bluuebunny/crossref_metadata_2025_split huggingface dataset:
Early and Late Functional Outcome Assessments following Endovascular and Open Aneurysm Repair
Authors: Arko Frank R. , Hill Bradley B. , Reeves Terrence R. , Olcott Cornelius , Harris E. John , Fogarty Thomas J. , Zarins Christopher K. 
Published: March 2015

Purpose: To compare early and late functional outcomes, as well as survival and recovery, following endovascular or open repair of abdominal aortic aneurysm (AAA). Methods: Between 1996 and 2000, 294 patients underwent AAA repair (141 open and 153 endovascular); 57 patients from each group had 12-month follow-up for functional outcome assessment. Recovery was measured as hospital length of stay, skilled nursing requirement, and hospital readmission within 1 year to determine cumulative hospital utilization. Early (<6 months) functional outcomes were measured by activity level and convalescence days following surgery. Late (>6 months) functional outcomes were measured as ambulation, independent living, and employment status pre- and postoperatively. Results: Operative mortality for open repair was 5 (3.5%) compared to 1 (0.6%) after an endovascular procedure (p<0.05). The endovascular group had a shorter hospital stay (2.8±2.8 versus 8.3±4.5 days) and fewer skilled nursing requirements (0% versus 26%; p<0.001). Cumulative hospital utilization over 12 months was 3.8 days for endovascular patients and 13.8 days for open repair (p<0.001). Recovery time was 99.3±84.1 days (range 14–365) in conventionally treated patients and 32.1 ±43.5 days (range 7–180) in the stent-graft group (p<0.001). At 6 months, 43 (75%) open and 54 (95%) endovascular patients had full recovery (p<0.01). Activity levels decreased in 13 (23%) open and 3 (5%) endovascular patients after surgery (p<0.01). There were no differences in ambulation, independent living, or employment status before and after treatment. Conclusions: Periprocedural survival following aneurysm repair is improved with endovascular grafting compared to open surgery, and recovery is more rapid, with a 78% reduction in total hospital days. Early functional outcomes are markedly improved with endovascular repair, while there is no difference in late functional outcomes between the procedures.
Clinical Application of a Curved Nitinol Stent-Graft for Thoracic Aortic Aneurysms
Authors: Sanada Junichiro , Matsui Osamu , Terayama Noboru , Kobayashi Satoshi , Minami Tetsuya , Kurozumi Masahiro , Ohtake Hiroshi , Urayama Hiroshi , Endo Masamitsu 
Published: March 2015

Purpose: To evaluate the clinical efficacy of a curved nitinol stent-graft for repair of thoracic aortic aneurysms. Methods: The Matsui-Kitamura stent-graft (MKSG), composed of a self-expanding nitinol stent and polyester fabric, was shaped to match the aortic curvature of 11 patients (6 men; mean age 72.6 years, range 33–90) with 6 true and 5 false aneurysms of the distal arch or proximal descending aorta. The delivery system was an 18 or 20-F J-shaped sheath combined with a preloader-type introducer. The original mean proximal neck length was 16.4 mm, but 4 patients received an axilloaxillary bypass to lengthen the neck. Although the mean corrected proximal neck length was 21.9 mm (overall), 5 cases still had proximal necks <15 mm long. Results: All curved MKSGs were successfully deployed in the correct position and fitted to the curvature of the aortic arch, achieving complete aneurysm exclusion in 8 (73%) cases. The other 3 repairs displayed early endoleaks; 1 received an additional MKSG, but the other 2 are being observed. Thirty-day mortality was 0%. One patient developed transient renal failure requiring hemodialysis; no neurological complications were observed. Conclusions: Endovascular repair of thoracic aortic aneurysms using curved MKSGs appears to be feasible and clinically effective. A tighter fit of the device to the curvature of the aortic arch may exclude distal arch aneurysms despite a short proximal neck.
Evaluation of Glycoprotein IIb/IIIa Inhibitors in Carotid Angioplasty and Stenting
Authors: Wholey Michael Henry , Wholey Mark Henry , Eles Gustave , Toursakissian Boulis , Bailey Steven , Jarmolowski Chester , Tan Walter A. 
Published: March 2015

