bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early Ambulation after Diagnostic Angiography Using 4-F Catheters and Sheaths: A Feasibility Study
Authors: Dowling Kyran , Todd David , Siskin Gary , Stainken Brian , Dolen Eric , Sansivero Gail , Quarfordt Steven , Mitchell Nancy , Darling R. Clement 
Published: March 2015

Purpose: To assess the feasibility and safety of early ambulation in patients undergoing transfemoral diagnostic angiography using 4-F catheters or sheaths. Methods: In this prospective study approved by the institutional review board, patients undergoing diagnostic angiography were randomized to ambulate 3 or 6 hours after catheter or sheath removal. All patients were assessed for hematoma formation, pseudoaneurysm development, and other groin complications during the in-hospital recovery period and after 30 days. Patient satisfaction and comfort level were also assessed by survey. Results: Of 110 patients (66 men; mean age 64.9 ± 12.8 years) who participated in this study, 47 were randomized to the 6-hour (6-H) group and 63 to the 3-hour (3-H) group. In the 3-H and 6-H groups, respectively, a 4-F catheter was used in 45 (71%) and 35 (74%) patients and a 4-F sheath in 18 (29%) and 12 (26%). No clinically significant groin complications were encountered in either group. Moderate to severe discomfort was reported in 9 (16%) of the 56 patients responding to the discomfort survey in the 3-H group compared to 10 (26%) of the 38 in the 6-H survey respondents. Conclusions: It is feasible and safe to ambulate patients 3 hours after diagnostic angiography performed with a 4-F catheter with or without a 4-F sheath. Early ambulation of patients after angiography has the additional benefits of increasing patient satisfaction and resource utilization.
Trends in Endovascular Surgery Training
Authors: Kashyap Vikram S. , Ahn Samuel S. , Davis Michael R. , Moore Wesley S. , Diethrich Edward B. 
Published: March 2015

Purpose: To gather vascular surgery fellows' opinions on various issues related to endovascular surgery (EVS) over a 2-year period and analyze the responses to identify trends in EVS training. Methods: Vascular surgery fellows in 2 consecutive years were given a 2-page questionnaire inquiring about training protocols and local practice habits. Respondents included 64 vascular fellows from the academic year 1998–1999 (F98) and 52 vascular fellows from the academic year 1999–2000 (F99) (78% men in the entire population; mean age 34 years), representing a significant fraction of trainees in North America. Data from F98 and F99 were compared and analyzed. Results: The majority (66%) of vascular surgery fellows were trained at university hospitals and performed EVS at the time of the survey: 83% in the F98 class and 92% in the F99 group (p=0.17). Utilization rates among the 9 interventions surveyed ranged from angiography (83%) and angioplasty (77%) to intravascular ultrasound (33%) and atherectomy (15%). Performance of endovascular grafting significantly increased among trainees (50% versus 81%, p<0.005), while atherectomy and angioscopy decreased. EVS performed in the operating room with portable imaging equipment decreased (67% versus 42%, p=0.02) as access to the radiology and cardiology suites increased. In most communities (63%), radiology specialists performed most of the EVS procedures, but the portion of communities where vascular surgery performed the majority of EVS procedures increased from 20% to 35% (p=0.10) from F98 to F99. Responders (90%) believed that EVS would become a major component of vascular surgery and comprise 30% of their future practice. The proportion of fellows who believed they were sufficiently trained in endovascular techniques increased from 30% to 50% (p=0.04), with the remainder willing to devote a short period (<3 months) for further training. Conclusions: The vast majority of vascular trainees perform EVS and believe that it will have an increasing role in their practice. Trends include increased endovascular grafting and performance of EVS by vascular surgeons in interventional suites.
Endotension Distribution and the Role of Thrombus following Endovascular AAA Exclusion
Authors: Pacanowski John P. , Stevens Scott L. , Freeman Michael B. , Dieter Robert S. , Klosterman Lance A. , Kirkpatrick Stacy S. , Ragsdale John W. , Davis S. Elizabeth , Goldman Mitchell H. 
Published: March 2015

