bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interventional Treatment of Traumatic Priapism
Authors: Görich Johannes , Ermis Cengiz , Krämer Stefan C. , Fleiter Thorsten , Wisianowsky Christian , Basche Steffen , Gottfried Hans-Werner , Volkmer Bjoern G. 
Published: March 2015

Purpose: To describe the effectiveness of transarterial embolization of traumatic priapism. Methods: Six patients ranging in age from 6 to 37 years with traumatic high-flow priapism underwent superselective embolization with gelatin sponges (n=3) or minicoils (n=3). Embolization was repeated up to 3 times. Results: Embolization was successful in all cases. In 2 patients, repeated embolization led to a flow reduction in the fistula, which spontaneously occluded a few days later. All patients experienced normal erections after intervention, and no side effects were observed. Conclusions: Transarterial superselective embolization is an effective and well-tolerated therapy in patients with traumatic priapism.
Management of Unexpected Balloon Rupture during Deployment of Balloon-Expandable Stents
Authors: Order Berndt M. , Müller-Hülsbeck Stefan 
Published: March 2015

Purpose: To describe a method for dealing with balloon rupture during stent deployment. Technique: A 10-mL Luer-Lock syringe containing contrast material and heparinized saline is used to re-expand a balloon ruptured during stent deployment, permitting maximum balloon expansion and successful initial stent-wall apposition. No adjunctive use of probing catheters or a power injector is necessary to achieve adequate stent expansion. Analysis of the rupture may identify procedural deficiencies that can be rectified. Conclusions: This technique is simple and timesaving, and interventionists should maintain vigilance when handling of balloon-expandable stents.
Gadodiamide as an Alternative Contrast Agent during Angioplasty in Patients with Contraindications to Iodinated Media
Authors: Zeller Thomas , Müller Christian , Frank Ulrich , Bürgelin Karlheinz , Sinn Lutz , Horn Barbara , Flügel Peter C. , Roskamm Helmut 
Published: March 2015

Purpose: To evaluate gadodiamide as an alternative contrast agent for peripheral and renal angioplasty in patients with contraindications to iodinated contrast media. Methods: Seventeen patients (10 men; mean age 74 years, range 68–83) with contraindication to iodinated contrast media were given gadodiamide as the contrast agent during peripheral and renal intra-arterial digital subtraction angiography (DSA) and subsequent percutaneous interventions (balloon angioplasty, stent placement). Results: The mean volume of gadodiamide used was 136 ± 46 mL (range 60–200). No serious side effects were observed, especially no change in renal or thyroid function; no exanthema or other allergic reactions were noted. In patients without renal artery intervention, serum creatinine at discharge remained unchanged (2.57 ± 1.43 mg/dL to 2.40 ± 1.28 mg/dL, p=NS). In patients undergoing angioplasty/stenting of renal artery stenoses, serum creatinine decreased significantly from 3.53 ± 1.75 mg/dL to 2.36 ± 1.15 mg/dL (p<0.01). All but 1 intervention was successful. Using a simple scoring system, 2 judges blinded to the contrast agent graded the quality of the peripheral DSAs as “good,” whereas renal DSA images were only “sufficient.” Conclusions: For patients with contraindications to iodinated materials, gadodiamide may be a suitable alternative for renal or peripheral DSA followed by angioplasty.
The Zenith Aortic Stent-Graft: A 5-Year Single-Center Experience
Authors: Alric Pierre , Hinchliffe Robert J. , MacSweeney Shane T.R. , Wenham Peter W. , Whitaker Simon C. , Hopkinson Brian R. 
Published: March 2015

