bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Repair of an Aortoduodenal Fistula
Authors: Eskandari Mark K. , Makaroun Michel S. , Abu-Elmagd Kareem M. , Billiar Timothy R. 
Published: March 2015

Purpose: To demonstrate the utility of endovascular stent-graft repair for the management of an unusual aortoduodenal fistula. Methods and Results: A 23-year-old man with an aortoduodenal fistula secondary to tumor necrosis was treated with a Corvita endoluminal stent-graft after several failed surgical attempts to repair the defect. At 2-year follow-up, the patient was clinically and radiographically devoid of any evidence of occult stent-graft infection. Conclusions: This case illustrates the usefulness of endovascular repair for the treatment of a primary aortoduodenal fistula. Endovascular repair should be included in the armamentarium for the management of difficult aortoduodenal fistulas.
Primary Stenting for Chronic Total Occlusion of the Infrarenal Aorta
Authors: Karkos Christos D. , D'Souza Stephen P. , Hughes Robert 
Published: March 2015

Purpose: To present a rare case of chronic total occlusion of the infrarenal aorta treated with a self-expanding endoluminal stent implanted without preliminary dilation. Methods and Results: A 68-year-old woman presented with severe bilateral buttock and thigh claudication. Angiography revealed total occlusion of the infrarenal abdominal aorta and relatively normal iliac vessels. Via a right groin puncture and a 9-F sheath, a 14-mm × 5-cm self-expanding Wallstent was deployed in the abdominal aorta and expanded with an angioplasty balloon. Completion angiography showed successful recanalization of the aorta with satisfactory distal flow. Palpable distal pulses were restored, and the patient's symptoms were alleviated. She remained asymptomatic until her death from a major stroke 11 months after aortic stent implantation. Conclusions: Primary stenting may be considered a viable alternative to conventional surgery in selected patients with total infrarenal aortic occlusion.
Endovascular Repair of Perisplanchnic Abdominal Aortic Aneurysm with Visceral Vessel Transposition
Authors: Macierewicz Jan A. , Jameel Mohamed M. M. , Whitaker Simon C. , Ludman Catherine N. , Davidson Ian R. , Hopkinson Brian R. 
Published: March 2015

Purpose: To report a combined endoluminal and open surgical approach for a suprarenal abdominal aortic aneurysm (AAA) with coexistent splanchnic vessel stenoses. Methods and Results: A 64-year-old man presented with an aneurysm of the proximal abdominal aorta and severe stenoses of the celiac axis and superior mesenteric artery (SMA). An initial 2-stage plan to stent the visceral vessel stenoses and exclude the aneurysm with a fenestrated stent-graft failed when the celiac lesion could not be crossed. The approach was changed to restore visceral perfusion with a bifurcated left iliosplenic and ilio-SMA bypass graft. Exclusion of the aneurysm was achieved with a custom-made suprarenal aortic tube stent-graft (Ivancev-Malmö) system. The patient is free of symptoms at 22 months, and there was no aneurysm visible on the 14-month CT scan. Conclusions: Hybrid techniques are an alternative treatment for complex perivisceral aortic aneurysms when total endovascular reconstruction is not possible.
Endovascular Management of Rare Sciatic Artery Aneurysm
Authors: Sultan Sherif A.H. , Pacainowski John P. , Madhavan Prakash , McDermott Ronan , Molloy Martin , Colgan Mary-Paula , Moore Dermot J. , Shanik Gregor D. 
Published: March 2015

Purpose: To present a rare case of complete persistent sciatic artery aneurysm successfully treated by coil embolization and to suggest a new classification for this anomaly that encompasses both clinical and pathological factors. Methods and Results: A 77-year-old female presented with sudden onset of sharp, throbbing left thigh and foot pain. A nontender 10.0- × 7.0-cm pulsatile mass was found over the inferolateral aspect of the left buttock on examination in the right lateral decubitus position. Angiography demonstrated a 6.9-cm sciatic artery aneurysm with the distal sciatic artery completely thrombosed. Before planned bypass grafting, the aneurysm and distal segment of the internal iliac artery were successfully embolized with coils through a left percutaneous approach. The patient's symptoms resolved with no deterioration in limb perfusion, and further revascularization was unnecessary. Postembolization imaging showed complete occlusion of the aneurysm, which has continued for 19 months. Conclusions: The application of endovascular techniques and surgical revascularization procedures provides numerous management options for the treatment of an aneurysmal persistent sciatic artery. This case demonstrates that clinical evaluation between staged procedures may obviate the need for further intervention.
A Retrospective Comparative Study of Open and Endoscopic Saphenous Vein Harvesting
Authors: Galbraith Gervis F. , Pica-Furey Wendy 
Published: March 2015

