bluuebunny/crossref_metadata_2025_split huggingface dataset:
Percutaneous Retrograde Tibial Access in Limb Salvage
Authors: Botti Charles F. , Ansel Gary M. , Silver Mitchell J. , Barker Billie J. , South Sheila 
Published: March 2015

Purpose: To describe a novel technique for percutaneous retrograde access of the tibial vessels after antegrade access failure in patients with chronic limb-threatening ischemia. Methods: Six patients who had failed antegrade access to infrapopliteal occlusions had attempted retrograde tibial puncture and wire passage into the proximally patent vessel. Endovascular intervention was carried out utilizing standard techniques. The patients were followed for functional class and wound healing. Results: All six patients were successfully recanalized. Five patients experienced rapid and dramatic healing of wounds that had previously been refractory to conservative therapy. The other patient did not experience healing and ultimately died of progressive intractable congestive heart failure in the setting of a severe ischemic cardiomyopathy. Conclusions: Retrograde tibial access can be a valuable technique in the armamentarium of a peripheral interventionist treating patients with chronic critical limb ischemia.
Percutaneous Treatment of Long Superficial Femoral Artery Occlusive Disease: Efficacy of the Hemobahn Stent-Graft
Authors: Bray Peter J. , Robson William J. , Bray Alan E. 
Published: March 2015

Purpose: To assess the efficacy of the Hemobahn stent-graft in the percutaneous treatment of long occlusive lesions of the superficial femoral artery (SFA). Methods: Fifty-nine limbs in 54 patients (42 men; mean age 73.3±8.2 years, range 55.2–91.3) with 59 symptomatic SFA occlusions >10 cm in length were selected for percutaneous treatment with the Hemobahn stent-graft. The treated SFA was assessed for patency and degree of stenosis by color-flow duplex ultrasound prior to discharge and at 1, 3, and 6 months and yearly thereafter. The actuarial life-table method was used to derive primary and secondary patency rates. Results: Primary technical success was achieved in 56 (95%) of 59 limbs on an intention-to-treat basis (2 access and 1 device failures). In the first 30 days, 4 (6.8%) stent-graft thromboses and 5 (8.5%) minor technical difficulties occurred. Up to 1 year, there were 15 (25.4%) primary occlusions, 7 (11.9%) of which were associated with restenosis. Cumulative primary patencies were 88%, 67%, and 58% at 1, 6, and 12 months, respectively; secondary patencies were 92%, 82%, and 73% at the same intervals. There was no statistically significant difference (p<0.05) in patency (primary or secondary) with respect to presenting symptoms, lesion length, stent-graft length, or distal runoff. Conclusions: Symptomatic long occlusive lesions of the SFA treated percutaneously with the Hemobahn stent-graft achieved good outcomes initially with a low complication rate. Primary and secondary patencies were similar to those reported for open synthetic femoropopliteal bypass procedures.
Primary Stenting of Embolic Occlusions in Iliac Arteries
Authors: Yilmaz Saim , Sindel Timur , Lüleci Ersin 
Published: March 2015

Purpose: To present our experience with the use of primary stenting to treat embolic iliac artery occlusions. Methods and Results: Six patients (5 men; mean age 50.6±14.1 years range 37–72) underwent primary stenting for embolic occlusions lodged in the common iliac and/or external iliac arteries and were retrospectively evaluated. The probable reason for the embolism was atrial fibrillation in 4 patients and acute myocardial infarction in 2. In 5 patients, an additional embolus was demonstrated in the renal, mesenteric, popliteal, and middle cerebral arteries. Iliac emboli were treated with primary implantation of self-expanding stents followed by very low-pressure balloon dilation. In all cases, primary stenting was technically successful and provided immediate recanalization with elimination or reduction of symptoms. There was no procedure-related complication. During the mean 11-month follow-up (range 1–18), all stented iliac arteries remained patient. One patient died due to cerebral embolism at 21 months. Conclusions: Although this experience is limited, excellent midterm results suggest that primary stenting may be a valuable alternative in the treatment of embolic occlusions of the iliac arteries in selected cases.
Management of Mobile Floating Carotid Plaque Using Carotid Artery Stenting
Authors: Chakhtoura Elie Y. , Goldstein Jonathan E. , Hobson Robert W. 
Published: March 2015

