bluuebunny/crossref_metadata_2025_split huggingface dataset:
Treatment of Traumatic False Aneurysm of the Thoracic Aorta with Endoluminal Grafts
Authors: Deshpande Arvind , Mossop Peter , Gurry John , Frydman Gary , Matalanis George , Walker Philip , Meckechnie Sunderland , Denton Michael 
Published: March 2015

Purpose: Traumatic false aneurysms of the thoracic aorta presenting at a time remote from the original injury are a rare but complex problem. The treatment of a traumatic false aneurysm by endovascular techniques may offer many advantages over conventional open surgery. Methods and Results: Two male patients presented with traumatic false aneurysm of the thoracic aorta after being treated emergently for visceral injuries from a gunshot wound in one and an automobile accident in the other. In both cases, the aneurysm was situated so that only the T11 intercostal artery would be sacrificed by endoluminal exclusion. Commercially available endoluminal stent-grafts (Talent) were deployed successfully. Recovery in both patients was rapid and uneventful with no neurological sequelae. Spiral computed tomographic scans at 1 year indicated sustained aneurysm exclusion and satisfactory endograft position. Conclusions: A customized endoluminal stent-graft can be used with great accuracy to exclude thoracic false aneurysms, avoiding the potential complexity and morbidity of an open thoracic approach.
The Effect of Angulation on Intravascular Ultrasound Imaging Observed in Vascular Phantoms
Authors: Geselschap Jim H. , Heilbron Mauricio J. , Hussain Farabi M. , Daskalakis Theodoros M. , Wilson Eric P. , Kopchok George E. , White Rodney A. 
Published: March 2015

Purpose: To quantify the error introduced by noncoaxial intravascular ultrasound (IVUS) imaging and to evaluate the use of a balloon-tipped catheter in compensating for intraluminal angulation and subsequent dimensional inaccuracy. Methods: The effect of noncoaxial IVUS imaging was investigated in both a polyvinyl chloride phantom and an in vitro canine aorta using a calibrated setup to measure angulation off axis. Imaging was performed at increasing angulation (creating an elliptical image) in both phantoms, with the transducer centered and off center. Diameters were compared to the original coaxial diameter, as well as calculated diameters based on specific angles off axis. The percentage change (error) was also calculated at these angles. The measurements were repeated using a balloon-tipped catheter to center the transducer. Results: The measured diameters and percentage changes compared closely with their calculated counterpart. Up to 25° off axis, the apparent increase in diameter measurement was nearly 10%. Angulation from 30° to 70° resulted in an increase of 15% to 192%. Use of the centering balloon reduced the amount of error by 70% to 85% but was limited to angles ≤ 25° due to the design of the test apparatus. Conclusions: The error introduced by noncoaxial IVUS imaging can be significant and may be partially corrected by the use of a centering balloon. Further studies in the clinical application of a centering device are warranted.
Transluminal Stent-Graft Repair for Pseudoaneurysm of PTFE Hemodialysis Grafts
Authors: Rabindranauth Prem , Shindelman Larry 
Published: March 2015

Purpose: To report the use of endovascular techniques to treat two cases of nonanastomotic pseudoaneurysm of a bridge graft fistula (BGF). Methods and Results: Two men with fully functional polytetrafluoroethylene (PTFE) BGFs both presented with an enlarging mass adjacent to their arteriovenous shunt. The false aneurysm in both instances was located by ultrasound and confirmed by shunt angiography at the time of surgery. Both fistulas were repaired by transluminally introducing a stented graft composed of a balloon-expandable Palmaz stent covered with a PTFE graft. Completion arteriography confirmed normal flow through the graft with no communication between the lumen and the aneurysmal cavity. Both patients recovered without complications and were discharged on the day of the procedure. Follow-up data reveal that both fistulas remain fully functional up to 5 and 6 months, respectively. Conclusions: Endovascular repair using stent-grafts can be a safe and effective method of excluding pseudoaneurysms associated with PTFE BGFs.
Dilatation of the Infrarenal Aneurysm Neck after Endovascular Exclusion of Abdominal Aortic Aneurysm
Authors: Sonesson Björn , Malina Martin , Ivancev Krasnodar , Lindh Mats , Lindblad Bengt , Brunkwall Jan 
Published: March 2015

