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Sample records for endovascular stent-graft management

  1. Endovascular stent-graft management of thoracic aortic diseases

    Energy Technology Data Exchange (ETDEWEB)

    Dake, Michael D. E-mail: mddake@stanford.edu

    2001-07-01

    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.

  2. The midterm experience of tapered stent grafts in the endovascular management of iliac artery aneurysms with unfavorable anatomy.

    Science.gov (United States)

    Aldin, Zaid; Kashef, Elika; Jenkins, Michael; Gibbs, Richard; Wolfe, John; Hamady, Mohamad

    2012-02-01

    We report our experience and the midterm results of a modern technique for endovascular management of isolated iliac artery aneurysms (IAAs) with unfavorable neck anatomy, which involves the inversion of an iliac leg of a Zenith stent graft. Patients who underwent endovascular IAA repair from 2002 to 2010 were reviewed. A total of 12 patients, with a mean age of 77.6 years, underwent endovascular repair of 13 IAAs. Mean size of the aneurysms was 54.6 mm (range 34-133 mm). Mean proximal neck diameter was 18 mm (range 15-22 mm). In 7 patients, the length of the proximal neck was <15 mm (10-14 mm). Only 1 patient developed thrombosis of the stent graft immediately after the operation. Patients were followed up for a mean of 31.5 months (range 18-72 months). Our midterm results demonstrate the durability of this technique in the management of iliac aneurysms with unfavorable anatomy.

  3. CASE REPORT CASE CASE Endovascular stent grafting of ...

    African Journals Online (AJOL)

    Endovascular stent graft repair for the treatment of post-traumatic aortic rupture is emerging as a safe, minimally invasive and attractive alternative to surgery. This report covers the importance of computer tomographic (CT) angiography as a non-invasive imaging modality in the diagnoses of post-traumatic aortic rupture and ...

  4. [Endovascular stent-grafting for mycotic thoracic aortic aneurysm].

    Science.gov (United States)

    Okada, S; Kaneko, T; Ezure, M; Satoh, Y; Hasegawa, Y; Koike, N; Okonogi, S; Takihara, H

    2009-02-01

    We report 3 cases of endovascular stent-grafting (ESG) for mycotic thoracic aortic aneurysm. The case 1 was a rupture of pseudoaneurysm of the descending aorta caused by mediastinitis due to perforation of esophageal ulcer. The patient underwent emergent ESG for temporary control of the rupture. He underwent esophagus reconstruction 5 month after ESG. The case 2 was admitted due to inflammatory reaction. She was diagnosed with mycotic descending aortic aneurysm and underwent elective ESG because of her old age. Her postoperative course was uneventful and no infection recurred. The case 3 underwent ESG for a ruptured mycotic descending aortic aneurysm. But 113 days after ESG, he underwent ESG again for a ruptured endoleak of the stentgraft. His blood culture demonstrated methillin-resistant Staphylococcus aureus (MRSA). He died of rupture to bronchus and esophagus at 18th day after ESG. We believe that ESG is useful in high risk patients for temporary management of the rupture.

  5. Modification of an endovascular stent graft for abdominal aortic aneurysm

    Science.gov (United States)

    Moloye, Olajompo Busola

    Endovascular surgery is currently used to treat abdominal aortic aneurysms (AAA). A stent graft is deployed to exclude blood flow from the aneurysm sac. It is an effective procedure used in preventing aneurysm rupture, with reduced patient morbidity and mortality compared to open surgical repair. Migration and leakage around the device ("endoleak") due to poor sealing of the stent graft to the aorta have raised concerns about the long-term durability of endovascular repair. A preliminary study of cell migration and proliferation is presented as a prelude to a more extensive in vivo testing. A method to enhance the biological seal between the stent graft and the aorta is proposed to eliminate this problem. This can be achieved by impregnating the stent graft with 50/50 poly (DL-lactide co glycolic acid) (PLGA) and growth factors such as basic fibroblast growth factor (bFGF) or connective tissue growth factor (CTGF), at the proximal and distal ends. It is hypothesized that as PLGA degrades it will release the growth factors that will promote proliferation and migration of aortic smooth muscle cells to the coated site, leading to a natural seal between the aorta and the stent graft. In addition, growth factor release should promote smooth muscle cell (SMC) contraction that will help keep the stent graft in place at the proximal and distal ends. It is shown that a statistically significant effect of increased cell proliferation and migration is observed for CTGF release. Less of an effect is noted for bFGF or just the PLGA. The effect is estimated to be large enough to be clinically significant in a future animal study. The long term goal of this study is to reduce migration encounter after graft deployment and to reduce secondary interventions of EVAR especially for older patients who are unfit for open surgical treatment.

  6. Endovascular stent-graft treatment of thoracic aortic syndromes: A 7-year experience

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    Dialetto, Giovanni [Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, V. Monaldi Hospital, Naples (Italy); Reginelli, Alfonso; Cerrato, Marcella [Department of Radiology, Second University of Naples, Naples (Italy); Rossi, Giovanni [Department of Radiology, Monaldi Hospital, Naples (Italy); Covino, Franco Enrico; Manduca, Sabrina [Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, V. Monaldi Hospital, Naples (Italy); Lassandro, Francesco [Department of Radiology, Monaldi Hospital, Naples (Italy)], E-mail: f.lassandro@tiscali.it

    2007-10-15

    Thoracic aortic diseases (TAD) are relatively frequent conditions associated with high mortality. Recently, several reports have demonstrated the safety and efficacy of endovascular stent-graft (EVG) placement for TAD as an alternative to open surgery. We report our experience in management of thoracic aortic syndrome on 56 consecutive patients with TAD that underwent endovascular stent-graft repair. MDCT angiography was used in all patients to provide preprocedure evaluation and measurements. In particular it is necessary to evaluate the proximal and distal landing zones of the stent-graft. All EVGs in our series were placed successfully. Conversion to open surgery was never required. Six patients (10.7%) died early after the stent-graft deployment. During follow-up four more patients died. The endoleak rate was 16.7% (no. 10 pt). We did not observe any case of paraplegia. The present study shows the efficacy of EVG in the long-term follow-up, with an overall survival of 82.1%, which is comparable to that reported in recent studies. In conclusion this technique is emerging as an alternative approach in the treatment of TAD because this approach offers a less invasive therapeutic option to standard surgical techniques, even in patients who have associated diseases that make them poor surgical candidates.

  7. 3D printing guiding stent graft fenestration: A novel technique for fenestration in endovascular aneurysm repair.

    Science.gov (United States)

    Huang, Jianhua; Li, Gan; Wang, Wei; Wu, Keming; Le, Tianming

    2017-08-01

    Objective To describe a novel approach, 3D printing guiding stent graft fenestration, for fenestration during endovascular aneurysm repair for juxtarenal abdominal aortic aneurysm. Methods A 69-year-old male with juxtarenal abdominal aortic aneurysm underwent endovascular aneurysm repair with "off the label" fenestrated stent graft. To precisely locate the fenestration position, we reconstructed a 3D digital abdominal aortic aneurysm model and created a skin template covering this abdominal aortic aneurysm model. Then the skin template was physically printed and the position of the visceral vessel was hollowed out, thereby helping in locating the fenestration on stent graft. Results and conclusions With the help of this 3D printed skin template, we fenestrated the stent graft accurately and rebuilt the bilateral renal artery successfully. This is the first clinical case that used 3D printing guiding stent graft fenestration, which is a novel approach for precise fenestration on stent graft on the table during endovascular aneurysm repair.

  8. Transluminal endovascular stent-graft for the treatment of aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Do Yun; Chang, Byung Chul; Shim, Won Heum; Cho, Seung Yun; Chung, Nam Sik; Kwon, Hyuk Moon; Lee, Young Joon; Lee, Jong Tae [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1995-09-15

    The standard treatment for aortic aneurysms is surgical replacement with a prosthetic graft. Currently there is great interest in endoluminal intervention for treatment of aortic aneurysm. The purpose of this study was to evaluate the safety and effectiveness of endoluminally placed Stent-graft for the treatment of aortic aneurysms. Transluminal endovascular Stent-graft placements were attempted in 9 patients with infra-renal aortic aneurysms(n 6), thoracic aortic aneurysm(n = 1), and aortic dissection(n = 2). The endovascular Stent-grafts were custom-designed for each patient and were constructed of self-expandable modified Gianturco Stents covered with polytetrafluroethylene. The Stent-grafts were introduced through a 16-18 French sheath and expanded to 17-30 mm in diameter. The endovascular therapy was performed using a common femoral artery cutdown with local anesthesia. The endovascular Stent-graft deployment was achieved in 7 of 9 patients. Two cases failed deployment of the Stent-graft due to iliac artery stenosis and tortousity. There were complete thrombosis of the thoracic and infra-renal aortic aneurysm surround the Stent-graft in 3 patients, and persistent leak with partial thrombosis in 2. Two patients with aortic dissection were successfully treated by obliteration of entry tears. There were no major complication associated with Stent-graft placement. These preliminary results show that transluminal endovascular Stent-grafts offer great promise and good results. Further investigation is needed to establish its long-term safety and efficacy.

  9. Long-term Results of Endovascular Stent Graft Placement of Ureteroarterial Fistula

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    Okada, Takuya, E-mail: okabone@gmail.com; Yamaguchi, Masato, E-mail: masato03310402@yahoo.co.jp [Kobe University Hospital, Department of Radiology (Japan); Muradi, Akhmadu, E-mail: muradiakhmadu@gmail.com; Nomura, Yoshikatsu, E-mail: y_katsu1027@yahoo.co.jp [Kobe University Hospital, Center for Endovascular Therapy (Japan); Uotani, Kensuke, E-mail: uotani@tenriyorozu.jp [Tenri Hospital, Department of Radiology (Japan); Idoguchi, Koji, E-mail: idoguchi@ares.eonet.ne.jp [Kobe University Hospital, Center for Endovascular Therapy (Japan); Miyamoto, Naokazu, E-mail: naoka_zu@yahoo.co.jp; Kawasaki, Ryota, E-mail: kawaryo1999@yahoo.co.jp [Hyogo Brain and Heart Center at Himeji, Department of Radiology (Japan); Taniguchi, Takanori, E-mail: tan9523929@yahoo.co.jp [Tenri Hospital, Department of Radiology (Japan); Okita, Yutaka, E-mail: yokita@med.kobe-u.ac.jp [Kobe University Hospital, Department of Cardiovascular Surgery (Japan); Sugimoto, Koji, E-mail: kojirad@med.kobe-u.ac.jp [Kobe University Hospital, Department of Radiology (Japan)

    2013-08-01

    PurposeTo evaluate the safety, efficacy, and long-term results of endovascular stent graft placement for ureteroarterial fistula (UAF).MethodsWe retrospectively analyzed stent graft placement for UAF performed at our institution from 2004 to 2012. Fistula location was assessed by contrast-enhanced computed tomography (CT) and angiography, and freedom from hematuria recurrence and mortality rates were estimated.ResultsStent graft placement for 11 UAFs was performed (4 men, mean age 72.8 {+-} 11.6 years). Some risk factors were present, including long-term ureteral stenting in 10 (91 %), pelvic surgery in 8 (73 %), and pelvic radiation in 5 (45 %). Contrast-enhanced CT and/or angiography revealed fistula or encasement of the artery in 6 cases (55 %). In the remaining 5 (45 %), angiography revealed no abnormality, and the suspected fistula site was at the crossing area between urinary tract and artery. All procedures were successful. However, one patient died of urosepsis 37 days after the procedure. At a mean follow-up of 548 (range 35-1,386) days, 4 patients (36 %) had recurrent hematuria, and two of them underwent additional treatment with secondary stent graft placement and surgical reconstruction. The hematuria recurrence-free rates at 1 and 2 years were 76.2 and 40.6 %, respectively. The freedom from UAF-related and overall mortality rates at 2 years were 85.7 and 54.9 %, respectively.ConclusionEndovascular stent graft placement for UAF is a safe and effective method to manage acute events. However, the hematuria recurrence rate remains high. A further study of long-term results in larger number of patients is necessary.

  10. Endovascular treatment of isolated common iliac artery aneurysms with short necks using bifurcated stent-grafts.

    Science.gov (United States)

    Wi, Jin; Ko, Young-Guk; Kim, Jung-Sun; Choi, Donghoon; Hong, Myeong-Ki; Lee, Do-Youn; Jang, Yangsoo; Shim, Won-Heum

    2010-07-01

    Elective surgical repair has traditionally been considered to be the treatment of choice for the exclusion of isolated iliac artery aneurysms (IAAs). Recently, endovascular repair has evolved as an alternative to surgical repair, especially in patients at high surgical risk. However, in the absence of sufficient proximal necks, iliac artery aneurysms are not suitable for direct deployment of a tubular-shaped endograft. Here we report two cases of IAAs with short proximal necks that were excluded using an endovascular bifurcated stent-graft. The bifurcated stent-graft was successfully deployed with complete exclusion of the aneurysm. In neither case was there evidence of procedural failures. There were no signs of significant complications. We conclude that endovascular repair of IAAs with short proximal necks is feasible and efficient using an endovascular bifurcated stent-graft.

  11. Endovascular treatment of isolated iliac artery aneurysms with anaconda stent graft limb.

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    Karathanos, Christos; Kaperonis, Elias; Xanthopoulos, Dimitrios; Konstantopoulos, Theophanis; Exarchou, Maria; Loupou, Caterini; Papavassiliou, Vassilios

    2013-01-01

    Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs) with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6 cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C) and gluteal claudication occurred. After 2 years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery.

  12. Endovascular Treatment of Isolated Iliac Artery Aneurysms with Anaconda Stent Graft Limb

    Directory of Open Access Journals (Sweden)

    Christos Karathanos

    2013-01-01

    Full Text Available Isolated aneurysms of the iliac arteries are relatively rare conditions that traditionally have been treated by surgical reconstruction. We report our experience with endovascular treatment of iliac artery aneurysms (IAAs with Anaconda stent graft limb. Two male patients were found to have 4.5 and 3.6 cm isolated common IAAs, respectively. The endograft was successfully advanced and deployed precisely to the intended position in both cases. In one case the internal iliac artery was embolized. No type I or II endoleak was observed immediately after the procedure. In one patient postimplantation fever (>38°C and gluteal claudication occurred. After 2 years followup both iliac endovascular stent grafts are patent and without endoleak. Endovascular treatment with Anaconda limb stent graft seems to be a safe and feasible alternative to open surgery.

  13. Immediate endovascular stent-graft repair of an acute traumatic ...

    African Journals Online (AJOL)

    Enrique

    tic ruptures include the lack of necessity for cardiopulmonary bypass and systemic heparinisation. The reported neurologi- cal complication rates are lower than with surgical repair. There are to date no reported cases of paraplegia following emergency or elective stent-graft repair for traumatic thoracic aortic rupture. Mitchell ...

  14. Factors and forces influencing stent-graft migration after endovascular aortic aneurysm repair.

    NARCIS (Netherlands)

    Mohan, I.V.; Harris, P.L.; Marrewijk, C.J. van; Laheij, R.J.F.; How, T.V.

    2002-01-01

    Purpose: To assess and validate the clinical features predisposing to stent-graft migration and to calculate the distal displacement forces exerted at the proximal fixation site following endovascular aortic aneurysm repair (EVAR). Methods: Demographic, anatomical, and graft-related features from

  15. Endovascular stent graft for treatment of complicated spontaneous dissection of celiac artery: Report of two cases

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    Kang, Ung Rae; Lee, Young Hwan [Dept. of Diagnostic Radiology, Catholic University of Daegu School of Medicine, Daegu (Korea, Republic of); Kim, Young Hwan [Dept. of Diagnostic Radiology, Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2013-06-15

    We report 2 cases of complicated spontaneous dissection of the celiac artery, which were successfully treated by a stent graft. The first patient was a 47-year-old man who presented with acute abdominal pain. CT scan showed ruptured saccular aneurysm with surrounding retroperitoneal hematoma. The second patient was a 57-year-old man with progressive dissecting aneurysm. Endovascular stent graft was placed in the celiac trunk to control bleeding, and to prevent rupture in each patient. Follow-up CT scans showed complete obliteration of a dissecting aneurysm.

  16. 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.

  17. Endovascular Repair of Celiac Artery Aneurysm with the Use of Stent Grafts.

    Science.gov (United States)

    Zhang, Wei; Fu, Yu-Fei; Wei, Pei-Lei; E, Bei; Li, De-Chun; Xu, Jian

    2016-04-01

    To determine the feasibility, safety, and long-term outcome of stent-graft insertion for endovascular repair of celiac artery aneurysm (CAA). From January 2010 to April 2015, 10 patients (three men and seven women; mean age, 51.6 y ± 12.1; age range, 39-81 y) with CAAs underwent endovascular repair via stent-graft insertion in a single center. During treatment, the stent graft was placed at the celiac and common hepatic arteries. Standard follow-up protocol included abdominal CT angiography and clinical examinations at 1, 3, 6, and 12 months and annually thereafter. Follow-up was performed every 2-3 months via telephone for the duration of the follow-up period to confirm patients' general condition. Data on patient characteristics, technical success, procedure-related complications, and follow-up were collected and analyzed retrospectively. CAA was successfully sealed by the stent graft in all patients. The common hepatic artery was patent after stent insertion in all patients, and no procedure-related complication occurred. All patients were followed up for 1-64 months (mean, 19.3 mo ± 18.9). Abdominal CT angiography demonstrated no endoleak, stent obstruction, or splenic infarction during follow-up. All patients experienced CAA shrinkage with formation of thrombi or increase in the quantity of thrombi in the CAA sac. Stent-graft insertion is a safe and effective method for endovascular repair of CAA. Copyright © 2016 SIR. Published by Elsevier Inc. All rights reserved.

  18. Endovascular tubular stent-graft placement for isolated iliac artery aneurysms.

    Science.gov (United States)

    Okada, Takuya; Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

    2012-02-01

    To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). 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. 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 IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

  19. Acute Symptomatic Abdominal Aortic Aneurysm Secondary to Endovascular Stent Graft Associated Type II Endoleak

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    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.

  20. 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...... evidence that there would be no extra benefit in conducting more RCTs to detect the effectiveness of EVAR versus open repair. For long-term mortality, TSA revealed either inconclusive evidence to support or refute endovascular or open repair; so, further RCTs should be performed to investigate long...

  1. Placement of an aortomonoiliac stent graft without femorofemoral revascularization in endovascular aneurysm repair: a case report

    Directory of Open Access Journals (Sweden)

    Schoenberg Stefan

    2011-08-01

    Full Text Available Abstract Introduction Endovascular aortic repair, if technically feasible, is the treatment of choice for patients with a contained ruptured aortic aneurysm who are unfit for open surgery. Case presentation We report the case of an 80-year-old Caucasian man who presented with an unusually configured, symptomatic infrarenal aortic aneurysm. His aneurysm showed an erosion of the fourth lumbar vertebra and a severely arteriosclerotic pelvic axis. A high thigh amputation of his right leg had been performed 15 months previously. On his right side, occlusion of his external iliac artery, common femoral artery, and deep femoral artery had occurred. His aneurysm was treated by a left-sided aortomonoiliac stent graft without femorofemoral revascularization, resulting in occlusions of both internal iliac arteries. No ischemic symptoms appeared, although perfusion of his right side was maintained only over epigastric collaterals. Conclusions The placement of aortomonoiliac stent grafts for endovascular treatment of infrarenal aortic aneurysms without contralateral revascularization is a feasible treatment option in isolated cases. In this report, access problems and revascularization options in endovascular aneurysm repair are discussed.

  2. Transcarotid Artery Endovascular Reconstruction of the Aortic Arch by Modified Bifurcated Stent Graft for Stanford Type A Dissection

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    Wei Guo

    2007-10-01

    Full Text Available A 40-year-old man with Stanford type B dissection underwent his first endovascular repair (EVAR in April 2004 by Talent thoracic stent graft. He had an uncomplicated recovery and maintained good blood pressure control. However, a new retrograde dissection appeared in September 2004. The new dissection involved his aortic arch and ascending thoracic aorta to the opening of the coronary arteries. To reconstruct the aortic arch, bypasses between the right common carotid artery (RCCA, left common carotid artery and left subclavian artery were performed before endovascular repair. A modified bifurcated Talent stent graft was deployed from the RCCA to the ascending thoracic aorta with a long limb in the innominate artery and a short limb in the aortic arch. A further two pieces of graft were deployed via the common femoral artery. The ascending thoracic aorta and aortic arch were reconstructed completely by the bifurcated stent graft. The final angiography confirmed that there was good stent graft configuration, normal blood flow, and stable haemodynamics. No endoleak or other major complications were encountered. This result indicated that it is possible to reconstruct the aortic arch with a bifurcated stent graft and could be a new endovascular repair model for complex thoracic aortic aneurysm and dissection.

  3. Contrast Medium Induced Nephropathy after Endovascular Stent Graft Placement: An Examination of Its Prevalence and Risk Factors

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    Yohei Kawatani

    2016-01-01

    Full Text Available 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.

  4. A Literature Review of the Numerical Analysis of Abdominal Aortic Aneurysms Treated with Endovascular Stent Grafts

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    David Roy

    2012-01-01

    Full Text Available The purpose of this paper is to present the basic principles and relevant advances in the computational modeling of abdominal aortic aneurysms and endovascular aneurysm repair, providing the community with up-to-date state of the art in terms of numerical analysis and biomechanics. Frameworks describing the mechanical behavior of the aortic wall already exist. However, intraluminal thrombus nonhomogeneous structure and porosity still need to be well characterized. Also, although the morphology and mechanical properties of calcifications have been investigated, their effects on wall stresses remain controversial. Computational fluid dynamics usually assumes a rigid artery wall, whereas fluid-structure interaction accounts for artery compliance but is still challenging since arteries and blood have similar densities. We discuss alternatives to fluid-structure interaction based on dynamic medical images that address patient-specific hemodynamics and geometries. We describe initial stresses, elastic boundary conditions, and statistical strength for rupture risk assessment. Special emphasis is accorded to workflow development, from the conversion of medical images into finite element models, to the simulation of catheter-aorta interactions and stent-graft deployment. Our purpose is also to elaborate the key ingredients leading to virtual stenting and endovascular repair planning that could improve the procedure and stent-grafts.

  5. Percutaneous endovascular stent-graft treatment of aortic aneurysms and dissections: new techniques and initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Do Yun; Choi, Dong Hoon; Kang, Sung Gwon; Lee, Kwang Hoon; Won, Jong Yun [Yonsei University College of Medicine, Seoul (Korea, Republic of); Kang, Sung Gwon [Chosun University College of Medicine, Gwangju (Korea, Republic of); Won, Je Whan [Aju University College of Medicine, Suwon (Korea, Republic of); Song, Ho Young [Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2003-01-01

    To evaluate the feasibility, safety and effectiveness of a newly designed percutaneously implanted separate stent-graft (SSG) for the treatment of aortic aneurysms and dissections. Using a percutaneous technique, SSG placement (in the descending thoracic aorta in 26 cases and infrarenal abdominal aorta in 24) was attempted in 50 patients with aortic aneurysms (n=27) or dissection (n=23). All SSGs were individually constructed using self-expandable nitinol stents and a Dacron graft, and were introduced through a 12 F sheath and expanded to a diameter of 20-34 mm. In all cases, vascular access was through the femoral artery. The clinical status of each patient was monitored, and postoperative CT was performed within one week of the procedure and at 3-6 month intervals afterwards. Endovascular stent-graft deployment was technically successful in 49 of 50 patients (98%). The one failure was due to torsion of the unsupported graft during deployment. Successful exclusion of aneurysms and the primary entry tears of dissections was achieved in all but three patients with aortic dissection. All patients in whom technical success was achieved showed complete thrombosis of the thoracic false lumen or aneurysmal sac, and the overall technique success rate was 92%. In addition, sixteen patients demonstrated complete resolution of the dissected thoracic false lumen (n=9) or aneurysmal sac (n=7). Immediate post-operative complications occurred at the femoral puncture site in one patient with an arteriovenous fistula, and in two, a new saccular aneurysm developed at the distal margin of the stent. No patients died, and there was no instance of paraplegia, stroke, side-branch occlusion or infection during the subsequent mean follow-up period of 9.4 (range, 2 to 26) months. In patients with aortic aneurysm and dissection, treatment with a separate percutaneously inserted stent-graft is technically feasible, safe, and effective.

  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. In-situ laser fenestration of endovascular stent-graft in abdominal aortic aneurysm repair (EVAR)

    Science.gov (United States)

    Micheletti, Filippo; Pini, Roberto; Piazza, Roberta; Ferrari, Vincenzo; Condino, Sara; Rossi, Francesca

    2017-02-01

    Endovascular abdominal aortic aneurysms repair (EVAR) involves the minimally invasive implantation of a stent-graft within the aorta to exclude the aneurysm from the circulation thus preventing its rupture. The feasibility of such operation is highly dependent on the aorta morphology and in general the presence of one/both renal arteries emerging from the aneurysm is the absolute limit for the implantation of a standard stent-graft. Consequently, classical intervention methods involve the implantation of a custom-made graft with fenestrations, leading to extremely complicated surgeries with high risks for the patient and high costs. Recent techniques introduced the use of standard grafts (i.e. without fenestrations) in association with mechanical in-situ fenestration, but this procedure is limited principally by the brittleness and low stability of the environment, in addition to the difficulty of controlling the guidance of the endovascular tools due to the temporarily block of the blood flow. In this work we propose an innovative EVAR strategy, which involves in-situ fenestration with a fiber guided laser tool, controlled via an electromagnetic navigation system. The fiber is sensorized to be tracked by means of the driving system and, using a 3D model of the patient anatomy, the surgeon can drive the fiber to the aneurysm, where the stent has been previously released, to realize the proper fenestration(s). The design and construction of the catheter laser tool will be presented, togheter with preliminary fenestration tests on graft-materials, including the effects due to the presence of blood and tissues.

  8. Current management of mesenteric extrahepatic arterioportal fistulas: report of a case treated with a gastroduodenal artery stent graft and literature review.

    Science.gov (United States)

    Krishan, Sonal; McPherson, Simon; Pine, James; Hayden, Jeremy

    2010-02-01

    Spontaneous arteriovenous fistulation of a pseudoaneurysm into superior mesenteric vein (SMV) has rarely been reported. We present the case of a 61-year-old woman who presented with a post pancreatic arterioportal fistula (APF) that was successfully managed by stent graft (SG) placement in the gastroduodenal artery (GDA). We also review the published experience of the endovascular management of mesenteric extrahepatic APFs. This review demonstrates the evolution from open surgical to endovascular management for majority of these patients.

  9. Endovascular treatment of visceral artery aneurysms and pseudoaneurysms with stent-graft: Analysis of immediate and long-term results.

    Science.gov (United States)

    Cappucci, Matteo; Zarco, Federico; Orgera, Gianluigi; López-Rueda, Antonio; Moreno, Javier; Laurino, Florindo; Barnes, Daniel; Tipaldi, Marcello Andrea; Gomez, Fernando; Macho Fernandez, Juan; Rossi, Michele

    2017-05-01

    The aim of this study is to analyze the safety and efficacy of stent-graft endovascular treatment for visceral artery aneurysms and pseudoaneurysms. Multicentric retrospective series of patients with visceral aneurysms and pseudoaneurysms treated by means of stent graft. The following variables were analyzed: Age, sex, type of lesion (aneurysms/pseudoaneurysms), localization, rate of success, intraprocedural and long term complication rate (SIR classification). Follow-up was performed under clinical and radiological assessment. Twenty-five patients (16 men), with a mean age of 59 (range 27-79), were treated. The indication was aneurysm in 19 patients and pseudoaneurysms in 6. The localizations were: splenic artery (12), hepatic artery (5), renal artery (4), celiac trunk (3) and gastroduodenal artery (1). Successful treatment rate was 96% (24/25 patients). Intraprocedural complication rate was 12% (4% major; 8% minor). Complete occlusion was demonstrated during follow up (mean 33 months, range 6-72) in the 24 patients with technical success. Two stent migrations (2/24; 8%) and 4stent thrombosis (4/24; 16%) were detected. Mortality rate was 0%. In our study, stent-graft endovascular treatment of visceral aneurysmns and pseudoaneurysms has demonstrated to be safe and is effective in the long-term in both elective and emergent cases, with a high rate of successful treatment and a low complication rate. Copyright © 2017 AEC. Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Perioperative Occupational Exposure to Coxiella burnetii-Infected Thoracic Endovascular Aneurysm Stent Graft

    Directory of Open Access Journals (Sweden)

    Jade Le

    2017-01-01

    Full Text Available We conducted this study to determine the risk of transmission of Q fever to health care workers (HCWs during perioperative exposure to Coxiella burnetii-infected thoracic endovascular aneurysm stent graft. Pre-operative and 6-week post-operative phase I and II IgG Q fever antibody titers were determined in 14 staff members of an operation room. The room had a negative pressure and all the members of the surgical team wore either a fitted N-95 mask or a powered purified air respirator. Phase I and II IgG antibody titers were <1:16 for 11 of the 14 studied HCWs; 2 HCWs did not follow up at 6 weeks and 1 had a pre-exposure phase II IgG titer of 1:128 with no change 6 weeks later. We concluded that risk of transmission of C. burnetii in the operating room from infected patient to HCWs who wore appropriate personal protective equipment is low.

  11. Hemodynamic determinants of aortic dissection propagation by 2D computational modeling: implications for endovascular stent-grafting.

    Science.gov (United States)

    Chitsaz, S; Azadani, A N; Matthews, P B; Chuter, T A; Tseng, E E; Ge, L

    2012-10-01

    Aortic dissection is a life-threatening aortic catastrophe where layers of the aortic wall are separated allowing blood flow within the layers. Propagation of aortic dissection is strongly linked to the rate of rise of pressure (dp/dt) experienced by the aortic wall but the hemodynamics is poorly understood. The purpose of this study was to perform computational fluid dynamics (CFD) simulations to determine the relationship between dissection propagation in the distal longitudinal direction (the tearing force) and dp/dt. Five computational models of aortic dissection in a 2D pipe were constructed. Initiation of dissection and propagation were represented in 4 single entry tear models, 3 of which investigated the role of length of dissection and antegrade propagation, 1 of which investigated retrograde propagation. The 5th model included a distal re-entry tear. Impact of pressure field distribution on tearing force was determined. Tearing force in the longitudinal direction for dissections with a single entry tear was approximately proportional to dp/dt and L2 where L is the length of dissection. Tearing force was much lower under steady flow than pulsatile flow conditions. Introduction of a second tear distally along the dissection away from the primary entry tear significantly reduced tearing force. The hemodynamic mechanism for dissection propagation demonstrated in these models support the use of β-blockers in medical management. Endovascular stent-graft treatment of dissection should ideally cover both entry and re-entry tears to reduce risk of retrograde propagation of aortic dissection.

  12. Endovascular Repair of Saccular Ascending Aortic Aneurysm After Orthotopic Heart Transplantation Using an Investigational Zenith Ascend Stent-Graft.

    Science.gov (United States)

    Oderich, Gustavo S; Pochettino, Alberto; Mendes, Bernardo C; Roeder, Blayne; Pulido, Juan; Gloviczki, Peter

    2015-08-01

    To report the use of an investigational stent-graft to treat an ascending aortic aneurysm in a patient with a heart transplant. A 48-year-old man presented with a 3.5×1.5-cm saccular aneurysm in the mid anterior ascending aorta, abutting the sternum. The patient's history was notable for placement of a left ventricular assist device followed by orthotopic heart transplantation 2 years prior to treat end-stage familial dilated cardiomyopathy. Under compassionate use, a custom-designed ascending aortic stent-graft (Zenith Ascend) was successfully delivered via an 18-F system and deployed just distal to the origin of the left main coronary artery under pulmonary artery catheter-guided rapid ventricular pacing. The patient was discharged the next day, and 6-month follow-up was unremarkable. Imaging at 5 months showed an excluded aneurysm sac with no endoleak or migration. The ideal ascending aortic stent-graft should be low profile, conformable to the arch anatomy, with short tip delivery system and a stepwise deployment mechanism that allows precise placement relative to the ostia of the coronary arteries and the innominate artery. This case illustrates the advancement of endovascular techniques to the most challenging segment of the aorta to decrease morbidity and mortality in high-risk patients. © The Author(s) 2015.

