bluuebunny/crossref_metadata_2025_split huggingface dataset:
Unprotected Carotid Artery Stenting Compared to Carotid Endarterectomy in a Community Setting
Authors: Madyoon Hooman , Braunstein Eric , Callcott Frank , Oshtory Meherji , Gurnsey Lynne , Croushore Linda , Macbeth Andrew 
Published: March 2015

Purpose: To evaluate the feasibility and safety of carotid artery stenting (CAS) performed by a dedicated multidisciplinary team in a community hospital. Methods: Forty-nine patients (30 men; mean age 74.3 ± 7.4 years, range 51–88) with 14 symptomatic and 35 asymptomatic >50% carotid stenoses were enrolled into the study and treated with self-expanding stents without cerebral protection. The patients were evaluated at 30 days for death, neurological sequelae, and length of stay. A contemporaneous group of 140 patients (80 men; mean age 72.3 ± 7.7 years, range 43–89) undergoing carotid endarterectomy (CEA) was used for comparison of the outcome measures. Owing to crossover of failed CAS patients to the CEA group, the data were analyzed according to intention-to-treat and treatment-received. Results: The only difference in baseline characteristics between the treatment and control groups was the greater frequency of bilateral disease in the CEA group (p=0.009). The CAS procedures were successful in 47 (96.0%) patients; 2 access failures were converted to endarterectomy, and 1 access-site pseudoaneurysm was treated surgically. There were no deaths or myocardial infarctions in either group. In the CAS group, there were no major and only 2 (4.1%) minor strokes compared to 4 (2.9%) major and 4 (2.9%) minor strokes in the CEA group (p>0.05). Median LOS was significantly lower in the CAS group (p<0.0001). Conclusions: Careful case selection and multidisciplinary collaboration facilitate the safe performance of carotid stenting in a community setting with acceptable early results.
Complications after Endovascular Repair of Type B Aortic Dissection
Authors: Pamler Reinhard S. , Kotsis Thomas , Görich Johannes , Kapfer Xaver , Orend Karl-Heinz , Sunder-Plassmann Ludger 
Published: March 2015

Purpose: To outline the complications encountered after endoluminal treatment in patients with type B aortic dissection. Methods: Between 1999 and 2001, 14 patients (12 men; mean age 60.3 years, range 39–79) with isolated type B aortic dissection (13 chronic, 1 acute) underwent aortic stent-grafting. Three patients with chronic dissection presented an acute clinical picture and were managed emergently. The left subclavian artery was intentionally covered by the prosthesis in 9 patients. Follow-up studies were performed at 6-month intervals. Results: Stent-graft implantation was technically successful in all patients, but incomplete sealing (endoleak) of the entry site required additional proximal stent-graft implantation in 4. The left subclavian artery remained patent in 5 patients. Secondary conversion was required in 3 patients: 2 for acute type A dissection resulting from injury to the aortic arch by Talent endografts and a sustained hemorrhage (left hemothorax). In another patient, a secondary intramural hematoma subsided spontaneously. Anterior spinal artery syndrome in 1 patient persisted at 1 month. No bypass was necessary for the 9 patients with the covered left subclavian arteries. Mean follow-up was 14 months (range 1–23). Conclusions: Stent-grafting is feasible in patients with type B aortic dissection, although it is associated with a considerable rate of complications. Frank reporting of these sequelae for a variety of stent-grafts is of paramount importance to clarifying the limitations of the method.
Side-Branched Modular Endograft System for Thoracoabdominal Aortic Aneurysm Repair
Authors: Bleyn Jacques , Schol François , Vanhandenhove Inga , Vercaeren Peter 
Published: March 2015

Purpose: To describe a side-branched modular endograft system that provides adequate visceral artery perfusion with perfect seal during thoracoabdominal aortic aneurysm (TAAA) repair. Case Report: A 76-year-old man with a 57-mm TAAA involving the celiac artery was treated with a customized Talent endograft consisting of a 46-mm × 18-cm stented main body and a 6-mm × 30-mm nonstented Dacron side branch. The graft was delivered through a surgical exposure of the left common femoral artery. A 6-mm × 10-cm Hemobahn stent-graft was introduced in the 30-mm side branch from the aorta to the celiac trunk through a long 8-F sheath via the left brachial artery. The patient recovered uneventfully except for a mild reactive inflammatory syndrome. Postoperative computed tomography demonstrated total exclusion of the TAAA sac and good antegrade perfusion of the celiac and superior mesenteric arteries, which has been maintained at the 6-month follow-up. Conclusions: Endovascular treatment of TAAA is feasible with further technical refinements of available technology.
Vascular Endothelial Growth Factor (VEGF165) and its Influence on Angiogenesis versus Arteriogenesis in Different Vascular Beds
Authors: Nikol Sigrid , Pelisek Jaroslav , Engelmann Markus G. , Shimizu Masumi , Fuchs Alexandra , Golda Adam , Armeanu Sorin , Mekkaoui Choukri , Rolland Pierre H. 
Published: March 2015

