bluuebunny/crossref_metadata_2025_split huggingface dataset:
Management of Neurological Complications of Carotid Artery Stenting
Authors: Wholey Michael H. , Wholey Mark H. , Tan Walter A. , Toursarkissian Boulis , Bailey Steven , Eles Gustave , Jarmolowski Chester 
Published: March 2015

Purpose: To review the neurological complications associated with extracranial carotid artery stenting and to preliminarily assess techniques used to manage these complications. Methods: Between April 1994 and August 2000, 450 patients (270 men; mean age 70.2 years, range 27–89) had stents implanted to treat 472 cervical carotid artery stenoses. Over half (257, 57%) of the patients were symptomatic. A variety of stents were implanted percutaneously after predilation of the lesion; a third of the patients received glycoprotein IIb/IIIa inhibitors intraprocedurally in addition to a standard oral antiplatelet regimen (aspirin and ticlopidine or clopidogrel). Occurrence and management of neurological complications within the 30-day periprocedural period were reviewed. Results: There were 14 (3.1%) transient ischemic attacks (TIAs), 10 (2.2%) minor strokes, and 3 (0.7%) major strokes. Among 6 (1.3%) procedure-related deaths, 4 had neurological causes. The total stroke and death rate was 4.2% (n =19). All the TIAs, 4 of which occurred between 1 and 14 days poststenting, were treated medically, as were the minor strokes, 3 of which occurred >24 hours after stenting. Only 2 minor stroke patients had mild residual upper extremity motor deficits. Intra-arterial thrombolytic therapy was administered in 5 cases (2 major strokes survivors and 3 patients who suffered a neurologically-related death); occlusions were identified in the proximal middle cerebral artery (MCA) in 3 and the distal MCA in 2. Angiographic improvement was noted in 4 (80%), but only the 2 (40%) with distal MCA occlusions did well clinically. Conclusions: Neurological complications following carotid artery stenting are inevitable. The occurrence of minor strokes >24 hours following stenting may indicate a possible late embolic phenomenon, which warrants investigation. Likewise, the marginal efficacy of intra-arterial thrombolytic therapy demonstrates an inability to lyse embolic plaque and underscores the need for effective distal protection.
Serial CT Volume Measurements after Endovascular Aortic Aneurysm Repair
Authors: Czermak Benedikt V. , Fraedrich Gustav , Schocke Michael F. , Steingruber Iris E. , Waldenberger Peter , Perkmann Reinhold , Rieger Michael , Jaschke Werner R. 
Published: March 2015

Purpose: To evaluate the efficacy of transluminal stent-graft placement in aortic aneurysms using postoperative enhanced spiral computed tomographic (CT) volumetric measurements of the aneurysm sac, the intra-aneurysmal vascular channel (IAVC), the thrombus, and the stent-graft. Methods: Among 53 patients (45 men; mean age 74 years, range 59–85) who underwent elective endovascular aortic aneurysm repair, 37 patients with 27 abdominal and 10 thoracic aortic aneurysms completed at least a 6-month follow-up that included computerized CT volumetric analysis prior to discharge and at 3, 6, 12, 24, and 36 months. A variety of bifurcated (n = 23) and tube (n = 14) stent-grafts were observed for signs of endoleak and aneurysm enlargement. Results: Mean follow-up was 16 months (range 6–48). Total aneurysm volumes and thrombus volumes decreased, whereas IAVC and stent-graft volumes increased over time. Between the postoperative and 12-month imaging studies, reductions in total aneurysm (p = 0.011) and thrombus (p < 0.001) volumes were significant. No statistically significant difference in volume changes for the aneurysm sac (p = 0.555) or the thrombus (p = 0.920) was found when comparing the 24 patients without primary leak to the 12 with primary type-II leak. In all 5 cases with secondary leak, the volume of the aneurysm sac increased after initial shrinkage. Conclusions: Postoperative CT volumetric analysis is an effective tool for evaluating the outcome of endovascular aortic aneurysm repair. Thrombus volume measurements are more accurate than total aneurysm volumes. In patients in whom contrast agents are contraindicated, volume measurements can also be obtained without the use of contrast.
Aneurysm Sac Hygroma: A Cause of Endotension
Authors: Risberg Bo , Delle Martin , Eriksson Elsa , Klingenstierna Hans , Lönn Lars 
Published: March 2015

