bluuebunny/crossref_metadata_2025_split huggingface dataset:
Noninvasive Diagnosis of Incomplete Endovascular Aneurysm Repair: D-Dimer Assay to Detect Type I Endoleaks and Nonshrinking Aneurysms
Authors: Serino Francesco , Abeni Damiano , Galvagni Elisabetta , Sardella Savino G. , Scuro Alberto , Ferrari Mauro , Ciarafoni Iole , Silvestri Lorena , Fusco Angelo 
Published: March 2015

Purpose: To test the hypothesis that D-dimer (D-D), a cross-linked fibrin degradation product of an ongoing thrombotic event, could be a marker for incomplete aneurysm exclusion after endovascular abdominal aortic aneurysm (AAA) repair. Methods: In a multicenter study, 83 venous blood samples were collected from 74 AAA endograft patients and controls. Twenty subjects who were >6 months postimplantation and had evidence of an endoleak and/or an unmodified or increasing AAA sac diameter formed the test group. Controls were 10 nondiseased subjects >65 years old, 18 AAA surgical candidates, and 26 postoperative endograft patients with no endoleak and a shrinking aneurysm. Blood samples were analyzed for D-D through a latex turbidimetric immunoassay. The endograft patients were stratified into 5 clinical groups for analysis: no endoleak and decreasing sac diameter, no endoleak and increasing/unchanged sac diameter, type II endoleak and decreasing sac diameter, type II endoleak and increasing/unchanged sac diameter, and type I endoleak. Results: Individual D-D values were highly variable, but differences among clinical groups were statistically significant (p < 0.0001). D-D values did not vary significantly between patients with stable, untreated AAAs and age-matched controls (238 ± 180 ng/mL versus 421 ± 400 ng/mL, p > 0.05). Median D-D values increased at 4 days postoperatively (963 ng/mL versus 382 ng/mL, p > 0.05) and did not vary thereafter if there was no endoleak and the aneurysm sac decreased. D-D mean values were higher in patients with type I endoleak (1931 ± 924 ng/mL, p < 0.005) and those with unchanged/increasing sac diameters (1272 ± 728 ng/mL) than in cases with decreasing diameters (median 638 ± 238 ng/mL) despite the presence of endoleak (p < 0.0005). Conclusions: Elevated D-D may prove to be a useful marker for fixation problems after endovascular AAA repair and may help rule out type I endoleak, thus excluding patients from unnecessary invasive tests.
“Pseudoendoleak”— Residual Intrasaccular Contrast after Endovascular Stent-Graft Repair
Authors: Lee W. Anthony , Rubin Geoffrey D. , Johnson Bonnie L. , Arko Frank , Fogarty Thomas J. , Zarins Christopher K. 
Published: March 2015

Purpose: To present a unique demonstration of postoperative perigraft contrast masquerading as an endoleak following endovascular abdominal aortic aneurysm (AAA) repair. Case Report: A 66-year-old man underwent endovascular stent-graft repair of a 4.6-cm infrarenal AAA. The procedure was uncomplicated, and intraoperative completion angiography demonstrated good proximal and distal fixation of the stent-graft without an endoleak. A spiral computed tomographic (CT) angiogram obtained on postoperative day 2 revealed a large amount of extrastent contrast along the posterior aspect of the aneurysm sac. This defect had the appearance of an endoleak, but it was also present on the noncontrast images. A color-flow duplex examination performed on the same day showed a widely patent stent-graft with no evidence of extrastent flow. Conclusions: Contrast trapped in the aneurysm sac during endovascular aneurysm repair may be misinterpreted as an endoleak on postprocedural CT scans. “Pseudoendoleaks” can be distinguished from true endoleaks by examination of prebolus, noncontrast CT images, as well as by duplex ultrasound scanning.
Partially Clipped Intracranial Aneurysm Obliterated with Combined Stent and Coil Implantation
Authors: Lylyk Pedro , Cohen José E. , Ferrario Angel , Ceratto Rosana , Miranda Carlos 
Published: March 2015

