bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increased Flexibility of AneuRx Stent-Graft Reduces Need for Secondary Intervention following Endovascular Aneurysm Repair
Authors: Arko Frank R. , Lee W. Anthony , Hill Bradley B. , Cipriano Paul , Fogarty Thomas J. , Zarins Christopher K. 
Published: March 2015

Purpose: To evaluate the impact of a change in the manufacturing of the AneuRx stent-graft on the long-term results of endovascular abdominal aortic aneurysm (AAA) repair. Methods: The first 70 AAA patients treated with the AneuRx stent-graft between October 1996 and December 1998 were reviewed. The early stiff bifurcated design (STIFF) was used in 23 patients (mean age 71.7 ± 9.3 years, range 45–87) and the current flexible bifurcated design (FLEX) in 47 mean age 75.0 ± 7.3 years, range 61–96). Data on patient demographics, aneurysm morphology, technical success, complications, secondary procedures, and outcomes were compared using Kaplan-Meier estimates to evaluate patient survival and freedom from surgical conversion, rupture, and secondary interventions at 6, 12, and 24 months. Results: The 2 groups were equally matched with regard to age, preoperative comorbidities, proximal neck dimensions, and aneurysm diameter. Mean follow-up times were 22.42 ± 11.72 months (range 1–46) for the STIFF cohort and 18.08 ± 6.14 months (range 1–30) for the FLEX (p = 0.057). Eleven (48%) of 23 STIFF patients required secondary interventions versus 6 (13%) of 47 FLEX patients (p < 0.05). There were no ruptures. At the 24-month interval, survival estimates were 86% for STIFF and 76% for FLEX (p = NS); freedom from surgical conversion was 100% for STIFF and 97% for FLEX (p = NS) and freedom from secondary interventions was 18% for STIFF and 90% for FLEX (p < 0.05) at 24 months. Conclusions: The AneuRx stent-graft was effective in achieving the primary objective of preventing aneurysm rupture in all patients. However, increasing the flexibility of the bifurcated module significantly improved the primary success rate by reducing the need for subsequent secondary interventions.
“Seat Belt and Air Bag” Technique for Cerebral Protection during Carotid Stenting
Authors: Parodi Juan C. , Schönholz Claudio , Ferreira L. Mariano , Mendaro Esteban , Ohki Takao 
Published: March 2015

Purpose: To present a 2-device technique for cerebral protection during carotid stenting of the internal carotid artery (ICA) in patients with high-grade lesions, contralateral occlusion, and/or an aberrant or nonfunctioning circle of Willis. Technique: A reverse flow system (Parodi Anti-Embolism System [PAES]) is first placed with a 260-cm exchange wire in the common carotid artery 3 cm below the carotid bifurcation. Flow reversal is obtained by inflating the balloons in the external and common carotid arteries. Via an external connector, a guidewire and E-Trap filter are delivered to the distal ICA with active suction from a syringe on the PAES catheter. Once the filter is above the stenosis, the reversed flow is discontinued, and the procedure proceeds under cerebral protection with the filter. Conclusions: The combination of 2 existing cerebral protection devices could, at least in theory, achieve what neither of them could independently. The “seat belt and air bag” approach may represent the ideal means of treating ICA stenoses in patients with a nonfunctioning circle of Willis.
Wallgraft Endoprosthesis for the Percutaneous Treatment of Femoral and Popliteal Artery Aneurysms
Authors: Howell Marcus , Krajcer Zvonimir , Diethrich Edward B. , Motarjeme Amir , Bacharach Michael , Dolmatch Bart , Walker Craig 
Published: March 2015

Purpose: To evaluate the safety and efficacy of the Wallgraft Endoprosthesis for the treatment of femoropopliteal artery aneurysms. Methods: From October 1997 to April 2000, 17 patients (13 men; mean age 73.5 ± 7.1 years) with 7 femoral and 13 popliteal artery aneurysms underwent percutaneous aneurysm exclusion using the Wallgraft Endoprosthesis as part of a larger clinical trial. The mean aneurysm diameters were 37.6 ± 12.9 mm and 22.3 ± 8.7 mm, respectively. Results: Acute procedural success was 100% for femoral aneurysms and 92.3% (12/13) in the popliteal artery owing to one endoleak that resolved after 1 month. There were no complications, and the mean length of stay was 2.2 ± 3.8 days. Six-month and 1-year aneurysm exclusion rates were 100% for both locations, but 4 (31%) popliteal stent-grafts thrombosed in follow-up. Three were recanalized, but the fourth underwent bypass grafting after 3 thrombotic episodes. The 1-year primary and secondary patency rates were both 100% for the femoral aneurysms and 69% and 92%, respectively, for popliteal repairs. No procedure or device-related deaths occurred. Conclusions: Treatment of aneurysms in the femoropopliteal segment appears to be safe and effective with the Wallgraft Endoprosthesis, although longer follow-up in a larger patient group will be needed to determine this technique's potential versus surgical repair.
A Useful Endovascular Technique for Treating Modular Limb Disconnection in a Bifurcated Stent-Graft
Authors: Brouard Remi , Otal Philippe , Soula Philippe , Chabbert Valérie , Chemla Patricia , Leger Philippe , Joffre Francis , Rousseau Hervé 
Published: March 2015

