bluuebunny/crossref_metadata_2025_split huggingface dataset:
Angioplasty and Elective Stenting of De Novo versus Recurrent Femoropopliteal Lesions: 1-Year Follow-up
Authors: Schillinger Martin , Mlekusch Wolfgang , Haumer Markus , Sabeti Schila , Ahmadi Ramazanali , Minar Erich 
Published: March 2015

Purpose: To investigate patency rates after percutaneous transluminal angioplasty (PTA) and PTA plus elective stenting in de novo versus recurrent femoropopliteal lesions. Methods: The data were collected from a prospective registry including 533 consecutive patients (284 men; median age 71 years, interquartile range [IQR] 72–78) with severe claudication (n=387) or critical limb ischemia (n = 146) who underwent femoropopliteal percutaneous interventions during a 36-month period. PTA was used to treat 357 de novo and 99 recurrent lesions; PTA plus elective stent implantation was performed in 58 de novo and 19 recurrent lesions. Patients were followed for a median 12 months (IQR 7–14) using color duplex sonography. Rates of restenosis (≥50%) were compared by multivariate analysis. Results: Overall primary technical success was achieved in 517 (97%) patients; 31 (6%) periprocedural complications were encountered. Restenosis occurred in 213 (40%) patients after a median 6 months (IQR 4–7). Twelve-month patency after PTA was 61% in de novo and 33% in recurrent lesions (p<0.0001). Patients with recurrent lesions had a 2.3-fold increased adjusted risk for restenosis after PTA (95% confidence interval 1.7 to 3.2). Twelve-month patency after stenting was 58% in de novo and 52% in recurrent lesions (p=0.9). In patients with de novo lesions, patency rates after PTA and stent were similar (p=0.8); however, in patients with recurrent lesions, elective stenting performed better (p=0.05). Conclusions: Recurrent stenosis after prior femoropopliteal balloon angioplasty is an independent risk factor for restenosis; these lesions exhibit disappointing patency after repeated PTA. Stent implantation may improve intermediate-term results in these patients.
Endovascular Brachytherapy after Percutaneous Transluminal Angioplasty of Recurrent Femoropopliteal Obstructions
Authors: Zehnder Thomas , von Briel Christian , Baumgartner Iris , Triller Jürgen , Greiner Richard , Mahler Felix , Do Dai-Do 
Published: March 2015

Purpose: To test the preventive effect of endovascular brachytherapy (EVBT) on restenosis following secondary angioplasty in patients with presumed neointimal restenosis in the femoropopliteal segment. Methods: From March 1997 through May 2000, 100 patients (58 men; mean age 70 years, range 45–87) with postangioplasty femoropopliteal segment restenoses were enrolled and randomized to treatment with repeat angioplasty and EVBT (n = 51) or to angioplasty alone (n=49) as control. The groups were similar with regard to demographics and lesion characteristics. High-dose-rate EVBT was performed with 192Ir irradiation without a centering device (12 Gy for a reference vessel radius of 3 mm and a 2-mm reference depth). Primary endpoint in the 1-year follow-up was recurrent obstruction >50% documented by duplex ultrasound; the secondary endpoint was clinical improvement. Results: Only 44 (86%) of 51 patients received adequate EVBT due to technical failure, so the 7 failures were included with the controls in the per-protocol adherence analysis. At 1 year, the patients receiving EVBT had a restenosis rate of 23% (10/44), which differed significantly (p<0.028) from the 42% (23/56) rate in controls. Clinical results tended to be better with EVBT, but differences did not achieve statistical significance. Conclusions: EVBT without a centering device reduced restenosis significantly in patients with recurrent stenosis after angioplasty, which confirms previous results in primary long-segment femoropopliteal obstructions.
Safety of Limited Supplemental Iodinated Contrast Administration in Azotemic Patients Undergoing CO2 Angiography
Authors: Dowling Kyran , Kan Herman , Siskin Gary , Stainken Brian , Ahn Jiyong , Herr Allen , Darling R. Clement 
Published: March 2015

