bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Grafting of Traumatic Aortic Aneurysms in Contaminated Fields
Authors: Krämer Stefan , Pamler Reinhard , Seifarth Harald , Brambs Hans-Jürgen , Sunder-Plassmann Ludger , Görich Johannes 
Published: March 2015

Purpose: To evaluate the potential of endovascular stent-grafts to treat traumatic aortic lesions in contaminated areas. Methods: Four patients (3 women; ages 26–78 years) underwent stent-grafting to repair an aortic rupture sustained in a motorcycle accident, aortic lacerations secondary to surgical treatment of spondylitis in 2 patients, and an aortobronchial fistula following surgical thoracic aortic repair 10 years earlier. Stent-grafts (2 Corvita, 1 Talent, and 1 Vanguard) were placed endoluminally into the infected areas via a transfemoral approach. Follow-up included erythrocyte sedimentation rate, white blood count, C-reactive protein, blood cultures, and computed tomography (CT). Results: The stent-grafts were successfully placed in all cases and excluded the aortic lesion. Under supportive antibiotic therapy, inflammation parameters returned to normal. CT imaging showed no evidence of paraprosthetic infection, nor were there any other complications over a follow-up that ranged from 3 to 34 months. Conclusions: Endovascular therapy may be an alternative in the acute management of aortic ruptures in the setting of infection. Long-term results are required for definitive evaluation of the method.
Intraoperative Proximal Endoleaks during AAA Stent-Graft Repair: Evaluation of Risk Factors and Treatment with Palmaz Stents
Authors: Dias Nuno V. , Resch Timothy , Malina Martin , Lindblad Bengt , Ivancev Krassi 
Published: March 2015

Purpose: To study factors that might contribute to intraoperative proximal type I endoleak and to evaluate the placement of giant Palmaz stents as a therapeutic option. Methods: Thirty-three patients (30 men; median age 72 years, range 50–85) with abdominal aortic aneurysms underwent implantation of fully supported Gianturco Z-stent—based endografts (12 custom-made aortomonoiliac and 21 bifurcated Zenith devices). Ten (30%) patients were treated for intraoperative proximal endoleaks. Stent-graft oversizing and neck angulation, length, and shape were compared between patients with and without leaks. Results: In 9 cases, the endoleaks were successfully treated with intraoperative placement of Palmaz stents without complications. In 1 patient, a leak that was resolved intraoperatively with balloon dilation reappeared 1 month later; a Palmaz stent was deployed successfully. Stent-graft oversizing did not differ significantly between patients who developed proximal endoleaks and those who did not (median 4.0 mm in both groups, p = 0.47). Median neck length was 21.0 mm in patients with endoleak and 28.0 mm in those without (p > 0.99). Median neck angulation was 30° in both groups (p = 0.33), and the presence of a conical aneurysm neck was not significantly different (2/10 versus 6/23, p > 0.99). All aneurysms remained excluded at a median follow-up of 13 months (range 6–24). Conclusions: Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.
Percutaneous Techniques for Managing Maldeployed or Migrated Stents
Authors: Gabelmann Andreas , Krämer Stefan C. , Tomczak Reinhard , Görich Johannes 
Published: March 2015

Purpose: To report our experience in the percutaneous management of dislocated endovascular stents. Methods: During a 6-year period, 28 (2.7%) patients with a maldeployed or migrated endovascular stent (20 Palmaz, 5 Wallstent, 2 Memotherm, and 1 AVE) were recognized among 1021 patients undergoing noncardiac vascular stent procedures. Percutaneous stent management was performed using balloon catheters, gooseneck snares, grasping forceps, or additional stent implantation on the basis of the stent type, degree of expansion, mechanical characteristics, and location of the stent. Results: Three stents that embolized into the pulmonary artery were left in situ, but percutaneous management was successful in 23 (92%) of the remaining 25 dislocated stents (12 venous and 13 arterial stents). Twelve stents were repositioned in an alternate, stable position or the primarily intended location; 4 stents were anchored by a second stent, and 7 stents were removed percutaneously. In the 2 failed cases, the stents were retrieved using a minor surgical procedure. There were 2 minor groin hematomas but no secondary complications during a median follow-up of 26.2 months (range 1–62). Conclusions: Percutaneous management of migrated or maldeployed endovascular stents is highly effective with few complications. On the basis of our findings, these techniques should be considered the therapy of choice.
Intravascular Ultrasound Evidence for Stabilization of Compensatory Enlargement of the Femoropopliteal Segment after Endograft Placement
Authors: Hagenaars Tjebbe , Gussenhoven Elma J. , Athanassopoulos Petros , Pattynama Peter M.T. , van Sambeek Marc R.H.M. 
Published: March 2015

