bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endoluminal Graft Exclusion of a Proximal Para-Anastomotic Pseudoaneurysm following Aortobifemoral Bypass
Authors: White Rodney A. , Donayre Carlos E. , Walot Irwin , Wilson Eric , Jackson George , Kopchok George 
Published: March 2015

Purpose: To describe a case of endoluminal graft exclusion of a proximal para-anastomotic pseudoaneurysm that occurred 17 years following aortobifemoral bypass for occlusive disease. Methods and Results: The lesion was found on abdominal ultrasound examination as part of a work-up for acute abdominal pain and upper gastrointestinal bleeding in a 67-year-old male. A 5-cm saccular pseudoaneurysm was confirmed by preintervention aortography and spiral computed tomography (CT) scanning. Because of the patient's acute symptoms and high-risk medical condition (cardiomyopathy), he was deemed a candidate for endoluminal bypass. At the time of intervention, intravascular ultrasound (IVUS) interrogation identified a 3.5-cm-long separation of the existing aortic graft from the proximal aortic stump with a large pseudoaneurysm. The lesion was isolated and repaired by placement of an aortic-to-right iliac endoluminal bypass, ligation of the left limb of the aortofemoral graft, and femorofemoral bypass to restore blood flow to the lower extremities. Spiral CT scans at 48 hours and 3 months following the procedure confirmed complete isolation of the lesion. Conclusions: This case illustrates the feasibility of endografting for repair of aortic para-anastomotic pseudoaneurysms, and it also highlights the potential role of IVUS imaging in endoluminal graft deployment.
Shortening of Endografts during Deployment in Endovascular AAA Repair
Authors: White Geoffrey H. , May James , Waugh Richard , Harris John P. , Chaufour Xavier , Yu Weiyun , Stephen Michael S. 
Published: March 2015

Purpose: To evaluate the incidence and extent of length changes during implantation of endovascular grafts in a prospective study of patients undergoing endovascular abdominal aortic aneurysm (AAA) repair. Methods: Data regarding the occurrence of intraoperative technical difficulties and device complications were recorded prospectively for the Vanguard or AneuRx self-expanding, bifurcated endovascular grafts in 64 patients (56 males; mean age 75 years). Graft length was measured in the sheath system before deployment and again immediately after deployment by fluoroscopic comparison to a graduated marking catheter. Results: Graft shortening ≥ 15 mm was documented in 22 (56%) of 39 Vanguard cases and 11 (44%) of 25 AneuRx endografts. Additional extension grafts were required to correct endoleak caused by inadequate graft length in 9 (14%) patients, but no conversion to open repair was necessary. Conclusions: There appears to be a high incidence of intraprocedural graft shortening with 2 current designs of self-expanding endoluminal grafts.
Longitudinal Aneurysm Shrinkage following Endovascular Aortic Aneurysm Repair: A Source of Intermediate and Late Complications
Authors: Harris Peter , Brennan John , Martin; Janis , Gould Derek , Bakran Ali , Gilling-Smith Geoffrey , Buth Jaap , Gevers Evelien , White Donagh 
Published: March 2015

Purpose: To report the incidence of delayed complications following endovascular abdominal aortic aneurysm (AAA) repair and the relationship of these sequelae to morphological changes in the sac and endograft. Methods: Twenty-six AAA patients treated with Vanguard endografts had completed ≥1-year follow-up. Postoperative angiograms and spiral computed tomographic (CT) scans with 3-dimensional reconstruction were compared to the 1-year images to determine morphological changes in the aneurysm sac and the endograft. These changes were then related to complications occurring between 1 and 12 months postoperatively in the study group. Results: Comparison of angiograms uncovered endograft buckling in 18 (69%) patients and acutely angled or kinked endografts in 10 (38%). Measurements from the CT scans found that undistorted endografts had a mean change in sac length of +6.6 mm. Mean sac length change in buckled endografts was −3.1 mm, while kinked endografts displayed a mean change of −6.2 mm (p < 0.002, Student's t-test). Five (19%) patients, all with distorted endografts, demonstrated late (1 to 12 months) complications (4 endoleaks and 1 graft limb thrombosis) owing to component separation, distal stent migration, and acute angulation. No movement in the proximal stent was observed. Elongation of the endograft (flow line measurement) was observed in one tube graft only. Conclusions: In this study, longitudinal shrinkage of the sac following endovascular aortic aneurysm repair led to buckling or kinking of the endograft within 1 year in 69% of patients. This appears to be an important source of delayed complications.
Percutaneous Transluminal Angioplasty of the Subclavian Arteries
Authors: Henry Michel , Amor Max , Henry Isabelle , Ethevenot Gérard , Tzvetanov Kiril , Chati Zukaï 
Published: March 2015