Purpose: To present management techniques for dealing with mobile floating carotid plaque (MFCP), which represents an indeterminate risk of embolic cerebrovascular events. Case Reports: Two high-risk patients with a history of carotid endarterectomy were diagnosed with MFCP by duplex ultrasound scanning. One patient had a left hemispheric transient ischemic attack while the other was asymptomatic with a moderate stenosis. Both were successfully treated with carotid artery stenting, achieving complete coverage of the MFCP. Their outcomes were uneventful, and sustained patency of the stented arteries has been observed during an event-free survival of 32 and 44 months, respectively. Conclusions: Based upon the unique nature of these lesions and our satisfactory clinical results, we believe that carotid stenting may be a viable option for the treatment of MFCP.
Supported Endograft Limb Occlusion Likely Occurring Secondary to Hip Arthroplasty
Authors: Woo Edward Y. , Zabinski Stephen J. , Milner Ross , Fairman Ronald M. 
Published: March 2015

Purpose: To report an acute endograft limb occlusion immediately subsequent to a total hip replacement. Case Report: A 62-year-old man underwent successful placement of a bifurcated stent-graft for a 5-cm abdominal aortic aneurysm (AAA). Surveillance imaging documented a satisfactory outcome and no defects in the stent-graft. Three months after the endograft procedure, he underwent left total hip arthroplasty, at which time the left endograft limb acutely thrombosed. He was successfully treated with thrombectomy and dilation/stenting of the thrombosed graft limb. Conclusions: Patients with aortoiliac stent-grafts need careful surveillance around the time of a procedure that may require extreme manipulation of the pelvis and hips. Even fully supported, widely patent endograft limbs may be vulnerable to acute thrombosis in this setting.
Endovascular Repair of External Iliac Artery Occlusion after Hip Prosthesis Migration
Authors: Kwolek Christopher J. , Matthews Marc R. , Hartford James M. , Minion David J. , Schwarcz Thomas H. , Quick Rhonda , Endean Eric 
Published: March 2015

Purpose: To report emergent endovascular intervention to restore lower extremity arterial patency after migration of a hip prosthesis caused thrombosis of the external iliac artery (EIA). Case Report: Nine months following left hip revision arthroplasty, a 66-year-old woman presented to the Emergency Department with the complaints of an acutely painful left lower extremity for over 6 hours. Imaging showed the metallic acetabular portion of the hip prosthesis in the iliac fossa, with severe external compression of the EIA. After thrombolysis to remove clot from the EIA, an 8×60-mm self-expanding Smart stent was deployed in the left EIA from a contralateral access. The procedure was successful, and the patient was discharged. An infected wound from a compartment fasciotomy delayed revision of the hip prosthesis. Nine weeks after stenting, the patient returned with a cold, pulseless left limb; a femorofemoral bypass was constructed to restore perfusion. Conclusions: While stent placement restored flow for 9 weeks after the initial ischemic event, the recurrent thrombosis could have been prevented by earlier revision of the migrated prosthesis.
Hemorrhage Secondary to Pelvic Fracture: Coil Embolization of an Aberrant Obturator Artery
Authors: Daeubler Bernd , Anderson Suzanne E. , Leunig Michael , Triller Jürgen 
Published: March 2015

Purpose: To describe the anatomical variations of the corona mortis, a vascular anomaly that may lead to dangerous hemorrhage and possible death. Case Report: A 46-year-old male cyclist was involved in a collision with a car, during which he sustained fractures to the left ribs and pelvic ring. Abdominal ultrasound imaging demonstrated a large (12×6×7 cm) nonhomogeneous mass ventral to the bladder, suggestive of a hematoma, which was confirmed on computed tomography. During angiography, 2 branches of the internal iliac artery were identified as sources of the bleeding; these were successfully embolized with microcoils, but the bleeding continued. Examination of the external iliac system found a lacerated aberrant obturator artery arising from the inferior epigastric branch of the external iliac artery, a condition known as the corona mortis. Additional embolization quelled the hemorrhage. Conclusions: Coil embolization of the internal iliac artery branches is very effective in managing hemorrhage due to pelvic fractures, but variations in the origin of the obturator artery from the internal or external iliac artery may be additional sources of bleeding.
Coil Embolization of a Left Pulmonary Artery Pseudoaneurysm after Penetrating Injury
Authors: de Jonge Ingeborg , Vahl Anco , van der Hulst Victor 
Published: March 2015

