bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Stent-Grafting in the Treatment of Superficial Femoral Artery Occlusive Disease
Authors: Bauermeister Günther 
Published: March 2015

Purpose: To explore the feasibility of using a flexible stent-graft in the treatment of superficial femoral artery occlusive lesions. Methods: Thirty-five patients (26 men; median age 65 years, range 41–85) with long-segment occlusions of the femoropopliteal arteries were treated with the Hemobahn endovascular prosthesis. The median occlusion length was 22 cm (range 4–40). Endografting was performed in conjunction with additional recanalization procedures as needed. Results: Primary recanalization and deployment of 47 Hemobahn endografts was successful in all cases; 12 patients had 2 devices implanted. The adjunctive recanalization techniques included balloon thrombectomy (n = 28), ring-stripper disobliteration (n = 7), local thrombolysis (n = 2), mechanical rotational thrombectomy (n = 2), local thromboendarterectomy and femoral bifurcation patch angioplasty (n = 14), iliac artery stenting (n = 3), and bypass grafting (n = 2). The median ankle-brachial index rose from 0.25 preoperatively to 0.87. Over an average 7-month follow-up (range 1–18), 10 (28.6%) occlusions occurred; 6 stent-graft thromboses were treated successfully with thrombectomy only. The other 4 occlusions were permanent. Life-table analysis documented cumulative primary and secondary patency rates of 73.2% and 82.6%, respectively, at 1 year. Conclusions: Intraoperative use of the Hemobahn endograft is feasible and effective in restoring adequate distal perfusion in the short term, especially when combined with conventional recanalization techniques.
Ischemic Transverse Myelopathy after Endovascular Repair of a Thoracic Aortic Aneurysm
Authors: Reichart Marjan , Balm Ron , Meilof Jan F. , de Haan Peter , Reekers Jim A. , Jacobs Michael J.H.M. 
Published: March 2015

Purpose: To report a dramatic complication after endovascular repair of a descending thoracic aortic aneurysm (TAA) and to present a classification system and possible methods to avoid spinal cord ischemia. Case Report: A 48-year-old man with a descending TAA between T5 and T9 was treated with endovascular stent-grafts. Fourteen hours after the operation, the patient developed partial transverse myelopathy at level T10. During emergency conversion to open surgery and implantation of a conventional tube graft, 3 intercostal arteries that had been covered by the stent-graft were revascularized. Postoperatively, the neurological deficit improved, and the patient was able to walk again. Methods to predict and possibly prevent the induction of spinal cord ischemia after endovascular repair of TAA are suggested. Conclusions: Endovascular repair of TAA may induce spinal cord ischemia; pre- and intraoperative assessment of involved intercostal arteries should be performed.
Long-Term Renal Function following Endovascular Aneurysm Repair with Infrarenal and Suprarenal Aortic Stent-Grafts
Authors: Alric Pierre , Hinchliffe Robert J. , Picot Marie-Christine , Braithwaite Bruce D. , MacSweeney Shane T.R. , Wenham Peter W. , Hopkinson Brian R. 
Published: March 2015

Purpose: To determine in a retrospective analysis the incidence of renal impairment (RI) following endovascular repair (EVR) of abdominal aortic aneurysm (AAA), to assess the morbidity and mortality in endograft patients with preoperative RI, and to examine the impact of suprarenal stent-grafts on renal function. Methods: From March 1994 to October 2001, 315 AAA patients (289 men; mean age 72.4±7.0 years) undergoing EVR were entered prospectively into a vascular registry. The patients received either an in-house custom-made stent-graft or one of several commercially made devices implanted with infrarenal or suprarenal fixation. Renal function was monitored by serum creatinine measurements prior to discharge and at 3, 6, and 12 months and annually thereafter. Preoperative RI was defined as a serum creatinine > 130 μmol/L and/or long-term dialysis. Postoperative RI referred to a >20% increase in the serum creatinine over baseline. Additional deterioration of renal function in patients with preoperative RI was referred to as postoperatively worsened RI. Results: Of the 315 patients treated, 220 (69.8%) were considered high risk (ruptured AAA or ASA grade III or IV). Sixty-nine (21.9%) patients had preoperative RI (6 [1.9%] on preoperative dialysis). A suprarenal stent-graft was used in 169 (53.7%) patients and infrarenal stent-graft in the remaining 146 (46.3%). The mean follow-up was 30.1 ±22.7 months. Postoperative RI occurred in 53 (16.8%) patients (24 [7.6%] transient, 29 [9.2%] persistent). Patients with preoperative RI had a significantly higher incidence of postoperatively worsened RI (37.7% versus 11.0%, p<0.0001) and a higher mortality related to RI (7.2% versus 1.6%, p=0.02). Suprarenal fixation had no influence on the incidence of RI, on perioperative mortality, or on mortality related to RI. The only significant predictive factor of postoperative RI was preoperative RI (risk ratio 5.09, 95% CI 2.38 to 10.87, p=0.0001). Conclusions: Endovascular AAA repair may lead to persistent postoperative RI in nearly 10% of cases, especially in patients with preoperative RI. Suprarenal stent-graft fixation does not seem to have any deleterious effect on renal function. Further long-term studies are required to confirm the innocuous nature of transrenal stent placement.
Does the Type of Endograft Affect AAA Volume Change after Endovascular Aneurysm Repair?
Authors: van der Laan Maarten J. , Prinssen Monique , Bertges Daniel , Makaroun Michel S. , Blankensteijn Jan D. 
Published: March 2015

