bluuebunny/crossref_metadata_2025_split huggingface dataset:
Does Fresh Clot Shrink Faster Than Preexistent Mural Thrombus after Endovascular AAA Repair?
Authors: Blankensteijn Jan D. , Prinssen Monique 
Published: March 2015

Purpose: To correlate the amount of preexistent thrombus in abdominal aortic aneurysms (AAA) to sac shrinkage after endovascular repair. Methods: From January 1993 through April 2000, 76 patients underwent endovascular AAA repair and were examined at 12 months to identify aneurysms that had decreased in size by >10%. Volume measurements were performed using a standardized spiral computed tomographic angiography (CTA) protocol with 3-dimensional postprocessing. Volume measurements were unavailable or incomplete in 16 patients, and another 16 did not have sac shrinkage >10%, leaving 44 patients in the study group. The percentage of preexistent mural thrombus in shrinking sacs (OldThr%) was calculated by dividing the preoperative thrombus volume by the postoperative nonluminal thrombus volume. The 12-month volume change, expressed as a percentage of the postoperative thrombus volume and as an absolute value, was correlated with OldThr% using the Pearson product moment test. Results: The median proportional shrinkage at 12 months was 56% (range 15%–89%) and the absolute nonluminal thrombus volume shrinkage was 49 mL (range 6–186). The median OldThr% was 53% (range 6%–94%). The correlation coefficients of OldThr% were 0.130 (p=0.40) with the proportional shrinkage in thrombus volume and 0.235 (p=0.13) with the absolute volume change. Conclusions: The rate of shrinkage of successfully excluded aneurysm sacs after endovascular repair is independent of the preoperative mural thrombus volume in the aneurysm. Other factors are responsible for the large variation in shrinkage.
The AneuRx Stent-Graft since FDA Approval: Single-Center Experience of 230 Cases
Authors: Ramaiah Venkatesh G. , Westerband Alex , Thompson Charles , Ravi Rajagopalan , Rodriguez Julio A. , DiMugno Leanne , Shafique Shoaib , Olsen Dawn , Diethrich Edward B. 
Published: March 2015

Purpose: To compare a single-center experience with the AneuRx stent-graft system before and after FDA approval to results from the multicenter phase II clinical trial. Methods: The medical records of 230 consecutive patients (218 men; mean age 74 years) undergoing AneuRx stent-graft implantation for abdominal aortic aneurysm (AAA) exclusion since September 1999 were reviewed to collect patient characteristics, aneurysm morphology, procedure variables, perioperative morbidity, mortality, and short-term outcome. These data were compared to the 30 patients treated at our institution during the AneuRx phase II clinical trial and to the overall multicenter trial data. Stent-graft difficulty was categorized from 1 (straight neck and access of appropriate size) to 4 (proximal neck <10 mm long or angulated >60° and/or difficult access) based on aneurysm morphology. Results: Data from the 30 patients enrolled in the phase II trial at our institution were comparable in terms of patient characteristics and procedure variables to patients treated after FDA approval and to the multicenter data. However, the proportion of cases involving aneurysms with a more complex morphology (levels 3 and 4) rose 22% after FDA approval, reflecting a change in referral patterns. Our postoperative endoleak and morbidity rates increased nonsignificantly with respect to our own phase II experience (17% versus 6%, 18% versus 11%, respectively);however, they were not significantly different from the multicenter data. Reintervention was performed in 15 of 38 endoleak cases, mostly type I. Only 5 (2.1%) cases had a persistent endoleak at the time of discharge. Conclusions: Since FDA approval of the AneuRx device, our endovascular practice has changed toward the management of increasingly more complex AAAs. Although we are attempting more challenging cases, we are able to maintain similarly high short-term success rates while offering stent-grafting to an increasing number of patients. These results suggest that more patients may be candidates for endoluminal graft placement than determined by the clinical trial selection criteria, provided that strict surveillance and long-term follow-up is maintained.
Long-term Results of Endovascular AAA Repair Using a Homemade Aortomonoiliac PTFE Device
Authors: Ingle Hemant , Fishwick Guy , Garnham Andrew , Thompson Matthew M. , Bell Peter R.F. 
Published: March 2015

