bluuebunny/crossref_metadata_2025_split huggingface dataset:
Relationship of Intimal Flap Position to Endovascular Treatment of Malperfusion Syndromes in Aortic Dissection
Authors: Gaxotte Virginia , Cocheteux Benjamin , Haulon Stéphan , Vincentelli André , Lions Christophe , Koussa Mohamad , Willoteaux Serge , Asseman Philippe , Prat Alain , Beregi Jean-Paul 
Published: March 2015

Purpose: To propose a classification system based on the position and extension of the intimal flap to assist in the endovascular repair of aortic dissection complicated by a malperfusion syndrome. Methods: Forty-one patients (34 men; mean age 58 years, range 22–78) with 19 type A and 22 type B dissections complicated by a malperfusion syndrome were treated with stenting, fenestration, or both for the peripheral ischemia. A retrospective review of the preprocedural imaging studies (computed tomographic angiography and arteriography) was performed to determine and categorize the position of the aortic intimal flap. In type 1, the flap was either parallel to or perpendicular to the origin of the malperfused collateral artery; type 2 referred to extension of the dissection into the collateral vessel, while type 3 represented the presence or absence of an avulsed branch ostium. Results: Patients treated with stenting (n = 19) alone had type 2 or type 3 arterial dissections, whereas the 12 patients who were treated with fenestration alone had type 1 lesions. Ten patients treated with stenting and fenestration had arterial lesions in which a type 1 dissection was associated with types 2 or 3. Conclusions: This appearance-based imaging approach combined with the symptoms of malperfusion syndromes during aortic dissection can help guide the endovascular treatment strategy.
Endoleak after Endovascular Repair of Ruptured Abdominal Aortic Aneurysm: Is it a Problem?
Authors: Verhagen Hence J.M. , Prinssen Monique , Milner Ross , Blankensteijn Jan D. 
Published: March 2015

Purpose: To illustrate the clinical significance of type I and type II endoleaks following endovascular treatment of a ruptured abdominal aortic aneurysm (AAA). Case Report: An 81-year-old patient presented with a ruptured AAA that was urgently treated with an Ancure aortomonoiliac endograft. After the postoperative computed tomographic (CT) scan, a distal type I endoleak was suspected, but the follow-up angiogram demonstrated only lumbar backbleeding. As the patient was stable, conservative treatment was recommended. After 3 months, a distal as well as a proximal type I endoleak were demonstrated, strangely enough, in the presence of a shrinking aneurysm and clearance of the retroperitoneal hematoma. Both endoleaks were treated endoluminally, after which the CT scan still showed contrast in the aneurysm sac, presumably from lumbar backbleeding. Twelve months after the initial procedure, the patient continues to do well. Conclusions: Although not well understood, the presence of an endoleak after endovascular repair of a ruptured AAA may not always be a life-threatening situation.
Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Is Bilateral Wallstent Placement Superior to Unilateral Placement?
Authors: Dinkel Hans-Peter , Mettke Birgit , Schmid Felix , Baumgartner Iris , Triller Jürgen , Do Dai-Do 
Published: March 2015

Purpose: To report our experience with unilateral versus bilateral stent placement in the treatment of malignant superior vena cava syndrome (SVCS). Methods: The records and films of 84 consecutive patients (69 men; mean age 64±10 years, range 39–79) referred for stent placement in malignant SVCS were reviewed for venous compromise, technical and clinical success, complications, and reocclusions. Wallstents were placed covering the SVC and both (bilateral technique) brachiocephalic veins (BCV) preferentially; unilateral stenting of only one BCV in addition to the SVC was performed based on operator preference or inability to access both sides. Technical success was defined as the ability to stent the SVC and at least one BCV; clinical success was the elimination of SVCS symptoms. Results: Technical success was achieved in 83 (99%) patients, using the unilateral technique in 22 and bilateral stenting in 61 patients. The groups did not differ with regard to age, sex, underlying diseases, or location and extent of venous compromise. Immediate clinical success was achieved in 20 (91%) of 22 patients in the unilateral group and 55 (90%) of 61 patients in the bilateral group. Two patients suffered late occlusion in the unilateral group, while in the bilateral group, 8 patients had early occlusion and 9 had late occlusion. Thus, the total occlusion rate was significantly (p<0.05) lower in the unilateral group. There was 1 other complication (pericardial tamponade) in the bilateral group, for a 28% total complication rate, which was significantly higher (p = 0.039) than the 9% in the unilateral group. The 1, 3, 6, and 12-month primary stent patency rates were 90%, 81%, 76%, and 69%, respectively. Patency tended to last longer in the unilateral group, but the difference was not significant (p = 0.11). Conclusions: Although bilateral Wallstent placement achieved equal technical and clinical success, it tended to confer shorter-lived patency and caused more complications.
False Aneurysm after Balloon Dilation of a Calcified Innominate Artery Stenosis
Authors: Walter Johannes , Hofmann Wolfgang J. , Ugurluoglu Ara , Magometschnigg Heinrich 
Published: March 2015