Purpose: To compare thrombus volume changes in a longitudinal study over 2 years after endovascular aneurysm repair using the Ancure and Excluder endografts. Methods: In 2 institutions, all consecutive patients treated with a bifurcated Ancure or Excluder endograft were included in this retrospective comparison of computed tomographic angiography (CTA) data recorded and stored to disk postoperatively and at the 12 (12M) and 24-month (24M) follow-up examinations. In one institution, among 45 Ancure endograft patients, 35 (group A) had the 3 requisite scans available. In the second institution, 23 (group B) of 36 patients with the Excluder endograft were eligible for analysis. The proportional volume change was calculated at 12M and 24M and compared to the postoperative CT data. More than 10% shrinkage was considered significant. Results: In both groups, the median absolute volume changed significantly. In group A, significant shrinkage was found in 66% (23/35) at 12M and 74% (26/35) at 24M; in group B, 46% (10/23) had significant shrinkage at 12M as well as at 24M (p=0.027 for the difference between groups A and B at 24M). Statistical analysis of the proportional volume change showed a significant difference between the Ancure and the Excluder devices at 12M (p=0.009) and 24M (p=0.001). Multivariate analysis found aneurysm size (p<0.012) and endograft type (p=0.026) to be independently predictive of the absolute volume change. Conclusions: Sac volume shrinkage after endovascular aneurysm repair is less pronounced and less frequent with the Excluder endoprosthesis than with the Ancure endograft.
Does Endograft Support Alter the Rate of Aneurysm Sac Shrinkage after Endovascular Repair?
Authors: Rhee Robert Y. , Garvey Laura , Missig-Carroll Nita , Makaroun Michel S. 
Published: March 2015

Purpose: To test the hypothesis that stent-graft support influences sac shrinkage independent of endoleak rates after endovascular repair of abdominal aortic aneurysms (AAA). Methods: Ninety AAA patients underwent treatment with bifurcated endoluminal devices at our institution between October 1996 and February 1999. Fifty-two patients were treated using a nonsupported (NS) Ancure endograft and 38 using a fully supported (FS) Excluder endograft. Computed tomographic (CT) scans were obtained during the first postoperative month and at 6, 12, and 24-month intervals. Aneurysm diameter was measured as the minor axis of the largest AAA axial slice on the CT scan. Six, 12, and 24-month sac sizes were compared to the first postoperative evaluation. Results: Successful endoluminal graft placement was accomplished in all patients. The two groups were matched for age, anatomical criteria, and comorbidities except for baseline AAA size: the mean diameter was 5.4 cm in the NS group and 5.0 cm for the FS group (p<0.01). Endoleak rates were 25% (13/52) in the NS group and 18% (7/38) in the FS group (p<0.05) at 1 month. All endoleaks that did not resolve spontaneously at 6 months were treated. Initial endoleak status did not affect the sac shrinkage rates at the 12 and 24-month evaluations. At 2 years, the NS group had greater shrinkage of the sac (1.2 cm) versus the FS cohort (0.3 cm, p<0.05). In addition, more patients in the NS group had sac shrinkage >5 mm (83% versus 18%, p<0.05). Conclusions: Despite a higher endoleak rate, the nonsupported Dacron Ancure endografts were associated with greater sac shrinkage at up to 24 months following implantation.
Modeling Endoleaks and Collateral Reperfusion following Endovascular AAA Exclusion
Authors: Chong Chuh K. , How Thien V. , Gilling-Smith Geoffrey L. , Harris Peter L. 
Published: March 2015