Purpose: To use local gene delivery to determine any district-specific influence of vascular endothelial growth factor (VEGF165) on angiogenesis and arteriogenesis in arteries of distinct developmental origin. Methods: Coronary and peripheral arteries were chronically occluded in 30 Pietrain pigs using a percutaneous approach and blinded stent-graft. DNA was delivered to the adventitia in dosages corresponding to 10% of the body weight—adapted amount used in clinical trials. The coronary arteries in 12 animals and the peripheral arteries in 12 animals were treated or used as controls (no occlusion or occlusion with transfection of the β-galactosidase gene). Six additional animals were sacrificed at 1 or 3 weeks for expression analyses, while the other 24 animals were sacrificed at 5 months for expression analysis and histology. Angiography, polymerase chain reaction analyses, and immunohistochemistry were performed. Results: Expression of the VEGF gene was observed at 1 and 3 weeks following application, while transfected DNA was detected up to 5 months. New collaterals formed around occluded coronary arteries (2.63 ± 0.69 fold, p<0.05 versus 1.24 ± 0.40 fold for peripheral arteries), and angiographic arterial area increase was more pronounced in coronary (2.49 ± 0.59 fold, p<0.05) than peripheral arteries (1.49 ± 0.05 fold). There was no collateralization surrounding occluded peripheral arteries, but new arterial branches were seen (2.0 ± 0.28, p<0.05 versus 1.07 ± 0.31 for coronary). Conclusions: The response to VEGF, whether it is predominantly angiogenesis or arteriogenesis, is dependent on the target vessel. These observed differences in the behavior of arteries may be related to their differing developmental origins, which may have important implications for future therapeutic strategies using VEGF in different vessels.
Vibrational Angioplasty in the Treatment of Chronic Infrapopliteal Arterial Occlusions: Preliminary Experience
Authors: Tsetis Dimitrios K. , Michalis Lampros K. , Rees Michael R. , Katsamouris Asterios N. , Matsagas Miltiadis I. , Katsouras Christos S. , Sideris Dimitrios A. , Gourtsoyiannis Nicholas C. 
Published: March 2015

Purpose: To evaluate the safety and efficacy of vibrational angioplasty in chronic infrapopliteal arterial occlusions. Methods: Twelve patients (9 men, aged 54 to 90 years) with 13 below-knee arterial chronic total occlusions were treated percutaneously using vibrational angioplasty. The occlusions were located in the anterior tibial artery (n=5), the tibioperoneal trunk (n=4), the peroneal artery (n=1), the posterior tibial artery (n=1), and in both the tibioperoneal trunk and peroneal artery (n=2). The length of the lesions ranged from 5 to 14 cm. Results: Recanalization was successful in 12 (92.3%) lesions. In 1 case, the wire perforated the arterial wall; the procedure was abandoned without clinical sequelae. The time to cross the occlusions with the wire ranged from 6 to 19 minutes. No other complications were observed. Clinical follow-up ranged to 18 months. Ten patients with ulceration or gangrene demonstrated good wound healing, and pain was alleviated in all successfully treated patients. Conclusions: Vibrational angioplasty appears feasible as a means of safely recanalizing chronic total occlusions of the infrapopliteal arteries. Further experience should be acquired to assess its short- and long-term effects on this vascular territory.
Internal Iliac Aneurysm Rupture into the Rectum following Endovascular Exclusion: An Unusual Cause of Massive Lower Gastrointestinal Bleeding
Authors: Karkos Christos D. , Oshodi Taohid O. , Vimalachandran Dale , Abraham John S. , Adiseshiah Mohan 
Published: March 2015

