bluuebunny/crossref_metadata_2025_split huggingface dataset:
Renal Atrophy Outcome after Revascularization in Fibromuscular Dysplasia Disease
Authors: Mounier-Véhier Claire , Haulon Stéphan , Devos Patrick , Lions Christophe , Jaboureck Olivier , Gaxotte Virginia , Carré Alain , Beregi Jean-Paul 
Published: March 2015

Purpose: To assess clinical, biological, and kidney parameters before and 6 months after revascularization of renal artery stenosis due to fibromuscular dysplasia (FMD). Methods: Twenty hypertensive patients (18 women; mean age 48.7 ± 15.4 years) with unilateral de novo FMD stenosis were studied before and 6 months after revascularization (balloon angioplasty 19; bypass surgery 1). Blood pressure and creatinine clearance were measured, and renal length, cortical thickness, cortical area (CA), and medullary length (ML) were evaluated by spiral computed tomographic angiography (CTA) in 20 poststenotic and 20 contralateral kidneys. Results: Six months after revascularization, the systolic and diastolic blood pressures decreased by 19 mmHg and 10 mmHg, respectively (p=0.02), the number of antihypertensive drugs decreased by 1 (p=0.01), but the increase in creatinine clearance was not significant. At baseline, the poststenotic kidneys were significantly more atrophied than the contralateral normal kidney (ML in normal kidney 89 ± 9 mm versus 81 ± 10 mm in poststenotic kidney, p<0.001; CA in normal kidney 824 ± 149 mm versus 703 ± 156 mm in poststenotic kidney, p<0.01), which persisted at 6 months (ML in normal kidney 89 ± 10 versus 80 ± 11 in poststenotic kidney, p<0.001; CA in normal kidney 807 ± 145 mm versus 696 ± 157 mm in poststenotic kidney, p<0.01). Renal length was still within normal range in all kidneys, and the morphological parameters remained stable after revascularization. Conclusions: We demonstrated significant cortical/medullary atrophy in poststenotic kidneys compared to contralateral normal kidneys. Despite intraparenchymal disease, clinical outcome was favorable after revascularization. Cortical/medullary thinning appears to be an early marker of renal ischemia that could support revascularization in FMD disease.
Stent-Graft Migration following Endovascular Repair of Aneurysms with Large Proximal Necks: Anatomical Risk Factors and Long-term Sequelae
Authors: Lee James T. , Lee Jason , Aziz Ihab , Donayre Carlos E. , Walot Irwin , Kopchok George E. , Heilbron Mauricio , Lippmann Maurice , White Rodney A. 
Published: March 2015

Purpose: To evaluate the outcome of aortic endografts deployed in large infrarenal necks and to identify any association of preoperative aneurysm characteristics and postoperative morphological changes with the incidence of neck dilatation and device migration in this patient subset. Methods: The records of 47 patients (41 men; mean age 74, range 55–84) with large aortic neck diameters treated with Talent stent-grafts from 1998 to 2001 were reviewed. Patients with anatomical criteria that precluded aneurysm exclusion with currently available devices were preferentially selected. Mean baseline aneurysm morphology included 27.6-mm (range 18–33.4) suprarenal and 28.1-mm (range 24–34) infrarenal neck diameters; the infrarenal neck length was 26 ± 16 mm with angulation of 37° ± 18°. Computed tomographic (CT) angiograms up to 3 years were analyzed using specialized interactive software; migration was defined as >1-cm change in the distance from the lower renal artery to the top of the device. Pre- and postoperative morphological characteristics of the aneurysm were compared between patients with and without migration. Results: Of the 45 patients successfully treated, 40 had complete CT data for analysis. During a mean 17-month follow-up, 7 (17.5%) of the 40 devices exhibited distal migration. Six patients required secondary procedures; 5 were in the migration cohort. No preoperative anatomical characteristic or degree of neck dilatation over time was predictive of stent-graft migration. Aneurysm sac regression was significant at 1 (–0.09 ± 4.90 mm) and 2 (–1.48 ± 2.56 mm) years in endografts without migration (p<0.001). Distal endograft migration >1 cm predicted the need for secondary interventions (p<0.001), with 83% sensitivity and 94% specificity. Conclusions: Endovascular repair is successful in patients with large infrarenal necks and complex neck morphology. Changes in aneurysm remodeling over time were similar to reported observations in patients with more favorable neck criteria. Although no anatomical factor associated with migration could be identified from this analysis, distal displacement >1 cm correlated with the need for a secondary intervention.
Percutaneous Stent-Graft Repair of Mycotic Common Femoral Artery Aneurysm
Authors: Kwon Kihwan , Choi Donghoon , Choi Seung-Hyuk , Koo Bon Kwon , Ko Young-Guk , Jang Yangsoo , Shim Won-Heum , Cho Seung-Yun 
Published: March 2015