Purpose: To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement. Methods: Over a 9-year period, 113 patients (67 males; mean age 63 ± 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% ± 7.4% (range 70 to 100). Mean lesion length was 24 ± 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine. Results: Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]). Conclusions: Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.
Stents in the Treatment of Renal Artery Stenosis: Long-Term Follow-up
Authors: Henry Michel , Amor Max , Henry Isabelle , Ethevenot Gérard , Tzvetanov Kiril , Courvoisier André , Mentre Bernard , Chati Zukaï 
Published: March 2015

Purpose: To evaluate the role of percutaneous stenting in the treatment of renal arterial lesions after failure of balloon angioplasty. Methods: Two hundred ten patients (139 males; mean age 67.7 ± 9.9 years, range 27 to 87) had 259 balloon-expandable stents (165 Palmaz and 94 Renal Bridge stents) implanted in 244 renal artery stenoses (171 ostial and 73 nonostial lesions). The patients were suffering from intractable hypertension (n = 210) and/or renal dysfunction (n = 48). The majority of the lesions (n = 234) were atheromatous in origin. Stents were implanted for suboptimal balloon dilation (n = 182, 75%), restenotic lesions (n = 27, 11%), or dissection (n = 9, 4%); 26 (11%) ostial lesions were stented primarily. Mean lesion length was 11.9 ± 4.4 mm (range 5 to 30) and mean percent stenosis was 81.9% ± 8.25% (range 70 to 100). Results: Immediate technical success was 99% (241 of 244). Three (1.2%) major complications included one intraprocedural stent thrombosis, one arterial perforation manifesting as a perirenal hematoma 24 hours after the procedure, and one renal arterial rupture. Follow-up over a mean 25.4 ± 22.8 months (range 1 to 96) in 185 eligible patients (209 arteries) found 24 cases of restenosis (11.4%). Primary and secondary patencies for all lesions at 60 months were 79% and 98%, respectively, with no significant differences between ostial and nonostial lesions or stent types. Hypertension was reversed in 35 (19%), improved in 112 (61%), and remained unchanged in 37 (20%). Renal function was improved in 29% (14 of 48), unchanged in 67% (32 of 48), and worse in 4% (2 of 48). Conclusions: Renal artery stenting is safe, effective, and may be an alternative to surgery, particularly in ostial lesions. Our experience shows reduction in the restenosis rate compared to conventional angioplasty. All ostial stenoses should be stented.
Angioplasty of Lower Limb Arterial Stenoses under Ultrasound Guidance: Single-Center Experience
Authors: Ramaswami Ganesh , Al-Kutoubi Aghiad , Nicolaides Andrew N. , Dhanjil Surinder , Vilkomerson David , Ferrara-Ryan Michelle , Stansby Gerard 
Published: March 2015

