bluuebunny/crossref_metadata_2025_split huggingface dataset:
Midterm Outcomes of Thoracic Aortic Stent-Grafts: Complications and Imaging Techniques
Authors: Chabbert Valérie , Otal Philippe , Bouchard Louis , Soula Philippe , Van Tuan Tran , Kos Xavier , Meites Geneviève , Claude Conil , Joffre Francis , Rousseau Hervé 
Published: March 2015

Purpose: To evaluate the midterm outcomes of thoracic aortic stent-grafting and the performance of computed tomographic angiography (CTA), radiography, and magnetic resonance angiography (MRA) in endograft surveillance. Methods: Forty-seven patients with traumatic thoracic aortic ruptures (n=16), aneurysms (n=14), false aneurysms (n=3), penetrating ulcers (n=3), and dissections (n=11) treated with stent-grafts were monitored in follow-up using chest radiography and CTA in all patients and MRA in 23 patients. Two perpendicular maximal aortic diameters, the sum of these diameters, and the elliptical cross-sectional area were determined and compared to baseline for the entire group and in subgroup analyses according to lesion type. CTA, MRA, and radiography were compared for their ability to detect endoleak, monitor stent-graft configuration, and measure aortic diameters. Results: The mortality rate was 8.5%. Severe complications were observed in 14.8% (6% neurological complications); 12 (25.5%) patients had primary endoleaks. Over a mean 11-month follow-up (range 0.25–46 months), the aortic diameters decreased for all patients without endoleak (p<0.001). In the diameter/area subgroup analyses, only the traumatic rupture cohort demonstrated significant decreases in all 4 measurements. CTA and MRA measurements correlated well, but chest radiography was superior to both for visualizing stent-graft shape. In terms of endoleak detection, MRA missed only 1 (12.5%) endoleak (type II) seen on CTA; there were no false positive results with MRA. Conclusions: Morbidity and mortality observed after thoracic stent-grafting are acceptable. Radiography is better for monitoring stent-graft conformation, while CTA provides the best overall morphological information. The performance of MRA in endoleak detection is encouraging.
Aortic Intimal Tears: Detection with Spiral Computed Tomography
Authors: Quint Leslie E. , Platt Joel F. , Sonnad Seema S. , Deeb G. Michael , Williams David M. 
Published: March 2015

Purpose: To determine the frequency, locations, and sizes of aortic intimal tears detected using spiral computed tomography (CT). Methods: CT scans (26 single detector and 26 multidetector studies) from 52 patients with an unoperated aortic dissection and a patent false lumen were evaluated on a workstation. The number, location, and size of aortic tears were recorded and compared between the following groups: acute and chronic dissection, type A and type B, and single detector and multidetector studies. Results: In 52 patients, 129 tears were identified (mean 2.48 per patient, median 2, range 1–7). There were no significant differences in the number or size of tears between the acute and chronic, the type A and type B, or the single detector and multidetector groups (p<0.05). The most common locations for tears were the descending aorta (57, 44%) and the juxtarenal region (26, 20%). Within the type B category, there was no significant difference in tear locations between the acute and chronic groups (p>0.05). The majority of tears (88, 68%) were <1 cm in each dimension. Tears in the thoracic aorta were significantly larger than abdominal aortic tears (p<0.05). Conclusions: All patients with an aortic dissection and a patent false lumen demonstrated one or more aortic intimal tears using spiral CT. Although most tears were small (<1 cm), they were usually easily visualized.
Endoluminal Repair of Mycotic Thoracic Aneurysms
Authors: Stanley Brendan M. , Semmens James B. , Lawrence-Brown Michael M.D. , Denton Michael , Grosser David 
Published: March 2015