  13. Early results from a Canadian multicenter prospective registry of the Endurant stent graft for endovascular treatment of abdominal aortic aneurysms.

    Science.gov (United States)

    Kvinlaug, Kylie E; Lawlor, D Kirk; Forbes, Thomas L; Willoughby, Rod; MacKenzie, Kent S; DeRose, Guy; Corriveau, Marc M; Steinmetz, Oren K

    2012-02-01

    To report the early results of a multicenter registry of endovascular aneurysm repair (EVAR) using the Endurant stent-graft. Patients having elective treatment of infrarenal abdominal aortic aneurysm (AAA) with the Endurant stent-graft at 3 Canadian centers were enrolled in a prospective registry between September 2008 and January 2010. In the 16-month period, 111 patients (90 men; mean age 75 years, range 53-93) were registered. Thirty-seven (33.3%) patients had challenging anatomy: short proximal aortic necks (n=17), large diameter (>28 mm) aortic necks (n=4), angulated (>60°) necks (n=3), and small (5 mm, secondary intervention, stent-graft migration, and graft thrombosis. The overall technical success rate was 100%. Nineteen (17.1%) patients experienced perioperative complications. After a mean follow-up of 6 months (range 0.1-16), mortality in the series was 4.5%: 1 perioperative death (multisystem organ failure) and 4 (3.6%) late deaths (3 cardiac, 1 cancer). Clinical and imaging follow-up past the perioperative period were available in 107 (96.4%) and 99 (89.2%) patients, respectively. Among the latter, 9 (9.1%) had a type II endoleak on the first scan; 4 resolved spontaneously. Three (3.0%) patients developed graft limb thrombosis in follow-up; one required an intervention. There was no graft migration, aneurysm expansion, secondary intervention for endoleak, aneurysm rupture, or conversion. Early results from this prospective multicenter registry indicate that the Endurant stent-graft is a safe option for elective EVAR in selected AAA patients. Longer follow-up is required to determine the durability of these outcomes.

  14. Open aortic stent grafting and prosthetic bypass in a child.

    Science.gov (United States)

    Ono, Takashi; Midorikawa, Hirofumi; Morishima, Shigehiro; Takano, Takashi; Nakazawa, Makoto; Kudo, Yoshimichi

    2011-10-01

    Pseudoaneurysm is a major complication of percutaneous balloon angioplasty to treat recoarctation and restenosis after an interrupted aortic arch repair. Endovascular stent grafting to manage this complication has rarely been performed in children. We used a combination of open stent grafting and a prosthetic ascending aorta-to-descending aorta bypass to treat a pseudoaneurysm and ascending aorta stenosis in a 7-year-old child. Copyright © 2011 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  15. Non-Anastomotic Rupture of a Woven Dacron Graft in the Descending Thoracic Aorta Treated with Endovascular Stent Grafting

    Directory of Open Access Journals (Sweden)

    Youngok Lee

    2016-12-01

    Full Text Available The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.

  16. Non-Anastomotic Rupture of a Woven Dacron Graft in the Descending Thoracic Aorta Treated with Endovascular Stent Grafting.

    Science.gov (United States)

    Lee, Youngok; Kim, Gun-Jik; Kim, Young Eun; Hong, Seong Wook; Lee, Jong Tae

    2016-12-01

    The intrinsic structural failure of a Dacron graft resulting from the loss of structural integrity of the graft fabric can cause late graft complications. Late non-anastomotic rupture has traditionally been treated surgically via open thoracotomy. We report a case of the successful use of thoracic endovascular repair to treat a Dacron graft rupture in the descending aorta. The rupture occurred 20 years after the graft had been placed. Two stent grafts were placed at the proximal portion of the surgical graft, covering almost its entire length.

  17. 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

    subclavian artery (LSA) limiting the proximal landing zone site without proximal vessel coverage. In patients in whom the distance between the LSA and aortic lesion is too short, extension of the landing zone can be obtained by covering the LSA's origin with the endovascular stent graft (ESG). This manoeuvre...... and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals...

  18. Endovascular repair of bilateral common iliac artery aneurysms using GORE Excluder iliac branch endoprosthesis without aortobi-iliac stent graft conjunction

    Science.gov (United States)

    Ardita, Vincenzo; Giaquinta, Alessia; Veroux, Massimiliano; Sanfiorenzo, Angelo; Virgilio, Carla; D’Arrigo, Giuseppe; Veroux, Pierfrancesco

    2017-01-01

    Abstract Introduction: Bilateral common iliac artery (CIA) aneurysm (CIAA) is a rare entity. In the past decade, different endovascular approaches have been adopted for patients with several comorbidities or unfit for open repair (OR). Recently, the use of iliac branch stent graft has been proposed, resulting in satisfactory patency rates and decrease in morbidity. Currently, according to instruction for use, the iliac branch stent graft is to be used with aortobi-iliac stent graft conjunction. We describe a case of a successful endovascular repair of bilateral CIAAs using the GORE Excluder iliac branch endoprosthesis (IBEs) without aortobi-iliac stent graft conjunction. Case presentation: An 83-year-old man was admitted with abdominal pain and presence of pulsatile mass in the right and left iliac fossa. Computed tomographic (CT) angiography showed the presence of large bilateral CIAAs (right CIA = 66 mm; left CIA = 38 mm), without concomitant thoracic or abdominal aorta aneurysm. Moreover, CT scan demonstrated the presence of bilateral lower accessory renal artery close to the aortic bifurcation. Due to the high operative risk, the patient was scheduled for endovascular repair with bilateral IBEs, without the aortobi-iliac stent graft conjunction to avoid the renal ischemia as a consequence of renal arteries covering. The procedure was completed without complications and duplex ultrasound demonstrated the complete exclusion of both aneurysms without any type of endoleaks at 1 month of follow-up. Conclusions: GORE IBEs without aortobi-iliac stent graft conjunction seem to be a feasible and effective procedure for the treatment of isolated CIAAs in patients with highly selected anatomical conditions. PMID:28207510

  19. Endovascular repair of bilateral common iliac artery aneurysms using GORE Excluder iliac branch endoprosthesis without aortobi-iliac stent graft conjunction: A case report.

    Science.gov (United States)

    Ardita, Vincenzo; Giaquinta, Alessia; Veroux, Massimiliano; Sanfiorenzo, Angelo; Virgilio, Carla; D'Arrigo, Giuseppe; Veroux, Pierfrancesco

    2017-02-01

    Bilateral common iliac artery (CIA) aneurysm (CIAA) is a rare entity. In the past decade, different endovascular approaches have been adopted for patients with several comorbidities or unfit for open repair (OR). Recently, the use of iliac branch stent graft has been proposed, resulting in satisfactory patency rates and decrease in morbidity. Currently, according to instruction for use, the iliac branch stent graft is to be used with aortobi-iliac stent graft conjunction. We describe a case of a successful endovascular repair of bilateral CIAAs using the GORE Excluder iliac branch endoprosthesis (IBEs) without aortobi-iliac stent graft conjunction. An 83-year-old man was admitted with abdominal pain and presence of pulsatile mass in the right and left iliac fossa. Computed tomographic (CT) angiography showed the presence of large bilateral CIAAs (right CIA = 66 mm; left CIA = 38 mm), without concomitant thoracic or abdominal aorta aneurysm. Moreover, CT scan demonstrated the presence of bilateral lower accessory renal artery close to the aortic bifurcation. Due to the high operative risk, the patient was scheduled for endovascular repair with bilateral IBEs, without the aortobi-iliac stent graft conjunction to avoid the renal ischemia as a consequence of renal arteries covering. The procedure was completed without complications and duplex ultrasound demonstrated the complete exclusion of both aneurysms without any type of endoleaks at 1 month of follow-up. GORE IBEs without aortobi-iliac stent graft conjunction seem to be a feasible and effective procedure for the treatment of isolated CIAAs in patients with highly selected anatomical conditions.

  20. Spontaneous rupture of superficial femoral artery repaired with endovascular stent-grafting with use of rendez-vous technique, followed by delayed infection.

    Science.gov (United States)

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

    2013-02-01

    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.

  1. Compliance Study of Endovascular Stent Grafts Incorporated with Polyester and Polyurethane Graft Materials in both Stented and Unstented Zones

    Directory of Open Access Journals (Sweden)

    Ying Guan

    2016-08-01

    Full Text Available Compliance mismatch between stent graft and host artery may induce complications and blood flow disorders. However, few studies have been reported on stent graft compliance. This study aims to explore the deformation and compliance of stent graft in stented and unstented zones under three pressure ranges. Compliance of two stent grafts incorporated with polyurethane graft (nitinol-PU and polyester graft (nitinol-PET materials respectively were tested; the stents used in the two stent grafts were identical. For the circumferential deformation of the stent grafts under each pressure range, the nitinol-PET stent graft was uniform in both zones. The nitinol-PU stent graft was circumferentially uniform in the stented zone, however, it was nonuniform in the unstented zone. The compliance of the PU graft material was 15 times higher than that of the PET graft. No significant difference in compliance was observed between stented and unstented zones of the nitinol-PET stent graft regardless of the applied pressure range. However, for the nitinol-PU stent graft, compliance of the unstented PU region was approximately twice that of the stented region; thus, compliance along the length of the nitinol-PU stent graft was not constant and different from that of the nitinol-PET stent graft.

  2. Midterm results of endovascular stent graft treatment for descending aortic aneurysms including high-risk patients

    Directory of Open Access Journals (Sweden)

    Gussmann, Andreas

    2006-04-01

    Full Text Available Methods: 21 patients (17 men, 4 women; mean age 66.1 years, range 29-90 years with 15 true aneurysms, and 6 type B-dissections were treated by implantation of a TalentTM Endoluminal Stentgraft System from February 2000 to July 2003. In 3 cases it was necessary to overstent the left subclavian artery, in 1 case to overstent the left common carotid. Results: 2 patients (9.5% died during the first 30 days (1 myocardial infarction, 1 pneumonia. Two patients (9.5% suffered from cerebral ischemia and needed revascularisation. No paraplegia, no stroke occurred. One endoleak required additional stenting. No patient needed conversion. Follow-up, average 25.4 months (range 0-39, was 100% complete. During this another two patients died of myocardial infarction i.e. 9.5% (the above mentioned endoleak, but no late migration were detected in the remaining patients. In all cases the graft lumen stayed patent. Conclusions: Treatment of descending thoracic aortic aneurysm with an endovascular approach has acceptable mortality and morbidity-rates even in high risk patients. Procedural overstenting of the subclavian artery requires subclavian revascularisation in a minority of cases.

  3. Tratamento do aneurisma da aorta toracoabdominal com endoprótese ramificada para as artérias viscerais Branched endovascular stent graft for thoracoabdominal aortic aneurysm repair

    Directory of Open Access Journals (Sweden)

    André Simi

    2007-03-01

    AATA com endoprótese ramificada é factível. A melhora dos recursos técnicos e da qualidade dos materiais poderá ampliar a indicação desse procedimento como alternativa à cirurgia aberta.We report a case of branched stent graft system for endovascular repair of thoracoabdominal aortic aneurysm (TAAA. A 68-year-old female patient, smoker, hypertensive, with a large TAAA and multiple comorbid conditions that restricted indication for conventional surgery. The aneurysm originated from the descending thoracic aorta, extending until the infrarenal abdominal aorta, involving the emergence of visceral arteries, celiac trunk, superior and renal mesenteric arteries. The TAAA was treated with the endovascular technique using a branched stent graft. This stent graft was customized based on the anatomical characteristics of the aorta and on the position of visceral branches, which were obtained by tomographic angiography, with the aim of excluding the aneurysm and maintaining perfusion of visceral arteries. The procedure was performed under regional and general anesthesia in the surgical room, preceded by cerebrospinal fluid drainage under fluoroscopic guidance. The femoral arteries, which were previously dissected, were used to implement the branched stent graft and for radiological control. Through the stent graft branches, secondary extensions were implanted, with covered stents, to the respective visceral arteries, which were approached via left axillary artery. Total operative time was 14 hours, 4 hours and 30 minutes of fluoroscopy time and 120 mL of iodinated contrast. The patient became hemodynamically unstable after the surgery. Transesophageal echocardiogram showed a type A retrograde dissection of the thoracic aorta, followed by spontaneous thrombosis of the false lumen. Control tomography showed exclusion of the TAAA and patency of the bypasses to visceral branches, with no endoleaks. The patient was discharged on the 13th postoperative day. Branched

  4. Comparison of Direct Site Endovascular Repair Utilizing Expandable PTFE Stent Grafts Vs. Standard Vascular Shunts in a Porcine (Sus Scrofa) Model.

    Science.gov (United States)

    Davidson, Anders J; Neff, Lucas P; Grayson, J Kevin; Clement, Nathan F; DeSoucy, Erik S; Simon-Logan, Meryl A; Abbot, Christopher M; Sampson, James B; Williams, Timothy K

    2017-07-08

    The small diameter of temporary vascular shunts for vascular trauma management may restrict flow and result in ischemia or early thrombosis. We have previously reported a clinical experience with direct, open surgical reconstruction using expanded polytetrafluoroethylene (ePTFE) stent grafts to create a "sutureless" anastomosis as an alternative to standard temporary vascular shunts. We sought to characterize patency and flow characteristics of these grafts compared to standard shunts in a survival model of porcine vascular injury. 12 Yorkshire-cross swine received a 2cm long near-circumferential defect in the bilateral iliac arteries. A14-French Argyle shunt was inserted into one randomly assigned artery, with a self-expanding ePTFE stent deployed in the other. At 72 hours, conduit patency was evaluated by angiography. Arterial flow measurements were obtained at baseline, immediately after intervention, and after 72 hours via direct measurement with perivascular flow meters. Blood pressure proximal and distal to the conduits and arterial samples for histopathology were obtained during the terminal procedure. Angiography revealed no difference in patency at 72 hours (P=1.0). While there was no difference in baseline arterial flow between arteries (P=0.63), the stent grafts demonstrated significantly improved blood flow compared to shunts both immediately after intervention (390±36mL/min vs 265±25mL/min, p=0.002) and at 72 hours (261±29mL/min vs 170±36mL/min, p=0.005). The pressure gradient across the shunts was greater than that of the stent grafts (11.5mmHg IQR[3-19] vs. 3mmHg IQR[3-5], p=0.013). The speed of deployment was similar between the two devices. Open "sutureless" direct site repair using commercially available stent grafts to treat vascular injury is a technically feasible strategy for damage control management of peripheral vascular injury and offers increased blood flow when compared to temporary shunts. Furthermore, stent grafts may offer

  5. Comparison of direct site endovascular repair utilizing expandable polytetrafluoroethylene stent grafts versus standard vascular shunts in a porcine (Sus scrofa) model.

    Science.gov (United States)

    Davidson, Anders J; Neff, Lucas P; Grayson, J Kevin; Clement, Nathan F; DeSoucy, Erik S; Simon Logan, Meryl A; Abbot, Christopher M; Sampson, James B; Williams, Timothy K

    2017-09-01

    The small diameter of temporary vascular shunts for vascular trauma management may restrict flow and result in ischemia or early thrombosis. We have previously reported a clinical experience with direct, open surgical reconstruction using expandable polytetrafluoroethylene stent grafts to create a "sutureless" anastomosis as an alternative to standard temporary vascular shunts. We sought to characterize patency and flow characteristics of these grafts compared with standard shunts in a survival model of porcine vascular injury. Twelve Yorkshire-cross swine received a 2-cm-long near-circumferential defect in the bilateral iliac arteries. A 14 Fr Argyle shunt was inserted into one randomly assigned artery, with a self-expanding expandable polytetrafluoroethylene stent deployed in the other. At 72 hours, conduit patency was evaluated by angiography. Arterial flow measurements were obtained at baseline, immediately after intervention, and after 72 hours via direct measurement with perivascular flow meters. Blood pressure proximal and distal to the conduits and arterial samples for histopathology were obtained during the terminal procedure. Angiography revealed no difference in patency at 72 hours (p = 1.0). While there was no difference in baseline arterial flow between arteries (p = 0.63), the stent grafts demonstrated significantly improved blood flow compared with shunts both immediately after intervention (390 ± 36 mL/min vs. 265 ± 25 mL/min, p = 0.002) and at 72 hours (261 ± 29 mL/min vs. 170 ± 36 mL/min, p = 0.005). The pressure gradient across the shunts was greater than that of the stent grafts (11.5 mm Hg [interquartile range, 3-19 mm Hg] vs. 3 mm Hg [interquartile range, 3-5 mm Hg], p = 0.013). The speed of deployment was similar between the two devices. Open "sutureless" direct site repair using commercially available stent grafts to treat vascular injury is a technically feasible strategy for damage control management of peripheral vascular injury and

  6. Endovascular management of acute bleeding arterioenteric fistulas

    DEFF Research Database (Denmark)

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

    2008-01-01

    . 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...

  7. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft

    Directory of Open Access Journals (Sweden)

    McGloughlin Tim M

    2009-10-01

    Full Text Available Abstract Background Abdominal aortic aneurysms (AAA are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. Methods Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. Results Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. Conclusion In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  8. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft.

    LENUS (Irish Health Repository)

    Molony, David S

    2009-01-01

    BACKGROUND: Abdominal aortic aneurysms (AAA) are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI) is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. METHODS: Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. RESULTS: Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. CONCLUSION: In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces.

  9. 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-Graft

  10. Repeated transluminal endovascular Inoue stent graft placement for progressive dilatation of prosthetic graft that had been repaired with Inoue stent graft placement for dilatation 23 years after extraanatomical bypass.

    Science.gov (United States)

    Anzai, Tomohiro; Shimizu, Hideyuki; Yozu, Ryohei; Hashimoto, Subaru; Kuribayashi, Sachio; Inoue, Kanji

    2007-02-01

    A 76-year-old man had undergone aneurysm exclusion and ascending abdominal aortic extraanatomical bypass for a thoracoabdominal aortic aneurysm in 1978. In 1983 hemoptysis occurred, and resection and closure of the central stump of the aorta and a left lower lobectomy were performed. Dilatation (phi50 mm) of a prosthetic graft (Cooley Graft phi18 mm) used for extraanatomical bypass was noted in 2001 and was repaired by placement of an Inoue stent graft. However, the aneurysm diameter increased further (phi70 mm), although no endoleak was noted: Placement of an Inoue stent graft covering the whole length of the prosthetic graft was repeated in 2006. The postoperative course was smooth, no endoleak occurred, and the patient was discharged 2 weeks after surgery.

  11. Automatic segmentation of the wire frame of stent grafts from CT data.

    NARCIS (Netherlands)

    Klein, A.; Vliet, J.A. van der; Oostveen, L.J.; Hoogeveen, Y.L.; Kool, L.J.; Renema, W.K.J.; Slump, C.H.

    2012-01-01

    Endovascular aortic replacement (EVAR) is an established technique, which uses stent grafts to treat aortic aneurysms in patients at risk of aneurysm rupture. Late stent graft failure is a serious complication in endovascular repair of aortic aneurysms. Better understanding of the motion

  12. 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

    and analysed three basic treatment concepts for LSA revascularisation in TEVAR patients (prophylactic, conditional prophylactic and no prophylactic LSA revascularisation). The available evidence supports prophylactic revascularisation of the LSA before ESG LSA coverage when preoperative imaging reveals......, covering, endovascular, revascularisation and thoracic aorta. We have gathered the most complete scientific evidence available used to support the various concepts to deal with this issue. After a review of the current available literature, 23 relevant articles were found, where we have identified...

  13. Real-world performance of the new C3 Gore Excluder stent-graft: 1-year results from the European C3 module of the Global Registry for Endovascular Aortic Treatment (GREAT).

    Science.gov (United States)

    Verhoeven, E L G; Katsargyris, A; Bachoo, P; Larzon, T; Fisher, R; Ettles, D; Boyle, J R; Brunkwall, J; Böckler, D; Florek, H-J; Stella, A; Kasprzak, P; Verhagen, H; Riambau, V

    2014-08-01

    The European C3 module of the Global Registry for Endovascular Aortic Treatment (GREAT) provides "real-world" outcomes for the new C3 Gore Excluder stent-graft, and evaluates the new deployment mechanism. This report presents the 1-year results from 400 patients enrolled in this registry. Between August 2010 and December 2012, 400 patients (86.8% male, mean age 73.9 ± 7.8 years) from 13 European sites were enrolled in this registry. Patient demographics, treatment indication, case planning, operative details including repositioning and technical results, and clinical outcome were analyzed. Technical success was achieved in 396/400 (99%) patients. Two patients needed intraoperative open conversion, one for iliac rupture, the second because the stent-graft was pulled down during a cross-over catheterization in an angulated anatomy. Two patients required an unplanned chimney renal stent to treat partial coverage of the left renal artery because of upward displacement of the stent-graft. Graft repositioning occurred in 192/399 (48.1%) patients, most frequently for level readjustment with regard to the renal arteries, and less commonly for contralateral gate reorientation. Final intended position of the stent-graft below the renal arteries was achieved in 96.2% of patients. Thirty-day mortality was two (0.5%) patients. Early reintervention (≤30 days) was required in two (0.5%) patients. Mean follow-up duration was 15.9 ± 8.8 months (range 0-37 months). Late reintervention (>30 days) was required in 26 (6.5%) patients. Estimated freedom from reintervention at 1 year was 95.2% (95% CI 92.3-97%), and at 2 years 91.5% (95% CI 86.8-94.5%). Estimated patient survival at 1 year was 96% (95% CI 93.3-97.6%) and at 2 years 90.6% (95% CI 85.6-93.9%). Early real-world experience shows that the new C3 delivery system offers advantages in terms of device repositioning resulting in high deployment accuracy. Longer follow-up is required to confirm that this high deployment accuracy

  14. Research of Customized Aortic Stent Graft Manufacture

    Science.gov (United States)

    Zhang, Lei; Chen, Xin; Liu, Muhan

    2017-03-01

    Thoracic descending aorta diseases include aortic dissection and aortic aneurysm, of which the natural mortality rate is extremely high. At present, endovascular aneurysm repair (EVAR) has been widely used as an effective means for the treatment of descending aortic disease. Most of the existing coating stents are standard design, which are unable to meet the size or structure of different patients. As a result, failure of treatment would be caused by dimensional discrepancy between stent and vessels, which could lead to internal leakage or rupture of blood vessels. Therefore, based on rapid prototyping sacrificial core - coating forming (RPSC-CF), a customized aortic stent graft manufactured technique has been proposed in this study. The aortic stent graft consists of film and metallic stent, so polyether polyurethane (PU) and nickel-titanium (NiTi) shape memory alloy with good biocompatibility were chosen. To minimum film thickness without degrading performance, effect of different dip coating conditions on the thickness of film were studied. To make the NiTi alloy exhibit super-elasticity at body temperature (37°C), influence of different heat treatment conditions on austenite transformation temperature (Af) and mechanical properties were studied. The results show that the customized stent grafts could meet the demand of personalized therapy, and have good performance in blasting pressure and radial support force, laying the foundation for further animal experiment and clinical experiment.

  15. Preservation of hypogastric artery blood flow during endovascular aneurysm repair of an abdominal aortic aneurysm with bilateral common and internal iliac artery involvement: utilization of off-the-shelf stent-graft components.

    Science.gov (United States)

    Riesenman, Paul J; Ricotta, Joseph J; Veeraswamy, Ravi K

    2012-01-01

    A 72-year-old male presented with a 7.4-cm abdominal aortic aneurysm with bilateral common and internal iliac involvement. To maintain pelvic perfusion, preservation of the patient's left hypogastric artery (HA) was pursued. Two weeks after right HA embolization, endovascular repair of the patient's aneurysms was performed using a branched endograft approach. A 22-mm main body bifurcated endograft was unsheathed and the proximal covered stent was removed. The contralateral gate was preloaded with a wire and catheter. The device was resheathed and placed in the left common iliac artery. The preloaded wire in the contralateral gate was snared from the right side, establishing through-and-through femoral access. A contralateral femoral sheath was advanced up and over the aortic bifurcation from the right side into the contralateral gate of the bifurcated endograft. The repair was bridged to the left HA using a balloon-expandable stent-graft, followed by standard endovascular abdominal aortic aneurysm repair. Completion angiography demonstrated exclusion of patient's aneurysms, without evidence of endoleak, and maintenance of pelvic blood flow through the left HA. The patient recovered without complication and was discharged home on postoperative day 4. This technique illustrates the technical feasibility of using a preloaded commercially available endograft to preserve HA blood flow and maintain pelvic perfusion during endovascular aortic aneurysm repair. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  16. Changes in aortic pulse wave velocity of four thoracic aortic stent grafts in an ex vivo porcine model

    NARCIS (Netherlands)

    de Beaufort, Hector W L; Coda, Margherita; Conti, Michele; van Bakel, Theodorus M J; Nauta, Foeke J H; Lanzarone, Ettore; Moll, Frans L|info:eu-repo/dai/nl/070246882; van Herwaarden, Joost A|info:eu-repo/dai/nl/304814733; Auricchio, Ferdinando; Trimarchi, Santi

    2017-01-01

    OBJECTIVES: Thoracic endovascular aortic repair (TEVAR) has been shown to lead to increased aortic stiffness. The aim of this study was to investigate the effect of stent graft type and stent graft length on aortic stiffness in a controlled, experimental setting. METHODS: Twenty porcine thoracic

  17. 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

    Repair Complications reported a total of 63 rAAD cases (incidence, 1.33%; 95% CI, 0.75 to 2.40). Eighty-one percent of patients underwent TEVAR for acute (n=26, 54%) or chronic type B dissection (n=13, 27%). Stent grafts with proximal bare springs were used in majority of patients (83%). Only 7 (15......%) patients had intraoperative rAAD, with the remaining occurring during the index hospitalization (n=10, 21%) and during follow-up (n=31, 64%). Presenting symptoms included acute chest pain (n=16, 33%), syncope (n=12, 25%), and sudden death (n=9, 19%) whereas one fourth of patients were asymptomatic (n=12...

  18. Performance of the Endurant stent graft in patients with abdominal aortic aneurysms independent of their morphologic suitability for endovascular aneurysm repair based on instructions for use.

    Science.gov (United States)

    Donas, Konstantinos P; Torsello, Giovanni; Weiss, Kristin; Bisdas, Theodosios; Eisenack, Markus; Austermann, Martin

    2015-10-01

    The aim of this study was to prospectively evaluate the early and late 7-year experience with the Endurant bifurcated stent graft system (Medtronic, Santa Rosa, Calif) in patients with abdominal aortic aneurysms. Between November 14, 2007, and December 2013, 712 consecutive high-risk patients with abdominal aortic aneurysms underwent elective or urgent placement of an Endurant bifurcated endograft in our institution. The included patients were consecutive (all comers) and treated independently from their morphologic eligibility for use of the Endurant device based on the instructions for use. The primary study outcome was freedom from all-cause reintervention. The median follow-up was 19.2 months (interquartile range, 6.3-35.9 months). Overall, 517 patients (72.6%) were treated on the basis of instructions for use conditions. On the other hand, 195 patients (27.4%) had morphologic data not consistent with the recommendations for the use of the Endurant system. The 30-day mortality was 1.4% (10 of 712). Nine patients (1.2%) were lost to follow-up because of relocation abroad. The overall mortality rate was 14.74% (101 of 703). Overall survival rate was 92.3% at 1 year, 86.4% at 2 years, and 65% at 5 years. Overall freedom from reintervention rate was 93.3%, 86.4%, and 65% at 1 year, 2 years, and 5 years, respectively. Five patients (0.7%) underwent a surgical conversion and explantation of the Endurant device. The reasons were endograft infection (n = 1), endoleak type Ia (n = 1), endoleak type II (n = 1), endograft and limb thrombotic occlusion (n = 1), and endotension (n = 1). The overall iliac limb occlusion rate was 2.1% (15 of 712). The performance of the Endurant stent graft during a period of 7 years under real-life conditions was good, with low incidence of reinterventions and endoleaks. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  19. Successful Implantation of a Coronary Stent Graft in a Peripheral Vessel

    Directory of Open Access Journals (Sweden)

    Alexander Hess

    2015-01-01

    Full Text Available Peripheral artery disease (PAD is a complex, often underdiagnosed illness with rising prevalence in western world countries. During the past decade there has been a rapid advance especially in the field of endovascular treatment of PAD. Here we present for the first time a case reporting on the placement of coronary stent graft in a peripheral vessel for the management of a peripheral side branch perforation. Interventional angiologists or radiologists may consider such an option for complication management after injury of smaller vessels during peripheral percutaneous interventions. Further specialization and novel options of complication management as described in our case may shift the treatment from surgical to even more endovascular treatment procedures in the future.

  20. MRI assessment of thoracic stent grafts after emergency implantation in multi trauma patients: a feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Rasche, Volker [University Hospital Ulm, Department of Internal Medicine II, Ulm (Germany); University Hospital Ulm, University of Ulm, Department of Internal Medicine II, Ulm (Germany); Oberhuber, Alexander; Orend, Karl-Heinz [University Hospital Ulm, Department of Vascular and Thoracic Surgery, Ulm (Germany); Trumpp, Stephan [University Hospital Ulm, Department of Internal Medicine II, Ulm (Germany); University Hospital Ulm, Department of Vascular and Thoracic Surgery, Ulm (Germany); Bornstedt, Axel; Merkle, Nico; Rottbauer, Wolfgang [University Hospital Ulm, Department of Internal Medicine II, Ulm (Germany); Hoffmann, Martin [University Hospital Ulm, Department of Diagnostic and Interventional Radiology, Ulm (Germany)

    2011-07-15

    To evaluate the feasibility of MRI for static and dynamic assessment of the deployment of thoracic aortic stent grafts after emergency implantation in trauma patients. Twenty patients initially presenting with a rupture of the thoracic aorta were enrolled in this study. All patients underwent thoracic endovascular aortic repair (TEVAR). The deployment of the implanted stent graft was assessed by CTA and MRI, comprising the assessment of the aortic arch with and without contrast agent, and the assessment of the motion of the stent graft over the cardiac cycle. The stent graft geometry and motion over the cardiac cycle were assessable by MRI in all patients. Flow-mediated signal variations in areas of flow acceleration could be well visualised. No statistically significant differences in stent-graft diameters were observed between CT and MRI measurements. MRI appears to be a valuable tool for the assessment of thoracic stent grafts. It shows similar performance in the accurate assessment of stent-graft dimensions to the current gold standard CTA. Its capability of providing additional functional information and the lack of ionising radiation and nephrotoxic contrast agents may make MRI a valuable tool for monitoring patients after TEVAR. (orig.)

  1. Validation of an image registration and segmentation method to measure stent graft motion on ECG-gated CT using a physical dynamic stent graft model

    NARCIS (Netherlands)

    Koenrades, Maaike A.; Struijs, Ella M.; Klein, Almar; Kuipers, Henny; Geelkerken, Robert H.; Slump, Cornelis H.

    2017-01-01

    The application of endovascular aortic aneurysm repair has expanded over the last decade. However, the long-term performance of stent grafts, in particular durable fixation and sealing to the aortic wall, remains the main concern of this treatment. The sealing and fixation are challenged at every

  2. Delayed endovascular treatment of descending aorta stent graft collapse in a patient treated for post- traumatic aortic rupture: a case report

    Directory of Open Access Journals (Sweden)

    Stegher Silvia

    2011-05-01

    Full Text Available Abstract Background We report a case of delayed endovascular correction of graft collapse occurred after emergent Thoracic Endovascular Aortic Repair (TEVAR for traumatic aortic isthmus rupture. Case presentation In 7th post-operative day after emergent TEVAR for traumatic aortic isthmus rupture (Gore TAG® 28-150, a partial collapse of the endoprosthesis at the descending tract occurred, with no signs of visceral ischemia. Considering patient's clinical conditions, the graft collapse wasn't treated at that time. When general conditions allowed reintervention, the patient refused any new treatment, so he was discharged. Four months later the patient complainted for severe gluteal and sural claudication, erectile disfunction and abdominal angina; endovascular correction was performed. At 18 months the graft was still patent. Discussion and Conclusion Graft collapse after TEVAR is a rare event, which should be detected and treated as soon as possible. Delayed correction of this complication can be lethal due to the risk of visceral ischemia and limbs loss.

