bluuebunny/crossref_metadata_2025_split huggingface dataset:
Common Iliac Artery Access during Endovascular Thoracic Aortic Repair Facilitated by a Transabdominal Wall Tunnel
Authors: Macdonald Sumaira , Byrne Dominique , Rogers Paul , Moss Jonathan G. , Edwards Richard D. 
Published: March 2015

Purpose: To describe a technique for common iliac artery (CIA) access during endovascular aortic aneurysm repair when unfavorable angulation between the CIA and the delivery sheath precludes direct arterial access. Technique: After retroperitoneal exposure of the CIA, a puncture site is chosen inferolateral to the surgical incision, and an 18-G trocar/cannula is advanced in alignment with the CIA through the anterior abdominal wall or skin of the upper thigh into the retroperitoneal space. Serial dilatation is performed over a guidewire placed through the cannula to create the subcutaneous tract. The trocar/cannula is replaced over the wire, and the CIA is punctured under direct vision. The guidewire is then advanced into the proximal aorta. A CIA arteriotomy is performed and the delivery system introduced over the guidewire through the tunnel into the iliac artery. Conclusions: Retroperitoneal exposure of the CIA with tunneled transabdominal wall delivery of the stent-graft avoids both external iliac artery injury and creation of a temporary access conduit in patients with iliac tortuosity and/or occlusive disease.
Endovascular Repair as First-Choice Treatment for Anastomotic and True Iliac Aneurysms
Authors: Curti Tiziano , Stella Andrea , Rossi Cristina , Galaverni Cristina , Saccà Antonino , Resta Francesco , D'Addato Massimo 
Published: March 2015

Purpose: To report our experience with the endovascular repair of iliac aneurysms secondary to aortoiliac bypass grafting. Methods: Thirteen patients (12 men; age range 62–86 years) with histories of aortoiliac reconstructions were treated with endovascular stent-grafts for 11 false and 2 true iliac aneurysms that averaged 5.2 cm in diameter (range 3.0–7.0). Via a percutaneous access and 9-F or 12-F sheaths, Passager or Wallgraft stent-grafts were delivered to exclude the aneurysms. Results: Twelve (92%) of 13 interventions were completed satisfactorily; 1 procedure for a true iliac aneurysm was converted to traditional bypass grafting. Two patients underwent additional surgical procedures. The average hospital stay for the patients with endovascular repairs only was 3 days (range 2–5). After a mean follow-up of 28 months (range 17–40), no complication or endoleak has been detected in any patient, and all endografts are patent. Conclusions: Endovascular repair is an effective treatment for secondary aneurysms arising after aortoiliac surgery. It is less invasive and involves a shorter hospital stay. Endovascular repair should be the first choice treatment for iliac aneurysms.
Excimer Laser-Assisted Recanalization of Long, Chronic Superficial Femoral Artery Occlusions
Authors: Scheinert Dierk , Laird John R. , Schröder Malte , Steinkamp Herrmann , Balzer Joern O. , Biamino Giancarlo 
Published: March 2015

Purpose: To examine the safety and efficacy of excimer laser-assisted angioplasty (ELA) for recanalization of superficial femoral artery (SFA) occlusions. Methods: Data were analyzed from 318 consecutive patients (207 men; mean age 64.2 ± 10.7 years, range 33–91) who underwent ELA of 411 SFAs with chronic occlusions averaging 19.4 ± 6.0 cm in length. More than 75% of patients had severe claudication (category 3). Critical lower limb ischemia with rest pain or minor tissue loss was present in 6 and 15 patients, respectively. The mean ankle brachial index (ABI) before and after exercise was 0.62 ± 0.15 and 0.40 ± 0.18, respectively. Results: The initial attempt (crossover approach 89.7%, antegrade 6.6%, transpopliteal 3.6%) to cross the occlusion with an excimer laser catheter was successful in 342 (83.2%) of 411 limbs. A secondary attempt performed in 44 of 69 failed cases was successful in 30 limbs, increasing the technical success rate to 90.5% (372/411). Complications included acute reocclusion (4, 1.0%), perforation (9, 2.2%), and distal thrombosis/embolization (16, 3.9%). Postprocedurally, 219 (68.8%) patients were asymptomatic; mild (category 1) or moderate (category 2) claudication remained in 53 (16.6%) and 26 (8.2%) patients, respectively. The primary patency at 1 year was 33.6%. In the majority of patients, reocclusion was treatable on an outpatient basis. The 1-year assisted primary and secondary patency rates were 65.1% and 75.9%, respectively. Conclusions: Long SFA occlusions can be recanalized safely and successfully by ELA. However, to maintain patency and quality of life, intensive surveillance using objective testing followed by prompt repeat intervention are mandatory.
Balloon Angioplasty for Arteriovenous Graft Stenosis
Authors: Anain Paul , Shenoy Sadashiv , O'Brien-Irr Monica , Harris Linda M. , Dryjski Maciej 
Published: March 2015