Purpose: To report a technique for treating a type III endoleak owing to disconnection of an iliac graft limb from a modular aortic stent-graft. Technique: A hydrophilic guidewire is introduced via a homolateral femoral access and passed through the thrombosed iliac extension. Once the errant graft limb is recanalized, wire exchange for an extra stiff guidewire facilitates passage of an angioplasty balloon into the stent. Inflated under low pressure, the balloon is used to push the thrombosed limb retrograde into the aneurysm sac. With the aortoiliac axis restored, a new covered stent can be deployed. Conclusions: This approach is one of several that may be used to treat a type III endoleak arising from a disconnected and occluded stent-graft limb. It avoids the bleeding complications of thrombolysis and restores the aortoiliac axis so that another stent-graft may be implanted to re-exclude the aneurysm.
Outcome of Conservative versus Interventional Treatment of Subclavian Artery Stenosis
Authors: Schillinger Martin , Haumer Markus , Schillinger Sabine , Mlekusch Wolfgang , Ahmadi Ramazanali , Minar Erich 
Published: March 2015

Purpose: To compare the outcome of conservative treatment versus percutaneous transluminal angioplasty (PTA) of subclavian artery stenosis in terms of long-term hemodynamic and symptomatic outcome in a retrospective, nonrandomized study. Methods: Within a 14-year period, 295 consecutive inpatients were treated for subclavian artery stenosis. Excluding 21 (7%) surgical cases, the remaining 274 patients were treated either conservatively (n = 165) or with PTA (n = 109). Medical history, physical findings, and sonographic and angiographic data were recorded from the medical records of the 223 (81%) patients who were followed until the year 2000; 166 patients were then reinvestigated with oscillography, Doppler measurements, and duplex sonography. Outcomes of conservative versus interventional therapy were analyzed based on the intention to treat principle. Results: After a median 42-month follow-up (interquartile range 18–85), patients treated with PTA had a 60% risk reduction for hemodynamic subclavian stenosis compared to conservative treatment (adjusted hazard ratio 0.4, 95% confidence interval 0.2–0.6, p<0.0001). However, the risk of having a symptomatic stenosis at the time of follow-up did not differ between the treatment groups (p=0.3). Conclusions: Endovascular revascularization improves the long-term hemodynamic outcome in patients with subclavian stenosis, but many conservatively treated patients become asymptomatic during follow-up. Interventional treatment may be considered primarily for patients with severe symptoms of vertebrobasilar insufficiency, critical ischemia, or peripheral emboli.
Use of the Parodi Anti-Embolism System in Carotid Stenting: Italian Trial Results
Authors: Adami Carlo A. , Scuro Alberto , Spinamano Luca , Galvagni Elisabetta , Antoniucci Davide , Farello Gian A. , Maglione Franco , Manfrini Stefano , Mangialardi Nicola , Mansueto Gian C. , Mascoli Francesco , Nardelli Ettore , Tealdi Domenico 
Published: March 2015

Purpose: To investigate the safety and efficacy of the Parodi anti-embolism system (PAES) in establishing flow reversal in the internal carotid artery (ICA) as a means of protecting against embolic phenomena during carotid stenting. Methods: Seven centers participated in a nonrandomized, prospective trial of carotid angioplasty and stenting under PAES protection in 30 patients (22 men; mean age 72 years, range 49–88) with 15 symptomatic (>70%) and 15 asymptomatic (>80%) stenotic ICAs. Safety was defined as achieving sufficient brain oxygenation during flow reversal as determined by level of awareness and motor control. The presence of new or enhanced neurological deficits and death were endpoints. Performance was based on angiographic evidence of successful retrograde flow. Results: The PAES was positioned in all 30 patients, but technical error and access-related difficulties prevented establishment of reversed flow in 2. Among the 28 (93%) patients treated under PAES protection, 1 patient developed aphasia after flow reversal, necessitating balloon deflation between subsequent stages of the procedure. Three other adverse events included 1 case of bradycardia and 2 cases of hypotension, with dysarthria and facial paresis in one and temporary loss of consciousness in the other. All events resolved with appropriate therapy, and there was no change from baseline in the neurological status or brain scans at 24 hours. There were no strokes or neurological deficits at 30 days. Conclusions: The PAES appears to be a safe and effective means of providing protection from embolic complications during carotid stenting.
Detection of Endoleak with Enhanced Ultrasound Imaging: Comparison with Biphasic Computed Tomography
Authors: McWilliams Richard G. , Martin Janis , White Donagh , Gould Derek A. , Rowlands Peter C. , Haycox Alan , Brennan John , Gilling-Smith Geoffrey L. , Harris Peter L. 
Published: March 2015