Purpose: To assess the long-term results of a homemade aortomonoiliac polytetrafluoroethylene (PTFE) device used for endovascular abdominal aortic aneurysm (AAA) repair. Methods: A vascular audit database was interrogated to identify 58 consecutive AAA patients (all men; median age 73 years, range 56–88) who underwent aortomonoiliac stent-graft repair. AAAs were eligible for endovascular treatment if the infrarenal neck was ≥15 mm long and ≤28 mm in diameter. Results: Nine (15.5%) procedures failed, 8 during the procedure and 1 on the 7th postoperative day; 8(13.8%) patients were converted, but one was unfit for surgery. There was one intraprocedural stroke, and 3 (5.2%) patients died within 30 days. The primary success rate (no conversion or mortality) was 79.3%. Over a median follow-up of 45 months (range 23–80), there were 3 (5.2%) graft occlusions, 1 kink requiring stent implantation, and 1 expanding sac without identifiable endoleak. There were 11 (19.0%) endoleaks in 10 patients, 9 type I leaks (2 proximal) and 1 type II. One patient with a distal type I endoleak (treated) also exhibited a type III leak at 2 years, but the sac size had not increased. There was a 40% incidence of bilateral buttock claudication, which was serious in only 1 patient. The long-term survival rate by Kaplan-Meier life-table analysis was 57% at 4 years. Conclusions: Implantation of an aortomonoiliac PTFE device can be achieved with good primary success, and the stent-graft seems durable over the long term. Proximal type I endoleaks are rare, but distal endoleaks from the contralateral common iliac artery can be solved by using a different covered stent.
A Hybrid Endovascular Procedure to Preserve Internal Iliac Artery Patency during Endovascular Repair of Aortoiliac Aneurysms
Authors: Hinchliffe Robert J. , Hopkinson Brian R. 
Published: March 2015

Purpose: To demonstrate the feasibility of a hybrid endovascular procedure to preserve blood flow in the internal iliac arteries (IIA) during aortoiliac endografting. Technique: When aneurysmal dilatation makes the distal neck in the common iliac artery (CIA) too short for an adequate seal, the CIA bifurcation is exposed via an extraperitoneal approach after endograft deployment. Via an arteriotomy in the CIA, the distal end of the stent-graft is sutured to the CIA bifurcation under direct vision to preserve IIA blood flow. This approach has been successful in preserving IIA blood flow in 5 of 7 endograft procedures; in the other 2, IIA occlusion was a predictable event. Conclusions: Direct suturing of an aortoiliac stent-graft to the CIA bifurcation via an extraperitoneal approach is a useful method of maintaining IIA perfusion. However, further study is required to identify patients at high risk of pelvic ischemia who would benefit from such intervention.
Predictors for Clinical Success at One Year following Renal Artery Stent Placement
Authors: Gill-Leertouwer Trude C. , Gussenhoven Elma J. , Bosch Johanna L. , Deinum Jaap , van Overhagen Hans , Derkx Frans H.M. , Pattynama Peter M.T. 
Published: March 2015

Purpose: To determine pretreatment variables that may predict 1-year clinical outcome of stent placement for renal artery stenosis. Methods: In a prospective study, 40 consecutive patients (29 men; mean age 60 ± 9.1 years) with angiographically proven atherosclerotic renal artery stenosis were treated with stent placement because of drug resistant hypertension (n=14), renal function impairment (n=14), or both (n=12). Clinical success at 1 year was defined as a decrease of diastolic blood pressure ≥10 mmHg or a decrease in serum creatinine ≥20%, depending on the indication for treatment. Regression analysis was performed using anatomical parameters from angiography and intravascular ultrasound, estimates of renal blood flow from renal scintigraphy, and single-kidney renal function measurements. Results: Patients treated for hypertension had better outcome than those treated for renal function impairment, with clinical success rates of 85% and 35%, respectively. Preserved renal function, with low serum creatinine and high 2-kidney glomerular filtration rate at baseline, was associated with clinical success in the entire patient group at follow-up (p=0.02 and p=0.03, respectively). An elevated vein-to-artery renin ratio on the affected side was borderline predictive (p=0.06). In patients treated for renal impairment, lateralization to the affected kidney (affected kidney—to–2-kidney count ratio ≤0.45) on the scintigram emerged as a significant predictor for clinical success, with an odds ratio of 15 (p=0.048). Conclusions: Clinical success of renal artery stent placement is better for the treatment of hypertension than for preserving renal function. In patients with renal function impairment, lateralization to the affected kidney on the scintigram appears to be a predictor of clinical success.
Contrast-Enhanced 3D MRA of the Aortoiliac and Infrainguinal Arteries When Conventional Transfemoral Arteriography is Not Feasible
Authors: Fenchel Sabine , Wisianowsky Christian , Schams Silvia , Nuessle Karin , Krämer Stefan C. , Görich Johannes , Merkle Elmar M. 
Published: March 2015

