bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stent-Graft Placement in Atherosclerotic Descending Thoracic Aortic Aneurysms: Midterm Results
Authors: Czerny Martin , Cejna Manfred , Hutschala Doris , Fleck Tatjana , Holzenbein Thomas , Schoder Maria , Lammer Johannes , Zimpfer Daniel , Ehrlich Marek , Wolner Ernst , Grabenwoger Martin 
Published: March 2015

Purpose: To determine midterm durability and need for reinterventions after stent-graft placement in atherosclerotic descending thoracic aortic aneurysms. Methods: Fifty-four patients (38 men; mean age 68 years, range 33–87) underwent stent-graft repair of chronic atherosclerotic aneurysms of the descending thoracic aorta between November 1996 and December 2002. Acute aortic syndromes (type B aortic dissections, perforating ulcers, and traumatic dissections) were excluded from analysis. Two types of commercially available stent-grafts were used (Talent and Excluder). Results: The primary technical success rate was 94.4%. In-hospital mortality was 3.7% (2/54). No adverse neurological events were encountered. Of 3 (5.6%) early type I endoleaks, 2 (3.7%) required reintervention; the other type I endoleak closed spontaneously. Mean follow-up was 38 months (range 1–72) in the 52 surviving patients. Four (7.7%) type I, 7 (13.5%) type II, and 4 (7.7%) type III endoleaks were seen. Three 3 patients had additional treatment for endoleaks (proximal stenting [type Ia], open thoracoabdominal repair [type Ib], and embolization [type II]). Two of the 3 reinterventions were performed in the first year of follow-up. One additional patient with a type Ia endoleak not suitable for reintervention is under close observation. There were no differences in the number of endoleaks between the 2 types of stent-grafts. Three-year event-free survival was 63%. Conclusions: Midterm durability of endovascular stent-graft placement in atherosclerotic descending aortic aneurysms seems promising, as the rate of endoleaks requiring reintervention is acceptably low. In our series, endoleak formation occurred during the first year after stent-graft placement, so close follow-up of patients after aortic aneurysm repair is crucial. Further studies are warranted to evaluate long-term durability of this new treatment modality.
How Many Patients with Infrarenal Aneurysms are Candidates for Endovascular Repair? The Northern California Experience
Authors: Arko Frank R. , Filis Konstantinos A. , Seidel Scott A. , Gonzalez Jim , Lengle Steve J. , Webb Ron , Rhee John , Zarins Christopher K. 
Published: March 2015

Purpose: To determine how many patients with abdominal aortic aneurysms (AAA) meet the anatomical selection criteria for AneuRx stent-graft repair in community hospitals of Northern California. Methods: The records were reviewed of 220 AAA patients (171 men, 49 women) who were considered for endovascular repair by the treating vascular surgeon at 28 community hospitals in Northern California between January and October 2001. Contrast computed tomographic angiography (CTA) and selective arteriography were performed at each institution and reviewed by a centralized, independent image-reading center. Selection criteria determined by the manufacturer and published in the indications for use were applied to each set of imaging studies. The number of patients who met inclusion criteria were recorded, as were the anatomical characteristics of each aneurysm. Results: The mean aneurysm size in the 220 patients was 55.3±0.7 mm. Among these patients, 122 (55%) were judged to be candidates for endovascular repair and 98 (45%) were considered ineligible. The primary anatomical reason for ineligibility was a short infrarenal neck in 43 (44%) patients, followed by a large proximal neck diameter (25, 25%), iliac aneurysms (10, 10%), extremely tortuous or calcified neck (7, 7%), iliac occlusion (6, 6%), and small distal aortic bifurcation and accessory renal arteries (5, 5%). Four (4%) patients were classified as non-candidates due to poor quality imaging. There was no difference in aneurysm diameter (54.0±0.8 versus 57.1±1.2 mm, p=NS) or age (72.2±1.2 versus 74.6±2.2 years, p=NS) between candidates and non-candidates. However, proportionally more men (60%) than women (39%) were eligible for endovascular repair with the AneuRx stent-graft (p<0.05). All 122 patients who were considered candidates for endovascular repair were treated, with successful stent-graft placement achieved in 121 (99%). Conclusions: Fifty-five percent of patients considered for endovascular AAA repair in community hospitals in Northern California met the anatomical selection criteria for the AneuRx stent-graft. Men appeared to be twice as likely to meet the eligibility requirements as women. Unfavorable infrarenal neck anatomy was the primary exclusion criterion for endovascular repair in this community setting.
Endoluminal Stent-Graft Repair of Aortobronchial Fistulas: Bridging or Definitive Long-Term Solution?
Authors: Böckler Dittmar , Schumacher Hardy , Schwarzbach Matthias , Ockert Stefan , Rotert Harald , Allenberg Jens-Rainer 
Published: March 2015

