bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed Complications after Endovascular AAA Repair in Women
Authors: Shames Murray L. , Sanchez Luis A. , Rubin Brian G. , Choi Eric T. , Geraghty Patrick J. , Flye M. Wayne , Thompson Robert W. , Sicard Gregorio A. 
Published: March 2015

Purpose: To assess whether women suffer more delayed complications or require more interventions after endovascular abdominal aortic aneurysm (AAA) repair. Methods: Over a 2-year period, 245 patients (203 men, 42 women) underwent endovascular repair with the AneuRx stent-graft at our institution. Baseline, operative, and follow-up data were reviewed and outcomes compared between men and women for complications or secondary procedures beyond the 30-day postoperative period. Results: The 42 (17.1%) women treated with the AneuRx graft experienced more technical complications (17% versus 8.3%; p<0.05) and acute conversions to open repair (6/7, 86%; p = 0.0005). At 30 days, systemic morbidity was significantly higher in women (26% versus 5.3%; p = 0.001.) However, mortality (2.3% versus 1.5%), length of hospital stay (2.6 versus 2.9 days), and major endoleaks at discharge (0% versus 1.6%) were similar. Over a mean follow-up of 11.3 months (range 1–26), graft limb occlusion occurred more frequently in female patients (12.2% versus 2.5%; p = 0.05), and secondary procedures were required in a significantly higher number of women (29% versus 9%; p<0.05). Three patients in each group (25% of women versus 17% of men) who had secondary procedures required additional interventions. Although not statistically significant, the mortality in women during follow-up was higher (9.7% versus 5%); 2 deaths were directly related to graft complications in the female group. Conclusions: Endoluminal AAA repair in women presents a technical challenge at the time of operation and may cause more frequent late complications, necessitating close post-procedural surveillance and prompt correction of complications to avoid potentially catastrophic outcomes. Reassessment of inclusion criteria for women may be necessary.
Elective and Emergent Endovascular Treatment of Subclavian Artery Aneurysms and Injuries
Authors: Schoder Maria , Cejna Manfred , Hölzenbein Thomas , Bischof Georg , Lomoschitz Fritz , Funovics Martin , Nöbauer-Huhmann Iris , Sulzbacher Irene , Lammer Johannes 
Published: March 2015

Purpose: To demonstrate our short and long-term results after transbrachial treatment of subclavian artery aneurysms and injuries with stent-grafts in elective and emergency settings. Methods: Ten of 12 consecutive patients (6 men; mean age 63.8 years, range 38–80) were treated electively with commercially prepared endografts delivered via a transbrachial access to repair a subclavian artery aneurysm (n = 3) or an injury from a misplaced central venous catheter (n = 7). Two patients required emergency treatment for a ruptured atherosclerotic aneurysm in one and an unintentional arterial puncture during placement of a central venous access in the other. Stent-graft patency during follow-up was assessed by physical examination with comparison of brachial blood pressures in all patients; computed tomography angiography (CTA) was performed in available patients. Results: Successful deployment of stent-grafts with sealing of the lesion was achieved in all cases. There were 2 (17%) procedural complications. One patient developed an access-site hematoma that required surgical revision. The second patient, who had a right subclavian injury, suffered an embolic cerebral infarction. The primary stent-graft patency during follow-up (mean 11.6 months) was 100%. CTA examinations in 7 patients at a mean 18 months showed strut dislocation at the thoracic outlet without luminal narrowing in 1 patient. A 50% intraluminal narrowing due to compression between the clavicle and the first rib occurred in another patient. Six patients with a mean follow-up of 23 months (range 0.3–4.5 years) are still alive with patent stent-grafts. Conclusions: Endovascular stent-graft treatment of subclavian artery aneurysms and injuries is a less invasive alternative to surgical repair. Long-term results must still be confirmed in further studies.
Suspected Pulmonary Artery Disruption after Transvenous Pulmonary Embolectomy Using a Hydrodynamic Thrombectomy Device: Clinical Case and Experimental Study on Porcine Lung Explants
Authors: Biederer Jürgen , Schoene Arne , Reuter Michael , Heller Martin , Müller-Hülsbeck Stefan 
Published: March 2015