Purpose: To examine the feasibility and utility of ultrasound-guided angioplasty for treating lower limb stenoses. Methods: Duplex ultrasonography was employed to guide 55 balloon dilation procedures (27 iliac, 26 superficial femoral, 1 profunda, and 1 vein graft) with the help of a special ultrasound catheter (EchoMark). Ultrasound was used to determine balloon size, monitor guidewire passage, direct the dilation, and judge procedural success. Angiography was performed prior to the procedure to confirm preprocedural ultrasound findings and afterward to compare with duplex visual and hemodynamic parameters of success (peak systolic velocity ratio < 2.0). Results: The balloon size determined from duplex measurements correlated in all cases with sizes selected based on the angiographic image. Guidewire visualization was possible in 95% of the cases. Angioplasty using ultrasound alone was feasible in 84%; inability to obtain a satisfactory image owing to vessel tortuosity, calcification, and bowel gas accounted for the failures. Against the duplex success criterion, initial completion angiograms had an accuracy of 76%, sensitivity of 76%, and specificity of 100%. The additional time for ultrasound guidance averaged 42 ± 12 minutes for all cases. Conclusions: Our results show that ultrasound guidance is feasible in routine clinical practice. In this series of well-selected cases of arterial stenoses, angioplasty was performed safely using ultrasound guidance alone in over 80% of the cases. Fluoroscopic monitoring is needed when ultrasound visualization is suboptimal.
The Role of Carotid Duplex Ultrasound in Evaluating Plaque Morphology: Potential Use in Selecting Patients for Carotid Stenting
Authors: AbuRahma Ali F. , Covelli Michael A. , Robinson Patrick A. , Holt Steven M. 
Published: March 2015

Purpose: To study the role of duplex ultrasonography in evaluating plaque morphology and its correlation to neurological symptoms and cerebral infarctions on computed tomographic scans. Methods: The hospital records of 181 patients (107 males; average age 66 years, range 41 to 89) with > 50% carotid stenosis (29 bilateral lesions) who had undergone duplex ultrasonography, carotid arteriography, and cerebral computed tomography were studied retrospectively. Of 210 duplex examinations, 139 were appropriate for morphological analysis of surface characteristics and echogenicity. Results: Over half of the plaques examined had irregular surfaces (81, 58%) and displayed mixed (i.e., heterogeneous) echogenic patterns (74, 53%). Irregular (68 of 81, 84%) and heterogeneous (65 of 74, 88%) plaques were associated with ipsilateral neurological symptoms (p < 0.0001). Similarly, 44 (54%) of 81 irregular plaques and 42 (57%) of 74 heterogeneous plaques were found in patients with cerebral infarctions in the carotid territory (p < 0.0001). Conclusions: Heterogeneous and/or irregular plaques were more often associated with both neurological symptoms and infarctions than smooth or homogeneous plaques. These findings may have implications in patient selection for endoluminal therapy.
Duplex Features of Vein Graft Stenosis and the Success of Percutaneous Transluminal Angioplasty
Authors: Gonsalves Chip , Bandyk Dennis F. , Avino Anthony J. , Johnson Brad L. 
Published: March 2015

Purpose: To determine if criteria exist that are correlated to a successful outcome after balloon angioplasty for vein graft stenosis. Methods: During a 5-year period, duplex surveillance of 380 infrainguinal vein bypasses identified 76 hemodynamically failing grafts (87 stenoses) requiring intervention. Percutaneous transluminal angioplasty (PTA) was selected over surgical repair based on 3 criteria: time interval from primary grafting procedure, vein graft diameter, and stenosis length. The 28 (32%) stenoses (20 grafts) treated by PTA were used in a retrospective analysis to test if any variables favored a successful outcome. Patient and lesion characteristics, graft patency, and restenosis following PTA were correlated with duplex features of the stenosis recorded prior to, immediately after, and at 3- to 6-month intervals postprocedurally. Results: Lesion characteristics that correlated with a successful outcome were vein size ≥3.5 mm, lesion length < 2 cm, and appearance > 3 months after surgery. Conduit type, PTA site, patient demographics, and indication for bypass did not correlate with PTA durability. Nineteen lesions in 13 grafts met these criteria (group 1), while 9 stenoses in 7 grafts did not (group 2). Lesion severity based on duplex velocity measurements were similar in both groups before (p = 0.40) and after (p = 0.32) treatment. During the mean 21-month follow-up, group 1 grafts required less intervention (p = 0.035). At last follow-up, hemodynamic changes were durable in group 1 (p = 0.0068) but not in group 2 (p = 0.39). Conclusions: Selection of vein graft stenoses for treatment by PTA can be based on temporal and duplex data. PTA of short (< 2 cm) stenoses in good caliber veins (≥ 3.5 mm) appearing > 3 months after bypass placement was durable with a late intervention rate of approximately 10%. Direct surgical repair or replacement is recommended for early (< 3 months) and/or long segment stenoses that develop in small caliber conduits.
Subclavian Stents and Stent-Grafts: Cause for Concern?
Authors: Phipp Laura H. , Scott D. Julian A. , Kessel David , Robertson Iain 
Published: March 2015