Purpose: To determine if limited doses of iodinated contrast significantly worsen the underlying renal insufficiency that had warranted the use of CO2 for diagnostic angiography. Methods: The records of 122 consecutive patients who had undergone CO2 angiography for peripheral vascular disease at our institution over a 5-year period were reviewed. The volume and type of iodinated contrast and the volume of CO2 administered were recorded. Serum creatinine measurements obtained before angiography and from 2 to 3 days after angiography were recorded. Results: One hundred patients had pre-angiography and post-angiography creatinine levels available for analysis (51 CO2 only, 49 CO2 with iodinated contrast). The average pre-treatment creatinine level was 2.8±1.5 mg/dL (range 1.8–6.6) for the CO2 only group and 3.0±1.4 mg/dL (range 1.8–8.2) for the CO2 plus iodinated contrast group (p=0.46). After angiography, the mean change in creatinine was +0.17±0.87 mg/dL for the CO2 only group and +0.03±0.98 mg/dL in the CO2 plus contrast group (p=0.27). Complications included 1 patient with a failing renal transplant who received iodinated contrast and ultimately required return to hemodialysis. A second patient had a transient 1-mg/dL rise of creatinine but did not require dialysis. Conclusions: This study supports the relative safety of CO2 angiography with the limited used of iodinated contrast supplementation for diagnostic studies or interventions in azotemic patients with peripheral vascular disease.
The Trellis Thrombectomy System in the Treatment of Acute Limb Ischemia
Authors: Kasirajan Karthikeshwar , Ramaiah Venkatesh G. , Diethrich Edward B. 
Published: March 2015

Purpose: To report the use of a new percutaneous mechanical thrombectomy device in the treatment of acute limb-threatening ischemia. Technique: The Trellis Thrombectomy System is a 7-F drug dispersion catheter that features a treatment segment isolated by proximal and distal occlusion balloons, which help prevent distal embolization and systemic release of the infused thrombolytic agent. After inflating the distal balloon, the thrombolytic agent is infused and held at the target site by inflation of the proximal balloon. An oscillating dispersion wire optimizes dispersal of the thrombolytic agent as the thrombus is mechanically fragmented. The liquefied thrombus is then aspirated. Four consecutive patients with acute lower extremity ischemia secondary to bypass graft thrombosis were treated with the Trellis thrombectomy catheter. Overall, 95% of thrombus was successfully removed from the treatment zone, with no device-related complications. Only one patient required adjunctive thrombolytic therapy after thrombectomy with the Trellis device. Conclusions: The Trellis thrombectomy device is a safe and effective technique to isolate the infused thrombolytic agent in association with mechanical fragmentation for rapid blood flow restoration.
Early Experience with a Rotational Thrombectomy Device for Treatment of Acute and Subacute Infra-Aortic Arterial Occlusions
Authors: Zeller Thomas , Frank Ulrich , Bürgelin Karlheinz , Müller Christian , Flügel Peter , Horn Barbara , Schwarzwälder Uwe , Neumann Franz-Josef 
Published: March 2015

Purpose: To evaluate a rotational thrombectomy device in the treatment of acute and subacute/chronic thrombotic infra-aortic occlusions of native vessels and bypass grafts. Methods: From July 2000 to February 2002, 98 patients (65 men; mean age 66±9 years, range 47–90) with 100 thrombotic occlusions (mean age of occlusion 31±33 days, range 0–140) measuring an average of 21±11 cm long (range 2–40) were treated with rotational thrombectomy (Rotarex). There were 33 acute (≤14 days) thrombotic/embolic native artery occlusions (group I), 58 subacute/chronic (>14 days) native artery occlusions (group II), and 9 acute bypass graft occlusions (group III). Results: The device activation time was 4.9±1.4 minutes, during which 4.0±1.4 passes of the device were performed. The amount of aspirated fluid was 240±119 mL. Slightly less than half the arteries (48%) were stented. Primary success (residual stenosis <30%) was achieved in 92% (94% for group I, 93% for group II, and 78% for group III; 100% for the ipsilateral approach, 56% for the crossover approach). Among the 18 complications, 3 were serious (2 amputations after unsuccessful intervention and 1 death); there were 8 vessel perforations and 7 cases of peripheral embolization. Thirty-day survival and limb salvage was 88% for group I, 100% for group II, and 66% for group III. Conclusions: The device is an easy-to-handle, useful tool for ipsilateral treatment of acute and subacute thrombotic arterial and bypass graft occlusions. The use of this device is limited by the 8-F diameter of the catheter and the limited capacity for crossover interventions.
Thrombolysis and Mechanical Fragmentation to Treat Massive Pulmonary Embolism in a Patient with an Anterior Communicating Artery Aneurysm
Authors: Kutlu Ramazan , Alkan Alpay , Kocak Ayhan , Sarac Kaya 
Published: March 2015