Purpose: To describe the occurrence of a false aneurysm after percutaneous transluminal angioplasty of a severely calcified, high-grade stenosis of the brachiocephalic trunk. Case Report: A 68-year-old patient was admitted with cerebrovascular insufficiency, right upper extremity ischemia, and recurrent amaurosis fugax. Magnetic resonance arteriography (MRA) and duplex ultrasound revealed a severely calcified, high-grade stenosis of the innominate artery. Balloon dilation of this lesion was performed with minimal morphological success. After dilation, the patient suffered a reversible ischemic neurological deficit, from which he recovered completely. The patient's symptoms improved, but after 3 weeks he was re-admitted with palsy of the recurrent laryngeal nerve. An MRA showed a false aneurysm at the dilation site. Open surgery was performed, and the patient received a bifurcated aorto-subclavian-carotid bypass graft. He was discharged free of his preoperative symptoms. Conclusions: This case illustrates the potential hazards of angioplasty of severely calcified stenoses of the supra-aortic vessels.
Migration versus Apparent Migration: Importance of Errors Due to Positioning Variation in Plain Radiographic Follow-up of Aortic Stent-Grafts
Authors: Hodgson Richard , McWilliams Richard G. , Simpson Alistair , Gould Derek A. , Brennan John A. , Gilling-Smith Geoffrey L. , Harris Peter L. 
Published: March 2015

Purpose: To demonstrate the influence of radiographic positioning on the assessment of stent-graft migration using plain radiographs following endovascular abdominal aortic aneurysm repair. Methods: Equations were derived to correct for artifactual stent-graft migration introduced by geometric distortion due to variations in positioning between radiographs acquired at different times. A phantom system was used to validate the equations. Results: Errors in stent position increase with (1) the distance of the aortic stent-graft from the midline and (2) differences in radiographic centering points in the craniocaudal direction; other variables have little effect. For typical stent positions, errors are small if the centering changes by <8 cm. Consistent radiographic positioning to within 4 cm on successive imaging studies limits errors to 1.5 mm. Even if artifactual migration is large, the true migration can be reliably calculated to within 2 mm. Conclusions: Artifactual migration due to variation in radiographic centering is not usually clinically significant if care is taken to center radiographs consistently. Radiographs in which artifactual migration may be important are readily identified, and mathematical correction is straightforward.
Plain Radiographic Surveillance of Abdominal Aortic Stent-Grafts: The Liverpool/Perth Protocol
Authors: Murphy Micheal , Hodgson Richard , Harris Peter L. , McWilliams Richard G. , Hartley David E. , Lawrence-Brown Michael M.D. 
Published: March 2015

Purpose: To present a protocol for plain radiographic surveillance of abdominal aortic stent-grafts that addresses the main variables in need of standardization: (1) patient position, (2) radiographic centering point, and (3) focus-to-film distance. Technique: Our policy is to perform baseline anteroposterior and lateral films following endoluminal grafting and repeat the studies annually. These are the most important films to assess migration and component separation; supplementary right and left posterior oblique radiographs may help identify wireform fractures. It is best to perform radiography before computed tomography if both tests are scheduled for the same day, as excretion of intravenous contrast opacifies the renal collecting systems and interferes with radiographic analysis. Conclusions: Evaluation of the radiographs depends on the design of the stent-graft, so it is important to understand graft construction and the position of the radiopaque markers to best assess changes on follow-up films.
Translumbar Extraperitoneal Decompression for Abdominal Compartment Syndrome after Endovascular Treatment of a Ruptured AAA
Authors: Van Herzeele Isabelle , De Waele Jan J. , Vermassen Frank 
Published: March 2015