Purpose: To report a series of endoluminally repaired mycotic thoracic aneurysms. Case Reports: Four patients with presumed mycotic aneurysms of the thoracic aorta were treated with endovascular grafts owing to overly high risk for open repair. All aneurysms were successfully excluded at the initial intervention. In one case, which required endograft fenestrations for the superior mesenteric and renal arteries, the patient died 53 days after the procedure, following graft migration and occlusion of major branch vessels. The other 3 patients remain alive and well at a mean follow-up of 16 months with no signs of ongoing sepsis. Conclusions: Endoluminal repair of thoracic mycotic aneurysms is technically feasible and, in association with long-term antibiotics, offers at least temporary protection against imminent rupture.
Distribution of Sac Pressure in an Experimental Aneurysm Model after Endovascular Repair: The Effect of Endoleak Types I and II
Authors: Xenos Eleftherios S. , Stevens Scott L. , Freeman Michael B. , Pacanowski John P. , Cassada David C. , Goldman Mitchell H. 
Published: March 2015

Purpose: To study in an experimental aneurysm model the differential distribution of strain/pressure (S/P) on the aneurysm wall before and after endograft exclusion and in the presence of individual type I and type II endoleaks. Methods: Two tapered elliptical Gore-Tex patches were sutured to an anterior and posterior longitudinal arteriotomy of an 8-mm Gore-Tex tube graft, thus creating a fusiform aneurysm. Two S/P transducers were placed at the proximal sac adjacent to the proximal neck, 2 at the site of the widest sac diameter, and 2 at the sac adjacent to the distal neck. The aneurysm, which was connected to a pulsatile pump system, was excluded using a 10-mm endograft. Type I and type II endoleaks were created and tested individually. S/P measurements were obtained at systemic systolic pressures (BP) of 80, 110, and 150 mmHg. Thrombosis of the sac contents was induced by injection of thrombin and calcium in the sac. Angiography was used to verify presence or absence of flow in the sac. Results: Aneurysm exclusion resulted in significant S/P reductions at all 3 BP levels versus prior to exclusion (p<0.05). Thrombus in the sac did not alter S/P in the excluded sac (p>0.05 for all 3 BP levels). In the presence of a proximal type I endoleak, S/P distribution was not uniform, and S/P at the proximal neck was close to S/P prior to exclusion (p>0.05 no graft versus type I endoleak for all 3 BP levels). This was also true in the presence of thrombus. With a type II endoleak, S/P was more evenly distributed and was not significantly elevated compared to the pressure without an endoleak (p>0.05, graft versus type II endoleak for all 3 BP levels). Thrombus had no effect on intrasac S/P with a type II endoleak. Intrasac S/P was significantly higher in the presence of a type I endoleak compared to a type II endoleak when BP=150 mmHg (p=0.008). Conclusions: Endovascular exclusion of an aneurysm results in uniform S/P reduction in the aneurysm sac. Type I endoleak, but not type II endoleak, results in significantly higher S/P in an area of the sac adjacent to the proximal neck. Thrombus does not result in significantly different S/P distribution in the aneurysm sac.
Can Intrasac Pressure Monitoring Reliably Predict Failure of Endovascular Aneurysm Repair?
Authors: Vallabhaneni Srinivasa R. , Gilling-Smith Geoffrey L. , Brennan John A. , Heyes Richard R. , Hunt John A. , How Thien V. , Harris Peter L. 
Published: March 2015

