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Sample records for emergency endovascular repair

  1. Emergency abdominal aortic aneurysm repair with a preferential endovascular strategy : Mortality and cost-effectiveness analysis

    NARCIS (Netherlands)

    Kapma, Marten R.; Groen, Henk; Oranen, Bjorn I.; van der Hilst, Christian S.; Tielliu, Ignace F.; Zeebregts, Clark J.; Prins, Ted R.; van den Dungen, Jan J.; Verhoeven, Eric L.

    2007-01-01

    Purpose: To assess mortality and treatment costs of a new management protocol with preferential use of emergency endovascular aneurysm repair (eEVAR) for acute abdominal aortic aneurysm (AAA). Methods: From September 2003 until February 2005, 49 consecutive patients (45 men; mean age 71 years) with

  2. Acute Testicular Ischemia following Endovascular Abdominal Aortic Aneurysm Repair Identified in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Nathan Finnerty

    2014-01-01

    Full Text Available Endovascular aneurysm repair (EVAR is perhaps the most widely utilized surgical procedure for patients with large abdominal aortic aneurysms. This procedure is minimally invasive and reduces inpatient hospitalization requirements. The case involves a 72-year-old male who presented to the emergency department with right testicular ischemia two days following EVAR. Given the minimal inpatient hospitalization associated with this procedure, emergency physicians are likely to encounter associated complications. Ischemic and thromboembolic events following EVAR are extremely rare but require prompt vascular surgery intervention to minimize morbidity and mortality.

  3. Sac Angiography and Glue Embolization in Emergency Endovascular Aneurysm Repair for Ruptured Abdominal Aortic Aneurysm

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    Koike, Yuya, E-mail: r06118@hotmail.co.jp; Nishimura, Jun-ichi, E-mail: jun-ichi-n@nifty.com; Hase, Soichiro, E-mail: haseman@hotmail.co.jp; Yamasaki, Motoshige, E-mail: genyamasaki@gmail.com [Kawasaki Saiwai Hospital, Department of Interventional Radiology (Japan)

    2015-04-15

    PurposeThe purpose of this study was to demonstrate a sac angiography technique and evaluate the feasibility of N-butyl cyanoacrylate (NBCA) embolization of the ruptured abdominal aortic aneurysm (AAA) sac in emergency endovascular aneurysm repair (EVAR) in hemodynamically unstable patients.MethodsA retrospective case series of three patients in whom sac angiography was performed during emergency EVAR for ruptured AAA was reviewed. After stent graft deployment, angiography within the sac of aneurysm (sac angiography) was performed by manually injecting 10 ml of contrast material through a catheter to identify the presence and site of active bleeding. In two patients, sac angiography revealed active extravasation of the contrast material, and NBCA embolization with a coaxial catheter system was performed to achieve prompt sealing.ResultsSac angiography was successful in all three patients. In the two patients who underwent NBCA embolization for aneurysm sac bleeding, follow-up computed tomography (CT) images demonstrated the accumulation of NBCA consistent with the bleeding site in preprocedural CT images.ConclusionsEVAR is associated with a potential risk of ongoing bleeding from type II or IV endoleaks into the disrupted aneurysm sac in patients with severe coagulopathy. Therefore, sac angiography and NBCA embolization during emergency EVAR may represent a possible technical improvement in the treatment of ruptured AAA in hemodynamically unstable patients.

  4. Endovascular repair of blunt popliteal arterial injuries

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    Zhong, Shan; Zhang, Xiquan; Chen, Zhong; Zhu, Wei; Pan, Xiaolin [Dept. of nterventional Vascular, The 148th Hospital of Chinese People' s Liberation Army, Zibo (China); Dong, Peng; Sun, Yequan [Dept. of Medical Imaging, Weifang Medical University, Weifang (China); Qi, Deming [Dept. of Medical Imaging, Qilu Medical University, Zibo (China)

    2016-09-15

    To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair.

  5. Late graft explants in endovascular aneurysm repair.

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    Turney, Eric J; Steenberge, Sean P; Lyden, Sean P; Eagleton, Matthew J; Srivastava, Sunita D; Sarac, Timur P; Kelso, Rebecca L; Clair, Daniel G

    2014-04-01

    With more than a decade of use of endovascular aneurysm repair (EVAR), we expect to see a rise in the number of failing endografts. We review a single-center experience with EVAR explants to identify patterns of presentation and understand operative outcomes that may alter clinical management. A retrospective analysis of EVARs requiring late explants, >1 month after implant, was performed. Patient demographics, type of graft, duration of implant, reason for removal, operative technique, length of stay, complications, and in-hospital and late mortality were reviewed. During 1999 to 2012, 100 patients (91% men) required EVAR explant, of which 61 were placed at another institution. The average age was 75 years (range, 50-93 years). The median length of time since implantation was 41 months (range, 1-144 months). Explanted grafts included 25 AneuRx (Medtronic, Minneapolis, Minn), 25 Excluder (W. L. Gore & Associates, Flagstaff, Ariz), 17 Zenith (Cook Medical, Bloomington, Ind), 15 Talent (Medtronic), 10 Ancure (Guidant, Indianapolis, Ind), 4 Powerlink (Endologix, Irvine, Calif), 1 Endurant (Medtronic), 1 Quantum LP (Cordis, Miami Lakes, Fla), 1 Aorta Uni Iliac Rupture Graft (Cook Medical, Bloomington, Ind), and 1 homemade tube graft. Overall 30-day mortality was 17%, with an elective case mortality of 9.9%, nonelective case mortality of 37%, and 56% mortality for ruptures. Endoleak was the most common indication for explant, with one or more endoleaks present in 82% (type I, 40%; II, 30%; III, 22%; endotension, 6%; multiple, 16%). Other reasons for explant included infection (13%), acute thrombosis (4%), and claudication (1%). In the first 12 months, 23 patients required explants, with type I endoleak (48%) and infection (35%) the most frequent indication. Conversely, 22 patients required explants after 5 years, with type I (36%) and type III (32%) endoleak responsible for most indications. The rate of EVAR late explants has increased during the past decade at our

  6. Preoperative Evaluation and Endovascular Procedure of Intraoperative Aneurysm Rupture During Thoracic Endovascular Aortic Repair

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    Zha, Bin-Shan, E-mail: binszha2013@163.com; Zhu, Hua-Gang, E-mail: huagzhu@yeah.net; Ye, Yu-Sheng, E-mail: yeyusheng@aliyun.com; Li, Yong-Sheng, E-mail: 872868848@qq.com; Zhang, Zhi-Gong, E-mail: zzgedward@sina.com; Xie, Wen-Tao, E-mail: 345344347@qq.com [The First Affiliated Hospital of Anhui Medical University, Department of Vascular Surgery (China)

    2017-03-15

    Thoracic aortic aneurysms are now routinely repaired with endovascular repair if anatomically feasible because of advantages in safety and recovery. However, intraoperative aneurysm rupture is a severe complication which may have an adverse effect on the outcome of treatment. Comprehensive preoperative assessment and considerate treatment are keys to success of endovascular aneurysm repair, especially during unexpected circumstances. Few cases have reported on intraoperative aortic rupture, which were successfully managed by endovascular treatment. Here, we present a rare case of an intraoperative aneurysm rupture during endovascular repair of thoracic aortic aneurysm with narrow neck and angulated aorta arch (coarctation-associated aneurysm), which was successfully treated using double access route approach and iliac limbs of infrarenal devices.Level of EvidenceLevel 5.

  7. Identifying patients with AAA with the highest risk following endovascular repair.

    Science.gov (United States)

    Cadili, Ali; Turnbull, Robert; Hervas-Malo, Marilou; Ghosh, Sunita; Chyczij, Harold

    2012-08-01

    It has been demonstrated that endovascular repair of arterial disease results in reduced perioperative morbidity and mortality compared to open surgical repair. The rates of complications and need for reinterventions, however, have been found to be higher than that in open repair. The purpose of this study was to identify the predictors of endograft complications and mortality in patients undergoing endovascular abdominal aortic aneurysm (AAA) repair; specifically, our aim was to identify a subset of patients with AAA whose risk of periprocedure mortality was so high that they should not be offered endovascular repair. We undertook a prospective review of patients with AAA receiving endovascular therapy at a single institution. Collected variables included age, gender, date of procedure, indication for procedure, size of aneurysm (where applicable), type of endograft used, presence of rupture, American Society of Anesthesiologists (ASA) class, major medical comorbidities, type of anesthesia (general, epidural, or local), length of intensive care unit (ICU) stay, and length of hospital stay. These factors were correlated with the study outcomes (overall mortality, graft complications, morbidity, and reintervention) using univariate and multivariate logistic regression. A total of 199 patients underwent endovascular AAA repair during the study period. The ICU stay, again, was significantly correlated with the primary outcomes (death and graft complications). In addition, length of hospital stay greater than 3 days, also emerged as a statistically significant predictor of graft complications in this subgroup (P = .024). Survival analysis for patients with AAA revealed that age over 85 years and ICU stay were predictive of decreased survival. Statistical analysis for other subgroups of patients (inflammatory AAA or dissection) was not performed due to the small numbers in these subgroups. Patients with AAA greater than 85 years of age are at a greater risk of mortality

  8. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

    International Nuclear Information System (INIS)

    Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Caronno, Roberto; Castelli, Patrizio; Cuffari, Salvatore; Fugazzola, Carlo

    2006-01-01

    Purpose. To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). Methods. During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Results. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Conclusions. Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment

  9. Total Endovascular Aortic Repair in a Patient with Marfan Syndrome.

    Science.gov (United States)

    Amako, Mau; Spear, Rafaëlle; Clough, Rachel E; Hertault, Adrien; Azzaoui, Richard; Martin-Gonzalez, Teresa; Sobocinski, Jonathan; Haulon, Stéphan

    2017-02-01

    The aim of this study is to describe a total endovascular aortic repair with branched and fenestrated endografts in a young patient with Marfan syndrome and a chronic aortic dissection. Open surgery is the gold standard to treat aortic dissections in patients with aortic disease and Marfan syndrome. In 2000, a 38-year-old man with Marfan syndrome underwent open ascending aorta repair for an acute type A aortic dissection. One year later, a redo sternotomy was performed for aortic valve replacement. In 2013, the patient presented with endocarditis and pulmonary infection, which necessitated tracheostomy and temporary dialysis. In 2014, the first stage of the endovascular repair was performed using an inner branched endograft to exclude a 77-mm distal arch and descending thoracic aortic aneurysm. In 2015, a 63-mm thoracoabdominal aortic aneurysm was excluded by implantation of a 4-fenestrated endograft. Follow-up after both endovascular repairs was uneventful. Total aortic endovascular repair was successfully performed to treat a patient with arch and thoraco-abdominal aortic aneurysm associated with chronic aortic dissection and Marfan syndrome. The postoperative images confirmed patency of the endograft and its branches, and complete exclusion of the aortic false lumen. Endovascular repair is a treatment option in patients with connective tissue disease who are not candidates for open surgery. Long-term follow-up is required to confirm these favorable early outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Endovascular repair of traumatic thoracic aortic tears.

    Science.gov (United States)

    Mansour, M Ashraf; Kirk, Jeffrey S; Cuff, Robert F; Banegas, Shonda L; Ambrosi, Gavin M; Liao, Timothy H; Chambers, Christopher M; Wong, Peter Y; Heiser, John C

    2012-03-01

    Patients with thoracic aorta injuries (TAI) present a unique challenge. The purpose of this study was to review the outcomes of thoracic endovascular aortic repair (TEVAR) in patients with TAI. A retrospective chart review of all patients admitted for TEVAR for trauma was performed. In a 5-year period, 19 patients (6 women and 13 men; average age, 42 y) were admitted to our trauma center with TAI. Mechanism of injury was a motor vehicle crash in 12 patients, motorcycle crash in 2 patients, automobile-pedestrian accident in 2 patients, 1 fall, 1 crush injury, and 1 stab wound to the back. A thoracic endograft was used in 6 patients and proximal aortic cuffs were used in 13 patients (68%). One patient (5%) died. There were no strokes, myocardial infarctions, paraplegia, or renal failure. TEVAR for TAI appears to be a safe option for patients with multiple injuries. TEVAR in young patients is still controversial because long-term endograft behavior is unknown. Copyright © 2012 Elsevier Inc. All rights reserved.

  11. Predictive factors for cerebrovascular accidents after thoracic endovascular aortic repair.

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    Mariscalco, Giovanni; Piffaretti, Gabriele; Tozzi, Matteo; Bacuzzi, Alessandro; Carrafiello, Giampaolo; Sala, Andrea; Castelli, Patrizio

    2009-12-01

    Cerebrovascular accidents are devastating and worrisome complications after thoracic endovascular aortic repair. The aim of this study was to determine cerebrovascular accident predictors after thoracic endovascular aortic repair. Between January 2001 and June 2008, 76 patients treated with thoracic endovascular aortic repair were prospectively enrolled. The study cohort included 61 men; mean age was 65.4 +/- 16.8 years. All patients underwent a specific neurologic assessment on an hourly basis postoperatively to detect neurologic deficits. Cerebrovascular accidents were diagnosed on the basis of physical examination, tomography scan or magnetic resonance imaging, or autopsy. Cerebrovascular accidents occurred in 8 (10.5%) patients, including 4 transient ischemic attack and 4 major strokes. Four cases were observed within the first 24-hours. Multivariable analysis revealed that anatomic incompleteness of the Willis circle (odds ratio [OR] 17.19, 95% confidence interval [CI] 2.10 to 140.66), as well as the presence of coronary artery disease (OR 6.86, 95 CI% 1.18 to 40.05), were independently associated with postoperative cerebrovascular accident development. Overall hospital mortality was 9.2%, with no significant difference for patients hit by cerebrovascular accidents (25.0% vs 7.3%, p = 0.102). Preexisting coronary artery disease, reflecting a severe diseased aorta and anomalies of Willis circle are independent cerebrovascular accident predictors after thoracic endovascular aortic repair procedures. A careful evaluation of the arch vessels and cerebral vascularization should be mandatory for patients suitable for thoracic endovascular aortic repair.

  12. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Hirofumi Kasahara

    2015-01-01

    Full Text Available A 69-year-old man underwent thoracic endovascular aortic repair of a descending aortic aneurysm. Three years later, he developed impending rupture due to aneurysmal expansion that included the proximal landing zone. Urgent open surgery was performed via lateral thoracotomy, and a Dacron graft was sewn to the previous stent graft distally with Teflon felt reinforcement. Postoperatively, four sequential computed tomography scans demonstrated that the aneurysm was additionally increasing in size probably due to continuous hematoma production, suggesting a possibility of endoleaks. This case demonstrates the importance of careful radiologic surveillance after endovascular repair, and also after partial open conversion.

  13. Intensive Care Management of Thoracic Aortic Surgical Patients, Including Thoracic and Infradiaphragmatic Endovascular Repair (EVAR/TEVAR).

    Science.gov (United States)

    Cole, Sheela Pai

    2015-12-01

    The patient with thoracic aortic disease can present for open or endovascular repair. Thoracic endovascular aortic repair (TEVAR) has emerged as a minimally invasive option for a multitude of aortic pathology, including dissections, aneurysms, traumatic injuries, and ulcers. Postoperative management of these patients depends on the extent of procedure, whether it was open or endovascular, and, finally, on the preoperative comorbidities present. While procedural success has catapulted TEVAR to popularity, midterm results have been mixed. Additionally, periprocedural complications such as paraplegia and renal failure remain a significant morbidity in these patients. © The Author(s) 2015.

  14. Endovascular repair of para-anastomotic aortoiliac aneurysms.

    LENUS (Irish Health Repository)

    Tsang, Julian S

    2009-11-01

    The purpose of this study is to evaluate the use of endovascular stent grafts in the treatment of para-anastomotic aneurysms (PAAs) as an alternative to high-risk open surgical repair. We identified all patients with previous open aortic aneurysm repair who underwent infrarenal endovascular aneurysm repair (EVAR) at our institution from June 1998 to April 2007. Patient demographics, previous surgery, and operative complications were recorded. One hundred forty-eight patients underwent EVAR during the study period and 11 patients had previous aortic surgery. Of these 11 redo patients, the mean age was 62 years at initial surgery and 71 years at EVAR. All patients were male. Initial open repair was for rupture in five (45%) patients. The average time between initial and subsequent reintervention was 9 years. All patients were ASA Grade III or IV. Fifty-five percent of the PAAs involved the iliac arteries, 36% the abdominal aorta, and 9% were aortoiliac. Ten patients had endovascular stent-grafts inserted electively, and one patient presented with a contained leak. Aorto-uni-iliac stent-grafts were deployed in seven patients, and bifurcated stent-grafts in four patients. A 100% successful deployment rate was achieved. Perioperative mortality was not seen and one patient needed surgical reintervention to correct an endoleak. Endovascular repair of PAAs is safe and feasible. It is a suitable alternative and has probably now become the treatment of choice in the management of PAAs.

  15. Endovascular repair of abdominal aortic aneurysm.

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    Paravastu, Sharath Chandra Vikram; Jayarajasingam, Rubaraj; Cottam, Rachel; Palfreyman, Simon J; Michaels, Jonathan A; Thomas, Steven M

    2014-01-23

    An abnormal dilatation of the abdominal aorta is referred to as an abdominal aortic aneurysm (AAA). Due to the risk of rupture, surgical repair is offered electively to individuals with aneurysms greater than 5.5 cm in size. Traditionally, conventional open surgical repair (OSR) was considered the first choice approach. However, over the past two decades endovascular aneurysm repair (EVAR) has gained popularity as a treatment option. This article intends to review the role of EVAR in the management of elective AAA. To assess the effectiveness of EVAR versus conventional OSR in individuals with AAA considered fit for surgery, and EVAR versus best medical care in those considered unfit for surgery. This was determined by the effect on short, intermediate and long-term mortality, endograft related complications, re-intervention rates and major complications. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator (TSC) searched the Specialised Register (January 2013) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 12). The TSC also searched trial databases for details of ongoing or unpublished studies. Prospective randomised controlled trials (RCTs) comparing EVAR with OSR in individuals with AAA considered fit for surgery. and comparing EVAR with best medical care in individuals considered unfit for surgery. We excluded studies with inadequate data or using an inadequate randomisation technique. Three reviewers independently evaluated trials for appropriateness for inclusion and extracted data using pro forma designed by the Cochrane PVD Group. We assessed the quality of trials using The Cochrane Collaboration's 'Risk of bias' tool. We entered collected data in to Review Manager (version 5.2.3) for analysis. Where direct comparisons could be made, we determined odds ratios (OR). We tested studies for heterogeneity and, when present, we used a random-effects model; otherwise we used a fixed-effect model. We tabulated

  16. Open Versus Endovascular Stent Graft Repair of Abdominal Aortic Aneurysms

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim

    2014-01-01

    We performed an analysis to assess the need for conducting additional randomized controlled trials (RCTs) comparing open and endovascular aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA). Trial sequential analysis (TSA) is a statistical methodology that can calculate the required inform...

  17. Suprarenal fixation barbs can induce renal artery occlusion in endovascular aortic aneurysm repair.

    Science.gov (United States)

    Subedi, Shree K; Lee, Andy M; Landis, Gregg S

    2010-01-01

    Renal artery occlusion following endovascular abdominal aortic aneurysm repair with suprarenal fixation is uncommon. We report one patient who was found to develop renal artery occlusion and parenchymal infarction 6 months after repair using an endovascular graft with suprarenal fixation. Our patient underwent emergent endovascular repair of a symptomatic 6 cm abdominal aortic aneurysm. The covered portion of the endograft was inadvertently deployed well below the renal artery orifices. At the completion of the procedure both renal arteries were confirmed to be patent. One month postoperatively, a computed tomographic (CT) scan showed exclusion of the aortic sac and normal enhancement of both kidneys. At 6 months, the patient was found to have elevated serum creatinine levels despite having no clinical symptoms. CT scanning revealed a nonenhancing left kidney, and angiography demonstrated an occlusion of the left renal artery. A barb welded to the bare metal stent appeared to be impinging on the renal artery. We believe that renal artery occlusion after endovascular repair can occur due to repetitive injury to the renal artery orifice from barbs welded to the bare metal stent. To our knowledge, this is the first reported case of renal artery occlusion caused by repetitive injury from transrenal fixation systems. Copyright 2010 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  18. Emergency endovascular management of peripheral artery aneurysms and pseudoaneurysms – a review

    Directory of Open Access Journals (Sweden)

    Gillard Jonathan H

    2008-07-01

    Full Text Available Abstract Endovascular stenting has been successfully employed in the management of aortic aneurysms; however, its use in managing peripheral arterial conditions remains questionable. We review the utility of endovascular technique in the management of peripheral arterial conditions like aneurysms, pseudoaneurysms and arterio-venous fistulas in the emergency setting. Though long term data about graft patency rates is not yet available, the endovascular approach appears to be a useful minimally invasive technique in situations where open repair is either difficult or not feasible.

  19. Emergency endovascular coiling of a ruptured giant splenic artery aneurysm

    DEFF Research Database (Denmark)

    Wernheden, Erika; Brenøe, Anne Sofie; Shahidi, Saeid

    2017-01-01

    Splenic artery aneurysms (SAAs) are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm) SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured...... 15-cm giant SAA in an 84-year-old woman treated successfully with emergency endovascular coiling. To our knowledge, this is one of the few reports of emergency endovascular treatment for ruptured giant SAA....

  20. The impact of endovascular repair on specialties performing abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    K.H.J. Ultee (Klaas); R. Hurks (Rob); D.B. Buck (Dominique B.); G.S. Dasilva (George S.); P.A. Soden (Peter A.); J.A. van Herwaarden (Joost); H.J.M. Verhagen (Hence); M.L. Schermerhorn (Marc)

    2015-01-01

    textabstractBackground Abdominal aortic aneurysm (AAA) repair has been performed by various surgical specialties for many years. Endovascular aneurysm repair (EVAR) may be a disruptive technology, having an impact on which specialties care for patients with AAA. Therefore, we examined the proportion

  1. The impact of endovascular repair on specialties performing abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Ultee, Klaas H J; Hurks, Rob; Buck, Dominique B.; Dasilva, George S.; Soden, Peter A.; Van Herwaarden, Joost A.; Verhagen, Hence J M; Schermerhorn, Marc L.

    2015-01-01

    Background Abdominal aortic aneurysm (AAA) repair has been performed by various surgical specialties for many years. Endovascular aneurysm repair (EVAR) may be a disruptive technology, having an impact on which specialties care for patients with AAA. Therefore, we examined the proportion of AAA

  2. Cost-effectiveness of endovascular repair, open repair, and conservative management of splenic artery aneurysms

    NARCIS (Netherlands)

    Hogendoorn, Wouter; Lavida, Anthi; Hunink, M. G Myriam; Moll, Frans L.; Geroulakos, George; Muhs, Bart E.; Sumpio, Bauer E.

    2015-01-01

    Objective Open repair (OPEN) and conservative management (CONS) have been the treatments of choice for splenic artery aneurysms (SAAs) for many years. Endovascular repair (EV) has been increasingly used with good short-term results. In this study, we evaluated the cost-effectiveness of OPEN, EV, and

  3. Flow and wall shear stress characterization following endovascular aneurysm repair and endovascular aneurysm sealing in an infrarenal aneurysm model

    NARCIS (Netherlands)

    Boersen, Johannes T.; Groot Jebbink, Erik; Versluis, Michel; Slump, Cornelis H.; Ku, David N.; de Vries, Jean-Paul P.M.; Reijnen, Michel M.P.J.

    2017-01-01

    Background Endovascular aneurysm repair (EVAR) with a modular endograft has become the preferred treatment for abdominal aortic aneurysms. A novel concept is endovascular aneurysm sealing (EVAS), consisting of dual endoframes surrounded by polymer-filled endobags. This dual-lumen configuration is

  4. Endovascular repair of aortic disease: a venture capital perspective.

    Science.gov (United States)

    Buchanan, Lucas W; Stavropoulos, S William; Resnick, Joshua B; Solomon, Jeffrey

    2009-03-01

    Endovascular devices for the treatment of abdominal and thoracic aortic disease are poised to become the next $1 billion medical device market. A shift from open repair to endovascular repair, advances in technology, screening initiatives, and new indications are driving this growth. Although billion-dollar medical device markets are rare, this field is fraught with risk and uncertainty for startups and their venture capital investors. Technological hurdles, daunting clinical and regulatory timelines, market adoption issues, and entrenched competitors pose significant barriers to successful new venture creation. In fact, the number of aortic endografts that have failed to reach commercialization or have been pulled from the market exceeds the number of Food and Drug Administration-approved endografts in the United States. This article will shed some light on the venture capital mind-set and decision-making paradigm in the context of aortic disease.

  5. Stent fractures in the Hemobahn/Viabahn stent graft after endovascular popliteal aneurysm repair

    NARCIS (Netherlands)

    Tielliu, Ignace F. J.; Zeebregts, Clark J.; Vourliotakis, George; Bekkema, Foppe; van den Dungen, Jan J. A. M.; Prins, Ted R.; Verhoeven, Eric L. G.

    Objective: During the last decade, endovascular repair of popliteal artery aneurysms (PAAs) has become a valid alternative to open repair. This study analyzes the incidence and origin of stein graft fractures after endovascular repair, its impact on patency, and strategies to prevent fractures.

  6. 'Regular' and 'emergency' repair

    International Nuclear Information System (INIS)

    Luchnik, N.V.

    1975-01-01

    Experiments on the combined action of radiation and a DNA inhibitor using Crepis roots and on split-dose irradiation of human lymphocytes lead to the conclusion that there are two types of repair. The 'regular' repair takes place twice in each mitotic cycle and ensures the maintenance of genetic stability. The 'emergency' repair is induced at all stages of the mitotic cycle by high levels of injury. (author)

  7. Endovascular repair of early rupture of Dacron aortic graft--two case reports.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2005-01-01

    Complications after open aortic surgery pose a challenge both to the vascular surgeon and the patient because of aging population, widespread use of cardiac revascularization, and improved survival after aortic surgery. The perioperative mortality rate for redo elective aortic surgery ranges from 5% to 29% and increases to 70-100% in emergency situation. Endovascular treatment of the postaortic open surgery (PAOS) patient has fewer complications and a lower mortality rate in comparison with redo open surgical repair. Two cases of ruptured abdominal aortic aneurysm (AAA) were managed with the conventional open surgical repair. Subsequently, spiral contrast computer tomography scans showed reperfusion of the AAA sac remnant mimicking a type III endoleak. These graft-related complications presented as vascular emergencies, and in both cases endovascular aneurysm repair (EVAR) procedure was performed successfully by aortouniiliac (AUI) stent graft and femorofemoral crossover bypass. These 2 patients add further merit to the cases reported in the English literature. This highlights the crucial importance of endovascular grafts in the management of such complex vascular problems.

  8. Endovascular Retrieval of Entrapped Elephant Trunk Graft During Complex Hybrid Aortic Arch Repair

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    Damodharan, Karthikeyan, E-mail: drdkarthik@hotmail.com [Singapore General Hospital, Department of Diagnostic Radiology (Singapore); Chao, Victor T. T., E-mail: victor.chao.t.t@singhealth.com.sg [National Heart Centre, Department of Cardiothoracic Surgery (Singapore); Tay, Kiang Hiong, E-mail: tay.kiang.hiong@singhealth.com.sg [Singapore General Hospital, Department of Diagnostic Radiology (Singapore)

    2016-12-15

    Entrapment of the elephant trunk graft within the false lumen is a rare complication of surgical repair of an aortic dissection. This is normally retrieved by emergent open surgery. We describe a technique of endovascular retrieval of the dislodged graft, during hybrid aortic arch repair. The elephant trunk was cannulated through and through from a femoral access and the free end of the wire was snared and retrieved from a brachial access. The wire was externalised from both accesses and was used to reposition the graft into the true lumen using a body flossing technique.

  9. Percutaneous endovascular aneurysm repair in morbidly obese patients.

    Science.gov (United States)

    Chin, Jason A; Skrip, Laura; Sumpio, Bauer E; Cardella, Jonathan A; Indes, Jeffrey E; Sarac, Timur P; Dardik, Alan; Ochoa Chaar, Cassius I

    2017-03-01

    Endovascular aneurysm repair (EVAR) with percutaneous femoral access (PEVAR) has several potential advantages. Morbidly obese (MO) patients present unique anatomical challenges and have not been specifically studied. This study examines the trends in the use of PEVAR and its surgical outcomes compared with open femoral cutdown (CEVAR) in MO patients. The American College of Surgeons National Surgical Quality Improvement Program files for the years 2005 to 2013 were reviewed. The study included all MO patients (body mass index [BMI] ≥40 kg/m 2 ) undergoing EVAR. Patients were categorized as having CEVAR if they had any one of 11 selected Current Procedural Terminology (American Medical Association, Chicago, Ill) codes describing an open femoral procedure. The PEVAR group included any remaining patients who had only codes for EVAR and endovascular procedures. Linear correlation was used to evaluate temporal trends in the use of PEVAR among MO patients. Baseline comorbidities and surgical outcomes were compared between the PEVAR and CEVAR groups using χ 2 tests or t-tests. There were 833 MO patients (470 CEVAR and 363 PEVAR) constituting 3.0% of all patients undergoing EVAR. The use of PEVAR in MO patients significantly increased from 27.3% of total EVARs in the years 2005 to 2006 to 48.6% in 2013 (P = .039). The two groups had similar baseline characteristics, including age, BMI, comorbidities, and emergency procedures, except for history of severe chronic obstructive pulmonary disease (29.6% CEVAR vs 22.6% PEVAR; P = .024). PEVAR patients had shorter duration of anesthesia (244 vs 260 minutes; P = .048) and shorter total operation time (158 vs 174 minutes; P = .002). PEVAR patients had significantly decreased wound complications (5.5% vs 9.4%; P = .039). There was a trend towards PEVAR patients being more likely to be discharged home than to a facility (93.6% vs 87.8%; P = .060). There was no difference in any other complication or mortality. A subgroup

  10. Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT.

    Science.gov (United States)

    Ulug, Pinar; Hinchliffe, Robert J; Sweeting, Michael J; Gomes, Manuel; Thompson, Matthew T; Thompson, Simon G; Grieve, Richard J; Ashleigh, Raymond; Greenhalgh, Roger M; Powell, Janet T

    2018-05-01

    Ruptured abdominal aortic aneurysm (AAA) is a common vascular emergency. The mortality from emergency endovascular repair may be much lower than the 40-50% reported for open surgery. To assess whether or not a strategy of endovascular repair compared with open repair reduces 30-day and mid-term mortality (including costs and cost-effectiveness) among patients with a suspected ruptured AAA. Randomised controlled trial, with computer-generated telephone randomisation of participants in a 1 : 1 ratio, using variable block size, stratified by centre and without blinding. Vascular centres in the UK ( n  = 29) and Canada ( n  = 1) between 2009 and 2013. A total of 613 eligible participants (480 men) with a ruptured aneurysm, clinically diagnosed at the trial centre. A total of 316 participants were randomised to the endovascular strategy group (immediate computerised tomography followed by endovascular repair if anatomically suitable or, if not suitable, open repair) and 297 were randomised to the open repair group (computerised tomography optional). The primary outcome measure was 30-day mortality, with 30-day reinterventions, costs and disposal as early secondary outcome measures. Later outcome measures included 1- and 3-year mortality, reinterventions, quality of life (QoL) and cost-effectiveness. The 30-day mortality was 35.4% in the endovascular strategy group and 37.4% in the open repair group [odds ratio (OR) 0.92, 95% confidence interval (CI) 0.66 to 1.28; p  = 0.62, and, after adjustment for age, sex and Hardman index, OR 0.94, 95% CI 0.67 to 1.33]. The endovascular strategy appeared to be more effective in women than in men (interaction test p  = 0.02). More discharges in the endovascular strategy group (94%) than in the open repair group (77%) were directly to home ( p  open repair group, respectively (OR 0.73, 95% CI 0.53 to 1.00; p  = 0.053), with a stronger benefit for the endovascular strategy in the subgroup of 502 participants

  11. Outcomes of endovascular aortic repair in the modern era

    DEFF Research Database (Denmark)

    Budtz-Lilly, Jacob; Wanhainen, Anders; Mani, Kevin

    2018-01-01

    Monitoring outcomes following endovascular aortic repair (EVAR) is critical. Although evidence from randomized controlled trials has solidified the role of EVAR, the analysis of outcomes and "real-world" data has uncovered limitations, improved the selection of appropriate patients, and underscored...... the importance of instructions for use. Subsequent studies demonstrated the learning curve of EVAR and gradual improvement of outcomes over time. Outcomes analyses will continue to play an important role, particularly as technological growth of endovascular therapy has enabled treatment of more complex aneurysm...... pathologies and patients. The important analyses are herein reviewed, following the development of EVAR in the treatment of intact abdominal aortic aneurysms (AAA) to ruptured AAAs, and finally to complex aneurysms, including thoracoabdominal aortic aneurysms and mycotic aneurysms. This includes an overview...

  12. Logistic considerations for a successful institutional approach to the endovascular repair of ruptured abdominal aortic aneurysms.

    Science.gov (United States)

    Mayer, Dieter; Rancic, Zoran; Pfammatter, Thomas; Hechelhammer, Lukas; Veith, Frank J; Donas, Konstantin; Lachat, Mario

    2010-01-01

    The value of emergency endovascular aneurysm repair (EVAR) in the setting of ruptured abdominal aortic aneurysm remains controversial owing to differing results. However, interpretation of published results remains difficult as there is a lack of generally accepted protocols or standard operating procedures. Furthermore, such protocols and standard operating procedures often are reported incompletely or not at all, thereby making interpretation of results difficult. We herein report our integrated logistic system for the endovascular treatment of ruptured abdominal aortic aneurysms. Important components of this system are prehospital logistics, in-hospital treatment logistics, and aftercare. Further studies should include details about all of these components, and a description of these logistic components must be included in all future studies of emergency EVAR for ruptured abdominal aortic aneurysms.

  13. Aorto-enteric Fistula 15 Years After Uncomplicated Endovascular Aortic Repair with Unforeseen Onset of Endocarditis

    DEFF Research Database (Denmark)

    Kadhim, M M K; Rasmussen, J B G; Eiberg, J P

    2016-01-01

    Introduction Aorto-enteric fistula after endovascular aortic repair is an exceedingly rare but serious condition. Report A rare case of a fistula between the excluded aortic sac and the transverse colon 15 years after endovascular aortic repair is described. Onset was endocarditis without...... such as endocarditis, which in this case probably occurred as metastatic sepsis from endograft infection....

  14. High risk endovascular aneurysm repair: a case report.

    Science.gov (United States)

    De Silva, Samanthi

    2017-10-01

    Mr AB is a 66-year old gentleman who presented for elective endovascular aneurysm repair (EVAR) following a routine screening scan identifying a 5.5cm abdominal aortic aneurysm (AAA). He had a past history of chronic obstructive pulmonary disease (COPD) with FEV1/FVC ratio of 48% on pre-assessment. He was hypertensive with a history of ischaemic heart disease (IHD), which has remained asymptomatic following coronary artery bypass grafting (CABG) eight years prior to this presentation. Copyright the Association for Perioperative Practice.

  15. Preoperative methylprednisolone enhances recovery after endovascular aortic repair

    DEFF Research Database (Denmark)

    de la Motte, Louise; Kehlet, Henrik; Vogt, Katja

    2014-01-01

    OBJECTIVE: To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR). BACKGROUND: The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators....... Glucocorticoids may reduce postoperative inflammatory responses and enhance recovery, but with limited information on EVAR. METHODS: A single-center, randomized, double-blind, placebo-controlled trial of 153 patients undergoing elective EVAR between November 2009 and January 2013. Patients received 30 mg.......001) and fulfillment of discharge criteria was shorter [2 days (IQR = 2-4 days) vs 3 days (IQR = 3-4 days)] (P factor receptor were also reduced (P

  16. Morphological risk factors of stroke during thoracic endovascular aortic repair.

    Science.gov (United States)

    Kotelis, Drosos; Bischoff, Moritz S; Jobst, Bertram; von Tengg-Kobligk, Hendrik; Hinz, Ulf; Geisbüsch, Philipp; Böckler, Dittmar

    2012-12-01

    This study aims to identify independent factors correlating to an increased risk of perioperative stroke during thoracic endovascular aortic repair (TEVAR). A prospective maintained TEVAR database, medical records, and imaging studies of 300 patients (205 men; median age of all, 66 years, range 21-89), who underwent TEVAR between March 1997 and February 2011, were reviewed. Preoperative CT data sets were reviewed by two experienced radiologists with focus on the atheroma burden in the aortic arch (grade I, normal, to grade V, ulcerated or pedunculated atheroma). Aortic arch geometry (arch types I-III) was documented. Further parameters included in the univariate analysis were age, gender, urgency of repair, duration of procedure, adenosine-induced cardiac arrest or rapid pacing, proximal landing zone, left subclavian artery (LSA) coverage, and number of stent grafts. Multivariate logistic regression analysis was performed to assess the independent correlations of potential risk factors. Atherosclerotic aneurysm was the most common pathology (44%). One hundred and fifty-four of our patients (51%) were treated under urgent or emergent conditions. Seventeen percent of all patients had significant arch atheroma (grade IV or V), and 43% had a steep type III aortic arch. The perioperative stroke was 4% (12 patients; median age, 73 years, range 31-78). Two strokes were lethal (0.7%). All strokes were classified as embolic based on imaging characteristics. In eight patients, strokes were located in the left cerebral hemisphere (seven of them in the anterior and one in the posterior circulation). Four stroke patients (one in the left posterior circulation) underwent LSA coverage without revascularization. Three stroke patients had severe arch atheroma grade V. Five patients suffering stroke were recognized to have a type III aortic arch. Strokes were equally distributed between zones 0-2 vs. 3-4 (n = 6 each, 5 vs. 3.3%). The highest incidence was found in zone 1 (11

  17. Emergency endovascular coiling of a ruptured giant splenic artery aneurysm

    Directory of Open Access Journals (Sweden)

    Erika Wernheden, MD

    2017-12-01

    Full Text Available Splenic artery aneurysms (SAAs are the third most common abdominal aneurysm. Endovascular treatment of SAAs is preferred, and coiling is the most commonly used technique. Ruptured giant (>5 cm SAAs are usually treated with open surgery including splenectomy. We present a rare case of a ruptured 15-cm giant SAA in an 84-year-old woman treated successfully with emergency endovascular coiling. To our knowledge, this is one of the few reports of emergency endovascular treatment for ruptured giant SAA.

  18. Nursing cooperation in endovascular aneurysm repair treatment for aortic dissection

    International Nuclear Information System (INIS)

    Xing Li; Yuan Chanjuan; Chen Rumei; Xiao Zhanqiang; Qi Youfei

    2014-01-01

    Objective: To summarize the main points of nursing cooperation in endovascular aneurysm repair treatment for aortic dissection. Methods: Preoperative psychological care and the other preparations were carefully conducted. During the operation, the patient's body was correctly placed. Active cooperation with the performance of angiography and close observation during heparinization were carried out. The proper delivery of catheter and stent to the operator was carefully done. Close observation for the patient's vital signs, the renal function and the changes of limb blood supply were made. Results: Under close cooperation of' the operators, nurses, anesthesiologists and technicians, the surgery was successfully accomplished in 35 patients. The monitoring of vital signs during the entire performance of operation was well executed. No surgical instruments delivery error's or surgery failure due to unsuitable cooperation occurred. Conclusion: Perfect preoperative preparation, strict nursing cooperation and team cooperation are the key points to ensure a successful endovascular aneurysm repair for aortic dissection. (authors)

  19. Fenestrated endovascular aortic aneurysm repair using physician-modified endovascular grafts versus company-manufactured devices.

    Science.gov (United States)

    Dossabhoy, Shernaz S; Simons, Jessica P; Flahive, Julie M; Aiello, Francesco A; Sheth, Parth; Arous, Edward J; Messina, Louis M; Schanzer, Andres

    2017-12-07

    Fenestrated endografts are customized, patient-specific endovascular devices with potential to reduce morbidity and mortality of complex aortic aneurysm repair. With approval from the U.S. Food and Drug Administration, our center began performing fenestrated endovascular aneurysm repair through a physician-sponsored investigational device exemption (IDE #G130210), using both physician-modified endografts (PMEGs) and company-manufactured devices (CMDs). Because these techniques are associated with specific advantages and disadvantages, we sought to investigate differences in outcomes between PMEG and CMD cases. A single-institution retrospective review of all fenestrated endovascular aneurysm repairs was performed. The cohort was analyzed by device type (PMEG or CMD) after matching of cases on the basis of (1) number of target vessels intended for treatment, (2) extent of aneurysm, (3) aneurysm diameter, (4) device configuration, and (5) date of operation. Outcomes of ruptures, common iliac artery aneurysms, and aortic arch aneurysms were excluded. Demographics, operative details, perioperative complications, length of stay, and reinterventions were compared. For patients with >1 year of follow-up time, survival, type I or type III endoleak rate, target artery patency, and reintervention rate were estimated using the Kaplan-Meier method. Between November 30, 2010, and July 30, 2016, 82 patients were identified and matched. The cohort included 41 PMEG and 41 CMD patients who underwent repair of 38 juxtarenal (PMEG, 17; CMD, 21; P = .38), 14 pararenal (PMEG, 6; CMD, 8; P = .56), and 30 thoracoabdominal type I to type IV (PMEG, 18; CMD, 12; P = .17) aneurysms. There were significant differences in presentation requiring urgent aneurysm repair (PMEG, 9; CMD, 0; P = .002), total fluoroscopy time (PMEG, 76 minutes; CMD, 61 minutes; P = .02), volume of contrast material used (PMEG, 88 mL; CMD, 70 mL; P = .02), in-operating room to out-of-operating room time

  20. Endovascular Repair of an Actively Hemorrhaging Stab Wound Injury to the Abdominal Aorta

    International Nuclear Information System (INIS)

    Hussain, Qasim; Maleux, Geert; Heye, Sam; Fourneau, Inge

    2008-01-01

    Traumatic injury of the abdominal aorta is rare and potentially lethal (Yeh et al., J Vasc Surg 42(5):1007-1009, 2005; Chicos et al., Chirurgia (Bucur) 102(2):237-240, 2007) as it can result in major retroperitoneal hemorrhage, requiring an urgent open surgery. In case of concomitant bowel injury or other conditions of hostile abdomen, endovascular repair can be an alternative treatment. This case report deals with a 50-year-old man presenting at the emergency ward with three stab wounds: two in the abdomen and one in the chest. During explorative laparotomy, liver laceration and bowel perforation were repaired. One day later, abdominal CT-scan revealed an additional retroperitoneal hematoma associated with an aortic pseudoaneurysm, located anteriorly 3 cm above the aortic bifurcation. Because of the risk of graft infection, an endovascular repair of the aortic injury using a Gore excluder stent-graft was performed. Radiological and clinical follow-up revealed a gradual shrinkage of the pseudo-aneurysm and no sign of graft infection at two years' follow-up.

  1. Endovascular Aneurysm Repair and Sealing (EVARS): A Useful Adjunct in Treating Challenging Morphology

    Energy Technology Data Exchange (ETDEWEB)

    Harrison, Gareth J., E-mail: garethjamesharrison@yahoo.co.uk; Antoniou, George A., E-mail: antoniou.ga@hotmail.com; Torella, Francesco, E-mail: francesco.torella@rlbuht.nhs.uk; McWilliams, Richard G., E-mail: richard.mcwilliams@rlbuht.nhs.uk; Fisher, Robert K., E-mail: robert.fisher@rlbuht.nhs.uk [Royal Liverpool University Hospital, Liverpool Vascular and Endovascular Service (United Kingdom)

    2016-04-15

    An 81-year-old male with previous open abdominal aortic aneurysm repair presented with asymptomatic large pseudoaneurysms at both ends of an open surgical tube graft. Endovascular aneurysm sealing (EVAS) in combination with the iliac limbs of a standard endovascular aneurysm repair (EVAR) successfully excluded both pseudoaneurysms from circulation. We describe the combination of elements of EVAS and EVAR and have termed this endovascular aneurysm repair and sealing (EVARS). EVARS has the advantage of harnessing the benefits of endobag sealing in aortic necks unsuitable for standard EVAR whilst providing the security of accurate stent placement within short common iliac arteries. In conclusion, EVAS may be combined with standard endovascular iliac limbs and is a possible treatment option for pseudoaneurysm following open aneurysm repair.

  2. Development of stroke-induced quadriplegia after endovascular repair of blunt aortic injury pseudoaneurysm.

    Science.gov (United States)

    Amoudi, Abdullah S; Merdad, Anas A; Makhdoom, Ahmed Q; Jamjoom, Reda A

    2015-01-01

    Endovascular repair of blunt aortic injury is now a first-line approach in management. This can warrant coverage of the left subclavian artery (LSA), which could lead to posterior strokes. In this case report, we present a severe complication of endovascular repair of a traumatic aortic aneurysm. A 53-year-old man presented with blunt aortic injury, endovascular repair was carried out where the left subclavian artery was covered. The intervention had a 100% technical success. Twelve hours later, he was discovered to have quadriplegia, a CT scan showed a large left cerebellar infarction extending to the medulla oblongata and proximal spinal cord. Strokes complicate 3% of thoracic endovascular aortic repairs, 80% of those strokes occur in patients who had their LSA`s covered. Most patients however, tolerate the coverage. Although our patient had a dominant right vertebral artery, and lacked risks for these strokes, he developed an extensive stroke that left him quadriplegic.

  3. The influence of neck thrombus on clinical outcome and aneurysm morphology after endovascular aneurysm repair

    NARCIS (Netherlands)

    F.M.V. Bastos Gonçalves (Frederico); H.J.M. Verhagen (Hence); K. Chinsakchai (Khamin); J.W. van Keulen (Jasper); M.T. Voûte (Michiel); H.J.A. Zandvoort (Herman); F.L. Moll (Frans); J.A. van Herwaarden (Joost)

    2012-01-01

    textabstractObjective: This study investigated the influence of significant aneurysm neck thrombus in clinical and morphologic outcomes after endovascular aneurysm repair (EVAR). Methods: The patient population was derived from a prospective EVAR database from two university institutions in The

  4. Emergent Endovascular Management of Acute Arterial Bleeding ...

    African Journals Online (AJOL)

    multiruka1

    little attention has been paid to the novel endovascular options available .... Fig 1b. Fig 1c. Figure 1a: Mass at gastric fundus enhanced in post contrast CT abdomen. ... 1c: Left gastric artery super selectively coiled to occlusion. Fig 2a. Fig 2b.

  5. Salvage of bilateral renal artery occlusion after endovascular aneurysm repair with open splenorenal bypass

    Directory of Open Access Journals (Sweden)

    Samuel Jessula, MDCM

    2017-09-01

    Full Text Available We report renal salvage maneuvers after accidental bilateral renal artery coverage during endovascular aneurysm repair of an infrarenal abdominal aortic aneurysm. A 79-year-old man with an infrarenal abdominal aortic aneurysm was treated with endovascular aneurysm repair. Completion angiography demonstrated coverage of the renal arteries. Several revascularization techniques were attempted, including endograft repositioning and endovascular stenting through the femoral and brachial approach. The patient eventually underwent open splenorenal bypass with a Y Gore-Tex graft (W. L. Gore & Associates, Flagstaff, Ariz. After 3 months, computed tomography showed no evidence of endoleak and patent renal arteries. Renal function was well maintained, and the patient did not require dialysis.

  6. Zone zero thoracic endovascular aortic repair: A proposed modification to the classification of landing zones.

    Science.gov (United States)

    Roselli, Eric E; Idrees, Jay J; Johnston, Douglas R; Eagleton, Matthew J; Desai, Milind Y; Svensson, Lars G

    2018-04-01

    Endovascular stent-grafting provides an alternative treatment option for high-risk patients with ascending aortic disease. The feasibility of this approach has been demonstrated before. We assess the updated experience with ascending thoracic endovascular aortic repair and propose a modification of the landing zone classification based on the outcomes. From 2006 to 2016, 39 patients deemed very high risk for open replacement underwent endovascular repair of ascending aorta for acute type A dissection (12, 31%), intramural hematoma (2, 5%), pseudoaneurysm (22, 56%), and chronic dissection suture line entry tear (3, 8%). Ascending thoracic endovascular aortic repair was performed in 36 patients. In 3 patients with pseudoaneurysm, occluder devices were used. Computed tomography imaging analysis was performed, and the extent of aortic pathology was designated by segmental proximity to the left ventricle. Segmental anatomy of the proximal aorta was designed as zone 0A from the annulus to the distal margin of highest coronary, 0B extends from above the coronary to the distal margin of right pulmonary artery, and 0C extends from the right pulmonary artery border to the innominate artery. Multivariable time to event Cox regression analysis was performed to predict mortality, and long-term survival was estimated using the Kaplan-Meier method. Operative mortality was 13%; all 5 deaths occurred after emergency ascending thoracic endovascular aortic repair for type A dissection. Other complications included stroke in 4 patients (10%), myocardial infarction in 2 patients (5%), tracheostomy in 2 patients (5%), and dialysis in 2 patients (5%). In patients with acute type A dissection, the ascending pathology extended into zone 0A in 10 (71%) and 0B in 4 (29%). Among those with pseudoaneurysm, the location of the defect was in 0B in 11 (50%), 0C in 10 (45%), and 0A in 1. Among the patients with chronic dissection, the defect was located in 0C in all 3 (100%). After multivariable

  7. Perioperative management of endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Wang Haofu; Wang Yuwei; Li Jun; Zhao Zonggang; Qi Sen

    2010-01-01

    Objective: To summarize the clinical experience of perioperative management in performing endovascular abdominal aortic aneurysm repair (EVAR). Methods: EVAR was performed in 22 patients with abdominal aortic aneurysm. The clinical data were retrospectively analyzed. Before treatment the functions of main organs were evaluated and certain measures were adopted in order to protect them. Useful parameters, including the length, diameter, angle and configuration of the proximal and distal aneurysmal neck, the relationship of the aneurysm to aortic branches, the distance from the lowest renal artery to the bifurcation of abdominal aorta, and the quality of access vessels (such as diameter, tortuosity and calcification degree) were determined and assessed with CTA. According to the parameters thus obtained, the suitable stent-graft with ideal diameter and length was selected, and the optimal surgery pattern was employed. Local anesthesia was employed in 20 patients, among them the local anesthesia had to be changed to general anesthesia in one. Epidural anesthesia was carried out in one patient through the surgically-reconstructed iliac artery access,and general anesthesia was employed in one patient who had Stanford type A aortic dissection. The lowest renal artery must be accurately localized before deployment of stent-graft was started. At least one patent internal iliac artery should be reserved when bilateral internal iliac arteries needed to be covered, to be covered by stages or to be reconstructed. After stent-graft placement, angiography must be performed to find out if there was any endoleak and, if any, to determine the type of endoleak and to deal with it properly. Two cases had proximal type I endoleak, so balloon dilation was employed in one and cuff implantation in another one. Distal type I endoleak occurred in one case, but, unfortunately, the iliac artery ruptured when balloon dilation was employed, therefore the patient had to receive vascular repair

  8. Endovascular Repair of Aortic Dissection in Marfan Syndrome: Current Status and Future Perspectives

    Directory of Open Access Journals (Sweden)

    Rosario Parisi

    2015-07-01

    Full Text Available Over the last decades, improvement of medical and surgical therapy has increased life expectancy in Marfan patients. Consequently, the number of such patients requiring secondary interventions on the descending thoracic aorta due to new or residual dissections, and distal aneurysm formation has substantially enlarged. Surgical and endovascular procedures represent two valuable options of treatment, both associated with advantages and drawbacks. The aim of the present manuscript was to review endovascular outcomes in Marfan syndrome and to assess the potential role of Thoracic Endovascular Aortic Repair (TEVAR in this subset of patients.

  9. Sex differences in 30-day and 5-year outcomes after endovascular repair of abdominal aortic aneurysms in the EUROSTAR study

    DEFF Research Database (Denmark)

    Grootenboer, Nathalie; Hunink, M G Myriam; Hendriks, Johanna M

    2013-01-01

    The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair.......The purpose of this study was to determine the effect of sex on 30-day and long-term outcomes after elective endovascular aneurysm repair....

  10. Extra-Thoracic Supra-aortic Bypass Surgery Is Safe in Thoracic Endovascular Aortic Repair and Arterial Occlusive Disease Treatment.

    Science.gov (United States)

    Gombert, Alexander; van Issum, Lea; Barbati, Mohammad E; Grommes, Jochen; Keszei, Andras; Kotelis, Drosos; Jalaie, Houman; Greiner, Andreas; Jacobs, Michael J; Kalder, Johannes

    2018-04-20

    The safety and feasibility of supra-aortic debranching as part of endovascular aortic surgery or as a treatment option for arterial occlusive disease (AOD) remains controversial. The aim of this study was to assess the clinical outcome of this surgery. This single centre, retrospective study included 107 patients (mean age 69.2 years, 38.4% women) who underwent supra-aortic bypass surgery (carotid-subclavian bypass, carotid-carotid bypass, and carotid-carotid-subclavian bypass) because of thoracic or thoraco-abdominal endovascular aortic repair (57%; 61/107) or as AOD treatment (42.9%; 46/107) between January 2006 and January 2015. Mortality, morbidity with a focus on neurological complications, and patency rate were assessed. Twenty-six of 107 (14.2%) of the debranching patients were treated under emergency conditions because of acute type B dissection or symptomatic aneurysm. Follow up, conducted by imaging interpretation and telephone interviews, continued till March 2017 (mean 42.1, 0-125, months). The in hospital mortality rate was 10.2% (11/107), all of these cases from the debranching group and related to emergency procedures (p supra-aortic bypass surgery involves low complication rates and high mid-term bypass patency rates. It is a safe and feasible treatment option in the form of debranching in combination with endovascular aortic aneurysm repair and in AOD. Copyright © 2018 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

  11. Outcomes of fenestrated and branched endovascular repair of complex abdominal and thoracoabdominal aortic aneurysms.

    Science.gov (United States)

    Schanzer, Andres; Simons, Jessica P; Flahive, Julie; Durgin, Jonathan; Aiello, Francesco A; Doucet, Danielle; Steppacher, Robert; Messina, Louis M

    2017-09-01

    More than 80% of infrarenal aortic aneurysms are treated by endovascular repair. However, adoption of fenestrated and branched endovascular repair for complex aortic aneurysms has been limited, despite high morbidity and mortality associated with open repair. There are few published reports of consecutive outcomes, inclusive of all fenestrated and branched endovascular repairs, starting from the inception of a complex aortic aneurysm program. Therefore, we examined a single center's consecutive experience of fenestrated and branched endovascular repair of complex aortic aneurysms. This is a single-center, prospective, observational cohort study evaluating 30-day and 1-year outcomes in all consecutive patients who underwent fenestrated and branched endovascular repair of complex aortic aneurysms (definition: requiring one or more fenestrations or branches). Data were collected prospectively through an Institutional Review Board-approved registry and a physician-sponsored investigational device exemption clinical trial (G130210). We performed 100 consecutive complex endovascular aortic aneurysm repairs (November 2010 to March 2016) using 58 (58%) commercially manufactured custom-made devices and 42 (42%) physician-modified devices to treat 4 (4%) common iliac, 42 (42%) juxtarenal, 18 (18%) pararenal, and 36 (36%) thoracoabdominal aneurysms (type I, n = 1; type II, n = 4; type III, n = 12; type IV, n = 18; arch, n = 1). The repairs included 309 fenestrations, branches, and scallops (average of 3.1 branch arteries/case). All patients had 30-day follow-up for 30-day event rates: three (3%) deaths; six (6%) target artery occlusions; five (5%) progressions to dialysis; eight (8%) access complications; one (1%) paraparesis; one (1%) bowel ischemia; and no instances of myocardial infarction, paralysis, or stroke. Of 10 type I or type III endoleaks, 8 resolved (7 with secondary intervention, 1 without intervention). Mean follow-up time was 563 days (interquartile range

  12. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rakesh P., E-mail: rpatel9@nhs.net [Northwick Park Hospital, Department of Vascular Radiology (United Kingdom); Katsargyris, Athanasios, E-mail: kthanassos@yahoo.com; Verhoeven, Eric L. G., E-mail: Eric.Verhoeven@klinikum-nuernberg.de [Klinikum Nuernberg, Department of Vascular and Endovascular Surgery (Germany); Adam, Donald J., E-mail: donald.adam@tiscali.co.uk [Heartlands Hospital, Department of Vascular Surgery (United Kingdom); Hardman, John A., E-mail: johnhardman@doctors.org.uk [Royal United Hospital Bath, Department of Vascular Radiology (United Kingdom)

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  13. Changes in Renal Anatomy After Fenestrated Endovascular Aneurysm Repair.

    Science.gov (United States)

    Maurel, B; Lounes, Y; Amako, M; Fabre, D; Hertault, A; Sobocinski, J; Spear, R; Azzaoui, R; Mastracci, T M; Haulon, S

    2017-01-01

    To assess short- and long-term movement of renal arteries after fenestrated endovascular aortic repair (FEVAR). Consecutive patients who underwent FEVAR at one institution with a custom-made device designed with fenestrations for the superior mesenteric (SMA) and renal arteries, a millimetric computed tomography angiography (CTA), and a minimum of 2 years' follow-up were included. Angulation between renal artery trunk and aorta, clock position of the origin of the renal arteries, distance between renal arteries and SMA, and target vessel occlusion were retrospectively collected and compared between the pre-operative, post-operative (12 months) CTA. From October 2004 to January 2014, 100 patients met the inclusion criteria and 86% of imaging was available for accurate analysis. Median follow-up was 27.3 months (22.7-50.1). There were no renal occlusions. A significant change was found in the value of renal trunk angulation of both renal arteries on post-operative compared with pre-operative CTA (17° difference upward [7.5-29], p renal clock positions (7.5° of change equivalent to 15 min of renal ostial movement): significant anterior change was found between post-operative and pre-operative CTA (15 min [0-30], p = .03 on the left and 15 min [15-30], p renal and SMA ostia (difference of 1.65 mm [1-2.5], p = .63). The renal arteries demonstrate tolerance to permanent changes in angulation after FEVAR of approximately 17° upward trunk movement and of 15-30 min ostial movement without adverse consequences on patency after a median of more than 2 years' follow-up. The distance between the target vessels remained stable over time. These results may suggest accommodation to sizing errors and thus a compliance with off the shelf devices in favourable anatomies. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  14. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Godfrey, Anthony D., E-mail: deangodfrey@yahoo.co.uk; Morbi, Abigail H. M., E-mail: a.morbi@soton.ac.uk; Nordon, Ian M., E-mail: ian.nordon@uhs.nhs.uk [University Hospital Southampton NHS Foundation Trust, Unit of Cardiac Vascular and Thoracic Surgery - CV& T, Department of Vascular Surgery (United Kingdom)

    2015-10-15

    PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR.

  15. Patient Compliance with Surveillance Following Elective Endovascular Aneurysm Repair

    International Nuclear Information System (INIS)

    Godfrey, Anthony D.; Morbi, Abigail H. M.; Nordon, Ian M.

    2015-01-01

    PurposeIntegral to maintaining good outcomes post-endovascular aneurysm repair (EVAR) is a robust surveillance protocol. A significant proportion of patients fail to comply with surveillance, exposing themselves to complications. We examine EVAR surveillance in Wessex (UK), exploring factors that may predict poor compliance.MethodsRetrospective analysis of 179 consecutive elective EVAR cases [2008–2013] was performed. 167 patients were male, with the age range of 50–95. Surveillance was conducted centrally (tertiary referral trauma centre) and at four spoke units. Surveillance compliance and predictors of non-compliance including age, gender, co-morbid status, residential location and socioeconomic status were analysed for univariate significance.ResultsFifty patients (27.9 %) were non-compliant with surveillance; 14 (8.1 %) had no imaging post-EVAR. At 1 year, 56.1 % (of 123 patients) were compliant. At years 2 and 3, 41.5 and 41.2 % (of 65 and 34 patients, respectively) were compliant. Four years post-EVAR, only one of eight attended surveillance (12.5 %). There were no statistically significant differences in age (p = 0.77), co-morbid status or gender (p = 0.64). Distance to central unit (p = 0.67) and surveillance site (p = 0.56) was non-significant. While there was a trend towards compliance in upper-middle-class socioeconomic groups (ABC1 vs. C1C2D), correlating with >50 % of non-compliant patients living within <10 mile radius of the central unit, overall predictive value was not significant (p = 0.82).ConclusionsCompliance with surveillance post-EVAR is poor. No independent predictor of non-compliance has been confirmed, but socioeconomic status appears to be relevant. There is a worrying drop-off in attendance beyond the first year. This study highlights a problem that needs to be addressed urgently, if we are to maintain good outcomes post-EVAR

  16. A case of acute ischemic colitis after endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Grigorios Voulalas

    2016-01-01

    Full Text Available Colonic ischemia is a recognized complication of either open or endovascular abdominal aortic aneurysm repair. The clinical difficulty in establishing the diagnosis, the severity of this complication and the patient's poor physiological status may lead to a fatal outcome. We presented a case of ischemic colitis in a patient with patent hypogastric arteries that occurred after an endovascular abdominal aortic aneurysm repair as well as a review of the available literature. The patient's preoperative, intraoperative and postoperative data were recorded. A thorough search through the Google data and Medline to review similar cases or any analyses that referred to ischemic colitis after endovascular abdominal aneurysm repair was conducted. A 76-year-old male was admitted to our department for an elective endovascular repair of an 8 cm in diameter abdominal aortic aneurysm. A Zenith bifurcation graft was implanted. The whole procedure was uneventful and the final angiogram showed an accurate deployment of the endograft without endoleaks and patency of both hypogastric arteries. During the 1st postoperative day, the patient developed symptoms of acute abdomen in combination with metabolic acidosis and oliguria. He underwent an exploratory laparotomy, which revealed necrosis of the sigmoid. A Hartmann's procedure was performed; the patient was transferred to the intensive care unit where he deceased after 24 h. Postoperative ischemic colitis has been described after open abdominal aneurysm repair. The description of this complication has been reported since the early phase of endovascular abdominal aneurysm repair development with a current incidence of 1.5%–3.0%. Possible mechanisms that may contribute to ischemic colitis in spite of the presence of patent hypogastric arteries include atheroembolization, shock, vasopressive drugs and inferior mesenteric artery occlusion.

  17. Contemporary economic and clinical evaluations of endovascular repair for intact descending thoracic aortic aneurysms.

    Science.gov (United States)

    Silingardi, Roberto; Gennai, Stefano; Coppi, Giovanni; Chester, Johanna; Marcheselli, Luigi; Brunetti, Massimo

    2017-12-01

    The aim of this study was to assess clinical and contemporary costs associated with elective endovascular repair of intact descending thoracic aortic aneurysms (DTAA) into the mid-term follow-up. A retrospective review of a prospectively maintained clinical database including 29 consecutive patients from July 2005 to December 2009 treated with elective endovascular repair (TEVAR) or TEVAR and surgical infrarenal repair (hybrid) of intact DTAA was performed. Mean age was 74.5 years old (±7.1). Primary clinical endpoints include mortality and major morbidity. Additionally a comprehensive economic appraisal of individual in-hospital and follow-up costs was executed. Economic endpoints include in-hospital and follow-up costs and patient discharge status. Elective endovascular and open repairs' clinical and economical outcomes in contemporary literature were assessed for comparison according to PRISMA standards. Immediate mortality was 6.9% (1/24 TEVAR and 1/5 hybrid). Three respiratory complications were recorded (11%; 2 TEVAR, 1 hybrid). Renal and cardiac complication rates were 7.4% (1 TEVAR, 1 hybrid) and 3.7% (1 TEVAR) respectively. Routine discharge home was achieved for 85% of patients (95.7% TEVAR, 25% hybrid). Three endoleaks were treated throughout the follow-up (2 TEVAR, 1 hybrid; mean 30.4 mo, ±19.9) rendering an 11% (3/27) reintervention rate. Average immediate cost was €21,976.87 for elective endovascular repair and €33,783.21 for elective endovascular hybrid repair. Additional reintervention and routine follow-up costs augmented immediate costs by 12.4%. This study supports satisfying immediate clinical outcomes for TEVAR and TEVAR+surgical infrarenal procedures. Although limited by a small population size and difficulties in economic comparisons, this study presents the real world social and economic cost scenario for both elective TEVAR and TEVAR hybrid treatment of DTAA of both the in-hospital and at mid term follow-up periods.

  18. Evolution of the Proximal Sealing Rings of the Anaconda Stent-Graft After Endovascular Aneurysm Repair

    NARCIS (Netherlands)

    Koenrades, Maaike A.; Klein, Almar; Leferink, Anne M.; Slump, Cornelis H.; Geelkerken, Robert H.

    2018-01-01

    Purpose: To provide insight into the evolution of the saddle-shaped proximal sealing rings of the Anaconda stent-graft after endovascular aneurysm repair (EVAR). Methods: Eighteen abdominal aortic aneurysm patients were consecutively enrolled in a single-center, prospective, observational cohort

  19. Statin use is associated with reduced all-cause mortality after endovascular abdominal aortic aneurysm repair.

    NARCIS (Netherlands)

    Leurs, L.J.; Visser, P.; Laheij, R.J.F.; Buth, J.; Harris, P.L.; Blankensteijn, J.D.

    2006-01-01

    It has been shown that preoperative statin therapy reduces all-cause and cardiovascular mortality in patients undergoing major noncardiac vascular surgery. In this report, we investigated the influence of statin use on early and late outcome following endovascular abdominal aortic aneurysm repair

  20. Outcome after endovascular abdominal aortic aneurysm repair: a meta-analysis.

    NARCIS (Netherlands)

    Walschot, L.H.B.; Laheij, R.J.F.; Verbeek, A.L.M.

    2002-01-01

    PURPOSE: To determine the frequencies of complications and risk factors for complications following endovascular abdominal aortic aneurysm (AAA) repair (EVAR). METHODS: Thirty-nine articles published between October 1995 and October 1999 in English, German, French, or Dutch were identified in

  1. Dynamic CE-MRA for endoleak classification after endovascular aneurysm repair.

    NARCIS (Netherlands)

    Laan, M.J. van der; Bakker, C.J.; Blankensteijn, J.D.; Bartels, L.W.

    2006-01-01

    AIM: To evaluate the value of dynamic contrast enhanced magnetic resonance angiography (CE-MRA) for classification of endoleaks after endovascular aneurysm repair (EVAR). MATERIALS AND METHODS: Twenty-eight patients, between 2 days and 54 months after EVAR, were evaluated with CTA, MRI and dynamic

  2. Dynamic CE=MRA for endoleak classification after endovascular aneurysm repair

    NARCIS (Netherlands)

    van der Laan, MJ; Bakker, CJG; Blankensteijn, JD; Bartels, LW

    Aim. To evaluate the value of dynamic contrast enhanced magnetic resonance angiography (CE-MRA)for classification of endoleaks after endovascular aneurysm repair (EVAR). Materials and methods. Twenty-eight patients, between 2 days and 54 months after EVAR, were evaluated with CTA, MRI and dynamic

  3. The Role of Transesophageal Echocardiography in Endovascular Repair of Traumatic Aortic Transection

    Directory of Open Access Journals (Sweden)

    Swathy B

    2014-09-01

    Full Text Available Traumatic rupture of the thoracic aorta is a leading cause of death, following major blunt trauma, and endovascular repair has evolved as a viable alternative to open repair. This report highlights the role of transesophageal echocardiography as a valuable imaging tool for locating the exact position of the lesion, guiding placement of the endograft, detecting leaks around it and supplementing information derived from angiography during endograft deployment.

  4. Predictors of Reintervention After Endovascular Repair of Isolated Iliac Artery Aneurysm

    International Nuclear Information System (INIS)

    Zayed, Hany A.; Attia, Rizwan; Modarai, Bijan; Clough, Rachel E.; Bell, Rachel E.; Carrell, Tom; Sabharwal, Tarun; Reidy, John; Taylor, Peter R.

    2011-01-01

    The objective of this study was to identify factors predicting the need for reintervention after endovascular repair of isolated iliac artery aneurysm (IIAA). We reviewed prospectively collected database records of all patients who underwent endovascular repair of IIAA between 1999 and 2008. Detailed assessment of the aneurysms was performed using computed tomography angiography (CTA). Follow-up protocol included CTA at 3 months. If this showed no complication, then annual duplex scan was arranged. Multivariate analysis and analysis of patient survival and freedom from reintervention were performed using Kaplan–Meier life tables. Forty IIAAs (median diameter 44 mm) in 38 patients were treated (all men; median age 75 years), and median follow-up was 27 months. Endovascular repair of IIAA was required in 14 of 40 aneurysms (35%). The rate of type I endoleak was significantly higher with proximal landing zone (PLZ) diameter >30 mm in the aorta or >24 mm in the common iliac artery or distal landing zone (DLZ) diameter >24 mm (P = 0.03, 0.03, and 0.0014, respectively). Reintervention rate (RR) increased significantly with increased diameter or decreased length of PLZ; increased DLZ diameter; and endovascular IIAA repair (P = 0.005, 0.005, 0.02, and 0.02 respectively); however, RR was not significantly affected by length of PLZ or DLZ. Freedom-from-reintervention was 97, 93, and 86% at 12, 24, and 108 months. There was no in-hospital or aneurysm-related mortality. Endovascular IIAA repair is a safe treatment option. Proper patient selection is essential to decrease the RR.

  5. Radiation Exposure in Endovascular Infra-Renal Aortic Aneurysm Repair and Factors that Influence It

    Directory of Open Access Journals (Sweden)

    Rui Machado

    Full Text Available Abstract Objective: The endovascular repair of aortic abdominal aneurysms exposes the patients and surgical team to ionizing radiation with risk of direct tissue damage and induction of gene mutation. This study aims to describe our standard of radiation exposure in endovascular aortic aneurysm repair and the factors that influence it. Methods: Retrospective analysis of a prospective database of patients with abdominal infra-renal aortic aneurysms submitted to endovascular repair. This study evaluated the radiation doses (dose area product (DAP, fluoroscopy durations and their relationships to the patients, aneurysms, and stent-graft characteristics. Results: This study included 127 patients with a mean age of 73 years. The mean DAP was 4.8 mGy.m2, and the fluoroscopy time was 21.8 minutes. Aortic bilateral iliac aneurysms, higher body mass index, aneurysms with diameters larger than 60 mm, necks with diameters larger than 28 mm, common iliac arteries with diameters larger than 20 mm, and neck angulations superior to 50 degrees were associated with an increased radiation dose. The number of anatomic risk factors present was associated with increased radiation exposure and fluoroscopy time, regardless of the anatomical risk factors. Conclusion: The radiation exposure during endovascular aortic aneurysm repair is significant (mean DAP 4.8 mGy.m2 with potential hazards to the surgical team and the patients. The anatomical characteristics of the aneurysm, patient characteristics, and the procedure's technical difficulty were all related to increased radiation exposure during endovascular aortic aneurysm repair procedures. Approximately 40% of radiation exposure can be explained by body mass index, neck angulation, aneurysm diameter, neck diameter, and aneurysm type.

  6. Comparative clinical effectiveness and cost effectiveness of endovascular strategy v open repair for ruptured abdominal aortic aneurysm: three year results of the IMPROVE randomised trial.