Purpose: To report an unusual case of abdominal compartment syndrome (ACS) following endovascular repair of a ruptured abdominal aortic aneurysm (rAAA) that had been treated with a stent-graft 3 years prior. Case Report: A 68-year-old man with a 3-year-old Vanguard bifurcated aortic stent-graft experienced sudden back pain and collapse. Aneurysm rupture documented by computed tomography was due to dislocation of the left graft limb. A Talent aortomonoiliac graft was deployed, followed by a femorofemoral bypass. No endoleak was evident. A few hours later, the patient became oliguric and hemodynamically unstable. Increased intra-abdominal pressure (IAP) was recorded. Abdominal decompression was performed, removing 1500 mL of blood from the retroperitoneum through an 18-cm lumbotomy; the peritoneum was opened, and another 500 mL of blood was aspirated. The IAP fell immediately, followed by diuresis a few hours later. The patient recovered and was discharged after 27 days. Conclusions: Some of the perioperative complications seen after conventional rAAA repair are also encountered after endovascular treatment. ACS requires urgent decompression, and less invasive approaches, such as translumbar extraperitoneal decompression, may be a good alternative to a midline laparotomy.
Acute Superior Mesenteric Artery Embolism: Rapid Reperfusion with Hydrodynamic Thrombectomy and Pharmacological Thrombolysis
Authors: Tsuda Masashi , Nakamura Mamoru , Yamada Yasuo , Saito Haruo , Ishibashi Tadashi , Takahashi Shoki 
Published: March 2015

Purpose: To report a case of acute superior mesenteric artery (SMA) embolism successfully treated with hydrodynamic thrombectomy and pharmacological thrombolysis. Case Report: A 67-year-old man was admitted to the hospital with acute severe abdominal pain. Selective angiography via a femoral puncture revealed a complete embolic occlusion distal to the first jejunal branch of the SMA. Hydrodynamic thrombectomy resolved the severe abdominal pain of the patient in approximately 10 minutes after the start of thrombectomy. Local continuous thrombolysis with urokinase resulted in near complete restoration of the mesenteric flow after 24 hours. The patient made an uneventful recovery and continues to do well on warfarin therapy 8 months after treatment; he has shown no evidence of malabsorption. Conclusions: Although insertion of the device into the SMA via a femoral puncture is a difficult approach, we propose that hydrodynamic thrombectomy followed by local thrombolysis is a useful treatment for acute superior mesenteric artery embolism.
Determinants of In-Stent Restenosis after Carotid Angioplasty: A Case-Control Study
Authors: Setacci Carlo , Pula Giorgio , Baldi Irene , de Donato Giammarco , Setacci Francesco , Cappelli Alessandro , Pieraccini Massimo , Cremonesi Alberto , Castriota Fausto , Neri Eugenio 
Published: March 2015

Purpose: To report a retrospective study that sought to identify clinical factors contributing to the development of in-stent restenosis in the carotid arteries, to profile the patients at greatest risk, and to review the treatment modalities evolved from our experience. Methods: Between December 2000 and April 2003, 195 carotid angioplasty/stenting (CAS) procedures (12 bilateral) were performed in 183 patients (131 men; median age 65.9 years, interquartile range 55.2–72.7). Stenting for de novo stenoses was performed in 119 (61%) carotid arteries; 76 (39%) vessels were treated for postsurgical restenosis. Nearly two thirds of the patients (117, 64%) were symptomatic. Patients were evaluated at 3 and 6 months and at 6-month intervals thereafter with duplex ultrasonography. Angiography was used to confirm any recurrent lesion detected on the ultrasound scan. Results: Overall perioperative neurological complications included 4 (2.2%) minor strokes, 1 (0.5%) intracranial hemorrhage, and 1 (0.5%) major stroke; both patients with major neurological complications died at 5 and 12 days, respectively, after the procedure. During the 12.5-month follow-up (range 0–27.2), 3 non-procedure-related late deaths and another 9 (4.9%) neurological events occurred (2 strokes and 7 transient ischemic attacks). In-stent restenosis after CAS was present in 10 (5.2%) of 193 carotid arteries (9/181 patients) in follow-up; all but 1 artery had been treated for postsurgical restenosis. All lesions were treated secondarily with endovascular procedures. Statistical analysis demonstrated that postsurgical restenosis was the only predictive factor for the development of in-stent restenosis (OR 15.5, 95% CI 2.05 to 125.6, p = 0.001) in this cohort. Conclusions: The present study, far from being exhaustive on the subject, indicates that patients who develop restenosis after carotid endarterectomy are also prone to develop restenosis after CAS; moreover, although strongly recommended for postsurgical restenosis, CAS carries a greater risk of in-stent restenosis in this subgroup, thus reducing the benefits of this procedure.
Complicated Acute Aortic Dissection Type B Caused by Femoral Cannulation for Endoscopic Coronary Artery Bypass Surgery
Authors: Fleck Tatiana , Wisser Wilfried , Cejna Manfred , Tschernko Edda , Lassnig Andrea , Wolner Ernst , Rand Thomas 
Published: March 2015