Purpose: To review the immediate neurological and bleeding complications associated with the use of glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing extracranial carotid artery stent placement. Methods: A retrospective review was performed of 550 patients (321 men; mean age 71.1 years, range 28–91) who underwent carotid artery angioplasty and stent placement. Glycoprotein IIb/IIIa inhibitors were given prophylactically along with heparin to 216 patients, whose outcomes were compared to a control group of 334 patients who received intravenous heparin alone. Primary endpoints were the immediate and 30-day neurological complications, including transient ischemic attacks (TIAs), minor and major strokes, and neurologically-related deaths. The secondary endpoint was any abnormal bleeding. Results: The all stroke/neurological death rate in 216 patients treated with heparin and GP IIb/IIIa inhibitors was 6.0% (13 events) compared 2.4% (8 events) in the 334 patients in the heparin-only control group (p = 0.0430). Two of the 4 neurologically-related deaths in the GP IIb/IIIa inhibitor group resulted from intracranial hemorrhages; there were no intracranial hemorrhages in the heparin-only group. There was 1 episode of extracranial bleeding in the GP IIb/IIIa inhibitor group treated with embolization. The incidences of significant puncture-site bleeding requiring transfusion were similar in the groups. Conclusions: Neurological complications following percutaneous carotid artery interventions have been relatively few. The neurological sequelae in carotid stent patients receiving glycoprotein IIb/IIIa inhibitors were more numerous and consequential, which suggests that the use of GP IIb/IIIa inhibitors in carotid stenting should be discouraged.
Stent-Graft Repair of a Mycotic Left Subclavian Artery Pseudoaneurysm
Authors: Sanada Junichiro , Matsui Osamu , Terayama Noboru , Kobayashi Satoshi , Minami Tetsuya , Chujo Tatsuya , Urayama Hiroshi 
Published: March 2015

Purpose: To report successful stent-graft treatment of a mycotic pseudoaneurysm of the left subclavian artery in an immunosuppressed patient. Case Report: A 17-year-old immunosuppressed woman undergoing treatment for recurrent leukemia developed persistent fever and 2 episodes of hemoptysis. A contrast-enhanced computed tomographic (CT) scan demonstrated a saccular aneurysm of the left subclavian artery, which was considered to be a mycotic aneurysm caused by erosive fungal infection from the lung. The pseudoaneurysm was treated with a homemade stent-graft consisting of a nitinol stent and a polyester fabric. A type II endoleak present at the end of the procedure appeared to have sealed spontaneously on the CT scan at 3 days. No neurological deficit or ischemic symptoms of the left arm were noted during the follow-up, which lasted until the patient died 11 months later after rejecting a second bone marrow transplant. Conclusions: Endovascular repair may be an alternative to open surgery for the management of mycotic aneurysms of the subclavian artery.
Endovascular Repair of a Ruptured Renal Artery Aneurysm
Authors: Schneidereit Nathan P. , Lee Shung , Morris D. Christopher , Chen Jerry C. 
Published: March 2015