Purpose: To retrospectively review the long-term outcome as well as the cost effectiveness of thrombolytic therapy and balloon angioplasty (TBA) versus surgical thrombectomy and balloon angioplasty (SBA) in the treatment of prosthetic dialysis access grafts. Methods: Between February 1996 and February 1999, 63 hemodialysis patients (35 women; mean age 62.2 years) were treated for 105 thromboses in 6-mm polytetrafluoroethylene straight or loop bridge arteriovenous grafts. Choice of treatment was at the discretion of the surgeon or interventional radiologist: either Fogarty balloon thrombectomy followed by balloon dilation of the venous anastomotic stenosis or urokinase thrombolysis followed by angioplasty. Results: Forty-eight SBAs and 55 TBAs were performed in 63 patients without complications. The primary patency rates in the entire cohort were 34%, 29%, and 17% at 1, 2, and 3 months, respectively. Primary patency after TBA was 29%, 18%, and 11%, and that for SBA, 45%, 45%, and 33% over the same time intervals. The mean graft survival was 10 days for TBA versus 31 days for SBA. Repeat angioplasty performed in 23 grafts produced secondary patency rates of 52% at 1 month, 34% at 3 months, and 5% at 5 months. The Medicare reimbursement for both treatments was identical ($1638 for TBA and $1670 for SBA). Conclusions: The poor patency rate and high cost of TBA and SBA suggests that these procedures should not be routinely used for salvage of thrombosed arteriovenous grafts with outflow stenosis. Patch angioplasty or creation of simultaneous temporary and new permanent accesses may be a more cost-effective approach in these patients.
Preliminary Report of a New Approach to Sparing the Greater Saphenous Vein for Grafting: Valvuloplasty Combined with Axial Transposition of a Competent Tributary Vein
Authors: Yamaki Takashi , Nozaki Motohiro , Sasaki Kenji 
Published: March 2015

Purpose: To compare a new vessel-sparing technique combining valvuloplasty with axial transposition of a competent tributary vein versus single valvuloplasty for the treatment of greater saphenous vein (GSV) incompetence. Methods: In 55 patients with GSV incompetence, 29 of 57 limbs were treated by angioscopic valvuloplasty of the subterminal valve alone, whereas the remaining 28 limbs underwent angioscopic valvuloplasty combined with axial transposition of a competent tributary vein identified preoperatively by duplex scanning. After angioscopic valvuloplasty in the latter group, the competent tributary vein was exposed and cut 1.5 cm distal to its insertion point on the GSV. The transected vein was anastomosed end to side to the GSV, which was ligated between the tributary insertion site and the anastomosis. Changes in venous hemodynamics, including venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF), were analyzed by use of air plethysmography. Results: In the 1-year follow-up, no venous thrombosis was detected in either group. In the valvuloplasty-only group, 22 (75.9%) limbs exhibited reflux in the proximal GSV; recurrent varicose veins were detected in 5 (17.2%) limbs. In contrast, only 2 (7.1%) limbs showed reflux in the valvuloplasty + transposition group. There were no significant differences in EF and RVF between the groups before or after the operation, although a significant difference was seen in VFI at 1 year (p = 0.005, Wilcoxon rank sum test). Conclusions: Valvuloplasty combined with tributary vein transposition gives a better result than valvuloplasty alone at 1 year. This new treatment option may be useful for both reducing the rate of varicose veins and sparing the GSV for grafting.
Traumatic Subclavian Artery Pseudoaneurysm: Periprocedural Salvage of Failed Stent-Graft Exclusion Using Coil Embolization
Authors: Watelet Jacques , Clavier Eric , Reix Thierry , Douvrin Françoise , Thomas Pascale , Testart Jacques 
Published: March 2015

