bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effort Subclavian Vein Thrombosis: Evolution of Management
Authors: AbuRahma Ali F. , Robinson Patrick A. 
Published: March 2015

Purpose: To analyze changes in the management of effort subclavian vein thrombosis at our institution. Methods: Records of 23 patients with effort subclavian vein thrombosis treated over a 10-year period were analyzed to compare the results of conventional therapy (heparin/warfarin) used in the first half of this period to a multimodality treatment strategy (thrombolysis and other adjunctive treatment as indicated, e.g., first rib resection, angioplasty/stenting, and vein reconstruction). Diagnostic testing included duplex ultrasound and venography. All patients had at least 1-year follow-up. Results: Eight patients (7 men; mean age 34 years, range 15–54) had conventional treatment (group A) and 15 patients (14 men; mean age 36 years, range 17–55) had multimodality therapy (group B). Demographics and clinical characteristics were comparable for both groups. Initial thrombolysis was achieved in 14 (93%) group B patients; 10 received adjunctive treatment to relieve external compression or vein stenosis. Four patients had successful first or cervical rib resection and scalenectomy, and first rib resection followed by angioplasty/stenting was successful in 2. However, angioplasty and stenting alone failed in 2 patients, while venous reconstruction was successful in only 1 of 2 cases. Mean follow-up was 72 months in group A patients and 59 months in group B. One (13%) group A patient and 12 (80%) group B patients demonstrated total venous recanalization and symptom resolution (p = 0.003). Overall, clinical resolution (total and partial symptom relief) was achieved in 3 (38%) group A patients and 13 (87%) group B patients (p = 0.026). Conclusions: Initial lytic therapy followed by adjunctive treatment to relieve external venous compression or venous stenosis is effective in treating patients with effort subclavian vein thrombosis.
Safety, Efficacy, and Durability of Carotid Artery Stenting for Restenosis following Carotid Endarterectomy: A Multicenter Study
Authors: New Gishel , Roubin Gary S. , Iyer Sriram S. , Vitek Jiri J. , Wholey Mark H. , Diethrich Edward B. , Hopkins L. Nelson , Hobson Robert W. , Leon Martin B. , Myla Subbarao V. , Shawl Fayaz , Ramee Stephen R. , Yadav Jay S. , Rosenfield Kenneth , Liu Ming W. , Gomez Camilo R. , Al-Mubarak Nadim , Gray William A. , Tan Walter A. , Goldstein Jonathan E. , Stack Richard S. 
Published: March 2015

Purpose: To present the results of a multicenter registry established to collect data on carotid stent procedures in patients with restenosis following carotid endarterectomy. Methods: The procedural details, outcomes, and late follow-up results were collected from 14 centers in the United States. Thirty-day and late stroke and death rates were analyzed. Results: Three hundred and thirty-eight patients (201 men; 71 ± 8 years) underwent carotid stenting in 358 arteries. The average duration from carotid endarterectomy was 5.5 ± 7.3 years. Sixty-one percent of the patients were asymptomatic. The overall 30-day stroke and death rate was 3.7%. The minor stroke rate was 1.7% (6/358), and the major nonfatal stroke rate was 0.8% (3/358). The fatal stroke rate was 0.3% (1/358), and the nonstroke-related death rate was 0.9% (3/338). There was 1 (0.3%) fatal and 1 (0.3%) nonfatal stroke during the follow-up period. The overall 3-year rate of freedom from all fatal and nonfatal strokes was 96% ± 1% (±SE). Conclusions: Carotid artery stenting can be performed in patients with restenosis following carotid endarterectomy with 30-day complication rates comparable to those of most published studies on repeat carotid endarterectomy. Results of late follow-up suggest that this technique is durable and efficacious.
Endovascular Repair of an Extracranial Internal Carotid Artery Aneurysm Complicated by Heparin-Induced Thrombocytopenia and Thrombosis
Authors: van Sambeek Marc R.H.M. , Segeren Christine M. , van Dijk Lukas C. , van Essen Jeroen A. , Dippel Diederik W.J. , van Urk Hero 
Published: March 2015