Purpose: To describe the percutaneous treatment of a ruptured renal artery aneurysm (RAA) using a stent-graft. Case Report: An 86-year-old woman had sudden onset of right-sided back pain and a swollen left leg. Computed tomography disclosed a right retroperitoneal mass involving the kidney; the inferior vena cava was compressed, with thrombus in the left common iliac artery. There was a suggestion of RAA associated with contrast extravasation. Angiography confirmed a saccular aneurysm of the distal right main renal artery immediately proximal to the first segmental branch. A Jostent peripheral stent-graft was implanted with complete exclusion of the lesion. At 6-month follow-up, the patient remained asymptomatic, but there was a suggestion of in-stent restenosis, which is being followed closely. Conclusions: In elderly patients who are hemodynamically stable and have aneurysm anatomy that is suitable for stent-graft placement, the endovascular approach may allow rapid and definitive treatment of the hemorrhage.
Endovascular Therapy Combined with Immunosuppressive Treatment for Pseudoaneurysms in Patients with Behçet's Disease
Authors: Koo Bon Kwon , Shim Won-Heum , Yoon Young-Sup , Lee Byoung Kwon , Choi Donghoon , Jang Yangsoo , Lee Do-Yun , Chang Byung-Chul 
Published: March 2015

Purpose: To evaluate the feasibility, efficacy, and outcome of endovascular therapy combined with immunosuppression for the treatment of arterial pseudoaneurysms due to Behçet's disease. Methods: Eleven pseudoaneurysms (3 in the abdominal aorta, 3 in the subclavian artery, and individual lesions in the brachiocephalic artery, renal artery, common iliac artery, common carotid artery, and the descending thoracic aorta) in 9 patients with Behçet's disease were treated with 10 stent-grafts and 1 self-expanding stent. All patients with elevated erythrocyte sedimentation rate (ESR) were treated with immunosuppressive agents (azathioprine, prednisolone) before and after the procedure. Results: Endovascular treatment was successful in all cases, without major adverse events. The ESR was reduced from 42.7 ± 18.0 mm/h initially to 18.6 ± 12.6 mm/h after immunosuppressive therapy prior to endovascular repair. During follow-up (mean 24.1 ± 14.0 months, range 6–43), 8 of 11 lesions showed complete resolution. One stent-graft to treat a postsurgical recurrent carotid artery pseudoaneurysm was occluded, and an abdominal aortic pseudoaneurysm recurred; both patients stopped their medications. ESR during follow-up was 7.9 ± 4.5 mm/h. Conclusions: Endovascular treatment for pseudoaneurysms due to Behçet's disease is feasible and effective when disease activity is strictly controlled with immunosuppressive therapy.
Thrombus Characterization with Intravascular Ultrasound: Potential to Predict Successful Thrombolysis
Authors: Kwan Damon , Dries Andrew , Burton Tamara , Bhandari Guru , Young Daniel , Green Richard , Ouriel Kenneth , Greenberg Roy K. 
Published: March 2015

Purpose: To define analysis methods using radiofrequency (RF) data from intravascular ultrasound (IVUS) to characterize thrombus so that the success or failure of thrombolysis can be predicted. Methods: Experimentation was done in 2 phases: first, 40 clots created from platelet-rich (n = 20) and platelet-poor (n = 20) plasma were imaged with 20 and 30-MHz IVUS probes. The digitized RF signals were analyzed to determine the attenuation and slope of attenuation characteristics as a reference standard for the second part of the study. In this phase, 20 perfusion trials were performed with 10 platelet-rich and 10 platelet-poor samples in an in vitro arterial perfusion model; the composition of the samples was blinded during interrogation with IVUS. Alteplase (0.1 mg) was then infused directly into the thrombus for 1 hour; restoration of flow and amount of lysis were quantified. Results: Significant differences were detected for the integrated attenuation value (p<0.001) between platelet-poor and platelet-rich clots interrogated with a 30-MHz probe, but no differences were noted using the 20-MHz catheter. However, both transducers were capable of differentiating platelet-rich and platelet-poor clots using a slope of attenuation analysis, which was successful in identifying all 20 (100%) of the blinded clots in the in vitro model. The speed and completeness of lysis were significantly higher (p<0.05) for platelet-rich (78%) than platelet-poor (21%) clots. Conclusions: IVUS preprocessed imaging is capable of differentiating various types of thrombus. This information can be used to predict the success or failure of pharmacological lysis techniques.
Deep Circumflex Iliac Artery as a Cause of Type II Endoleak
Authors: Teh Lip Gen , van Schie Greg , Sieunarine Kishore 
Published: March 2015

