bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Endovascular Abdominal Aortic Aneurysm Repair: Anatomical Classification, Procedural Success, Clinical Assessment, and Data Collection
Authors: Dorros Gerald , Parodi Juan , Schonholz Claudio , Jaff Michael R. , Diethrich Edward B. , White Geoffrey , Mialhe Claude , Marin Michael L. , Stelter Wolf-J. , White Rodney , Coppi Gioacchino , Bergeron Patrice 
Published: March 2015

Purpose: To detail a methodology for evaluation of endovascular abdominal aortic aneurysm (AAA) repair that has been achieved through consensus of an international multidisciplinary team of investigators. Methods: This schema features an anatomical classification for AAAs, a definition of procedural success, and a procedure for clinical assessment, as well as the necessary data collection forms. Patient data include demographics, procedural and clinical success, complications, and follow-up. Procedural details can be related to anatomic situations, comorbid processes, devices, and effective aneurysmal exclusion. Results: These data would allow assessment of the procedures, physician learning curves, procedural indications, techniques, methodologies, the relationship of indications to success and complications, devices and subsequent graft patency, and aneurysmal exclusion. Conclusions: The use of this standardized data collection system could enable physicians and industry to better understand endovascular AAA repair and ultimately improve patient care.
Abdominal Aortic Aneurysms: Experience with the Ivancev-Malmö Endovascular System for Aortomonoiliac Stent-Grafts
Authors: Ivancev Krassi , Malina Martin , Lindblad Bengt , Chuter Timothy A.M. , Brunkwall Jan , Lindh Mats , Nyman Ulf , Risberg Bo 
Published: March 2015

Purpose: To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair. Methods: From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Ivancev-Malmö system. Results: Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients. Conclusions: Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.
The Italian Trial of Endovascular AAA Exclusion Using the Parodi Endograft
Authors: Coppi Gioacchino , Moratto Roberto , Silingardi Roberto , Tusini Nicola , Vecchioni Roberto , Scuro Alberto , Stimamiglio Piero , Adami Carlo A. 
Published: March 2015

Purpose: To report the outcome of the prospective 11-center Italian Parodi Trial using straight and tapered endografts for the endovascular exclusion of abdominal aortic aneurysms (AAA). Methods: From April 1994 to July 1995, 27 patients were evaluated and selected for endovascular AAA exclusion. The Parodi devices were delivered through femoral arteriotomies using 18 to 22F introducers and deployed by balloon expansion of the terminal stents. Results: Of 27 cases attempted, 24 endografts (15 tube, 9 aortomonoiliac) were implanted (1 deployment and 2 access failures [11.1%] were converted). Three endoleaks (12.5%) were treated intraoperatively with covered stents, two successfully, and the third sealed within 30 days. Three (12.5%) of the 24 treated patients died in-hospital of device- (n = 2) and procedure-related (n = 1) causes; the remaining 21 patients were discharged within 8 days. Of the 8 aortomonoiliac grafts in follow-up, only 1 (12.5%) failed in the mean 23-month (range 18 to 30) follow-up; however, 4 (31%) of 13 tube graft patients were converted to surgery within 18 months. Of the 16 (66.7%) surviving endografts at 2 years, 6 (38%) showed no change in the AAA diameter, while 10 (62%) had shrunk. Conclusions: The tube graft was applicable in only about 5% of cases, and accurate endograft sizing and distal fixation were problematic. The aortomonoiliac design was not appealing to surgeons but fared better in the long term. Given the advent of newer endograft models, the Italian Parodi Trial has been terminated.
Endograft Repair of an Aortic Pseudoaneurysm following Gunshot Wound Injury: Impact of Imaging on Diagnosis and Planning of Intervention
Authors: White Rodney , Donayre Carlos , Walot Irwin , Kopchok George E. , Wilson Eric , Klein Stanley 
Published: March 2015