Purpose: To determine the fate of the infrarenal aneurysm neck and suprarenal aorta after endovascular exclusion of abdominal aortic aneurysms (AAAs). Methods: Thirty-four patients underwent endovascular AAA repair between January 1994 and December 1995 using custom-made stent-grafts constructed from polyester graft material and modified self-expanding Gianturco Z-stents sutured to the graft orifices. Thirty-one patients were available for follow-up. Pre- and postimplantation diameters were measured using spiral computed tomography in the infrarenal aneurysm neck and the suprarenal aorta at the level of the superior mesenteric artery (SMA). Results: The mean follow-up time was 25 months. There was a significant increase of the diameter of the infrarenal aneurysm neck (+ 1.65 mm, p = 0.002), but not in the aorta at the level of the SMA (+ 0.52 mm, p = 0.100). There was no difference in the change in diameter in the infrarenal neck in the group with a stent adjacent to the level of measurement (n = 20) compared with the group without an adjacent stent (n = 11, p = 0.790). There was no correlation between preimplantation size of the infrarenal neck and its diameter change (r = 0.14, p = 0.488). There was no correlation (r = 0.10, p = 0.603) or association (chi-square test, p = 0.211) between aortic diameter change at the level of the SMA and the infrarenal neck. Conclusions: This investigation shows a significant dilatation of the infrarenal aneurysm neck, but not in the suprarenal aorta, after endovascular AAA repair with this device. The clinical significance of these findings is unclear. Whether such a dilatation in the infrarenal aneurysm neck may affect the long-term attachment of stent-grafts remains to be shown in the future.
Experience with the Stentor Endograft at Four Italian Centers
Authors: Coppi Gioacchino , Pacchioni Roberto , Moratto Roberto , Gennai Stefano , Farello Gianantonio A. , Bergamaschi Gastone , Rabbia Claudio , Rossato Denis , Ponzio Federico , Stancanelli Vincenzo , Piccinini Elio 
Published: March 2015

Purpose: To report the outcome of an Italian multicenter trial of endovascular abdominal aortic aneurysm (AAA) exclusion using the Stentor device. Methods: Between April 1995 and July 1996, 66 patients (63 men; average age 69 years, range 53 to 84) with infrarenal AAAs meeting the inclusion criteria were enrolled. The average diameter of the aneurysm was 4.6 cm (range 4.2 to 7). Three (4.5%) of the 66 AAAs were anastomotic aneurysms. Results: Sixteen (25%) tubular and 50 (76%) bifurcated endograft procedures were attempted; 4 (6.1%) were converted and 1 terminated owing to technical faults with the bifurcated graft's second limb. One tube graft was too short and failed to exclude an anastomotic aneurysm. Sixty (91%) endograft procedures were completed successfully. Six (9.1%) vascular complications occurred, three in one patient who subsequently died of pulmonary embolism 72 hours postoperatively (1.5% mortality). There were four (6.1%) proximal endoleaks; two sealed spontaneously in < 1 month, and a third was converted (7.6% conversion rate). The fourth is being observed. Clinical success (aneurysm exclusion with no death or endoleak) at 30 days was 86.3% (57/66). In the 23-month follow-up of 57 eligible patients, 2 patients died of unrelated causes and 1 graft limb thrombosed, requiring a crossover femoral bypass. One patient was converted to surgical repair at 5 months postoperatively when increasing aneurysm size signaled an undisclosed endoleak (1.8% late conversion rate). Five other secondary endoleaks were treated with endovascular techniques. Conclusions: The Stentor was technically feasible in 10% to 40% of AAA candidates in this study, although deployment of the second limb was problematic in the bifurcated device. Introduction of the second-generation Vanguard endograft brought this study to an end.
Spiral CT Angiography versus Aortography in the Assessment of Aortoiliac Length in Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair
Authors: Armon Matthew P. , Whitaker Simon C. , Gregson Roger H.S. , Wenham Peter W. , Hopkinson Brian R. 
Published: March 2015

Purpose: To compare measurements of aortoiliac length obtained with spiral computed tomographic angiography (CTA) and aortography in patients undergoing endovascular aneurysm repair. Methods: The distances from the lower-most renal artery to the aortic bifurcation and from the aortic bifurcation to the common iliac artery (CIA) bifurcation were measured using both CTA and aortography in 108 patients with abdominal aortic aneurysms. Results: The level of agreement between CTA and aortography was high, with 69% of aortic and 76% of iliac measurements within 1 cm and > 90% within 2 cm of each other. Mean differences were −0.35 ± 1.20 cm and 0.25 ± 1.10 cm, respectively, for aortic and iliac lengths. Aortography overestimated renal artery to aortic bifurcation length in comparison to CTA (p = 0.003), particularly in patients with large aneurysms (> 6.5 cm) and lumen diameters > 4.5 cm (p < 0.0001). Measurements of CIA length were shorter by aortography than CTA (p = 0.02). Conclusions: There is a high level of agreement between CTA and aortography in the measurement of aortoiliac length, but aortography overestimates renal artery to aortic bifurcation length in patients with large-diameter aneurysms and wide aneurysm lumens. CTA is sufficiently accurate in the majority of cases to be used as the sole basis for the construction of endovascular grafts.
Femoral Artery Exposure for Endovascular Aneurysm Repair through Oblique Incisions
Authors: Chuter Timothy A.M. , Reilly Linda M. , Stoney Ronald J. , Messina Louis M. 
Published: March 2015

