clinical examination and serial duplex ultrasound scanning. Restenosis was defined as a diameter reduction >50%. Results: Of 18 stent procedures attempted (2 staged), 1 was abandoned owing to failure to pass the guidewire across a tight lesion (94% technical success by intent to treat). In the 17 successfully completed procedures, 17 Wallstents and 4 SMART stents were deployed with satisfactory anatomical results. One postoperative stroke occurred as a result of thromboembolism to the ipsilateral middle cerebral artery and led to hospital death (5.9% combined stroke and death rate). One transient ischemic attack occurred (11.6% neurological event rate). With a median 30-month follow-up (range 5–55), 3 (17.6%) recurrent stenoses (>50%) were detected on duplex scan; 1 repeat angioplasty was performed. No new neurological event has been detected. Conclusions: Carotid stenting may be performed in patients with irradiation-induced carotid stenosis with acceptable risks and midterm durability.
Comparison of Surgical versus Endovascular Occlusion Models in Pig Femoral Arteries
Authors: Engelmann Markus G. , Shimizu Masumi , Pelisek Jaroslav , Fuchs Alexandra , Golda Adam , Mekkaoui Choukri , Fraunberger Peter , Rolland Pierre H. , Nikol Sigrid 
Published: March 2015

Purpose: To compare an endovascular technique with a well established surgical approach to achieve long-term occlusions of large porcine arteries while preserving the integrity of periarterial tissue. Methods: The femoral arteries in 11 pigs were occluded using surgical techniques on one side and blinded stent-grafts in the contralateral vessel. Feasibility, safety, primary and long-term success, and the extent of vascularization were determined over a 3-month period by conventional angiography and histological analysis. A subgroup of animals (n=5) was treated with a locally administered plasmid coding for vascular endothelial growth factor (pVEGF165) to compare both occlusion techniques under conditions of collateral growth induction. Results: The primary and long-term success rates for both occlusion models were 100%. Surgical occlusion of arteries resulted in a significant amount of scar dehiscence and local groin infection compared to the endograft-occluded side. There was no significant difference in capillary densities and collateralization of periarterial areas in a comparison of the occlusion technique: the cross-sectional area of the superficial femoral artery (SFA) was 300±24 mm2 for endovascular occlusion versus 320±23 mm2 for surgical occlusion (p=0.559). In the profunda femoris artery, respective values were 418±35 and 448±18 mm2 (p=0.474). The local delivery of pVEGF165 resulted in a significant increase in collateral growth in both occlusion models with comparable neovascularization: cross-sectional SFA area increased from 310±16 to 428±13 mm2 (p<0.0001); in the PFA, the area increased from 422±19 to 658±49 mm2 (p<0.0001). Conclusions: Endovascular arterial occlusions using blinded stent-grafts allow easy and safe creation of long-term occlusions. Previously described collateralization following surgical occlusions was not observed, indicating that those collaterals may be associated with wound healing rather than ischemia. The occlusion of arteries using blinded stent-grafts in pigs may therefore be an appropriate model for assessing the effects of angiogenic factors in vivo.
Endovascular Techniques in the Management of Acute Arterioenteric Fistulas
Authors: Knape Susanne , Van Nieuwenhove Yves , van Tussenbroek Frank , Van den Brande Pierre , Delvaux Georges 
Published: March 2015

Purpose: To report the use of endovascular techniques to emergently treat hemorrhagic complications of rare arterioenteric fistulas. Case Reports: Two patients, a 71-year-old man and a 61-year-old woman, presented with acute bleeding arising from primary arterioenteric fistulas. In the first patient, a fistula between the iliac artery and the small intestine complicated laparoscopic treatment of acute appendicitis. In the second patient, irradiation of a metastatic cervical carcinoma led to a fistula between the right iliac artery and the terminal ileum. In both patients, the hemorrhage was controlled with implantation of a Jostent Peripheral Stent-Graft. The man is alive at 3 years with a patent endograft, but the woman died 1 month after treatment from complications of tumor progression. Conclusions: Endovascular application of covered stents provides an alternative treatment, avoiding extensive surgery. In cases of neoplastic erosion of a large vessel, endovascular stenting can offer a palliative solution.