  3. Endovascular management of ureteroarterial fistula: a rare potentially life threatening cause of hematuria.

    Science.gov (United States)

    Copelan, Alexander; Chehab, Monzer; Cash, Charles; Korman, Howard; Dixit, Purushottam

    2014-07-01

    Ureteroarterial fistula is a rare, potentially life-threatening cause of hematuria characterized by an abnormal channel between a ureter and artery. The rarity of this condition, complexity of predisposing risk factors and intermittence of symptoms may delay or obscure its diagnosis. With a high index of suspicion and careful angiographic evaluation, embarking on this condition is not only possible but sets the stage for curative intervention. We report a case of a ureteroarterial fistula presenting with intermittent hematuria, successfully diagnosed at angiography and managed with endovascular stent graft placement.

  4. Technical features of the INCRAFT™ AAA Stent Graft System.

    Science.gov (United States)

    Bertoglio, L; Logaldo, D; Marone, E M; Rinaldi, E; Chiesa, R

    2014-10-01

    The INCRAFT® AAA Stent Graft System is the advanced endovascular aneurysm repair (EVAR) technology for the treatment of infrarenal abdominal aneurysms. This new system is designed to address the unmet needs of current endografts by combining unique features and adding new refinements compared to existing endografts delivered through a flexible 14-Fr ultra-low system. The INCRAFT® AAA Stent Graft System introduces innovative features without deviating from proven stent-graft design principles. It is a three-piece modular system, made of low porosity polyester and segmented nitinol stents. However, the introduction of cap-free delivery and partial proximal repositioning enhances the ability of the device to better match individual aortoiliac anatomy with a high deliverability and placement accuracy in a easy to use system. Moreover, the INCRAFT® System allows a "customization" of the implant during the procedure with bilateral in-situ length adjustment features. The present data from the ongoing clinical trials confirm excellent results with this system, but postmarket studies will be necessary to verify the effectiveness of this system in the real-world setting.

  5. Segmentation and motion estimation of stent grafts in abdominal aortic aneurysms

    NARCIS (Netherlands)

    Klein, Almar

    2011-01-01

    Patients with an Abdominal Aortic Aneurysm have a high risk of dying due to the rupture of a dilated aorta. Endovascular aneurysm repair is a technique to threat AAA, by which a stent graft prosthesis is implanted in the aorta of the patient. Due to its minimal invasive character, this intervention

  6. Treatment of a ruptured thoracoabdominal aneurysm with a stent-graft covering the celiac axis

    NARCIS (Netherlands)

    Jorna, Francisca H.; Verhoeven, Eric L. G.; Bos, Wendy T. J. G.; Prins, Ted R.; Dol, Johan A.; Reijnen, Michel M. P. J.

    2006-01-01

    Purpose: To present a case of successful emergency endovascular repair of a ruptured, probably mycotic, thoracoabdominal aortic aneurysm (TAAA) with a stent-graft deliberately covering the celiac axis. Case Report. A 79-year-old woman with significant pulmonary comorbidity presented with a ruptured

  7. Stent graft placement for dysfunctional arteriovenous grafts

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Gyeong Sik [Dept. of Radiology, CHA Bundang Medical Center, College of Medicine, CHA University, Seongnam (Korea, Republic of); Shin, Byung Seok; Ohm, Joon Young; Ahn, Moon Sang [Chungnam National University Hospital, Daejeon (Korea, Republic of)

    2015-07-15

    This study aimed to evaluate the usefulness and outcomes of stent graft use in dysfunctional arteriovenous grafts. Eleven patients who underwent stent graft placement for a dysfunctional hemodialysis graft were included in this retrospective study. Expanded polytetrafluoroethylene covered stent grafts were placed at the venous anastomosis site in case of pseudoaneurysm, venous laceration, elastic recoil or residual restenosis despite the repeated angioplasty. The patency of the arteriovenous graft was evaluated using Kaplan-Meier analysis. Primary and secondary mean patency was 363 days and 741 days. Primary patency at 3, 6, and 12 months was 82%, 73%, and 32%, respectively. Secondary patency at the 3, 6, 12, 24, and 36 months was improved to 91%, 82%, 82%, 50%, and 25%, respectively. Fractures of the stent graft were observed in 2 patients, but had no effect on the patency. Stent graft placement in dysfunctional arteriovenous graft is useful and effective in prolonging graft patency.

  8. 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.

  9. Tissue Responses to Stent Grafts with Endo-Exo-Skeleton for Saccular Abdominal Aortic Aneurysms in a Canine Model

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Il Young; Chung, Jin Wook; Kim, Hyo Cheol [Dept. of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Clinical Research Institute, Seoul (Korea, Republic of); Choi, Young Ho; So Young Ho [Dept. of Radiology, Seoul National University Boramae Hospital, Seoul (Korea, Republic of); Kim, Hyun Beom [Dept. of Radiology, National Cancer Center, Goyang (Korea, Republic of); Min, Seung Kee [Dept. of Surgery, Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Jae Hyung [Dept. of Radiology, Gachon University Gil Medical Center, Incheon (Korea, Republic of)

    2014-10-15

    We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 ± 0.05 mm, mean ± standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 ± 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms.

  10. Tissue responses to stent grafts with endo-exo-skeleton for saccular abdominal aortic aneurysms in a canine model.

    Science.gov (United States)

    Kim, Young Il; Choi, Young Ho; Chung, Jin Wook; Kim, Hyo-Cheol; So, Young Ho; Kim, Hyun Beom; Min, Seung-Kee; Park, Jae Hyung

    2014-01-01

    We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly and evaluated microscopically. The animals were sacrificed at two (n = 3), six (n = 3), and eight months (n = 2) after endovascular repair. In two dogs, the aortic lumen was occluded at two months after the placement. On gross inspection of specimens from the other six dogs with a patent aortic lumen, stent grafts placed over the normal aortic wall were covered by glossy white neointima, whereas, stent grafts placed over the aneurysmal aortic wall were covered by brownish neointima. On microscopic inspection, stent grafts placed over the normal aortic wall were covered by thin neointima (0.27 ± 0.05 mm, mean ± standard deviation) with an endothelial layer, and stent grafts placed over the aneurysmal aortic wall were covered by thick neointima (0.62 ± 0.17 mm) without any endothelial lining. Transgraft cell migration at the normal aortic wall was more active than that at the aneurysmal aortic wall. Close contact between the stent and the graft, which was achieved with stent grafts with endo-exo-skeleton, could not enhance endothelial covering on the stent graft placed over the aneurysms.

  11. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

    Energy Technology Data Exchange (ETDEWEB)

    Pecoraro, Felice, E-mail: felicepecoraro@libero.it; Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido [University of Palermo, Vascular Surgery Unit (Italy)

    2015-10-15

    A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

  12. Endovascular treatment of a bleeding secondary aorto-enteric fistula. A case report with 1-year follow-up.

    Science.gov (United States)

    Brountzos, Elias N; Vasdekis, Spyros; Kostopanagiotou, Georgia; Danias, Nikolaos; Alexopoulou, Efthymia; Petropoulou, Konstantina; Gouliamos, Athanasios; Perros, Georgios

    2007-01-01

    We report a patient with life-threatening gastrointestinal bleeding caused by a secondary aorto-enteric fistula. Because the patient had several comorbid conditions, we succesfully stopped the bleeding by endovascular placement of a bifurcated aortic stent-graft. The patient developed periaortic infection 4 months later, but he was managed with antibiotics. The patient is well 1 year after the procedure.

  13. Balloon Tamponade Treatment of a Stent-graft Related Rupture with a Splenic Artery Pseudoaneurysm: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, See Hyung; Kim, Young Hwan [Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2009-09-15

    An arterial rupture resulting from stent-graft placement of a splenic artery pseudoaneurysm is a life-threatening complication and immediate endovascular or surgical treatment is indicated. We report a case of a stentgraft related splenic artery rupture treated solely with a prolonged balloon catheter tamponade, which resulted in preservation of vessel patency

  14. Assessment of Competence in EVAR Stent Graft Sizing and Selection

    DEFF Research Database (Denmark)

    Strøm, M; Lönn, L.; Bech, B.

    2017-01-01

    Objectives and background: The aims of this study were to develop a test of competence in endovascular aortic repair (EVAR) stent graft sizing and selection; to examine the test for evidence of validity; and to explore the experience required for the task. Methods: The test was developed based...... on a literature review resulting in 22 anatomical assessment points and a graft selection. Validity evidence was explored in an international cross sectional study. Twenty-two consultants with varying levels of experience in the field (novices, intermediates, and experts) were presented with computed tomography...... angiography of the aortic vessels from three patients. Test scores were based on summed z-scores using the anatomical measurements and graft choices of the experts as a reference. A proficiency score was established using the contrasting groups standard setting method. Results: The assessment was shown...

  15. Comparison of Temporary Open Arterial Revascularization Using Stent Grafts vs. Standard Vascular Shunts in a Porcine (Sus scrofa) Model

    Science.gov (United States)

    2017-01-24

    feasible strategy for damage control management of peripheral vascular injury and offers increased blood flow when compared to temporary shunts...survival model of porcine vascular injury . Methods: 12 Yorkshire-cross swine received a 2cm long near-circumferential defect in the iliac arteries. A14...shunts was greater than that of the stent grafts. Conclusion: Open sutureless direct site repair using stent grafts to treat vascular injury is a

  16. Importance of stent-graft design for aortic arch aneurysm repair

    Directory of Open Access Journals (Sweden)

    C Singh

    2017-02-01

    Full Text Available Aneurysm of the aorta is currently treated by open surgical repair or endovascular repair. However, when the aneurysm occurs in regions between the aortic arch and proximal descending aorta, it can be a complex pathology to treat due to its intricate geometry. When complex aortic aneurysms are treated with the conventional procedures, some of the patients present with significant post-operative complications and high mortality rate. Consequently, a clinically driven hybrid innovation known as the frozen elephant trunk procedure was introduced to treat complex aortic aneurysms. Although this procedure significantly reduces mortality rate and operating time, it is still associated with complications such as endoleaks, spinal cord ischemia, renal failure and stroke. Some of these complications are consequences of a mismatch in the biomechanical behaviour of the stent-graft device and the aorta. Research on complex aneurysm repair tended to focus more on the surgical procedure than the stent-graft design. Current stent-graft devices are suitable for straight vessels. However, when used to treat aortic aneurysm with complex geometry, these devices are ineffective in restoring the normal biological and biomechanical function of the aorta. A stent-graft device with mechanical properties that are comparable with the aorta and aortic arch could possibly lead to fewer post-operative complications, thus, better outcome for patients with complex aneurysm conditions. This review highlights the influence stent-graft design has on the biomechanical properties of the aorta which in turn can contribute to complications of complex aneurysm repair. Design attributes critical for minimising postoperative biomechanical mismatch are also discussed.

  17. Effects of Microporous Stent Graft on the Descending Aortic Aneurysm: A Patient-Specific Computational Fluid Dynamics Study.

    Science.gov (United States)

    Ong, Chi-Wei; Ho, Pei; Leo, Hwa-Liang

    2016-11-01

    Thoracic endovascular aortic repair (TEVAR) method is an alternative treatment for thoracic aortic aneurysm (TAA) compared to open surgery. It is believed that stent graft implantation can potentially reduce the risk of aneurysm rupture by altering the associated blood flow disturbances within an aneurysm. To investigate the hemodynamics changes of TEVAR intervention to the TAA, three models, namely healthy, aneurysm before treatment, and aneurysm after stent graft implantation models were built. These three models were presented and compared in terms of their flow patterns, time-averaged wall shear stress (TAWSS), oscillating shear index (OSI), and relative residence time (RRT). Reduced TAWSS and OSI with altered flow pattern were found on the aneurysm wall after the deployment of the microporous stent graft. Elevated RRT on the aneurysm sac indicated that red blood cells and platelets tended to stay longer in the aneurysm sac after implantation of the microporous stent graft. The alteration of flow patterns caused by the microporous stent graft revealed its potential to create a beneficial hemodynamic environment, which promotes platelet activation within the aneurysm and elicits localization of thrombus formation that ultimately lead to the recovery of an aortic aneurysm. Copyright © 2016 Wiley Periodicals, Inc. and International Center for Artificial Organs and Transplantation.

  18. Use of a Stent Graft for Bleeding Hepatic Artery Pseudoaneurysm Following Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Leoncio L. Kaw, Jr

    2006-10-01

    Full Text Available Although uncommon, bleeding following pancreaticoduodenectomy is associated with high mortality. Management generally includes surgical reexploration or, alternatively, transarterial embolization. We report the case of a 62-year-old man who presented with massive upper gastrointestinal bleeding 3 weeks after pancreaticoduodenectomy. Selective coeliac angiography revealed a large pseudoaneurysm involving the proper hepatic artery. This was treated successfully with a stent graft. There was no recurrence of bleeding at the 6-month follow-up. To our knowledge, this is the first report of stent graft repair of bleeding hepatic artery pseudoaneurysm following pancreaticoduodenectomy.

  19. Covered Stent-Graft Treatment of a Postoperative Common Carotid Artery Pseudoaneurysm

    Science.gov (United States)

    Ergun, Onur; Celtikci, Pinar; Canyigit, Murat; Birgi, Erdem; Hidiroglu, Mete; Hekimoglu, Baki

    2014-01-01

    Background Extracranial carotid artery pseudoaneurysms are rare cases resulting from trauma, mycotic infection, head and neck carcinomas or complications related to their treatment. Trauma is the most common cause of carotid artery pseudoaneurysms. They can also present after surgery, most commonly following endarterectomy, which is a rare cause with an estimated incidence of 0.3–0.6%. Case Report A 26-year-old male patient was admitted with swelling in his left neck after left carotid endarterectomy. Angiography confirmed pseudoaneursym in the left carotid bulb and it was treated successfully with two heparin-bonded covered stent grafts. Conclusions Endovascular treatment of carotid pseudoaneurysms with covered stent-grafts is a safe and efficient method providing definitive arterial reconstruction. But series with longer follow-up periods are needed to evaluate patient compatibility to lifelong antiplatelet theraphy. PMID:25279023

  20. [Evaluation of Radiation Dose during Stent-graft Treatment Using a Hybrid Operating Room System].

    Science.gov (United States)

    Haga, Yoshihiro; Chida, Kouichi; Kaga, Yuji; Saitou, Kazuhisa; Arai, Takeshi; Suzuki, Shinichi; Iwaya, Yoshimi; Kumasaka, Eriko; Kataoka, Nozomi; Satou, Naoto; Abe, Mitsuya

    2015-12-01

    In recent years, aortic aneurysm treatment with stent graft grafting in the X-ray fluoroscopy is increasing. This is an endovascular therapy, because it is a treatment which includes the risk of radiation damage, having to deal with radiation damage, to know in advance is important. In this study, in order to grasp the trend of exposure stent graft implantation in a hybrid operating room (OR) system, focusing on clinical data (entrance skin dose and fluoroscopy time), was to count the total. In TEVAR and EVAR, fluoroscopy time became 13.40 ± 7.27 minutes, 23.67 ± 11.76 minutes, ESD became 0.87 ± 0.41 mGy, 1.11 ± 0.57 mGy. (fluoroscopy time of EVAR was 2.0 times than TEVAR. DAP of EVAR was 1.2 times than TEVAR.) When using the device, adapted lesions and usage are different. This means that care changes in exposure-related factors. In this study, exposure trends of the stent graft implantation was able to grasp. It can be a helpful way to reduce/optimize the radiation dose in a hybrid OR system.

  1. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm.

    Science.gov (United States)

    Georgiadis, George S; van Herwaarden, Joost A; Antoniou, George A; Giannoukas, Athanasios D; Lazarides, Miltos K; Moll, Frans L

    2016-06-01

    The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR). © The Author(s) 2016.

  2. 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.

  3. Magnetizable stent-grafts enable endothelial cell capture

    Energy Technology Data Exchange (ETDEWEB)

    Tefft, Brandon J. [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Uthamaraj, Susheil [Division of Engineering, Mayo Clinic, Rochester, MN (United States); Harburn, J. Jonathan [School of Medicine, Pharmacy and Health, Durham University, Stockton-on-Tees (United Kingdom); Hlinomaz, Ota [Department of Cardioangiology, St. Anne' s University Hospital, Brno (Czech Republic); Lerman, Amir [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States); Dragomir-Daescu, Dan [Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN (United States); Sandhu, Gurpreet S., E-mail: sandhu.gurpreet@mayo.edu [Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (United States)

    2017-04-01

    Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance. - Highlights: • Magnetic stent-grafts were made from 2205 steel stents and polyurethane nanofibers. • Stent-grafts remained patent and formed a thin and uniform neointima when implanted. • Stent-grafts captured endothelial cells labeled with magnetic nanoparticles.

  4. CT Imaging Findings and Their Relevance to the Clinical Outcomes After Stent Graft Repair of Penetrating Aortic Ulcers: Six-year, Single-center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Ji Hoon [University of Ulsan College of Medicine, Asan Medical Center, Department of Radiology and Research Institute of Radiology (Korea, Republic of); Angle, John F.; Park, Auh Whan; Anderson, Curtis; Sabri, Saher S.; Turba, Ulku C. [University of Virginia Health System, Division of Angiography, Interventional Radiology and Special Procedures, Department of Radiology (United States); Kern, John A.; Cherry, Kenneth J. [University of Virginia Health System, Department of Surgery (United States); Matsumoto, Alan H., E-mail: ahm4d@virginia.edu [University of Virginia Health System, Division of Angiography, Interventional Radiology and Special Procedures, Department of Radiology (United States)

    2012-12-15

    Purpose: To present the computed tomographic (CT) imaging findings and their relevance to clinical outcomes related to stent graft placement in patients with penetrating aortic ulcers (PAUs). Methods: Medical and imaging records and imaging studies were reviewed for consecutive patients who underwent stent graft repair of a PAU. The distribution and characteristics of the PAU, technical success of stent graft repair, procedure-related complications, associated aortic wall abnormalities, and outcomes of the PAUs at follow-up CT scans were evaluated. Results: Fifteen patients underwent endovascular treatment for PAU. A total of 87% of the PAUs were in the proximal (n = 8) or distal (n = 5) descending thoracic aorta. There was a broad spectrum of PAU depth (mean, 7.9 {+-} 5.6 mm; range 1.5-25.0 mm) and diameter (mean, 13.5 {+-} 9.7 mm; range 2.2-41.0 mm). Atherosclerosis of the thoracic aorta and intramural hematoma were associated in 53 and 93% of the patients, respectively. Technical success was achieved in 100%. Two or more stent grafts were used in five patients. Endoleaks were observed in two patients within 2 weeks of the procedure, both of which resolved spontaneously. At follow-up CT scanning, regression and thrombosis of the PAUs were observed in all patients. The average patient survival was 61.8 months, with an overall mortality of 13% (2 of 15) at follow-up. Neither death was related to the endograft device or the PAU. Conclusion: Endovascular stent graft placement was safe and effective in causing regression and thrombosis of PAUs in this small series of patients. Two or more stent grafts were used in five patients (33%) with associated long-segmental atherosclerotic changes of the thoracic aorta or intramural hematoma.

  5. Extrahepatic Pseudoaneurysms and Ruptures of the Hepatic Artery in Liver Transplant Recipients: Endovascular Management and a New Iatrogenic Etiology

    Energy Technology Data Exchange (ETDEWEB)

    Saad, Wael E. A., E-mail: wspikes@yahoo.com; Dasgupta, Niloy; Lippert, Allison J.; Turba, Ulku C.; Davies, Mark G. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Kumer, Sean [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Gardenier, Jason C.; Sabri, Saher S.; Park, Auh-Whan [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States); Waldman, David L. [University of Rochester Medical Center, Department of Imaging Sciences (United States); Schmitt, Timothy [University of Virginia Health System, Division of Solid Organ Transplantation, Department of Surgery (United States); Matsumoto, Alan H.; Angle, John F. [University of Virginia Health System, Division of Vascular Interventional Radiology, Department of Radiology (United States)

    2013-02-15

    To characterize extrahepatic pseudoaneurysm regarding incidence and etiology and determine the effectiveness of endovascular management. A retrospective audit of 1,857 liver transplants in two institutions was performed (1996-2009). Recipients' demographics, clinical presentation, transplant type, biliary anastomosis, and presence of biliary endoprostheses were noted. Pseudoaneurysms were classified into iatrogenic (associated with biliary endoprosthesis or angioplasty) or spontaneous extrahepatic pseudoaneurysms. Spontaneous and iatrogenic pseudoaneurysms were compared for time from transplant, presenting symptoms, location in the arterial anatomy, and 3-month graft survival. Arterial patency and 6-month graft survival were calculated. Twenty pseudoaneurysms were found (1.1 %, 20/1,857): 9 (0.5 % of transplants, 9/1,857) were spontaneous and 11 (0.6 % of transplants, 11/1,857) were 'iatrogenic' (due to minimally invasive procedures: 4 angioplasty and 7 biliary endoprostheses). Sixty percent (12/20) underwent endovascular management (4 coil embolization and 8 stent-grafts). Technical success was 83 % (10/12) with a mean arterial patency of 70 % (follow-up mean, 4.9; range, 0-18 months). The 1-, 3-, and 6-month graft survival was 70, 40, and 35 %, respectively. Due to minimally invasive procedures, posttransplant extrahepatic pseudoaneurysms are no longer an exclusive complication of the transplant surgery itself. Endovascular management is effective to stabilize patients but has not improved historic postsurgical graft survival.

  6. Computer modeling for the prediction of thoracic aortic stent graft collapse.

    Science.gov (United States)

    Pasta, Salvatore; Cho, Jae-Sung; Dur, Onur; Pekkan, Kerem; Vorp, David A

    2013-05-01

    TASG wall, a load that would portend TASG collapse. Patient-specific computational modeling may allow for identification of patients with high risk of TASG collapse and guide preventive intervention. A potentially devastating complication that may occur after endovascular repair of traumatic thoracicaortic injuries is stent graft collapse. Although usually asymptomatic, stent graft collapse may be accompanied by adverse hemodynamic consequences. Numerous anatomic and device-related factors contribute to the development of collapse, but predictive factors have not yet been clearly defined. In the present study, we assessed the relevant hemodynamics and solid mechanics underlying stent graft collapse using a computational fluid-structure interaction framework of stent graft malapposition. Our findings suggest that both increased stent graft angle and extension into the aortic arch lead to a markedly increased transmural pressure across the stent graft wall, portending collapse. Patient-specific computational modeling may allow for identification of patients at high risk for collapse and aid in planning for an additional, prophylactic intervention to avert its occurrence. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  7. Electrical potentials between stent-grafts made from different metals induce negligible corrosion.

    Science.gov (United States)

    Kazimierczak, A; Podraza, W; Lenart, S; Wiernicki, I; Gutowski, P

    2013-10-01

    Evaluation of the risk of galvanic corrosion in various stent-grafts in current practice, when devices with unmatched alloy compositions are deployed together. Five nitinol (NT) and two steel (SS) stent-grafts produced by different companies were used in different combinations to create 21 samples (NT:NT, n = 10; NT:SS, n = 10; SS:SS, n = 1). Electric potential was measured between the metal couplings after immersion in 0.9% NaCl at a temperature of 37 °C. Subsequently, the same samples were incubated for 24 months in 0.9% NaCl at 37-39 °C under hermetic conditions and examined under a scanning electron microscope in order to search for any evidence of corrosion. Electric potentials between different metals alloys were found (means: NT:SS, 181 μV; NT:NT, 101 μV; SS:SS, 160 μV). The mean electrical potential between stainless steel and nitinol samples was significantly higher than between NT:NT couplings (p corrosion (>10 μm) on a nitinol surface was found (associated with previous mechanical damage) in an NT:SS sample after 24 months of incubation in vitro and no sign of mechanical failure of the wires was found. Direct contact between the stainless steel and the nitinol alloys does indeed create electrical potential but with a minimal risk of galvanic corrosion. No evidence was found for significant galvanic corrosion when two endovascular implants (stent-grafts) made from different metal composition were used in the same procedure. Copyright © 2013 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  8. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement

    Energy Technology Data Exchange (ETDEWEB)

    Mehta, Vimal, E-mail: drvimalmehta@yahoo.co.in; Pandit, Bhagya Narayan; Mehra, Pratishtha; Nigam, Arima; Vyas, Aniruddha; Yusuf, Jamal; Mukhopadhyay, Saibal; Trehan, Vijay [G.B. Pant Institute of Postgraduate Medical Education and Research (India)

    2016-01-15

    We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.

  9. Misplaced central venous catheter in the vertebral artery: endovascular treatment of foreseen hemorrhage during catheter withdrawal.

    Science.gov (United States)

    Akkan, Koray; Cindil, Emetullah; Kilic, Koray; Ilgit, Erhan; Onal, Baran; Erbas, Gonca

    2014-01-01

    We report on the endovascular management of hemorrhage with stent-graft due to a misplaced central venous catheter in the vertebral artery (VA) during percutaneous internal jugular vein catheterization in a child. A 16-year-old female was presented with the diagnosis of familial Mediterranean fever related chronic renal insufficiency. An attempt was made to place a central venous catheter via the right internal jugular vein without image guidance and the patient experienced dyspnea and pain at the catheter insertion site. Computerized tomography (CT) showed hemorrhage in the cervical region and upper mediastinum, also reformatted images showed that the catheter was passing through the proximal part of the VA and terminating in the right mediastinum. The catheter was removed during manual compression under angio-flouroscopic monitoring and ongoing extravasation was observed. A stent-graft was placed to the bleeding site of the VA. Angiography immediately after the stent-graft placement revealed complete disappearance of extravasation and patency of vertebral and subclavian arteries. Central venous catheterization (CVC) is not a risk-free procedure and arterial injuries are in a wide spectrum from a simple puncture to rupture of the artery. Inadvertent VA cannulation is a rare and serious complication necessitating prompt diagnosis and early treatment. If an arterial injury with a large-caliber catheter occurs, endovascular treatment with stent-graft seems to be a safe and effective option in terms of achieving hemostasis and preserving arterial patency. Recent findings suggest that endovascular management of inadvertent cervical arterial injury secondary to CVC seems to be the safest strategy.

  10. Clinical testing of Belarusian aortic stent graft system

    Directory of Open Access Journals (Sweden)

    А. П. Шкет

    2016-12-01

    Full Text Available Aim. The study looks at the results of clinical testing of the first Belarusian aortic stent graft system developed and manufactured by a team of specialists from RSPC "Cardiology", Minsk, Belarus, and Belarusian Technical University.Methods. The original system of aortic stent graft includes a delivery system and an aortic stent graft itself. It is used in surgical treatment of complicated and common aneurysms of the thoracic aorta, as well as in cases of concomitant thoracic aneurysms and heart pathology to be treated under cardiopulmonary bypass. Clinical testing of the stent graft was carried out according to the requirements of Ministry of Health of the Republic of Belarus on the basis of three different cardiac hospitals of the country. Results. All the three hospitals treated one patient each. The first patient underwent implantation of the stent graft into the descending thoracic aorta, with the thoracic aorta aneurysm isolated and the aortic valve replaced with bioprosthesis. The second patient underwent ascending aorta and aortic valve replacement with a conduit and implantation of aortic stent graft into the descending thoracic aorta. In the third patient the domestic aortic stent graft was implanted into the descending thoracic aorta with isolation of the thoracic aneurysm; aortic valve and ascending aorta were replaced with ‘MedEng' conduit and the aortic arch was also replaced, with the brachiocephalic arteries re-implanted in place. All the patients were followed-up for both early and long-term outcomes for more than 1 year and were examined by using CT angiography in the early postoperative period and after 1 year. Uncomplicated postoperative course was observed in all the patients. There were no complications in the long-term follow-up as well. CT angiography data confirmed good positioning of the stent graft and good isolation of the aneurysm lumen. Preoperative and postoperative СТ data of one patient are presented in the

  11. Haemodynamic imaging of thoracic stent-grafts by computational fluid dynamics (CFD): presentation of a patient-specific method combining magnetic resonance imaging and numerical simulations.

    Science.gov (United States)

    Midulla, Marco; Moreno, Ramiro; Baali, Adil; Chau, Ming; Negre-Salvayre, Anne; Nicoud, Franck; Pruvo, Jean-Pierre; Haulon, Stephan; Rousseau, Hervé

    2012-10-01

    In the last decade, there was been increasing interest in finding imaging techniques able to provide a functional vascular imaging of the thoracic aorta. The purpose of this paper is to present an imaging method combining magnetic resonance imaging (MRI) and computational fluid dynamics (CFD) to obtain a patient-specific haemodynamic analysis of patients treated by thoracic endovascular aortic repair (TEVAR). MRI was used to obtain boundary conditions. MR angiography (MRA) was followed by cardiac-gated cine sequences which covered the whole thoracic aorta. Phase contrast imaging provided the inlet and outlet profiles. A CFD mesh generator was used to model the arterial morphology, and wall movements were imposed according to the cine imaging. CFD runs were processed using the finite volume (FV) method assuming blood as a homogeneous Newtonian fluid. Twenty patients (14 men; mean age 62.2 years) with different aortic lesions were evaluated. Four-dimensional mapping of velocity and wall shear stress were obtained, depicting different patterns of flow (laminar, turbulent, stenosis-like) and local alterations of parietal stress in-stent and along the native aorta. A computational method using a combined approach with MRI appears feasible and seems promising to provide detailed functional analysis of thoracic aorta after stent-graft implantation. • Functional vascular imaging of the thoracic aorta offers new diagnostic opportunities • CFD can model vascular haemodynamics for clinical aortic problems • Combining CFD with MRI offers patient specific method of aortic analysis • Haemodynamic analysis of stent-grafts could improve clinical management and follow-up.

  12. Magnetizable stent-grafts enable endothelial cell capture

    Science.gov (United States)

    Tefft, Brandon J.; Uthamaraj, Susheil; Harburn, J. Jonathan; Hlinomaz, Ota; Lerman, Amir; Dragomir-Daescu, Dan; Sandhu, Gurpreet S.

    2017-04-01

    Emerging nanotechnologies have enabled the use of magnetic forces to guide the movement of magnetically-labeled cells, drugs, and other therapeutic agents. Endothelial cells labeled with superparamagnetic iron oxide nanoparticles (SPION) have previously been captured on the surface of magnetizable 2205 duplex stainless steel stents in a porcine coronary implantation model. Recently, we have coated these stents with electrospun polyurethane nanofibers to fabricate prototype stent-grafts. Facilitated endothelialization may help improve the healing of arteries treated with stent-grafts, reduce the risk of thrombosis and restenosis, and enable small-caliber applications. When placed in a SPION-labeled endothelial cell suspension in the presence of an external magnetic field, magnetized stent-grafts successfully captured cells to the surface regions adjacent to the stent struts. Implantation within the coronary circulation of pigs (n=13) followed immediately by SPION-labeled autologous endothelial cell delivery resulted in widely patent devices with a thin, uniform neointima and no signs of thrombosis or inflammation at 7 days. Furthermore, the magnetized stent-grafts successfully captured and retained SPION-labeled endothelial cells to select regions adjacent to stent struts and between stent struts, whereas the non-magnetized control stent-grafts did not. Early results with these prototype devices are encouraging and further refinements will be necessary in order to achieve more uniform cell capture and complete endothelialization. Once optimized, this approach may lead to more rapid and complete healing of vascular stent-grafts with a concomitant improvement in long-term device performance.