    Science.gov (United States)

    2017-11-14

    Objective  To assess the three year clinical outcomes and cost effectiveness of a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair for patients with suspected ruptured abdominal aortic aneurysm. Design  Randomised controlled trial. Setting  30 vascular centres (29 in UK, one in Canada), 2009-16. Participants  613 eligible patients (480 men) with a clinical diagnosis of ruptured aneurysm, of whom 502 underwent emergency repair for rupture. Interventions  316 patients were randomised to an endovascular strategy (275 with confirmed rupture) and 297 to open repair (261 with confirmed rupture). Main outcome measures  Mortality, with reinterventions after aneurysm repair, quality of life, and hospital costs to three years as secondary measures. Results  The maximum follow-up for mortality was 7.1 years, with two patients in each group lost to follow-up by three years. After similar mortality by 90 days, in the mid-term (three months to three years) there were fewer deaths in the endovascular than the open repair group (hazard ratio 0.57, 95% confidence interval 0.36 to 0.90), leading to lower mortality at three years (48% v 56%), but by seven years mortality was about 60% in each group (hazard ratio 0.92, 0.75 to 1.13). Results for the 502 patients with repaired ruptures were more pronounced: three year mortality was lower in the endovascular strategy group (42% v 54%; odds ratio 0.62, 0.43 to 0.88), but after seven years there was no clear difference between the groups (hazard ratio 0.86, 0.68 to 1.08). Reintervention rates up to three years were not significantly different between the randomised groups (hazard ratio 1.02, 0.79 to 1.32); the initial rapid rate of reinterventions was followed by a much slower mid-term reintervention rate in both groups. The early higher average quality of life in the endovascular strategy versus open repair group, coupled with the lower mortality at three years, led to a

  7. Outcomes of endovascular management of acute thoracic aortic emergencies in an academic level 1 trauma center.

    Science.gov (United States)

    Echeverria, Angela B; Branco, Bernardino C; Goshima, Kay R; Hughes, John D; Mills, Joseph L

    2014-12-01

    Thoracic aortic emergencies account for 10% of thoracic-related admissions in the United States and remain associated with high morbidity and mortality rates. Open repair has declined owing to the emergence of thoracic endovascular aortic repair (TEVAR), but data on emergency TEVAR use for acute aortic pathology remain limited. We therefore reviewed our experience. We retrospectively evaluated emergency descending thoracic aortic endovascular interventions performed at a single academic level 1 trauma center between January 2005 and August 2013 including all cases of traumatic aortic injury, ruptured descending thoracic aneurysm, penetrating atherosclerotic ulcer, aortoenteric fistula, and acute complicated type B dissection. Demographics, clinical data, and outcomes were extracted. Stepwise logistic regression was used to identify independent risk factors for death. During the study period, 51 patients underwent TEVAR; 22 cases (43.1%) were performed emergently (11 patients [50.0%] traumatic aortic injury; 4 [18.2%] ruptured descending thoracic aneurysm; 4 [18.2%] complicated type B dissection; 2 [9.1%] penetrating aortic ulcer; and 1 [4.5%] aortoenteric fistula). Overall, 72.7% (n = 16) were male with a mean age of 54.8 ± 15.9 years. Nineteen patients (86.4%) required only a single TEVAR procedure, whereas 2 (9.1%) required additional endovascular therapy, and 1 (4.5%) open thoracotomy. Four traumatic aortic injury patients required exploratory laparotomy for concomitant intra-abdominal injuries. During a mean hospital length of stay of 18.9 days (range, 1 to 76 days), 3 patients (13.6%) developed major complications. In-hospital mortality was 27.2%, consisting of 6 deaths from traumatic brain injury (1); exsanguination in the operating room before repair could be achieved (2); bowel ischemia (1) and multisystem organ failure (1); and family withdrawal of care (1). A stepwise logistic regression model identified 24-hour packed red blood cell requirements ≥4

  8. Innovative chimney-graft technique for endovascular repair of a pararenal abdominal aortic aneurysm.

    Science.gov (United States)

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A; Krajcer, Zvonimir

    2015-02-01

    After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta.

  9. Endovascular Repair of Traumatic Rupture of the Thoracic Aorta: Single-Center Experience

    International Nuclear Information System (INIS)

    Saratzis, Nikolaos A.; Saratzis, Athanasios N.; Melas, Nikolaos; Ginis, Georgios; Lioupis, Athanasios; Lykopoulos, Dimitrios; Lazaridis, John; Dimitrios, Kiskinis

    2007-01-01

    Purpose. Traumatic rupture of the thoracic aorta secondary to blunt chest trauma is a life-threatening emergency and a common cause of death, usually following violent collisions. The objective of this retrospective report was to evaluate the efficacy of endovascular treatment of thoracic aortic disruptions with a single commercially available stent-graft. Methods. Nine men (mean age 29.5 years) were admitted to our institution between January 2003 and January 2006 due to blunt aortic trauma following violent motor vehicle collisions. Plain chest radiography, spiral computed tomography, aortography, and transesophageal echocardiography were used for diagnostic purposes in all cases. All patients were diagnosed with contained extramural thoracic aortic hematomas, secondary to aortic disruption. One patient was also diagnosed with a traumatic thoracic aortic dissection, secondary to blunt trauma. All subjects were poor surgical candidates, due to major injuries such as multiple bone fractures, abdominal hematomas, and pulmonary contusions. All repairs were performed using the EndoFit (LeMaitre Vascular) stent-graft. Results. Complete exclusion of the traumatic aortic disruption and pseudoaneurysm was achieved and verified at intraoperative arteriography and on CT scans, within 10 days of the repair in all patients. In 1 case the deployment of a second cuff was necessary due to a secondary endoleak. In 2 cases the left subclavian artery was occluded to achieve adequate graft fixation. No procedure-related deaths have occurred and no cardiac or peripheral vascular complications were observed within the 12 months (range 8-16 months) follow-up. Conclusions. This is the first time the EndoFit graft has been utilized in the treatment of thoracic aortic disruptions secondary to chest trauma. The repair of such pathologies is technically feasible and early follow-up results are promising

  10. Endovascular control of haemorrhagic urological emergencies: an observational study

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    Thorpe Peter

    2006-09-01

    Full Text Available Abstract Background Transarterial embolisation (TAE is an effective method in control of haemorrhage irrespective of the nature of urological emergency. As the technique and technology have evolved, it is now possible to perform highly selective embolisation. The aim of this study was to critically appraise feasibility and efficacy of therapeutic TAE in control of haemorrhagic urological emergencies using selective and non-selective embolisation. Specifically, we aimed to assess the impact of timing of embolisation on the requirement of blood transfusion and long-term morphological and functional follow-up of embolised organs. Methods This is a single institutional observational study carried out between March 1992 and March 2006. Records of all patients who underwent selective and non-selective angioembolisation to control bleeding in urological emergencies were reviewed. Data on success rate, periprocedural complications, timing of embolisation, requirement of blood transfusion and the long-term morphological and functional outcomes of embolised organs was recorded. Results Fourteen patients underwent endovascular control of bleeding as a result of trauma, iatrogenic injury and spontaneous perinephric haemorrhage during a period of 14 years. All these patients would have required emergency open surgery without the option of embolisation procedure. The mean time between the first presentation and embolisation was 22 hours (range 30 minutes to 60 hours. Mean pre-embolisation transfusion requirement was 6.8 units (range 0–22 units. None of the patients with successful embolisation required post-procedural blood transfusion. Permanent haemostasis was achieved in all but one patient, who required emergency nephrectomy. There were no serious procedure related post-embolisation complications. Conclusion Endovascular control using transarterial angioembolisation is an effective method for managing haematuria or haemorrhage in urological emergencies

  11. Hybrid Endovascular Aortic Aneurysm Repair: Preservation of Pelvic Perfusion with External to Internal Iliac Artery Bypass.

    Science.gov (United States)

    Mansukhani, Neel A; Havelka, George E; Helenowski, Irene B; Rodriguez, Heron E; Hoel, Andrew W; Eskandari, Mark K

    2017-07-01

    Diminished pelvic arterial flow as a result of intentional coverage/embolization of internal iliac arteries (IIA) during isolated endovascular common iliac artery aneurysm (CIAA) repair or endovascular repair of abdominal aortic aneurysms (EVAR) may result in symptomatic pelvic ischemia. Although generally well tolerated, in severe cases, pelvic ischemia may manifest as recalcitrant buttock claudication, vasculogenic impotence, or perineal, vesicle, rectal, and/or spinal cord ischemia. Branched graft technology has recently become available; however, many patients are not candidates for endovascular repair with these devices. Therefore, techniques to preserve pelvic arterial flow are needed. We reviewed our outcomes of isolated endovascular CIAA repair or EVAR in conjunction with unilateral external-internal iliac artery bypass. Single-center, retrospective review of 10 consecutive patients who underwent hybrid endovascular abdominal aortic aneurysm (AAA) or CIAA repair with concomitant external-internal iliac artery bypass between 2006 and 2015. Demographics, index procedural details, postoperative symptoms, hospital length of stay (LOS), follow-up imaging, and bypass patency were recorded. The cohort of 10 patients was all men with a mean age of 71 years (range: 56-84). Hybrid repair consisted of contralateral IIA coil embolization followed by EVAR with external iliac artery-internal iliac artery (EIA-IIA) bypass. All EIA-IIA bypasses were performed via a standard lower quadrant retroperitoneal approach with a prosthetic bypass graft. Technical success was 100%, and there were no perioperative deaths. One patient developed transient paraplegia, 1 patient had buttock claudication on the side of his hypogastric embolization contralateral to his iliac bypass, and 1 developed postoperative impotence. 20% of patients sustained long-term complications (buttock claudication and postoperative impotence). Mean LOS was 2.8 days (range: 1-9 days). Postoperative imaging

  12. Comparison of hybrid endovascular and open surgical repair for proximal aortic arch diseases.

    Science.gov (United States)

    Kang, Woong Chol; Ko, Young-Guk; Shin, Eak Kyun; Park, Chul-Hyun; Choi, Donghoon; Youn, Young Nam; Lee, Do Yun

    2016-01-15

    To compare the outcomes of hybrid endovascular and open surgical repair for proximal aortic arch diseases. A total of 55 consecutive patients with aortic arch aneurysm or aortic dissection involving any of zone 0 to 1 (39 male, age 63.4 ± 14.3 years) underwent a hybrid endovascular repair (n=35) or open surgical repair (n=20) from 2006 to 2014 were analyzed retrospectively. Perioperative and late outcomes were compared. Baseline characteristics were similar between the two groups, except age and EuroSCORE II, which were higher in the hybrid group. Perioperative mortality or stroke was not significantly different between the two groups, however, tended to be lower in the hybrid repair group than in the open repair group (11.4% vs. 30.0%, p=0.144). Incidences of other morbidities did not differ. During follow-up, over-all survival was similar between the hybrid and the open repair was similar (87.3% vs. 79.7% at 1 year and 83.8% vs. 72.4% at 3 years; p=0.319). However, reintervention-free survival was significantly lower for hybrid repair compared with open repair (83.8% vs. 100% at 1 year and 65.7% vs. 100% at 3 years; p=0.022). Hybrid repair of proximal aortic disease showed comparable perioperative and late outcomes compared with open surgical repair despite a higher reintervention rate during follow-up. Therefore, hybrid repair may be considered as an acceptable treatment alternative to surgery especially in patients at high surgical risk. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  13. The risk of endoleak following stent covering of the internal iliac artery during endovascular aneurysm repair

    International Nuclear Information System (INIS)

    Rajesparan, K.; Partridge, W.; Refson, J.; Abidia, A.; Aldin, Z.

    2014-01-01

    Aim: To investigate the risk of endoleak during endovascular aneurysm repair (EVAR) involving the distal common iliac artery (CIA) when the internal iliac artery (IIA) is covered without prior coil embolization. Materials and methods: Retrospective analysis of 145 (125 men, 20 women) consecutive EVAR cases. Clinical notes and radiological images were reviewed, and data collected on patient demographics, aneurysm morphology, covering of the IIA with or without embolization, presence of endoleaks, and patient symptoms relating to IIA ischaemia. Results: A total of 29 IIAs (10%) were covered in a total of 25 patients. Seven IIAs (24%) were embolized before stent covering (Embolization group), and 22 IIAs (76%) were covered only without embolization (Cover group). There was no statistically significant difference in the mean size of the abdominal aortic aneurysm diameter or CIA diameter between each group. No endoleaks from IIA retrograde filling were found in either group. Conclusion: The results of the present study do not support the traditional view that coverage of the IIA without prior embolization carries a high risk of endoleak, with no endoleaks seen in all 22 cases. Large-scale trials are required. However, the advent of branched-stenting techniques and the emergence of their success in long-term follow-up may preclude the former. - Highlights: • No EVAR endoleaks due to retrograde filling of the internal iliac artery (IIA). • No increased risk of endoleak with stent coverage of the IIA without embolisation. • Current evidence does not support traditional views

  14. Endovascular Repair of a Pseudoaneurysm of the Abdominal Aorta Secondary to Translumbar Aortography

    International Nuclear Information System (INIS)

    Mir, Naheed; Nunzio, Mario De; Pollock, John G

    2006-01-01

    This report describes an incidental finding of a pseudoaneurysm of the abdominal aorta on a computed tomography (CT) renal angiogram during investigation of chronic renal failure in a 73-year-old man. The patient had undergone a translumbar aortogram 20 years previously. An increase in the size of the aneurysm by 7 mm over 6 months prompted treatment and the aneurysm underwent successful endovascular repair with a custom-made stent-graft

  15. Thoracic Endovascular Aortic Repair (TEVAR) in Proximal (Type A) Aortic Dissection: Ready for a Broader Application?

    OpenAIRE

    Nienaber, Christoph A.; Sakalihasan, Natzi; Clough, Rachel E.; Aboukoura, Mohamed; Mancuso, Enrico; Yeh, James S.M.; Defraigne, Jean-Olivier; Cheshire, Nick; Rosendahl, Ulrich Peter; Quarto, Cesare; Pepper, John

    2016-01-01

    ObjectiveThoracic endovascular aortic repair (TEVAR) has demonstrated encouraging results and is gaining increasing acceptance as a treatment option for aortic aneurysms and dissections. Yet, its role in managing proximal aortic pathologies is unknown - this is important because in proximal (Stanford type A) aortic dissections, 10-30% are not accepted for surgery, and 30-50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated using TEVAR.Method...

  16. Can an accessory renal artery be safely covered during endovascular aortic aneurysm repair?

    OpenAIRE

    Antoniou, George A.; Karkos, Christos D.; Antoniou, Stavros A.; Georgiadis, George S.

    2013-01-01

    A best evidence topic was constructed according to a structured protocol. The question addressed was whether coverage of an accessory renal artery (ARA) in patients undergoing endovascular aortic aneurysm repair (EVAR) is associated with increased risk of renal impairment. Altogether, 106 papers were located using the reported searches, of which 5 represented the best evidence to answer the question. The authors, journal, date and country of publication, study type, patient group studied, rel...

  17. Percutaneous Transabdominal Approach for the Treatment of Endoleaks after Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sun Young; Lee, Do Yun; Lee, Kwang Hun [Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Won, Jong Yun [Gangnam Severance Hospital, University of Yonsei, Seoul (Korea, Republic of); Choi, Dong Hoon; Shim, Won Heum [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    2010-02-15

    The purpose of this study was to evaluate the technical feasibility and clinical efficacy of percutaneous transabdominal treatment of endoleaks after endovascular aneurysm repair. Between 2000 and 2007, six patients with type I (n = 4) or II (n = 2) endoleaks were treated by the percutaneous transabdominal approach using embolization with N-butyl cyanoacrylate with or without coils. Five patients underwent a single session and one patient had two sessions of embolization. The median time between aneurysm repair and endoleak treatment was 25.5 months (range: 0-84 months). Follow-up CT images were evaluated for changes in the size and shape of the aneurysm sac and presence or resolution of endoleaks. The median follow-up after endoleak treatment was 16.4 months (range: 0-37 months). Technical success was achieved in all six patients. Clinical success was achieved in four patients with complete resolution of the endoleak confirmed by follow-up CT. Clinical failure was observed in two patients. One eventually underwent surgical conversion, and the other was lost to follow-up. There were no procedure-related complications. The percutaneous transabdominal approach for the treatment of type I or II endoleaks, after endovascular aneurysm repair, is an alternative method when conventional endovascular methods have failed.

  18. A multidetector tomography protocol for follow-up of endovascular aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Roberto Moraes Bastos

    2011-01-01

    Full Text Available OBJECTIVE: The purpose of this study was to improve the use of 64-channel multidetector computed tomography using lower doses of ionizing radiation during follow-up procedures in a series of patients with endovascular aortic aneurysm repair. METHODS: Thirty patients receiving 5 to 29 months of follow-up after endovascular aortic aneurysm repair were analyzed using a 64-channel multidetector computed tomography device by an exam that included pre-and postcontrast with both arterial and venous phases. Leak presence and type were classified based on the exam phase. RESULTS: Endoleaks were identified in 8/30 of cases; the endoleaks in 3/8 of these cases were not visible in the arterial phases of the exams. CONCLUSION: The authors conclude that multidetector computed tomography with pre-contrast and venous phases should be a part of the ongoing follow-up of patients undergoing endovascular aortic aneurysm repair. The arterial phase can be excluded when the aneurism is stable or regresses. These findings permit a lower radiation dose without jeopardizing the correct diagnosis of an endoleak.

  19. Type A dissection following endovascular repair of type B dissection

    International Nuclear Information System (INIS)

    Juszkat, R.; Zabicki, M.; Jemielity, M.; Buczkowski, P.; Urbanowicz, T.

    2009-01-01

    Background: We present a patient, who was treated with thoracic stentgraft implantation, because of acute type B aortic dissection (according to Stanford classification). The endovascular procedure was performed without any complications. Case Report: The patient was discharged in the 3 rd postprocedural day and was transferred to another hospital for further recovery. Nine days after the procedure, the patient was readmitted in cardiogenic shock to the Cardiac Surgery Department. The patient was immediately operated on, after dissection of the ascending aorta and pericardial tamponade had been diagnosed in transthoracic echocardiography. Conclusions: Total replacement of the aortic arch and its ascending part was performed successfully. The surgery was carried out in deep hypothermia with temporary circulatory arrest. The patient was discharged from the Cardiac Surgery Unit 15 days after the surgery, and transferred to another unit for further recovery. (authors)

  20. Endovascular strategy or open repair for ruptured abdominal aortic aneurysm: one-year outcomes from the IMPROVE randomized trial

    Science.gov (United States)

    Braithwaite, Bruce; Cheshire, Nicholas J.; Greenhalgh, Roger M.; Grieve, Richard; Hassan, Tajek B.; Hinchliffe, Robert; Howell, Simon; Moore, Fionna; Nicholson, Anthony A.; Soong, Chee V.; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Heatley, Francine; Anjum, Aisha; Kalinowska, Gosia; Sweeting, Michael J.; Thompson, Simon G.; Gomes, Manuel; Grieve, Richard; Powell, Janet T.; Ashleigh, Ray; Gomes, Manuel; Greenhalgh, Roger M.; Grieve, Richard; Hinchliffe, Robert; Sweeting, Michael; Thompson, Matt M.; Thompson, Simon G.; Ulug, Pinar; Roberts, Ian; Bell, Peter R. F.; Cheetham, Anne; Stephany, Jenny; Warlow, Charles; Lamont, Peter; Moss, Jonathan; Tijssen, Jan; Braithwaite, Bruce; Nicholson, Anthony A.; Thompson, Matthew; Ashleigh, Ray; Thompson, Luke; Cheshire, Nicholas J.; Boyle, Jonathan R.; Serracino-Inglott, Ferdinand; Thompson, Matt M.; Hinchliffe, Robert J.; Bell, Rachel; Wilson, Noel; Bown, Matt; Dennis, Martin; Davis, Meryl; Ashleigh, Ray; Howell, Simon; Wyatt, Michael G.; Valenti, Domenico; Bachoo, Paul; Walker, Paul; MacSweeney, Shane; Davies, Jonathan N.; Rittoo, Dynesh; Parvin, Simon D.; Yusuf, Waquar; Nice, Colin; Chetter, Ian; Howard, Adam; Chong, Patrick; Bhat, Raj; McLain, David; Gordon, Andrew; Lane, Ian; Hobbs, Simon; Pillay, Woolagasen; Rowlands, Timothy; El-Tahir, Amin; Asquith, John; Cavanagh, Steve; Dubois, Luc; Forbes, Thomas L.; Ashworth, Emily; Baker, Sara; Barakat, Hashem; Brady, Claire; Brown, Joanne; Bufton, Christine; Chance, Tina; Chrisopoulou, Angela; Cockell, Marie; Croucher, Andrea; Dabee, Leela; Dewhirst, Nikki; Evans, Jo; Gibson, Andy; Gorst, Siobhan; Gough, Moira; Graves, Lynne; Griffin, Michelle; Hatfield, Josie; Hogg, Florence; Howard, Susannah; Hughes, Cían; Metcalfe, David; Lapworth, Michelle; Massey, Ian; Novick, Teresa; Owen, Gareth; Parr, Noala; Pintar, David; Spencer, Sarah; Thomson, Claire; Thunder, Orla; Wallace, Tom; Ward, Sue; Wealleans, Vera; Wilson, Lesley; Woods, Janet; Zheng, Ting

    2015-01-01

    Aims To report the longer term outcomes following either a strategy of endovascular repair first or open repair of ruptured abdominal aortic aneurysm, which are necessary for both patient and clinical decision-making. Methods and results This pragmatic multicentre (29 UK and 1 Canada) trial randomized 613 patients with a clinical diagnosis of ruptured aneurysm; 316 to an endovascular first strategy (if aortic morphology is suitable, open repair if not) and 297 to open repair. The principal 1-year outcome was mortality; secondary outcomes were re-interventions, hospital discharge, health-related quality-of-life (QoL) (EQ-5D), costs, Quality-Adjusted-Life-Years (QALYs), and cost-effectiveness [incremental net benefit (INB)]. At 1 year, all-cause mortality was 41.1% for the endovascular strategy group and 45.1% for the open repair group, odds ratio 0.85 [95% confidence interval (CI) 0.62, 1.17], P = 0.325, with similar re-intervention rates in each group. The endovascular strategy group and open repair groups had average total hospital stays of 17 and 26 days, respectively, P < 0.001. Patients surviving rupture had higher average EQ-5D utility scores in the endovascular strategy vs. open repair groups, mean differences 0.087 (95% CI 0.017, 0.158), 0.068 (95% CI −0.004, 0.140) at 3 and 12 months, respectively. There were indications that QALYs were higher and costs lower for the endovascular first strategy, combining to give an INB of £3877 (95% CI £253, £7408) or €4356 (95% CI €284, €8323). Conclusion An endovascular first strategy for management of ruptured aneurysms does not offer a survival benefit over 1 year but offers patients faster discharge with better QoL and is cost-effective. Clinical trial registration ISRCTN 48334791. PMID:25855369

  1. Endovascular abdominal aortic aneurysm repair (EVAR) procedures: counterbalancing the benefits with the costs.

    Science.gov (United States)

    Paraskevas, Kosmas I; Bessias, Nikolaos; Giannoukas, Athanasios D; Mikhailidis, Dimitri P

    2010-05-01

    Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) is associated with lower 30-day mortality rates compared with open repair. Despite that, there are no significant differences in mortality rates between the two procedures at 2 years. On the other hand, EVAR is associated with considerably higher costs compared with open repair. The lack of significant long-term differences between the two procedures together with the substantially higher cost of EVAR may question the appropriateness of EVAR as an alternative to open surgical repair in patients fit for surgery. With several thousands of AAA procedures performed worldwide, the employment of EVAR for the management of all AAAs irrespective of the patient's surgical risk may hold implications for several national health economies. The lower perioperative mortality and morbidity rates associated with EVAR should thus be counterbalanced against the considerable costs of these procedures.

  2. Endovascular aneurysm repair (EVAR) follow-up imaging: the assessment and treatment of common postoperative complications

    International Nuclear Information System (INIS)

    Ilyas, S.; Shaida, N.; Thakor, A.S.; Winterbottom, A.; Cousins, C.

    2015-01-01

    Endovascular abdominal aortic aneurysm repair (EVAR) is a well-established procedure, which has long-term mortality rates similar to that of open repair. It has the additional benefit of being less invasive, making it the favoured method of treating abdominal aortic aneurysms in elderly and high-risk patients with multiple co-morbidities. The main disadvantage of EVAR is the higher rate of re-intervention, due to device-related complications, including endoleaks, limb occlusion, stent migration, kinking, and infection. As a result lifelong surveillance is required. In order to avoid missing these complications, intricate knowledge of stent graft design, good-quality diagnostic ultrasound skills, multiplanar reformatting of CT images, and reproducible investigations are important. Most of these complications can be treated via an endovascular approach using cuff extensions, uncovered stents, coils, and liquid embolic agents. Open surgery is reserved for complex complications, where an endovascular approach is not feasible. - Highlights: • Comprehensive pictorial review of EVAR related complications. • Importance of life-long EVAR surveillance, to prevent aortic rupture or lower limb ischaemia. • Identification and management of endoleaks, rupture, migration, kink/infolding, occlusion and infection

  3. Comparison of Total Arch and Partial Arch Transposition During Hybrid Endovascular Repair for Aortic Arch Disease.

    Science.gov (United States)

    Kang, W C; Ko, Y-G; Oh, P C; Shin, E K; Park, C-H; Choi, D; Youn, Y N; Lee, D Y

    2016-08-01

    Total arch transposition (TAT) during hybrid endovascular repair for aortic arch disease is believed to allow a better landing zone, but also to be associated with higher peri-operative mortality than partial arch transposition (PAT). Information on this issue is limited. This study was a retrospective analysis. All 53 consecutive patients with aortic arch disease (41 males, mean age 65.0 years) who underwent hybrid endovascular repair with TAT (zone 0, n=20) or PAT (zone 1 or 2, n=33) from 2008 to 2014 were analyzed retrospectively. The peri-operative and late outcomes of these two groups were compared. Baseline characteristics, including EuroSCORE II results, were similar in the two groups. After procedures, peri-operative mortalities and stroke rates were similar in the two groups (5.0% vs. 9.1%, p=1.000, and 10.0% vs. 6.1%, p=.627). Interestingly, all four strokes occurred in patients with a type III aortic arch irrespective of transposition type. Primary success rates (80.0% vs. 69.7%, p=.527) and type I endoleak incidences (20.0% vs. 27.3%, p=.744) were not significantly different. During follow up (mean duration 36.9 months), overall survival (89.7% vs. 87.4% at 1 year and 89.7% vs. 79.3% at 3 years; p=.375) and re-intervention free survival rates (78.6% vs. 92.0% at 1 year; 72.0% vs. 62.2% at 3 years, p=.872) were similar in the two groups. Morbidity and mortality were high within the first year of hybrid endovascular therapy for aortic arch disease, implying that candidates for hybrid procedures need to be selected carefully. Hybrid endovascular repair with TAT was found to have peri-operative mortality, stroke, and long-term survival rates comparable with PAT, so hybrid endovascular repair may be considered, irrespective of type of arch reconstruction, when clinically indicated. Copyright © 2016 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  4. Covered stents for endovascular repair of iatrogenic injuries of iliac and femoral arteries

    Energy Technology Data Exchange (ETDEWEB)

    Kufner, Sebastian, E-mail: kufners@dhm.mhn.de [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Cassese, Salvatore; Groha, Philipp; Byrne, Robert A. [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); Schunkert, Heribert; Kastrati, Adnan [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany); DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich (Germany); Ott, Ilka; Fusaro, Massimiliano [Deutsches Herzzentrum München, Technische Universität München, Munich (Germany)

    2015-04-15

    Background: The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. A strategy of percutaneous transluminal angioplasty (PTA) with covered stent (CS) may represent a valuable alternative to open surgery. However, systematic evaluations of CS in this setting represent a scientific gap. In the present study, we investigate the procedural and clinical outcomes associated with PTA and CS implantation to repair iatrogenic injuries of peripheral arteries. Methods: All patients undergoing PTA with CS for endovascular repair of iatrogenic injuries of peripheral arteries between August 2010 and July 2013 at our Institution were retrospectively analyzed. The primary endpoint was the technical success. Secondary endpoints were in-hospital mortality and cumulative death, target lesion revascularization (TLR), amputation and major stroke at 12-month follow-up. Results: During the period of observation, a total of 30 patients underwent PTA with either self-expandable (43.3%) or balloon-expandable CS (56.7%) for iatrogenic injuries of peripheral arteries. Injuries consisted of perforation/rupture (76.7%), arteriovenous fistula (16.7%) and pseudoaneurysm (6.7%) of iliac–femoral arteries. Technical success was achieved in all cases. Median follow-up was 409 days [210–907]. The incidence of in-hospital mortality was 10.0%. At 12-month follow-up, the incidence of death, TLR, amputation and major stroke was 20.0%, 17.0%, 3.3% and 6.7%, respectively. Conclusion: The use of covered stents for endovascular repair of iatrogenic injuries of peripheral arteries shows a high technical success and may be alternative to surgery. Further studies with larger populations are needed to confirm these preliminary findings. - Highlights: • The growing number of complex endovascular procedures is expected to increase the risk of iatrogenic injuries of peripheral arteries. • Percutaneous transluminal angioplasty with

  5. Endovascular Treatment of Late Thoracic Aortic Aneurysms after Surgical Repair of Congenital Aortic Coarctation in Childhood

    Science.gov (United States)

    Juszkat, Robert; Perek, Bartlomiej; Zabicki, Bartosz; Trojnarska, Olga; Jemielity, Marek; Staniszewski, Ryszard; Smoczyk, Wiesław; Pukacki, Fryderyk

    2013-01-01

    Background In some patients, local surgery-related complications are diagnosed many years after surgery for aortic coarctation. The purposes of this study were: (1) to systematically evaluate asymptomatic adults after Dacron patch repair in childhood, (2) to estimate the formation rate of secondary thoracic aortic aneurysms (TAAs) and (3) to assess outcomes after intravascular treatment for TAAs. Methods This study involved 37 asymptomatic patients (26 female and 11 male) who underwent surgical repair of aortic coarctation in the childhood. After they had reached adolescence, patients with secondary TAAs were referred to endovascular repair. Results Follow-up studies revealed TAA in seven cases (19%) (including six with the gothic type of the aortic arch) and mild recoarctation in other six (16%). Six of the TAA patients were treated with stentgrafts, but one refused to undergo an endovascular procedure. In three cases, stengrafts covered the left subclavian artery (LSA), in another the graft was implanted distally to the LSA. In two individuals, elective hybrid procedures were performed with surgical bypass to the supraaortic arteries followed by stengraft implantation. All subjects survived the secondary procedures. One patient developed type Ia endoleak after stentgraft implantation that was eventually treated with a debranching procedure. Conclusions The long-term course of clinically asymptomatic patients after coarctation patch repair is not uncommonly complicated by formation of TAAs (particularly in individuals with the gothic pattern of the aortic arch) that can be treated effectively with stentgrafts. However, in some patients hybrid procedures may be necessary. PMID:24386233

  6. Anastomotic pseudoaneurysms after surgical reconstruction: Outcomes after endovascular repair of symptomatic versus asymptomatic patients

    International Nuclear Information System (INIS)

    Nolz, Richard; Gschwendtner, Manfred; Jülg, Gregor; Plank, Christina; Beitzke, Dietrich; Teufelsbauer, Harald; Wibmer, Andreas; Kretschmer, Georg; Lammer, Johannes

    2012-01-01

    Purpose: To compare perioperative and follow-up outcomes of symptomatic versus asymptomatic patients following endovascular repair of anastomotic pseudoaneurysms (APAs) of the abdominal aorta and iliac arteries. Methods: We retrospectively evaluated 17 patients (two women), with a mean age of 66.2 years (range 30–83 years). Endovascular treatment was performed in ten symptomatic, and seven asymptomatic patients electively. Data included technical success, perioperative (within 30 days) mortality and morbidity, as well as stent graft-related complications, reinterventions, and survival in follow-up. Results: Bifurcated (n = 13), aortomonoiliac (n = 3) endoprosthesis and one aortic cuff were implanted with a primary technical success rate of 100%. The overall in-hospital mortality and morbidity rate was 11.8% and 35.3%. The mean survival was 36.5 (range 0–111) months. There was a clear trend toward a lower overall survival within hospital and at one and three years for symptomatic patients compared to asymptomatic patients. (47.7 (CI: 0–138.8) versus 52.6 (CI: 28.5–76.8) months (p = 0.274)). During follow-up, late stent graft related complications were observed in six patients (35.3%) necessitating eight endovascular reinterventions. Additional three patients with primary fistulas between the APA and the intestine were treated by late surgical revision. Conclusion: Endovascular therapy of APAs represents a considerable alternative to open surgical repair. Short proximal anchoring zones still pose a risk for endoleaks and unintentional overstenting of side branches with commercially available devices, but this might be overcome by use of fenestrated and branched stent grafts in elective cases.

  7. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    International Nuclear Information System (INIS)

    Wu, Ziheng; Xu, Liang; Qu, Lefeng; Raithel, Dieter

    2015-01-01

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC

  8. Seventeen Years’ Experience of Late Open Surgical Conversion after Failed Endovascular Abdominal Aortic Aneurysm Repair with 13 Variant Devices

    Energy Technology Data Exchange (ETDEWEB)

    Wu, Ziheng, E-mail: wuziheng303@hotmail.com [Zhejiang University, Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine (China); Xu, Liang, E-mail: maxalive@163.com [Zhejiang University, Department of Neurosurgery, The Second Affiliated Hospital, School of Medicine (China); Qu, Lefeng, E-mail: qulefeng@gmail.com [The Second Military Medical University, Department of Vascular and Endovascular Surgery, Changzheng Hospital (China); Raithel, Dieter, E-mail: dieter.raithel@rzmail.uni-erlangen.de [Nuremberg Southern Hospital, Department of Vascular and Endovascular Surgery (Germany)

    2015-02-15

    PurposeTo investigate the causes and results of late open surgical conversion (LOSC) after failed abdominal aortic aneurysm repair (EVAR) and to summarize our 17 years’ experience with 13 various endografts.MethodsRetrospective data from August 1994 to January 2011 were analyzed at our center. The various devices’ implant time, the types of devices, the rates and causes of LOSC, and the procedures and results of LOSC were analyzed and evaluated.ResultsA total of 1729 endovascular aneurysm repairs were performed in our single center (Nuremberg South Hospital) with 13 various devices within 17 years. The median follow-up period was 51 months (range 9–119 months). Among them, 77 patients with infrarenal abdominal aortic aneurysms received LOSC. The LOSC rate was 4.5 % (77 of 1729). The LOSC rates were significantly different before and after January 2002 (p < 0.001). The reasons of LOSC were mainly large type I endoleaks (n = 51) that were hard to repair by endovascular techniques. For the LOSC procedure, 71 cases were elective and 6 were emergent. The perioperative mortality was 5.2 % (4 of 77): 1 was elective (due to septic shock) and 3 were urgent (due to hemorrhagic shock).ConclusionLarge type I endoleaks were the main reasons for LOSC. The improvement of devices and operators’ experience may decrease the LOSC rate. Urgent LOSC resulted in a high mortality rate, while selective LOSC was relatively safe with significantly lower mortality rate. Early intervention, full preparation, and timely LOSC are important for patients who require LOSC.

  9. Mid-term cost-effectiveness analysis of open and endovascular repair for ruptured abdominal aortic aneurysm.

    Science.gov (United States)

    Rollins, K E; Shak, J; Ambler, G K; Tang, T Y; Hayes, P D; Boyle, J R

    2014-02-01

    Emergency endovascular repair (EVAR) for ruptured abdominal aortic aneurysm (rAAA) may have lower operative mortality rates than open surgical repair. Concerns remain that the early survival benefit after EVAR for rAAA may be offset by late reinterventions. The aim of this study was to compare reintervention rates and cost-effectiveness of EVAR and open repair for rAAA. A retrospective analysis was undertaken of patients with rAAA undergoing EVAR or open repair over 6 years. A health economic model developed for the cost-effectiveness of elective EVAR was used in the emergency setting. Sixty-two patients (mean age 77·9 years) underwent EVAR and 85 (mean age 75·9 years) had open repair of rAAA. Median follow-up was 42 and 39 months respectively. There was no significant difference in 30-day mortality rates after EVAR and open repair (18 and 26 per cent respectively; P = 0·243). Reintervention rates were also similar (32 and 31 per cent; P = 0·701). The mean cost per patient was €26,725 for EVAR and €30,297 for open repair, and the cost per life-year gained was €7906 and €9933 respectively (P = 0·561). Open repair had greater initial costs: longer procedural times (217 versus 178·5 min; P < 0·001) and intensive care stay (5·0 versus 1·0 days; P = 0·015). Conversely, EVAR had greater reintervention (€156,939 versus €35,335; P = 0·001) and surveillance (P < 0·001) costs. There was no significant difference in reintervention rates after EVAR or open repair for rAAA. EVAR was as cost-effective at mid-term follow-up. The increased procedural costs of open repair are not outweighed by greater surveillance and reintervention costs after EVAR. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

  10. Endovascular repair of abdominal aortic aneurysms: vascular anatomy, device selection, procedure, and procedure-specific complications.

    Science.gov (United States)

    Bryce, Yolanda; Rogoff, Philip; Romanelli, Donald; Reichle, Ralph

    2015-01-01

    Abdominal aortic aneurysm (AAA) is abnormal dilatation of the aorta, carrying a substantial risk of rupture and thereby marked risk of death. Open repair of AAA involves lengthy surgery time, anesthesia, and substantial recovery time. Endovascular aneurysm repair (EVAR) provides a safer option for patients with advanced age and pulmonary, cardiac, and renal dysfunction. Successful endovascular repair of AAA depends on correct selection of patients (on the basis of their vascular anatomy), choice of the correct endoprosthesis, and familiarity with the technique and procedure-specific complications. The type of aneurysm is defined by its location with respect to the renal arteries, whether it is a true or false aneurysm, and whether the common iliac arteries are involved. Vascular anatomy can be divided more technically into aortic neck, aortic aneurysm, pelvic perfusion, and iliac morphology, with grades of difficulty with respect to EVAR, aortic neck morphology being the most common factor to affect EVAR appropriateness. When choosing among the devices available on the market, one must consider the patient's vascular anatomy and choose between devices that provide suprarenal fixation versus those that provide infrarenal fixation. A successful technique can be divided into preprocedural imaging, ancillary procedures before AAA stent-graft placement, the procedure itself, postprocedural medical therapy, and postprocedural imaging surveillance. Imaging surveillance is important in assessing complications such as limb thrombosis, endoleaks, graft migration, enlargement of the aneurysm sac, and rupture. Last, one must consider the issue of radiation safety with regard to EVAR. (©)RSNA, 2015.

  11. JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

    International Nuclear Information System (INIS)

    Ricci, Carmelo; Ceccherini, Claudio; Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-01-01

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  12. The effect of endograft device on patient outcomes in endovascular repair of ruptured abdominal aortic aneurysms.

    Science.gov (United States)

    Kansal, Vinay; Nagpal, Sudhir; Jetty, Prasad

    2017-12-01

    Objective Endovascular aneurysm repair for ruptured abdominal aortic aneurysm is being increasingly applied as the intervention of choice. The purpose of this study was to determine whether survival and reintervention rates after ruptured abdominal aortic aneurysm vary between endograft devices. Methods This cohort study identified all ruptured abdominal aortic aneurysms performed at The Ottawa Hospital from January 1999 to May 2015. Data collected included patient demographics, stability index at presentation, adherence to device instructions for use, endoleaks, reinterventions, and mortality. Kruskal-Wallis test was used to compare outcomes between groups. Mortality outcomes were assessed using Kaplan-Meier survival analysis, and multivariate Cox regression modeling. Results One thousand sixty endovascular aneurysm repairs were performed using nine unique devices. Ninety-six ruptured abdominal aortic aneurysms were performed using three devices: Cook Zenith ( n = 46), Medtronic Endurant ( n = 33), and Medtronic Talent ( n = 17). The percent of patients presented in unstable or extremis condition was 30.2, which did not differ between devices. Overall 30-day mortality was 18.8%, and was not statistically different between devices ( p = 0.16), although Medtronic Talent had markedly higher mortality (35.3%) than Cook Zenith (15.2%) and Medtronic Endurant (15.2%). AUI configuration was associated with increased 30-day mortality (33.3% vs. 12.1%, p = 0.02). Long-term mortality and graft-related reintervention rates at 30 days and 5 years were similar between devices. Instructions for use adherence was similar across devices, but differed between the ruptured abdominal aortic aneurysm and elective endovascular aneurysm repair cohorts (47.7% vs. 79.0%, p 30 days post-endovascular aneurysm repair ( p = 0.01). Type 1 endoleak rates differed significantly across devices (Cook Zenith 0.0%, Medtronic Endurant 18.2%, Medtronic Talent 17.6%, p = 0

  13. CT appearance of complications related to thoracic endovascular aortic repair (TEVAR): a pictorial essay

    International Nuclear Information System (INIS)

    Pua, U.; Tay, K.H.; Tan, B.S.; Htoo, M.M.; Sebastian, M.; Sin, K.; Chua, Y.L.

    2009-01-01

    Thoracic endovascular aortic repair (TEVAR) is a recognized treatment for various diseases involving the thoracic aorta. Patients treated with TEVAR require lifelong surveillance for potential complications, with CT being highly utilized in most centres. Endoleak is the most common complication and can be detected using CT. However, other complications such as stent strut perforations and end organ ischemia can also be detected on CT. The purpose of this pictorial essay is to illustrate the CT appearance of post-TEVAR complications encountered in our institution and to highlight their significance. (orig.)

  14. CT appearance of complications related to thoracic endovascular aortic repair (TEVAR): a pictorial essay

    Energy Technology Data Exchange (ETDEWEB)

    Pua, U. [Singapore General Hospital, Department of Diagnostic Radiology, Singapore (Singapore); Tan Tock Seng Hospital, Department of Diagnostic Radiology, Singapore (Singapore); Tay, K.H.; Tan, B.S.; Htoo, M.M. [Singapore General Hospital, Department of Diagnostic Radiology, Singapore (Singapore); Sebastian, M. [Singapore General Hospital, Department of General Surgery, Singapore (Singapore); Sin, K.; Chua, Y.L. [National Heart Centre, Department of Cardiothoracic and Vascular Surgery, Singapore (Singapore)

    2009-05-15

    Thoracic endovascular aortic repair (TEVAR) is a recognized treatment for various diseases involving the thoracic aorta. Patients treated with TEVAR require lifelong surveillance for potential complications, with CT being highly utilized in most centres. Endoleak is the most common complication and can be detected using CT. However, other complications such as stent strut perforations and end organ ischemia can also be detected on CT. The purpose of this pictorial essay is to illustrate the CT appearance of post-TEVAR complications encountered in our institution and to highlight their significance. (orig.)

  15. Survival affects decision making for fenestrated and branched endovascular aortic repair.

    Science.gov (United States)

    Beach, Jocelyn M; Rajeswaran, Jeevanantham; Parodi, F Ezequiel; Kuramochi, Yuki; Brier, Corey; Blackstone, Eugene; Eagleton, Matthew J

    2018-03-01

    Repair options for complex abdominal and thoracoabdominal aortic aneurysms (TAAAs) are evolving with increased experience and availability of less invasive endovascular techniques. Identifying risk factors for mortality after fenestrated and branched endovascular aortic repair (F/B-EVAR) could improve patient selection and facilitate decision making regarding who may benefit from prophylactic F/B-EVAR. We evaluated 1091 patients in a prospective investigational device exemption trial who underwent F/B-EVAR from August 2001 to June 2015 for complex aortic aneurysms (CAAs). Multivariable analysis of risk factors for death was performed using a nonproportional hazards model and a nonparametric analysis using random survival forest technology. Operative mortality after F/B-EVAR was low (3.7%), with high CAA-related survival at 30 day and 5 years (96.8% and 94.0%, respectively). All-cause 5-year survival, however, was 46.2% and older age, heart failure, chronic obstructive pulmonary disease, renal disease, anemia, and coagulation disorders were risk factors. Risk was highest for those undergoing type I/II TAAA repairs and those with larger aneurysms. Patients with multiple comorbidities and those undergoing type I or II TAAA repair are at greatest risk of mortality; however, in this high-risk population, F/B-EVAR offers greater survival compared with that reported for the natural history of untreated aneurysms. Operative and early mortality is lower than the best-reported open repair outcomes, even in this high-risk population, suggesting a potential benefit in extending the use of F/B-EVAR to low-to-average risk CAA patients. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  16. Flow and wall shear stress characterization after endovascular aneurysm repair and endovascular aneurysm sealing in an infrarenal aneurysm model.

    Science.gov (United States)

    Boersen, Johannes T; Groot Jebbink, Erik; Versluis, Michel; Slump, Cornelis H; Ku, David N; de Vries, Jean-Paul P M; Reijnen, Michel M P J

    2017-12-01

    Endovascular aneurysm repair (EVAR) with a modular endograft has become the preferred treatment for abdominal aortic aneurysms. A novel concept is endovascular aneurysm sealing (EVAS), consisting of dual endoframes surrounded by polymer-filled endobags. This dual-lumen configuration is different from a bifurcation with a tapered trajectory of the flow lumen into the two limbs and may induce unfavorable flow conditions. These include low and oscillatory wall shear stress (WSS), linked to atherosclerosis, and high shear rates that may result in thrombosis. An in vitro study was performed to assess the impact of EVAR and EVAS on flow patterns and WSS. Four abdominal aortic aneurysm phantoms were constructed, including three stented models, to study the influence of the flow divider on flow (Endurant [Medtronic, Minneapolis, Minn], AFX [Endologix, Irvine, Calif], and Nellix [Endologix]). Experimental models were tested under physiologic resting conditions, and flow was visualized with laser particle imaging velocimetry, quantified by shear rate, WSS, and oscillatory shear index (OSI) in the suprarenal aorta, renal artery (RA), and common iliac artery. WSS and OSI were comparable for all models in the suprarenal aorta. The RA flow profile in the EVAR models was comparable to the control, but a region of lower WSS was observed on the caudal wall compared with the control. The EVAS model showed a stronger jet flow with a higher shear rate in some regions compared with the other models. Small regions of low WSS and high OSI were found near the distal end of all stents in the common iliac artery compared with the control. Maximum shear rates in each region of interest were well below the pathologic threshold for acute thrombosis. The different stent designs do not influence suprarenal flow. Lower WSS is observed in the caudal wall of the RA after EVAR and a higher shear rate after EVAS. All stented models have a small region of low WSS and high OSI near the distal outflow

  17. Periprocedural and long-term outcomes of endovascular abdominal aortic aneurysm repair in cardiology practice.

    Science.gov (United States)

    Basoor, Abhijeet; Patel, Kiritkumar C; Halabi, Abdul R; Todorov, Mina; Senthilvadivel, Prashanth; Choksi, Nishit; Phan, Thanh; LaLonde, Thomas; Yamasaki, Hiroshi; DeGregorio, Michele

    2014-12-01

    Endovascular repair of abdominal aortic aneurysm (AAA) has recently been made a class I indication in the treatment of AAA. In comparison to the conventional open surgical treatment, endovascular AAA repair (EVAR) is associated with equivalent long-term morbidity and mortality rates. Vascular surgeons perform majority of EVAR. There are no reports for the long-term results of this intervention performed by interventional cardiologists. We present one of the first reports of periprocedural and long-term outcomes of EVAR performed by interventional cardiologists. Retrospective chart review on patients with attempted EVAR between September 2005 and January 2011 was performed. Included cases were all consecutive patients who had attempted EVAR by interventional cardiologists. During the study period EVAR was attempted in 170 patients, with 27% being women. The mean age was 74 years (range 52-93). The endovascular graft placement was successful in 96% (163/170) of patients. Procedure failures were more common in women (6 of 46 vs 1 of 124, P = 0.003). The 30-day mortality was 1.8 % (3 of 170). In patients with successful EVAR the mean follow-up was 30 months and mean length of hospital stay was 3.5 ± 3.2 days. Major periprocedural complications were noted in 9% patients (15 of 167). During follow-up, six patients (3.5%) required re-intervention and additional 16 patients died with no aneurysm related deaths. EVAR primarily performed by interventional cardiologists demonstrates high periprocedural and long-term success rates. A higher EVAR failure rate has been observed in women. © 2014 Wiley Periodicals, Inc.

  18. [Midterm results of thoracic aortic dissection endovascular repair in conjunctions with the location of Adamkiewicz artery].

    Science.gov (United States)

    Jia, Ying-bin; Li, Jian; Su, Yong-hui; Ma, Jie-fei; Guan, Xiao-dong; Zhang, Bai-meng

    2012-10-23

    To evaluate the effects of using longer xenografts in conjunctions with the location of Adamkiewicz artery (AKA) on midterm outcomes of endovascular treatment for thoracic aortic dissection. From March 2005 to September 2011, 217 patients with type B dissection were recruited. There were 143 males and 74 females with a mean age of 65 ± 11 years. Among them, 43 patients were from Fifth Affiliated Hospital of Sun Yat-Sen University while another 174 patients from Affiliated Zhongshan Hospital of Fudan University. They were divided into 2 groups according to whether AKA was identified or not pre-operatively. Endovascular repairs were performed for all patients. Distal landing levels of xenografts were recorded. The thrombosis of false lumen and the complications of spinal cord injury and endoleak were analyzed. AKA was detected in 121 (55.8%) patients (group A) but not in 96 (44.2%) patients (group B). According to the levels of AKA, the patients of group A obtained the stabilization of affected thoracic aorta over a longer distance. And the ratio of patients with distal landing levels at T8-T10 was significantly higher than in group B (59.5% vs 12.5%, χ² = 49.85, P < 0.01). Also, during the follow-up period of 7.3 months, the ratio of patients with total thrombosis of false lumen in group A was significantly higher than that in group B (32.1% vs 19.1%, χ² = 4.34, P < 0.05). During the endovascular repair of thoracic aortic dissection, selecting a longer device may provide a better structural stability of affected aorta and promote false lumen thrombosis.

  19. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    International Nuclear Information System (INIS)

    Silverberg, Daniel; Yalon, Tal; Halak, Moshe

    2015-01-01

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft

  20. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    Energy Technology Data Exchange (ETDEWEB)

    Silverberg, Daniel, E-mail: silverberg-d@msn.com; Yalon, Tal; Halak, Moshe [The Chaim Sheba Medical Center, The Department of Vascular Surgery (Israel)

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  1. A prospective clinical, economic, and quality-of-life analysis comparing endovascular aneurysm repair (EVAR), open repair, and best medical treatment in high-risk patients with abdominal aortic aneurysms suitable for EVAR: the Irish patient trial.

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2007-12-01

    To report the results of a trial comparing endovascular aneurysm repair (EVAR) to open repair (OR) and best medical therapy (BMT) involving high-risk patients with abdominal aortic aneurysms (AAA) suitable for EVAR.

  2. Outcome after open surgery repair in endovascular-suitable patients with ruptured abdominal aortic aneurysms.

    Science.gov (United States)

    Krenzien, Felix; Matia, Ivan; Wiltberger, Georg; Hau, Hans-Michael; Freitas, Bruno; Moche, Michael; Schmelzle, Moritz; Jonas, Sven; Fellmer, Peter T

    2013-11-01

    Endovascular aneurysm repair (EVAR) has been suggested in several studies to be superior to open surgery repair (OSR) for the treatment of ruptured abdominal aortic aneurysms (rAAAs), but this finding might be affected by selection bias based on aneurysm morphology and patient characteristics. We tested rAAA anatomy according to EVAR suitability in patients undergoing OSR to assess the impact on mortality. This retrospective analysis reports on 83 patients with rAAAs treated between November 2002 and July 2013. Pre-operative computed tomography (CT) scans were evaluated based on EVAR suitability and were determined by blinded independent reviewers. CT scans were lacking due to acquisition in an external institution with no availability (n = 9) or solely ultrasound evaluations (n = 8). In addition patient characteristics and outcomes were assessed. All patients who underwent OSR and who had available preoperative CT scans were included in the study (n = 66). In summary, 42 % of the patients (28/66; 95 % confidence interval [CI], 30.5 - 54.4) were considered eligible for EVAR according to pre-operative CT scans and 58 % of the patients (38/66; 95 % CI, 45.6 - 69.5) were categorized as unsuitable for endovascular repair. Patients suitable for EVAR had a significantly lower prevalence of in-hospital deaths (25 % [7/28]; 95 % CI, 9 - 41) in contrast to patients unsuitable for EVAR (53 % [20/38]; 95 % CI, 36.8 - 68.5; p = 0.02). EVAR-suitable patients had a highly significant mortality reduction undergoing OSR. Thus, the present study proposes that EVAR suitability is a positive predictor for survival after open repair of rAAA.

  3. The imaging assessment and specific endograft design for the endovascular repair of ascending aortic dissection

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2016-07-01

    (10.4%, 22 (45.9%, 13 (27.1%, six (12.5%, and two (4.2% patients, respectively. Conclusion: In this selected number of Chinese patients, the suitability of endovascular repair has been demonstrated based on the CT imaging. Shorter, larger, and bare spring-free conical endografts were preferred in the ascending aortic pathology. Keywords: type A dissection, endovascular, endograft, design

  4. Decision-making in follow-up after endovascular aneurysm repair based on diameter and volume measurements : a blinded comparison

    NARCIS (Netherlands)

    Prinssen, M; Verhoeven, ELG; Verhagen, HJM; Blankensteijn, JD

    Objective: to assess whether volume, in addition to diameter, measurements facilitate decision-making after endovascular aneurysm repair (EVAR). Material/Methods: patients (n = 82) with an immediately post-EVAR, and at least one follow-up (3-60 months), computed tomographic angiogram (CTA) were

  5. Validation of the Simbionix PROcedure Rehearsal Studio sizing module : A comparison of software for endovascular aneurysm repair sizing and planning

    NARCIS (Netherlands)

    Velu, Juliëtte F.; Groot Jebbink, Erik; de Vries, Jean-Paul P.M.; Slump, Cornelis H.; Geelkerken, Robert H.

    2017-01-01

    An important determinant of successful endovascular aortic aneurysm repair is proper sizing of the dimensions of the aortic-iliac vessels. The goal of the present study was to determine the concurrent validity, a method for comparison of test scores, for EVAR sizing and planning of the recently

  6. A geometric reappraisal of proximal landing zones for thoracic endovascular aortic repair according to aortic arch types

    NARCIS (Netherlands)

    Marrocco-Trischitta, Massimiliano M.; de Beaufort, Hector W.; Secchi, Francesco; van Bakel, Theodorus M.; Ranucci, Marco; van Herwaarden, Joost A.; Moll, Frans L.; Trimarchi, Santi

    Objective: This study assessed whether the additional use of the aortic arch classification in type I, II, and III may complement Ishimaru's aortic arch map and provide valuable information on the geometry and suitability of proximal landing zones for thoracic endovascular aortic repair. Methods:

  7. Retrograde type A dissection following hybrid supra-aortic endovascular surgery in high-risk patients unfit for conventional open repair.

    Science.gov (United States)

    Yip, Hon C; Chan, Yiu C; Qing, Kai X; Cheng, Stephen W

    2018-04-01

    Hybrid procedures with combined open extra-anatomical supra-aortic bypasses and endovascular surgery are less invasive for patients with complex aortic arch pathology. The aim of this paper is to report patients who developed retrograde type A aortic dissection following initially successful hybrid endovascular treatment. Retrospective review of prospectively collected computerized departmental database. All patients with supra-aortic hybrid endovascular surgery and post-procedure retrograde type A dissection were identified. Patient demographics, comorbid conditions, perioperative parameters, procedural details and post-operative complications were collected. From May 2005 to July 2014, 163 patients underwent thoracic aortic endovascular procedures at our institution. From the 46 patients who had supra-aortic hybrid endovascular repair, six patients (6/46, 13% of all supra-aortic hybrid cases, 3 males) developed retrograde type A aortic dissection. All were elective cases, with 3 chronic dissecting aneurysms and 3 atherosclerotic aneurysms. All had one-stage hybrid procedures: 2 patients had carotid-carotid bypass grafts, one had carotid-carotid-left subclavian bypass graft, and 3 had bypass grafts from ascending aorta to innominate artery and left carotid artery. Five patients had Cook Zenith thoracic stent-grafts (Cook Medical, Bloomington, IN, USA), and one had Medtronic Valiant stent-grafts (Medtronic Vascular Inc, Santa Rosa, CA, USA). The retrograde type A dissection occurred with sudden symptoms at day 5, 6, 10, 20, 105 and 128, respectively. There were 3 immediate fatalities and 2 patients treated conservatively deemed unfit for reintervention (one died of pneumonia at 9 months, and one remained alive at 7 months post-complication). One patient underwent successful emergency open surgery and survived. Supra-aortic hybrid procedures in treating aortic arch pathology may be at risk of developing retrograde type A dissection. This post-operative complication

  8. Emergent endovascular embolization of iatrogenic renal vascular injuries

    International Nuclear Information System (INIS)

    Liu Fengyong; Wang Maoqiang; Duan Feng; Wang Zhijun; Wang Zhongpu

    2007-01-01

    Objective: To evaluate the efficacy and safety of the interventional techniques for emergent treatment of iatrogenic renal injuries. Methods: Nine patients with iatrogenic renal vascular injuries were treated with superselective renal arterial embolization. The causes of renal injury included post-renal biopsy in 5 patients, endovascular interventional procedure-related in 2, post-renal surgery in 1, and post-percutaneous nephrostomy in 1 patient. The patients presented clinically with hemodynamical unstability with blood loss shock in 7 patients, severe flank pain in 7, and hematuria in 8 patients. Perirenal hematoma was confirmed in 8 patients by CT and ultrasonography. The embolization materials used were microcoils in 7 and standard stainless steel coils in 2 patients, associated with polyvinyl alcohol particles (PVA) in 5, and gelfoam particles in 2 cases. Results: Renal angiogram revealed intra-renal arteriovenous fistula in 6 cases, intrarenal pseudoaneurysm in 2 cases, and the contrast media extravasation in 1 patient. The technical success of the arterial embolization was achieved in all 9 cases within a single session. All angiographies documented complete obliteration of the abnormal vessels together with all major intrarenal arterial branches maintaining patent. Seven patients with hemodynamically compromise experienced immediate relief of their blood loss related symptoms, and another 7 with severe flank pain got relief progressively.. Hematuria ceased in 8 patients within 2-14 days after the embolization and impairment of renal function occurred after the procedure in 5 cases, including transient aggravation (n=3 )and developed new renal dysfunction (n=2). Two of these patients required hemodialysis. Perirenal hematoma were gradually absorbed on ultrasonography during 2-4 months after the procedures. Follow-up time ranged from 6-78 months (mean, 38 months), 4 patients died of other primary diseases of renal and multi-organ failures. Five patients are

  9. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications

    DEFF Research Database (Denmark)

    Eggebrecht, Holger; Thompson, Matt; Rousseau, Hervé

    2009-01-01

    BACKGROUND: Single-center reports have identified retrograde ascending aortic dissection (rAAD) as a potentially lethal complication of thoracic endovascular aortic repair (TEVAR). METHODS AND RESULTS: Between 1995 and 2008, 28 centers participating in the European Registry on Endovascular Aortic...

  10. Suprarenal fixation resulting in intestinal malperfusion after endovascular aortic aneurysm repair.

    Science.gov (United States)

    Siani, Andrea; Accrocca, Federico; De Vivo, Gennaro; Marcucci, Giustino

    2016-05-01

    Superior mesenteric artery (SMA) and coeliac axis (CA) occlusion after endovascular abdominal aneurysm aortic repair (EVAR-AAA), using endograft with suprarenal fixation, are uncommon. However, we are reporting a case of visceral malperfusion, which occurred 7 days after successful EVAR with suprarenal fixation for symptomatic AAA. Endograft metal stent barbs caused severe stenosis of SMA and CA. A successful recovery of SMA was carried out by means of a balloon-expandable stent released through bare metal stent barbs. We believe that an unfavourable anatomy of a proximal aortic neck and visceral aorta may have caused a wrong stent strut deployment with the coverage of CA and SMA. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  11. Application of thoracic endovascular aortic repair (TEVAR) in treating dwarfism with Stanford B aortic dissection

    Science.gov (United States)

    Qiu, Jian; Cai, Wenwu; Shu, Chang; Li, Ming; Xiong, Qinggen; Li, Quanming; Li, Xin

    2018-01-01

    Abstract Rationale: To apply thoracic endovascular aortic repair (TEVAR) to treat dwarfism complicated with Stanford B aortic dissection. Patient concerns: In this report, we presented a 63-year-old male patient of dwarfism complicated with Stanford B aortic dissection successfully treated with TEVAR. Diagnoses: He was diagnosed with dwarfism complicated with Stanford B aortic dissection. Interventions: After conservative treatment, the male patient underwent TEVAR at 1 week after hospitalization. After operation, he presented with numbness and weakness of his bilateral lower extremities, and these symptoms were significantly mitigated after effective treatment. At 1- and 3-week after TEVAR, the aorta status was maintained stable and restored. Outcomes: The patient obtained favorable clinical prognosis and was smoothly discharged. During subsequent follow-up, he remained physically stable. Lessons: TEVAR is probably an option for treating dwarfism complicated with Stanford B aortic dissection, which remains to be validated by subsequent studies with larger sample size. PMID:29703033

  12. Aortopulmonary Fistula Presenting without an Endoleak after Thoracic Endovascular Aortic Repair

    Directory of Open Access Journals (Sweden)

    Giacomo Sica

    2017-08-01

    Full Text Available Herein, we report the case of a 60-year-old man, a smoker with a history of arterial hypertension and diabetes mellitus. After computed tomography (CT for an episode of hemoptysis, the patient underwent elective thoracic endovascular aortic repair (TEVAR because of a degenerative aneurysm of the descending thoracic aorta. The area of perianeurysmal pulmonary atelectasis reported on the CT scan was not considered. Three months later, he developed an aortopulmonary fistula without endoleaks. Although TEVAR is a relatively safe procedure, no detail should be overlooked in the preoperative evaluation in order to avoid life-threatening complications. Further, the effectiveness and modality of prolonged antibiotic prophylaxis and/or preoperative respiratory physiotherapy should be assessed in such cases.

  13. [Outcomes of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures].

    Science.gov (United States)

    Wang, Mian; Chang, Guangqi; Yin, Henghui; Yao, Chen; Wang, Jinsong; Wang, Shenming

    2015-11-01

    To summarize the experience of endovascular repairing aortic arch disease hybrid with supra-arch debranching procedures. It was a retrospective study. From January 2002 to December 2014, 42 high risk patients with aortic arch disease were treated by supra-arch debranching hybrid with subsequent endovascular repair in the First Affiliated Hospital of Sun Yat-sen University. There were 39 male and 3 female patients with a mean age of (53±13) years (ranging from 34 to 80 years). Of the 42 patients, 7 were thoracic aortic aneurysm, 20 were Stanford type B aortic dissection and 15 were Stanford type A aortic dissection. After the supra-aortic debranching technique, simultaneous (n=16) or staged (n=26, mean interval (7±3) days) endovascular repair were performed. Fisher exact test was used to compare the in-hospital mortality of ascending aorta based debranching and non-ascending aorta based debranching. Technical success rate was 81.0% (34/42). The overall 30-day complication rate was 31.0% (13/42), including 3 cerebral stroke (7.1%), 8 endoleak (19.0%, including 6 type I endoleak and 2 type II endoleak), 1 circulatory failure, 1 aorto-tracheal fistula. The 30-day mortality was 9.5% (4/42), 2 died of cerebral stroke, 1 died of circulatory failure, 1 died of aorto-tracheal fistula. The in-hospital mortality of ascending aorta based debranching group was obviously higher than that of the non-ascending aorta based debranching group (4/16 vs. 0, P=0.02). The median time of follow-up was 64.8 (2 to 156.9) months. CT scanning was performed at 1, 3 months after surgery and annually thereafter. The overall survival rate was 76.6%. During the follow-up period, there was 4 deaths, and 2 of them were aortic artery related (5.3%). There were 4 de novo complications during the follow-up period, 1 stroke attributed to bypass occlusion was cured by medical treatment, 2 pseudoaneurysm was successfully treated with open surgery, 1 stent-graft induced new distal entry tear was

  14. Open and endovascular aneurysm repair in the Society for Vascular Surgery Vascular Quality Initiative.

    Science.gov (United States)

    Spangler, Emily L; Beck, Adam W

    2017-12-01

    The Society for Vascular Surgery Vascular Quality Initiative is a patient safety organization and a collection of procedure-based registries that can be utilized for quality improvement initiatives and clinical outcomes research. The Vascular Quality Initiative consists of voluntary participation by centers to collect data prospectively on all consecutive cases within specific registries which physicians and centers elect to participate. The data capture extends from preoperative demographics and risk factors (including indications for operation), through the perioperative period, to outcomes data at up to 1-year of follow-up. Additionally, longer-term follow-up can be achieved by matching with Medicare claims data, providing long-term longitudinal follow-up for a majority of patients within the Vascular Quality Initiative registries. We present the unique characteristics of the Vascular Quality Initiative registries and highlight important insights gained specific to open and endovascular abdominal aortic aneurysm repair. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Vascular Rupture Caused by a Molding Balloon during Endovascular Aneurysm Repair: Case Report

    International Nuclear Information System (INIS)

    Lee, Hee Young; Do, Young Soo; Park, Hong Suk; Park, Kwang Bo; Kim, Young Wook; Kim, Dong Ik

    2011-01-01

    Endovascular aneurysm repair (EVAR) has been accepted as an alternative to traditional open surgery in selected patients. Despite the minimally invasiveness of this treatment, several complications may occur during or after EVAR. Complications include endoleak, aortic dissection, distal embolism, or iatrogenic injury to the access artery. However, there are few reports on the vascular rupture caused by a molding balloon during EVAR. We report two cases of infrarenal abdominal aortic aneurysms complicated by procedure-related aortic or iliac artery rupture by the molding balloon during EVAR. In our cases, we observed suddenly abrupt increase of the diameter of the endograft during balloon inflation, because we inflated the balloon rapidly. In conclusion, careful attention must be paid during inflation of the molding balloon to prevent vascular rupture.

  16. The repair of a type Ia endoleak following thoracic endovascular aortic repair using a stented elephant trunk procedure.

    Science.gov (United States)

    Qi, Rui-Dong; Zhu, Jun-Ming; Liu, Yong-Min; Chen, Lei; Li, Cheng-Nan; Xing, Xiao-Yan; Sun, Li-Zhong

    2018-04-01

    Type Ia endoleaks are not uncommon complications that occur after thoracic endovascular aortic repair (TEVAR). Because aortic arch vessels prevent extension of the landing zone, it is very difficult to manipulate a type Ia endoleak using an extension cuff or stent-graft, especially when the aortic arch is involved. Here, we retrospectively review our experience of surgical treatment of type Ia endoleak after TEVAR using a stented elephant trunk procedure. From July 2010 to August 2016, we treated 17 patients diagnosed with a type Ia endoleak following TEVAR using stented elephant trunk procedure. The mean age of our patients was 52 ± 8 years. The mean interval between TEVAR and the open surgical repair was 38 ± 43 months. All cases of type Ia endoleak (100%) were repaired successfully. There were no in-hospital deaths. One case required reintubation and continuous renal replacement therapy due to renal failure; this patient recovered smoothly before discharge. One other patient suffered a stroke and renal failure and did not fully recover following discharge, or follow-up. During follow-up, there were 3 deaths. Acceptable results were obtained using a stented elephant trunk procedure in patients with a type Ia endoleak after TEVAR. This technique allowed us to repair the proximal aortic arch lesions, surgically correct the type Ia endoleak, and promote false lumen thrombosis in the distal aorta. Implantation of a stented elephant trunk, with or without a concomitant aortic arch procedure, is an alternative approach for this type of lesion. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  17. Trends in treatment of ruptured abdominal aortic aneurysm: impact of endovascular repair and implications for future care.

    Science.gov (United States)

    Park, Brian D; Azefor, Nchang; Huang, Chun-Chih; Ricotta, John J

    2013-04-01

    Our aim was to determine national trends in treatment of ruptured abdominal aortic aneurysm (RAAA), with specific emphasis on open surgical repair (OSR) and endovascular aneurysm repair (EVAR) and its impact on mortality and complications. Data from the Nationwide Inpatient Sample (NIS) from 2005 to 2009 were queried to identify patients older than 59 years with RAAA. Three groups were studied: nonoperative (NO), EVAR, and OSR. Chi-square analysis was used to determine the relationship between treatment type and patient demographics, clinical characteristics, and hospital type. The impact of EVAR compared with OSR on mortality and overall complications was examined using logistic regression analysis. We identified 21,206 patients with RAAA from 2005 to 2009, of which 16,558 (78.1%) underwent operative repair and 21.8% received no operative treatment. In the operative group, 12,761 (77.1%) underwent OSR and 3,796 (22.9%) underwent EVAR. Endovascular aneurysm repair was more common in teaching hospitals (29.1% vs 15.2%, p < .0001) and in urban versus rural settings. Nonoperative approach was twice as common in rural versus urban hospitals. Reduced mortality was seen in patients transferred from another institutions (31.2% vs 39.4%, p = 0.014). Logistic regression analysis demonstrated a benefit of EVAR on both complication rate (OR = 0.492; CI, 0.380-0.636) and mortality (OR=0.535; CI, 0.395-0.724). Endovascular aneurysm repair use is increasing for RAAA and is more common in urban teaching hospitals while NO therapy is more common in rural hospitals. Endovascular aneurysm repair is associated with reduced mortality and complications across all age groups. Efforts to reduce mortality from RAAA should concentrate on reducing NO and OSR in patients who are suitable for EVAR. Copyright © 2013 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Early-Dynamic Positron Emission Tomography (PET)/Computed Tomography and PET Angiography for Endoleak Detection After Endovascular Aneurysm Repair.

    Science.gov (United States)

    Drescher, Robert; Gühne, Falk; Freesmeyer, Martin

    2017-06-01

    To propose a positron emission tomography (PET)/computed tomography (CT) protocol including early-dynamic and late-phase acquisitions to evaluate graft patency and aneurysm diameter, detect endoleaks, and rule out graft or vessel wall inflammation after endovascular aneurysm repair (EVAR) in one examination without intravenous contrast medium. Early-dynamic PET/CT of the endovascular prosthesis is performed for 180 seconds immediately after intravenous injection of F-18-fluorodeoxyglucose. Data are reconstructed in variable time frames (time periods after tracer injection) to visualize the arterial anatomy and are displayed as PET angiography or fused with CT images. Images are evaluated in view of vascular abnormalities, graft configuration, and tracer accumulation in the aneurysm sac. Whole-body PET/CT is performed 90 to 120 minutes after tracer injection. This protocol for early-dynamic PET/CT and PET angiography has the potential to evaluate vascular diseases, including the diagnosis of complications after endovascular procedures.

  19. Endovascular Aneurysm Repair Using a Reverse Chimney Technique in a Patient With Marfan Syndrome and Contained Ruptured Chronic Type B Dissection

    International Nuclear Information System (INIS)

    Ketelsen, Dominik; Kalender, Guenay; Heuschmid, Martin; Syha, Roland; Mangold, Stefanie; Claussen, Claus D.; Brechtel, Klaus

    2011-01-01

    We report endovascular thoracic and abdominal aneurysm repair (EVAR) with reverse chimney technique in a patient with contained ruptured type B dissection. EVAR seems feasible as a bailout option in Marfan patients with acute life-threatening disease.

  20. Late type III endoleak after thoracic endovascular aneurysm repair and previous infrarenal stent graft implantation - a case report and review of the literature.

    Science.gov (United States)

    Leszczyński, Jerzy; Macioch, Waldemar; Chudziński, Witold; Gałązka, Zbigniew

    2017-09-01

    Thoracic endovascular aortic repair (TEVAR) effectively improved the results of thoracic aortic aneurysm treatment. TEVAR is a less invasive procedure that can be performed under local anesthesia with shorter hospital stay. The perioperative morbidity and mortality rates are lower for endovascular than open repair, but the rate of secondary interventions is higher for TEVAR. We report a case of an elderly man with synchronous abdominal and thoracic aortic aneurysms. A type III dangerous endoleak was recognized 3 years after TEVAR. It was successfully repaired during an endovascular procedure. There were no new endoleaks after 12 months of follow-up. TEVAR may be the only option of treatment for risky and elderly patients. However, postoperative monitoring is necessary to exclude different types of endoleaks. Most of them undergo effective endovascular repair.

  1. Endovascular treatment of type II endoleak following thoracic endovascular aortic repair for thoracic aortic aneurysm: Case report of squeeze technique to reach the aneurysmal sac

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Hyun Jung; Kim, Chang Won; Lee, Tae Hong; Song, Seung Hwan; Lee, Chung Won; Chung, Sung Woon [Pusan National University Hospital, School of Medicine, Pusan National University, Busan (Korea, Republic of)

    2014-12-15

    Type II endoleaks are common after thoracic endovascular aortic repair (TEVAR). Various strategies are introduced to manage type II endoleaks, such as the use of coils, plugs, or liquid embolic agents (histoacryl, thrombin, onyx, etc.) through a transarterial approach or a direct puncture of the aneurysmal sac. We herein report a case of a type II endoleak caused by reverse blood flow through intercostal artery after TEVAR which was successfully treated with n-butyl cyanoacrylate (histoacryl)-lipiodol mixture by a squeeze technique to reach the aneurismal sac using a microcatheter.