Purpose: To determine if pressure measured at a single location within aneurysm sac thrombus accurately reflects the force applied to the aneurysm wall and the risk of rupture by examining (1) if pressure is distributed uniformly within aneurysm thrombus, (2) the pressure transmission through aneurysm thrombus, and (3) the microstructural basis for pressure transmission. Methods: Pressure within aneurysm thrombus was measured by direct puncture through the aneurysm wall at 121 sites in 26 patients during open abdominal aortic aneurysm repair. Measurements were taken prior to cross clamping and compared with intrasac pressure measured at 30 sites in 6 patients without aneurysm thrombus (controls). Transmission of pressure through aneurysm thrombus was further examined ex vivo by subjecting fresh thrombus to a pressure gradient in a custom-made pressure cell. Pressure transmission was correlated with matrix density as determined by light microscopy and image analysis. Results: Mean pressure within aneurysm thrombus was higher than mean systemic pressure in 11 patients, lower in 1, and identical in 9. In 5 patients, the pressure was greater than systemic in some areas of the thrombus but less in others. Sac pressure was identical to systemic pressure at all sites in the controls. In 12 thrombus specimens (6 patients) examined in the pressure cell, pressure transmission varied significantly between specimens, correlating directly with matrix density ( R2=0.747, p=0.001). Conclusions: Pressure transmission through aneurysm thrombus is variable and depends upon the microstructure of the thrombus. Pressure measured at a single location may not, therefore, accurately reflect the pressure acting on the aneurysm wall.
Two-Dimensional versus Three-Dimensional CT Scan for Aortic Measurement
Authors: Dillavou Ellen D. , Buck David G. , Muluk Satish C. , Makaroun Michel S. 
Published: March 2015

Purpose: To examine if 3-dimensional (3D) reconstructions of computed tomographic (CT) data, by imaging perpendicular to blood flow, can improve aortic diameter measurement accuracy over axial (2D) CT. Methods: Two independent, blinded observers used electronic calipers to measure the minor axis and the line perpendicular to it on 40 2.5-mm 2D CT scans from 31 patients. A circular electronic tool was used to estimate diameters on 3D reconstructions from the same 40 scans. Measurements of the aortic neck were obtained 5 mm below the renal arteries and the widest slice of the aneurysm was used to measure sac diameter. Only the minor axis was measured at the iliac arteries immediately above the left (LI) and right (RI) iliac bifurcations. Datasets were compared with an intraclass correlation coefficient (ICC), Bland and Altman variation assessments, and absolute differences. Results: ICC between 2D and 3D scans demonstrated high correlation with 2D minor axis measurements (neck=0.9282, sac=0.8956, RI=0.8755, LI=0.7381). 3D to 2D major axis correlation was lower (neck=0.6388, sac=0.8995). Variation between 3D and 2D minor axis measurements was low (0.51-mm average variation from the mean for the minor axis and 1.30-mm variation for the major axis). Average absolute difference between 3D and 2D diameters was 1.01 mm (minor axis) versus 2.61 mm (major axis). Interobserver correlation was highest for sac measurements both in 2D minor axis (ICC=0.8990) and 3D (ICC=0.9518). Conclusions: Minor axis measurements on axial CT scan can substitute for diameters obtained from 3D reconstructions in most clinical situations.
Survival after Stenting of Severe Atherosclerotic Ostial Renal Artery Stenoses
Authors: Zeller Thomas , Müller Christian , Frank Ulrich , Bürgelin Karlheinz , Schwarzwälder Uwe , Horn Barbara , Roskamm Helmut , Neumann Franz-Josef 
Published: March 2015