Purpose: To describe our experience with endoluminal stent-graft repair of aortobronchial fistulas (ABF) and to analyze midterm results focusing on late chronic graft infections, secondary conversion, and survival. Methods: The records of 8 patients (6 men; mean age 69 years, range 28–88) treated between March 1997 and October 2003 for traumatic and postsurgical ABFs were reviewed. Seven presented with hemoptysis and 1 with hemorrhagic shock. According to the severity of emergency, patients underwent computed tomography, angiography, bronchoscopy, and transesophageal echocardiography. Preoperatively, no clinical signs of infection were evident. Two different stent-graft models (Talent and Excluder) were implanted using standard endovascular techniques. Results: Procedural and clinical success was achieved in all patients. Paraplegia, secondary intervention, conversion, or procedure-related death was not observed. Mean follow-up was 30 months (range 0.6–77). One patient with a postsurgical ABF (Dacron tube graft) successfully treated with an Excluder stent-graft died 13 months later from hemorrhage secondary to aortoesophageal fistula repair procedures. A second patient died from pneumonia after 42 months. A third patient, in whom 2 Talent stent-grafts had been implanted to treat an ABF from the false lumen of a type B dissection, died 7 months later from massive hemorrhage. Conclusions: Endoluminal stent-grafting of ABF is feasible and the preferred method of treatment. Secondary conversion due to endograft infection is not absolutely mandatory, but close surveillance is necessary.
Prophylactic Stenting of the Inferior Vena Cava before Transcatheter Embolization of Renal Cell Carcinomas: An Alternative to Filter Placement
Authors: Zamora Carlos Armando , Sugimoto Koji , Mori Takeki , Taniguchi Takanori , Tsurusaki Masakatsu , Izaki Kenta , Yamaguchi Masato , Sugimura Kazuro 
Published: March 2015

Purpose: To report the use of the self-expanding Wallstent as an alternative to prophylactic inferior vena cava (IVC) filter placement before embolization of renal carcinomas with tumor thrombus. Case Reports: Two patients, a 71-year-old man and an 88-year-old woman, were diagnosed with extensive tumor infiltration of the IVC secondary to renal cell carcinomas. Prophylactic placement of an IVC filter before transcatheter embolization was unsuccessful in both cases; a reduced space for deployment would have left part of the filter inside the right atrium. Instead, a Wallstent was used to constrain the tumor thrombus against the vessel wall and, at the same time, protect the patency of the contralateral kidney. Adequate patencies were confirmed 9 months after stenting in the first patient and after 19 days in the second patient. There were no clinical manifestations of pulmonary embolism. Conclusions: Wallstent implantation is an alternative prophylactic measure before transarterial embolization of renal carcinomas if IVC filters cannot be placed.
The Excimer Laser: Science Fiction Fantasy or Practical Tool?
Authors: Biamino Giancarlo 
Published: March 2015

Nearly 20 years ago, in vitro experiments left no doubt about the fact that laser light can ablate atherosclerotic plaque. The initial enthusiastic results with the technology, particularly in coronary arteries, were followed by reports showing unacceptably high restenosis and complication rates. These poor results were due to the premature application of an underdeveloped technology, a lack of understanding of laser/tissue interaction, and the use of incorrect lasing techniques. Consequently, and without discrimination, all lasers were banned from the catheterization laboratories for nearly a decade. Technological enhancements of the excimer laser, combined with refined catheter lasing techniques, resulted in greater debulking of atherosclerotic material in long superficial femoral artery occlusions. These results triggered the application of the excimer laser technique as an atherectomy tool in more complex lesions below the knee. The multicenter Laser Atherectomy for Critical Ischemia study clearly demonstrated that the excimer laser technology resulted in limb salvage rates >90% in patients with critical limb ischemia (CLI). Furthermore, new clinical results indicate that the excimer laser is very effective in dissolving thrombotic obstructions, redirecting this technology to the coronary field. The results of the excimer laser in CLI validate the role of the cool laser in treating complex peripheral vascular disease. The results suggest a larger indication for this technology and support a more aggressive use of these interventional techniques in the treatment of this large patient cohort. However, all lasers are not equally effective in debulking atherosclerotic material. Only the athermic process associated with the excimer laser produces a safe and effective endovascular ablation of obstructive atherosclerotic and/or thrombotic material. The appropriate and safe utilization of the equipment and lasing techniques, combined with correct indications and patient selection, will contribute to the successful application of laser-assisted atherectomy in complex peripheral and coronary artery obstructive disease. Unfortunately, little consistent scientific data has been generated to convince the interventional community of the usefulness of excimer laser ablation.
Influence of Pulmonary Status and Diabetes Mellitus on Aortic Neck Dilatation following Endovascular Repair of Abdominal Aortic Aneurysms: A EUROSTAR Report
Authors: Diehm Nicolas , Hobo Roel , Baumgartner Iris , Do Dai-Do , Keo Hak-Hong , Kalka Christoph , Dick Florian , Buth Jaap , Schmidli Juerg 
Published: March 2015