Purpose: To use porcine lung explants for reconstructing possible situations in which a vessel wall disruption might have occurred in a patient suffering fatal hemoptysis after pulmonary embolectomy with a hydrodynamic thrombectomy device. Methods: A 76-year-old woman with massive pulmonary embolism underwent transvenous pulmonary embolectomy using a 6-F AngioJet Xpeedior catheter according to manufacturer's instructions. While activating the device in the middle lobe artery (∼8 mm diameter), massive and ultimately fatal arterial bleeding occurred through the tracheal tube. Because no autopsy was authorized, an experimental study was designed to examine possible causes for the vessel disruption. Five fresh porcine heart-lung preparations were examined inside a dedicated chest phantom. Access to the pulmonary vessels was provided through catheters inside the right and left ventricular outlets. A low-flow circulation was maintained with an external pump. The 6-F AngioJet thrombectomy device was activated at 42 sites inside vessels from 2 to 10 mm in diameter; in one lung, 8 activations were made after deliberately withdrawing the guidewire. Results: Vessels >6 mm in diameter remained intact. Vessel wall disruption occurred in 4 of 7 vessels between 4 and 6 mm in diameter and in 13 of 14 segmental arteries <4 mm in diameter (regardless of whether or not a guidewire was used). The signs of vessel wall disruption included extravasation of contrast material, arteriovenous fistula, and laceration of distal airspaces with contrast inside the bronchus. Conclusions: The application of this system has to be considered potentially dangerous when activated inside vessels with diameters < 6 mm. The use of this device appears to be safe only inside main branches of the lung vessels at this time. Additional experiments will be required to substantiate these initial results.
Open Surgical versus Minimally Invasive in Situ Femorodistal Bypass: Long-term Results
Authors: Renken Nomdo S. , Wittens Cees H.A. , Pattynama Peter M.T. , Du Bois Nico A.J.J. , van Dijk Lukas C. 
Published: March 2015

Purpose: To compare long-term patency and limb survival rates for the classical in situ surgical bypass procedure versus a minimally invasive technique for femorodistal revascularization. Methods: From May 1992 to June 1994, a prospective multicenter study was undertaken at 4 centers to evaluate the open versus closed technique for femorodistal bypass grafting. Of 97 patients enrolled in the trial, 73 patients (49 men; mean age 71 years) were assigned to the long-term follow-up protocol and prospectively randomized to the open (n = 38) or closed (n = 35) procedure. The classical open technique is characterized by a long incision over the length of the bypass graft, while the minimally invasive procedure involves only two short incisions over each anastomosis site (the side branches are closed with a coaxial embolization catheter system). Graft patency was evaluated with duplex imaging periodically throughout the 4-year observation period. Results: There was no statistically significant difference between the treatment groups with respect to age, sex, hypertension, ischemic heart disease, or smoking. However, the open group had a significantly greater incidence of diabetes (p = 0.037). Over a median 4.7-year follow-up (range 0.3–6.4), 9 (12%) patients (3 open and 6 closed) were lost to follow-up: 2 died and 7 refused the duplex examination. No significant differences in 4-year patency, limb salvage, or survival was demonstrated between the open versus closed treatment groups; 4-year secondary patency was 62% versus 64%, respectively, and limb salvage was 72% versus 86%. Conclusions: The closed technique for femorodistal in situ bypass procedures yields favorable long-term outcomes compared to the traditional open technique.
Simple Technique to Decrease Total Clamping Time during Combined Iliac and Femoral Endovascular Procedures
Authors: Giudice Rocco , Scoccianti Marco 
Published: March 2015

Purpose: To describe an alternative method of gaining vascular access while preserving blood flow to the profunda femoral artery during combined iliac and superficial femoral artery (SFA) recanalization. Technique: A sheath is introduced through the occluded SFA to reduce the total ischemic time when both the external iliac artery and SFA are obstructed. After iliac stenting and remote endarterectomy of the SFA with stent-graft deployment, blood flow to the profunda is interrupted only briefly when the proximal anastomosis of the femoral endobypass is completed. Conclusions: Sheath insertion into the proximal portion of an occluded SFA can be an effective option in reducing ischemic time when dealing with combined iliac and femoral endovascular procedures.
Stenting for Pulmonary Artery Stenosis Due to a Recurrent Primary Leiomyosarcoma
Authors: Meckel Stephan , Buitrago-Téllez Carlos , Herrmann Richard , Jacob Augustinus Ludwig 
Published: March 2015

