bluuebunny/crossref_metadata_2025_split huggingface dataset:
What are the Characteristics of the Ideal Endovascular Graft for Abdominal Aortic Aneurysm Exclusion?
Authors: Allen Robert C. , White Rodney A. , Zarins Christopher K. , Fogarty Thomas J. 
Published: March 2015

Purpose: To review the anatomic factors crucial to successful endoluminal abdominal aortic aneurysm (AAA) repair and propose an ideal endograft design for AAA exclusion. Methods and Results: The anatomic features of critical importance to endovascular AAA exclusion comprise remote arterial access, proximal and distal fixation sites, AAA morphology, and arterial wall pathology. When designing an aortic endograft, the major components to consider are stent selection, graft material, and the delivery system. The ideal endograft design must be sufficiently versatile to treat a broad range of patients. To meet this requirement, the endograft should display a high degree of dimensional adaptability. A modular bifurcated endograft design permits intraoperative customization to tailor the device to each patient's anatomy and pathology. Conclusions: The modular stent-graft concept addresses many of the important factors in the evolution toward an ideal aortic endograft. Extensive testing will be needed to determine if the bifurcated stent-graft described here is the optimal design for effective AAA exclusion.
Preoperative Sizing of Grafts for Transfemoral Endovascular Aneurysm Management: A Prospective Comparative Study of Spiral CT Angiography, Arteriography, and Conventional CT Imaging
Authors: Broeders Ivo A.M.J. , Blankensteijn Jan D. , Olree Marco , Mali Willem , Eikelboom Bert C. 
Published: March 2015

Purpose: To define the impact of spiral computed tomographic angiography (CTA) with image reconstruction on graft selection for Transfemoral Endovascular Aneurysm Management (TEAM) by comparing it to conventional computed tomography (CT) and contrast arteriography. Methods: Twenty-one candidates for TEAM were included. The diameters of the superior and inferior aneurysm necks and lengths between the graft attachment sites were measured using the three imaging techniques. These measurements and their consequences on graft selection were studied. Results: The difference in length sizing between spiral CTA and arteriography never exceeded 1 cm; however, lengths measured by conventional CT scanning resulted in underestimation of graft length in 91% of patients. Graft diameters were chosen too small in 62% of the patients when based on arteriographic diameter measurements. A graft of similar diameter was selected by spiral CTA and conventional CT scanning in 81% of the patients, while minor oversizing by conventional CT scanning was found in 14%. Conclusions: Neither conventional CT scanning nor arteriography is adequate as a sole preoperative radiological investigation for TEAM graft sizing. Spiral CTA with image processing produces all information required for selection of tho-optimal graft size and should be regarded the method of first choice for this purpose.
Postoperative Color Flow Duplex Scanning in Aortic Endografting
Authors: Heilberger Peter , Schunn Christian , Ritter Wolfgang , Weber Sepp , Raithel Dieter 
Published: March 2015

Purpose: To report the feasibility and sensitivity of duplex sonography compared to computed tomography (CT) for aortic endograft follow-up surveillance. Methods: In a 26-month period, 113 aortic aneurysm patients received 79 tube and 34 bifurcated stent-grafts. Follow-up used contrast-enhanced CT scanning and duplex sonography with an intravenous ultrasound contrast agent (Levovist). Results: Eleven patients (9.7%) were converted to open repair; 1 died from hemorrhagic shock secondary to retroperitoneal hematoma. The mean follow-up time was 7.2 months (range 1 to 24), during which 5 patients died of unrelated causes. Sixteen primary (within 30 days) and 5 secondary endoleaks were detected by duplex after tube graft implantation. Among 5 endoleaks due to retrograde side-branch perfusion, 3 were detected only with contrast-enhanced duplex scanning. Iliac artery occlusion was also documented using duplex; however, 2 stent fractures could not be seen with ultrasound. Ten primary endoleaks were detected in bifurcated stent-graft patients. One endoleak originating from the distal iliac limb anchoring site was missed by duplex owing to bowel gas. Graft limb thrombosis was clearly identified by lack of a flow signal on duplex. Conclusions: Duplex sonography could be a valuable, reliable, and economical surveillance tool for endovascular aortic reconstructions. The adjunctive use of an intravenous ultrasound contrast agent increased the sensitivity for detecting endoleak to a level comparable to contrast-enhanced CT scanning. However, stent fractures may not be seen on ultrasound, and bowel gas can interfere with obtaining an adequate image.
Influence of Abdominal Aortic Aneurysm Size on the Feasibility of Endovascular Repair
Authors: Armon Matthew P. , Yusuf S. Waquar , Whitaker Simon C. , Gregson Roger H.S. , Wenham Peter W. , Hopkinson Brian R. 
Published: March 2015