Purpose: To report successful percutaneous repair of a peripheral mycotic aneurysm as a bridge to standard surgical therapy. Case Report: An aneurysm of the left common femoral artery was diagnosed in a 43-year-old man with subacute infective endocarditis. A Jostent stent-graft was percutaneously deployed to exclude the mycotic lesion. Computed tomography at 8 months after the procedure documented aneurysm regression and stent-graft patency without evidence of infection. Arteriography at 18 months has confirmed continued stent-graft patency and the patient remains asymptomatic. Conclusions: The standard management of mycotic aneurysms is usually by surgical resection and repair. However, this case suggests that percutaneous stent-graft implantation may be an option for the treatment of mycotic aneurysms.
Endovascular Aneurysm Exclusion along a Femorodistal Venous Bypass in Active Behçet's Disease
Authors: Gretener Silvia B. , Do Dai-Do , Baumgartner Iris , Dinkel Hans-Peter , Schmidli Jürg , Birrer Manuela 
Published: March 2015

Purpose: To report the endovascular repair of dual aneurysms along a femorodistal venous bypass graft in a patient with Behçet's disease. Case Report: A 55-year-old man of middle European ancestry with Behçet's disease had dual aneurysms evolve along the proximal segment of a femorodistal venous bypass that had been implanted 2.5 years earlier for recurrent false aneurysm formation. Owing to the lack of suitable venous conduits and the active nature of the disease, the aneurysms were successfully excluded with overlapping Hemobahn and Jostent endografts; the immunosuppressive therapy was intensified. Rupture of the aneurysms was successfully prevented, but the stent-grafts thrombosed 6 weeks later owing to exacerbation of the underlying disease. Conclusions: Endovascular exclusion of aneurysm in venous bypass grafts in Behçet's disease is feasible. Although the stent-grafts thrombosed, they did prevent rupture of the aneurysms.
Twin Pregnancy following Endoluminal Exclusion of an Iliac Arteriovenous Fistula
Authors: Frego Mauro , Kontothanassis Dimitrios , Miotto Diego , Chiesura-Corona Matteo , Verlato Fabio 
Published: March 2015

Purpose: To demonstrate the sustained efficacy of stent-graft exclusion of a pelvic arteriovenous fistula (AVF) in a woman who became pregnant after treatment. Case Report: An iatrogenic iliac arteriovenous fistula caused by redo surgery for a herniated disk in a 23-year-old woman was successfully treated with percutaneous endoluminal exclusion. Intravascular ultrasound was particularly useful for localization of the fistula during the procedure. The patient subsequently became pregnant, and serial Doppler studies were used to monitor the stent-graft until the uneventful delivery of twins by Caesarian section. At 36 months after endograft implantation, the patient has no complaints relative to the device. Conclusions: Uncomplicated twin pregnancy following stent-graft repair of an AVF in the pelvis appears feasible.
Endovascular Repair Reduces Early and Late Morbidity Compared to Open Surgery for Abdominal Aortic Aneurysm
Authors: Arko Frank R. , Hill Bradley B. , Olcott Cornelius , Harris E. John , Fogarty Thomas J. , Zarins Christopher K. 
Published: March 2015