  13. 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.

  14. Dynamics of Endovascular Eneurysm Repair

    NARCIS (Netherlands)

    Herwaarden, J.A. van

    2006-01-01

    Endovascular aneurysm repair (EVAR) was in 1996 started at the St. Antonius Hospital, Nieuwegein, The Netherlands, with use of the AneuRx stent-graft system (Medtronic AVE, Santa Rosa, CA, USA). All data were captured prospectively in a vascular database. In Chapter 2 a general overview of recent

  15. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

    Energy Technology Data Exchange (ETDEWEB)

    Schmelter, Christopher, E-mail: christopher.schmelter@klinikum-ingolstadt.de; Raab, Udo, E-mail: udo.raab@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany); Lazarus, Friedrich, E-mail: friedrich.lazarus@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Nephrology (Germany); Ruppert, Volker, E-mail: volker.ruppert@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Vascular Surgery (Germany); Vorwerk, Dierk, E-mail: dierk.vorwerk@klinikum-ingolstadt.de [Klinikum Ingolstadt, Department of Diagnostic and Interventional Radiology (Germany)

    2015-08-15

    PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  16. Conformability of GORE Excluder Iliac Branch Endoprosthesis and COOK Zenith Bifurcated Iliac Side Branched Iliac Stent Grafts.

    Science.gov (United States)

    Della Schiava, Nellie; Arsicot, Matthieu; Boudjelit, Tarek; Feugier, Patrick; Lermusiaux, Patrick; Millon, Antoine

    2016-10-01

    Forty percent of the abdominal aortic aneurysms present an extension to the iliac axes. The access to a distal neck requiring an embolization of the internal iliac artery (IIA) may cause buttock claudication, colic ischemia, perineal necrosis, erectile dysfunction, and spinal cord ischemia. The aim of the branched iliac stent grafts is to preserve pelvic vascularization while adapting to the constraints of arterial tortuosity which generate type Ib endoleaks, plications, and limb thromboses. The objective was to analyze and compare the in vivo anatomical conformability of the Gore Excluder(®) Iliac Branch Endoprosthesis (IBE) and the Zenith Bifurcated Iliac Side(®) (ZBIS) Cook Iliac Endovascular Device branched stent grafts. This was a monocentric retrospective therapeutic study including 13 IBE and 9 ZBIS stent grafts. Three indices of tortuosity were measured with EndoSize: common iliac artery, pelvic artery index (PAI), and the double iliac sign (DIS). The centerline lengths of the iliac axes and the iliac axis and the IIA were measured by 2 different operators as a blind fashion. The interoperator correlation of the measurements was r = 0.841 (P < 0.0001). Twenty-two patients had a high iliac tortuosity: PAI ≥ 1.14 (mean PAI 1.43 [1.16-2.09]). The IBE stent graft modified neither the ipsilateral length nor tortuosity of the common iliac axis or the PAI (P ≤ 0.17, P ≤ 0.16, and P ≤ 0.23, respectively). The ZBIS stent graft significantly modified (P ≤ 0.02) the length and the tortuosity measured by the PAI compared with the IBE group (P ≤ 0.02). The use of IBE or ZBIS did not modify the postoperative length of the IIA (P ≤ 0.34). Three patients of the IBE group presented one DIS. Postoperatively, they did not present any DIS without significant modification of the postoperative PAI (P ≤ 0.07). In patients with a severe iliac tortuosity, the IBE Gore branched iliac stent graft is more conformable than the ZBIS Cook. IBE, more conformable

  17. Coagulopathy associated with sac reperfusion for reversing paraplegia after endovascular repair of type II thoracoabdominal aneurysm.

    Science.gov (United States)

    Lioupis, Christos; Katsanos, Konstantinos; Clough, Rachel; Matharu, Nick; Modarai, Bijan; Carrell, Tom; Taylor, Peter

    2013-11-01

    Sac perfusion may be helpful in preventing or reversing spinal cord injury after endovascular repair of thoracoabdominal aneurysms and it has been used as an adjunct to the standard physiologic measures of sustained hypertension and cerebrospinal fluid drainage. Coagulopathy as a result of endoleak after endovascular aneurysm repair has been reported, and very rare cases of treatment after repair of these endoleaks have been described. We report a 73-year-old man who had endovascular repair of a type II thoracoabdominal aneurysm with a branched stent graft. Sac reperfusion was initiated to manage postoperative paraplegia. The paraplegia partially resolved but severe hemorrhagic complications developed that were attributed to sac perfusion-related hyperfibrinolysis. Discontinuation of sac perfusion resolved the coagulopathy but resulted in paraplegia. Copyright © 2013 Elsevier Inc. All rights reserved.

  18. Dialysis catheter-related superior vena cava syndrome with patent vena cava: Long term efficacy of unilateral viatorr stent-graft avoiding catheter manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Quaretti, Pietro; Galli, Franco; Maramarco, Lorenzo Paplo; Corti, Riccardo; Leati, Giovanni; Fiorina, Ilaria; Maestri, Marcello [IRCCS Policlinico San Matteo Foundation, Pavia (Italy)

    2014-06-15

    Central venous catheters are the most frequent causes of benign central vein stenosis. We report the case of a 79-year-old woman on hemodialysis through a twin catheter in the right internal jugular vein, presenting with superior vena cava (SVC) syndrome with patent SVC. The clinically driven endovascular therapy was conducted to treat the venous syndrome with a unilateral left brachiocephalic stent-graft without manipulation of the well-functioning catheter. The follow-up was uneventful until death 94 months later.

  19. Juxtarenal Modular Aortic Stent Graft Infection Caused by Staphylococcus aureus

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    Róbert Novotný

    2016-01-01

    Full Text Available Introduction. We are presenting a case report of an infected modular abdominal stent graft. Case Presentation. A 67-year-old male patient three years after Cook’s modular abdominal aortic aneurysm (AAA graft implantation for juxtarenal AAA with an implantation of a stent extension into the right common iliac artery for type Ib endoleak. The patient was admitted into our center in severe condition with suspected retroperitoneal bleeding. Computed tomography angiography (CTAG confirmed retroperitoneal bleeding in the right common iliac artery. An urgent surgical revision was indicated; destructed arterial wall around the stent extension in the right common iliac artery was discovered. Due to the severe state of health of the patient, a resection of the infected stent and affected arterial wall was performed, followed by an iliac-femoral crossover bypass. The patient was transported to the intensive care unit with hepatic and renal failure, with maximal catecholamine support. Combined antibiotic treatment was started. The patient died five hours after the procedure. The cause of death was multiorgan failure caused by sepsis. Hemocultures and perioperative microbiological cultures showed the infection agent to be Staphylococcus aureus methicillin sensitive. Conclusion. Stent graft infection is a rare complication. Treatment is associated with high mortality and morbidity.

  20. Disección de aorta: Aspectos básicos y manejo endovascular Aortic dissection: Basic aspects and endovascular management

    Directory of Open Access Journals (Sweden)

    Nicolás I Jaramillo

    2005-08-01

    Full Text Available El tratamiento de la patología aórtica torácica se complica por la asociación con una alta mortalidad en la reparación quirúrgica, y al mismo tiempo fragilidad y gran comorbilidad en los adultos de edad avanzada. En la búsqueda por reducir la incidencia de resultados negativos, en la década pasada se introdujo la técnica de intervención por la vía de la mínima invasión, con la colocación de dispositivos del tipo stent vía endovascular. La técnica, originalmente descrita por Parodi e inicialmente diseñada para uso en la corrección de aneurismas de aorta abdominal, ha sido adoptada para el uso en la patología aórtica torácica. El mejoramiento en el entendimiento de la fisiopatología y la historia natural de la enfermedad de la aorta torácica y el análisis de los resultados, han facilitado la toma de decisiones en cuanto al tratamiento en términos del tiempo de la intervención apropiada. El tratamiento de la disección de la aorta torácica con el uso de stent endovascular, es uno de los más recientes avances en el tratamiento y hoy recibe una atención especial, al punto que es una alternativa menos invasiva; incluso la tecnología está apenas en sus primeras etapas y en los últimos años se han mejorado significativamente el diseño y el sistema de liberación de estos dispositivos endovasculares conocidos como stent-grafts. Estas prótesis se utilizan de forma creciente en el tratamiento de aneurismas, disecciones, rupturas traumáticas, úlceras penetradas gigantes y hematomas intramurales de la aorta torácica descendente, con buenos resultados tanto tempranos como a mediano plazo. La poca frecuencia, la alta complejidad y la severidad de la patología, y al mismo tiempo el alto riesgo teórico de las complicaciones que se pueden generar, deben mantener cauto al operador, especialmente cuando esta técnica se aplica en pacientes jóvenes. De manera conceptual la solución por la vía endoluminal en las fases agudas

  1. Iatrogenic Vascular Injuries Due to Spinal Surgeries: Endovascular Perspective.

    Science.gov (United States)

    Gok, Mustafa; Aydin, Elcin; Guneyli, Serkan; Akay, Ali; Cinar, Celal; Oran, Ismail

    2017-01-17

    Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Surgical management of these injuries is challenging with high morbidity rates. In this study we aim to present the results of endovascular management of iatrogenic vascular injuries due to spinal surgeries. We retrospectively reviewed 11 patients (5 male, 6 female) who had vascular injuries due to cervical and lumbar spinal surgeries. Clinical findings were bleeding (n=5), leg edema (n=6) and right heart failure with severe dyspnea (n=1). The age range of the patients were between 42-67 (mean: 57.1). Six patients were reviewed with imaging before the procedures and the rest of the patients (n=5) were directly referred to the angiography unit for diagnosis and possible endovascular treatment. The types of surgeries were; cervical surgery (n=5) and lumbar disc operation (n=6). The type of vascular injuries were; vertebral artery stenosis (n=1), vertebral artery pseudoaneurysm (n=3), vertebral artery occlusion (n=1) and iliac arteriovenous fistula (n=6). The type of endovascular treatments were; parent artery occlusion (PAO) (n=2), covered stent graft implantation (n=6) and intrasaccular coil embolization of pseudoaneurysm (n=1). The remaining 2 patients were managed conservatively. No major complications or mortality occured during endovascular interventions. No bleeding or ischemia occured in the follow-up period. Iatrogenic vascular injuries due to spinal surgeries are rare but serious complications. Endovascular interventions are safe and effective in the diagnosis and treatment of such vascular injuries.

  2. 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.

  3. Tissue Responses to Stent Grafts with Endo-Exo-Skeleton for Saccular Abdominal Aortic Aneurysms in a Canine Model

    OpenAIRE

    Kim, Young Il; Choi, Young Ho; Chung, Jin Wook; Kim, Hyo-Cheol; So, Young Ho; Kim, Hyun Beom; Min, Seung-Kee; Park, Jae Hyung

    2014-01-01

    Objective We evaluated the effect of close contact between the stent and the graft on the induction of endothelial covering on the stent graft placed over an aneurysm. Materials and Methods Saccular abdominal aortic aneurysms were made with Dacron patch in eight dogs. The stent graft consisted of an inner stent, a expanded polytetrafluoroethylene graft, and an outer stent. After sacrificing the animals, the aortas with an embedded stent graft were excised. The aortas were inspected grossly an...

  4. Endovascular treatment of thoracic aortic aneurysms: a review

    Energy Technology Data Exchange (ETDEWEB)

    Thurnher, Siegfried A. [Department of Radiology, University Hospital, Wien (Austria); Grabenwoeger, Martin [Department of Cardio-Thoracic Surgery, University of Vienna (Austria)

    2002-06-01

    Open surgical repair is considered the traditional treatment for patients with thoracic aortic aneurysms (TAA). In view of the persistent perioperative mobidity and mortality, endovascular stent-graft placement as a minimally invasive and potentially safer treatment for aneurysm of the descending aorta was introduced in 1992. Since then, progress has been made and several institutions have substantiated the safety and effectiveness of stent grafts in the repair of descending TAAs or type-B aortic dissections. Currently, both custom-designed, home-made, and commercially available stent grafts are used. Prior to placement of the endoprosthesis, three major prerequisites must be considered: the localization and morphology of the aneurysm; the distal vascular access of sufficient size; and a limited tortuosity of the abdominal and thoracic aorta. Although short-term results are encouraging, severe complications, including paraplegia, cerebral strokes, and aortic rupture, have been encountered. The long-term durability of currently available stent-graft systems is nonexistent and material fatigue are of major concern to both surgeons and radiologists. Nevertheless, endovascular stent-graft placement could become the procedure of choice in a substantial number of patients with descending TAA. (orig.)

  5. 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.

  6. A Novel Attempt to Standardize Results of CFD Simulations Basing on Spatial Configuration of Aortic Stent-Grafts.

    Directory of Open Access Journals (Sweden)

    Andrzej Polanczyk

    Full Text Available Currently, studies connected with Computational Fluid Dynamic (CFD techniques focus on assessing hemodynamic of blood flow in vessels in different conditions e.g. after stent-graft's placement. The paper propose a novel method of standardization of results obtained from calculations of stent-grafts' "pushing forces" (cumulative WSS--Wall Shear Stress, and describes its usefulness in diagnostic process. AngioCT data from 27 patients were used to reconstruct 3D geometries of stent-grafts which next were used to create respective reference cylinders. We made an assumption that both the side surface and the height of a stent-graft and a reference cylinder were equal. The proposed algorithm in conjunction with a stent-graft "pushing forces" on an implant wall, allowed us to determine which spatial configuration of a stent-graft predispose to the higher risk of its migration. For stent-grafts close to cylindrical shape (shape factor φ close to 1 WSS value was about 267 Pa, while for stent-grafts different from cylindrical shape (φ close to 2 WSS value was about 635 Pa. It was also noticed that deformation in the stent-graft's bifurcation part impaired blood flow hemodynamic. Concluding the proposed algorithm of standardization proved its usefulness in estimating the WSS values that may be useful in diagnostic process. Angular bends or tortuosity in bifurcations of an aortic implant should be considered in further studies of estimation of the risk of implantation failure.

  7. [Endovascular management of cavernous sinus dural fistulas].

    Science.gov (United States)

    Zenteno, Marco; Santos Franco, Jorge; Moscote-Salazar, Luis Rafael; Lee, Angel

    2014-01-01

    Describe the outcomes of patients diagnosed with indirect carotid-cavernous fistula treated by endovascular methods. A retrospective case series. Twelve patients with dural cavernous sinus fistula with important ophthalmologic involvement admitted and treated at the National Institute of Neurology and Neurosurgery between February 1990 and January 2005. Patients were managed by endovascular embolization for all fistulas. Angiographic controls to 24 hours and at 6 and 12 months were performed. 67 % were female and 33 % male. The mean age was 44 years. 67 % were spontaneous and 33% of traumatic origin. All patients had eye involvement with proptosis (92%) and involvement of the oculomotor nerve (67%). Headache and pulsatile tinnitus were not frequent ophthalmologic data. All were diagnosed by cerebral angiography, 33 % were type C, type D 67 %, and none of the type B classification Barrow. In 17 % of cases the distal arterial robbery showed severe. Predominance of anterior and superior venous drainage in 83 % and 42 % of cases occurred respectively. The surgical approach was arterial in 84% of cases, while in 17 % venous through the superior ophthalmic vein. Cyanoacrylate embolization material was used in 58 % of the cases, as it was associated with the use of removable ball with polyvinyl alcohol particles in 16 % in of venous approach cases. 17% detachable coils were utilized. There were no complications. After angiographic controls at 24 hours 100% occlusion was seen in patients treated with cyanoacrylate (58%) (p = 0.03). The remaining 42% were prescribed maneuver of manual compression. At 12-months angiography all patients had 100% occlusion of the carotid-cavernous fistula. CONCLSUIONS: This is the world's second largest series with indirect carotid-cavernous fistulas treated after trauma. 100 % of cases were cured with the use of a transarterial-controlled approach and N-butyl-cyanoacrylate after long-term observation.

  8. Balloon-Expandable Stent Graft for Treating Uretero-Iliac Artery Fistula

    Energy Technology Data Exchange (ETDEWEB)

    Guntau, Moritz, E-mail: guntau@med.uni-marburg.de [Philipps University, Department of Diagnostic and Interventional Radiology, Marburg University Hospital (Germany); Hegele, Axel [Philipps University, Department of Urology and Pediatric Urology, Marburg University Hospital (Germany); Rheinheimer, Stephan [Philipps University, Department of Diagnostic and Interventional Radiology, Marburg University Hospital (Germany); Hofmann, Rainer [Philipps University, Department of Urology and Pediatric Urology, Marburg University Hospital (Germany); Mahnken, Andreas H. [Philipps University, Department of Diagnostic and Interventional Radiology, Marburg University Hospital (Germany)

    2017-06-15

    PurposeTo evaluate the safety, efficacy and outcome of percutaneous balloon-expandable covered stent graft placement for uretero-iliac artery fistula (UAF) treatment.MethodsThis retrospective study evaluated the single-center experience of percutaneous balloon-expandable covered stent graft placement (ADVANTA™, Atrium Hudson, NH, USA) in UAF. Data were obtained from a prospective institutional database. Patient follow-up included complications, symptoms recurrence and mortality rate.ResultsTen UAFs in eight patients (3 males; 5 females) with a mean age of 64.5 (35–77) years were identified. All patients had a history pelvic malignancy, extirpative surgery (n = 6), long-term ureteral stenting (n = 7) and pelvic radiation (n = 5). All procedures were completed successfully without complications. Thirty-day mortality rate was zero. At a median follow-up of 6 (1–60) months, one patient suffered recurrent hematuria requiring a secondary stent graft placement 26 months after the initial treatment. During follow-up, five patients died of the underlying disease (43, 66, 105, and 183 and 274 days after the last procedure).ConclusionPercutaneous balloon-expandable stent graft placement in UAF is a safe and effective treatment option. Implantation of stent grafts should be considered as treatment of choice in UAF.

  9. Abdominal aortic endografting beyond the trials: a 15-year single-center experience comparing newer to older generation stent-grafts.

    Science.gov (United States)

    Verzini, Fabio; Isernia, Giacomo; De Rango, Paola; Simonte, Gioele; Parlani, Gianbattista; Loschi, Diletta; Cao, Piergiorgio

    2014-06-01

    To evaluate the late results of endovascular aneurysm repair (EVAR) with the endografts currently in use and compare outcomes to older devices. Clinical, demographic, and imaging data on consecutive patients undergoing elective EVAR from January 1997 to December 2011 at a single center were retrieved from an electronic database and reviewed. Newer stent-grafts (NSG) were defined as those introduced after 2004 (second-generation Excluder and Anaconda) or currently in use without modifications (Zenith, Endurant). Of the 1412 consecutive patients (1290 men; mean age 73 years) who underwent elective EVAR in a tertiary university hospital, 882 were treated with NSGs and 530 with older stent-grafts (OSGs). In the NSG group, the abdominal aortic aneurysms (AAA) were larger (55.7 vs. 53.2 mm, polder (p5 mm (p=0.022) were higher in the NSG group. In adjusted analyses, the use of a new-generation device was a negative independent predictor of reintervention [hazard ratio (HR) 0.67, 95% confidence interval (CI) 0.49 to 0.93, p=0.015] and aneurysm growth (HR 0.63, 95% CI 0.45 to 0.89, p=0.010). Newer-generation endografts can perform substantially better than the older devices. In the long term, incidences of reintervention, conversion, and AAA growth are decreased in patients treated with devices currently in use. However, the need for continuous surveillance is still imperative for all endografts.

  10. Endovascular treatment of spontaneous isolated abdominal aortic dissection

    Directory of Open Access Journals (Sweden)

    Anna Maria Giribono

    2016-12-01

    Full Text Available Isolated abdominal aortic dissection is a rare clinical disease representing only 1.3% of all dissections. There are a few case series reported in the literature. The causes of this pathology can be spontaneous, iatrogenic, or traumatic. Most patients are asymptomatic and symptoms are usually abdominal or back pain, while claudication and lower limb ischemia are rare. Surgical and endovascular treatment are two valid options with acceptable results. We herein describe nine cases of symptomatic spontaneous isolated abdominal aortic dissection, out of which four successfully were treated with an endovascular approach between July 2003 and July 2013. All patients were men, smokers, symptomatic (either abdominal or back pain or lower limb ischemia, with a history of high blood pressure, with a medical history negative for concomitant aneurysmatic dilatation or previous endovascular intervention. Diagnosis of isolated abdominal aortic dissection were established by contrast-enhanced computed tomography angiography (CTA of the thoracic and abdominal aorta. All nine patients initially underwent medical treatment. In four symptomatic cases, non-responsive to medical therapy, bare-metal stents or stent grafts were successfully positioned. All patients completed a CTA follow-up of at least 12 months, during which they remained symptom-free. Endovascular management of this condition is associated with a high rate of technical success and a low mortality; therefore, it can be considered the treatment of choice when it is feasible.

  11. Endovascular management of traumatic thoracic aortic transection.

    Science.gov (United States)

    Asmat, Atasha; Tan, Lenny; Caleb, Michael George; Lee, Chuen-Neng; Robless, Peter Ashley

    2009-10-01

    The conventional treatment of traumatic thoracic aortic transection is open surgical repair but it is associated with high rates of morbidity and mortality, particularly in patients with multiple injuries. We reviewed our experience of endovascular repair of traumatic thoracic aortic transection. Between March 2002 and December 2007, 7 patients (male 6, female 1; mean age 40 years) with multiple injuries secondary to blunt trauma underwent endovascular stenting. One patient required adjunctive surgery to facilitate endovascular stenting. Mean intensive care unit stay was 8.6 days (range, 3-16 days). Arterial access in all patients was obtained by femoral cut-down. The mean operating time was 122 min. Technical success was achieved in all cases. There was no mortality. One patient suffered a right parietal stroke, but none developed procedure-related paralysis. The mean follow-up period was 18.6 months (range, 6-48 months). There was no evidence of endoleak, stent migration, or late pseudoaneurysm formation on follow-up computed tomography. Endovascular stents can be used to treat traumatic thoracic aortic transection, with low rates of morbidity and mortality. Although early and midterm results are promising, the long-term durability of endovascular stenting for traumatic thoracic aortic transection remains unknown.

  12. Stent-Graft Relining in a Patient with Acute Aortic Aneurysm and a Completely Migrated Endograft

    Science.gov (United States)

    Pillai, Jayandiran; Yazicioglu, Ceyhan; Omar, Mahad; Veller, Martin G.

    2017-01-01

    Stent-graft migration and type I endoleaks are associated with a higher rate of reintervention and increased mortality and morbidity. This article describes a patient presented with an infrarenal aortic stent-graft which had migrated into the aortic sac with loss of all aortic neck attachment. The acutely expanding abdominal aortic aneurysm was treated by placing a second modular endograft within and above the migrated stentgraft. The patient returned 36 months later, with features of an acute myocardial infarction, severe bilateral lower limb ischemia, and renal failure. He was too ill for intervention and demised within 48 hours. PMID:29267621

  13. Robotic endovascular surgery.

    Science.gov (United States)

    Au, Stephanie; Ko, Koel; Tsang, Josephine; Chan, Yiu Che

    2014-01-01

    The purpose of this review is to compare conventional endovascular procedures and the robotic endovascular approach in aortic aneurysm repair. Despite advantages over open surgery, conventional endovascular surgery has limitations. To develop an alternative, efforts have been focused on robotic endovascular systems. Two of the 3 studies comparing procedure times demonstrated reduced procedure time in the robotic group, by 6 times (p robotic procedures reduced fluoroscopic exposure time by 12 minute (p robotic surgery was reduced up to 10 times (p robotic performance score showed a better performance score in the robotic endovascular group (p = 0.007). These results demonstrate that the robotic technique has multiple advantages over the conventional procedure, including improved catheter stability, a shorter learning curve, reduced procedure time, and better performance in cannulating tortuous vessels. However, robotic endovascular technology may be limited by the cost of the system, the size of the catheter, and the setup time required preoperatively. Further comparative studies between conventional and robotic approaches regarding cost-effectiveness, safety, and performance in cases involving complex anatomy and fenestrated stent grafts are essential. Nevertheless, this revolutionary technology is increasingly popular and may be the next milestone in endovascular surgery.

  14. Deformation mechanisms of prototype composite braided stent-grafts in bending fatigue for peripheral artery application.

    Science.gov (United States)

    Xue, Wen; Gao, Jing; Lin, Jing; Wang, Fujun; Guan, Guoping; Wang, Lu

    2017-10-31

    Stent-grafts in peripheral arteries suffer from complex cyclic loadings in vivo, including pulsatile, axial bending and torsion. Normal fatigue durability evaluation technologies, however, are majorly based on pulsation and thus are short of accuracy under the complicated stress conditions experienced physiologically. While there is a little research focused on the cyclic fatigue of stent-grafts in bending, it remains an almost total lack of deformation or fatigue mechanisms. In this work, composite braided stent-grafts incorporating Nitinol (NiTi) yarns and polyethylene terephthalate (PET) multifilament yarns were cycled in bending by the self-developed testing system to investigate their deformation behaviors. Deformation mechanisms at the yarn level were discussed, and NiTi yarn crossover structure was considered the primary factor affecting the deformation modes. Four yarn-crossover-based deformation modes (accordion buckling, diamond-shaped buckling, neck propagation and microbuckling) revealed the mechanisms of energy absorption of braided stent-grafts on the mesoscopic scale. Further, mechanical modes were applied to help regulate stent designs. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Thoracic stent grafts with a distal fenestration for the celiac axis

    NARCIS (Netherlands)

    Tielliu, IFJ; Verhoeven, ELG; Zeebregts, CJ; Prins, TR; van den Dungen, JJAM

    2005-01-01

    Descending thoracic aneurysms can be treated with a stent graft provided that there is sufficient proximal and distal aortic neck length above the celiac axis. One of the options for the treatment of thoracic aneurysms with a too short distal neck is described in this report. For this purpose, a

  16. Left subclavian artery revascularization as part of thoracic stent grafting

    NARCIS (Netherlands)

    Saouti, N.; Hindori, V.; Morshuis, W.J.; Heijmen, R.H.

    2015-01-01

    OBJECTIVES: Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our

  17. Vascular Biocompatibility of a Triple Layered Self Expanding Stent-Graft in a Dog Mode

    Energy Technology Data Exchange (ETDEWEB)

    Bae, Jae Ik; Won, Je Hwan; Jang, Eun Ho; Lee, Sung Yeong; Ko, Kwang Tae [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of); Jin, Bo Hwan [Medical Science Research Center, Ajou University School of Medicine, Suwon (Korea, Republic of); Lee, June Woo [Dept. of Radiology, Busan National University College of Medicine, Busan (Korea, Republic of)

    2012-02-15

    To evaluate performance and biocompatibility of a newly designed self-expanding stent graft, which consisted of two nitinol stents and an intervening expanded polytetrafluoroethylene membrane in a dog artery model. Twelve stent grafts were placed in the aorta of 6 dogs (beagle, mean body weight 11 kg) for 4 weeks (n = 4) and 12 weeks (n = 8). Luminal diameters were measured for each segment (the proximal bare, the middle graft, the distal bare) by angiographies after implantation and follow up periods. Percent luminal stenosis based on angiographies, histomorphometric, histologic, and scanning electron microscopic analyses of each segments were performed. Blood flow through the stent grafts was good after implantation and during the follow up period, without thrombotic occlusion or stent graft migration. The mean percent luminal stenosis of the proximal bare, the middle grafted and the distal bare segments after 12 weeks were 13.5%, 3.9%, 9.6% retrospectively. The mean neointimal areas of the middle grafted segment were 4.39 mm{sup 2} (4 week) and 4.92 mm{sup 2} (12 week). Mature endothelialization was evident in over 70% of the area of the stented artery after 4 weeks and in over 90% after 12 weeks. The stent graft was well placed in the attempted area without migration. During the 12-week-follow up period, it showed a good patency without thrombotic occlusion or significant in-stent luminal stenosis. Endothelialization was rapid and nearly complete. Neointima was thin and smooth on the middle graft segment and thicker and irregular on the bare segments.

  18. Endovascular treatment for pseudoaneurysms arising from the hepatic artery after liver transplantation

    Directory of Open Access Journals (Sweden)

    Ashok Thorat

    2017-05-01

    Full Text Available Hepatic artery pseudoaneurysm after liver transplantation is an uncommon but potentially lethal complication. Early diagnosis and treatment are essential to avoid life-threatening hemorrhage in these patients. We herein report the case of three patients who developed hepatic artery pseudoaneurysms after living donor liver transplantation. Two patients presented with massive duodenal bleeding secondary to erosion of the hepatic artery into the bile duct, and one patient presented with intra-abdominal bleeding. These patients were managed by catheter-based minimal invasive endovascular procedures including coil embolization and stent grafting. All the patients were treated successfully with uneventful recovery. This technique can be considered as an effective treatment option for hepatic artery pseudoaneurysms instead of a difficult surgical intervention.

  19. Heparin and Vascular Endothelial Growth Factor Loaded Poly(L-lactide-co-caprolactone) Nanofiber Covered Stent-Graft for Aneurysm Treatment.

    Science.gov (United States)

    Wang, Jing; An, Qingzhu; Li, Dawei; Wu, Tong; Chen, Weiming; Sun, Binbin; El-Hamshary, Hany; Al-Deyab, Salem S; Zhu, Wei; Mo, Xiumei

    2015-11-01

    Restenosis caused by thrombopoiesis is one of the biggest hinders of endovascular stent-graft used in small-diameter vessels. Rapid endothelialization of the lumen of stent is a promising approach to prevent thrombosis. In this study, we aimed at loading heparin, a potent anticoagulants, and vascular endothelial growth factor (VEGF) into the core of poly(L-lactide-co-caprolactone) nanofiber via emulsion electrospinning. The nanofiber was covered on the stent and applied in the treatment of vascular diseases such as aneurysm. The morphologies of the emulsion electrospun nanofibers and core--shell structure were observed by scanning electron microscope and laser scanning confocal microscope. The release profiles of heparin and VEGF, degradation rate of nanofiber mats and cell proliferation in vitro were investigated. It was found that the release of both heparin and VEGF from the nanofiber lasted for more than 30 days without serious initial burst release. The degradation rate of nanofiber mats containing heparin and VEGF was faster than that of pure PLCL nanofiber mats. Moreover, the released VEGF could promote the proliferation of Pig iliac endothelial cells (PIECs) cultured on the nanofiber mat, which was of great benefit to stent endothelialization. The results of digital subtraction angiography (DSA) follow-up indicated the aneurysm was obliterated by separating the aneurysm dome from the blood circulation and the parent artery kept long-term patency. Results of the study demonstrated that the heparin and VEGF loaded nanofiber could provide an approach to fabricate covered stent-graft with properties of anticoagulation and induction of rapid endothelialization.

  20. Hemodynamic Study of Flow Remodeling Stent Graft for the Treatment of Highly Angulated Abdominal Aortic Aneurysm

    OpenAIRE

    Siang Lin Yeow; Hwa Liang Leo

    2016-01-01

    This study investigates the effect of a novel flow remodeling stent graft (FRSG) on the hemodynamic characteristics in highly angulated abdominal aortic aneurysm based on computational fluid dynamics (CFD) approach. An idealized aortic aneurysm with varying aortic neck angulations was constructed and CFD simulations were performed on nonstented models and stented models with FRSG. The influence of FRSG intervention on the hemodynamic performance is analyzed and compared in terms of flow patte...

  1. Irreversible Electroporation of a Hepatocellular Carcinoma Lesion Adjacent to a Transjugular Intrahepatic Portosystemic Shunt Stent Graft

    Energy Technology Data Exchange (ETDEWEB)

    Niessen, Christoph; Jung, Ernst Michael; Wohlgemuth, Walter A. [Department of Radiology, University Medical Center Regensburg, Regensburg D-93053 (Germany); Trabold, Benedikt [Department of Anaesthesia, University Medical Center Regensburg, Regensburg D-93053 (Germany); Haimerl, Michael; Schreyer, Andreas; Stroszczynski, Christian; Wiggermann, Philipp [Department of Radiology, University Medical Center Regensburg, Regensburg D-93053 (Germany)

    2013-07-01

    We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures.