Purpose: To report successful coil embolization of a rare traumatic pulmonary artery pseudoaneurysm. Case Report: A 57-year-old man developed a pulmonary artery pseudoaneurysm 14 days after he had been stabbed with a knife in the left lung. The pseudoaneurysm was diagnosed with contrast-enhanced computed tomography and confirmed by pulmonary arteriography. Coils were deployed in the feeding vessels to occlude the defect. Conclusions: Pulmonary artery pseudoaneurysm after penetrating chest injury can be treated by percutaneous catheter embolization, which is less invasive than surgery.
Thrombolytic Therapy in Acute Stroke
Authors: Higashida Randall T. , Halbach Van V. , Barnwell Stanley L. , Dowd Christopher F. , Hieshima Grant B. 
Published: March 2015

Purpose: To report the safety and efficacy of local, direct, intra-arterial and intravenous fibrinolysis treatment in selected cases of clinically symptomatic patients with acute occlusion of the intracranial cerebral arteries and dural sinuses. Methods: Patients with acute progressive neurological deterioration, in spite of systemic anticoagulation and/or antiplatelet medications, presenting with occlusion of a major intracranial cerebral artery or dural sinus were treated. From a transfemoral approach through a guiding catheter, a 2.5F microcatheter was guided directly into the intracranial cerebral circulation and embedded within the clot. Infusion of urokinase was then performed directly into the thrombus until lysis was attained. Results: In 36 total patients, 27 cases were treated for an acute arterial occlusion in 45 vascular territories. Clinically, there was neurological improvement in 18 (66.7%) cases. Complications directly related to therapy included symptomatic intracranial hemorrhage in three cases (11.1%), which included 1 case (3.7%) of vessel perforation. In 8 (29.6%) patients, there was no evidence of clinical improvement, and in long-term follow-up there were 9 (33.3%) patient deaths. Nine patients were treated for an intracerebral dural sinus thrombosis in ten vascular territories by local urokinase infusion. In 7 (77.8%) cases, there was angiographic evidence of clot lysis and clinical improvement of the patient's neurological condition. Minor complications including infection and noncerebral sites of bleeding occurred in 3 (33.3%) patients, requiring adjustment in urokinase infusion therapy. Conclusions: Local, direct intra-arterial or intravenous infusion of thrombolytic drugs for treatment of stroke patients may improve overall patient morbidity and mortality related to acute thromboembolic disease in the central nervous system. Further clinical studies are warranted to evaluate this form of therapy.
A New Nonstented Balloon-Expandable Graft for Straight or Bifurcated Endoluminal Bypass
Authors: White Geoffrey H. , Yu Weiyun , May James , Stephen Michael S. , Waugh Richard C. 
Published: March 2015

Purpose: The aim of this study was to determine the feasibility of endoluminal grafting of aneurysms using a new design of nonstented endograft. Methods: Initial studies were undertaken in bench models and by implantation of endografts into animal vessels. Between May 1992 and June 1994, endoluminal repair of aneurysms was undertaken in 47 patients (44 male, 3 female). A new balloon-expandable endoluminal graft was developed and has now been studied in 25 of these 47 cases. This graft does not require adjunctive use of a vascular stent because of its unique construction, which incorporates metallic implants (graft attachment device or “GAD”) into the graft material. The design is applicable to endovascular grafting of occlusive arterial disease, as well as aneurysms. All patients were investigated by duplex scan, calibrated angiogram, and angio-CT scan and then allocated into groups that we defined according to the following criteria: group I, considered suitable for transfemoral implantation of a straight tube graft (n = 12); group II, unsuitable for transfemoral tube graft because of short neck of aneurysm, absent distal neck, or diseased iliac arteries (n = 10); and group III, peripheral aneurysms (n = 3). All patients were followed by clinical examination, duplex scan, and CT scan, with selective use of angiography. Results: Intraluminal deployment of the graft was achieved in all 25 patients; however, 3 patients from group II subsequently required conversion to open procedures because of the following complications: (1) partial graft thrombosis resulting from inadvertent omission of systemic anticoagulation during deployment (n = 1); and (2) unsuccessful deployment of the contralateral limb of a bifurcated graft in the iliac artery (n = 2). Successful endoluminal repair was achieved in 100% of patients in groups I and III, compared to 70% in group II. Conclusions: These preliminary results (in a series of high-risk patients) have demonstrated that endoluminal abdominal aortic aneurysm repair with this graft can be achieved reliably and with low morbidity in patients who fulfill the selection criteria (group I) and in peripheral aneurysms (group III), but the results were less satisfactory in aneurysms that do not have a good proximal or distal neck or in patients with diseased iliac arteries (group II). Further modification of the bifurcated version of this graft design, together with improvements in access techniques and graft materials, is required for successful endoluminal grafting in a wider range of patients.
Ultrasonic Endarterectomy: Experimental and Initial Clinical Results in Carotid Stenosis
Authors: La Rosa Antonio , Argenteri Angelo , Cugnasca Marco , Rossi Guido , Odero Attilio 
Published: March 2015

