bluuebunny/crossref_metadata_2025_split huggingface dataset:
Emergency Endograft Placement for Recurrent Aortocaval Fistula after Conventional AAA Repair
Authors: Gandini Roberto , Ippoliti Arnaldo , Pampana Enrico , Marchetti Andrea Ascoli , Pistolese Giuseppe Raimondo , Simonetti Giovanni 
Published: March 2015

Purpose: To report a novel case in which a stent-graft was used to emergently treat an aortocaval fistula that recurred after conventional abdominal aortic aneurysm (AAA) repair. Case Report: A 67-year-old man was treated urgently for ruptured AAA with surgical placement of a 16-mm Dacron interposition graft. During the procedure, an aortocaval fistula was repaired primarily. The patient was discharged in satisfactory condition but returned 20 days later with dyspnea, bilateral perimalleolar edema, and a bruit in the mesogastric region. The high flow fistula was again present just above the aortic bifurcation at the distal anastomosis of the existing graft. The patient's condition deteriorated rapidly, so a bifurcated Vanguard stent-graft was deployed in an emergency procedure. Subsequent imaging confirmed satisfactory closure of the fistula. The patient was discharged 8 days after endograft placement, and he continues to be without signs of fistula recurrence at 2 years. Conclusions: Endograft treatment of vascular lesions in the acute setting is becoming more common as our experience with the devices grows. Endovascular repair of primary aortocaval fistulas appears to be an efficacious and minimally invasive means of dealing with these lesions in AAA patients.
Aortoesophageal Fistula Secondary to Mycotic Thoracic Aortic Aneurysm: Endovascular Repair and Transhiatal Esophagectomy
Authors: van Doorn Ruth C. , Reekers Jim , de Mol Bas A.J.M. , Obertop Huug , Balm Ron 
Published: March 2015

Purpose: To report a case of aortoesophageal fistula secondary to a mycotic thoracic aortic aneurysm (TAA) successfully repaired by stent-grafting of the descending thoracic aorta. Case Report: A 66-year-old woman with a recent history of hemicolectomy for colon cancer complicated by postoperative infection presented with midthoracic pain, fever, hoarseness, and blood chemistries consistent with an inflammatory process. Imaging showed a widened mediastinum and displacement of the trachea due to a mycotic thoracic aneurysm; endoscopy confirmed a large fistula in the esophageal wall. There was no active bleeding, so an Excluder thoracic endograft was positioned in the aortic arch, partially covering the left subclavian artery origin. Three days later, a transhiatal esophagectomy was performed. Intravenous antibiotic therapy was continued for 6 weeks. At 18 months, a minithoracotomy was performed because of extreme dyspnea. An aneurysm sac hygroma was drained in the thoracic cavity. At 2 years, the patient was well, and there were no signs of infection or dyspnea. Conclusions: Along with a transhiatal esophagectomy, we suggest that endovascular stent-grafting has a place as a minimally invasive technique in the treatment of aortoesophageal fistula secondary to aneurysm of the thoracic aorta.
Preventive Stent Placement for Renal Artery Stenosis Prior to Emergent Coronary Artery Bypass Grafting
Authors: Martin-Ucar Antonio E. , Patel Ramesh L. 
Published: March 2015

Purpose: To illustrate the benefits of treating severe renal artery stenosis in renally compromised patients prior to surgery for coronary artery disease. Case Report: A 63-year-old woman with unstable angina, severe coronary artery disease, and long-term severe renal impairment with a single functioning kidney underwent renal stent placement for high-grade renal artery stenosis prior to coronary artery surgery. The procedure improved her serum creatinine from 528 µmol/L at baseline to 385 µmol/L, and she subsequently underwent coronary artery bypass grafting without deterioration in her renal function. At 1 year, the patient has a serum creatinine of 400 µmol/L, and there is no evidence of in-stent stenosis. Conclusions: Percutaneous renal angioplasty or stenting prior to coronary surgery in patients with concomitant renal and coronary artery disease may reduce perioperative renal deterioration in this specific group of patients.
Covered Stent to Exclude Intravascular Thrombus
Authors: Liistro Francesco , Stankovic Goran , Di Mario Carlo , Montorfano Matteo , Briguori Carlo , Colombo Antonio 
Published: March 2015