  2. Stent-Graft Placement with Early Debridement and Antibiotic Treatment for Femoral Pseudoaneurysms in Intravenous Drug Addicts

    Energy Technology Data Exchange (ETDEWEB)

    Fu, Qining, E-mail: cqmufqn@163.com; Meng, Xiyun, E-mail: 383274177@qq.com; Li, Fenghe, E-mail: lfh-cqmu@gmail.com; Wang, Xuehu, E-mail: 184037696@qq.co; Cheng, Jun, E-mail: cqdcj@163.com; Huang, Wen, E-mail: dhuangwen@hotmail.com; Ren, Wei, E-mail: renwei9771@yahoo.com.cn; Zhao, Yu, E-mail: zhaoyu-cqmu@126.com [The First Affiliated Hospital of Chongqing Medical University, Department of Vascular Surgery (China)

    2015-06-15

    PurposeExplore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts.Materials and MethodsWe evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013.Results15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication.ConclusionsSG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.

  3. The Impact of Distal Stent Graft-Induced New Entry on Aortic Remodeling of Chronic Type B Dissection.

    Science.gov (United States)

    Huang, Chun-Yang; Hsu, Hung-Lung; Chen, Po-Lin; Chen, I-Ming; Hsu, Chiao-Po; Shih, Chun-Che

    2017-12-01

    In chronic type B aortic dissection, late distal stent graft-induced new entry (SINE) has a possible negative role in long-term aortic remodeling. This study aimed to investigate the impact of SINE occurrence on survival by evaluating true and false lumen remodeling in thoracic and abdominal segments at midterm surveillance. This study enrolled 65 patients with chronic type B aortic dissection (DeBakey type IIIb), who had received hybrid thoracic endovascular aortic repair (TEVAR) and had completed surveillance for at least 3 years. The 3-year survival rate was 84.7%. The patients were classified into non-SINE (n = 47) and SINE (n = 18) groups. Serial computed tomography scans were used to analyze volumetric change, true and false lumens, and thrombus volume from arch to aortic bifurcation level. The SINE event occurred at a median of 22.5 months. In the SINE group, there was a significant interruption of the abdominal true lumen expansion in the second year (median 0.01 [interquartile range (IQR), -0.03 to 0.12] in the non-SINE group versus median -0.04 [IQR, -0.12 to 0.04] in the SINE group; p = 0.014). There was a significantly worse thoracic false lumen remodeling in the SINE group compared with the non-SINE group in the third year after the SINE event occurred (median 0 [IQR, -0.09 to 0.05] in the non-SINE group versus median 0.06 [IQR, 0 to 0.13] in the SINE group; p = 0.038). For chronic aortic dissection, late occurrence of distal SINE could influence abdominal true lumen expansion and thoracic false lumen shrinkage. Early reintervention for distal SINE could improve aortic remodeling in chronic aortic dissection. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Simultaneous endovascular repair of an iatrogenic carotid-jugular fistula and a large iliocaval fistula presenting with multiorgan failure: a case report

    Directory of Open Access Journals (Sweden)

    Yuminaga Yuigi

    2012-01-01

    Full Text Available Abstract Introduction Iliocaval fistulas can complicate an iliac artery aneurysm. The clinical presentation is classically a triad of hypotension, a pulsatile mass and heart failure. In this instance, following presentation with multiorgan failure, management included the immediate use of an endovascular stent graft on discovery of the fistula. Case presentation A 62-year-old Caucasian man presented to our tertiary hospital for management of iatrogenic trauma due to the insertion of a central venous line into his right common carotid artery, causing transient ischemic attack. Our patient presented to a peripheral hospital with fever, nausea, vomiting, acute renal failure, acute hepatic dysfunction and congestive heart failure. A provisional diagnosis of sepsis of unknown origin was made. There was a 6.5 cm×6.5 cm right iliac artery aneurysm present on a non-contrast computed tomography scan. An unexpected intra-operative diagnosis of an iliocaval fistula was made following the successful angiographic removal of the central line to his right common carotid artery. Closure of the iliocaval fistula and repair of the iliac aneurysm using a three-piece endovascular aortic stent graft was then undertaken as part of the same procedure. This was an unexpected presentation of an iliocaval fistula. Conclusion Our case demonstrates that endovascular repair of a large iliac artery aneurysm associated with a caval fistula is safe and effective and can be performed at the time of the diagnostic angiography. The presentation of an iliocaval fistula in this case was unusual which made the diagnosis difficult and unexpected at the time of surgery. The benefit of immediate repair, despite hemodynamic instability during anesthesia, is clear. Our patient had two coronary angiograms through his right femoral artery decades ago. Unusual iatrogenic causes of iliocaval fistulas secondary to previous coronary angiograms with wire and/or catheter manipulation should be

  5. 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.

  6. Left subclavian artery revascularization as part of thoracic stent grafting.

    Science.gov (United States)

    Saouti, Nabil; Hindori, Vikash; Morshuis, William J; Heijmen, Robin H

    2015-01-01

    Intentional covering of the left subclavian artery (LSA) as part of thoracic endovascular aortic repair (TEVAR) can cause (posterior) strokes or left arm malperfusion. LSA revascularization can be done as prophylaxis against, or as treatment of, these complications. We report our experience with the surgical technique, indications and the results of LSA revascularization. Between 2000 and 2013, 51 patients of 444 patients who were treated by TEVAR, had LSA revascularization. All elective patients had a preoperative work-up with magnetic resonance angiography to evaluate the circle of Willis. In all, surgical access was through a left supraclavicular incision only. The majority (90%) had prophylactic LSA revascularization because of incomplete circle of Willis and or dominant left vertebral artery (LVA) (n=29), patent left internal mammary artery (n=1), prevention spinal cord ischaemia (SCI) (n=2), prevention left arm ischaemia due to small LVA (n=2) and LVA origin in arch (n=1). Fourteen percent had secondary revascularization, either immediate because of malperfusion of the left arm (n=2) or late after TEVAR because of persisting left arm claudication (n=5). In 12 patients, the following early complications were observed: re-exploration for bleeding, n=1; left recurrent nerve paralysis, n=2; left phrenic nerve paralysis, n=1; left sympathetic chain neuropraxia, resulting in Horner's syndrome, n=3; Chyle duct lesions, resulting in persistent Chyle leakage, n=3. Neither strokes nor SCI was observed. One patient experienced occlusion of the bypass at 6 months. The present study shows that the procedure of LSA revascularization as part of TEVAR is safe with low morbidity consisting of mainly (transient) nerve palsy. © The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  7. 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.

  8. Percutaneous subclavian artery stent-graft placement following failed ultrasound guided subclavian venous access

    Directory of Open Access Journals (Sweden)

    Szkup Peter

    2006-05-01

    Full Text Available Abstract Background Ultrasound guidance for central and peripheral venous access has been proven to improve success rates and reduce complications of venous cannulation. Appropriately trained and experienced operators add significantly to diminished patient morbidity related to venous access procedures. We discuss a patient who required an arterial stent-graft to prevent arterial hemorrhage following inadvertent cannulation of the proximal, ventral, right subclavian artery related to unsuccessful ultrasound guided access of the subclavian vein. Case presentation During pre-operative preparation for aortic valve replacement and aorto-coronary bypass surgery an anesthetist attempted ultrasound guided venous access. The ultrasound guided attempt to access the right jugular vein failed and the ultrasound guided attempt at accessing the subclavian vein resulted in inappropriate placement of an 8.5 F sheath in the arterial system. Following angiographic imaging and specialist consultations, an arterial stent-graft was deployed in the right subclavian artery rather than perform an extensive anterior chest wall resection and dissection to extract the arterial sheath. The patient tolerated the procedure, without complication, despite occlusion of the right internal mammary artery and the right vertebral artery. There were no neurologic sequelae. There was no evidence of hemorrhage after subclavian artery sheath extraction and stent-graft implantation. Conclusion The attempted ultrasound guided puncture of the subclavian vein resulted in placement of an 8.5 F subclavian artery catheter. Entry of the catheter into the proximal subclavian artery beneath the medial clavicle, the medial first rib and the manubrium suggests that the operator, most likely, did not directly visualize the puncture needle enter the vessel with the ultrasound. The bones of the anterior chest impede the ultrasound beam and the vessels in this area would not be visible to ultrasound

  9. Endovascular management for significant iatrogenic portal vein bleeding.

    Science.gov (United States)

    Kim, Jong Woo; Shin, Ji Hoon; Park, Jonathan K; Yoon, Hyun-Ki; Ko, Gi-Young; Gwon, Dong Il; Kim, Jin Hyoung; Sung, Kyu-Bo

    2017-11-01

    Background Despite conservative treatment, hemorrhage from an intrahepatic branch of the portal vein can cause hemodynamic instability requiring urgent intervention. Purpose To retrospectively report the outcomes of hemodynamically significant portal vein bleeding after endovascular management. Material and Methods During a period of 15 years, four patients (2 men, 2 women; median age, 70.5 years) underwent angiography and embolization for iatrogenic portal vein bleeding. Causes of hemorrhage, angiographic findings, endovascular treatment, and complications were reported. Results Portal vein bleeding occurred after percutaneous liver biopsy (n = 2), percutaneous radiofrequency ablation (n = 1), and percutaneous cholecystostomy (n = 1). The median time interval between angiography and percutaneous procedure was 5 h (range, 4-240 h). Common hepatic angiograms including indirect mesenteric portograms showed active portal vein bleeding into the peritoneal cavity with (n = 1) or without (n = 2) an arterioportal (AP) fistula, and portal vein pseudoaneurysm alone with an AP fistula (n = 1). Successful transcatheter arterial embolization (n = 2) or percutaneous transhepatic portal vein embolization (n = 2) was performed. Embolic materials were n-butyl cyanoacrylate alone (n = 2) or in combination with gelatin sponge particles and coils (n = 2). There were no major treatment-related complications or patient mortality within 30 days. Conclusion Patients with symptomatic or life-threatening portal vein bleeding following liver-penetrating procedures can successfully be managed with embolization.

  10. Endovascular "neobranching" to manage acute aortic syndrome.

    Science.gov (United States)

    Vandormael, Isabelle L; Salmasi, Mohammad Y; Yeh, James S-M; Nienaber, Christoph A

    2017-08-01

    Acute aortic syndrome was coined in 2001 to describe a spectrum of acute aortic wall pathologies. The syndrome represents a cluster of aortic conditions such as aortic dissection, intramural hematoma and penetrating atherosclerotic ulcer. Acute aortic dissection is more common than the latter two pathologies with an incidence of up to 6 cases per 100,000 per year. The following report focuses on an unusual case presentation emphasizing the newest management techniques including "neobranching" whilst dealing with challenging patient anatomy and refractory hypertension. We believe this case report eventually broadens our understanding of acute aortic syndrome whilst addressing an entry tear outside the aorta by placing "neobranches". © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  11. In Vitro Laser Fenestration of Aortic Stent-Grafts: A Qualitative Analysis Under Scanning Electron Microscope.

    Science.gov (United States)

    Lin, Jing; Udgiri, Naval; Guidoin, Robert; Panneton, Jean; Guan, Xiaoning; Guillemette, Maxime; Wang, Lu; Du, Jia; Zhu, Dajie; Nutley, Mark; Zhang, Ze

    2016-11-01

    In situ fenestration of stent-grafts allows patients with life threatening aortic pathologies to be amenable to emergent "off the shelf indications for use" percutaneous treatments as a bail out technique. Three types of aortic stent-grafts were subjected to laser fenestration in a physiological saline solution followed by balloon angioplasty using 8, 10 or 12 mm in diameter noncompliant balloons. The morphology and the size of fenestrations were observed under optical and scanning electron microscopy. The damage to the fabrics was analyzed and quantified. The creation of fenestrations was feasible in all devices, with varying degrees of fraying and/or tearing. The monofilament twill weave (Medtronic Valiant) tore in two directions (warp and weft) while the multifilament weave fenestrations showed more fraying (Anaconda Vascutek and Zenith TX2 Cook). The size and directions of tearing were more predictable with the 8 mm diameter balloon whereas the results obtained with the 10 and 12 mm diameter balloons were more unpredictable. The fenestrations were free of melting of the yarns and blackening of the filaments. The in situ fenestration is feasible but the observed damage to the fabric constructions must be carefully considered. This procedure must currently be limited to urgent and emergent life threatening cases because it is off indications for use for approved devices. Copyright © 2016 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.

  12. Morphological Changes and Device Migration After Stent Graft Insertion - Clinical Application of an Image-Based Modeling System and Analysis With Geometric Parameters.

    Science.gov (United States)

    Nemoto, Youkou; Hoshina, Katsuyuki; Kobayashi, Masaharu; Kimura, Masaru; Yamamoto, Sota; Watanabe, Toshiaki; Ohshima, Marie

    2017-08-25

    Previously, we developed an image-based modeling system (V-Modeler) to investigate geometric changes in stent grafts (SGs) following their implantation for abdominal aortic aneurysms (AAAs). The aims of the present study were to improve this system for clinical use, to chronologically analyze postoperative morphological changes in SGs, and to demonstrate scenarios of SG migration.Methods and Results:Contrast-enhanced computed tomography data from 36 patients who underwent endovascular aneurysm repair (EVAR) for AAAs were used, with 72 centerline paths, in total, analyzed for bilateral SG legs. The existing V-modeler system was modified by introducing a penalty term, optimizing the number of control points using Akaike's information criterion, and changing the degree of the function from 3 to 5. Geometric parameters were then analyzed immediately, as well as >1 year after EVAR. Eight migrations were found and although overall SG curvature and curvature at the distal (leg) site did not change, curvature at the proximal (trunk) site of SGs decreased over time. Subanalysis revealed that SGs with severe curvature showed the same trend, whereas distal curvature increased in the non-severe curvature group. In addition, proximal curvature decreased more in Excluder than Zenith devices. The present study demonstrates SG behavior after implantation with numerical values for SG length and curvature.

  13. 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.

  14. Endovascular Management of Vascular Injury during Transsphenoidal Surgery.

    Science.gov (United States)

    Cinar, C; Bozkaya, H; Parildar, M; Oran, I

    2013-03-01

    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. During the last ten-year period, we retrospectively evaluated nine patients with vascular injury after transsphenoidal surgery. Eight patients were symptomatic due to vascular injury, while one had only suspicion of vascular injury during surgery. Four patients presented with epistaxis, two with subarachnoid hemorrhage, one with exophthalmos, and one with hemiparesia. Emergency angiography revealed a pseudoaneurysm in four patients, contrast extravasation in two, vessel dissection in one, vessel wall irregularity in one, and arteriovenous fistula in one. All patients but one were treated successfully with parent artery occlusion, with one covered stent implantation, one stent-assisted coiling method, while one patient was managed conservatively. One patient died due to complications related to the primary insult without rebleeding. Vascular injuries suspected intra or postoperatively must be investigated rapidly after transsphenoidal surgery. Endovascular treatment with parent artery occlusion is feasible with acceptable morbidity and mortality rates in the treatment of vascular injuries occurring in transsphenoidal surgery.

  15. Air Embolism During TEVAR: Carbon Dioxide Flushing Decreases the Amount of Gas Released from Thoracic Stent-Grafts During Deployment.

    Science.gov (United States)

    Rohlffs, Fiona; Tsilimparis, Nikolaos; Saleptsis, Vasilis; Diener, Holger; Debus, E Sebastian; Kölbel, Tilo

    2017-02-01

    To investigate the amount of gas released from Zenith thoracic stent-grafts using standard saline flushing vs the carbon dioxide flushing technique. In an experimental bench setting, 20 thoracic stent-grafts were separated into 2 groups of 10 endografts. One group of grafts was flushed with 60 mL saline and the other group was flushed with carbon dioxide for 5 minutes followed by 60 mL saline. All grafts were deployed into a water-filled container with a curved plastic pipe; the deployment was recorded and released gas was measured using a calibrated setup. Gas was released from all grafts in both study groups during endograft deployment. The average amount of released gas per graft was significantly lower in the study group with carbon dioxide flushing (0.79 vs 0.51 mL, p=0.005). Thoracic endografts release significant amounts of air during deployment if flushed according to the instructions for use. Application of carbon dioxide for the flushing of thoracic stent-grafts prior to standard saline flush significantly reduces the amount of gas released during deployment. The additional use of carbon dioxide should be considered as a standard flush technique for aortic stent-grafts, especially in those implanted in proximal aortic segments, to reduce the risk of air embolism and stroke.

  16. An in Vitro Twist Fatigue Test of Fabric Stent-Grafts Supported by Z-Stents vs. Ringed Stents

    Directory of Open Access Journals (Sweden)

    Jing Lin

    2016-02-01

    Full Text Available Whereas buckling can cause type III endoleaks, long-term twisting of a stent-graft was investigated here as a mechanism leading to type V endoleak or endotension. Two experimental device designs supported with Z-stents having strut angles of 35° or 45° were compared to a ringed control under accelerated twisting. Damage to each device was assessed and compared after different durations of twisting, with focus on damage that may allow leakage. Stent-grafts with 35° Z-stents had the most severe distortion and damage to the graft fabric. The 45° Z-stents caused less fabric damage. However, consistent stretching was still seen around the holes for sutures, which attach the stents to the graft fabric. Larger holes may become channels for fluid percolation through the wall. The ringed stent-graft had the least damage observed. Stent apexes with sharp angles appear to be responsible for major damage to the fabrics. Device manufacturers should consider stent apex angle when designing stent-grafts, and ensure their devices are resistant to twisting.

  17. Emergency endovascular repair of acute descending thoracic aortic dissection

    Directory of Open Access Journals (Sweden)

    Muhammad Anees Sharif

    2007-11-01

    Full Text Available Muhammad Anees Sharif, Mark Edward O’Donnell, Paul Henry Blair, Peter KennedyDepartment of Vascular and Endovascular Surgery, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, United KingdomBackground: Acute descending thoracic aortic dissection is a life-threatening emergency. It is not often considered as the initial diagnosis in patients presenting with epigastric pain and could easily be missed in a busy casualty department.Aim: This case report is aimed to highlight the feasibility of the technique and the need for long-term surveillance following endovascular repair of acute thoracic aortic dissection.Results: The patient presented with epigastric pain radiating to the interscapular region with a stable hemodynamic status. A computerized tomography (CT scan demonstrated type B thoracic aortic dissection of the proximal descending thoracic aorta. A successful endovascular repair was carried out with uneventful recovery and follow-up CT scan six years after stent-grafting shows satisfactory position of the stent-graft, patent false lumen in the abdominal aorta perfusing the right kidney, and progressively enlarging diameter of the abdominal aorta.Conclusion: Thoracic aortic dissection should be considered as a differential diagnosis in patients presenting with epigastric and interscapular chest pain. Emergency endovascular repair of acute thoracic aortic dissection is feasible and relatively safe. Regular follow-up with CT scan is required to evaluate the long-term effi cacy and identify the need for re-intervention.Keywords: aortic, dissection, endovascular, thoracic

  18. Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application?

    Science.gov (United States)

    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

    2017-02-01

    Thoracic 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% to 30% are not accepted for surgery and 30% to 50% are technically amenable for TEVAR. We describe our case series of type A aortic dissections treated by using TEVAR. Between year 2009 and 2016, 12 patients with acute, subacute, or chronic type A aortic dissection with the proximal entry tear located between the coronaries and brachiocephalic artery were treated with TEVAR at 3 centers. Various stent-graft configurations were used to seal the proximal entry tear in the ascending aorta under rapid pacing. A total of 12 patients (9 male, 3 female), mean age 81 ± 7 years, EuroSCORE II 9.1 ± 4.5, underwent TEVAR for the treatment of type A aortic dissection. Procedural success was achieved in 11 of 12 patients (91.7%). There was 1 minor stroke and 1 intraprocedural death. No additional deaths were reported at 30 days. At 36 months, there were 4 further deaths (all from nonaortic causes). The mean survival of these 4 deceased was 23 months (range 15-36 months). Follow-up computed tomography demonstrated favorable aortic remodeling. TEVAR is feasible and reveals promising early results in selected patients with type A aortic dissection who are poor candidates for surgical repair. The current iteration of stent-graft technology, however, needs to be adapted to features specific to the ascending aorta. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

  19. Clinical outcomes of endovascularly managed iatrogenic renal hemorrhages

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    George Koshy Chiramel

    2015-01-01

    Full Text Available Objective: To evaluate the effectiveness of endovascular management in iatrogenic renal injuries with regard to clinical status on follow-up and requirements for repeat angiography and embolization. Materials and Methods: This retrospective study included patients who were referred for endovascular management of significant hemorrhage following an iatrogenic injury. Data was recorded from the Picture Archiving and Communication system (PACS and electronic medical records. The site and type of iatrogenic injury, imaging findings, treatment, angiography findings, embolization performed, clinical status on follow-up, and requirement for repeat embolization were recorded. The outcomes were clinical resolution, nephrectomy, or death. Clinical findings were recorded on follow-up visits to the clinic. Statistical analysis was performed using descriptive statistics. Results: Seventy patients were included in this study between January 2000 and June 2012. A bleeding lesion (a pseudoaneurysm or arteriovenous fistula was detected during the first angiogram in 55 patients (78.6% and was selectively embolized. Fifteen required a second angiography as there was no clinical improvement and five required a third angiography. Overall, 66 patients (94.3% showed complete resolution and 4 patients (5.7% died. Three patients (4.3% underwent nephrectomy for clinical stabilization even after embolization. There were no major complications. The two minor complications resolved spontaneously. Conclusions: Angiography and embolization is the treatment of choice in iatrogenic renal hemorrhage. Upto 20% of initial angiograms may not reveal the bleed and repeat angiography is required to identify a recurrent or unidentified bleed. The presence of multiple punctate bleeders on angiography suggests an enlarging subcapsular hematoma and requires preoperative embolization and nephrectomy.

  20. Role of CT and Endovascular Embolization in Managing Pseudoaneurysms of the Internal Maxillary Artery

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    Chao-Bao Luo

    2006-07-01

    Conclusion: CT is a useful tool for guiding catheter angiography to localize the majority of IMPAs. Endovascular embolization can succeed in managing IMPAs, and should be performed as soon as the IMPA is depicted.

  1. Endovascular Treatment of Thoracic Aortic Floating Thrombus in Patients Presenting with Acute Lower Limb Ischemia

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    Nano Giovanni

    2011-01-01

    Full Text Available We report two cases of descending thoracic aorta floating thrombus treated with Bolton Relay thoracic free-flow stent graft. The patients had symptoms of lower limb ischemia; they underwent preoperative angiography and CTscan, then we proceeded with endovascular exclusion of the thrombus from the systemic circulation. At 12 months, the graft was still patent in both patients, without any signs of endoleak.

  2. 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.

  3. Risk factor analysis of bird beak occurrence after thoracic endovascular aortic repair

    OpenAIRE

    Boufi, M.; Guivier-Curien, C.; Deplano, V.; Boiron, O.; Loundou, A.D.; Dona, B.; Hartung, O.; Alimi, Y.S.

    2015-01-01

    Objectives: The aim was to analyze the role played by anatomy and stent graft in the incidence of incomplete apposition to aortic arch.Methods: Between 2007 and 2014 data including available and suitable computed tomographic angiography (CIA) imaging of patients who had undergone thoracic endovascular aortic repair were reviewed. The study included 80 patients (65 men, 54 /- 21 years) treated for traumatic aortic rupture (n = 27), thoracic aortic aneurysm (n = 15), type B aortic dissection (...

  4. Tratamento endovascular de lesões arteriais traumáticas Endovascular management of traumatic arterial injuries

    Directory of Open Access Journals (Sweden)

    Ruy Fernandes e Fernandes

    2011-03-01

    . Todos os procedimentos foram realizados com sucesso. Não se verificou mortalidade. No doente com RAS houve necessidade de cirurgia de descorticação pulmonar esquerda, por hematoma organizado, e o doente com FAV foi submetido com sucesso a nova embolização com coils por recorrência precoce de hematúria. Conclusão: O tratamento endovascular é, em casos seleccionados, uma alternativa válida e menos invasiva de lesões traumáticas complexas em regiões anatómicas de difícil acesso e morbi-mortalidade cirúrgica elevada.Introduction: Traumatic vascular injuries are present in less than 10% of patients with multi-organ trauma and, in western countries, the incidence of iatrogenic vascular lesions has been increasing. Conventional surgery in the approach of these lesions usually requires extended surgical exposure, presents increased technical challenges and has high morbidity and mortality. Recently, several authors have described the successful management of traumatic injuries with endovascular techniques with diminished surgical risk. Endovascular surgery has also been increasingly applied in management of chronic traumatic injuries like chronic post-traumatic thoracic aneurysms with significant improved outcomes. The authors present clinical cases with several acute and chronic traumatic vascular injuries treated with endovascular techniques, Clinical reports: Seven patients (21-77 years with traumatic vascular injuries were treated. Four patients presented acute injuries: 1 case of traumatic aortic injury in a patient with multi-organ trauma after automobile crash; 1 case of iatrogenic subclavian artery rupture after inadvertent subclavian artery catheterization during attempted venous central access ; 1 case of iatrogenic renal artery rupture during renal angioplasty and stenting; 1 case of iatrogenic intra-renal arterio-venous fistula (AVF after laparoscopic resection of a renal tumour. Three patients presented with chronic post-traumatic thoracic aneurysms

  5. Stent-graft repair of isolated iliac aneurysms with wide or ectatic necks with use of inverted zenith device legs.

    Science.gov (United States)

    Klonaris, Chris; Verikokos, Christos; Avgerinos, Efthimios D; Bellos, John; Katsargyris, Athanasios; Liapis, Christos D

    2009-03-01

    Although there is considerable experience in the management of iliac artery aneurysms (IAAs) accompanying abdominal aortic aneurysms, less is known about endovascular management of isolated IAAs. The distal landing zone can be secured if necessary by extending the graft to the external iliac artery, but the proximal landing zone remains a challenging issue, on which technical success is dependent. The present report describes a novel technique for endovascular management of isolated IAAs with wide proximal necks for which no commercially available grafts with fitting sizes exist: inversion of the iliac leg of a Zenith device.

  6. Endolymphatic Thoracic Duct Stent-Graft Reconstruction for Chylothorax: Approach, Technical Success, Safety, and Short-term Outcomes.

    Science.gov (United States)

    Srinivasa, Rajiv N; Chick, Jeffrey Forris Beecham; Hage, Anthony N; Gemmete, Joseph J; Murrey, Douglas C; Srinivasa, Ravi N

    2017-12-05

    To report approach, technical success, safety, and short-term outcomes of thoracic duct stent-graft reconstruction for the treatment of chylothorax. Two patients, 1 (50%) male and 1 (50%) female, with mean age of 38 years (range: 16-59 years) underwent endolymphatic thoracic duct stent-graft reconstruction between September 2016 and July 2017. Patients had radiographic left-sided chylothoraces (n = 2) from idiopathic causes (n = 1) and heart transplantation (n = 1). In both (100%) patients, antegrade lymphatic access was used to opacify the thoracic duct after which retrograde access was used for thoracic duct stent-graft placement. Pelvic lymphangiography technical success, antegrade cisterna chyli cannulation technical success, thoracic duct opacification technical success, retrograde thoracic duct access technical success, thoracic duct stent-graft reconstruction technical success, ethiodized oil volume, contrast volume, estimated blood loss, procedure time, fluoroscopy time, radiation dose, clinical success, complications, deaths, and follow-up were recorded. Pelvic lymphangiography, antegrade cisterna chyli cannulation, thoracic duct opacification, retrograde thoracic duct access, and thoracic duct stent-graft reconstruction were technically successful in both (100%) patients. Mean ethiodized oil volume was 8 mL (range: 5-10 mL). Mean contrast volume was 13 mL (range: 5-20 mL). Mean estimated blood loss was 13 mL (range: 10-15 mL). Mean fluoroscopy time was 50.4 min (range: 31.2-69.7 min). Mean dose area product and reference air kerma were 954.4 μGmy 2 (range: 701-1,208 μGmy 2 ) and 83.5 mGy (range: 59-108 mGy), respectively. Chylothorax resolved in both (100%) patients. There were no minor or major complications directly related to the procedure. Thoracic duct stent-graft reconstruction may be a technically successful and safe alternative to thoracic duct embolization, disruption, and surgical ligation for the treatment of chylothorax

  7. Management of Iatrogenic Direct Carotid Cavernous Fistula Occurring During Endovascular Treatment of Stroke.

    Science.gov (United States)

    Alan, Nima; Nwachuku, Enyinna; Jovin, Tudor J; Jankowitz, Brian T; Jadhav, Ashutosh P; Ducruet, Andrew F

    2017-04-01

    Traumatic carotid cavernous fistula may occur as a complication of endovascular treatment of acute stroke. We report 3 cases of such lesions. All patients were initially managed conservatively. Two patients have remained asymptomatic. One patient became symptomatic with right eye proptosis, chemosis, and right lateral gaze diplopia 3 weeks post thrombectomy. He underwent endovascular embolization via transfemoral transvenous approach via the inferior ophthalmic vein. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Endovascular Management of an Infected Superficial Femoral Artery Pseudoaneurysm

    Energy Technology Data Exchange (ETDEWEB)

    Damodharan, Karthik, E-mail: drdkarthik@hotmail.com; Beckett, David [Royal Bournemouth Hospital (United Kingdom)

    2013-10-15

    This article describes an endovascular technique of treating an infected pseudoaneurysm by direct thrombin injection via a catheter placed inside the aneurysm sac while maintaining temporary balloon occlusion of the neck of the false aneurysm.

  9. 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.)

  10. A Pilot Study of Open Venous Revascularization using Expandable PTFE Stent Grafts in a Porcine (Sus scrofa) Model

    Science.gov (United States)

    2017-05-23

    evidence from Iraq and Afghanistan has shown improved limb salvage with venous repair. However, complex venous repairs are technically challenging and time ...expandable PTFE stent graft was deployed into the vessel in an open direct fashion . The swine were awoken and allowed to ambulate. At 72 hours, conduit...patency was evaluated by venography. Results: All animals appeared grossly normal with no changes on physical exam to suggest venous insufficiency. At 72

  11. Treatment of carotid siphon aneurysms by use of the Willis stent graft: an angiographic and histopathological study

    Energy Technology Data Exchange (ETDEWEB)

    Zhu, Yue-Qi; Li, Ming-Hua; Xie, Jian; Tan, Hua-Qiao; Wang, Jian-Bo [Medical School of Shanghai Jiao Tong University, Department of Radiology, Sixth Affiliated People' s Hospital, Shanghai (China); Cheng, Ying-Sheng [Shanghai Tong Ji University, Department of Radiology, Tenth Affiliated People' s Hospital, Shanghai (China)

    2010-08-15

    We designed a carotid siphon (CS) aneurysm model in dogs to test a new stent graft (the Willis covered stent) and compared tissue reaction over 12-month follow-up versus a comparison group with stents implanted in straight vessels. Twenty-four saccular sidewall aneurysms (group A) and 12 CS aneurysms (group B) were created surgically. A Willis stent graft was implanted in each aneurysm. Angiography was performed immediately and at 1-, 3-, 6- and 12-month post-implantation to investigate aneurysm isolation, endoleak, stent angulation, parent artery (PA) patency and restenosis. Light and scanning electron microscopy were used to identify aneurysmal sac thrombi, intima hyperplasia and endothelial progress. Immediate angiography demonstrated mild endoleak in two aneurysms and three stent angulations in group B. Follow-up at 12 months revealed resolved endoleaks, occlusion in one PA and mild stenosis in three in group B. In group A, occlusion occurred in one PA and mild stenosis in two. Light microscopy revealed new intima, and all aneurysm sacs were filled with thrombi. In group B, endothelial progress was complete at 12 months, and closely correlated with haemodynamic changes. Application of a Willis stent graft is a feasible method of treating CS aneurysms, and it exhibits a prolonged endothelial progress compared with that in straight vessels. (orig.)