Purpose: To describe successful management of massive pulmonary embolism suffered by a patient with an unsecured intracranial aneurysm. Case Report: An anterior communicating artery aneurysm was found 10 days after a 50-year-old woman was admitted to the intensive care unit with subarachnoid hemorrhage. The patient developed severe acute dyspnea before planned surgery; imaging demonstrated thrombus in the right and left pulmonary arteries. Heparin was contraindicated, so an emergent coil embolization procedure was undertaken. In the same session, recombinant tissue plasminogen activator was administered directly into the thrombus. After 2 hours of thrombolysis and intermittent mechanical fragmentation, lung perfusion improved, and the patient's symptoms abated. Conclusions: Mechanical fragmentation together with fibrinolytic agent administration is a safe and effective treatment for pulmonary embolism after securing cerebral aneurysms.
A Percutaneous Approach to Deep Venous Valve Insufficiency with a New Self-Expanding Venous Frame Valve
Authors: de Borst Gerrit J. , Teijink Joep A.W. , Patterson Marlowe , Quijano Tino C. , Moll Frans L. 
Published: March 2015

Purpose: To ascertain if a percutaneously delivered venous valve bioprosthesis (PVVB) can be implanted in the porcine venous system and function without complications. Methods: The PVVB is a glutaraldehyde-preserved, valve-bearing venous xenograft sutured inside a memory-coded nitinol frame (diameter 10, 12, or 14 mm). In 10 50-kg pigs, the external jugular vein was exposed, and a 16-F introducer sheath was positioned in the common iliac vein. One PVVB was inserted and deployed in each iliac vein under fluoroscopic control. After PVVB implantation, all animals were randomly given either vitamin K antagonists (1–2 mg/d) (group I) or a combination of aspirin (150 mg/d) and clopidogrel (75 mg/d) (group II), which were shown in a preliminary pilot study to be the most effective anticoagulation regimens in the pig model. Ascending and descending completion phlebograms were performed. PVVBs were evaluated with phlebography at 4 weeks to assess patency and competence; all PVVBs were explanted and processed for histological analysis. Results: In 8 animals, the PVVB was successfully deployed in both the left and right iliac veins. In 2 pigs, only 1 PVVB was inserted due to vascular anomalies. Completion phlebography demonstrated 18 patent and competent valves. At 2 weeks, bleeding complications occurred in 3 group I pigs; all 5 animals were terminated to prevent further complications. Of the 8 valves in this group, 7 were patent (3 competent) by phlebography; 1 PVVB had migrated due to known undersizing of the stent frame. At 4 weeks, group II (5 pigs, 10 valves) analysis revealed 5 patent (3 competent) valves; no bleeding complications occurred in this group. Histology showed thrombosis as the cause of occlusion in all 5 non-patent valves from group II. Conclusions: Deployment of a glutaraldehyde-fixed bovine vein sutured to a self-expanding nitinol stent in the porcine iliac vein is technically feasible. Development of a venous bioprosthesis that can be placed percutaneously may have important clinical applications as an endovascular treatment for chronic venous insufficiency when it is due to valvular incompetence.
Venous Function after Restoring Valve Competence of the Great Saphenous Vein
Authors: Danielsson Gudmundur , Jungbeck Christel , Peterson Karin , Norgren Lars 
Published: March 2015

Purpose: To measure changes in venous function after elimination of great saphenous vein reflux using endovenously-applied heat with a specially designed catheter. Methods: In a prospective clinical study, 13 patients (8 women; mean age 39 years, range 25–59) with symptomatic chronic venous insufficiency were treated for reflux at the saphenofemoral junction. A radiofrequency catheter (Restore) with expandable electrodes that shrinks the vein by controlled constriction of subendothelial collagen was used to restore valve competence. Extirpation of local varicosities was performed simultaneously. Main outcome was change in venous function as measured by plethysmography (foot volumetry) and change in diameter and reflux time at the saphenofemoral junction after 6 and 12 months. Results: Reflux in the greater saphenous vein was eliminated or reduced to below 0.5 seconds in all patients. The venous function was significantly improved after 6 months' follow-up, with decreased refilling rate/expelled volume related to foot volume (p=0.019). The patients were clinically improved, although only 7 (54%) were entirely free from reflux. Three (21%) patients had thrombus in the vein the day after the treatment, 2 at the treatment site and 1 at the entry site of the introducer. After 1 year, the patients are still satisfied with the results, although venous function is no longer significantly improved compared to baseline. Conclusions: It is possible to safely restore valvular competence by means of internally shrinking the vein diameter. The venous function is improved, although the vein has a tendency to increase in width with time; limited reflux reappears, with deterioration of venous function.
Color Doppler Ultrasound Guidance during Renal Angioplasty and Stenting
Authors: Cianci Rosario , Zaccaria Alvaro , Lai Silvia , Coen Giorgio , Mander Antonio , Manfredini Paolo , Minnetti Marco , Clemenzia Gianfranco , Fiorani Paolo 
Published: March 2015