Purpose: To report stent implantation for a malignant obstruction within the pulmonary artery (PA) caused by a recurrent leiomyosarcoma in the pulmonary trunk. Case Report: A 62-year-old man with a non-metastatic primary leiomyosarcoma of the right PA underwent pneumectomy of the right lung and postoperative radiotherapy in 1994. Six years later, he presented with symptoms of progressive right ventricular dysfunction. Computed tomography (CT) identified a high-grade stenosis of the left PA due to recurrent tumor within the pulmonary trunk extending into the left PA. Transthoracic ultrasound documented severe pulmonary hypertension with a high pressure gradient across the stenosis. A stent was deployed percutaneously, successfully establishing PA patency. Pressure measurements showed a significantly reduced gradient across the stented area. In follow-up, the patient reported subjective improvement of symptoms; CT scans revealed a fully patent stent. His status remained stable 11 months after stent implantation. Conclusions: PA leiomyosarcoma is a rare and highly malignant tumor. In most cases, surgery can only prolong survival for the short term. Palliative interventional PA stenting performed under local anesthesia can offer improvement in quality of life by reducing excessive pulmonary hypertension.
Spontaneous Common Iliac Artery Dissection after Exercise
Authors: Teh Lip Gen , Sieunarine Kishore , van Schie Greg , Vasudevan Thodur 
Published: March 2015

Purpose: To review the clinical features and management of spontaneous iliac dissections. Case Report: A healthy 60-year-old competitive cyclist presented with acute onset of short-distance claudication following vigorous exercise. Angiography showed a dissection flap extending from the right common iliac artery to the external iliac artery. An uncovered stent was placed across the proximal entry site but did not obliterate the false lumen; open surgical intervention was required. Conclusions: Spontaneous dissection of the iliac artery is a rare but important condition to suspect in high performance athletes complaining of leg pain following exercise.
Internal Carotid Artery Pseudoaneurysms: Treatment with the Wallgraft Endoprosthesis
Authors: Kubaska Stephen M. , Greenberg Roy K. , Clair Daniel , Barber Gregory , Srivastava Sunita D. , Green Richard M. , Waldman David L. , Ouriel Kenneth 
Published: March 2015

Purpose: To report several cases illustrating the feasibility and mid-term efficacy of deploying a self-expanding stent-graft to treat traumatic ruptures, pseudoaneurysms, and a spontaneous dissection of the internal carotid artery (ICA). Case Reports: One patient suffered a stab wound and another developed a large pseudoaneurysm years after a gunshot to the neck. The third patient presented with a spontaneous rupture in the setting of fibromuscular dysplasia, and the final patient developed a pseudoaneurysm following carotid endarterectomy in an irradiated neck. All 4 patients were successfully treated with Wallgrafts deployed in the ICA using either an open carotid (first 3 cases) or percutaneous approach (fourth patient). There were no adverse neurological events. During a mean 16-month follow-up (range 6–24), duplex ultrasound and CT scanning found no evidence of restenosis, occlusion, or persistent perfusion of the pseudoaneurysm, which was noted to decrease in all cases. Conclusions: The thin-walled fabric of the Wallgraft appears capable of completely excluding the pseudoaneurysm, resulting in decreased aneurysm size overtime.
Ruptured AAA in a Patient with a Horseshoe Kidney: Emergent Treatment Using the Talent Acute Endovascular Aneurysm Repair Kit
Authors: Teijink Joep A.W. , Odink Henk F. , Bendermacher Bianca , Welten Rob J.T.J. , van Zanten G. Otto Veldhuijzen 
Published: March 2015

Purpose: To report emergent endovascular repair of a ruptured abdominal aortic aneurysm (AAA) in a patient with a horseshoe kidney. Case Report: A 78-year-old man with a horseshoe kidney presented with a contained rupture of a 72-mm AAA. After urgent computed tomographic angiography (CTA) documented the blood supply to the kidney and the suitability of the aneurysm for endovascular repair, the patient was given a local anesthetic. An aortomonoiliac stent-graft constructed from components provided in a Talent Acute Endovascular Aneurysm Repair Kit was inserted successfully. The procedure was completed with placement of a contralateral common iliac artery occluder and a femorofemoral bypass graft. No complications were encountered, and the patient was discharged with an excluded aneurysm on the fourth postoperative day. At 3 months, aneurysm exclusion was confirmed by CTA, and no endoleak was present; the retroperitoneal hematoma had disappeared. The patient remains in good general condition 8 months after treatment Conclusions: The advantages of endovascular aneurysm repair in the emergency setting can facilitate rapid recovery in patients with symptomatic or ruptured aneurysms, especially those having a horseshoe kidney.
False Aneurysms at Both Ends of a Descending Thoracic Aortic Stent-Graft: Complication after Endovascular Repair of a Penetrating Atherosclerotic Ulcer
Authors: Chen Fang Hong , Shim Won Heum , Chang Byung Chul , Park Sang Joon , Won Jong Yun , Lee Do Yun 
Published: March 2015