  2. Endovascular repair of an aorto-iliac aneurysm succeeded by kidney transplantation Tratamento endovascular de aneurisma aorto-ilíaco sucedido por transplante renal

    Directory of Open Access Journals (Sweden)

    Marcelo Bellini Dalio

    2010-09-01

    Full Text Available We present the case of aorto-iliac aneurysm in a patient with chronic renal failure requiring dialysis who were treated with an endovascular stent graft and, later on, submitted to kidney transplantation. A 53-year-old male with renal failure requiring dialysis presented with an asymptomatic abdominal aorto-iliac aneurysm measuring 5.0cm of diameter. He was treated with endovascular repair technique, being used an endoprosthesis Excluder®. After four months, he was successfully submitted to kidney transplantation (dead donor, with anastomosis of the graft renal artery in the external iliac artery distal to the endoprosthesis. The magnetic resonance imaging, carried out 30 days after the procedure, showed a good positioning of the endoprosthesis and adequate perfusion of the renal graft. In the follow-up, the patient presented improvement of nitrogenous waste, good positioning of the endoprosthesis without migration or endoleak. The endovascular repair of aorto-iliac aneurysm in a patient with end-stage renal failure under hemodialysis treatment showed to be feasible, safe and efficient, as it did not prevent the success of the posterior kidney transplantation.Apresentamos o caso de aneurisma aortoilíaco em um paciente com insuficiência renal crônica dialítica tratado com uma endoprótese vascular, sendo, após, submetido a transplante renal. Um homem de 53 anos com insuficiência renal dialítica apresentava um aneurisma abdominal aortoilíaco assintomático com 5,0cm de diâmetro. Foi tratado com técnica endovascular com uma endoprótese Excluderâ. Após quatro meses, foi submetido a transplante renal (doador cadáver com sucesso, com anastomose da artéria renal do enxerto na artéria ilíaca externa distal à endoprótese. A ressonância magnética 30 dias após o procedimento mostrou a endoprótese bem posicionada e o enxerto renal bem perfundido. No seguimento, o paciente evoluiu com melhora das escórias nitrogenadas, bom

  3. Aortic Arch Aneurysms: Treatment with Extra anatomical Bypass and Endovascular Stent-Grafting

    International Nuclear Information System (INIS)

    Kato, Noriyuki; Shimono, Takatsugu; Hirano, Tadanori; Mizumoto, Toru; Ishida, Masaki; Fujii, Hideki; Yada, Isao; Takeda, Kan

    2002-01-01

    Endovascular repair of thoracic aortic aneurysms is emerging as an attractive alternative to surgical graft replacement. However,patients with aortic arch aneurysms are often excluded from the target of endovascular repair because of lack of suitable landing zones, especially at the proximal ones. In this paper we describe our method for treating patients with aortic arch aneurysms using a combination of extra anatomical bypass surgery and endovascular stent-grafting

  4. Endovascular abdominal aortic aneurysm repair complicated by spondylodiscitis and iliaco-enteral fistula.

    Science.gov (United States)

    de Koning, Heleen D; van Sterkenburg, Steven M M; Pierie, Maurice E N; Reijnen, Michel M P J

    2008-06-01

    Infections of abdominal aortic endografts are rare. There are no reports on the association with spondylodiscitis. We report a case of a 74-year-old man who underwent endovascular aneurysm repair (EVAR) and subsequently femorofemoral bypass placement due to occlusion of the right limb of the endograft. Six months later, he presented with rectal bleeding, weight loss, back pain, and low abdominal pain. Computed tomography revealed extensive abscess formation with air in and around the endograft and psoas muscles, in continuity with destructive spondylodiscitis L3-4. There was a small bowel loop in close proximity to the occluded right leg of the endograft, which was filled with air bubbles. An axillofemoral bypass was created followed by a laparotomy. Intra-operatively, an iliaco-enteral fistula was found. The small bowel defect was sutured, the endograft completely removed, and the infrarenal aorta and both common iliac arteries were closed. Necrotic fragments of the former L3-4 disk were removed. The postoperative course was uneventful. Seven months postoperatively, the patient had recovered well. Iliaco-enteric fistula and spondylodiscitis are rare complications of aortic aneurysm repair. This is the first report of spondylodiscitis after EVAR.

  5. Geometric Deformations of the Thoracic Aorta and Supra-Aortic Arch Branch Vessels Following Thoracic Endovascular Aortic Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Hirotsu, Kelsey; Zhu, David; Lee, Jason T; Dake, Michael D; Fleischmann, Dominik; Cheng, Christopher P

    2018-04-01

    To utilize 3-D modeling techniques to better characterize geometric deformations of the supra-aortic arch branch vessels and descending thoracic aorta after thoracic endovascular aortic repair. Eighteen patients underwent endovascular repair of either type B aortic dissection (n = 10) or thoracic aortic aneurysm (n = 8). Computed tomography angiography was obtained pre- and postprocedure, and 3-D geometric models of the aorta and supra-aortic branch vessels were constructed. Branch angle of the supra-aortic branch vessels and curvature metrics of the ascending aorta, aortic arch, and stented thoracic aortic lumen were calculated both at pre- and postintervention. The left common carotid artery branch angle was lower than the left subclavian artery angles preintervention ( P Supra-aortic branch vessel angulation remains relatively static when proximal landing zones are distal to the left common carotid artery.

  6. Can Surgeons Assess CT Suitability for Endovascular Repair (EVAR) in Ruptured Abdominal Aortic Aneurysm? Implications for a Ruptured EVAR Trial

    International Nuclear Information System (INIS)

    Rayt, Harjeet; Lambert, Kelly; Bown, Matthew; Fishwick, Guy; Morgan, Robert; McCarthy, Mark; London, Nick; Sayers, Robert

    2008-01-01

    The purpose of this study was to determine whether surgeons without formal radiological training are able to assess suitability of patients with ruptured abdominal aortic aneurysms (AAA) for EVAR. The CT scans of 20 patients with AAA were reviewed under timed conditions by six vascular surgeons. Twenty minutes was allocated per scan. They were asked to determine if each aneurysm would be treatable by EVAR in the emergency setting and, if so, to measure for device selection. The results were then compared with those of a vascular radiologist. Six surgeons agreed on the suitability of endovascular repair in 45% of cases (95% CI, 23.1-68.5%; 9/20 scans; κ = 0.41 [p = 0.01]) and concurred with the radiologist in eight of these. Individually, agreement ranged from 13 to 16 of the 20 scans, 65-80% between surgeons. The kappa value for agreement between all the surgeons and the radiologist was 0.47 (p = 0.01, moderate agreement). For the individual surgeons, this ranged from 0.3 to 0.6 (p = 0.01). In conclusion, while overall agreement was moderate between the surgeons and the radiologist, it is clear that if surgeons are to assess patients for ruptured EVAR in the future, focused training of surgical trainees is required.

  7. Transthoracic Echocardiography Provides Important Long-Term Prognostic Information in Selected Patients Undergoing Endovascular Abdominal Aortic Repair.

    Science.gov (United States)

    O'Driscoll, Jamie M; Bahia, Sandeep S; Gravina, Angela; Di Fino, Sara; Thompson, Matthew M; Karthikesalingam, Alan; Holt, Peter J E; Sharma, Rajan

    2016-02-01

    The value of performing transthoracic echocardiography (TTE) as part of the clinical assessment of patients awaiting endovascular repair of the abdominal aorta is little evaluated. We aimed to estimate the prognostic importance of information derived from TTE on long-term all-cause mortality in a selected group of patients undergoing endovascular aneurysm repair. This was a retrospective cohort study of 273 consecutive patients selected for endovascular aneurysm repair. All patients included in the analysis underwent TTE before their procedure. Multivariable Cox regression analysis was used to estimate the effect of TTE measures on all-cause mortality. Over a mean follow-up of 3.2±1.5 years, there were 78 deaths with a mean time to death of 1.28±1.16 years. A greater tubular ascending aorta (hazard ratio [HR] 5.6, 95% confidence interval [CI] 2.77-11.33), presence of mitral regurgitation (HR 8.13, 95% CI 4.09-12.16), lower left ventricular ejection fraction (HR 0.96, 95% CI 0.93-0.98), younger age (HR 0.97, 95% CI 0.95-0.99), and presence of diabetes mellitus (HR 1.46, 95% CI 1.24-1.89) were predictors of all-cause mortality. Echocardiography provides important long-term prognostic information in patients undergoing endovascular aneurysm repair. These TTE indices were more important at predicting outcome than standard conventional risk factors in this patient group. A greater tubular ascending aorta, presence of mitral regurgitation, reduced left ventricular ejection fraction, younger age, and diabetes mellitus were independently associated with long-term mortality. © 2016 American Heart Association, Inc.

  8. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study

    International Nuclear Information System (INIS)

    Cantador, Alex Aparecido; Siqueira, Daniel Emilio Dalledone; Jacobsen, Octavio Barcellos; Baracat, Jamal; Pereira, Ines Minniti Rodrigues; Menezes, Fabio Hüsemann; Guillaumon, Ana Terezinha

    2016-01-01

    Objective: To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. (author)

  9. Duplex ultrasound and computed tomography angiography in the follow-up of endovascular abdominal aortic aneurysm repair: a comparative study

    Energy Technology Data Exchange (ETDEWEB)

    Cantador, Alex Aparecido; Siqueira, Daniel Emilio Dalledone; Jacobsen, Octavio Barcellos; Baracat, Jamal; Pereira, Ines Minniti Rodrigues; Menezes, Fabio Hüsemann; Guillaumon, Ana Terezinha, E-mail: alex_cantador@yahoo.com.br [Universidade Estadual de Campinas (FCM/UNICAMP), Campinas, SP (Brazil). Faculdade de Ciencias Medicas

    2016-07-15

    Objective: To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods: This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results: The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion: Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. (author)

  10. Embolization by micro navigation for treatment of persistent type 2 Endoleaks after endovascular abdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    Bruno Lorenção de Almeida

    2014-12-01

    Full Text Available Background:Endovascular repair has become established as a safe and effective method for treatment of abdominal aortic aneurysms. One major complication of this treatment is leakage, or endoleaks, of which type 2 leaks are the most common.Objective:To conduct a brief review of the literature and evaluate the safety and effectiveness of embolization by micronavigation for treatment of type 2 endoleaks.Method:A review of medical records from patients who underwent endovascular repair of abdominal aortic aneurysms identified 5 patients with persistent type 2 endoleaks. These patients were submitted to embolization by micronavigation.Results:In all cases, angiographic success was achieved and control CT scans showed absence of type 2 leaks and aneurysm sacs that had reduced in size after the procedure.Conclusion:Treatment of type 2 endoleaks using embolization by micronavigation is an effective and safe method and should be considered as a treatment option for this complication after endovascular repair of abdominal aortic aneurysms.

  11. Application of rapid artificial cardiac pacing in thoracic endovascular aortic repair in aged patients

    Directory of Open Access Journals (Sweden)

    Chen J

    2013-12-01

    Full Text Available Jun Chen,1,* Wenhui Huang,2,* Songyuan Luo,2,* Dahao Yang,1 Zhengrong Xu,1 Jianfang Luo21Department of Angiocardiopathy, Affiliated Baoan Hospital of Southern Medical University, Shenzhen City, People's Republic of China; 2Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China*These authors contributed equally to this workObjective: To compare the safety, efficacy, and impact on stent graft positioning between rapid artificial cardiac pacing (RACP, induced hypotension and sodium nitroprusside (SNP induced hypotension during thoracic endovascular aortic repair (TEVAR for Stanford B aortic dissection.Methods: One hundred and sixty-eight patients, who were diagnosed with Stanford B aortic dissection and who underwent selective TEVAR in Guangdong General Hospital and the People's Hospital of Baoan District, Shenzhen, People's Republic of China, were enrolled in this study. Patients were randomly divided into a RACP group (n=77 and a SNP group (n=91. During localization and deployment of the stent graft, hypotension was induced by RACP or intravenous SNP, according to randomization. Hemodynamics, landing precision (deviation from planned placement site, duration of procedure, renal function, neurocognitive function, and incidence of endoleaks and paraplegia/hemiplegia were compared. Except for methods of inducing hypotension, TEVAR was performed according to the same protocol in each group.Results: RACP was successfully performed in all patients assigned to the RACP group. Compared with the SNP group, blood pressure was significantly lower (43±5 versus 81±6 mmHg, P=0.003 and the restoration time of blood pressure and the operation duration were significantly shorter (7±2 versus 451±87 seconds, P<0.001; 87±15 versus 106±18 minutes, P<0.001, respectively in the RACP group. Stent graft localization/deployment was more precise in the RACP

  12. Pros and Cons of 3D Image Fusion in Endovascular Aortic Repair: A Systematic Review and Meta-analysis.

    Science.gov (United States)

    Goudeketting, Seline R; Heinen, Stefan G H; Ünlü, Çağdaş; van den Heuvel, Daniel A F; de Vries, Jean-Paul P M; van Strijen, Marco J; Sailer, Anna M

    2017-08-01

    To systematically review and meta-analyze the added value of 3-dimensional (3D) image fusion technology in endovascular aortic repair for its potential to reduce contrast media volume, radiation dose, procedure time, and fluoroscopy time. Electronic databases were systematically searched for studies published between January 2010 and March 2016 that included a control group describing 3D fusion imaging in endovascular aortic procedures. Two independent reviewers assessed the methodological quality of the included studies and extracted data on iodinated contrast volume, radiation dose, procedure time, and fluoroscopy time. The contrast use for standard and complex endovascular aortic repairs (fenestrated, branched, and chimney) were pooled using a random-effects model; outcomes are reported as the mean difference with 95% confidence intervals (CIs). Seven studies, 5 retrospective and 2 prospective, involving 921 patients were selected for analysis. The methodological quality of the studies was moderate (median 17, range 15-18). The use of fusion imaging led to an estimated mean reduction in iodinated contrast of 40.1 mL (95% CI 16.4 to 63.7, p=0.002) for standard procedures and a mean 70.7 mL (95% CI 44.8 to 96.6, p<0.001) for complex repairs. Secondary outcome measures were not pooled because of potential bias in nonrandomized data, but radiation doses, procedure times, and fluoroscopy times were lower, although not always significantly, in the fusion group in 6 of the 7 studies. Compared with the control group, 3D fusion imaging is associated with a significant reduction in the volume of contrast employed for standard and complex endovascular aortic procedures, which can be particularly important in patients with renal failure. Radiation doses, procedure times, and fluoroscopy times were reduced when 3D fusion was used.

  13. Extra-anatomic endovascular repair of an abdominal aortic aneurysm with a horseshoe kidney supplied by the aneurysmal aorta.

    Science.gov (United States)

    Rey, Jorge; Golpanian, Samuel; Yang, Jane K; Moreno, Enrique; Velazquez, Omaida C; Goldstein, Lee J; Chahwala, Veer

    2015-07-01

    Abdominal aortic aneurysm complicated by a horseshoe kidney (HSK, fused kidney) represents a unique challenge for repair. Renal arteries arising from the aneurysmal aorta can further complicate intervention. Reports exist describing the repair of these complex anatomies using fenestrated endografts, hybrid open repairs (debranching), and open aneurysmorrhaphy with preservation of renal circulation. We describe an extra-anatomic, fully endovascular repair of an abdominal aortic aneurysm with a HSK partially supplied by a renal artery arising from the aneurysm. We successfully applied aortouni-iliac endografting, femorofemoral bypass, and retrograde renal artery perfusion via the contralateral femoral artery to exclude the abdominal aortic aneurysm and preserve circulation to the HSK. Copyright © 2015 Elsevier Inc. All rights reserved.

  14. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

    International Nuclear Information System (INIS)

    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young; Kim, Soo Hyun; Chang, Nam Kyu

    2013-01-01

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  15. Is Internal Iliac Artery Embolization Essential Prior to Endovascular Repair of Aortoiliac Aneurysms?

    International Nuclear Information System (INIS)

    Bharwani, N.; Raja, J.; Choke, E.; Belli, A. M.; Thompson, M. M.; Morgan, R. A.; Munneke, G.

    2008-01-01

    Patients who undergo endovascular repair of aorto-iliac aneurysms (EVAR) require internal iliac artery (IIA) embolization (IIAE) to prevent type II endoleaks after extending the endografts into the external iliac artery. However, IIAE may not be possible in some patients due to technical factors or adverse anatomy. The aim of this study was to assess retrospectively whether patients with aorto-iliac aneurysms who fail IIAE have an increase in type II endoleak after EVAR compared with similar patients who undergo successful embolization. We retrospectively analyzed the records of 148 patients who underwent EVAR from December 1997 to June 2005. Sixty-one patients had aorto-iliac aneurysms which required IIAE before EVAR. Fifty patients had successful IIAE and 11 patients had unsuccessful IIAE prior to EVAR. The clinical and imaging follow-up was reviewed before and after EVAR. The endoleak rate of the embolized group was compared with that of the group in whom embolization failed. After a mean follow-up of 19.7 months in the study group and 25 months in the control group, there were no statistically significant differences in outcome measures between the two groups. Specifically, there were no type II endoleaks related to the IIA in patients where IIAE had failed. We conclude that failure to embolize the IIA prior to EVAR should not necessarily preclude patients from treatment. In patients where there is difficulty in achieving coil embolization, it is recommended that EVAR should proceed, as clinical sequelae are unlikely

  16. The Preclose Technique in Percutaneous Endovascular Aortic Repair: A Systematic Literature Review and Meta-analysis

    International Nuclear Information System (INIS)

    Jaffan, Abdel Aziz A.; Prince, Ethan A.; Hampson, Christopher O.; Murphy, Timothy P.

    2013-01-01

    Purpose. To establish the efficacy and safety of the preclose technique in total percutaneous endovascular aortic repair (PEVAR).MethodsA systematic literature search of Medline database was conducted for series on PEVAR published between January 1999 and January 2012.ResultsThirty-six articles comprising 2,257 patients and 3,606 arterial accesses were included. Anatomical criteria used to exclude patients from undergoing PEVAR were not uniform across all series. The technical success rate was 94 % per arterial access. Failure was unilateral in the majority (93 %) of the 133 failed PEVAR cases. The groin complication rate in PEVAR was 3.6 %; a minority (1.6 %) of these groin complications required open surgery. The groin complication rate in failed PEVAR cases converted to groin cutdown was 6.1 %. A significantly higher technical success rate was achieved when arterial access was performed via ultrasound guidance. Technical failure rate was significantly higher with larger sheath size (≥20F). Conclusion. The preclose technique in PEVAR has a high technical success rate and a low groin complication rate. Technical success tends to increase with ultrasound-guided arterial access and decrease with larger access. When failure occurs, it is unilateral in the majority of cases, and conversion to surgical cutdown does not appear to increase the operative risk.

  17. Fate of patients with spinal cord ischemia complicating thoracic endovascular aortic repair.

    Science.gov (United States)

    DeSart, Kenneth; Scali, Salvatore T; Feezor, Robert J; Hong, Michael; Hess, Philip J; Beaver, Thomas M; Huber, Thomas S; Beck, Adam W

    2013-09-01

    Spinal cord ischemia (SCI) is a potentially devastating complication of thoracic endovascular aortic repair (TEVAR) that can result in varying degrees of short-term and permanent disability. This study was undertaken to describe the clinical outcomes, long-term functional impact, and influence on survival of SCI after TEVAR. A retrospective review of all TEVAR patients at the University of Florida from 2000 to 2011 was performed to identify individuals experiencing SCI, defined by any new lower extremity neurologic deficit not attributable to another cause. SCI was dichotomized into immediate or delayed onset, with immediate onset defined as SCI noted upon awakening from anesthesia, and delayed characterized as a period of normal function, followed by development of neurologic injury. Ambulatory status was determined using database query, record review, and phone interviews with patients and/or family. Mortality was estimated using life-table analysis. A total of 607 TEVARs were performed for various indications, with 57 patients (9.4%) noted to have postoperative SCI (4.3% permanent). SCI patients were more likely to be older (63.9 ± 15.6 vs 70.5 ± 11.2 years; P = .002) and have a number of comorbidities, including chronic obstructive pulmonary disease, hypertension, dyslipidemia, and cerebrovascular disease (P impact on postdischarge FI or long-term mortality. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  18. Outcomes of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    International Nuclear Information System (INIS)

    Choke, Edward; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria; Loftus, Ian; McFarland, Robert; Loosemore, Thomas; Thompson, Matthew M.

    2006-01-01

    Purpose. The principal anatomic contraindication to endovascular aneurysm repair (EVR) is an unfavorable proximal aortic neck. With increasing experience, a greater proportion of patients with unfavorable neck anatomy are being offered EVR. This study aimed to evaluate outcomes in patients with challenging proximal aortic neck anatomy. Methods. Prospectively collected data from 147 consecutive patients who underwent EVR between December 1997 and April 2005 were supplemented with a retrospective review of medical records and radiological images. Unfavorable anatomic features were defined as neck diameter >28 mm, angulation >60 deg., circumferential thrombus >50%, and length 30 days) (p = 0.57), distal type I endoleak (p = 0.40), type III endoleak (p 0.51), secondary interventions (p = 1.0), aneurysm sac expansion (p = 0.44), or 30 day mortality (p = 0.70). The good neck group had a significantly increased incidence of type II endoleak (p = 0.023). By multivariate analysis, the incidence of intraoperative adjunctive procedures was significantly increased in the presence of severe angulation (p = 0.041, OR 3.08, 95% CI 1.05-9.04). Conclusion. Patients with severely hostile proximal aortic neck anatomy may be treated with EVR, although severely angulated necks require additional intraoperative procedures. Early outcomes are encouraging and suggest that indications for EVR may be expanded to include patients with hostile neck anatomy

  19. Endovascular Aneurysm Repair of Acute Occlusion of Abdominal Aortic Aneurysm with Intra-Aneurysmal Dissection.

    Science.gov (United States)

    Terai, Yasuhiko; Mitsuoka, Hiroshi; Nakai, Masanao; Goto, Shinnosuke; Miyano, Yuta; Tsuchiya, Hirokazu; Yamazaki, Fumio

    2015-11-01

    To report a rare case of acute abdominal aortic aneurysm (AAA) occlusion successfully treated by endovascular aneurysm repair (EVAR). An 89-year-old man complained of severe back pain and weakness in the bilateral lower extremities. Although there were neither acute ischemic signs on the brain computed tomography (CT) nor critical leg ischemia, the patient presented progressing weakness in the bilateral lower extremities and decreased sensation in the perianal and saddle area. Contrast-enhanced CT demonstrated an infrarenal AAA, the formation of an ulcer-like lesion in the aneurysmal wall, and the complete occlusion of distal AAA because of the caudal extension of intramural hematoma. Both common iliac arteries were patent because of the development of collateral vessels. The neurologic symptoms were considered to be caused by the occlusion of lumbar radicular arteries. EVAR seemed anatomically feasible, if the occlusion could be crossed by guidewires from both side of the common femoral artery. Wires easily traversed the occlusion, and the stent graft could be smoothly unwrapped and opened. The patient could recover decent iliac arterial flow. The neurovascular deficits recovered within 4 days after the procedure. Although our experience may not be reproduced in all case of AAA occlusion, EVAR warrants consideration to reduce the high mortality rate associated with the classical treatments. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. Influence of Anatomic Angulations in Chimney and Fenestrated Endovascular Aneurysm Repair.

    Science.gov (United States)

    Caradu, Caroline; Bérard, Xavier; Midy, Dominique; Ducasse, Eric

    2017-08-01

    The lack of widespread availability of Fenestrated endovascular aneurysm repair (F-EVAR) encouraged alternative strategies. Hence, Chimney graft (CG)-EVAR spread when costs, manufacturing delays, or anatomy preclude F-EVAR. Our objective is to evaluate CG- and F-EVAR outcomes depending on the angulation of target renal arteries and hostility of iliac accesses in order to determine the potential impact of a choice made between both techniques on the basis of preoperative anatomic criteria. Consecutive patients treated by CG-EVAR or F-EVAR, from January 2010 to January 2015, were considered for inclusion. Anatomic parameters were defined by preoperative computed tomography angiography. A subgroup analysis was performed depending on renal arteries' angulation (cut-off: -30°) and iliac arteries' hostility (cut-off: diameter renal artery was shorter in the CG group (11.7 ± 6.2 mm vs. 14.1 ± 5.9 mm, P = 0.06). Longitudinal angulation of the right renal artery was not statistically different between both groups, while the left renal artery presented with a significantly more downward angulation in the CG group (-32.0 ± 15.3 vs. -19.0 ± 19.6, P = 0.003). There were significantly more grade 3 iliac tortuosity indexes for CG-EVAR (P = 0.03) with significantly smaller external iliac diameters (7.8 ± 1.7 vs. 8.8 ± 1.6 mm, P = 0.0009). There was 1 renal artery early occlusion in the renal artery angulation and diameter, iliac artery hostility, and aortic neck length among other parameters may help the surgeon make a decision toward the endovascular strategy that seems best suited for each specific patient. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Editor's Choice - Late Open Surgical Conversion after Endovascular Abdominal Aortic Aneurysm Repair.

    Science.gov (United States)

    Kansal, Vinay; Nagpal, Sudhir; Jetty, Prasad

    2018-02-01

    Late open surgical conversion following endovascular aneurysm repair (EVAR) may occur more frequently after performing EVAR in anatomy outside the instructions for use (IFU). This study reviews predictors and outcomes of late open surgical conversion for failed EVAR. This retrospective cohort study reviewed all EVARs performed at the Ottawa Hospital between January 1999 and May 2015. Open surgical conversions >1 month post EVAR were identified. Variables analysed included indication for conversion, pre-intervention AAA anatomy, endovascular device and configuration, operative technique, re-interventions, complications, and death. Of 1060 consecutive EVARs performed, 16 required late open surgical conversion. Endografts implanted were Medtronic Talent (n = 8, 50.0%), Medtronic Endurant (n = 3, 18.8%), Cook Zenith (n = 4, 25.0%), and Terumo Anaconda (n = 1, 6.2%). Eleven grafts were bifurcated (68.8%), five were aorto-uni-iliac (31.2%). The median time to open surgical conversion was 3.1 (IQR 1.0-5.2) years. There was no significant difference in pre-EVAR rupture status (1.4% elective, 2.1% ruptured, p = .54). Indications for conversion included: Type 1 endoleak with sac expansion (n = 4, 25.0%), Type 2 endoleak with expansion (n = 2, 12.5%), migration (n = 3, 18.8%), sac expansion without endoleak (n = 2, 12.5%), graft infection (n = 3, 18.8%), rupture (n = 2, 12.5%). Nine patients (56.2%) underwent stent graft explantation with in situ surgical graft reconstruction, seven had endograft preserving open surgical intervention. The 30 day mortality was 18.8% (n = 3, all of whom having had endograft preservation). Ten patients (62.5%) suffered major in hospital complications. One patient (6.5%) required post-conversion major surgical re-intervention. IFU adherence during initial EVAR was 43.8%, versus 79.0% (p Open surgical conversion following EVAR results in significant morbidity and mortality. IFU adherence of EVARs later requiring open surgical

  2. Emergency Endovascular “Bridge” Treatment for Iliac-Enteric Fistula

    International Nuclear Information System (INIS)

    Franchin, Marco; Tozzi, Matteo; Piffaretti, Gabriele; Carrafiello, Gianpaolo; Castelli, Patrizio

    2011-01-01

    Aortic aneurysm has been reported to be the dominant cause of primary iliac-enteric fistula (IEF) in >70% of cases [1]; other less common causes of primary IEF include peptic ulcer, primary aortitis, pancreatic pseudocyst, or neoplastic erosion into an adjacent artery [2, 3]. We describe an unusual case of IEF managed with a staged approach using an endovascular stent-graft as a “bridge” in the emergency setting to optimize the next elective definitive excision of the lesion.

  3. Vestibular system paresis due to emergency endovascular catheterization

    Directory of Open Access Journals (Sweden)

    Simoceli, Lucinda

    2012-01-01

    Full Text Available Objective: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. Conclusion: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations.

  4. Vestibular system paresis due to emergency endovascular catheterization.

    Science.gov (United States)

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-04-01

     The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation.  Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations.

  5. Evaluation of diffusion-perfusion mismatch for determining indication for emergency endovascular revascularization

    International Nuclear Information System (INIS)

    Masuda, Atsushi; Miki, Takanori; Matsumoto, Hiroaki

    2010-01-01

    We evaluated the usefulness of assessing by diffusion-perfusion mismatch (D/P mismatch) whether there is adaptation of neuroendovascular revascularization for acute ischemic stroke out of intravenous tissue plasminogen activator (IV t-PA). We retrospectively analyzed 24 patients who underwent D/P mismatch and endovascular treatment between October 2005 and September 2008. This investigation included stroke patients with a National Institutes of Health Stroke Scale (NIHSS) score less than 4. Sixteen acute ischemic stroke patients had an NIHSS score greater than 5. Eight patients (50%) had a favorable neurological outcome (modified Rankin Scale 0 to 2). Eight acute ischemic stroke patients had an NIHSS score equal to or less than 4. Four patients who underwent emergency endovascular treatment on admission had a favorable neurological outcome, but 3 patients treated for progressive stroke after admission all had a poor prognosis. Evaluating D/P mismatch was useful for determining the adaptation of emergency neuroendovascular revascularization for acute ischemic stroke out of IV t-PA. Acute ischemic stroke patients with an NIHSS score equal to or less than 4 and diffusion/perfusion mismatch need careful observation to enable endovascular treatment immediately after progressive stroke. (author)

  6. Dynamic Geometric Analysis of the Renal Arteries and Aorta following Complex Endovascular Aneurysm Repair.

    Science.gov (United States)

    Ullery, Brant W; Suh, Ga-Young; Kim, John J; Lee, Jason T; Dalman, Ronald L; Cheng, Christopher P

    2017-08-01

    Aneurysm regression and target vessel patency during early and mid-term follow-up may be related to the effect of stent-graft configuration on the anatomy. We quantified geometry and remodeling of the renal arteries and aneurysm following fenestrated (F-) or snorkel/chimney (Sn-) endovascular aneurysm repair (EVAR). Twenty-nine patients (mean age, 76.8 ± 7.8 years) treated with F- or Sn-EVAR underwent computed tomography angiography at preop, postop, and follow-up. Three-dimensional geometric models of the aorta and renal arteries were constructed. Renal branch angle was defined relative to the plane orthogonal to the aorta. End-stent angle was defined as the angulation between the stent and native distal artery. Aortic volumes were computed for the whole aorta, lumen, and their difference (excluded lumen). Renal patency, reintervention, early mortality, postoperative renal impairment, and endoleak were reviewed. From preop to postop, F-renal branches angled upward, Sn-renal branches angled downward (P renals exhibited increased end-stent angulation (12 ± 15°, P renals, whereas F-renals exhibited increased end-stent angulation (5 ± 10°, P renal stent patency was 94.1% and renal impairment occurred in 2 patients (6.7%). Although F- and Sn-EVAR resulted in significant, and opposite, changes to renal branch angle, only Sn-EVAR resulted in significant end-stent angulation increase. Longitudinal geometric analysis suggests that these anatomic alterations are primarily generated early as a consequence of the procedure itself and, although persistent, they show no evidence of continued significant change during the subsequent postoperative follow-up period. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. An anatomic risk model to screen post endovascular aneurysm repair patients for aneurysm sac enlargement.

    Science.gov (United States)

    Png, Chien Yi M; Tadros, Rami O; Beckerman, William E; Han, Daniel K; Tardiff, Melissa L; Torres, Marielle R; Marin, Michael L; Faries, Peter L

    2017-09-01

    Follow-up computed tomography angiography (CTA) scans add considerable postimplantation costs to endovascular aneurysm repairs (EVARs) of abdominal aortic aneurysms (AAAs). By building a risk model, we hope to identify patients at low risk for aneurysm sac enlargement to minimize unnecessary CTAs. 895 consecutive patients who underwent EVAR for AAA were reviewed, of which 556 met inclusion criteria. A Probit model was created for aneurysm sac enlargement, with preoperative aneurysm morphology, patient demographics, and operative details as variables. Our final model included 287 patients and had a sensitivity of 100%, a specificity of 68.9%, and an accuracy of 70.4%. Ninety-nine (35%) of patients were assigned to the high-risk group, whereas 188 (65%) of patients were assigned to the low-risk group. Notably, regarding anatomic variables, our model reported that age, pulmonary comorbidities, aortic neck diameter, iliac artery length, and aneurysms were independent predictors of post-EVAR sac enlargement. With the exception of age, all statistically significant variables were qualitatively supported by prior literature. With regards to secondary outcomes, the high-risk group had significantly higher proportions of AAA-related deaths (5.1% versus 1.1%, P = 0.037) and Type 1 endoleaks (9.1% versus 3.2%, P = 0.033). Our model is a decent predictor of patients at low risk for post AAA EVAR aneurysm sac enlargement and associated complications. With additional validation and refinement, it could be applied to practices to cut down on the overall need for postimplantation CTA. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection

    International Nuclear Information System (INIS)

    Chen, I-Ming; Chen, Po-Lin; Huang, Chun-Yang; Weng, Shih-Hsien; Chen, Wei-Yuan; Shih, Chun-Che

    2017-01-01

    PurposeThe purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection.Materials and MethodsThe patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen.ResultsA total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively.ConclusionsIncreased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection.Level of EvidenceIII.

  9. Ultrasound surveillance of endovascular aneurysm repair: a safe modality versus computed tomography.

    Science.gov (United States)

    Collins, John T; Boros, Michael J; Combs, Kristin

    2007-11-01

    Routine ultrasound surveillance is adequate and safe for monitoring endovascular aneurysm repairs (EVARs). A retrospective chart review including 160 endograft patients was performed from August 2000 to September 2005. All ultrasound examinations (n = 359) were performed by a board-certified vascular surgery group's accredited laboratory. Registered vascular technologists utilized the same equipment consisting of Siemens Antares high-definition ultrasonography with tissue harmonics and color flow Doppler. An identical protocol was followed by each technologist: scan body and both limbs of the endograft and distal iliac vessels, measure anterior-posterior aneurysm sac size, and detect intrasac pulsatility and color flow. Statistical analysis utilized Pearson's correlation coefficient and the paired t-test. Forty-one endoleaks were discovered out of the 359 exams (11.4%). There were type I (7, 17%), type II (26, 63%), and combined type I with type II (8, 20%) endoleaks. Correlation with computed tomography (CT) was obtained in 35 of these cases. CT discovered three endoleaks that were not seen with ultrasound. However, these particular ultrasound exams were inadequate due to additional factors (bowel gas, body habitus, hernia), which prompted CT investigation and, hence, endoleak discovery. Of the 41 endoleaks found on ultrasound, only 14 were seen on CT. Specifically, 26 type II endoleaks were seen with ultrasound versus only nine during CT. Additional factors addressed included comparison between ultrasound and CT of residual aneurysm sac measurements and conditions limiting ultrasound examination. Although criticized in the past, color flow ultrasonography is a safe and effective modality for surveillance of aortic endografts. Utilizing ultrasound to analyze abdominal aortic aneurysm (AAA) sac dimensions and endoleak detection is statistically sound for screening AAA status post-EVAR.

  10. Fitness plus American Society of Anesthesiologists grade improve outcome prediction after endovascular aneurysm repair.

    Science.gov (United States)

    Boult, Margaret; Cowled, Prue; Barnes, Mary; Fitridge, Robert A

    2017-09-01

    Although the American Society of Anesthesiologists (ASA) grade was established for statistical purposes, it is often used prognostically. However, older patients undergoing elective surgery are typically ASA III, which limits patient stratification. We look at the prognostic effect on early complications and survival of using ASA and self-reported physical fitness to stratify patients undergoing endovascular repair of abdominal aortic aneurysms. Data were extracted from a trial database. All patients were assigned a fitness level (A (fit) or B (unfit)) based on their self-reported ability to walk briskly for 1 km or climb two flights of stairs. Fitness was used to stratify ASA III patients, with fitter patients assigned ASA IIIA and less fit patients ASA IIIB. Outcomes assessed included survival, reinterventions, endoleak, all early and late complications and early operative complications. A combined ASA/fitness scale (II, IIIA, IIIB and IV) correlated with 1- and 3-year survival (1-year P = 0.001, 3-year P = 0.001) and early and late complications (P = 0.001 and P = 0.05). On its own, ASA predicted early complications (P = 0.0004) and survival (1-year P = 0.01, 3-year P = 0.01). Fitness alone was predictive for survival (1-year P = 0.001, 3-year P = 0.001) and late complications (P = 0.009). This study shows that even a superficial assessment of fitness is reflected in surgical outcomes, with fitter ASA III patients showing survival patterns similar to ASA II patients. Physicians should be alert to differences in fitness between patients in the ASA III group, despite similarities based on preexisting severe systemic disease. © 2017 Royal Australasian College of Surgeons.

  11. Laparotomy during endovascular repair of ruptured abdominal aortic aneurysms increases mortality.

    Science.gov (United States)

    Adkar, Shaunak S; Turley, Ryan S; Benrashid, Ehsan; Cox, Mitchell W; Mureebe, Leila; Shortell, Cynthia K

    2017-02-01

    Subset analyses from small case series suggest patients requiring laparotomy during endovascular repair of ruptured abdominal aortic aneurysms (REVAR) have worse survival than those undergoing REVAR without laparotomy. Most concomitant laparotomies are performed for abdominal compartment syndrome. This study used data from the American College of Surgeons National Surgical Quality Improvement Program to determine whether the need for laparotomy during REVAR is associated with increased mortality. Data were obtained from the 2005 to 2013 National Surgical Quality Improvement Program participant user files based on Current Procedural Terminology (American Medical Association, Chicago, Ill) and International Classification of Diseases-9 Edition coding. Patient and procedure-related characteristics and 30-day postoperative outcomes were compared using Pearson χ 2 tests for categoric variables and Wilcoxon rank sum tests for continuous variables. A backward-stepwise multivariable logistic regression model was used to identify patient- and procedure-related factors associated with increased death after REVAR. We identified 1241 patients who underwent REVAR, and 91 (7.3%) required concomitant laparotomy. The 30-day mortality was 60% in the laparotomy group and 21% in the standard REVAR group (P < .001). The major complication rate was also higher in the laparotomy group (88% vs 63%; P < .001). Multivariable analysis showed laparotomy was strongly associated with 30-day mortality (odds ratio, 5.91; 95% confidence interval, 3.62-9.62; P < .001). Laparotomy during REVAR is a commonly used technique for the management of elevated intra-abdominal pressure and abdominal compartment syndrome development. The results of this study strongly confirm findings from smaller studies that the need for laparotomy during REVAR is associated with significantly worse 30-day survival. Copyright © 2016. Published by Elsevier Inc.

  12. Perioperative risk factors for hospital readmission after elective endovascular aortic aneurysm repair.

    Science.gov (United States)

    Chen, Samuel L; Kuo, Isabella J; Kabutey, Nii-Kabu; Gabra, Fady; Fujitani, Roy M

    2018-04-02

    Elective endovascular aneurysm repair (EVAR) is generally well tolerated. However, the incidence of hospital readmission after EVAR and the risk factors and reasons for it are not well studied. This study sought to determine the incidence, to characterize the indications, and to identify perioperative patient-centered risk factors for hospital readmission within 30 days after elective EVAR. All patients who underwent EVAR electively in 2012 to 2013 were identified from the American College of Surgeons National Surgical Quality Improvement Program Targeted Vascular database (n = 3886). Preoperative demographics, operation-specific variables, and postoperative outcomes were compared between those who were readmitted within 30 days of the index operation and those who were not. Multivariate logistic regression was then used to determine independent predictors of hospital readmission. The unadjusted 30-day readmission rate after EVAR was 8.2%. Of all readmissions, 55% were for reasons related to the procedure. Median time to readmission was 12 days. Significant preoperative risk factors associated with readmission were female sex, preoperative steroid use, congestive heart failure, and dialysis dependence (P readmission, including myocardial infarction and deep venous thrombosis (P readmission were surgical site infection (odds ratio, 10.24; 95% confidence interval, 5.31-19.75; P readmissions remain a costly problem after vascular surgery and are associated with 30-day mortality after elective EVAR. Whereas female sex and certain irreversible medical comorbidities are nonmodifiable, focusing on medical optimization and identifying those perioperative variables that can affect the need for post-EVAR interventions will be an important step in decreasing hospital readmission. Copyright © 2018 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  13. Prevalence and risk factors of type II endoleaks after endovascular aneurysm repair: A meta-analysis.

    Directory of Open Access Journals (Sweden)

    Qiang Guo

    Full Text Available This systematic review and meta-analysis aims to determine the current evidence on risk factors for type II endoleaks after endovascular aneurysm repair (EVAR.A systematic literature search was carried out for studies that evaluated the association of demographic, co-morbidity, and other patient-determined factors with the onset of type II endoleaks. Pooled prevalence of type II endoleaks after EVAR was updated.Among the 504 studies screened, 45 studies with a total of 36,588 participants were included in this review. The pooled prevalence of type II endoleaks after EVAR was 22% [95% confidence interval (CI, 19%-25%]. The main factors consistently associated with type II endoleaks included age [pooled odds ratio (OR, 0.37; 95% CI, 0.31-0.43; P<0.001], smoking (pooled OR, 0.71; 95% CI, 0.55-0.92; P<0.001, patent inferior mesenteric artery (pooled OR, 1.98; 95% CI, 1.06-3.71; P = 0.012, maximum aneurysm diameter (pooled OR, 0.23; 95% CI, 0.17-0.30; P<0.001, and number of patent lumbar arteries (pooled OR, 3.07; 95% CI, 2.81-3.33; P<0.001. Sex, diabetes, hypertension, anticoagulants, antiplatelet, hyperlipidemia, chronic renal insufficiency, types of graft material, and chronic obstructive pulmonary diseases (COPD did not show any association with the onset of type II endoleaks.Clinicians can use the identified risk factors to detect and manage patients at risk of developing type II endoleaks after EVAR. However, further studies are needed to analyze a number of potential risk factors.

  14. Endovascular repair or medical treatment of acute type B aortic dissection? A comparison

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    Chemelli-Steingruber, I. [Department of Radiology, Innsbruck Medical University (Austria); Chemelli, A. [Department of Radiology, Innsbruck Medical University (Austria)], E-mail: andreas.chemelli@i-med.ac.at; Strasak, A. [Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University (Austria); Hugl, B. [Department of Vascular Surgery, Innsbruck Medical University (Austria); Hiemetzberger, R. [Department of Cardiology, Innsbruck Medical University (Austria); Jaschke, W.; Glodny, B.; Czermak, B.V. [Department of Radiology, Innsbruck Medical University (Austria)

    2010-01-15

    Introduction: The aim of this retrospective study was to compare the outcome of thoracic endovascular aortic repair (TEVAR) to that of medical therapy in patients with acute type B aortic dissection (TBD). Materials and methods: From July 1996 to April 2008, 88 patients presenting with acute TBD underwent either TEVAR (group A, n = 38) or medical therapy (group B, n = 50). Indications for TEVAR were intractable pain, aortic branch compromise resulting in end-organ ischemia, rapid aortic dilatation and rupture. Follow-up was performed postinterventionally, at 3, 6 and 12 months and yearly thereafter and included clinical examinations and computed tomography (CT), as well as aortic diameter measurements and assessment of thrombosis. Results: Mean follow-up was 33 months in group A and 36 months in group B. The overall mortality rate was 23.7% in group A and 24% in group B, where 4 patients died of late aortic rupture. In group A, complications included 9 endoleaks and 4 retrograde type A dissections, 3 patients were converted to open surgery and 2 needed secondary intervention. None of the patients developed paraplegia. In group B, 4 patients were converted to open surgery and 2 to TEVAR. The maximal aortic diameter increased in both groups. Regarding the extent of thrombosis, our analyses showed slightly better overall results after TEVAR, but they also showed a tendency towards approximation between the two groups during follow-up. Conclusion: TEVAR is a feasible treatment option in acute TBD. However, several serious complications may occur during and after TEVAR and it should therefore be reserved to patients with life-threatening symptoms.

  15. Mid-term outcomes of endovascular aortic aneurysm repair with carbon dioxide-guided angiography.

    Science.gov (United States)

    Takeuchi, Yuriko; Morikage, Noriyasu; Matsuno, Yutaro; Nakamura, Tamami; Samura, Makoto; Ueda, Koshiro; Harada, Takasuke; Ikeda, Yoshitaka; Suehiro, Kotaro; Ito, Hiroshi; Sakata, Kensuke; Hamano, Kimikazu

    2018-05-14

    Although iodinated contrast (IC) agents are commonly used in endovascular aneurysm repair (EVAR), perioperative use in patients with renal dysfunction or IC allergies is avoided. Carbon dioxide (CO 2 )-guided angiography is a promising alternative. We aimed to evaluate short-term and mid-term outcomes of EVAR using CO 2 -guided angiography. Three hundred and eighty-one patients who underwent EVAR from January 2012 to September 2016 were retrospectively reviewed and divided into an IC-EVAR group (n=351) and CO 2 -EVAR group (n=30). Subjects in the CO 2 -EVAR group had severe renal dysfunction (n=27) and IC allergy (n=4). Intraoperative, postoperative, and follow-up variables were compared. Compared to the IC-EVAR group, preoperative serum creatinine level was significantly higher (2.0 vs. 0.92 mg/dL, P < .0001) and mean IC dose significantly lower (18 vs. 55 mL P < .0001) in the CO 2 -EVAR group. The fluoroscopy time, operative time, number of stent grafts placed, and technical success rates of the groups were similar; no type I and/or type III endoleaks were detected on completion angiography. There was no acute kidney injury and one case of intestinal necrosis in the CO 2 -EVAR group, potentially due to cholesterol embolism. Postoperative endoleak, enlargement of aneurysms, survival, freedom from secondary intervention, and renal function change up to 3 months postoperatively were similar between groups. CO 2 -EVAR is technically feasible and exhibits prominent renal protection. However, consideration of the aortic lumen status remains an important challenge. Copyright © 2018. Published by Elsevier Inc.

  16. The financial implications of endovascular aneurysm repair in the cost containment era.

    Science.gov (United States)

    Stone, David H; Horvath, Alexander J; Goodney, Philip P; Rzucidlo, Eva M; Nolan, Brian W; Walsh, Daniel B; Zwolak, Robert M; Powell, Richard J

    2014-02-01

    Endovascular aneurysm repair (EVAR) is associated with significant direct device costs. Such costs place EVAR at odds with efforts to constrain healthcare expenditures. This study examines the procedure-associated costs and operating margins associated with EVAR at a tertiary care academic medical center. All infrarenal EVARs performed from April 2011 to March 2012 were identified (n = 127). Among this cohort, 49 patients met standard commercial instruction for use guidelines, were treated using a single manufacturer device, and billed to Medicare diagnosis-related group (DRG) 238. Of these 49 patients, net technical operating margins (technical revenue minus technical cost) were calculated in conjunction with the hospital finance department. EVAR implant costs were determined for each procedure. DRG 238-associated costs and length of stay were benchmarked against other academic medical centers using University Health System Consortium 2012 data. Among the studied EVAR cohort (age 75, 82% male, mean length of stay, 1.7 days), mean technical costs totaled $31,672. Graft implants accounted for 52% of the allocated technical costs. Institutional overhead was 17% ($5495) of total technical costs. Net mean total technical EVAR-associated operating margins were -$4015 per procedure. Our institutional costs and length of stay, when benchmarked against comparable centers, remained in the lowest quartile nationally using University Health System Consortium costs for DRG 238. Stent graft price did not correlate with total EVAR market share. EVAR is currently associated with significant negative operating margins among Medicare beneficiaries. Currently, device costs account for over 50% of EVAR-associated technical costs and did not impact EVAR market share, reflecting an unawareness of cost differential among surgeons. These data indicate that EVAR must undergo dramatic care delivery redesign for this practice to remain sustainable. Copyright © 2014 Society for Vascular

  17. Endoscopic repair of an injured internal carotid artery utilizing femoral endovascular closure devices.

    Science.gov (United States)

    Van Rompaey, Jason; Bowers, Greg; Radhakrishnan, Jay; Panizza, Benedict; Solares, C Arturo

    2014-06-01

    Injury to the internal carotid artery is a feared complication of endoscopic endonasal surgery of the skull base. Such an event, although rare, is associated with high morbidity and mortality. Even if bleeding is controlled, permanent neurological defects frequently persist. Many techniques have been developed to manage internal carotid artery rupture with varying degrees of success. The purpose of this study was to explore endoscopic management of arterial damage with endovascular closure devices used for a femoral arteriotomy. The ability to remotely suture a damaged artery permits the possible adaptation of this technology in managing endoscopic arterial complications. Technical note. After the creation of an endoscopic endonasal corridor in a cadaveric specimen, an arteriotomy was created at the cavernous portion of the internal carotid artery. The Angio-Seal, StarClose, and MynxGrip vascular closure devices were utilized under endoscopic guidance to repair the arteriotomy. Angiography was then done on a cadaver sutured with the StarClose. Both the Angio-Seal and StarClose were deployed quickly and appeared to provide sufficient closure of the arteriotomy. The Angio-Seal required the use of a guidewire and was longer to deploy when compared with the StarClose. The StarClose deployment was quick and facile. The MynxGrip also deployed without difficulty. The Angio-Seal and StarClose systems were both successfully deployed utilizing an endoscopic endonasal approach. The MynxGrip was the easiest to deploy and has the greatest potential to be of benefit in this application. Further studies with hemodynamic models are required to properly assess the appropriateness in this setting. NA. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  18. Management of aorto-esophageal fistula secondary after thoracic endovascular aortic repair: a review of literature.

    Science.gov (United States)

    Uno, Kaname; Koike, Tomoyuki; Takahashi, Seiichi; Komazawa, Daisuke; Shimosegawa, Tooru

    2017-10-01

    Aorto-esophageal fistula (AEF) is a rare and lethal entity, and the difficulty of making diagnosis of AEF is well-known. As promising results in the short-term effectiveness of thoracic endovascular aortic repair (TEVAR) promote its usage, the occurrence of AEF after TEVAR (post-TEVAR AEF) increases as one of the major complications. Therefore, we provide a review concerning the management strategy of post-TEVAR AEF. Although its representative symptom was reported as the triad of mid-thoracic pain and sentinel hematemesis followed by massive hematemesis, the symptom-free interval between sentinel hemorrhage and massive exsanguination is unpredictable. However, the physiological condition represents a surgical contraindication. Accordingly, early diagnosis is important, but either CT or esophago-gastro-duodenoscopy rarely depicts a typical image. The formation of post-TEVAR AEF might be associated with the infection of micro-organisms, which is uncontrollable with anti-biotic administration. The current first-line strategy is combination therapy as follows, (1) to control bleeding by TEVAR in the urgent phase, and (2) radical debridement and aortic/esophageal re-construction in the semi-urgent phase. In view of the high mortality and morbidity rate, it is proposed that the choice in treatment strategies might be affected by patient`s condition, size of the wall defects and the etiology of AEF. Practically, we should keep in mind the importance of making an early diagnosis and, once a suspicious symptom has occurred in a patient with a history of TEVAR, the existence of post-TEVAR AEF should be suspected. A prospective registry together with more developed technologies will be needed to establish a future strategy.

  19. Factors Affecting Optimal Aortic Remodeling After Thoracic Endovascular Aortic Repair of Type B (IIIb) Aortic Dissection

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    Chen, I-Ming [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China); Chen, Po-Lin; Huang, Chun-Yang [National Yang Ming University, Department of Medicine, School of Medicine (China); Weng, Shih-Hsien; Chen, Wei-Yuan; Shih, Chun-Che, E-mail: ccshih@vghtpe.gov.tw [National Yang Ming University, Institute of Clinical Medicine, School of Medicine (China)

    2017-05-15

    PurposeThe purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection.Materials and MethodsThe patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen.ResultsA total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively.ConclusionsIncreased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection.Level of EvidenceIII.

  20. A simulator for training in endovascular aneurysm repair: The use of three dimensional printers.

    Science.gov (United States)

    Torres, I O; De Luccia, N

    2017-08-01

    To develop an endovascular aneurysm repair (EVAR) simulation system using three dimensional (3D) printed aneurysms, and to evaluate the impact of patient specific training prior to EVAR on the surgical performance of vascular surgery residents in a university hospital in Brazil. This was a prospective, controlled, single centre study. During 2015, the aneurysms of patients undergoing elective EVAR at São Paulo University Medical School were 3D printed and used in training sessions with vascular surgery residents. The 3D printers Stratasys-Connex 350, Formlabs-Form1+, and Makerbot were tested. Ten residents were enrolled in the control group (five residents and 30 patients in 2014) or the training group (five residents and 25 patients in 2015). The control group performed the surgery under the supervision of a senior vascular surgeon (routine procedure, without simulator training). The training group practised the surgery in a patient specific simulator prior to the routine procedure. Objective parameters were analysed, and a subjective questionnaire addressing training utility and realism was answered. Patient specific training reduced fluoroscopy time by 30% (mean 48 min, 95% confidence interval [CI] 40-58 vs. 33 min, 95% CI 26-42 [p training useful and realistic, and reported that it increased their self confidence. The 3D printers Form1+ (using flexible resin) and Makerbot (using silicone) provided the best performance based on simulator quality and cost. An EVAR simulation system using 3D printed aneurysms was feasible. The best results were obtained with the 3D printers Form1+ (using flexible resin) and Makerbot (using silicone). Patient specific training prior to EVAR at a university hospital in Brazil improved residents' surgical performance (based on fluoroscopy time, surgery time, and volume of contrast used) and increased their self confidence. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  1. Endovascular aneurysm repair delivery redesign leads to quality improvement and cost reduction.

    Science.gov (United States)

    Warner, Courtney J; Horvath, Alexander J; Powell, Richard J; Columbo, Jesse A; Walsh, Teri R; Goodney, Philip P; Walsh, Daniel B; Stone, David H

    2015-08-01

    Endovascular aneurysm repair (EVAR) is now a mainstay of therapy for abdominal aortic aneurysm, although it remains associated with significant expense. We performed a comprehensive analysis of EVAR delivery at an academic medical center to identify targets for quality improvement and cost reduction in light of impending health care reform. All infrarenal EVARs performed from April 2011 to March 2012 were identified (N = 127). Procedures were included if they met standard commercial instructions for use guidelines, used a single manufacturer, and were billed to Medicare diagnosis-related group 238 (n = 49). By use of DMAIC (define, measure, analyze, improve, and control) quality improvement methodology (define, measure, analyze, improve, control), targets for EVAR quality improvement were identified and high-yield changes were implemented. Procedure technical costs were calculated before and after process redesign. Perioperative services and clinic visits were identified as targets for quality improvement efforts and cost reduction. Mean technical costs before the intervention were $31,672, with endograft implants accounting for 52%. Pricing redesign in collaboration with hospital purchasing reduced mean EVAR technical costs to $28,607, a 10% reduction in overall cost, with endograft implants now accounting for 46%. Perioperative implementation of instrument tray redesign reduced instrument use by 32% (184 vs 132 instruments), saving $50,000 annually. Unnecessary clinic visits were reduced by 39% (1.6 vs 1.1 clinic visits per patient) through implementation of a preclinic imaging protocol. There was no difference in mean length of stay after the intervention. Comprehensive EVAR delivery redesign leads to cost reduction and waste elimination while preserving quality. Future efforts to achieve more competitive and transparent device pricing will make EVAR more cost neutral and enhance its financial sustainability for health care systems. Copyright © 2015 Society for

  2. Evaluation of Aneurysm Neck Angle Change After Endovascular Aneurysm Repair Clinical Investigations

    Energy Technology Data Exchange (ETDEWEB)

    Le, Trong Binh; Moon, Mi Hyoung [Inha University Hospital, Endovascular Training Center (Korea, Republic of); Jeon, Yong Sun, E-mail: radjeon@inha.ac.kr [Inha University Hospital, Inha University School of Medicine, Department of Radiology (Korea, Republic of); Hong, Kee Chun [Inha University School of Medicine, Department of Vascular Surgery (Korea, Republic of); Cho, Soon Gu [Inha University Hospital, Inha University School of Medicine, Department of Radiology (Korea, Republic of); Park, Keun-Myoung [Inha University School of Medicine, Department of Vascular Surgery (Korea, Republic of)

    2016-05-15

    PurposeTo evaluate the aneurysm neck angle changes and post-endovascular aneurysm repair (EVAR) complications.MethodsWe retrospectively analyzed 72 cases of elective EVAR for abdominal aortic aneurysm among 109 consecutive cases from December 2005 to April 2014. Patients were divided into angulated and non-angulated groups. The angulated group was defined as neck angulation ≥60°. Neck angle was evaluated pre- and post-EVAR during short- (within 1 month), mid- (3–6 months), and long-term (>1 year) follow-up. Aneurysm sac diameter change, aneurysm neck morphology other than angulation, endoleaks, and other post-procedural complications were also documented.ResultsA total of 34 patients were enrolled in the angulated group. There were no statistical differences in age, sex, follow-up duration, and aneurysm neck profile between the two groups (p > 0.05). Both groups showed statistically significant and consistent decreases in angulation during the follow-up period (p < 0.01). The angulated group revealed 22.45 % more straightening than the non-angulated group. Recoil of the Endurant device occurred in the angulated group. No statistically significant intergroup differences were observed in any endoleaks, complications, or re-intervention rates (p > 0.05). Pre-EVAR angle was the only predictor for post-procedural angle change (p < 0.001).ConclusionEVAR is applicable for patients with highly angulated aneurysm neck and provides consistent neck straightening over long-term follow-up. Recoil was evident in the angulated group using the Endurant device.

  3. Outcomes and Prognostic Factors of Endovascular Abdominal Aortic Aneurysm Repair in Patients with Hostile Neck Anatomy

    International Nuclear Information System (INIS)

    Jung, Hye Doo; Lee, Yun Young; Lee, Seung Jin; Yim, Nam Yeol; Kim, Jae Kyu; Choi, Soo Jin Na; Jung, Sang Young; Chang, Nam Kyu; Lim, Jae Hoon

    2012-01-01

    To evaluate the outcomes and find the prognostic factors of endovascular abdominal aortic aneurysm repair (EVAR) in patients with hostile neck anatomy of the abdominal aorta. This study was performed on 100 patients with abdominal aneurysm who were treated with EVAR between March 2006 and December 2010. We divided the patients into two groups: good neck anatomy (GNA), and hostile neck anatomy (HNA) and then compared the primary success rate and the incidence rate of complications with EVAR between the two groups. Our aim was to determine the factors related to the complications of EVAR among HNA types. There were no significant differences of primary success rate and incidence rate of complications between the two groups. Among the types of HNA, the short neck angle [odd ratio (OR), 4.23; 95% confidence interval (CI), 1.21-18.70; p = 0.023] and large neck angle (OR, 2.58; 95% CI, 0.15-11.85; p = 0.031) showed a low primary success rate. The short neck angle (OR, 2.32; 95% CI, 1.18-12.29; p = 0.002) and large neck angle (OR, 4.67; 95% CI, 0.14-19.07; p = 0.032) showed a high incidence rate of early type 1 complication. In the case of the large neck angle (OR, 3.78; 95% CI, 0.96-20.80; p = 0.047), the large neck thrombus (OR, 2.23; 95% CI, 0.24-7.12; p = 0.035) and large neck calcification (OR, 2.50; 95% CI, 0.08-18.37; p 0.043) showed a high incidence rate of complications within a year. The results suggest that patients with hostile neck anatomy can be treated with EVAR successfully, although there was a higher incidence of complications in patients with a short neck length, severe neck angulation, circumferential thrombosis, and calcified proximal neck.

  4. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    International Nuclear Information System (INIS)

    Steingruber, I.E.; Neuhauser, B.; Seiler, R.; Greiner, A.; Chemelli, A.; Kopf, H.; Walch, C.; Waldenberger, P.; Jaschke, W.; Czermak, B.

    2006-01-01

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions

  5. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Steingruber, I.E. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)]. E-mail: iris.steingruber@uibk.ac.at; Neuhauser, B. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Seiler, R. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Greiner, A. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Chemelli, A. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Kopf, H. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Walch, C. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Waldenberger, P. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Jaschke, W. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Czermak, B. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)

    2006-09-15

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

  6. Endovascular repair of arterial iliac vessel wall lesions with a self-expandable nitinol stent graft system.

    Directory of Open Access Journals (Sweden)

    Birger Mensel

    Full Text Available To assess the therapeutic outcome after endovascular repair of iliac arterial lesions (IALs using a self-expandable Nitinol stent graft system.Between July 2006 and March 2013, 16 patients (13 males, mean age: 68 years with a self-expandable Nitinol stent graft. A total of 19 lesions were treated: nine true aneurysms, two anastomotic aneurysms, two dissections, one arteriovenous fistula, two type 1B endoleaks after endovascular aneurysm repair, one pseudoaneurysm, and two perforations after angioplasty. Pre-, intra-, and postinterventional imaging studies and the medical records were analyzed for technical and clinical success and postinterventional complications.The primary technical and clinical success rate was 81.3% (13/16 patients and 75.0% (12/16, respectively. Two patients had technical failure due to persistent type 1A endoleak and another patient due to acute stent graft thrombosis. One patient showed severe stent graft kinking on the first postinterventional day. In two patients, a second intervention was performed. The secondary technical and clinical success rate was 87.5% (14/16 and 93.8% (15/16. The minor complication rate was 6.3% (patient with painful hematoma at the access site. The major complication rate was 6.3% (patient with ipsilateral deep vein thrombosis. During median follow-up of 22.4 months, an infection of the aneurysm sac in one patient and a stent graft thrombosis in another patient were observed.Endovascular repair of various IALs with a self-expandable Nitinol stent graft is safe and effective.

  7. Endovascular repair as a sole treatment in multiple aneurysms in patient with SLE

    International Nuclear Information System (INIS)

    Dineva, S.; Al-Amin, M.; Demetriou, S.; Tsetis, D.

    2013-01-01

    Full text: Introduction: Most aneurysms are local manifestations of systemic disease. For patients over 65 years the incidence of aneurysm of the abdominal aorta (AAA) is approximately 5-6% in men and 1-2 % for women. The presence of both the AAA and aneurysms in other location is even rarer, and this percentage is likely increase further in patients with systemic lupus erythematosus (SLE). What you will learn: We present a rare clinical case of endovascular treatment of multifocal aneurysm including post catheterization pseudoaneurysm. The patient is a 73 years old woman with a history of SLE and age-related comorbidity. Originally an endovascular treatment of aneurysms of the abdominal aorta and right common iliac artery was used. Two years later a successfully endovascular treatment of aneurysm of the right renal artery was conducted, which however is complicated by the formation of a pseudoaneurysm in access through the left femoral artery. The late one is again treated endovascular by placement of a covered stent after failure of percutaneous injection of 1000 UI thrombin. Discussion: Adult patients with a long history of SLE are unsuitable candidates for surgical treatment of aneurysmal disease, especially in its multifocal form. In our case we have taken multistep successful endovascular procedures, including technically hard placing of the stent at the site of the right renal aneurysms, and post catheterization pseudoaneurysm. Conclusion: Multifocal aneurysmal vascular changes due to macroangiopathia in SLE can be treated alone by endovascular means in multi-stages procedures

  8. Emergent cardiopulmonary bypass during pectus excavatum repair

    Directory of Open Access Journals (Sweden)

    Ryan Craner

    2013-01-01

    Full Text Available Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.

  9. A trade off between emergency repair and inventory investment

    NARCIS (Netherlands)

    Verrijdt, J.H.C.M.; Adan, I.J.B.F.; Kok, de A.G.

    1998-01-01

    In this paper we present an emergency repair model. We model a situation where failed parts arrive at a repair shop according to a Poisson process. If the stock on hand of serviceable spare parts exceeds a given emergency trigger level, the failed part is sent into normal repair. Otherwise the

  10. Endovascular Aneurysm Repair: Is Imaging Surveillance Robust, and Does It Influence Long-term Mortality?

    Energy Technology Data Exchange (ETDEWEB)

    Waduud, Mohammed Abdul, E-mail: m.a.waduud@doctors.org.uk [Glasgow Royal Infirmary, Department of Surgery (United Kingdom); Choong, Wen Ling, E-mail: wenlingchoong@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Surgery (United Kingdom); Ritchie, Moira, E-mail: moirasim9@gmail.com; Williams, Claire, E-mail: c.williams.3@research.gla.ac.uk [University of Glasgow, Institute of Health and Wellbeing Glasgow (United Kingdom); Yadavali, Reddi, E-mail: reddi.yadavali@nhs.net [Aberdeen Royal Infirmary, NHS Grampian, Department of Radiology (United Kingdom); Lim, Shueh, E-mail: s.lim.06@aberdeen.ac.uk [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Buchanan, Fraser, E-mail: f.buchanan.11@aberdeen.ac.uk [University of Aberdeen, The School of Medicine and Dentistry (United Kingdom); Bhat, Raj, E-mail: raj.bhat@nhs.net [Ninewells Hospital, NHS Tayside, Department of Radiology (United Kingdom); Ramanathan, Krishnappan, E-mail: k.ramanathan@dundee.ac.uk [University of Dundee, School of Medicine (United Kingdom); Ingram, Susan, E-mail: susan.ingram@luht.scot.nhs.uk; Cormack, Laura, E-mail: lgcormack@googlemail.com [Royal Infirmary of Edinburgh, NHS Lothian, Department of Radiology (United Kingdom); Moss, Jonathan G., E-mail: jon.moss@ggc.scot.nhs.uk [Gartnavel General Hospital, Department of Radiology (United Kingdom)

    2015-02-15

    PurposeEndovascular aneurysm repair (EVAR) is the dominant treatment strategy for abdominal aortic aneurysms. However, as a result of uncertainty regarding long-term durability, an ongoing imaging surveillance program is required. The aim of the study was to assess EVAR surveillance in Scotland and its effect on all-cause and aneurysm-related mortality.MethodsA retrospective analysis of all EVAR procedures carried out in the four main Scottish vascular units. The primary outcome measure was the implementation of post-EVAR imaging surveillance across Scotland. Patients were identified locally and then categorized as having complete, incomplete, or no surveillance. Secondary outcome measures were all-cause mortality and aneurysm-related mortality. Cause of death was obtained from death certificates.ResultsData were available for 569 patients from the years 2001 to 2012. All centers had data for a minimum of 5 contiguous years. Surveillance ranged from 1.66 to 4.55 years (median 3.03 years). Overall, 53 % had complete imaging surveillance, 43 % incomplete, and 4 % none. For the whole cohort, all-cause 5-year mortality was 33.5 % (95 % confidence interval 28.0–38.6) and aneurysm-related mortality was 4.5 % (.8–7.3). All-cause mortality in patients with complete, incomplete, and no imaging was 49.9 % (39.2–58.6), 19.1 % (12.6–25.2), and 47.2 % (17.7–66.2), respectively. Aneurysm-related mortality was 3.7 % (1.8–7.4), 4.4 % (2.2–8.9), and 9.5 % (2.5–33.0), respectively. All-cause mortality was significantly higher in patients with complete compared to incomplete imaging surveillance (p < 0.001). No significant differences were observed in aneurysm-related mortality (p = 0.2).ConclusionOnly half of EVAR patients underwent complete long-term imaging surveillance. However, incomplete imaging could not be linked to any increase in mortality. Further work is required to establish the role and deliverability of EVAR imaging surveillance.

  11. Duplex ultrasound in aneurysm surveillance following endovascular aneurysm repair: a comparison with computed tomography aortography.

    LENUS (Irish Health Repository)

    Manning, Brian J

    2012-02-01

    OBJECTIVES: Cumulative radiation dose, cost, and increased demand for computed tomography aortography (CTA) suggest that duplex ultrasonography (DU) may be an alternative to CTA-based surveillance. We compared CTA with DU during endovascular aneurysm repair (EVAR) follow-up. METHODS: Patients undergoing EVAR had clinical and radiological follow-up data entered in a prospectively maintained database. For the purpose of this study, the gold standard test for endoleak detection was CTA, and an endoleak detected on DU alone was assumed to be a false positive result. DU interpretation was performed independently of CTA and vice versa. RESULTS: One hundred thirty-two patients underwent EVAR, of whom 117 attended for follow-up ranging from six months to nine years (mean, 32 months). Adequate aneurysm sac visualisation on DU was not possible in 1.7% of patients, predominantly due to obesity. Twenty-eight endoleaks were detected in 28 patients during follow-up. Of these, 24 were initially identified on DU (four false negative DU examinations), and eight had at least one negative CTA with a positive DU prior to diagnosis. Twenty-three endoleaks were type II in nature and three of these patients had increased sac size. There was one type I and four type III endoleaks. Two of these (both type III) had an increased sac size. Of 12 patients with increased aneurysm size of 5 mm or more at follow-up, five had an endoleak visible on DU, yet negative CTA and a further five had endoleak visualisation on both DU and CTA. Of six endoleaks which underwent re-intervention, all were initially picked up on DU. One of these endoleaks was never demonstrated on CTA and a further two had at least one negative CTA prior to endoleak confirmation. Positive predictive value for DU was 45% and negative predictive value 94%. Specificity of DU for endoleak detection was 67% when compared with CTA, because of the large number of false positive DU results. Sensitivity for DU was 86%, with all

  12. Intentional left subclavian artery coverage during thoracic endovascular aortic repair for traumatic aortic injury.

    Science.gov (United States)

    McBride, Cameron L; Dubose, Joseph J; Miller, Charles C; Perlick, Alexa P; Charlton-Ouw, Kristofer M; Estrera, Anthony L; Safi, Hazim J; Azizzadeh, Ali

    2015-01-01

    Thoracic endovascular aortic repair (TEVAR) is widely used for treatment of traumatic aortic injury (TAI). Stent graft coverage of the left subclavian artery (LSA) may be required in up to 40% of patients. We evaluated the long-term effects of intentional LSA coverage (LSAC) on symptoms and return to normal activity in TAI patients compared with a similarly treated group whose LSA was uncovered (LSAU). Patients were identified from a prospective institutional trauma registry between September 2005 and July 2012. TAI was confirmed using computed tomography angiography. The electronic medical records, angiograms, and computed tomography angiograms were reviewed in a retrospective fashion. In-person or telephone interviews were conducted using the SF-12v2 (Quality Metrics, Lincoln, RI) to assess quality of life. An additional questionnaire was used to assess specific LSA symptoms and the ability to return to normal activities. Data were analyzed by Spearman rank correlation and multiple linear and logistic regression analysis with appropriate transformations using SAS software (SAS Institute, Cary, NC). During the study period, 82 patients (57 men; mean age 40.5 ± 20 years, mean Injury Severity Score, 34 ± 10.0) underwent TEVAR for treatment of TAI. Among them, LSAC was used in 32 (39.5%) and LSAU in 50. A group of the LSAU patients (n = 22) served as matched controls in the analysis. We found no statistically significant difference in SF-12v2 physical health scores (ρ = -0.08; P = .62) between LSAC and LSAU patients. LSAC patients had slightly better mental health scores (ρ = 0.62; P = .037) than LSAU patients. LSAC patients did not have an increased likelihood of experiencing pain (ρ = -0.0056; P = .97), numbness (ρ = -0.12; P = .45), paresthesia (ρ = -0.11; P = .48), fatigue (ρ = -0.066; P = .69), or cramping (ρ = -0.12; P = .45). We found no difference between groups in the ability to return to activities. The mean follow-up time was 3.35 years. Six LSAC

  13. Emerging issues in peripheral nerve repair

    Institute of Scientific and Technical Information of China (English)

    Stefano Geuna; Pierluigi Tos; Bruno Battiston

    2012-01-01

    It is today widely acknowledged that nerve repair is now more than a matter of perfect microsurgical reconstruction only and that,to further improve clinical outcome,the involvement of different scientific disciplines is required.This evolving reconstructive/regenerative approach is based on the interdisciplinary and integrated pillars of tissue engineering such as reconstructive microsurgery,transplantation and biomaterials.In this paper,some of the most promising innovations for the tissue engineering of nerves,emerging from basic science investigation,are critically overviewed with special focus on those approaches that appear today to be more suitable for clinical translation.

  14. Endovascular Repair of Thoracoabdominal and Arch Aneurysms in Patients with Connective Tissue Disease Using Branched and Fenestrated Devices.