Purpose: To assess the effect of abdominal aortic aneurysm (AAA) size on overall aneurysm morphology with special attention to possible relationships among various anatomic variables that determine the feasibility of endovascular repair. Methods: One hundred sixty-eight patients were assessed with spiral computed tomographic angiography to measure the length and diameter of the AAA, the proximal neck, and the common iliac arteries. Anatomic variables were correlated with aneurysm size using Spearman's rank order correlation coefficients (rs); comparisons among small, intermediate, and large aneurysms were made using the Chi-square test. Results: Correlations between aneurysm size and the anatomic variables above were weak. The strongest association was between aneurysm size and aortic length (rs = 0.41, p < 0.001). Subgroup analysis showed no difference in proximal neck length, neck diameter, or overall suitability for endovascular repair between aneurysms greater or smaller than 5.5-cm diameter. However, significantly more short (< 1.5 cm), wide (> 3 cm), and, hence, unsuitable proximal necks were found in patients with aneurysms > 7 cm in diameter (χ2 = 7.8, p < 0.01). Conclusions: Shortening and widening of the proximal neck seems to increase with aneurysm size but only after the aneurysm expands beyond 7 cm in diameter. Aneurysms with diameters in the 4.5- to 5.5-cm range are no more suitable for endovascular repair than those between 5.5 and 7 cm. The lack of any significant correlation between anatomic variables emphasizes the need for accurate preoperative assessment of the anatomy of each individual patient before endovascular repair.
Endoluminal Repair of Large Abdominal Aortic Aneurysms Using PTFE: A Feasibility Study
Authors: Adiseshiah Mohan , Bray Alan J. , Bergeron Patrice , Raphael Maurice J. 
Published: March 2015

Purpose: To investigate the feasibility of using predilated thin-wall polytetrafluoroethylene (PTFE) secured by extra-large Palmaz stents for endoluminal repair of abdominal aortic aneurysms (AAA). Methods: Thirty-two patients (26 males; aged 69 to 83 years) from three centers (two in Europe, one in Australia) were selected for endoluminal stent-grafting using predilated 8-mm PTFE graft material fitted with extra-large Palmaz stents at the terminal ends. Aortoaortic tube grafts were implanted in 12 patients, while the remainder received aortomonoiliac endografts and femorofemoral bypass. Follow-up at 5 days and then biannually was by contrast-enhanced computed tomography (CT) or duplex scanning. Results: There were 13 conversions to open surgery; three patients died within 30 days. Nineteen patients were discharged with functioning endografts within 5 days of treatment. Of these, two have had their grafts removed owing to infection in one and distal stent migration in the other. Two endoleaks have been detected in follow-up; one has been sealed by covered stenting. One twisted graft was repaired by Wallstent implantation. Seventeen patients remain well, one with persistent distal endoleak, but none shows an increase in AAA diameter on imaging over the 6- to 26-month (median 13) follow-up. Conclusions: These results represent the learning curves of three separate centers. Technical failure and complications were more common early in the study. Advantages of the technique include relative low cost and the ability to tailor the stent-graft to the individual aneurysm.
An Experimental Model for the Acute and Chronic Evaluation of Intra-Aneurysmal Pressure
Authors: Faries Peter L. , Sanchez Luis A. , Marin Michael L. , Parsons Richard E. , Lyon Ross T. , Oliveri Steve , Veith Frank J. 
Published: March 2015