Purpose: To describe the utility of stent-graft implantation to avoid distal embolization from a large thrombus-containing lesion. Case Report: A 67-year-old man was evaluated for recent onset of disabling left leg claudication. Angiography disclosed a mobile lobular mass occluding the left common iliac artery; irregular staining suggested an atherothrombotic lesion. Through a percutaneous ipsilateral access and an 8-F sheath, a balloon-expandable Jostent peripheral stent-graft was positioned with the distal edge immediately proximal to the internal iliac artery ostium. A prominent “waist” at the center of the balloon confirmed entrapment of the thrombotic mass. Completion angiography showed an optimal result with no residual stenosis or evidence of distal embolization. At 6-month follow-up, the patient was asymptomatic with angiographically documented luminal patency and no evidence of in-stent stenosis. Conclusions: Stent-graft implantation appears a viable treatment alternative for thrombus-containing lesions, particularly when the thrombotic material is localized or is in a large vessel.
The First 150 Endovascular AAA Repairs at a Single Institution: How Steep is the Learning Curve?
Authors: Lee W. Anthony , Wolf Yehuda G. , Hill Bradley B. , Cipriano Paul , Fogarty Thomas J. , Zarins Christopher K. 
Published: March 2015

Purpose: To determine whether increasing experience with endovascular abdominal aortic aneurysm (AAA) repair in a single institution will result in improved outcome. Methods: A retrospective review was undertaken of 150 consecutive cases of endovascular AAA repairs performed using the AneuRx device between October 1996 and April 2000 in a university-based medical center. The population was divided into early and late groups of 75 patients each. Endpoints included technical success; complications; early (≤30-day) morbidity, mortality and rupture; endoleak at discharge and at 1 month; early secondary intervention; proximal neck and iliac tortuosity; extender cuff placement; femoral reconstructions beyond primary repair; total fluoroscopy time; and contrast load. Results: Baseline patient and aneurysm characteristics were similar between the 2 groups. Technical success was 98.7%; 2 cases were converted intraprocedurally owing to difficult iliac access (early group) and a severely angulated proximal neck (late group). There was a tendency toward more frequent use of intraoperative proximal extender cuffs in the early group (12% versus 4% in the late group, p=0.13). Femoral reconstructions were more frequent in the early group (36% versus 19%, p<0.025). While total contrast volume was similar (111 ± 56 versus 105 ± 45 mL, p=NS), total fluoroscopy time was significantly reduced (p<0.05) between the early and late groups. Conclusions: With attention to detail and careful patient selection, successful endovascular AAA repair can be achieved with very few conversions and low perioperative mortality even during the center's early experience. Evidence indicates, however, that a learning curve definitely exists, as shown by fewer access site problems, more accurate device deployments, and decreased fluoroscopy times as proficiency is attained.
Institutional Economic Losses Associated with AAA Repair are Independent of Technique
Authors: Berman Scott S. , Gentile Andrew T. , Berens Eric S. , Haskell Jan 
Published: March 2015

Purpose: To investigate the perception of significant economic loss associated with endovascular abdominal aortic aneurysm (AAA) repair by comparing economic variables for the open and endovascular techniques. Methods: In a 1-year period, 20 consecutive patients (19 men; mean age 73.3 years, range 62–89) were treated for uncomplicated infrarenal AAAs using conventional open repair in 11 and endovascular repair (EVR) in 9. For the open repair, standard techniques were employed, including transperitoneal and retroperitoneal exposures; in EVR, both the AneuRx and Ancure systems were utilized. Length of stay and institutional costs were carefully tracked and compared. Results: The patients were similar with regard to comorbidities, but the endograft patients were older (p=0.02) Length of stay was significantly lower in the EVR group (1.9 ± 0.9 days) compared with the open group (8.4 ± 4.5 days, p=0.0004). However, total mean treatment costs (open: $17,576 ± $11,025 and EVR: $20,247 ± $5003; p=0.51) and subsequent losses (open: –$3949 ± $7095 and EVR: –$7572 ± $4488; p=0.20) were not significantly different between the groups. Conclusions: The costs associated with the care of AAA patients are independent of the technique used for repair. The economic loss associated with treatment is directly related to inadequate reimbursement on the part of Medicare and other carriers.
Single-Center Experience with Carotid Stent Restenosis
Authors: Willfort-Ehringer Andrea , Ahmadi Ramazanali , Gschwandtner Michael E. , Haumer Markus , Lang Wilfried , Minar Erich 
Published: March 2015