Purpose: To investigate the effect on intrasac pressure of stent-graft deployment within a life-size silicone rubber model of an abdominal aortic aneurysm (AAA) maintained under physiological conditions of pressure and flow. Methods: A commercial bifurcated device with the polyester fabric preclotted with gelatin was deployed in the AAA model. A pump system generated physiological flow. Mean and pulse aortic and intrasac pressures were measured simultaneously using pressure transducers. To simulate a type I endoleak, plastic tubing was placed between the aortic wall and the stent-graft at the proximal anchoring site. Type II endoleak was simulated by means of side branches with set inflow and outflow pressures and perfusion rates. Type IV endoleak was replicated by removal of gelatin from the graft fabric. Results: With no endoleak, the coated graft reduced the mean and pulse sac pressures to negligible values. When a type I endoleak was present, mean sac pressure reached a value similar to mean aortic pressure. When net flow through the sac due to a type II endoleak was present, mean sac pressure was a function of the inlet pressure, while pulse pressure in the sac was dependent on both inlet and outlet pressures. As perfusion rates increased, both mean and pulse sac pressures decreased. When there was no outflow, mean sac pressure was similar to mean aortic pressure. In the presence of both type I and type II endoleaks, mean sac pressure reached mean aortic pressure when the net perfusion rate was low. Conclusions: In vitro studies are useful in gaining an understanding of the impact of different types of endoleaks, in isolation and in combination, on intrasac pressure after aortic stent-graft deployment.
Cine MRI Assessment of Aortic Aneurysm Dynamics before and after Endovascular Repair
Authors: Vos A.W. Floris , Wisselink Willem , Marcus J. Tim , Vahl Anco C. , Manoliu Radu A. , Rauwerda Jan A. 
Published: March 2015

Purpose: To evaluate stent-graft and aneurysm wall motions during the cardiac cycle using cine magnetic resonance imaging (MRI) to identify mechanisms of long-term failure of endovascular aneurysm repair (EVAR). Methods: Prior to and after EVAR in 7 patients with abdominal aortic aneurysms (AAA), 12 MRI images per cardiac cycle were acquired in transverse, sagittal, and coronal planes of the aneurysm. Two independent observers blinded to the aim of the study manually traced stent-graft and aneurysm wall contours. Translation was defined as the maximal displacement of the contours in the peak-systolic image compared to the end-diastolic image. Aneurysm wall motions before and after repair were compared. Stent-graft and aneurysm configuration changes during the cardiac cycle were evaluated. The relation between translation and the degree of angulation of the stent-graft was calculated. Results: The anteroposterior translation of the aneurysm decreased from a median 1.05 mm (range <0.5–1.29) before EVAR to within pixel size (<0.5 mm) after EVAR (p=0.04). The cranial-caudal translation of the aneurysm increased from a median 1.01 mm (range <0.5–1.51) before to 1.69 mm (range 1.1–1.99) after EVAR (p=0.02). In 4 stent-grafts, bending during cardiac systole was observed at the site of maximal angulation of the device. In transverse sections, 2-dimensional pulsatile wall motion of the aneurysm was 0.25 cm2 (range 0.07–0.29) before and 0.17 cm2 (range 0.07–0.42) after EVAR (p=0.79). No pulsatility of the stent-graft itself was observed. The correlation coefficient between angulation of the stent-graft and the increase in cranial-caudal translation after EVAR was 0.67 (p>0.05). Conclusions: After EVAR, increased longitudinal translation of both the aneurysm and stent-graft was observed, indicating downward pulling forces at the proximal fixation site. Secondly, increased bending was seen at the site of maximal angulation, which implies a risk of metal fatigue and fabric damage at sites of stent-graft angulation.
Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: Logistics and Short-Term Results
Authors: Resch Timothy , Malina Martin , Lindblad Bengt , Dias Nuno V. , Sonesson Björn , Ivancev Krassi 
Published: March 2015