Purpose: To compare the operative variables, complications, and potential benefits of endoscopic saphenous vein harvesting (ESVH) with traditional open vein retrieval for coronary artery bypass grafting (CABG). Methods: Data were collected retrospectively on 212 consecutive CABG patients from whom saphenous veins were harvested by one surgeon using either an open saphenous vein harvesting (OSVH) technique (n = 135) or ESVH (n = 77) performed with the ENDOSAPH Vein Harvest System. Fifty-three patients underwent a purely endoscopic procedure, whereas 24 patients had either a combined endo-open procedure (n = 13) or were converted to an open technique (n = 11) because of equipment failure or adverse anatomical characteristics. Harvest time was measured from initial leg incision to aortic cross-clamping. Leg wound complications were evaluated on the basis of progressive severity. Results: Harvest and procedural times were longer for the ESVH group (111 and 313 minutes, respectively) than for the OSVH patients (63 and 252 minutes, respectively, p < 0.001). Mean length of stay was not appreciably different: 11.7 ± 6.2 days (range 3–52) for the OSVH group, compared with 11.0 ± 6.0 days (range 3–41) for the ESVH patients (p = 0.40). Fewer complications occurred in the ESVH group when a purely endoscopic procedure was performed (17% versus 35% for OSVH, p = 0.012). Infection occurred in 1 OSVH and in 4 ESVH patients, but 3 of the endoscopic patients had a combined procedure. Bivariate correlational analysis showed that an increased number of incisions ( r = 0.29, p < 0.01), obesity ( r = 0.18, p < 0.01), and short stature ( r = −0.16, p < 0.05) were associated with leg wound complications, but hierarchial stepwise regression analysis determined only short stature to be a predictive variable (β = 0.17, R2 = 0.03). Conclusions: Despite increased operating time, ESVH results in fewer complications when a purely endoscopic procedure is performed.
Does Prosthetic Covering of Nitinol Stents Alter Healing Characteristics or Hemodynamics?
Authors: Avino Anthony , Johnson Brad , Bandyk Dennis , Back Martin , Roth Steven , Kudryk Bruce , Cantor Alan 
Published: March 2015

Purpose: To evaluate placement of polyester (Dacron) coverings on nitinol stents implanted in the canine aorta to determine the effect on cross-sectional lumen area, development of intimal hyperplasia, device endothelialization, and flow hemodynamics. Methods: Ten polyester-covered and 10 uncovered nitinol stents (60-mm length, 10- or 12-mm diameter) were deployed percutaneously in the normal infrarenal aorta of 20 adult mongrel dogs using random assignment. Angiography, intravascular ultrasound (IVUS), and duplex ultrasound performed at device deployment and before explantation at 6 weeks were used to measure aorta/device diameter and cross-sectional area. Pressure-perfusion-fixed aortic segments were compared for surface endothelialization (CD31 staining) and for thickness of neointimal formation. Results: All 20 endoluminal devices were accurately positioned in the infrarenal aorta without early or delayed evidence of device thrombosis, significant lumen narrowing, or device deformity. IVUS and duplex scanning identified no anatomical stenosis in either the covered or the bare devices by duplex ultrasound; peak systolic velocity measurements were similar (106 ± 25 cm/s in the covered stent versus 96 ± 25 cm/s for bare stents, p > 0.05). Mean neointimal thickness was significantly greater (p < 0.005) in the covered (326 ± 145 µm) compared with the bare (219 ± 62 µm) stents. Intima-to-media height ratios were greater in the covered stents (3.0 ± 1.1 compared with 1.1 ± 0.2, p < 0.003). Mean surface area endothelialization in the proximal, middle, and distal sections of each device was similar (p > 0.05) in covered (59%, 56%, and 69%) and bare (59%, 65%, and 53%) stents. Conclusions: Deployment and balloon dilation of a covered nitinol stent in a nondiseased canine aorta increased neointimal development compared with an uncovered stent, but overall lumen cross-sectional area was preserved. No differences in device patency, intradevice thrombus formation, flow hemodynamics, or luminal endothelialization were demonstrated, despite a thicker intradevice neointima induced by the polyester covering.
Differing Morphological Changes following Endovascular AAA Repair Using Balloon-Expandable or Self-Expanding Endografts
Authors: Singh-Ranger Ravinder , Adiseshiah Mohan 
Published: March 2015