Purpose: To report the angiographic morphology of carotid stent restenosis and the possible therapies based on data from a single-center experience. Methods: In a 45-month period, 279 patients (196 men; mean age 70 ± 9 years, range 50–89) underwent successful Wallstent placement in 303 stenotic internal carotid arteries (ICA). Patients were followed with duplex sonography; angiography was used to confirm any significant (≥70%) recurrent lesions detected on the ultrasound scan. Further balloon dilation with or without stent placement was undertaken. Results: Over a median 12-month follow-up (interquartile range 6–24), there were 9 (3.0%) carotid stent restenoses found, all within 12 months after stent placement. Two types of restenosis were differentiated. In the more common form, “in-stent” stenoses (n = 6) were detected and treated with stent placement; lasting success (patency >12 months after retreatment) was achieved in 4. Early second and third recurrences arose in the other 2 stents within 3 months of the first retreatment; additional stents were placed at each recurrence. Both patients suffered a major cerebral event after 17 months. Less often, an “end of stent” stenosis (n = 3) developed at a kink in the ICA adjacent to the cephalad end of the stent. Lasting success was achieved by balloon dilation without additional stent placement in all 3 cases. No procedure-related complications were observed within 30 days after any treatment for restenosis. Conclusions: Carotid stent restenosis, which occurs rarely after 1 year, can be treated safely by further percutaneous interventions.
Coil Embolization Combined with Carotid-Subclavian Bypass for Treatment of Subclavian Artery Aneurysm
Authors: Bush Ruth L. , Lin Peter H. , Najibi Sasan , Dion Jacques E. , Smith Robert B. 
Published: March 2015

Purpose: To report 2 cases of proximal subclavian artery aneurysm treated with carotid-subclavian bypass and coil embolization. Case Reports: A subclavian artery aneurysm was discovered incidentally during presurgical coronary angiography in 2 men (72 and 63 years of age). Both patients underwent planned carotid endarterectomy, during which a carotid-subclavian bypass was created with a Dacron graft; the distal subclavian artery was also ligated. The aneurysm was completely excluded from the circulation by coil embolization in a separate procedure. The patients were discharged after 3 days with no adverse events. Magnetic resonance angiography at 6 months showed continued aneurysm exclusion in both cases. The patients continue to be well >1 year after treatment. Conclusions: Embolization with supraclavicular bypass represents a viable alternative to traditional thoracotomy and subclavian artery reconstruction for treatment of subclavian artery aneurysms.
Histological Changes in Canine Aorta 1 Year after Stent-Graft Implantation: Implications for the Long-term Stability of Device Anchoring Zones
Authors: Bashar Abul Hasan Muhammad , Kazui Teruhisa , Terada Hitoshi , Suzuki Kazuya , Washiyama Naoki , Yamashita Katsushi , Baba Satoshi 
Published: March 2015

Purpose: To examine aortic histology 1 year after stent-graft implantation in a canine model as a means of assessing the durability of endograft fixation. Methods: Fourteen mongrel dogs each received 1 stent-graft and 1 bare stent placed endoluminally in the abdominal aorta. Eight animals were followed for 1 year, 3 for 4 to 8 weeks, and the remaining 3 for 24 to 48 hours. Aortic specimens were stained with hematoxylin-eosin, elastica-van Gieson, and Masson's trichrome and examined with light and electron microscopy and immunohistochemistry to identify smooth muscle cells (SMC), endothelialization, aortic wall ultrastructure, and changes at the device anchoring sites. Results: No dilatation or dissection was noted at any of the device anchoring sites. The aortic media at 1 year was remarkably decreased in thickness: 891 ± 196 µm in the control tissue versus 388 ± 70 µm for the proximal stent-grafted aorta and 457 ± 148 µm for the bare-stented aortic segment. Other important histological features were reduced elastic lamellae in the stent-grafted aorta versus control (p<0.0001), increased SMC density in the stent-grafted aortic region (p<0.0001 versus control), and absence of inflammatory infiltrate. Complete neointimal covering and endothelialization of the luminal endograft surface were found. SMCs generally showed no ultrastructural features of necrosis. Conclusions: Aortic stent-grafts induce distinctive histological changes in the aortic wall at 1 year, even when implanted in a healthy aorta. Although there is considerable medial elastin loss, an increased medial SMC density, an exuberant neointima, and a general absence of perigraft inflammation suggest an ongoing process of structural restoration at the device anchoring sites.
Abdominal Aortic Healing Associated with a Thin-Walled Dacron—Covered Endovascular Graft in a Canine Model
Authors: Dal Ponte Donny B. , Berman Scott S. , Patula Vangie , Kleinert Leigh , Williams Stuart K. 
Published: March 2015