Purpose: To report a collateral pathway involving the deep circumflex iliac artery causing a type II endoleak following endoluminal exclusion of an abdominal aortic aneurysm (AAA). Case Report: A 75-year-old man was investigated for a persistent type II endoleak 2 years after endovascular AAA repair with a Zenith Trifab stent-graft. Angiography revealed contrast in the sac from a lumbar artery fed via a collateral of the deep circumflex iliac artery. The lumbar artery was embolized with coils, but an endoleak persisted and is being followed. Conclusions: This collateral pathway is easily missed during angiography for endoleaks and should be considered where an endoleak is suspected but cannot be found.
Percutaneous Treatment of Placenta Percreta Using Coil Embolization
Authors: Dinkel Hans-Peter , Dürig Peter , Schnatterbeck Peter , Triller Jürgen 
Published: March 2015

Purpose: To report the use of embolotherapy to avoid hysterectomy in rare placenta percreta. Case Report: A pregnant 34-year-old woman (gravida 3, para 2) was admitted with premature rupture of membranes and vaginal bleeding in the 32nd week. Prenatal B-mode and Doppler ultrasound revealed marked hypervascularity of the placenta with disruption of the uterine-bladder interface consistent with placenta percreta. Since the patient insisted on uterine preservation, uterus and placenta were left in situ after caesarean section, which was followed by coaxial microcoil embolization of 6 pelvic arteries and postoperative methotrexate administration. Three months later, the patient had severe bleeding from the retained placenta, possibly under the influence of anticoagulation administered for pulmonary embolism. Emergent hysterectomy was performed. Conclusions: Coil embolization may avoid immediate hysterectomy and reduce peri-delivery blood loss in placenta percreta. However, retained placenta poses a serious risk, even after months, and secondary hysterectomy should be performed as an elective procedure after embolization.
A Comparison of Balloon-Mounted and Self-Expanding Stents in the Carotid Arteries: Immediate and Long-Term Results of More Than 500 Patients
Authors: Wholey Michael Henry , Wholey Mark Henry , Tan Walter A. , Eles Gustave , Jarmolowski Chester , Cho Simon 
Published: March 2015

Purpose: To compare the rates of neurological complications and restenosis for balloon-mounted (BM) versus self-expanding (SE) stents deployed in the extracranial carotid arteries. Methods: Among 513 patients (312 men; mean age 71.3 years, range 27–91) who underwent carotid artery stent placement, 496 received 520 stents. The patients were followed with periodic duplex ultrasound examinations; angiography was performed whenever the duplex scan identified a >50% stenosis or symptoms warranted investigation. Periproce-dural data on complications were analyzed on an intention-to-treat basis, while intermediate-term neurological complications were compared in stented patients. Results: In the periprocedural period, there were 19 (3.7%) transient ischemic attacks, 10 (1.9%) minor strokes, 6 (1.2%) major strokes, and 8 (1.6%) deaths among the 513 patients. Five (1.0%) of the deaths were related to neurological complications (3.9% all stroke/neurological death rate). Among the 496 patients receiving 247 (48%) BM stents and 273 (52%) SE stents in 518 arteries, the all stroke/neurological death rates were 3.6% and 4.0%, respectively (p>0.05). During a mean follow-up of 20.6 months (range to 5.6 years), the 3-year freedom from all fatal and ipsilateral nonfatal strokes excluding the 30-day periprocedural period was 95.0% for BM stents and 95.2% for SE devices. Vessel patency (>50%) at 3 years was 92.0% in the population: 96.3% for BM stents and 83.7% for SE stents (p=0.0422). Conclusions: The rate of neurological complications following carotid stenting has been relatively low overall, and no differences were found relative to the type of stent deployed. Vessel patency was excellent at 3 years, with slightly better patency in BM stents, but because of their vulnerability to compression, they will not replace SE stents.
Cytokine Activation and Intestinal Mucosal and Renal Dysfunction are Reduced in Endovascular AAA Repair Compared to Surgery
Authors: Junnarkar Sameer , Lau Luk Louis , Edrees Waleed K. , Underwood David , Smye Michael G. , Lee Bernard , Hannon Raymond J. , Soong Chee V. 
Published: March 2015