Purpose: To document whether the vasodilatory response seen at the anastomotic segment 6 months after placement of a balloon-expandable endograft in the femoropopliteal segment progresses between 6 and 24 months. Methods: Twelve patients (9 men; median age 65 years, range 47–75) treated with an investigational polytetrafluoroethylene (PTFE) endograft for obstructive disease of the femoropopliteal segment were studied with intravascular ultrasound (IVUS) immediately after placement and at 6 months (first follow-up period) and 24 months (second follow-up period). Matched IVUS cross sections derived from the endograft and the anastomotic segment were analyzed for changes in lumen (LA), vessel (VA), and plaque areas (PLA). Results: Five patients had complete IVUS surveillance at both the first (mean 8 months, range 7–9) and second (mean 25 months, range 23–26) follow-up periods; 1 patient was lost to follow-up during the second interval, and another 6 were excluded owing to graft occlusion (n = 4) or no IVUS surveillance available (n = 2) during the second follow-up period. Matched IVUS cross sections derived from the endograft showed no significant change in LA during both follow-up periods (–8% and +1%, respectively). There was no evidence for intimal hyperplasia or endograft recoil. During both follow-up periods, IVUS cross sections derived from the anastomotic segment revealed significant increases in LA (+37% and +8%, respectively) and VA (+26% and +6%, respectively) (both p < 0.05). The change in PLA during both follow-up periods was not significant (+13% and +3%, respectively). Conclusions: The PTFE endograft seems to inhibit both intimal hyperplasia and constrictive remodeling. The short-term (6-month) vascular dilatory response seen at the anastomotic segment tends to stabilize at 2 years. Therefore, this endovascular anastomosis acts as an “ideal” end-to-end anastomosis.
Noninvasive Evaluation of the Effectiveness of Endovascular AAA Exclusion
Authors: van der Laan Maarten J. , Teutelink Arno , Meijer Rudy , Wixon Christopher L. , Blankensteijn Jan D. 
Published: March 2015

Purpose: To evaluate the relationship between aneurysm sac pressure and endograft wall motion in vitro and in vivo and to compare this to sac volume changes after endovascular aneurysm repair. Methods: In a flow model of an aneurysm with a stent-graft in situ, sac pressure was incrementally increased by adding volume to an otherwise excluded sac; sac pressure waves were registered. Clinically, 43 patients who had unsupported endografts were monitored for stent-graft wall motion using electrocardiographically-guided M-mode ultrasonography. At 3 predetermined points in the cardiac cycle, 2 independent observers measured the maximal endograft diameter. Graft wall motion was then compared to changes in aneurysm thrombus volume (shrinking, static, growth) based on serial spiral computed tomographic angiography measurements. Results: In the in vitro model, as the sac was incrementally pressurized, the initially static pressure waveform changed to a more dynamic waveform identical to that of the systemic pressure. Additionally, graft wall motion was noted visually when the pressure exceeded 40 mm; it became increasingly vigorous at higher pressures. The 0.13-cm wall motion in the growth group (n=5) was significantly larger than the 0.04 cm in the static group (n=19; p=0.012) and the 0.03 cm in the shrinking group (n=19; p=0.002). No significant difference was found between the static and the shrinking groups (p=0.209). Conclusions: Increases in sac pressure are reflected as increased wall motion in unsupported endografts. Clinically, increased endograft wall motion can be demonstrated by M-mode ultrasound; in growing aneurysms, the significant change in wall motion may suggest increased sac pressures as the etiology of the aneurysm growth.
Three-Dimensional Rotational Angiography in Peripheral Endovascular Interventions
Authors: van den Berg Jos C. , Moll Frans L. 
Published: March 2015