Purpose: To report the formation of false aneurysms at both ends of a stent-graft implanted in the descending thoracic aorta to repair a penetrating atherosclerotic ulcer. Case Report: A 66-year-old woman with a penetrating atherosclerotic ulcer was treated with a 34 × 70-mm homemade Gianturco-type stent covered with polytetrafluoroethylene graft. Four months later, she developed false aneurysms at both ends of the stent-graft. The patient refused further endovascular repairs, so the stent-graft was surgically removed and the aorta repaired. Conclusions: This case demonstrates an unusual complication that should be anticipated when a stent-graft is deployed in the acute phase of thoracic aortic ulcer or its variants.
Type a Aortic Dissection Developing during Endovascular Repair of an Acute Type B Dissection
Authors: Fanelli Fabrizio , Salvatori Filippo Maria , Marcelli Giulia , Bezzi Mario , Totaro Marco , Vagnarelli Simone , Dake Michael D. , Rossi Plinio , Passariello Roberto 
Published: March 2015

Purpose: To describe an extension of type B dissection into type A during endoluminal treatment of acute type B dissection. Case Report: A 57-year-old man with acute type B dissection underwent endovascular repair using 2 Excluder stent-grafts. Before releasing the second stent-graft, the patient complained of mild central chest pain, headache, and visual flashes, but no hemodynamic changes were noticed. An angiogram, performed soon afterwards, showed a retrograde extension of the dissection through the aortic arch involving both the left carotid artery and the ascending aorta. The procedure was completed, and the patient was transported to the operating room where the proximal ascending aorta was replaced. Spiral computed tomographic angiography performed 2 weeks after the procedure showed complete exclusion of the primary entry tear. At 6-month follow-up, the patient was asymptomatic; the left carotid artery dissection had disappeared. Conclusions: Endovascular repair of acute type B dissection is technically feasible, but longer experience will help prevent technical complications.
Changes in Carotid Artery Flow Velocities after Stent Implantation: A Fluid Dynamics Study with Laser Doppler Anemometry
Authors: Greil Oliver , Pflugbeil Gottlieb , Weigand Klaus , Weiß Wolfgang , Liepsch Dieter , Maurer Peter C. , Berger Hermann 
Published: March 2015

Purpose: To study the influence of stent size and location on flow patterns in a physiological carotid model. Methods: Wallstents were positioned in silicon models of the carotid artery at various locations: 2 stents appropriately sized to the anatomy were placed in (1) the internal carotid artery (ICA) and (2) the ICA extending completely into the common carotid artery so as to cover the external carotid artery (ECA) orifice. Another 2 stents were placed in the ICA extending (1) partially and (2) completely into the bulb to simulate stent displacement and disproportion between stent size and the original vessel geometry. Measurements were performed with laser Doppler anemometry (LDA) using pulsatile flow conditions (Reynolds number=250; flow 0.431 L/min; ICA:ECA flow rate ratio 70:30) in hemodynamically relevant cross sections. The hemodynamic changes were analyzed with 1-dimensional flow profiles. Results: With the stent in the ICA, no changes of the normal flow profile were seen. For stents positioned in the ICA and extending partially or completely into the carotid bulb, the flow behavior was affected by the resistance of the stent to flow in the ECA. Hemodynamically relevant disturbances were seen in the ICA and ECA, especially in the separation zones (regions along the walls just after a bifurcation, bend, or curve). The ICA:ECA flow rate ratios shifted from 70:30 to 71.3:28.7 and from 70:30 to 75.1:24.9, respectively, in the 2 malpositioned stent models. With the stent placed in the ICA extending completely into the CCA, the ICA:ECA flow rate ratio shifted from 70:30 to 72.4:27.6. In this configuration, there were no notable flow changes in the ICA, but a clear diminishing of the separation zones in the ECA separation zones. Conclusions: Anatomically correct positioning of appropriately sized stents does not lead to relevant flow disturbances in the ICA. In the ECA, depending on the position, size, and interstices of the stent, the physiological flow was considerably disturbed when any part of the stent covered the inflow of the vessel. Disturbances were seen when the stent was positioned into the bulb. For clinical application, stent location and size must be carefully determined so that the stent covers the bifurcation completely or is in the ICA only.
Percutaneous Transluminal Angioplasty in the Treatment of Critical Limb Ischemia
Authors: Molloy Kevin J. , Nasim Akhtar , London Nick J.M. , Naylor A. Ross , Bell Peter R.F. , Fishwick Guy , Bolia Amman , Thompson Matthew M. 
Published: March 2015