Purpose: To compare systemic complications between standard surgery and endovascular repair of abdominal aortic aneurysms (AAA) for both primary and late secondary procedures. Methods: At a single center between July 1993 and May 2000, 297 patients (255 men; mean age 73.4 ± 8.1 years, range 50–93) were treated with open surgical repair; beginning in 1996, 200 (166 men; mean age 73.6 ± 8.0 years, range 45–96) patients were treated with the AneuRx stent-graft. In a comparison of the cohorts, which were similar in terms of age, gender, and aneurysm diameter, the main outcomes were early major systemic morbidity following the primary procedure to treat the aneurysm and late (>30 days) organ system morbidity for any secondary procedures. Results: Mean length of follow-up for open patients was 20.1 ± 17.1 months (range 1–150) compared to 12.4 ± 9.6 months (range 1–60) after endovascular repair (p<0.05). There were 36 (12.1%) systemic complications after the primary open surgery and 15 (7.5%) after endovascular repair (p=NS). There were 43 (14.5%) combined primary and secondary morbidities in the open surgery group versus 15 (7.5%) for patients undergoing endovascular repair (p<0.01). The need for invasive procedures to treat these primary and secondary systemic complications was 4 times greater in the open group (17, 5.7%) than in endograft patients (3, 1.5%) (p<0.05). After secondary procedures (32 in the open group and 30 in the endovascular patients) for graft-related complications, there were 7 (21.9%) adverse events in the open group versus none (0%) for endograft patients (p<0.01). Hospital lengths of stay following both primary and secondary procedures were lower for the endograft patients (p<0.01 and p<0.001, respectively). Conclusions: Endovascular stent-graft repair compared to open surgery has reduced the early and late morbidity by half. Complications that require invasive or secondary surgical procedures and hospitalization are reduced with endovascular repair.
Endovascular Repair of Acute AAAs under Local Anesthesia with Bifurcated Endografts: A Feasibility Study
Authors: Verhoeven Eric L.G. , Prins Ted R. , van den Dungen Jan J.A.M. , Tielliu Ignace F.J. , Hulsebos Robin G. , van Schilfgaarde Reinout 
Published: March 2015

Purpose: To evaluate endovascular repair of abdominal aortic aneurysms (AAA) under local anesthesia in the acute setting. Methods: Between 1998 and 2001, 47 patients with an acute AAA were evaluated for endovascular repair after informed consent, provided they were in a stable, albeit hypotensive condition. The patients underwent urgent computed tomography to assess suitability for endovascular repair; 16 were eligible for stent-graft repair: 9 were frank ruptures and 7 were symptomatic aneurysms. Complications and outcome of endovascular repair were evaluated; mortality was compared to a contemporaneous surgical cohort. Results: Seven (23%) of 31 patients having a standard surgical procedure died in the study period compared to 1 (6%) of 16 patients undergoing endovascular repair (following conversion to surgery because of calcified access vessels). Twelve (75%) of the endovascular repairs were performed under local anesthesia; no complications with this mode of anesthesia were encountered. The median duration of the endovascular procedures was 110 minutes (range 75–240); median blood loss was 250 mL (range 100–2800 mL). Only 4 patients required blood transfusion, and only 8 patients required admission to the intensive care unit. There were 3 postoperative complications (1 ischemic colitis, 1 renal failure, 1 groin hematoma). During follow-up, 3 endograft patients received stent-graft extensions in uneventful procedures. Two patients died at 9 and 16 months from cardiac causes. Conclusions: This study demonstrates the feasibility and possible advantages of endovascular repair under local anesthesia in selected acute AAA patients. Further studies are needed to prove the advantages over open repair.
Stent-Graft Migration after Endovascular Repair of Abdominal Aortic Aneurysm
Authors: Kalliafas Stavros , Albertini Jean-Noel , Macierewicz Jan , Yusuf Syed W. , Whitaker Simon C. , Davidson Ian , Hopkinson Brian R. 
Published: March 2015

Purpose: To report the incidence of graft migration in patients after endovascular repair of abdominal aortic aneurysms (AAA) and assess the significance of neck diameter changes in patients with and without suprarenal stent implantation. Methods: The medical records and imaging studies of 176 consecutive patients (175 men; median age 71 years, range 48–88) who had endovascular AAA repair with the Nottingham aortomonoiliac system were reviewed. The following parameters were recorded: preoperative neck diameter and length, presence of intraoperative and late graft migrations, time to onset of late migration, length of late migration, and neck diameter changes in patients with documented late graft migration. The patients were divided into 2 groups based on the placement of an endograft with or without suprarenal bare stent fixation. Median follow-up was 15 months (range 1–48). Results: There were 15 (8.5%) graft migrations (6 intraoperative and 9 late). Of those, 14 (10.9%) were in the 128-patient infrarenal fixation group and 1 (2.1%) in the 48-patient suprarenal stent group. Median neck diameters on preoperative and postoperative computed tomography scans in patients with late migration were 22.2 mm and 23.0 mm, respectively (p>0.05). The median time to graft migration was 14 months after the original operation (range 6–36). Conclusions: Distal device migration occurred frequently with the Nottingham system. Late graft migration was not associated with neck enlargement. Endografts with a suprarenal stent may have a decreased incidence of graft migration.
Factors and Forces Influencing Stent-Graft Migration after Endovascular Aortic Aneurysm Repair
Authors: Mohan Irwin V. , Harris Peter L. , van Marrewijk Corine J. , Laheij Robert J. , How Thien V. 
Published: March 2015