Purpose: To report the endovascular treatment of a symptomatic extracranial internal carotid artery (ICA) aneurysm that was complicated by heparin-induced thrombocytopenia and thrombosis. Methods and Results: After undergoing a coronary artery bypass graft procedure, a patient was diagnosed with a symptomatic, 3.5-cm ICA aneurysm by computed tomography and angiography. Via a semiclosed access, an Enduring vascular graft was inserted under controlled back bleeding from the ICA. The patient was recovering uneventfully when routine duplex scanning on the fifth postoperative day suggested multiple thrombi within the graft, which was confirmed by arteriography. Thrombectomy and local fibrinolysis were performed; however, the graft occluded the next day without causing neurological symptoms. Heparin-induced thrombocytopenia was diagnosed by enzyme-linked immunosorbent assay. Conclusions: Endovascular repair of high cervical extracranial ICA aneurysms is feasible, and protection against intracerebral embolization can be achieved using a semiclosed technique with controlled back bleeding from the ICA during endograft deployment. However, multiple thrombi or thrombotic occlusion during the postoperative period, particularly in a patient already sensitized to heparin, should direct attention toward possible heparin-induced thrombocytopenia.
Quality of Life before and after Endovascular and Open Repair of Asymptomatic AAAs: A Prospective Study
Authors: Malina Martin , Nilsson Marie , Brunkwall Jan , Ivancev Krasnodar , Resch Timothy , Lindblad Bengt 
Published: March 2015

Purpose: To assess how patients perceive health-related quality of life (HRQOL) after endovascular and open abdominal aortic aneurysm (AAA) repair. Methods: Forty-two consecutive patients (33 men; mean age 74 years, range 46–81) were assessed prospectively before and after elective endovascular (n = 21) and open (n = 21) AAA repair. Aneurysm morphology dictated the type of repair. The two patient groups were similar regarding age, gender, comorbidities, and cardiopulmonary function. Data concerning surgical trauma were compiled. The Nottingham Health Profile (NHP) score was used to assess the perceived HRQOL (criteria: pain, mobility, sleep, emotion, energy, and isolation) preoperatively and at 5, 30, and 90 days postoperatively. Specific treatment perception questions were added. Results: One patient from each group died, leaving 40 patients to complete the study. Two patients with open repair and 1 patient with endovascular repair were unfit to answer the questionnaire on day 5. The HRQOL improved at 3 months compared with the preoperative values (p < 0.05). No significant difference was found at any time between the open and endovascular groups regarding the NHP score, although the operative time, blood loss, analgesic use, and hospital stay were significantly in favor of endovascular repair. Reinterventions were required in 5 patients with endovascular and 2 patients with open repair. Conclusions: In general, 3 months after AAA repair, the perceived HRQOL seems better than before treatment. Perceived HRQOL is similar after endovascular and open AAA repair despite greater surgical trauma in open surgery. This may reflect the higher number of reinterventions following endovascular repair but also difficulties in defining HRQOL.
Suprarenal Mycotic Aneurysm Exclusion Using a Stent with a Partial Autologous Covering
Authors: Madhavan Prakash , McDonnell Ciaran O. , Dowd Mariana O. , Sultan Sherif A. H. , Doyle Maeve , Colgan Mary-Paula , McEniff Nial , Molloy Martin , Moore Dermot J. , Shanik Gregor D. 
Published: March 2015

Purpose: To report a combined endovascular and open technique to manage a suprarenal mycotic aortic aneurysm using a stent-graft partially covered with a section of autologous artery. Methods and Results: A 50-year-old was hospitalized for staphylococcal septicemia and severe back pain. A previously diagnosed 3-cm abdominal aortic aneurysm was found to have expanded 2 cm in 3 weeks. Aortography documented some periaortic thickening and 2 mycotic aneurysms, one posterior at the level of the superior mesenteric artery and the second at the aortic bifurcation. After intensive antibiotic therapy, an endovascular approach to exclude the suprarenal mycotic aneurysm was undertaken in tandem with surgical excision of the infrarenal aneurysm. The harvested right common iliac artery was used to partially cover a Palmaz stent, which was deployed under direct vision just above the renal artery ostia so that the covered portion of the stent excluded the aneurysm. A right axillofemoral bypass with a femorofemoral bypass completed the revascularization. Postoperatively, the patient developed renal failure, ischemic colitis necessitating a left hemicolectomy, and paraplegia. Although the patient is paralyzed, the aneurysm remains excluded with patent visceral vessels at 12 months following surgery. No organisms were grown from excised aortic tissue, and no signs of recurrent infection have been seen. Conclusions: Stent-graft repair may be able to lessen the invasiveness and reduce the morbidity associated with treatment of mycotic aortic aneurysms.
Does Successful Embolization of Endoleaks Lead to Aneurysm Sac Shrinkage?
Authors: Ermis Cengiz , Krämer Stefan , Tomczak Reinhard , Pamler Reinhard , Kolokythas Orpheus , Schütz Ansgar , Wisianowsky Christian , Kapfer Xaver , Görich Johannes 
Published: March 2015