Purpose: To determine whether changes in aneurysm morphology after endovascular abdominal aortic aneurysm (AAA) repair differ according to the type of endograft (self-expanding versus balloon-expandable). Methods: Among 88 patients with AAA treated with either homemade polytetrafluoroethylene (PTFE) aortomonoiliac endografts or Talent stent-grafts, 30 patients (24 males; mean age 73 years, range 55–93) were selected for this study based on a >2-year follow-up and freedom from endoleak or conversion. Of these, 12 had PTFE endografts and 18 Talent devices. All patients had spiral computed tomographic angiography with 3-dimensional reconstruction at 5 days post-treatment and 6-month intervals thereafter. Neck dimensions (length and diameters at 3 levels) were measured, along with volumes and maximal diameters of the sac and lengths of the aneurysm and endograft. Intra- and interobserver errors were <5% for linear and volume measurements. Results: Both groups had an initial 20-mL increase in median volume (p = 0.02) followed, only in Talent patients, by marked shrinkage at 6 months (–87.4 mL; p = 0.09). PTFE patients had no further changes in sac volume. Maximal sac diameters reflected volumes, but only after day 5. PTFE patients had an immediate increase (p = 0.03) in aneurysm neck diameters, which then remained stable. Talent patients had continuing increases in diameter to 6 months (p < 0.05), with no change thereafter. Length changes were not significant in either group. PTFE patients had an increase in median aneurysm length at day 5 (+3.2 mm, p = 0.04) and again at 1.5 years (+6.4 mm, p = 0.03). Endograft length slowly increased (+18.7 mm) over 1.5 years (p = 0.02). Talent patients had no length changes in the device or aneurysm. Conclusions: Aneurysm morphology appeared to alter according to the type of endograft deployed. With PTFE endografts, aneurysm volume does not change, whereas impressive sac shrinkage occurs in conjunction with the Talent system. Aneurysm/graft lengths increase with unsupported stent-grafts. Neck diameter increases immediately with balloon-expandable endografts and then remains constant. In the self-expanding models, neck diameter increases at 6 months but not thereafter.
Percutaneous Stenting of an Iatrogenic Superior Mesenteric Artery Dissection Complicating Suprarenal Aortic Aneurysm Repair
Authors: Desgranges Pascal , Bourriez Armand , d'Audiffret Alexandre , Zubilewicz Thomas , Mathieu Didier , Becquemin Jean-Pierre , Kobeiter Hicham 
Published: March 2015

Purpose: To report endovascular repair of an iatrogenic superior mesenteric artery (SMA) dissection caused by a balloon occlusion catheter. Case Report: A 68-year-old man with a suprarenal aortic aneurysm underwent conventional prosthetic replacement, during which visceral artery back bleeding was controlled with balloon occlusion catheters. Six hours postoperatively, the patient experienced an episode of bloody diarrhea with abdominal pain and tenderness and mild metabolic acidosis. Colonoscopy revealed colitis (grade I) without necrosis of the right and left colon. An emergent abdominal computed tomographic scan showed signs of mesenteric ischemia with bowel dilatation and SMA wall hematoma; angiography identified a dissection 1 cm distal to the SMA origin. An Easy Wallstent was deployed percutaneously, successfully reestablishing SMA patency. The postoperative course was uneventful, and the patient remains asymptomatic with a patent SMA stent and aortic graft at 1 year. Conclusions: Iatrogenic SMA dissection should be suspected after suprarenal aortic aneurysm repair if signs of mesenteric ischemia arise. Prompt and thorough imaging studies are necessary to confirm the diagnosis and assess the potential for an endoluminal treatment.
Fenestration in Endovascular Grafts for Aortic Aneurysm Repair: New Horizons for Preserving Blood Flow in Branch Vessels
Authors: Stanley Brendan M. , Semmens James B. , Lawrence-Brown Michael M.D. , Goodman Marcel A. , Hartley David E. 
Published: March 2015