Purpose: To report the exclusion of a subclavian pseudoaneurysm by a combination of covered stent implantation and coil embolization. Case Report: A 30-year-old man presented with a posttraumatic pseudoaneurysm of the left subclavian artery. A covered Jostent was inserted via a percutaneous femoral approach and deployed in the injured subclavian artery. Because of tapering of the artery proximally, apposition of the covered stent to the arterial wall was insufficient, leading to persistent filling of the pseudoaneurysm. Exclusion of the pseudoaneurysm was achieved by coil embolization through a gap between the stent-graft and the arterial wall. Conclusions: This report illustrates that successful endovascular treatment of a left subclavian pseudoaneurysm may require a combination of catheter-based techniques.
Stent-Related Iliac Artery and Iliac Vein Infections: Two Unreported Presentations and Review of the Literature
Authors: Dosluoglu H. Haldun , Curl G. Richard , Doerr Ralph J. , Painton Frederick , Shenoy Sadashiv 
Published: March 2015

Purpose: To discuss the presentation, diagnosis, and treatment of stent-related infections on the basis of 2 new cases and historical review. Case Reports: Two previously unreported cases of vascular stent infection are presented with a summary of cases from the literature. One case involved an iliac artery stent infection secondary to a remote bacteremia 6 months after stent placement. The other case was an early iliac vein stent infection, a previously unreported site of this complication. Both cases were diagnosed by use of computed tomography and were treated surgically after medical management failed. Both patients survived. Conclusions: A high index of suspicion is necessary for the diagnosis of stent infections, and an aggressive treatment is usually necessary for survival. Prophylactic antibiotics should definitely be considered in cases involving repeat interventions and prolonged catheterization, as well as before bacteremia-inducing therapies.
Therapeutic Embolization of Idiopathic Renal Arteriovenous Fistula Using the “Stop-Flow” Technique
Authors: Mansueto Giancarlo , D'Onofrio Mirko , Minniti Salvatore , Ferrara Rosa Maria , Procacci Carlo 
Published: March 2015

Purpose: To present a case of massive idiopathic arteriovenous fistula (AVF) successfully treated with an endovascular procedure. Case Report: A 42-year-old woman with microscopic hematuria was found to have a massive idiopathic renal AVF. Percutaneous embolization was undertaken using a dual approach to deliver an occluding balloon through the draining vein and an arterial access to selectively catheterize the aneurysmal afferent artery. With the balloon inflated to interrupt flow (“stop-flow” technique), acrylic glue was delivered precisely to occlude the lesion. Duplex scans at 12 months have documented continued complete occlusion of the anomalous communication. Conclusions: The dual arterial and venous approach with the “stop-flow” technique makes it possible to successfully treat idiopathic AVFs that have constant high-flow connections.
Protected Renal Stenting with the PercuSurge GuardWire Device: A Pilot Study
Authors: Henry Michel , Klonaris Christos , Henry Isabelle , Tzetanov Kiril , Le Borgne Edmond , Foliguet Bernard , Hugel Michele 
Published: March 2015

Purpose: To evaluate the feasibility and safety of renal artery angioplasty and stenting utilizing a distal protection device to reduce the risk of intraprocedural atheroembolism. Methods: Twenty-eight hypertensive patients (18 men; mean age 71.3 ± 8.6 years, range 49–87) with atherosclerotic renal artery stenosis (4 bilateral) underwent angioplasty and stenting with distal protection in 32 renal arteries (29 ostial lesions). The lesion was crossed with a GuardWire temporary occlusion balloon, which was inflated to provide parenchymal protection. Generated debris was aspirated and analyzed. Blood pressure and serum creatinine levels were followed. Results: Immediate technical success was 100%. All lesions were stented, either directly (14 ostial lesions), after predilation (15 ostial lesions), or owing to suboptimal angioplasty (3 nonostial lesions). Visible debris was aspirated from all patients. Mean particle number and diameter were 98.1 ± 60.0 per procedure (range 13–208) and 201.2 ± 76.0 µm (range 38–6206), respectively. Mean renal artery occlusion time was 6.55 ± 2.46 min (range 2.29–13.21). Mean follow-up was 6.7 ± 2.9 months (range 2–17). Systolic and diastolic blood pressure declined from 167.0 ± 15.2 and 103.0 ± 12.0 mm Hg, respectively, to 154.7 ± 12.3 and 93.2 ± 6.8 mm Hg after the procedure. The mean creatinine level dropped from 1.34 ± 0.35 mg/dL preprocedurally to 1.22 ± 0.36 mg/dL at 24 hours and remained constant. At 6-month follow-up, renal function did not deteriorate in any patient, whereas 5 patients with baseline renal insufficiency improved after the procedure. Conclusions: These preliminary results suggest the feasibility and safety of distal balloon occlusion during renal interventions to protect against atheroembolism. This technique's beneficial effects should be evaluated by randomized studies.
Intravascular Ultrasound—Guided Renal Artery Stenting
Authors: Dangas George , Laird John R. , Mehran Roxana , Lansky Alexandra J. , Mintz Gary S. , Leon Martin B. 
Published: March 2015