Purpose: To describe a new pathophysiological mechanism for endotension. Case Reports: Four patients developed aneurysm sac expansion after repair of abdominal aortic aneurysms, one with a conventional polytetrafluoroethylene (PTFE) graft and the others with a variety of commercially made endografts (2 PTFE, 1 Dacron). Pressures within the sacs were nonpulsatile and approximately half the systemic blood pressure. Attenuation on computed tomography (CT) was significantly less in the sac than in the graft in 3 of the patients. A clear, highly viscous fluid was aspirated from all 4 sacs, supporting the diagnosis of aneurysm sac hygroma. Prominent local hyperfibrinolysis in the sac was combined with signs of local coagulation activation. Conclusions: A new mechanism for continued sac expansion based on aneurysm sac hygroma is proposed. Measurement of attenuation may be of diagnostic value. It is further proposed that local hyperfibrinolysis/coagulation may promote rebleeding, liquefaction, and continued expansion analogous to the chronic subdural hematoma.
Evaluation of Patient Selection Guidelines for Endoluminal AAA Repair with the Zenith Stent-Graft: The Australasian Experience
Authors: Stanley Brendan M. , Semmens James B. , Mai Qun , Goodman Marcel A. , Hartley David E. , Wilkinson Catherine , Lawrence-Brown Michael M.D. 
Published: March 2015

Purpose: To review the patient selection guidelines for endovascular repair of abdominal aortic aneurysms (AAA) using the Zenith Endovascular Graft and establish an order of importance for each criterion. Methods: The Zenith Endovascular Graft Research Database was interrogated for information on 238 patients (209 men; mean age 74.9 ± 0.9 years, range 50–94) treated with a Zenith bifurcated graft from 1994 to 1998. The common complications of endoluminal AAA repair (endoleak, migration, graft occlusion, graft kinking, conversion, and deployment failure) were analyzed to determine any associations with selection criteria. Results: By 1998, 69% of endograft patients did not meet the recommended guidelines; however, primary and secondary aneurysm exclusion rates were 87% and 94%, respectively. Over a median follow-up of 13.4 months (interquartile range 2.8–24.0), 38 (16%) patients developed 28 (74%) early and 10 (26%) late type-I endoleaks. The endoleak rate in necks ≤10 mm long was 57% (8/14). Endoleak was associated with a neck contour change >3 mm (p = 0.003) and neck length <20 mm (p = 0.045). The risk of proximal endoleak was 4 times greater if at least one of the proximal neck guidelines was breached; combined guideline deviations of “contour change and large diameter” (p = 0.0004), “contour change and short length” (p = 0.006), “large diameter and short length” (p = 0.01), and “contour change and angle” (p = 0.03) also increased the risk of endoleak. Endograft migration was seen in 10 (4.2%) cases; only neck diameter >28 mm (p = 0.0024) was associated with this complication. Conclusions: Proximal neck contour, length, and diameter are the most important criteria in terms of endoleak development. Breaching the proximal neck length criterion resulted in a 4-fold increase in endoleak, and combined deviations from the guidelines multiplied the effect. Necks ≤10 mm long are unsuitable for the standard Zenith graft.
Angioplasty and Stenting in the Posterior Cerebral Circulation
Authors: Barakate Michael S. , Snook Kylie L. , Harrington Timothy J. , Sorby William , Pik Justin , Morgan Michael K. 
Published: March 2015

Purpose: To report initial experience with intracranial vertebral artery (VA) and basilar artery (BA) percutaneous transluminal angioplasty (PTA) and stenting. Methods: Eleven patients (10 men; mean age 66 years, range 56–75) with intracranial 14 VA and 3 BA stenoses were managed from December 1997 through November 1999. All patients presented with vertebrobasilar ischemia (VBI) despite antiplatelet and anticoagulant therapy. Clinical presentations included visual disturbance (n = 8), dysarthria/dysphasia (n = 5), and vertigo (n = 5). Results: Five patients underwent PTA only of 7 lesions with a mean preprocedural stenosis of 80% (range 50%–90%) that was reduced to 54% (range 30%–70%) after dilation. Six patients received 9 stents, 2 for VA dissections, 3 for tandem lesions, and 1 for a BA lesion. There were no embolic strokes. Patients were followed by clinical evaluation and personal or telephone interviews. Over a mean 18-month follow-up (range 12–35), 8 (73%) patients remained asymptomatic, while 3 (27%) had permanent deficits, 2 related to the procedure and 1 owing to distal disease Conclusions: Intracranial VA or BA angioplasty and stenting alleviated symptoms in patients with vertebrobasilar ischemia despite best medical management and may prevent stroke.
Carotid Stenting with Distal-Balloon Protection via the Transbrachial Approach
Authors: Al-Mubarak Nadim , Vitek Jiri J. , Iyer Sriram S. , New Gishel , Roubin Gary S. 
Published: March 2015

