bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multicenter Trial of the Jostent Balloon-Expandable Stent-Graft in Renal and Iliac Artery Lesions
Authors: Gaxotte Virginia , Laurens Brigitte , Haulon Stéphan , Lions Christophe , Mounier-Véhier Claire , Beregi Jean-Paul 
Published: March 2015

Purpose: To report the results of a multicenter feasibility study of the Jostent balloon-expandable stent-graft in the treatment of renal and iliac artery lesions. Methods: Twenty-three patients (17 men; mean age 62 years, range 38–80) with lesions in the renal (n = 12) or iliac arteries (n = 12) were enrolled in 6 centers over a 1-year period. Preprocedural computed tomography (CT) and angiography were performed in all patients. The Jostent device was implanted in the 24 arteries to treat 11 in-stent stenoses, 2 arterial ruptures, 2 aneurysms, 2 dissections, 2 ulcerated stenoses, and 5 chronic occlusions. Follow-up included color duplex ultrasound examination on the day after the procedure and at 6 months; patients with renal artery stent-grafts were also evaluated with CT angiography. Results: Twenty-seven stent-grafts were deployed successfully in the 24 (100%) arteries. Seven (30%) patients required adjunctive procedures to address 1 acute in-stent thrombosis, 2 dissections, and 4 in-stent residual stenoses. At 6-month follow-up, 2 (8.3%) restenoses occurred in the renal arteries; these were treated successfully using balloon angioplasty. Conclusions: These data suggest that a balloon-expandable stent-graft may be safe and useful in patients with selected peripheral indications.
The Role of Routine Angioscopy in Vascular Access Surgery
Authors: Hölzenbein Thomas J. , Miller Arnold , Gottlieb Michael N. , Gupta Sushil K. 
Published: March 2015

Purpose: The purpose of this retrospective study is to describe our techniques, review our experience, and determine the feasibility, safety, and role of the routine use of angioscopy during primary and revision vascular access surgery. Methods: Between February 1991 and October 1993, intraoperative angioscopy was routinely performed in 84 consecutive operations (51 patients) for vascular access surgery. We reviewed the videotaped recordings of the angioscopic studies together with the clinical data according to a predetermined protocol. Results: There were 43 primary procedures (36 autogenous arteriovenous fistulas and 7 bridge graft fistulas) and 41 revision procedures for failed vascular access (7 autogenous arteriovenous fistulas and 34 graft bridge fistulas). In 20.9% of the primary vascular access procedures, abnormal endoluminal findings were noted. Based on these findings, only one additional intervention was performed. In revision vascular access surgery, abnormal endoluminal findings were noted in 92.7%, resulting in additional surgical interventions in 65.9% of the procedures. In the revised synthetic bridge graft fistulas, stenosis of the mid-graft (n = 9) as a result of needle insertion for dialysis was more common than at venous anastomosis (n = 4). Detection and correction of endoluminal abnormalities resulted in a 30-day patency of 66.6% as opposed to 33.3% when none was detected (p ≤ 0.012, Fisher's exact test). Conclusions: Routine angioscopy is technically feasible and can be performed safely in anuric patients during vascular access surgery. It provides additional and useful intraoperative information that may significantly alter the surgical procedure. Routine angioscopy may also provide new insights into the pathophysiology of vascular access failure.
The Role of Endovascular Surgery in Carotid Restenosis
Authors: Pratesi Carlo , Credi Giovanni , Pulli Raffaele , Michelangnoli Stefano , Bertini Domenico 
Published: March 2015

Purpose: To report the immediate and long-term outcome of intraoperative balloon angioplasty for the treatment of recurrent disease in the internal carotid arteries (ICAs). Methods: Three patients (2 males, 1 female; ages 53 to 70 years) presented with > 80% restenotic lesions (bilateral in one patient) at the distal aspect of a previous carotid endarterectomy. Two patients exhibited hemianopia, while the third was asymptomatic but had a contralateral ICA occlusion. All four lesions appeared smooth and fibrous on ultrasonography and were located high in the ICA. The location and morphology of the lesions made balloon angioplasty a more potentially successful treatment option. Results: Through open access to the common carotid artery, the lesions were approached and dilated under fluoroscopic guidance with monitoring of evoked potentials. The lesions were successfully dilated as determined by control arteriography, and no complications were encountered. Over a follow-up period extending to 18 months in one patient and 24 months in the other two, ultrasound imaging and arteriography have shown no restenosis at any treatment site. Conclusions: Although caution is prudent when dealing with lesions in the cervical arteries, balloon angioplasty may have a role in treating surgically in accessible restenotic carotid lesions that demonstrate a low potential for embolic complications. More experience with this technique will be required before widespread application of balloon angioplasty in the cervical vessels can occur.
Percutaneous Peripheral Atherectomy Using the Rotablator: A Single-Center Experience
Authors: Henry Michel , Amor Max , Ethevenot Gérard , Henry Isabelle , Allaoui Mohamed 
Published: March 2015