Purpose: To offer an alternative technique for accessing the femoral artery prior to endovascular grafting. Technique: An oblique incision is made over the medial half of the inguinal ligament and continues to the femoral sheath, which is opened longitudinally. The distal external iliac artery and proximal common femoral artery are isolated. A tiny stab wound is made distal to the primary wound for femoral artery puncture and catheter access. Conclusions: Using an oblique incision at the level of the inguinal ligament optimizes exposure for endograft insertion and may minimize the frequency of serious wound complications.
A Method for Adjusting a Malpositioned Bifurcated Aortic Endograft
Authors: Rückert Ralph I. , Romaniuk Paul , Rogalla Patrik , Umscheid Thomas , Stelter Wolf J. , Müller Joachim M. 
Published: March 2015

Purpose: To report the successful application of a method to adjust a malpositioned bifurcated stent-graft after endovascular aortic aneurysm repair. Method and Results: A 62-year-old male patient underwent endovascular repair of a 5.1-cm abdominal aortic aneurysm (AAA) with a Vanguard bifurcated stent-graft. After complete deployment of the stent-graft, the intraoperative completion angiogram disclosed unexpected occlusion of the left renal artery. Intra-aortic adjustment of the bifurcated graft was possible with a crossover guidewire, which was pulled caudally. The method worked perfectly to restore blood flow to the left renal artery. The patient is well 16 months postoperatively without any evidence of endoleak or graft migration; the left renal artery remains open. Conclusions: A technique is demonstrated for intra-aortic repositioning of a bifurcated stent-graft to correct insufficient deployment. If required, this technique should be attempted before conversion to an open procedure.
Endovascular Repair of Aortic Aneurysms in the Presence of a Horseshoe Kidney
Authors: Loftus Ian K. , Thompson Matthew M. , Fishwick Guy , Boyle Jonathan R. , Bell Peter R.F. 
Published: March 2015

Purpose: To report two cases of endovascular aortic aneurysm exclusion in patients with a horseshoe kidney. Methods and Results: Two male patients, one with a known horseshoe kidney and history of multiple previous laparotomies, presented with abdominal aortic aneurysms of approximately 6-cm diameter. Each was treated with a tapered aortomonoiliac polytetrafluoroethylene graft secured proximally with a Palmaz balloon-expandable stent. The endograft was sutured distally to a Dacron femorofemoral crossover graft. An anomalous renal vessel was sacrificed in one case. The aneurysms were successfully excluded, and the patients recovered without sequelae. Conclusions: Endovascular repair should be considered as a treatment option in patients with aortic aneurysm in the presence of a horseshoe kidney, particularly if the renal vasculature can be wholly preserved.
Renal Complications following Endovascular Repair of Abdominal Aortic Aneurysms
Authors: Walker Stuart R. , Yusuf S. Waquar , Wenham Peter W. , Hopkinson Brian R. 
Published: March 2015

Purpose: To investigate the renal complications associated with endovascular repair of abdominal aortic aneurysms (AAAs). Methods: Data were prospectively collected on 164 AAA patients (154 males; median age 72 years; interquartile range 51 to 88) undergoing endovascular grafting. Any history of renal failure and diabetes mellitus was recorded. Serum urea and creatinine levels were measured preoperatively and at regular intervals postoperatively. Renal impairment was defined as serum creatinine > 130 μmol/L. Results: There were no significant differences in pre- and 1-day postoperative serum urea and creatinine levels. Among 15 (9.1%) patients with preoperative renal failure, 7 (47%) died, 4 (27%) in the perioperative period. Of the 149 patients with normal renal function preoperatively, 4 (2.7%) developed renal failure as part of multisystem organ failure. Another 9 (6.2%) developed significant postoperative elevations (> 20%) in their creatinine levels compared to baseline; 4 of these patients died, 2 in the perioperative period. There was no significant difference in the median dose of intravascular contrast used for those patients that did and did not have a deterioration in their renal function (250 mL versus 300 mL). Conclusions: In this study, approximately 6% of patients with normal preoperative renal function who undergo endovascular AAA repair develop renal dysfunction. For patients with preoperative renal impairment, the perioperative mortality rate is high, 27%, following endovascular aortic aneurysm repair.
Combined Approach to Stent-Graft Treatment of an Aortic Arch Aneurysm
Authors: Buth Jacob , Penn Olaf , Tielbeek Alexander , Mersman Marijke 
Published: March 2015