    Science.gov (United States)

    Clough, Rachel E; Martin-Gonzalez, Teresa; Van Calster, Katrien; Hertault, Adrien; Spear, Rafaëlle; Azzaoui, Richard; Sobocinski, Jonathan; Haulon, Stéphan

    2017-10-01

    Prophylactic open surgery is the standard practice in patients with connective tissue and thoracoabdominal aortic aneurysm (TAAA) and aortic arch disease. Branched and fenestrated devices offer a less invasive alternative but there are concerns regarding the durability of the repair and the effect of the stent graft on the fragile aortic wall. The aim of this study is to evaluate mid-term outcomes of fenestrated and/or branched endografting in patients with connective tissue disease. All patients with connective tissue disease who underwent TAAA or arch aneurysm repair using a fenestrated and/or branched endograft in a single, high-volume center between 2004 and 2015 were included. Ruptured aneurysms and acute aortic dissections were excluded from this study, but not chronic aortic dissections. In total, 427 (403 pararenal and TAAAs, and 24 arch aneurysms) endovascular interventions were performed during the study period. Of these, 17 patients (4%) (16 TAAAs, 1 arch) had connective tissue disease. All patients were classified as unfit for open repair. The mean age was 51 ± 8 years. Thirteen patients with TAAA were treated with a fenestrated, 1 with a branched, and 2 with a combined fenestrated/branch device. A double inner branch device was used to treat the arch aneurysm. The technical success rate was 100% with no incidence of early mortality, spinal cord ischemia, stroke, or further dissection. Postoperative deterioration in renal function was seen in 3 patients (18.8%) and no hemodialysis was required. The mean follow-up was 3.4 years (0.3-7.4). Aneurysm sac shrinkage was seen in 35% of patients (6/17) and the sac diameter remained stable in 65% of patients (11/17). No sac or sealing zone enlargement was observed in any of the patients and there were no conversions to open repair. Reintervention was required in 1 patient at 2 years for bilateral renal artery occlusion (successful fibrinolysis). One type II endoleak (lumbar) is under surveillance and 1 type

  15. Low mortality rates after endovascular aortic repair expand use to high-risk patients.

    Science.gov (United States)

    Adkar, Shaunak S; Turner, Megan C; Leraas, Harold J; Gilmore, Brian F; Nag, Uttara; Turley, Ryan S; Shortell, Cynthia K; Mureebe, Leila

    2018-02-01

    The 2010 endovascular aneurysm repair (EVAR) trial 2 (EVAR 2) reported that patients with comorbidity profiles rendering them unfit for open aneurysm repair who underwent EVAR did not experience a survival advantage compared with those who did not undergo intervention. These patients experienced a 30-day mortality of 7.3%, whereas reports from similar cohorts reported far lower mortality rates. The primary objective of our study was to compare the incidence of 30-day mortality in low- and high-risk patients undergoing EVAR in a contemporary data set, using patient risk stratification criteria from EVAR 2. Secondarily, we sought to identify risk factors associated with a disproportionate contribution to 30-day mortality risk. Data were obtained from the 2005 to 2013 American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use Data Files (N = 24,813). Patients were included in the high-risk cohort with the presence of renal, respiratory, or cardiac preoperative criteria alone or in combination. Renal impairment criteria were defined as dialysis and creatinine concentration >2.26 mg/dL. Respiratory impairment criteria included history of chronic obstructive pulmonary disease and preoperative ventilator support. Cardiac impairment criteria included history of myocardial infarction, congestive heart failure, angina, and prior coronary intervention. Patient and procedural characteristics and 30-day postoperative outcomes were compared using Pearson χ 2 tests for categorical variables and Wilcoxon rank sum tests for continuous variables. Among 24,813 patients undergoing EVAR, 12,043 (48%) patients were characterized as high risk (at least one impairment criterion); 12,770 (52%) patients were stratified as low risk. The 30-day mortality rate was 1.9% in the high-risk cohort compared with the 7.3% reported by EVAR 2, and it was higher in the high-risk cohort compared with the low-risk cohort (1.9% vs 0.9%; P < .001). Whereas the

  16. Endovascular repair of multiple infrageniculate aneurysms in a patient with vascular type Ehlers-Danlos syndrome.

    Science.gov (United States)

    Domenick, Natalie; Cho, Jae S; Abu Hamad, Ghassan; Makaroun, Michel S; Chaer, Rabih A

    2011-09-01

    Patients with vascular type Ehler-Danlos syndrome can develop aneurysms in unusual locations. We describe the case of a 33-year-old woman with vascular type Ehlers-Danlos syndrome who developed metachronous tibial artery aneurysms that were sequentially treated with endovascular means. Copyright © 2011 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  17. Retrograde Ascending Dissection After Thoracic Endovascular Aortic Repair Combined With the Chimney Technique and Successful Open Repair Using the Frozen Elephant Trunk Technique.

    Science.gov (United States)

    Hirano, Koji; Tokui, Toshiya; Nakamura, Bun; Inoue, Ryosai; Inagaki, Masahiro; Maze, Yasumi; Kato, Noriyuki

    2018-01-01

    The chimney technique can be combined with thoracic endovascular aortic repair (TEVAR) to both obtain an appropriate landing zone and maintain blood flow of the arch vessels. However, surgical repair becomes more complicated if retrograde type A aortic dissection occurs after TEVAR with the chimney technique. We herein report a case involving a 73-year-old woman who developed a retrograde ascending dissection 3 months after TEVAR for acute type B aortic dissection. To ensure an adequate proximal sealing distance, the proximal edge of the stent graft was located at the zone 2 level and an additional bare stent was placed at the left subclavian artery (the chimney technique) at the time of TEVAR. Enhanced computed tomography revealed an aortic dissection involving the ascending aorta and aortic arch. Surgical aortic repair using the frozen elephant trunk technique was urgently performed. The patient survived without stroke, paraplegia, renal failure, or other major complications. Retrograde ascending dissection can occur after TEVAR combined with the chimney technique. The frozen elephant trunk technique is useful for surgical repair in such complicated cases.

  18. Detecting endoleaks after endovascular AAA repair with a minimally invasive, implantable, telemetric pressure sensor: an in vitro study

    International Nuclear Information System (INIS)

    Springer, Fabian; Pfeffer, Joachim-Georg; Schmitz-Rode, Thomas; Schlierf, Roland; Schnakenberg, Uwe; Mahnken, Andreas H.

    2007-01-01

    A feasibility study on a completely digital telemetric pressure sensor (TPS) to detect endoleaks was performed in an in vitro model of an abdominal aortic aneurysm (AAA). An endovascular-stented AAA silicone model with different types (I-III) and sizes (3-11 French) of endoleaks was created and pulsatile pressure was applied with physiological flow and pressure rates [mean intraaortic pressure (IAP): 95-130 mmHg] and different degrees of thrombosis of the aneurysm sac. Aneurysm sac pressure (ASP) was measured with the TPS and with wired pressure sensors (WPS) as a reference. Statistical analysis included paired t-test, Pearson's correlation analysis and Bland-Altman plots. After opening an endoleak, the mean ASP increased significantly (P < 0.0001) from 15 to almost 95% of the mean IAP depending on endoleak type and size. ASP could be measured accurately with the TPS and the WPS. The telemetric and wired ASP increase showed a high Pearson's correlation coefficient (r) for a non-thrombosed (r 0.97) and a thrombosed (r = 0.96) aneurysm sac. In an in vitro silicone model, the newly designed telemetric pressure sensor was able to detect the occurrence of an endoleak in a non-invasive way and might be a valuable device for follow-up of endovascular AAA repair. (orig.)

  19. Select early type IA endoleaks after endovascular aneurysm repair will resolve without secondary intervention.

    Science.gov (United States)

    O'Donnell, Thomas F X; Corey, Michael R; Deery, Sarah E; Tsougranis, Gregory; Maruthi, Rohit; Clouse, W Darrin; Cambria, Richard P; Conrad, Mark F

    2018-01-01

    Although it is traditionally considered ominous, the natural history of early proximal attachment site endoleaks (IA) after endovascular aneurysm repair (EVAR) is not well known. Our aim was to identify risk factors for persistent type IA endoleaks and to determine their effect on long-term outcomes after EVAR. All patients who underwent infrarenal EVAR at a single institution between 1998 and 2015 were identified. Preoperative axial imaging and intraoperative arteriograms were reviewed, and those patients with a type IA endoleak were further studied. Aneurysm features were characterized by two reviewers and were studied for predictors of persistent endoleaks at the conclusion of the case. Patient records and the Social Security Death Index were used to record 1-year and overall survival. We identified 1484 EVARs, 122 (8%) of which were complicated by a type IA endoleak on arteriography after graft deployment, with a median follow-up of 4 years. The majority of patients underwent additional ballooning of the proximal site (52 [43%]) or placement of an aortic cuff (47 [39%]); 30 patients (25%) received a Palmaz stent, and four patients were treated with coils or anchors. At case end, only 43 (35%) of the type IA endoleaks remained; at 1 month, only 16 endoleaks persisted (13%), and only six persisted at 1 year (6%). In multivariable analysis, the only independent predictor of persistence of type IA endoleak at the conclusion of the case was the presence of extensive neck calcifications (odds ratio [OR], 9.9; 95% confidence interval [CI], 1.4-67.9; P = .02). Thirteen patients (11%) underwent reintervention for type IA endoleaks, with a time frame ranging from 3 days postoperatively to 11 years. There were three patients (2.4%) who experienced aneurysm rupture. Postoperative type IA endoleak was associated with lower survival at 1 year (79% vs 91%; relative risk, 2.5; 95% CI, 1.1-5.4; P = .02), but it did not affect long-term survival (log-rank, P = .45

  20. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    International Nuclear Information System (INIS)

    Leonhardt, Henrik; Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-01-01

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  1. Application of thoracic endovascular aortic repair (TEVAR) in treating dwarfism with Stanford B aortic dissection: A case report.

    Science.gov (United States)

    Qiu, Jian; Cai, Wenwu; Shu, Chang; Li, Ming; Xiong, Qinggen; Li, Quanming; Li, Xin

    2018-04-01

    To apply thoracic endovascular aortic repair (TEVAR) to treat dwarfism complicated with Stanford B aortic dissection. In this report, we presented a 63-year-old male patient of dwarfism complicated with Stanford B aortic dissection successfully treated with TEVAR. He was diagnosed with dwarfism complicated with Stanford B aortic dissection. After conservative treatment, the male patient underwent TEVAR at 1 week after hospitalization. After operation, he presented with numbness and weakness of his bilateral lower extremities, and these symptoms were significantly mitigated after effective treatment. At 1- and 3-week after TEVAR, the aorta status was maintained stable and restored. The patient obtained favorable clinical prognosis and was smoothly discharged. During subsequent follow-up, he remained physically stable. TEVAR is probably an option for treating dwarfism complicated with Stanford B aortic dissection, which remains to be validated by subsequent studies with larger sample size.

  2. Successful Aortic Banding for Type IA Endoleak Due to Neck Dilatation after Endovascular Abdominal Aortic Aneurysm Repair: Case Report.

    Science.gov (United States)

    Tashima, Yasushi; Tamai, Koichi; Shirasugi, Takehiro; Sato, Kenichiro; Yamamoto, Takahiro; Imamura, Yusuke; Yamaguchi, Atsushi; Adachi, Hideo; Kobinata, Toshiyuki

    2017-09-25

    A 69-year-old man with a type IA endoleak that developed approximately 21 months after endovascular abdominal aortic aneurysm repair (EVAR) of a 46 mm diameter aneurysm was referred to our department. He had impaired renal function, Parkinson's disease, and previous cerebral infarction. Computed tomography angiography showed a type IA endoleak with neck dilatation and that the aneurysm had grown to 60 mm in diameter. We decided to perform aortic banding. The type IA endoleak disappeared after banding and the patient was discharged on postoperative day 10. Aortic banding may be effective for type IA endoleak after EVAR and less invasive for high-risk patients in particular.

  3. Volumetric analysis demonstrates that true and false lumen remodeling persists for 12 months after thoracic endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Ga-Young Suh, PhD

    2016-09-01

    Full Text Available A 62-year-old man underwent an elephant trunk procedure followed by thoracic endovascular aortic repair (TEVAR. Computed tomography angiography-based models were built to quantify volume of the whole aorta and true and false lumens preoperatively, before TEVAR, after TEVAR, and at follow-up at 3, 6, and 12 months. With TEVAR, descending aortic true lumen volume increased by 54%, then increased additionally by 60% during 12 months. The descending aortic false lumen volume regressed continuously for 12 months following TEVAR, with the most rapid rate from 6 to 12 months at 16 cm3/month. TEVAR immediately increased true lumen volume and continued to remodel the true and false lumens throughout the following 12 months.

  4. Multimodality Imaging Approach towards Primary Aortic Sarcomas Arising after Endovascular Abdominal Aortic Aneurysm Repair: Case Series Report

    Energy Technology Data Exchange (ETDEWEB)

    Kamran, Mudassar, E-mail: kamranm@mir.wustl.edu; Fowler, Kathryn J., E-mail: fowlerk@mir.wustl.edu; Mellnick, Vincent M., E-mail: mellnickv@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States); Sicard, Gregorio A., E-mail: sicard@wudosis.wustl.edu [Washington University School of Medicine, Department of Surgery (United States); Narra, Vamsi R., E-mail: narrav@mir.wustl.edu [Washington University School of Medicine, Mallinckrodt Institute of Radiology (United States)

    2016-06-15

    Primary aortic neoplasms are rare. Aortic sarcoma arising after endovascular aneurysm repair (EVAR) is a scarce subset of primary aortic malignancies, reports of which are infrequent in the published literature. The diagnosis of aortic sarcoma is challenging due to its non-specific clinical presentation, and the prognosis is poor due to delayed diagnosis, rapid proliferation, and propensity for metastasis. Post-EVAR, aortic sarcomas may mimic other more common aortic processes on surveillance imaging. Radiologists are rarely knowledgeable about this rare entity for which multimodality imaging and awareness are invaluable in early diagnosis. A series of three pathologically confirmed cases are presented to display the multimodality imaging features and clinical presentations of aortic sarcoma arising after EVAR.

  5. Use of Suture-Mediated Closure Device in Percutaneous Direct Carotid Puncture During Chimney-Thoracic Endovascular Aortic Repair

    International Nuclear Information System (INIS)

    Chan, Gabriel; Quek, Lawrence Hwee Han; Tan, Glenn Leong Wei; Pua, Uei

    2016-01-01

    BackgroundInsertion of a carotid chimney graft during thoracic endovascular aortic repair (Ch-TEVAR) is a recognized technique to extend the proximal landing zone into the aortic arch in the treatment of thoracic aortic disease. Conventional technique requires surgical exposure of the carotid artery for insertion of the carotid chimney graft.MethodologyWe describe our experience in the use of a suture-mediated closure device in percutaneous Ch-TEVAR in four patients.ResultsSuccessful hemostasis was achieved in all four patients. No complications related to the carotid puncture were recorded.ConclusionWe conclude that using suture-mediated closure device for carotid closure appears feasible and deserves further studies as a potential alternative to conventional surgical approach.

  6. Use of Suture-Mediated Closure Device in Percutaneous Direct Carotid Puncture During Chimney-Thoracic Endovascular Aortic Repair

    Energy Technology Data Exchange (ETDEWEB)

    Chan, Gabriel, E-mail: dr.changabriel@gmail.com; Quek, Lawrence Hwee Han, E-mail: lawrence-quek@ttsh.com.sg [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore); Tan, Glenn Leong Wei, E-mail: glenn-tan@ttsh.com.sg [Tan Tock Seng Hospital, Department of General Surgery (Singapore); Pua, Uei, E-mail: druei@yahoo.com [Tan Tock Seng Hospital, Department of Diagnostic Radiology (Singapore)

    2016-07-15

    BackgroundInsertion of a carotid chimney graft during thoracic endovascular aortic repair (Ch-TEVAR) is a recognized technique to extend the proximal landing zone into the aortic arch in the treatment of thoracic aortic disease. Conventional technique requires surgical exposure of the carotid artery for insertion of the carotid chimney graft.MethodologyWe describe our experience in the use of a suture-mediated closure device in percutaneous Ch-TEVAR in four patients.ResultsSuccessful hemostasis was achieved in all four patients. No complications related to the carotid puncture were recorded.ConclusionWe conclude that using suture-mediated closure device for carotid closure appears feasible and deserves further studies as a potential alternative to conventional surgical approach.

  7. The Burden of Hard Atherosclerotic Plaques Does Not Promote Endoleak Development After Endovascular Aortic Aneurysm Repair: A Risk Stratification

    International Nuclear Information System (INIS)

    Petersen, Johannes; Glodny, Bernhard

    2011-01-01

    Purpose: To objectify the influence of the atherosclerotic burden in the proximal landing zone on the development of endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) or thoracic endovascular aneurysm repair (TEVAR) using objective aortic calcium scoring (ACS). Materials and Methods: This retrospective observation study included 267 patients who received an aortic endograft between 1997 and 2010 and for whom preoperative computed tomography (CT) was available to perform ACS using the CT-based V600 method. The mean follow-up period was 2 ± 2.3 years. Results: Type I endoleaks persisted in 45 patients (16.9%), type II in 34 (12.7%), type III in 8 (3%), and type IV or V in 3 patients, respectively (1.1% each). ACS in patients with type I endoleaks was not increased: 0.029 ± 0.061 ml compared with 0.075 ± 0.1349 ml in the rest of the patients, (p > 0.05; Whitney–Mann U-Test). There were significantly better results for the indication “traumatic aortic rupture” than for the other indications (p < 0.05). In multivariate logistic regression analyses, age was an independent risk factor for the development of type I endoleaks in the thoracic aorta (Wald 9.5; p = 0.002), whereas ACS score was an independent protective factor (Wald 6.9; p = 0.009). In the abdominal aorta, neither age nor ACS influenced the development of endoleaks. Conclusion: Contrary to previous assumptions, TEVAR and EVAR can be carried out without increasing the risk of an endoleak of any type, even if there is a high atherosclerotic “hard-plaque” burden of the aorta. The results are significantly better for traumatic aortic.

  8. Dual-energy CT for detection of endoleaks after endovascular abdominal aneurysm repair: usefulness of colored iodine overlay.

    Science.gov (United States)

    Ascenti, Giorgio; Mazziotti, Silvio; Lamberto, Salvatore; Bottari, Antonio; Caloggero, Simona; Racchiusa, Sergio; Mileto, Achille; Scribano, Emanuele

    2011-06-01

    The purpose of our study was to evaluate the value of dual-source dual-energy CT with colored iodine overlay for detection of endoleaks after endovascular abdominal aortic aneurysm repair. We also calculated the potential dose reduction by using a dual-energy CT single-phase protocol. From November 2007 to November 2009, 74 patients underwent CT angiography 2-7 days after endovascular repair during single-energy unenhanced and dual-energy venous phases. By using dual-energy software, the iodine overlay was superimposed on venous phase images with different percentages ranging between 0 (virtual unenhanced images) and 50-75% to show the iodine in an orange color. Two blinded readers evaluated the data for diagnosis of endoleaks during standard unenhanced and venous phase images (session 1, standard of reference) and virtual unenhanced and venous phase images with colored iodine overlay images (session 2). We compared the effective dose radiation of a single-energy biphasic protocol with that of a single-phase dual-energy protocol. The diagnostic accuracy of session 2 was calculated. The mean dual-energy effective dose was 7.27 mSv. By using a dual-energy single-phase protocol, we obtained a mean dose reduction of 28% with respect to a single-energy biphasic protocol. The diagnostic accuracy of session 2 was: 100% sensitivity, 100% specificity, 100% negative predictive value, and 100% positive predictive value. Statistically significant differences in the level of confidence for endoleak detection between the two sessions were found by reviewers for scores 3-5. Dual-energy CT with colored iodine overlay is a useful diagnostic tool in endoleak detection. The use of a dual-energy single-phase study protocol will lower radiation exposure to patients.

  9. 40 CFR 264.227 - Emergency repairs; contingency plans.

    Science.gov (United States)

    2010-07-01

    ... 40 Protection of Environment 25 2010-07-01 2010-07-01 false Emergency repairs; contingency plans... FACILITIES Surface Impoundments § 264.227 Emergency repairs; contingency plans. (a) A surface impoundment... days after detecting the problem. (c) As part of the contingency plan required in subpart D of this...

  10. Meta-analysis of individual-patient data from EVAR-1, DREAM, OVER and ACE trials comparing outcomes of endovascular or open repair for abdominal aortic aneurysm over 5 years

    NARCIS (Netherlands)

    Powell, J. T.; Sweeting, M. J.; Ulug, P.; Blankensteijn, J. D.; Lederle, F. A.; Becquemin, J.-P.; Greenhalgh, R. M.; Beard, J. D.; Buxton, M. J.; Brown, L. C.; Harris, P. L.; Rose, J. D. G.; Russell, I. T.; Sculpher, M. J.; Thompson, S. G.; Lilford, R. J.; Bell, P. R. F.; Whitaker, S. C.; Poole-Wilson, The Late P. A.; Ruckley, C. V.; Campbell, W. B.; Dean, M. R. E.; Ruttley, M. S. T.; Coles, E. C.; Halliday, A.; Gibbs, S. J.; Epstein, D.; Hannon, R. J.; Johnston, L.; Bradbury, A. W.; Henderson, M. J.; Parvin, S. D.; Shepherd, D. F. C.; Mitchell, A. W.; Edwards, P. R.; Abbott, G. T.; Higman, D. J.; Vohra, A.; Ashley, S.; Robottom, C.; Wyatt, M. G.; Byrne, D.; Edwards, R.; Leiberman, D. P.; McCarter, D. H.; Taylor, P. R.; Reidy, J. F.; Wilkinson, A. R.; Ettles, D. F.; Clason, A. E.; Leen, G. L. S.; Wilson, N. V.; Downes, M.; Walker, S. R.; Lavelle, J. M.; Gough, M. J.; McPherson, S.; Scott, D. J. A.; Kessell, D. O.; Naylor, R.; Sayers, R.; Fishwick, N. G.; Gould, D. A.; Walker, M. G.; Chalmers, N. C.; Garnham, A.; Collins, M. A.; Gaines, P. A.; Ashour, M. Y.; Uberoi, R.; Braithwaite, B.; Davies, J. N.; Travis, S.; Hamilton, G.; Platts, A.; Shandall, A.; Sullivan, B. A.; Sobeh, M.; Matson, M.; Fox, A. D.; Orme, R.; Yusef, W.; Doyle, T.; Horrocks, M.; Hardman, J.; Blair, P. H. B.; Ellis, P. K.; Morris, G.; Odurny, A.; Vohra, R.; Duddy, M.; Thompson, M.; Loosemore, T. M. L.; Belli, A. M.; Morgan, R.; Adiseshiah, M.; Brookes, J. A. S.; McCollum, C. N.; Ashleigh, R.; Aukett, M.; Baker, S.; Barbe, E.; Batson, N.; Bell, J.; Blundell, J.; Boardley, D.; Boyes, S.; Brown, O.; Bryce, J.; Carmichael, M.; Chance, T.; Coleman, J.; Cosgrove, C.; Curran, G.; Dennison, T.; Devine, C.; Dewhirst, N.; Errington, B.; Farrell, H.; Fisher, C.; Fulford, P.; Gough, M.; Graham, C.; Hooper, R.; Horne, G.; Horrocks, L.; Hughes, B.; Hutchings, T.; Ireland, M.; Judge, C.; Kelly, L.; Kemp, J.; Kite, A.; Kivela, M.; Lapworth, M.; Lee, C.; Linekar, L.; Mahmood, A.; March, L.; Martin, J.; Matharu, N.; McGuigen, K.; Morris-Vincent, P.; Murray, S.; Murtagh, A.; Owen, G.; Ramoutar, V.; Rippin, C.; Rowley, J.; Sinclair, J.; Spencer, S.; Taylor, V.; Tomlinson, C.; Ward, S.; Wealleans, V.; West, J.; White, K.; Williams, J.; Wilson, L.; Grobbee, D. E.; Bak, A. A. A.; Buth, J.; Pattynama, P. M.; Verhoeven, E. L. G.; van Voorthuisen, A. E.; Balm, R.; Cuypers, P. W. M.; Prinssen, M.; van Sambeek, M. R. H. M.; Baas, A. F.; Hunink, M. G.; van Engelshoven, J. M.; Jacobs, M. J. H. M.; de Mol, B. A. J. M.; van Bockel, J. H.; Reekers, J.; Tielbeek, X.; Wisselink, W.; Boekema, N.; Heuveling, L. M.; Sikking, I.; de Bruin, J. L.; Tielbeek, A. V.; Pattynama, P.; Prins, T.; van der Ham, A. C.; van der Velden, J. J. I. M.; van Sterkenburg, S. M. M.; ten Haken, G. B.; Bruijninckx, C. M. A.; van Overhagen, H.; Tutein Nolthenius, R. P.; Hendriksz, T. R.; Teijink, J. A. W.; Odink, H. F.; de Smet, A. A. E. A.; Vroegindeweij, D.; van Loenhout, R. M. M.; Rutten, M. J.; Hamming, J. F.; Lampmann, L. E. H.; Bender, M. H. M.; Pasmans, H.; Vahl, A. C.; de Vries, C.; Mackaay, A. J. C.; van Dortmont, L. M. C.; van der Vliet, A. J.; Schultze Kool, L. J.; Boomsma, J. H. B.; van Dop, H. R.; de Mol van Otterloo, J. C. A.; de Rooij, T. P. W.; Smits, T. M.; Yilmaz, E. N.; van den Berg, F. G.; Visser, M. J. T.; van der Linden, E.; Schurink, G. W. H.; de Haan, M.; Smeets, H. J.; Stabel, P.; van Elst, F.; Poniewierski, J.; Vermassen, F. E. G.; Freischlag, J. A.; Kohler, T. R.; Latts, E.; Matsumura, J.; Padberg, F. T.; Kyriakides, T. C.; Swanson, K. M.; Guarino, P.; Peduzzi, P.; Antonelli, M.; Cushing, C.; Davis, E.; Durant, L.; Joyner, S.; Kossack, The Late A.; LeGwin, Mary; McBride, V.; O'Connor, T.; Poulton, J.; Stratton, The Late S.; Zellner, S.; Snodgrass, A. J.; Thornton, J.; Haakenson, C. M.; Stroupe, K. T.; Jonk, Y.; Hallett, J. W.; Hertzer, N.; Towne, J.; Katz, D. A.; Karrison, T.; Matts, J. P.; Marottoli, R.; Kasl, S.; Mehta, R.; Feldman, R.; Farrell, W.; Allore, H.; Perry, E.; Niederman, J.; Randall, F.; Zeman, M.; Beckwith, The Late D.; O'Leary, T. J.; Huang, G. D.; Bader, M.; Ketteler, E. R.; Kingsley, D. D.; Marek, J. M.; Massen, R. J.; Matteson, B. D.; Pitcher, J. D.; Langsfeld, M.; Corson, J. D.; Goff, J. M.; Kasirajan, K.; Paap, C.; Robertson, D. C.; Salam, A.; Veeraswamy, R.; Milner, R.; Guidot, J.; Lal, B. K.; Busuttil, S. J.; Lilly, M. P.; Braganza, M.; Ellis, K.; Patterson, M. A.; Jordan, W. D.; Whitley, D.; Taylor, S.; Passman, M.; Kerns, D.; Inman, C.; Poirier, J.; Ebaugh, J.; Raffetto, J.; Chew, D.; Lathi, S.; Owens, C.; Hickson, K.; Dosluoglu, H. H.; Eschberger, K.; Kibbe, M. R.; Baraniewski, H. M.; Endo, M.; Busman, A.; Meadows, W.; Evans, M.; Giglia, J. S.; El Sayed, H.; Reed, A. B.; Ruf, M.; Ross, S.; Jean-Claude, J. M.; Pinault, G.; Kang, P.; White, N.; Eiseman, M.; Jones, The Late R.; Timaran, C. H.; Modrall, J. G.; Welborn, M. B.; Lopez, J.; Nguyen, T.; Chacko, J. K. Y.; Granke, K.; Vouyouka, A. G.; Olgren, E.; Chand, P.; Allende, B.; Ranella, M.; Yales, C.; Whitehill, T. A.; Krupski, The Late W. C.; Nehler, M. R.; Johnson, S. P.; Jones, D. N.; Strecker, P.; Bhola, M. A.; Shortell, C. K.; Gray, J. L.; Lawson, J. H.; McCann, R.; Sebastian, M. W.; Kistler Tetterton, J.; Blackwell, C.; Prinzo, P. A.; Lee, N.; Cerveira, J. J.; Zickler, R. W.; Hauck, K. A.; Berceli, S. A.; Lee, W. A.; Ozaki, C. K.; Nelson, P. R.; Irwin, A. S.; Baum, R.; Aulivola, B.; Rodriguez, H.; Littooy, F. N.; Greisler, H.; O'Sullivan, M. T.; Kougias, P.; Lin, P. H.; Bush, R. L.; Guinn, G.; Bechara, C.; Cagiannos, C.; Pisimisis, G.; Barshes, N.; Pillack, S.; Guillory, B.; Cikrit, D.; Lalka, S. G.; Lemmon, G.; Nachreiner, R.; Rusomaroff, M.; O'Brien, E.; Cullen, J. J.; Hoballah, J.; Sharp, W. J.; McCandless, J. L.; Beach, V.; Minion, D.; Schwarcz, T. H.; Kimbrough, J.; Ashe, L.; Rockich, A.; Warner-Carpenter, J.; Moursi, M.; Eidt, J. F.; Brock, S.; Bianchi, C.; Bishop, V.; Gordon, I. L.; Fujitani, R.; Kubaska, S. M.; Behdad, M.; Azadegan, R.; Ma Agas, C.; Zalecki, K.; Hoch, J. R.; Carr, S. C.; Acher, C.; Schwarze, M.; Tefera, G.; Mell, M.; Dunlap, B.; Rieder, J.; Stuart, J. M.; Weiman, D. S.; Abul-Khoudoud, O.; Garrett, H. E.; Walsh, S. M.; Wilson, K. L.; Seabrook, G. R.; Cambria, R. A.; Brown, K. R.; Lewis, B. D.; Framberg, S.; Kallio, C.; Barke, R. A.; Santilli, S. M.; d'Audiffret, A. C.; Oberle, N.; Proebstle, C.; Johnson, L. L.; Jacobowitz, G. R.; Cayne, N.; Rockman, C.; Adelman, M.; Gagne, P.; Nalbandian, M.; Caropolo, L. J.; Pipinos, I. I.; Johanning, J.; Lynch, T.; DeSpiegelaere, H.; Purviance, G.; Zhou, W.; Dalman, R.; Lee, J. T.; Safadi, B.; Coogan, S. M.; Wren, S. M.; Bahmani, D. D.; Maples, D.; Thunen, S.; Golden, M. A.; Mitchell, M. E.; Fairman, R.; Reinhardt, S.; Wilson, M. A.; Tzeng, E.; Muluk, S.; Peterson, N. M.; Foster, M.; Edwards, J.; Moneta, G. L.; Landry, G.; Taylor, L.; Yeager, R.; Cannady, E.; Treiman, G.; Hatton-Ward, S.; Salabsky, The Late B.; Kansal, N.; Owens, E.; Estes, M.; Forbes, B. A.; Sobotta, C.; Rapp, J. H.; Reilly, L. M.; Perez, S. L.; Yan, K.; Sarkar, R.; Dwyer, S. S.; Perez, S.; Chong, K.; Hatsukami, T. S.; Glickerman, D. G.; Sobel, M.; Burdick, T. S.; Pedersen, K.; Cleary, P.; Back, M.; Bandyk, D.; Johnson, B.; Shames, M.; Reinhard, R. L.; Thomas, S. C.; Hunter, G. C.; Leon, L. R.; Westerband, A.; Guerra, R. J.; Riveros, M.; Mills, J. L.; Hughes, J. D.; Escalante, A. M.; Psalms, S. B.; Day, N. N.; Macsata, R.; Sidawy, A.; Weiswasser, J.; Arora, S.; Jasper, B. J.; Dardik, A.; Gahtan, V.; Muhs, B. E.; Sumpio, B. E.; Gusberg, R. J.; Spector, M.; Pollak, J.; Aruny, J.; Kelly, E. L.; Wong, J.; Vasilas, P.; Joncas, C.; Gelabert, H. A.; DeVirgillio, C.; Rigberg, D. A.; Cole, L.; Marzelle, J.; Sapoval, M.; Favre, J.-P.; Watelet, J.; Lermusiaux, P.; Lepage, E.; Hemery, F.; Dolbeau, G.; Hawajry, N.; Cunin, P.; Harris, P.; Stockx, L.; Chatellier, G.; Mialhe, C.; Fiessinger, J.-N.; Pagny, L.; Kobeiter, H.; Boissier, C.; Lacroix, P.; Ledru, F.; Pinot, J.-J.; Deux, J.-F.; Tzvetkov, B.; Duvaldestin, P.; Jourdain, C.; DAVID, V.; Enouf, D.; Ady, N.; Krimi, A.; Boudjema, N.; Jousset, Y.; Enon, B.; Blin, V.; Picquet, J.; L'Hoste, P.; Thouveny, F.; Borie, H.; Kowarski, S.; Pernes, J.-M.; Auguste, M.; Desgranges, P.; Allaire, E.; Meaulle, P.-Y.; Chaix, D.; Juliae, P.; Fabiani, J. N.; Chevalier, P.; Combes, M.; Seguin, A.; Belhomme, D.; Baque, J.; Pellerin, O.; Favre, J. P.; Barral, X.; Veyret, C.; Peillon, C.; Plissonier, D.; Thomas, P.; Clavier, E.; Martinez, R.; Bleuet, F.; C, Dupreix; Verhoye, J. P.; Langanay, T.; Heautot, J. F.; Koussa, M.; Haulon, S.; Halna, P.; Destrieux, L.; Lions, C.; Wiloteaux, S.; Beregi, J. P.; Bergeron, P.; Patra, P.; Costargent, A.; Chaillou, P.; D'Alicourt, A.; Goueffic, Y.; Cheysson, E.; Parrot, A.; Garance, P.; Demon, A.; Tyazi, A.; Pillet, J.-C.; Lescalie, F.; Tilly, G.; Steinmetz, E.; Favier, C.; Brenot, R.; Krause, D.; Cercueil, J. P.; Vahdat, O.; Sauer, M.; Soula, P.; Querian, A.; Garcia, O.; Levade, M.; Colombier, D.; Cardon, J.-M.; Joyeux, A.; Borrelly, P.; Dogas, G.; Magnan, P.-É; Branchereau, A.; Bartoli, J.-M.; Hassen-Khodja, R.; Batt, M.; Planchard, P.-F.; Bouillanne, P.-J.; Haudebourg, P.; Bayne, J.; Gouny, P.; Badra, A.; Braesco, J.; Nonent, M.; Lucas, A.; Cardon, A.; Kerdiles, Y.; Rolland, Y.; Kassab, M.; Brillu, C.; Goubault, F.; Tailboux, L.; Darrieux, H.; Briand, O.; Maillard, J.-C.; Varty, K.; Cousins, C.

    2017-01-01

    The erosion of the early mortality advantage of elective endovascular aneurysm repair (EVAR) compared with open repair of abdominal aortic aneurysm remains without a satisfactory explanation. An individual-patient data meta-analysis of four multicentre randomized trials of EVAR versus open repair

  11. Spinal arterial anatomy and risk factors for lower extremity weakness following endovascular thoracoabdominal aortic aneurysm repair with branched stent-grafts.

    Science.gov (United States)

    Chang, Catherine K; Chuter, Timothy A M; Reilly, Linda M; Ota, Maile K; Furtado, Andre; Bucci, Monica; Wintermark, Max; Hiramoto, Jade S

    2008-06-01

    To evaluate spinal arterial anatomy and identify risk factors for lower extremity weakness (LEW) following endovascular thoracoabdominal aortic aneurysm (TAAA) repair. A retrospective review was conducted of 37 patients (27 men; mean age 74.8+/-7.1 years, range 58-86) undergoing endovascular TAAA repair with branched stent-grafts at a single academic institution from July 2005 to December 2007. Data were collected on preoperative comorbidities, duration of operation, blood loss, type of anesthesia, extent of aortic coverage, blood pressure, cerebrospinal fluid (CSF) pressure and drainage, and postoperative development of LEW. Pre- and postoperative contrast-enhanced computed tomographic angiograms (CTA) in a 26-patient subset were analyzed to evaluate the number of patent intercostal and lumbar arteries before and after repair. All patients were neurologically intact at the end of the operation. Seven (19%) patients developed LEW postoperatively: 6 perioperatively and 1 after discharge. LEW was associated with postoperative hypotension, internal iliac artery (IIA) occlusion, and fewer patent segmental arteries on preoperative CTA. Lowest mean systolic blood pressure was segmental arteries in patients with or without LEW. Endovascular TAAA repair inevitably occludes direct inflow to lumbar and intercostal arteries. The distal segments of these arteries to the spine, however, are seen to remain patent through collaterals. Measures to preserve collateral pathways and increase perfusion pressure may help prevent or treat LEW.

  12. DNA repair in cancer: emerging targets for personalized therapy

    International Nuclear Information System (INIS)

    Abbotts, Rachel; Thompson, Nicola; Madhusudan, Srinivasan

    2014-01-01

    Genomic deoxyribonucleic acid (DNA) is under constant threat from endogenous and exogenous DNA damaging agents. Mammalian cells have evolved highly conserved DNA repair machinery to process DNA damage and maintain genomic integrity. Impaired DNA repair is a major driver for carcinogenesis and could promote aggressive cancer biology. Interestingly, in established tumors, DNA repair activity is required to counteract oxidative DNA damage that is prevalent in the tumor microenvironment. Emerging clinical data provide compelling evidence that overexpression of DNA repair factors may have prognostic and predictive significance in patients. More recently, DNA repair inhibition has emerged as a promising target for anticancer therapy. Synthetic lethality exploits intergene relationships where the loss of function of either of two related genes is nonlethal, but loss of both causes cell death. Exploiting this approach by targeting DNA repair has emerged as a promising strategy for personalized cancer therapy. In the current review, we focus on recent advances with a particular focus on synthetic lethality targeting in cancer

  13. Endovascular repair of renal artery aneurysm with the multilayer stent – a short report

    Directory of Open Access Journals (Sweden)

    Vojko Flis

    2012-10-01

    in the main left renal artery involving all three major branches of the renal artery. Via a percutaneous femoral approach a multilayer stent was deployed without complications. Blood flow inside the sac was immediately and significantly reduced. All the renal branches remained patent. Conclusion: New multilayer fluid modulating stent concept appears to be a very useful and attractive alternative to surgery or other endovascular techniques for those RAA involving or very close to major branch vessels, especially in patients with very high risk of loosing the only viable kidney, as in our case.

  14. Endovascular repair of mycotic aneurysm of the descending thoracic aorta: diagnostic and therapeutic dilemmas-two case reports with 1-year follow-up.

    Science.gov (United States)

    Marjanovic, Ivan; Sarac, Momir; Tomic, Aleksandar; Bezmarevic, Mihailo

    2013-10-01

    A mycotic aneurysm of the thoracic aorta is a rare diagnosis with high mortality. We present two cases of endovascular reconstruction of mycotic descending thoracic aorta. Specific or nonspecific bacterial or other infectious agent in serial samples of blood, urine, cerebrospinal fluid, and pleural puncture was not detected in the first case, but we found in sputum sample Mycobacterium tuberculosis in the second patient. We empirically began by administering broad-spectrum intravenous antibiotics in the first case, with preoperative antibiotic prophylaxis and antituberculotic drugs therapy in the second case, and continued with the same medication for 4 months after endovascular repair. Control computed tomographic scans 6 months after reconstruction showed no endoleak in both patients. Repair of mycotic descending thoracic aortic aneurysms by endoluminal stent graft is reasonable alternative to open surgical intervention. A broad-spectrum antibiotic therapy has a high significance in the treatment of patients with mycotic aneurysm. Georg Thieme Verlag KG Stuttgart · New York.

  15. Long-Term Follow-Up After Endovascular Treatment of Acute Aortic Emergencies

    International Nuclear Information System (INIS)

    Pitton, M. B.; Herber, S.; Schmiedt, W.; Neufang, A.; Dorweiler, B.; Dueber, C.

    2008-01-01

    Purpose. To investigate the long-term outcome and efficacy of emergency treatment of acute aortic diseases with endovascular stent-grafts. Methods. From September 1995 to April 2007, 37 patients (21 men, 16 women; age 53.9 ± 19.2 years, range 18-85 years) with acute complications of diseases of the descending thoracic aorta were treated by endovascular stent-grafts: traumatic aortic ruptures (n = 9), aortobronchial fistulas due to penetrating ulcer or hematothorax (n = 6), acute type B dissections with aortic wall hematoma, penetration, or ischemia (n = 13), and symptomatic aneurysm of the thoracic aorta (n = 9) with pain, penetration, or rupture. Diagnosis was confirmed by contrast-enhanced CT. Multiplanar reformations were used for measurement of the landing zones of the stent-grafts. Stent-grafts were inserted via femoral or iliac cut-down. Two procedures required aortofemoral bypass grafting prior to stent-grafting due to extensive arteriosclerotic stenosis of the iliac arteries. In this case the bypass graft was used for introduction of the stent-graft. Results. A total of 46 stent-grafts were implanted: Vanguard/Stentor (n = 4), Talent (n = 31), and Valiant (n = 11). Stent-graft extension was necessary in 7 cases. In 3 cases primary graft extension was done during the initial procedure (in 1 case due to distal migration of the graft during stent release, in 2 cases due to the total length of the aortic aneurysm). In 4 cases secondary graft extensions were performed-for new aortic ulcers at the proximal stent struts (after 5 days) and distal to the graft (after 8 months) and recurrent aortobronchial fistulas 5 months and 9 years after the initial procedure-resulting in a total of 41 endovascular procedures. The 30-day mortality rate was 8% (3 of 37) and the overall follow-up was 29.9 ± 36.6 months (range 0-139 months). All patients with traumatic ruptures demonstrated an immediate sealing of bleeding. Patients with aortobronchial fistulas also demonstrated a

  16. Retrograde type A dissection: a serious complication due to thoracic aortic endovascular stent-graft repair for Stanford type B aortic dissection

    International Nuclear Information System (INIS)

    Wang Guoquan; Zhai Shuiting; Li Tianxiao; Shi Shuaitao; Zhang Kewei; Li Kun

    2011-01-01

    Objective: to discuss the possible causes and prevention of retrograde type A dissection occurred after thoracic aortic endovascular stent-graft repair (TEVAR) for symptomatic type B dissection. Methods: During the period from January 2005 to January 2011, TEVAR was carried out in 189 patients (157 males and 32 females) with symptomatic type B dissection. The average age of the patients was (51.2±13.5) years, ranged from 26 to 78 years. A follow-up lasting for 3-63 months (mean 32 months) was conducted in 135 patients (71.43%). Fifty-four patients lost in touch with the authors (28.57%). The occurrence of retrograde type A dissection after TEVAR was calculated and the possible causes were analyzed. Results: After TEVAR retrograde type A dissection occurred in two patients (1.48%), and both were males. One patient developed retrograde type A dissection in perioperative period, and the patient refused to have surgery. Conservative treatment was employed for over three years and be was still alive so far. The other patient developed retrograde type A dissection one month after TEVAR, and emergency surgery was performed. The patient was followed up for three months and he was still alive. Conclusion: The retrograde type A dissection occurred after TEVAR may be closely related to the stent-graft device, to the interventional manipulations and to the vascular disorders. Close attention should be paid to the direct damage produced by the stent-graft device to the vascular wall. (authors)

  17. Long-term decline in renal function is more significant after endovascular repair of infrarenal abdominal aortic aneurysms.

    Science.gov (United States)

    Al Adas, Ziad; Shepard, Alexander D; Nypaver, Timothy J; Weaver, Mitchell R; Maatman, Thomas; Yessayan, Lenar T; Balraj, Praveen; Kabbani, Loay S

    2018-03-20

    It is not clear whether endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) results in an increase in renal insufficiency during the long term compared with open repair (OR). We reviewed our experience with AAA repair to determine whether there was a significant difference in postoperative and long-term renal outcomes between OR and EVAR. A retrospective cohort study was conducted of all patients who underwent AAA repair between January 1993 and July 2013 at a tertiary referral hospital. Demographics, comorbidities, preoperative and postoperative laboratory values, morbidity, and mortality were collected. Patients with ruptured AAAs, preoperative hemodialysis, juxtarenal or suprarenal aneurysm origin, and no follow-up laboratory values were excluded. Preoperative, postoperative, 6-month, and yearly serum creatinine values were collected. Glomerular filtration rate (GFR) was calculated on the basis of the Chronic Kidney Disease Epidemiology Collaboration equation. Acute kidney injury (AKI) was classified using the Kidney Disease: Improving Global Outcomes guidelines. Change in GFR was defined as preoperative GFR minus the GFR at each follow-up interval. Comparison was made between EVAR and OR groups using multivariate logistics for categorical data and linear regression for continuous variables. During the study period, 763 infrarenal AAA repairs were performed at our institution; 675 repairs fit the inclusion criteria (317 ORs and 358 EVARs). Mean age was 73.9 years. Seventy-nine percent were male, 78% were hypertensive, 18% were diabetic, and 31% had preoperative renal dysfunction defined as GFR below 60 mL/min. Using a multivariate logistic model to control for all variables, OR was found to have a 1.6 times greater chance for development of immediate postoperative AKI compared with EVAR (P = .038). Hypertension and aneurysm size were independent risk factors for development of AKI (P = .012 and .022, respectively). Using a linear

  18. Pattern of informed consent acquisition in patients undergoing emergent endovascular treatment for acute ischemic stroke

    Science.gov (United States)

    Qureshi, Adnan I; Gilani, Sarwat; Adil, Malik M; Majidi, Shahram; Hassan, Ameer E; Miley, Jefferson T; Rodriguez, Gustavo J

    2014-01-01

    Background Telephone consent and two physician consents based on medical necessity are alternate strategies for time sensitive medical decisions but are not uniformly accepted for clinical practice or recruitment into clinical trials. We determined the rate of and associated outcomes with alternate consenting strategies in consecutive acute ischemic stroke patients receiving emergent endovascular treatment. Methods We divided patients into those treated based on in-person consent and those based on alternate strategies. We identified clinical and procedural differences and differences in hospital outcomes: symptomatic ICH and favorable outcome (defined by modified Rankin Scale of 0–2 at discharge) based on consenting methodology. Results Of a total of 159 patients treated, 119 were treated based on in-person consent (by the patient in 27 and legally authorized representative in 92 procedures). Another 40 patients were treated using alternate strategies (20 telephone consents and 20 two physician consents based on medical necessity). There was no difference in the mean ages and proportion of men among the two groups based on consenting methodology. There was a significantly greater time interval incurred between CT scan and initiation of endovascular procedure in those in whom in-person consent was obtained (117 ± 65 min versus 101 ± 45 min, p = 0.01). There was no significant difference in rates of ICH (9% versus 8%, p = 0.9), or favorable outcome at discharge (28% versus 30%, p = 0.8). Conclusions Consent through alternate strategies does not adversely affect procedural characteristics or outcome of patients and may be more time efficient than in-person consenting process. PMID:25132906

  19. Association of left subclavian artery coverage without revascularization and spinal cord ischemia in patients undergoing thoracic endovascular aortic repair: A Vascular Quality Initiative® analysis.

    Science.gov (United States)

    Teixeira, Pedro Gr; Woo, Karen; Beck, Adam W; Scali, Salvatore T; Weaver, Fred A

    2017-12-01

    Objectives Investigate the impact of left subclavian artery coverage without revascularization on spinal cord ischemia development in patients undergoing thoracic endovascular aortic repair. Methods The Vascular Quality Initiative thoracic endovascular aortic repair module (April 2011-July 2014) was analyzed. Patients undergoing left subclavian artery coverage were divided into two groups according to revascularization status. The association between left subclavian artery revascularization with the primary outcome of spinal cord ischemia and the secondary outcome of stroke was assessed with multivariable analysis adjusting for between-group baseline differences. Results The left subclavian artery was covered in 508 (24.6%) of the 2063 thoracic endovascular aortic repairs performed. Among patients with left subclavian artery coverage, 58.9% underwent revascularization. Spinal cord ischemia incidence was 12.1% in the group without revascularization compared to 8.5% in the group undergoing left subclavian artery revascularization (odds ratio (95%CI): 1.48(0.82-2.68), P = 0.189). Multivariable analysis adjustment identified an independent association between left subclavian artery coverage without revascularization and the incidence of spinal cord ischemia (adjusted odds ratio (95%CI): 2.29(1.03-5.14), P = 0.043). Although the incidence of stroke was also higher for the group with a covered and nonrevascularized left subclavian artery (12.1% versus 8.5%), this difference was not statistically significant after multivariable analysis (adjusted odds ratio (95%CI): 1.55(0.74-3.26), P = 0.244). Conclusion For patients undergoing left subclavian artery coverage during thoracic endovascular aortic repair, the addition of a revascularization procedure was associated with a significantly lower incidence of spinal cord ischemia.

  20. Hemodynamic and Anatomic Predictors of Renovisceral Stent-Graft Occlusion Following Chimney Endovascular Repair of Juxtarenal Aortic Aneurysms.

    Science.gov (United States)

    Tricarico, Rosamaria; He, Yong; Laquian, Liza; Scali, Salvatore T; Tran-Son-Tay, Roger; Beck, Adam W; Berceli, Scott A

    2017-12-01

    To identify anatomic and hemodynamic changes associated with impending visceral chimney stent-graft occlusion after endovascular aneurysm repair (EVAR) with the chimney technique (chEVAR). A retrospective evaluation was performed of computed tomography scans from 41 patients who underwent juxtarenal chEVAR from 2008 to 2012 to identify stent-grafts demonstrating conformational changes following initial placement. Six subjects (mean age 74 years; 3 men) were selected for detailed reconstruction and computational hemodynamic analysis; 4 had at least 1 occluded chimney stent-graft. This subset of repairs was systematically analyzed to define the anatomic and hemodynamic impact of these changes and identify signature patterns associated with impending renovisceral stent-graft occlusion. Spatial and temporal analyses of cross-sectional area, centerline angle, intraluminal pressure, and wall shear stress (WSS) were performed within the superior mesenteric and renal artery chimney grafts used for repair. Conformational changes in the chimney stent-grafts and associated perturbations, in both local WSS and pressure, were responsible for the 5 occlusions in the 13 stented branches. Anatomic and hemodynamic signatures leading to occlusion were identified within 1 month postoperatively, with a lumen area 25 Pa/mm (p=0.03), and systolic WSS >45 Pa (p=0.03) associated with future chimney stent-graft occlusion. Chimney stent-grafts at increased risk for occlusion demonstrated anatomic and hemodynamic signatures within 1 month of juxtarenal chEVAR. Analysis of these parameters in the early postoperative period may be useful for identifying and remediating these high-risk stent-grafts.

  1. Risk models for mortality following elective open and endovascular abdominal aortic aneurysm repair: a single institution experience.

    Science.gov (United States)

    Choke, E; Lee, K; McCarthy, M; Nasim, A; Naylor, A R; Bown, M; Sayers, R

    2012-12-01

    To develop and validate an "in house" risk model for predicting perioperative mortality following elective AAA repair and to compare this with other models. Multivariate logistics regression analysis was used to identify risk factors for perioperative-day mortality from one tertiary institution's prospectively maintained database. Consecutive elective open (564) and endovascular (589) AAA repairs (2000-2010) were split randomly into development (810) and validation (343) data sets. The resultant model was compared to Glasgow Aneurysm Score (GAS), Modified Customised Probability Index (m-CPI), CPI, the Vascular Governance North West (VGNW) model and the Medicare model. Variables associated with perioperative mortality included: increasing age (P = 0.034), myocardial infarct within last 10 years (P = 0.0008), raised serum creatinine (P = 0.005) and open surgery (P = 0.0001). The areas under the receiver operating characteristic curve (AUC) for predicted probability of 30-day mortality in development and validation data sets were 0.79 and 0.82 respectively. AUCs for GAS, m-CPI and CPI were poor (0.63, 0.58 and 0.58 respectively), whilst VGNW and Medicare model were fair (0.73 and 0.79 respectively). In this study, an "in-house" developed and validated risk model has the most accurate discriminative value in predicting perioperative mortality after elective AAA repair. For purposes of comparative audit with case mix adjustments, national models such as the VGNW or Medicare models should be used. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  2. Surgical treatment and thoracic endovascular aortic repair in type A aortic dissection in a pregnant patient with Marfan syndrome.

    Science.gov (United States)

    Sterner, Doerthe; Probst, Chris; Mellert, Friedrich; Schiller, Wolfgang

    2014-07-01

    We report an acute aortic dissection type Stanford A extending down to both iliac arteries affecting a 32-year-old woman suspected to have Marfan syndrome during week 37 of pregnancy. In a multidisciplinary approach, and emergency Cesarean section was performed followed by an abdominal hysterectomy and a valve-sparing aortic root replacement using a reimplantation technique. The aorta was replaced up to the hemi arch. Because of the high suspicion of visceral ischemia as confirmed ex juvantibus, an endovascular stent graft was implanted. Molecular testing revealed a frameshift mutation and confirmed the diagnosis of Marfan syndrome. Both the patient and her healthy child underwent an uneventful recovery. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Celiac Trunk Embolization, as a Means of Elongating Short Distal Descending Thoracic Aortic Aneurysm Necks, Prior to Endovascular Aortic Repair

    International Nuclear Information System (INIS)

    Belenky, Alexander; Haddad, Menashe; Idov, Igor; Knizhnik, Michael; Litvin, Sergey; Bachar, Gil N.; Atar, Eli

    2009-01-01

    The purpose of this study was to report our experience in elongating short distal necks of descending thoracic aortic aneurysms (DTAAs) by coil embolization of the celiac trunk prior to endovascular aneurysm repair (EVAR). During 6 years seven patients (five men and two women; mean age, 74) who had DTAAs with short distal necks unsuitable for conventional EVAR, and well patent superior and inferior mesenteric arteries based on CT, were treated in one session with EVAR after the celiac trunk was coil embolized to elongate the neck. All patients were followed by CT every 3 months in the first year and every 6 months thereafter. Technical success was achieved in all patients, and no early or late ischemic complications were noted. No procedural complications occurred and good aneurysm sealing was obtained in all patients. Three endoleaks were identified after 3 months (one patient) and 6 months (two patients); all were treated successfully with insertion of an additional stent-graft. In patients with DTAAs who are candidates for EVAR but have short aneurysm distal necks, celiac trunk embolization-only if the superior and inferior mesenteric arteries are patent-is a good and safe way to elongate the neck and enable EVAR.

  4. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    Energy Technology Data Exchange (ETDEWEB)

    Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); Wisniowski, Brendan; Walker, Philip J. [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia); Bradshaw, Barbara [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); Golledge, Jonathan [James Cook University, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, Townsville, Queensland (Australia); The Townsville Hospital, Department of Vascular and Endovascular Surgery, Douglas (Australia); University of Queensland, School of Medicine and Centre for Clinical Research, Department of Vascular Surgery, Royal Brisbane and Women' s Hospital, Herston, QLD (Australia)

    2014-08-15

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  5. The Role of Learning in Health Technology Assessments: An Empirical Assessment of Endovascular Aneurysm Repairs in German Hospitals.

    Science.gov (United States)

    Varabyova, Yauheniya; Blankart, Carl Rudolf; Schreyögg, Jonas

    2017-02-01

    Changes in performance due to learning may dynamically influence the results of a technology evaluation through the change in effectiveness and costs. In this study, we estimate the effect of learning using the example of two minimally invasive treatments of abdominal aortic aneurysms: endovascular aneurysm repair (EVAR) and fenestrated EVAR (fEVAR). The analysis is based on the administrative data of over 40,000 patients admitted with unruptured abdominal aortic aneurysm to more than 500 different hospitals over the years 2006 to 2013. We examine two patient outcomes, namely, in-hospital mortality and length of stay using hierarchical regression models with random effects at the hospital level. The estimated models control for patient and hospital characteristics and take learning interdependency between EVAR and fEVAR into account. In case of EVAR, we observe a significant decrease both in the in-hospital mortality and length of stay with experience accumulated at the hospital level; however, the learning curve for fEVAR in both outcomes is effectively flat. To foster the consideration of learning in health technology assessments of medical devices, a general framework for estimating learning effects is derived from the analysis. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd. © 2017 The Authors. Health Economics published by John Wiley & Sons, Ltd.

  6. Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

    International Nuclear Information System (INIS)

    England, Andrew; Butterfield, John S.; McCollum, Charles N.; Ashleigh, Raymond J.

    2008-01-01

    The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters 18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs ≥18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs ≥18 mm (p = 0.232). One-year freedom from IRSI was 92% ± 3% and 84% ± 9% for the <18-mm and ≥18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

  7. Anatomical Features and Early Outcomes of Endovascular Repair of Abdominal Aortic Aneurysm from a Korean Multicenter Registry.

    Science.gov (United States)

    Kwon, Hyunwook; Lee, Do Yun; Choi, Soo Jin Na; Park, Ki Hyuk; Min, Seung-Kee; Chang, Jeong-Hwan; Huh, Seung; Jeon, Yong Sun; Won, Jehwan; Byun, Seung Jae; Park, Sang Jun; Jang, Lee Chan; Kwon, Tae-Won

    2015-09-01

    To introduce a nation-based endovascular aneurysm repair (EVAR) registry in South Korea and to analyze the anatomical features and early clinical outcomes of abdominal aortic aneurysms (AAA) in patients who underwent EVAR. The Korean EVAR registry (KER) was a template-based online registry developed and established in 2009. The KER recruited 389 patients who underwent EVAR from 13 medical centers in South Korea from January 2010 to June 2010. We retrospectively reviewed the anatomic features and 30-day clinical outcomes. Initial deployment without open conversion was achieved in all cases and procedure-related 30-day mortality rate was 1.9%. Anatomic features showed the following variables: proximal aortic neck angle 48.8±25.7° (mean±standard deviation), vertical neck length 35.0±17.2 mm, aneurysmal sac diameter 57.2±14.2 mm, common iliac artery (CIA) involvement in 218 (56.3%) patients, and median right CIA length 34.9 mm. Two hundred and nineteen (56.3%) patients showed neck calcification, 98 patients (25.2%) had neck thrombus, and the inferior mesenteric arteries of 91 patients (23.4%) were occluded. Anatomical features of AAA in patients from the KER were characterized as having angulated proximal neck, tortuous iliac artery, and a higher rate of CIA involvement. Long-term follow-up and ongoing studies are required.

  8. Abdominal aortic aneurysm calcification and thrombus volume are not associated with outcome following endovascular abdominal aortic aneurysm repair

    International Nuclear Information System (INIS)

    Rai, Divyajeet; Velu, Ramesh; Tosenovsky, Patrik; Quigley, Francis; Wisniowski, Brendan; Walker, Philip J.; Bradshaw, Barbara; Golledge, Jonathan

    2014-01-01

    Aortic calcification and thrombus have been postulated to worsen outcome following endovascular abdominal aortic aneurysm repair (EVAR). The purpose of this study was to assess the association of abdominal aortic aneurysm (AAA) calcification and thrombus volume with outcome following EVAR using a reproducible, quantifiable computed tomography (CT) assessment protocol. Patients with elective EVAR performed between January 2002 and 2012 at the Townsville Hospital, Mater Private Hospital (Townsville) and Royal Brisbane and Women's Hospital (RBWH) were included if preoperative CTAs were available for analysis. AAA calcification and thrombus volume were measured using a semiautomated workstation protocol. Outcomes were assessed in terms of clinical failure, endoleak (type I, type II) and reintervention. Univariate and multivariate analyses were performed. Median follow-up was 1.7 years and the interquartile range 1.0-3.8 years. One hundred thirty-four patients undergoing elective EVAR were included in the study. Rates of primary clinical success and freedom from reintervention were 82.8 % and 88.9 % at the 24-month follow-up. AAA calcification and thrombus volume were not associated with clinical failure, type I endoleak, type II endoleak or reintervention. AAA calcification and thrombus volume were not associated with poorer outcome after EVAR in this study. (orig.)

  9. Correlation between intrasac pressure measurements of a pressure sensor and an angiographic catheter during endovascular repair of abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Pierre Galvagni Silveira

    2008-01-01

    Full Text Available PURPOSE: To establish a correlation between intrasac pressure measurements of a pressure sensor and an angiographic catheter placed in the same aneurysm sac before and after its exclusion by an endoprosthesis. METHODS: Patients who underwent endovascular abdominal aortic aneurysm repair and received an EndoSureTM wireless pressure sensor implant between March 19 and December 11, 2004 were enrolled in the study. Simultaneous readings of systolic, diastolic, mean, and pulse pressure within the aneurysm sac were obtained from the catheter and the sensor, both before and after sac exclusion by the endoprosthesis (Readings 1 and 2, respectively. Intrasac pressure measurements were compared using Pearson's correlation and Student's t test. Statistical significance was set at p0.05, mean (p>0.05, and pulse (p0.05 by the sensor. CONCLUSION: The excellent agreement between intrasac pressure readings recorded by the catheter and the sensor justifies use of the latter for detection of post-exclusion abdominal aortic aneurysm pressurization.

  10. Open fenestration of the distal landing zone via a subxyphoid incision for subsequent endovascular repair of a dissecting thoracic aneurysm.

    Science.gov (United States)

    Konings, Renske; de Bruin, Jorg L; Wisselink, Willem

    2013-02-01

    To describe a novel hybrid technique to address two challenges in endovascular repair of chronic dissecting thoracic aortic aneurysm (dTAA): obtaining an adequate seal of the stent-graft in a half-moon-shaped fibrotic aortic lumen and preserving flow into the distal true and false lumens. The technique is demonstrated in a 52-year-old man who presented with progressive asymptomatic dilatation of the thoracic aorta 9 years after undergoing a Bentall procedure for a Stanford type A dissection followed by arch replacement and elephant trunk construction. Imaging at this admission showed a 6.8-cm dissecting aneurysm extending distally to ∼4 cm above the celiac trunk; the dissection included both common iliac arteries. The patient refused a thoracotomy, so a hybrid procedure was devised to resect the intimal flap via a median subxyphoid incision and transperitoneal approach through the lesser sac. Two overlapping Zenith TX-2 stent-grafts were deployed into the elephant trunk, terminating just above the surgically created "flow divider" at the level of the celiac trunk. Imaging showed adequate sealing at both ends of the stent-graft and a type II endoleak that persisted into follow-up, but the aneurysm diameter decreased to 6.4 cm, and there was unobstructed flow into the visceral, renal, and iliac arteries. In this case of chronic dTAA, open surgical removal of a segment of the dissection flap via a subxyphoid incision provided a distal landing zone for subsequent endoluminal repair, with exclusion of the aneurysm and preservation of antegrade flow in both true and false lumens.

  11. Case report and review of the literature total endovascular repair of acute ascending aortic rupture: a case report and review of the literature.

    Science.gov (United States)

    McCallum, John C; Limmer, Karl K; Perricone, Anthony; Bandyk, Dennis; Kansal, Nikhil

    2013-07-01

    Thoracic aortic endografting has been successfully implemented to treat aneurysmal disease of the distal aortic arch and descending thoracic aorta. Although there are reports of ascending aortic endovascular interventions, the total endovascular repair of a ruptured ascending aorta secondary to a Type A dissection has not been described. We report the case of a 77-year-old patient who presented with a ruptured ascending aortic aneurysm secondary to degeneration of a Stanford type A aortic dissection. His surgical history was significant for orthotropic heart transplant 19 years prior. The dissection, aneurysm, and rupture occurred in the native aorta distal to the ascending aortic suture line. At presentation, he was hemodynamically unstable with a right hemothorax. We placed 3 Medtronic Talent Thoracic Stent Graft devices (Medtronic Inc, Minneapolis, MN) across the suture line in the ascending aorta, excluding the rupture. The patient survived and has been followed to 25 months.

  12. Quality Improvement Guidelines for Imaging Detection and Treatment of Endoleaks following Endovascular Aneurysm Repair (EVAR)

    International Nuclear Information System (INIS)

    Rand, T.; Uberoi, R.; Cil, B.; Munneke, G.; Tsetis, D.

    2013-01-01

    Major concerns after aortic aneurysm repair are caused by the presence of endoleaks, which are defined as persistent perigraft flow within the aortic aneurysm sac. Diagnosis of endoleaks can be performed with various imaging modalities, and indications for treatment are based on further subclassifications. Early detection and correct classification of endoleaks are crucial for planning patient management. The vast majority of endoleaks can be treated successfully by interventional means. Guidelines for Imaging Detection and Treatment of endoleaks are described in this article.

  13. Lower extremity weakness is associated with elevated blood and cerebrospinal fluid glucose levels following multibranched endovascular aortic aneurysm repair.

    Science.gov (United States)

    Hiramoto, Jade S; Fernandez, Charlene; Gasper, Warren; Vartanian, Shant; Reilly, Linda; Chuter, Timothy

    2017-02-01

    Hyperglycemia is associated with worsened clinical outcomes after central nervous system injury. The purpose of this study was to examine the association between lower extremity weakness (LEW) and the glucose levels of blood and cerebrospinal fluid (CSF) in patients undergoing multibranched endovascular aneurysm repair (MBEVAR) of thoracoabdominal and pararenal aortic aneurysms. Blood and CSF samples were collected preoperatively, immediately after aneurysm repair, and on postoperative day 1 in 21 patients undergoing MBEVAR. Data on demographics, operative repair, complications, and outcomes were collected prospectively. There were 21 patients who underwent successful MBEVAR. Two patients had pre-existing paraplegia from prior open aortic surgery and were excluded from the current analysis. The mean age was 73 ± 8 years, and 15 of 19 (79%) were men. In the postoperative period, 7 of 19 (37%) patients developed LEW. This was temporary in 5 of 19 (26%) patients and permanent in 2 of 19 (11%) patients. The LEW group was older than the non-LEW group (77 ± 6 vs 70 ± 9 years, respectively; P = .10), had a lower preoperative glomerular filtration rate (58.6 ± 18.5 vs 71.4 ± 23.5 mL/min per 1.73 m 2 ; P = .24), and was more likely to be taking a statin (100% vs 67%, respectively; P = .13), but these did not reach statistical significance. There was no significant difference in the prevalence of diabetes mellitus, hypertension, coronary artery disease, lung disease, or peripheral artery disease between the LEW and non-LEW groups. There was also no difference in operative time, blood loss, contrast material volume, or fluoroscopy times between the two groups. Preoperative blood and CSF glucose levels were similar in those with and without LEW. During the postoperative period, glucose values in the blood and CSF were significantly higher in those patients who developed LEW compared with those who did not develop LEW. In all patients with LEW, the elevation

  14. WSES guidelines for emergency repair of complicated abdominal wall hernias

    NARCIS (Netherlands)

    M. Sartelli (Massimo); F. Coccolini (Federico); G.H. van Ramshorst (Gabrielle); G. Campanelli (Giampiero); V. Mandala; L. Ansaloni (Luca); E.E. Moore (Ernest); A. Peitzman (Andrew); G.C. Velmahos (George ); F.A. Moore (Fredrick); A. Leppaniemi (Ari); C.C. Burlew (Clay); W.L. Biffl (Walter); K. Koike (Kaoru); Y. Kluger (Yoram); G.P. Fraga (Gustavo); C.A. Ordonez (Carlos); S. Di Saverio (Salomone); F. Agresta; B. Sakakushev (Boris); I. Gerych (Igor); I. Wani (Imtiaz); M.D. Kelly (Michael ); C.A. Gomes (Carlos); M.P. Faro Jr (Mario); K. Taviloglu (Korhan); Z. Demetrashvili (Zaza); J.G. Lee (Jeong ); N. Vettoretto (Nereo); G. Guercioni (Gianluca); C. Tranà (Cristian); Y. Cui (Yijun); K.Y.Y. Kok (Kenneth); W.M. Ghnnam (Wagih); A.E.S. Abbas (Ashraf El-Sayed); N. Sato (Norio); S. Marwah (Sanjay); M. Rangarajan (Muthukumaran); O. Ben-Ishay (Offir); A.R.K. Adesunkanmi (Abdul Rashid); H.A. Segovia Lohse (Helmut); J. Kenig (Jakub); V. Mandalà (Vincenzo); A. Patrizi (Andrea); R. Scibé (Rodolfo); F. Catena (Fausto)

    2013-01-01

    textabstractEmergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of

  15. Endovascular repair of an innominate artery pseudoaneurysm using the Valiant Mona LSA branched graft device

    Directory of Open Access Journals (Sweden)

    Josh A. Sibille, MD

    2017-03-01

    Full Text Available A 60-year-old woman involved in a motor vehicle collision presented with a traumatic pseudoaneurysm of the innominate artery origin in addition to multiple concomitant injuries. She was classified as a high-risk candidate for open repair. An experimental thoracic branched graft device was used for coverage of the injury with the addition of a right carotid-to-left carotid-to-left subclavian artery bypass. Follow-up imaging showed resolution of the pseudoaneurysm and patency of her bypass grafts. This is the first described use of the Mona LSA Branch Thoracic Stent Graft System (Medtronic, Minneapolis, Minn in the innominate artery.

  16. Innovative postmarket device evaluation using a quality registry to monitor thoracic endovascular aortic repair in the treatment of aortic dissection.

    Science.gov (United States)

    Beck, Adam W; Lombardi, Joseph V; Abel, Dorothy B; Morales, J Pablo; Marinac-Dabic, Danica; Wang, Grace; Azizzadeh, Ali; Kern, John; Fillinger, Mark; White, Rodney; Cronenwett, Jack L; Cambria, Richard P

    2017-05-01

    United States Food and Drug Administration (FDA)-mandated postapproval studies have long been a mainstay of the continued evaluation of high-risk medical devices after initial marketing approval; however, these studies often present challenges related to patient/physician recruitment and retention. Retrospective single-center studies also do not fully represent the spectrum of real-world performance nor are they likely to have a sufficiently large enough sample size to detect important signals. In recent years, The FDA Center for Devices and Radiological Health has been promoting the development and use of patient registries to advance infrastructure and methodologies for medical device investigation. The FDA 2012 document, "Strengthening the National System for Medical Device Post-market Surveillance," highlighted registries as a core foundational infrastructure when linked to other complementary data sources, including embedded unique device identification. The Vascular Quality Initiative (VQI) thoracic endovascular aortic repair for type B aortic dissection project is an innovative method of using quality improvement registries to meet the needs of device evaluation after market approval. Here we report the organization and background of this project and highlight the innovation facilitated by collaboration of physicians, the FDA, and device manufacturers. This effort used an existing national network of VQI participants to capture patients undergoing thoracic endovascular aortic repair for acute type B aortic dissection within a registry that aligns with standard practice and existing quality efforts. The VQI captures detailed patient, device, and procedural data for consecutive eligible cases under the auspices of a Patient Safety Organization (PSO). Patients were divided into a 5-year follow-up group (200 acute; 200 chronic dissections) and a 1-year follow-up group (100 acute; 100 chronic). The 5-year cohort required additional imaging details, and the 1-year

  17. Early inflammatory response following elective abdominal aortic aneurysm repair: A comparison between endovascular procedure and conventional, open surgery

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2011-01-01

    Full Text Available Background/Aim. Abdominal aorta aneurysm (AAA represents a pathological enlargment of infrarenal portion of aorta for over 50% of its lumen. The only treatment of AAA is a surgical reconstruction of the affected segment. Until the late XX century, surgical reconstruction implied explicit, open repair (OR of AAA, which was accompanied by a significant morbidity and mortality of the treated patients. Development of endovascular repair of (EVAR AAA, especially in the last decade, offered another possibility of surgical reconstruction of AAA. The preliminary results of world studies show that complications of such a procedure, as well as morbidity and mortality of patients, are significantly lower than with OR of AAA. The aim of this paper was to present results of comparative clinical prospective study of early inflammatory response after reconstruction of AAA between endovascular and open, conventional surgical technique. Methods. A comparative clinical prospective study included 39 patients, electively operated on for AAA within the period of December 2008 - February 2010, divided into two groups. The group I counted 21 (54% of the patients, 58-87 years old (mean 74.3 years, who had been submited to EVAR by the use of excluder stent graft. The group II consisted of 18 (46% of the patients, 49-82 (mean 66.8 years, operated on using OR technique. All of the treated patients in both groups had AAA larager than 50 mm. The study did not include patients who have been treated as urgent cases, due to the rupture or with simptomatic AAA. Clinical, biochemical and inflamatory parameters in early postoperative period were analyzed, in direct postoperative course (number of leucocytes, thrombocytes, serum circulating levels of cytokine - interleukine (IL-2, IL-4, IL-6 and IL-10. Parameters were monitored on the zero, first, second, third and seventh postoperative days. The study was approved by the Ethics Commitee of the Military Medical Academy. Results

  18. Efficacy and Safety of Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Rafiuddin, E-mail: rafiuddin.patel@ouh.nhs.uk [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Juszczak, Maciej T. [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Bratby, Mark J. [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Sideso, Ediri [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Anthony, Susan; Tapping, Charles R. [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom); Handa, Ashok; Darby, Christopher R.; Perkins, Jeremy [Oxford University Hospitals NHS Trust, Department of Vascular Surgery, John Radcliffe Hospital (United Kingdom); Uberoi, Raman [Oxford University Hospitals NHS Trust, Department of Radiology, John Radcliffe Hospital (United Kingdom)

    2015-08-15

    PurposeTo report our experience of selectively augmenting the preclose technique for percutaneous endovascular aneurysm repair (p-EVAR) with an Angio-Seal device as a haemostatic adjunct in cases of significant bleeding after tensioning the sutures of the suture-mediated closure devices.Materials and MethodsProspectively collected data for p-EVAR patients at our institute were analysed. Outcomes included technical success and access site complications. A logistic regression model was used to analyse the effects of sheath size, CFA features and stent graft type on primary failure of the preclose technique necessitating augmentation and also on the development of complications.Resultsp-EVAR was attempted via 122 CFA access sites with a median sheath size of 18-French (range 12- to 28-French). Primary success of the preclose technique was 75.4 % (92/122). Angio-Seal augmentation was utilised as an adjunct to the preclose technique in 20.5 % (25/122). The overall p-EVAR success rate was 95.1 % (116/122). There was a statistically significant relationship (p = 0.0093) between depth of CFA and primary failure of preclose technique. CFA diameter, calcification, type of stent graft and sheath size did not have significant effects on primary preclose technique failure. Overall 4.9 % (6/122) required surgical conversion but otherwise there were no major complications.ConclusionAugmentation with an Angio-Seal device is a safe and effective adjunct to increase the success rate of the preclose technique in p-EVAR.