Purpose: To examine long-term survival after angioplasty and stenting of atherosclerotic renal artery stenosis (RAS). Methods: Over a 5-year period, 241 consecutive patients (153 men; mean age 67±9 years, range 44–84) were treated with angioplasty and stent implantation for 355 ostial renal stenoses >70%. The procedures were performed in standard fashion using a variety of stents. For survival analysis, the patients were divided into 3 groups based on baseline creatinine levels: group 1: 115 (48%) patients with normal renal function (creatinine <1.2 mg/dL); group 2: 93 (39%) patients with moderately impaired renal function (creatinine 1.2 to 2.5 mg/dL); and group 3: 33 (13%) patients with severely impaired renal function (creatinine >2.5 mg/dL). Results: All patients were treated successfully without any procedure-related mortality. The 30-day mortality was 0.4% (1/241). Twenty-two patients died during a follow-up of 27±15 months (range 1–60) (overall survival 91%). The causes of death were cardiac (congestive heart failure or myocardial infarction, 73%), stroke (13.5%), and malignant disease (13.5%). The survival rate was significantly lower (29.6%) in patients with a baseline serum creatinine >2.5 mg/dL (p<0.0001) than in groups 2 (89.1%) or 1 (95.4%). Long-term survival without hemodialysis or restenosis was 66.6% at 48 months. Independent predictors for a reduced survival were left ventricle function (HR 2.59, 95% CI 1.45 to 4.63, p=0.001 for each 15% incremental decrease), age (HR 1.13, 95% CI 1.03 to 1.25, p=0.011), and baseline renal function (HR 1.58, 95% CI 1.10 to 2.29, p=0.014). Conclusions: Survival after successful stenting for severe ostial RAS depends on baseline serum creatinine and left ventricle function. Efforts must be made to avoid the development of advanced ischemic nephropathy and congestive heart failure.
Percutaneous Stenting of Incidental Unilateral Renal Artery Stenosis: Decision Analysis of Costs and Benefits
Authors: Axelrod David A. , Fendrick A. Mark , Carlos Ruth C. , Lederman Robert J. , Froehlich James B. , Weder Alan B. , Abrahamse Paul H. , Stanley James C. 
Published: March 2015

Purpose: To determine the incremental cost-effectiveness of prophylactic percutaneous transluminal angioplasty with stent placement (PTA-S) in patients with incidentally discovered, asymptomatic renal artery stenosis (RAS) compared to delaying PTA-S until patients develop refractory hypertension or renal insufficiency (therapeutic PTA-S). Methods: The Markov decision analysis model was used to determine the incremental cost per quality adjusted life year (QALY) saved for prophylactic PTA-S as compared to therapeutic PTA-S in a hypothetical cohort of patients with 50% unilateral atherosclerotic RAS followed from age 61 to death. Results: Prophylactic PTA-S compared to therapeutic PTA-S results in more QALYs/patient (10.9 versus 10.3) at higher lifetime costs ($23,664 versus $16,558). The incremental cost effectiveness of prophylactic PTA-S was estimated to be $12,466/QALY. Prophylactic stenting was not cost effective (>$50,000/QALY) if the modeled incidence of stent restenosis exceeded 15%/year and the incidence of progression in the contralateral renal artery was <2% of arteries/year. Conclusions: PTA-S of incidental, asymptomatic unilateral RAS may improve patients' quality of life at an acceptable incremental cost. However, this technology should be used hesitantly until a randomized comparison confirms its effectiveness.
Restenosis after Femoropopliteal PTA and Elective Stent Implantation: Predictive Value of Monocyte Counts
Authors: Schillinger Martin , Exner Markus , Mlekusch Wolfgang , Haumer Markus , Sabeti Schila , Ahmadi Ramazanali , Schwarzinger Ilse , Wagner Oswald , Minar Erich 
Published: March 2015

Purpose: To investigate the association of baseline peripheral blood monocyte counts and restenosis after femoropopliteal percutaneous transluminal angioplasty (PTA) and PTA plus elective stent implantation. Methods: Three hundred thirty consecutive patients (170 men; median age 71 years, interquartile range 61–78) with peripheral artery disease underwent femoropopliteal PTA (n=258) or PTA plus elective stent implantation (n=72). Multivariate Cox regression analysis was used to determine the predictive value of baseline peripheral blood monocyte counts on the rate of restenosis (≥50% luminal reduction) in follow-up. Results: Cumulative patency at 6 and 12 months was 55% and 39% after PTA and 70% and 41% after elective stenting, respectively (p=0.19). Pretreatment monocyte counts (in tertiles) were associated with restenosis after PTA (p=0.002) and stent implantation (p=0.02). Compared to patients with monocyte counts <0.3×109/L (lower tertile, n=128), patients with monocytes from 0.3 to 0.4×109/L (middle tertile, n=91) had a 1.8-fold increased adjusted risk for restenosis (95% CI 1.1 to 2.8, p=0.01). Patients with monocytes >0.4×109/L (upper tertile, n=87) had a 2.3-fold increased adjusted risk (95% CI 1.4 to 3.5, p<0.0001). Conclusions: Baseline monocyte counts were associated with restenosis after femoropopliteal PTA and elective stent implantation, suggesting that circulating monocytes play a pivotal role in the development of recurrent lumen narrowing.
Leucine 7 to Proline 7 Polymorphism of the Preproneuropeptide Y Gene is Not Associated with Restenosis after Coronary Stenting
Authors: Pesonen Ullamari , Koch Werner , Schömig Albert , Kastrati Adnan 
Published: March 2015