Purpose: To compare unenhanced and enhanced ultrasound imaging to biphasic computed tomography (CT) in the detection of endoleak after endovascular abdominal aortic aneurysm (AAA) repair. Methods: Fifty-three patients (44 men; mean age 70 years) were examined during 96 follow-up visits after endovascular AAA repair. All patients had color Doppler and power Doppler ultrasound studies performed before and after the administration of an ultrasound contrast agent. Biphasic (arterial and delayed) CT was performed on the same day, and the ultrasound and CT studies were independently scored to record the presence or absence of endoleak and the level of confidence in the observation. Results: The sensitivity of the ultrasound techniques to detect endoleak improved with the use of ultrasound contrast media, ranging from a low of 12% with unenhanced color Doppler to 50% with enhanced power Doppler. However, the enhanced power Doppler failed to detect 9 type II endoleaks identified by CT (86% negative predictive value for endoleak). There were only 2 graft-related endoleaks in the study; one was diagnosed from the ultrasound image, but the other had nondiagnostic ultrasound scans because of poor views. Conclusions: Ultrasound scanning with or without contrast enhancement was not as reliable as CT in diagnosing type II endoleak. CT imaging remains our surveillance modality of choice.
Hemorrhage from a Right Hepatic Artery Pseudoaneurysm: Endovascular Treatment with a Coronary Stent-Graft
Authors: Venturini Massimo , Angeli Enzo , Salvioni Marco , De Cobelli Francesco , Trentin Chiara , Carlucci Michele , Staudacher Carlo , Del Maschio Alessandro 
Published: March 2015

Purpose: To report a novel case demonstrating the successful endovascular treatment of a right hepatic artery pseudoaneurysm using a balloon-expandable coronary stent-graft. Case Report: A 60-year-old woman underwent surgical treatment for a Klatskin tumor, but her postoperative course was complicated by serious blood loss. An emergent celiac angiogram through a right transfemoral approach demonstrated a small iatrogenic pseudoaneurysm in the proximal right hepatic artery. A 7-F guiding catheter was positioned at the origin of the celiac trunk, and a Jostent coronary stent-graft mounted on a 2.7-F, 4-mm × 30-mm balloon catheter was successfully placed across the aneurysm neck. The final angiogram demonstrated total exclusion of the pseudoaneurysm with preservation of the arterial lumen. The hemodynamic condition of the patient became stable. At 12-month follow-up, duplex scanning confirmed regular right hepatic artery patency and absence of thrombotic tissue or signs of infection around the stent-graft. Conclusions: For hepatic artery pseudoaneurysms, endovascular repair using small covered stents may be a viable alternative to transcatheter embolization. The use of coronary instruments facilitates treatment of vascular lesions in small caliber visceral vessels.
Preliminary Observations on the Need for Control Angiography after Peripheral Endovascular Brachytherapy Using a Centering Balloon
Authors: Hofmann Wolfgang J. , Kopp Michael , Kofler Barbara , Ugurluoglu Ara , Kogelnik Dieter , Magometschnigg Heinrich 
Published: March 2015