  19. Investigation of reference levels and radiation dose associated with abdominal EVAR (endovascular aneurysm repair) procedures across several European Centres

    Energy Technology Data Exchange (ETDEWEB)

    Tuthill, E.; Rainford, L. [University College Dublin, Diagnostic Imaging, School of Medicine, Dublin (Ireland); O' Hora, L.; O' Donohoe, M. [Mater Misericordiae University Hospital, Dublin (Ireland); Panci, S. [San Giovanni di Dio Hospital, Florence (Italy); Gilligan, P.; Fox, E. [Mater Private Hospital, Dublin (Ireland); Campion, D. [Mauriziano-Umberto Hospital, Turin (Italy); Trenti, R. [Policlinico S. Orsola-Malpighi, Bologna (Italy); Catania, D. [AITRI, Association of Italian Interventional Radiographers, Milan (Italy)

    2017-11-15

    Endovascular aneurysm repair (EVAR) is considered the treatment of choice for abdominal aortic aneurysms with suitable anatomy. In order to improve radiation safety, European Directive (2013/59) requires member states to implement diagnostic reference levels (DRLs) in radio-diagnostic and interventional procedures. This study aimed to determine local DRLs for EVAR across five European centres and identify an interim European DRL, which currently remains unestablished. Retrospective data was collected for 180 standard EVARs performed between January 2014 and July 2015 from five specialist centres in Ireland (n=2) and Italy (n=3). Data capture included: air kerma-area product (P{sub KA}), total air kerma at the reference point (K{sub a,r}), fluoroscopic time (FT), number of acquisitions, frame rate of acquisition, type of acquisition, patient height, weight, and gender. The mean values for each site A, B, C, D, and E were: P{sub KA}s of 4343 ± 994 μGym{sup 2}, 18,200 ± 2141 μGym{sup 2}, 11,423 ± 1390 μGym{sup 2}, 7796 ± 704 μGym{sup 2}, 31,897 ± 5798 μGym{sup 2}; FTs of 816 ± 92 s, 950 ± 150 s, 708 ± 70 s, 972 ± 61 s, 827 ± 118 s; and number of acquisitions of 6.72 ± 0.56, 10.38 ± 1.54, 4.74 ± 0.19, 5.64 ± 0.36, 7.28 ± 0.65, respectively. The overall pooled 75th percentile P{sub KA} was 15,849 μGym{sup 2}. Local reference levels were identified. The pooled data has been used to establish an interim European DRL for EVAR procedures. (orig.)

  20. Complete ten-year follow-up after endovascular abdominal aortic aneurysm repair: Survival and causes of death

    International Nuclear Information System (INIS)

    Wibmer, Andreas; Nolz, Richard; Teufelsbauer, Harald; Kretschmer, Georg; Prusa, Alexander M.; Funovics, Martin; Lammer, Johannes; Schoder, Maria

    2012-01-01

    Purpose: To analyze the hazard and causes of death after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms during a complete ten year follow-up. Methods: This is a retrospective clinical study of 130 consecutive patients undergoing EVAR between 1995 and 1998. One-hundred twenty-one patients (93.1%) were treated with first-generation stentgrafts and nine patients (6.9%) received second-generation devices. All patients completed a follow-up of at least 10 years, unless death occurred before then. Time and causes of death were provided by the Austrian central register of deaths. Results: The median follow-up was 7.6 years, and the 130 patients had 968.5 person-years of follow-up. The ten-year mortality rate was 62.3%. Cardiovascular events were the most frequent causes of death, with a 3.9 incidence rate per 100 person-years. Cancer death and death due to other causes occurred in 2.1 and 1.8 cases per 100 person-years, respectively. Lethal late aneurysm rupture happened in 4.6% (n = 6), which corresponds to an annual incidence rate of 0.6 per 100 person-years. All of those patients had been treated with first-generation devices. Conclusions: Cardiovascular events were the most frequent cause of death after EVAR, followed by malignancy and other diseases. The risk of dying from secondary rupture was clearly lower than that of death due to other reasons during ten years after EVAR, even in patients with first-generation stentgrafts.

  1. Maximum Diameter Measurements of Aortic Aneurysms on Axial CT Images After Endovascular Aneurysm Repair: Sufficient for Follow-up?

    International Nuclear Information System (INIS)

    Baumueller, Stephan; Nguyen, Thi Dan Linh; Goetti, Robert Paul; Lachat, Mario; Seifert, Burkhardt; Pfammatter, Thomas; Frauenfelder, Thomas

    2011-01-01

    Purpose: To assess the accuracy of maximum diameter measurements of aortic aneurysms after endovascular aneurysm repair (EVAR) on axial computed tomographic (CT) images in comparison to maximum diameter measurements perpendicular to the intravascular centerline for follow-up by using three-dimensional (3D) volume measurements as the reference standard. Materials and Methods: Forty-nine consecutive patients (73 ± 7.5 years, range 51–88 years), who underwent EVAR of an infrarenal aortic aneurysm were retrospectively included. Two blinded readers twice independently measured the maximum aneurysm diameter on axial CT images performed at discharge, and at 1 and 2 years after intervention. The maximum diameter perpendicular to the centerline was automatically measured. Volumes of the aortic aneurysms were calculated by dedicated semiautomated 3D segmentation software (3surgery, 3mensio, the Netherlands). Changes in diameter of 0.5 cm and in volume of 10% were considered clinically significant. Intra- and interobserver agreements were calculated by intraclass correlations (ICC) in a random effects analysis of variance. The two unidimensional measurement methods were correlated to the reference standard. Results: Intra- and interobserver agreements for maximum aneurysm diameter measurements were excellent (ICC = 0.98 and ICC = 0.96, respectively). There was an excellent correlation between maximum aneurysm diameters measured on axial CT images and 3D volume measurements (r = 0.93, P < 0.001) as well as between maximum diameter measurements perpendicular to the centerline and 3D volume measurements (r = 0.93, P < 0.001). Conclusion: Measurements of maximum aneurysm diameters on axial CT images are an accurate, reliable, and robust method for follow-up after EVAR and can be used in daily routine.

  2. Early experience with the multilayer aneurysm repair stent in the endovascular treatment of trans/infragenicular popliteal artery aneurysms: a mixed bag.

    Science.gov (United States)

    Thakar, Tejal; Chaudhuri, Arindam

    2013-06-01

    To present a preliminary experience using a multilayer flow-modulating stent for trans/infragenicular popliteal endovascular aneurysm repair. Five men (mean age 76 years, range 62-86) with 6 popliteal artery aneurysms (PAAs) measuring 22 to 39 mm in diameter (mean 30) underwent endovascular repair using the Cardiatis Multilayer Aneurysm Repair System (MARS) between June and August 2011. Radiological assessments post procedure using duplex ultrasonography and biplanar knee radiographs (additional contrast studies as necessary) sought evidence of aneurysm exclusion, graft patency, and preservation of branches and runoff vessels. Technical success was achieved in each case. There was one symptomatic stent occlusion requiring thrombectomy at 4 days, with reocclusion, and one leak via the stent struts into the sac with no branch outflow identified. Two further symptomatic stent occlusions were identified within a 6-week follow-up period, totaling 3 occlusions among the 6 devices deployed. No firm conclusion can be reached on the efficacy of the MARS in PAAs due to the inherent limitations of this small series, although a 50% thrombosis rate is a poor outcome. The risk of early thrombosis in flow-modulating stents deployed in the popliteal artery exists, as it does with earlier generation stent-grafts. Larger prospective trials and the influence of more aggressive antithrombotic/anticoagulant therapy should be considered to enable accurate evaluation of this device in popliteal artery aneurysms.

  3. Low baseline and subsequent higher aortic abdominal aneurysm FDG uptake are associated with poor sac shrinkage post endovascular repair

    Energy Technology Data Exchange (ETDEWEB)

    Marie, Pierre-Yves [CHRU-Nancy, Universite de Lorraine, Nuclear Medecine and Nancyclotep Platform, Nancy (France); INSERM, University of Lorraine, UMR 1116, Nancy (France); CHRU-Nancy, Hopitaux de BRABOIS, Service de Medecine Nucleaire, Vandoeuvre (France); Plissonnier, Didier; Rouer, Martin [CHU-Rouen, Department of Vascular Surgery, Rouen (France); Bravetti, Stephanie [CHRU-Nancy, Universite de Lorraine, Department of Radiology, Nancy (France); Coscas, Raphael [Hopital Ambroise Pare, APHP, Chirurgie Vasculaire, Boulogne-Billancourt (France); Haulon, Stephan [CHU-Lille, Department of Vascular Surgery, Lille (France); Mandry, Damien [CHRU-Nancy, Universite de Lorraine, Department of Radiology, Nancy (France); INSERM, University of Lorraine, UMR 947, Nancy (France); Alsac, Jean-Marc [grid.414093.b, APHP, HEGP, Department of Vascular Surgery, Paris (France); Malikov, Serguei; Settembre, Nicla [CHRU-Nancy, Universite de Lorraine, Vascular Surgery, Nancy (France); Goueffic, Yann [CHU-Nantes, Department of Vascular Surgery, Nantes (France); Morel, Olivier [CHU-Besancon, Department of Nuclear Medecine, Besancon (France); Roch, Veronique [CHRU-Nancy, Universite de Lorraine, Nuclear Medecine and Nancyclotep Platform, Nancy (France); Micard, Emilien [INSERM, University of Lorraine, UMR 947, Nancy (France); INSERM, CHRU-Nancy, Universite de Lorraine, CIC-1433, FCRIN INI-CRCT, Nancy (France); Lamiral, Zohra [INSERM, CHRU-Nancy, Universite de Lorraine, CIC-1433, FCRIN INI-CRCT, Nancy (France); Michel, Jean-Baptiste [INSERM, Bichat, UMR 698, Paris (France); Rossignol, Patrick [INSERM, University of Lorraine, UMR 1116, Nancy (France); INSERM, CHRU-Nancy, Universite de Lorraine, CIC-1433, FCRIN INI-CRCT, Nancy (France)

    2018-04-15

    The growth phases of medically treated abdominal aortic aneurysms (AAA) are frequently associated with an {sup 18}F-fluorodesoxyglucose positron emission tomography (FDG-PET) pattern involving low baseline and subsequent higher FDG uptake. However, the FDG-PET patterns associated with the endovascular aneurysm repair (EVAR) of larger AAA are presently unknown. This study aimed to investigate the relationship between serial AAA FDG uptake measurements, obtained before EVAR and 1 and 6 months post-intervention and subsequent sac shrinkage at 6 months, a well-recognized indicator of successful repair. Thirty-three AAA patients referred for EVAR (maximal diameter: 55.4 ± 6.0 mm, total volume: 205.7 ± 63.0 mL) underwent FDG-PET/computed tomography (CT) before EVAR and at 1 and 6 months thereafter, with the monitoring of AAA volume and of a maximal standardized FDG uptake [SUVmax] averaged between the axial slices encompassing the AAA. Sac shrinkage was highly variable and could be stratified into three terciles: a first tercile in which shrinkage was absent or very limited (0-29 mL) and a third tercile with pronounced shrinkage (56-165 mL). SUVmax values were relatively low at baseline in the 1st tercile (SUVmax: 1.69 ± 0.33), but markedly increased at 6 months (2.42 ± 0.69, p = 0.02 vs. baseline). These SUV max values were by contrast much higher at baseline in the 3rd tercile (SUVmax: 2.53 ± 0.83 p = 0.009 vs. 1st tercile) and stable at 6 months (2.49 ± 0.80), while intermediate results were documented in the 2nd tercile. Lastly, the amount of sac shrinkage, expressed in absolute values or in percentages of baseline AAA volumes, was positively correlated with baseline SUVmax (p = 0.001 for both). A low pre-EVAR FDG uptake and increased AAA FDG uptake at 6 months are associated with reduced sac shrinkage. This sequential FDG-PET pattern is similar to that already shown to accompany growth phases of medically treated AAA. (orig.)

  4. Low baseline and subsequent higher aortic abdominal aneurysm FDG uptake are associated with poor sac shrinkage post endovascular repair

    International Nuclear Information System (INIS)

    Marie, Pierre-Yves; Plissonnier, Didier; Rouer, Martin; Bravetti, Stephanie; Coscas, Raphael; Haulon, Stephan; Mandry, Damien; Alsac, Jean-Marc; Malikov, Serguei; Settembre, Nicla; Goueffic, Yann; Morel, Olivier; Roch, Veronique; Micard, Emilien; Lamiral, Zohra; Michel, Jean-Baptiste; Rossignol, Patrick

    2018-01-01

    The growth phases of medically treated abdominal aortic aneurysms (AAA) are frequently associated with an 18 F-fluorodesoxyglucose positron emission tomography (FDG-PET) pattern involving low baseline and subsequent higher FDG uptake. However, the FDG-PET patterns associated with the endovascular aneurysm repair (EVAR) of larger AAA are presently unknown. This study aimed to investigate the relationship between serial AAA FDG uptake measurements, obtained before EVAR and 1 and 6 months post-intervention and subsequent sac shrinkage at 6 months, a well-recognized indicator of successful repair. Thirty-three AAA patients referred for EVAR (maximal diameter: 55.4 ± 6.0 mm, total volume: 205.7 ± 63.0 mL) underwent FDG-PET/computed tomography (CT) before EVAR and at 1 and 6 months thereafter, with the monitoring of AAA volume and of a maximal standardized FDG uptake [SUVmax] averaged between the axial slices encompassing the AAA. Sac shrinkage was highly variable and could be stratified into three terciles: a first tercile in which shrinkage was absent or very limited (0-29 mL) and a third tercile with pronounced shrinkage (56-165 mL). SUVmax values were relatively low at baseline in the 1st tercile (SUVmax: 1.69 ± 0.33), but markedly increased at 6 months (2.42 ± 0.69, p = 0.02 vs. baseline). These SUV max values were by contrast much higher at baseline in the 3rd tercile (SUVmax: 2.53 ± 0.83 p = 0.009 vs. 1st tercile) and stable at 6 months (2.49 ± 0.80), while intermediate results were documented in the 2nd tercile. Lastly, the amount of sac shrinkage, expressed in absolute values or in percentages of baseline AAA volumes, was positively correlated with baseline SUVmax (p = 0.001 for both). A low pre-EVAR FDG uptake and increased AAA FDG uptake at 6 months are associated with reduced sac shrinkage. This sequential FDG-PET pattern is similar to that already shown to accompany growth phases of medically treated AAA. (orig.)

  5. Endovascular Repair of a Perforation of the Vena Caval Wall Caused by the Retrieval of a Gunther Tulip Filter After Long-Term Implantation

    International Nuclear Information System (INIS)

    Morishita, Hiroyuki; Yamagami, Takuji; Matsumoto, Tomohiro; Takeuchi, Yoshito; Sato, Osamu; Nishimura, Tsunehiko

    2011-01-01

    Symptomatic penetration of the inferior vena cava (IVC) wall reportedly occurs in 0.3% of patients in whom a filter has been implanted, and it causes injury to the adjacent structures (Bogue et al. in Pediatr Radiol 39(10):1110–1113, 1; Brzezinski et al. in Burns 32(5):640–643, 2). We succeeded in the endovascular repair of perforation of the IVC wall occurring during the retrieval of a penetrated Gunther tulip vena cava filter (Cook, Bjaeverskov, Denmark) after long-term implantation.

  6. Epidemiology of abdominal aortic aneurysms in a Chinese population during introduction of endovascular repair, 1994 to 2013: A retrospective observational study.

    Science.gov (United States)

    Tam, Greta; Chan, Yiu Che; Chong, Ka Chun; Lee, Kam Pui; Cheung, Grace Chung-Yan; Cheng, Stephen Wing-Keung

    2018-03-01

    The aim of this study was to examine changes in abdominal aortic aneurysm repair and mortality during a period when endovascular aneurysm repair (EVAR) was introduced.Open repair surgery was the mainstay of treatment for abdominal aortic aneurysm (AAA), but EVAR is increasingly utilized. Studies in the Western population have reported improved short-term or postoperative mortality and shorter length of hospital stay with EVAR. However, scant data are available in the Chinese population.We conducted a retrospective observational study using the database of the Hospital Authority, which provides public health care to most of the Hong Kong population. AAA patients admitted to public hospitals for intact repair or rupture from 1994 to 2013 were included in this study. We calculated the incidence of ruptured AAA, annual repair rates according to type of AAA and surgery, as well as death rates (operative and overall short-term). We calculated whether there were significant changes over time and compared short-term mortality between open surgery and EVAR.One thousand eight hundred eighty-five patients were admitted for intact repair and 1306 patients were admitted for AAA rupture, of whom 795 underwent rupture repair. Intact repair rates significantly increased in all age groups (7.3-37.8%, P short-term AAA-related deaths decreased by more than half (73% in 1994 to 24% in 2013, P Short-term mortality was significantly lower for EVAR than for open repair (17.2% vs 40.3%, P Short-term AAA-related deaths have declined likely due to decreased operative mortality and rupture deaths during the period of EVAR introduction and expansion.

  7. Outcomes of Endovascular Aneurysm Repair using the Ovation Stent Graft System in Adverse Anatomy.

    Science.gov (United States)

    Greaves, Nicholas S; Moore, Aiden; Seriki, Dare; Ghosh, Jonathan

    2018-04-01

    The aim was the evaluation of mid-term efficacy and safety outcome measures for the Ovation (Endologix, Santa Rosa, CA, USA) stent graft system in the management of infrarenal abdominal aortic aneurysms (iAAA) with adverse anatomy. A retrospective observational study of all patients undergoing elective iAAA repair was carried out from 2012 to 2017 using Ovation Prime or iX stent grafts with a minimum of 3 months follow-up at a single UK vascular centre. Post-operative surveillance involved computed tomography scans at 3 months and 1 year, with duplex ultrasound yearly thereafter. Outcome measures were established with retrospective analysis of pre- and post-operative imaging, and included peri-operative mortality, major adverse events, limb complications, aneurysm diameter change, and endoleak rates. All patients were within Ovation instructions for use (IFU), and assessment was made to determine whether aneurysms had anatomical features considered adverse for other commonly used stent graft platforms. Ovation stent grafts were implanted in 52 patients (79% male, mean age 75.7 years) with a mean aneurysm diameter of 62.5 mm (range 55-107 mm). There was 100% technical deployment success. The 30 day mortality was 0% and there was no aneurysm related mortality during follow-up (median 24 months, range 3-48 months). There were no type I or III endoleaks, but 19% developed type II endoleaks with one patient requiring re-intervention. No iliac limb occlusions were identified but one case required relining for limb kinking. All 52 cases were within the IFU for Ovation but only 12% met the IFU criteria for the Cook and Medtronic devices. The mid-term experience with Ovation demonstrates safe, durable treatment of iAAAs, including those with unfavourable anatomy, frequently off IFU for other commonly used devices. Copyright © 2017 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.

  8. Improving Results of Elective Abdominal Aortic Aneurysm Repair at a Low-Volume Hospital by Risk-Adjusted Selection of Treatment in the Endovascular Era

    International Nuclear Information System (INIS)

    Wibmer, Andreas; Meyer, Bernhard; Albrecht, Thomas; Buhr, Heinz-Johannes; Kruschewski, Martin

    2009-01-01

    Several studies have observed both higher mortality rates and lower utilization of endovascular aneurysm repair (EVAR) at low-volume centers. This article presents the results of elective abdominal aortic aneurysm (AAA) repair at a low-volume center in the endovascular era and investigates whether postprocedural mortality can be improved by extension of EVAR application also in this setting. This is an 11.6-year retrospective cohort study of 132 patients undergoing elective surgical or endovascular AAA repair at a tertiary care academic hospital between 1997 and July 2008, i.e., a median volume of 12 cases per year. The study was divided into two periods of time according to the respective indications and contraindications for EVAR, which substantially changed in 2005. During period 1, only aneurysms with necks ≥20 mm long and not involving the iliac arteries were treated endoluminally. Beginning in 2005, indication for EVAR was expanded to aortoiliac aneurysms with a minimum neck length of 15 mm. Preoperative risk was assessed by the SVS/AAVS comorbidity score. During the first period (1997-2004) 18.4% (16/87) of all patients received EVAR. By extending anatomical confines and indications for EVAR in 2005, the utilization rate of EVAR increased to 40.0% (18/45) during the second period (2005-July 2008; p = 0.007). Prevalence of preoperative risk factors did not change during the two observation periods. In contrast to period 1, high-risk patients were preferentially treated endoluminally during the second period, resulting in a significantly higher median SVS/AAVS score in the EVAR group (p < 0.001). A significant decrease in median length of stay at the intensive/intermediate care unit (5 vs. 2 days; p = 0.006) and length of in-hospital stay (20 vs. 12.5 days; p < 0.001) was observed during period 2. Overall perioperative mortality was reduced from 6.9% during the first period to 2.2% during the second period (p = 0.256). EVAR mortality was 0%, mortality after

  9. Predictors of outcome after elective endovascular abdominal aortic aneurysm repair and external validation of a risk prediction model.

    Science.gov (United States)

    Wisniowski, Brendan; Barnes, Mary; Jenkins, Jason; Boyne, Nicholas; Kruger, Allan; Walker, Philip J

    2011-09-01

    Endovascular abdominal aortic aneurysm (AAA) repair (EVAR) has been associated with lower operative mortality and morbidity than open surgery but comparable long-term mortality and higher delayed complication and reintervention rates. Attention has therefore been directed to identifying preoperative and operative variables that influence outcomes after EVAR. Risk-prediction models, such as the EVAR Risk Assessment (ERA) model, have also been developed to help surgeons plan EVAR procedures. The aims of this study were (1) to describe outcomes of elective EVAR at the Royal Brisbane and Women's Hospital (RBWH), (2) to identify preoperative and operative variables predictive of outcomes after EVAR, and (3) to externally validate the ERA model. All elective EVAR procedures at the RBWH before July 1, 2009, were reviewed. Descriptive analyses were performed to determine the outcomes. Univariate and multivariate analyses were performed to identify preoperative and operative variables predictive of outcomes after EVAR. Binomial logistic regression analyses were used to externally validate the ERA model. Before July 1, 2009, 197 patients (172 men), who were a mean age of 72.8 years, underwent elective EVAR at the RBWH. Operative mortality was 1.0%. Survival was 81.1% at 3 years and 63.2% at 5 years. Multivariate analysis showed predictors of survival were age (P = .0126), American Society of Anesthesiologists (ASA) score (P = .0180), and chronic obstructive pulmonary disease (P = .0348) at 3 years and age (P = .0103), ASA score (P = .0006), renal failure (P = .0048), and serum creatinine (P = .0022) at 5 years. Aortic branch vessel score was predictive of initial (30-day) type II endoleak (P = .0015). AAA tortuosity was predictive of midterm type I endoleak (P = .0251). Female sex was associated with lower rates of initial clinical success (P = .0406). The ERA model fitted RBWH data well for early death (C statistic = .906), 3-year survival (C statistic = .735), 5-year

  10. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    International Nuclear Information System (INIS)

    Saha, Prakash; Hughes, John; Patel, Ashish S.; Donati, Tommaso; Sallam, Morad; Patel, Sanjay D.; Bell, Rachel E.; Katsanos, Konstantinos; Modarai, Bijan; Zayed, Hany A.

    2015-01-01

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities

  11. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    Energy Technology Data Exchange (ETDEWEB)

    Saha, Prakash, E-mail: prakash.2.saha@kcl.ac.uk; Hughes, John, E-mail: johnhughes387@rocketmail.com; Patel, Ashish S., E-mail: ashish.s.patel@kcl.ac.uk; Donati, Tommaso, E-mail: tommaso.donati@gstt.nhs.uk; Sallam, Morad, E-mail: morad.sallam@gstt.nhs.uk; Patel, Sanjay D., E-mail: sanjay.patel@gstt.nhs.uk; Bell, Rachel E. [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Katsanos, Konstantinos, E-mail: katsanos@med.upatras.gr [King’s Health Partners, Department of Interventional Radiology, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom); Modarai, Bijan, E-mail: bijan.modarai@kcl.ac.uk; Zayed, Hany A., E-mail: hany.zayed@gstt.nhs.uk [King’s Health Partners, Department of Vascular Surgery, Guy’s and St. Thomas’ Hospitals, NHS Foundation Trust (United Kingdom)

    2015-08-15

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

  12. Type 1a endoleak following Zone 1 and Zone 2 thoracic endovascular aortic repair: effect of bird-beak configuration.

    Science.gov (United States)

    Kudo, Tomoaki; Kuratani, Toru; Shimamura, Kazuo; Sakamoto, Tomohiko; Kin, Keiwa; Masada, Kenta; Shijo, Takayuki; Torikai, Kei; Maeda, Koichi; Sawa, Yoshiki

    2017-10-01

    Type 1a endoleak is one of the most severe complications after thoracic endovascular aortic repair (TEVAR), because it carries the risk of aortic rupture. The association between bird-beak configuration and Type 1a endoleak remains unclear. The purpose of this study was to analyse the predictors of Type 1a endoleak following Zone 1 and Zone 2 TEVAR, with a particular focus on the effect of bird-beak configuration. From April 2008 to July 2015, 105 patients (mean age 68.6 years) who underwent Zone 1 and 2 landing TEVAR were enrolled, with a mean follow-up period of 4.3 years. The patients were categorized into 2 groups, according to the presence (Group B, n = 32) or the absence (Group N, n = 73) of bird-beak configuration on the first postoperative multidetector computed tomography. The Kaplan-Meier event-free rate curve showed that Type 1a endoleak and bird-beak progression occurred less frequently in Group N than in Group B. Five-year freedom from Type 1a endoleak rates were 79.7% and 100% for Groups B and N, respectively (P = 0.007). Multivariable logistic regression analysis showed that dissecting aortic aneurysm (odds ratio 3.72, 95% confidence interval 1.30-11.0; P = 0.014) and shorter radius of inner curvature (odds ratio 1.09, 95% confidence interval 0.85-0.99; P = 0.025) were significant risk factors for bird-beak configuration. Multivariable Cox proportional hazard regression showed that Z-type stent graft (hazard ratio 2.69, 95% confidence interval 1.11-6.51; P = 0.030) was a significant risk factor for bird-beak progression. Appropriate stent grafts need to be chosen carefully to prevent Type 1a endoleak and bird-beak configuration after landing Zone 1 and 2 TEVAR. Patients with bird-beak configuration on early postoperative multidetector computed tomography require closer follow-up to screen for Type 1a endoleak. © The Author 2017. Published by Oxford University Press on behalf of the European Association for Cardio

  13. One Year Outcomes of 101 BeGraft Stent Grafts used as Bridging Stents in Fenestrated Endovascular Repairs.

    Science.gov (United States)

    Spear, Rafaelle; Sobocinski, Jonathan; Hertault, Adrien; Delloye, Matthieu; Azzauiu, Richard; Fabre, Dominique; Haulon, Stéphan

    2018-04-01

    To evaluate the outcomes of the second generation BeGraft balloon expandable covered stent Graft System (Bentley InnoMed, Hechingen, Germany) implanted as bridging stent grafts during fenestrated endovascular aortic repair (FEVAR) of complex aneurysms. This was a single centre prospective study including all consecutive patients treated by FEVAR performed with second generation BeGraft stent grafts as bridging stents. Demographics of patients, diameter and length of the bridging stent grafts, technical success, re-interventions, occlusions, post-operative events, and imaging (Cone Beam CT and/or CT scan, and contrast enhanced ultrasound) were prospectively collected in an electronic database. Duplex ultrasound was performed before discharge and at 6 month follow-up. At 1 year, patients were evaluated clinically and by imaging (CT and ultrasound). Between November 2015 and September 2016, 39 consecutive patients (one woman) were treated with custom made fenestrated endografts (2-5 fenestrations) for complex aneurysms or type 1 endoleak after EVAR, using a variety of bridging stents including the BeGraft. All 101 BeGraft stent grafts were successfully delivered and deployed. There was no in hospital mortality. Early fenestration patency rate was 99% (96/97); the sole target vessel post-operative occlusion was secondary to a dissection of the renal artery distal to the stent. Complementary stenting was unsuccessful in recovering renal artery patency; bilateral renal stent occlusion was observed in the same patient on a CT scan performed 2 months after the procedure. He required post-operative dialysis. No additional renal impairment was observed. During follow-up (median 13 months [11-15]), all fenestrations stented with BeGraft stent grafts remained patent (95/97, 98%). One type 1b endoleak was detected and treated (2.6%). BeGraft stent grafts used as bridging stents during FEVAR are associated with favourable outcomes at 1 year follow-up. Long-term follow-up is

  14. Contemporary methods of emergency repair works on transit pipelines. Repair works on in-service pipelines

    International Nuclear Information System (INIS)

    Olma, T.; Winckowski, J.

    2007-01-01

    The paper presents modern methods and relevant technologies of pipeline failure repairs, basing on TD Williamson technique for hermetic plugging of gas pipelines without interrupting service. Rules for management of emergency situations on the Polish Section of Yamal - Europe Transit Gas Pipeline are being discussed as well. (author)

  15. Delayed endovascular aortic repair is associated with reduced in-hospital mortality in patients with blunt thoracic aortic injury.

    Science.gov (United States)

    Marcaccio, Christina L; Dumas, Ryan P; Huang, Yanlan; Yang, Wei; Wang, Grace J; Holena, Daniel N

    2018-02-13

    The traditional approach to stable blunt thoracic aortic injury (BTAI) endorsed by the Society for Vascular Surgery is early (<24 hours) thoracic endovascular aortic repair (TEVAR). Recently, some studies have shown improved mortality in stable BTAI patients repaired in a delayed manner (≥24 hours). However, the indications for use of delayed TEVAR for BTAI are not well characterized, and its overall impact on the patient's survival remains poorly understood. We sought to determine whether delayed TEVAR is associated with a decrease in mortality compared with early TEVAR in this population. We conducted a retrospective cohort study of adult patients with BTAI (International Classification of Diseases, Ninth Revision diagnosis code 901.0) who underwent TEVAR (International Classification of Diseases, Ninth Revision procedure code 39.73) from 2009 to 2013 using the National Sample Program data set. Missing physiologic data were imputed using chained multiple imputation. Patients were parsed into groups based on the timing of TEVAR (early, <24 hours, vs delayed, ≥24 hours). The χ 2 , Mann-Whitney, and Fisher exact tests were used to compare baseline characteristics and outcomes of interest between groups. Multivariable logistic regression for mortality was performed that included all variables significant at P ≤ .2 in univariate analyses. A total of 2045 adult patients with BTAI were identified, of whom 534 (26%) underwent TEVAR. Patients with missing data on TEVAR timing were excluded (n = 27), leaving a total of 507 patients for analysis (75% male; 69% white; median age, 40 years [interquartile range, 27-56 years]; median Injury Severity Score [ISS], 34 [interquartile range, 26-41]). Of these, 378 patients underwent early TEVAR and 129 underwent delayed TEVAR. The two groups were similar with regard to age, sex, race, ISS, and presenting physiology. Mortality was 11.9% in the early TEVAR group vs 5.4% in the delayed group, with the early group

  16. Endovascular repair of inadvertent arterial injury induced by central venous catheterization using a vascular closure device: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, So Hee; Jang, Woo Jin; Oh, Ju Heyon; Song, Yun Gyu [Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon (Korea, Republic of)

    2017-04-15

    Central venous catheterization can cause various complications. Inadvertent subclavian artery catheterization was performed during insertion of a central venous catheter in a 73-year-old man suffering from panperitonitis due to small-bowel perforation. Endovascular treatment was conducted to treat the injured subclavian artery with a FemoSeal vascular closure device.

  17. Endovascular repair of an iliac arteriovenous fistula secondary to perforation from a common iliac aneurysm in a patient with Ehler-Danlos syndrome.

    Science.gov (United States)

    Sala Almonacil, Vicente Andrés; Zaragozá García, José Miguel; Gómez Palonés, Francisco Julián; Plaza Martínez, Ángel; Ortíz Monzón, Eduardo

    2012-08-01

    Type IV Ehler-Danlos syndrome (EDS) patients are prone to life-threatening vascular complications. Surgical management of those complications is challenging owing to vessel wall fragility, which may result in hemorrhagic events and high mortality rates. Here we report a case of left common iliac aneurysm perforation of the ipsilateral iliac vein repaired using endovascular technique in a patient with EDS. A 54-year-old patient presented with heart failure symptoms that evolved over 1 week in association with left leg edema and steal syndrome due to a perforation of the left iliac vein caused by a left common iliac aneurysm. A thrombosed right common iliac aneurysm and several other visceral and peripheral aneurysms were discovered on computed tomographic scan at admission. An aortouniiliac stent graft was used to seal the fistula. After 18 months of follow-up, the patient remained asymptomatic. We suggest that endovascular therapy is useful to manage vascular complications in patients with EDS. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  18. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

    International Nuclear Information System (INIS)

    Fanelli, Fabrizio; Cannavale, Alessandro; Gazzetti, Marianna; Fantozzi, Cristiano; Taurino, Maurizio; Speziale, Francesco

    2013-01-01

    This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient’s clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

  19. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

    Energy Technology Data Exchange (ETDEWEB)

    Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it; Cannavale, Alessandro [University of Rome ' Sapienza,' , Department of Radiological Sciences, Vascular and Interventional Radiology Unit (Italy); Gazzetti, Marianna [Sapienza University of Rome ' Sapienza,' , Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy); Fantozzi, Cristiano; Taurino, Maurizio [University of Rome ' Sapienza,' , Department of Vascular Surgery (Italy); Speziale, Francesco [Sapienza University of Rome ' Sapienza,' , Department of Surgery Paride Stefanini, Vascular Surgery Division, Policlinico Umberto I (Italy)

    2013-02-15

    This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

  20. [Endovascular surgery in the war].

    Science.gov (United States)

    Reva, V A; Samokhvalov, I M

    2015-01-01

    Rapid growth of medical technologies has led to implementation of endovascular methods of diagnosis and treatment into rapidly developing battlefield surgery. This work based on analysing all available current publications generalizes the data on using endovascular surgery in combat vascular injury. During the Korean war (1950-1953) American surgeons for the first time performed endovascular balloon occlusion of the aorta - the first intravascular intervention carried out in a zone of combat operations. Half a century thereafter, with the beginning of the war in Afghanistan (2001) and in Iraq (2003) surgeons of central hospitals of the USA Armed Forces began performing delayed endovascular operations to the wounded. The development of technologies, advent of mobile angiographs made it possible to later on implement high-tech endovascular interventions in a zone of combat operations. At first, more often they performed implantation of cava filters, somewhat afterward - angioembolization of damaged accessory vessels, stenting and endovascular repair of major arteries. The first in the theatre of war endovascular prosthetic repair of the thoracic aorta for severe closed injury was performed in 2008. Russian experience of using endovascular surgery in combat injuries is limited to diagnostic angiography and regional intraarterial perfusion. Despite the advent of stationary angiographs in large hospitals of the RF Ministry of Defence in the early 1990s, endovascular operations for combat vascular injury are casuistic. Foreign experience in active implementation of endovascular technologies to treatment of war-time injuries has substantiated feasibility of using intravascular interventions in tertiary care military hospitals. Carrying out basic training courses on endovascular surgery should become an organic part of preparing multimodality general battlefield surgeons rendering care on the theatre of combat operations.

  1. New Technique for the Preservation of the Left Common Carotid Artery in Zone 2a Endovascular Repair of Thoracic Aortic Aneurysm

    International Nuclear Information System (INIS)

    Juszkat, Robert; Kulesza, Jerzy; Zarzecka, Anna; Jemielity, Marek; Staniszewski, Ryszard; Majewski, Wacław

    2011-01-01

    To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a—the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.

  2. Brain aneurysm repair

    Science.gov (United States)

    ... aneurysm repair; Dissecting aneurysm repair; Endovascular aneurysm repair - brain; Subarachnoid hemorrhage - aneurysm ... Your scalp, skull, and the coverings of the brain are opened. A metal clip is placed at ...

  3. 3D printing of an aortic aneurysm to facilitate decision making and device selection for endovascular aneurysm repair in complex neck anatomy.

    Science.gov (United States)

    Tam, Matthew D B S; Laycock, Stephen D; Brown, James R I; Jakeways, Matthew

    2013-12-01

    To describe rapid prototyping or 3-dimensional (3D) printing of aneurysms with complex neck anatomy to facilitate endovascular aneurysm repair (EVAR). A 75-year-old man had a 6.6-cm infrarenal aortic aneurysm that appeared on computed tomographic angiography to have a sharp neck angulation of ~90°. However, although the computed tomography (CT) data were analyzed using centerline of flow, the true neck length and relations of the ostial origins were difficult to determine. No multidisciplinary consensus could be reached as to which stent-graft to use owing to these borderline features of the neck anatomy. Based on past experience with rapid prototyping technology, a decision was taken to print a model of the aneurysm to aid in visualization of the neck anatomy. The CT data were segmented, processed, and converted into a stereolithographic format representing the lumen as a 3D volume, from which a full-sized replica was printed within 24 hours. The model demonstrated that the neck was adequate for stent-graft repair using the Aorfix device. Rapid prototyping of aortic aneurysms is feasible and can aid decision making and device delivery. Further work is required to test the value of 3D replicas in planning procedures and their impact on procedure time, radiation dose, and procedure cost.

  4. Endovascular aneurysm repair simulation can lead to decreased fluoroscopy time and accurately delineate the proximal seal zone.

    Science.gov (United States)

    Kim, Ann H; Kendrick, Daniel E; Moorehead, Pamela A; Nagavalli, Anil; Miller, Claire P; Liu, Nathaniel T; Wang, John C; Kashyap, Vikram S

    2016-07-01

    The use of simulators for endovascular aneurysm repair (EVAR) is not widespread. We examined whether simulation could improve procedural variables, including operative time and optimizing proximal seal. For the latter, we compared suprarenal vs infrarenal fixation endografts, right femoral vs left femoral main body access, and increasing angulation of the proximal aortic neck. Computed tomography angiography was obtained from 18 patients who underwent EVAR at a single institution. Patient cases were uploaded to the ANGIO Mentor endovascular simulator (Simbionix, Cleveland, Ohio) allowing for three-dimensional reconstruction and adapted for simulation with suprarenal fixation (Endurant II; Medtronic Inc, Minneapolis, Minn) and infrarenal fixation (C3; W. L. Gore & Associates Inc, Newark, Del) deployment systems. Three EVAR novices and three experienced surgeons performed 18 cases from each side with each device in randomized order (n = 72 simulations/participant). The cases were stratified into three groups according to the degree of infrarenal angulation: 0° to 20°, 21° to 40°, and 41° to 66°. Statistical analysis used paired t-test and one-way analysis of variance. Mean fluoroscopy time for participants decreased by 48.6% (P time decreased by 33.8% (P zone coverage in highly angulated aortic necks was significantly decreased. The infrarenal device resulted in mean aortic neck zone coverage of 91.9%, 89.4%, and 75.4% (P zone coverage. The side of femoral access for the main body did not influence proximal seal zone coverage regardless of infrarenal angulation. Simulation of EVAR leads to decreased fluoroscopy times for novice and experienced operators. Side of femoral access did not affect precision of proximal endograft landing. The angulated aortic neck leads to decreased proximal seal zone coverage regardless of infrarenal or suprarenal fixation devices. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  5. Clinical applications of robotic technology in vascular and endovascular surgery.

    Science.gov (United States)

    Antoniou, George A; Riga, Celia V; Mayer, Erik K; Cheshire, Nicholas J W; Bicknell, Colin D

    2011-02-01

    Emerging robotic technologies are increasingly being used by surgical disciplines to facilitate and improve performance of minimally invasive surgery. Robot-assisted intervention has recently been introduced into the field of vascular surgery to potentially enhance laparoscopic vascular and endovascular capabilities. The objective of this study was to review the current status of clinical robotic applications in vascular surgery. A systematic literature search was performed in order to identify all published clinical studies related to robotic implementation in vascular intervention. Web-based search engines were searched using the keywords "surgical robotics," "robotic surgery," "robotics," "computer assisted surgery," and "vascular surgery" or "endovascular" for articles published between January 1990 and November 2009. An evaluation and critical overview of these studies is reported. In addition, an analysis and discussion of supporting evidence for robotic computer-enhanced telemanipulation systems in relation to their applications in laparoscopic vascular and endovascular surgery was undertaken. Seventeen articles reporting on clinical applications of robotics in laparoscopic vascular and endovascular surgery were detected. They were either case reports or retrospective patient series and prospective studies reporting laparoscopic vascular and endovascular treatments for patients using robotic technology. Minimal comparative clinical evidence to evaluate the advantages of robot-assisted vascular procedures was identified. Robot-assisted laparoscopic aortic procedures have been reported by several studies with satisfactory results. Furthermore, the use of robotic technology as a sole modality for abdominal aortic aneurysm repair and expansion of its applications to splenic and renal artery aneurysm reconstruction have been described. Robotically steerable endovascular catheter systems have potential advantages over conventional catheterization systems

  6. Alginate oligosaccharide indirectly affects toll-like receptor signaling via the inhibition of microRNA-29b in aneurysm patients after endovascular aortic repair

    Directory of Open Access Journals (Sweden)

    Yang Y

    2017-09-01

    Full Text Available Yong Yang,1–4,* Zhenhuan Ma,1–4,* Guokai Yang,1–4 Jia Wan,1–4 Guojian Li,1–4 Lingjuan Du,1–4 Ping Lu1–4 1Department of Vascular Surgery, The Second People’s Hospital of Yunnan Province, Kunming, China; 2Department of Vascular Surgery, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China; 3Department of Vascular Surgery, Vascular Surgery Centre in Yunnan Province, Kunming, China; 4Department of Vascular Surgery, Abdominal Surgery Centre in Yunnan Province, Kunming, China *These authors contributed equally to this work Abstract: Endovascular aortic repair (EVAR is often followed by aneurysm recurrence. Alginate oligosaccharide (AOS has potential antitumor properties as a natural product while the related mechanisms remain unclear. Toll-like receptor (TLR signaling is associated with inflammatory activity of aneurysm and may be affected by miR-29b. Thus, inhibitory function of AOS on aneurysms was explored by measuring the important molecules in TLR4 signaling. After EVAR, a total of 248 aortic aneurysm patients were recruited and randomly assigned into two groups: AOS group (AG, oral administration 10-mg AOS daily and control group (CG, placebo daily. The size of residual aneurysms, aneurysm recurrence, and side effects were investigated. Aneurysm recurrence was determined by Kaplan–Meier analysis. After 2 years, eight and two patients died in the CG and AG, respectively. The sizes of residual aneurysms were significantly larger in the CG than in the AG (P<0.05. The incidence of aneurysm recurrence was also significantly higher in the CG than in the AG (P<0.05. AOS treatment reduced the levels of miR-29b, TLR4, mitogen-activated protein kinase (MAPK, nuclear factor kappa B (NF-kappa B, interleukin 1 (IL-1 beta, and interleukin 6 (IL-6. Overexpression and silence of miR-29b increased and reduced the level of TLR4, phospho-p65 NF-kappa B, phospho-p38 MAPK, IL-1 beta, and IL-6. Spearman’s rank correlation

  7. Should intentional endovascular stent-graft coverage of the left subclavian artery be preceded by prophylactic revascularisation?

    DEFF Research Database (Denmark)

    Weigang, Ernst; Parker, Jack A T C; Czerny, Martin

    2011-01-01

    Thoracic endovascular aortic repair (TEVAR) has emerged as a promising therapeutic alternative to conventional open aortic replacement but it requires suitable proximal and distal landing zones for stent-graft anchoring. Many aortic pathologies affect in the immediate proximity of the left subcla...

  8. The β-d-Endoglucuronidase Heparanase Is a Danger Molecule That Drives Systemic Inflammation and Correlates with Clinical Course after Open and Endovascular Thoracoabdominal Aortic Aneurysm Repair: Lessons Learnt from Mice and Men

    Directory of Open Access Journals (Sweden)

    Lukas Martin

    2017-06-01

    Full Text Available Thoracoabdominal aortic aneurysm (TAAA is a highly lethal disorder requiring open or endovascular TAAA repair, both of which are rare, but extensive and complex surgical procedures associated with a significant systemic inflammatory response and high post-operative morbidity and mortality. Heparanase is a β-d-endoglucuronidase that remodels the endothelial glycocalyx by degrading heparan sulfate in many diseases/conditions associated with systemic inflammation including sepsis, trauma, and major surgery. We hypothesized that (a perioperative serum levels of heparanase and heparan sulfate are associated with the clinical course after open or endovascular TAAA repair and (b induce a systemic inflammatory response and renal injury/dysfunction in mice. Using a reverse-translational approach, we assessed (a the serum levels of heparanase, heparan sulfate, and the heparan sulfate proteoglycan syndecan-1 preoperatively as well as 6 and 72 h after intensive care unit (ICU admission in patients undergoing open or endovascular TAAA repair and (b laboratory and clinical parameters and 90-day survival, and (c the systemic inflammatory response and renal injury/dysfunction induced by heparanase and heparan sulfate in mice. When compared to preoperative values, the serum levels of heparanase, heparan sulfate, and syndecan-1 significantly transiently increased within 6 h of ICU admission and returned to normal within 72 h after ICU admission. The kinetics of any observed changes in heparanase, heparan sulfate, or syndecan-1 levels, however, did not differ between open and endovascular TAAA-repair. Postoperative heparanase levels positively correlated with noradrenalin dose at 12 h after ICU admission and showed a high predictive value of vasopressor requirements within the first 24 h. Postoperative heparan sulfate showed a strong positive correlation with interleukin-6 levels day 0, 1, and 2 post-ICU admission and a strong negative correlation with

  9. Patient and Aneurysm Characteristics Predicting Prolonged Length of Stay After Elective Open AAA Repair in the Endovascular Era.

    Science.gov (United States)

    Casillas-Berumen, Sergio; Rojas-Miguez, Florencia A; Farber, Alik; Komshian, Sevan; Kalish, Jeffrey A; Rybin, Denis; Doros, Gheorghe; Siracuse, Jeffrey J

    2018-01-01

    Open aortic aneurysm repair (AAA) repair can be resource intensive and associated with a prolonged length of stay (LOS). We sought to examine patient and aneurysm predictors of prolonged LOS to better identify those at risk in the preoperative setting. Patient data were obtained from the targeted AAA American College of Surgery National Surgical Quality Improvement Program database from 2012 to 2014 of patients undergoing open AAA repair. Multivariable logistic regression was used to determine predictors of prolonged postoperative LOS defined as greater than 10 days (75th percentile). There were 1172 open AAA repairs identified. The majority (54%) of patients were older than 70 years and male (74%). Surgical approach was transperitoneal (70.9%) and retroperitoneal (29.1%). Aneurysms were 51.4% infrarenal, 33% juxtarenal, 5.7% pararenal, 7.4% suprarenal, and 2.5% type IV thoracoabdominal. Mean and median LOS were 9.1 ± 7.4 and 7 (0-72) days, respectively. Independently associated with extended LOS factors were visceral revascularization (odds ratio [OR]: 5.32, 95% confidence interval [CI]: 2.77-10.22, P AAA repair. Prospective identification of high-risk patients may allow physicians and hospitals to engage in multidisciplinary collaborations preoperatively to try to improve LOS in this resource-intensive population.

  10. Endovascular repair of posttraumatic multiple femoral-femoral and popliteal-popliteal arteriovenous fistula with Viabahn and excluder stent graft

    Directory of Open Access Journals (Sweden)

    Šarac Momir

    2011-01-01

    . Also, numerous metallic balls - grains of shotgun were present. After the preoperative preparation under local infiltrative anesthesia, transfemoral endovascular reconstruction was done of the surface femoral and popliteal artery by the use of stent grafts Viabahn 6 × 50 mm and excluder PXL 161 007. Within the immediate postoperative course a significant reduction of the leg edema and disappearance of thrill occurred, and, latter, healing of ulceration, and disappearance of signs of the foot ischemia. Also, patient's both cardiac and breathing functions became normal. Conclusion. In patients with chronic traumatic AV fistulas in the femoropopliteal region, especially with multiple fistulas, the gold standard is their endovascular reconstruction which, although being minimally traumatic and invasive, offers a complete reconstruction besides keeping integrity of both distal and proximal circulation in the leg.

  11. Aortic aneurysm sac pressure measurements after endovascular repair using an implantable remote sensor: initial experience and short-term follow-up

    International Nuclear Information System (INIS)

    Hoppe, Hanno; Kaufman, John A.; Segall, Jocelyn A.; Liem, Timothy K.; Landry, Gregory J.

    2008-01-01

    The purpose of this single-center study was to report our initial experience with an implantable remote pressure sensor for aneurysm sac pressure measurement in patients post-endovascular aneurysm repair (EVAR) including short-term follow-up. A pressure sensor (EndoSure, Atlanta, GA) was implanted in 12 patients treated with different commercially available aortic endografts for EVAR. Pressure was read pre- and post-EVAR in the operating room. One-month follow-up (30 days ± 6 days) was performed including sac pressure readings and IV contrast CT scans. Variables were compared using the paired Student's t test. An intraprocedure type-I endoleak and a type-III endoleak were successfully treated resulting in decreasing sac pressures. In all patients, post-EVAR systolic sac pressure decreased by an average of 33% (P ≤ 0.005) compared to pre-EVAR measurements. One-month follow-up demonstrated a 47% decrease in systolic sac pressure (P ≤ 0.05). On follow-up CT scans, the average maximum aneurysm diameter pre-EVAR was 6.3 ± 1.6 cm and post-EVAR 6.0 ± 1.7 cm (P≤0.05). The diameter of the aneurysm sac was larger only in one patient with a type-III endoleak. Remote sac pressure measurement may provide important information in addition to imaging and may help to reduce the number of follow-up CT scans. (orig.)

  12. International trends in patient selection for elective endovascular aneurysm repair: sicker patients with safer anatomy leading to improved 1-year survival.

    Science.gov (United States)

    Fitridge, Robert A; Boult, Margaret; Mackillop, Clare; De Loryn, Tania; Barnes, Mary; Cowled, Prue; Thompson, Matthew M; Holt, Peter J; Karthikesalingam, Alan; Sayers, Robert D; Choke, Edward; Boyle, Jonathan R; Forbes, Thomas L; Novick, Teresa V

    2015-02-01

    To review the trends in patient selection and early death rate for patients undergoing elective endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) in 3 countries. For this study, audit data from 4,163 patients who had undergone elective infrarenal EVAR were amalgamated. The data originated from Australia, Canada (Ontario), and England (London, Cambridge, and Leicester). Statistical analyses were undertaken to determine whether patient characteristics and early death rate varied between and within study groups and over time. The study design was retrospective analysis of data collected prospectively between 1999 and 2012. One-year survival improved over time (P = 0.0013). Canadian patients were sicker than those in Australia or England (P international comparison, several trends were noted including improved 1-year survival despite declining patient health (as measured by increasing ASA status). This may reflect greater knowledge regarding EVAR that centers from different countries have gained over the last decade and improved medical management of patients with aneurysmal disease. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Endovascular Repair of Acute Symptomatic Pararenal Aortic Aneurysm With Three Chimney and One Periscope Graft for Complete Visceral Artery Revascularization

    International Nuclear Information System (INIS)

    Brechtel, Klaus; Ketelsen, Dominik; Endisch, Andrea; Heller, Stephan; Heuschmid, Martin; Stock, Ulrich A.; Kalender, Guenay

    2012-01-01

    PurposeTo describe a modified endovascular technique for complete revascularization of visceral and renal arteries in symptomatic pararenal aortic aneurysm (PRAA).TechniqueArterial access was surgically established in both common femoral arteries (CFAs) and the left subclavian artery (LSA). Revascularization of the left renal artery, the celiac trunk, and the superior mesenteric artery was performed through one single sheath via the LSA. Suitable covered stents were put in the aortic branches but not deployed. The right renal artery was accessed over the left CFA. Due to the longitudinal extension of the presented aneurysm two stent-grafts were introduced via the right CFA. After deploying the aortic stent-grafts, all covered stents in the side branches were deployed consecutively with a minimum overlap of 5 mm over the cranial and caudal stent-graft edges. Simultaneous ballooning was performed to fully expand all stent-grafts and warranty patency. Conclusion: This is the first report in the literature of chimney grafting in PRAA for complete revascularization of visceral and renal branches by using more than two covered stents introduced from one side through one single sheath. However this technique is modified, it should be used only in bailout situations when branched stent-grafts are not available and/or surgery is not suitable.

  14. Expression in Whole Blood Samples of miRNA-191 and miRNA-455-3p in Patients with AAA and Their Relationship to Clinical Outcomes after Endovascular Repair.

    Science.gov (United States)

    Tenorio, Emanuel Junio Ramos; Braga, Andre Felipe Farias; Tirapelli, Daniela Pretti Da Cunha; Ribeiro, Mauricio Serra; Piccinato, Carlos Eli; Joviliano, Edwaldo Edner

    2018-03-05

    The purpose of this study was to quantify and evaluate the expression response of miRNA-191 and miRNA-455-3p endovascular repair of abdominal aortic aneurysm (AAA) based in whole blood samples. This report describes a prospective study of a single center of 30 patients with AAA who underwent endovascular repair. Blood samples were collected preoperatively and 6 months postoperatively. The differential expression of the miRNAs was performed by the real-time polymerase chain reaction method, after extraction of the RNA from the blood samples at the 2 moments. In addition, bioinformatic tools were used to determine pathophysiological pathways related to AAA. The miR-191 and miR-455-3p were overexpressed preoperatively. After 6 months postoperatively, miR-191 (median 0.98, IQR 0.5-2.1, P AAA showed no significant differences in the expression of miR-191 and miR-455-3p. Exclusion of the aneurysmal sac after endovascular treatment induces a decrease in the expression of the studied miRNAs in whole blood samples, which suggests a possible use of them as biomarkers of therapeutic success. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Surgeon leadership in the coding, billing, and contractual negotiations for fenestrated endovascular aortic aneurysm repair increases medical center contribution margin and physician reimbursement.

    Science.gov (United States)

    Aiello, Francesco; Durgin, Jonathan; Daniel, Vijaya; Messina, Louis; Doucet, Danielle; Simons, Jessica; Jenkins, James; Schanzer, Andres

    2017-10-01

    Fenestrated endovascular aneurysm repair (FEVAR) allows endovascular treatment of thoracoabdominal and juxtarenal aneurysms previously outside the indications of use for standard devices. However, because of considerable device costs and increased procedure time, FEVAR is thought to result in financial losses for medical centers and physicians. We hypothesized that surgeon leadership in the coding, billing, and contractual negotiations for FEVAR procedures will increase medical center contribution margin (CM) and physician reimbursement. At the UMass Memorial Center for Complex Aortic Disease, a vascular surgeon with experience in medical finances is supported to manage the billing and coding of FEVAR procedures for medical center and physician reimbursement. A comprehensive financial analysis was performed for all FEVAR procedures (2011-2015), independent of insurance status, patient presentation, or type of device used. Medical center CM (actual reimbursement minus direct costs) was determined for each index FEVAR procedure and for all related subsequent procedures, inpatient or outpatient, 3 months before and 1 year subsequent to the index FEVAR procedure. Medical center CM for outpatient clinic visits, radiology examinations, vascular laboratory studies, and cardiology and pulmonary evaluations related to FEVAR were also determined. Surgeon reimbursement for index FEVAR procedure, related adjunct procedures, and assistant surgeon reimbursement were also calculated. All financial analyses were performed and adjudicated by the UMass Department of Finance. The index hospitalization for 63 FEVAR procedures incurred $2,776,726 of direct costs and generated $3,027,887 in reimbursement, resulting in a positive CM of $251,160. Subsequent related hospital procedures (n = 26) generated a CM of $144,473. Outpatient clinic visits, radiologic examinations, and vascular laboratory studies generated an additional CM of $96,888. Direct cost analysis revealed that grafts

  16. Mid-term results of zone 0 thoracic endovascular aneurysm repair after ascending aorta wrapping and supra-aortic debranching in high-risk patients.

    Science.gov (United States)

    Pecoraro, Felice; Lachat, Mario; Hofmann, Michael; Cayne, Neal S; Chaykovska, Lyubov; Rancic, Zoran; Puippe, Gilbert; Pfammatter, Thomas; Mangialardi, Nicola; Veith, Frank J; Bettex, Dominique; Maisano, Francesco; Neff, Thomas A

    2017-06-01

    Surgical repair of aneurysmal disease involving the ascending aorta, aortic arch and eventually the descending aorta is generally associated with significant morbidity and mortality. A less invasive approach with the ascending wrapping technique (WT), supra-aortic vessel debranching (SADB) and thoracic endovascular aneurysm repair (TEVAR) in zone 0 was developed to reduce the associated risk in these patients. During a 10-year period, consecutive patients treated by the ascending WT, SADB and TEVAR in zone 0 were included. All patients were considered at high risk for conventional surgery. Measured outcomes included perioperative deaths and morbidity, maximal aortic transverse diameter (TD) and its postoperative evolution, endoleak, survival, freedom from cardiovascular reinterventions, SADB freedom from occlusion and aortic valve function during follow-up. Median follow-up was 37.4 [mean = 34; range, 0-65; standard deviation (SD) = 20] months. Twenty-six cases were included with a mean age of 71.88 ( r  = 56-87; SD = 8) years. A mean of 2.9 supra-aortic vessels (75) per patient was debranched from the ascending aorta. The mean time interval from WT/SADB and TEVAR was 29 ( r  = 0-204; SD = 48) days. TEVAR was associated with chimney and/or periscope grafts in 6 (23%) patients, and extra-anatomical supra-aortic bypasses were performed in 6 (23%) patients. Perioperative mortality was 7.7% (2/26). Neurological events were registered in 3 (11.5%) cases, and a reintervention was required in 3 (11.5%) cases. After the WT, the ascending diameter remained stable during the follow-up period in all cases. At mean follow-up, significant shrinkage of the arch/descending aorta diameter was observed. A type I/III endoleak occurred in 3 cases. At 5 years, the rates of survival, freedom from cardiovascular reinterventions and SADB freedom from occlusion were 71.7, 82.3 and 96%, respectively. The use of the ascending WT, SADB and TEVAR in selected patients

  17. Thoracic aortic aneurysms and dissections: endovascular treatment.

    Science.gov (United States)

    Baril, Donald T; Cho, Jae S; Chaer, Rabih A; Makaroun, Michel S

    2010-01-01

    The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256-269, 2010. (c) 2010 Mount Sinai School of Medicine.

  18. Outcome of emergency endovascular treatment of large internal iliac artery aneurysms with guidewires

    International Nuclear Information System (INIS)

    Cambj-Sapunar, Liana; Maskovic, Josip; Brkljacic, Boris; Radonic, Vedran; Dragicevic, Dragan; Ajduk, Marko

    2010-01-01

    Purpose: Guidewires have been reported as a useful occlusion material for large aneurysms of different locations with good short-term results. In this study we retrospectively evaluate long-term results of emergency embolization technique with guidewires in symptomatic internal iliac artery aneurysm (IIAA) impending rupture. Patients and methods: In four patients presented with acute abdominal pain, multidetector computed tomography revealed unstable, 7-14 cm large, IIAAs. Two patients were treated with coil embolization of distal branches followed by occlusion of aneurysmal sac with guidewires. In two patients embolization of aneurysmal sac alone was performed. Results: In three patients complete or near complete occlusion of the aneurysmal sac was achieved and abdominal pain ceased within hours. Two patients treated with embolization of distal iliac artery branches and aneurysmal sac developed claudication that lasted up to 1 year. Their aneurysms remained thrombosed and they were without symptoms until they died 31 and 56 months later of causes unrelated to IIAA. Two patients treated with embolization of the aneurysm alone were free of ischemic symptoms. Because of incomplete embolization of the sac in one patient open surgery treatment in a non-emergency setting was performed. Complete filling of aneurysmal sac was achieved in other patient but 2 years later his aneurysm re-opened and required open surgery treatment. Conclusion: Embolization of aneurysmal sac of large IIAA with guidewires may be effective for immediate treatment of impending rupture. Long-term results were better when embolization of the aneurysmal sac was combined with embolization of distal IIA branches.

  19. A comparison of Percutaneous femoral access in Endovascular Repair versus Open femoral access (PiERO): study protocol for a randomized controlled trial.

    Science.gov (United States)

    Vierhout, Bastiaan P; Saleem, Ben R; Ott, Alewijn; van Dijl, Jan Maarten; de Kempenaer, Ties D van Andringa; Pierie, Maurice E N; Bottema, Jan T; Zeebregts, Clark J

    2015-09-14

    Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical cutdown or percutaneously. The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery (CFA) are the Prostar(™) and Proglide(™) devices (Abbott Vascular). Positive effects of these devices seem to consist of a lower infection rate, and shorter operation time and hospital stay. This conclusion was published in previous reports comparing techniques in patients in two different groups (cohort or randomized). Access techniques were never compared in one and the same patient; this research simplifies comparison because patient characteristics will be similar in both groups. Percutaneous access of the CFA is compared to surgical cutdown in a single patient; in EVAR surgery, access is necessary in both groins in each patient. Randomization is performed on the introduction site of the larger main device of the endoprosthesis. The contralateral device of the endoprosthesis is smaller. When we use this type of randomization, both groups will contain a similar number of main and contralateral devices. Preoperative nose cultures and perineal cultures are obtained, to compare colonization with postoperative wound cultures (in case of a surgical site infection). Furthermore, patient comfort will be considered, using VAS-scores (Visual analog scale). Punch biopsies of the groin will be harvested to retrospectively compare skin of patients who suffered a surgical site infection (SSI) to patients who did not have an SSI. The PiERO trial is a multicenter randomized controlled clinical trial designed to show the consequences of using percutaneous access in EVAR surgery and focuses on the occurrence of surgical site infections. NTR4257 10 November 2013, NL44578.042.13.

  20. Systolic Sac Pressure Index for the Prediction of Persistent Type II Endoleak for 12 Months After Endovascular Abdominal Aortic Aneurysm Repair

    Energy Technology Data Exchange (ETDEWEB)

    Ikoma, Akira, E-mail: yfb04322@nifty.com; Nakai, Motoki, E-mail: momonga@wakayama-med.ac.jp; Sato, Morio, E-mail: morisato@wakayama-med.ac.jp; Sato, Hirotatsu, E-mail: kuppa1220@yahoo.co.jp; Minamiguchi, Hiroki, E-mail: hiromina4@hotmail.com; Sonomura, Tetsuo, E-mail: sonomura@wakayama-med.ac.jp [Wakayama Medical University, Departments of Radiology (Japan); Nishimura, Yoshiharu, E-mail: nishim-y@wakayama-med.ac.jp; Okamura, Yoshitaka, E-mail: y-ok@wakayama-med.ac.jp [Wakayama Medical University, Thoracic and Cardiovascular Surgery (Japan)

    2016-04-15

    PurposeTo assess the relationship between the systolic sac pressure index (SPI) and the presence of endoleaks 12 months after endovascular abdominal aortic aneurysm repair (EVAR).Materials and MethodsWe performed a single-center prospective trial of consecutively treated patients. SPI (calculated as systolic sac pressure/systolic aortic pressure) was measured by catheterization immediately after EVAR. Contrast-enhanced computed tomography was scheduled 12 months after EVAR to detect possible endoleaks.ResultsData were available for 34 patients who underwent EVAR for an AAA. Persisting type II endoleak was found in 8 patients (endoleak-positive group) but not in the other 26 patients (endoleak-negative group). The mean ± standard deviation SPI was significantly greater in the endoleak-positive group than in the endoleak-negative group (0.692 ± 0.048 vs. 0.505 ± 0.081, respectively; P = .001). Receiver-operating characteristic curve analysis revealed that an SPI of 0.638 was the optimum cutoff value for predicting a persistent endoleak at 12 months with high accuracy (0.971; 33/34), sensitivity (1.00), and specificity (0.962) values. The mean change in AAA diameter was −4.28 ± 5.03 mm and 2.22 ± 4.54 mm in patients with SPI of <0.638 or ≥0.638, respectively (P = .002).ConclusionPatients with an SPI of ≥0.638 immediately after EVAR were more likely to have a persistent type II endoleak at 12 months with an accuracy of 0.971, and showed increases in aneurysm sac diameter compared with patients with an SPI of <0.638.

  1. Carbon dioxide (CO2) angiography as an option for endovascular abdominal aortic aneurysm repair (EVAR) in patients with chronic kidney disease (CKD).

    Science.gov (United States)

    De Angelis, Chiara; Sardanelli, Francesco; Perego, Matteo; Alì, Marco; Casilli, Francesco; Inglese, Luigi; Mauri, Giovanni

    2017-11-01

    To assess feasibility, efficacy and safety of carbon dioxide (CO 2 ) digital subtraction angiography (DSA) to guide endovascular aneurysm repair (EVAR) in a cohort of patients with chronic kidney disease (CKD). After Ethical Committee approval, the records of 13 patients (all male, mean age 74.6 ± 8.0 years) with CKD, who underwent EVAR to exclude an abdominal aortic aneurysm (AAA) under CO 2 angiography guidance, were reviewed. The AAA to be excluded had a mean diameter of 52.0 ± 8.0 mm. CO 2 angiography was performed by automatic (n = 7) or hand (n = 6) injection. The endograft was correctly placed and the AAA was excluded in all cases, without any surgical conversions. Two patients (15.4%) had an endoleak: one type-Ia, detected by CO 2 -DSA and effectively treated with prosthesis dilatation; one type-III, detected by CO 2 -DSA, confirmed using 10 ml of ICM, and conservatively managed. In one patient, CO 2 angiograms were considered of too low quality for guiding the procedure and 200 ml of ICM were administered. Overall, 11 patients (84.6%) underwent a successful EVAR under the guidance of the sole CO 2 angiography. No patients suffered from major complications, including those typically CO 2 -related. Two patients suffered from abdominal pain during the procedure secondary to a transient splanchnic perfusion's reduction due to CO 2 , and one patient had a worsening of renal function probably caused by a cholesterol embolization during the procedure. In patients with CKD, EVAR under CO 2 angiography guidance is feasible, effective, and safe.

  2. Systematic review of recent evidence for the safety and efficacy of elective endovascular repair in the management of infrarenal abdominal aortic aneurysm.

    Science.gov (United States)

    Drury, D; Michaels, J A; Jones, L; Ayiku, L

    2005-08-01

    Conventional management of abdominal aortic aneurysm (AAA) is by open repair and is associated with a mortality rate of 2-6 per cent. Endovascular aneurysm repair (EVAR) is an alternative technique first introduced in 1991. A systematic review was undertaken of the evidence for the safety and efficacy of elective EVAR in the management of asymptomatic infrarenal AAA. Thirteen electronic bibliographical databases were searched, covering biomedical, health-related, science and social science literature. Outcomes were assessed with respect to efficacy (successful deployment, technical success, conversion rates and secondary intervention rates) and safety (30-day mortality rate, procedure morbidity rates and technical issues-endoleaks, graft thrombosis, stenosis and migration). Of 606 reports identified, 61 met the inclusion criteria (three randomized and 15 non-randomized controlled trials, and 43 uncontrolled studies). There were 29 059 participants in total; 19,804 underwent EVAR. Deployment was successful in 97.6 per cent of cases. Technical success (complete aneurysm exclusion) was 81.9 per cent at discharge and 88.8 per cent at 30 days. Secondary intervention to treat endoleak or maintain graft patency was required in 16.2 per cent of patients. Mean stay in the intensive care unit and mean hospital stay were significantly shorter following EVAR. The 30-day mortality rate for EVAR was 1.6 per cent (randomized controlled trials) and 2.0 per cent in nonrandomized trials and case series. Technical complications comprised stent migration (4.0 per cent), graft limb thrombosis (3.9 per cent), endoleak (type I, 6.8 per cent; type II, 10.3 per cent; type III, 4.2 per cent) and access artery injury (4.8 per cent). EVAR is technically effective and safe, with lower short-term morbidity and mortality rates than open surgery. However, there is a need for extended follow-up as the long-term success of EVAR in preventing aneurysm-related deaths is not yet known.

  3. The INNOVATION Trial: four-year safety and effectiveness of the INCRAFT® AAA Stent-Graft System for endovascular repair.

    Science.gov (United States)

    Pratesi, Giovanni; Pratesi, Carlo; Chiesa, Roberto; Coppi, Gioacchino; Scheinert, Dierk; Brunkwall, Jan S; van der Meulen, Stefaan; Torsello, Giovanni

    2017-10-01

    This paper reports the 4-year safety and effectiveness of the INCRAFT® AAA Stent-Graft System (Cordis Corp., Milpitas, CA, USA), an ultra-low-profile device for the treatment of abdominal aortic aneurysms. The INNOVATION Trial is the prospective, first-in-human, multicenter trial to evaluate the safety and effectiveness of the INCRAFT® System. Patients underwent annual clinical and computed tomography angiography examination as part of the study protocol. The INCRAFT® AAA Stent-Graft System is a customizable tri-modular design, with an ultra-low profile (14-Fr) delivery system. Patient were treated under approved protocol, the prescribed clinical and imaging follow-up at annually through 5 years. Results analyzed and adjudicated by a clinical events committee, independent core laboratory, and a data safety and monitoring board. This manuscript reports results through 4 years of follow-up. A total of 60 patients were enrolled in the trial, all of whom were successfully treated. Follow-up rates at 1 and 4 years were 93% (56/60) and 85% (51/60), respectively. All-cause mortality at 4 years was 17.6% and no death was AAA-, device-, or procedure-related. The secondary reintervention rate at 1 year was 4.6%, primarily the result of stent thrombosis. In total, 10 patients required 13 post-procedure interventions within 4-years of follow-up (2 to repair a type I endoleak, 4 to repair a type II endoleak, 1 for stent thrombosis, 1 for renal stenosis, 1 for aneurysm enlargement, 2 for limb migration and 2 for prosthesis stenosis or occlusion). There were 4 cases (10%) of aneurysm enlargement reported at the 4 year follow-up. At 4 years, 38 out of 39 patients were free from type I and III endoleaks. There were no proximal type I or type III endoleaks at 4-year follow-up. Core laboratory evaluation of the postoperative imaging studies indicated absence of endograft migration while a single fracture was demonstrated without any clinical sequelae. The INCRAFT® AAA Stent

  4. Immunocosmeceuticals: An emerging trend in repairing human hair damage

    Directory of Open Access Journals (Sweden)

    Karthika Selvan

    2013-01-01

    Full Text Available Hair is one of the most important portions for beauty care and in recent years grooming and cosmetic treatment of hair has drastically risen. Substantially, it may deteriorate and weaken the hair by modification of keratin protein. This makes the hair dry, brittle and split vend occurs due to loss of hair strength and the damage further increases with cosmetic treatments. The various poor ingredients are being used for repairing which have extremely poor compatibility with hair. Now the hair care products can be introduced with an active ingredient comprising a yolk derived anti-hair antibody immunoglobin obtained from egg of chickens immunized with damaged hair as antigen. This immuno-cosmeceuticals can repair the hair damage and imparts flexibility and smoothness to the hair. These effects are not lost by the ordinary shampooing. This article focuses on the characteristic of human hair, its damaging processes and the effects of immuno-cosmeceuticals for repairing the hair damage.