Purpose: To document the feasibility of brachial artery access for carotid stenting with distal-balloon protection of the internal carotid artery (ICA). Technique: Via percutaneous access to the brachial artery, a large double-curve catheter is advanced into the aortic arch over a hydrophilic guidewire to cannulate the left common carotid artery. Following sheath exchange, a GuardWire distal-protection balloon is positioned within the left ICA distal to the stenosis. The lesion is dilated, followed by deployment and dilation of a self-expanding stent. Transcranial Doppler monitoring shows only scarce microembolic signals during the procedure. Conclusions: Carotid stenting with distal balloon protection via the brachial artery appears feasible as an alternative to standard femoral access.
Modified Technique for Using Vascular Sheaths in Carotid Artery Stent Placement
Authors: Wholey Michael H. , Toursarkissian Boulos , Bailey Steven 
Published: March 2015

Purpose: To report a technical modification that will prevent sheath kinking in acutely angled vessels during carotid stent placement. Technique: If a long vascular sheath kinks when engaging an acutely angled common carotid or innominate artery, the sheath is pulled caudally approximately 2 cm while a 0.014-inch guidewire, supported by a coronary balloon catheter, is advanced toward the internal carotid artery (ICA). Alternatively, to avoid kinking, the original 0.035-inch super stiff wire is maintained within the sheath until the 0.014-inch wire and coronary balloon have exited the sheath's distal tip. Conclusions: If an aortic arch is tortuous and the angle of the common carotid artery is unfavorable, a guiding catheter is preferable to a long vascular sheath for accessing the ICA during carotid stent procedures.
Endovascular Stenting for the Nutcracker Phenomenon
Authors: Chiesa Roberto , Anzuini Angelo , Marone Enrico Maria , Briguori Carlo , Moura Marcelo R.L. , Melissano Germano , Colombo Antonio , Rosanio Salvatore 
Published: March 2015

Purpose: To present a case highlighting the efficacy of stent implantation for left renal vein (LRV) entrapment, otherwise known as the nutcracker phenomenon. Case Report: A 17-year-old boy presented with a history of gross hematuria and left flank pain. Magnetic resonance angiography documented compression of the LRV between the superior mesenteric artery and aorta. A Memotherm stent was successfully placed across the LRV to restore adequate luminal flow after a Wallstent failed to adequately span the narrowed segment. Spiral CT angiography at 6 months confirmed LRV patency; the patient remains asymptomatic and free of hematuria at 12 months. Conclusions: Endovascular stenting for the nutcracker phenomenon is safe and effective and may represent a valuable approach for lessening the morbidity of surgical procedures.
Autologous Thrombin: A New Embolization Treatment for Traumatic Intrasplenic Pseudoaneurysm
Authors: Engelke Christoph , Quarmby John , Ubhayakar Gaurang , Morgan Robert , Holmes Keith , Belli Anna-Maria 
Published: March 2015

Purpose: To report the use of autologous thrombin for transcatheter embolization of a traumatic parenchymal splenic pseudoaneurysm. Case Report: A 15-year-old boy presented with a splenic parenchymal laceration after blunt abdominal trauma. The patient was managed conservatively but developed an intrasplenic pseudoaneurysm (grade III AAST scale) with subcapsular contrast extravasation after 3 weeks. Autologous thrombin was isolated from the patient's blood and subsequently delivered to the lesion by transcatheter superselective injection into the aneurysm neck. The patient was asymptomatic after the procedure. Nine months' follow-up demonstrated a normal spleen with completely homogenous parenchyma. Conclusions: Autologous thrombin injection to induce thrombosis of intrasplenic pseudoaneurysm represents a new treatment option for traumatic abdominal organ injuries. Intrasac thrombosis can be safely induced to successfully restore the splenic parenchymal integrity without introduction of foreign material and associated risks of adverse reactions or infection that might accompany the use of commercial thrombin preparations.
Delayed Pseudoaneurysm after Renal Artery Angioplasty
Authors: McWilliams Richard G. , Godfrey Hugh , Bakran Ali , Kool Leo J. Schultze , van Bockel J. Hajo , van Oostayen Jacques A. 
Published: March 2015