Purpose: To report endovascular treatment of a patient with complicated acute aortic type B dissection caused by cannulation of the femoral artery for endoscopic coronary artery bypass (CAB) surgery. Case Report: A 63-year-old man underwent single-vessel CAB surgery facilitated by the Da Vinci surgical system. After the procedure, acute lower limb ischemia led to the discovery of a type B dissection from the left subclavian artery to the iliac arteries. The subclavian artery was also dissected, with only minimal flow in the left mammary artery. The visceral and renal vessels originated from the false lumen and were not perfused. Emergent stent-graft placement was undertaken to close the entry tear and re-establish perfusion of the lower extremity as well as visceral and renal organs. Additional stent-grafts were placed in the dissected left subclavian artery to perfuse the left internal mammary bypass and in the inferior mesenteric artery, which arose from the false lumen. Six months after operation, the patient is well. Conclusions: Acute iatrogenic aortic dissection secondary to endoscopic CAB surgery can be treated emergently to restore distal perfusion to vital organs.
Regression of Left Ventricular Hypertrophy following Stenting of Renal Artery Stenosis
Authors: Zeller Thomas , Rastan Aljoscha , Schwarzwälder Uwe , Müller Christian , Frank Ulrich , Bürgelin Karlheinz , Sixt Sebastian , Schwarz Thomas , Noory Elias , Neumann Franz-Josef 
Published: March 2015

Purpose: To determine if angioplasty of atherosclerotic renal artery stenosis, which reduces the activation of the renin-angiotensin-aldosterone system (RAAS), may lead to regression of left ventricular hypertrophy. Methods: The study included 102 patients (58 men; mean age 67 years, range 66–69) who underwent stent-supported percutaneous transluminal renal angioplasty (PTRA) and were included in a clinical follow-up program (mean 24±14 months, range 6–60). As a control group, 101 contemporaneous patients (68 men; mean age 68 years, range 66–70) with essential hypertension were investigated. The primary endpoint was the change in left ventricular mass index (LVMI) determined by echocardiography. Results: Mean follow-up intervals were 24±14 months (range 6–60) in the study group and 27±14 months (range 6–60) in the controls (p=0.09). LVMI decreased significantly by −10±26 g/m2 in the study group, while it increased significantly by 9±28 g/m2 in the control group (p=0.001 between groups). In the study group, mean arterial blood pressure was significantly reduced from 99±11 mmHg to 90±11 mmHg (p<0.0001) during follow-up despite a significant reduction in medication, whereas it increased significantly from 102±11 mmHg to 105±11 mmHg (p=0.008) in the control group, although medication was significantly increased. After adjustment for various factors and covariables, PTRA prevailed as an independent predictor for regression of LVMI (p=0.038). Conclusion: PTRA induces regression of LVMI that is independent of the reduction in blood pressure induced by this procedure. Reduced activity of the RAAS may account for this regression.
Digital Embolization Due to Partially Uncovered Left Subclavian Artery Post TEVAR: Management with Amplatzer Vascular Plug Occlusion
Authors: Chaudhuri Arindam , Tibballs Jonathan , Nadkarni Sanjay , Garbowski Marek 
Published: March 2015

Purpose: To describe the use of the Amplatzer vascular plug to treat a partially uncovered left subclavian artery (LSA) causing digital embolism following thoracic endovascular aneurysm repair. Case Report: A 70-year-old man presented with digital ischemia of the left index and middle fingers due to embolism from a partially covered LSA orifice during thoracic endovascular aneurysm repair for a type I thoracic aortic aneurysm. The orifice was successfully occluded using the vascular plug, supplemented by a left carotid-subclavian bypass to treat ongoing arm and hand claudication. The patient has had no further embolic episodes. Conclusion: A partially uncovered LSA during thoracic endovascular aneurysm repair poses a risk of thromboembolism, with resultant upper limb claudication or tissue loss. If recognized at the time of the procedure, this should be treated by proximal extension; otherwise, proximal LSA occlusion using an Amplatzer occluder may be a safe and effective option in preventing further embolic episodes.
Treatment of Critical Limb Ischemia Using Ultrasound-Enhanced Thrombolysis (PARES Trial): Final Results
Authors: Wissgott Christian , Richter André , Kamusella Peter , Steinkamp Hermann J. 
Published: March 2015