Purpose: To characterize the healing response associated with an experimental endovascular graft (EVG) by examining the lumen of the prosthesis and the native vessel wall responses after implantation in a canine model. Methods: An endovascular graft (EVG) constructed of hookless self-expanding nitinol springs covered by an ultrathin Dacron fabric was placed in the abdominal aorta of 8 dogs following femoral artery catheterization. After 12 weeks, specimens were subjected to histological and immunocytochemical testing to quantitatively and qualitatively analyze the cellular makeup of the luminal and abluminal tissues. Results: Gross examination revealed a glistening, thrombus-free luminal surface on all prostheses, which was confirmed by scanning electron microscopy. The EVGs were well incorporated into the aortic wall, leaving a concentric, smooth flow surface. Immunocytochemistry-verified the presence of von Willebrand factor—positive endothelial cells on the luminal surface and α-smooth muscle cell actin—positive smooth muscle and/or fibroblast cells in the subendothelial space. A sparse inflammatory response and a paucity of proliferating nuclear cell antigen—positive cells were noted within the neomedial lining adjacent to the graft material. In addition, a rich vaso vasorum—like plexus of microvessels was evident within the neomedial tissue. The native vessel wall upon which the EVG impinged was largely unaffected. Conclusions: These data demonstrate that placement of an experimental EVG in the canine abdominal aorta elicits a healing response that is distinct from interpositional vascular grafts. Results from this study have particular relevance to the proximal and distal anastomotic neck regions.
Endovascular Management of Blunt Traumatic Renal Artery Dissection
Authors: Lee James T. , White Rodney A. 
Published: March 2015

Purpose: To describe the importance of accurate diagnosis and successful emergent endovascular repair of intimal injury to the renal artery from sudden deceleration. Case Report: A 22-year-old man was evaluated after jumping head first out of a fourth floor window. Gross hematuria was detected at the initial assessment. Contrast-enhanced computed tomography (CT) revealed diminished uptake in the right kidney. Arteriographic examination of the renal artery demonstrated 2 areas of intimal disruption, which a team of physicians decided to treat with angioplasty and stent placement owing to the associated intracranial injuries. Two balloon-expandable stents were successfully deployed to exclude the intimal defects. Once the associated injuries were also addressed, the patient made an uneventful recovery. Conclusions: Management of blunt traumatic injuries to the renal vasculature involves timely assessment to maximize preservation of renal function. In the setting of multiple concomitant injuries, recent experience supports the consideration of endoluminal intervention for traumatic renal artery dissections.
Percutaneous Reconstruction of the Aortoiliac Bifurcation with the “Kissing Stents” Technique: Long-term Follow-up in 106 Patients
Authors: Haulon Stéphan , Mounier-Véhier Claire , Gaxotte Virginia , Koussa Mohamad , Lions Christophe , Haouari Ben Ahmed , Beregi Jean-Paul 
Published: March 2015

Purpose: To evaluate the long-term results using the kissing stents technique for treatment of occlusive disease involving the aortoiliac bifurcation. Methods: One hundred six patients (97 men; mean age 52.5 ± 10.2 years, range 33–78) were treated with the kissing stents technique for bilateral aortoiliac stenosis (55, 51.9%), unilateral occlusion of the common iliac artery (CIA) with contralateral stenosis (47, 44.3%), and bilateral CIA occlusion (4, 3.8%). Clinical examination and duplex scans were performed prior to discharge and at 1, 6, and 12 months, followed by yearly examinations thereafter. Results: Bilateral stent implantation was successful in all patients. No major procedure-related complications were observed. Self-expanding stents were deployed in 62 (58.5%) patients and balloon-expandable devices in 44 (41.5%). Fifteen (7.1%) hematomas were observed at the 212 access sites. Mean follow-up was 30.1 ± 11.1 months (range 12–137). Duplex imaging diagnosed significant (>50%) restenosis in 15 (14.8%) of 101 patients and reocclusion in 4 (4%); 17 (89.5%) of these patients had recurrent symptoms and all were retreated (endovascular procedure in 18 and an aortobifemoral bypass in 1). Primary and secondary cumulative patency rates at 36 months were 79.4% and 97.7%, respectively. Balloon-expandable stents had a nonsignificantly higher patency rate compared to self-expanding stents. Conclusions: Based on our experience, aortoiliac endovascular reconstruction with the kissing stents technique is a safe and effective procedure, representing an alternative to conventional surgery in selected patients.
Rheolytic Thrombectomy in the Management of Limb Ischemia: 30-Day Results from a Multicenter Registry
Authors: Ansel Gary M. , George Barry S. , Botti Charles F. , McNamara Thomas O. , Jenkins J. Stephen , Ramee Steven R. , Rosenfield Kenneth , Noethen Alice A. , Mehta Tejas 
Published: March 2015