Purpose: To evaluate the efficacy and midterm results of the Zenith stent-graft in the treatment of abdominal aortic aneurysms (AAA). Methods: Since March 1994, 364 patients have undergone endovascular repair of infrarenal AAA. Of the 94 who were treated with the Zenith stent-graft from 1996 to 2002, 88 patients (82 men; mean age 72.6 ± 6.5 years, range 47–88) with at least 6-month follow-up were analyzed. Sixty-one (69.3%) patients were considered at high risk for intervention; 7 ruptured AAAs were treated emergently. In all, 68 (77.3%) bifurcated stent-grafts (including 18 TriFab systems) and 20 aortomonoiliac configurations were used. Cumulative data on endoleak, migration, secondary procedures, and survival were evaluated with Kaplan-Meier analyses. Results: Implantation success was 97.7%; 2 (2.3%) access-related failures were converted to open repair (1 immediate, 1 at 3 months). There were 3 (3.4%) graft limb thromboses (2 immediate, 1 late), 3 (3.4%) cases of colon ischemia due to embolization in 1 and hypogastric artery occlusion in 2, and 1 (1.1%) renal infarction due to embolism. Three (3.4%) patients died within 30 days. Eleven (12.5%) endoleaks and 1 (1.1%) late endograft migration were recorded. The 5-year cumulative endoleak and migration rates were 15% and 7%, respectively. Sixty-three (71.6%) patients did not present any complication related to the repair during a mean follow-up of 20.6 ± 14.9 months (range 6–68); notably, no complications were associated with the 18 TriFab systems. Six (6.8%) secondary procedures were performed (31% 5-year cumulative secondary procedural rate). All 6 (6.8%) aneurysm-related deaths (the 3 perioperative, 2 from late AAA rupture, and 1 during a secondary procedure) and 14 of 18 (20.4%) non-aneurysm—related deaths occurred in high-risk patients; the 5-year cumulative survival rates were 57% for any death and 92% for aneurysm-related deaths. Conclusions: The Zenith stent-graft appears both safe and effective in terms of midterm outcome of endovascular aortic aneurysm repair.
Treatment of Thoracic Aortic Dissection with Stent-Grafts: Midterm Results
Authors: Shim Won-Heum , Koo Bon-Kwon , Yoon Young-Sup , Choi Donghoon , Jang Yangsoo , Lee Do-Yun , Chang Byoung-Chul 
Published: March 2015

Purpose: To evaluate the early and midterm outcomes after stent-graft implantation for dissection in the descending thoracic aorta. Methods: Sixteen custom-made endovascular stent-grafts were implanted in 15 patients (10 men; mean age 55.9 ± 13.7 years, range 32–82) with descending thoracic aortic dissection. Indications for stent-graft implantation were persistent symptoms unresponsive to medical treatment or progressive enlargement of the false lumen. Clinical and imaging surveillance with computed tomography was performed within 1 month of the procedure and at 3 to 6-month intervals in follow-up. Results: Endovascular stent-graft implantation at the target site was successful in 14 (93%) patients; 1 device migrated, leaving the false lumen open to flow in the failed case. One (7%) patient who was treated emergently for rupture died suddenly 2 days after the procedure. Over an average follow-up of 31.5 ± 23.8 months, 1 (7%) patient died and 2 (14%) patients underwent surgical treatment due to recurrent dissection. The remaining 10 patients showed complete thrombosis of the false lumen; in 3, the false lumen completely resolved. Conclusions: Endovascular stent-graft implantation in descending thoracic aortic dissection is a feasible, safe, and effective treatment modality. However, further studies are necessary in a greater number of patients to determine if wider application of this minimally invasive procedure is justified.
Renal Atrophy in Atherosclerotic Renovascular Disease: Gradual Changes 6 Months after Successful Angioplasty
Authors: Mounier-Véhier Claire , Haulon Stéphan , Lions Christophe , Devos Patrick , Jaboureck Olivier , Willoteaux Serge , Carré Alain , Beregi Jean-Paul 
Published: March 2015

Objective: To assess renal morphology using spiral computed tomographic angiography (CTA) before and 6 months after angioplasty of unilateral atherosclerotic renal artery stenosis (RAS). Methods: Spiral CTA scans from 14 hypertensive patients (7 men; mean age 57.4 ± 13.1 years) with significant RAS were performed before and 6 months after angioplasty; renal length, mean cortical thickness (MCT), cortical area (CA), and medullary length (ML) were measured from the axial slices in the 14 contralateral and 14 poststenotic then revascularized kidneys. Blood pressure, creatinine clearance, and number of antihypertensive drugs were analyzed. Results: At 6 months, the systolic blood pressure was significantly reduced (p=0.007), but the number of antihypertensive drugs and the creatinine clearance did not change significantly. Most morphological parameters before and after angioplasty were different in the contralateral versus poststenotic kidneys (renal length, p=0.01; MCT, p=0.01; ML, p=0.03; CA, p=0.008). After angioplasty, there was an 11% drop in cortical atrophy associated with a mean 4-mm increase in medullary length in the poststenotic/revascularized kidneys. The contralateral kidneys exhibited corticomedullary thinning after angioplasty. Conclusions: In atherosclerotic renal disease, cortical thinning could be a useful timesaving marker to assess the significance of the lesion and to evaluate associated distal lesions. The favorable blood pressure outcome supports the existence of reversible ischemic lesions, particularly in the medulla. Angioplasty appears to be useful for the poststenotic kidney, according to the morphological study.
Duplex Ultrasound—Guided Femoropopliteal Angioplasty: Initial and 12-Month Results from a Case Controlled Study
Authors: Ahmadi Ramazanali , Ugurluoglu Ara , Schillinger Martin , Katzenschlager Reinhold , Sabeti Schila , Minar Erich 
Published: March 2015