Purpose: To determine whether embolization of endoleaks after endovascular repair of aortic aneurysms is associated with a decrease in the diameter of the aneurysm. Methods: Fifteen patients (13 men; median age 76 years) demonstrated primary endoleaks persisting ≥ 3 months after endovascular abdominal aortic aneurysm repair with a variety of commercial endografts. In 8 patients, coil embolization failed to completely obliterate the leak, whereas embolotherapy proved successful in the remaining 7 patients. Surveillance of endoleaks and the effect of their embolization on aneurysm size were followed with serial computed tomographic (CT) scans. Follow-up after embolization extended for at least 12 months. Results: Patients with persistent leak exhibited a slight increase in mean aneurysm area from 21.41 ± 4.25 to 22.47 ± 6.70 cm2. Medians differed from 20.03 (range 16.59–28.73) to 23.03 (range 14.14–33.69) cm2 (p = 0.0078, 95% confidence interval [CI] = 0.0075 to 0.0081). Successfully treated patients, however, showed a mean decrease from 20.58 ± 3.63 (median 19.87) to 16.36 ± 6.46 cm2 (median 18.10) at 1 year (p = 0.0156, 95% CI = 0.0151 to 0.0160). The medians differed significantly between groups (p < 0.05). Conclusions: Persistent endoleaks after endovascular aortic aneurysm treatment led to an increase in the diameter of the aneurysm, whereas complete occlusion was associated with a significant decrease in aneurysm diameter.
Aneurysm Expansion and Retroperitoneal Hematoma after Thrombolysis for Stent-Graft Limb Occlusion Caused by Distal Endograft Migration
Authors: Resch Timothy , Lindblad Bengt , Lindh Mats , Brunkwall Jan , Ivancev Krassi 
Published: March 2015

Purpose: To describe a complication of thrombolytic therapy used to treat graft limb occlusion precipitated by distal migration and kinking of an abdominal aortic stent-graft. Case Report: A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woman was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up, she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated distally approximately 5 mm, and the left graft limb was occluded. Thrombolysis was initiated, but after approximately 8 hours, abdominal pain began. Emergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped; transfusions and thrombogenic drugs were given to restore hemodynamic stability. The aneurysm began to decrease in size. The occluded graft limb had been reopened by the lytic therapy, uncovering a stenosis in the native artery distal to the graft limb. Stent placement restored outflow. The retroperitoneal hematoma resolved over time, and the aneurysm sac shrank to its prelytic diameter. The patient is well with a functioning endograft 18 months after the occlusion (30 months after stent-grafting). Conclusions: Caution must be taken when using thrombolysis in patients with endovascular aortic grafts because unexpected bleeding complications might arise. Thrombectomy, femorofemoral bypass, or stent or stent-graft extensions might be safer alternatives for treating occluded stent-graft limbs.
Role of Duplex Imaging in Endovenous Obliteration for Primary Venous Insufficiency
Authors: Pichot Olivier , Sessa Carmine , Chandler James G. , Nuta Michel , Perrin Michel 
Published: March 2015