  5. On-Shore Pipeline Emergency Repair Center; Centro de Reparos Emergenciais de Dutos Terrestres

    Energy Technology Data Exchange (ETDEWEB)

    Souza Filho, Byron Goncalves de [TRANSPETRO - PETROBRAS Transportes, Rio de Janeiro, RJ (Brazil)

    2003-07-01

    After the accidents happened on years 2000 and 2001, in TRANSPETRO's operated pipelines, appeared a common conscientiousness about the necessity for the creation of a basic infrastructure for emergency and contingency pipeline repair that centralize equipment, procedures and technologies applied to pipeline maintenance. Then, it was planned the creation of the On-Shore Pipeline Emergency Center (CRE-DUT), following the model of the Off-Shore Pipelines Repair Group from PETROBRAS/EP, (Exploration and Production) and other similar centers of pipeline transport companies worldwide (Canada, Colombia, Mexico, Argentina). The CRE-DUT has the Mission of offering contingency; emergency and specials on-shore pipelines repair services, with safety, quality and at the less possible time, seeking for the leadership on applying new technologies and the excellency in repair activities. (author)

  6. Can Early Computed Tomography Angiography after Endovascular Aortic Aneurysm Repair Predict the Need for Reintervention in Patients with Type II Endoleak?

    Energy Technology Data Exchange (ETDEWEB)

    Dudeck, O., E-mail: oliver.dudeck@med.ovgu.de [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Schnapauff, D. [Charité Universitätsmedizin Berlin, Department of Radiology (Germany); Herzog, L.; Löwenthal, D.; Bulla, K.; Bulla, B. [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Halloul, Z.; Meyer, F. [University of Magdeburg, Department of General, Visceral and Vascular Surgery (Germany); Pech, M. [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany); Gebauer, B. [Charité Universitätsmedizin Berlin, Department of Radiology (Germany); Ricke, J. [University of Magdeburg, Department of Radiology and Nuclear Medicine (Germany)

    2015-02-15

    PurposeThis study was designed to identify parameters on CT angiography (CTA) of type II endoleaks following endovascular aortic aneurysm repair (EVAR) for abdominal aortic aneurysm (AAA), which can be used to predict the subsequent need for reinterventions.MethodsWe retrospectively identified 62 patients with type II endoleak who underwent early CTA in mean 3.7 ± 1.9 days after EVAR. On the basis of follow-up examinations (mean follow-up period 911 days; range, 373–1,987 days), patients were stratified into two groups: those who did (n = 18) and those who did not (n = 44) require reintervention. CTA characteristics, such as AAA, endoleak, as well as nidus dimensions, patency of the inferior mesenteric artery, number of aortic branch vessels, and the pattern of endoleak appearance, were recorded and correlated with the clinical outcome.ResultsUnivariate and receiver operating characteristic curve regression analyses revealed significant differences between the two groups for the endoleak volume (surveillance group: 1391.6 ± 1427.9 mm{sup 3}; reintervention group: 3227.7 ± 2693.8 mm{sup 3}; cutoff value of 2,386 mm{sup 3}; p = 0.002), the endoleak diameter (13.6 ± 4.3 mm compared with 25.9 ± 9.6 mm; cutoff value of 19 mm; p < 0.0001), the number of aortic branch vessels (2.9 ± 1.2 compared with 4.2 ± 1.4 vessels; p = 0.001), as well as a “complex type” endoleak pattern (13.6 %, n = 6 compared with 44.4 %, n = 8; p = 0.02).ConclusionsEarly CTA can predict the future need for reintervention in patients with type II endoleak. Therefore, treatment decision should be based not only on aneurysm enlargement alone but also on other imaging characteristics.

  7. Endovascular abdominal aortic repair for AAA. Anatomical suitability and limitation in Japanese population according to the inclusion criteria of Zenith AAA stent graft

    International Nuclear Information System (INIS)

    Kitagawa, Atsushi; Okita, Yutaka; Okada, Kenji

    2009-01-01

    Since 2007, the EVAR (endovascular abdominal aortic repair) grafts, Zenith, Excluder and Powerlink had been commercially available in Japan. However, a small iliac artery, typical of Japanese population especially in women, was a limiting factor to indicate EVAR. We analyzed the suitability of EVAR in Japanese population according to the inclusion criteria of Zenith AAA stent graft in the current study. From January 2006 to December 2007, 106 AAA (abdominal aortic aneurysm) patients (88 men, 18 women) with a mean age of 73 years were investigated in our institution by multi-slice CT scan in terms of suitability of EVAR, then we measured their abdominal aorta and iliac artery parameters as follows; proximal neck diameter (PND) and length (PNL), common iliac artery diameter (CIAD) and length (CIAL), suprarenal (SNA) and infrarenal neck angulation (INA), external iliac artery diameter (EIAD) and aortic length from the lowest renal artery to the aortic bifurcation (AOL). The inclusion criteria for Zenith AAA stent graft treatment were; PND: 18-28 mm, PNL more than 15 mm, unilateral CIAD less than 20 mm, CIAL at least 10 mm, SNA less than 45 degree and INA less than 60 degree, unilateral EIAD more than 7.5 mm. The indication of EVAR was 25.5% (27/106 patients), and was especially very low in women (5.6%) strictly according to the inclusion criteria of the Zenith AAA stent graft. The main reason of exclusion of EVAR was proximal short neck (40.5%), small iliac artery (30.4%) and infrarenal aortic neck angulation (29.1%). In our analysis, female AAA patients had small PNL and EIAD with angulated neck compared with male AAA ones. Anatomical suitability of EVAR in Japanese population strictly following by the inclusion criteria of Zenith AAA stent graft was low due to their characteristic differences from the European Union (EU) and the United States (US) patients, such as short proximal neck, steep neck angulation and small iliac artery, especially in women. More flexible

  8. Source of errors and accuracy of a two-dimensional/three-dimensional fusion road map for endovascular aneurysm repair of abdominal aortic aneurysm.

    Science.gov (United States)

    Kauffmann, Claude; Douane, Frédéric; Therasse, Eric; Lessard, Simon; Elkouri, Stephane; Gilbert, Patrick; Beaudoin, Nathalie; Pfister, Marcus; Blair, Jean François; Soulez, Gilles

    2015-04-01

    To evaluate the accuracy and source of errors using a two-dimensional (2D)/three-dimensional (3D) fusion road map for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm. A rigid 2D/3D road map was tested in 16 patients undergoing EVAR. After 3D/3D manual registration of preoperative multidetector computed tomography (CT) and cone beam CT, abdominal aortic aneurysm outlines were overlaid on live fluoroscopy/digital subtraction angiography (DSA). Patient motion was evaluated using bone landmarks. The misregistration of renal and internal iliac arteries were estimated by 3 readers along head-feet and right-left coordinates (z-axis and x-axis, respectively) before and after bone and DSA corrections centered on the lowest renal artery. Iliac deformation was evaluated by comparing centerlines before and during intervention. A score of clinical added value was estimated as high (z-axis 5 mm). Interobserver reproducibility was calculated by the intraclass correlation coefficient. The lowest renal artery misregistration was estimated at x-axis = 10.6 mm ± 11.1 and z-axis = 7.4 mm ± 5.3 before correction and at x-axis = 3.5 mm ± 2.5 and z-axis = 4.6 mm ± 3.7 after bone correction (P = .08), and at 0 after DSA correction (P artery was estimated at x-axis = 2.4 mm ± 2.0 and z-axis = 2.2 mm ± 2.0. Score of clinical added value was low (n = 11), good (n= 0), and high (n= 5) before correction and low (n = 5), good (n = 4), and high (n = 7) after bone correction. Interobserver intraclass correlation coefficient for misregistration measurements was estimated at 0.99. Patient motion before stent graft delivery was estimated at x-axis = 8 mm ± 5.8 and z-axis = 3.0 mm ± 2.7. The internal iliac artery misregistration measurements were estimated at x-axis = 6.1 mm ± 3.5 and z-axis = 5.6 mm ± 4.0, and iliac centerline deformation was estimated at 38.3 mm ± 15.6. Rigid registration is feasible and fairly accurate. Only a partial reduction of vascular

  9. Endovascular treatment of thoracic aorta aneurysm and dissection

    International Nuclear Information System (INIS)

    Petrov, I.; Stankov, Z.; Stefanov, St.; Stoyanov, Hr.

    2015-01-01

    Full text: The aim is to give up to date information about modern endovascular treatment of aortic pathology Dissection and aneurysms of the aorta are life threatening condition requiring in most of the cases prompt surgical or endovascular treatment because of the poor natural evolution. Purpose: to assess the immediate and 1-year outcome of endovascular treatment in broad spectrum of acute and subacute aortic syndrome during the last 3 years (November 2012 - August 2015) in City Clinic (Sofia, Bulgaria). We performed endovascular treatment of 47 patients (43 men, 4 women) at average age 54 y. with dissection (24) and aneurysms (23) of the aortic arch and thoracic aorta (in 5 emergent treatment was performed for aortic rupture). All patients were treated with minimal surgical femoral approach. In 4 (9%) of them initial carotid to carotid bypass was performed in order to provide a sufficient landing zone for the endograft implantation.the last 9 patients (19%) were treated without general anesthesia with either deep sedation or epidural anesthesia. Results: In all patients successful endograft implantation was achieved. Additional stent-graft or open cell stent was implanted in 4 cases in order to centralize the flow in the compressed true lumen. In 5 cases additional vascular plug or large coil was delivered in the left subclavian arteryostium in order to interrupt retrograde aneurysm or false lumen filling. Complications: 30 days mortality-2.2%, neurologic disorders (4.4%). one year survival- 45 (90.5%). 3 and 6 mo control CT scan showed no migration of the graft in 100%, full false lumen isolation in 19 out of 24 dissections (80%) and aneurysm free of expansion in 20 out of 23 (86%), patent carotid bay-pass graft in 4 of 4 (100%). This one center study showed excellent immediate and 1 year clinical and device results from endovascular repair of potentially fatal disease. Endovascular treatment is a method of choice for broad spectrum of aortic pathology

  10. Emerging connection between centrosome and DNA repair machinery

    International Nuclear Information System (INIS)

    Shimada, Mikio; Komatsu, Kenshi

    2009-01-01

    Centrosomes function in proper cell division in animal cells. The centrosome consists of a pair of centrioles and the surrounding pericentriolar matrix (PCM). After cytokinesis, daughter cells each acquire one centrosome, which subsequently duplicates at the G1/S phase in a manner that is dependent upon CDK2/cyclin-E activity. Defects in the regulation of centrosome duplication lead to tumorigenesis through abnormal cell division and resulting inappropriate chromosome segregation. Therefore, maintenance of accurate centrosome number is important for cell fate. Excess number of centrosomes can be induced by several factors including ionizing radiation (IR). Recent studies have shown that several DNA repair proteins localize to the centrosome and are involved in the regulation of centrosome number possibly through cell cycle checkpoints or direct modification of centrosome proteins. Furthermore, it has been reported that the development of microcephaly is likely caused by defective expression of centrosome proteins, such as ASPM, which are also involved in the response to IR. The present review highlights centrosome duplication in association with genotoxic stresses and the regulatory mechanism mediated by DNA repair proteins. (author)

  11. Correção endovascular de aneurisma de aorta abdominal e artéria ilíaca comum esquerda em paciente com hemofilia C grave Endovascular repair of abdominal aortic aneurysm and left common iliac artery in a patient with severe hemophilia C

    Directory of Open Access Journals (Sweden)

    Sergio Quilici Belczak

    2012-03-01

    Full Text Available A deficiência do fator XI, também conhecida como hemofilia C, é uma doença hematológica hereditária rara, que se manifesta clinicamente com hemorragia persistente após cirurgias, traumas, menorragias e extrações dentárias. Neste artigo, relatou-se a correção endovascular de um paciente com aneurisma de aorta e de artéria ilíaca comum esquerda em um paciente portador de deficiência major do fator XI (atividade do fator XI inferior a 20%. O procedimento foi realizado com sucesso, com o manuseio do distúrbio da coagulação por meio da infusão de plasma fresco no pré-operatório imediato e no pós-operatório, e controle laboratorial da coagulação do paciente.Factor XI deficiency, also known as hemophilia C, is a rare hereditary blood disease that manifests with persistent bleeding after surgery, trauma, menorrhagia, and dental extractions. This article reports an endovascular repair of a patient diagnosed with an aortic and left common iliac aneurysm, with severe factor XI deficiency (factor XI activity below 20%. The procedure was successfully performed with management of the coagulation disorder by preoperative and postoperative infusion of plasma and laboratory control of the coagulation.

  12. Polar orientation of renal grafts within the proximal seal zone affects risk of early type IA endoleaks after chimney endovascular aneurysm repair.

    Science.gov (United States)

    Tran, Kenneth; Ullery, Brant W; Itoga, Nathan; Lee, Jason T

    2018-04-01

    The objective of this study was to describe the polar orientation of renal chimney grafts within the proximal seal zone and to determine whether graft orientation is associated with early type IA endoleak or renal graft compression after chimney endovascular aneurysm repair (ch-EVAR). Patients who underwent ch-EVAR with at least one renal chimney graft from 2009 to 2015 were included in this analysis. Centerline three-dimensional reconstructions were used to analyze postoperative computed tomography scans. The 12-o'clock polar position was set at the takeoff of the superior mesenteric artery. Relative polar positions of chimney grafts were recorded at the level of the renal artery ostium, at the mid-seal zone, and at the proximal edge of the graft fabric. Early type IA endoleaks were defined as evidence of a perigraft flow channel within the proximal seal zone. There were 62 consecutive patients who underwent ch-EVAR (35 double renal, 27 single renal) for juxtarenal abdominal aortic aneurysms with a mean follow-up of 31.2 months; 18 (29%) early type IA "gutter" endoleaks were identified. During follow-up, the majority of these (n = 13; 72%) resolved without intervention, whereas two patients required reintervention (3.3%). Estimated renal graft patency was 88.9% at 60 months. Left renal chimney grafts were most commonly at the 3-o'clock position (51.1%) at the ostium, traversing posteriorly to the 5- to 7-o'clock positions (55.5%) at the fabric edge. Right renal chimney grafts started most commonly at the 9-o'clock position (n = 17; 33.3%) and tended to traverse both anteriorly (11 to 1 o'clock; 39.2%) and posteriorly (5 to 7 o'clock; 29.4%) at the fabric edge. In the polar plane, the majority of renal chimney grafts (n = 83; 85.6%) traversed 90 degrees were independently associated with early type IA endoleaks (odds ratio, 11.5; 95% confidence interval, 2.1-64.8) even after controlling for other device and anatomic variables. Polar orientation of the chimney

  13. Emergency Endovascular Treatment of an Acute Traumatic Rupture of the Thoracic Aorta Complicated by a Distal Low-Flow Syndrome

    International Nuclear Information System (INIS)

    Bruninx, Guy; Wery, Didier; Dubois, Eric; El Nakadi, Badih; Dueren, Eric van; Verhelst, Guy; Delcour, Christian

    1999-01-01

    We report the case of a patient who suffered major trauma following a motorcycle accident that resulted in multiple fractures, bilateral hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta with a pseudoaneurysm compressing the descending aorta. This compression was responsible for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the patient, which prevented any type of open thoracic surgery, endovascular treatment was performed. An initial stent-graft permitted alleviation of the compression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second stent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery

  14. Idarucizumab (Praxbind for reversal of pradaxa prior to emergent repair of contained ruptured transverse arch aneurysm

    Directory of Open Access Journals (Sweden)

    Erol Vahit Belli

    2017-01-01

    Full Text Available Idarucizumab before cardiopulmonary bypass was used for the reversal of dabigatran during an emergent frozen elephant trunk repair of a transverse arch aneurysm. Reversal was successful and minimal not massive transfusion was required with no abnormal sequelae seen with use before cardiopulmonary bypass.

  15. Emergency repair of severely damaged reinforced concrete columns using active confinement with shape memory alloys

    International Nuclear Information System (INIS)

    Shin, Moochul; Andrawes, Bassem

    2011-01-01

    This experimental study focuses on investigating the feasibility of utilizing spirals made of shape memory alloys (SMAs) to conduct emergency repair on severely damaged reinforced concrete (RC) columns. The thermally triggered shape memory feature of SMAs is sought in this study, to apply active confinement pressure on the column's damaged region. Two severely damaged 1/3-scale RC columns are repaired using the proposed technique and tested under a quasi-static lateral cyclic load. The repair of each column is conducted in less than 15 h, and the columns are tested 24 h after the starting of the repair process. The experimental results show that the new repair technique is successful in either fully restoring the as-built lateral strength, stiffness, and flexural ductility of the columns or making them even better. The efficacy of the proposed repair technique is mainly attributed to the ability of the SMA spirals to apply and maintain active confining pressure on the damaged region of the columns, which increases the strength of the already damaged concrete and delays its damage

  16. Influence of diabetes mellitus on the endovascular treatment of abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Leurs, L.J.; Laheij, R.J.F.; Buth, J.

    2005-01-01

    PURPOSE: To investigate the influence of diabetes mellitus on outcome after endovascular abdominal aortic aneurysm (AAA) repair. METHODS: Of 6017 patients enrolled in the EUROSTAR registry after undergoing endovascular AAA repair between May 1994 and December 2003, 731 (12%) had diabetes mellitus

  17. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias.

    LENUS (Irish Health Repository)

    Birindelli, Arianna

    2017-01-01

    Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.

  18. X-ray endovascular repair of the venous bed of the pyelonephritically contracted kidney in the treatment of nephrogenic and chronic renal failure

    International Nuclear Information System (INIS)

    Galkin, E.V.; Gladkov, V.V.; Inozemtsev, G.S.

    2000-01-01

    For compensation for chronic ischemia of the pyelonephritically contracted kidney the X-ray endovascular venous revascularization was used for the first time. The surgical intervention was to stenosis the subsegmental veins of the diseased kidney resulting in recanalization of the arterial system. Outcomes of X-ray treatment were analyzed in 38 patients with chronic degree I-II renal failure and nephrogenic hypertension. In 35 (92.1 %) patients of them, there was improvement in the clinical picture of the underlying disease and in the filtrating and reabsorbing function of the kidney operated on, an increase in its sizes, and decrease in systemic blood pressure [ru

  19. Update on acute endovascular and surgical stroke treatment

    DEFF Research Database (Denmark)

    Kondziella, D; Cortsen, M; Eskesen, V

    2013-01-01

    Emergency stroke care has become a natural part of the emerging discipline of neurocritical care and demands close cooperation between the neurologist and neurointerventionists, neurosurgeons, and anesthesiologists. Endovascular treatment (EVT), including intra-arterial thrombolysis, mechanical...

  20. Emergency Stenting of a Ruptured Infected Anastomotic Femoral Pseudoaneurysm

    International Nuclear Information System (INIS)

    Klonaris, Chris; Katsargyris, Athanasios; Matthaiou, Alexandros; Giannopoulos, Athanasios; Tsigris, Chris; Papadopouli, Katerina; Tsiodras, Sotiris; Bastounis, Elias

    2007-01-01

    A 74-year-old man presented with a ruptured infected anastomotic femoral pseudoaneurysm. Due to severe medical comorbidities he was considered unsuitable for conventional surgical management and underwent an emergency endovascular repair with a balloon-expandable covered stent. The pseudoaneurysm was excluded successfully and the patient had an uneventful postoperative recovery with long-term suppressive antimicrobials. He remained well for 10 months after the procedure with no signs of recurrent local or systemic infection and finally died from an acute myocardial infarction. To our knowledge, emergency endovascular treatment of a free ruptured bleeding femoral artery pseudoaneurysm has not been documented before in the English literature. This case illustrates that endovascular therapy may be a safe and efficient alternative in the emergent management of ruptured infected anastomotic femoral artery pseudoaneurysms when traditional open surgery is contraindicated

  1. Fatores envolvidos na migração das endopróteses em pacientes submetidos ao tratamento endovascular do aneurisma da aorta abdominal Factors involved in the migration of endoprosthesis in patients undergoing endovascular aneurysm repair

    Directory of Open Access Journals (Sweden)

    Marcelo José de Almeida

    2010-06-01

    Full Text Available A migração da endoprótese é complicação do tratamento endovascular definida como deslocamento da ancoragem inicial. Para avaliação da migração, verifica-se a posição da endoprótese em relação a determinada região anatômica. Considerando o aneurisma da aorta abdominal infrarrenal, a área proximal de referência consiste na origem da artéria renal mais baixa e, na região distal, situa-se nas artérias ilíacas internas. Os pacientes deverão ser monitorizados por longos períodos, a fim de serem identificadas migrações, visto que estas ocorrem normalmente após 2 anos de implante. Para evitar migrações, forças mecânicas que propiciam fixação, determinadas por características dos dispositivos e incorporação da endoprótese, devem predominar sobre forças gravitacionais e hemodinâmicas que tendem a arrastar a prótese no sentido caudal. Angulação, extensão e diâmetro do colo, além da medida transversa do saco aneurismático, são importantes aspectos morfológicos do aneurisma relacionados à migração. Com relação à técnica, não se recomenda implante de endopróteses com sobredimensionamento excessivo (> 30%, por provocar dilatação do colo do aneurisma, além de dobras e vazamentos proximais que também contribuem para a migração. Por outro lado, endopróteses com mecanismos adicionais de fixação (ganchos, farpas e fixação suprarrenal parecem apresentar menos migrações. O processo de incorporação das endopróteses ocorre parcialmente e parece não ser suficiente para impedir migrações tardias. Nesse sentido, estudos experimentais com endopróteses de maior porosidade e uso de substâncias que permitam maior fibroplasia e aderência da prótese à artéria vêm sendo realizados e parecem ser promissores. Esses aspectos serão discutidos nesta revisão.Migration of the endoprosthesis is defined as the misplacement of its initial fixation. To assess the migration, the position of the

  2. A Matched Case-Control Study on Open and Endovascular Treatment of Popliteal Artery Aneurysms.

    Science.gov (United States)

    Dorigo, W; Fargion, A; Masciello, F; Piffaretti, G; Pratesi, G; Giacomelli, E; Pratesi, C

    2018-01-01

    To compare early and late results of open and endovascular management of popliteal artery aneurysm in a retrospective single-center matched case-control study Methods: From 1981 to 2015, 309 consecutive interventions for popliteal artery aneurysm were performed in our institution, in 59 cases with endovascular repair and in 250 cases with open repair. Endovascular repair was preferred in older asymptomatic patients, while open repair was offered more frequently to patients with a thrombosed popliteal artery aneurysm and a poor run-off status. A one-to-one coarsened exact matching on the basis of the baseline demographic, clinical, and anatomical covariates significantly different between the two treatment options was performed and two equivalent groups of 56 endovascular repairs and open repairs were generated. The two groups were compared in terms of perioperative results with χ 2 test and of follow-up outcomes with the Kaplan-Meier curves and log-rank test. There were no differences between the two groups in terms of perioperative outcomes. Median duration of follow-up was 38 months. Five-year survival rates were 94% in endovascular repair group and 89.5% in open repair group (p = 0.4, log-rank 0.6). Primary patency rates at 1, 3, and 5 years were 81%, 78%, and 72% in endovascular repair group and 82.5%, 80%, and 64% in open repair group (p = 0.8, log-rank 0.01). Freedom from reintervention at 5 years was 65.5% in endovascular repair group and 76% in open repair group (p = 0.2, log-rank 1.2). Secondary patency at 1, 3, and 5 years was 94%, 86%, and 74% in endovascular repair group, and 94%, 89%, and 71% in open repair group, respectively (p = 0.9, log-rank 0.01). The rates of limb preservation at 5 years were 94% in endovascular repair group and 86.4% in open repair group (p = 0.3, log-rank 0.8). Open repair and endovascular repair of popliteal artery aneurysms provided in this retrospective single-center experience similar perioperative and follow-up results in

  3. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation

    International Nuclear Information System (INIS)

    Bilos, Linda; Pirouzram, Artai; Toivola, Asko; Vidlund, Mårten; Cha, Soon Ok; Hörer, Tal

    2017-01-01

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  4. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation

    Energy Technology Data Exchange (ETDEWEB)

    Bilos, Linda, E-mail: linda.bilos@regionorebrolan.se; Pirouzram, Artai; Toivola, Asko; Vidlund, Mårten; Cha, Soon Ok; Hörer, Tal [Örebro University Hospital and Örebro University, Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health (Sweden)

    2017-01-15

    Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.

  5. Endovascular treatment of complex traumatic lesions of the infrapopliteal segment Tratamento endovascular de lesões traumáticas complexas do segmento infrapoplíteo

    Directory of Open Access Journals (Sweden)

    Roberta C. A. Campos

    2009-06-01

    Full Text Available The occurrence of vascular trauma due to a range of causes has increased considerably. In this setting, endovascular repair has arisen as a new and less invasive approach. We report the case of three patients with lesions of below-knee vessels that were treated by endovascular procedures.A ocorrência de trauma vascular decorrente de diversas causas aumentou consideravelmente. Nesse contexto, o tratamento endovascular surge como um método novo e menos invasivo. Relatamos o caso de três pacientes com lesões abaixo do joelho que foram tratadas por procedimentos endovasculares.

  6. Regulatory mechanisms of RNA function: emerging roles of DNA repair enzymes.

    Science.gov (United States)

    Jobert, Laure; Nilsen, Hilde

    2014-07-01

    The acquisition of an appropriate set of chemical modifications is required in order to establish correct structure of RNA molecules, and essential for their function. Modification of RNA bases affects RNA maturation, RNA processing, RNA quality control, and protein translation. Some RNA modifications are directly involved in the regulation of these processes. RNA epigenetics is emerging as a mechanism to achieve dynamic regulation of RNA function. Other modifications may prevent or be a signal for degradation. All types of RNA species are subject to processing or degradation, and numerous cellular mechanisms are involved. Unexpectedly, several studies during the last decade have established a connection between DNA and RNA surveillance mechanisms in eukaryotes. Several proteins that respond to DNA damage, either to process or to signal the presence of damaged DNA, have been shown to participate in RNA quality control, turnover or processing. Some enzymes that repair DNA damage may also process modified RNA substrates. In this review, we give an overview of the DNA repair proteins that function in RNA metabolism. We also discuss the roles of two base excision repair enzymes, SMUG1 and APE1, in RNA quality control.

  7. Tissue-Derived Extracellular Matrix Bioscaffolds: Emerging Applications in Cartilage and Meniscus Repair.

    Science.gov (United States)

    Monibi, Farrah A; Cook, James L

    2017-08-01

    Musculoskeletal injuries are a common problem in orthopedic practice. Given the long-term consequences of unaddressed cartilage and meniscal pathology, a number of treatments have been attempted to stimulate repair or to replace the injured tissue. Despite advances in orthopedic surgery, effective treatments for cartilage and meniscus injuries remain a significant clinical challenge. Tissue engineering is a developing field that aims to regenerate injured tissues with a combination of cells, scaffolds, and signals. Many natural and synthetic scaffold materials have been developed and tested for the repair and restoration of a number of musculoskeletal tissues. Among these, biological scaffolds derived from cell and tissue-derived extracellular matrix (ECM) have shown great promise in tissue engineering given the critical role of the ECM for maintaining the biological and biomechanical properties, structure, and function of native tissues. This review article presents emerging applications for tissue-derived ECM scaffolds in cartilage and meniscus repair. We examine normal ECM composition and the current and future methods for potential treatment of articular cartilage and meniscal defects with decellularized scaffolds.

  8. Paraesophageal hernia repair in the emergency setting: is laparoscopy with the addition of a fundoplication the new gold standard?

    Science.gov (United States)

    Klinginsmith, Michael; Jolley, Jennifer; Lomelin, Daniel; Krause, Crystal; Heiden, Jace; Oleynikov, Dmitry

    2016-05-01

    Laparoscopic repair of paraesophageal hernia (PEH) with fundoplication is currently the preferred elective strategy, but emergent cases are often done open without an anti-reflux (AR) procedure. This study examined PEH repair in elective and urgent/emergent settings and investigated patient characteristic influence on the use of adjunctive techniques, such as AR procedures or gastrostomy tube (GT) placement. Utilizing the University HealthSystem Consortium Clinical Database Resource Manager, selected discharge data were retrieved using International Classification of Disease 9 diagnosis codes for PEH and procedure specific codes. Chi-squared and paired t tests were applied (α = 0.05). Discharge data from October 2010 through June 2014 indicated 7950 patients (≥18 years) underwent PEH surgery, 84.7 % were performed laparoscopically and 15.3 % open. 24.6 % of cases were classified urgent/emergent upon admission, and almost 70 % of these were completed laparoscopically. Open paraesophageal hernia repairs (OHR) represented a higher proportion of urgent/emergent cases but were only 30 % of this total. Laparoscopic paraesophageal hernia repair (LHR) patients were more likely to receive an AR procedure in all situations (54.9 % LHR vs. 26.3 % OHR). Almost 90 % of elective PEH repairs in this cohort were laparoscopic. Elective cases were more commonly associated with AR procedures than emergent cases which frequently incorporated GT placement. We demonstrate that laparoscopic PEH repair has become accepted in emergent cases. Open PEH repair is often reserved for emergent surgeries and less commonly includes an AR procedure. Laparoscopy with an AR procedure is clearly the standard of care in elective surgery. The decision to perform an open or laparoscopic surgery, with or without adjunctive techniques, may be based more on the physician's comfort with laparoscopic surgery and surgical practices than the patient's condition. Long-term follow-up studies are

  9. Unplanned return to operating room after endovascular repair of abdominal aortic aneurysm (EVAR) is associated with increased risk of hospital readmission.

    Science.gov (United States)

    Aziz, Faisal; Ferranti, Katelynn; Lehman, Erik B

    2018-04-01

    Objectives Hospital readmissions after surgical operations are considered serious events. Centers for Medicare and Medicaid (CMS) consider surgical readmissions as preventable and hold hospitals responsible for them. Endovascular abdominal aortic aneurysm (EVAR) has become the first line modality of treatment for suitable patients with abdominal aortic aneurysm (AAA). The purpose of this study is to retrospectively review the factors associated with hospital readmission after EVAR. Methods The 2013 EVAR targeted American College of Surgeons (ACS-NSQIP) database and generalized 2013 general and vascular surgery ACS-NSQIP participant use files were used for this study. Patient, diagnosis, and procedure characteristics of patients undergoing EVAR surgery were assessed. Multivariate logistic regression analysis was used to determine independent risk factors for hospital readmission within 30 days after surgery. Results A total of 2277 patients (81% males, 19% females) underwent EVAR operations in the year 2013. Indications for operations included: asymptomatic large diameter (79%), symptomatic (5.7%), rupture without hypotension (4.3%), and rupture with hypotension (2.8%). Among these patients, 178 (7.8%) were readmitted to the hospital within 30 days after surgery. About 53% of all readmissions were within two weeks after the discharge. Risk factors, associated with readmission included: body mass index (per 5-units, OR 1.23, CI 1.06-1.42, p readmission for patients with presence of all these seven factors was 99.9%. Conclusions Readmission after EVAR is a serious occurrence. Various factors predispose a patient at a high risk for readmission. Unplanned return to operating room after EVAR is associated with a 11-fold increase in hospital readmission.

  10. Endovascular repair of primary retrograde Stanford type A aortic dissection%腔内修复术治疗原发性逆撕型Stanford A型主动脉夹层

    Institute of Scientific and Technical Information of China (English)

    吴海卫; 孙磊; 李德闽; 景华; 许飚; 王常田; 张雷

    2016-01-01

    Objective To summarize the short-and mid-term results on endovascular repair of primary retrograde Stanford type A aortic dissection with an entry tear in distal aortic arch or descending aorta.Methods Between December 2009 and December 2014,21 male patients of primary retrograde Stanford type A aortic dissection with a mean age of (52 ± 9) years received endovascular repair in Department of Cardiothoracic Surgery,Jinling Hospital.Among the 21 cases,17 patients were presented as ascending aortic intramural hematoma,4 patients as active blood flow in false lumen and partial thrombosis,8 patients as ulcer on descending aorta combined intramural hematoma in descending aorta,and 13 patients as typical dissection changes.All patients received cndovascular stent-graft repair successfully,with 15 cases in acute phase and 6 cases in chronic phase.Results Cone stent was implanted in 13 cases,while straight stent in 8 cases,including 1 case of left common carotid-left subclavian artery bypass surgery and 1 case of restrictive bare-metal stent implantation.No perioperative stroke,paraplegia,stent fracture or displacement,limbs or abdominal organ ischemia or other severe complications occured,except for tracheotomy in 2 patients.Active blood flow in ascending aorta or aortic arch disappeared,and intramural hematoma started being absorbed on CT angiography images before discharge.All patients were alive during follow-up (6 to 72 months),and intramural hematoma in ascending aorta and aortic arch was absorbed thoroughly.Type Ⅰ endoleak and ulcer expansion were found in 1 patient,and type Ⅳ endoleak in distal stent was found in another one patient.Secondary ascending aortic dissection was found in 1 case two years later,which was cured by hybrid procedure with cardiopulmonary bypass.Conclusion Endovascular repair of primary retrograde Stanford type A aortic dissection was safe and effective,which correlated with favorable short-and mid-term results.%目的 探讨腔内修复

  11. Laparoscopic inguinal hernia repair by the hook method in emergency setting in children presenting with incarcerated inguinal hernia.

    Science.gov (United States)

    Chan, Kin Wai Edwin; Lee, Kim Hung; Tam, Yuk Him; Sihoe, Jennifer Dart Yin; Cheung, Sing Tak; Mou, Jennifer Wai Cheung

    2011-10-01

    The development of laparoscopic hernia repair has provided an alternative approach to the management of incarcerated inguinal hernia in children. Different laparoscopic techniques for hernia repair have been described. However, we hereby review the role of laparoscopic hernia repair using the hook method in the emergency setting for incarcerated inguinal hernias in children. A retrospective review was conducted of all children who presented with incarcerated inguinal hernia and underwent laparoscopic hernia repair using the hook method in emergency setting between 2004 and 2010. There were a total of 15 boys and 1 girl with a mean age of 30 ± 36 months (range, 4 months to 12 years). The hernia was successfully reduced after sedation in 7 children and after general anesthesia in 4 children. In 5 children, the hernia was reduced by a combined manual and laparoscopic-assisted approach. Emergency laparoscopic inguinal hernia repair using the hook method was performed after reduction of the hernia. The presence of preperitoneal fluid secondary to recent incarceration facilitated the dissection of the preperitoneal space by the hernia hook. All children underwent successful reduction and hernia repair. The median operative time was 37 minutes. There was no postoperative complication. The median hospital stay was 3 days. At a median follow-up of 40 months, there was no recurrence of the hernia or testicular atrophy. Emergency laparoscopic inguinal hernia repair by the hook method is safe and feasible. Easier preperitoneal dissection was experienced, and repair of the contralateral patent processus vaginalis can be performed in the same setting. Copyright © 2011 Elsevier Inc. All rights reserved.

  12. Endovascular interventional magnetic resonance imaging

    International Nuclear Information System (INIS)

    Bartels, L W; Bakker, C J G

    2003-01-01

    Minimally invasive interventional radiological procedures, such as balloon angioplasty, stent placement or coiling of aneurysms, play an increasingly important role in the treatment of patients suffering from vascular disease. The non-destructive nature of magnetic resonance imaging (MRI), its ability to combine the acquisition of high quality anatomical images and functional information, such as blood flow velocities, perfusion and diffusion, together with its inherent three dimensionality and tomographic imaging capacities, have been advocated as advantages of using the MRI technique for guidance of endovascular radiological interventions. Within this light, endovascular interventional MRI has emerged as an interesting and promising new branch of interventional radiology. In this review article, the authors will give an overview of the most important issues related to this field. In this context, we will focus on the prerequisites for endovascular interventional MRI to come to maturity. In particular, the various approaches for device tracking that were proposed will be discussed and categorized. Furthermore, dedicated MRI systems, safety and compatibility issues and promising applications that could become clinical practice in the future will be discussed. (topical review)

  13. The Usefulness of Leukosan SkinLink for Simple Facial Laceration Repair in the Emergency Department

    Directory of Open Access Journals (Sweden)

    Hyunjoo Kim

    2015-07-01

    Full Text Available BackgroundRepair of facial laceration in the emergency department can pose a number of difficulties. Children can be uncooperative, but adults can also be if they have sustained head trauma or are intoxicated. Leukosan SkinLink consists of topical adhesive and adhesive tape that can be applied easily to long or tense wounds. In this study, the authors compared conventional suturing with Leukosan SkinLink for facial laceration patients in the emergency department.MethodsThe prospective study was carried out from March 2013 to September 2013 with linear facial laceration patients visiting the emergency department. Exclusion criteria were open fractures, joint injuries, skin defects, hairy skin, and mucosa. The author used Leukosan SkinLink for skin closure in the experimental group and used conventional suturing in the control group. The scar evaluation using the Patient and Observer Scar Assessment Scale (POSAS along with satisfaction scores, procedure times, and complications were compared.ResultsA total of 77 patients (30 in the control group and 47 in the experimental group participated and underwent follow-up for 6 months postoperatively. The scar assessment using the POSAS and the satisfaction score in both groups were similar. The average procedure time in the experimental group was shorter. In the control group, there were four cases of wound dehiscence, two of infection, and one of skin necrosis, whereas four cases of wound dehiscence and one allergic reaction occurred in the experimental group.ConclusionsWith a simple application technique, Leukosan SkinLink is a new effective method for facial laceration repair especially useful for children and uncooperative adults.

  14. Is Conventional Open Repair for Abdominal Aortic Aneurysm Feasible in Nonagenarians?

    Science.gov (United States)

    Uehara, Kyokun; Matsuda, Hitoshi; Inoue, Yosuke; Omura, Atsushi; Seike, Yoshimasa; Sasaki, Hiroaki; Kobayashi, Junjiro

    2017-09-25

    Background : Although endovascular repair for abdominal aortic aneurysm has been found to be beneficial in very elderly patients, some patients have contraindications to this procedure. For nonagenarians, the results of open repair remain unclear. The purpose of this study was to compare the outcomes of open vs. endovascular repair for abdominal aortic aneurysm in nonagenarian patients. Methods and Results : Fourteen patients undergoing open surgical repair and 24 undergoing endovascular repair for abdominal aortic aneurysm were evaluated. There was no significant difference in early mortality between the open and endovascular groups (0% vs. 4.1%, p=0.16). The open repair group required much longer hospital stays (26.4 vs. 10.6 days, respectively, p=0.003). Finally, 12 patients (86%) undergoing open repair vs. 21 (88%) undergoing endovascular repair returned home (p=0.49). During a mean follow-up period of 23.4±23.5 months, cumulative estimated 1- and 3-year survival rates were 90.0% and 48.0%, respectively in the open repair group and 90.6% and 54.9%, respectively in the endovascular repair group (p=0.51). Conclusion : Although endovascular repair for abdominal aortic aneurysm was superior in terms of recovery, the results of conventional open repair were acceptable even in nonagenarian patients. Open repair remains an alternative for patients with contraindications to endovascular repair.

  15. MATHEMATICAL MODEL OF OSCILLATIONS OF BEARING BODY FRAME OF EMERGENCY AND REPAIR RAILCARS

    Directory of Open Access Journals (Sweden)

    Galina KHROMOVA

    2017-04-01

    Full Text Available Nowadays, the importance of maintenance and effective use of available railcars in the railway transport is growing, and researchers and technical experts are working to address this issue with the use of various techniques. The authors address the use of analytical technique, which includes mathematical solutions for flexural and longitudinal fluctuations of the bearing framework of a railcar body frame. The calculation is performed in connection with the modernization of the body frame of emergency and repair rail service car, taking into account the variability in section, mass, longitudinal stiffness, and bending stiffness. It allows for extension of the useful life of their operation, with special focus on vehicles owned by Joint-Stock Company "Uzbekistan Railways". The simulation of equivalent bearing body frame of emergency and repair rail service car was carried out using an elastic rod with variable parameters including stiffness and mass. The difference between the proposed model and the existing ones is due to the variability in cross section, mass, and the longitudinal and bending stiffness along the length of equivalent beam, which corresponds to the actual conditions of operation and data of the experimental studies conducted by the authors on the bearing frames of electric locomotives’ variable sections. The frequency analysis that was carried out with the use of the Mathcad 14 programming showed that the frequencies of natural oscillations change on n harmonicas = 1, 2, 3 … 5. As regards longitudinal oscillations of system, in case of introduction of the damping subfloor, the frequency of natural oscillations of the upgraded rail car frame λ1mn increases on comparing with standard λ1n (for example, in case of n = 5 the frequency is 0.587 and 0.602 Hz/m, respectively.

  16. Perioperative complications in endovascular neurosurgery: Anesthesiologist's perspective

    Science.gov (United States)

    Sharma, Megha U.; Ganjoo, Pragati; Singh, Daljit; Tandon, Monica S.; Agarwal, Jyotsna; Sharma, Durga P.; Jagetia, Anita

    2017-01-01

    Background: Endovascular neurosurgery is known to be associated with potentially serious perioperative complications that can impact the course and outcome of anesthesia. We present here our institutional experience in the anesthetic management of various endovascular neurosurgical procedures and their related complications over a 10-year period. Methods: Data was obtained in 240 patients pertaining to their preoperative status, details of anesthesia and surgery, perioperative course and surgery-related complications. Information regarding hemodynamic alterations, temperature variability, fluid-electrolyte imbalance, coagulation abnormalities and alterations in the anesthesia course was specifically noted. Results: Among the important complications observed were aneurysm rupture (2.5%), vasospasm (6.67%), thromboembolism (4.16%), contrast reactions, hemodynamic alterations, electrolyte abnormalities, hypothermia, delayed emergence from anesthesia, groin hematomas and early postoperative mortality (5.14%). Conclusion: Awareness of the unique challenges of endovascular neurosurgery and prompt and appropriate management of the associated complications by an experienced neuroanesthesiologist is vital to the outcome of these procedures. PMID:28413524

  17. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

    Leonhardt, H.; Mellander, S.; Snygg, J.

    2008-01-01

    follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed....... All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean...... arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered. Patients with cancer may only need treatment for the acute bleeding episode, and an endovascular approach has the advantage...

  18. Tratamiento endovascular de urgencia con endoprótesis de aneurisma roto disecado de aorta torácica: A propósito de un caso Emergency endovascular treatment with endoprosthesis of ruptured dissected aneurysm of thoracic aorta: Report of one case

    Directory of Open Access Journals (Sweden)

    José Lugo

    2007-12-01

    rupture or dissection. Approximately 50% of all thoracic aortic aneurysms are atherosclerotic and are the result of arterial restructure and dilation or are due to an abnormal collagen metabolism. Most thoracic aortic aneurysms are only found by chance during other medical problems evaluation. The goal of thoracic aortic aneurysms treatment is the prevention of death due to its rupture. Ruptured risk of untreated aneurysms oscillates between 46% and 74% and mortality rate due to its rupture is extremely high. Large aneurysms, especially when they are greater than 6 cm in diameter are more susceptible of ruptures than smaller aneurysms. Endovascular treatment, initially developed for abdominal aortic aneurysms, was introduced in 1992 as a less invasive alternative to open surgery treatment for descending thoracic aortic aneurysms. Endovascular stent or endoprosthesis is actually getting more attention as an alternative to surgical repair of thoracic aortic aneurysms.

  19. Emergent revascularization of acute tandem vertebrobasilar occlusions: Endovascular approaches and technical considerations-Confirming the role of vertebral artery ostium stenosis as a cause of vertebrobasilar stroke.

    Science.gov (United States)

    Cohen, José E; Leker, Ronen R; Gomori, J Moshe; Eichel, Roni; Rajz, Gustavo; Moscovici, Samuel; Itshayek, Eyal

    2016-12-01

    Patients suffering from acute atherothrombotic occlusion of the proximal vertebral artery (VA) and concomitant basilar artery (BA) occlusion present a grim prognosis. We describe our experience in the endovascular recanalization of tandem vertebrobasilar occlusions using endovascular techniques. The BA was accessed through the normal VA (clean-road) or the occluded, thrombotic VA (dirty-road), and stentriever-based thrombectomy was performed using antegrade or reverse revascularization variants. Seven patients underwent successful stentriever-assisted mechanical thrombectomy of the BA and five sustained concomitant VA revascularization. Stroke onset to endovascular intervention initiation (time-to-treatment) ranged from 4.5-13hours (mean 8.6). In two of seven patients, the BA occlusion was approached with a 'clean-road' approach via the contralateral VA; in five of seven patients, a 'dirty-road' approach via the occluded VA was used. Mean time-to-recanalization was 66minutes (range 55-82). There were no perforations, iatrogenic vessel dissections, or other technical complications. Four patients presented mild-to-moderate disability (modified Rankin Scale [mRS] 0-3) at 3months, one remained with moderate-to-severe disability (mRS 4), and two patients died on days 9 and 23 after their strokes. Follow-up ranged from 6-45months (mean 24months). In selected patients with acute VA-BA occlusion, stentriever-based thrombectomy performed through either the patent or the occluded VA, may be feasible, effective, and safe. Clinical outcomes in these patients seem to equipoise the neurological outcome of patients with successful revascularization for isolated BA occlusion. This unique pair of occlusions confirms the role of VA ostium stenosis as a cause of vertebrobasilar stroke. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Endovascular Therapy of Ruptured Abdominal Aortic Aneurysm: Mid- and Long-Term Results

    International Nuclear Information System (INIS)

    Kubin, Klaus; Sodeck, Gottfried H.; Teufelsbauer, H.; Nowatschka, Bernd; Kretschmer, Georg; Lammer, Johannes; Schoder, Maria

    2008-01-01

    As an alternative to open aneurysm repair, emergency endovascular aortic repair (EVAR) has emerged as a promising technique for ruptured abdominal aortic aneurysm (rAAA) within the last decade. The aim of this retrospective study is to present early and late outcomes of patients treated with EVAR for rAAA. Twenty-two patients (5 women, 17 men; mean age, 74 years) underwent EVAR for rAAA between November 2000 and April 2006. Diagnostic multislice computed tomography angiography was performed prior to stent-graft repair to evaluate anatomical characteristics and for follow-up examinations. Periprocedural patient characteristics and technical settings were evaluated. Mortality rates, hospital stay, and early and late complications, within a mean follow-up time of 744 ± 480 days, were also assessed. Eight of 22 patients were hemodynamically unstable at admission. Stent-graft insertion was successful in all patients. The total early complication rate was 54%, resulting in a 30-day mortality rate of 23%. The median intensive care unit stay was 2 days (range, 2-48 days), and the median hospital stay was 16 days (range, 9-210 days). During the follow-up period, three patients suffered from stent-graft-related complications. The overall mortality rate in our study group was 36%. EVAR is an acceptable, minimally invasive treatment option in patients with acute rAAA, independent of the patient's general condition. Short- and long-term outcomes are definitely comparable to those with open surgical repair procedures

  1. Complexity Quantification for Overhead Transmission Line Emergency Repair Scheme via a Graph Entropy Method Improved with Petri Net and AHP Weighting Method

    Directory of Open Access Journals (Sweden)

    Jing Zhou

    2014-01-01

    Full Text Available According to the characteristics of emergency repair in overhead transmission line accidents, a complexity quantification method for emergency repair scheme is proposed based on the entropy method in software engineering, which is improved by using group AHP (analytical hierarchical process method and Petri net. Firstly, information structure chart model and process control flowchart model could be built by Petri net. Then impact factors on complexity of emergency repair scheme could be quantified into corresponding entropy values, respectively. Finally, by using group AHP method, weight coefficient of each entropy value would be given before calculating the overall entropy value for the whole emergency repair scheme. By comparing group AHP weighting method with average weighting method, experiment results for the former showed a stronger correlation between quantified entropy values of complexity and the actual consumed time in repair, which indicates that this new method is more valid.

  2. The emerging age of endovascular treatment of acute ischaemic stroke and the role of CT angiography in patient work-up: a guide for the radiologist

    International Nuclear Information System (INIS)

    Loughborough, W.; Mahady, K.; Bradley, M.D.; Renowden, S.A.; Mortimer, A.M.

    2016-01-01

    Recent trial evidence suggests that for patients suffering large-vessel occlusive stroke, endovascular therapy based on the stent-retriever technique is associated with superior clinical outcomes when compared to intravenous thrombolysis alone. The challenge now is how this service is to be delivered. This may involve both centralisation of services around large cities and development of robust networks to receive patients from district general hospitals situated further afield. Both diagnostic and interventional neuroradiology will need to expand. Furthermore, we suggest that it would be advantageous for radiology departments in those hospitals receiving hyperacute stroke patients to perform computed tomography (CT) angiography in addition to non-contrast CT, which also has implications for service delivery in these units. This could swiftly aid identification of patients who might benefit from thrombectomy and improve decision-making through demonstration of occlusive thrombus and of collateral status.

  3. Emerging Importance of Helicases in Plant Stress Tolerance: Characterization of Oryza sativa Repair Helicase XPB2 Promoter and Its Functional Validation in Tobacco under Multiple Stresses

    OpenAIRE

    Raikwar, Shailendra; Srivastava, Vineet K.; Gill, Sarvajeet S.; Tuteja, Renu; Tuteja, Narendra

    2015-01-01

    Genetic material always remains at the risk of spontaneous or induced damage which challenges the normal functioning of DNA molecule, thus, DNA repair is vital to protect the organisms against genetic damage. Helicases, the unique molecular motors, are emerged as prospective molecules to engineer stress tolerance in plants and are involved in nucleic acid metabolism including DNA repair. The repair helicase, XPB is an evolutionary conserved protein present in different organisms, including pl...

  4. Emerging importance of helicases in plant stress tolerance: characterization of Oryza sativa repair helicase XPB2 promoter and its functional validation in tobacco under multiple stresses

    OpenAIRE

    Shailendra eRaikwar; Vineet Kumar Shrivastava; Sarvajeet Singh Gill; Renu eTuteja; Narendra eTuteja; Narendra eTuteja

    2015-01-01

    Genetic material always remains at the risk of spontaneous or induced damage which challenges the normal functioning of DNA molecule, thus, DNA repair is vital to protect the organisms against genetic damage. DNA hHelicases, the unique molecular motors, are emerged as potentialprospective molecules to engineer stress tolerance in plants and are involved in a variety of DNA nucleic acid metabolismc processes including DNA repair. The DNA repair helicase, OsXPB2 is an evolutionary conserved pr...

  5. Emergency Stent Grafting After Unsuccessful Surgical Repair of a Mycotic Common Femoral Artery Pseudoaneurysm in a Drug Abuser

    International Nuclear Information System (INIS)

    Lupattelli, Tommaso; Garaci, Francesco Giuseppe; Basile, Antonio; Minnella, Daniela Paola; Casini, Andrea; Clerissi, Jacques

    2009-01-01

    Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

  6. Spinal anesthesia for inguinal hernia repair in infants: a feasible and safe method even in emergency cases.

    Science.gov (United States)

    Lambertz, A; Schälte, G; Winter, J; Röth, A; Busch, D; Ulmer, T F; Steinau, G; Neumann, U P; Klink, C D

    2014-10-01

    Inguinal hernia repair is the most frequently performed surgical procedure in infants and children. Especially in premature infants, prevalence reaches up to 30% in coincidence with high rates of incarceration during the first year of life. These infants carry an increased risk of complications due to general anesthesia. Thus, spinal anesthesia is a topic of growing interest for this group of patients. We hypothesized that spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants even at high risk and cases of incarceration. Between 2003 and 2013, we operated 100 infants younger than 6 months with inguinal hernia. Clinical data were collected prospectively and retrospectively analyzed. Patients were divided into two groups depending on anesthesia procedure (spinal anesthesia, Group 1 vs. general anesthesia, Group 2). Spinal anesthesia was performed in 69 infants, and 31 infants were operated in general anesthesia, respectively. In 7 of these 31 infants, general anesthesia was chosen because of lumbar puncture failure. Infants operated in spinal anesthesia were significantly smaller (54 ± 4 vs. 57 ± 4 cm; p = 0.001), had a lower body weight (4,047 ± 1,002 vs. 5,327 ± 1,376 g; p emergent incarcerated hernia repairs were performed in spinal anesthesia (p = 0.429). Spinal anesthesia is a feasible and safe option for inguinal hernia repair in infants, especially in high-risk premature infants and in cases of hernia incarceration.

  7. Headache and endovascular procedures.

    Science.gov (United States)

    de Biase, Stefano; Longoni, Marco; Gigli, Gian Luigi; Agostoni, Elio

    2017-05-01

    The International Classification of Headache Disorders (ICHD-3 beta) includes headache attributed to intracranial endovascular procedures (EVPs). The aim of this review is to describe the clinical and pathophysiological aspects of headache related to vascular lesions and EVPs. Current studies regarding this issue are contradictory, although generally favouring headache improvement after EVPs. Further large studies are needed to adequately assess the effect of EVPs on headache.

  8. Endovascular stenting of a chronic ruptured type B thoracic aortic dissection, a second chance: a case report.

    Science.gov (United States)

    Arshad, Ali; Khan, Sumaira L; Whitaker, Simon C; Macsweeney, Shane T

    2008-02-07

    We aim to highlight the need for awareness of late complications of endovascular thoracic aortic stenting and the need for close follow-up of patients treated by this method. We report the first case in the English literature of an endovascular repair of a previously stented, ruptured chronic Stanford type B thoracic aortic dissection re-presenting with a type III endoleak of the original repair. Endovascular thoracic stenting is now a widely accepted technique for the treatment of thoracic aortic dissection and its complications. Long term follow up is necessary to ensure that late complications are identified and treated appropriately. In this case of type III endoleak, although technically challenging, endovascular repair was feasible and effective.

  9. Endovascular Treatment of Ruptured Abdominal Aneurysm into the Inferior Vena Cava in Patient After Stent Graft Placement

    International Nuclear Information System (INIS)

    Juszkat, Robert; Pukacki, Fryderyk; Zarzecka, Anna; Kulesza, Jerzy; Majewski, Waclaw

    2009-01-01

    We report the case of a patient who underwent endovascular repair and then reintervention as a result of the presence of a persistent endoleak complicated by an aortocaval fistula. A 76-year-old patient with a history of endovascular treatment for abdominal aortic aneurysm 2 years earlier had a palpable abdominal mass, high-output cardiac failure, and renal failure. A computed tomographic scan and angiography revealed bending of the right iliac limb, a type I endoleak, and rupture of the aneurysm into the inferior vena cava with aortocaval fistula formation. An iliac extension was positioned in the right external iliac artery. The procedure was finished successfully. Control angiography showed normal flow within the endoprosthesis, and both iliac arteries were without signs of endoleakage and aortocaval fistula. Ectatic common iliac artery may lead to a late distal attachment site endoleak. The application of a stent graft in cases of secondary aortocaval fistula after stent graft repair is a good option, particularly in emergency cases.

  10. Endovascular treatment in pregnancy

    International Nuclear Information System (INIS)

    Ishii, Akira; Miyamoto, Susumu

    2013-01-01

    There is an increased risk of stroke during pregnancy and the puerperium. Decisions should be made immediately upon transfer to each institution, particularly with respect to when and how to treat the patient. This review highlights the feasibility of endovascular treatment in pregnancy. Most of the pharmaceutical agents and therapeutic devices used in clinical practice can be utilized in pregnant patients. Comprehensive information on the benefits and risks of treatment should be explained to the patient and her family, with particular attention to the safety of the mother and fetus. Radiation exposure to the fetus is also a concern; the hazard can be minimized with optimal protection. Several studies have demonstrated that conventional procedures do not cause serious radiation exposure exceeding the threshold of safety to the fetus. Endovascular therapy can be safely performed for the treatment of acute stroke as in non-pregnant patients with adequate attention to pharmaceutical agents and shielding from radiation. In contrast to therapy for acute stroke, preventive endovascular treatment for asymptomatic lesions remains controversial. Several conditions, such as cerebral aneurysms and arteriovenous malformations, are known to bleed more frequently in pregnancy, but whether the benefits of preventive treatment outweigh the associated risks is unknown. The decision for preventive treatment should be carefully made on a case-by-case basis after extensive discussion with the patient. (author)

  11. Emerging critical roles of Fe-S clusters in DNA replication and repair

    Science.gov (United States)

    Fuss, Jill O.; Tsai, Chi-Lin; Ishida, Justin P.; Tainer, John A.

    2015-01-01

    Fe-S clusters are partners in the origin of life that predate cells, acetyl-CoA metabolism, DNA, and the RNA world. The double helix solved the mystery of DNA replication by base pairing for accurate copying. Yet, for genome stability necessary to life, the double helix has equally important implications for damage repair. Here we examine striking advances that uncover Fe-S cluster roles both in copying the genetic sequence by DNA polymerases and in crucial repair processes for genome maintenance, as mutational defects cause cancer and degenerative disease. Moreover, we examine an exciting, controversial role for Fe-S clusters in a third element required for life – the long-range coordination and regulation of replication and repair events. By their ability to delocalize electrons over both Fe and S centers, Fe-S clusters have unbeatable features for protein conformational control and charge transfer via double-stranded DNA that may fundamentally transform our understanding of life, replication, and repair. PMID:25655665

  12. Endovascular Treatment of Ruptured Abdominal Aortic Aneurysm with Aortocaval Fistula

    International Nuclear Information System (INIS)

    Guzzardi, Giuseppe; Fossaceca, Rita; Divenuto, Ignazio; Musiani, Antonello; Brustia, Piero; Carriero, Alessandro

    2010-01-01

    Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA). We report the endovascular repair of an AAA rupture into the inferior vena cava. A 78-year-old woman was admitted to our hospital for acute hypotension. She presented with a pulsatile abdominal mass and became rapidly anuric. Abdominal computed tomography (CT) showed an AAA rupture into the inferior vena cava. The features of the AAA made it suitable for endovascular repair. To prevent pulmonary embolism caused by the presence of sac thrombosis near the vena cava lumen, a temporary vena cava filter was deployed before the procedure. A bifurcated stent-graft was placed with the patient under local anaesthesia, and the AAA was successfully treated. A transient type II endoleak was detected on CT 3 days after endograft placement. At routine follow-up 6 and 12 months after the procedure, the patient was in good clinical condition, and the type II endoleak had sealed completely. Endovascular treatment offers an attractive therapeutic alternative to open repair in case of ACF; however, only small numbers of patients have been treated, and long-term follow-up interval is lacking.

  13. Endovascular management of an acquired aortobronchial fistula following aortic bypass for coarctation.

    LENUS (Irish Health Repository)

    O'Sullivan, Katie E

    2013-09-20

    Aortobronchial fistula (ABF) in the setting of aortic coarctation repair is very rare but uniformly fatal if untreated. Endovascular stenting of the descending aorta is now the first-choice approach for ABF presenting with haemoptysis and offers a less-invasive technique with improved outcomes, compared with open repair. We report a case of late ABF occurring following bypass for aortic coarctation. Management focused on two key manoeuvres: use of a covered endovascular stent to occlude the aortic bypass thus controlling the fistula and dilatation and stenting of native coarctation.

  14. Dynamics of the aorta and its sidebranches : implications for endovascular treatment of aortic disease

    NARCIS (Netherlands)

    Muhs, B.E.

    2007-01-01

    The main objective of this thesis is to critically evaluate the clinical results of emerging aortic endovascular therapies and then to utilize dynamic imaging modalities [EKG gated dynamic computerized tomographic angiography (CTA) and magnetic resonance angiography (MRA)] to understand the

  15. Aortic dissection. Basic aspects and endovascular management

    International Nuclear Information System (INIS)

    Jaramillo, Nicolas I; Alviar, Carlos I

    2005-01-01

    Treatment of thoracic aortic pathology is complicated by the morbidity associated to the surgical procedure and to the frailty of an elderly and difficult population. Surgical operation in this kind of population frequently bears a significant incidence of death and long-term disability. In an effort to reduce the incidence of negative outcomes, minimally invasive techniques in the form of endovascular stenting have been introduced during the past decade. The technology, originally described by Parodi, and initially designed for its use in abdominal aortic aneurysms, has been adapted for the treatment of thoracic aortic aneurysms. Furthermore, an improved understanding of the pathophysiology and the natural history of thoracic aortic disease as well as the analysis of the outcomes have facilitated our treatment decisions in terms of the timing for an appropriate intervention. Treatment of thoracic aortic dissection using endovascular Stent is one of the more recent advances in this condition and is receiving increasing attention, as it is a less invasive alternative to an open surgical repair. Although this technology is still innovative, significant improvements have been made lately in the design and deployment of the endovascular Stent-grafts. These prostheses have been increasingly used to treat aneurysms, dissections and traumatic ruptures, as well as giant penetrating ulcers and intramural hematomas of the descending thoracic aorta with good early and mid-term outcomes. The rareness, complexity and severity of the pathology and the theoretically high risk of complications should render the surgeon extremely cautious especially with young patients. Conceptually, the endo luminal treatment in the acute phase seems to be the solution and will probably become a preferred therapy while technical refinement is under way. Worldwide experience is growing and with this a better understanding of the indications and limitations of this innovative therapy will be

  16. Transarterial endovascular treatment in the management of life-threatening carotid blowout syndrome in head and neck cancer patients: review of the literature.

    Science.gov (United States)

    Dequanter, D; Shahla, M; Paulus, P; Aubert, C; Lothaire, P

    2013-12-01

    Carotid blowout syndrome is a rare but devastating complication in patients with head and neck malignancy, and is associated with high morbidity and mortality. Bleeding from the carotid artery or its branches is a well-recognized complication following treatment or recurrence of head and neck cancer. It is an emergency situation, and the classical approach to save the patient's life is to ligate the carotid artery. But the surgical treatment is often technically difficult. Endovascular therapies were recently reported as good alternatives to surgical ligation. Retrospective review of three cases of acute or threatened carotid hemorrhage managed by endovascular therapies. Two patients presented with acute carotid blowout, and one patient with a sentinel bleed. Two patients had previously been treated with surgery and chemo radiation. One patient was treated by chemo radiation. Two had developed pharyngocutaneous fistulas, and one had an open necrosis filled wound that surrounded the carotid artery. In two patients, stent placement resolved the acute hemorrhage. In one patient, superselective embolization was done. Mean duration follow-up was 10.2 months. No patient had residual sequelae of stenting or embolization. Management of carotid blow syndrome is very critical and difficult. A multidisciplinary approach is very important in the management of carotid blow syndrome. Correct and suitable management can be life saving. An endovascular technique is a good and effective alternative with much lower morbidity rates than surgical repair or ligation. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  17. Developing Animal Models for Optimizing the Musculoskeletal Repair Potential of Emerging Human Progenitor Cell Therapies

    Science.gov (United States)

    2014-06-01

    into a central hub for group analysis and reporting. It is now being used for a just received R21 award to assess skeletal variation in a population...model to produce, and the use of the 3D X-rays the extent of deformity and the tempo of repair can be easily documented. Addition of the...Liu, Y., Boyd, N., Dennis, J., Jiang, X., Xin, X., Wang, L., Aguila, H., Rowe, D., Lichtler, A. and Goldberg , J. Developmental engineering of bone

  18. Radial force measurement of endovascular stents: Influence of stent design and diameter.

    Science.gov (United States)

    Matsumoto, Takuya; Matsubara, Yutaka; Aoyagi, Yukihiko; Matsuda, Daisuke; Okadome, Jun; Morisaki, Koichi; Inoue, Kentarou; Tanaka, Shinichi; Ohkusa, Tomoko; Maehara, Yoshihiko

    2016-04-01

    Angioplasty and endovascular stent placement is used in case to rescue the coverage of main branches to supply blood to brain from aortic arch in thoracic endovascular aortic repair. This study assessed mechanical properties, especially differences in radial force, of different endovascular and thoracic stents. We analyzed the radial force of three stent models (Epic, E-Luminexx and SMART) stents using radial force-tester method in single or overlapping conditions. We also analyzed radial force in three thoracic stents using Mylar film testing method: conformable Gore-TAG, Relay, and Valiant Thoracic Stent Graft. Overlapping SMART stents had greater radial force than overlapping Epic or Luminexx stents (P stents was greater than that of all three endovascular stents (P stents, site of deployment, and layer characteristics. In clinical settings, an understanding of the mechanical characteristics, including radial force, is important in choosing a stent for each patient. © The Author(s) 2015.

  19. Endovascular treatment of three traumatic lesions of the vertebral artery

    International Nuclear Information System (INIS)

    Galvis, Victor Raul; Medina V, Francisco Jose

    2007-01-01

    The purpose is to expose the results of the endovascular treatment of three traumatic lesions of the vertebral artery. Methods: in the period from October 2005 to May 2006, three patients with traumatic lesions in the vertebral artery were treated by endovascular therapy with an age average of 32 years. All the procedures were carried out using subtraction digital angiography under anesthesiology supervision and were started with a 5,000 IU heparin bolus, previous antiplatelet medication with clopidogrel. For the treatment of the lesions covered stents and coils were used. results: there were three documented cases of traumatic lesions of the vertebral artery treated by endovascular therapy, in two cases arteriovenous fistulas were identified (between vertebral artery and internal jugular vein) with associated pseudo aneurysms, and in one case a pseudo aneurysm without fistula was found. The first patient was treated with placement of a covered stent, in a second patient the lesion was occluded with coils and a third patient required stent and coils with satisfactory repair of the lesions. Complications were not presented as a result of the procedures. Conclusions: the endovascular treatment for traumatic lesions of the vertebral artery is an alternative with minimum morbidity and reasonable costs avoiding the open surgery and conserving the permeability of the vessel when it is possible

  20. Impact of smartphone digital photography, email, and media communication on emergency room visits post-hypospadias repair.

    Science.gov (United States)

    Chua, Michael E; Saunders, Megan A; Bowlin, Paul R; Ming, Jessica M; Lopes, Roberto Iglesias; Farhat, Walid A; Dos Santos, Joana

    2017-01-01

    Advances in communication technology are shaping our medical practice. To date, there is no clear evidence that this mode of communication will have any effect on unnecessary postoperative emergency room (ER) visits. We aim to evaluate the effect of email and media communication with application of smartphone digital photography on post-hypospadias repair ER visit rates. This prospective cohort study included all patients who underwent hypospadias repair performed by a single surgeon from October 2014 to November 2015. Patients were categorized into two groups: Group A consented for smartphone photography and email communication and Group B declined. Reason for ER visits within 30 days postoperatively was assessed by another physician, who was blinded of patient group assignment. The reasons were categorized as: unnecessary ER visit, indicated ER visit, or visit unrelated to hypospadias surgery. Chi-square test and T-test were used for statistical analysis. Relative risk (RR) and corresponding 95% confidence interval (CI) were also calculated. Statistical significance was set at pcommunication with the use of smartphone digital photography significantly reduced the number of unnecessary ER visits for post-hypospadias wound checks.

  1. Open surgery versus endovascular approach in treatment of extracranial carotid artery aneurysms.

    Science.gov (United States)

    Ni, Leng; Weng, Huiling; Pu, Zuo; Zheng, Yuehong; Liu, Bao; Ye, Wei; Zeng, Rong; Liu, Changwei

    2018-05-01

    The objective of this study was to investigate and to compare the early and long-term results of open surgery with endovascular intervention in the treatment of extracranial carotid artery aneurysms (ECCAs). A retrospective review of patients diagnosed with ECCAs who underwent open surgical or endovascular treatment from 1997 to 2017 was performed. Clinical characteristics, aneurysm profile, and treatment outcomes were recorded. Early results (open surgery; endovascular repair was performed on 16 patients (33.3%). The 30-day stroke or transient ischemic attack rate was not significantly different between the open group (6.3% [2/32]) and the endovascular group (0% [0/16]; P = .307). Cranial nerve injuries occurred in eight patients in the open group (25%) and in no patient in the endovascular group (0%; P = .029). Median length of stay was significantly longer in the open group than in the endovascular group (20 vs 14 days, respectively; P = .013). Median follow-up was 46 months (range, 0-20 years), and no aneurysm-related death occurred during this period. Overall survival rates at 5 years were 88.7% (standard error [SE], 0.08) in the open group and 91.7% (SE, 0.08) in the endovascular group (P = .319; log-rank, .992). For the same time interval, stroke-free survival rates were 85.2% (SE, 0.10) in the open group and 92.2% (SE, 0.07) in the endovascular group (P = .653; log-rank, .201). One patient (1/28 [3.6%]) in the open group and two patients (2/16 [12.5%]) in the endovascular group underwent endovascular reinterventions because of restenosis during the follow-up period. Reintervention-free survival rates were 90.9% in the open group (SE, 0.09) and 69.2% in the endovascular group (SE, 0.21; P = .082; log-rank, 3.016). In this single-institutional experience, both operative and endovascular interventions for ECCAs provided acceptable early and 5-year results. The endovascular approach had significantly less cranial nerve injury and shorter length of

  2. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    International Nuclear Information System (INIS)

    Villegas, Miguel O.; Mereles, Alberto Pérez; Tamashiro, Gustavo A.; Dini, Andrés E.; Mollón, Ana P.; De Cándido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A.

    2013-01-01

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2–L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  3. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.; Dini, Andres E.; Mollon, Ana P.; De Candido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A., E-mail: joseantoniodiaz@hotmail.com [Hospital Nacional Prof. Alejandro Posadas, Department of Cardiology, Section of Hemodinamia (Argentina)

    2013-04-15

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  4. A novel technique combining laparoscopic and endovascular approaches using image fusion guidance for anterior embolization of type II endoleak

    Directory of Open Access Journals (Sweden)

    M. Mujeeb Zubair, MD

    2017-03-01

    Full Text Available Type II endoleak (T2E leading to aneurysm sac enlargement is one of the challenging complications associated with endovascular aneurysm repair. Recent guidelines recommend embolization of T2E associated with aneurysmal sac enlargement. Various percutaneous and endovascular techniques have been reported for embolization of T2E. We report a novel technique for T2E embolization combining laparoscopic and endovascular approaches using preoperative image fusion. We believe our technique provides a more direct access to the lumbar feeding vessels that is typically challenging with transarterial or translumbar embolization techniques.

  5. Endovascular stent graft treatment of acute thoracic aortic transections due to blunt force trauma.

    LENUS (Irish Health Repository)

    Bjurlin, Marc A

    2012-02-01

    Endovascular stent graft treatment of acute thoracic aortic transections is an encouraging minimally invasive alternative to open surgical repair. Between 2006 and 2008, 16 patients with acute thoracic aortic transections underwent evaluation at our institution. Seven patients who were treated with an endovascular stent graft were reviewed. The mean Glasgow Coma Score was 13.0, probability of survival was .89, and median injury severity score was 32. The mean number of intensive care unit days was 7.7, mean number of ventilator support days was 5.4, and hospital length of stay was 10 days. Mean blood loss was 285 mL, and operative time was 143 minutes. Overall mortality was 14%. Procedure complications were a bleeding arteriotomy site and an endoleak. Endovascular treatment of traumatic thoracic aortic transections appears to demonstrate superior results with respect to mortality, blood loss, operative time, paraplegia, and procedure-related complications when compared with open surgical repair literature.

  6. Carotid and coronary disease management prior to open and endovascular aortic surgery. What are the current guidelines?

    Science.gov (United States)

    Thompson, J P

    2014-04-01

    Several bodies produce broadly concurring and updated guidelines for the evaluation and treatment of cardiovascular disease in both surgical and non-surgical patients. Recent developments include revised recommendations on preoperative stress testing, referral for possible coronary revascularization and medical management. It is recognized that non-invasive cardiac tests are relatively poor at predicting perioperative risk, and "prophylactic" coronary revascularization has a limited role. The planned aortic intervention (open or endovascular repair) also influences preoperative management. Patients presenting for elective abdominal aortic aneurysm (AAA) repair should only be referred for cardiological testing if they have active symptoms of coronary artery disease (CAD), known CAD and poor functional exercise capacity, or multiple risk factors for CAD. Coronary revascularization before AAA surgery should be limited to patients with established indications, so cardiac stress testing should only be performed if it would change management i.e. the patient is a candidate for and would benefit from coronary revascularization. When endovascular aortic repair is planned, it is reasonable to proceed to surgery without further cardiac stress testing or evaluation unless otherwise indicated. All non-emergency patients require medical optimization, but perioperative beta blockade benefits only certain patients. Some of the data informing recent guidelines have been questioned and some guidelines are being revised. Current guidelines do not specifically address the management of patients with known or suspected carotid artery disease who may require aortic surgery. For these patients, an individualized approach is required. This review considers recent guidelines. Algorithms for investigation and management based on their recommendations are included.