Purpose: To evaluate whether contrast-enhanced 3-dimensional (3D) magnetic resonance angiography (MRA) can substitute for transaxillary or transbrachial catheter access when angiography via the transfemoral route is not possible. Methods: Contrast-enhanced 3D MRA was performed in 14 patients (12 men; mean 66.1 ± 12.4 years, range 48–98) with atherosclerotic disease of the aorta or lower extremities in whom conventional transfemoral arteriography was not feasible. The images were evaluated for their ability to identify and characterize lesions directly responsible for the patient's symptoms, adequately depict the vascular anatomy for therapy planning, and identify additional lesions not directly responsible for the patient's symptoms. The arterial system was divided into 15 segments, and image quality and the presence of occlusive disease were determined. Results: MRA adequately depicted 387 (95%) of 406 arterial segments in 14 patients. Nineteen (5%) arterial segments were inadequately delineated because of low signal intensity distal from severe stenoses (n = 11), venous overlap (n = 6), or metallic clip—induced signal voids (n = 2). The lesions directly responsible for the patients' symptoms were identified in all 14 patients (2 aortic occlusions [Leriche's syndrome] and 12 iliac occlusions or severe stenoses). Visualization of the vascular anatomy was adequate for therapy planning in 13 of 14 patients, and 3D MRA satisfactorily identified other lesions not directly responsible for the current symptoms. Conclusions: When transfemoral catheter angiography of the aortoiliac and lower extremities is not feasible, contrast-enhanced 3D MRA is suitable for determining and planning therapy and can be used instead of angiography via the transaxillary or transbrachial routes.
Computerized Modeling Based on Spiral CT Data for Noninvasive Determination of Aortic Stent-Graft Length
Authors: Rott Albert , Boehm Thomas , Söldner Joachim , Reichenbach Jürgen R. , Heyne Jürgen , Bartel Martin , Kaiser Werner A. 
Published: March 2015

Purpose: To preprocedurally determine the correct length of a nonbifurcated endovascular prosthesis for abdominal aortic aneurysm (AAA) repair using a computerized model. Methods: A computer program was implemented to calculate the optimal intraluminal course of nonbifurcated stent-grafts from spiral computed tomographic (CT) images of the aortic lumen reconstructed at 2.5, 5, and 10-mm slice thicknesses. The algorithm was tested using 10 phantoms fabricated from 150-mm-long, 10-mm-diameter copper rods that were bent into shapes mimicking different aortic configurations. Midpoint coordinates and rod diameters were determined from each CT image by 3 independent observers and served as input parameters to the program. The influence of the different CT reconstructions on the calculated lengths and possible observer dependence were assessed using calculated length estimation errors. Spiral CT images from 20 consecutive AAA patients scanned before stent-graft implantation were also processed to evaluate the algorithm under clinical conditions. Results: Length estimation errors of the phantoms depended on the degree of bending as well as on the CT reconstruction slice thickness but were observer independent. Maximum errors were 7% for the 10-mm slices, 3.5% for the 5-mm slices, and 1.2% for a 2.5-mm reconstruction. The mean longitudinal shortening of the aorta due to vessel tortuosity was 9.1% ± 4.8% among the 20 patients. Based on the results of the phantom study, errors of the calculated stent-graft lengths in patients were estimated to be ∼1% for a 5-mm CT reconstruction increment and <2% for a 10-mm increment. Conclusions: The proposed algorithm makes it possible to calculate noninvasively the correct length of straight stent-grafts under clinical conditions with a 1% to 2% error.
Type III Endoleak from a Thoracic Aortic Stent-Graft
Authors: Lange Conrad , Ødegård Asbjørn , Lundbom Jan , Hatlinghus Staal , Myhre Hans O. 
Published: March 2015

Purpose: To present an as yet unreported late complication of an Excluder thoracic endograft. Case Report: A 78-year-old man underwent surgery for a ruptured type V thoracoabdominal aortic aneurysm in 1996. Four years later, an aneurysm was detected in the proximal thoracic aorta and repaired with 2 Excluder endoprostheses. At 12 months, computed tomography showed an increase in the aneurysm sac diameter and a type III endoleak, which was traced to a hole in the stent-graft fabric on arteriography. No fracture of the metal components was detected in the stent-grafts. Another Excluder device was implanted within the distal endograft. Satisfactory exclusion of the leak has been maintained for 6 months. Conclusions: The risk of type III leaks must be minimized before stent-grafting can be regarded as a routine procedure in the treatment of thoracic aortic aneurysms.
Endovascular Treatment and Complete Regression of an Infected Abdominal Aortic Aneurysm
Authors: Berchtold Christoph , Eibl Charis , Seelig Matthias H. , Jakob Pedi , Schönleben Klaus 
Published: March 2015