Purpose: To report the first use of dual brachiocephalic vessel transposition from the aortic arch prior to endovascular exclusion of an arch aneurysm. Methods and Results: Patch graft repair of a saccular aortic arch aneurysm in a 74-year-old woman failed to exclude the lesion, resulting in aneurysm enlargement. Because the patient was debilitated, a combined open and endovascular procedure was performed in which the common carotid and subclavian arteries were transposed prior to successful insertion of a Vanguard aortic stent-graft to exclude the aneurysm. Imaging 1 and 6 months after the combined procedure demonstrated complete thrombosis of the aneurysm. Conclusions: Transposition from the aortic arch of one or more brachiocephalic vessels may allow stent-graft exclusion of aortic arch aneurysms. However, the durability of thoracic aortic endografts must be ascertained before the indications for their use are expanded.
Endovascular Treatment of Internal Iliac Artery Aneurysms
Authors: Henry Michel , Amor Max , Henry Isabelle , Tzvetanov Kiril , Buniet Jean-Michel , Amicabile Claude 
Published: March 2015

Purpose: To describe a technique for percutaneous endovascular repair of internal iliac artery aneurysms. Technique: In a patient with an isolated internal iliac artery aneurysm and combined tight stenoses at the origins of the external and internal iliac arteries, interventional treatment consisted of coil embolization of the internal iliac artery and branches using the contralateral femoral approach. Balloon dilation of the external iliac stenosis occluded the internal iliac artery, and Palmaz stents were placed in the external iliac stenosis to overcome residual luminal narrowing. Conclusions: This one-step percutaneous technique allows total exclusion of the internal iliac artery aneurysm using coil embolization. This treatment may be an alternative to surgery in isolated internal iliac artery aneurysms with small orifices.
The Effect of Nonporous PTFE-Covered Stents on Intimal Hyperplasia following Balloon Arterial Injury in Minipigs
Authors: Yuan John G. , Ohki Takao , Marin Michael L. , Quintos Ricardo T. , Krohn Douglas L. , Beitler Jonathan J. , Veith Frank J. 
Published: March 2015

Purpose: To report an experimental study investigating the ability of nonporous polytetrafluoroethylene (PTFE) covering on a metallic stent to retard the development of neointimal hyperplasia (NIH). Methods: Three groups of Hanford miniature swine underwent standardized balloon injury to both external iliac arteries. Group I animals (control) received balloon injuries only. Group II had the site of balloon injury supported by a properly sized, balloon-expandable Palmaz stent placed directly over the injury site. Group III animals received a Palmaz stent covered with PTFE graft. All animals underwent arteriography immediately after intervention and again prior to sacrifice and specimen harvest at 4 weeks. The specimens were examined grossly and histologically at the proximal, middle, and distal segments for NIH development. Results: Uncovered stents developed significantly more NIH (p < 0.0001) and greater luminal narrowing (p < 0.001) than the controls. PTFE-covered stents (group III) exhibited less NIH (p < 0.001) and luminal reduction (p < 0.01) than bare stents (group II) at the middle portion of the stent-graft, but the PTFE cover had no effect on NIH and lumen reduction at the proximal or distal ends of the prosthesis. Conclusions: PTFE-covered stents retarded NIH at 4 weeks, but only at the midportion of the devices; the covering did not prevent neointimal pannus ingrowth at the proximal and distal ends.
In Vivo Crushing of an Aortic Stent Enables Endovascular Repair of a Large Infrarenal Aortic Pseudoaneurysm
Authors: Dorros Gerald , Jaff Michael R. , Parikh Ashish , Sehgal Rajesh , Thota Venkat , Ramireddy Keshav , Carballo Richard E. 
Published: March 2015

