bluuebunny/crossref_metadata_2025_split huggingface dataset:
Endovascular Management of a Pancreaticoduodenal Aneurysm: A Clinical Dilemma
Authors: Sultan Sherif , Molloy Martin , Evoy Denis , Colgan Mary-Paula , Madhavan Prakash , Moore Dermot , Shanik Gregor 
Published: March 2015

Purpose: To report the successful endovascular embolization of a pancreaticoduodenal aneurysm (PDA). Case Report: A 56-year-old man with a history of pancreatitis presented with insidious, progressive epigastric pain for the preceding 6 months. Contrast-enhanced computed tomography (CT) and selective hepatic digital subtraction angiography identified a 7.7-cm aneurysm that arose from the pancreaticoduodenal branch of the gastroduodenal artery. Through a percutaneous common femoral approach, 10 stainless steel coils were delivered to occlude the aneurysm. A single coil detached and became lodged in a small branch of the right hepatic artery without sequelae. At 26 months, duplex and CT scans show continued occlusion of the aneurysm. Conclusions: Transcatheter coil embolization should be the first choice treatment for aneurysms of the pancreaticoduodenal artery.
Preliminary Experience with the Xtrak Debulking Device in the Treatment of Peripheral Occlusions
Authors: Yoffe Boris , Yavnel Leonty , Altshuler Alexander , Scheinowitz Mickey , Lebovici Octavian 
Published: March 2015

Purpose: To report our initial experience with a new rotary debulking device designed for treating long, diffusely diseased arterial segments. Methods: Ten symptomatic patients (8 men; mean age 63 years, range 34–76) with occluded superficial femoral (n = 6) or popliteal (n = 4) arteries were enrolled into a study to evaluate the debulking capabilities of a rotational atherectomy device. Occlusion length ranged from 4.0 to 16.1 cm (mean 11.1 ± 4.10). The occlusions were treated with a low-speed, over-the-wire rotary device featuring a flexible, spiral “corkscrew” that embeds itself in the obstructive material while a rotary cutting catheter simultaneously cuts and captures the obstruction in a single pass. Results: The device cut and retrieved material in a single pass from all segments without device-related complications. The captured material consisted of a mixture of atherosclerotic plaque and thrombus. Minimum lumen diameters (MLD) increased from 0.0 to 2.2 ± 1.09 mm (p<0.05) after Xtrak treatment and to 4.09 ± 1.20 mm (p<0.05) after adjunctive balloon dilation, which was used in 8 of 10 segments. All patients improved clinically after the procedure, with an increased the mean ankle-brachial index sustained at 6 months (0.69 ± 0.32, p<0.05 compared to baseline and 1-month measurements). Six months after the procedure, 7 patients remained free of clinical symptoms, while 3 patients required a subsequent intervention. Conclusions: These initial results demonstrate that the Xtrak device can safely debulk long segments of diffusely diseased arteries in a single pass while simultaneously retrieving the occluding material. Supplementary angioplasty may be required in the majority of cases. Larger studies are required to determine whether debulking followed by balloon dilation improves the long-term prognosis in patients with chronic lower limb occlusions.
Open versus Endovascular AAA Repair in Patients Who are Morphological Candidates for Endovascular Treatment
Authors: Hill Bradley B. , Wolf Yehuda G. , Lee W. Anthony , Arko Frank R. , Olcott Cornelius , Schubart Peter J. , Dalman Ronald L. , Harris E. John , Fogarty Thomas J. , Zarins Christopher K. 
Published: March 2015

Purpose: To compare the outcomes of open versus endovascular repair of abdominal aortic aneurysm (AAA) in a cohort of patients who fulfill morphological criteria for endovascular repair. Methods: A retrospective review of 229 consecutive AAA patients treated over a 3-year period identified 149 patients who were candidates for endovascular repair based on preoperative computed tomography and angiography. Of the 149 patients, 79 (68 men; mean age 74 ± 8 years) underwent endovascular repair with the AneuRx stent-graft; the remaining 70 (56 men; mean age 72 ± 8 years) had open repair. Short-term outcome measures were 30-day mortality and procedure-related morbidity, length of stay in the intensive care unit and hospital, intraoperative blood loss, interval to oral diet, and time to ambulation. Long-term outcome measures included death and secondary procedures. Results: There was no difference in the 30-day mortality between endovascular repair (2, 2.5%) and open repair (2, 2.9%), even though endovascular patients had more comorbidities (p<0.05). Overall length of stay was reduced for endovascular patients (3.9 ± 2.4 days versus 7.7 ± 3.1 days for surgical patients, p<0.0001). Fewer endograft patients had complications (24% versus 40% for open repair, p<0.05), and the severity of these complications was less, as evidenced by the shorter hospital stays for endovascular patients with complications compared to conventionally treated patients with complications (6.7 ± 2.4 days versus 22.5 ± 35.2 days, p<0.05). There were no aneurysm ruptures or late surgical conversions in either group. Conclusions: Patients with AAA who were endograft candidates but who were treated with open repair experienced more morbidity and had more complications than patients treated with stent-grafts. Despite increased comorbidities in the endograft patients, there was no increase in mortality compared to open repair. Both treatments required secondary procedures and appeared to be equally effective in preventing aneurysm rupture up to 3 years.
Learning Curve for Endovascular Abdominal Aortic Aneurysm Repair: Evaluation of a 277-Patient Single-Center Experience
Authors: Lobato Armando C. , Rodriguez-Lopez Julio , Diethrich Edward B. 
Published: March 2015