Purpose: To determine the pattern of strain and pressure transmitted to an aortic aneurysm wall before and after endovascular exclusion and to evaluate the role of sac thrombus on the conduction of pressure and wall strain. Methods: Three canine thoracic aortas were used to create abdominal aortic aneurysms (AAA). The segments were placed on a pulsatile pump system, and 8 strain transducers were positioned in the aneurysm sac. Baseline strain/pressure (S/P) was recorded in 1 animal, then the AAA was excluded with a stent-graft. Thrombin was injected into the sac, and strain/pressure was recorded at 7 systemic pressures (35 to 120 mmHg) over 6 hours. The thrombus was replaced with fibrin glue, and S/P was recorded over 4 hours. Additional trials using whole and 50% diluted unclotted blood were performed prior to sac thrombosis. Computed tomography and angiography were performed before and after aneurysm exclusion. Results: Pressure transmitted to the aneurysm wall decreased following stent-graft placement (p≤0.001). Strain/pressure was not distributed evenly in the sac (p≤0.05), and varying systemic pressures did not affect this distribution. Pressures near the stent-graft were higher than those laterally (p≤0.001) in all trials with interposed fresh thrombus and fibrin thrombus. The fibrin group had elevated baseline measurements, but correction for the elevated values did not influence the statistical significance (p≤0.001). Blood and fibrin thrombus reduced transmitted wall pressure to a similar degree. Overall S/P in the fluid-filled nonclotted sac was significantly lower (p≤0.001) than in the thrombus groups. Conclusions: Endovascular AAA exclusion reduced strain and pressure conducted to the aneurysm wall, and the distribution of transmitted pressure in the excluded sac without endoleak differed regardless of the sac contents. Fresh thrombus reduced transmitted S/P in all trials at all systemic pressures, as did fibrin thrombus but in a less predictable fashion.
Aneurysm Wall Stress and Tendency to Rupture are Features of Physical Wall Properties: An Experimental Study
Authors: Flora Harpaul S. , Talei-Faz Bijan , Ansdell Leslie , Chaloner Edmund J. , Sweeny Aaron , Grass Anthony , Adiseshiah Mohan 
Published: March 2015

Purpose: To use bench top techniques to examine the biophysical phenomena affecting the risk of abdominal aortic aneurysm (AAA) rupture relative to the physical properties of the aneurysm sac. Methods: Three latex AAAs with different wall elasticities were tested in a validated pulsatile flow model (PFM). Strain gauges were wired to each AAA model at the neck, inflection point, and at the maximum diameter. In initial studies, the influence of pressurization and the mechanical properties of AAA wall stress were evaluated. In subsequent studies, the latex AAAs were excluded with a tube graft and retested in the PFM. After creation of either a type I or II endoleak of known size and pressure, the systemic/intrasac pressure and the AAA wall stress were measured. Results: Each model had a complex wall-stress pattern comprising radial, longitudinal, and shear components. The peak wall stress at any point, in the presence of systemic pressurization or endoleak pressure, only reached 1% of the failure strength. In an AAA with a reinforced wall, the peak stress was significantly greater. Statistical analysis showed that wall strength contributed more significantly to wall stress than increasing pressurization within the AAA sac. Conclusions: AAA wall mechanics contribute more significantly to peak wall stress than pressure variations within the system. In particular, increased stiffness (analogous to collagen deposition) significantly increased peak wall stress, which was located at the inflection point rather than at the maximum diameter. Techniques to measure the AAA wall mechanics and the rate of deterioration may predict AAA rupture in the untreated state or in the presence of an endoleak following endovascular repair.
Accidental Small Bowel Perforation after Antegrade Femoral Artery Access for Percutaneous Thromboembolectomy and Angioplasty
Authors: Seyfarth Tobias , Baumgartner Iris , Triller Jürgen , Dinkel Hans-Peter 
Published: March 2015

Purpose: To report a rare complication of antegrade femoral access for percutaneous aspiration thromboembolectomy and transluminal angioplasty. Case Report: A 73-year-old obese woman underwent antegrade femoral aspiration thromboembolectomy for lower limb arterial embolism. Fifteen hours later, she presented with acute abdomen and decreased hemoglobin. Computed tomography showed small bowel obstruction, incarcerated femoral hernia, and free peritoneal air and fluid suggesting bowel perforation. Emergent laparotomy revealed an incarcerated, perforated femoral bowel loop and 4-quadrant peritonitis. Conclusions: Femoral hernia injury is an exceptional complication of vascular interventions. Knowledge of this potential hazard may help to avoid its occurrence.
Hematoma after Percutaneous Transpopliteal Stenting and Remote Suturing of the Popliteal Artery
Authors: Yilmaz Saim , Sindel Timur , Erdoğan Abdullah , Mete Atalay , Lüleci Ersin 
Published: March 2015