Purpose: To report a case of endovascular stent placement to assist stable coil deployment in a symptomatic, wide-necked, partially clipped aneurysm. Case Report: A 48-year-old woman presented for endovascular treatment of a symptomatic posterior communicating artery aneurysm remnant that was surgically clipped 10 years ago. A 3.5-mm × 12-mm balloon-expandable stent was placed across the aneurysm orifice followed by complete obliteration of the remnant with coils implanted through the stent mesh. Digital subtraction angiography documented continued patency of the arterial lumen and complete obliteration of the aneurysm at 11 months. Conclusions: Partial aneurysm clipping may assist or complicate secondary interventional procedures and interfere with correct visualization of the neck. Stent placement obviates the need for the balloon-assist method of coil embolization for wide-necked aneurysm remnants, acting as a mechanical barrier to hold the coils in a very unfavorable anatomy.
Emergent Repair of a Ruptured Abdominal Aortic Aneurysm Using an AneuRx Stent-Graft
Authors: Kumar Vinay , Campbell Joe H. , Andy Orlando J. , Hatten Lewis E. 
Published: March 2015

Purpose: To report a case of ruptured abdominal aortic aneurysm (AAA) treated with a commercially available endoluminal graft. Case Report: Ruptured AAA was diagnosed in a 58-year-old man with lower abdominal pain, hypotension, and syncope. A contrast-enhanced computed tomographic (CT) scan confirmed the presence of a 7-cm ruptured infrarenal AAA associated with a large retroperitoneal hematoma. The aneurysm was successfully excluded with a bifurcated AneuRx stent-graft placed through a femoral approach in an emergent procedure. The patient was discharged on the third postoperative day. CT scans at 1 and 10 months demonstrated complete resolution of the retroperitoneal hematoma and continued exclusion of the aneurysm. Conclusions: The AneuRx stent-graft can be successfully applied for the treatment of a ruptured AAA in emergency situations.
CT-Guided Percutaneous Embolization of a Lumbar Artery Maintaining a Type II Endoleak
Authors: Schmid Roger , Gürke Lorenz , Aschwanden Markus , Stierli Peter , Jacob Augustinus Ludwig 
Published: March 2015

Purpose: To demonstrate the possibility of percutaneous embolization of a type II endoleak guided by computed tomographic (CT) fluoroscopy. Case Report: A type II endoleak maintained by a hypertrophic fourth lumbar artery failed to occlude spontaneously 7 months after stent-graft deployment for endovascular repair of an infrarenal abdominal aortic aneurysm. A percutaneous procedure was performed to eliminate the endoleak using needle puncture and embolization under CT fluoroscopic guidance. The sagittal diameter of the aneurysm sac, which had remained constant after initial endovascular exclusion, shrank from 5.2 to 4.8 cm in the 3 months following embolization. Conclusions: Percutaneous embolization of lumbar branches guided by CT fluoroscopy may be an alternative to other therapies for type II endoleaks.
Preoperative Duplex-Derived Parameters and Angioscopic Evidence of Valvular Incompetence Associated with Superficial Venous Insufficiency
Authors: Yamaki Takashi , Sasaki Kenji , Nozaki Motohiro 
Published: March 2015

Purpose: To determine if an association exists between duplex-derived parameters and intraoperative angioscopic findings of valvular incompetence. Methods: Preoperative duplex scanning and intraoperative angioscopy were performed on 153 limbs in 116 patients (84 women; mean age 53 years, range 24–79) with superficial venous incompetence (SVI). The duplex parameters of vein diameter at the saphenofemoral junction (SFJ), reflux duration, and peak retrograde reflux velocity at the SFJ were analyzed among SVI patients categorized by intraoperative angioscopy as type I (valves with elongated and atrophic cusps), type II (valves with expanded and depressed commissures with cusp changes), type III (cusps with other deformities), or type IV (absent valves). Results: There were 33 limbs with type I valves, 56 with type II, 25 with type III, and 39 with type IV. Among the 89 limbs with type I or II valves, 64 (71.9%) had a peak velocity <30 cm/s, while only a quarter of the limbs with type III or IV values had a velocity <30 cm/s. The majority of patients with types I or II valves had a vein diameter <0.9 cm (25 [75.8%] type I and 37 [66.1%] type II). The sensitivity, specificity, and predictive value for identifying type I and II valve lesions were maximized at 90.0%, 66.7%, and 77.8%, respectively, when vein diameter <0.9 cm was combined with a peak reflux velocity >30 cm/s. Conclusions: These data suggest that a combination of variables determined by preoperative duplex scans may correlate to the severity of valvular deformity determined by direct angioscopic inspection.
Predicting Spinal Cord Ischemia before Endovascular Thoracoabdominal Aneurysm Repair: Monitoring Somatosensory Evoked Potentials
Authors: Bafort Catherine , Astarci Parla , Goffette Pierre , El Khoury Gebrine , Guerit Jean-Michel , de Tourtchaninoff Marianne , Verhelst Robert 
Published: March 2015