Purpose: To assess and validate the clinical features predisposing to stent-graft migration and to calculate the distal displacement forces exerted at the proximal fixation site following endovascular aortic aneurysm repair (EVAR). Methods: Demographic, anatomical, and graft-related features from 2862 patients were analyzed in a regression model to identify variables associated with stent-graft migration, which was defined as device movement >5 mm or considered significant by the investigator. Using the principles of continuity and momentum, a mathematical model of blood flow was created. The pulse pressure, proximal aortic and distal iliac diameters, and the degree of iliac angulation were varied in the calculations, and the distal displacement force exerted at the proximal fixation site was calculated. Results: Ninety-nine patients developed stent-graft migration, which was clinically relevant in 85 (3.0%). Hypertension (p=0.015), smoking (p=0.009), maximal aortic diameter (p=0.004), and distal transverse aortic diameter (p=0.03) correlated with migration in the univariate analysis, but iliac angulation did not quite achieve significance (p=0.06). On multivariate analysis, current smoking, hypertension, distal transverse aortic diameter, maximum common iliac diameter, and increasing proximal graft size were significantly associated with stent-graft migration. The mathematical model calculated the distal displacement force exerted on the proximal fixation site of the stent-graft and validated the clinical findings. The ratio of graft-diameter change from proximal aorta to distal iliac influenced the greatest increase in the displacement force. Conclusions: The mathematical model validated hypertension, aneurysm morphology, and endograft size as clinical factors significantly associated with stent-graft migration. These findings may have important implications for the choice and design of future stent-grafts.
Successful Treatment of Aortic Endograft Thrombosis with Rheolytic Thrombectomy
Authors: Krajcer Zvonimir , Gilbert Jerry H. , Mortazavi Kathy Dougherty Ali , Strickman Neil 
Published: March 2015

Purpose: To report the benefits of rheolytic thrombectomy for treating aortic endograft thrombosis. Methods: Of 40 patients who received the Ancure bifurcated endograft to treat abdominal aortic aneurysm (AAA) during a 9-month period, 6 (15%) patients (6 men; mean age 62.6 years, range 53–77) developed thrombosis of the endograft at an average of 9 weeks (range 1–20 months). Five patients were taking aspirin, and 3 were on warfarin therapy for atrial fibrillation. Immediately after angiography, rheolytic thrombectomy was used to remove the thrombus, followed by adjunctive procedures to treat the underlying pathology. Results: Causes were kinking or extrinsic compression of the graft limb in 5 cases and thrombosis of the surgical closure site in a common femoral artery. Mechanical thrombectomy was successful in restoring circulation in all cases; thrombolysis was used in 1. All 6 patients had additional stents placed in the graft limbs, re-establishing patency. There was no mortality or recurrent thrombosis in a follow-up that has extended to 26 months, but 1 patient required additional stenting for subsequent focal kinking of a graft limb above the previously implanted stent. Conclusions: Rheolytic thrombectomy can safely and effectively treat endograft thrombosis after endovascular AAA repair. Additional thrombolytic agents, angioplasty, and stenting may be needed to correct the underlying causes of the thrombosis. Prophylactic stenting of iliac limbs at the time of implantation in patients with complex anatomy may prevent thrombosis of unsupported bifurcated endografts.
Aortomonoiliac Stent-Grafts for Abdominal Aortic Aneurysm Repair: Association with Iliofemoral Crossover Grafts
Authors: Pereira Adamastor Humberto , Sanvitto Paulo Cesar , de Souza Gilberto Gonçalves , Costa Luiz Francisco , Grudtner Marco Aurélio 
Published: March 2015