Purpose: To present a case of extensive thigh hematoma that developed after use of a percutaneous suturing device for retrograde popliteal artery puncture. Case Report: A 55-year-old woman underwent endovascular treatment for a short occlusion of the right superficial femoral artery via a retrograde popliteal approach, after which the puncture site was closed with a Closer suture-mediated device. Several hours later, massive hematoma of the right thigh developed, which was noticed only after the patient's leg became markedly swollen and hypotension developed. Conclusions: The use of a suture-mediated closure device for a retrograde popliteal artery puncture may not be recommended.
Impact of Cerebral Protection Devices on Early Outcome of Carotid Stenting
Authors: Castriota Fausto , Cremonesi Alberto , Manetti Raffaella , Liso Armando , Oshola Kareem , Ricci Enrico , Balestra Guido 
Published: March 2015

Purpose: To evaluate the impact of cerebral protection devices on the procedural safety and outcome of carotid stent procedures. Methods: From June 1997 to July 2001, 275 consecutive patients (208 men; mean age 71 ± 7.4 years) underwent percutaneous angioplasty and/or stenting of the extracranial carotid artery. In the first 125 (45.4%) patients, the procedures were performed without cerebral protection. After January 2000, protection devices were routinely used (150 [54.6%] patients), including the Angioguard filter, GuardWire occlusion system, TRAP Vascular Filtration System, EPI Filter Wire, NeuroShield, Parodi Anti-Embolism System, and Medicorp occlusive balloon. Results: The percutaneous procedures were effective in 273 (99.3%) patients. No death or major stroke occurred in either group. In the unprotected group, 5 (4.0%) complications occurred: 3 (2.4%) minor strokes, 1 (0.8%) transient ischemic attack (TIA), and 1 (0.8%) subarachnoid hemorrhage. In the patients treated under cerebral protection, there were 2 (1.3%) complications: 1 (0.7%) minor stroke and 1 (0.7%) subarachnoid hemorrhage. There were 4 (3.2%) periprocedural embolic complications in the unprotected group versus 1 (0.7%) in the protected patients. Conclusions: Our data suggest that percutaneous dilation and stenting of the carotid arteries protected by cerebral protection devices is feasible and effective. In a consecutive series, the use of the cerebral protection systems reduced the acute neurological event rate related to embolic complications by 79%.
Effect of Mesenteric Ischemia/Reperfusion on Spinal Cord Injury following Transient Aortic Occlusion in Rabbits
Authors: Morrissey Nicholas J. , Kantonen Ilkka , Liu Harry , Sidiqui Mohamed , Marin Michael L. , Hollier Larry H. 
Published: March 2015

Purpose: To investigate in a rabbit model if prolonged periods of mesenteric ischemia followed by reperfusion may affect the rate of neurological complications. Methods: An infrarenal aortic snare, which consisted of a Silastic vessel loop whose ends were passed through plastic tubing, was placed in 50 male New Zealand white rabbits. In 40 of these animals, a similar but smaller device was placed around the superior mesenteric artery (SMA); all devices were exteriorized to allow vessel occlusion in the awake animal. The aorta was occluded for 12 minutes in the 10 control and 40 experimental animals, but the experimental rabbits also had occlusion of the SMA for varying intervals: 10 minutes (group 1), 12 minutes (group 2), and 18 minutes (group 3). To assess the hemodynamic effects of aortic and aortic/SMA occlusion, select control and test animals had blood pressure and heart rate monitoring via indwelling carotid catheters during the occlusion periods. The animals were euthanized, and spinal cords from paralyzed and normal rabbits were examined histologically Results: Neurological deficit occurred in 20% of controls and in 70%, 80%, and 100% in the experimental groups, respectively. There were no significant differences in systemic blood pressure at any time point during occlusion and reperfusion in the monitored control or test animals. There was no evidence of thrombosis of spinal arteries on histological analysis, nor was there evidence of bowel infarction at the time of sacrifice in animals undergoing combined aortic/SMA occlusion. Conclusions: Mesenteric ischemia/reperfusion worsens the neurological outcome in animals undergoing transient aortic occlusion. This observation is independent of hemodynamic influences and not the result of spinal artery thrombosis.
Endovascular Repair of Recurrent Thoracoabdominal Aortic Aneurysm
Authors: Khoury Michael 
Published: March 2015