Purpose: To present a method of predicting spinal cord ischemia before deployment of an endograft in the thoracoabdominal aorta. Case Report: A 76-year-old high-risk patient presented with an aneurysm of the distal thoracic and proximal abdominal aorta. An endovascular treatment was scheduled, but before deployment of the endograft, occlusion of the aneurysmal segment was monitored for 15 minutes using multilevel somatosensory evoked potentials (SEP). An external axillofemoral bypass was necessary during the test period to prevent distal ischemia; transesophageal echocardiography verified the absence of flow inside the aneurysm during occlusion. Because no SEP changes occurred during the 15-minute test, a 20-cm-long endograft was deployed. No postoperative neurological event was encountered, and the aneurysm has remained successfully excluded with shrinkage of the sac diameter by 1 cm at 6 months. Conclusions: An occlusion test to detect spinal cord ischemia before deployment of an endograft could be useful in lowering the risk of paraplegia associated with endovascular treatment of thoracoabdominal aneurysm.
Endoventricular Transplantation of Allogenic Skeletal Myoblasts in a Porcine Model of Myocardial Infarction
Authors: Dib Nabil , Diethrich Edward B. , Campbell Ann , Goodwin Noreen , Robinson Barb , Gilbert James , Hobohm Dan W. , Taylor Doris A. 
Published: March 2015

Purpose: To assess the technical feasibility of percutaneous endoventricular injection of skeletal myoblasts into an infarcted porcine myocardium. Methods: A skeletal muscle biopsy was obtained from a donor pig and processed for myoblast expansion in vitro. Myocardial infarction was induced in a host pig via fibrin coil placement in the left anterior descending artery. Four weeks later, electromechanical mapping of the left ventricle identified the infarction site, into which ∼200 million allogenic cells obtained from the muscle biopsy were directly injected (0.1 mL/injection at 25 sites) from inside the ventricular cavity via a needle injection catheter inserted through the femoral artery. Ten days after transplantation, the injected heart was evaluated histologically for the presence of myoblasts. Results: Electrocardiography, echocardiography, left ventricular angiography, and electromechanical mapping confirmed the myocardial infarction. During the cell transfer procedure, premature ventricular contractions confirmed needle placement in the endocardium. Histological evaluation of the host heart 10 days after cell transfer revealed living myoblasts and multinucleated myotubes in the infarcted region, indicating successful transplantation. Conclusions: Direct myoblast transplantation into infarcted porcine myocardium using an endoventricular injection was technically feasible. The results in this model show that transplanted myoblasts were able to survive for 10 days after transplantation.
Endoluminal Stent-Graft Repair of a Renal Artery Aneurysm
Authors: Bruce Michael , Kuan Yew-Ming 
Published: March 2015

Purpose: To present a renal artery aneurysm that was treated successfully by endoluminal grafting. Case Report: A 48-year-old woman presented with a 2.5-cm saccular left renal artery aneurysm. A Jostent coronary stent-graft was placed transluminally into the left renal artery via a femoral artery cutdown. After 12 months, renal function remained normal, and computed tomography revealed normal kidney perfusion with complete resolution of the renal artery aneurysm. Conclusions: The advances in endovascular stent-grafts will allow more visceral artery aneurysms to be treated with a minimally invasive approach.
Stent-Graft Repair of a Recurrent Popliteal Arteriovenous Fistula
Authors: Tielliu Ignace F.J. , Verhoeven Eric L.G. , Prins Ted R. , van Det Marc , van den Dungen Jan J.A.M. 
Published: March 2015

Purpose: To describe the successful endovascular treatment of a popliteal arteriovenous fistula with a stent-graft. Case Report: A 54-year-old man was referred to our hospital with a distal popliteal arteriovenous fistula following an arthroscopic meniscectomy 6 years earlier. Three surgical attempts to close the fistula were undertaken, but the fistula recurred. He now presented with symptoms of progressive venous hypertension with claudication, swelling of the leg, and ulceration at the ankle. The fistula was closed with a stent-graft deployed percutaneously. At 18 months, the patient is doing well; duplex evaluation has documented the patency of the popliteal artery and the stent-graft. Conclusions: Endovascular treatment of a popliteal arteriovenous fistula is an alternative to open surgical reconstruction. In this situation, after multiple failed surgical closures and in a leg with extensive venous hypertension, it may be the best treatment option.
Heme Oxygenase-1 Genotype is a Vascular Anti-inflammatory Factor following Balloon Angioplasty
Authors: Schillinger Martin , Exner Markus , Mlekusch Wolfgang , Ahmadi Ramazanali , Rumpold Helmut , Mannhalter Christine , Wagner Oswald , Minar Erich 
Published: March 2015