Purpose: To evaluate the use of rheolytic thrombectomy (RT) with the AngioJet catheter for treatment of lower extremity ischemia due to arterial/graft thrombotic occlusion. Methods: A retrospective multicenter review was performed of 99 consecutive patients (52 men; mean age 67 ± 13 years, range 30–90) who underwent RT for thrombotic occlusions in native arteries (n=80) or bypass grafts (n=19). Pre- and postprocedural limb ischemia and in-hospital events were evaluated. Amputation and mortality rates at 30 days were determined. Results: The majority of patients (78.8%) presented within 14 days of symptom onset. RT resulted in substantial to complete thrombus removal in 70 (70.7%) patients and partial in 22 (22.2%); there was no angiographic change in 7 (7.1%). Adjunctive post RT thrombolysis was used in 37 patients. Underlying stenoses found in 81 limbs were treated with one or more of the following procedures: balloon angioplasty (n=62), stenting (n=35), or non-emergent surgical revision (n=5). In-hospital complications included 2 major amputations, 5 cases of minor tissue loss, 7 rethromboses, and 3 cases of transient renal insufficiency. Four (4.0% patients died in-hospital; the 95 surviving patients all had viable limbs at discharge. Mortality and amputation rates at 30 days were 7.1% and 4.0%, respectively. Conclusions: Percutaneous treatment of thrombotic occlusions with RT, followed by definitive treatment of the underlying stenosis, is a promising therapeutic option for patients with limb-threatening ischemia.
Emergency Treatment of Symptomatic or Ruptured Abdominal Aortic Aneurysms: The Role of Endovascular Repair
Authors: Yilmaz Neval , Peppelenbosch Noud , Cuypers Philippe W.M. , Tielbeek Alexander V. , Duijm Luciën E.M. , Buth Jacob 
Published: March 2015

Purpose: To report the initial experience with endovascular aortic repair (EVAR) in patients with ruptured or symptomatic abdominal aortic aneurysms (AAA) and to compare the results with conventional open surgery. Methods: Between May 1999 and December 2001, 24 patients (21 men; mean age 75 years, range 56–89) with ruptured or symptomatic AAA underwent EVAR using a specially designed aortomonoiliac endograft. Six patients were selected based on device and operator availability; the subsequent 18 patients were treated under a modified management protocol that offered stent-graft repair to all symptomatic AAA patients. The results of this new treatment protocol were analyzed on an intention-to-treat basis for the last 8 months of the study. The 30-day outcomes in all patients treated with emergency EVAR were compared with 40 consecutive, contemporaneous patients undergoing open surgery for symptomatic or ruptured AAA. Results: No early conversions to open surgery were performed. Significantly decreased operative blood loss and intensive care stay (p<0.05 for both) were observed in EVAR patients. The mortality rate for EVAR patients was 17% compared to 32% in conventionally treated patients (NS). Among patients with ruptured AAA, the 30-day mortality rates were 24% (4/17) and 41% (12/29) for EVAR and open surgery, respectively (NS). Of 26 unselected patients who were treated prospectively under the modified protocol, the majority (81%, 21/26) had anatomy suitable for endovascular repair; however, only 18 (69%) underwent EVAR owing to a short infrarenal neck (n=2) or device/operator unavailability (n=6). Conclusions: EVAR is a feasible treatment in the majority of patients with ruptured or symptomatic AAA. The 30-day mortality appears to be similar between conventionally treated patients and those undergoing endovascular repair.