Purpose: To demonstrate the feasibility and applicability of 3-dimensional rotational angiography (3D-RA) in the assessment of candidates for endovascular treatment of occlusive or aneurysmal arterial disease. Technique: In 3D-RA, a continuous rotation of the fluoroscopic tube around the region of interest is made while intra-arterial contrast is continuously infused. The area of interest is placed in the isocenter in both frontal and lateral planes. Images are acquired at a rate of 12.5 frames per second at a rotation speed of 30° per second. Injection protocols are adjusted according to the anatomical location. The acquisition takes 8 seconds and yields 100 contrast-enhanced cinefluoroscopic images that are automatically reconstructed within 5 minutes to yield a 3D volume that can be rotated and viewed in any direction. Measuring the diameter of the target vessel and length of the lesion can be performed in the same session. An initial evaluation of this technique in 101 patients with known peripheral vascular disease yielded diagnostically adequate images preprocedurally while adding a maximum of only 10 minutes to the endovascular procedure: 5 minutes for reconstruction and another 2 to 5 minutes for measurements, which were made without difficulty in all cases. 3D-RA aided in selection of the optimal fluoroscopic tube angulation for the endovascular procedures and provided assessment of the interventional results comparable to angiography. Conclusions: Our preliminary experience suggests that 3D-RA appears to be a valid tool in the pre- and periprocedural assessment of patients treated endovascularly for both aneurysmal and occlusive peripheral arterial diseases.
Healing of Carotid Stents: A Prospective Duplex Ultrasound Study
Authors: Willfort-Ehringer Andrea , Ahmadi Ramazanali , Gschwandtner Michael E. , Haumer Angelika , Heinz Gottfried , Lang Wilfried , Ehringer Herbert 
Published: March 2015

Purpose: To study the dynamics of carotid stent healing over a 2-year period using duplex ultrasound imaging. Methods: One hundred twelve patients with 121 successfully stented carotid arteries were examined with color-coded duplex ultrasound the day after the stent procedure and at 1, 3, 6, 12, and 24 months in follow-up. The maximal thickness and echogenicity of the layer between the stent and the perfused lumen (SPL) were evaluated. Echogenicity was classified as echogenic if the SPL layer was clearly detected in B mode and echolucent if the SPL layer was barely visible in B mode, its border defined by assistance of color-coded flow. Results: At day 1, an echolucent SPL layer with a median thickness of 0.7 mm was interpreted as a thrombotic layer, which decreased at 1 month to practically zero (i.e., not detectable). In follow-up, increases in thickness (mainly up to 6 months) and echogenicity (up to 12 months) of the SPL layer were interpreted as neointimal ingrowth. At 3, 6, and 12 months, the median maximal thickness of the SPL layer was 0.5 mm, 0.9 mm, and 1.0 mm, respectively, whereas the percentage of patients with an echogenic SPL layer was 27% (32/119), 56% (66/117), and 95% (105/110), respectively, at the same time intervals. No further change was observed at the 24-month examination. Conclusions: Three phases of carotid stent incorporation are defined: (1) an early unstable period soon after stent placement with an echolucent (thrombotic) SPL layer, (2) a moderately unstable phase with ingrowing neointima (1–12 months), and (3) a stable phase from the second year on. These data may indicate the need for different intensities of therapy and surveillance intervals.
Emergent Endovascular Treatment of a Spontaneous Internal Carotid Artery Dissection with Pseudoaneurysm
Authors: Tseng Albert , Ramaiah Venkatesh , Rodriguez-Lopez Julio A. , Perkowshi Paul E. , Del Santo Peter B. , Gowda Ramesh G. , Diethrich Edward B. 
Published: March 2015

Purpose: To report the use of a coronary stent-graft for the endovascular treatment of a spontaneous internal carotid artery (ICA) dissection complicated by a large pseudoaneurysm. Case Report: A 68-year-old man presented to an outside hospital with complaints of headache, severe left-sided neck pain, fever, chills, and vomiting. Contrast-enhanced computed tomography revealed a large (3.5×3 cm) extracranial aneurysm of the left ICA. The patient was emergently transferred to our facility for endovascular treatment of the carotid aneurysm. Via a percutaneous access in the right common femoral artery, 2 Jostent coronary stent-grafts were deployed across the aneurysm with no evidence of a residual pseudoaneurysm. The patient was hemodynamically stable throughout the procedure. Duplex examination at 9 months revealed no evidence of a residual pseudoaneurysm, dissection, or endoleak. Conclusions: Covered coronary stents may have a role in the treatment of spontaneous ICA dissection with pseudoaneurysm formation.
Covered Stents for True Subclavian Aneurysms in Patients with Degenerative Connective Tissue Disorders
Authors: Kasirajan Karthikeshwar , Matteson Brian , Marek John M. , Langsfeld Mark 
Published: March 2015