Purpose: To describe techniques for deploying fenestrated stent-grafts that use partial graft deployment and guided tracking of the fenestration to the arterial orifice. Technique: Fenestrations have been added to custom-made tube grafts and commercially manufactured Zenith stent-graft systems to preserve perfusion of aortic side branches. Partial device deployment, orientation markers on the endograft, and intraoperative angiography enable maneuvering of the fenestration over the orifice of the target vessel with the aid of guiding catheters. Placement of a Palmaz stent overlapping the fenestration and vessel orifice secures the junction. Two variations of fenestration have preserved blood flow in renal arteries during endovascular repair of abdominal aortic aneurysms (AAAs); similar techniques have maintained flow to the celiac axis in a thoracic aortic aneurysm. Conclusions: Accurate placement of a fenestration over the orifice of a target vessel is feasible, but long-term maintenance of position is dependent on secure graft fixation. This capability brings us a step closer to overcoming the problem of inadequate necks in infrarenal AAAs, especially when the neck is foreshortened by asymmetry of the renal origins. It may also pave the way for the eventual replacement of the entire aorta with an endoluminal graft.
Geometric Changes in Aortic Endografts over a 2-Year Observation Period
Authors: Krämer Stefan C. , Seifarth Harald , Pamler Reinhard , Fleiter Thorsten , Görich Johannes 
Published: March 2015

Purpose: To report geometric changes in bifurcated aortic endografts observed over a 2-year follow-up period. Methods: Twenty-two patients (21 men; mean age 68 years, range 57–83) with abdominal aortic aneurysms were treated with an endovascular stent-graft. Follow-up examinations included spiral computed tomographic scanning postoperatively and at 3, 6, 9, 12, 18, and 24 months after treatment. Geometric changes were measured using 3-dimensional reconstructed images in anteroposterior (AP) and lateral projections. Locations for the measurements were the proximal neck, the midportion of the endograft, and the graft limbs at the origin of the iliac arteries. Results: Lateral changes predominated, demonstrating maximum angles on the side of the inserted left limb. For the proximal neck, the stent angle changed by a mean −0.71° in the AP and 4.0° in the lateral projection. At the midgraft, changes were −0.56° for AP and 12.5° for lateral. The right limb showed an angle of 6.43° in AP and −0.43° in lateral, whereas the left limb angles changed 1.38° in AP and 11.71° in the lateral plane after 2 years. There was no statistically significance difference in these changes from baseline. Conclusions: Aortic endografts are exposed to a significant amount of movement after insertion, but the resultant changes are very inhomogeneous, unpredictable, and ongoing even after 2 years. The most vulnerable location seems to be the attachment zone of the modular graft limb. These geometric changes might be one cause for late complications, including leaks and limb dislocations.
Carotid Artery Stenting in Patients with High-Risk Anatomy for Carotid Endarterectomy
Authors: Dangas George , Laird John R. , Mehran Roxana , Satler Lowell F. , Lansky Alexandra J. , Mintz Gary , Monsein Lee H. , Laureno Robert , Leon Martin B. 
Published: March 2015

Purpose: To report the results of carotid artery stenting (CAS) in patients considered to have high-risk anatomical characteristics for carotid endarterectomy. Methods: CAS was performed in 39 carotid arteries of 37 consecutive patients (26 men; mean age 72 ± 8 years, range 56–88) who met the criteria for high-risk surgical anatomy: previous ipsilateral carotid endarterectomy (20/39, 51.3%), common carotid bifurcation above the mandibular angle (5/39, 12.8%), contralateral carotid artery occlusion (15/39, 38.5%), or previous radiation therapy to the neck (1/39, 2.6%). Palmaz, Integra, or Wallstents were deployed via a percutaneous femoral artery access. Independent neurological evaluation was performed at specified time points, and a dedicated committee adjudicated all clinical events. Results: Procedural success was 100%, with no major in-hospital complications. Neurological events were rare. Only 1 (2.6%) transient ischemic attack occurred prior to discharge; at 30 days, 1 (2.6%) additional minor stroke had been observed, giving a 2.6% cumulative 30-day “death plus any stroke” rate. Over a mean 11 ± 6-month follow-up, 2 (5.4%) patients died of nonneurological causes, but there were no strokes. Conclusions: CAS is a viable endovascular revascularization technique that can be performed safely and effectively in patients with high-risk anatomy for carotid endarterectomy.
Endoluminal Stent Placement and Coil Embolization for the Management of Carotid Artery Pseudoaneurysms
Authors: Bush Ruth L. , Lin Peter H. , Dodson Thomas F. , Dion Jacques E. , Lumsden Alan B. 
Published: March 2015