Purpose: In order to assess the role of percutaneous peripheral rotational ablation using Rotablator™, 150 symptomatic patients (94 males, 56 females; mean age 73 ± 1 years, range 42 to 90) having 212 complex peripheral vascular lesions were treated. Methods: Fifty percent of lesions were below the knee; 65% of patients had severe claudication, 11% moderate (24% were in stage III or IV Fontaine classification). The femoral lesions were significantly longer than those at other sites (5.7 ± 0.4 versus 2.9 ± 0.3 cm, p < 0.001). The mean length was 4.0 ± 0.2 cm (range 1 to 20). All the lesions were considered complex; 93% of the lesions were calcified, and 63% were located at a bifurcation. Complementary balloon dilation (percutaneous transluminal angioplasty [PTA]) was significantly (p < 0.001) more frequent in femoropopliteal lesions (70 PTAs in 86 femoral arteries, 10 PTAs in 19 popliteal arteries) than in distal leg lesions (14 in 106 arteries). Results: After Rotablator therapy alone, the percent stenosis decreased from 81.0% ± 0.8% to 18.0% ± 1.1%. The residual stenosis was greater at the femoral (44%) than at the distal level (19%) (p < 0.01). Adjunctive PTA (47 lesions) lowered residual stenosis to 10% at the femoral level and 3% at the distal level. Thirty-seven in traprocedural complications occurred (spasm, thrombosis, dissection, perforation, distal emboli, no reflow); seven procedures subsequently failed for an overall technical success of 97%. The mean follow-up period was 14.4 ± 1.0 months (range 1 to 51). Among 125 patients having a follow-up period > 4 months, 114 patients representing 163 lesions underwent angiography. One hundred twenty-three lesions (76%) were patent, and 40 lesions (24%) showed restenosis (> 50% luminal narrowing) of 82.0% ± 2.1. The restenosis rate was higher in femoral (36%) than in distal (21%) or popliteal arteries (7%). Restenosis was more frequent for all lesions > 7 cm (p < 0.001) and for both above- and below-knee locations: 55% versus 19% for < 7 cm at the femoropopliteal level (p < 0.03), and 80% versus 18% at the distal level (p < 0.01). Conclusions: In our experience, percutaneous peripheral rotational ablation has taken a pre-eminent position in the treatment of distal leg arteries, especially in complex lesions. Our results have led us to broaden its indications to complex vascular lesions ≤ 6 cm. In particular, the use of this technique for treatment of runoff vessels should improve the long-term patency of proximal PTA and bypass grafts. This device has become in dispensable in our laboratory, where Rotablator therapy comprises 15% of all PTA procedures.
Strecker Stents in the Femoropopliteal Arteries: Value of Duplex Ultrasonography in Restenosis Assessment
Authors: Bray Alan E. , Liu Wei G. , Lewis Warren A. , Harrison Catherine , Maullin Ann 
Published: March 2015