Purpose: To report cases of stent and stent-graft fracture in the subclavian vessels. Methods and Results: Three patients with self-expanding stents of 3 different types in 1 subclavian artery and 2 subclavian veins presented with recurrent symptoms 6 months to 2 years after stenting. All devices showed signs of compression with stent fracture. The covered stent in the subclavian artery was excised. Of the 2 venous patients, 1 was treated with first rib resection and the other refused further treatment. Conclusions: The subclavian vessels are prone to flexion during movement, and the vessels may be compressed by external structures, including the clavicle and first rib. Stents that have not been designed to withstand these forces may be damaged.
Abdominal Aortic Aneurysm Morphology in Candidates for Endovascular Repair Evaluated with Spiral Computed Tomography and Digital Subtraction Angiography
Authors: Resch Timothy , Ivancev Krassi , Lindh Mats , Nirhov Nick , Nyman Ulf , Lindblad Bengt 
Published: March 2015

Purpose: To analyze the morphology of abdominal aortic aneurysms (AAAs) and to study the usefulness of spiral computed tomography (CT) versus digital subtraction angiography (DSA) in the evaluation of patients for endovascular repair. Methods: Of 133 AAA patients (120 men, mean age 67 years, range 52 to 84) evaluated preoperatively with CT imaging, 77 endograft candidates (68 men) were also assessed with intra-arterial DSA. Arterial parameters were measured on axial CT scans and angiographic films for comparison. Results: Mean maximum AAA diameter was 58 ± 11 mm (range 39 to 95). Aneurysmal neck diameter was consistently smaller on DSA than on CT (20.7 ± 3.6 mm versus 23.0 ± 3.5 mm, p < 0.0001). The distance from the most distal renal artery to the aortic bifurcation was longer on angiography than on CT (mean difference 10.0 mm, p < 0.0001). There was a positive correlation between the maximum AAA diameter and the AAA length (r = 0.49, p < 0.0001) and an inverse relationship between the neck length and the neck diameter (r = −0.36, p < 0.0001). No correlation was found between the maximum AAA diameter and maximum iliac diameter, angulation, or length. Conclusions: AAA anatomy varies widely and independently of the aneurysm size. Therefore, the maximum size of the aneurysm is a poor predictor of whether or not an aneurysm is suitable for endovascular repair. The discrepancy between angiographic and axial CT measurements suggests that neither alone is sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure.
Mortality Rates following Endovascular Repair of Abdominal Aortic Aneurysms
Authors: Walker Stuart R. , Macierewicz Jan , MacSweeney Shane T. , Gregson Roger H. S. , Whitaker Simon C. , Wenham Peter W. , Hopkinson Brian R. 
Published: March 2015

Purpose: To present the perioperative and late mortality following endovascular repair (EVR) of abdominal aortic aneurysms (AAAs). Methods: Data were collected prospectively on 221 patients undergoing AAA EVR over a 4-year period (median 5-month follow-up). Patients were classified preoperatively as high risk with at least 1 of these features: serum creatinine > 150 μmol/L, ischemic heart disease or poor left ventricular function, respiratory function < 50% of predicted normal, ruptured or symptomatic AAA, contraindication to or failed open repair, and age > 80 years. Results: One hundred forty (63.3%) patients were classified as high risk, the most common criterion being cardiac disease (n = 96, 68.6%). There were 25 (11.3%) deaths in the 30-day perioperative period, 22 (15.7%) in the high-risk group compared to 3 (3.7%) in the acceptable-risk group (p = 0.02). The most common causes of perioperative death were multisystem organ failure and myocardial infarction. A further 21 (9.5%) late deaths occurred, 16 (11.4%) in the high-risk group and 5 (6.2%) in the acceptable-risk group (p > 0.1). Conclusions: The mortality of patients at acceptable risk undergoing EVR compares with the best published series for conventional open AAA repair. The perioperative and late mortality in the high-risk patients are substantially higher.
Quality Control during Endovascular Aneurysm Repair: Monitoring Aneurysmal Sac Pressure and Superficial Femoral Artery Flow Velocity
Authors: Treharne Gareth D. , Loftus Ian M. , Thompson Matthew M. , Lennard Nicola , Smith Julia , Fishwick Guy , Bell Peter R.F. 
Published: March 2015