Purpose: To report a case of successful endovascular treatment of an infected abdominal aortic aneurysm (AAA) following Salmonella septicemia. Case Report: A 60-year-old man was admitted for rapid onset of urinary frequency, fever, and suprapubic pain extending to the flanks. Blood cultures were positive for Salmonella enteritidis, and appropriate antibiotic treatment was started. After 4 weeks, fever ceased and the C-reactive protein fell to 5.8 mg/dL, but the erythrocyte sedimentation rate remained unchanged. Back pain prompted computed tomography, which showed a large AAA with a very irregular aortic wall suspicious of impending rupture. A tube stent-graft was introduced under general anesthesia from a left groin incision and deployed immediately below the renal arteries; a proximal type I endoleak was suspected but not repaired. Oral antibiotic therapy was continued for 2 months after discharge. By 6 months, the endoleak had sealed with a concomitant decrease in the maximal diameter of the aneurysm from 7.4 to 5.6 cm. At 4 years, the aneurysm sac was no longer visible. Conclusions: Although experience is limited, endovascular grafting in combination with antibiotic therapy in selected infected aneurysms might represent an effective low-risk alternative to conventional surgery with the potential to restore normal vascular anatomy.
Endovascular Repair of a Type B Aortic Dissection with Transposition of a Coexistent Aberrant Subclavian (Lusorian) Artery
Authors: Vos A.W. Floris , Wisselink Willem , Rijbroek Abraham , Avontuur Jurgen A. , Manoliu Radu A. , Rauwerda Jan A. 
Published: March 2015

Purpose: To report the endovascular treatment of a relatively uncommon entity: an aortic type B dissection combined with an aberrant subclavian artery (SA). Case Report: A 59-year-old patient was admitted with chest pain and interscapular back pain. A transesophageal ultrasound and magnetic resonance angiography revealed a type B aortic dissection originating at the level of an aberrant SA orifice. After failure of medical therapy, the dissection was treated by transluminal implantation of an Excluder stent-graft covering the entry site of the dissection at the aberrant SA orifice. Prior to the endovascular procedure, a transposition of the aberrant SA to the right carotid artery was performed through a supraclavicular approach. The patient remains asymptomatic at 19 months after the endovascular repair. Conclusions: Endovascular repair of a type B aortic dissection in the presence of a lusorian artery appears to be a feasible, safe, and less invasive alternative to conventional surgery. The need for concurrent transposition of the SA remains to be determined.
Endovascular Repair of Traumatic Descending Aortic Transection
Authors: Orend Karl Heinz , Pamler Reinhard , Kapfer Xaver , Liewald Florian , Görich Johannes , Sunder-Plassmann Ludger 
Published: March 2015

Purpose: To present the results of endovascular repair of acute traumatic descending aortic transection. Methods: Among 66 thoracic stent-graft repairs performed between 1995 and 2001, 11 patients (9 men; mean age 34 years, range 12–73) underwent emergent endovascular repair of acute traumatic descending aortic transection following traffic accidents. Immediate treatment of aortic rupture was indicated in all patients because of a marked fresh hematoma with hemothorax; the spiral computed tomographic (CT) scans showed circular or semicircular descending thoracic aortic injuries. The devices used included 11 thoracic Excluders and 1 Talent stent-graft. Results: No patient required conversion to an open transthoracic operation. No patient developed temporary or permanent neurological deficit after endovascular treatment. Two type I endoleaks required periprocedural treatment: a second stent-graft was deployed in one and the existing stent-graft was balloon dilated in the other. Two patients underwent secondary procedures (iliac access complication and revascularization of the left subclavian artery). One patient died 22 days postoperatively secondary to injuries unrelated to the aortic repair. Over a mean 14-month follow-up (range 1–26), the surveillance CT scans have shown the stent-graft to be correctly positioned in all patients. Conclusions: The treatment of acute traumatic descending aortic transection with an endovascular approach is feasible and safe and may offer the best means of therapy. Mortality and the risk of neurological deficit are low compared with open operations.
Crossing the Limbs: A Useful Adjunct for Successful Deployment of the AneuRx Stent-Graft
Authors: Ramaiah Venkatesh G. , Thompson Charles S. , Shafique Shoaib , Rodriguez Julio A. , Ravi Rajagopalan , DiMugno Leanne , Diethrich Edward B. 
Published: March 2015