Purpose: To describe the endovascular treatment of a gunshot injury to the visceral aorta and the role of various imaging modalities in the staging and planning of the endograft procedure. Methods and Results: The bullet entered the aorta posteriorly beneath the origin of the superior mesenteric artery and traversed the wall in a tangential manner entering the lumen proximal to the renal arteries. Intravascular ultrasound (IVUS) imaging and spiral computed tomography (CT) identified the injury that the initial angiograms failed to demonstrate. Combined use of IVUS and CT imaging enabled observation of the evolution of a pseudoaneurysm until an interval when endograft exclusion was possible. A stent-graft was customized based on precise IVUS and CT dimensional data and implanted successfully through an arteriotomy in the common femoral artery 3 weeks after the initial injury. Three-month follow-up imaging demonstrated continued exclusion of the pseudoaneurysm, and the patient remains well at 16 months. Conclusions: IVUS and spiral CT scans were instrumental in identifying an arteriographically undetected aortic injury. The combined imaging modalities also helped determine the timing for the endovascular procedure and provided the precise measurements for device fabrication and deployment.
Percutaneous Endovascular Stent-Graft Repair of Iliac Artery Aneurysms
Authors: Dorros Gerald , Cohn Joel M. , Jaff Michael R. 
Published: March 2015

Purpose: To report a percutaneous technique for endovascular repair of iliac artery aneurysms using commercially available materials. Methods: Ten patients (9 males; mean age 65 ± 11 years) presented with 11 isolated iliac artery aneurysms; 3 patients were asymptomatic. Stent-grafts were customized for each patient from polytetrafluoroethylene grafts with Palmaz stents sutured at either end of the tube. The devices were delivered percutaneously through standard 14F sheaths and deployed by balloon dilation. Results: All iliac aneurysms were excluded without procedural incident. One patient with chronic renal insufficiency (baseline serum creatinine 1.9 mg/dL) experienced transient contrast-induced renal failure inhospital. The average hospital stay was 2.5 days (range 1 to 7). One vessel thrombosed 2 weeks following the procedure; the culprit stenosis at the site of arterial cannulation was dilated. One patient died of myocardial infarction at 6 weeks. The remaining eight grafts are patent and free of endoleak at a mean 14-month follow-up. Conclusions: This percutaneous technique appears to be an acceptable alternative to open surgical repair.
Recurrence of Pseudoaneurysm after Successful Embolization
Authors: Garby Karen B. , King Teresa S. , Tsai Fong Y. 
Published: March 2015

Purpose: To report the initial successful treatment of a hepatic pseudoaneurysm by a partially formed coil and subsequent recurrence secondary to coil migration and configuration change. Methods and Results: A 22-year-old man suffered a gunshot wound in the abdomen; a grade 4 liver laceration was identified and repaired. Eight days later, abdominal pain developed, and pseudoaneurysms were noted off both the superior and inferior branches of the right hepatic artery. Coil embolization was successful in occluding both defects; however, the inferior branch coil was incompletely formed. Twenty days later, symptom recurrence prompted angiography. The inferior branch coil had changed position and configuration, resulting in a larger pseudoaneurysm. Repeat embolotherapy was successful. Conclusions: The possible sequelae to maldeployed occluding coils must be considered even if the procedure appears successful. It may be advisable to place additional coils to more confidently occlude the pseudoaneurysm.
Stent-Graft Arteriovenous Fistula: An Endovascular Technique in Hemodialysis Access
Authors: Masuda Elna M. , Kistner Robert L. , Eklof Bo , Lipman Robert A. , Balkin Peter W. , Kamida Curtis B. 
Published: March 2015