  12. A biomimetic approach for designing stent-graft structures: Caterpillar cuticle as design model.

    Science.gov (United States)

    Singh, Charanpreet; Wang, Xungai

    2014-02-01

    Stent-graft (SG) induced biomechanical mismatch at the aortic repair site forms the major reason behind postoperative hemodynamic complications. These complications arise from mismatched radial compliance and stiffness property of repair device relative to native aortic mechanics. The inability of an exoskeleton SG design (an externally stented rigid polyester graft) to achieve optimum balance between structural robustness and flexibility constrains its biomechanical performance limits. Therefore, a new SG design capable of dynamically controlling its stiffness and flexibility has been proposed in this study. The new design is adopted from the segmented hydroskeleton structure of a caterpillar cuticle and comprises of high performance polymeric filaments constructed in a segmented knit architecture. Initially, conceptual design models of caterpillar and SG were developed and later translated into an experimental SG prototype. The in-vitro biomechanical evaluation (compliance, bending moment, migration intensity, and viscoelasticity) revealed significantly better performance of hydroskeleton structure than a commercial SG device (Zenith(™) Flex SG) and woven Dacron(®) graft-prosthesis. Structural segmentation improved the biomechanical behaviour of new SG by inducing a three dimensional volumetric expansion property when the SG was subjected to hoop stresses. Interestingly, this behaviour matches the orthotropic elastic property of native aorta and hence proposes segmented hydroskeleton structures as promising design approach for future aortic repair devices. © 2013 Published by Elsevier Ltd.

  13. Hemodynamic Study of Flow Remodeling Stent Graft for the Treatment of Highly Angulated Abdominal Aortic Aneurysm

    Directory of Open Access Journals (Sweden)

    Siang Lin Yeow

    2016-01-01

    Full Text Available This study investigates the effect of a novel flow remodeling stent graft (FRSG on the hemodynamic characteristics in highly angulated abdominal aortic aneurysm based on computational fluid dynamics (CFD approach. An idealized aortic aneurysm with varying aortic neck angulations was constructed and CFD simulations were performed on nonstented models and stented models with FRSG. The influence of FRSG intervention on the hemodynamic performance is analyzed and compared in terms of flow patterns, wall shear stress (WSS, and pressure distribution in the aneurysm. The findings showed that aortic neck angulations significantly influence the velocity flow field in nonstented models, with larger angulations shifting the mainstream blood flow towards the center of the aorta. By introducing FRSG treatment into the aneurysm, erratic flow recirculation pattern in the aneurysm sac diminishes while the average velocity magnitude in the aneurysm sac was reduced in the range of 39% to 53%. FRSG intervention protects the aneurysm against the impacts of high velocity concentrated flow and decreases wall shear stress by more than 50%. The simulation results highlighted that FRSG may effectively treat aneurysm with high aortic neck angulations via the mechanism of promoting thrombus formation and subsequently led to the resorption of the aneurysm.

  14. Surgical and endovascular management of symptomatic posterior circulation fusiform aneurysms

    NARCIS (Netherlands)

    Coert, Bert A.; Chang, Steven D.; Do, Huy M.; Marks, Michael P.; Steinberg, Gary K.

    2007-01-01

    OBJECT: Patients with fusiform aneurysms can present with subarachnoid hemorrhage (SAH), mass effect, ischemia, or unrelated symptoms. The absence of an aneurysm neck impedes the direct application of a clip and endovascular coil deployment. To evaluate the effects of their treatments, the authors

  15. Evidence for and risks of endovascular treatment of asymptomatic acute type B aortic dissection.

    Science.gov (United States)

    Clough, Rachel E; Nienaber, Christoph A

    2017-04-01

    Acute aortic dissection is a challenging disease to manage. Type B aortic dissection has traditionally been divided temporally into acute and chronic cases but more recently this classification has been modified to include a sub-acute phase. Computed tomography is the imaging technique used most frequently in diagnosis and management. Active management of blood pressure is essential and should include beta-blockade unless contraindicated. In-hospital outcomes are generally acceptable in patients with medically managed acute uncomplicated type B aortic dissection, with up to 90% of patients surviving to hospital discharge but by 5 years up to 50% of patients are dead with a significant proportion dying from aortic rupture. The aim of endovascular repair is to treat the complications of the dissection, induce aortic remodeling and false lumen thrombosis and it has been shown to result in good long-term outcomes. Stent graft placement however is associated with an incidence of death, stroke, paraplegia and retrograde type A dissection. Some experts now advocate high intensity imaging in the first 14 days to detect development of complications early in the disease course, with planned elective treatment in the subacute phase.

  16. Surgical repair and reconstruction of aortic arch in debakey type I aortic dissection: recent advances and single-center experience in the application of branched stent graft.

    Science.gov (United States)

    Zhang, Qian; Ma, Xiaochun; Zhang, Wenlong; Wang, Zhengjun; Zhang, Haizhou; Zhang, Xiaofeng; Song, Jian; Zou, Chengwei

    2017-10-03

    Aortic dissection (AD) represents a clinically uncommon aortic pathology which predicts a dismal prognosis if not promptly treated. In acute Debakey type I AD (ADIAD), aortic lesion extends from aortic root to even distal abdominal aorta among which aortic arch and its three main branches still remain a great surgical challenge for repair and reconstruction. Several decades have witnessed the painstaking efforts of cardiovascular surgeons across the globe for optimizing the surgical procedures, from total or hemi-arch replacement, "elephant trunk" technique to branched stent graft. However, operative mortality and morbidity still remain to be reduced and surgical strategy is to be advanced and simplified, particularly the repair and reconstruction of aortic arch and supra-aortic vessels. In this paper, we reviewed the relevant literature concerning recent advances in surgical intervention of aortic arch and summarized our opinions in the application of branched stent graft in ADIAD. The operative strategy for acute Debakey type I aortic dissection still remain to be advanced and simplified, especially the repair and reconstruction of aortic arch and supra-aortic vessels. For selection of branched stent grafts, the anatomic features and pathological changes of diseased arch are the crucial factors for clinical decision making. Branched stent graft is potentially an effective alternative for the treatment of type I AD with diseased aortic arch and supra-aortic vessels. The selection of branched stent grafts still remains to be further discussed in large-scale studies in the future.

  17. Emergency endovascular management of the common femoral artery rupture due to radiotherapy for scrotal carcinoma

    OpenAIRE

    Bracale, Umberto Marcello; Merola, Giovanni; del Guercio, Luca; Sodo, Maurizio; Maria Giribono, Anna; Bracale, Umberto

    2015-01-01

    We describe the case of a 72-year-old man with massive hemorrhage and shock resulting from rupture of the left common femoral artery as a complication of radiotherapy in the groin for cancer of the scrotum. This complication is extremely rare, presents dramatically, and is usually fatal. The patient was successfully treated with a stent graft deployment in order to achieve immediate hemostasis maintaining blood flow to the leg. Open surgery is not ideal in those cases especially when there is...

  18. Anesthetic management in endovascular treatment of aortic pathologies

    Directory of Open Access Journals (Sweden)

    Abdulmenap Güzel

    2014-06-01

    Full Text Available Objective: In this study we aimed to compare the anesthesia methods we used in the endovascular treatment of thoracic and abdominal aorta pathologies and to discuss accompanied by literature. Methods: Our study was carried out be retrospectively assessing a total of 20 patients on whom we had administered endovascular treatment for aortic aneurism and aortic dissection. The demographic features of the patients, their American Anesthesia Association (ASA scores, laboratory findings, accompanying diseases, whether they smoke, their ejection fraction and the place and type of aortic pathology was recorded. Also the surgical procedure, anesthesia method, the amounts of crystalloids, colloids and blood products used during the surgery, the anesthesia and surgery durations, complications and interventions, duration of stays in intensive care and the hospital in general and the mortality rates were recorded. All cases were provided with standard anesthesia monitoring. Results: A total of 20 (M=15, F=5 cases were included in our study. 16 of our cases were in ASA 3 risk group and 4 were in ASA 4 risk group. While patients who had been administered with thoracic endovascular aortic repair (TEVAR were all given general anesthesia, seven patients who had been administered with abdominal endovascular aortic repair (EVAR were given regional and 6 were given general anesthesia and one case was only given sedoanalgesia. While 8 of the patients administered with EVAR had hypertension all of the patients administered with TEVAR had hypertension. No significant differences were found in blood and blood product transfusions, preoperative and postoperative hemoglobin, hematocrit, urea and creatinine values between two groups. Conclusion: In EVAR and TEVAR applications general anesthesia, regional anesthesia, sedoanalgesia accompanied by local anesthesia can be successfully administered depending on the patient’s status and the location of the procedure.

  19. Endovascular Management of Iatrogenic Native Renal Arterial Pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Sildiroglu, Onur; Saad, Wael E.; Hagspiel, Klaus D.; Matsumoto, Alan H.; Turba, Ulku Cenk, E-mail: Turba@me.com [University of Virginia Health System, Department of Radiology (United States)

    2012-12-15

    Purpose: Our purpose was to evaluate iatrogenic renal pseudoaneurysms, endovascular treatment, and outcomes. Methods: This retrospective study (2003-2011) reported the technical and clinical outcomes of endovascular therapy for renal pseudoaneurysms in eight patients (mean age, 46 (range 24-68) years). Renal parenchymal loss evaluation was based on digital subtraction angiography and computed tomography. Results: We identified eight iatrogenic renal pseudoaneurysm patients with symptoms of hematuria, pain, and hematoma after renal biopsy (n = 3), surgery (n = 3), percutaneous nephrolithotomy (n = 1), and endoscopic shock-wave lithotripsy (n = 1). In six patients, the pseudoaneurysms were small-sized (<20 mm) and peripherally located and were treated solely with coil embolization (n = 5). In one patient, coil embolization was preceded by embolization with 500-700 micron embospheres to control active bleeding. The remaining two patients had large-sized ({>=}50 mm), centrally located renal pseudoaneurysms treated with thrombin {+-} coils. Technical success with immediate bleeding cessation was achieved in all patients. There were no procedure-related deaths or complications (mean follow-up, 23.5 (range, 1-67) months). Conclusions: Treatment of renal pseudoaneurysms using endovascular approach is a relatively safe and viable option regardless of location (central or peripheral) and size of the lesions with minimal renal parenchymal sacrifice.

  20. 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.

  1. Bilateral spontaneous internal carotid artery dissection managed with endovascular stenting – A case report

    Directory of Open Access Journals (Sweden)

    Manoj Kumar Agarwala

    2016-09-01

    We describe a patient with ischemic stroke from spontaneous bilateral ICAD with completely occluded left ICA. Having failed medical therapy with antiplatelets and anticoagulants due to extensive loss of carotid vascular supply, he was managed successfully with endovascular stenting with good neurological recovery.

  2. Imaging for surveillance and operative management for endovascular aortic aneurysm repairs.

    Science.gov (United States)

    Lau, Christopher; Feldman, Dmitriy N; Girardi, Leonard N; Kim, Luke K

    2017-04-01

    Endovascular aortic aneurysm repairs rely heavily on radiologic imaging modalities for preoperative surveillance, intraoperative management, and postoperative follow-up. Ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography all have utility at different stages of management. Often one imaging modality compliments another by providing supplementary information. Data from the imaging exams must be synthesized into one coherent plan for managing patients with aortic aneurysms.

  3. The 100 most cited articles in the endovascular management of intracranial aneurysms.

    Science.gov (United States)

    Maingard, Julian; Phan, Kevin; Ren, Yifan; Kok, Hong Kuan; Thijs, Vincent; Hirsch, Joshua A; Lee, Michael J; Chandra, Ronil V; Brooks, Duncan Mark; Asadi, Hamed

    2018-01-19

    Endovascular interventions for intracranial aneurysms have evolved substantially over the past several decades. A citation rank list is used to measure the scientific and/or clinical impact of an article. Our objective was to identify and analyze the characteristics of the 100 most cited articles in the field of endovascular therapy for intracranial aneurysms. We performed a retrospective bibliometric analysis between July and August 2017. Articles were searched on the Science Citation Index Expanded database using Web of Science in order to identify the most cited articles in the endovascular therapy of intracranial aneurysms since 1945. Using selected key terms ('intracranial aneurysm', 'aneurysm', 'aneurysmal subarachnoid', 'endovascular', 'coiling', 'stent-assisted', 'balloon-assisted', 'flow-diversion') yielded a total of 16 314 articles. The top 100 articles were identified and analyzed to extract relevant information, including citation count, authorship, article type, subject matter, institution, country of origin, and year of publication. Citations for the top 100 articles ranged from 133 to 1832. All articles were cited an average of 27 times per year. There were 45 prospective studies, including 7 level-II randomized controlled trials. Most articles were published in the 2000s (n=53), and the majority constituted level III or level IV evidence. Half of the top 100 articles arose from the USA. This study provides a comprehensive overview of the most cited articles in the endovascular management of intracranial aneurysms. It recognizes the contributions made by key authors and institutions, providing an important framework to an enhanced understanding of the evidence behind the endovascular treatment of aneurysms. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Management and outcome of cardiac and endovascular cystic echinococcosis.

    Directory of Open Access Journals (Sweden)

    Marta Díaz-Menéndez

    2012-01-01

    Full Text Available BACKGROUND: Cystic echinococcosis (CE can affect the heart and the vena cava but few cases are reported. METHODS: A retrospective case series of 11 patients with cardiac and/or endovascular CE, followed-up over a period of 15 years (1995-2009 is reported. RESULTS: Main clinical manifestations included thoracic pain or dyspnea, although 2 patients were asymptomatic. Cysts were located mostly in the right atrium and inferior vena cava. Nine patients were previously diagnosed with disseminated CE. Echocardiography was the diagnostic method of choice, although serology, electrocardiogram, chest X-ray, computed tomography/magnetic resonance imaging and histology aided with diagnosis and follow-up. Nine patients underwent cardiac surgery and nine received long-term antiparasitic treatment for a median duration of 25 months (range 4-93 months. One patient died intra-operatively due to cyst rupture and endovascular dissemination. Two patients died 10 and 14 years after diagnosis, due to pulmonary embolism (PE and cardiac failure, respectively. One patient was lost to follow-up. Patients who had cardiac involvement exclusively did not have complications after surgery and were considered cured. There was only one recurrence requiring a second operation. Patients with vena cava involvement developed PEs and presented multiple complications. CONCLUSIONS: Cardiovascular CE is associated with a high risk of potentially lethal complications. Clinical manifestations and complications vary according to cyst location. Isolated cardiac CE may be cured after surgery, while endovascular extracardiac involvement is associated with severe chronic complications. CE should be included in the differential diagnosis of cardiovascular disease in patients from endemic areas.

  5. Endovascular treatment of huge saccular abdominal aortic aneurysm in a young Behcet patient: mid-term result

    Directory of Open Access Journals (Sweden)

    Turkoz Riza

    2002-03-01

    Full Text Available Abstract Background Abdominal aortic aneurysm formation is among the arterial complications of Behcet's disease. Weakness and fragility of aortic walls leads to the development of arterial complications like pseudoaneurysms. Case Presentation A case of huge saccular abdominal aortic aneurysm in a young Behcet patient who was successfully treated with endovascular stent graft placement is reported, diagnostic and interventional procedures are discussed, and mid-term follow-up results are presented. Conclusions Endovascular treatment of abdominal aortic aneurysm complications of young Behcet patients who are not suitable for open surgery and need intervention could be an alternative treatment modality even without performing preprocedural angiography.

  6. Complications after endovascular treatment of hepatic artery stenosis after liver transplantation.

    Science.gov (United States)

    Goldsmith, Leighton E; Wiebke, Kristy; Seal, John; Brinster, Clayton; Smith, Taylor A; Bazan, Hernan A; Sternbergh, W Charles

    2017-11-01

    Hepatic artery stenosis (HAS) after liver transplantation can progress to hepatic artery thrombosis (HAT) and a subsequent 30% to 50% risk of graft loss. Although endovascular treatment of severe HAS after liver transplantation has emerged as the dominant method of treatment, the potential risks of these interventions are poorly described. A retrospective review of all endovascular interventions for HAS after liver transplantation between August 2009 and March 2016 was performed at a single institution, which has the largest volume of liver transplants in the United States. Severe HAS was identified by routine surveillance duplex ultrasound imaging (peak systolic velocity >400 cm/s, resistive index liver transplant recipients during the study period, 106 angiograms were performed in 79 patients (6.9%) for severe de novo or recurrent HAS. Interventions were performed in 99 of 106 cases (93.4%) with percutaneous transluminal angioplasty alone (34 of 99) or with stent placement (65 of 99). Immediate technical success was 91%. Major complications occurred in eight of 106 cases (7.5%), consisting of target vessel dissection (5 of 8) and rupture (3 of 8). Successful endovascular treatment was possible in six of the eight patients (75%). Ruptures were treated with the use of a covered coronary balloon-expandable stent graft or balloon tamponade. Dissections were treated with placement of bare-metal or drug-eluting stents. No open surgical intervention was required to manage any of these complications. With a median of follow-up of 22 months, four of eight patients (50%) with a major complication progressed to HAT compared with one of 71 patients (1.4%) undergoing a hepatic intervention without a major complication (P liver transplant before intervention compared with 12.6% (9 of 71) of the patients in the noncomplication cohort (P = .097). Although endovascular treatment of HAS is safe and effective in most patients, target vessel injury is possible. Severe

  7. Neonatal Intracranial Aneurysm Rupture Treated by Endovascular Management: A Case Report

    Directory of Open Access Journals (Sweden)

    Yi-Pei Tai

    2010-08-01

    Full Text Available Pediatric intracranial aneurysm rupture is rare, and is traditionally managed by surgical clipping. To the best of our knowledge, endovascular embolization of aneurysms in neonates has not previously been reported in Taiwan. We report a 9-day-old boy with intracranial aneurysms who underwent endovascular embolization, representing the youngest reported case in Taiwan. The 9-day-old boy presented with non-specific symptoms of irritable crying, seizure and respiratory distress. Computed tomography disclosed intraventricular hemorrhage, subarachnoid hemorrhage and focal intracranial hemorrhage around the right cerebellum. Subsequent computed tomographic angiography showed two sequential fusiform aneurysms, measuring 3 mm, located in the right side posterior inferior cerebellar artery (PICA. The patient underwent endovascular embolization because of the high risk of aneurysm re-rupture and the impossibility of surgical clipping due to the fusiform nature of the aneurysms. A postembolization angiogram revealed complete obliteration of the right distal PICA and proximal aneurysm. The distal PICA aneurysm was revascularized from the collateral circulation, but demonstrated a slow and delayed filling pattern. The patient's condition remained stable over the following week, and he was discharged without anticonvulsant therapy. No significant developmental delay was noted at follow-up at when he was 3 months old. This case emphasizes the need for clinical practitioners to consider a diagnosis of intracranial hemorrhage in neonates with seizure and increased intracranial pressure. Neonatal intracranial aneurysms can be treated safely by endovascular treatment.

  8. Combined Surgical and Endovascular Management of a Giant Fusiform PCA Aneurysm in a Pediatric Patient

    Science.gov (United States)

    Shin, S.H.; Choi, I.S.; Thomas, K.; David, C.A.

    2013-01-01

    Summary Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm. PMID:23693047

  9. Pregnancy with a ruptured renal artery aneurysm: management concerns and endovascular management.

    Science.gov (United States)

    Yadav, Siddharth; Sharma, Sanjay; Singh, Prabhjot; Nayak, Brusabhanu

    2015-10-26

    Renal artery aneurysm (RAA) affects pregnancy and is associated with high maternal and fetal mortality. Presentation is usually acute with severe flank pain, with or without haematuria, and haemodynamic instability requiring exploration and nephrectomy. A 26-year-old pregnant woman had sudden onset of gross haematuria and on evaluation was found to have a left RAA with an intrapelvic rupture and thinned out renal parenchyma. In view of the high risk of surgery, she was managed with endovascular placement of an Amplatzer type II vascular plug. Immediate and complete occlusion of blood flow was achieved and nephrectomy was avoided. Follow-up Doppler ultrasound revealed a reduced 5 cm mass in the left renal fossa with no internal flow and plug in position. She is currently on follow-up with 3-6 monthly ultrasonography not requiring any intervention. 2015 BMJ Publishing Group Ltd.

  10. Endovascular Management of Deep venous Thrombosis of Lower Extremity in Patients with Malignant Disease

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, Su Jin; Kim, Jae Kyu; Jang, Nam Kyu; Han, Seung Min; Kang, Heoung Keun; Choi, Soo Jin Nah [Chonnam National University Hospital, Gwangju (Korea, Republic of)

    2009-07-15

    To evaluate the efficacy of endovascular management of lower extremity deep vein thrombosis (DVT) in patients with malignant disease. Between January 2002 and January 2008, six consecutive patients (5 male and 1 female, mean age-65 years) with lower extremity DVT and malignant disease underwent endovascular management. The duration of symptoms lasted 4-120 days (mean-31 days; 20 days or less in four patients and more than 20 days in two). A catheter-directed thrombolysis was performed via the ipsilateral popliteal vein or common femoral vein, used alone or combined with a percutaneous mechanical thrombectomy. Angioplasty or stent placement was performed in residual stenosis or occlusion of the vein. The follow-up period lasted 1-14 months (mean 7.6 months) and was performed via a color Doppler ultrasonography or computed tomographic venography. Technical success and relief from symptoms was achieved within two days was achieved in five patients. Minor hemorrhagic complications occurred in two cases: hematuria and a hematoma at the puncture site. Upon follow-up, a recurrent DVT occurred in three patients as well as a patent venous flow in two. One patient died within 1 month due to a metastatic mediastinal lymphadenopathy. Endovascular management of the lower extremity DVT is effective for quickly eliminating a thrombus, relieving symptoms, and decreasing hemorrhagic complications in patients with malignant disease.

  11. Accidental Coverage of Both Renal Arteries during Infrarenal Aortic Stent-Graft Implantation: Cause and Treatment

    Directory of Open Access Journals (Sweden)

    Umberto Marcello Bracale

    2014-01-01

    Full Text Available The purpose of this paper is to report a salvage maneuver for accidental coverage of both renal arteries during endovascular aneurysm repair (EVAR of an infrarenal abdominal aortic aneurysm (AAA. A 72-year-old female with a 6 cm infrarenal abdominal aortic aneurysm was treated by endovascular means with a standard bifurcated graft. Upon completing an angiogram, both renal arteries were found to be accidentally occluded. Through a left percutaneous brachial approach, the right renal artery was catheterized and a chimney stent was deployed; however this was not possible for the left renal artery. A retroperitoneal surgical approach was therefore carried out with a retrograde chimney stent implanted to restore blood flow. After three months, both renal arteries were patent and renal function was not different from the baseline. Both endovascular with percutaneous access via the brachial artery and open retroperitoneal approaches with retrograde catheterization are feasible rescue techniques to recanalize the accidentally occluded renal arteries during EVAR.

  12. Fenestrated Stent Graft Repair of Abdominal Aortic Aneurysm: Hemodynamic Analysis of the Effect of Fenestrated Stents on the Renal Arteries

    Energy Technology Data Exchange (ETDEWEB)

    Sun, Zhonghua; Chaichana, Thanapong [Curtin University of Technology, Perth (Australia)

    2010-02-15

    We wanted to investigate the hemodynamic effect of fenestrated stents on the renal arteries with using a fluid structure interaction method. Two representative patients who each had abdominal aortic aneurysm that was treated with fenestrated stent grafts were selected for the study. 3D realistic aorta models for the main artery branches and aneurysm were generated based on the multislice CT scans from two patients with different aortic geometries. The simulated fenestrated stents were designed and modelled based on the 3D intraluminal appearance, and these were placed inside the renal artery with an intra-aortic protrusion of 5.0-7.0 mm to reflect the actual patients' treatment. The stent wire thickness was simulated with a diameter of 0.4 mm and hemodynamic analysis was performed at different cardiac cycles. Our results showed that the effect of the fenestrated stent wires on the renal blood flow was minimal because the flow velocity was not significantly affected when compared to that calculated at pre-stent graft implantation, and this was despite the presence of recirculation patterns at the proximal part of the renal arteries. The wall pressure was found to be significantly decreased after fenestration, yet no significant change of the wall shear stress was noticed at post-fenestration, although the wall shear stress was shown to decrease slightly at the proximal aneurysm necks. Our analysis demonstrates that the hemodynamic effect of fenestrated renal stents on the renal arteries is insignificant. Further studies are needed to investigate the effect of different lengths of stent protrusion with variable stent thicknesses on the renal blood flow, and this is valuable for understanding the long-term outcomes of fenestrated repair.

  13. National survey on perioperative anaesthetic management in the endovascular treatment of acute ischaemic stroke.

    Science.gov (United States)

    Romero Kräuchi, O; Valencia, L; Iturri, F; Mariscal Ortega, A; López Gómez, A; Valero, R

    2018-01-01

    To assess the anaesthetic management of treatment for endovascular acute ischaemic stroke (AIS) in Spain. A survey was designed by the SEDAR Neuroscience Section and sent to the Spanish anaesthesiology departments with a primary stroke centre between July and November 2016. Of the 47 hospitals where endovascular treatment of AIS is performed, 37 anaesthesiology departments participated. Thirty responses were obtained; three of which were eliminated due to duplication (response rate of 72.9%). Health coverage for AIS endovascular treatment was available 24hours a day in 63% of the hospitals. The anaesthesiologist in charge of the procedure was physically present in the hospital in 55.3%. There was large inter-hospital variability in non-standard monitoring and type of anaesthesia. The most important criterion for selecting type of anaesthesia was multidisciplinary choice made by the anaesthesiologist, neurologist and neuroradiologist (59.3%). The duration of time from arrival to arterial puncture was 10-15minutes in 59.2%. In 44.4%, systolic blood pressure was maintained between 140-180mmHg, and diastolic blood pressure<105mmHg. Glycaemic levels were taken in 81.5% of hospitals. Intravenous heparinisation was performed during the procedure in 66.7% with different patterns of action. In cases of moderate neurological deterioration with no added complications, 85.2% of the included hospitals awakened and extubated the patients. The wide variability observed in the anaesthetic management and the organization of the endovascular treatment of AIS demonstrates the need to create common guidelines for anaesthesiologists in Spain. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Miscellaneous Endovascular Treatment of Ruptured Hepatic Artery Pseudoaneurysms after Pylorus Preserving Pancreaticoduodenectomy

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Ung Rae; Lee, Young Hwan [Dept. of Radiology, Daegu Catholic University Medical Center, Catholic of Daegu University School of Medicine, Daegu (Korea, Republic of); Ahn, Eun Joung; Kim, See Hyung; Kim, Young Hwan [Dept. of Radiology, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, Daegu (Korea, Republic of)

    2012-03-15

    To assess the feasibility and safety of the endovascular treatment of ruptured hepatic artery pseudoaneurysms after pylorus preserving pancreaticoduodenectomy (PPPD). Thirteen patients with hepatic artery pseudoaneurysm after PPPD were enrolled. Various endovascular techniques were used depending on the sites and morphologies of the pseudoaneurysms. Five cases were treated by coil embolization, five with stent-graft, one by thrombin injection and coil embolization, one with stent-graft and coil embolization, and one with N-butyl cyanoacrylate (NBCA) injection. Computed tomography scans and liver function test were performed after the procedures. Pseudoaneurysm exclusion and bleeding cessation was achieved in all patients. In four patients that underwent coil or NBCA embolization of the hepatic artery, aspartate transaminase (AST) and alanine transaminase (ALT) were markedly elevated. Two of these four patients with narrowing of the portal vein due to surrounding hematoma died of hepatic infarction or hepatic abscess. In other nine patients, AST and ALT were unchanged. In the 11 surviving patients, normal hepatic function and complete pseudoaneurysm disappearance were achieved during follow-up. Endovascular treatment of ruptured hepatic artery pseudoaneurysms can be considered as a feasible and safe method. However, complete occlusion of the hepatic artery with coils should be avoided in patients with inadequate portal flow.

  15. Endovascular repair of postoperative vascular graft related complications after aorto-iliac surgery

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Andersen, P E; Larsen, K E

    2014-01-01

    AIM: Para-anastomotic aneurysms, leakage due to anastomotic failure, aorto- and arterioenteric fistulas are some of the serious complications after aorto-iliac surgical reconstructions. Treatment of these complications is challenging and is either done by open surgery or by endovascular therapy...... endoprosthesis was implanted in one case and in two cases aortic cuff was used. Fluency periphery stent grafts were used in four cases. There was a 100% technical success. Intervention related early mortality was 8%. One patient with pseudoaneurysm died 28 months after endovascular treatment because of cardiac...... infarct and one patient with previously infected arterio-enteric fistula and advanced malignancy died 7 months after second endovascular treatment. Overall the mortality was 25%. There was no procedure related morbidity or complications during hospitalization and follow-up of mean 12, 3 months (range 1...

  16. Experiencia en el manejo endovascular para el tratamiento de la aorta torácica Experience in endovascular management for thoracic aorta treatment

    Directory of Open Access Journals (Sweden)

    Juan G Barrera

    2007-12-01

    aneurysm, showing a 16% mortality reduction. Objective: evaluate surgical results in terms of morbid-mortality in patients submitted to endovascular management of thoracic aortic lesions in the Colombian Cardiovascular Foundation from 2003 to 2005. Design-Method: longitudinal descriptive retrospective study in which clinical histories of all patients submitted to endovascular treatment of thoracico-abdominal aortic lesions were evaluated. Only patients with thoracic aortic procedures between 2003 and 2005 were included. Data analysis was realized in Stata/SE 8,0. Results: thoracic aortic procedures were performed in 16 patients. 75% were male with mean age 55.9 ± 12.6 years. 87.5% (14 had type A or B aortic dissection; one patient had traumatic aortic transection and one had aneurysm of thoracic descendant aorta. Acute dissections were presented in 78.6% (11 patients and chronic dissections in 21.4% (3 patients. Average of endoprosthesis employed was 2.8 ± 1. Intensive care unit stay was 3 ± 2.7 days. 81.3% had no mayor complications. Mortality was 18.7% (3 patients. All patients had post-operative computerized tomography scan, with satisfactory evolution. Conclusion: according to the largest casuistics literature reports, endovascular management of dissection, aneurysm or aortic trauma is considered a trustworthy procedure that diminishes morbid-mortality.

  17. Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi

    Energy Technology Data Exchange (ETDEWEB)

    Mahnken, Andreas H., E-mail: mahnken@med.uni-marburg.de [University Hospital Giessen and Marburg, Philipps University of Marburg, Department of Diagnostic Radiology (Germany); Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M., E-mail: anneke.damberg@rwth-aachen.de [University Hospital RWTH Aachen, Department of Thoracic, Cardiac and Vascular Surgery (Germany)

    2013-08-01

    BackgroundAortic thrombi in the ascending aorta or aortic arch are rare but are associated with a relevant risk of major stroke or distal embolization. Although stent grafting is commonly used as a treatment option in the descending aorta, only a few case reports discuss stenting of the aortic arch for the treatment of a thrombus. The use of bare metal stents in this setting has not yet been described.MethodsWe report two cases of ascending and aortic arch thrombus that were treated by covering the thrombus with an uncovered stent. Both procedures were performed under local anesthesia via a femoral approach. A femoral cutdown was used in one case, and a total percutaneous insertion was possible in the second case.ResultsBoth procedures were successfully performed without any periprocedural complications. Postoperative recovery was uneventful. In both cases, no late complications or recurrent embolization occurred at midterm follow-up, and control CT angiography at 1 respectively 10 months revealed no stent migration, freely perfused supra-aortic branches, and no thrombus recurrence.ConclusionTreating symptomatic thrombi in the ascending aorta or aortic arch with a bare metal stent is feasible. This technique could constitute a minimally invasive alternative to a surgical intervention or complex endovascular therapy with fenestrated or branched stent grafts.