Purpose: To elucidate the association of impaired pulmonary status (IPS) and diabetes mellitus (DM) with clinical outcome and the incidences of aortic neck dilatation and type I endoleak after elective endovascular infrarenal aortic aneurysm repair (EVAR). Methods: In 164 European institutions participating in the EUROSTAR registry, 6383 patients (5985 men; mean age 72.4±7.6 years) underwent EVAR. Patients were divided into patients without versus with IPS or with/without DM. Clinical assessment and contrast-enhanced computed tomography (CT) were performed at 1, 3, 6, 12, 18, and 24 months and annually thereafter. Cumulative endpoint analysis comprised death, aortic rupture, type I endoleak, endovascular reintervention, and surgical conversion. Results: Prevalence of IPS was 2733/6383 (43%) and prevalence of DM was 810/6383 (13%). Mean follow-up was 21.1±18.4 months. Thirty-day mortality, AAA rupture, and conversion rates did not differ between patients with versus without IPS and between patients with versus without DM. All-cause and AAA-related mortality, respectively, were significantly higher in patients with IPS compared to patients with normal pulmonary status (31.0% versus 19.0%, p<0.0001 and 6.8% versus 3.3%, p=0.0057) throughout follow-up. In multivariate analysis adjusted for smoking, age, gender, comorbidities, fitness for open repair, co-existing common iliac aneurysm, neck and aneurysm size, arterial angulations, aneurysm classification, endograft oversizing >15%, and type of stent-graft, the presence of IPS was not associated with significantly higher rates of aortic neck dilatation (30.6% versus 38.0%, p>0.05) and did not influence cumulative rates of type I endoleak, endovascular reintervention, or conversion to open surgery (p>0.05). Similarly, the presence of DM did not influence the above-mentioned study endpoints. Conclusion: In contrast to observations regarding the natural course of AAAs, impaired pulmonary status does not negatively influence aortic neck dilatation, while the presence of diabetes does not protect from these dismal events after EVAR.
Virtual Histology Intravascular Ultrasound in Carotid Interventions
Authors: Irshad Khalid , Millar Samuel , Velu Raj , Reid Allan W. , Diethrich Edward B. , Reid Donald B. 
Published: March 2015

Purpose: To report early clinical experience with virtual histology intravascular ultrasound (VH IVUS) in carotid endoluminal repair. Technique: A 2.9-F, 20-MHz catheter that utilizes computer software to demonstrate the histological components of arteriosclerotic plaque was evaluated during carotid angioplasty and stenting. VH IVUS images were created following a pullback through the carotid stenosis and produced a color-coded map of the different histological constituents of the disease (dark green: fibrous, yellow/green: fibrofatty, white: calcified, and red: necrotic lipid core plaque). Conclusion: VH IVUS produces a color-coded map of the different histological components of artery plaque. It has the potential to predict how the plaque is likely to behave at the moment of endoluminal treatment.
Sirolimus-Elutin

g

versus Bare-Metal Low-Profile Stent for

R

enal

A

rtery

T

reatment (GREAT Trial): Angiographic Follow-up after 6 Months and Clinical Outcome up to 2 Years
Authors: Zähringer Markus , Sapoval Marc , Pattynama Peter M. T. , Rabbia Claudio , Vignali Claudio , Maleux Geert , Boyer Louis , Szczerbo-Trojanowska Malgorzata , Jaschke Werner , Hafsahl Geir , Downes Mark , Bérégi Jean-Paul , Veeger Nic J. G. M. , Stoll Hans-Peter , Talen Aly 
Published: March 2015