Purpose: To determine the feasibility and safety of a new endovascular technique for creating an arteriovenous (AV) fistula utilizing catheter-directed techniques and stents. Methods: Stent-graft AV fistulas were offered on an experimental basis to 8 patients who had a history of multiple failed access procedures or very small arm veins unsuitable for standard vascular access techniques. The device consisted of a balloon-expandable Palmaz stent attached to the designated venous end of a polytetrafluoroethylene graft. The balloon-mounted stent-graft was inserted into the brachial vein through an arteriotomy and advanced over a guidewire into the axillary vein. After the stent-graft was deployed, the arterial anastomosis was completed in standard surgical fashion using an end-to-side anastomosis of the graft to the brachial artery. Results: The stent-graft was inserted successfully in all patients, but there were two early failures. The first resulted from a steal phenomenon secondary to high flows through the stent-graft, necessitating ligation of the fistula. Another stent-graft was placed too peripherally in the upper arm, and the stainless steel stent was crushed by external compression. Three of the 6 remaining grafts were patent for over 1 year, and 2 grafts are still functioning at 22 and 13 months. Conclusions: Endoluminal stent-grafts can be successfully inserted into the axillary vein for creation of an AV fistula and remain patent for 2 years or more. This method may be most useful in patients with very small, unusable arm veins or multiple failed AV grafts.
Emergent Endoluminal Repair of Delayed Abdominal Aortic Rupture after Blunt Trauma
Authors: Scharrer-Pamler Reinhard , Görich Johannes , Orend Karl H. , Sokiranski Roman , Sunder-Plassmann Ludger 
Published: March 2015

Purpose: To report the emergency repair of a traumatic abdominal aortic rupture using endoluminal techniques. Methods and Results: A 25-year-old female sustained multiple head, chest, and abdominal injuries in a motorcycle accident. Six days after emergency treatment (including splenectomy and repair of a superficial hepatic rupture and lacerations to the stomach, small bowel, and colon), she became hemodynamically unstable. A massive retroperitoneal hematoma had evolved from a distal aortic rupture. Owing to a hostile abdomen and possibility of bacterial contamination, a self-expanding stent-graft was inserted transfemorally to repair the aortic injury. The patient recovered uneventfully and continues in good health with a patent endograft repair 2 years after treatment. Conclusions: This experience would support the efficacy of endograft implantation for emergent repair of trauma aortic injuries; however, proper facilities, an experienced interventional team, and an assortment of endografts and stents must be available.
Changes in Referral Practice, Workload, and Operative Mortality after Establishment of an Endovascular Abdominal Aortic Aneurysm Program
Authors: Boyle Jonathan R. , Thompson Matthew M. , Sayers Robert D. , Nasim Ahktar , Healey Patricia , Bell Peter R.F. 
Published: March 2015

Purpose: To determine the change in referral practice following establishment of an endovascular abdominal aortic aneurysm (AAA) program. Methods: A prospective audit of all elective admissions for AAA was established in January 1994 at the initiation of an endovascular AAA program. A comparison was made between this cohort and the elective AAA repairs performed between 1981 and 1993. Results: Since January 1994, 213 AAA patients (177 men; median age 73 years, range 54 to 88) have been referred for potential endovascular aneurysm repair. To date, 142 patients have undergone elective surgery (41 endovascular and 101 conventional). Between 1981 and 1993, 304 patients (255 men; median age 69 years, range 45 to 86) had elective aneurysm repair. Comparison of the two time periods has revealed significant increases in the number of tertiary referrals (41.8% versus 9.5%, p < 0.01), annual operations (50 versus 23, p < 0.05), and overall mortality (12% versus 6.7%, p < 0.05), the latter attended by a significant increase in cardiorespiratory comorbidity. Conclusions: The higher elective AAA mortality rate since the establishment of an endovascular program reflects a change in referral practice and may be directly attributable to an increase in the number of high-risk patients. An endovascular AAA program has clinical and financial implications for the hospital concerned.
Percutaneous Endoluminal Treatment of Iliac Occlusions: Long-Term Follow-up in 105 Patients
Authors: Henry Michel , Amor Max , Ethevenot Gérard , Henry Isabelle , Mentre Bernard , Tzvetanov Kiril 
Published: March 2015