Purpose: To report a rare iliorectal fistula following endovascular treatment of an internal iliac aneurysm. Case Report: A 76-year-old man developed lower gastrointestinal bleeding 3 months after successful endovascular exclusion of a left internal iliac aneurysm with coil embolization, attempted stent-grafting, ligation of the distal external iliac artery, and a femorofemoral crossover bypass. Aortography showed no clear intestinal bleeding point, but demonstrated recanalization and continued perfusion of the aneurysm. At laparotomy, an iliorectal fistula was detected. The common iliac artery was ligated proximally, the aneurysm sac was opened, and the back-bleeding internal iliac artery branches were oversewn. The rectum was closed primarily. He made an uneventful recovery. Conclusions: An iliorectal fistula is an extremely rare and unlikely complication of coil occlusion of an iliac aneurysm. A high index of suspicion for the diagnosis is of paramount importance. Periodic imaging in these patients is required to detect recanalization and continuing aneurysm expansion.
Perivascular Inflammatory Reaction to a Hemobahn Stent-Graft: Diagnosis with 3D MR Angiography
Authors: Juergens Kai Uwe , Tombach Bernd , Reimer Peter , Vestring Thomas , Heindel Walter 
Published: March 2015

Purpose: To present a rare perivascular inflammatory reaction to a commercially produced polytetrafluoroethylene-covered stent and demonstrate the utility of 3-dimensional (3D) magnetic resonance angiography (MRA) in the diagnosis of this phenomenon. Case Report: Three weeks after percutaneous deployment of a Hemobahn stent-graft to treat a high-grade stenosis and aneurysm of the proximal left superficial femoral artery (SFA), a 70-year-old diabetic man developed fever, pain, and local swelling of the left thigh. Venous thrombosis was excluded by ultrasound imaging; a normal flow profile was seen in the left common and superficial femoral arteries. Blood analysis found elevated inflammatory markers. MRA revealed extensive soft-tissue edema and perivascular contrast enhancement around the left SFA, but the stent-graft was patent. The clinical symptoms resolved within 7 days after initiation of anti-inflammatory therapy. Follow-up MRA scans demonstrated significantly reduced inflammatory reaction over the next few months. Conclusions: Symptomatic perivascular inflammatory soft-tissue response to a stent-graft can be diagnosed with MR imaging studies.
Coil Embolization of an Aortic Arch False Aneurysm
Authors: Chapot René , Aymard Armand , Saint-Maurice Jean-Pierre , Bel Alain , Merland Jean-Jacques , Houdart Emmanuel 
Published: March 2015

Purpose: To report the endovascular occlusion of an anastomotic false aneurysm of the ascending aorta. Case Report: A 51-year-old patient developed an anastomotic false aneurysm at the level of the aortic arch after surgical replacement of the aortic root and arch for aortic dissection. The aneurysm expanded after 6 months and because of its saccular shape was treated by selective occlusion with detachable microcoils. Magnetic resonance angiography showed the stability of the occlusion after 2 years. Conclusions: Endovascular treatment with coils may be a good alternative to surgery for saccular anastomotic false aneurysms.
Intravascular Ultrasound—Guided Stenting for Chronic Abdominal Aortic Dissection
Authors: Giudice Rocco , Frezzotti Antonio , Scoccianti Marco 
Published: March 2015

Purpose: To describe how the combined use of duplex and intravascular ultrasound (IVUS) can assist in the evaluation and treatment of isolated abdominal aortic dissection without need for contrast angiography. Case Report: A 78-year-old man presented with intermittent bilateral buttock and thigh claudication. Duplex ultrasound and contrast-enhanced computed tomography (CT) confirmed a chronic dissection along 3 to 4 cm of the infrarenal abdominal aorta. During Extra Large Palmaz stent implantation, the procedure was based on IVUS images and fluoroscopy without angiography. Both duplex and IVUS images were critical in assessing the type and extent of the lesion to be treated, in guiding the procedure, and in assessing its satisfactory outcome. Conclusions: In selected cases, ultrasound-based imaging modalities can provide most of the information required to accomplish complex aortic procedures.
Percutaneous Infusion System for in Situ Thrombolysis in the Abdominal Aorta and Iliac Arteries
Authors: Viña Roberto Fernandez , Benetti Federico , Vrsalovick Francisco , Rizzardi José Luis , Petroni Danilo , de Zappetti Mariana , Zappetti Alejandro , Leeflang Stephen 
Published: March 2015