Purpose: To report our experience in establishing a treatment protocol for endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (rAAA), including an investigation of the reasons for patient exclusion and a report of our short-term results. Methods: Between 1997 and July 2002, 21 patients with rAAA underwent endovascular repair according to our protocol and were followed prospectively. A retrospective analysis was also conducted of 23 rAAA patients treated with open repair from January 2001 through June 2002. Procedural and clinical data from this sample were compared to 14 contemporaneous emergent EVAR cases and analyzed to determine why the open repair patients were not treated with an endovascular approach. Results: Among the 21 patients treated with emergent EVAR since the beginning of this protocol, 6 (29%) procedures were performed under local anesthesia and 6 were performed percutaneously. Thirty-day mortality was 19%. In the comparison of 14 emergent EVAR cases to 23 open rAAA repairs, the mean duration of symptoms prior to intervention was 12 hours for the EVAR patients and <1 hour for OR patients. No significant difference was found in operating time, but the EVAR group had significantly less blood loss (p=0.0001) and transfusion needs (p=0.02); duration of intensive care unit stay was significantly shorter in the EVAR group (p=0.02). Thirty-day mortality was 29% (4/14) for EVAR and 35% for OR (8/23) (p>0.05). Reasons for not performing EVAR were unavailability of adequate equipment (n=11) or trained staff (n=7), hemodynamically unstable patient (n=2), mycotic aneurysm (n=2), and unfavorable anatomy in a 60-year old patient with a <5-mm-long, sharply angled infrarenal neck. Conclusions: Endovascular repair of ruptured aortic aneurysms is feasible, and short-term results are promising. Good logistics, adequate training of physicians and staff in an elective setting, and versatile endografts are prerequisites for this type of treatment program.
Endovascular Stent-Graft Repair of Ruptured Aortic Aneurysms
Authors: Scharrer-Pamler Reinhard , Kotsis Thomas , Kapfer Xaver , Görich Johannes , Sunder-Plassmann Ludger 
Published: March 2015

Purpose: To demonstrate the endovascular approach to the management of ruptured abdominal aortic aneurysms (AAA). Methods: From 1995 to 2001, 24 patients (21 men; mean age 69 years, range 26–92) underwent emergency endovascular treatment for ruptured AAA. The average interval between onset of symptoms and admission to the hospital was 8.0 hours; the mean time between admission and the operation was 2.3 hours. No suprarenal occluding catheter was used. The stent-graft configurations were 19 bifurcated, 4 tube, and 1 aortomonoiliac. Results: Stent-graft placement was successful in 23 (96%) cases. Failed limb extension deployment prompted conversion to open surgery in the remaining patient. One case was converted to open surgery. Mean duration of treatment was 122 minutes. Three (12.5%) patients died in-hospital. The median hospital stay was 12 days. The rate of endoleaks (all type I) was 16.7%. The overall technical success rate was 77%. The 3-year actuarial survival rate was 75%. Conclusions: Our experience shows excellent results in emergency patients with ruptured AAAs treated with endovascular surgery. In order to verify these promising results, a broader-scale clinical study must be conducted.
Anatomical Suitability of Ruptured Abdominal Aortic Aneurysms for Endovascular Repair
Authors: Rose Daniel F.G. , Davidson Ian R. , Hinchliffe Robert J. , Whitaker Simon C. , Gregson Roger H. , MacSweeney Shane T. , Hopkinson Brian R. 
Published: March 2015

Purpose: To assess the anatomical suitability of ruptured abdominal aortic aneurysms (AAA) for emergency endovascular repair. Methods: All cases (46 patients [35 men; mean age 74 years, range 54–85]) in which computed tomographic angiography (CTA) confirmed AAA rupture over a 5-year period at our university hospital were reviewed for anatomical suitability for endovascular repair. Measurements were made by a radiologist experienced in anatomical assessment of CT criteria for elective endovascular aneurysm repair (EVAR). Results: The mean aneurysm neck length was 18 mm (range 0–59); 17 were conical, 13 straight, 4 barrel, and 6 reverse conical. Six cases had no proximal neck. Overall, 37 (80%) patients were unsuitable for EVAR according to our criteria. Nearly half the patients (22, 48%) had ≥2 adverse features. Unsuitable neck morphology (35, 76%) was the primary reason for exclusion, but CIA aneurysm (10, 22%) and EIA tortuosity (7, 15%) were secondary adverse features. Conclusions: With current stent-graft design, the majority of ruptured abdominal aortic aneurysms are anatomically unsuitable for endovascular repair.
Endoluminal AAA Repair Using Intravascular Ultrasound for Graft Planning and Deployment: A 2-Year Community-Based Experience
Authors: Slovut David P. , Ofstein Lewis C. , Bacharach J. Michael 
Published: March 2015