Purpose: To analyze the outcome of endovascular exclusion of abdominal aortic aneurysm (AAA) using aortomonoiliac stent-grafts. Methods: Fifty-seven consecutive patients (49 men; median age 70, range 56–89) with AAA >5 cm were treated in a 6-year period with the conical ELLA stent-graft. Forty-two (73.9%) patients were classified ASA (American Society of Anesthesiologists) IV and 6 as ASA V. In the majority of cases, the implantation procedure featured device delivery through the external iliac artery, transrenal placement of a bare stent in selected cases, and an iliofemoral crossover graft through a prevesical tunnel. Results: Successful deployment was achieved in 56 (98.2%) patients. Mean time to discharge was 8.7 days (range 2–125). Two patients died in the 30-day period. Nine endoleaks occurred in 8 (14%) patients; 4 required further intervention. Mean follow-up was 35.3 months (range 1–66), during which 5 patients died from unrelated causes. No late endoleak, graft occlusion, device twisting/migration, or aneurysm rupture was observed. No correlation between type I endoleaks and unfavorable proximal neck or iliac artery anatomical characteristics could be found. Primary technical and clinical success rates were 86.0% and 94.7%, respectively. Conclusions: In this approach, the crossover graft remains in a retropubic space and consequently does not have all the disadvantages of a subcutaneously placed prosthesis. The results achieved in this group of high-risk patients support recommendation of this technique as a simple and safe alternative to bifurcated systems.
Buttress Technique to Insure Accurate Placement of AneuRx Stent-Grafts in Patients with Complex Anatomy
Authors: Krajcer Zvonimir , Strickman Neil , Dougherty Kathryn , Howell Marcus H. 
Published: March 2015

Purpose: To describe a technique that prevents caudal displacement of the AneuRx stent-graft during removal of the nose cone and runners. Technique: The buttress technique uses a 16-F sheath positioned from the contralateral femoral approach at the inferior edge of the endograft's main body to provide safe retraction of the runners and the nose cone and accurate endograft deployment. Conclusions: If accurate deployment of the stent-graft according to the manufacturer's directions is not possible, this buttress technique can insure proper positioning. It adds no additional time or equipment to the procedure, and it appears to be a safe and easily applied maneuver.
In Vitro Comparison of Four Cerebral Protection Filters for Preventing Human Plaque Embolization during Carotid Interventions
Authors: Müller-Hülsbeck Stefan , Jahnke Thomas , Liess Carsten , Glass Christoph , Paulsen Friedrich , Grimm Jan , Heller Martin 
Published: March 2015

Purpose: To evaluate in an in vitro bench-top model the efficacy of 4 filtration devices designed for cerebral protection during carotid angioplasty. Methods: Embolization during carotid angioplasty was simulated with human plaque material (8 to 12 particles weighing 6.02 ± 0.10 mg) in an open flow model with the aortic arch and carotid bifurcation made from elastic silicone tubes and saline used as the fluid medium. The 500 to 1500-µm particles were injected into the internal carotid artery (ICA) in front of the test protection device, which was deployed 5 cm distal to the bifurcation. Particles getting past the protection device or flowing into the external carotid artery (ECA) were caught in 100-µm filters and weighed. Ten trials were made on each of 4 devices: Angioguard, FilterWire EX, TRAP, and NeuroShield. All were deployed according to the manufacturers' directions except the FilterWire, which was manually repositioned in all tests to eliminate a gap between the filter and the tube wall. Results: The lowest weight of missed particles in the effluent was obtained with the NeuroShield (0.05 ± 0.04 mg, 0.8% of injected particle weight) and FilterWire (0.08 ± 0.05 mg, 1.3%; p=0.254 compared to NeuroShield, p=0.006 versus TRAP). The weight of particles missed by the TRAP device (0.16 ± 0.06 mg, 2.6%; p<0.001 versus NeuroShield and Angioguard, p<0.05 compared to Filter Wire) was higher, and the largest amount of missed particles was observed with the Angioguard filter (0.27 ± 0.06 mg, 4.4%; p<0.001 compared to all). NeuroShield and FilterWire were significantly different (p<0.001) compared to Angioguard and TRAP in a pairwise analysis. No embolization into the ECA occurred. Conclusions: In vitro, none of the tested devices had the ability to completely prevent embolization into the ICA. Comparing current designs, the NeuroShield filter and the FilterWire EX captured the highest percentage of human particles in this in vitro model, probably due to their larger filter volume.