Purpose: Experience with Strecker stent implantation in the femoropopliteal arteries has been described; however, few of the reports were prospective studies, and none routinely used site-specific assessment methods for follow-up evaluation of stent patency. The purpose of this study was to evaluate 1-year Strecker stent patency using duplex ultrasound imaging to obtain a more precise delineation of stent restenosis than is possible with other noninvasive assessment modalities. Methods: A prospective study involved 52 patients with 57 sites treated by angioplasty and Strecker stent deployment in the femoropopliteal arteries. Assessment included clinical evaluation; ankle-brachial index (ABI) measurements at rest and after exercise; and duplex ultrasound imaging preprocedurally and at 3 and 12 months after the intervention. Results: All 74 stents were deployed successfully in the 35 occluded arteries and 22 stenotic lesions. Acute reocclusion occurred in 6 (10%). At 3 months, primary patency was 81% and secondary patency 84%. Mean (± SD) ABIs increased from 0.64 ± 0.15 at rest and 0.32 ± 0.17 after exercise to 0.89 ± 0.14 and 0.68 ± 0.23, respectively (p < 0.0001). At 12 months, primary patency was 79%, and secondary patency was 82%. Mean ABIs were 0.82 ± 0.15 at rest and 0.52 ± 0.22 after exercise at 12 months (p < 0.0001 compared with preprocedural ABIs). Analysis of the length of lesion treated showed better results with shorter diseased segments, but this was not statistically significant (p > 0.05). Better outcomes were also obtained when one stent was used rather than two stents at 12 months (p = 0.15), but there was no difference at 3 months (p = 0.3). Thirty-four percent of the stented segments progressed from < 20% stenosis at 3 months to > 50% stenosis at 12 months. Overall, 19 (43%) of 44 segments progressed from < 50% stenosis at 3 months to a > 50% stenosis at 12 months. Restenosis seen at 3 months generally was in the native artery just proximal or distal to the stent, but at 12 months, restenosis was mainly inside the stent. Conclusions: Strecker stents at 1-year demonstrated satisfactory patency in the femoropopliteal arteries when deployed for angioplasty salvage or recurrent disease. The 3- and 12-month evaluations obtained with duplex ultrasound provided site-specific hemodynamic data for stent assessment. Resting ankle pressures were a poor index of restenosis.
Transbrachial Endovascular Exclusion of an Axillary Artery Pseudoaneurysm with PTFE-Covered Stents
Authors: Marston William A. , Criado Enrique , Mauro Matthew A. , Keagy Blair A. 
Published: March 2015

Purpose: Endovascular exclusion of arterial injuries associated with arteriovenous fistulas and pseudoaneurysms has only recently been described using various stent-graft prostheses. This report details a transbrachial technique used to exclude an axillary artery pseudoaneurysm developing at the axillary anastomosis of an axillofemoral graft. Methods and Results: Thin-walled polytetrafluoroethylene was expanded with an angioplasty balloon catheter and used to cover standard Palmaz stents. Two covered stents were delivered under fluoroscopic guidance via open brachial artery access to the site, resulting in complete exclusion of the pseudoaneurysm. Follow-up duplex scanning confirmed aneurysm exclusion 3 months postprocedure. Conclusions: This technique can be applied in arteries of different sizes and lengths, using currently available materials. However, the long-term behavior of these devices in the arterial tree must be determined before their widespread use can be recommended for most indications.
Endoluminal Grafting for Aneurysmal and Occlusive Disease in the Superficial Femoral Artery: Early Experience
Authors: Diethrich Edward B. , Papazoglou Konstantine 
Published: March 2015

Purpose: To examine whether endoluminal grafts (ELGs) of radially expandable polytetrafluoroethylene (PTFE) can successfully form durable internal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the femoropopliteal (FP) arteries. Methods: Under protocol, implantation of an unpredilated PTFE tube ELG anchored with Palmaz stents using a low-profile percutaneous delivery system was attempted in 50 symptomatic patients for a variety of pathologies: (1) restenosis; (2) complex lesions unlikely to be treated successfully with other endoluminal therapies; (3) acute angioplasty failure; and (4) aneurysms. There were 37 occlusions, 14 stenoses, and 2 long, combined stenoticaneurysmal lesions in 47 native arteries, 5 FP grafts, and 1 femorotibial (FT) vein graft. Thirty-two percent of the patients had ≤ 1 vessel runoff. The average lesion length was 20.4 ± 11.4 cm (range 1.5 to 40), and the mean preoperative ankle-brachial index (ABI) at rest was 0.53 ± 0.14. Results: In a 20-month period through April 1995, 50 patients (34 males, 16 females; mean age 69.5 years, range 45 to 87) underwent 54 procedures in 53 limbs; 55 ELGs were successfully deployed in 51 limbs; 2 patients were converted to FP bypass owing to technical problems (96% procedural success). There were 18 inhospital complications: 1 distal wire dissection repaired with an additional ELG; 2 hematomas requiring surgical repair; 1 graft collapse; 1 pseudoaneurysm at the site of a mid-ELG leak; 7 minor access sequelae; and 6 acute ELG thromboses, 4 treated with lytic therapy and balloon dilation, 1 with open thrombectomy, and 1 with bypass grafting. The mean postoperative ABI was 1.01 ± 0.10. During the 30-day postprocedure period, 2 ELGs rethrombosed and 2 other limbs (3 ELGs) occluded; 1 thrombosis and 1 rethrombosis were lysed successfully, but the other 2 patients had an FP bypass. Over the mean 8.3 ± 5.5 month follow-up, 6 additional ELGs occluded and 1 reoccluded; 4 were successfully treated by endovascular techniques for a primary patency of 72% and secondary patency of 84% by life-table analysis. Conclusions: Endovascular grafting is a conceptually attractive technique that has the potential to expand the current boundaries of interventional treatment. This preliminary experience attests to the feasibility and safety of ELG deployment in the superficial femoral arteries. Whether such a device can match the durability of classical revascularization techniques remains to be determined in clinical trials when device configurations and deployment techniques have been standardized.
Use of Polyetherurethane to Improve the Biocompatibility of Vascular Stents
Authors: Fontaine Arthur B. , Passos Susan Dos , Spigos Dimitrios , Cearlock Jody , Urbaneja Alberto 
Published: March 2015