Purpose: The effects of ultrasonic endarterectomy, evaluated experimentally and clinically, were compared with the results obtained with conventional endarterectomy. Methods: Experimental: An ultrasonic vascular dissector with a frequency of 29 kHz was used for ultrasonic endarterectomy. Gross and histologic observation was made on 22 fresh human cadaver atherosclerotic vessels, of which 16 were treated with ultrasound endarterectomy and 6 conventionally. Clinical: Twenty-eight patients requiring carotid endarterectomy were chosen at random. Seven patients underwent ultrasonic endarterectomy after traditional access surgery, while 21 patients were treated with conventional endarterectomy. In the clinical study, an intraoperative gross observation of the endarterectomized surfaces was made, followed by duplex scanning after 18 and 24 months. Results: Histologic observation of the cadaveric vessels revealed particularly smooth surfaces in 87.5%; there was no debris, flaps, or vessel damage in any of the ultrasonically treated samples. In contrast, the traditional technique produced regular surfaces without residual debris in only 50% of the experimental cases. Favorable results were also seen in the clinical carotid experience, in which there was no need to surgically correct the ultrasonically endarterectomized surface in any case. In fact, achieving a satisfactory outcome was greatly facilitated by the use of ultrasound. In the conventionally treated patients, however, only 19% (4) demonstrated a smooth luminal surface on gross observation even after surgical correction. No postoperative complications were encountered in either group, and no restenosis has occurred in ultrasonic endarterectomy-treated patients after 2 years. Conclusions: Favorable experimental results using ultrasonic endarterectomy prompted the successful clinical application of this new technique in carotid stenosis treatment. Whether or not ultrasonic endarterectomy can reduce postoperative morbidity and restenosis is still under study.
Initial Experience with the Cragg Endopro System 1 for Intraluminal Treatment of Peripheral Vascular Disease
Authors: Henry Michel , Amor Max , Ethevenot Gérard , Henry Isabelle , Abdelwahab Wagli , Leborgne Edmond , Allaoui Mohamed 
Published: March 2015

Purpose: To evaluate the safety and efficacy of a new covered stent, the Cragg Endopro System 1, for intraluminal treatment of peripheral vascular disease in the iliac and femoropopliteal arteries. Methods: Forty symptomatic patients with predominantly lengthy stenotic (24) or occlusive (13) lesions or aneurysms (3) in the iliac (19), femoral (19), or popliteal (2) arteries were treated percutaneously with balloon angioplasty followed by implantation of the self-expanding nitinol Cragg stent covered by a woven polyester fabric coated with low-molecular-weight heparin. The mean length of femoropopliteal lesions was 13.0 ± 1.8 cm, as compared to 6.7 ± 0.8 cm (p < 0.01) for iliac lesions. Mean percent stenosis was 89% ± 2% with no significant difference between the arterial segments. Results: With a total of 52 covered stents implanted, technical success was achieved in 98% (39/40 patients). One tortuous femoral artery aneurysm was not satisfactorily excluded to prevent leakage. Clinical success was seen in all patients with demonstrable improvements in the claudication stage and the ankle-brachial index from a mean 0.54 to 0.92. Three local complications (one hematoma, two false aneurysms) required surgical repair. One distal embolism, one acute thrombosis, and three subacute thromboses were encountered and successfully treated by thrombolysis and/or surgery. One patient with two iliac stents developed contralateral common iliac artery occlusion from a stent partially obstructing the aorta; placement of a covered stent in the blocked artery re-established normal flow. Over an 8-month follow-up with arteriographic re-examination, all iliac stents remained patent. At the femoropopliteal level, two stents were occluded at 4 months; one was successfully dilated, but the other required surgical bypass grafting. A third patient developed a stenotic lesion proximal to the stent; dilation restored adequate inflow to the stent. Conclusions: The Cragg Endopro System 1 appears to be effective as an “internal bypass” for iliac and femoropopliteal occlusive disease. More complications and restenosis were seen in femoropopliteal implantations; however, a change in postoperative medication may improve these results. Long-term results will determine if the Cragg Endopro System 1 can achieve a patency equal to conventional bypass grafting.
Percutaneous Angioplasty, Endothelial Markers, and Fibrin Turnover
Authors: Woodburn Kenneth R. , Lowe Gordon D.O. , Pollock John G. , Rumley Ann , Reid Alan W. 
Published: March 2015