Purpose: To examine the need for completion angiography after endovascular femoropopliteal brachytherapy using a centering catheter. Methods: Nine consecutive patients (7 men; mean age 68 years, range 53–79) were enrolled in a double-blinded multicenter randomized trial of endovascular brachytherapy after femoropopliteal balloon angioplasty. All patients underwent postdilation angiography, after which the centering catheter was placed in the dilated segment. The patients were randomized and transferred to the radiotherapy unit; the centering catheter was inflated only in patients randomized to receive brachytherapy (18 Gy of γ radiation delivered to the target site 2 mm from an iridium-192 source axis). Because the local ethics committee required angiography after any interventional procedure (not stipulated in the study protocol), our patients were taken back to the angiosuite for angiography. Results: There were no complications of angioplasty or centering catheter introduction. In the 5 patients randomized to brachytherapy, the median inflation time of the centering catheter was 12.1 minutes (range 9.1–13.3). The completion angiogram following brachytherapy showed peripheral embolization in 2 patients and lesion recoil that required redilation in another; all the complications were confined to the treatment group. Conclusions: Three of 5 patients who received brachytherapy via a centering catheter demonstrated sequelae on postradiation angiography. Therefore, as in any other peripheral vascular intervention, completion angiography after brachytherapy seems to be essential in preventing delayed diagnosis of procedural complications.
Endovascular Brachytherapy for Prevention of Recurrent Renal In-Stent Restenosis
Authors: Stoeteknuel-Friedli Sandra , Do Dai-Do , von Briel Christian , Triller Jürgen , Mahler Felix , Baumgartner Iris 
Published: March 2015

Purpose: To examine the ability of endovascular brachytherapy to prevent recurrent in-stent restenosis in patients at high risk for this complication. Methods: Thirteen renal stent patients (8 women; mean age 66 ± 8 years) with an initial (n=9) or recurrent (n=4) in-stent restenosis underwent redilation followed by high-dose-rate brachytherapy (12 Gy of γ radiation delivered to the target site 5 mm from an iridium-192 source axis). Results: The procedure was technically successful in 11 (85%) patients; in the other 2, the renal artery could not be accessed with the large sheaths required for brachytherapy. One patient with no clinical suspicion of restenosis died of an unrelated cause during the 1-year follow-up. Eight (80%) of 10 patients alive at 1 year had no in-stent restenosis apparent on duplex sonography or angiography. One of the postradiation recurrent restenoses was redilated, but the other patient was treated conservatively. Conclusions: Renal angioplasty followed by brachytherapy seems to be a feasible and efficient method to prevent recurrent in-stent restenosis in renal arteries at increased risk.
Balloon Angioplasty in Chronic Critical Limb Ischemia: Factors Affecting Clinical and Angiographic Outcome
Authors: Balmer Hannes , Mahler Felix , Do Dai-Do , Triller Jürgen , Baumgartner Iris 
Published: March 2015

Purpose: To assess factors that affect clinical and angiographic outcome in chronic critical limb ischemia (CLI) 12 months after primary, technically successful balloon angioplasty (BA) in infrainguinal arteries. Methods: Sixty consecutive patients (37 women; mean age 75 ± 10 years, range 53–99) with technically successful BA in 66 limbs were followed for 12 months or until death, for major amputation, or repeat target lesion revascularization (TLR). Assessment at baseline and 1 day and 12 months after BA or at an endpoint event, if feasible, was performed with angiography or duplex ultrasound (above-knee revascularization only). Mortality, limb prognosis, and restenosis rate were correlated with cardiovascular risk factors, hemodynamic measures, and angiographic features. Results: Mortality was 25% at 1 year; compared to survivors, nonsurvivors more often had coronary artery disease (93% versus 44% for survivors, p<0.001), bilateral CLI (60% versus 29%, p=0.033), and higher fibrinogen levels (5.1 g/L versus 4.3 g/L, p=0.049). CLI resolved in more than half (35, 53%) of the limbs without repeat TLR. The major amputation rate was 6%. Limb prognosis correlated with ankle pressures after BA. Restenosis rates were 65% at the femoropopliteal and 56% at the infrapopliteal level (NS); these correlated with the length of the treated arterial segment (8.7 cm with restenosis versus 4.0 cm without, p<0.001). Conclusions: High mortality in CLI was associated with an extensive, clinically manifest arteriosclerotic process and high fibrinogen levels. Limb prognosis and restenosis after BA were primarily influenced by local hemodynamic and technical factors. Despite considerable restenosis, more than 90% of survivors avoided major amputations.
Subintimal Angioplasty of Isolated Infragenicular Vessels in Lower Limb Ischemia: Long-term Results
Authors: Ingle Hemant , Nasim Ahktar , Bolia Amman , Fishwick Guy , Naylor Ross , Bell Peter R.F. , Thompson Matthew M. 
Published: March 2015