Purpose: To evaluate the long-term results of percutaneous recanalization techniques in occluded iliac arteries. Methods: Percutaneous recanalization was attempted in 105 patients (97 men; mean age 56 years, range 34 to 80) with iliac occlusions using thrombolysis (n = 15), excimer laser (n = 4), mechanical thrombectomy (n = 16), balloon angioplasty alone (n = 23), and angioplasty plus stenting (n = 69). The majority of lesions (n = 72) were in the common iliac artery (CIA); 33 were in the external iliac artery (EIA). Results: The primary recanalization rate was 88% (92/105) independent of location (EIA: 90%, CIA: 86%) and lesion length, but dependent on age of thrombus (< 3 months: 100%, > 3 months: 79%, p < 0.02). Complications included 5 (4.8%) cases of distal embolism treated by thromboaspiration or Fogarty balloon embolectomy. Seven (6.7%) early thromboses were treated surgically. Primary and secondary patency rates were calculated at 6 years for all 105 cases and for the 92 recanalized lesions using life-table analysis. Overall, primary patency was 52% (CIA: 58%, EIA: 34%) and secondary 66% (CIA: 74%, EIA: 40%). Lesions < 6 cm had a primary patency of 70%, while those > 6 cm had a 31% rate (p < 0.01). Secondary patencies were 86% and 42%, respectively (p < 0.01). Among recanalized lesions, the primary patency was 61% (CIA: 69%, EIA: 38%) and secondary 77% (CIA: 88%, EIA: 45%; p < 0.05). Lesions < 6 cm had a primary patency rate of 72%, while longer lesions had a primary rate of 44% (p < 0.04); secondary patencies were 89% and 59%, respectively (NS). Primary patency without stent was 57% and with stent 65% (NS); secondary patency without stent was 71% and with stent 82% (NS). Conclusions: Percutaneous recanalization of iliac occlusions represents a true alternative to vascular surgery and a first-line treatment option. Stents have a tendency to improve long-term results and are recommended for routine use in chronic iliac occlusions.
Assessment of Apparent Vena Caval Penetration by the Greenfield Filter
Authors: Proctor Mary C. , Greenfield Lazar J. , Cho Kyung J. , Moursi Mohammed M. , James Eric A. 
Published: March 2015

Purpose: To examine and elucidate the mechanisms for apparent “penetration” by Greenfield vena caval filters. Methods: Two filters were placed in the inferior venae cavae (IVC) of four immature sheep and followed with cavography for 1 year. Two animals underwent computed tomography (CT) and laparoscopic examination. At necropsy, the vena cava and adjacent structures of all four animals were examined grossly and histologically. Results: Based upon cavography and CT imaging, all filters appeared to penetrate the vena cava at 12 months. However, at laparoscopy, no hooks or limbs were exposed, and the pericaval tissues remained intact; each hook or limb was within the adventitia or encapsulated in scar tissue. Histology of the tissue at the hook sites revealed remodeling of the intimal surface of the IVC and thinning of the adventitia. Conclusions: Based upon these data, we hypothesize that the vena cava gradually adapts by medial and adventitial thinning and myointimal remodeling to the radial force exerted by a filter. This process allows increase in the filter base diameter while maintaining the integrity of the cava and protecting adjacent structures.
Angioplasty and Stenting of the Extracranial Carotid Arteries
Authors: Henry Michel , Amor Max , Masson Isabelle , Henry Isabelle , Tzvetanov Kiril , Chati Zukaï , Khanna Narendra 
Published: March 2015