Purpose: To determine the minimum number of stent-graft deployments that an interventional team with endovascular skills must do to be considered well trained in endovascular abdominal aortic aneurysm (AAA) exclusion. Methods: The records of 277 consecutive patients (236 men; median age 73 years, range 49–91) undergoing endovascular AAA repair at a single institution between 1994 and 1998 were reviewed. Information was collected on procedural success, conversion, time interval between procedures, operative complications, operative mortality, contrast volume, blood loss, intensive care unit (ICU) length of stay (LOS), and hospital LOS. A first-order differential equation was used to calculate a learning curve based on the success rate. Patients were subsequently divided into 5 sequential groups of 55 patients (the last group had 57 patients). Results: Analyzing the pattern of procedural success to failures, a sharp change in the slope was observed between 50 and 65 trials. The number 55 was arbitrarily chosen to represent the point after which the incremental change in the success rate never exceeded 0.01 (<1 failure per 100 attempts). In the intergroup comparisons, success rate (p<0.04), conversion rate (p<0.0001), and procedural frequency (p<0.0001) were statistically significant when the first 55-patient group was compared to the others. Operative complications (p=0.08) and operative mortality (p=0.16) were numerically but not significantly different. Contrast volume was significantly reduced for the last group (p<0.0001). A Cox regression model identified only procedural frequency (p=0.03) and procedural volume (p=0.04) as predictive of technical success. Performing endovascular AAA repairs at a ≤10-day interval was associated with a >80% success rate. Conclusions: This study shows that not only is the number of procedures important to outcome, but also the frequency with which they are performed. Based on our team's performance data, 55 cases would appear to be the minimum volume and 1 case every 10 days the minimum frequency to obtain good operative results with aortic endografting.
Endovascular Repair of Inflammatory Abdominal Aortic Aneurysms
Authors: Hinchliffe Robert J. , Macierewicz Jan A. , Hopkinson Brian R. 
Published: March 2015

Purpose: To report a single-center experience with endovascular repair of inflammatory abdominal aortic aneurysm (IAAA), with particular attention to the fate of the aneurysm sac, perianeurysmal fibrosis (PAF), and renal function. Methods: A retrospective review of 350 patients undergoing endovascular aortic aneurysm repair during a 7-year period at University Hospital, Nottingham, identified 14 (4%) cases of IAAA confirmed either on preoperative spiral computed tomography (CT) or at laparotomy in attempted open aneurysm repair. All data were reviewed from a prospectively maintained database, hospital notes, and serial CT studies. Results: Endovascular repair was successfully completed in all 14 IAAA patients, but 2 (14%) died in the perioperative period. One patient referred from another center was lost to imaging follow-up, leaving 11 patients who were followed for a mean 29 months (range 1–73). All 11 IAAAs remained excluded, but 1 patient required a secondary transabdominal intervention for a type III endoleak. There was no CT evidence of PAF progression in any patient. Postoperative renal complications were not encountered where there had been none preoperatively. Conclusions: IAAA may be successfully excluded by the endovascular technique, and EVAR is particularly useful where open repair has failed. The impact of endograft placement on perianeurysmal fibrosis is less clear. In this study, there was no suggestion that the degree of PAF worsens following endovascular repair.
Endovascular Exclusion of Saccular AAAs Using “Stacked” AneuRx Aortic Cuffs
Authors: York John W. , Sternbergh W. Charles , Lepore Michael R. , Yoselevitz Moises , Money Samuel R. 
Published: March 2015