Purpose: To evaluate the clinical outcomes of patients undergoing renal artery stenting with intravascular ultrasound (IVUS) guidance and compare measurements between IVUS and angiography. Methods: One hundred thirty-one patients (71 women; mean age 71 ± 8 years) underwent IVUS-guided Palmaz stent implantation in 153 stenotic renal arteries at a single center. The indications for stenting were uncontrolled hypertension (102, 77.9%), renal insufficiency (10, 7.6%), and both conditions (19, 14.5%). The majority of lesions were ostial (114, 74.5%); the remainder occupied the proximal renal artery (39, 25.5%). The mean lesion length and diameter stenosis were 6.5 ± 3.0 mm and 74% ± 10%, respectively, as measured by angiography. Data were recorded in a pre-specified database; angiographic and IVUS images were analyzed at dedicated core laboratories and compared. Results: Angiographic success was achieved in all patients, but IVUS indicated the need for additional intervention in 36 (23.5%) cases. There was strong correlation between the angiographic and IVUS measurements of lesion length ( r = 0.60, p < 0.0001) and pre-/postprocedural minimal luminal diameter ( r = 0.72 and 0.63, respectively; p < 0.0001). The mean contrast volume was 74 ± 18 mL per case. In-hospital renal failure occurred in 8 (6.1%) patients; 2 (1.5%) required transient hemodialysis. At a mean 15-month follow-up, patients were treated with fewer antihypertensive medications (p = 0.05), and systolic and diastolic arterial blood pressures had decreased (p = 0.001); no significant change was noted in serum creatinine. Conclusions: IVUS-guided stenting facilitates safe renal artery revascularization. IVUS imaging may complement angiography in certain cases, which should be studied further in prospective studies with iodinated or noniodinated contrast agents.
Failed AAA Endograft Exclusion Due to Type II Endoleak: Explant Analysis
Authors: White Rodney A. , Walot Irwin , Donayre Carlos E. , Woody Jonathan , Kopchok George E. 
Published: March 2015

Purpose: To report the patient history and analysis of an explanted modular bifurcated endograft that was implanted to exclude an abdominal aortic aneurysm (AAA). Case Report: An 80-year-old man with a 6-cm AAA underwent uneventful endovascular implantation of a bifurcated AneuRx stent-graft. His postprocedural clinical course was uneventful, although persistent contrast enhancement of the aneurysm remained via the inferior mesenteric artery (IMA). By 6 months, an endoleak connecting to the lumbar and mesenteric arteries became apparent. Over the ensuing 12 months, the endoleak and aneurysm enlarged; branch artery embolization was attempted in 4 percutaneous procedures. Despite successful IMA occlusion, the aneurysm continued to increase in diameter and volume, necessitating conversion to a conventional bypass at 20 months. Analysis of the explanted specimen revealed an intact endograft with fibrous incorporation of the stent framework at the proximal and distal fixation sites only; no incorporation of the endograft was noted within the aneurysm. The feeding channel for the endoleak was not identified. Conclusions: Serial imaging is a vital component of endograft surveillance, and persistent type II endoleaks that cannot be completely embolized endanger the longevity of the aneurysm exclusion. Explant analysis can play an important role in understanding the mechanisms of endograft failure.
Healing Response of Normal Canine Aorta and Iliac Artery to a Nitinol Stent Encapsulated in Carbon-Lined ePTFE
Authors: Woody Jonathan D. , Nishanian Gary , Kopchok George E. , Kim Nam I.I. , Donayre Carlos E. , White Rodney A. 
Published: March 2015