Purpose: To develop an animal model for the acute and chronic monitoring of pressure within abdominal aortic aneurysms (AAAs) to be treated with endovascular grafts. Methods: A strain-gauge pressure transducer was placed within an AAA created from a prosthetic vascular graft. Prosthetic aneurysms were implanted into 17 canine infrarenal aortas. The intra-aneurysmal pressure was monitored and correlated with noninvasive forelimb sphygmomanometry for 2 weeks. After this time, an intravascular manometer catheter was passed into the aneurysm. Simultaneous pressure measurements were obtained using the implanted strain-gauge pressure transducer, the manometer catheter, and the forelimb sphygmomanometer. Angiography was performed to assess intraluminal morphology, aneurysm anastomoses, and adjoining aortic vessels. In addition, two control animals underwent intra-aneurysmal pressure monitoring after standard surgical aneurysm repair. Results: There was excellent correlation (r = 0.97) between the pressure measurements obtained with the implanted strain-gauge pressure transducer and the intravascular manometer. Close correlation was also observed between the implanted strain-gauge transducer and the forelimb sphygmomanometer (r = 0.88) during postprocedural monitoring. Intra-aneurysmal pressure was lowered dramatically by surgical exclusion (aneurysm: 15/5 ± 7/4 mmHg; systemic: 124/66 ± 34/17 mmHg; p < 0.001). The prosthetic aneurysms were successfully imaged with angiography. Conclusions: This animal model provides an accurate and reproducible means for measuring intra-aneurysmal pressure on an acute and chronic basis. It may be possible to use this model in the assessment of endovascular devices to determine their efficacy in reducing intra-aneurysmal pressure. Evaluation of complications associated with their use, such as patent aneurysm side branches, perigraft channels, and perianastomotic reflux, may also be possible.
Surgical Reconstruction of the Iliac Arteries Prior to Endovascular Aortic Aneurysm Repair
Authors: Chuter Timothy A.M. , Reilly Linda M. 
Published: March 2015

Purpose: To explore a method of combined endovascular/conventional treatment of abdominal aortic aneurysm (AAA), in which the iliac arteries are reconstructed by conventional surgical techniques to provide the anatomic substrate for subsequent endovascular repair of the aortic aneurysm. Method: A 77-year-old patient with severe cardiac disease was found to have a 6.5-cm AAA, bilateral common iliac artery (CIA) aneurysms, and diffusely narrowed, tortuous external iliac arteries. The left internal iliac artery was occluded. At operation, the right CIA was exposed through a transverse retroperitoneal incision under epidural anesthesia. An iliobifemoral bypass was constructed using a preformed bifurcated graft. A stent-graft was delivered through the right limb of the bifurcated iliobifemoral graft. The proximal end of the stent-graft was implanted in the neck of the aneurysm, and the distal end was deployed in the common trunk of the iliobifemoral graft, thereby excluding the AAA and both native iliac arteries from prograde arterial flow. Results: Completion angiography and follow-up contrast computed tomography showed the aneurysm to be excluded from the circulation. The patient was not intubated, was never hemodynamically unstable, and had aortic blood flow interrupted for no more than 20 seconds. In addition, he was able to resume his usual diet on the first postoperative day. He continues to be well and without evidence of endoleak at 6-month follow-up. Conclusions: This case demonstrates that iliac artery stenosis, tortuosity, and aneurysmal dilatation are not impediments to endovascular AAA exclusion. Any necessary surgical modifications of pelvic arterial anatomy can be performed before stent-graft insertion to minimize aortic occlusion time.
Endovascular Stents for Carotid Artery Occlusive Disease
Authors: Wholey Michael H. , Wholey Mark H. , Jarmolowski Chester R. , Eles Gustav , Levy David , Buecthel Jack 
Published: March 2015