Purpose: To show that AneuRx aortic cuffs might be used in a “stacked” configuration to effectively treat saccular abdominal aortic aneurysm (AAA). Methods: In a recent 1-year period, 147 patients underwent endovascular AAA repair. Of these, 5 (4 men; mean age 61.6 years, range 55–69) had saccular AAAs with a mean diameter of 3.7 ± 0.2 cm (range 3.0–4.7). AneuRx aortic cuff prostheses (3.75-cm length) were deployed sequentially in these 5 patients via a right femoral approach; the devices were overlapped ∼1.5 to 2.0 cm until complete exclusion of the aneurysm was achieved. Endograft surveillance was performed using computed tomography at 4 weeks postoperatively and then every 6 months. Results: Successful exclusion of the saccular infrarenal aortic aneurysms was achieved in all 5 patients using 2 or 3 “stacked” stent-graft extensions. Four of the 5 procedures were performed under spinal anesthesia; the average procedural time was 96 ± 41 minutes. The average hospital length of stay was 1.6 days; no major morbidity or mortality was encountered. There were no early or late endoleaks, aneurysm expansion, or device migration over a follow-up that ranged to 12 months. Conclusions: Saccular AAA provides ideal anatomy for endovascular repair with a “tube” endograft. “Stacked” aortic cuffs create a customized stent-graft that is not otherwise commercially available.
A Laparoscopic Approach to the Abdominal Aorta for Thoracic Stent-Graft Deployment: Evaluation in a Porcine Model
Authors: Formichi Maxime , Renier Jean-François 
Published: March 2015

Purpose: To develop laparoscopic techniques for aortic stent-graft placement as an alternative to the femoral approach. Methods: Endovascular stent-grafts were placed in 8 pigs via a totally laparoscopic retroperitoneal approach. After needle puncture, a guidewire was inserted into the abdominal aorta, followed by an 18-F sheath through which a Talent stent-graft was deployed in the descending thoracic aorta without aortic clamping. All the endovascular tools were inserted into the retroperitoneal area via the ports. After the sheath was withdrawn, hemostasis was achieved by suturing the aortic puncture under aortic cross-clamping. After sacrificing the animals, the thoracic aorta was removed to verify the position and deployment of the stent-grafts. Results: Seven (87.5%) of 8 procedures were successfully completed; the first animal died from hemorrhage due to inadvertent injury to the posterior infrarenal aortic wall. The accurate deployment and position of the stent-grafts were verified visually after sacrifice. Mean (± SD) procedural, implantation, and aortic cross-clamping times were 205 ± 56, 22 ± 9, and 30 ± 19 minutes, respectively. Mean blood loss was 120 ± 56 mL. Conclusions: Thoracic aortic stent-grafting using a laparoscopic approach to the infrarenal aorta is feasible. More studies will be required to define the place of combined endovascular and laparoscopic procedures as an alternative to the femoral surgical approach for stent-graft placement.
Diameter of Occluded Superficial Femoral Arteries Limits Percutaneous Recanalization: Preliminary Results
Authors: Kröger Knut , Buss Carsten , Goyen Matthias , Santosa Frans , Rudofsky Gottfried 
Published: March 2015

Purpose: To explore if the diameter of an occluded superficial femoral artery (SFA) can predict the technical success of percutaneous recanalization. Methods: Two hundred patients (151 men; mean age 57 ± 16 years) suffering from peripheral arterial occlusive disease were evaluated with duplex ultrasonography to measure arterial diameters and percent diameter reduction. Seventy-nine (39.5%) patients had segmental or complete SFA occlusions that ranged in age from 2 to 26 months (median 11). The majority of occlusions (45, 57.0%) were ≤10 cm long (range 10–35). Percutaneous recanalization was performed in 71 patients using either conventional angioplasty or local low-dose thrombolysis with rtPA. Results: Diameters of 79 unilaterally occluded SFAs at the level of occlusion were 4.5 ± 1.4 mm versus 5.7 ± 1.3 mm for the patent contralateral artery (p=0.055). None of the 121 patent SFAs had diameters ≤3.5 mm, but 12 (15%) of the 79 occluded SFAs did, and none of these could be recanalized. The sensitivity of the 3.5-mm cut point to predict recanalization failure was 44% (specificity 100%). Conclusions: Our data suggest that occluded SFAs with a diameter reduction to ≤3.5 mm are not suitable for percutaneous recanalization, as the original arterial lumen cannot be reconstructed.
Midterm Follow-up of Balloon-Expandable ePTFE Endografts in the Femoropopliteal Segment
Authors: Hagenaars Tjebbe , Gussenhoven Elma J. , Smeets Luuk , Moll Frans L. , Buth Jacob , Nevelsteen Andre , van Dijk Lukas C. , van Sambeek Marc R.H.M. , van Urk Hero 
Published: March 2015