Purpose: To assess the role of duplex imaging in defining suitable pathological anatomy for endovenous obliteration and characterizing its treatment outcomes over time. Methods: Eighteen lower limbs in 17 patients (12 women; mean age 48 years; range 29– 74 years) presenting with varicose greater saphenous veins (GSVs) were treated with endovenous obliteration without adjunctive high ligation. Duplex imaging was used as an intraprocedural guidance tool for vein access and catheter positioning and for preprocedural evaluation and serial surveillance after the procedures. Results: In the 18 limbs, preprocedural duplex scanning defined reflux owing to incompetence of the terminal valve (n = 6), subterminal valve (n = 9), or truncal valve (n = 3). Duplex imaging facilitated percutaneous vein puncture and was essential in catheter positioning at the saphenofemoral junction (SFJ). At 1 week, the saphenous trunks of all 18 limbs were either shrunken and obliterated (n = 7) or occluded by thrombus without shrinkage (n = 11). By 6 months, 7 GSVs were no longer sonographically visible, 10 were shrunken and obliterated, and 1 had a segmental partial recanalization. In the 15 limbs with terminal or subterminal valve incompetence at 1 week, 5 had total SFJ obliteration, 4 had ≥1 patent tributaries draining directly into the femoral vein through an open SFJ, and 6 had ≥1 patent tributaries draining into an open SFJ through a short (<2 cm) proximal saphenous trunk. By 6 months, only 1 limb had total SFJ occlusion; the other 14 had at least 1 persistent or reopened tributary. Conclusions: Duplex scanning is indispensable for selecting patients, guiding the procedure, and defining the morphological maturation and hemodynamic changes that appear to characterize successful endovenous obliteration.
An Endovascular Model of Carotid Stenosis for the Evaluation of Thrombolysis and Angioplasty
Authors: Lin Peter H. , Surowiec Scott M. , Conklin Brian , Bush Ruth L. , Chen Changyi , Chaikof Elliot L. , Lumsden Alan B. 
Published: March 2015

Purpose: To develop a porcine carotid artery thrombosis model using a novel stent-graft device to evaluate the efficacy of thrombolytic therapy and angioplasty procedures. Methods: An endovascular device made from a tapered polytetrafluoroethylene graft inverted in a self-expanding nitinol stent was delivered to bilateral carotid arteries via a right femoral approach in 16 pigs. Carotid thrombotic occlusion ensued from flow stasis created by the intrastent stenosis. Via selective carotid catheterization from a femoral approach, urokinase (250,000 IU) was pulse-sprayed in one carotid artery while a control saline solution was infused in the contralateral vessel; delivery times were 1 hour, 8 hours, 3 days, or 6 days after carotid occlusion (4 animals per time period). After thrombolysis, balloon angioplasty was performed to maintain carotid patency. Arteriography and intravascular ultrasound were used to evaluate the efficacy of thrombolysis. Light microscopy was used for histological analysis of the thrombus. Results: Carotid artery occlusion occurred in 15 ± 8 minutes after stent-graft placement in all animals. Urokinase was effective in recanalizing all occluded arteries in the 1-hour, 4-hour, and 3-day groups (100%) but was effective in only 2 of 4 animals in the 6-day group (p < 0.05). Overall thrombolytic efficacy was 78% ± 7%. Control saline solution showed no thrombolytic effect (p < 0.001). Angioplasty successfully restored normal luminal diameter in all fully lysed arteries (100%). Histological analysis showed fibrin-predominant thrombus with a varying degree of platelet deposition. Conclusions: This endovascular approach, which creates a carotid stenosis using this novel stent-graft device, is reliable in producing carotid thrombosis. In our model, thrombolytic therapy was effective in restoring luminal patency, and the intraluminal stenosis is amenable to balloon angioplasty. The model is useful for the evaluation of antithrombotic therapy and adjunctive endovascular interventions.
Does Complete Aneurysm Exclusion Ensure Long-term Success after Endovascular Repair?
Authors: Lee W. Anthony , Wolf Yehuda G. , Fogarty Thomas J. , Zarins Christopher K. 
Published: March 2015