Purpose: To report delayed pseudoaneurysm formation after percutaneous renal artery angioplasty. Case Reports: A 56-year-old woman succumbed to complications of a ruptured right juxtarenal aortic pseudoaneurysm 2 years after right renal artery stenting for renal impairment. The juxtarenal aorta had been normal on aortography at the time of angioplasty. She gave a history of right-sided back pain that started within 8 months of the angioplasty. A 21-year-old woman with left renal artery stenosis due to fibromuscular dysplasia was treated with balloon angioplasty, after which there was evidence of active extravasation. The completion angiogram, after a period of observation, documented cessation of the leak. Follow-up angiography because of persisting hypertension disclosed a large, asymptomatic, intrarenal pseudoaneurysm that was repaired with bench surgery and autotransplantation. Conclusions: We advise that patients with symptoms referable to the site of renal artery intervention and those who have had complicated interventions should have follow-up imaging to exclude pseudoaneurysm formation.
Outcome after Endovascular Abdominal Aortic Aneurysm Repair: A Meta-Analysis
Authors: Walschot Luc H. B. , Laheij Robert J. F. , Verbeek André L. M. 
Published: March 2015

Purpose: To determine the frequencies of complications and risk factors for complications following endovascular abdominal aortic aneurysm (AAA) repair (EVAR). Methods: Thirty-nine articles published between October 1995 and October 1999 in English, German, French, or Dutch were identified in electronic databases. All articles reported perioperative (30-day) complications on 2387 patients, while postoperative complications (>30 days) were reported on 1645 patients in 30 of 39 studies. Data were pooled and subjected to multivariable logistic regression analysis to identify risk factors for death, endoleak, rupture, conversion, and local and systemic complications. Effects of risk factors were expressed as odds ratios (OR) with 95% confidence interval (CI). Results: Mean follow-up was 13.9 months (range 4–29). The perioperative death rate (3.7%) was lower than postoperative mortality (5.0% per annum). The risks for both endoleak (13.1%) and conversion (5.0%) were higher in the perioperative period than postoperatively (5.4% and 1.4% per annum, respectively). Independent risk factors for perioperative complications were: general anesthesia (death: OR = 5.1, 95% CI 1.9–13.3); EVT graft (endoleak: OR = 3.0, 95% CI 1.3–7.0); female sex (rupture: OR = 2.8, 95% CI 1.4–5.8); hypertension (conversion: OR = 0.03, 95% CI 0.0–0.3); age >70 years (conversion: OR = 3.5, 95% CI 1.3–9.2); and team experience >30 patients (conversion: OR = 3.0, 95% CI 1.2–7.6). Independent risk factors for postoperative complications were: predischarge examination (death: OR = 0.2, 95% CI 0.0–0.7); follow-up 30 days after operation (death: OR = 0.3, 95% CI 0.1–1.0); and female sex (rupture: OR = 1.4, 95% CI 0.5–4.4; conversion: OR 6.8, 95% CI 2.0–23.4; and systemic complications: OR = 2.9, 95% CI 1.1–7.5). Conclusions: The risk of complications after EVAR is high, supporting the cautious use of EVAR. Both patient characteristics and procedural variables were independent risk factors for complications. To avoid the limitations of this study, the results of randomized clinical trials must determine if EVAR offers a safe and durable alternative to open AAA repair.
Surgical Conversion after Endovascular Grafting for Abdominal Aortic Aneurysms
Authors: Böckler Dittmar , Probst Thomas , Weber Heinz , Raithel Dieter 
Published: March 2015

Purpose: To analyze the indications, results, and technical problems associated with conversion after endoluminal repair of abdominal aortic aneurysms (AAA) based on a 6-year experience in endovascular grafting. Methods: From August 1994 to May 2000, 520 patients with AAA were deemed candidates for endovascular therapy based on data from contrast-enhanced computed tomography and aortography. Any conversions were performed using an open operation modified according to the indication for conversion, elapsed time from the endoluminal repair, and type of endograft (tube, bifurcated, infra-/suprarenal fixation). Results: Conversion to open repair was required in 37 (7.1%) cases: 23 tube grafts and 14 bifurcated devices. Seventeen (3.2%) conversions occurred at the original operation and 20 (3.8%) were performed secondarily. Indications for primary conversion were mainly device defects (n = 5) or access problems (n = 5), while secondary conversion was primarily owing to type I endoleak (n = 16). The conversion rate was significantly higher in modular devices (5.9%) than unibody designs (1.4%) (p = 0.003). The rate of primary conversions diminished from 10.9% in 1994–1995 to 2.4% between 1996 and 2000, as did the overall mortality rate, from 8.3% in the first time period to 0% in the second for elective conversions, but emergency operations had 40% mortality. Conclusions: Most AAAs require bifurcated devices for complete exclusion, and older model modular grafts have higher conversion rates. Primary conversion decreases as more experience in endoluminal grafting is acquired. Emergency open repair results in a high mortality rate.
Emergent Axillary Artery Stent-Graft Placement for Massive Hemorrhage from an Avulsed Subscapular Artery
Authors: Dinkel Hans-Peter , Eckstein Friedrich S. , Triller Jürgen , Do Dai-Do 
Published: March 2015