Purpose: To investigate the association of the heme oxygenase-1 (HO-1) genotype, which has potent anti-inflammatory capability, and the inflammatory response induced by balloon angioplasty. Methods: Three hundred seventeen patients (188 men; median age 70 years, range 57–77) undergoing femoropopliteal balloon angioplasty (n=150) or stenting (n=61) were evaluated for upregulation of the HO-1 genotype; 106 patients undergoing lower limb angiography served as controls. The acute phase reactants C-reactive protein (CRP), serum amyloid A (SAA), and fibrinogen were measured 24 and 48 hours postintervention and compared to baseline values. An association of the relative increase (Δ, %) of these inflammatory markers with short (<25) (GT)n dinucleotide repeats in the HO-1 gene promoter was assessed. Results: The HO-1 genotype was significantly associated with ΔCRP24 (p<0.0001), ΔCRP48 (p<0.0001), ΔSAA24 (p=0.02), and ΔSAA48 (p=0.006) after balloon angioplasty; Δfibrinogen showed no association. Patients with a higher ΔCRP48 after balloon angioplasty exhibited significantly reduced odds for the presence of short (<25) (GT)n repeats. The adjusted odds reduction in the multivariate model was 80% (p=0.002) in the third quartile of ΔCRP48 values and 90% (p=0.001) in the fourth quartile. No association of HO-1 genotype and inflammatory response was found 24 and 48 hours after stenting (p=0.3, p=0.5) or angiography (p=0.2, p=0.6). Conclusions: The HO-1 promoter genotype is independently associated with the inflammatory response seen after balloon angioplasty. Short alleles (<25 GT repeats) seem to be an intrinsic vascular anti-inflammatory factor.
Percutaneous Inferior Vena Cava—to—Portal Vein Shunt (PIPS) Using a Stent-Graft: Preliminary Results
Authors: Quinn Stephen F. , Sheley Robert C. 
Published: March 2015

Purpose: To present preliminary results of an inferior vena cava (IVC)–to—portal vein shunt (PIPS) that is created through the caudate lobe of the liver. Methods: Sixteen patients (13 men; mean age 50 years, range 32–63) were referred for PIPS procedures because of bleeding varices (n = 11), intractable ascites (n = 4), and hepatorenal syndrome (n = 1). The severity of liver disease was Child's B in 2 and Child's C in 14. The PIPS was created by a transhepatic puncture through the IVC and the portal vein; an endograft made of polytetrafluoroethylene sutured to a Palmaz stent was placed through a jugular approach. Results: In 13 (81%) patients, the portal vein—to—IVC tracts were successfully created. The postprocedural portal vein—IVC gradients varied from 1 to 9 mm Hg (mean 5). There were 2 deaths in the 30-day periprocedural period from adult respiratory distress syndrome and hepatorenal syndrome. A third patient died at 31 days from liver failure owing to continuing alcohol abuse. In addition, there was 1 case of peritoneal bleeding treated with blood product replacement. The follow-up period ranged from 14 to 671 days (mean 343). None of the patients treated for variceal bleeding had another bleeding episode, but 2 patients who had a PIPS procedure for refractory ascites did not benefit from the procedure. Postprocedure, 46% (6/13) of the patients had hepatic encephalopathy, which was unchanged from baseline. The primary and secondary patency rates at 365 days were 60% and 65%, respectively. Conclusions: The preliminary results using a stent-graft to create an IVC-portal vein shunt are encouraging and support further work to better determine the role of this procedure.
Virtual Angioscopy Using 3-Dimensional Rotational Digital Subtraction Angiography for Endovascular Assessment
Authors: Unno Naoki , Mitsuoka Hiroshi , Takei Yasutaka , Igarashi Tatsuya , Uchiyama Takashi , Yamamoto Naoto , Saito Takaaki , Nakamura Satoshi 
Published: March 2015