Purpose: To examine whether complete aneurysm exclusion is a reliable marker for successful long-term endovascular abdominal aortic aneurysm (AAA) repair. Methods: The medical records, computed tomographic (CT) scans, and duplex examinations of all the patients who underwent endovascular AAA repair at a single institution and had at least 12 months of follow-up were reviewed. Sixty-seven patients (58 men; mean age 74 years, range 57–87) were identified. Complete aneurysm exclusion was defined by the absence of an endoleak at any time before an adverse event. The primary endpoint included all major adverse events that occurred during the postoperative period, including aneurysm expansion, acute symptoms referable to the AAA, late secondary procedures, ruptures, and deaths from ruptures and all other causes. Results: There were 44 adverse events (8 expanding aneurysms, 4 acute symptoms, 17 secondary procedures, and 15 deaths from other causes) in 28 (42%) patients. Among 36 (54%) patients who had initial complete aneurysm exclusion (no endoleak), 12 (33%) experienced adverse events, compared with 16 (52%) events in 31 patients who had endoleak (χ2 = 1.59, p = 0.21). Conclusions: There was no statistically significant difference in adverse events based on the presence or absence of endoleak. Complete aneurysm exclusion as defined by absence of an endoleak does not indicate an event-free postoperative course. A better marker of clinical success of endovascular AAA repair is needed.
Transseptal Guidewire Stabilization Facilitates Stent-Graft Deployment for Persistent Proximal Ascending Aortic Dissection
Authors: Dorros Gerald , Dorros Ari M. , Planton Sara , O'Hair Daniel , Zayed Mahmoud 
Published: March 2015

Purpose: To report endovascular repair of a DeBakey type I ascending aortic dissection. Case Report: Five months after aortocoronary bypass grafting, a 56-year-old woman demonstrated a persistent ascending aortic type I dissection whose entry tear proximal to the innominate artery spiraled down the descending thoracic aorta into the iliofemoral arteries. Repair was facilitated with a guidewire passed through a transseptal sheath in the right femoral vein. The guidewire traversed the right and left atria and the left ventricle and then exited into the ascending aorta and was exteriorized through the right femoral artery. A right brachial catheter aided contrast visualization of the innominate artery. Adenosine-induced elective cardiac arrest promoted precise placement of a customized polyester-covered balloon-expandable stent, which closed the aortic rent. Conclusions: A transseptal approach enables the guidewire to follow the curvature of the aortic arch, providing precise control of the stent-graft delivery system. This case illustrates the applicability of endovascular techniques to repair ascending aortic pathologies using readily available techniques, equipment, and drugs.
An Endovascular System for Thoracoabdominal Aortic Aneurysm Repair
Authors: Chuter Timothy A.M. , Gordon Roy L. , Reilly Linda M. , Goodman Jay D. , Messina Louis M. 
Published: March 2015

Purpose: To describe a stent-graft system for endovascular repair of thoracoabdominal aortic aneurysm (TAAA) that preserves side branch perfusion. Technique: The modular endograft system includes 3 components. The primary stent-graft is custom-made from conventional graft fabric and Gianturco Z-stents. Covered nitinol Smart Stents are used for the visceral and renal extensions, and the distal extension is made from a modified Zenith system. With the supine patient under general anesthesia, the components are delivered sequentially through surgically exposed femoral and right brachial arteries in an operation that requires prolonged periods of magnified high-resolution imaging. This system was first used in a 76-year-old man with a contained rupture of a supraceliac ulcer and a large abdominal aortic aneurysm ending proximally at the celiac artery. The endograft was implanted successfully, but the patient developed paraplegia on day 2; imaging documented an excluded aneurysm and excellent flow through the endograft and all prosthetic branches. Discussion: Endovascular repair of TAAA appears to be feasible. If there are no serious, specific, unavoidable complications, the potential advantages are enormous.
Sequential Coil Embolization of Bilateral Internal Iliac Artery Aneurysms Prior to Endovascular Abdominal Aortic Aneurysm Repair
Authors: Halloul Zuhir , Bürger Thomas , Grote Reinhard , Fahlke Jörg , Meyer Frank 
Published: March 2015

Purpose: To report the endovascular repair of concomitant aneurysms of the abdominal aorta and both internal iliac arteries. Case Report: A 72-year-old man with a 5.5-cm abdominal aortic aneurysm (AAA) extending to the right common iliac artery also presented with separate aneurysms of both internal iliac arteries. The patient refused conventional surgery, so an endovascular strategy was devised. Initially, the iliac aneurysms were sequentially coil embolized, allowing several weeks to elapse between the embolization sessions to encourage collateral development. A bifurcated Talent endograft was inserted successfully 8 months after the initial intervention; no evidence of endoleaks or mesenteric ischemia has been seen over a 1-year follow-up. Conclusions: This case illustrates the feasibility of inducing collateralization prior to endovascular AAA repair that would jeopardize internal iliac artery circulation bilaterally. Sequential embolization of the internal iliac arteries over several months initiates this response, paving the way for eventual endovascular repair of the primary aortic aneurysm.