Purpose: To assess the role of percutaneous transluminal angioplasty (PTA) to treat critical limb ischemia (CLI) and to relate the changing experience with endovascular treatment of this condition in a major vascular unit. Methods: A prospective study was performed involving 110 consecutive patients (57 women; mean age 76 years, range 57–99) undergoing balloon angioplasty for critical limb ischemia in 133 limbs. Outcome at 1 year was examined by case note review or questionnaire to determine survival, amputation-free survival, limb salvage, and CLI recurrence. Results: Technical success was achieved in 105 (79%) of 133 limbs; the overall complication rate was 20% (3.8% major, 16.2% minor). The median follow-up was 15 months (minimum 12). The 12-month limb salvage rate by life-table analysis was 88%. Patients with an initially successful angioplasty had an extremely good outcome (95% 1-year limb salvage). In contrast, the 28 patients with failed angioplasty fared very poorly; a major amputation was required in 10, and death occurred in another 9, leaving only 9 survivors with limbs intact at 1 year. Conclusions: The results of this study justify the continuing use of PTA as first-line treatment for critical limb ischemia.
Percutaneous Mechanical Thrombectomy for the Management of Venous Thoracic Outlet Syndrome
Authors: Schneider Darren B. , Curry Thomas K. , Eichler Charles M. , Messina Louis M. , Gordon Roy L. , Kerlan Robert K. 
Published: March 2015

Purpose: To describe the successful use of percutaneous mechanical thrombectomy as an adjunct to thrombolysis for acute subclavian vein thrombosis due to venous thoracic outlet syndrome Case Report: A 40-year-old man presented with arm swelling due to acute subclavian vein thrombosis and venous thoracic outlet syndrome. Percutaneous mechanical thrombectomy with the AngioJet device and thrombolysis were used to restore venous patency. Immediately following operative thoracic outlet decompression, the patient experienced rethrombosis, which was successfully treated using percutaneous mechanical thrombectomy. After 6 months, the patient remains symptom-free, with a patent subclavian vein by duplex ultrasonography. Conclusions: Thrombus debulking or removal with percutaneous mechanical thrombectomy devices may reduce the amount or duration of thrombolytic therapy required, making treatment of venous thoracic outlet syndrome safer. Moreover, patients with recurrent thrombosis after thoracic outlet decompression may be safely treated with percutaneous mechanical thrombectomy, even when thrombolytic therapy is contraindicated.
Infrainguinal Atherectomy Using the Auth Rotablator: Patency Rates and Clinical Success for 36 Procedures
Authors: Myers Kenneth A. , Denton Michael J. 
Published: March 2015

Purpose: To determine whether the Auth Rotablator device is suitable for endoluminal atherectomy for infrainguinal occlusive arterial disease. Methods: Two surgeons used the Auth Rotablator to perform 36 infrainguinal atherectomy procedures in 34 patients for severe intermittent claudication in 21, critical ischemia in 12, or graft stenosis in 3 limbs. There were 24 stenoses and 12 occlusions. Adjuvant balloon dilation was performed in 13 limbs and stenting in 5. Results: There was initial technical and anatomical success in 34 procedures (94%), and 24 technically successful procedures persisted at mean follow-up of 16.5 months, although 1 limb required major amputation. Three failures were due to stenosis requiring further intervention, and 9 were due to occlusion. Failure led to no further intervention in 2, amputation in 1, further endovascular intervention in 5, and open surgical reconstruction in 4 limbs. After further treatment, 29 limbs are patent with no return of symptoms, 3 are occluded, and 4 have required amputation, all for initial presentation with critical ischemia. Life-table analyses calculate primary and secondary patency rates of 61% and 67% and a clinical success rate of 56% at 12 months. Conclusions: Atherectomy using the Auth Rotablator provides acceptable results, but its role in comparison to other endovascular techniques is still to be defined.