Purpose: To use intraoperative aneurysmal sac pressure measurement and flow monitoring of the superficial femoral artery (SFA) to ensure complete exclusion of the aneurysm from the circulation. Methods: A 5F catheter was positioned in the aneurysmal sac of 15 consecutive patients undergoing endovascular aortomonoiliac aneurysm repair between February and September 1997. The catheter was connected to an external pressure transducer allowing pressure monitoring throughout the operation and for 24 hours postprocedurally. Flow velocity was monitored in the contralateral SFA by insonation with a 2-MHz Doppler ultrasound probe. Results: No technical defect was observed in the deployment of 10 endografts, which demonstrated marked reduction in sac pressure and good flow in the lower limb. The mean aneurysm pressure dropped from 123 to 57 mmHg after graft insertion. In 5 cases, monitoring detected problems during the endograft procedure. In 3, incomplete stent deployment was detected by a failure of sac pressure to fall following stent inflation and by the presence of flow in the contralateral femoral artery. In the other 2 cases, a distal endoleak was detected by direct injection of contrast into the sac. Conclusions: Measuring aneurysm pressure in combination with SFA Doppler flow monitoring can detect complications of endovascular aneurysm repair.
Histology and Electron Microscopy of Explanted Bifurcated Endovascular Aortic Grafts: Evidence of Early Incorporation and Healing
Authors: Shin Chung K. , Rodino William , Kirwin Jon D. , Ramirez Jose A. , Wisselink Willem , Papierman Gary , Panetta Thomas F. 
Published: March 2015

Purpose: To report an examination of explanted bifurcated endovascular aortic grafts for histologic evidence of early healing and incorporation. Method: Two bifurcated endovascular aortic grafts composed of polycarbonate urethane and Elgiloy wire were explanted 42 and 21 days after successful endovascular exclusion of abdominal aortic aneurysms. Both patients expired from causes unrelated to endograft deployment. The explanted devices were examined using immunohistochemical analysis and electron microscopy. Results: On explantation, both grafts appeared to have excluded the aneurysm with no evidence of endoleak, graft migration, or thrombosis. Histological examination showed numerous inflammatory cells and good ingrowth of tissue into the proximal 2 cm of the graft. Collagen and smooth muscle cells were evident in the proximal portion of the graft with only collagen in the distal segments. Neointimal formation was seen within the proximal 2 cm also, but not at the distal segments. Macrophages were present in the graft. Scanning electron microscopy showed an extensive matrix of fibers that most likely represented collagen. Conclusions: Bifurcated endovascular aortic grafts show inflammatory and mild foreign body reactions, collagen formation, and intimal ingrowth during healing. These findings are similar to some of the healing properties reported for sutured grafts, as well as other endovascular grafts.
Graft-Wall Endoleak 18 Months after Successful Endoluminal AAA Repair
Authors: Midorikawa Hirofumi , Hoshino Shunichi , Iwaya Fumio , Igari Tsuguo 
Published: March 2015

Purpose: To describe a case of graft-wall endoleak 18 months after successful endoluminal repair of an abdominal aortic aneurysm (AAA). Methods and Results: A 71-year-old man with infrarenal AAA was successfully treated with an endoluminal aortomonoiliac graft and femorofemoral crossover bypass with surgical ligation of the right external iliac artery. The stent-graft was made from 2 Gianturco Z-stents and a tapered thin-walled (0.1-mm) Dacron graft. Eighteen months after endografting, the patient complained of a pulsatile abdominal mass. Angiography and computed tomography showed graft-wall endoleak. Aneurysmectomy was performed, and the aneurysm was successfully replaced with a Y-shaped knitted Dacron graft. A hole in the graft wall was found 3 cm from the proximal edge of the stent-graft. Conclusions: This case suggests that the use of thin-walled graft material in endografts may not be sufficiently durable.