Purpose: To investigate potential differential growth of neointima following overdilating arterial trauma with polyetherurethane-coated versus bare metalìc stents in swine. Methods: Twelve specially constructed tantalum stents, 6 coated with polyetherurethane block copolymer and 6 uncoated, were overdilated by 25% in 12 normal renal arteries of six swine. The stents were harvested 8 weeks after implantation and prepared for histologic examination. Neointimal thickness was quantified and analyzed for significant differences between coated and uncoated prostheses. Results: All specimens demonstrated fractures of the internal elastic lamina consistent with vascular injury. There was significantly less neointimal formation (0.0001 < p < 0.05) in coated specimens as compared to uncoated controls in each test animal. Conclusion: The vascular response to overdilating stent trauma appears to be moderated with the use of polyetherurethane block copolymer as compared to control.
The Mollring Cutter™ Remote Endarterectomy: Preliminary Experience with a New Endovascular Technique for Treatment of Occlusive Superficial Femoral Artery Disease
Authors: Ho Gwan H. , Moll Frans L. , Joosten Paul Ph.A. Hedeman , van de Pavoordt Eric D.W.M. , Overtoom Tim Th.C 
Published: March 2015

Purpose: To evaluate the feasibility and efficacy of the Mollring Cutter™ remote endarterectomy (EA) technique in the treatment of occlusive superficial femoral artery (SFA) disease. Methods: A new device was developed to perform remote EA of occluded SFAs through a single groin incision. The technique initially uses a conventional ring stripper, which is exchanged for a double-ring cutter that transects the distal atheroma core. The entire core and cutter are removed simultaneously, and a Palmaz stent is implanted to secure the distal intimal flap. Results: Twenty-six consecutive patients with disabling claudication or critical ischemia were treated for long segment occlusions (n = 23) and multiple stenoses (n = 3). Patients were evaluated on the intention-to-treat basis. Clinical and anatomic success was achieved in all 26 SFAs. Average length of the endarterectomized segments was 29.9 cm (range 23 to 41). Technical problems were encountered intraoperatively in four patients, including one who required a second incision at the distal SFA to retrieve a broken ring. Recovery was uneventful in all patients. At up to 6-month follow-up, one reocclusion has been seen at 5 months. Conclusions: Based on this early experience, remote EA with the Mollring Cutter appears to be a feasible and effective method for treating occlusive SFA disease. Obviating the need for a second incision at knee level, this technique offers a less invasive approach that should facilitate postoperative recovery and earlier discharge.
A Prospective Study of Changes in Morphology and Dimensions of Abdominal Aortic Aneurysms following Endoluminal Repair: A Preliminary Report
Authors: May James , White Geoffrey H. , Yu Weiyun , Waugh Richard C. , Stephen Michael S. , Harris John P. 
Published: March 2015

Purpose: The aim of this prospective study was to analyze early changes in morphology and dimensions of abdominal aortic aneurysms (AAA) following endoluminal repair. Methods: Forty-two of 62 patients undergoing endoluminal repair of AAAs between May 1992 and November 1994 were potentially available for follow-up at 6 months or longer after operation. After excluding patients with failed endoluminal repairs, patients who died within 6 months of operation, and patients with anastomotic aneurysms, a study group of 30 patients remained. Contrast-enhanced computed tomography (CE-CT) was performed preoperatively, within 10 days of operation, and at 6 and 12 months postprocedure. Based on the postoperative CE-CT findings, patients were divided into two groups: those with no extravasation of contrast into the aneurysmal sac (group I; n = 26), and those in which there was contrast extravasation (“leak”) into the aneurysmal sac (group II; n = 4). Results: The mean maximum diameters of AAAs in group I diminished progressively at 6 and 12 months, while those in group II increased. Twenty-three (88%) patients in group I had decreased diameter of AAA, while all patients in group II had progressive increase in AAA diameter. Patients who had an increase in AAA diameter had a significantly higher incidence of leak compared with those who had a decrease in diameter (p = 0.001). Conclusions: The majority of AAAs in which the sac has been excluded from the general circulation diminish in size following successful endoluminal repair. An increase in size occurs in those AAAs in which a communication exists between the aortic lumen and the sac. These results suggest that successfully excluded AAAs that continue to increase in size should be suspected of having an undetected leak.
Local Anesthesia in Carotid Angioplasty
Authors: Alessandri Christian , Bergeron Patrice 
Published: March 2015