  7. Endovascular stent-graft management of thoracic aortic diseases

    International Nuclear Information System (INIS)

    Dake, Michael D.

    2001-01-01

    The traditional standard therapy for descending thoracic aortic aneurysm (TAA) is open operative repair with graft replacement of the diseased aortic segment. Despite important advances in surgical techniques, anesthetic management, and post-operative care over the last 30 years, the mortality and morbidity of surgery remains considerable, especially in patients at high risk for thoracotomy because of coexisting severe cardiopulmonary abnormalities or other medical diseases. The advent of endovascular stent-graft technology provides an alternative to open surgery for selected patients with TAA. The initial experience suggests that stent-graft therapy potentially may reduce the operative risk, hospital stay and procedural expenses of TAA repair. These potential benefits are especially attractive for patients at high risk for open TAA repair. Current results of endovascular TAA therapy document operative mortalities of between 0 and 4%, aneurysm thrombosis in 90 and 100% of cases, and paraplegia as a complication in 0 and 1.6% of patients. The early success of stent-graft repair of TAA has fostered the application of these devices for the management of a wide variety of thoracic aortic pathologies, including acute and chronic dissection, intramural hematoma, penetrating ulcer, traumatic injuries, and other diseases. The results of prospective controlled trials that compare the outcomes of stent-graft therapy with those of surgical treatment in patients with specific types of aortic disease are anxiously awaited before recommendations regarding the general use of these new devices can be made with confidence

  8. Collected world and single center experience with endovascular treatment of ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Veith, F.J.; Lachat, M.; Mayer, D.; Malina, M.; Holst, J.; Mehta, M.; Verhoeven, E.L.; Larzon, T.; Gennai, S.; Coppi, G.; Lipsitz, E.C.; Gargiulo, N.J.; Vliet, J.A. van der; Blankensteijn, J.D.; Buth, J.; Lee, W.A.; Biasiol, G.; Deleo, G.; Kasirajan, K.; Moore, R.; Soong, C.V.; Cayne, N.S.; Farber, M.A.; Raithel, D.; Greenberg, R.K.; Sambeek, M.R. van; Brunkwall, J.S.; Rockman, C.B.; Hinchliffe, R.J.

    2009-01-01

    BACKGROUND: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. OBJECTIVE: To clarify these we examined a

  9. Collected World and Single Center Experience With Endovascular Treatment of Ruptured Abdominal Aortic Aneurysms

    NARCIS (Netherlands)

    Veith, Frank J.; Lachat, Mario; Mayer, Dieter; Malina, Martin; Holst, Jan; Mehta, Manish; Verhoeven, Eric L. G.; Larzon, Thomas; Gennai, Stefano; Coppi, Gioacchino; Lipsitz, Evan C.; Gargiulo, Nicholas J.; van der Vliet, J. Adam; Blankensteijn, Jan; Buth, Jacob; Lee, W. Anthony; Biasi, Giorgio; Deleo, Gaetano; Kasirajan, Karthikeshwar; Moore, Randy; Soong, Chee V.; Cayne, Neal S.; Farber, Mark A.; Raithel, Dieter; Greenberg, Roy K.; van Sambeek, Marc R. H. M.; Brunkwall, Jan S.; Rockman, Caron B.; Hinchliffe, Robert J.

    2009-01-01

    Background: Case and single center reports have documented the feasibility and suggested the effectiveness of endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysms (RAAAs), but the role and value of such treatment remain controversial. Objective: To clarify these we examined a

  10. Endovascular Management of Central Retinal Arterial Occlusion.

    Science.gov (United States)

    Agarwal, Nitin; Gala, Nihar B; Baumrind, Benjamin; Hansberry, David R; Thabet, Ahmad M; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-11-01

    Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy. The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes. Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.

  11. Recent Development in Pulmonary Valve Replacement after Tetralogy of Fallot Repair: The Emergence of Hybrid Approaches

    Directory of Open Access Journals (Sweden)

    Tariq eSuleiman

    2015-06-01

    Full Text Available In the current era approximately 90% of infants born with tetralogy of Fallot (ToF are expected to live beyond 40 years of age making it the fastest growing population amongst patients with congenital heart disease. One of the most common late consequences after repair of ToF, is pulmonary valve regurgitation (PVR. Significant PVR results in progressive dilatation and dysfunction of the right ventricle, decrease in exercise tolerance, arrhythmias, heart failure, and increased risk of sudden death. The conventional approach of dealing with this problem is to perform pulmonary valve replacement using cardiopulmonary bypass (CPB and cardioplegic arrest. However, this approach is associated not only with long operative times but also side effects related to the use of CPB. Development of percutaneous approaches to valve disease is one of the most exciting areas of research and clinical innovation in cardiovascular research. The main development has been that of transcatheter pulmonary valve replacement for the rehabilitation of conduits between the right ventricle and pulmonary artery in patients after surgery for ToF. However, with the percutaneous technique, a limited size of prosthesis can be inserted. Moreover, the technique does not offer the opportunity of treating additional defects that are frequently associated with severe PR, such as pulmonary artery dilatation, and it cannot be used in the significantly dilated native right ventricular outlet tract (RVOT. The advent of the hybrid surgical options for treating cardiac disease has integrated the techniques of interventional cardiology with the techniques of cardiac surgery to provide a form of therapy that combines the respective strengths of both fields.In this review, we present and compare recent advances in procedures to replace the pulmonary valve in patients with ToF presenting with severe PVR and dilated RVOT.

  12. Endovascular aortic graft infection resulting in retroperitoneal abscess: report of a case

    Directory of Open Access Journals (Sweden)

    Salvatore Di Somma

    2010-06-01

    Full Text Available Infection is a rare complication of aortoiliac endovascular procedures, with an incidence inferior to 0.5%, and it may result in a retroperitoneal abscess potentially evolving to sepsis and gastrointestinal bleeding. In more than 50% of cases endovascular aortoiliac prosthetic grafts infection occur months or years after the procedure. The growing number of endovascular procedures, and as the actually midterm follow up in most cases, septic sequelae will no doubt continue to occur with increased frequency and may represent an emerging problem in the ED for the emergency physician. Endovascular graft infection begins with unspecific clinical manifestations. An high index of suspicion in any patient with an aortic stent graft presenting prolonged or recurrent fever and or abdominal or back pain and a low threshold for obtaining CT scan should increase the clinician’s ability to make a timely diagnosis in the ED setting.

  13. ORIGINAL ARTICLES Endovascular treatment of cerebral ...

    African Journals Online (AJOL)

    With this in mind we looked at the costs ... of surgical or endovascular disposables. ... surgical versus endovascular treatment were 18 and 6 days .... 329: 527) gives a list of nine risk factors which explain most heart attacks: an abnormal ratio.

  14. Emerging roles of the nucleolus in regulating the DNA damage response: the noncanonical DNA repair enzyme APE1/Ref-1 as a paradigmatical example.

    Science.gov (United States)

    Antoniali, Giulia; Lirussi, Lisa; Poletto, Mattia; Tell, Gianluca

    2014-02-01

    An emerging concept in DNA repair mechanisms is the evidence that some key enzymes, besides their role in the maintenance of genome stability, display also unexpected noncanonical functions associated with RNA metabolism in specific subcellular districts (e.g., nucleoli). During the evolution of these key enzymes, the acquisition of unfolded domains significantly amplified the possibility to interact with different partners and substrates, possibly explaining their phylogenetic gain of functions. After nucleolar stress or DNA damage, many DNA repair proteins can freely relocalize from nucleoli to the nucleoplasm. This process may represent a surveillance mechanism to monitor the synthesis and correct assembly of ribosomal units affecting cell cycle progression or inducing p53-mediated apoptosis or senescence. A paradigm for this kind of regulation is represented by some enzymes of the DNA base excision repair (BER) pathway, such as apurinic/apyrimidinic endonuclease 1 (APE1). In this review, the role of the nucleolus and the noncanonical functions of the APE1 protein are discussed in light of their possible implications in human pathologies. A productive cross-talk between DNA repair enzymes and proteins involved in RNA metabolism seems reasonable as the nucleolus is emerging as a dynamic functional hub that coordinates cell growth arrest and DNA repair mechanisms. These findings will drive further analyses on other BER proteins and might imply that nucleic acid processing enzymes are more versatile than originally thought having evolved DNA-targeted functions after a previous life in the early RNA world.

  15. Traumatic intracranial internal carotid artery pseudoaneurysm presenting as epistaxis treated by endovascular coiling

    Science.gov (United States)

    Al-Jehani, Hosam M.; Alwadaani, Hassan A.; Almolani, Fadhel M.

    2016-01-01

    Traumatic intracranial pseudoaneurysm is a rare complication of blunt trauma. It is even more rare when it presents as epistaxis. Massive epistaxis of a ruptured intracranial internal carotid artery pseudoaneurysm is a major cause of mortality, which requires emergency intervention. We report a case of traumatic intracranial internal carotid artery pseudoaneurysm secondary to skull base fracture, which presented with delayed onset of epistaxis. This was successfully treated by primary endovascular coil embolization. We discuss endovascular treatment options and review the literature. PMID:26818170

  16. Acute coronary syndrome in a patient with Marfan syndrome following emergent surgical repair of aortic dissection.

    Science.gov (United States)

    Bovolato, Francesca Elisa; Isabella, Giambattista; Rampazzo, Debora; Guglielmi, Cosimo; Gerosa, Gino; Iliceto, Sabino; Bilato, Claudio

    2008-06-01

    We report a case of acute coronary syndrome in a patient with suspect Marfan syndrome, 25 days after emergent modified Bentall-De Bono intervention for acute type I peripartum aortic dissection. She was admitted to our intensive care unit because of unstable angina, caused by critical blood flow reduction in a large portion of the myocardium, according to the severity of the symptoms and the electrocardiographic alterations. Coronary angiography showed a sub-occlusive stenosis of the left main coronary artery as a result of the dissection extension to the coronary ostium. Because of the high risk related to heart surgery, the patient was successfully treated by unprotected angioplasty and drug-eluting stent positioning. Short- and mid-term outcomes were favourable. Subsequent tests confirmed the diagnosis of Marfan syndrome. After 2 years of follow-up, the patient remains asymptomatic and in good health. To our knowledge, this is the first report of a successful percutaneous intervention of the left main coronary artery in a patient with Marfan syndrome who had already undergone ascending aortic root and valve replacement by the Bentall-De Bono procedure for acute dissection.

  17. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    International Nuclear Information System (INIS)

    Nayeemuddin, M.; Pherwani, A.D.; Asquith, J.R.

    2012-01-01

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  18. Endovascular treatment of PICA aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mukonoweshuro, W.; Laitt, R.D.; Hughes, D.G. [Radiology Dept., Greater Manchester Neurosciences Unit, Hope Hospital, Salford, Manchester (United Kingdom)

    2003-03-01

    Endovascular treatment of aneurysms of the posterior inferior cerebellar artery (PICA) avoids manipulation of the brainstem or lower cranial nerves and should therefore carry a lower risk of neurological morbidity than surgical clipping. We reviewed our experience of 23 patients with PICA aneurysms treated by endovascular occlusion with Guglielmi detachable coils and documented their long-term outcome on follow-up. We observed a 28 day procedure-related neurological morbidity of 13% (3/23 patients). One patient suffered permanent neurological complications. There were no procedure-related deaths. None of our patients suffered a re-bleed from their treated aneurysms. Our series shows endovascular treatment of ruptured PICA aneurysms to be safe and effective. (orig.)

  19. Endovascular surgery in Marfan syndrome: CON.

    Science.gov (United States)

    Kouchoukos, Nicholas T

    2017-11-01

    The frequency of endovascular stent grafting procedures to treat various conditions of the thoracic aorta has increased dramatically over the past three decades. Stent grafting has been applied on a limited basis in patients with Marfan syndrome and other connective tissue disorders, despite recommendations from current guidelines and expert consensus statements against its use in this setting. A review of publications reporting outcomes after stent grafting of the descending thoracic aorta in Marfan patients with acute or chronic aortic dissection indicates that these procedures can be accomplished with rates of early mortality, stroke and spinal cord ischemic injury that are comparable to those observed in patients who do not have Marfan syndrome. However, the rates of primary treatment failure (principally endoleak), secondary treatment failure, need for open repair and late death among the Marfan patients are substantially higher than those observed in patients without this condition. In addition, the rates of retrograde aortic dissection and development of stent-graft induced new entry (SINE), are also greater among patients with Marfan syndrome. All of these findings argue strongly against the routine use of endovascular grafts in Marfan patients with type B or residual type A dissection. Few data are available to assess the role of endografting in Marfan patients with aneurysmal disease, but the progressive aortic dilatation noted in these patients argues strongly against its use in this setting as well. At present, the available data indicate that there is no justification for elective stent grafting in Marfan patients with aortic dissection or aneurysm. The only reasonable indications for primary aortic stent grafting are in the setting of acute aortic dissection or rupture, where the intervention is considered life-saving and rarely, considering the relatively young age of these patients, where the risk of open operation is considered to be prohibitive.

  20. Immediate endovascular treatment of an aortoiliac aneurysm ruptured into the inferior vena cava.

    Science.gov (United States)

    Kopp, Reinhard; Weidenhagen, Rolf; Hoffmann, Ralf; Waggershauser, Tobias; Meimarakis, Georgios; Andrassy, Joachim; Clevert, Dirk; Czerner, Stephan; Jauch, Karl-Walter

    2006-07-01

    An aortocaval fistula is a severe complication of an aortoiliac aneurysm, usually associated with high perioperative morbidity and mortality during open operative repair. We describe the successful endovascular treatment of a symptomatic infrarenal aortic aneurysm ruptured into the inferior vena cava with secondary interventional coiling of a persistent type II endoleak because of retrograde perfusion of the inferior mesenteric artery. Endovascular exclusion of ruptured abdominal aneurysms seems to be a valuable treatment option for selected patients even with complicated vascular conditions like an aortocaval fistula.

  1. Endovascular stent-graft placement for the treatment of acute onset and chronic aortic dissections of the descending aorta (Short-term follow-up)

    International Nuclear Information System (INIS)

    Petrov, I; Jorgova, J.; Trendafilova, D.

    2004-01-01

    The leading cause of death for patients with surgically untreated thoracic aortic aneurysms is the rupture of the aneurysm. Almost one half of these patients are left to medical treatment assuming the risk of late rupture and aneurysm sac enlargement - the late surgical treatment of these patients is too risky and with poor results. On the other hand the emergent surgical treatment of these cases is related with relatively high mortality rate. Recently, thoracic aortic stent-grafting has emerged as a less traumatic alternative therapeutic modality for patients with thoracic aortic aneurysms and aortic dissections. The first case of stent implantation in a dissected descending aorta was performed in Bulgaria at 09.04.2003. Since then we implanted in 8 patients thoracic stent grafts, The mean age of the patients was 67.5 years. The primary success was 100%. One died on the second postoperative day by abdominal aorta rupture. No other complications were registered. The mean follow-up of 5 months proved to be uneventful and the control CT revealed efficacious sealing of the entry and false lumen thrombosis in all except one cases. We report our initial clinical experience of endovascular stent-graft repair for dissection of the descending aorta that is encouraging. These preliminary data suggest that endovascular stent-grafting is a viable treatment for acute onset and chronic aortic dissection type B

  2. WE-DE-207A-04: Advances in Radiological Neuro-Endovascular Interventional Imaging

    Energy Technology Data Exchange (ETDEWEB)

    Rudin, S. [University at Buffalo (SUNY) School of Medicine (United States)

    2016-06-15

    audience. Learning Objectives: To understand the clinical need of one-stop-shop stroke imaging workflow To understand to technical challenges in cone beam CT perfusion To understand the potential technical solutions to enable one-stop-shop imaging workflow Recent advances in devices used in neuro--interventions Mattew Gounis - Over the past two decades, there has been explosive development of medical devices that have revolutionized the endovascular treatment of cerebrovascular diseases. There is now Level 1, Class A evidence that intra-arterial, mechanical thrombectomy in acute ischemic stroke is superior to medical management; and similarly that minimally invasive, endovascular repair of ruptured brain aneurysms is superior to surgical treatment. Stent-retrievers are now standard of care for emergent large vessel occlusions causing a stroke, with a number of patients need to treat for good clinical outcomes as low as 4. Recent technologies such as flow diverters and disrupters, intracranial self-expanding stents, flexible large bore catheters that can reach vessels beyond the circle of Willis, stent-retrievers, and super-compliant balloons are the result of successful miniaturization of design features and novel manufacturing technologies capable of building these devices. This is a rapidly evolving field, and the device technology enabling such advancements will be reviewed. Importantly, image-guidance technology has not kept pace in neurointervention and the ability to adequately characterize these devices in vivo remains a significant opportunity. Learning Objectives: A survey of devices used in neurointerventions, their materials and essential design characteristics Funding support received from NIH and DOD; Funding support received from GE Healthcare; Funding support received from Siemens AX; Patent royalties received from GE Healthcare; G. Chen, Funding received from NIH; funding received from DOD; funding received from GE Healthcare; funding received from Siemens

  3. WE-DE-207A-04: Advances in Radiological Neuro-Endovascular Interventional Imaging

    International Nuclear Information System (INIS)

    Rudin, S.

    2016-01-01

    audience. Learning Objectives: To understand the clinical need of one-stop-shop stroke imaging workflow To understand to technical challenges in cone beam CT perfusion To understand the potential technical solutions to enable one-stop-shop imaging workflow Recent advances in devices used in neuro--interventions Mattew Gounis - Over the past two decades, there has been explosive development of medical devices that have revolutionized the endovascular treatment of cerebrovascular diseases. There is now Level 1, Class A evidence that intra-arterial, mechanical thrombectomy in acute ischemic stroke is superior to medical management; and similarly that minimally invasive, endovascular repair of ruptured brain aneurysms is superior to surgical treatment. Stent-retrievers are now standard of care for emergent large vessel occlusions causing a stroke, with a number of patients need to treat for good clinical outcomes as low as 4. Recent technologies such as flow diverters and disrupters, intracranial self-expanding stents, flexible large bore catheters that can reach vessels beyond the circle of Willis, stent-retrievers, and super-compliant balloons are the result of successful miniaturization of design features and novel manufacturing technologies capable of building these devices. This is a rapidly evolving field, and the device technology enabling such advancements will be reviewed. Importantly, image-guidance technology has not kept pace in neurointervention and the ability to adequately characterize these devices in vivo remains a significant opportunity. Learning Objectives: A survey of devices used in neurointerventions, their materials and essential design characteristics Funding support received from NIH and DOD; Funding support received from GE Healthcare; Funding support received from Siemens AX; Patent royalties received from GE Healthcare; G. Chen, Funding received from NIH; funding received from DOD; funding received from GE Healthcare; funding received from Siemens

  4. Endovascular treatment of the subclavian artery aneurysm in high-risk patient - a single-center experience

    Directory of Open Access Journals (Sweden)

    Marjanović Ivan

    2016-01-01

    Full Text Available We present our first experience with endovascular treatment of 6 subclavian artery aneurysms (SAA occurring in five male and one female patient. All patients, in our studies, according to ASA classification were high risk for open repair of SAA. The etiology of the all aneurysms was atherosclerosis degeneration of the artery. Two aneurysms were of intrathoracic location, then the other were extrathoracic. Symptoms related to subclavian artery aneurysms were present in two patients, compression and chest pain in one, and hemorrhage shock in second, while the remaining patients were asymptomatic. We preferred the Viabhan endoprosthesis for endovascular repair in 5 cases. In one patient with ruptured of subclavian artery aneurysm who was high-risk for open repair we made combined endovascular procedure. First at all, we covered the origin of left subclavian artery with thoracic stent graft and after that we put two coils in proximal part of subclavian artery. There was no operative mortality, and the early patency rate was 100%. The follow-up period was from 3 months to 3 years. During this period, one patient died of heart failure and one patient required endovascular reoperation due to endoleak type I. Endovascular treatment is recommended for all patients with subclavian artery aneurysm whenever this is possible due to anatomical reasons especially in high-risk patient with intrathoracic localization of aneurysm, to prevent potential complications.

  5. Human Thiel-Embalmed Cadaveric Aortic Model with Perfusion for Endovascular Intervention Training and Medical Device Evaluation.

    Science.gov (United States)

    McLeod, Helen; Cox, Ben F; Robertson, James; Duncan, Robyn; Matthew, Shona; Bhat, Raj; Barclay, Avril; Anwar, J; Wilkinson, Tracey; Melzer, Andreas; Houston, J Graeme

    2017-09-01

    The purpose of this investigation was to evaluate human Thiel-embalmed cadavers with the addition of extracorporeal driven ante-grade pulsatile flow in the aorta as a model for simulation training in interventional techniques and endovascular device testing. Three human cadavers embalmed according to the method of Thiel were selected. Extracorporeal pulsatile ante-grade flow of 2.5 L per min was delivered directly into the aorta of the cadavers via a surgically placed connection. During perfusion, aortic pressure and temperature were recorded and optimized for physiologically similar parameters. Pre- and post-procedure CT imaging was conducted to plan and follow up thoracic and abdominal endovascular aortic repair as it would be in a clinical scenario. Thoracic endovascular aortic repair (TEVAR) and endovascular abdominal repair (EVAR) procedures were conducted in simulation of a clinical case, under fluoroscopic guidance with a multidisciplinary team present. The Thiel cadaveric aortic perfusion model provided pulsatile ante-grade flow, with pressure and temperature, sufficient to conduct a realistic simulation of TEVAR and EVAR procedures. Fluoroscopic imaging provided guidance during the intervention. Pre- and post-procedure CT imaging facilitated planning and follow-up evaluation of the procedure. The human Thiel-embalmed cadavers with the addition of extracorporeal flow within the aorta offer an anatomically appropriate, physiologically similar robust model to simulate aortic endovascular procedures, with potential applications in interventional radiology training and medical device testing as a pre-clinical model.

  6. Acute Iliac Artery Rupture: Endovascular Treatment

    International Nuclear Information System (INIS)

    Chatziioannou, A.; Mourikis, D.; Katsimilis, J.; Skiadas, V.; Koutoulidis, V.; Katsenis, K.; Vlahos, L.

    2007-01-01

    The authors present 7 patients who suffered iliac artery rupture over a 2 year period. In 5 patients, the rupture was iatrogenic: 4 cases were secondary to balloon angioplasty for iliac artery stenosis and 1 occurred during coronary angioplasty. In the last 2 patients, the rupture was secondary to iliac artery mycotic aneurysm. Direct placement of a stent-graft was performed in all cases, which was dilated until extravasation was controlled. Placement of the stent-graft was successful in all the cases, without any complications. The techniques used, results, and mid-term follow-up are presented. In conclusion, endovascular placement of a stent-graft is a quick, minimally invasive, efficient, and safe method for emergency treatment of acute iliac artery rupture, with satisfactory short- and mid-term results

  7. Anesthesia Approach in Endovascular Aortic Reconstruction

    Directory of Open Access Journals (Sweden)

    Ayşin Alagöl

    2013-03-01

    Full Text Available Introduction: We have analyzed our initial results of our anesthesia techniques in our new-onset endovascular aortic reconstruction cases.Patients and Methods: The perioperative data of 15 elective and emergent endovascular aortic reconstruction cases that were operated in 2010-2011 were collected in a database. The choice of anesthesia was made by the risk factors, surgical team’s preferences, type and location of the aortic pathology and by the predicted operation duration. The data of local and general anesthesia cases were compared.Results: Thirteen (86.7% cases were male and 2 (13.3% female. Eleven patients were in ASA Class III. The demographic parameters, ASA classifications, concurrent diseases were similar in both groups. Thirteen (86.7% cases had infrarenal abdominal aortic aneurysm and 2 (13.3% had Type III aortic dissection. The diastolic arterial pressures were lower in general anesthesia group in 20th and 40th minutes’ measurements just like the mean arterial pressure measurements at the 40th, 100th minutes and during the deployment of the graft. Postoperative mortality occurred in 3 (20.0% patients and they all had general anesthesia and they were operated on emergency basis. Postoperative morbidity occurred in four patients that had general anesthesia (acute renal failure, multi-organ failure and pneumonia. The other patient had atrial fibrillation on the 1st postoperative day and was converted to sinus rhythm with amiodarone infusion.Conclusion: Edovascular aortic reconstruction procedures can safely be performed with both general and local anesthesia less invasively compared to open surgery. General anesthesia may be preferred for the better hemodynamic control.

  8. Endovascular Treatment of Various Aortic Pathologies: Review of the Latest Data and Technologies.

    Science.gov (United States)

    Maeda, Koji; Ohki, Takao; Kanaoka, Yuji

    2018-06-01

    The technologies and innovations applicable to endovascular treatment for complex aortic pathologies have progressed rapidly over the last two decades. Although the initial outcomes of an endovascular aortic repair have been excellent, as long-term data became available, complications including endoleaks, endograft migration, and endograft infection have become apparent and are of concern. Previously, the indication for endovascular therapy was restricted to descending thoracic aortic aneurysms and abdominal aortic aneurysms. However, its indication has expanded along with the improvement of techniques and devices, and currently, it has become possible to treat pararenal aortic aneurysms and Crawford type 4 thoracoabdominal aortic aneurysm (TAAA) using the off-the-shelf devices. Additionally, custom-made devices allow for the treatment of arch or more extensive TAAAs. Endovascular treatment is applied not only to aneurysms but also to acute/chronic dissections. However, long-term outcomes are still unclear. This article provides an overview of available devices and the results of endovascular treatment for various aortic pathologies.

  9. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

    International Nuclear Information System (INIS)

    Okada, Takuya; Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

    2012-01-01

    Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non–contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47–2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

  10. Endovascular treatment of ruptured splenic artery aneurysm

    DEFF Research Database (Denmark)

    Bjerring, Ole Steen

    2008-01-01

    Splenic artery aneurysms (SAA) are traditionally treated surgically, but endovascular techniques are becoming increasingly popular. A 64 year-old male with chest pain and low blood pressure was admitted under suspicion of AMI. A CT scan showed a 56 mm SAA with signs of rupture. The patient...... was treated with endovascular embolisation of the SAA with coils. Blood pressure and haemoglobin levels were stabilized and the patient was discharged. In the case of rupture the treatment of choice seems to be endovascular....

  11. Endovascular treatment of splenic artery aneurysms

    International Nuclear Information System (INIS)

    Lagana, Domenico; Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Dizonno, Massimiliano; Fugazzola, Carlo; Castelli, Patrizio

    2005-01-01

    Purpose. To assess the feasibility and effectiveness of endovascular treatment of splenic artery aneurysm (SAAs). Materials and methods. Between May 2000 and June 2003 we treated 11 true SAAs in 9 patients (7 females and 2 males; mean age 58 years), 8 saccular and 3 fusiform, 4 located at the middle tract of the splenic artery, 5 at the distal tract and 2 intra-parenchymal. The diagnosis was performed with colour-Doppler ultrasound and/or CT-angiography; 7 patients were symptomless, 1 had left hypochondriac pain, and 1 had acute abdomen caused by a ruptured SAA. Four SAAs were treated by micro coil embolisation of the aneurysmal sac with preservation of splenic artery patency; in 2 cases this was associated with transcatheter injection of N-butyl-2-cyanoacrylate. Four cases were treated by endovascular ligature, with sectoral spleen ischaemia. One ruptured SAA received emergency treatment with splenic artery cyanoacrylate embolisation. Two intra-parenchymal SAAs were excluded, one by cyanoacrylate embolisation of the afferent artery and the other by transcatheter thrombin injection in the aneurysmal sac. Results. Technical success was observed in all cases (in 10/11 at the end of the procedure; in 1/11 at CT performed 3 days after the procedure). The follow-up (mean 18 months; range 6-36) was performed by colour-Doppler ultrasound and/or CT-angiography 3, 6 and 12 months after the procedure and subsequently once a year; the complete exclusion of the aneurysms was confirmed in 11/11 cases. The complications were: 4 cases of mild pleuritis; fever and left hypochondriac pain 1 day after the procedure (in the same 4 patients and in one other case); 5 cases of sectorial spleen ischaemia and 1 case of diffuse spleen infarction with partial revascularization by collateral vessels. No alteration of the levels of pancreatic enzymes was found; a transitory increase in platelet count occurred only in the patient with diffuse spleen infarction. Conclusions. Using different

  12. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  13. Prevention of paraplegia after endovascular exclusion for stanford B thoracic aortic dissection aneurism

    International Nuclear Information System (INIS)

    Feng Rui; Jing Zaiping; Bao Junmin; Zhao Zhiqing; Zhao Jun; Feng Xiang; Lu Qingsheng; Huang Cheng

    2003-01-01

    Objective: To assess the prophylactic measures of paraplegia and paralysis after endovascular graft exclusion (EVE) for Stanford B thoracic aortic dissections (TAD). Methods: The records of 116 consecutive patients undergoing endovascular TAD repair from 1998 to 2001 were retrospectively reviewed. Steroids were administrated postoperatively in high risk patients likely to be candidates for paraplegia or paralysis. Results: No paraplegia or paralysis occurred postoperatively in all cases, including the patient undergone selective spinal artery angiography (SSAA). Conclusions: Transluminal repair can avoid spinal cord ischemia due to aortic cross-clamping, there is still a risk of spinal cord injury caused by occlusion of intercostal arteries under the cover of endograft. A combination of the prophylactic measures, including SSAA and steroids, have been able to reduce the risk of paraplegia and paralysis. A graft-stent of appropriate length is the key point of this procedure

  14. Tratamento endovascular de ruptura traumática da aorta torácica descendente Endovascular treatment of traumatic descending thoracic aortic rupture

    Directory of Open Access Journals (Sweden)

    João Roberto Breda

    2007-06-01

    Full Text Available Paciente do sexo feminino, 55 anos de idade, vítima de atropelamento, foi admitida em unidade de emergência, onde se realizou o diagnóstico clínico, radiológico e tomográfico de ruptura traumática da aorta torácica descendente. Diante do achado, a paciente foi encaminhada para tratamento endovascular com colocação de endoprótese auto-expansível (stent pela artéria femoral. O tratamento obteve sucesso, evidenciado pela exclusão da lesão localizada previamente no istmo aórtico. O tratamento endovascular tem sido indicado nas afecções de aorta torácica descendente com bons resultados iniciais. Na ruptura traumática de aorta, a terapêutica endovascular representa uma alternativa aceitável, especialmente devido aos riscos do tratamento operatório convencional.A 55-year-old, female patient who was run over by a motor vehicle was admitted at an emergency room. Clinical, radiological and tomographic diagnosis of traumatic descending aortic thoracic rupture was performed. The patient was referred for endovascular treatment with placement of a self-expandable stent through the femoral artery. Treatment was successful, with exclusion of the lesion previously located in the aortic isthmus. Endovascular treatment has been indicated in the treatment of descending thoracic aortic diseases, with good initial results. In case of traumatic aortic rupture, endovascular treatment is a feasible alternative, especially due to risks offered by the conventional surgical treatment.

  15. Successful endovascular treatment of a hemodialysis graft pseudoaneurysm by covered stent and direct percutaneous thrombin injection.

    LENUS (Irish Health Repository)

    Keeling, Aoife N

    2011-07-25

    Vascular access for hemodialysis remains a challenge for nephrologists, vascular surgeons, and interventional radiologists alike. Arteriovenous fistula and synthetic grafts remain the access of choice for long-term hemodialysis; however, they are subject to complications from infection and repeated needle cannulation. Pseudoaneurysms are an increasingly recognized adverse event. At present, there are many minimally invasive methods to repair these wall defects. We present a graft pseudoaneurysm, which required a combination of endovascular stent graft placement and percutaneous thrombin injection for successful occlusion.

  16. A look into the endovascular crystal ball

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith

    2009-01-01

    This paper summarizes the highlights of the 15th International Workshop of Endovascular Surgery, held in Ajaccio in June 2008. This is an annual event that attracts leading endovascular therapists from both sides of the Atlantic Ocean as well as a contingency from down-under. The layout of this m...

  17. 76 FR 25704 - Announcement of Funding Awards for the Emergency Capital Repair Grant Program; Fiscal Year 2010

    Science.gov (United States)

    2011-05-05

    .... Four Freedoms House of Seattle.. Four Freedoms House of Seattle WA 302 431,113 Replace the brick canopy...,114 Repair the elevators and replace the windows, cooling chassis units in the through-wall... Castle......... PA 128 294,265 Replace the roof and grinder pump. Sandpiper Run National Church Ft. Myers...

  18. Atypical Presentation of a Type 2 Endoleak following Emergency Open Repair of a Ruptured Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    K. Sharma

    Full Text Available : Background: An endoleak is a common complication following EVAR. Specifically, a Type 2 endoleak occurs because of retrograde flow from lumbar vessels outside the endograft within the aneurysm sac. Even though it is common following EVAR, it has not been identified as a complication following open ruptured abdominal aortic aneurysm (AAA repair. Report: A 73-year-old male underwent open repair of a ruptured AAA. Five months later, computed tomography revealed filling from a lumbar vessel mimicking a Type 2 “endoleak.” The initial ultrasound showed a single pair of lumbar vessels with aneurysm sac expansion 8 weeks later. The “endoleak” and expanding sac were treated, and the 2-year surveillance demonstrated sac shrinkage. Discussion: Because endoleak is a complication after EVAR, this case provides a unique presentation of Type 2 “endoleak” physiology following open repair of a ruptured AAA. It is believed that it is necessary to expand the list of possible complications after open ruptured AAA repair to include “endoleaks.” Keywords: Endoleak: EVAR, Ruptured aneurysm, Open abdominal aortic aneurysm

  19. Physical aspects of endovascular brachytherapy

    International Nuclear Information System (INIS)

    Kirisits, C.

    2001-11-01

    Restenosis is severely limiting the outcome of vascular interventions. In several clinical trials endovascular brachytherapy has shown to reduce the restenosis rate. Local radiotherapy to the injured vessel wall is a promising new type of treatment in order to inhibit a complex wound healing process resulting in cell proliferation and re-obstruction of the treated vessel. Treatment planning has to be based on the dose distribution in the vicinity of the sources used. Source strength was determined in terms of air kerma rate for gamma nuclides (Iridium-192) and absorbed dose to water at reference distance of 2 mm for beta nuclides (Strontium-90/Yttrium-90, Phosphor-32), respectively. Radial dose profiles and the Reference Isodose Length (RIL) were determined using the EGSnrc code and GafChromic film. Good agreement was found between both methods. In order to treat the entire clinical target length, the (RIL) is an essential value during treatment planning. Examples are described for different levels of treatment planing including recommendations for optimal choice and positioning of the radioactive devices inside the artery. IVUS based treatment planning is illustrated with superposition of isodoses on cross-sectional images. A calculation model for radioactive stents is presented in order to determine dose volume histograms in a retrospective analysis. Radiation protection issues for endovascular brachytherapy are discussed in detail. Personal dose for the involved personnel is estimated based on calculations and measurements. Beta ray dosimetry is performed with suitable detectors. In order to estimate the exposure to the patient the dose to organs at risk is calculated and compared to the dose from angiography. There is an additional radiation exposure to patients and personnel caused by endovascular brachytherapy, but the values are much smaller than those caused by diagnostic angiography. (author)

  20. Emergency repair of upper extremity large soft tissue and vascular injuries with flow-through anterolateral thigh free flaps.

    Science.gov (United States)

    Zhan, Yi; Fu, Guo; Zhou, Xiang; He, Bo; Yan, Li-Wei; Zhu, Qing-Tang; Gu, Li-Qiang; Liu, Xiao-Lin; Qi, Jian

    2017-12-01

    Complex extremity trauma commonly involves both soft tissue and vascular injuries. Traditional two-stage surgical repair may delay rehabilitation and functional recovery, as well as increase the risk of infections. We report a single-stage reconstructive surgical method that repairs soft tissue defects and vascular injuries with flow-through free flaps to improve functional outcomes. Between March 2010 and December 2016 in our hospital, 5 patients with severe upper extremity trauma received single-stage reconstructive surgery, in which a flow-through anterolateral thigh free flap was applied to repair soft tissue defects and vascular injuries simultaneously. Cases of injured artery were reconstructed with the distal trunk of the descending branch of the lateral circumflex femoral artery. A segment of adjacent vein was used if there was a second artery injury. Patients were followed to evaluate their functional recoveries, and received computed tomography angiography examinations to assess peripheral circulation. Two patients had post-operative thumb necrosis; one required amputation, and the other was healed after debridement and abdominal pedicle flap repair. The other 3 patients had no major complications (infection, necrosis) to the recipient or donor sites after surgery. All the patients had achieved satisfactory functional recovery by the end of the follow-up period. Computed tomography angiography showed adequate circulation in the peripheral vessels. The success of these cases shows that one-step reconstructive surgery with flow-through anterolateral thigh free flaps can be a safe and effective treatment option for patients with complex upper extremity trauma with soft tissue defects and vascular injuries. Copyright © 2017. Published by Elsevier Ltd.

  1. Advances in endovascular aneurysm treatment: are we making a difference?

    International Nuclear Information System (INIS)

    Katz, Jeffrey M.; Ougorets, Igor; Tsiouris, Apostolos J.; Biondi, Alessandra; Salvaggio, Kimberly A.; Gobin, Y. Pierre; Stieg, Philip E.; Riina, Howard A.

    2005-01-01

    Recent advancements in endovascular aneurysm repair, including bioactive and expansile coils and intracranial stents, hold promise for improved aneurysm occlusion rates. We report the immediate and midterm clinical and angiographic outcomes of a consecutive series of patients treated since the advent of these technologies. Clinical and radiological records of 134 patients with 142 aneurysms treated between 2001 and 2004 were retrospectively evaluated by an independent neurologist. Endovascular procedures were analyzed by an independent neuroradiologist blinded to all clinical information. Seventy-two ruptured and 60 un-ruptured saccular aneurysms, nine fusiform and one post-traumatic aneurysm were treated. Matrix coils were used in 53% of saccular aneurysms and HydroCoils in 13% of all aneurysms. Neuroform stents were deployed in 19% of aneurysms. Angiographic total or subtotal occlusion was achieved in 76% of cases and in 96% at last follow-up. Aneurysm recanalization was observed in 14% over a mean follow-up of 12 months, and 18% of aneurysms were retreated. Clinically relevant complications occurred in 6.0%, resulting in procedure-related morbidity of 0.6% and 0.6% mortality at 6 months. No aneurysm bled over a cumulative 1,347 months of observation. Newer embolization technologies can be exploited successfully even in more complex aneurysms with very low morbidity and mortality. (orig.)

  2. Endovascular therapy for chronic cerebrospinal venous insufficiency in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Marc A. Lazzaro

    2011-07-01

    Full Text Available Recent reports have emerged suggesting that multiple sclerosis (MS may be due to abnormal venous outflow from the central nervous system, termed Chronic Cerebrospinal Venous Insufficiency (CCSVI. These reports have generated strong interest and controversy over the prospect of a treatable cause of this chronic debilitating disease. This review aims to describe the proposed association between CCSVI and MS, summarize the current data, and discuss the role of endovascular therapy and the need for rigorous randomized clinical trials to evaluate this association and treatment.

  3. Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary. BET 4: Hydrotherapy following rotator cuff repair.

    Science.gov (United States)

    Hay, Laura; Wylie, Katherine

    2011-07-01

    A short cut review was carried out to establish whether hydrotherapy is beneficial in rehabilitation after rotator cuff repair. 27 papers were found using the reported searches, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of that best paper are tabulated. It is concluded that while there may be some short term benefit to passive range of movement, further research is needed.

  4. Stroke Neurologist's Perspective on the New Endovascular Trials.

    Science.gov (United States)

    Grotta, James C; Hacke, Werner

    2015-06-01

    Before December 2014, the only proven effective treatment for acute ischemic stroke was recombinant tissue-type plasminogen activator (r-tPA). This has now changed with the publication of the Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands (MR CLEAN), Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times (ESCAPE), Extending the Time for Thrombolysis in Emergency Neurological Deficits--Intra-Arterial (EXTEND IA), Solitaire With the Intention for Thrombectomy as Primary Endovascular Treatment Trial (SWIFT PRIME), and Randomized Trial of Revascularization With the Solitaire FR Device Versus Best Medical Therapy in the Treatment of Acute Stroke Due to Anterior Circulation Large Vessel Occlusion Presenting Within Eight Hours of Symptom Onset (REVASCAT) studies. We review the main results of these studies and how they inform stroke patient management going forward. The main take home points for neurologists are (1) intra-arterial thrombectomy is a potently effective treatment and should be offered to patients who have documented occlusion in the distal internal carotid or the proximal middle cerebral artery, have a relatively normal noncontrast head computed tomographic scan, severe neurological deficit, and can have intra-arterial thrombectomy within 6 hours of last seen normal; (2) benefits are clear in patients receiving r-tPA before intra-arterial thrombectomy; r-tPA should not be withheld if the patient meets criteria, and benefit in patients who do not receive r-tPA or have r-tPA exclusions requires further study; and (3) these favorable results occur when intra-arterial thrombectomy is performed in an endovascular stroke center by a coordinated multidisciplinary team that extends from the prehospital stage to the endovascular suite, minimizes time to recanalization, uses stent-retriever devices, and avoids general

  5. Incidence of systemic inflammatory response syndrome after endovascular aortic repair

    DEFF Research Database (Denmark)

    De La Motte, L; Vogt, K; Jensen, Leif Panduro

    2011-01-01

    : Sixty-six patients were included, 40 (60%) met the SIRS criteria within the first 5 postoperative days (95% of the 40 patients met the criteria within 3 days). We found no significant differences between the SIRS and the non-SIRS group in baseline characteristics or other data including volume...... in the groups (3% in the SIRS group vs. none in the non-SIRS group). CONCLUSION: The high incidence of SIRS after EVAR is unexpected considering the minimally invasive procedure. Further studies on the cause of this response and measures to attenuate the response seem appropriate....... during 2007, were retrospectively evaluated for SIRS within the first 5 postoperative days. The only exclusion-criteria were missing data. SIRS was assessed using the criteria defined by the American College of Chest Physicians and Society of Critical Care Medicine Consensus Conference Committee. RESULTS...

  6. Immediate endovascular stent-graft repair of an acute traumatic

    African Journals Online (AJOL)

    Enrique

    device intended for abdominal deployment. The stent-graft was manually removed from its short delivery device and ... Largely on the basis of the Parmley report, standard teaching was that these injuries ... 5 mm to allow adequate proximal anchorage. Tactics to ... Temporary hypotension is generally induced during the.

  7. Emerging Importance of Helicases in Plant Stress Tolerance: Characterization of Oryza sativa Repair Helicase XPB2 Promoter and Its Functional Validation in Tobacco under Multiple Stresses.

    Science.gov (United States)

    Raikwar, Shailendra; Srivastava, Vineet K; Gill, Sarvajeet S; Tuteja, Renu; Tuteja, Narendra

    2015-01-01

    Genetic material always remains at the risk of spontaneous or induced damage which challenges the normal functioning of DNA molecule, thus, DNA repair is vital to protect the organisms against genetic damage. Helicases, the unique molecular motors, are emerged as prospective molecules to engineer stress tolerance in plants and are involved in nucleic acid metabolism including DNA repair. The repair helicase, XPB is an evolutionary conserved protein present in different organisms, including plants. Availability of few efficient promoters for gene expression in plants provoked us to study the promoter of XPB for better understanding of gene regulation under stress conditions. Here, we report the in silico analysis of novel stress inducible promoter of Oryza sativa XPB2 (OsXPB2). The in vivo validation of functionality/activity of OsXPB2 promoter under abiotic and hormonal stress conditions was performed by Agrobacterium-mediated transient assay in tobacco leaves using OsXPB2::GUS chimeric construct. The present research revealed that OsXPB2 promoter contains cis-elements accounting for various abiotic stresses (salt, dehydration, or cold) and hormone (Auxin, ABA, or MeJA) induced GUS expression/activity in the promoter-reporter assay. The promoter region of OsXPB2 contains CACG, GTAACG, CACGTG, CGTCA CCGCCGCGCT cis acting-elements which are reported to be salt, dehydration, cold, MeJA, or ABA responsive, respectively. Functional analysis was done by Agrobacterium-mediated transient assay using agroinfiltration in tobacco leaves, followed by GUS staining and fluorescence quantitative analyses. The results revealed high induction of GUS activity under multiple abiotic stresses as compared to mock treated control. The present findings suggest that OsXPB2 promoter is a multi-stress inducible promoter and has potential applications in sustainable crop production under abiotic stresses by regulating desirable pattern of gene expression.

  8. Vascular training and endovascular practice in Europe

    DEFF Research Database (Denmark)

    Liapis, C.D.; Avgerinos, E.D.; Sillesen, H.

    2009-01-01

    specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. RESULTS: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1....... Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted......% respectively. Countries with independent vascular certification, despite their lower average endovascular index (procedures per 100,000 population), reported a higher growth rate of aortic endovascular procedures (VS independent 132% vs VS non-independent 87%), within a four-year period (2003-2007). Peripheral...

  9. Acute vasculitis after endovascular brachytherapy

    International Nuclear Information System (INIS)

    Fajardo L-G, Luis F.; Prionas, Stavros D.; Kaluza, Grzegorz L.; Raizner, Albert E.

    2002-01-01

    Purpose: Angioplasty effectively relieves coronary artery stenosis but is often followed by restenosis. Endovascular radiation (β or γ) at the time of angioplasty prevents restenosis in a large proportion of vessels in swine (short term) and humans (short and long term). Little information is available about the effects of this radiation exposure beyond the wall of the coronary arteries. Methods and Materials: Samples were obtained from 76 minipigs in the course of several experiments designed to evaluate endovascular brachytherapy: 76 of 114 coronary arteries and 6 of 12 iliac arteries were exposed to endovascular radiation from 32 P sources (35 Gy at 0.5 mm from the intima). Two-thirds of the vessels had angioplasty or stenting. The vessels were systematically examined either at 28 days or at 6 months after radiation. Results: We found an unexpected lesion: acute necrotizing vasculitis in arterioles located ≤2.05 mm from the target artery. It was characterized by fibrinoid necrosis of the wall, often associated with lymphocytic exudates or thrombosis. Based on the review of perpendicular sections of tissue samples, the arterioles had received between 6 and 40 Gy. This arteriolar vasculitis occurred at 28 days in samples from 51% of irradiated coronary arteries and 100% of irradiated iliac arteries. By 6 months, the incidence of acute vasculitis decreased to 24% around the coronary arteries. However, at that time, healing vasculitis was evident, often with luminal narrowing, in 46% of samples. Vasculitis was not seen in any of 44 samples from unirradiated vessels (0%) and had no relation to angioplasty, stenting, or their sequelae. This radiation-associated vasculitis in the swine resembles the localized lymphocytic vasculitis that we have reported in tissues of humans exposed to external radiation. On the other hand, it is quite different from the various types of systemic vasculitis that occur in nonirradiated humans. Conclusion: Endoarterial brachytherapy

  10. Endovascular Management of Acute Limb Ischemia.

    LENUS (Irish Health Repository)

    Hynes, Brian G

    2011-09-14

    Despite major advances in pharmacologic and endovascular therapies, acute limb ischemia (ALI) continues to result in significant morbidity and mortality. The incidence of ALI may be as high as 13-17 cases per 100,000 people per year, with mortality rates approaching 18% in some series. This review will address the contemporary endovascular management of ALI encompassing pharmacologic and percutaneous interventional treatment strategies.

  11. Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors

    International Nuclear Information System (INIS)

    Kawatani, Yohei; Nakamura, Yoshitsugu; Mochida, Yoshihiko; Yamauchi, Naoya; Hayashi, Yujiro; Taneichi, Tetsuyoshi; Ito, Yujiro; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    Endovascular stent graft placement has become a major treatment for thoracic and abdominal aneurysms. While endovascular therapy is less invasive than open surgery, it involves the use of a contrast medium. Contrast media can cause renal impairment, a condition termed as contrast-induced nephropathy (CIN). This study sought to evaluate the incidence and risk factors of CIN following endovascular stent graft placement for aortic aneurysm repair. The study included 167 consecutive patients who underwent endovascular stent graft placement in our hospital from October 2013 to June 2014. CIN was diagnosed using the European Society of Urogenital Radiology criteria. Patients with and without CIN were compared. Chi-squared tests, t-tests, and multivariate logistic regression analyses were performed. Thirteen patients (7.8%) developed CIN. Left ventricular dysfunction and intraoperative blood transfusion were significantly more frequent in the CIN group (P = 0.017 and P = 0.032, resp.). Multivariate analysis showed that left ventricular dysfunction had the strongest influence on CIN development (odds ratio 9.34, P = 0.018, and 95% CI = 1.46–59.7). Patients with CIN also experienced longer ICU and hospital stays. Measures to improve renal perfusion flow should be considered for patients with left ventricular dysfunction who are undergoing endovascular stent graft placement

  12. Endovascular treatment of type B dissection in patients with Marfan syndrome: mid-term outcomes and aortic remodeling.

    Science.gov (United States)

    Eid-Lidt, Guering; Gaspar, Jorge; Meléndez-Ramírez, Gabriela; Cervantes S, Jorge; González-Pacheco, Hector; Dámas de Los Santos, Félix; Meave-González, Aloha; Ramírez Marroquín, Samuel

    2013-12-01

    To evaluate the mid-term outcomes, and the aortic remodeling in Marfan syndrome (MFS) patients with type B dissection that were treated with endovascular repair. MFS is a relative contraindication to thoracic endovascular aortic repair (TEVAR). Mid-term aortic outcomes data in MFS after TEVAR are limited, and the occurrence of late events remains unclear. Of 89 patients that underwent TEVAR between September 2002 and February 2011, 10 patients with mid-term follow-up fulfilled the Ghent criteria for MFS and complicated type B dissection. High risk for open surgery was documented in 90%. The mean age was 35.1 ± 9.4 years and all patients presented with acute aortic syndrome complicating a chronic type B dissection (DeBakey type IIIb). Five patients underwent a Bentall surgical procedure previous to endovascular repair, and in four patients initial TEVAR was followed by surgery of the ascending aorta. Treatment was limited to endovascular repair in only one patient. In-hospital mortality was 10%. At a mean follow-up of 59.6 ± 38.9 months, the cumulated mortality was of 20% and late mortality 11.1%. The rate of secondary endoleak was 44.4%, and late reintervention of 33.3%. Survival freedom from cardiovascular death at 8 years was 80.0%, and positive remodeling was documented in 37.5% of patients. Our results suggest that TEVAR is feasible, safe, and associated with a high reintervention rate and reduced rate of positive aortic remodeling in patients with Marfan syndrome. Survival at 8 years was comparable to contemporary series of open repair. Copyright © 2013 Wiley Periodicals, Inc.

  13. Supra-aortic interventions for endovascular exclusion of the entire aortic arch.

    Science.gov (United States)

    Andrási, Terézia B; Grossmann, Marius; Zenker, Dieter; Danner, Bernhard C; Schöndube, Friedrich A

    2017-07-01

    Our aim was to analyze the outcomes of endovascular exclusion of the entire aortic arch (proximal landing in zone 0, distal landing in zone III or beyond, after Ishimaru) in which complete surgical debranching of the supra-aortic vessels (I), endovascular supra-aortic revascularization (chimney, fenestrated, or branched grafts) with partial surgical debranching (II), or total endovascular supra-aortic revascularization (III) was additionally performed. Publications describing endovascular repair of the aortic arch (2000-2016) were systematically searched and reviewed. From a total of 53 relevant studies including 1853 patients, only 1021 patients undergoing 35 different total aortic arch procedures were found eligible for further evaluation and included in group I, II, or III (429, 190, and 402 patients, respectively). Overall early mortality was higher in group I vs groups II and III (P = .001; 1 - β = 95.6%) but exceeded in group III (18.6%) and group II (14.0%) vs group I (8.0%; P = .044; 1 - β = 57.4%) for diseases involving zone 0. Mortality was higher in all subgroups treated for zone 0 disease compared with corresponding subgroups treated for zone I to zone III disease. The incidence of cerebral ischemic events was increased in groups I and II vs group III (7.5% and 11% vs 1.7%; P = .0001) and correlated with early mortality (R 2  = .20; P = .033). The incidence of type II endoleaks and endovascular reintervention was similar between groups and correlated with each other (R 2  = .37; P = .004). Type Ia endoleak occurred more often in groups II and III than in group I (7.1% and 12.1% vs 5.8%; P = .023) and correlated with midterm mortality (R 2  = .53; P = .005). Retrograde type A dissection was low in all groups, whereas aneurysm growth was higher in group III (2.6%, 4.2%, 10.7%; P = .002), correlating with midterm mortality (R 2  = .311; P = .009). Surgical revision slightly correlated with surgical complications (R 2  = .18; P = .044

  14. Intra-Abdominal Hypertension and Abdominal Compartment Syndrome in Association with Ruptured Abdominal Aortic Aneurysm in the Endovascular Era: Vigilance Remains Critical

    Directory of Open Access Journals (Sweden)

    Matthew C. Bozeman

    2012-01-01

    In this review, we describe published experience with IAH and ACS complicating abdominal vascular catastrophes, experience with ACS complicating endovascular repair of rAAAs, and techniques for management of the abdominal wound. Vigilance and appropriate management of IAH and ACS remains critically important in decreasing morbidity and optimizing survival following catastrophic intra-abdominal vascular events.

  15. Endovascular aneurysm exclusion along a femorodistal venous bypass in active Behçet's disease.

    Science.gov (United States)

    Gretener, Silvia B; Do, Dai-Do; Baumgartner, Iris; Dinkel, Hans-Peter; Schmidli, Jürg; Birrer, Manuela

    2002-10-01

    To report the endovascular repair of dual aneurysms along a femorodistal venous bypass graft in a patient with Behçet's disease. A 55-year-old man of middle European ancestry with Behçet's disease had dual aneurysms evolve along the proximal segment of a femorodistal venous bypass that had been implanted 2.5 years earlier for recurrent false aneurysm formation. Owing to the lack of suitable venous conduits and the active nature of the disease, the aneurysms were successfully excluded with overlapping Hemobahn and Jostent endografts; the immunosuppressive therapy was intensified. Rupture of the aneurysms was successfully prevented, but the stent-grafts thrombosed 6 weeks later owing to exacerbation of the underlying disease. Endovascular exclusion of aneurysm in venous bypass grafts in Behçet's disease is feasible. Although the stent-grafts thrombosed, they did prevent rupture of the aneurysms.

  16. Unusual rapid evolution of type B aortic dissection in a marfan patient following heart transplantation: successful endovascular treatment.

    Science.gov (United States)

    Botta, L; Russo, V; Grigioni, F; Arpesella, G; Rocchi, G; Di Bartolomeo, R; Fattori, R

    2006-10-01

    A patient with Marfan syndrome with previous Bentall operation for mitral and tricuspid valve repair, required orthotopic cardiac transplantation for end stage cardiomyopathy. Postoperatively he suffered type-B aortic dissection, despite normal aortic diameters. Following sudden increase of aortic diameters, two years later, he underwent successful stent graft implantation. In patients with Marfan syndrome, post transplantation morbidity is high, with a 40% incidence of thoracic aortic dissection. This case highlights the potential of endovascular approach for treating post-transplantation aortic dissection.

  17. Emerging importance of helicases in plant stress tolerance: characterization of Oryza sativa repair helicase XPB2 promoter and its functional validation in tobacco under multiple stresses

    Directory of Open Access Journals (Sweden)

    Shailendra eRaikwar

    2015-12-01

    Full Text Available Genetic material always remains at the risk of spontaneous or induced damage which challenges the normal functioning of DNA molecule, thus, DNA repair is vital to protect the organisms against genetic damage. DNA hHelicases, the unique molecular motors, are emerged as potentialprospective molecules to engineer stress tolerance in plants and are involved in a variety of DNA nucleic acid metabolismc processes including DNA repair. The DNA repair helicase, OsXPB2 is an evolutionary conserved protein present in different organisms, including plants. Availability of few efficient promoters for gene expression in plants provoked us to study the promoter of XPB for better understanding of gene regulation under stress The analysis of promoter sequence from plant genome is important in understanding the gene regulation. Hereconditions. Here, we report the in silico analysis of novel stress inducible promoter of rice Oryza sativa OsXPB2 (OsXPB2. gene is reported. The in vivo validation of functionality/activity of novel stress inducible promoter of rice OsXPB2 gene promoter under abiotic and hormonal stress conditions was performed by Agrobacterium-mediated transient assay in tobacco leaves using OsXPB2::GUS chimeric construct. Our resultsThe present research revealed that OsXPB2 promoter contains cis-elements accounting for various abiotic stresses (salt, dehydration or cold and hormone (Auxin, ABA or MeJA induced GUS expression/activity in the promoter-reporter assay. The promoter region of OsXPB2 contains CACG, GTAACG, CACGTG, CGTCA CCGCCGCGCT cis acting-elements which are reported to be salt, dehydration, cold, MeJA or ABA responsive, respectively. Functional analysis was done by Agrobacterium-transient assays using agroinfiltration in tobacco leaves, followed by GUS staining and fluorescence quantitative analyses. The results revealed high induction of GUS activity under multiple abiotic stresses as compared to mock treated control. The present

  18. Outcomes after open repair for ruptured abdominal aortic aneurysms in patients with friendly versus hostile aortoiliac anatomy

    NARCIS (Netherlands)

    van Beek, S. C.; Reimerink, J. J.; Vahl, A. C.; Wisselink, W.; Reekers, J. A.; Legemate, D. A.; Balm, R.

    2014-01-01

    In patients with a ruptured abdominal aortic aneurysm (RAAA), anatomic suitability for endovascular aneurysm repair (EVAR) depends on aortic neck and iliac artery characteristics. If the aortoiliac anatomy is unsuitable for EVAR ("hostile anatomy"), open repair (OR) is the next option. We

  19. DNA repair

    International Nuclear Information System (INIS)

    Setlow, R.

    1978-01-01

    Some topics discussed are as follows: difficulty in extrapolating data from E. coli to mammalian systems; mutations caused by UV-induced changes in DNA; mutants deficient in excision repair; other postreplication mechanisms; kinds of excision repair systems; detection of repair by biochemical or biophysical means; human mutants deficient in repair; mutagenic effects of UV on XP cells; and detection of UV-repair defects among XP individuals

  20. Intravascular ultrasound based dose assessment in endovascular brachytherapy

    International Nuclear Information System (INIS)

    Catalano, Gianpiero; Tamburini, Vittorio; Colombo, Antonio; Nishida, Takahiro; Parisi, Giovanni; Mazzetta, Chiara; Orecchia, Roberto

    2003-01-01

    Background: the role of endovascular brachytherapy in restenosis prevention is well documented. Dose is usually prescribed at a fixed distance from the source axis by angiographic quantification of vessel diameter. Recently, intravascular ultrasound (IVUS) was introduced in dose prescription, allowing a better evaluation of the vessel anatomy. This study retrospectively explores the difference between prescription following angiographic vessel sizing and delivered dose calculated with IVUS. Methods and results: Seventeen lesions were studied with IVUS, identifying on irradiated segment, three sections on which measuring minimal and maximal distance from the centre of IVUS catheter to the adventitia; using dedicated software, corresponding doses were calculated. The dose ranged widely, with maximal and minimal values of 71.6 and 4.9 Gy; furthermore, heterogeneity in dose among different sections was observed. In the central section, the maximal dose was 206% of the one prescribed with the QCA model at 2 mm from the source axis, while the minimal dose was 96%. In proximal and distal sections, respective values were 182, 45, 243, and 122%. Conclusions: Our analysis confirmed the dose inhomogeneity delivered with an angiographic fixed-dose prescription strategy. A dose variation was found along the irradiated segment due to the differences in vessel thickness. IVUS emerged as an important tool in endovascular brachytherapy, especially for irregular-shaped vessels

  1. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy.

    Science.gov (United States)

    Moon, Michael C; Greenberg, Roy K; Morales, Jose P; Martin, Zenia; Lu, Qingsheng; Dowdall, Joseph F; Hernandez, Adrian V

    2011-04-01

    Proximal aortic dissections are life-threatening conditions that require immediate surgical intervention to avert an untreated mortality rate that approaches 50% at 48 hours. Advances in computed tomography (CT) imaging techniques have permitted increased characterization of aortic dissection that are necessary to assess the design and applicability of new treatment paradigms. All patients presenting during a 2-year period with acute proximal aortic dissections who underwent CT scanning were reviewed in an effort to establish a detailed assessment of their aortic anatomy. Imaging studies were assessed in an effort to document the location of the primary proximal fenestration, the proximal and distal extent of the dissection, and numerous morphologic measurements pertaining to the aortic valve, root, and ascending aorta to determine the potential for an endovascular exclusion of the ascending aorta. During the study period, 162 patients presented with proximal aortic dissections. Digital high-resolution preoperative CT imaging was performed on 76 patients, and 59 scans (77%) were of adequate quality to allow assessment of anatomic suitability for treatment with an endograft. In all cases, the dissection plane was detectable, yet the primary intimal fenestration was identified in only 41% of the studies. Scans showed 24 patients (32%) appeared to be anatomically amenable to such a repair (absence of valvular involvement, appropriate length and diameter of proximal sealing regions, lack of need to occlude coronary vasculature). Of the 42 scans that were determined not to be favorable for endovascular repair, the most common exclusion finding was the absence of a proximal landing zone (n = 15; 36%). Appropriately protocoled CT imaging provides detailed anatomic information about the aortic root and ascending aorta, allowing the assessment of which dissections have proximal fenestrations that may be amenable to an endovascular repair. Copyright © 2011 Society for

  2. Endovascular Neurosurgery: Personal Experience and Future Perspectives.

    Science.gov (United States)

    Raymond, Jean

    2016-09-01

    From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress. We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Endovascular Management of Infected Femoral Artery Pseudoaneurysms in High-Risk Patients: A Case Series

    Energy Technology Data Exchange (ETDEWEB)

    D’Oria, Mario, E-mail: mario.doria88@outlook.com; Sgorlon, Giada; Calvagna, Cristiano; Zamolo, Francesca; Chiarandini, Stefano; Adovasio, Roberto; Griselli, Filippo [University Hospital of Cattinara, Vascular and Endovascular Surgery Unit (Italy)

    2017-04-15

    We report our experience with the urgent treatment of two high-risk patients with infected femoral artery pseudoaneurysms (IFAPs) with the placement of a self-expandable covered stent (SECS). In both cases, there was no perioperative mortality and the aneurysm exclusion was successful without early or late stent thrombosis/stent fracture nor acute or chronic limb ischemia or limb loss. There was no recurrence of local or systemic infection during the follow-up period. Endovascular therapy represents a feasible treatment option for IFAPs in those patients for whom the risk of open surgical repair would be prohibitive, especially under urgent circumstances.

  4. Endovascular Treatment of a Gastroduodenal Artery Pseudoaneurysm Rupture after a Car Accident

    Directory of Open Access Journals (Sweden)

    Sofia Dutra

    2017-09-01

    Full Text Available The authors present a case of a 39-year-old man with alcoholic chronic pancreatitis that was admitted in the emergency department after a car accident, complaining of abdominal pain and looking pale. The patient was hemodinamically unstable, requiring blood transfusions. He underwent computed tomography angiogram of the abdomen and pelvis, showing a pseudoaneurysm of the gastroduodenal artery and a hemoperitoneum. He was referred to our interventional radiology unit and submitted to endovascular treatment, consisting of ‘backdoor’ and ‘frontdoor’ embolization of the gastroduodenal artery and pseudoaneurysm neck with coils, with total exclusion in control angiography. With this case description we intend to highlight the rarity of the pseudoaneurysm rupture of the gastroduodenal artery and to emphasize the importance of an interventional radiology response that had a fundamental role in the endovascular treatment, in an emergency context.

  5. The Weekend Effect in AAA Repair.

    Science.gov (United States)

    O'Donnell, Thomas F X; Li, Chun; Swerdlow, Nicholas J; Liang, Patric; Pothof, Alexander B; Patel, Virendra I; Giles, Kristina A; Malas, Mahmoud B; Schermerhorn, Marc L

    2018-04-18

    Conflicting reports exist regarding whether patients undergoing surgery on the weekend or later in the week experience worse outcomes. We identified patients undergoing abdominal aortic aneurysm (AAA) repair in the Vascular Quality Initiative between 2009 and 2017 [n = 38,498; 30,537 endovascular aneurysm repair (EVAR) and 7961 open repair]. We utilized mixed effects logistic regression to compare adjusted rates of perioperative mortality based on the day of repair. Tuesday was the most common day for elective repair (22%), Friday for symptomatic repairs (20%), and ruptured aneurysms were evenly distributed. Patients with ruptured aneurysms experienced similar adjusted mortality whether they underwent repair during the week or on weekends. Transfers of ruptured AAA were more common over the weekend. However, patients transferred on the weekend experienced higher adjusted mortality than those transferred during the week (28% vs 21%, P = 0.02), despite the fact that during the week, transferred patients actually experienced lower adjusted mortality than patients treated at the index hospital (21% vs 31%, P AAA repair. However, patients with ruptured AAA transferred on the weekend experienced higher mortality than those transferred during the week, suggesting a need for improvement in weekend transfer processes.

  6. WE-DE-207A-01: Parallels in the Evolution of X-Ray Angiographic Systems and Devices Used for Minimally Invasive Endovascular Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Strother, C. [University of Wisconsin (United States)

    2016-06-15

    audience. Learning Objectives: To understand the clinical need of one-stop-shop stroke imaging workflow To understand to technical challenges in cone beam CT perfusion To understand the potential technical solutions to enable one-stop-shop imaging workflow Recent advances in devices used in neuro--interventions Mattew Gounis - Over the past two decades, there has been explosive development of medical devices that have revolutionized the endovascular treatment of cerebrovascular diseases. There is now Level 1, Class A evidence that intra-arterial, mechanical thrombectomy in acute ischemic stroke is superior to medical management; and similarly that minimally invasive, endovascular repair of ruptured brain aneurysms is superior to surgical treatment. Stent-retrievers are now standard of care for emergent large vessel occlusions causing a stroke, with a number of patients need to treat for good clinical outcomes as low as 4. Recent technologies such as flow diverters and disrupters, intracranial self-expanding stents, flexible large bore catheters that can reach vessels beyond the circle of Willis, stent-retrievers, and super-compliant balloons are the result of successful miniaturization of design features and novel manufacturing technologies capable of building these devices. This is a rapidly evolving field, and the device technology enabling such advancements will be reviewed. Importantly, image-guidance technology has not kept pace in neurointervention and the ability to adequately characterize these devices in vivo remains a significant opportunity. Learning Objectives: A survey of devices used in neurointerventions, their materials and essential design characteristics Funding support received from NIH and DOD; Funding support received from GE Healthcare; Funding support received from Siemens AX; Patent royalties received from GE Healthcare; G. Chen, Funding received from NIH; funding received from DOD; funding received from GE Healthcare; funding received from Siemens

  7. WE-DE-207A-01: Parallels in the Evolution of X-Ray Angiographic Systems and Devices Used for Minimally Invasive Endovascular Therapy

    International Nuclear Information System (INIS)

    Strother, C.

    2016-01-01

    audience. Learning Objectives: To understand the clinical need of one-stop-shop stroke imaging workflow To understand to technical challenges in cone beam CT perfusion To understand the potential technical solutions to enable one-stop-shop imaging workflow Recent advances in devices used in neuro--interventions Mattew Gounis - Over the past two decades, there has been explosive development of medical devices that have revolutionized the endovascular treatment of cerebrovascular diseases. There is now Level 1, Class A evidence that intra-arterial, mechanical thrombectomy in acute ischemic stroke is superior to medical management; and similarly that minimally invasive, endovascular repair of ruptured brain aneurysms is superior to surgical treatment. Stent-retrievers are now standard of care for emergent large vessel occlusions causing a stroke, with a number of patients need to treat for good clinical outcomes as low as 4. Recent technologies such as flow diverters and disrupters, intracranial self-expanding stents, flexible large bore catheters that can reach vessels beyond the circle of Willis, stent-retrievers, and super-compliant balloons are the result of successful miniaturization of design features and novel manufacturing technologies capable of building these devices. This is a rapidly evolving field, and the device technology enabling such advancements will be reviewed. Importantly, image-guidance technology has not kept pace in neurointervention and the ability to adequately characterize these devices in vivo remains a significant opportunity. Learning Objectives: A survey of devices used in neurointerventions, their materials and essential design characteristics Funding support received from NIH and DOD; Funding support received from GE Healthcare; Funding support received from Siemens AX; Patent royalties received from GE Healthcare; G. Chen, Funding received from NIH; funding received from DOD; funding received from GE Healthcare; funding received from Siemens

  8. Percutaneous Stent-Graft Repair of a Mycotic Pulmonary Artery Pseudoaneurysm

    International Nuclear Information System (INIS)

    Chou Meichun; Liang Hueilung; Pan Huayban; Yang Chienfang

    2006-01-01

    Ruptured mycotic pulmonary pseudoaneurysm is a lethal complication. Emergent surgical repair is usually recommended, but still associated with a high mortality rate. We present a patient in whom mycotic pulmonary pseudoaneurysm was a complication after surgical lobectomy 2 weeks earlier. This patient had suffered from repeated massive hemoptysis. After emergent surgical repair of the ruptured pulmonary artery stump, another episode of massive hemorrhage occurred. The pulmonary arteriogram revealed a segmental stenosis and a large, wide-necked, lobulated pseudoaneurysm at the left proximal pulmonary artery. We deployed a balloon-expandable stent-graft (48 mm in length mounted on a 12 mm x 40 mm angioplasty balloon) across the stenotic segment and the neck of the pulmonary pseudoaneurysm. Hemostasis was achieved immediately and, under a 4-week antibiotic treatment, patient was transferred to a local hospital for medical care. This case report demonstrates the benefit of minimally invasive endovascular therapy in a critically ill patient. A literature review of the etiology and management of mycotic pulmonary pseudoaneurysm is included

  9. Endovascular treatment of intracranial arteriovenous malformations

    International Nuclear Information System (INIS)

    Seruga, T.

    2002-01-01

    Background. The aim of the study was the introduction of endovascular interventional treatment of cerebral arteriovenous malformations (AVM) with superselective embolization with cyanoacrylic polymerisation agent. Case reports. Endovascular embolization was performed in five patients with cerebral AVMs. Three of these patients were presented with intracerebral haemathomas whereas in other two patients, cerebral AVM was an incidental finding. Superselective catheterisation of AVMs was performed and acrylic glue was selectively injected into the nidus. Conclusions. Control cerebral angiography after embolization of AVM showed different results. In one patient, AVM was totally occluded after three sessions and in second case AVM was occluded in a single session. The rate of occlusion in other two cases was estimated between 70% in 80%. Both of these two patients underwent surgery. One patient is still in the process of treatment. Endovascular treatment of cerebral AVMs with superselective embolization with liquid cyanoacrilyc adhesive agent is a safe and effective alternative treatment paths next to microsurgery. Endovascular treatment in combination with radiosurgery could become the method of choice in the therapy of cerebral AVMs in the future. (author)

  10. Endovascular Treatment of an Aortobronchial Fistula

    International Nuclear Information System (INIS)

    Numan, Fueruezan; Arbatli, Harun; Yagan, Naci; Demirsoy, Ergun; Soenmez, Binguer

    2004-01-01

    A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure

  11. Carotid artery revascularization : Surgical and endovascular developments

    NARCIS (Netherlands)

    Borst, G.J. de

    2007-01-01

    Carotid artery revascularization. Surgical and endovascular developments. Stroke is among the most disabling chronic diseases and the third major cause of death in the Western world. In the Netherlands around 12 per 1000 inhabitants suffers a stroke, and in 2005 over 10.000 people died as a result

  12. Manejo endovascular de la aorta torácica Endovascular treatment of thoracic aorta

    Directory of Open Access Journals (Sweden)

    Juan G Barrera

    2006-10-01

    Full Text Available En comparación con el tratamiento convencional, la terapia endovascular en aneurisma de aorta torácica, presenta los mejores resultados, por lo que se convierte en el tratamiento de elección para la patología de aorta torácica descendente endovascular, por su baja morbimortalidad perioperatoria. El tratamiento quirúrgico por vía retroperitoneal y/o endovascular para aneurisma de aorta abdominal infrarrenal, resulta ser especialmente seguro en pacientes octogenarios o con alta morbilidad. Esta cohorte institucional presenta resultados perioperatorios y en el seguimiento, similares a los reportados en la literatura mundial.Compared with the conventional treatment, endovascular therapy in thoracic aortic aneurysm shows the best results, being the election treatment for the pathology of the descending thoracic aorta, due to its low peri-operative morbid-mortality. Surgical treatment by retro-peritoneal route and/or endovascular for infra-renal abdominal aortic aneurysm is especially safe in octogenarian patients or in those with a high mortality rate. This institutional cohort show peri-operative and follow-up results similar to those reported in the world literature.