Purpose: To report the endovascular repair of a complicated, recurrent thoracoabdominal aortic aneurysm (TAAA) using stacked, customized stent-grafts. Case Report: A 75-year-old man was evaluated for an enlarging 7-cm suprarenal abdominal aortic aneurysm. The patient had repair of a distal TAAA in the past, as well as multiple visceral revascularizations from the infrarenal aorta. A 3-segment aortic endograft with proximal and distal extensions was delivered with the aid of a prosthetic conduit from the right common iliac artery to the end of the right renal artery; spinal fluid drainage was performed to mitigate paraplegia. The stent-graft components were serially deployed from the level of the left common carotid artery and ended with the bare springs of the distal extension covering the renal arteries. The patient was discharged but returned within a month for drainage of a purulent retroperitoneal hematoma. He has since resumed his preoperative activities and remains well with documented exclusion of the aneurysm and satisfactory visceral and distal perfusion at 21 months. Conclusions: This case illustrates that aortic endografting can be a viable option for the treatment of recurrent thoracoabdominal aortic aneurysms.
Thrombolysis of Occluded Synthetic Bypass Grafts in the Lower Limb: Technical Success and 1-Year Follow-up in 32 Patients
Authors: van Holten Jacqueline , van Dijk Lukas C. , van Sambeek Marc R.H.M. , van Urk Hero , van Overhagen Hans , Pattynama Peter M.T. 
Published: March 2015

Purpose: To evaluate prospectively the technical success and clinical outcome of thrombolysis for acute occlusion of synthetic arterial bypass grafts in the lower limb. Methods: Thirty-two consecutive patients (27 men; median age 65 years, range 41–80) with occluded polytetrafluoroethylene bypass grafts were treated with direct-catheter thrombolysis (100,000-IU bolus of urokinase with 100,000-IU/h infusion) followed by ancillary interventions to treat underlying stenosis whenever necessary. All patients received oral anticoagulation to maintain the international normalized ratio at 3.0 to 4.0. Clinical follow-up and duplex ultrasound examinations were performed at 3-month intervals up to 1 year. Results: Thrombolysis was technically successful in 27 (84%) patients; 3 of the 5 failed patients had amputations. Mean duration of urokinase therapy was 36±14 hours. In 18 patients, underlying stenoses (11 distal anastomosis, 5 proximal anastomosis, and 3 inflow) were treated, 15 by an endovascular procedure and 3 surgically. Four major complications occurred: groin hematoma, sepsis, transient renal dysfunction, and a hemorrhage at the proximal anastomosis after urokinase treatment. At 1 year, 21 bypass grafts had reoccluded (20% patency rate on intention-to-treat basis); 3 reocclusions resulted in amputation (overall 19% amputation rate). Conclusions: Thrombolysis in the setting of acute lower limb bypass graft occlusion is associated with good initial technical success rates and satisfactory clinical results. However, the re-occlusion rate within 1 year is high.
Treatment of Popliteal Artery Aneurysms with the Hemobahn Stent-Graft
Authors: Tielliu Ignace F.J. , Verhoeven Eric L.G. , Prins Ted R. , Post Wendy J. , Hulsebos Robin G. , van den Dungen Jan J.A.M. 
Published: March 2015

Purpose: To report a prospective study to ascertain the results of popliteal aneurysm treatment with a self-expanding stent-graft. Methods: In a recent 3-year period, 21 patients (18 men; median age 67 years, range 52–82) with 23 popliteal aneurysms were treated with Hemobahn stent-grafts. Follow-up evaluation included duplex scanning, ankle-brachial index (ABI) measurements, and radiographic examination of the knee. Outcome measures were occlusion of the stent-graft and limb loss. Results: Technical success in placing the stent-graft and excluding the aneurysm was 100%. An additional vascular intervention was performed in the same session in 5 (24%) cases. In the other 16 patients, local anesthesia was used in 10 (63%). During a median follow-up of 15 months (range 2–37), 5 (22%) of 23 stent-grafts occluded, resulting in a cumulative patency of 74%. All occlusions occurred within 6 months after the intervention; 2 were successfully recanalized, and none of the 3 patients with persisting occlusion required an amputation. Conclusions: The results of this study suggest that endovascular stent-graft repair of popliteal artery aneurysms is feasible. Midterm patency rates are lower compared to traditional surgical repair.
Endovascular Aortic Biopsy in the Diagnosis of Takayasu Arteritis
Authors: Morrissey Nicholas J. , Goldman Jeffrey , Fallon John T. , Faries Peter L. , Marin Michael L. , Hollier Larry H. 
Published: March 2015