Purpose: To examine the effectiveness of intravascular ultrasound (IVUS) and digital subtraction angiography (DSA) for preoperative planning and intraoperative deployment of stent-grafts to treat abdominal aortic aneurysms. Methods: One hundred seventy patients (143 men; mean age 73.6±7.2 years, range 51–89) underwent successful DSA and IVUS to determine suitability for stent-graft repair. Patients subsequently received the AneuRx (n=157) or Ancure (n=13) device; intraprocedural IVUS was used to survey the proximal endograft for proper apposition to the aortic wall. Results: Reliable preoperative IVUS measurements were obtained in all patients. Plaque morphology was assessed in 140 (82.3%) aortic necks; in 36 (25.7%), preoperative IVUS showed high-grade atherosclerotic plaque in the nonaneurysmal abdominal aortic neck. The procedure was successful in 168 (98.8%) cases (1 [0.6%] acute conversion and 1 access failure). There were 2 (1.2%) periprocedural deaths related to bowel ischemia. Four (2.3%) patients developed graft occlusion/kinking and 2 (1.2%) developed renal failure requiring dialysis within 30 days. Multivariate logistic regression analysis revealed that female gender (p=0.0247), a short nonaneurysmal aortic neck (p=0.0185), and presence of high-grade atherosclerotic plaque (p=0.0185) correlated with major acute complications. Over a mean 10.4-month follow-up (range 1–25), 11 patients died of unrelated causes; there was no known AAA rupture or device failure. The Kaplan-Meier estimate of survival at 1 year was 91.0%±2.8%. Sixteen (9.4%) patients underwent 17 secondary procedures for endoleak or graft limb occlusion at a mean 5.4 months after stent-graft repair (freedom from secondary intervention at 1 year 86.5%±3.2%). Conclusions: Our findings suggest that IVUS may identify patients at increased risk of major adverse complications following endovascular repair. The combination of IVUS and DSA for endoluminal stent-graft planning and placement provides excellent short- and mid-term patient outcomes.
Endovascular Treatment of Acute Complications Associated with Aortic Dissection: Midterm Results from a Multicenter Study
Authors: Beregi Jean-Paul , Haulon Stéphan , Otal Philippe , Thony Frédéric , Bartoli Jean-Michel , Crochet Dominique , Lacombe Pascal , Bonneville Jean-François , Besse Francis , Douek Philippe , Heautot Jean-François , Rousseau Hervé ,   For the Société Française d'Imagerie Cardio-Vasculaire (SFICV) Research Group on Aortic Dissection
Published: March 2015

Purpose: To evaluate endovascular procedures in the management of acute ischemic complications and rupture of the false lumen in aortic dissections. Methods: Data on patients with aortic dissection and noncardiac acute complications (peripheral ischemia or thoracic aortic rupture) treated with endovascular techniques were collected from 10 institutions and retrospectively analyzed. From March 1997 to January 2000, 58 patients (50 men; mean age 59.6±12.8 years) were treated for 19 (33%) type A and 39 (67%) type B dissections. Twelve (21%) patients had thoracic aortic rupture; 46 (79%) patients had one or more peripheral ischemic complications that included bowel pain (19, 41%), anuria associated with acute renal insufficiency (18, 39%), lower limb ischemia (15, 33%), and/or uncontrolled hypertension with renal ischemia (14, 30%). Results: In the thoracic rupture cohort, all 12 patients were treated successfully with stent-grafts; one distal endoleak required a secondary procedure. There were 2 (12%) periprocedural deaths; one patient developed transient paraplegia after a secondary surgical procedure. In the 46 patients treated with stent implantation, fenestration, or both for peripheral ischemic symptoms, 44 (96%) had patency restored to the malperfused vessel. Eight (17%) patients died within 30 days. Over a mean follow-up of 8.2±8.9 months, the false lumen had thrombosed in 7 (70%) of the stent-graft patients. In the 38 surviving ischemic patients, the diameters of the true and false lumens and maximum transverse aorta all increased; only 4 (11%) had total thrombosis of the false lumen. Conclusions: Endovascular treatment of noncardiac acute complications associated with aortic dissection has favorable early and midterm outcomes.