Purpose: A number of thrombotic mediators have been related to peripheral arterial disease in both epidemiological and pathological studies. Methods: We measured preoperative levels of fibrinogen, cross-linked fibrin degradation products (FDP), and the endothelial markers, von Willebrand factor (vWF), tissue plasminogen activator (tPA), and plasminogen activator inhibitor (PAD, in the venous blood of 43 claudicants undergoing percutaneous transluminal angioplasty (PTA). Samples were repeated 4 months later, and changes in the levels of thrombotic mediators were compared with ten controls undergoing angiography alone. Additional perilesional arterial samples were obtained from 11 of the patients. Results: Arterial sampling indicated that successful PTA led to an immediate fall in tPA levels and a rise in arterial vWF (p < 0.05), together with a trend toward a significant rise in cross-linked FDP levels. Only the increase in FDP following successful PTA (36 cases) (p < 0.05) was observed in 4-month postangioplasty venous samples, whereas all variables remained unchanged in cases of restenosis (4 patients) and in controls (all comparisons made by Wilcoxon matched pairs test). Conclusions: These findings suggest that successful PTA in patients with intermittent claudication results in acute endothelial disturbance and increased fibrin turnover at the site of angioplasty and in sustained increases in fibrin turnover (as reflected by FDP levels). The observation that this increase in fibrin turnover is absent in cases of restenosis within 4 months of PTA merits further study to determine whether increases in fibrin turnover are necessary to maintain patency following PTA.
Infrainguinal Atherectomy Using the Transluminal Endarterectomy Catheter: Patency Rates and Clinical Success for 144 Procedures
Authors: Myers Kenneth A. , Denton Michael J. , Devine Terence J. 
Published: March 2015

Purpose: To determine if atherectomy using the transluminal endarterectomy catheter (TEC) is an effective endoluminal therapy for infrainguinal occlusive disease. Methods: Three surgeons used the TEC for 144 infrainguinal atherectomy procedures in 133 patients. The indications were severe claudication in 83, critical ischemia in 56, and graft stenosis in 5 limbs. The pathology was stenosis in 36 and occlusion in 105 limbs. Balloon dilation was also performed in 109 and stenting in 17 limbs. Results: There was initial technical and anatomic success in 124 (86%) procedures. There were 67 technically successful procedures at mean follow-up of 19 months, although 3 of these limbs with gangrene and extensive distal disease required major amputation. There were 26 failures due to stenosis leading to further intervention and 51 due to occlusion. Twenty of these cases were managed conservatively, 21 were treated with repeat endovascular intervention, 31 with bypass grafting, and 5 with amputation. Repeat intervention in 52 limbs resulted in 36 with patent arteries, 10that are occluded, and 6that required amputation. Thirteen of the 14 amputations were for limbs with critical ischemia, but 1 was in a patient with claudication. Life-table analysis showed that the primary patency rate was 51%, the assisted primary patency rate was 61%, and the secondary patency rate was 75% at 15 months. The clinical success rate was 49%, and the salvage rate for limbs with critical ischemia was 78% at 12 months. Univariate log-rank testing showed no significant differences according to the clinical presentation or pathology, but results were worse for lesions > 5 cm long due to more frequent immediate failures. However, multivariate Cox regression analysis showed that results were significantly worse for critical ischemia than for claudication, stenosis compared to occlusions, for limbs with poor runoff, for operations performed by percutaneous rather than an open approach, and for those performed more recently. Conclusions: TEC atherectomy may have a place in selected patients, but the optimal circumstances for its use and long-term efficacy require further study.