Purpose: To use a minimally invasive approach to obtain biopsy specimens of the aorta to confirm the diagnosis of Takayasu arteritis and formulate a therapeutic plan. Case Report: A 17-year-old woman with lower extremity claudication and a normal erythrocyte sedimentation rate had magnetic resonance angiography, which suggested stenotic lesions of the infrarenal aorta and left renal artery. An endovascular biopsy of the aortic lesion was performed under local anesthesia, retrieving sufficient tissue to make the diagnosis of Takayasu arteritis. The patient was discharged the same day. Conclusions: Endovascular aortic biopsy may be useful in diagnosing Takayasu arteritis and guiding the clinician toward the proper mode of treatment.
Intrahepatic Aneurysmal Portohepatic Venous Shunt: Embolization with a Tissue Adhesive Solution
Authors: Fanelli Fabrizio , Marcelli Giulia , Bezzi Mario , Salvatori Filippo Maria , Rossi Michele , Rossi Plinio , Passariello Roberto 
Published: March 2015

Purpose: To report the endovascular treatment of an intrahepatic portosystemic venous shunt (IPSVS) using a tissue adhesive solution. Case Report: A 40-year-old woman without diagnosed liver disease presented for evaluation of vague abdominal pains. A latent portosystemic encephalopathy was diagnosed only during hospitalization, when ultrasound examination disclosed a venous-venous right hepatic communication. The patient was treated with selective percutaneous embolization using a tissue adhesive after blocking the lesion's venous inflow and outflow tracts. The result was excellent, and the patient recovered completely in a few days. After 5 months, the patient is asymptomatic and event-free. Conclusions: Large IPSVS may be successfully treated percutaneously using a tissue adhesive solution, avoiding a more invasive procedure.
A Modular Multi-Branched System for Endovascular Repair of Bilateral Common Iliac Artery Aneurysms
Authors: Abraham Cherrie Z. , Reilly Linda M. , Schneider Darren B. , Dwyer Shelley , Sawhney Rajiv , Messina Louis M. , Chuter Timothy A.M. 
Published: March 2015

Purpose: To describe a modular stent-graft for cases of bilateral common iliac aneurysm. Technique: The aortic aneurysm is repaired using a standard bifurcated modular system (Zenith). A modified bifurcated component is deployed with its trunk in one limb of the original aortic stent-graft, its long limb in the external iliac artery, and its short limb in the iliac aneurysm just above the internal iliac orifice. A flexible extension is introduced from the right brachial artery and used to bridge the gap between the short limb of the modified bifurcated component and the left internal iliac artery. Conclusions: Endovascular repair of bilateral iliac aneurysm is feasible using a modular stent-graft with separate branches to the internal and external iliac arteries.
Alternative Method of Rapid Drying Vascular Specimens for Scanning Electron Microscopy
Authors: Slížová DáŠa , Krs Otakar , PospíŠilová Blanka 
Published: March 2015

Purpose: To report the use of hexamethyldisilazane (HMDS) as an alternative to critical point drying for preparing stented canine peripheral vessels for scanning electron microscopy (SEM). Technique: Vascular specimens were fixed in 4% formaldehyde overnight, dehydrated in a graded ethanol series, followed by immersion in 100% hexamethyldisilazane. After air drying, the specimens were mounted on stainless steel stubs, coated with gold, and examined in the SEM. The electron micrographs were of high quality, showing the layers of the vascular wall and the incorporated stent covered by a neointimal layer. The micrographs were comparable to corresponding histological sections, but detailed endothelial patterns were more visible. Conclusions: HMDS treatment and subsequent air drying provides good quality scanning electron micrographs that reveal both endothelial patterns and the layered architecture of stented vessels. The disadvantage of HMDS drying may be a shrinkage and distortion similar to other drying agents. Ease of handling, low cost, and a high rate of success are advantages that favor HMDS desiccation over other drying methods.