Purpose: To investigate the feasibility of 3-dimensional rotational digital subtraction angiography (3D DSA) and the creation of virtual angioscopic images from its data before and after endovascular treatment. Technique: Data sets from 3D DSA studies were used to create intraluminal images simulating angioscopy for 36 patients with arterial stenosis, aneurysm, or endoleak after stent-graft deployment. A biplanar DSA unit was used to acquire rotational angiography data, which was then processed with a surface-rendering technique to create maximum intensity projections, shaded surface displays, multiplanar reconstructions, and virtual angioscopy. 3D reconstructions were created in 2 minutes after angiography and provided realistic views adequate for vessel measurement, morphology assessment, and endoleak evaluation. Conclusions: 3D DSA and virtual angioscopy are novel techniques that have been successful in recreating images of blood vessels immediately after angiography. These techniques could be useful as additional imaging modalities to complement computed tomography or magnetic resonance imaging in the evaluation of vascular diseases after endovascular therapy.
Type II Endoleak: Transperitoneal Sacotomy and Ligation of Side Branch Endoleaks Responsible for Aneurysm Sac Expansion
Authors: Hinchliffe Robert J. , Singh-Ranger Ravinder , Whitaker Simon C. , Hopkinson Brian R. 
Published: March 2015

Purpose: To demonstrate aneurysm sac expansion in the face of a type II endoleak and its treatment with open ligation of multiple side branch endoleaks. Case Report: An 81-year-old patient had undergone elective endovascular repair of a 6.3-cm infrarenal abdominal aortic aneurysm in September 1999. Routine spiral computed tomographic angiography at 10 months disclosed a type II endoleak; the aneurysm sac diameter had grown to 7.4 cm. Selective angiography revealed multiple lumbar endoleaks and a patent inferior mesenteric artery. Laparotomy and sacotomy was performed, confirming the presence of pulsatile type II endoleaks, which were ligated successfully. The patient made a full postoperative recovery. Conclusions: Type II endoleaks may cause aneurysm expansion. Open repair of multiple type II endoleaks is feasible and may be useful where endovascular or laparoscopic techniques are at high risk of procedural failure, such as multiple endoleak channels.
Carotid Artery Stenting in Older Patients: Is Age a Risk Factor for Poor Outcome?
Authors: Ahmadi Ramazanali , Schillinger Martin , Lang Wilfried , Mlekusch Wolfgang , Sabeti Schila , Minar Erich 
Published: March 2015

Purpose: To assess the impact of age on technical success and complications of carotid stenting in a prospective single-center cohort study. Methods: One hundred eleven consecutive patients (74 men; median age 70 years) with ≥70% symptomatic (n=33) or ≥90% asymptomatic (n=78) internal carotid artery (ICA) stenosis underwent carotid artery stent implantation. Primary technical success and periprocedural complications were compared in patients aged >75 years (n=28) to patients <75 years (n=83). Results: Patient groups below and above 75 years compared well with respect to baseline demographic and clinical data. Successful stenting was achieved in 108 (97%) patients. The combined neurological complication rate was 7% (n=8), with 1 (1%) major stroke, 1 (1%) minor stroke, and no 30-day mortality. Technical angiographic complications occurred in 8 (7%) patients. No significant differences between patients >75 years and those <75 years were observed for primary success rates (100% [28/28] versus 96% [80/83]; p=0.8), overall complications (14% [4/28] versus 16% [13/83]; p=1.0), neurological complications (7% [2/28] versus 7% [6/83]; p=1.0), or technical complications (7% [2/28] versus 4% [3/83]; p=0.6). Conclusions: Elective carotid stenting can be performed safely in older patients with several comorbidities. Patient age does not seem to be an independent risk factor for poor outcome after endovascular treatment of internal carotid artery stenosis. Both Drs. Ahmadi and Schillinger contributed equally to the study.
Endoluminal Repair of Infrarenal AAA in the Presence of Aortic Dissection
Authors: Tefera Girma , Carr Sandra , Hoch John , Acher Charles W. , Turnipseed William D. 
Published: March 2015

Purpose: To report a challenging case of infrarenal abdominal aortic aneurysm (AAA) treated with a commercial stent-graft in the face of thoracoabdominal aortic dissection. Case Report: A 73-year-old patient was admitted because of acute descending thoracic and abdominal aortic dissection. He was also found to have an 8-cm infrarenal AAA. After initial medical management of the acute aortic dissection, the patient underwent endoluminal AAA repair with an AneuRx stent-graft. The completion angiogram showed that the graft was deployed in the false lumen; this complication was treated with fenestration of the intimal flap, establishing flow through both lumens. The patient's recovery was uneventful, and he was discharged on the fourth postoperative day. Follow-up at 1 year with computed tomographic angiography documented a stable descending thoracic aorta with a suggestion of a type II endoleak and no change in the aneurysm volume. Conclusions: This case illustrates the feasibility of endograft repair of infrarenal AAA with a modular stent-graft in the presence of aortic dissection extending below the renal arteries.