Purpose: To study the feasibility and safety of endovascular stenting of cervical carotid artery stenosis. Methods: Between April 1994 and May 1997, 108 consecutive patients (58 men; mean age 70.1 years) with ≥ 70% carotid stenosis were treated with percutaneous stent implantation under a protocol that featured independent neurological review. Forty-four percent were asymptomatic. Over half the lesions (59%) were in the internal carotid artery; the mean stenosis was 86%. Palmaz stents were implanted without cerebral protection following preliminary balloon dilation; two Wallstents were used in long lesions. Results: Carotid stents were successfully placed in 108 of 114 (95%) lesions. Of the 6 technical failures, 5 were access related and 1 was due to seizures during balloon dilation. Two major (1.8%) and 2 minor (1.8%) strokes occurred (3.7% stroke rate for 108 patients; 3.5% in 114 procedures), all in symptomatic patients, one of whom died. There were 5 (4.4%) transient ischemic attacks and 2 (1.8%) brief seizure episodes during dilation. One patient died of a cardiac event on day 20. The all stroke or death rate was 5.3% based on 114 arteries at risk (5.6% in 108 patients). In the mean 6-month follow-up (range 1 to 36) of 97 eligible patients, 3 (3.1%) died from unrelated causes. There was 1 restenosis (1.0%) from a stent compression, which was successfully redilated. There were no neurological sequelae, cranial palsies, or cases of stent or vessel thrombosis in follow-up. Conclusions: The use of stents in the treatment of cervical carotid occlusive disease appears feasible, effective in the short term, and without excessive risk of periprocedural stroke.
Transcatheter Embolization of a Ruptured Superior Gluteal Artery Aneurysm: Case Report and Review of the Literature
Authors: McMillan William D. , Smith Norm D. , Nemcek Albert , Pearce William H. 
Published: March 2015

Purpose: To report the successful coil embolization of a true gluteal artery aneurysm and review therapeutic options for this rare condition. Methods and Results: A ruptured superior gluteal artery aneurysm in a symptomatic 80-year-old man was successfully thrombosed by embolization using a combination of Gianturco coils and helical platinum microcoils. Six-month computed tomography demonstrated persistent thrombosis of the aneurysm and resolution of the perivascular blood. Conclusions: This report offers support for the use of catheter-based techniques as an alternative to standard surgical repair of gluteal artery aneurysms.
Intravascular Stenting in the Superior Mesenteric Artery for Chronic Abdominal Angina
Authors: Busquet Jacques 
Published: March 2015

Purpose: Abdominal angina is an early clinical expression of occlusive mesenteric arterial insufficiency, a condition that requires aggressive treatment to prevent intestinal infarction. We report a case of chronic mesenteric ischemia in a young polyvascular man who had symptoms of abdominal angina. Methods and Results: An aortic angiogram revealed a significant ostial stenosis of the superior mesenteric artery (SMA) associated with an occlusion of the inferior mesenteric artery. After predilation of the ostial portion of the SMA, significant residual stenosis remained. A balloon-expandable Palmaz P154 stent was deployed, restoring adequate luminal dimensions and blood flow. The patient was discharged after 2 days and remains asymptomatic at 5 months. Conclusion: Intraluminal stenting for treatment of mesenteric ischemia represents a viable alternative to surgical revascularization in selected cases.
Rupture of the External Iliac Artery during Balloon Angioplasty: Endovascular Treatment Using a Covered Stent
Authors: Formichi Maxime , Raybaud Gilles , Benichou Hubert , Ciosi Godefroy 
Published: March 2015

Purpose: To report the emergent endovascular management of an external iliac artery (EIA) rupture after standard guidewire recanalization and balloon angioplasty. Method and Results: A 54-year-old diabetic male presented with an occlusion of the EIA associated with severe stenotic lesions of the femoral bifurcation. Guidewire recanalization of the lumen was followed by balloon angioplasty, but evidence of EIA rupture was detected on the intraoperative arteriogram. Temporary homeostasis was achieved using the angioplasty balloon, and a Cragg EndoPro System 1 stent-graft was inserted transluminally to repair the injury. At 18 months poststenting, routine color Doppler confirmed continued patency of the vessel repair. Conclusions: While rupture of the EIA during angioplasty usually demands open surgical correction, an endovascular procedure can provide a fast, efficient, and less aggressive method of treating this serious complication.
Tube Collapse and Valve Closure in Ambulatory Venous Pressure Regulation: Studies with a Mechanical Model
Authors: Raju Seshadri , Green Austin B. , Fredericks Ruth K. , Neglen Peter N. , Hudson C. Alexander , Koenig Keith 
Published: March 2015