Purpose: To determine the safety and efficacy of local anesthesia for percutaneous carotid angioplasty and stenting performed via a direct common carotid access. Methods: Deep cervical plexus blockade was used for anesthesia in 22 of 32 patients (26 males; mean age 66 years) undergoing percutaneous carotid balloon angioplasty and/or stenting via direct carotid puncture. Local anesthesia was selected according to patient preference (n = 9); advanced age (n = 4); ischemic heart disease (n = 4); intended extracorporeal circulation for unstable angina (n = 3); and an incompetent circle of Willis (n = 2). The technique involved injection of bupivacaine hydrochloride along the C2, C3, and C4 transverse processes. No superficial cervical plexus blockade was used. Results: No complications of anesthesia were observed, though there were cases in which surgery became necessary under local anesthesia for angioplasty-related complications. These conversions were accomplished without difficulty. Conclusions: Cervical nerve blockade appears to be a safe and effective anesthetic method for endovascular carotid interventions performed percutaneously through direct carotid puncture.
Imaging Modalities for Aortic Endografting
Authors: Beebe Hugh G. 
Published: March 2015

One of the most fundamental and influential differences between conventional surgery and endovascular grafting for aortic aneurysm is the central role of imaging in every aspect of management. This review summarizes five imaging techniques for aortic endografting: intravascular ultrasound, contrast angiography, conventional computed tomography (CT), spiral CT with image processing, and magnetic resonance angiography (MRA). External ultrasound and intravascular ultrasound have important relevance to endovascular aortic surgery. Artifacts of arteriography include magnification, thrombus effect, foreshortening of tortuosity, loss of luminal detail, parallax error, and projection errors. Conventional CT scans have artifacts and difficulties also. Diameter measurement by CT suffers from methodology errors and observer variability. If conventional CT and angiography are used for endovascular aortic graft planning, both should be obtained since neither alone provides sufficient data. The use of spiral CT scanning and computerized image processing has clearly aided the preoperative definition of aneurysm morphology both in terms of dimensional accuracy and by adding diagnostic information. MRA is capable of producing three-dimensional images, axial sections, and longitudinal projections in any plane. It can detect blood flow without contrast medium, but gadolinium enhances MRA by avoiding the “signal dropout” artifact. Technology exists to provide new forms of imaging for endovascular surgery that combines three-dimensional models with on-line image data in a process called “data fusion.” This may offer improved ease and accuracy for conducting endovascular procedures in the future.
Endoleak as a Complication of Endoluminal Grafting of Abdominal Aortic Aneurysms: Classification, Incidence, Diagnosis, and Management
Authors: White Geoffrey H. , Yu Weiyun , May James , Chaufour Xavier , Stephen Michael S. 
Published: March 2015

The inability to obtain or maintain a secure seal between a vessel wall and a transluminally implanted intra-aneurysmal graft is a complication unique to the evolving technique of endovascular aneurysm exclusion. Because the term “leak” has long been associated with aneurysm rupture, the term “endoleak” is proposed as a more definitive description of this phenomenon. Embracing both persistent blood flow into the aneurysmal sac from within or around the graft (graft related) and from patent collateral arteries (nongraft related), endoleak can be classified as primary or secondary depending on the time of occurrence (within 30 days of implantation or following apparent initial seal, respectively). Diagnostic techniques to detect endoleak include arteriography, intraprocedural pressure monitoring, contrast-enhanced computed tomography, abdominal X ray, and duplex scanning. Management strategies for endoleak range from observation with periodic imaging surveillance to correction by additional endoluminal or surgical procedures. Standardization of the terminology describing this important sequela to endovascular aneurysm exclusion should facilitate uniform reporting of clinical trial data vital to the evaluation of this emerging technique.