Purpose: To evaluate initial technical success, procedural complications, and 12-month patency of duplex-guided angioplasty compared to conventional fluoroscopically-guided procedures. Methods: One hundred four patients (65 men; mean age 69 years) who underwent duplex-guided femoropopliteal angioplasty were compared to 104 patients undergoing fluoroscopically-guide procedures who were matched for age, sex, baseline ankle-brachial index (ABI), and length and grade of lesion. Patients were followed for 12 months, and restenosis was assessed by ABI and duplex sonography. Results: Technical success was achieved in 88 (84.6%) patients from the duplex-guided group and in 102 (98.1%) control patients (p=0.001). Periprocedural complications occurred in 12.5% (n=13) and 18.3% (n=19), respectively (p=0.4). Contrast-induced transient renal impairment was observed in 7 (6.7%) patients in the fluoroscopic group. One hundred (96.1%) patients in the duplex and 102 (98.1%) patients in the fluoroscopic group completed the 12-month follow-up. Restenosis was found in 35 (39.8%) patients of the duplex group and in 38 (37.2%) patients of the fluoroscopic group (p=0.8). Conclusions: Technical success of duplex-guided procedures was significantly lower compared to fluoroscopic angioplasty; complications and 12-month patency were similar with both techniques. Duplex-guided angioplasty may be a feasible alternative, particularly for patients at high risk for contrast-induced complications.
Percutaneous Transluminal Laser Angioplasty versus Balloon Dilation for Treatment of Popliteal Artery Occlusions
Authors: Steinkamp Hermann J. , Rademaker Jürgen , Wissgott Christian , Scheinert Dierk , Werk Michael , Settmacher Utz , Felix Roland 
Published: March 2015

Purpose: To compare the immediate results, complication rates, and long-term outcomes of percutaneous transluminal laser angioplasty (PTLA) versus balloon dilation alone in the treatment of popliteal artery occlusions. Methods: In a prospective nonrandomized study conducted between December 1994 and June 2000, 215 symptomatic patients with unilateral popliteal occlusions were treated with either dilation alone (88 patients: 52 men; mean age 62 years, range 48–83) or PTLA (127 patients: 70 men; mean age 64 years, range 49–86) using a 308-nm excimer laser followed by dilation. The average occlusion length was 10.4 cm (range 3–14). Results: PTLA was successful in recanalizing 105 (82.7%) arteries, while the recanalization rate for dilation alone was only 70.4% (62/88; p=0.045). After a mean follow-up of 36 months (range 6–52), the primary and secondary patency rates were 21.7% and 50.8%, respectively, in patients with PTLA and 16.3% and 35.2% in the angioplasty group (p=0.762). The complication rates associated with both techniques were similar. Conclusions: Although initial recanalization may be better with PTLA, it does not appear to add any long-term benefit over balloon dilation alone.
Endovascular Treatment of a Multimorbid Patient with Late AAA Rupture after Stent-Graft Placement: 1-Year Follow-up
Authors: Teufelsbauer Harald , Prusa Alexander M. , Prager Manfred , Thurnher Siegfried , Lammer Johannes , Hölzenbein Thomas , Kretschmer Georg , Huk Ihor , Polterauer Peter 
Published: March 2015