Purpose: To investigate whether an imaging technique combining color Doppler ultrasonography and selective renal artery digital subtraction angiography reduces contrast requirements in patients with progressive renal insufficiency undergoing renal artery angioplasty and stenting. Methods: Eight patients (5 men; mean age 58 years) with renal artery stenosis and renal insufficiency underwent percutaneous transluminal angioplasty and stenting under color Doppler ultrasound guidance. Results: Color Doppler ultrasound imaging yielded the information necessary for verifying catheter position, stent placement and expansion, and hemodynamics after revascularization. The combined imaging technique considerably reduced contrast requirements to only 10 mL in each case. No worsening of renal function was seen in any patient. Conclusions: The combined imaging procedure uses low doses of contrast agent and is especially suited to patients with renal dysfunction undergoing percutaneous renal revascularization.
Embolization of a Renal Artery Aneurysm Using Ethylene Vinyl Alcohol Copolymer (Onyx)
Authors: Lupattelli Tommaso , Abubacker Ziyad , Morgan Robert , Belli Anna-Maria 
Published: March 2015

Purpose: To report the embolization of a renal artery aneurysm using Onyx, a radiopaque nonadhesive liquid embolic agent. Case Report: A 28-year-old woman with hypertension and fibromuscular dysplasia presented with a 20-mm renal artery aneurysm. In order to avoid any migration of embolic material into the parent vessel, a compliant balloon was inflated to exclude the aneurysm from the blood flow while injecting the liquid embolic agent. Complete aneurysm exclusion was achieved immediately, with no angiographic or duplex evidence of distal embolization or intra-aneurysmal flow. The Doppler ultrasound at 6 months confirmed aneurysm exclusion. Conclusions: The ease of use and nature of this material makes Onyx an effective and safe option in the treatment of wide-necked renal aneurysms.
Endovascular Treatment of a Recipient Celiac Trunk Stenosis after Orthotopic Liver Transplantation
Authors: Yilmaz Saim , Çeken Kağan , Gürkan Alihan , Erdoğan Okan , Demirbaş Alper , Kabaalioğlu Adnan , Sindel Timur , Lüleci Ersin 
Published: March 2015

Purpose: To present the successful endovascular treatment of a severe recipient celiac trunk stenosis that led to allograft ischemia following liver transplantation. Case Report: A 56-year-old woman underwent orthotopic liver transplantation because of hepatitis C—induced cirrhosis. After the operation, routine hepatic Doppler ultrasonography showed a tardus parvus flow pattern in the hepatic artery, suggesting an impending hepatic artery thrombosis. Digital subtraction angiography (DSA), however, showed severe stenosis of the recipient celiac trunk and moderate splenic artery steal. The stenosis was dilated and stented in the same session. The postprocedural DSA showed good dilation of the lesion with immediate improvement of hepatic opacification. Follow-up Doppler ultrasound scans showed normal flow patterns in the hepatic artery at 3 and 6 months. Conclusions: In the presence of a tardus parvus flow pattern on Doppler ultrasound after liver transplantation, the possibility of an undetected recipient celiac stenosis should be considered in the differential diagnosis. Such lesions can successfully be treated with angioplasty and stenting.
Mediastinal Bronchial Artery Aneurysm Treated with a Stent-Graft
Authors: Kasashima Fuminori , Endo Masamitsu , Kosugi Ikuko , Matsumoto Yasushi , Abe Yoshinobu , Sasaki Hisao , Sanada Junichiro , Matsui Osamu 
Published: March 2015

Purpose: To report a rare case of mediastinal bronchial artery aneurysm successfully treated with an endovascular stent-graft. Case Report: A 79-year-old man with a history of tuberculosis was admitted to our hospital complaining of worsening hoarseness. Examination revealed a large mediastinal bronchial artery aneurysm located near the origin of the artery. Since neither surgical intervention nor transcatheter embolization was feasible, an endovascular stent-graft repair was performed using a newly developed stent-graft constructed from a nitinol stent and a thin membrane of polyester. Postprocedural angiography showed satisfactory exclusion of the aneurysm. The patient made an uneventful recovery. The 18-month computed tomographic scan documented continued exclusion of the aneurysm, with no evidence of endoleak, graft thrombosis, or migration. Conclusions: When conventional procedures are too complicated for bronchial artery aneurysms, endovascular stent-graft repair can be a useful approach.
Endovascular Treatment of an Acute Superior Mesenteric Artery Occlusion following Failed Surgical Embolectomy
Authors: Yilmaz Saim , Gürkan Alihan , Erdoğan Okan , Sindel Timur , Çeken Kağan , Lüleci Ersin 
Published: March 2015