Purpose: To report the endovascular repair of rare true aneurysms of the subclavian artery in patients with degenerative connective tissue disorders. Case Reports: Two patients, one with Marfan syndrome and the other with idiopathic cystic medial necrosis, presented with 3 subclavian artery aneurysms. A Wallgraft and 2 Viabahn covered stents were used to successfully exclude these aneurysms. After 3 months, the Wallgraft thrombosed, but the contralateral Viabahn remained patent at the most recent examination 13 months after treatment. The other patient with the unilateral aneurysm had a patent Viabahn stent-graft at 10 months. Conclusions: Patients with degenerative connective tissue disorders may benefit from less invasive treatment with stent-grafts. The more flexible Viabahn stent-graft may be better able to adapt to arterial tortuosity. However, the long-term results of this new technique have not yet been established.
Iatrogenic Vertebral Arteriovenous Fistula Treated with a Hemobahn Stent-Graft
Authors: Priestley Rhyan , Bray Peter , Bray Alan , Hunter Jenny 
Published: March 2015

Purpose: To illustrate the utility of color flow duplex ultrasound (CFDU) in the diagnosis and stent-graft treatment of a rare arteriovenous fistula (AVF) involving the vertebral artery and vein. Case Report: An iatrogenic AVF involving the right vertebral artery and vein was diagnosed in a 45-year-old man using CFDU. Treatment was recommended due to the large volume of blood shunted through the fistula and the associated loud bruit. Endoluminal treatment involved deployment of a covered stent within the vertebral artery to exclude the fistula. Postoperative CFDU confirmed the success of the treatment. Conclusions: CFDU can be utilized to accurately diagnose unusual lesions, such as AVFs involving the vertebral artery. The technique is also useful in planning treatment and monitoring the durability of stent-grafts implanted to obliterate this type of defect.
Endovascular Treatment of External Iliac Artery Injuries after Hip Arthroplasty
Authors: Adovasio Roberto , Mucelli Fabio Pozzi , Lubrano Giovanni , Gasparini Cristiana , Belgrano Manuel , Griselli Filippo , Fancellu Giovanni 
Published: March 2015

Purpose: To report endovascular repair of injuries to the external iliac artery during hip surgery. Case Reports: Two elderly women with histories of chronically infected hip prostheses were found to have iatrogenic leaking pseudoaneurysms of the external iliac artery due to hip surgery trauma in the past. Both were treated successfully with a Jostent Peripheral Stent-Graft. The first patient died 17 months after treatment, and the second was well, with an excluded false aneurysm, at the 6-month follow-up. Conclusions: Stent-graft repair may be an appropriate and effective treatment for some traumatic arterial lesions.
Endoluminal Grafting of Abdominal Aortic Aneurysms: Causes of Failure and Their Prevention
Authors: May James , White Geoffrey H. , Yu Weiyun , Waugh Richard C. , McGahan Timothy , Stephen Michael S. , Harris John P. 
Published: March 2015

Purpose: The aim of this study was to analyze the causes of failure of endoluminal grafting for abdominal aortic aneurysms (AAA) and to put forward proposals for preventing these failures. Methods: Since May 1992, endoluminal repair of aneurysms was undertaken in 47 patients. Forty-three of these patients had AAAs and are the basis of this study. All procedures were nonurgent and were performed in the operating room with the patient draped for an open repair in the event of failed endoluminal repair. Radiographic guidance was used to pass the endografts into the aorta via a delivery sheath introduced through the femoral or iliac arteries. The configuration of the endografts was tubular (n = 28), tapered aortoiliac/aorto-femoral (n = 11), and bifurcated (n = 4). Results: Successful endoluminal repair was achieved in 34 of 43 (79%) patients. The remaining nine were terminated in favor of an open repair. The causes of failure were problems with access (2), balloon malfunction (1), stent dislodgment (3), graft thrombosis (1), and inability to deploy the contralateral limb of a bifurcated graft (2). All failed endoluminal repairs proceeded to successful open repair. There was no perioperative mortality in patients undergoing endoluminal repair or in those whose endoluminal repair was converted to open operation. Conclusions: The failures of endoluminal grafting have been analyzed. Methods of avoiding access problems, balloon malfunction, and stent dislodgment have been defined and recommendations made.
PTA and Thrombolysis in Leg Salvage
Authors: Motarjeme Amir 
Published: March 2015