Purpose: To report successful endovascular management of a ruptured abdominal aortic aneurysm (AAA) in a multimorbid patient 40 months after primary stent-grafting. Case Report: A 64-year-old man presented with hypotension, severe back pain, and abdominal distension. Immediate computed tomography revealed a proximal type I endoleak due to distal migration of the stent-graft with subsequent rupture of the aneurysm. The patient was hemodynamically unstable, and open surgery was refused because of severe comorbidities that were the indications for initial endovascular repair. The diameter of the proximal aneurysm neck required the use of a thoracic stent-graft that was overly long, which led to occlusion of the contralateral stent-graft limb supplying not only the left leg but also a left kidney transplant. A crossover bypass was implanted to revascularize both. Conclusions: Minimally invasive strategies, even when challenged by complex vascular reconstructions, offer the possibility of managing ruptured aortic aneurysms in patients unsuitable for open surgery.
Aortic Stent-Graft Infection Due to a Presumed Aortoenteric Fistula
Authors: Kar Biswajit , Dougherty Kathy , Reul George J. , Krajcer Zvonimir 
Published: March 2015

Purpose: To report a case of late stent-graft infection with aortoenteric fistula. Case Report: A 76-year-old Colombian man received an AneuRx stent-graft for a 5.5-cm infrarenal AAA. The aneurysm sac progressively shrank until 22 months postoperatively, when an increase in diameter was noted on magnetic resonance imaging without evidence of endoleak or air in the sac. Two months prior, the patient had developed fever and an elevated white blood cell count; he underwent a 6-week course of intravenous antibiotics. Shortly thereafter, the fever recurred, along with progressive weight loss, which prompted admission. The computed tomographic scan showed no evidence of endoleak, but gas collection was seen anteriorly in the sac; aspirated material was positive for a variety of organisms. At surgery 23 months after stent-graft implantation, pronounced inflammatory reaction and scarring were seen around the graft in conjunction with evidence of a healed duodenal perforation, suggestive of an aortoenteric fistula. The excised stent-graft was intact; no deterioration was seen. The patient had a protracted recovery but has been afebrile and asymptomatic >1 year after stent-graft explantation Conclusions: Close surveillance after endovascular AAA repair is essential to detect late leaks, secondary migration, endotension, structural failure, and infection with or without aortoenteric fistula.
Acute Thrombotic Subclavian Artery Occlusion Treated with a New Rotational Thrombectomy Device
Authors: Zeller Thomas , Frank Ulrich , Bürgelin Karlheinz , Sinn Lutz , Horn Barbara , Roskamm Helmut 
Published: March 2015

Purpose: To report the use of a new rotational thrombectomy device for percutaneous thrombectomy of an acutely occluded subclavian artery. Case Report: A 71-year-old woman with a history of multivessel coronary disease complained of sudden onset of pain at rest and paleness of the left arm. Duplex ultrasound showed a localized thrombotic occlusion of the postvertebral subclavian artery and another at the bifurcation of the brachial artery. After angiographic confirmation, the subclavian artery was recanalized with an 8-F Rotarex device via a percutaneous transfemoral access; the bifurcation of the brachial artery was recanalized by local thrombolysis (50 mg rtPA) because the thrombectomy device was too short to reach the occlusion. Follow-up examinations up to 1 year have shown normalized perfusion of the left arm. Conclusions: This new thrombectomy device is a useful tool for the percutaneous treatment of acute occlusion in the brachiocephalic arteries.
Magnetic Resonance Imaging versus Multislice Computed Tomography of Thoracic Aortic Endografts
Authors: Merkle Elmar M. , Klein Stefan , Wisianowsky Christian , Boll Daniel T. , Fleiter Thorsten R. , Pamler Reinhard , Görich Johannes , Brambs Hans-Jürgen 
Published: March 2015