Purpose: To present the successful primary stenting of a superior mesenteric artery (SMA) occlusion following failed surgical embolectomy. Case Report: A 65-year-old woman with a history of atrial fibrillation underwent surgical embolectomy of an acute embolic occlusion of the superior mesenteric artery (SMA). The following day, symptom recurrence suggested reocclusion, which was confirmed with emergent arteriography. Two balloon-expandable stents were deployed primarily, which ameliorated the patient's symptoms. Follow-up angiography at 3 months showed continued SMA patency, with no evidence of distal embolization or restenosis. The patient remains asymptomatic at 9 months after the stent procedure. Conclusions: Although more experience is required, primary stenting may be a valuable alternative in the treatment of acute SMA occlusions, in particular, for reocclusions after failed surgery.
Endoluminal Grafting for Percutaneous Aneurysm Exclusion in an Aortocoronary Saphenous Vein Graft: The First Clinical Experience
Authors: Heuser Richard R. , Reynolds Glenn T. , Papazoglou Constantine , Diethrich Edward B. 
Published: March 2015

Purpose: Aneurysms develop only rarely in aortocoronary saphenous vein grafts (SVGs), and the usual treatment is surgical replacement of the diseased segment. However, in patients at appreciable risk for redo surgery, alternative therapies are desirable. We report the first compassionate use of a percutaneously delivered endoluminal graft (ELG) for internal exclusion of an SVG aneurysm. Methods: A 47-year-old male with two coronary bypass procedures and SVG angioplasty presented with an 8-mm diameter aneurysm lying between 80% and 70% stenotic lesions in an SVG to the obtuse marginal branch. The risks of a third bypass operation were considerable, so the decision was made to attempt internal exclusion of the SVG aneurysm. Results: An ELG composed of 2.0-mm diameter unexpanded PTFE graft material with Palmaz stents for fixation was delivered with a low-profile system, but a second ELG was necessary for complete exclusion of the aneurysmal sac. Both ELGs were dilated after initial deployment. The patient was discharged after 9 days without sequelae, and he remains asymptomatic with arteriographically documented ELG patency 5 months after treatment. Conclusions: In this patient with limited therapeutic options, percutaneous aneurysm exclusion in an SVG was effective in restoring a viable blood conduit. It remains to be seen if ELGs have a potential in aortocoronary SVGs.
Long-term Results with the Palmaz Stent in the Superficial Femoral Artery
Authors: Bergeron Patrice , Pinot Jean J. , Poyen Vincent , Benichou Huber , Khanoyan Patrick , Rudondy Philippe , Wang Yu , Chiarandini Stefano , El Hussein Radwan , Rieu Regis , Larroude Laurence , Pelissier Robert 
Published: March 2015

Purpose: Femoral stenting has demonstrated inconsistent and often disappointing long-term results. To compare our experience, we retrospectively analyzed a series of patients who had Palmaz balloon-expandable stents placed exclusively for superficial femoral artery (SFA) lesions. Methods: From January 1990 to November 1993, 39 patients were evaluated for claudication (79%) or critical ischemia in 42 limbs. The culprit lesions were confined to the SFA: 24 (57%) occlusions and 18 (43%) stenoses, including 3 restenotic lesions. Stenting was elective in 12 (29%) cases: the 3 restenoses and 9 chronic, calcified occlusions. The remaining stents were applied for postangioplasty residual stenosis or angioscopic findings of thrombogenic luminal irregularities. A total of 55 prostheses were successfully implanted. All patients were maintained on ticlopidine and followed by routine duplex scanning. Follow-up angiography was performed in 28 (72%) patients between 4 and 45 months. Results: In the postprocedural period, two acute thromboses (4.8%) occurred within 48 hours in patients who had long occlusions and poor runoff; no other major complications were encountered, for a clinical success rate of 95%. Follow-up evaluation ranged from 4 months to 4 years with a mean of 25 months. The restenosis rate was 19% (34% in occlusions; 10% in stenotic lesions, p = NS). At 24 months, cumulative primary patency was 77% and secondary patency 89%. Conclusions: Palmaz stents performed well in the SFA, demonstrating a low acute thrombosis rate and good long-term patency. The incidence of restenosis is likely to be greater in occlusions than in stenoses.