  18. Endovascular Treatment of Thoracic Aortic Dissection: Hemodynamic Shear Stress Study

    Science.gov (United States)

    Tang, Yik Sau; Lai, Siu Kai; Cheng, Stephen Wing Keung; Chow, Kwok Wing

    2012-11-01

    Thoracic Aortic Dissection (TAD), a life threatening cardiovascular disease, occurs when blood intrudes into the layers of the aortic wall, creating a new artificial channel (the false lumen) beside the original true lumen. The weakened false lumen wall may expand, enhancing the risk of rupture and resulting in high mortality. Endovascular treatment involves the deployment of a stent graft into the aorta, thus blocking blood from entering the false lumen. Due to the irregular geometry of the aorta, the stent graft, however, may fail to conform to the vessel curvature, and would create a ``bird-beak'' configuration, a wedge-shaped domain between the graft and the vessel wall. Computational fluid dynamics analysis is employed to study the hemodynamics of this pathological condition. With the `beaking' configuration, the local hemodynamic shear stress will drop below the threshold of safety reported earlier in the literature. The oscillating behavior of the shear stress might lead to local inflammation, atherosclerosis and other undesirable consequences. Supported by the Innovation and Technology Fund of the Hong Kong Government.

  19. Early Results with the Use of Heparin-bonded Stent Graft to Rescue Failed Angioplasty of Chronic Femoropopliteal Occlusive Lesions: TASC D Lesions Have a Poor Outcome

    Energy Technology Data Exchange (ETDEWEB)

    Kuhan, Ganesh, E-mail: gkuhan@nhs.net; Abisi, Said; Braithwaite, Bruce D.; MacSweeney, Shane T. R. [Nottingham University Hospitals, Vascular and Endovascular Unit, Queens Medical Centre (United Kingdom); Whitaker, Simon C.; Habib, Said B. [Nottingham University Hospitals, Department of Radiology, Queen' s Medical Centre (United Kingdom)

    2012-10-15

    Purpose: To evaluate early patency rate of the heparin-bonded stent grafts in atherosclerotic long femoropopliteal occlusive disease, and to identify factors that affect outcome. Methods: Heparin-bonded Viabahn stent grafts were placed in 33 limbs in 33 patients during 2009-2010. The stents were deployed to rescue failed conventional balloon angioplasty. Mean age was 69 (range 44-88) years, and 67 % (22 of 33) were men. Most procedures (21 of 33, 64 %) were performed for critical limb ischemia (33 % for rest pain, 30 % tissue loss). Kaplan-Meier plots and Cox regression analysis were used to identify significant risk factors. Results: The average length of lesions treated was 25 {+-} 10 cm, and they were predominantly TASC (Transatlantic Intersociety Consensus) D (n = 13) and C (n = 17) lesions. The median primary patency was 5.0 months (95 % confidence interval 1.22-8.77). The mean secondary patency was 8.6 months (95 % confidence interval 6.82-10.42). Subsequently, 4 patients underwent bypass surgery and 5 patients underwent major amputation. One patient died. There were 5 in-stent or edge-stent stenoses. Cox multivariate regression analysis identified TASC D lesions to be a significant risk factor for early occlusion (p = 0.035). Conclusion: TASC D lesions of femoropopliteal occlusions have poor patency rates with the use of heparin-bonded stent grafts after failed conventional angioplasty. Alternative options should be considered for these patients.

  20. Outcomes of thoracic endovascular aortic repair in adult coarctation patients.

    Science.gov (United States)

    Lala, Salim; Scali, Salvatore T; Feezor, Robert J; Chandrekashar, Satish; Giles, Kristina A; Fatima, Javairiah; Berceli, Scott A; Back, Martin R; Huber, Thomas S; Beaver, Thomas M; Beck, Adam W

    2017-09-22

    Aortic coarctation (AC) is most commonly identified in pediatric patients; however, adults can present with late sequelae of untreated coarctation or complications of prior open repair. To date, there are limited data about the role of thoracic endovascular aortic repair (TEVAR) in this group of patients. The purpose of this analysis was to describe our experience with management of adult coarctation patients using TEVAR. All TEVAR patients treated for primary coarctation or late sequelae of previous open repair (eg, pseudoaneurysm, recurrent coarctation or anastomotic stenosis related to index open coarctation repair) were reviewed. Demographics, comorbidities, procedure-related variables, postoperative outcomes, and reintervention were recorded. Computed tomography centerline assessments of endograft morphology were completed to delineate stent anatomy at the coarctation site. Survival and reintervention were estimated using life-table analysis. A total of 21 patients were identified (median age, 46 years [range, 33-71 years]; 67% male [n = 14]). Nine patients (43%) were treated for symptomatic primary (n = 6) or recurrent (n = 3) coarctation. Other indications included degenerative thoracic aneurysm (n = 6), pseudoaneurysm (n = 4), and dissection (n = 2). Technical success was 100% (95% confidence interval [CI], 84%-100%). No 30-day mortality or paraplegia events occurred; however, two patients (10%) experienced postoperative nondisabling stroke. In primary or recurrent coarctation patients with available computed tomography imaging (n = 8 of 9), nominal stent graft diameters were achieved proximal and distal to the coarctation (range, -0.4 to -1.2 mm of desired final stent diameter). Specific to the coarctation site, there was a significant increase in aortic diameter after TEVAR (before stenting, 11.5 [95% CI, 6.8-12.3] mm; after stenting, 15 [95% CI, 13.7-15.7] mm; P = .004). Concurrently, systolic arterial blood pressure at time of discharge was

  1. Endovascular Management for Symptomatic Chronic Mesenteric Ischemia: A Single-Center Experience.

    Science.gov (United States)

    Guo, Baolei; Guo, Daqiao; Xu, Xin; Chen, Bin; Jiang, Junhao; Yang, Jue; Shi, Zhenyu; Fu, Weiguo

    2017-10-01

    Chronic mesenteric ischemia (CMI) is an uncommon condition encountered by clinicians. Presentation may vary from asymptomatic to classical intestinal ischemia, although a clear pathophysiology has yet to be elucidated. Here, we have presented our institution's experience in the management of symptomatic CMI. From February 2007 to February 2016, a retrospective study was performed of all consecutive patients with symptomatic CMI managed by endovascular treatment (ET). We reviewed these patients' demographics, comorbidities, clinical presentations, and treatment modalities. Perioperative and midterm outcomes included technical success, clinical symptom relief, complications, symptomatic recurrence, mortality, restenosis, and reintervention. Thirty-five mesenteric arteries (74.3% stenotic/25.7% occluded) identified in 32 patients (12 females, 20 males) were treated with endovascular procedures. There were no 30-day deaths; the perioperative complication rate was 12.5%. Overall, the median postprocedural time to symptom relief was 7.6 days (range: 1-30 days). Twenty-two (68.8%) had complete remission of symptom, whereas 7 (21.9%) had partial improvement in symptom after ET. After a mean follow-up of 35.4 (25.9) months, 5 (15.6%) patients developed recurrent symptoms, with 4 requiring reinterventions. The primary patency was 93.7%, 82.6%, and 73.1% at 12, 24, and 36 months, respectively, and the freedom from symptomatic recurrence was 90.6%, 84.0%, 84.0%, and 84.0% at 6, 12, 24, and 36 months, respectively. Endovascular treatment for patients with CMI had a high technical success rate and satisfactory clinical outcomes. Symptomatic recurrence was not frequent but found mainly within 12 months following the initial procedure.

  2. Early and long-term clinical and radiological follow-up results of expanded-polytetrafluoroethylene-covered stent-grafts for transjugular intrahepatic portosystemic shunt procedures

    Energy Technology Data Exchange (ETDEWEB)

    Maleux, Geert; Heye, Sam; Thijs, Maria; Wilms, Guy [University Hospitals Gasthuisberg, Department of Radiology, Leuven (Belgium); Nevens, Frederik; Verslype, Chris [University Hospitals Gasthuisberg, Department of Hepatology, Leuven (Belgium); Wilmer, Alexander [University Hospitals Gasthuisberg, Department of Medical Intensive Care Unit, Leuven (Belgium)

    2004-10-01

    The purpose of this study was to assess the therapeutic efficacy and immediate and long-term safety of expanded-tetrafluoroethylene covered stent-grafts for transjugular intrahepatic portosystemic shunts in patients with portal hypertension-related complications. A cohort of 56 patients suffering from severe portal hypertension-related complications underwent implantation of an expanded-polytetrafluoroethylene-covered stent-graft. All patients suffered from severe liver cirrhosis graded Child-Pugh A (n=8; 16%), B (n=13; 21%) or C (n=35; 63%). In 44 patients, the stent-graft was placed during the initial TIPS procedure (de novo TIPS); in the other 12 patients, the stent-graft was placed to repermeabilize the previously placed bare stent (TIPS revision). Follow-up was performed with clinical assessment, duplex ultrasound and, if abnormal or inconclusive, with invasive venography and pressure measurements. Per- en immediate post-procedural complications occurred in four patients (4/56, 7%). None of them was lethal. During follow-up, stent occlusion appeared in one patient and stenosis in two; no recurrence of bleeding was noted in all patients treated for variceal bleeding (n=28), and 24 of the 28 patients (86%) suffering from refractory ascites and/or hepatic hydrothorax were free of regular paracenteses and/or drainage of pleural effusion after shunt creation. The 30-day and global mortality for the total study population (n=56) was, respectively, 7% (n=4) and 28.5% (n=16). In the patient subgroup with variceal bleeding (n=28), 30-day mortality was 3.5% (n=1) and global mortality 14.2% (n=4). In the ascites and/or hydrothorax subgroup (n=28), 8.1% (n=3) mortality at 30 days was found and global mortality was 32.4% (n=12). In 10 patients of the 56 studied patients (18%), isolated hepatic encephalopathy occurred, which was lethal in 4 (Child C) patients (7%). Three of these four patients died within the 1st month after TIPS placement. A very high primary patency rate

  3. Endovascular management of immediate procedure-related complications of failed hemodialysis access recanalization

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Dong Hun [Chosun University Hospital, Kwangju (Korea, Republic of); Goo, Dong Erk; Yang, Seung Boo; Choi, Deuk Lin; Moon Cheul [Soonchunhyang University Hospital, Chunan (Korea, Republic of)

    2005-09-15

    Endovascular procedures are becoming the standard type of care for the management of hemodialysis vascular access dysfunction. As with any type of medical procedure, these techniques can result in procedure-related complications, although the expected number of complications is low. The clinical extent of these complications varies from case to case. Management of these cases depends on the clinical presentation. Major complications such as vein rupture, arterial embolism, remote site bleeding or hematoma, symptomatic pulmonary embolism and puncture site complications necessitating treatment require major therapy. Minor complications such as non-flow compromising small puncture site hematoma or pseudoaneurysms require little or no therapy. It is essential that the interventionist be prepared to manage these complications appropriately when they arise.

  4. Multimodal approach to endovascular treatment of visceral artery aneurysms and pseudoaneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Lagana, Domenico [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy); Carrafiello, Gianpaolo [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy)]. E-mail: gcarraf@tin.it; Mangini, Monica [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy)]. E-mail: monica.mangini@tin.it; Dionigi, Gianlorenzo [Department of Surgery, University of Insubria, Varese (Italy); Caronno, Roberto [Vascular Surgery, University of Insubria, Varese (Italy); Castelli, Patrizio [Vascular Surgery, University of Insubria, Varese (Italy); Fugazzola, Carlo [Vascular and Interventional Radiology, Department of Radiology, University of Insubria, Varese (Italy)

    2006-07-15

    Purpose: To assess the feasibility and the effectiveness of endovascular treatment of visceral arteries aneurysms (VAAs) using a 'multimodal approach'. Material and methods: Twenty-five patients (mean age 60.1 years) with 29 VAAs (13 splenic, 4 hepatic, 3 gastroduodenal, 6 renal, 2 pancreatic-duodenal, 1 superior mesenteric) were considered suitable for endovascular treatment; 8/29 were ruptured. Saccular aneurysms (9/29) were treated by sac embolization with coils (in 4 cases associated with cyanoacrylate or thrombin) with preservation of artery patency. Fusiform aneurysms (6/29), were treated by an 'endovascular exclusion'. In 10/29 cases, supplied by a terminal branch, we performed an embolization of the afferent artery, with coils and cyanoacrylate or thrombin. 2/29 cases were treated with a stent-graft and 2/29 cases with a percutaneous ultrasound-guided thrombin injection and coils embolization of the afferent artery. The follow-up was performed by ultrasonography and/or CT-angiography 1 week after the procedure and then after 1, 6, and 12 months and thereafter annually. Results: In 29/29 cases we obtained an immediate exclusion. Two patient died for other reasons. Complication rate was 27.6% (7 spleen ischemia and 1 stent-graft occlusion). During the follow-up (range: 7 days-36 months, mean 18.7 months), we observed 3/29 (10.3%) cases of reperfusion in the first month, all treated successfully with a further endovascular procedure. Primary technical success was 89.7%; secondary technical success was 100%. Conclusion: Endovascular therapy can be considered a feasible and effective approach for VAAs with good primary and secondary success rates.

  5. Endovascular Management of Intractable Postpartum Hemorrhage Caused by Vaginal Laceration

    Energy Technology Data Exchange (ETDEWEB)

    Koganemaru, Masamichi, E-mail: mkoganemaru@med.kurume-u.ac.jp; Nonoshita, Masaaki, E-mail: z2rs-1973@yahoo.co.jp; Iwamoto, Ryoji, E-mail: iwamoto-ryouji@kurume-u.ac.jp; Kuhara, Asako, E-mail: kuhara-asako@med.kurume-u.ac.jp; Nabeta, Masakazu, E-mail: nabeta-masakazu@med.kurume-u.ac.jp; Kusumoto, Masashi, E-mail: kusumoto-masashi@med.kurume-u.ac.jp; Kugiyama, Tomoko, E-mail: kugiyama-tomoko@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan); Kozuma, Yutaka, E-mail: kouduma-yutaka@kurume-u.ac.jp [Kurume University School of Medicine, Department of Obstetrics and Gynecology (Japan); Nagata, Shuji, E-mail: sn4735@med.kurume-u.ac.jp; Abe, Toshi, E-mail: toshiabe@med.kurume-u.ac.jp [Kurume University School of Medicine, Department of Radiology (Japan)

    2016-08-15

    PurposeWe evaluated the management of transcatheter arterial embolization for postpartum hemorrhage caused by vaginal laceration.Materials and MethodsWe reviewed seven cases of patients (mean age 30.9 years; range 27–35) with intractable hemorrhages and pelvic hematomas caused by vaginal lacerations, who underwent superselective transcatheter arterial embolization from January 2008 to July 2014. Postpartum hemorrhage was evaluated by angiographic vascular mapping to determine the vaginal artery’s architecture, technical and clinical success rates, and complications.ResultsThe vaginal artery was confirmed as the source of bleeding in all cases. The artery was found to originate from the uterine artery in three cases, the uterine and obturator arteries in two, or the internal pudendal artery in two. After vaginal artery embolization, persistent contrast extravasation from the inferior mesenteric artery as an anastomotic branch was noted in one patient. Nontarget vessels (the inferior vesical artery and nonbleeding vaginal arterial branches) were embolized in one patient. Effective control of hemostasis and no post-procedural complications were confirmed for all cases.ConclusionPostpartum hemorrhages caused by vaginal lacerations involve the vaginal artery arising from the anterior trunk of the internal iliac artery with various branching patterns. Superselective vaginal artery embolization is clinically acceptable for the successful treatment of vaginal laceration hemorrhages, with no complications. After vaginal artery embolization, it is suggested to check for the presence of other possible bleeding vessels by pelvic aortography with a catheter tip at the L3 vertebral level, and to perform a follow-up assessment.

  6. Tratamento das afecções da aorta com a primeira geração de stents auto-expansíveis Aortic diseases treatment with a first generation of self expanding stent-grafts

    Directory of Open Access Journals (Sweden)

    Wagner Michael PEREIRA

    2001-09-01

    ,57%, com 70,15% dos pacientes livre de eventos em 33 meses de seguimento, tornando o método factível e diminuindo a mortalidade no tratamento cirúrgico das dissecções agudas e crônicas do tipo B.INTRODUCTION: The authors describe the implantation of an endovascular self-expanding stents grafts at 33 months of follow-up. The use can be a new alternative for the treatment of descending aortic dissections and aneurysms disease. MATERIAL AND METHODS: From April 1998 to November 2000 (32 months, 37 endovascular stent grafts were implanted, 21 in acute dissections type B, 7 in acute dissections type A and 9 in chronic dissections type B and aneurysms ones. The age varied between 39 and 79 years (mean=57.94 ± 1.91 years, considering that 64.86% were male patients. The patients were submitted to median esternotomy, extracorporeal circulation (ECC, with deep hipothermia (18-20ºC, total circulatory arrest (TCA, and retrograde cerebral perfusion (RCP. The transverse aorta was incised and the stent was implanted in the descending proximal aorta with the aid sometimes of aortoscopy. The times of ECC, aortic clamping, TCA, RCP, rewarming, mechanic ventilation, hospitalization, trans and post-operative bleeding, blood replacement, events curve and survival curve were analyzed. RESULTS: The hospital mortality (30 days was 13.51%; 32 have been followed up from 1 to 33 months, 70.7% are free of events and survival curve with 63.19% (33 months. CONCLUSIONS: The implant of self-expanding intraluminal stent grafts presented has lower hospital mortality in the acute phase and follow-up in acute aortic dissections type B (10% than clinical treatment (IRAD. In spite of the small sample the procedure is promising and needs longer follow-up.

  7. Pain assessment and management in patients undergoing endovascular procedures in the catheterization laboratory.

    Science.gov (United States)

    Hilário, Thamires de Souza; Santos, Simone Marques Dos; Kruger, Juliana; Goes, Martha Georgina; Casco, Márcia Flores; Rabelo-Silva, Eneida Rejane

    2017-05-25

    To describe how pain is assessed (characteristic, location, and intensity) and managed in clinical practice in patients undergoing endovascular procedures in the catheterization laboratory setting. Cross-sectional study with retrospective data collection. Overall, 345 patients were included; 116 (34%) experienced post-procedural pain; in 107 (92%), pain characteristics were not recorded; the location of pain was reported in 100% of patients, and its intensity in 111 (96%); management was largely pharmacologic; of the patients who received some type of management (n=71), 42 (59%) underwent reassessment of pain. The location and intensity of pain are well reported in clinical practice. Pharmacologic pain management is still prevalent. Additional efforts are needed to ensure recording of the characteristics of pain and its reassessment after interventions. Describir cómo se evalúa el dolor (características, localización e intensidad) y su manejo en la práctica clínica en pacientes sometidos a procedimientos endovasculares en el laboratorio de cateterización. Estudio transversal con recolección retrospectiva de datos. En total, se incluyeron 345 pacientes; 116 (34%) experimentaron dolor post-procedimiento; en 107 (92%), no se registraron las características del dolor; la localización del dolor se informó en el 100% de los pacientes, y su intensidad en 111 (96%); el manejo fue en gran medida farmacológico; de los pacientes que recibieron algún tipo de tratamiento (n=71), 42 (59%) fueron sometidos a reevaluación del dolor. La ubicación y la intensidad del dolor se informan bien en la práctica clínica. El manejo farmacológico del dolor sigue siendo frecuente. Se necesitan esfuerzos adicionales para asegurar el registro de las características del dolor y su reevaluación después de las intervenciones.

  8. Initial experience with the Ventana fenestrated system for endovascular repair of juxtarenal and pararenal aortic aneurysms.

    Science.gov (United States)

    Holden, Andrew; Mertens, Renato; Hill, Andrew; Mariné, Leopoldo; Clair, Daniel G

    2013-05-01

    Customized fenestrated endovascular stent grafts have been investigated as an alternative to open surgery for repair of more complex juxtarenal aortic aneurysms (JAAs). The substantial time required to design and manufacture these devices has led to the desire for a standardized fenestrated endovascular system. We report the initial pilot study results of a potential "off-the-shelf" fenestrated device system to assess its initial safety and feasibility for endovascular repair of JAAs and pararenal aortic aneurysms (PAAs). Following ethics committee approvals, consenting patients were evaluated for eligibility. Patients with aneurysms abutting or including the renal artery orifices who were not candidates for standard infrarenal endograft placement because of proximal aortic neck morphology were further assessed for anatomic suitability for this "off-the-shelf" device. There were a number of anatomic requirements, the most important being a stable infra-superior mesenteric artery aortic neck length ≥ 15 mm. Patients are assessed in-hospital and in follow-up at 1, 6, and 12 months, and annually thereafter to 5 years for adverse events and using contrast-enhanced computed tomography angiography with Core Laboratory interpretation of renal perfusion, device integrity, migration, endoleak, and aneurysm morphology. Fifteen patients (87% male) with JAAs (93%) or PAAs (6.7%) presented at mean age of 77 years (range, 66-85 years) and with mean sac diameter of 5.9 cm (range, 5.1-7.9 cm). Four Ventana fenestrated stent graft models having aligned fenestrations (three models) or offset fenestrations (one model) and renal stent grafts were successfully implanted among the patients, and all renal and visceral arteries were preserved. Mean endovascular procedure time was 108 minutes (range, 71-212 minutes) with mean contrast usage and fluoroscopy time of 254 mL (range, 67-420 mL) and 55 minutes (range, 27-104 minutes), respectively. Five patients received blood products. Mean

  9. Endovascular abdominal aortic aneurysm sizing and case planning using the TeraRecon Aquarius workstation.

    Science.gov (United States)

    Lee, W Anthony

    2007-01-01

    The gold standard for preoperative evaluation of an aortic aneurysm is a computed tomography angiogram (CTA). Three-dimensional reconstruction and analysis of the computed tomography data set is enormously helpful, and even sometimes essential, in proper sizing and planning for endovascular stent graft repair. To a large extent, it has obviated the need for conventional angiography for morphologic evaluation. The TeraRecon Aquarius workstation (San Mateo, Calif) represents a highly sophisticated but user-friendly platform utilizing a combination of task-specific hardware and software specifically designed to rapidly manipulate large Digital Imaging and Communications in Medicine (DICOM) data sets and provide surface-shaded and multiplanar renderings in real-time. This article discusses the basics of sizing and planning for endovascular abdominal aortic aneurysm repair and the role of 3-dimensional analysis using the TeraRecon workstation.

  10. Endovascular management of deep venous thrombotic diseases of the lower extremity

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Byung Suk [School of Medicine, Wonkwang Univ., Iksan (Korea, Republic of)

    2004-07-01

    Pulmonary embolism and venous ischemia are acute complications of deep vein thrombosis (DVT) of the lower extremities. Delayed complications include a spectrum of debilitating symptoms referred to as postthrombotic syndrome (PST). Because the early symptoms and patient signs are nonspecific for DVT, careful history taking and radiological evaluation of the extent and migration of thrombus should be used to establish an objective diagnosis and the need for treatment. Anticoagulation therapy is recognized as the mainstay treatment in acute DVT. However, there are few data to suggest any major beneficial effect of the early clearing of massive DVT and PTS. Endovascular, catheter-directed, thrombolysis techniques, used alone or in combination with mechanical thrombectomy devices, have been proven to be highly effective in clearing acute DVT, which may allow the preservation of venous valve function and the prevention of subsequent venous occlusive disease. Definitive management of the underlying anatomic occlusive abnormalities should also be undertaken.

  11. Management of the left subclavian artery and neurologic complications after thoracic endovascular aortic repair.

    Science.gov (United States)

    Patterson, Benjamin O; Holt, Peter J; Nienaber, Christoph; Fairman, Ronald M; Heijmen, Robin H; Thompson, Matt M

    2014-12-01

    Thoracic endovascular aortic repair (TEVAR) of various pathologies has been associated with peri-interventional neurologic complication rates of up to 15%. The objective of this study was to determine the influence of the management of the left subclavian artery (LSA) on neurologic complications and to define subgroups that might benefit from LSA revascularization. The Medtronic Thoracic Endovascular Registry (MOTHER; Medtronic, Santa Rosa, Calif), consists of data from five sponsored trials and one institutional series incorporating 1010 patients undergoing TEVAR from 2002 to 2010. Perioperative stroke and spinal cord injury (SCI) rates were described according to the management of the LSA and presenting pathology. Multivariate analysis was performed to determine factors associated with perioperative neurologic complications. Of 1002 patients included in the analysis, stroke occurred in 48 (4.8%), and SCI developed in 42 (4.2%) ≤ 30 days of surgery. The stroke rate was 2.2% in patients with no coverage of the LSA vs 9.1% with coverage alone and 5.1% in patients who underwent LSA revascularization before coverage (P < .001). This relationship was strongest in the aneurysm group. Coverage of the LSA without revascularization was independently associated with stroke (odds ratio [OR], 3.5; 95% confidence interval [CI], 1.7-7.1), specifically in the posterior territory (OR, 11.7; 95% CI, 2.5-54.6), as was previous cerebrovascular accident (OR, 7.1; 95% CI, 2.2-23.1; P = .001), whereas a covered LSA was not associated with an increased risk of SCI. Coverage of the LSA without revascularization is an important modifiable risk factor for stroke in patients undergoing TEVAR for a thoracic aortic aneurysm. Prior revascularization appears to protect against posterior circulation territory stroke. Copyright © 2014 Society for Vascular Surgery. All rights reserved.

  12. Endovascular Management of Acute Embolic Occlusion of the Superior Mesenteric Artery: A 12-Year Single-Centre Experience

    Energy Technology Data Exchange (ETDEWEB)

    Raupach, J., E-mail: janraupach@seznam.cz; Lojik, M., E-mail: miroslav.lojik@fnhk.cz; Chovanec, V., E-mail: chovanec.v@seznam.cz; Renc, O., E-mail: ondrejrenc@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Strýček, M., E-mail: m.strycek@gmail.com [Faculty of Medicine at Charles University (Czech Republic); Dvořák, P., E-mail: petr.dvorak@fnhk.cz; Hoffmann, P., E-mail: hoffmpet@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Guňka, I., E-mail: gunka@email.cz; Ferko, A., E-mail: a.ferko@seznam.cz [Faculty of Medicine at Charles University and University Hospital, Department of Surgery (Czech Republic); Ryška, P., E-mail: ryska@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Omran, N., E-mail: nidal81@gmail.com [Faculty of Medicine at Charles University and University Hospital, Department of Cardiac Surgery (Czech Republic); Krajina, A., E-mail: krajina@fnhk.cz; Čabelková, P., E-mail: pavla.cabelkova@fnhk.cz [Faculty of Medicine at Charles University and University Hospital, Department of Radiology (Czech Republic); Čermáková, E., E-mail: cermakovae@lfhk.cuni.cz [Faculty of Medicine at Charles University, Computer Technology Center (Czech Republic); Malý, R., E-mail: malyr@volny.cz [Faculty of Medicine at Charles University and University Hospital, Department of Medicine (Czech Republic)

    2016-02-15

    PurposeRetrospective evaluation of 12-year experience with endovascular management of acute mesenteric ischemia (AMI) due to embolic occlusion of the superior mesenteric artery (SMA).Materials and methodsFrom 2003 to 2014, we analysed the in-hospital mortality of 37 patients with acute mesenteric embolism who underwent primary endovascular therapy with subsequent on-demand laparotomy. Transcatheter embolus aspiration was used in all 37 patients (19 women, 18 men, median age 76 years) with embolic occlusion of the SMA. Adjunctive local thrombolysis (n = 2) and stenting (n = 2) were also utilised.ResultsWe achieved complete recanalization of the SMA stem in 91.9 %. One patient was successfully treated by surgical embolectomy due to a failed endovascular approach. Subsequent exploratory laparotomy was performed in 73.0 % (n = 27), and necrotic bowel resection in 40.5 %. The total in-hospital mortality was 27.0 %.ConclusionPrimary endovascular therapy for acute embolic SMA occlusion with on-demand laparotomy is a recommended algorithm used in our centre to treat SMA occlusion. This combined approach for the treatment of AMI is associated with in-hospital mortality rate of 27.0 %.

  13. [A case of thoracic endovascular aortic repair using a transapical approach through the left ventricular apex for an ascending aortic pseudoaneurysm].

    Science.gov (United States)

    Murakami, Kotaro; Kotani, Taichi; Ito, Chiaki; Haga, Ayako; Kunitoku, Yuji; Sakata, Yoichiro; Haratake, Yoshikazu

    2013-02-01

    We report a case of a patient with two previous histories of resection of thymoma using median sternotomy and repair for an ascending aortic pseudoaneurysm using median thoracotomy undergoing endovascular aortic repair of the recurrence of pseudoaneurysm in the same site. Due to severe adhesion and calcification in the tissue after two histories of thoracotomy, we expected it impossible to repair the pseudoaneurysm with open thracotomy. We concluded that endovascular aortic repair was the best way for the case. Only problem was the limitation of the characters of current devices for thoracic endovascular aortic repair. If the procedure is done in the ordinary way, the tips of stent graft delivery systems are so long that there may be a danger of damaging the aortic valve, coronary artery, and left ventricle. This is why we decided to use a transapical approach through the left ventricular apex by using left thoracotomy. For the operation, an arterial line and central venous line were secured and one-lung ventilation was performed. We used femoral-femoral bypass to prepare for unexpected bleeding. During the deployment of the stent graft, ventricular fibrillation was produced by the fibrillator to locate in the appreciate site. In the end, the operation was successful.

  14. Combined surgical and endovascular management of a giant fusiform PCA aneurysm in a pediatric patient. A case report.

    Science.gov (United States)

    Shin, S H; Choi, I S; Thomas, K; David, C A

    2013-06-01

    Treatment of intracranial giant aneurysms presents is challenging. In the case of pediatric giant aneurysm, more challenges arise. We describe our experience with a 17-year-old pediatric patient who presented with severe headache. She was diagnosed as having a giant fusiform aneurysm at the right P1-P2-Pcom junction. The aneurysm was treated with superficial temporal artery-posterior cerebral artery bypass and subsequent coil embolization of the aneurysm with parent artery occlusion. The patient had an excellent outcome at one-year follow-up. Our case suggests a combined approach of surgical and endovascular management may yield a better outcome than surgery or endovascular management alone in the treatment of pediatric giant aneurysm.

  15. Endovascular therapy is effective and safe for patients with severe ischemic stroke : Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data

    NARCIS (Netherlands)

    Broderick, Joseph P.; Berkhemer, Olvert A.; Palesch, Yuko Y.; Dippel, Diederik W J; Foster, Lydia D.; Roos, Yvo B. W. E. M.; van der Lugt, Aad; Tomsick, Thomas A.; Majoie, Charles B L M; van Zwam, Wim H; Demchuk, Andrew M.; Oostenbrugge, Robert J.; Khatri, Pooja; Lingsma, Hester F.; Hill, Michael D.; Roozenbeek, Bob; Jauch, Edward C.; Jovin, Tudor G.; Yan, Bernard; Von Kummer, Rüdiger; Molina, Carlos A.; Goyal, Mayank; Schonewille, Wouter J.; Mazighi, Mikael; Engelter, Stefan T.; Anderson, Craig S.; Spilker, Judith; Carrozzella, Janice; Ryckborst, Karla J.; Janis, L. Scott; Simpson, Kit N.

    2015-01-01

    Background and Purpose - We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. Methods - The pooled analysis of the Interventional Management of

  16. The current role of endovascular intervention in the management of diabetic peripheral arterial disease

    Directory of Open Access Journals (Sweden)

    Benjamin J. Pearce

    2012-10-01

    Full Text Available Poor arterial inflow continues to be a major contributing factor in the failure to heal diabetic foot wounds. Options for revascularization have significantly increased with the development of sophisticated endovascular techniques. However, the application of this technology is variable due to relatively little prospective, randomized data on newer techniques. Further, multiple specialties are capable of performing endovascular interventions and proper referral can be difficult. This article will review the basics of application of endovascular intervention in the diabetic patient with arterial disease and provide a broad understanding of the literature behind the decision-making on appropriate therapy.