Purpose: To compare the potential of magnetic resonance imaging (MRI) to multislice computed tomography (CT) for evaluating stent-graft placement in the thoracic aorta. Methods: Susceptibility artifacts in 2 different stent-graft systems (Talent and Excluder) were evaluated in vitro in 2 angulations (straight and 33° curved) using 3 different MRI gradient echo sequences (True FISP, 2-dimensional FLASH, and 3-dimensional Turbo FLASH). The size of the stent-related artifact was measured, and the relative stent lumen was calculated. In vivo stent demarcation, stent patency, and additional findings were determined in 13 patients (3 Talent, 9 Excluder, and 1 combined) and compared to CT findings. Results: In vitro, both endograft systems proved to be MR compatible, with the relative stent lumen value ranging from 82% to 100% in the straight configuration; in a curved model, the relative stent lumen value ranged from 56% to 92% with the 3D Turbo FLASH sequence, which provided the smallest susceptibility artifacts. The Excluder endoprosthesis caused significant signal inhomogeneity within the stent in a curved configuration. In vivo, MRI and multislice CT showed similar results, with CT imaging slightly superior in stent demarcation and MRI better in demonstrating thrombus. CT beam hardening artifacts were pronounced in the Talent system, while the Excluder device caused significant signal inhomogeneity within the stent on magnetic resonance angiography. Conclusions: Multislice CT and contrast-enhanced MRI are fast, reliable means of providing all relevant information for surveillance of fully MR-compatible stent-grafts in the thoracic aorta.
Transesophageal Echocardiographic Guidance of Thoracic Aortic Stent-Graft Implantation
Authors: Schütz Wolfram , Gauss Albrecht , Meierhenrich Rainer , Pamler Reinhard , Görich Johannes 
Published: March 2015

Purpose: To evaluate the efficacy of intraoperative transesophageal echocardiography (TEE) as an adjunctive measure in guiding the implantation of endoluminal stent-grafts in the thoracic aorta. Methods: TEE was used in 21 of 30 patients (27 men; median age 70 years; range 19–77) undergoing implantation of Excluder or Talent stent-grafts for management of 11 type B aortic dissections, 7 thoracic aortic aneurysms, 2 traumatic thoracic aortic ruptures, and an aortic coarctation. We evaluated the ability of TEE to provide evidence of (1) correct placement of the guidewire within the true lumen, (2) reduction in blood flow in the false lumen following stent deployment, and (3) early complications. Results: Definite identification of the true lumen and a reliable evaluation of the position of the stent-graft guidewire during advancement were possible in all patients. Reduction of blood flow within the false lumen following deployment of the stent-graft was visualized in >70% of patients with aortic dissection. In the patient with aortic coarctation, TEE recognized the acute onset of aortic dissection following stent dilation, which resulted in immediate management with an additional stent. Conclusions: The intraoperative use of TEE in the implantation of stent-grafts in the thoracic aorta is not significantly invasive and is easily employed. It permits excellent evaluation of the correct placement of the stent guidewire and, in patients with aortic dissection, intraoperatively visualizes effective blood flow reduction in the false lumen following stent-graft deployment. Its ability to recognize early complications may indicate the need for additional maneuvers during the surgical procedure.
Salvage of an Acutely Ruptured Thoracic Aortic Aneurysm during CPR
Authors: Larzon Thomas , Jansson Håkan , Holmström Björn , Lund Philip , Norgren Lars , Arfvidsson Berndt , Berggren Lars , Nydahl Anders , Eriksson Tomas , Jonsson Thomas , Stenberg Björn 
Published: March 2015

Purpose: To report the successful endovascular treatment of a ruptured thoracic aortic aneurysm during cardiopulmonary resuscitation. Case Report: A 72-year-old woman with a type B aortic dissection treated conservatively for 8 years was referred for rupture of a 16-cm aneurysm of the descending thoracic aorta. During transfer to the operating room, the patient suffered cardiac arrest; cardiopulmonary resuscitation (CPR) was initiated. A few minutes later during CPR, the surgical procedure began with a cutdown of the right femoral artery and insertion of a guidewire and an aortic occlusion balloon, which was inflated at the origin of the left subclavian artery (LSA). Blood pressure was immediately measurable. By only partially deflating the occluding balloon, a thoracic stent-graft was advanced above it and deployed at the origin of the LSA while rapidly deflating and retracting the occluding balloon. Three stent-grafts were required to cover 27 cm of the descending aorta. The patient was partly ventilator dependent for 3 months due to a massive pleural hematoma that was not evacuated. At the 10-month follow-up, the patient is fully recovered without any sign of respiratory dysfunction or any other sequela. CT scans reveal that the massive hematoma is almost completely resolved. Conclusions: This case illustrates that optimal collaboration between anesthesiologists, interventional radiologists, and vascular surgeons with appropriate resources can significantly expand the possibilities of emergent treatment in the face of aortic rupture.