Purpose: To compare endovascular (EVR) to open repair (OR) of abdominal aortic aneurysm (AAA) for cytokine activation, changes in the intestinal mucosal barrier, and renal dysfunction. Methods: In a prospective nonrandomized study, 15 patients admitted to a university hospital for elective infrarenal AAA repair (8 OR and 7 EVR) were recruited. Intestinal permeability was assessed preoperatively (PO), at day 1 (D1), and at day 3 (D3) after surgery using the lactulose/mannitol differential excretion (LMR) test. Renal damage was assessed from measurements of the urinary albumin:creatinine ratio (ACR); cytokine activation was based on the urinary concentration of tumor necrosis factor receptor p55 (TNF-Rp55) at the same time points. Serum creatinine and urea concentrations were measured preoperatively and daily for 5 days postoperatively. Results: A significant increase in LMR was found in the OR group at D1 and D3 compared to PO (p<0.05). The LMR increase at D3 was significantly greater in the OR group (p<0.01). A significant difference was observed in the percentage rise in ACR on D1 in the OR group compared to the EVR group (p<0.005). The urinary TNF-Rp55 concentration was significantly elevated in the OR group at D1 (p<0.05) and D3 (p<0.05) compared to baseline; in the EVR group, it was elevated at D1 (p<0.05) compared to PO. The difference was also significant for this marker between the 2 groups at D1 (p<0.01). No significant change was observed in the serum creatinine or urea concentrations in either group perioperatively Conclusions: Endovascular AAA repair is associated with less cytokine production and less intestinal and renal dysfunction compared to the open approach.
Contrast-Enhanced Ultrasound Imaging for Aortic Stent-Graft Surveillance
Authors: Giannoni Maria Fabrizia , Palombo Giovanni , Sbarigia Enrico , Speziale Francesco , Zaccaria Alvaro , Fiorani Paolo 
Published: March 2015

Purpose: To compare unenhanced and enhanced ultrasound imaging to computed tomographic angiography (CTA) or magnetic resonance angiography (MRA) for surveillance of aortic endografts. Methods: Thirty consecutive patients (29 men; mean age 69 years, range 50–82) who underwent endovascular aortic aneurysm repair agreed to participate in a follow-up program. Patients underwent CTA (26/30) or MRA (4/30), plain abdominal radiography, and unenhanced and enhanced ultrasound examinations at 3, 12, and 24 months to evaluate aneurysm diameter, endoleaks, and graft patency. The accuracy of ultrasound was compared with CTA or MRA as the reference standards. Results: Twenty-six patients reached the 24-month assessment (mean follow-up 30 months, range 6–60). All endoleaks detected by CTA or MRA were confirmed by enhanced ultrasound; the aneurysm diameter in these patients remained unchanged or increased. In patients without endoleaks on any imaging method, the sac diameter remained unchanged or decreased. Endoleaks disclosed by enhanced ultrasound alone, all type II, numbered 16 at 3 months, 6 at 12 months, and 3 at 24 months. In this group, the aneurysm diameter remained unchanged or increased. Enhanced ultrasound yielded 100% sensitivity in detecting endoleaks, but compared with CTA and MRA, all endoleaks detected by enhanced ultrasound alone were false positives (mean specificity 65%). Nevertheless, because changes in the postoperative aneurysm diameter were similar in patients with endoleaks detectable on CTA/MRA and on enhanced ultrasound (“true positives”) and in those with endoleaks detectable only on enhanced ultrasound (“false positives”), some endoleaks were possibly “true positive” results. Conclusions: Enhanced ultrasound is a useful method in the long-term surveillance of endovascular aortic aneurysm repairs, possibly in association with CTA or MRA. Enhanced ultrasound also seems able to identify endoleaks missed by other imaging techniques, but this conclusion awaits further investigation.
IVUS Guidance of Thoracic and Complex Abdominal Aortic Aneurysm Stent-Graft Repairs Using an Intracardiac Echocardiography Probe: Preliminary Report
Authors: Zanchetta Mario , Rigatelli Gianluca , Pedon Luigi , Zennaro Marco , Ronsivalle Salvatore , Maiolino Pietro 
Published: March 2015