  13. Endovascular treatment of spine and spinal cord lesions

    International Nuclear Information System (INIS)

    Berenstein, A.

    1992-01-01

    Completing this comprehensive series on endovascular interventional angiography, Volume 5 focuses on the vascular abnormalities of the spine and spinal cord. It is based on the detailed functional vascular anatomy described in Volume 3 and the principles and function of endovascular treatment described in Volumes 1-4. As in the companion volumes, the unique approach gives view of the disease itself, its anatomical features and its clinical presentation. The technical aspects of the interventional or endovascular neuroradiology are built upon the solid analysis of the disease and its angioarchitecture. The recent developments in endovascular procedures, such as aneurysm treatment, angioplasty, and vascular recanalizations, are reviewed. (orig.). 118 figs. in 442 separate illustrations

  14. Endovascular Treatment of Chronic Mesenteric Ischemia: Report of Five Cases

    International Nuclear Information System (INIS)

    Nyman, Ulf; Ivancev, Krasnodar; Lindh, Mats; Uher, Petr

    1998-01-01

    Purpose: To evaluate the midterm results of percutaneous transluminal angioplasty (PTA) and stent placement in stenotic and occluded mesenteric arteries in five consecutive patients with chronic mesenteric ischemia. Methods: Five patients with 70%-100% obliterations of all mesenteric vessels resulting in chronic mesenteric ischemia (n= 4) and as a prophylactic measure prior to abdominal aortic aneurysm repair (n= 1) underwent PTA of celiac and/or superior mesenteric artery (SMA) stenoses (n= 2), primary stenting of ostial celiac occlusions (n= 2), and secondary stenting of a SMA occlusion (n= 1; recoil after initial PTA). All patients underwent duplex ultrasonography (US) (n= 3) and/or angiography (n= 5) during a median follow-up of 21 months (range 8-42 months). Results: Clinical success was obtained in all five patients. Asymptomatic significant late restenoses (n3) were successfully treated with repeat PTA (n= 2) and stenting of an SMA occlusion (n= 1; celiac stent restenosis). Recurrent pain in one patient was interpreted as secondary to postsurgical abdominal adhesions. Two puncture-site complications occurred requiring local surgical treatment. Conclusions: Endovascular techniques may be attempted prior to surgery in cases of stenotic or short occlusive lesions in patients with chronic mesenteric ischemia. Surgery may still be preferred in patients with long occlusions and a low operative risk

  15. Endovascular Embolization of Intracranial Infectious Aneurysms in Patients Undergoing Open Heart Surgery Using n-Butyl Cyanoacrylate.

    Science.gov (United States)

    Cheng-Ching, Esteban; John, Seby; Bain, Mark; Toth, Gabor; Masaryk, Thomas; Hui, Ferdinand; Hussain, Muhammad Shazam

    2017-03-01

    Mycotic aneurysms are a serious complication of infective endocarditis with increased risk of intracranial hemorrhage. Patients undergoing open heart surgery for valve repair or replacement are exposed to anticoagulants, increasing the risk of aneurysm bleeding. These patients may require endovascular or surgical aneurysm treatment prior to heart surgery, but data on this approach are scarce. Retrospective review of consecutive patients with infectious endocarditis and mycotic aneurysms treated endovascularly with Trufill n-butyl cyanoacrylate (n-BCA) at the Cleveland Clinic between January 2013 and December 2015. Nine patients underwent endovascular treatment of mycotic aneurysms with n-BCA (mean age of 39 years). On imaging, 4 patients had intracerebral hemorrhage, 2 had multiple embolic infarcts, and the rest had no imaging findings. Twelve mycotic aneurysms were detected (3 patients with 2 aneurysms). Seven aneurysms were in the M4 middle cerebral artery segment, 4 in the posterior cerebral artery distribution, and 1 in the callosomarginal branch. n-BCA was diluted in ethiodized oil (1:1 to 1:2). Embolization was achieved in a single rapid injection with immediate microcatheter removal. Complete aneurysm exclusion was achieved in all cases without complications. All patients underwent open heart surgery and endovascular embolization within a short interval, 2 with both procedures on the same day. There were no new hemorrhages after aneurysm embolization. Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation. Early embolization prior to and within a short interval from open heart surgery is feasible.

  16. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    to large aneurysms (> 3 mm). However the data also suggest that endovascular treatment of very small aneurysms might be associated with an increased risk of procedural ruptures and mortality. At nine-month follow-up results indicate significantly less compaction in the very small aneurysms....... endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms...... aneurysms and less than 90% aneurysm occlusion in six aneurysms. Complications occurred in the treatment of 15 aneurysms, including eight procedural ruptures, six thromboembolic events and one case of early hemorrhage. Compared with larger aneurysms, treatment of very small aneurysms was associated...

  17. Intestinal infarction: A complication of endovascular therapy

    International Nuclear Information System (INIS)

    England, Andrew; Butterfield, John S.; Sukumar, Sathi; Thompson, David; Roulson, Jo-An; Pritchard, Susan; Ashleigh, Raymond J.

    2007-01-01

    This report presents a rare case of intestinal infarction following endovascular therapy. A female patient who had undergone an internal carotid artery stenting procedure presented suddenly with abdominal pain. Radiological and clinical examinations at the time suggested a picture of intestinal ischaemia, in view of the patient's general conditions and co-existing morbidities surgical intervention was not considered to be an option. The patient died 4 days after the carotid stenting procedure, post-mortem examination revealed infarction of the ileum and caecum. The learning outcomes are if performing endovascular therapy in a patient with diffuse atherosclerotic disease early consideration of intestinal ischaemia should be given to any patient who presents with acute post-procedural abdominal pain

  18. Endovascular revascularization for aortoiliac atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Aggarwal V

    2016-03-01

    Full Text Available Vikas Aggarwal,1 Stephen W Waldo,2,3 Ehrin J Armstrong2,3 1Prairie Heart Institute, St John's Hospital, Springfield, IL, 2Section of Cardiology, Denver Veterans Affairs Medical Center, 3Section of Cardiology, University of Colorado, Aurora, CO, USA Abstract: Atherosclerotic iliac artery disease is increasingly being treated with endovascular techniques. A number of new stent technologies can be utilized with high long-term patency, including self-expanding stents, balloon-expandable stents, and covered stents, but comparative data on these stent types and in more complex lesions are lacking. This article provides a review of currently available iliac stent technologies, as well as complex procedural aspects of iliac artery interventions, including approaches to the treatment of iliac bifurcation disease, long segment occlusions, choice of stent type, and treatment of iliac artery in-stent restenosis. Keywords: peripheral artery disease, iliac artery, balloon expandable stent, self expanding stent, covered stent, claudication, endovascular

  19. Intestinal infarction: A complication of endovascular therapy

    Energy Technology Data Exchange (ETDEWEB)

    England, Andrew [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)]. E-mail: andrew.england@smtr.nhs.uk; Butterfield, John S. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Sukumar, Sathi [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Thompson, David [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Roulson, Jo-An [Department of Histopathology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Pritchard, Susan [Department of Histopathology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom); Ashleigh, Raymond J. [Department of Radiology, South Manchester University Hospitals NHS Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT (United Kingdom)

    2007-08-15

    This report presents a rare case of intestinal infarction following endovascular therapy. A female patient who had undergone an internal carotid artery stenting procedure presented suddenly with abdominal pain. Radiological and clinical examinations at the time suggested a picture of intestinal ischaemia, in view of the patient's general conditions and co-existing morbidities surgical intervention was not considered to be an option. The patient died 4 days after the carotid stenting procedure, post-mortem examination revealed infarction of the ileum and caecum. The learning outcomes are if performing endovascular therapy in a patient with diffuse atherosclerotic disease early consideration of intestinal ischaemia should be given to any patient who presents with acute post-procedural abdominal pain.

  20. Endovascular Exclusion of Renal Artery Aneurysm

    International Nuclear Information System (INIS)

    Andersen, Poul Erik; Rohr, Nils

    2005-01-01

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90 o , but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable

  1. Endovascular Treatment Strategies in Aortoiliac Occlusion

    International Nuclear Information System (INIS)

    Ozkan, Ugur; Oguzkurt, Levent; Tercan, Fahri; Gumus, Burcak

    2009-01-01

    The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

  2. Current status of endovascular catheter robotics.

    Science.gov (United States)

    Lumsden, Alan B; Bismuth, Jean

    2018-06-01

    In this review, we will detail the evolution of endovascular therapy as the basis for the development of catheter-based robotics. In parallel, we will outline the evolution of robotics in the surgical space and how the convergence of technology and the entrepreneurs who push this evolution have led to the development of endovascular robots. The current state-of-the-art and future directions and potential are summarized for the reader. Information in this review has been drawn primarily from our personal clinical and preclinical experience in use of catheter robotics, coupled with some ground-breaking work reported from a few other major centers who have embraced the technology's capabilities and opportunities. Several case studies demonstrating the unique capabilities of a precisely controlled catheter are presented. Most of the preclinical work was performed in the advanced imaging and navigation laboratory. In this unique facility, the interface of advanced imaging techniques and robotic guidance is being explored. Although this procedure employs a very high-tech approach to navigation inside the endovascular space, we have conveyed the kind of opportunities that this technology affords to integrate 3D imaging and 3D control. Further, we present the opportunity of semi-autonomous motion of these devices to a target. For the interventionist, enhanced precision can be achieved in a nearly radiation-free environment.

  3. Endovascular treatment of intracranial venous sinus thrombosis

    International Nuclear Information System (INIS)

    Xu Shubin; Liang Zhihui; Cui Jinguo; Tian Huiqin; Li Liang; Chen Feng

    2009-01-01

    Objective: To evaluate the clinical efficacy and safety of endovascular treatment for intracranial venous sinus thrombosis. Methods: Ten patients with intracranial venous sinus thrombosis, confirmed by CT, MRI, MRV and / or DSA and encountered during the period of Aug. 2005-Aug. 2007, were treated with endovascular management after they failed to respond to anticoagulant therapy. Of ten patients, intravenous thrombolysis and mechanical thrombus maceration were carried out in 6, while intravenous thrombolysis, mechanical thrombus maceration together with intra-arterial thrombolysis were employed in 4. After the treatment, the anticoagulant therapy continued for 6 months. The patients were followed up for 12-29 months (mean 21 months). Results: After the treatment, the clinical symptoms and signs were completely or partially relieved in eight patients, including disappearance of headache (n=6) and relive of headache (n=2). No obvious improvement was found in one patient and linguistic function disturbance was seen in the remaining one. Lumbar puncture showed that the cerebrospinal fluid pressure returned to normal in all patients. Neither recurrence of thrombosis nor new symptom of neuralgic dysfunction was observed. No procedure-related intracranial or systemic hemorrhagic complications occurred both during and after the operation. Conclusion: Endovascular treatment is an effective and safe procedure for the potentially catastrophic intracranial venous thrombosis. (authors)

  4. Complications of endovascular treatment of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  5. Osteomyelitis and Discitis Following Translumbar Repair of a Type II Endoleak

    Energy Technology Data Exchange (ETDEWEB)

    Sella, David M., E-mail: Sella.david@mayo.edu; Frey, Gregory T., E-mail: Frey.gregory@mayo.edu; Giesbrandt, Kirk, E-mail: giesbrandt.kirk@mayo.edu [Mayo Clinic, Department of Radiology (United States)

    2016-03-15

    Here we present the case of an 80-year-old man who developed a type II endoleak following endovascular abdominal aortic aneurysm repair. Initial attempts at treating the endoleak via a transarterial approach were unsuccessful; therefore the patient underwent percutaneous translumbar endoleak embolization. Approximately 1 month following the translumbar procedure, he developed back pain, with subsequent workup revealing osteomyelitis and discitis as a complication following repair via the translumbar approach.

  6. Retrograde Embolization of the Left Vertebral Artery in a Type II Endoleak After Endovascular Treatment of Aortic Thoracic Rupture: Technical Note

    International Nuclear Information System (INIS)

    Rabellino, Martin; Garcia Nielsen, L.; Baldi, S.; Zander, T.; Arnaiz, L.; Llorens, R.; Zerolo, I.; Maynar, M.

    2009-01-01

    Endoleak is a frequent complication after endovascular repair of aortic rupture. We describe the case of a female patient with traumatic aortic injury, treated with endograft, who developed a type II endoleak through the left subclavian and vertebral arteries. Both arteries originated independently from the aortic arch, and were managed with coil embolization of each vessel. We also report our experience with treating the left vertebral artery by placing a microcatheter through the right vertebral one.

  7. Endovascular treatment of cerebral aneurysms - a cost analysis | Le ...

    African Journals Online (AJOL)

    The average cost for endovascular treatment per patient was R37 041. Surgical treatment was more expensive at R44 104, a difference of 16%. Conclusions. Despite the high cost of endovascular devices, appropriate use of this technology ultimately offers less expensive treatment than microsurgical clipping of aneurysms.

  8. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  9. Simulation and augmented reality in endovascular neurosurgery: lessons from aviation.

    Science.gov (United States)

    Mitha, Alim P; Almekhlafi, Mohammed A; Janjua, Major Jameel J; Albuquerque, Felipe C; McDougall, Cameron G

    2013-01-01

    Endovascular neurosurgery is a discipline strongly dependent on imaging. Therefore, technology that improves how much useful information we can garner from a single image has the potential to dramatically assist decision making during endovascular procedures. Furthermore, education in an image-enhanced environment, especially with the incorporation of simulation, can improve the safety of the procedures and give interventionalists and trainees the opportunity to study or perform simulated procedures before the intervention, much like what is practiced in the field of aviation. Here, we examine the use of simulators in the training of fighter pilots and discuss how similar benefits can compensate for current deficiencies in endovascular training. We describe the types of simulation used for endovascular procedures, including virtual reality, and discuss the relevant data on its utility in training. Finally, the benefit of augmented reality during endovascular procedures is discussed, along with future computerized image enhancement techniques.

  10. Life satisfaction in patients with and without spinal cord ischemia after advanced endovascular therapy for extensive aortic disease at mid-term follow-up.

    Science.gov (United States)

    Mehmedagic, Irma; Santén, Stefan; Jörgensen, Sophie; Acosta, Stefan

    2016-11-11

    Advanced endovascular aortic repair can be used to treat patients with extensive and complex aortic disease who are at risk of spinal cord ischaemia. The aim of this study was to compare whether life satisfaction differs between patients with and without spinal cord ischaemia at mid-term follow-up. Nested case-control study. Among patients undergoing advanced endovascular aortic repair between 2009 and 2012, 18 patients with spinal cord ischaemia and 33 without were interviewed at home. The Life Satisfaction Questionnaire (LiSat-11) and the Satisfaction With Life Scale (SWLS) were used. LiSat-11 found that patients with spinal cord ischaemia were more dissatisfied with their activities of daily living than were patients without spinal cord ischaemia (p=0.012). Both groups had similar, very low, scores in the sexual life domain; median 2.0 (interquartile range (IQR) 1.5-3.0) and 3.0 (IQR 2.0-4.0), respectively. There was no difference in SWLS between the groups. This study cohort of patients who underwent advanced endovascular aortic repair was rather homo-genous in their rating of life satisfaction and there was little difference between mid-term survivors who had spinal cord ischaemia and those who did not.

  11. Endovascular treatment of peripheral and visceral arterial injuries in patients with acute trauma.

    Science.gov (United States)

    Erbahçeci Salık, Aysun; Saçan İslim, Filiz; Çil, Barbaros Erhan

    2016-11-01

    The present study is an evaluation of the efficacy of endovascular treatment in emergency setting for patients with acute peripheral and visceral arterial injury secondary to penetrating or blunt trauma. Twelve patients (11 men) aged 35.8±11.3 years (range: 18-56 years) with penetrating or blunt trauma who underwent endovascular treatment in our department between March 2010 and June 2014 for peripheral and visceral arterial injury were retrospectively reviewed. Selective coil embolization was performed on 11 patients and particle embolization of the injured vessel was performed on 1 patient. Criteria for endovascular treatment included active extravasation or pseudoaneurysm on contrast-enhanced computed tomography and decrease in hemoglobin level or temporary hemodynamic instability. Arterial injuries were secondary to penetrating injury due to gunshot wound in 4 patients and stab wound in 5, and blunt abdominal injury as result of traffic accident in 3 patients. Traumatic lesions were in the right hepatic artery (n=3), left hepatic (n=2), right hepatic and right renal (n=1), left inferior epigastric (n=2), left facial (n=1), anterior tibial (n=1), and deep femoral (n=1) arteries. Technical success with no procedural complications was seen in all cases. Two patients died due to coexisting injuries on 29th and 43rd days of hospitalization. Median hospitalization period was 6.0 days (range: 1-43 days) and mean intensive care unit hospitalization was 7.7 days (range: 0-43 days). In our experience, endovascular treatment was a safe and effective option for acute traumatic peripheral and visceral arterial lesions.

  12. Vestibular system paresis due to emergency endovascular catheterization

    OpenAIRE

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-01-01

    Summary Objective:?The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case:?Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing ...

  13. de novo'' aneurysms following endovascular procedures

    International Nuclear Information System (INIS)

    Briganti, F.; Cirillo, S.; Caranci, F.; Esposito, F.; Maiuri, F.

    2002-01-01

    Two personal cases of ''de novo'' aneurysms of the anterior communicating artery (ACoA) occurring 9 and 4 years, respectively, after endovascular carotid occlusion are described. A review of the 30 reported cases (including our own two) of ''de novo'' aneurysms after occlusion of the major cerebral vessels has shown some features, including a rather long time interval after the endovascular procedure of up to 20-25 years (average 9.6 years), a preferential ACoA (36.3%) and internal carotid artery-posterior communicating artery (ICA-PCoA) (33.3%) location of the ''de novo'' aneurysms, and a 10% rate of multiple aneurysms. These data are compared with those of the group of reported spontaneous ''de novo'' aneurysms after SAH or previous aneurysm clipping. We agree that the frequency of ''de novo'' aneurysms after major-vessel occlusion (two among ten procedures in our series, or 20%) is higher than commonly reported (0 to 11%). For this reason, we suggest that patients who have been submitted to endovascular major-vessel occlusion be followed up for up to 20-25 years after the procedure, using non-invasive imaging studies such as MR angiography and high-resolution CT angiography. On the other hand, periodic digital angiography has a questionable risk-benefit ratio; it may be used when a ''de novo'' aneurysm is detected or suspected on non-invasive studies. The progressive enlargement of the ACoA after carotid occlusion, as described in our case 1, must be considered a radiological finding of risk for ''de novo'' aneurysm formation. (orig.)

  14. Endovascular treatment of stroke. When and How?

    International Nuclear Information System (INIS)

    Mantatzis, M.

    2012-01-01

    Full text: It is well known that stroke is the third leading cause of death and the most common cause of permanent disability in the Western countries. Ischemic stroke is the commonest between the causes and atheroembolic events is principally involved. Intravenous thrombolysis (IVT) has dramatically changed the treatment mentality which previously was mostly supportive and didn't change significantly the prognosis. IVT is now considered the standard of care, having however certain limitations that have paved the way for the development of endovascular treatment. The main disadvantage of IVT is the relatively limited available time window, leading very few patients to receive the treatment. Intra-arterial options for treatment are not confined to delivery of a thrombolytic drug into the thrombus, but extended to quite variable mechanical options. The use of thrombolytic agents regionally or locally (Intra-arterial Thrombolysis - IAT), although may be allowed for an extended time window comparatively to IVT, has more or less the same disadvantages and the complications that related to the administrated drug. Moreover and despite the good results of several randomized trials, IAT has never granted an FDA approval. Nevertheless its use is included in the AHA/ASA guidelines under recommended in certain situations. IAT can be used as a standalone treatment or may be combined (bridging therapy) with IVT. Endovascular treatment has been boosted however, after the advent of mechanical devices for clot removal in acute stroke. These devices have become more sophisticated nowadays and this treatment is more and more is preferred when endovascular means are considered. Initially, mechanical devices were used for the clot disruption in combination with IAT (augmented thrombolysis). Other devices have been developed aiming to directly remove a clot rather than disrupt or macerate it, and the procedure turned to be a thrombectomy. Many different devices had been used with

  15. Endovascular strategy for the elective treatment of concomitant aortoiliac aneurysm and symptomatic large bowel diverticular disease.

    Science.gov (United States)

    Illuminati, Giulio; Ricco, Jean-Baptiste; Schneider, Fabrice; Caliò, Francesco G; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

    2014-07-01

    The purpose of this study was to evaluate the strategy for treatment of patients presenting with asymptomatic diverticular disease of the large bowel associated with an asymptomatic aortoiliac aneurysmal (AAA) disease. Sixty-nine patients were included in this retrospective study. The patients were divided into 5 groups according to the type and sequence of the surgical treatment: 32 patients (47%) underwent colectomy followed by a staged open AAA repair (group A); 10 patients (14%) were treated with open AAA repair followed by a staged colectomy (group B); 13 patients (18%) received endovascular aneurysm repair (EVAR) followed by a staged bowel resection (group C); 8 patients (12%) had a bowel resection followed by staged EVAR (group D); and 6 patients (9%) underwent simultaneous open AAA repair and bowel resection (group E). Primary end points were mortality and complications after any of the procedures. Secondary end point was the time interval between the staged procedures. The cumulative death rate for delayed treatment of AAA was 6.5% and 0% for delayed treatment of diverticular disease [P=0.22]. The mean time interval between the staged procedures was 11 days for EVAR/colon resection (group C and group D) and 73 days for open AAA repair/colon resection (group A and group B; P<0.01). EVAR allows a significant reduction in the time required between AAA repair and colon resection, but no definite rule can be established regarding the sequence of staged procedures. Combined procedures should be reserved for selected cases. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Meningocele repair

    Science.gov (United States)

    ... is surgery to repair birth defects of the spine and spinal membranes. Meningocele and myelomeningocele ... is covered by a sterile dressing. Your child may then be transferred to a neonatal intensive ...

  17. Total Percutaneous Aortic Repair: Midterm Outcomes

    International Nuclear Information System (INIS)

    Bent, Clare L.; Fotiadis, Nikolas; Renfrew, Ian; Walsh, Michael; Brohi, Karim; Kyriakides, Constantinos; Matson, Matthew

    2009-01-01

    The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 ± 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 ± 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.

  18. Endovascular approach to treat ascending aortic pseudoaneurysm in a patient with previous CABG and very high surgical risk.

    Science.gov (United States)

    Zago, Alexandre C; Saadi, Eduardo K; Zago, Alcides J

    2011-10-01

    Pseudoaneurysm of the ascending aorta is an uncommon pathology and a challenge in high-risk patients who undergo conventional surgery because of high operative morbidity and mortality. Endovascular exclusion of an aortic pseudoaneurysm using an endoprosthesis is a less invasive approach, but few such cases have been reported. Moreover, the use of this approach poses unique therapeutic challenges because there is no specific endoprosthesis for ascending aortic repair, particularly to treat patients with previous coronary artery bypass graft (CABG). We describe the case of a 74-year-old patient who had undergone CABG and later presented with an iatrogenic ascending aortic pseudoaneurysm that occurred during an angiography. This patient was at very high risk for surgical treatment and, therefore, an endovascular approach was adopted: percutaneous coronary intervention for the left main coronary artery, left anterior descending and left circumflex native coronary arteries followed by endovascular endoprosthesis deployment in the ascending aorta to exclude the pseudoaneurysm. Both procedures were successfully performed, and the patient was discharged without complications 4 days later. At 5 months' clinical follow-up, his clinical condition was good and he had no complications. Copyright © 2011 Wiley-Liss, Inc.

  19. Hybrid aortic repair with antegrade supra-aortic and renovisceral debranching from ascending aorta.

    Science.gov (United States)

    Del Castro-Madrazo, José Antonio; Rivas-Domínguez, Margarita; Fernández-Prendes, Carlota; Zanabili Al-Sibbai, Amer; Llaneza-Coto, José Manuel; Alonso-Pérez, Manuel

    2017-05-01

    Aortic dissection is a life threatening condition. Hybrid repair has been described for the treatment of complex aortic pathology such as thoracoabdominal aortic aneurysms (TAAA) and type A and B dissections, although open and total endovascular repair are also possible. Open surgery is still associated with substantial perioperative morbi-mortality rates, thus less invasive techniques such as endovascular repair and hybrid procedures can achieve good results in centers with experience. We present the case of a patient with a chronic type B dissection and TAAA degeneration that was treated in a single stage hybrid procedure with antegrade supra-aortic and renovisceral debranching from the ascending aorta and TEVAR. At three-year follow up, the patient is free of intervention-related complications.

  20. Endovascular treatment with a stent-graft for internal carotid artery laceration during trans sphenoidal surgery: a case report

    International Nuclear Information System (INIS)

    Choe, Eun Hwa; Ko, Ji Ho; Lee, Tae Hong; Rho, Myung Ho

    2008-01-01

    An internal carotid artery (ICA) tear during or after trans-sphenoidal surgery (TSS) is rare but may cause potentially lethal complications. A 23-year-old female patient visited our hospital for treatment of a Rathke's cleft cyst. The patient had massive hemorrhage during surgery and angiography performed after surgery showed laceration of the cavernous ICA. We successfully controlled the hemorrhage with emergency placement of an endovascular stent-graft

  1. Endovascular brachytherapy to prevent restenosis after angioplasty

    International Nuclear Information System (INIS)

    Wohlgemuth, W.A.; Bohndorf, K.

    2003-01-01

    Endovascular radiotherapy is the first effective prophylaxis of restenosis after percutaneous transluminal angioplasty (PTA) and stenting. The FDA recently approved two devices for the delivery of intracoronary radiation following coronary artery stenting. Published multicenter, double-blind, randomized trials of intracoronary radiation therapy report good results for preventing in-stent restenosis, while the data for the peripheral circulation are still inconclusive. Beta-emitters are easier applicable and probably also safer, whereas gamma-emitters have been more extensively evaluated clinically so far. Primary indication for endovascular brachytherapy are patients at high risk for restenosis, such as previous restenoses, in-stent hyperplasia, long stented segment, long PTA lesion, narrow residual vascular lumen and diabetes. Data from coronary circulation suggest a safety margin of at least 4 to 10 mm at both ends of the angioplastic segment to avoid edge restenosis. To prevent late thrombosis of the treated coronary segment, antiplatelet therapy with clopidogrel and aspirin are recommended for at least 6 months after PTA and for 12 months after a newly implanted stent. An established medication regimen after radiotherapy of peripheral arteries is still lacking. (orig.) [de

  2. Endovascular strategy for unruptured cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Mangiafico, S., E-mail: mangiax@libero.it [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Guarnieri, G., E-mail: gianluigiguarnieri@hotmail.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Consoli, A., E-mail: onemed21@gmail.com [Interventional Neuroradiology Unit, Careggi University Hospital, Florence (Italy); Ambrosanio, G., E-mail: gambros@libero.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy); Muto, M., E-mail: mutomar@tiscali.it [Neuroradiology Service, Cardarelli Hospital, Naples (Italy)

    2013-10-01

    The treatment of unruptured intracranial aneurysms (UIAs) remains complex and not clearly defined. While for ruptured intracranial aneurysms the management and the treatment option (surgery or endovascular treatment) are well defined by several trials, for asymptomatic UIAs the best management is still currently uncertain. The rationale to treat an UIA is to prevent the rupture and its consequent SAH and all complications derived from hemorrhage or reduce/eliminate neurological palsy. Although this statement is correct, the indication to treat an UIA should be based on a correct balance between the natural history of UIA and treatment risk. Patient's clinical history, aneurysm characteristics, and strategy management influence the natural history of UIAs and treatment outcomes. In the last 10 years and more, two important large multicenter studies were performed in order to analysis of all these factors and to evaluate the best treatment option for UIAs. The aim of this paper is to try to synthesize the possible indications to the endovascular treatment (EVT), when and how to treat an UIA.

  3. Endovascular therapeutic strategies in ruptured intracranial aneurysms

    International Nuclear Information System (INIS)

    Machi, Paolo; Lobotesis, Kyriakos; Vendrell, Jean Francoise; Riquelme, Carlos; Eker, Omer; Costalat, Vincent; Bonafe, Alain

    2013-01-01

    The aim of the present study was to evaluate endovascular techniques used currently which were not available at the time of ISAT inclusion period, such as balloon remodelling and flow-divertion, in order to assess whether these new technologies have improved the endovascular approach outcomes. We present a review of articles, published in major journals, with the aim to evaluate the efficacy and the safety of coiling with balloon remodelling for the treatment of ruptured aneurysms in comparison to coiling performed without such coadjutant techniques. Furthermore, we reviewed publications reporting on the treatment of ruptured aneurysms in the acute phase with the one of the most recent technologies available nowadays: the flow diverting stent. Looking at the recent literature the results regarding ruptured aneurysms treated with balloon assisted coiling (BAC) have shown an improvement in terms of anatomical results and morbi-mortality rates. Case series of ruptured middle cerebral artery (MCA) aneurysms treated by EVT report results similar to those obtained by surgical clipping. Several articles recently report encouraging results in treating ruptured dissecting and blister aneurysms with flow diverters. Questions regarding the best treatment available for ruptured aneurysms are yet to be answered. Hence there is a need for a subsequent trial aiming to answer these unresolved issues

  4. Endovascular Interventions for the Morbidly Adherent Placenta

    Directory of Open Access Journals (Sweden)

    Claire Kaufman

    2018-05-01

    Full Text Available Morbidly adherent placentas are a spectrum of abnormalities ranging from placental invasion of the myometrium to invasion past the myometrium and muscular layers into adjacent structures. This entity is becoming more prevalent recently with increased number of cesarean deliveries. Given the high risk of morbidity and mortality, this was traditionally treated with pre-term planned cesarean hysterectomy. However, recently, uterine preservation techniques have been implemented for those women wishing to preserve future fertility or their uterus. Early identification is crucial as studies have shown better outcomes for women treated at tertiary care facilities by a dedicated multidisciplinary team. Interventional radiologists are frequently included in the care of these patients as there are several different endovascular techniques which can be implemented to decrease morbidity in these patients both in conjunction with cesarean hysterectomy and in the setting of uterine preservation. This article will review the spectrum of morbidly adherent placentas, imaging, as well as the surgical and endovascular interventions implemented in the care of these complex patients.

  5. DNA repair

    International Nuclear Information System (INIS)

    Van Zeeland, A.A.

    1984-01-01

    In this chapter a series of DNA repair pathways are discussed which are available to the cell to cope with the problem of DNA damaged by chemical or physical agents. In the case of microorganisms our knowledge about the precise mechanism of each DNA repair pathway and the regulation of it has been improved considerably when mutants deficient in these repair mechanisms became available. In the case of mammalian cells in culture, until recently there were very little repair deficient mutants available, because in almost all mammalian cells in culture at least the diploid number of chromosomes is present. Therefore the frequency of repair deficient mutants in such populations is very low. Nevertheless because replica plating techniques are improving some mutants from Chinese hamsters ovary cells and L5178Y mouse lymphoma cells are now available. In the case of human cells, cultures obtained from patients with certain genetic diseases are available. A number of cells appear to be sensitive to some chemical or physical mutagens. These include cells from patients suffering from xeroderma pigmentosum, Ataxia telangiectasia, Fanconi's anemia, Cockayne's syndrome. However, only in the case of xeroderma pigmentosum cells, has the sensitivity to ultraviolet light been clearly correlated with a deficiency in excision repair of pyrimidine dimers. Furthermore the work with strains obtained from biopsies from man is difficult because these cells generally have low cloning efficiencies and also have a limited lifespan in vitro. It is therefore very important that more repair deficient mutants will become available from established cell lines from human or animal origin

  6. Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Larry E. Miller

    2012-01-01

    Full Text Available Blunt thoracic aortic injury (BTAI is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology VOMIT.

  7. Acute Symptomatic Abdominal Aortic Aneurysm Secondary to Endovascular Stent Graft Associated Type II Endoleak

    Directory of Open Access Journals (Sweden)

    Karen Ka Leung Chan

    2006-07-01

    Full Text Available Endovascular abdominal aneurysm repair (EVAR is popular because of its low invasiveness and feasibility for high-risk patients. Endoleak is common after EVAR and is characterized by blood flow within the aneurysm sac but outside the stent graft. Type II or collateral endoleak commonly results from retrograde filling of the aneurysm from collateral visceral vessels, lumbar, inferior mesenteric, accessory renal or sacral arteries. Collateral leaks are generally thought to be benign and over half of the early leaks will seal spontaneously. Sporadically, collateral endoleak could lead to aneurysm sac pressurization and place the patient at ongoing risk of rupture. Herein, we report an uncommon case of early post-stent graft placement symptomatic abdominal aortic aneurysm associated with type II endoleak.

  8. Endovascular treatment of thoracic aortic pseudoaneurysm due to brucellosis: a rare case report.

    Science.gov (United States)

    Wang, Shuai; Wang, Qi; Liu, Han; Sun, Siqiao; Sun, Xiwei; Zhang, Yang; Wang, Zhongying; Cheng, Zhihua

    2017-06-02

    Arterial damage is a known complication of brucellosis, but the occurrence of a thoracic aortic pseudoaneurysm secondary to brucellosis has not been previously reported. A 65-year-old Chinese man presented with a pseudoaneurysm in the descending segment of the thoracic aorta that caused symptoms of chest pain and intermittent fever. He was diagnosed with a thoracic aortic pseudoaneurysm secondary to brucellosis based on a positive brucella serology test (standard-tube agglutination test) and imaging examination (computed tomography angiography). Anti-brucellosis treatment and covered stent graft implantation were attempted to eliminate the brucellosis and pseudoaneurysm, respectively, and were ultimately successful, with no symptoms after 6 months of follow-up. Endovascular repair may be effective and safe for treating a thoracic aortic pseudoaneurysm resulting from brucellosis.

  9. Standards for Endovascular Neurosurgical Training and Certification of the Society of Korean Endovascular Neurosurgeons 2013

    Science.gov (United States)

    Shin, Dong-Seong; Park, Sukh-Que; Kang, Hyun-Seung; Yoon, Seok-Mann; Cho, Jae-Hoon; Lim, Dong-Jun; Baik, Min-Woo; Kwon, O Ki

    2014-01-01

    The need for standard endovascular neurosurgical (ENS) training programs and certification in Korea cannot be overlooked due to the increasing number of ENS specialists and the expanding ENS field. The Society of Korean Endovascular Neurosurgeons (SKEN) Certification Committee has prepared training programs and certification since 2010, and the first certificates were issued in 2013. A task force team (TFT) was organized in August 2010 to develop training programs and certification. TFT members researched programs and systems in other countries to develop a program that best suited Korea. After 2 years, a rough draft of the ENS training and certification regulations were prepared, and the standard training program title was decided. The SKEN Certification Committee made an official announcement about the certification program in March 2013. The final certification regulations comprised three major parts: certified endovascular neurosurgeons (EN), certified ENS institutions, and certified ENS training institutions. Applications have been evaluated and the results were announced in June 2013 as follows: 126 members received EN certification and 55 hospitals became ENS-certified institutions. The SKEN has established standard ENS training programs together with a certification system, and it is expected that they will advance the field of ENS to enhance public health and safety in Korea. PMID:24851145

  10. Endovascular Treatment of Descending Thoracic Aortic Aneurysms with the EndoFit Stent-Graft

    International Nuclear Information System (INIS)

    Saratzis, N.; Saratzis, Athanasios; Melas, N.; Ginis, G.; Lioupis, A.; Lykopoulos, D.; Lazaridis, J.; Kiskinis, Dimitrios

    2007-01-01

    Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endografts were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising

  11. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    Energy Technology Data Exchange (ETDEWEB)

    Choi, You Ri; Chang, Nam Kyu [Chonnam National University Hwasun Hospital, Hwasun (Korea, Republic of); Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young [Chonnam National University Hospital, Gwangju (Korea, Republic of); Yim, Nam Yeol [Armed Forces Yangju Hospital, Yangju (Korea, Republic of)

    2010-08-15

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  12. Endovascular Exclusion of an Abdominal Aortic Aneurysm in Patients with Concomitant Abdominal Malignancy: Early Experience

    International Nuclear Information System (INIS)

    Choi, You Ri; Chang, Nam Kyu; Shin, Hyo Hyun; Oh, Hyun Jun; Kim, Jae Kyu; Choi, Soo Jin Na; Chung, Sang Young; Yim, Nam Yeol

    2010-01-01

    To assess the outcomes of endovascular aortic aneurysm repair (EVAR) for the treatment of an abdominal aortic aneurysm in patients undergoing curative surgical treatment for concomitant abdominal malignancy. The study included 12 patients with abdominal neoplasia and an abdominal aortic aneurysm (AAA), which was treated by surgery and stent EVAR. The neoplasm consisted of the gastric, colorectal, pancreas, prostate, and gall bladder. The follow up period was 3-21 months (mean 11.8 months). All medical records and imaging analyses were reviewed by CTA and/or color Doppler US, retrospectively. Successful endoluminal repair was accomplished in all twelve patients. The mean interval time between EVAR and surgery was 58.6 days. Small amounts of type 2 endoleaks were detected in two patients (17%). One patient developed adult respiratory distress syndrome after Whipple's operation 20 days after surgery, which led to hopeless discharge. No procedure-related mortality, morbidity, or graft-related infection was noted. Exclusion of AAA in patients with accompanying malignancy show with a relatively low procedure morbidity and mortality. Hence, endoluminal AAA repair in patients with synchronous neoplasia may allow greater flexibility in the management of an offending malignancy

  13. Mortality within the endovascular treatment in Stanford type B aortic dissections Mortalidade no tratamento endovascular nas dissecções aórticas tipo B

    Directory of Open Access Journals (Sweden)

    Alexandre Fioranelli

    2011-06-01

    Full Text Available BACKGROUND: Endovascular stent-graft repair of aortic dissections is a relatively new procedure, and although apparently less invasive, the efficacy and safety of this technique have not been fully established. OBJECTIVE: To evaluate mortality in patients with complicated Stanford type B aortic dissections submitted to endovascular treatment. METHODS: Clinical, anatomical, imaging and autopsy data of 23 patients with complicated type B aortic dissections were reviewed from November 2004 to October 2007. The main indications for transluminal thoracic stent-grafting included: persistent pain in spite of medical therapy, signs of distal limb ischemia, signs of aortic rupture, progression of aneurismal dilation of the descending aorta during follow-up (defined as a diameter > 50 mm and the diameter of descending thoracic aorta of 40mm or larger at the onset of aortic dissection. Data were analyzed statistically; all p-values were two-tailed and differences INTRODUÇÃO: O tratamento endovascular na dissecção de aorta é um procedimento relativamente novo e, embora aparentemente menos invasivo, a eficácia e a segurança dessa técnica não estão totalmente estabelecidas. OBJETIVO: Avaliar a mortalidade e complicações nos pacientes submetidos a tratamento endovascular na dissecção de aorta tipo B de Stanford. MÉTODOS: Foram revisados, a partir de novembro de 2004 a outubro de 2007, em estudo clínico, anatômico, de imagens e dados da autopsia de 23 pacientes com dissecção aórtica tipo B. As principais indicações para o procedimento foram: dor persistente apesar da terapia médica, sinais de isquemia distal do membro, sinais de ruptura da aorta, progressão da dilatação do aneurisma da aorta descendente, durante o seguimento (definida como um diâmetro > 5 cm e descendente da aorta torácica de 40 mm ou mais de diâmetro no início da dissecção aórtica. Os dados foram analisados estatisticamente considerados erro alfa de 5%. As vari

  14. Endovascular treatment of a true posterior communicating artery aneurysm.

    Science.gov (United States)

    Munarriz, Pablo M; Castaño-Leon, Ana M; Cepeda, Santiago; Campollo, Jorge; Alén, Jose F; Lagares, Alfonso

    2014-01-01

    Posterior communicating artery (PCoA) aneurysms are most commonly located at the junction of the internal carotid artery and the PCoA. "True" PCoA aneurysms, which originate from the PCoA itself, are rarely encountered. Most previously reported cases were treated surgically mainly before the endovascular option became available. A 53-year-old male presented with sudden onset of right hemiparesis and aphasia. Left middle cerebral artery stroke was diagnosed. Further studies revealed a 3 mm left PCoA aneurysm arising from the PCoA itself, attached to neither the internal carotid artery nor the posterior cerebral artery. Endovascular treatment was performed and the aneurysm was coiled completely. Technical advances in endovascular interventional technology have permitted an additional approach to these lesions. The possible endovascular significance of the treatment of true PCoA aneurysms is discussed.

  15. Endovascular Management of Vascular Injury during Transsphenoidal Surgery

    OpenAIRE

    Çinar, C.; Bozkaya, H.; Parildar, M.; Oran, I.

    2013-01-01

    Vascular injury is an unusual and serious complication of transsphenoidal surgery. We aimed to define the role of angiography and endovascular treatment in patients with vascular injuries occurring during transsphenoidal surgery.

  16. The importance of expert feedback during endovascular simulator training.

    LENUS (Irish Health Repository)

    Boyle, Emily

    2011-07-01

    Complex endovascular skills are difficult to obtain in the clinical environment. Virtual reality (VR) simulator training is a valuable addition to current training curricula, but is there a benefit in the absence of expert trainers?

  17. Hepatic vascular injury: Clinical profile, endovascular management and outcomes

    Directory of Open Access Journals (Sweden)

    Bishav Mohan

    2013-01-01

    Conclusion: Prompt endovascular management is the modality of choice in comparison to NOM without AE in both pediatric and adult patients with hemodynamically compromised inaccessible intra hepatic vascular trauma.

  18. Modern radiosurgical and endovascular classification schemes for brain arteriovenous malformations.

    Science.gov (United States)

    Tayebi Meybodi, Ali; Lawton, Michael T

    2018-05-04

    Stereotactic radiosurgery (SRS) and endovascular techniques are commonly used for treating brain arteriovenous malformations (bAVMs). They are usually used as ancillary techniques to microsurgery but may also be used as solitary treatment options. Careful patient selection requires a clear estimate of the treatment efficacy and complication rates for the individual patient. As such, classification schemes are an essential part of patient selection paradigm for each treatment modality. While the Spetzler-Martin grading system and its subsequent modifications are commonly used for microsurgical outcome prediction for bAVMs, the same system(s) may not be easily applicable to SRS and endovascular therapy. Several radiosurgical- and endovascular-based grading scales have been proposed for bAVMs. However, a comprehensive review of these systems including a discussion on their relative advantages and disadvantages is missing. This paper is dedicated to modern classification schemes designed for SRS and endovascular techniques.

  19. Construct canine intracranial aneurysm model by endovascular technique

    International Nuclear Information System (INIS)

    Liang Xiaodong; Liu Yizhi; Ni Caifang; Ding Yi

    2004-01-01

    Objective: To construct canine bifurcation aneurysms suitable for evaluating the exploration of endovascular devices for interventional therapy by endovascular technique. Methods: The right common carotid artery of six dogs was expanded with a pliable balloon by means of endovascular technique, then embolization with detached balloon was taken at their originations DAS examination were performed on 1, 2, 3 d after the procedurse. Results: 6 aneurysm models were created in six dogs successfully with the mean width and height of the aneurysms decreasing in 3 days. Conclusions: This canine aneurysm model presents the virtue in the size and shape of human cerebral bifurcation saccular aneurysms on DSA image, suitable for developing the exploration of endovascular devices for aneurismal therapy. The procedure is quick, reliable and reproducible. (authors)

  20. Patterns in neurosurgical adverse events: endovascular neurosurgery.

    Science.gov (United States)

    Wong, Judith M; Ziewacz, John E; Panchmatia, Jaykar R; Bader, Angela M; Pandey, Aditya S; Thompson, B Gregory; Frerichs, Kai; Gawande, Atul A

    2012-11-01

    As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in endovascular neurosurgery concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice. Based on a review of the literature, thromboembolic events appeared to be the most common adverse events in endovascular neurosurgery, with a reported incidence ranging from 2% to 61% depending on aneurysm rupture status and mode of detection of the event. Intraprocedural and periprocedural prevention and rescue regimens are advocated to minimize this risk; however, evidence on the optimal use of anticoagulant and antithrombotic agents is limited. Furthermore, it is unknown what proportion of eligible patients receive any prophylactic treatment. Groin-site hematoma is the most common access-related complication. Data from the cardiac literature indicate an overall incidence of 9% to 32%, but data specific to neuroendovascular therapy are scant. Manual compression, compression adjuncts, and closure devices are used with varying rates of success, but no standardized protocols have been tested on a broad scale. Contrast-induced nephropathy is one of the more common causes of hospital-acquired renal insufficiency, with an incidence of 30% in high-risk patients after contrast administration. Evidence from medical fields supports the use of various preventive strategies. Intraprocedural vessel rupture is infrequent, with the reported incidence ranging from 1% to 9%, but it is potentially devastating. Improvements in device technology combined with proper endovascular technique play an important role in reducing

  1. Complications in Endovascular Neurosurgery: Critical Analysis and Classification.

    Science.gov (United States)

    Ravindra, Vijay M; Mazur, Marcus D; Park, Min S; Kilburg, Craig; Moran, Christopher J; Hardman, Rulon L; Couldwell, William T; Taussky, Philipp

    2016-11-01

    Precisely defining complications, which are used to measure overall quality, is necessary for critical review of delivery of care and quality improvement in endovascular neurosurgery, which lacks common definitions for complications. Furthermore, in endovascular interventions, events that may be labeled complications may not always negatively affect outcome. Our objective is to provide precise definitions for quality evaluation within endovascular neurosurgery. Thus, we propose an endovascular-specific classification system of complications based on our own patient series. This single-center review included all patients who had endovascular interventions from September 2013 to August 2015. Complication types were analyzed, and a descriptive analysis was undertaken to calculate the incidence of complications overall and in each category. Two hundred and seventy-five endovascular interventions were performed in 245 patients (65% female; mean age, 55 years). Forty complications occurred in 39 patients (15%), most commonly during treatment of intracranial aneurysms (24/40). Mechanical complications (eg, device deployment, catheter, or closure device failure) occurred in 8/40, technical complications (eg, failure to deploy flow diverter, unintended embolization, air emboli, retroperitoneal hemorrhage, dissection) in 11/40, judgment errors (eg, patient or equipment selection) in 9/40, and critical events (eg, groin hematoma, hemorrhagic or thromboembolic complications) in 12/40 patients. Only 12/40 complications (30%) resulted in new neurologic deficits, vessel injury requiring surgery, or blood transfusion. We propose an endovascular-specific classification system of complications with 4 categories: mechanical, technical, judgment errors, and critical events. This system provides a framework for future studies and quality control in endovascular neurosurgery. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Early endovascular treatment of superior mesenteric occlusion secondary to thromboemboli.

    Science.gov (United States)

    Jia, Z; Jiang, G; Tian, F; Zhao, J; Li, S; Wang, K; Wang, Y; Jiang, L; Wang, W

    2014-02-01

    To evaluate our early experience with endovascular revascularization in patients with acute thromboembolic occlusion of the superior mesenteric artery (SMA). A retrospective review was conducted of all patients who underwent endovascular revascularization for acute thromboembolic SMA occlusion from May 2005 to May 2012. Endovascular revascularization was performed using aspiration, intra-arterial thrombolysis, and adjunctive stent-placement techniques. Laparotomy was performed if the patient developed clinical signs of advanced bowel ischemia after endovascular procedure. Twenty-one patients underwent endovascular revascularization for acute thromboembolic SMA occlusion. All presented with acute-onset abdominal pain. Three patients had rebound tenderness before the procedure. Computed tomography angiography revealed complete occlusion in seven cases and incomplete occlusion in 14 cases, with no evidence of free gas or bowel necrosis. The median duration from onset of symptoms to revascularization was 8.7 ± 4.1 hours (range, 2-18 hours). Completely successful endovascular revascularization occurred in six cases (aspiration alone, 3 cases; combined aspiration and urokinase, 3 cases); partial success was achieved in 15 cases (aspiration alone, 4 cases; combined aspiration and urokinase, 10 cases; and combined aspiration, urokinase, and stent placement, 1 case). Laparotomy was required in five patients, all of whom had SMA main trunk complete occlusion and required small bowel resection. The 30-day mortality for all patients was 9.5%. During a median follow-up of 26 months, 15 patients remained asymptomatic, three patients reported occasional abdominal pain, and one patient had temporary short-bowel syndrome. Percutaneous revascularization is a promising alternative to surgery for acute SMA occlusion in selected patients who have no signs of advanced bowel ischemia. Early diagnosis followed by prompt endovascular intervention with close postprocedural monitoring is

  3. Endovascular image-guided interventions (EIGIs)

    International Nuclear Information System (INIS)

    Rudin, Stephen; Bednarek, Daniel R.; Hoffmann, Kenneth R.

    2008-01-01

    Minimally invasive interventions are rapidly replacing invasive surgical procedures for the most prevalent human disease conditions. X-ray image-guided interventions carried out using the insertion and navigation of catheters through the vasculature are increasing in number and sophistication. In this article, we offer our vision for the future of this dynamic field of endovascular image-guided interventions in the form of predictions about (1) improvements in high-resolution detectors for more accurate guidance, (2) the implementation of high-resolution region of interest computed tomography for evaluation and planning, (3) the implementation of dose tracking systems to control patient radiation risk, (4) the development of increasingly sophisticated interventional devices, (5) the use of quantitative treatment planning with patient-specific computer fluid dynamic simulations, and (6) the new expanding role of the medical physicist. We discuss how we envision our predictions will come to fruition and result in the universal goal of improved patient care.

  4. Endovascular management of delayed post-pancreatectomy haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Pottier, Edwige [Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Department of Radiology, Clichy, Hauts-de-Seine (France); Ronot, Maxime; Vilgrain, Valerie [Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Department of Radiology, Clichy, Hauts-de-Seine (France); University Paris Diderot, Paris (France); INSERM U1149, centre de recherche biomedicale Bichat-Beaujon, CRB3, Paris (France); Gaujoux, Sebastien; Cesaretti, Manuela; Barbier, Louise [APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Department of Surgery, Clichy, Hauts-de-Seine (France); Sauvanet, Alain [University Paris Diderot, Paris (France); APHP, University Hospitals Paris Nord Val de Seine, Beaujon, Department of Surgery, Clichy, Hauts-de-Seine (France)

    2016-10-15

    To assess the patient outcome after endovascular treatment of delayed post-pancreatectomy haemorrhage (PPH) as first-line treatment. Between January 2005 and November 2013, all consecutive patients referred for endovascular treatment of PPH were included. Active bleeding, pseudoaneurysms, collections and the involved artery were recorded on pretreatment CT. Endovascular procedures were classified as technical success (source of bleeding identified on angiogram and treated), technical failure (source of bleeding identified but incompletely treated) and abstention (no abnormality identified, no treatment performed). Factors associated with rebleeding were analysed. Sixty-nine patients (53 men) were included (mean 59 years old (32-75)). Pretreatment CT showed 27 (39 %) active bleeding. In 22 (32 %) cases, no involved artery was identified. Technical success, failure and abstention were observed in 48 (70 %), 9 (13 %) and 12 patients (17 %), respectively. Thirty patients (43 %) experienced rebleeding. Rebleeding rates were 29 %, 58 % and 100 % in case of success, abstention and failure (p < 0.001). Treatment failure/abstention was the only factor associated with rebleeding. Overall, 74 % of the patients were successfully treated by endovascular procedure(s) alone. After a first endovascular procedure for PPH, the rebleeding rate is high and depends upon the success of the procedure. Most patients are successfully treated by endovascular approach(es) alone. (orig.)

  5. Endovascular management of delayed post-pancreatectomy haemorrhage

    International Nuclear Information System (INIS)

    Pottier, Edwige; Ronot, Maxime; Vilgrain, Valerie; Gaujoux, Sebastien; Cesaretti, Manuela; Barbier, Louise; Sauvanet, Alain

    2016-01-01

    To assess the patient outcome after endovascular treatment of delayed post-pancreatectomy haemorrhage (PPH) as first-line treatment. Between January 2005 and November 2013, all consecutive patients referred for endovascular treatment of PPH were included. Active bleeding, pseudoaneurysms, collections and the involved artery were recorded on pretreatment CT. Endovascular procedures were classified as technical success (source of bleeding identified on angiogram and treated), technical failure (source of bleeding identified but incompletely treated) and abstention (no abnormality identified, no treatment performed). Factors associated with rebleeding were analysed. Sixty-nine patients (53 men) were included (mean 59 years old (32-75)). Pretreatment CT showed 27 (39 %) active bleeding. In 22 (32 %) cases, no involved artery was identified. Technical success, failure and abstention were observed in 48 (70 %), 9 (13 %) and 12 patients (17 %), respectively. Thirty patients (43 %) experienced rebleeding. Rebleeding rates were 29 %, 58 % and 100 % in case of success, abstention and failure (p < 0.001). Treatment failure/abstention was the only factor associated with rebleeding. Overall, 74 % of the patients were successfully treated by endovascular procedure(s) alone. After a first endovascular procedure for PPH, the rebleeding rate is high and depends upon the success of the procedure. Most patients are successfully treated by endovascular approach(es) alone. (orig.)

  6. Repair process and a repaired component

    Energy Technology Data Exchange (ETDEWEB)

    Roberts, III, Herbert Chidsey; Simpson, Stanley F.

    2018-02-20

    Matrix composite component repair processes are disclosed. The matrix composite repair process includes applying a repair material to a matrix composite component, securing the repair material to the matrix composite component with an external securing mechanism and curing the repair material to bond the repair material to the matrix composite component during the securing by the external securing mechanism. The matrix composite component is selected from the group consisting of a ceramic matrix composite, a polymer matrix composite, and a metal matrix composite. In another embodiment, the repair process includes applying a partially-cured repair material to a matrix composite component, and curing the repair material to bond the repair material to the matrix composite component, an external securing mechanism securing the repair material throughout a curing period, In another embodiment, the external securing mechanism is consumed or decomposed during the repair process.

  7. Motorcycle Repair.

    Science.gov (United States)

    Hein, Jim; Bundy, Mike

    This motorcycle repair curriculum guide contains the following ten areas of study: brake systems, clutches, constant mesh transmissions, final drives, suspension, mechanical starting mechanisms, electrical systems, fuel systems, lubrication systems, and overhead camshafts. Each area consists of one or more units of instruction. Each instructional…

  8. Resuscitative endovascular balloon occlusion of the aorta with a low profile, wire free device: A game changer?

    Directory of Open Access Journals (Sweden)

    James N. Bogert

    2017-02-01

    Full Text Available A 24 year old male arrived to our hospital after a motor cycle crash with evidence of a traumatic brain injury and in hemorrhagic shock not responsive to volume administration. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA was performed in a timely fashion using a new, low profile, wire free device. This lead to rapid reversal of hypotension while his bleeding source was sought and controlled.Recently, REBOA has emerged as an adjunct in the hypotensive trauma patient with noncompressible torso hemorrhage. As first described, this procedure makes use of commonly available vascular surgery and endovascular products requiring large introducer sheaths (12–14 French and long guidewires. Concerns regarding this technique center around the safety and feasibility of using such equipment in the emergency setting outside an angiography suite. This has likely limited widespread adoption of this technique. To address these concerns, newer products designed to be placed through a smaller sheath (7 French and without the use of guidewires have been developed. Here we report on our first clinical use of such a device that we believe represents a significant advance in the care of the trauma patient. Keywords: REBOA, Resuscitation, Hemorrhage, Endovascular

  9. Turbine repair process, repaired coating, and repaired turbine component

    Science.gov (United States)

    Das, Rupak; Delvaux, John McConnell; Garcia-Crespo, Andres Jose

    2015-11-03

    A turbine repair process, a repaired coating, and a repaired turbine component are disclosed. The turbine repair process includes providing a turbine component having a higher-pressure region and a lower-pressure region, introducing particles into the higher-pressure region, and at least partially repairing an opening between the higher-pressure region and the lower-pressure region with at least one of the particles to form a repaired turbine component. The repaired coating includes a silicon material, a ceramic matrix composite material, and a repaired region having the silicon material deposited on and surrounded by the ceramic matrix composite material. The repaired turbine component a ceramic matrix composite layer and a repaired region having silicon material deposited on and surrounded by the ceramic matrix composite material.

  10. Endovascular treatment of radiation-induced carotid blowout syndrome. Report of two cases

    International Nuclear Information System (INIS)

    Adachi, Akihiko; Kobayashi, Eiichi; Watanabe, Yoshiyuki; Yoneyama, Tomoko S.; Hayasaka, Michihiro; Suzuki, Homare; Okamoto, Yoshitaka; Saeki, Naokatsu

    2011-01-01

    Carotid Blowout Syndrome (CBS), or Carotid Artery Rupture (CAR), is a delayed complication with potentially fatal consequences occurring after the implementation of radiotherapy on head and neck tumors. In this report we describe two patients received endovascular treatment for severe hemorrhagic CBS developing 36 and 2 years, respectively, after radiotherapy. Both patients survived and responded positively to treatment. Case 1 was an 80-year-old woman found with minor hemorrhage near the bifurcation of the common carotid artery, 36 years after neck irradiation. She experienced frequent hemorrhagic events during the following years. Six years after the initial discovery of bleeding, she experienced massive hemorrhage, lapsed into shock, and was admitted to an Emergency Room. Connective tissue around the carotid artery was largely exposed due to neck skin defect. After hemorrhage was halted by manual compression, transient hemostasis was achieved with coil embolization of the aneurysm presumed to be the source of bleeding. Recurrent hemorrhage developed two weeks later with unraveled coil mass extrusion. Parent artery occlusion was performed by endovascular trapping, achieving permanent hemostasis. Case 2 presented massive nasal bleeding originating from the petrous segment of the internal carotid artery, 2 years after having been treated with heavy particle irradiation for olfactory neuroblastoma. Ischemic tolerance was confirmed by balloon occlusion test. Based on previous experiences, the bleeding was immediately halted by endovascular trapping. Both patients were subsequently discharged, free of new neurological symptoms. Emergent hemostatic treatment is required in CBS developing severe hemorrhage. However, within irradiation fields, temporal embolization devices hardly lead to complete resolution. This is due to the deteriorated condition of the vascular wall incapable to enduring the expansion power of coils, stents or balloons. Bypass grafting is also

  11. Early experience with transfemoral endovascular aneurysm management (TEAM) in the treatment of aortic aneurysms

    NARCIS (Netherlands)

    Balm, R.; Eikelboom, B. C.; May, J.; Bell, P. R.; Swedenborg, J.; Collin, J.

    1996-01-01

    OBJECTIVES: To evaluate the early experience with transfemoral endovascular aortic aneurysm management using the Endovascular Grafting System. DESIGN: Multi-centre prospective evaluation of the implantation procedure and early results (median follow-up 153 days). SETTING: Department of Surgery,

  12. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Sandermann, Jes; Bruun-Petersen, J

    1998-01-01

    The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits....

  13. Causes and Implications of Readmission after Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Greenblatt, David Yu; Greenberg, Caprice C.; Kind, Amy J.H.; Havlena, Jeffrey A.; Mell, Matthew W.; Nelson, Matthew T.; Smith, Maureen A.; Kent, K. Craig

    2012-01-01

    Objective To determine the frequency, causes, predictors, and consequences of 30-day readmission after abdominal aortic aneurysm (AAA) repair. Summary Background Data CMS will soon reduce total Medicare reimbursements for hospitals with higher-than-predicted 30-day readmission rates after vascular surgical procedures including AAA repair. However, causes and factors leading to readmission in this population have never before been systematically analyzed. Methods We analyzed elective AAA repairs over a two-year period from the CMS Chronic Conditions Warehouse, a 5% national sample of Medicare beneficiaries. Results 2481 patients underwent AAA repair – 1502 endovascular (EVAR) and 979 open. 30-day readmission rates were equivalent for EVAR (13.3%) and open repair (12.8%). While wound complication was the most common reason for readmission after both procedures, the relative frequency of other causes differed – e.g., bowel obstruction was common following open repair and graft complication after EVAR. In multivariate analyses, preoperative comorbidities had a modest effect on readmission; however, postoperative factors including serious complications leading to prolonged length of stay and discharge destination other than home had a profound influence on the probability of readmission. The one-year mortality in readmitted patients was 23.4% versus 4.5% in those not readmitted (preadmission is common after AAA repair. Adjusting for comorbidities, postoperative events predict readmission, suggesting that proactively preventing, detecting, and managing postoperative complications may provide an approach to decreasing readmissions, with the potential to reduce cost and possibly enhance long-term survival. PMID:22964736

  14. Endovascular treatment of head and neck arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Dmytriw, A.A. [University Health Network, Joint Department of Medical Imaging, Toronto, Ontario (Canada); Ter Brugge, K.G.; Krings, T.; Agid, R. [Toronto Western Hospital, Division of Neuroradiology, Department of Medical Imaging, Toronto, Ontario (Canada)

    2014-03-15

    Head and neck arteriovenous malformations (H and N AVM) are associated with considerable clinical and psychosocial burden and present a significant treatment challenge. We evaluated the presentation, response to treatment, and outcome of patients with H and N AVMs treated by endovascular means at our institution. Patients with H and N AVMs treated by endovascular means from 1984 to 2012 were evaluated retrospectively. These included AVMs involving the scalp, orbit, maxillofacial, and upper neck localizations. Patient's clinical files, radiological images, catheter angiograms, and surgical reports were reviewed. Eighty-nine patients with H and N AVMs (46 females, 43 males; 48 small, 41 large) received endovascular therapy. The goals of treatment were curative (n = 30), palliative (n = 34), or presurgical (n = 25). The total number of endovascular treatment sessions was 244 (average of 1.5 per patient). The goal of treatment was met in 92.1 % of cases. Eventual cure was achieved in 42 patients accounting for 58.4 % (52/89) of all patients who underwent treatment for any goal. Twenty-eight of these patients were cured by embolization alone (28/89, 31.4 %) of which 18 were single-hole AVFs. Twenty-four were cured by planned surgical excision after presurgical embolization (24/89, 27 %). Seven patients (7/89, 7.2 %) suffered transient and two (2/89, 2.2 %) permanent endovascular treatment complications. Endovascular treatment is effective for H and N AVMs and relatively safe. It is particularly effective for symptom palliation and presurgical aid. Embolization is curative mostly in small lesions and single-hole fistulas. In patients with large non-curable H and N AVMs, endovascular therapy is often the only palliative option. (orig.)

  15. Endovascular recanalization of native chronic total occlusions in patients with failed lower-extremity bypass grafts.

    Science.gov (United States)

    Wrigley, Clinton W; Vance, Ansar; Niesen, Timothy; Grilli, Christopher; Velez, J Daniel; Agriantonis, Demetrios J; Kimbiris, George; Garcia, Mark J; Leung, Daniel A

    2014-09-01

    To investigate the feasibility, safety, and outcome of endovascular recanalization of native chronic total occlusions (CTOs) in patients with failed lower-extremity bypass grafts. Retrospective review of 19 limbs in 18 patients with failed lower-extremity bypass grafts that underwent recanalization of native arterial occlusions between February 2009 and April 2013 was performed. Nine of the limbs presented with acute ischemia and 10 presented with chronic ischemia, including eight with critical limb ischemia and two with disabling claudication. The mean patency of the failed bypass grafts (63% venous) was 27 months. All limbs had Transatlantic Inter-Society Consensus class D lesions involving the native circulation. Technical success of the endovascular recanalization procedure was achieved in all but one limb (95%). The mean ankle brachial indices before and after treatment were 0.34 and 0.73, respectively. There were no major complications or emergency amputations. Mean patient follow-up was 64 weeks, and two patients were lost to follow-up. Primary patency rates at 3, 6, and 12 months were 87%, 48%, and 16%, respectively. Successful secondary procedures were performed in seven patients, with secondary patency rates at 3, 6, and 12 months of 88%, 73%, and 44%, respectively. Limb salvage rates at 12 and 24 months were 94% and 65%, and amputation-free survival rates at 12 and 24 months were 87% and 60%, respectively. Endovascular recanalization of native CTOs in patients with failed lower-extremity bypass grafts is technically feasible and safe and results in acceptable limb salvage. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.

  16. Endovascular treatment of renal artery stenoses

    International Nuclear Information System (INIS)

    Lashari, M.N.

    2015-01-01

    To evaluate the procedure success and effect on hypertension after stenting of incidentally diagnosed atherosclerotic renal artery stenoses. Study Design: An experimental study. Place and Duration of Study: A multicentric study was conducted at the Plastic Surgery and General Hospital, National Medical Center and Ziauddin University Hospital, Karachi, Pakistan from January 2009 to March 2013. Methodology: Hypertension (systolic blood pressure > 160 and diastolic > 90 mmHg with two or more than two medications) with coronary artery disease were initially evaluated for coronary angiography, Renal artery angiography was also endovascular performed and stent was deployed for atherosclerotic renal artery stenosis when found. Blood pressure readings, reduction in need of antihypertensive medication and serum creatinine levels were taken as outcome measures. Patients having renal artery stenoses secondary to connective tissue disorders and fibromuscular dysplasia were excluded. Results: There were 25 patients, 14 (56%) male and 11 (44%) female, with mean age of 49 +- 6 years. Diabetes mellitus, dyslipidemia and smoking were seen in 11 (44%), 10 (40%) and 4 (16%) patients respectively. Renal insufficiency (serum creatinine > 1.5 mg/dl) was seen in one (04%) patient. Bilateral, and isolated right and left renal artery stenoses was seen in 5 (20%), 9 (36%) and 11(44%) patients respectively. Mean percentage of renal artery stenoses was 89%, ranged from 70% to 99% while ostial lesion was found in 20 (80%) patients. A significant decrease in systolic (168.20 +- 9.987 vs. 140.60 +- 5.649 mmHg, p < 0.001) and diastolic blood pressure (88.60 +- 5.50 vs. 77.20 +- 5.017 mmHg, p < 0.001) and reduction of medication (2.72 +- 0.458 vs. 1.5 +- 0.510, p < 0.01) were noted without a change in renal function (p= 0.061) after renal artery stenting. Conclusion: Endovascular stenting of renal artery stenoses in patients with poorly controlled hypertension is a safe and effective treatment

  17. Open Repair of a 12-cm Posttraumatic Aneurysm of Right Subclavian Artery

    Directory of Open Access Journals (Sweden)

    Konstantinos Tigkiropoulos

    2017-11-01

    Full Text Available PurposeTo present a rare case of a patient with a 12-cm posttraumatic right subclavian artery aneurysm successfully treated with aneurysmectomy and innominate-axillary bypass.Case reportA 54-year-old man presented to the emergency department due to progressive dyspnea and hoarseness of voice. His medical record was unremarkable except that he had right-sided pneumothorax and multiple rib fractures from a car accident 16 years ago. A chest X-ray showed a mass in the upper lobe of the right lung, and the patient was hospitalized for further investigation. A computed tomography (CT with intravenous contrast of the thorax was performed, which depicted a giant aneurysm of the right subclavian artery. Vascular and cardiothoracic surgeons were consulted immediately, and the operation was scheduled. Aneurysmectomy and innominate-axillary bypass were performed. The patient had an uncomplicated progress and was discharged on 5 days followed by a single antiplatelet therapy and symptom-free.ConclusionPosttraumatic subclavian artery aneurysm is a rare entity. Imaging of the thorax is essential for the diagnosis and surgical preparation of the patient. Open repair remains the gold standard therapy for subclavian artery aneurysm despite the improvements in endovascular surgery in such huge aneurysms.

  18. Endovascular treatment of false-aneurysm ten years after dacron patch aortoplasty for coarctation of the aortic isthmus. Report of a case.

    Science.gov (United States)

    Illuminati, Giulio; Pacilè, Maria Antonietta; Palumbo, Piergaspare; Salvatori, Filippo Maria; Vietri, Francesco

    2013-01-01

    False aneurysm degeneration is a known complication of patch aortoplasty for coarctation of the aortic isthmus. Open surgical treatment consists of prosthetic graft repair of the involved aorta, often requires circulatory arrest to achieve a safe proximal aortic control and perform proximal anastomosis, and finally is associated with substantial perioperative morbidity. Endografting of the diseased aorta is a valuable alternative to open repair, when feasible, with good short and long term results. We now report one more case of false aneurysm ten years after Dacron patch aortoplasty for isthmic coarctation in a 26-year-old woman, successfully treated by endovascular repair via the left common iliac artery, and a complete exclusion of the aneurysm at two year follow-up.

  19. Contemporary management of carotid blowout syndrome utilizing endovascular techniques.

    Science.gov (United States)

    Manzoor, Nauman F; Rezaee, Rod P; Ray, Abhishek; Wick, Cameron C; Blackham, Kristine; Stepnick, David; Lavertu, Pierre; Zender, Chad A

    2017-02-01

    To illustrate complex interdisciplinary decision making and the utility of modern endovascular techniques in the management of patients with carotid blowout syndrome (CBS). Retrospective chart review. Patients treated with endovascular strategies and/or surgical modalities were included. Control of hemorrhage, neurological, and survival outcomes were studied. Between 2004 and 2014, 33 patients had 38 hemorrhagic events related to head and neck cancer that were managed with endovascular means. Of these, 23 were localized to the external carotid artery (ECA) branches and five localized to the ECA main trunk; nine were related to the common carotid artery (CCA) or internal carotid artery (ICA), and one event was related to the innominate artery. Seven events related to the CCA/ICA or innominate artery were managed with endovascular sacrifice, whereas three cases were managed with a flow-preserving approach (covered stent). Only one patient developed permanent hemiparesis. In two of the three cases where the flow-preserving approach was used, the covered stent eventually became exposed via the overlying soft tissue defect, and definitive management using carotid revascularization or resection was employed to prevent further hemorrhage. In cases of soft tissue necrosis, vascularized tissues were used to cover the great vessels as applicable. The use of modern endovascular approaches for management of acute CBS yields optimal results and should be employed in a coordinated manner by the head and neck surgeon and the neurointerventionalist. 4. Laryngoscope, 2016 127:383-390, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  20. Endovascular US: Adjunct to percutaneous atherectomy

    International Nuclear Information System (INIS)

    Schwarten, D.E.; Cutcliff, W.B.

    1987-01-01

    Percutaneous atherectomy with the Simpson atherectomy catheter has been performed at our institution since the third quarter of 1986. The first 45 patients underwent atherectomy with fluoroscopic guidance and multiplane documentary arteriography to assess the anatomic appearance of vessels after atherectomy and to assist in judging the completeness of the procedure. Each of the 45 patients underwent repeated cuts on each lesion until no further atheromatous specimens could be removed. Since late 1987, all lesions subjected to atherectomy have also been examined intraprocedure with an intraarterial US probe 0.040 inches in diameter fixed to a 0.040-inch guide wire and covered by a sonolucent radome. The US images were reviewed in real time and permitted much more accurate placement of the atherectomy catheter to effect more complete removal of the atheromatous material. It is anticipated that the use of the endovascular US device to accurately localize residual atheroma will result in more complete removal of atheroma, in turn decreasing the possibility of recurrence

  1. Endovascular vein harvest: systemic carbon dioxide absorption.

    Science.gov (United States)

    Maslow, Andrew M; Schwartz, Carl S; Bert, Arthur; Hurlburt, Peter; Gough, Jeffrey; Stearns, Gary; Singh, Arun K

    2006-06-01

    Endovascular vein harvest (EDVH) requires CO(2) insufflation to expand the subcutaneous space, allowing visualization and dissection of the saphenous vein. The purpose of this study was to assess the extent of CO(2) absorption during EDVH. Prospective observational study. Single tertiary care hospital. Sixty patients (30 EDVH and 30 open-vein harvest) undergoing isolated coronary artery bypass graft surgery. Hemodynamic, procedural, and laboratory data were collected prior to (baseline), during, and at it the conclusion (final) of vein harvesting. Data were also collected during cardiopulmonary bypass (CPB). Data were compared by using t tests, analysis of variance, and correlation statistics when needed. There were significant increases in arterial