Purpose: To report successful treatment of an occluded aorta with a new percutaneous infusion system. Case Report: A 57-year-old man was admitted in severe pain with cyanosis and acrocyanotic pigmentation in the lower abdomen and limbs. The patient had symptoms of renal disease and severe oligoanuria. Ultrasound scanning detected no flow in the lower limbs, and angiography identified total thromboembolic occlusion of the aorta immediately below the origin of the renal arteries. A new Trellis percutaneous thrombolytic infusion system was used for controlled site-specific infusion and dispersion of streptokinase into the abdominal aorta and the iliofemoral arteries bilaterally with successful restoration of flow and no complications. Conclusions: The Trellis system is effective for rapid lysis of thrombotic emboli using low doses of lytic agents. The unique design of the Trellis allowed complete aspiration of the residual thrombus, thus avoiding adverse effects.
Initial Experience with Intentional Stent-Graft Coverage of the Subclavian Artery during Endovascular Thoracic Aortic Repairs
Authors: Görich Johannes , Asquan Yahia , Seifarth Harald , Krämer Stefan , Kapfer Xaver , Orend Karl-Heinz , Sunder-Plassmann Ludger , Pamler Reinhard 
Published: March 2015

Purpose: To investigate the extent to which clinical status is affected by covering the left subclavian artery (LSA) with stent-grafts in the thoracic aorta. Methods: Stent-graft reconstruction of the thoracic aorta was performed in 23 patients (20 men; mean age 50.8 years, range 17–77) for management of rupture (n = 11), type B dissection (n = 9), or aneurysm (n = 3). All patients had bilaterally equal systolic and diastolic blood pressures (141.3 ± 19.8 and 78.9 ± 11.0 mmHg, respectively). Twenty Gore TAG and 1 Talent thoracic endografts were used; 2 cases required a combination of prostheses. In all patients, the stent-graft was intentionally placed to cover the LSA. Follow-up included clinical examination with blood pressure measurements and computed tomography during the first postoperative week and at 3-month intervals thereafter. Results: After coverage of the LSA by the stent-graft, systolic pressure fell by a mean 48.3 ± 23.4 mmHg. In 4 cases of proximal endoleak, however, systolic pressure fell by only 25.0 ± 15.0 mmHg. Twenty (78.5%) patients reported no complaints during a mean follow-up of 12.1 ± 7.3 months. Postinterventional complaints reported by 3 patients included exercise-dependent paresthesias; nonexercise-dependent, intermittent, and completely reversible dizziness; and a temperature difference between the upper extremities with no decrease in strength. Conclusions: Covering the LSA is generally well tolerated by patients and increases the landing zone for the placement of thoracic stent-grafts. Long-term studies, however, must investigate the hemodynamic effects of this procedure on the vertebrobasilar circulation.
Emergency Endovascular Treatment of Thoracic Aortic Rupture in Three Accident Victims with Multiple Injuries
Authors: Nio Denise , Vos Patrick M. , de Mol Bas A.J.M. , Ponsen Kees J. , Reekers Jim A. , Balm Ron 
Published: March 2015

Purpose: To report an experience with emergency endovascular treatment of traumatic thoracic aortic ruptures in multi-injured patients. Case Reports: Three victims of motor vehicle accidents with multiple head, chest, and abdominal injuries in addition to fractures were treated urgently for thoracic aortic lacerations with transluminal placement of an endovascular graft during the initial emergent laparotomy. In all cases, ruptured visceral organs were treated first and the abdomen closed. Femoral artery access was gained through a cutdown, and the endografts were delivered with no systemic heparinization. The endovascular component of the surgical session took ∼50 minutes. All patients survived to discharge. Two patients are alive at 5 and 12 months with sustained endovascular exclusion of the pseudoaneurysm, but one patient with severe brain damage died 9 months after treatment from respiratory insufficiency. Conclusions: Acute endovascular treatment of thoracic aortic ruptures is feasible and has the advantage of avoiding thoracotomy in otherwise severely injured patients.
Emergency Stent-Graft Placement for Impending Rupture of the Descending Thoracic Aorta
Authors: Nesser H. Joachim , Eggebrecht Holger , Baumgart Dietrich , Ebner Christian , Gschwendtner Manfred , Barkhausen Jörg , Erbel Raimund , Nienaber Christoph A. 
Published: March 2015