Purpose: To assess the outcome of subintimal angioplasty in treating isolated infragenicular arterial disease in patients with severe lower limb ischemia. Methods: A retrospective study reviewed 67 consecutive patients (39 men; mean age 76 years, range 41–96) who underwent infragenicular subintimal angioplasty between March 1997 and May 2000 for ischemia in 70 limbs. The median length of occlusion was 6 cm (range 1–10) in the below-knee popliteal arteries, 4 cm (range 1–4) in the tibioperoneal trunk, 21 cm(range 1–35) in the anterior tibial artery, 10 (1–30) in the posterior tibial artery, and 5 (range 1–20) in the peroneal artery. Results: The technical and clinical success rates were 86% and 80%, respectively. In the 10 (14%) patients with a technical failure, 3 underwent successful bypass, 4 had an amputation, 1 had a lumbar sympathectomy, and 2 were treated conservatively. Of the 4 (6%) limbs that did not achieve clinical success, 2 patients required femorodistal bypass and their ulcers improved; in the other 2, ulcerations did not heal completely. The cumulative limb salvage rate and freedom from critical limb ischemia (CLI) quantified by Kaplan-Meier life-table analysis were 94% and 84% at 36 months. Mortality rates were 19% at 1 year, 43% at 2 years, and 51% at 3 years. In a subgroup analysis, the rate of CLI was significantly lower in nondiabetics (4%) and than in diabetics (24%, p=0.02), but neither survival nor amputation rates were significantly different. Conclusions: Subintimal angioplasty is a safe and effective procedure for treating isolated crural vessels in patients with severe lower limb ischemia.
Arterial Perforation during Infrainguinal Lower Limb Angioplasty Does Not Worsen Outcome: Results from 1409 Patients
Authors: Hayes Paul D. , Chokkalingam Arun , Jones Robert , Bell Peter R.F. , Fishwick Guy , Bolia Amman , Naylor A. Ross 
Published: March 2015

Purpose: To assess the prevalence and clinical significance of arterial perforation during lower limb angioplasty and determine the outcome of patients suffering this complication. Methods: The radiology department records of 1409 patients (878 men; mean age 69.6 years) undergoing peripheral angioplasty in 1532 limbs between January 1996 and December 1998 were studied to identify patients with a perforated vessel. Results: Fifty-two (3.7%) perforations occurred. Patients with a perforation were significantly older (median 74.8 years versus 69.6, p=0.03) and were more likely to be diabetic (p=0.01). The median age of a smoker with a perforation was 68 years versus 78 years for nonsmokers (p=0.02). Among the perforations, 29 resolved without intervention, 6 required temporary balloon occlusion, 15 were coil embolized, and 2 needed both balloon and coil treatment. Twenty-four (46%) of the 52 patients had a clinically successful angioplasty despite the perforation. No patient needed further urgent intervention. Seven patients underwent subsequent surgery to treat the underlying vascular disease that had prompted treatment initially; no one was treated for complications of the perforation. Due to the more extensive nature of the procedure, subintimal angioplasty was associated with an unsurprising increase in the rate of perforation (RR, 2.06;95% CI, 1.19–3.56;p=0.01). In no case did the perforation prejudice the eventual outcome of the patient. Conclusions: Arterial perforation during angioplasty is more common in the elderly and in diabetics. The perforation itself does not influence the ultimate outcome of the case; rather, it is the underlying vascular pathology.
Short-term Results of Endovascular AAA Repair with the Excluder Bifurcated Stent-Graft
Authors: Pfammatter Thomas , Lachat Mario L. , Künzli Andreas , Baur Daniel R. , Koppensteiner Renate , Turina Marko , Blum Ulrich 
Published: March 2015

Purpose: To evaluate the safety and efficacy of endovascular abdominal aortic aneurysm (AAA) repair with a commercial modular stent-graft. Methods: Between February 1998 and May 2000, 66 consecutive patients (56 men; mean age 70 years, range 51–87) were recruited for a single-center study to examine the safety and efficacy of the Excluder stent-graft for endovascular AAA repair. The patients were predominantly asymptomatic (2 symptomatic) and categorized as ASA III or IV (62, 94%), with aneurysms that ranged from 35 to 89 mm in diameter (mean 56). Surveillance included clinical examination and computed tomographic aortography at discharge, 6 weeks, and at 6, 12, and 24 months. Results: All endoprostheses were implanted as intended, but 1 patient succumbed to an intraprocedural brainstem infarction (1.5% 30-day mortality rate). The major and minor morbidity rates were 21% and 4.5%, respectively. Primary technical success at discharge was 68% (45/66), largely as the result of a 30% (20/66) endoleak rate. The aneurysm exclusion rate at 30 days was 88%. During the mean 5.8-month follow-up, no device migration, limb kinking, aneurysm rupture, or limb thrombosis was observed. Conclusions: Endoluminal AAA repair with the bifurcated Excluder stent-graft is safe and efficacious in the short term. Longer surveillance will have to demonstrate if the excellent early results can be maintained over the years.