Purpose: To evaluate the healing response of normal canine arteries to a self-expanding nitinol stent encapsulated in carbon-lined expanded polytetrafluoroethylene (ePTFE). Methods: Twenty-eight dogs were divided into aortic (n = 18) or iliac (n = 10) groups. In the latter, 2 animals were assigned to implantation intervals of 7, 30, and 90 days, respectively; 4 were designated for 180-day implantation. Half of the animals in each subgroup received a second overlapping stent-graft in one iliac artery. In the aortic cohort, 6 animals were assigned to the 180-day implantation group (2 with dual devices) and 3 to each of the others (1 dual implantation in each group). The devices were evaluated with angiography and intravascular ultrasound at implantation and explantation. After harvesting and gross examination, the specimens were examined microscopically and with scanning electron microscopy. Results: The 49 implanted devices (24 aortic and 25 common iliac) were all widely patent at explantation, save for 2 iliac stents that had moderate (<40%) stenosis. No neointima was present at the 7-day interval. All stents were covered by thin neointima (<150 µm) at 30 days. At 180 days, an endothelial lining was present in the proximal and distal segments of all stents; in 4 of the 6 aortic stents, this endothelial lining was complete, whereas none of the iliac devices had endothelium in the midsegment at 180 days. At 1 year, 2 of the aortic specimens had an incomplete endothelial lining, whereas the lining was complete in the third. There was no evidence of stent-graft migration or inflammation associated with any device. Conclusions: The carbon-lined ePTFE-encapsulated stent is a novel approach to arterial stenting. The progressive endothelialization and lack of inflammatory reaction may provide improved long-term patency. Further study of this stent-graft design is warranted.
Arterial Thrombus Dissolution in Vivo Using a Transducer-Tipped, High-Frequency Ultrasound Catheter and Local Low-Dose Urokinase Delivery
Authors: Atar Shaul , Luo Huai , Nagai Tomoo , Sahm Roger A. , Fishbein Michael C. , Siegel Robert J. 
Published: March 2015

Purpose: To examine the hypothesis that a transducer-tipped high-frequency ultrasound drug-delivery catheter may augment the thrombolytic effects of locally delivered low-dose urokinase and result in improved recanalization rates and reduced residual thrombotic burden. Methods: Thrombi were induced in situ bilaterally in 5- to 6-cm-long segments of the superficial femoral arteries in 9 dogs by intraluminal thermal damage and injection of thrombin. A transducer-tipped high-frequency local drug-delivery catheter was applied at 1.1 MHz and 0.6 W for 60 minutes to one superficial femoral artery segment, and an identical catheter with an inactivated ultrasound transducer was used to treat the contralateral control segment. Urokinase (5000 IU/kg) was delivered bilaterally into the thrombi during the treatment interval. Results: Angiography documented TIMI grade 2 or 3 flow in 9 (100%) segments in the ultrasound-treated group versus 6 (67%) of the controls (no ultrasound) (p = 0.058). Angiographically detected distal embolization was found in 2 ultrasound-treated segments compared with 5 controls (p = 0.02). Protruding or occlusive thrombi were seen angioscopically in 8 (89%) control segments but in only 1 (11%) of the ultrasound-treated arteries (p < 0.001). By histopathology, 7 (78%) segments in the control group had occlusive thrombi, whereas only 3 nonocclusive thrombi were found in the ultrasound-treatment group (p < 0.001). Conclusions: Catheter-delivered high-frequency ultrasound and local low-dose urokinase infusion is efficacious for the treatment of acute thrombotic occlusions as evaluated by angiography, angioscopy, and histopathology.
Pseudoaneurysm Formation at the Site of External Iliac Artery Stents: Percutaneous Stent-Graft Treatment
Authors: Scheinert Dierk , Ludwig Josef , Schröder Malte , Bräunlich Sven , Balzer Joern O. , Biamino Giancarlo 
Published: March 2015

Purpose: To present a patient who developed an asymptomatic large iliac pseudoaneurysm complicating stent-supported iliac artery recanalization. Case Report: The pseudoaneurysm was detected in an asymptomatic 69-year-old man during routine angiography 6 months after an uncomplicated procedure to implant 3 overlapping Palmaz stents in an occluded external iliac artery. There was no evidence of stent infection. During a second intervention, the pseudoaneurysm was successfully treated by percutaneous implantation of an EndoPro System I stent-graft. Contrast-enhanced spiral computed tomography at 6 and 12 months confirmed the durability of aneurysm exclusion and the patency of the endoprosthesis. Conclusions: Angioplasty-induced pseudoaneurysm is rare and usually asymptomatic, but elective percutaneous stent-graft repair should be considered as the first treatment option.