Purpose: To evaluate the patency of sirolimus-eluting stents (SES) compared to bare-metal stents (BMS) in the treatment of atherosclerotic renal artery stenosis (RAS). Methods: Between November 2001 to June 2003, 105 consecutive symptomatic patients (53 men; mean age 65.7 years) with RAS were treated with either a bare-metal (n=52) or a drug-eluting (n=53) low-profile Palmaz-Genesis peripheral stent at 11 centers in a prospective nonrandomized trial. The primary endpoint was the angiographic result at 6 months measured with quantitative vessel analysis by an independent core laboratory. Secondary endpoints were technical and procedural success, clinical patency [no target lesion revascularization (TLR)], blood pressure and antihypertensive drug use, worsening of renal function, and no major adverse events at 1, 6, 12, and 24 months. Results: At 6 months, the overall in-stent diameter stenosis for BMS was 23.9%±22.9% versus 18.7%±15.6% for SES (p=0.39). The binary restenosis rate was 6.7% for SES versus 14.6% for the BMS (p=0.30). After 6 months and 1 year, TLR rate was 7.7% and 11.5%, respectively, in the BMS group versus 1.9% at both time points in the SES group (p=0.21). This rate remained stable up to the 2-year follow-up but did not reach significance due to the small sample. Even as early as 6 months, both types of stents significantly improved blood pressure and reduced antihypertensive medication compared to baseline (p<0.01). After 6 months, renal function worsened in 4.6% of the BMS patients and in 6.9% of the SES group. The rate of major adverse events was 23.7% for the BMS group and 26.8% for the SES at 2 years (p=0.80). Conclusion: The angiographic outcome at 6 months did not show a significant difference between BMS and SES. Renal artery stenting with both stents significantly improved blood pressure. Future studies with a larger patient population and longer angiographic follow-up are warranted to determine if there is a significant benefit of drug-eluting stents in treating ostial renal artery stenosis.
Risk Factors for Perioperative Stroke during Thoracic Endovascular Aortic Repairs (TEVAR)
Authors: Feezor Robert J. , Martin Tomas D. , Hess Philip J. , Klodell Charles T. , Beaver Thomas M. , Huber Thomas S. , Seeger James M. , Lee W. Anthony 
Published: March 2015

Purpose: To determine the clinical and anatomical risk factors for cerebrovascular accidents (CVA) in patients undergoing thoracic endovascular aortic repair (TEVAR). Methods: Between September 2000 and December 2006, 196 patients (135 men; mean age 68.6±13.5 years, range 17–92) underwent TEVAR for a variety of aortic pathologies. The majority (156, 79.6%) were treated with the TAG stent-graft. Demographics, pathologies, intraoperative procedure-related measures, device usage, and postoperative outcomes were assessed. CVA was defined as a new focal or global neurological (motor or sensory) deficit lasting >48 hours associated with acute intracranial abnormalities on computed tomography or magnetic resonance brain imaging. Spinal cord ischemia was excluded. In a subset of patients with planned left subclavian artery (LSA) coverage and an incomplete circle of Willis or a dominant left vertebral artery, prophylactic carotid-subclavian bypasses were performed. Results: Nine (4.6%) patients suffered a CVA. Factors not predictive of a CVA on univariate analysis included aortic pathology, urgency of repair, ASA classification, type of anesthesia, blood loss, procedure time, and device used. Proximal extent of repair (with or without extra-anatomical revascularization) was significantly associated with a higher incidence of strokes (zones 0–2 versus 3–4, p=0.025). Five (55.6%) patients with a CVA had documented intraoperative hypotension (systolic blood pressure <80 mmHg). Additionally, while 2 patients had hemispheric infarcts, 5 had acute posterior circulation infarcts involving the cerebellum and brainstem; a single patient had both anterior and posterior circulation infarcts. Seven of the CVA patients had proximal coverage of the thoracic aorta in zones 0–2; of these, 6 had posterior circulation infarcts. Selective LSA revascularization based on preoperative cerebrovascular imaging resulted in lower rates of CVA (6.4% to 2.3%, p=0.30) and posterior circulation infarcts (5.5% to 1.2%, p=0.13). Conclusion: Proximal extent of repair may serve as a surrogate marker for greater severity of degenerative disease of the aortic arch. Avoidance of intraoperative hypotension and preservation of antegrade vertebral perfusion may be important in prevention of posterior circulation strokes.
Device-Specific Resistance to in Vivo Displacement of Stent-Grafts Implanted with Maximum Iliac Fixation
Authors: Murphy Erin H. , Johnson Eric D. , Arko Frank R. 
Published: March 2015