Purpose: To determine the role of valve closure and column segmentation in ambulatory venous pressure regulation. Methods: Using a mechanical model consisting of a graduated adjustable valve and a collapsible tube, we studied the differential effects of valve closure and tube collapse on venous pressure regulation. By utilizing materials with differing wall properties for the infravalvular tube, the influence of wall property changes on tube function and pressure regulation was explored. Results: Valve closure, per se, does not cause venous pressure reduction. Collapse of the tube below the valve is the primary pressure regulatory mechanism. The nonlinear volume-pressure relationship that exists in infravalvular tubes confers significant buffering properties to the collapsible tube, which tends to retain a near-constant pressure for a wide range of ejection fractions, residual tube volumes, and valve leaks. Changes in tube wall property affect this buffering action, at both the low and high ends of the physiological venous pressure range. Conclusions: The valve and the infravalvular venous segment should be considered together in venous pressure regulation. Tube collapse of the segment below the valve is the primary pressure regulatory mechanism. An understanding of the hydrodynamic principles involved in pressure regulation derived from this model will provide the basis for construction of more complex models to explore clinical physiology and dysfunction.
Combined Operative and Endovascular Treatment of a Post-Traumatic Embolizing Aneurysm of the Subclavian Artery
Authors: Meyer Thomas , Merkel Susanne , Lang Werner 
Published: March 2015

Purpose: To describe a combined endovascular and surgical approach for an embolizing subclavian artery aneurysm as an alternative to conventional reconstructive surgery. Methods and Results: A 39-year-old woman presented with a post-traumatic aneurysm of the left subclavian artery and occlusion of the brachial artery due to embolization. Exclusion of the aneurysm was achieved by intraoperative implantation of a covered stent during simultaneous reconstruction of the brachial artery by a venous bypass graft. The patient is well and free of symptoms 24 months after the operation. Conclusions: Repeat operative trauma to the supraclavicular region was avoided by transluminal implantation of a covered stent-graft in combination with an axilloulnar bypass procedure for chronic embolic occlusion of the brachial artery.
Popliteal Artery Aneurysm Treated with a Minimally Invasive Endovascular Approach: An Initial Report
Authors: Rosenthal David , Atkins Colby P. , Shuler Frederick W. , Jerius Hilde S. , Clark Michael D. , Matsuura John H. 
Published: March 2015

Purpose: To report a minimally invasive approach to popliteal artery aneurysm (PAA) treatment. Methods and Results: A 48-year-old male with a 3-cm PAA was treated electively with an endovascular in situ saphenous vein bypass and transluminal antegrade coil embolization of the PAA prior to completion of the proximal anastomosis. Two short incisions at the anastomosis sites resulted in no wound complications, and the patient was discharged after 2 days. After 14 months of follow-up, the patient is asymptomatic with continued patency of the in situ bypass and occlusion of the PAA. Conclusions: This endovascular approach for minimally invasive femoropopliteal in situ saphenous vein bypass grafting appears feasible for treatment of PAAs. This method may reduce the rate of wound complications attending classic open in situ bypass grafts.
Biplane Color Flow Duplex Intravenous Intravascular Ultrasound for Arterial Visualization
Authors: Beebe Hugh G. , Assadnia Shahin , Kriegel Andrew V. , Salles-Cunha Sergio X. 
Published: March 2015

Purpose: To describe a feasibility study in a sheep model using an intravascular ultrasound (IVUS) instrument in an intravenous position to produce color flow, B-mode images of arterial segments along with Doppler blood flow velocities. Methods: Four healthy adult male sheep were anesthetized for surgical exposure of the right external jugular vein. A 9.0F sheath was also introduced in the common femoral artery for arteriography and device insertion. A 7.5-MHz ultrasound probe with 1-cm graduation markers was passed into the jugular vein. B-mode and color flow pictures were captured at aortic branches in cross and longitudinal sections. Length measurements between aortic branches and Doppler spectral velocities were obtained. Guidewire, balloon, and stent maneuvers were monitored by the stationary intravenous IVUS probe. Results: High-quality visualization of the entire abdominal aorta and its branches was achieved in all animals. With the probe stationary in the vena cava, a 1.5-cm linear segment of the aorta could be continuously observed in both B-mode and color flow ultrasound scans. Insertion and implantation of a Palmaz balloon-expandable stent was guided by intravenous IVUS alone. Selective catheterization of the right renal artery was followed visually by moving the intravenous IVUS probe sequentially. Conclusions: Intravenous IVUS appears feasible as a guidance and monitoring tool for endovascular interventions. While conventional IVUS provides only cross-sectional images in B-mode, intravenous IVUS captures color flow and Doppler velocity data as well. These added ultrasound modalities may offer potential advantages for guidance of endovascular procedures and endoleak detection.