Purpose: To study the feasibility and safety of stent-supported angioplasty in the treatment of atherosclerotic stenoses of the extracranial carotid arteries. Methods: Carotid angioplasty was attempted in 174 arteries (163 patients: 126 males; mean age: 71 ± 10 years, range 47 to 93). Mean lesion length was 15.1 ± 4.1 mm, and mean percent stenosis was 83.8% ± 7.3% (reference diameter 5.8 ± 0.7 mm). The majority (106, 65%) were asymptomatic (51% of all patients had severe coronary disease, 32% had peripheral vascular diseases). Patients underwent independent neurological examination, computed tomography, duplex ultrasonography, and angiography preprocedurally, 24 hours after the procedure, and at 6-month follow-up intervals. Most (142, 82%) carotid arteries were treated without cerebral protection, but a protective triple coaxial catheter was used in 32 (18%) patients. Stents (primarily Palmaz and Wallstent) were deployed routinely in all cases; 18% were implanted without predilation. Results: Immediate technical success was 173 of 174 (99.4%) (1 access failure referred electively to surgery). Eight (4.6%) neurological complications occurred in the periprocedural period: 3 transient ischemic attacks, 2 minor strokes, and 3 major strokes (1 amaurosis and 2 hemiplegias). Two major complications developed despite cerebral protection. There were no deaths or myocardial infarctions and only 3 cervical access site hematomas. Over a mean 12.7 ± 9.2 month follow-up (range 1 to 36), no ipsilateral neurological complications have been seen. There were 4 (2.3%) restenoses (3 redilated, 1 treated medically) and 1 mild Palmaz stent compression, all found within the first 6 months. Primary and secondary patencies at 3 years are 96% and 99%, respectively. Conclusions: Angioplasty with routine stenting seems feasible and safe for treating certain types of carotid stenoses even in high-surgical risk patients; however, randomized trials are necessary before this treatment can be offered as an alternative to endarterectomy.
Endovascular AAA Exclusion: Will Stents with Hooks and Barbs Prevent Stent-Graft Migration?
Authors: Malina Martin , Lindblad Bengt , Ivancev Krasnodar , Lindh Mats , Malina Janne , Brunkwall Jan 
Published: March 2015

Purpose: To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta. Methods: Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force. Results: The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects. Conclusions: Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.
Initial Experiences with Percutaneous Endovascular Repair of Popliteal Artery Lesions Using a New PTFE Stent-Graft
Authors: Bürger Thomas , Meyer Frank , Tautenhahn Jörg , Halloul Zuhir , Fahlke Jörg 
Published: March 2015

Purpose: To report the percutaneous endovascular management of popliteal artery lesions with a new polytetrafluoroethylene (PTFE) stent-graft. Methods and Results: Three patients have undergone endovascular treatment in the popliteal region owing to: (1) an iatrogenic false aneurysm with arteriovenous fistula, (2) entrapment syndrome, and (3) an isolated arterial aneurysm. In each case, arterial occlusion was treated initially with thrombolysis. The underlying vascular lesions then were stented using the new Hemobahn endograft, a nitinol stent covered internally with PTFE. Each percutaneous procedure was completed successfully without major complications. During early follow-up (6 to 7 months), no signs of intimal hyperplasia, occlusion, or stent migration have been observed. Conclusions: Based on these early experiences, percutaneous treatment of stenotic and aneurysmal lesions in the popliteal artery using the Hemobahn endograft appears feasible and effective. Further experience and longer follow-up are required to evaluate this new prosthesis.
Successful Endoluminal Repair of a Popliteal Artery Aneurysm Using the Wallgraft Endoprosthesis
Authors: Kudelko Paul E. , Alfaro-Franco Carina , Diethrich Edward B. , Krajcer Zvonimir 
Published: March 2015

Purpose: To describe the first application of the Wallgraft endovascular prosthesis to aneurysm exclusion in the popliteal artery. Methods and Results: A 61-year-old man was admitted to our institution with a popliteal artery aneurysm complicated by associated popliteal vein compression, deep venous thrombosis, and pulmonary embolism. The endovascular procedure was performed percutaneously with local anesthesia using a low-profile, covered stent (Wallgraft Endoprosthesis). The aneurysm was successfully excluded from the arterial circulation, and there were no postprocedural complications. Follow-up evaluation with appropriate imaging at 10 months revealed no endoleaks. Conclusions: This initial result indicates that percutaneous deployment of the Wallgraft endoprosthesis, with its smaller diameter and flexible design, may offer significant advantages over currently available devices for repair of popliteal artery aneurysms. This method obviates the need for general anesthesia or surgical exposure, which is particularly beneficial in patients with comorbid illnesses.