Purpose: To compare the in vivo device-specific downward displacement force of various externally supported endografts implanted with maximum iliac fixation. Methods: Twenty female sheep had aneurysms created with a graft patch in the infrarenal aorta. In 12 animals, a fully supported modular bifurcated stent-graft [AneuRx (n=4), Talent (n=4), or Zenith (n=4)] was deployed; in the other 8, a bifurcated aortic graft was surgically anastomosed to the infrarenal aorta. All grafts were displaced in vivo by applying downward traction to a guidewire brought out both femoral arteries. The peak force to cause initial stent-graft migration or disruption of the sutured anastomosis was recorded and compared. Results: There was no difference in animal size, aortic neck diameter or length, aneurysm size, or iliac artery diameter for animals receiving the AneuRx, Talent, or Zenith stent-grafts and those undergoing surgical repair. The mean length of iliac fixation was 31.0±0.3 mm, 30.8±0.5 mm, and 31.3±0.6 mm for the AneuRx, Talent, and Zenith devices, respectively (p=NS). Peak force to initiate migration was 30.2=5.5 N (range 25–38) for the AneuRx, 44.8±5.5 N (range 40–53) for the Talent, 46.7±5.4 N (range 38–55) for the Zenith, and 40.6±7.5 N (range 31–50) for the surgical anastomosis (p=0.01). There was no difference detected in the peak force to initiate migration between the suprarenally affixed Talent and Zenith stent-grafts and the surgical anastomosis (p=0.55). Conclusion: Devices with a suprarenal component require significantly greater force to cause downward displacement compared to infrarenal devices. The force required to displace a suprarenal device with maximal iliac fixation was equivalent to the force required to disrupt a surgical anastomosis.
Endovascular Treatment of Aneurysmal Deterioration in Peripheral Arterial Allografts
Authors: Castier Yves , Alsac Jean-Marc , Paraskevas Nikos , Francis Fady , Coppin Thierry , Cerceau Olivier , Leseche Guy 
Published: March 2015

Purpose: To report endovascular treatment of 2 patients with aneurysmal deterioration of peripheral arterial allografts. Case Report: Two men (65 and 64 years old) who had undergone an arterial allograft reconstruction for infection of prosthetic infrapopliteal bypass grafts 5 and 7 years ago, respectively, were diagnosed with asymptomatic aneurysmal deterioration of the allografts. Stent-graft repair was successful in both cases, completely excluding the aneurysms. At ≥1 year, continued aneurysm exclusion was confirmed by duplex scan, with no evidence of endoleak, migration, or stenosis. Conclusion: Endovascular treatment may be a useful therapeutic option when treating patients with late peripheral allograft deterioration.
Natural History of the Iliac Arteries after Endovascular Abdominal Aortic Aneurysm Repair and Suitability of Ectatic Iliac Arteries as a Distal Sealing Zone
Authors: Falkensammer Juergen , Hakaim Albert G. , Oldenburg W. Andrew , Neuhauser Beate , Paz-Fumagalli Ricardo , McKinney J. Mark , Hugl Beate , Biebl Matthias , Klocker Josef 
Published: March 2015

Purpose: To investigate the natural history of dilated common iliac arteries (CIA) exposed to pulsatile blood flow after endovascular abdominal aortic aneurysm repair (EVAR) and the suitability of ectatic iliac arteries as sealing zones using flared iliac limbs. Methods: Follow-up computed tomograms of 102 CIAs in 60 EVAR patients were investigated. Diameter changes in CIAs ≤16 mm (group 1) were compared with changes in vessels where a dilated segment >16 mm in diameter continued to be exposed to pulsatile blood flow (group 2). Within group 2, cases in which the stent terminated proximal to the dilated artery segment (2a) were compared with those that had been treated with a flared limb (2b). Results: The mean CIA diameter increased by 1.0±1.0 mm in group 1 (p<0.001 versus immediately after EVAR) and by 1.5±1.7 mm in group 2 (p<0.001 versus immediately after EVAR) within an average follow-up of 43.6±18.0 months. Diameter increase was more pronounced in dilated CIAs (p=0.048), and it was not significantly different between groups 2a and 2b (p=0.188). No late distal type I endoleak or stent-graft migration associated with CIA ectasia was observed. Conclusion: Dilatation of the CIA is significant after EVAR, and it is more pronounced in ectatic iliac arteries. Although ectatic iliac arteries appear to be suitable sealing zones in the short term, continued follow-up is mandatory.