Purpose: To present initial experience with emergent stent-graft placement for impending rupture of the descending thoracic aorta. Case Reports: Intramural hematoma (IMH) of the descending thoracic aorta was diagnosed by transesophageal echocardiography and computed tomography in 3 patients with acute onset of severe thoracic pain. Because of signs of impending rupture, e.g., pleural effusion, sustained pain, or transadventitial bleeding, the patients underwent emergency stent-graft placement, which was successful in all cases. No procedure-related complications were observed. Follow-up to 18 months has revealed no evidence of endoleak, and all patients remain free of symptoms. Conclusions: Emergency stent-graft placement may be a promising alternative to conventional surgery in patients with impending aortic rupture due to IMH.
Endovascular Exclusion of Leaking Thoracic Aortic Aneurysms
Authors: Woody Jonathan D. , Walot Irwin , Donayre Carlos E. , Eugene John , Carey Joseph S. , White Rodney A. 
Published: March 2015

Purpose: To describe the endovascular exclusion of leaking thoracic aortic aneurysms (TAA). Case Report: Two elderly patients with leaking TAAs who were at high risk for surgical intervention were transferred to our institution for possible endovascular treatment. Both patients underwent successful endovascular exclusion of the leaking TAAs using multiple stacked AneuRx thoracic endoprostheses. One patient remains alive and well at 1 year with an excluded aneurysm; the other patient died from heart failure 2 months after endografting. Conclusions: While the early results of the endovascular exclusion of leaking TAAs are promising, the use of thoracic endoprostheses remains investigational.
Angiographic Description of Blunt Traumatic Injuries to the Thoracic Aorta with Specific Relevance to Endograft Repair
Authors: Borsa John J. , Hoffer Eric K. , Karmy-Jones Ryad , Fontaine Arthur B. , Bloch Robert D. , Yoon Justin K. , So Coralli R. , Meissner Mark H. , Demirer Seher 
Published: March 2015

Purpose: To describe the precise anatomical location and extent of injury (based on angiography) in a series of patients with blunt thoracic aortic injury (BTAI) and evaluate the findings relative to the potential for endograft repair. Methods: Thoracic aortograms from 50 trauma patients (37 men; mean age 37 years, range 13–87) with BTAI were retrospectively reviewed. Parameters important for endograft repair were recorded, including the length of the pseudoaneurysm, the distance between the origin of the most distal arch vessel and the pseudoaneurysm, the diameter of the aorta both above and below the pseudoaneurysm, and finally, the curvature of the aorta in the vicinity of the pseudoaneurysm. Results: The mean distance from the left subclavian artery to the superior aspect of the injury measured 5.8 mm along the lesser curve and 14.9 mm along the greater curve. The mean length of the injury was 17.0 mm and 26.0 mm along the lesser and greater curves, respectively. The mean aortic diameter adjacent to the injury measured 19.3 mm. The mean degree of curvature of the aorta over the length of the injury was 27.2°, with a mean radius of curvature of 32.6 mm at the superior aspect of the injury and 39.3 mm inferiorly. Conclusions: In most cases of BTAI, the location of the injury will necessitate covering the origin of the left subclavian artery if endovascular repair is to be performed. The curvature of the aorta in the region predisposed to these injuries requires that the endograft be very flexible and/or precurved.
Regression of a Descending Thoracoabdominal Aortic Dissection following Staged Deployment of Thoracic and Abdominal Aortic Endografts
Authors: White Rodney A. , Donayre Carlos , Walot Irwin , Lee James , Kopchok George E. 
Published: March 2015

Purpose: To describe the successful endovascular repair and regression of an extensive descending thoracoabdominal aortic dissection associated with thoracic and abdominal aortic aneurysms. Case Report: An 83-year-old man presented with acute chest pain and shortness of breath. A descending thoracoabdominal aortic dissection that extended from near the left subclavian artery (LSA) to the right common iliac artery was found on computed tomography. Separate aneurysms in the thoracic and abdominal aorta were also identified. Staged endovascular procedures were undertaken to (1) close the single entry site and exclude the aneurysm in the thoracic aorta with an AneuRx thoracic stent-graft, (2) exclude the abdominal aneurysm and distal re-entry site with a bifurcated AneuRx endograft, and (3) treat a newly dilated thoracic segment between the LSA and first thoracic stent-graft. At 1 year, the false lumen had completely disappeared, the thoracic aneurysm had collapsed onto the endograft, and the abdominal aneurysm had shrunk by 30%. Conclusions: The potential to treat extensive aortic dissections with the hope that they might regress is promising, but repair of highly complex lesions involving one or more aneurysms in addition to the dissection requires meticulous imaging studies both preoperatively and intraprocedurally.