Purpose: To report our learning experience using an intracardiac echocardiography (ICE) probe to guide endovascular aortic procedures. Methods: Between November 1999 and July 2001, 17 patients (12 men; mean age 73.1 ± 2.3 years) underwent endovascular repair of 9 thoracic, 6 complex abdominal, and 2 thoracoabdominal aortic aneurysms. The most suitable dimensions and configuration of the stent-graft were based on preoperative computed tomographic (CTA) or magnetic resonance (MRA) angiography. Intraoperative intravascular ultrasound (IVUS) imaging was obtained using a 9-F, 9-MHz ICE probe, 110 cm in length, inserted through a 10-F, 55° precurved long polyethylene sheath. Results: The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, interrogation with the ICE probe visualized the aortic arch and descending thoracoabdominal aorta without position-related artefacts and identified the sites of stent-graft fixation. After stent-graft deployment, visualization with the ICE probe detected the need for additional procedures in 8 patients, including 2 incompletely expanded thoracic grafts, which were treated with adjunctive balloon angioplasty. In 1 patient, ICE probe interrogation determined that the lesion was inappropriate for endovascular exclusion. Conclusions: ICE probe interrogation provides accurate information on the anatomy of thoracic and abdominal aortic aneurysms and allows rapid identification of attachment sites and stent-graft characteristics. It might be considered as a valid imaging modality for monitoring all phases of endovascular procedures.
Preoperative Embolization of Collateral Side Branches: A Valid Means to Reduce Type II Endoleaks after Endovascular AAA Repair
Authors: Bonvini Robert , Alerci Mario , Antonucci Francesco , Tutta Paolo , Wyttenbach Rolf , Bogen Marcel , Pelloni Angelo , von Segesser Ludwig , Gallino Augusto 
Published: March 2015

Purpose: To report the results of preprocedural embolization of collateral branches arising from abdominal aortic aneurysms (AAA) scheduled for endovascular repair. Methods: Twenty-three consecutive AAA patients (all men; mean age 73 years, range 56–82) had coil embolization of patent lumbar and inferior mesenteric arteries (IMA) in a staged procedure prior to endovascular repair. Embolization with microcoils was attempted in 37 of the 52 identified lumbar arteries and 14 of 15 inferior mesenteric arteries. Follow-up included biplanar abdominal radiography, spiral computed tomography, and duplex ultrasonography at 1, 30, 90, and 180 days after the stent-graft procedure and at 6-month intervals thereafter. Results: Successful embolization was obtained in 24 (65%) of lumbar arteries, while all 14 (100%) IMAs were occluded with coils. No complication was associated with embolotherapy. Over a mean 17-month follow-up of 22 patients (1 intraoperative death), there was only 1 (4.5%) type II endoleak from a patent lumbar artery, with no sac expansion after 2 years. There were 4 (18%) type I and 1 (4.5%) type III endoleaks. Conclusions: The embolization of side branches arising from an infrarenal aortic aneurysm before endovascular repair is feasible, with a high success rate; this maneuver may play a relevant role in reducing the rate of type II endoleak, improving long-term outcome.