Purpose: To identify if an association exists between the leucine 7 (Leu7) to proline 7 (Pro7) polymorphism located in the signal peptide of the preproneuropeptide Y (preproNPY) gene and restenosis after coronary stenting. The Pro7 allele of the preproNPY gene affects the plasma levels of human neuropeptide Y, a potent mitogen of vascular smooth muscle cells. Methods: A population of 1850 consecutive patients with symptomatic coronary artery disease undergoing coronary stent implantation was enrolled in a study that featured angiography at 6 months and genotype determination. The primary endpoint was angiographically documented restenosis (≥50% diameter stenosis) at 6 months. The secondary endpoint was the clinical outcome at 1 year (death, myocardial infarction, target vessel revascularization). Genotyping was based on the polymerase chain reaction with fluorescent allele-specific oligonucleotide probes (TaqMan method). Results: The carrier frequency of the rare Pro7 allele was 6.2%. Baseline, lesion-related, angiographic, and procedural parameters were similar in the patients with the Leu7/Leu7 genotype and carriers of the Pro7 allele (i.e., subjects with genotype Leu7/Pro7 or Pro7/Pro7). Restenosis rates at 6 months did not differ significantly between the groups (33% versus 30%, p=0.54). In addition, no relationship of the polymorphism with the clinical outcomes at 1 year was observed. Conclusion: Our results suggest that the Leu7 to Pro7 polymorphism of the preproNPY gene is not associated with angiographic restenosis or adverse clinical events after stent placement in coronary arteries.
Endovascular Gamma Irradiation of the Iliac Arteries: 1-Year Results from a Clinical Safety and Feasibility Study
Authors: Walichiewicz Piotr , Piecuch Jerzy , Białas Brygida , Orkisz Witold , Fijałkowski Marek , Slosarek Krzysztof , Miszczyk Leszek 
Published: March 2015

Purpose: To estimate safety and feasibility of vascular brachytherapy in iliac arteries. Methods: Fourteen patients (11 men; mean age 56.7±9.9 years, range 44–81) with occlusive disease in 15 iliac arteries (7 external, 8 common) were treated with balloon dilation followed by irradiation from an iridium 192 source (15 Gy at 3 mm from the inner surface of the artery wall) applied with a PARIS centering catheter and bilateral 10-mm margins. Patients receiving stents for suboptimal angioplasty were prescribed a 6-month course of antiplatelet treatment with ticlopidine. Angiography was routinely scheduled for 6 months after intervention. Results: There were no complications of the angioplasty procedure or EVBT treatment; 7 patients received stents for dissection or residual stenosis. Mean follow-up was 12.4±6.0 months. At 6-month angiography, 1 (6.7%) restenosis in a common iliac artery stent was found. Another patient with a common iliac artery stent developed transient lower limb ischemia at 4 months, probably due to temporary suspension of antiplatelet treatment and distal disease. Conclusions: Brachytherapy in the iliac arteries appears to be feasible and safe; longer follow-up in more patients is needed to determine its clinical utility in the prevention of restenosis.
Wall Mechanics of the Stented Rabbit Aorta: Long-Term Study and Correlation with Histological Findings
Authors: Vernhet Hélène , Demaria Roland , Pérez-Martin Antonia , Juan Jean Marie , Oliva-Lauraire Marie Claire , Marty-Double Christiane , Sénac Jean Paul , Dauzat Michel 
Published: March 2015