Purpose: To evaluate the midterm clinical outcome of patients treated with a balloon-expandable polytetrafluoroethylene (ePTFE) endograft for long-segment occlusive disease of the femoropopliteal segment. Methods: Eighty-nine patients (68 men; median age 69 years, range 43–81) with disabling claudication (n=73) or critical ischemia (n=16) were treated with an ePTFE endograft (mean length 29 cm) for 7 stenosis (mean length 9 cm) and 82 occlusions (mean length 19 cm) in the femoropopliteal segment. The follow-up protocol included Doppler ankle-brachial pressure measurement and duplex scanning or angiography of the endograft at 6-month intervals. Primary and secondary patency rates were analyzed. Results: At the last examination, the endograft was patent in 52 patients (median 17 months, range 7–50) and occluded in 35 (median 7 months, range 0–40);2 patients died of nonvascular causes with a patent endograft at 6.5 and 7 months. At follow-up, the primary and secondary endograft patency rates were 71% and 83% at 6 months, 57% and 69% at 1 year, 45% and 49% at 2 years, and 30% and 44% at 3 years, respectively. Conclusions: The midterm success of this new ePTFE endograft is limited; therefore, the device needs to be refined if this minimally invasive technique is to compete with conventional bypass surgery.
Eligibility Rates of Ruptured and Symptomatic AAA for Endovascular Repair
Authors: Lee W. Anthony , Huber Thomas S. , Hirneise Christa M. , Berceli Scott A. , Seeger James M. 
Published: March 2015

Purpose: To determine the anatomical eligibility rate for endovascular repair of ruptured and symptomatic abdominal aortic aneurysms (AAA) using commercially available endografts. Methods: In a retrospective review, 28 preoperative computed tomographic (CT) scans were examined from among 83 patients who underwent surgical repair of a ruptured or acutely symptomatic AAA at a university-based tertiary care center during the past 10 years. The proximal aortic neck, aneurysm, and iliac dimensions were compared to corresponding measurements from 100 preoperative CT scans from patients who underwent elective repair of asymptomatic AAA. Based on expanded selection criteria for the 2 FDA-approved endografts (AneuRx and Ancure), eligibility rates for endovascular repair were compared between patients with ruptured/symptomatic and asymptomatic AAAs. Results: The proximal neck of the ruptured/symptomatic AAAs was on the average 2 mm larger in diameter (25 ± 4 versus 23 ± 3 mm, p=0.04) and 7 mm shorter (16 ± 10 versus 23 ± 14, p=0.017) than asymptomatic AAAs. The maximum AAA diameter was significantly larger in the ruptured/symptomatic group (64 ± 16 mm) than in the asymptomatic group (58 ± 11 mm, p=0.033). Of the 28 ruptured/symptomatic AAAs assessed morphologically, 13 (46%) were anatomically eligible for endovascular repair compared to 74 of the 100 asymptomatic AAAs (p=0.006). The main cause for exclusion was an unfavorable proximal neck, which was present in 15 (54%) of the 28 ruptured/symptomatic AAAs and in 24 (24%) of the 100 asymptomatic AAAs (p = 0.003). Conclusions: A significantly smaller proportion of patients presenting with ruptured/symptomatic AAA are anatomically eligible for endovascular AAA repair compared to patients with asymptomatic AAA due to unfavorable proximal neck anatomy.
Endovascular versus Conventional Open Repair of Acute Abdominal Aortic Aneurysm: Feasibility and Preliminary Results
Authors: van Sambeek Marc R.H.M. , van Dijk Lukas C. , Hendriks Johanna M. , van Grotel Martine , Kuiper Jan-Willem , Pattynama Peter M.T. , van Urk Hero 
Published: March 2015