Purpose: To present a series of carotid artery pseudoaneurysms treated successfully using an endovascular approach. Methods: From April 1995 to November 1999, 5 patients with neurological symptoms not explained by computed tomography of the head were identified by carotid angiography as having internal carotid artery (ICA) pseudoaneurysms. Three patients had sustained blunt trauma, and 2 had previous elective carotid endarterectomies for atherosclerotic disease. The time between injury and treatment ranged from 3 days to 10 years. The patients were treated with endovascular stent placement for exclusion of the pseudoaneurysm, followed by filling of the cavity with multiple detachable coils. Patients were maintained on oral antiplatelet agents or anticoagulant therapy after the procedure. Results: Primary technical success was 100%. No patient suffered permanent neurological sequelae. Postprocedure angiography demonstrated a patent ICA in all cases, with complete obliteration of the pseudoaneurysm. At a mean 8.4-month follow-up (range 2–21), all patients remained symptom free; angiograms in 3 patients at a mean 11.7 months demonstrated continued ICA patency. One patient had a 60% focal narrowing of the distal common carotid artery, which was treated successfully with balloon dilation and stenting. Conclusions: Endovascular treatment of carotid artery pseudoaneurysms is a useful alternative to standard surgical repair. This modality avoids the necessity for surgical exposure at the skull base with its inherent morbidity.
Combined Endovascular and Open Surgery for Four-Vessel Cerebrovascular Occlusive Disease
Authors: Barakate Michael S. , Fisher Charles M. , Appleberg Michael , Farrar Michelle A. , Tse Regina V. , Harrington Timothy J. , Sorby William 
Published: March 2015

Purpose: To report a case of bilateral simultaneous percutaneous transluminal angioplasty and stenting of the intracranial vertebral arteries prior to staged bilateral carotid endarterectomy. Case Report: A 68-year-old man presented with a 3-month history of recurrent, intermittent left-sided weakness and diplopia. Imaging defined bilateral 80% to 99% internal carotid artery stenoses and >90% stenoses of both distal vertebral arteries at the level of the foramen magnum. Bilateral intracranial vertebral artery stenting was performed, followed by staged carotid endarterectomies. No complications occurred, and the patient recovered uneventfully from all 3 procedures. He remains symptom- and event-free 20 months later. Conclusions: Our initial success in this case indicates a role for percutaneous transluminal angioplasty and stenting as an alternative to open surgery for intracranial vertebral artery stenosis.
Percutaneous Access and Closure of Femoral Artery Access Sites Associated with Endoluminal Repair of Abdominal Aortic Aneurysms
Authors: Howell Marcus , Villareal Rollo , Krajcer Zvonimir 
Published: March 2015

Purpose: To report longer follow-up and further experience using the Prostar XL Percutaneous Vascular Surgery (PVS) device for access and closure of large bore femoral artery access sites during endovascular repair of abdominal aortic aneurysms (AAAs). Methods: One hundred forty-four patients (128 men; mean age 72 years, range 56–89) undergoing endovascular AAA repair had percutaneous access and closure of their 16-F femoral artery access sites using a 10-F PVS device. The first 54 patients were enrolled in the phase III trial of the AneuRx stent-graft for AAA treatment. Results: The femoral artery access site was successfully closed in 136 (94.4%) patients, with only 8 patients in whom adequate hemostasis could not be obtained. One-month follow-up was available in 144 patients, 6-month in 100, and 1-year in 59. No groin or lower extremity complications have been observed in any patient who had successful closure of the femoral artery access site. Conclusions: Large-bore femoral artery access sites can be percutaneously repaired using this device, which minimizes the invasiveness of the endograft procedure.