Purpose: To evaluate long-term changes in arterial wall mechanics induced by stenting of the rabbit aorta. Methods: Eighteen New Zealand white rabbits had initial stent deployment (3×8 mm Multilink) at 110% of the pre-stenting abdominal aortic diameter. Group A (n=10) had no post-deployment stent expansion and group B (n=8) had 30% overdilation of the stent. A noninvasive B-mode ultrasound examination coupled with image processing allowed measurement of diameters at systole and diastole and the calculation of diameter compliance. Measurements were performed before stenting and compared to those recorded immediately after stenting and at 3 months at 3 locations: upstream from the stent, at the stent level, and downstream from the stent. Measurements were also compared among measurement sites. The pathological study included measurement of intimal thickening and calculation of an injury score. Results: At the stent level, diameter compliance was significantly lower after initial stenting and at 3 months than before stenting (group A: p<0.005; group B: p<0.001) and than downstream or upstream from the stent (group A: p<0.0001, group B: p<0.005). No significant difference in diameter compliance was found between groups A and B. In group B, intimal thickening and the injury score were greater than in group A (p<0.05 and p<0.0001, respectively). Conclusions: Endovascular stenting of the rabbit aorta impairs wall mechanics. Performing 30% overdilation of the stent does not worsen this impairment but induces greater in-stent intimal hyperplasia.
Trellis Thrombectomy System for the Treatment of Iliofemoral Deep Venous Thrombosis
Authors: Ramaiah Venkatesh , Del Santo Peter B. , Rodriguez-Lopez Julio A. , Gowda Ramesh G. , Perkowski Paul E. , Diethrich Edward B. 
Published: March 2015

Purpose: To describe the use of a new percutaneous mechanical thrombectomy device to clear thrombus from the iliofemoral vein. Case Report: A 52-year-old woman with non-Hodgkin's lymphoma presented to the emergency room with a posterior tibial vein deep vein thrombosis and a greater saphenous vein thrombosis. Heparin therapy caused the clot to propagate into the iliofemoral vein. Catheter-directed thrombolysis for 36 hours with 24 units of reteplase failed to clear the clot. The Trellis Thrombectomy System, a new percutaneous mechanical thrombectomy device, was used to deliver a low dose of reteplase into the clot. Complete clot lysis was achieved in 45 minutes using only 5 units of reteplase. The patient's symptoms resolved completely, and she continues to be asymptomatic at 6 months with no evidence of residual clot on duplex scans. Conclusions: The Trellis device may be used to rapidly clear thrombus from the iliofemoral vein with a low dose of thrombolytic agent.
Thrombolytic Therapy in the Setting of Arterial Line-Induced Ischemia
Authors: Geschwind Jean-François H. , Dagli Mandeep S. , Lambert Ew L. , Kobeiter Hicham 
Published: March 2015

Purpose: To evaluate the use of percutaneous transcatheter thrombolysis in the treatment of thrombosis due to radial artery cannulation. Methods and Results: Seven patients (4 women; age range 41–62 years) with symptomatic cannulation-induced thrombosis and failure to improve after systemic anticoagulation underwent 8 catheter-directed thrombolytic infusions at our institution over a 3-year period. Access was either antegrade through the brachial artery or retrograde through the femoral artery. Thrombolytic infusions with urokinase began 2 to 12 days (average 6) after removal of the radial artery catheter. The thrombolytic infusion was successful in 5 of 7 patients based on angiographic flow restoration with <20% residual thrombus and significant clinical improvement in the ischemia. Conclusions: When systemic anticoagulation has failed, percutaneous catheter-directed thrombolytic infusion appears to be effective in the treatment of most patients with severe ischemic hand symptoms due to thrombosis after radial artery cannulation.