Purpose: To report the successful endovascular repair of an acute axillary artery hemorrhage. Case Report: An 87-year-old woman with Charcot-Marie-Tooth ataxia presented with an enormous shoulder hematoma and clinical signs of exsanguination after a fall. Angiography demonstrated complete avulsion of the right subscapular artery from the axillary artery, and active bleeding into a hematoma of at least 1500 mL. Endovascular repair with a balloon-mounted covered stent-graft was performed percutaneously, which controlled the bleeding and averted surgery. The patient recovered uneventfully and was without signs of recurrent bleeding or ischemia on the 6-month ultrasound examination; she reports no symptoms referable to her upper extremity after 14 months. Conclusions: Endovascular repair with stent-grafts is effective in controlling arterial bleeding from supra-aortic vessels even under emergency conditions.
Efficacy of a Nitinol Filter Device in the Prevention of Embolic Events during Carotid Interventions
Authors: Cremonesi Alberto , Castriota Fausto 
Published: March 2015

Purpose: To evaluate the feasibility, safety, and efficacy of the TRAP Vascular Filtration System (VFS) during carotid interventions as a deterrent to embolic complications. Methods: Thirty-one consecutive patients (18 men; mean age 72 ± 8 years) gave informed consent to undergo elective percutaneous angioplasty and stenting of the extracranial carotid artery protected by the TRAP VFS, a nitinol basket filter system. Results: The TRAP VFS was delivered and retrieved safely in all patients; procedural success for carotid stenting was 100%. In 3 (9.7%) cases, the filters were positioned after lesion predilation. Nearly half (13, 41.9%) of the retrieved filters contained visible plaque debris that histology identified as cholesterol crystals, fibrin material, atheromatous plaque, and macrophage foam cells. There were no symptomatic major or minor neurological complications encountered in this cohort during hospitalization. Conclusions: Our data indicate that percutaneous dilation and stenting of the carotid artery protected by TRAP VFS appears to be feasible, safe, and effective in preventing cerebral embolization.
Simultaneous Stent-Graft Repair of Thoracic and Infrarenal Abdominal Aortic Aneurysms
Authors: Meguid Ahmed A. , Bove Paul G. , Long Graham W. , Kirsch Matthias J. , Bendick Phillip J. , Zelenock Gerald B. 
Published: March 2015

Purpose: To describe a technique for concomitant endovascular stent-graft repair of thoracic and infrarenal abdominal aortic aneurysms. Case Report: A 68-year-old man was found to have concomitant thoracic and abdominal aortic aneurysms. Both of the aneurysms were excluded successfully in one procedure using Talent stent-grafts. The patient tolerated the procedure well and was discharged on postoperative day 4. Aside from an infected groin wound, the patient did not have any complications. Computed tomographic scans at 6, 12, and 18 months showed proper position of both stents without evidence of endoleak. Conclusions: Simultaneous endovascular treatment of thoracic and infrarenal abdominal aortic aneurysms may represent a viable alternative for therapy in some patients.
Endograft Fabric Disintegration Simulating a Type II Endoleak
Authors: Becquemin Jean-Pierre , Poussier Bertrand , Allaire Eric , Kobeiter Hischam , Desgranges Pascal 
Published: March 2015

Purpose: To report a case of endograft disintegration misinterpreted as a type II endoleak. Case Report: An 86-year-old man underwent successful Vanguard stent-graft implantation for a 49-mm abdominal aortic aneurysm. At 1 month, a distal type I endoleak was repaired, but another endoleak thought to arise from the lumbar or inferior mesenteric arteries remained. Multiple interventions to embolize the feeding arteries were unsuccessful, and the endoleak persisted. At 1 year, the leak was still present, and the aneurysm had increased to 69 mm. After failing to demonstrate the source of the leak radiographically, surgery was performed. At operation, the endoleak was traced to small holes in the graft fabric. The endograft was removed without difficulty, and the flow was re-established with an aortobiiliac woven graft. Conclusions: Chronically implanted stent-grafts can show signs of failure that are confusing or misleading. Correct diagnosis of endoleaks may be difficult, but every effort must be made to identify their source. It is vital that no enlarging aneurysm be left untreated.