Purpose: To evaluate the safety and performance of ultrasound-enhanced thrombolysis in the treatment of acute thrombotic or embolic occlusion of the lower limb arteries. Methods: From April 2005 to July 2006, 25 patients (15 men; mean age 64.1 years, range 37–82) presenting with acute (<14 days old) occlusions of the lower limb arteries were treated with local thrombolysis [recombinant tissue plasminogen activator (rtPA)] in a dosage of 1.0 mg/h using the EKOS Lysus Peripheral Catheter System with an ultrasound core. No bolus injection of rtPA was given. The mean occlusion length was 25.1 cm (range 2–70). Results: The technical success rate was 100%. Total clot removal was achieved in 22 (88%) patients after 16.9 hours (range 5–24) using a mean 17 mg (range 5–25) of rtPA. In 8 cases, total clot removal of the main lesion was achieved after 6 hours (6 mg of rtPA). In 1 patient, lysis was stopped after 2.5 hours because of bleeding due a dislocation of the introducer sheath. In 2 cases, total clot removal could not be achieved; these patients were successfully treated with thromboaspiration. At the 1-month follow-up, the treated vessel was still patent in 20 patients. Two reocclusions occurred; 1 was treated with a bypass graft and the other with conservative therapy. There were no cases of amputation or death during follow-up. There were no side effects related to rtPA or the catheter system. Conclusion: This study demonstrates that local lysis of acute arterial occlusions using the Lysus Peripheral Catheter System is safe and effective. Blood flow is restored quickly.
Role of the Hardman Index in Predicting Mortality for Open and Endovascular Repair of Ruptured Abdominal Aortic Aneurysm
Authors: Sharif Muhammad Anees , Lee Bernard , Makar Ragai Reda , Loan William , Soong Chee Voon 
Published: March 2015

Purpose: To correlate the Hardman prognostic index with perioperative mortality in patients undergoing open and endovascular repair of ruptured abdominal aortic aneurysm (rAAA). Methods: Over a 5-year period, 126 patients (109 men; mean age 74 years, range 51–91) underwent open (n=74) or endovascular (n=52) repair of rAAA in a single unit. Five Hardman factors (age >76 years, history of loss of consciousness, ECG evidence of ischemia, hemoglobin <9.0 g/dL, and serum creatinine >0.19 mmol/L) were assessed, and their association with in-hospital or 30-day mortality was evaluated retrospectively by chi-square or logistic regression analysis. Results: The mortality for open repair was 51.4% (38/74) in comparison to 32.7% (17/52) for the endovascular group (p=0.05). On multivariate analysis, loss of consciousness (p=0.03, OR 2.9, 95% CI 1.1 to 7.5) was the only significant predictor of mortality in both groups. The mortality rates for open repair patients with Hardman scores <2 were 43.5% (20/46) in comparison to 22.9% (8/35) for the endovascular group (p=0.06), whereas mortality rates for patients with scores ≥2 were 64.3% (18/28) and 52.9% (9/17) for the respective groups (p=0.54). Conclusion: The Hardman index correlates well with mortality in both the open and endovascular groups. Those with a score <2 have a trend toward better survival following endovascular repair compared to open repair, while this benefit is not obvious in patients with a score ≥2.
Impact of Randomized Trials Comparing Conventional and Endovascular Abdominal Aortic Aneurysm Repair on Clinical Practice
Authors: Baas Annette F. , Grobbee Diederick E. , Blankensteijn Jan D. 
Published: March 2015

Purpose: To report a retrospective study into the effects of trials on clinical decision-making regarding abdominal aortic aneurysm (AAA) patients suitable for both conventional open (OR) and endovascular aneurysm repair (EVAR). Methods: A questionnaire was sent to 1400 Dutch surgeons and trainees. Interviewees had to choose between OR and EVAR for AAA patients with and without comorbidity. Specifically, their preferences before and after the publication of 2 randomized trials (EVAR-1 and DREAM) were polled. Results: Of the 524 (37%) questionnaires returned, 223 (43%) respondents treated AAA patients. Before publication of the trials, 160 (72%) preferred OR for the patient without comorbidity and 169 (76%) preferred EVAR for the patient with comorbidity. In total, 72 (32%) respondents changed their preference after the trials were published; however, there was no overall major shift. Focusing on the different cases revealed that the OR preference was significantly enhanced for the patient without comorbidity (p<0.01), while the EVAR preference was significantly enhanced for the patient with comorbidity (p<0.05). Conclusion: The randomized trials have not induced major overall changes in surgical decision-making for AAA patients suitable for both EVAR and OR.