Purpose: To describe a technique for deploying an AneuRx stent-graft in an abdominal aortic aneurysm (AAA) with an acutely angled aortic neck. Technique: In routine cases, the AneuRx stent-graft main body is positioned with the nose cone notch facing the contralateral side. In severely angulated aortic necks, however, the main body of the AneuRx stent-graft can be positioned with the nose cone notch and iliac limb gate facing the ipsilateral side; this dramatically reduces the acuity of the angle at the aortic neck and the iliac gate. This technique of “crossing the limbs” has been successfully used in 7 cases since FDA approval of the AneuRx device. Conclusions: Proximal neck angulation is an important factor for successful endovascular AAA repair. Crossing the graft limbs reduces the effect of neck angulation on the proximal main body and may decrease the stress upon the contralateral limb gate, which may avoid graft gate disconnection and endoleak.
Initial Clinical Results of Tenecteplase (TNK) in Catheter-Directed Thrombolytic Therapy
Authors: Razavi Mahmood K. , Wong Humberto , Kee Stephen T. , Sze Daniel Y. , Semba Charles P. , Dake Michael D. 
Published: March 2015

Purpose: To investigate the safety and immediate efficacy of 2 different doses of tenecteplase (TNK) in peripheral catheter-directed thrombolytic therapy of arterial occlusions and deep vein thrombosis (DVT). Methods: Over a 20-month period, 63 nonconsecutive patients underwent catheter-directed thrombolytic therapy with either 0.25 mg/h or 0.50 mg/h of TNK in a nonrandomized, open-label study. Of these, 55 patients (60 limbs) were treated for DVT (36 limbs in 16 men and 15 women; mean age 41 years, range 21–73) or peripheral arterial occlusions (24 limbs in 16 men and 8 women; mean age 63 years, range 32–91). The primary endpoints were major bleeding complications and angiographic reduction in clot burden. Results: The mean duration of infusion was 18 ± 4 hours in patients with arterial occlusions and 30 ± 13 in those with DVT. Twenty-one (87.5%) patients with occlusive disease had marked or complete lysis of clot. Thirty (83.3%) limbs with DVT had either marked or complete resolution of thrombus. There were 4 (7.3%) episodes of minor bleeding with 1 (1.8%) major hemorrhagic event. Fibrinogen levels dropped by an average of 23%. Conclusions: Preliminary evidence suggests that TNK doses of 0.25 mg/h to 0.50 mg/h appear to be safe and effective. The potential benefits of TNK therapy warrant further investigation.
Complex Endovascular Treatment for Critical Limb Ischemia in Poor Surgical Candidates: A Pilot Study
Authors: Gray Bruce H. , Laird John R. , Ansel Gary M. , Shuck John W. 
Published: March 2015

Purpose: To evaluate the effectiveness of complex endovascular treatment for limb salvage in patients with critical limb ischemia. Methods: In a prospective study, 23 patients (13 men; mean age 70 ± 11 years, range 44–87) with ischemic ulceration or gangrene of 25 lower limbs were enrolled at 4 sites to evaluate treatment with excimer laser recanalization followed by balloon angioplasty with optional stenting in the superficial femoral, popliteal, and/or tibial arteries. Results: Multiple lesions (mean 3.1, range 1–8) were treated in most cases. Reduction of stenosis/occlusion to <50% was achieved in 22 (88%) limbs. Individual cases of vessel perforation, inability to cross the lesion, and excessive residual stenosis accounted for the 3 failures. Over a 6-month period, 4 patients died of cardiac comorbidity and 1 was lost to follow-up. Adverse events included 4 minor and 2 below-knee amputations, 4 secondary angioplasties, and 4 femorodistal bypasses. The mean wound area reduction was 70% at 3 months, increasing to 89% at 6 months. According to life table analysis, the limb salvage rate was 90% with bypass and 69% without in the successfully treated patients (corresponding intention-to-treat rates were 79% and 61%). Conclusions: Complex endovascular treatment combining laser debulking and angioplasty/stenting offers an alternative for patients with critical limb ischemia who lack good surgical options.