Purpose: To report an unusual approach to endovascular exclusion of a large aortic pseudoaneurysm. Methods and Results: A 63-year-old male had an unsuccessful endovascular repair of an aortic anastomotic pseudoaneurysm that left an expanded, uncovered Palmaz stent lying obliquely within the aorta. After nearly 3 years, the pseudoaneurysm enlarged to 7 cm, and the patient became symptomatic. Repair of the pseudoaneurysm was accomplished by crushing the indwelling stent to allow placement of a stent-graft. Conclusions: Malpositioned stents that are hindering an endoluminal procedure may be crushed against the arterial wall in vivo to facilitate passage of endovascular instruments or devices.
Endovascular Repair of Aortic Aneurysms: Treatment of Complications
Authors: Görich Johannes , Rilinger Norbert , Söldner Joachim , Krämer Stefan , Orend Karl-Heinz , Schütz Ansgar , Sokiranski Roman , Bartel Martin , Sunder-Plassmann Ludger , Scharrer-Pamler Reinhard 
Published: March 2015

Purpose: To evaluate the use of interventional procedures for treating complications following endovascular repair of aortic aneurysms. Methods: Fifty-five patients (49 men; mean age 67.5 years) underwent endoluminal stent-graft repair of traumatic (n = 4) or arteriosclerotic (n = 51) aortic aneurysms in the thoracic (n = 3) or infrarenal (n = 52) aorta. Follow-up of therapeutic success included periodic clinical examination, angiography, and spiral computed tomography. Results: Discounting the 25 (45%) cases of postimplantation syndrome that did not require treatment, there were 22 complications observed in 20 (36%) patients over a mean 10-month follow-up (range 1 to 27). There were 2 transrenal endograft maldeployments, 1 case of twisted graft limbs, 2 access site problems (1 patient), 12 endoleaks (11 patients), 1 late graft limb thrombosis, 1 symptomatic internal iliac artery occlusion, 2 myocardial infarctions, and 1 transient psychosis. Seven (13%) patients did not undergo specific therapy, while 4 (7%) required operation (2 crossover bypass grafts, 1 suture revision, and 1 graft replacement). Among 9 (16%) patients treated with interventional techniques, 7 underwent percutaneous coil embolization for 8 endoleaks (7 successfully resolved). One late stent-graft disconnection required an additional stent-graft, and 1 of the 2 malpositioned endografts was repositioned. All patients remain alive with no increase in the diameter of the aneurysm in any patient. Conclusions: Technical problems resulting from the endovascular repair of aortic aneurysms often respond to interventional treatment.
Ambulatory Endovascular Surgery: Cost Advantage and Factors Influencing its Safe Performance
Authors: Shindelman Larry E. , Ninnul Gowen B. , Curtiss Steven I. , Konigsberg Stephen F. 
Published: March 2015

Purpose: To perform a retrospective analysis of chronic limb ischemia and determine whether endovascular surgery can be performed safely and cost effectively on an ambulatory basis. Methods: Among 42 patients undergoing endovascular interventions for lower limb ischemia over a 12-month period ending October 1997, 32 (18 men, mean age 68 years, range 44 to 89) were treated solely by endovascular interventions. These patients were grouped according to time inhospital: 20 (63%) patients had endovascular procedures performed on an ambulatory basis, 7 (22%) were hospitalized for > 24 hours, and 5 (16%) required an overnight stay. The angioplasty procedures, which included placement of 21 stents, were performed in the abdominal aorta (n = 1) and the common iliac (n = 9), external iliac (n = 7), superficial femoral (n = 11), popliteal (n = 5), tibioperoneal (n = 7), and subclavian (n = 1) arteries. Hospital charges were compared for the 3 groups. Results: Other than the presence of coronary artery disease, there were no significant differences in demographics or risk factors among the 3 groups. Angioplasty was technically successful in all patients, and there were no procedural complications. Patients with tissue loss required hospitalization more frequently compared to those with claudication. Significantly more patients who were hospitalized had epidural anesthesia as opposed to local when compared to the ambulatory group, 43% versus 5%, respectively (p = 0.04). Excluding professional fees, mean total hospital cost differed significantly between the ambulatory group and the group of patients with a hospital stay > 24 hours ($8227 versus $40,383, respectively; p = 0.03) and between the 2 hospitalized groups ($9476 for overnight stay versus $40,383 for > 24-hour stay, p = 0.03). Conclusions: Peripheral endovascular interventions can be performed safely on an ambulatory basis resulting in decreased hospital cost. Patients who receive epidural anesthesia, require concomitant open vascular reconstruction, present with tissue loss, or have unstable medical conditions are more likely to require hospitalization.