Purpose: The goals of any treatment for ischemic vascular disease are to relieve pain, allow wound healing, and regain/maintain ambulatory abilities. To determine if endovascular therapy could accomplish these goals in patients with limbs at risk, we undertook a retrospective analysis of the results of percutaneous transluminal angioplasty (PTA) and thrombolysis in leg salvage. Methods: Over an 8-year period ending in 1993, 327 patients (209 males, 118 females) with limb-threatening ischemia (defined as one or more of the following: ischemic rest pain, ischemic ulceration, or gangrene) in 361 limbs were seen. These patients had an ante-brachial index ≤ 0.40 in nondiabetic patients and/or toe-brachial index ≤ 0.30 in diabetic patients. The patients were treated with thrombolysis and/or PTA according to standard techniques; intravascular stenting was used occasionally as required to treat PTA deficiencies or inadequate recanalization. Results: Among the 327 patients, 805 arteries and 25 thrombosed arterial grafts were treated. The arteries treated were: 6 aorta (0.75%), 75 iliac (9.3%), 34 common femoral (4.2%), 3 deep femoral (0.4%), 235 superficial femoral (29.2%), 219 popliteal (27.2%), 193 infrapopliteal (24.0%), and 40 pedal (5.0%). The patients were treated primarily with PTA (n = 307); urokinase thrombolysis (n = 99) and stents (n = 12) were used less frequently. Procedural success was 92.5. Patients were followed from 6 months to 8 years (mean 3 years). Eighty-three patients were retreated during this time. Of the 249 patients available for this follow-up, total salvage was achieved in 181 (72.7%). Nineteen patients (7.6%) underwent minor amputations (e.g., toes); 4 patients (1.6%) had transmetatarsal amputation. Fifteen patients (3.6%) had above-knee amputation despite successful recanalization. In all, 32 patients (8.8%) had the amputation level extended from above to below knee, bringing the total leg salvage rate to 82% (defined as patients able to ambulate without any prosthesis). Using life-table analysis, the 5-year survival rate was 71. Conclusion: This study shows that endovascular therapy for leg salvage is as effective as reconstructive vascular surgery in achieving wound healing and maintaining ambulation and has a more favorable 5-year survival rate.
Endovascular Stent-Anchored Aortic Grafts: A Comparison between Self-Expanding and Balloon-Expandable Stents in Minipigs
Authors: Lindh Mats , Malina Martin , Ivancev Krasnodar , Brunkwall Jan , Lindblad Bengt 
Published: March 2015

Purpose: To study endovascular graft attachment with self-expanding Gianturco Z-stents and balloon-expanded Palmaz stents and the effect of these devices on the renal ostia. Methods: Ten stent-grafts were constructed, 5 with Gianturco Z-stents and 5 with Palmaz stents. The endografts were implanted under fluoroscopic guidance into the abdominal aorta of 10 pigs so that the uncovered portion of the proximal stent extended over the renal artery orifices. Distal aortic blood pressure and flow were measured before and after graft placement and 1 hour postprocedure. The aorta was then exposed surgically, and the central portion of the stent-graft was inspected through an aortotomy to assess perigraft leakage. Results: Stent-graft implantation was accurate and hemostatic in all cases, despite longitudinal folding of the graft due to oversizing. However, transverse folds produced pressure gradients (> 15 mmHg) between the ends of the graft in two cases. In another case, a pressure gradient resulted from partial thrombosis of the graft. In two cases, renal artery occlusion and thrombosis occurred due to coverage by the graft material. In two other animals, one of the renal arteries was entirely uncovered by a stent. The remaining 16 renal arteries were covered by the proximal stent but not the graft, as intended. One (6.25%) of these arteries thrombosed, but the remainder were grossly patent when the animals were sacrificed at 1 hour. Conclusions: Both Palmaz and Gianturco Z-stents produced hemostatic endovascular graft attachment, even in the presence of moderate graft oversizing. The risk of acute renal artery occlusion from juxtarenal stenting does not appear to be prohibitive, but longer term observations are needed.