Purpose: To evaluate the feasibility of endovascular treatment of acute abdominal aortic aneurysm (AAA) with commercially prepared bifurcated systems. Methods: From January through July 2001, 22 patients (17 men; mean age 73.6 years, range 59–89) were referred with an acute (symptomatic/ruptured) AAA. Six patients were treated with emergent open surgery because of hemodynamic instability, but the other 16 patients underwent computed tomographic angiography with multidirectional reconstruction. Six (27%) aneurysms were suitable for endovascular repair (EVR) and were successfully treated. Procedural variables, morbidity, and mortality were compared between the EVR group and 6 patients of equivalent hemodynamic status from among the conventionally treated patients. Results: There was no mortality in either group. The median aneurysm diameter in the EVR group was 63 mm (range 48–84) versus 80 mm (45–82) in the matched surgically treated AAAs (p=0.628). Procedural duration was 193 minutes (150–265) for the EVR group compared to 203 minutes (130–270) for the matched group (p=0.630). Median blood loss was significantly less (p=0.010) in the EVR group (125 versus 3400 mL). Median length of stay (LOS) in intensive care was 8 hours (0–21) versus 62 hours (48–112) for the surgical group (p=0.004). Hospital LOS was significantly reduced (p=0.024) for the EVR patients (7.5 [2–16] versus 15.5 [10–34] days). Conclusions: Endovascular treatment of acute aneurysm is feasible, and preliminary results are promising.
Colonic Infarction following Endovascular AAA Repair: A Multifactorial Complication
Authors: Hinchliffe Robert J. , Armon Matthew P. , Tse Chad Cheuk-Wa , Wenham Peter W. , Hopkinson Brian R. 
Published: March 2015

Purpose: To report a case of colonic infarction following endovascular abdominal aortic aneurysm (AAA) repair in a patient with both internal iliac arteries (IIA) unobstructed by the endograft. Case Report: A 73-year-old man presented with blue toes as a result of emboli from a 6.4-cm AAA. As he was medically at high risk for open repair and his aneurysm morphology was suitable for a modular bifurcated endovascular graft, a Zenith endograft was used to exclude the aneurysm. Twenty hours after the successful procedure, in which both IIAs were preserved, the patient regurgitated coffee-ground vomit; an upper gastrointestinal endoscopy found a small Mallory-Weiss tear and antral gastritis. A proton-pump inhibitor was begun, but his symptoms progressed. Laparotomy revealed transmural ischemia and infarction of the upper rectum, sigmoid, descending colon, and the splenic flexure; a colonic resection with formation of Hartmann's pouch and colostomy was performed. He made a slow but uncomplicated recovery. Conclusions: Colonic necrosis can complicate endovascular AAA repair even when both IIAs are preserved. Advantageously, the clinical signs of severe colonic ischemia in endograft patients are not obscured by aftereffects of a laparotomy.
Early Rupture of a Partially Treated Abdominal Aortic Aneurysm: Another Endovascular Lesson
Authors: Walker Stuart , Papavassiliou Vassilios , Fishwick Guy , Bell Peter R.F. 
Published: March 2015

Purpose: To report early rupture of a partially treated abdominal aortic aneurysm. Case Report: A 76-year-old man with a 6.4-cm abdominal aortic aneurysm had the main body of a bifurcated graft inserted into the aneurysm. However, it was not possible to cannulate the short cuff of the graft to deploy the contralateral limb, probably due to a proximal aortic stenosis compressing the stent-graft. The plan was for the patient to return on another date for a further attempt at recannulation; however, shortly after the patient was discharged, the aneurysm ruptured, necessitating conventional open repair, which the patient survived. Conclusions: Every effort should be made to complete endovascular treatment of abdominal aortic aneurysms at a single session.
Endovascular Exclusion of a Ruptured Pseudoaneurysm of the Infrarenal Abdominal Aorta Secondary to Pancreatitis
Authors: Hinchliffe Robert J. , Yung Ming , Hopkinson Brian R. 
Published: March 2015

Purpose: To report the successful repair of a ruptured pseudoaneurysm of the infrarenal abdominal aorta secondary to pancreatitis Case Report: A 47-year-old man was admitted with abdominal pain due to an acute exacerbation of chronic alcoholic pancreatitis. He was found to have an infrarenal abdominal aortic aneurysm, which was confirmed by spiral computed tomography (CT), but there had been no evidence of aneurysm formation on a scan performed 1 year previously. Persistent symptoms prompted a further CT scan 48 hours later; this revealed evidence of a ruptured infrarenal abdominal aortic pseudoaneurysm. The pseudoaneurysm was excluded using a Zenith aortomonoiliac endovascular graft. Recovery was uneventful, and the patient underwent pancreatic resection 6 months later. A duplex scan 10 months after endograft placement could not identify an aneurysm sac. Conclusions: In selected cases, endovascular repair provides a useful method of excluding ruptured aortic pseudoaneurysms due to pancreatitis. It allows hemorrhage control in a potentially infected operative field and permits elective pancreatic resection. Prolonged follow-up is mandatory to ensure there is no evidence of graft sepsis and that aneurysm exclusion is maintained.