  17. Radiological findings and endovascular management of three cases with segmental arterial mediolysis.

    Science.gov (United States)

    Davran, Ramazan; Cinar, Celal; Parildar, Mustafa; Oran, Ismail

    2010-06-01

    Segmental arterial mediolysis (SAM) is an uncommon self-limited disorder that can cause abdominal catastrophes through massive bleeding or bowel infarction. The former arise from arterial aneurysms, and the latter from arterial stenosis or occlusions. Although this is an acute self-limiting disease, the catastrophic consequence, originating from intra-abdominal hemorrhage (arterial dilatation, aneurysms, dissecting hematomas) or bowel infarction (arterial stenosis, arterial occlusions), is not rare. The identification of these lesions is very important in the differential diagnosis of suspected patients with complaints of abdominal pain with hemorrhage. We report computerized tomography angiography and digital subtraction angiography findings of three cases with abdominal SAM, who were treated with endovascular management due to abdominal bleeding. Angiography showed arterial dilatations, aneurysms, and occlusions of visceral arteries in all three cases, The string-of-beads appearance was present in only one case. Bleeding stopped immediately after embolization of three cases and follow-up revealed no evidence of recurrences at 23, 18, and 15 months, respectively, Arterial coil embolization is an effective treatment modality for bleeding complications of SAM. Close follow-up is recommended, primarily to ascertain the fate of the nontreated arterial lesions.

  18. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2013-01-01

    performed with explantation of stent-graft and open aortic in situ recontruction, followed by esophagectomy and the creation of cervical and gastrical stoma. Conclusion. Having in mind initial results of the 3 main vascular clinics in Belgrade, Serbia, economical situation in our country, as well as the published international results, endovascular treatment of thoracic aortic diseases is indicated in hemodinamicaly unstable patients with acute traumatic aneurysm, or in stabile patients older than 65, as well as in case of chronic diseases of the thoracic aorta in patients with significant comorbid conditions or in patients older than 65 years. Endovascular procedures on the thoracic aorta could be performed, hower, only in high-volume centers with experience in routine open surgery of thoracic aorta.

  19. Total Endovascular Treatment of Acute Non-A-non-B Dissection Complicated by Visceral Malperfusion without Primary Entry Tear Coverage.

    Science.gov (United States)

    Soler, Raphael J; Bartoli, Michel A; Simonet, Gaetan; Amabile, Philippe; Sarlon-Bartoli, Gabrielle; Magnan, Pierre-Edouard

    2017-11-01

    Management of visceral ischemia due to non-A, non-B dissection is extremely challenging due to the position of the primary entry tear at the level of the brachiocephalic vessels. We report on a patient who was admitted for a complicated non-A, non-B-type dissection with visceral and leg ischemia. A covered stent graft was implanted below the primary entry tear to redirect the flow in the true lumen, associated with stents implantation in the visceral arteries, to treat the dissection's static component. The patient did well, without need for bowel resection visceral or late stent restenosis. Stent-graft implantation below the primary entry tear in cases of visceral ischemia due to non-A, non-B dissection seems feasible. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Gianturco Z-Stent Fixation of a Modified Iliac Limb Stent-Graft Endoprosthesis for the Treatment of Malignant Superior Vena Cava Syndrome.

    Science.gov (United States)

    Chick, Jeffrey Forris Beecham; Osher, Matthew L; Cooper, Kyle J; Saad, Wael E; Williams, David M; Khaja, Minhaj S

    2017-11-01

    Superior vena cava (SVC) syndrome, characterized by facial and arm swelling, is most frequently caused by intrathoracic malignancies. Decompression may be achieved with endovenous stent placement. Polytetrafluoroethylene-covered stents have shown to have higher long-term cumulative patency rates compared with uncovered stents for the treatment of malignant SVC syndrome. Unfortunately, polytetrafluoroethylene-covered stents are not readily available worldwide. Moreover, the existing armamentarium, including balloon-expandable iCAST stents (maximum diameter 10 mm) and heparin-coated Viabahn stent-graft endoprostheses (maximum diameter 13 mm), is too small to adequately treat malignant obstruction of the SVC. This report describes a patient with SVC syndrome and SVC tumor thrombus secondary to recurrent nonseminomatous germ cell carcinoma of the mediastinum treated with a Gianturco Z-stent-fixed modified EXCLUDER abdominal aortic aneurysm iliac limb endoprosthesis. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. [Case in which renal function improved following stent-graft placement in the aorta two months after the onset of stanford type B acute aortic dissection].

    Science.gov (United States)

    Fusamae, Juri; Nishino, Tomoya; Uramatsu, Tadashi; Obata, Yoko; Furusu, Akira; Sakamoto, Ichiro; Kohno, Shigeru

    2011-01-01

    A 48-year-old man was admitted to the Department of Cardiovascular Surgery in our hospital after developing Stanford type B acute aortic dissection with a patent false lumen in July 2008. Conservative treatment involving rest and antihypertensive therapy was provided following admission. Urine volume decreased from day 9, and serum creatinine increased to 7.7 mg/dL. As it was suspected that the reduced renal blood flow was caused by progression of aortic dissection, contrast-enhanced computed tomography (CT)was performed. The left kidney showed reduced enhancement and the right kidney was heterogeneously enhanced. The dissection had extended to the left renal artery, and the reduced renal blood flow caused by narrowing of the left renal artery was thought to have caused the renal dysfunction. As elevated urea nitrogen and serum creatinine levels and hyperkalemia persisted, hemodialysis was performed a total of four times. Although the patient was subsequently withdrawn from dialysis, he continued to display severe renal dysfunction and was transferred to our department on day 28 for the treatment of renal failure. Conservative treatment was continued, but the maximum diameter of the thoracic aorta gradually increased, and stent placement at the entry of aortic dissection was indicated. On day 86, two stent-grafts were placed for entries at the distal site of the descending aorta and the distal site of the aortic arch. Postoperative abdominal contrast-enhanced CT showed expansion of the true lumen, and blood flow and contrast enhancement improved in both kidneys. Postoperatively, serum creatinine gradually decreased, improving to 1.16 mg/dL on day 96. Renography in the third month after stent-graft placement showed improved renal function in both kidneys. These findings suggest that even at approximately 2 months after the onset of acute renal failure associated with aortic dissection, renal function can be improved by restoring blood flow in the renal arteries.

  2. Endovascular management of posttraumatic and iatrogenic large pelvic pseudoaneurysms following biopsy: case report

    Directory of Open Access Journals (Sweden)

    Win Phyu, BA

    2017-03-01

    Full Text Available Pelvic traumatic and iatrogenic pseudoaneurysms supplied by the internal iliac artery are very rare but can present with pain, nerve compression, and rupture. Particularly with more chronic pseudoaneurysms, their imaging appearance can be confusing and they can be mistaken for tumors. We present two cases of pelvic pseudoaneurysms supplied by the superior gluteal artery that were initially mistaken for masses and subsequently biopsied. We report the subsequent successful endovascular embolization technique subsequently utilized for both of these cases. A high index of suspicion should be maintained to avoid biopsy of these lesions. In the appropriately selected patient, an endovascular approach may be safely used to perform embolization.

  3. Endovascular management of internal carotid artery injuries secondary to endonasal surgery: case series and review of the literature.

    Science.gov (United States)

    Sylvester, Peter T; Moran, Christopher J; Derdeyn, Colin P; Cross, DeWitte T; Dacey, Ralph G; Zipfel, Gregory J; Kim, Albert H; Uppaluri, Ravi; Haughey, Bruce H; Tempelhoff, Rene; Rich, Keith M; Schneider, John; Chole, Richard A; Chicoine, Michael R

    2016-11-01

    OBJECTIVE Internal carotid artery (ICA) injury is a rare but severe complication of endonasal surgery. The authors describe their endovascular experience managing ICA injuries after transsphenoidal surgery; they review and summarize the current literature regarding endovascular techniques; and they propose a treatment algorithm based on the available evidence. METHODS A retrospective review of 576 transsphenoidal pituitary adenoma resections was performed. Cases of ICA injury occurring at our institution and transfers from other hospitals were evaluated. Endovascular treatments for ICA injury reported in the literature were also reviewed and summarized. RESULTS Seven cases were identified from the institutional cohort (mean age 46.3 years, mean follow-up 43.4 months [1-107 months]) that received endovascular treatment for ICA injury. Five injuries occurred at our institution (5 [0.9%] of 576), and 2 injuries occurred at outside hospitals. Three patients underwent ICA sacrifice by coil placement, 2 underwent lesion embolization (coil or stent-assisted coil placement), and 2 underwent endoluminal reconstruction (both with flow diversion devices). Review of the literature identified 98 cases of ICA injury treated with endovascular methods. Of the 105 total cases, 46 patients underwent ICA sacrifice, 28 underwent lesion embolization, and 31 underwent endoluminal reconstruction. Sacrifice of the ICA proved a durable solution in all cases; however, the rate of persistent neurological complications was relatively high (10 [21.7%] of 46). Lesion embolization was primarily performed by coil embolization without stenting (16 cases) and stent-assisted coiling (9 cases). Both techniques had a relatively high rate of at least some technical complication (6 [37.5%] of 16 and 5 [55.6%] of 9, respectively) and major technical complications (i.e., injury, new neurological deficit, or ICA sacrifice) (5 [31.3%] of 16 and 2 [22.2%] of 9, respectively). Endoluminal reconstruction was

  4. 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.

  5. An overview of thin film nitinol endovascular devices.

    Science.gov (United States)

    Shayan, Mahdis; Chun, Youngjae

    2015-07-01

    Thin film nitinol has unique mechanical properties (e.g., superelasticity), excellent biocompatibility, and ultra-smooth surface, as well as shape memory behavior. All these features along with its low-profile physical dimension (i.e., a few micrometers thick) make this material an ideal candidate in developing low-profile medical devices (e.g., endovascular devices). Thin film nitinol-based devices can be collapsed and inserted in remarkably smaller diameter catheters for a wide range of catheter-based procedures; therefore, it can be easily delivered through highly tortuous or narrow vascular system. A high-quality thin film nitinol can be fabricated by vacuum sputter deposition technique. Micromachining techniques were used to create micro patterns on the thin film nitinol to provide fenestrations for nutrition and oxygen transport and to increase the device's flexibility for the devices used as thin film nitinol covered stent. In addition, a new surface treatment method has been developed for improving the hemocompatibility of thin film nitinol when it is used as a graft material in endovascular devices. Both in vitro and in vivo test data demonstrated a superior hemocompatibility of the thin film nitinol when compared with commercially available endovascular graft materials such as ePTFE or Dacron polyester. Promising features like these have motivated the development of thin film nitinol as a novel biomaterial for creating endovascular devices such as stent grafts, neurovascular flow diverters, and heart valves. This review focuses on thin film nitinol fabrication processes, mechanical and biological properties of the material, as well as current and potential thin film nitinol medical applications. Copyright © 2015 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  6. Endovascular therapy for infected aortic aneurysms.

    Science.gov (United States)

    Kritpracha, Boonprasit; Premprabha, Dhanakom; Sungsiri, Jitpreedee; Tantarattanapong, Wittawat; Rookkapan, Sorracha; Juntarapatin, Pong

    2011-11-01

    To determine the outcome of endovascular therapy for an infected aortic aneurysm in patients with or without aorto-aerodigestive/aortocaval fistulas. From September 2005 to May 2010, 21 patients, 17 abdominal and four thoracic infected aortic aneurysms were treated with an endovascular stent graft at Songklanagarind Hospital, Thailand. Five patients presented with fistula complications, 1 aortoesophageal, 1 aortobronchial, 1 aortocaval, and 2 aortoenteric fistulas. Lifelong antibiotics were planned for all patients. In-hospital mortality and follow-up outcomes were examined. The average age was 66 years (range, 42-84) and 18 patients were male. All five cases in the fistulous group presented with symptoms related to the organs involved, four massive bleedings and one congestive heart failure. Symptoms of patients in the nonfistulous group were abdominal, back, or chest pain in 94%, fever in 81%, and diarrhea in 19%. Blood culture was positive in 10 patients (48%): eight Salmonella spp and two Burkholderia pseudomallei. The overall in-hospital mortality was 19% (4/21): 60% (3/5) in the fistula group and only 6% (1/16) in the nonfistula group. One conversion to open repair was performed in the fistula group 2 weeks after the endovascular procedure. During the follow-up period, one of the two survivors in the fistula group died at 18 months from unrelated causes, while there were no deaths in the 15 patients of the nonfistula group with an average patient follow-up of 22 months (range, 1-54). Periaortic inflammation and aneurysms in the nonfistula group completely disappeared in 10 of the 15 patients (67%). The aneurysm significantly shrunk in four patients (27%), and was stable at 1 month in one patient. There were no late conversions. Endovascular therapy, as a definite treatment for infected aortic aneurysms, provided excellent short- and medium-term results in patients without fistula complications. However, a poorer outcome was evident in patients with fistula

  7. [Endovascular approach in the management of intracranial aneurysms. Part 2: indications and therapeutic strategy].

    Science.gov (United States)

    Zenteno, Marco; Santos Franco, Jorge Arturo; Lee, Angel; Viñuela, Fernando; Modenesi Freitas, José María; Vega Montesinos, Susana

    2012-01-01

    The success and stability of the occlusion of intracranial aneurysms can be achieved after an adequate conceptualization and implementation of current endovascular techniques, which in turn should be based on knowledge of available devices and the analysis of the specific characteristics the aneurysm and its parent artery to what we called aneurysmal complex.

  8. Management and outcomes of isolated renal artery aneurysms in the endovascular era

    NARCIS (Netherlands)

    Buck, Dominique B; Curran, Thomas; McCallum, John C; Darling, Jeremy; Mamtani, Rishi; van Herwaarden, JA|info:eu-repo/dai/nl/304814733; Moll, Frans L|info:eu-repo/dai/nl/070246882; Schermerhorn, Marc L

    2016-01-01

    OBJECTIVE: Isolated renal artery aneurysms are rare, and controversy remains about indications for surgical repair. Little is known about the impact of endovascular therapy on selection of patients and outcomes of renal artery aneurysms. METHODS: We identified all patients undergoing open or

  9. From puncture to closure of the common femoral artery in endovascular aortic repair

    DEFF Research Database (Denmark)

    Lönn, Lars; Larzon, Thomas; Van Den Berg, Jos C

    2010-01-01

    or epidural anesthesia. The evolving stent-technology with smaller sheath sizes has broadened the scenario for alternative approaches for access and closure of the common femoral arteries. The following review presents an introduction on technical aspects of puncture of the femoral artery and closure...... of today. The traditional approach in EVAR involves surgical exposure of the femoral arteries with bilateral groin incisions. Through the groin access, and under fluoroscopy, a special insertion sheath introducer is used to position a stent graft in the desired location with the patient in general...... of the arterial wall using percutaneous closure devices. We also aim to discuss three important approaches to expose and close the femoral arteries during endovascular aortic repair: The cut down approach, the true percutaneous technique, and the femoral fascial closure. Finally, factors important in the choice...

  10. 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.

  11. Endovascular repair of traumatic external iliac vessel pseudoaneurysm and arteriovenous fistulae

    Directory of Open Access Journals (Sweden)

    Juan Marin

    2013-09-01

    Full Text Available A 17-year-old male patient presenting with an abdominal gunshot wound and severe hypovolemic shock was initially operated and presented several injuries to the small bowel and cecum associated with severe hemorrhage. The patient had to be operated twice due to hypothermia, acidosis, and coagulopathy. In the late postoperative period, murmur and fremitus were observed. Angiography revealed a pseudoaneurysm associated with arteriovenous fistulae at the left external iliac vessels. Lesions were repaired with a stent graft placed in the external iliac artery, with a satisfactory outcome. Control computed tomography performed 6 months later evidenced artery integrity with closure of the fistulae. Endovascular therapy should be the preferred method in this type of vascular trauma complications.

  12. Endovascular Management of Refractory Hepatic Encephalopathy Complication of Transjugular Intrahepatic Portosystemic Shunt (TIPS): Comprehensive Review and Clinical Practice Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Keith, E-mail: keithjppereira@gmail.com [Jackson Memorial Hospital/University of Miami Hospital, Department of Interventional Radiology (United States); Carrion, Andres F., E-mail: andres.carrionmonsa@jhsmiami.org [Jackson Memorial Hospital/University of Miami Hospital, Department of Hepatology (United States); Salsamendi, Jason, E-mail: JSalsamendi@med.miami.edu; Doshi, Mehul, E-mail: MDoshi@med.miami.edu; Baker, Reginald, E-mail: RBaker@med.miami.edu; Kably, Issam, E-mail: ikably@med.miami.edu [Jackson Memorial Hospital/University of Miami Hospital, Department of Interventional Radiology (United States)

    2016-02-15

    Transjugular intrahepatic portosystemic shunt (TIPS) has evolved as an effective intervention for treatment of complications of portal hypertension. The use of polytetrafluoroethylene-covered stents have improved the patency of the shunts and diminished the incidence of TIPS dysfunction. However, TIPS-related refractory hepatic encephalopathy (rHE) poses a significant challenge. Approximately 3–7 % of patients with TIPS develop rHE. Refractory hepatic encephalopathy is defined as a recurrent or persistent encephalopathy despite appropriate medical treatment. Hepatic encephalopathy can be an extremely debilitating complication that profoundly affects quality of life. The approach to management of patients with rHE is complex and typically requires collaboration between different specialties. Liver transplantation is the ultimate treatment for rHE; however, the ongoing shortage of organ donation markedly limits this treatment option. Alternative therapies such as shunt occlusion or reduction can control symptoms and serve as a ‘bridge’ therapy to liver transplantation. Therefore, interventional radiologists play a key role in the management of these patients by offering a variety of endovascular techniques. The purpose of this review is to highlight some of these endovascular techniques and to develop a therapeutic algorithm that can be applied in clinical practice for the management of rHE.

  13. 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.

  14. "Snare-Ride": A Bailout Technique to Catheterize Target Vessels With Unfriendly Anatomy in Branched Endovascular Aortic Repair.

    Science.gov (United States)

    Ferreira, Marcelo; Katsargyris, Athanasios; Rodrigues, Eduardo; Ferreira, Diego; Cunha, Rodrigo; Bicalho, Guilherme; Oderich, Gustavo; Verhoeven, Eric L G

    2017-08-01

    To describe a novel endovascular bailout technique for successful completion of target vessel stenting during branched stent-graft repair of thoracoabdominal aortic aneurysms (TAAA) after encountering difficulties with standard catheterization techniques. Technical difficulties when using fenestrated and branched grafts should be expected, especially in difficult anatomy or when an off-the-shelf device (eg, standard 4-branch device) is used that does not perfectly "match" the anatomy. The "snare-ride technique" facilitates antegrade transaxillary side branch catheterization and stent placement during TAAA branched grafting using a snare via a transfemoral approach. The branch of the graft is catheterized from an axillary access. The respective target vessel is then catheterized via a femoral access. An Indy snare is advanced over the transfemoral wire and positioned near the entrance of the target vessel. The transaxillary wire inside the branch of the graft is then advanced, snared, and pushed inside the target vessel with the snare. The procedure is thereafter continued with antegrade bridging of the target vessel in routine fashion. The snare-ride technique can be a useful maneuver to catheterize target vessels with difficult anatomy in TAAA branched stent-graft repair. Early experience shows safety and feasibility.

  15. 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.

  16. Novel Endovascular Management of Proximal Type A (DeBakey II) Aortic Dissection With a Patent Foramen Ovale Occluder.

    Science.gov (United States)

    Yuan, Xun; Mitsis, Andreas; Mozalbat, David; Nienaber, Christoph A

    2017-12-01

    To present a novel endovascular management option that avoids open surgery in selected patients with subacute type A aortic dissection (DeBakey II). A 75-year-old woman with previous infrarenal abdominal aortic aneurysm repaired in 2006 and multiple comorbidities (EURO score II 20.5%) was admitted with chest pain; computed tomography angiography (CTA) showed a new dissection in the ascending aorta just above the right coronary ostium. As the patient was considered unfit to undergo surgery, an endovascular solution was suggested after multidisciplinary team discussion. With a single entry identified, coils were deployed in the false lumen followed by a patent foramen ovale (PFO) occluder placed across the entry tear to seal the cavity. Intraprocedural digital subtraction angiography and transesophageal echocardiography, as well as CTA 3 days postprocedure, confirmed an entirely thrombosed false lumen. The 6-month follow-up CTA demonstrated the PFO occluder firmly in place, shrinkage of the false lumen, and remodeling of the ascending aorta. Interventional management of the false lumen in proximal (type A) dissection is feasible and sustainable. The use of coils and closure devices may present a new, efficient, minimalistic strategy to avoid open surgery in selected cases.

  17. Endovascular Management of True Renal Arterial Aneurysms: Results from a Single Centre

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Raymond, E-mail: chung.raymond.jh@alexandrahealth.com.sg [Khoo Teck Puat Hospital, Department of Radiology (Singapore); Touska, Philip, E-mail: p.touska@doctors.org.uk [St. George’s Hospital NHS Trust, Department of Radiology (United Kingdom); Morgan, Robert; Belli, Anna-Maria [St. George’s Hospital NHS Trust, Department of Interventional Radiology (United Kingdom)

    2016-01-15

    PurposeTo report a single centre’s experience of the endovascular treatment of renal arterial aneurysms, including techniques and outcomes.Materials and MethodsThis is a retrospective analysis of true renal arterial aneurysms (TRAAs) treated using endovascular techniques over a period of 12 years and 10 months. The clinical presentations, aneurysm characteristics, endovascular techniques and outcomes are reported.ResultsThere were nine TRAA cases with a mean aneurysm size of 21.0 mm, located at the main renal arterial bifurcation in all cases. Onyx{sup ®} was used as the embolic agent of choice (88.9 % cases), with concurrent balloon remodelling. The overall primary technical success rate was 100 %. Repeat intervention was carried out in 1 case, secondary to reperfusion >8 years post-initial treatment. Long-term clinical follow-up was available in 55.6 % of cases (mean 29.8 months; range 3.3–90.1 months). Early post-procedural renal function, as measured by serum creatinine, remained within the normal reference range. Renal parenchymal loss post-embolisation was ≤20 % in 77.8 % of cases, as estimated on imaging. Minor complications included non-target embolization of Onyx{sup ®} with no clinical sequelae (n = 1), transient pain requiring only oral analgesia with no prolongation of hospital stay (n = 2). No major complications occurred as a consequence of embolisation.ConclusionEndovascular therapy is an effective and safe primary therapy for TRAA with high success rate and low morbidity, supplanting surgery as primary therapy. Current experience in the use of Onyx{sup ®} in TRAA is primarily limited to individual case reports, and this represents the largest case series of Onyx{sup ®}-treated TRAAs to date.

  18. Operative and endovascular management of extracranial vertebral artery aneurysm in Ehlers-Danlos syndrome:a clinical dilemma--case report and literature review.

    LENUS (Irish Health Repository)

    Sultan, Sherif

    2002-01-01

    The most prevalent lesion of the vertebral artery is an atheromatous plaque located at its origin from the subclavian artery. A case of successful management of a symptomatic vertebral artery aneurysm due to Ehlers-Danlos syndrome is reported. The patient had asymptomatic posterior intracerebral artery dissection on the contralateral side. A common carotid artery to V-3 segment bypass using reversed saphenous vein graft was carried out. Avulsion of the V-2 segment occurred peroperatively and endovascular coil embolization of the vertebral artery aneurysm was performed. Endovascular equipment and training must be in the armamentarium of vascular surgeons as more complex cases are being treated, which demands new approaches for ultimate clinical success. This unique case outlines what might unexpectedly occur. Endovascular intervention as an adjuvant procedure provides a satisfactory outcome in what could have been a catastrophe.

  19. 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.

  20. Endovascular management of lap belt-related abdominal aortic injury in a 9-year-old child.

    Science.gov (United States)

    Papazoglou, Konstantinos O; Karkos, Christos D; Kalogirou, Thomas E; Giagtzidis, Ioakeim T

    2015-02-01

    Blunt abdominal aortic trauma is a rare occurrence in children with only a few patients having been reported in the literature. Most such cases have been described in the context of lap belt injuries. We report a 9-year-old boy who suffered lap belt trauma to the abdomen during a high-speed road traffic accident resulting to the well-recognized pattern of blunt abdominal injury, that is, the triad of intestinal perforation, fractures of the lumbar spine, and abdominal aortic injury. The latter presented with lower limb ischemia due to dissection of the infrarenal aorta and right common iliac artery. Revascularization was achieved by endovascular means using 2 self-expanding stents in the infrarenal aorta and the right common iliac artery. This case is one of the few reports of lap belt-related acute traumatic abdominal aortic dissection in a young child and highlights the feasibility of endovascular management in the pediatric population. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Management of major vascular injury during pedicle screw instrumentation of thoracolumbar spine.

    Science.gov (United States)

    Mirza, Aleem K; Alvi, Mohammed Ali; Naylor, Ryan M; Kerezoudis, Panagiotis; Krauss, William E; Clarke, Michelle J; Shepherd, Daniel L; Nassr, Ahmad; DeMartino, Randall R; Bydon, Mohamad

    2017-12-01

    Vascular injury is a rare complication of spinal instrumentation. Presentation can vary from immediate hemorrhage to pseudoaneurysm formation. In the literature, surgical approach to repair has varied based on anatomy, acuity of diagnosis, infection, and available technology. In this manuscript, we aim to describe our institutional experience with vascular injuries in thoraco-lumbar spine surgery. We report our institutional experience of three cases of vascular injury secondary to pedicle screw misplacement and their management, as well as a review of the literature. The first case had a history of previous instrumentation and presented with back pain and fever. The patient was taken for instrumentation exploration via a posterior approach. Aortic violation was discovered at T6 intraoperatively during instrumentation removal and the patient underwent emergent endovascular repair. The second case presented with chronic back pain after multiple prior posterior fusions and CT angiogram showing screw perforation on the aorta at T10. The patient underwent elective endovascular repair with synchronous removal of the instrumentation. The third case presented with radicular leg pain 6 months after L4-S1 posterior lumbar interbody fusion, with CT scan demonstrating the left S1 screw abutting the L5 nerve root and common iliac vein. The patient underwent elective instrumentation revision with intraoperative venography. Major vascular injury is a known complication of spinal surgery, especially if it involves instrumentation with pedicle screws. Treatment approach has evolved with the advancement of endovascular technology; however, open surgery remains an option when anatomy or infection is prohibitive. In the elective setting, preoperative planning with attention to surgical approach, positioning, and contingencies, should occur in a multidisciplinary fashion. Repair with an aortic stent-graft cuff may minimize unnecessary coverage of the descending thoracic aorta and

  2. 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.

  3. Endovascular management of a case of spontaneous retroperitoneal haematoma complicated with deep vein thrombosis and pulmonary embolism.

    Science.gov (United States)

    Singh, Balbir; Bharadwaj, Prashant; Bajaj, Nitin; Chadha, Davinder

    2017-12-01

    Spontaneous retroperitoneal haematoma (SRH) can be a life-threatening emergency presenting with hypovolaemic shock. SRH has been rarely reported with May-Thurner syndrome (MTS) where it occurs due to rupture of the iliac vein or venous collaterals. We report a case of MTS that presented with deep venous thrombosis of the left lower limb complicated by bilateral pulmonary embolism (PE) and a large pelvic haematoma. The simultaneous occurrence of a large pelvic haematoma and PE offered a therapeutic challenge. Successful endovascular management of the case is discussed in this report. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Personalized design and virtual evaluation of physician-modified stent grafts for juxta-renal abdominal aortic aneurysms

    Science.gov (United States)

    Sanathkhani, Soroosh; Shroff, Sanjeev G.; Menon, Prahlad G.

    2017-02-01

    Endovascular aneurysm repair (EVAR) of juxtarenal aortic aneurysms (JAA) is particularly challenging owing to the requirement of suprarenal EVAR graft fixation, which has been associated with significant declines in long term renal function. Therefore, the ability to design fenestrated EVAR grafts on a personalized basis in order to ensure visceral and renal perfusion, is highly desirable. The objectives of this study are: a) To demonstrate novel 3D geometric methods to virtually design and deploy EVAR grafts into a virtually designed JAA, by applying a custom surface mesh deformation tool to a patient-specific descending aortic model reconstructed from computed tomographic (CT) images; and b) To virtually evaluate patient-specific renal flow and wall stresses in these patient-specific virtually EVAR geometries, using computational fluid dynamics (CFD). The presented framework may provide the modern cardiovascular surgeon the ability to leverage non-invasive, pre-operative imaging equipment to personalize and guide EVAR therapeutic strategy. Our CFD studies revealed that virtual EVAR grafting of a patient-specific JAA, with optimal fenestration sites and renal stenting, led to a 179.67±15.95% and 1051.43±18.34% improvement in right and left renal flow rates, respectively, when compared with the baseline patient-specific aortic geometry with renal stenoses, whereas a right and left renal flow improved by 36.44±2.24% and 885.93±12.41%, respectively, relative to the equivalently modeled JAA with renal stenoses, considering averages across the three simulated inflow rate cases. The proposed framework have utility to iteratively optimize suprarenal EVAR fixation length and achieve normal renal wall shear stresses and streamlined juxtarenal hemodynamics.

  5. Current management of inguinal false aneurysms

    DEFF Research Database (Denmark)

    Houlind, Kim Christian; Jepsen, Jørn M; Saicu, Christian

    2017-01-01

    from puncture sites after percutaeous intervention. Anticoagulative medication, low patelet counts and severely calcified vessels increase the risk of forming a false aneurysm. Experienced specialists may make the diagnosis from physical examination, but ultrasound imaging is almost always needed...... vessels. endovascular treatment with coils or covered stent grafts have proven useful in infected ilio-femoral false aneurysms. Open surgical repair may be the best treatment in the setting of imminent rupture, massive haematoma and skin necrosis. We present three patient cases treated with open surgery...

  6. Power of an Adaptive Trial Design for Endovascular Stroke Studies: Simulations Using IMS (Interventional Management of Stroke) III Data.

    Science.gov (United States)

    Lansberg, Maarten G; Bhat, Ninad S; Yeatts, Sharon D; Palesch, Yuko Y; Broderick, Joseph P; Albers, Gregory W; Lai, Tze L; Lavori, Philip W

    2016-12-01

    Adaptive trial designs that allow enrichment of the study population through subgroup selection can increase the chance of a positive trial when there is a differential treatment effect among patient subgroups. The goal of this study is to illustrate the potential benefit of adaptive subgroup selection in endovascular stroke studies. We simulated the performance of a trial design with adaptive subgroup selection and compared it with that of a traditional design. Outcome data were based on 90-day modified Rankin Scale scores, observed in IMS III (Interventional Management of Stroke III), among patients with a vessel occlusion on baseline computed tomographic angiography (n=382). Patients were categorized based on 2 methods: (1) according to location of the arterial occlusive lesion and onset-to-randomization time and (2) according to onset-to-randomization time alone. The power to demonstrate a treatment benefit was based on 10 000 trial simulations for each design. The treatment effect was relatively homogeneous across categories when patients were categorized based on arterial occlusive lesion and time. Consequently, the adaptive design had similar power (47%) compared with the fixed trial design (45%). There was a differential treatment effect when patients were categorized based on time alone, resulting in greater power with the adaptive design (82%) than with the fixed design (57%). These simulations, based on real-world patient data, indicate that adaptive subgroup selection has merit in endovascular stroke trials as it substantially increases power when the treatment effect differs among subgroups in a predicted pattern. © 2016 American Heart Association, Inc.

  7. Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient.

    Science.gov (United States)

    Gist, Taylor L; Rangel-Castilla, Leonardo; Krishna, Chandan; Roman, Gustavo C; Cech, David A; Diaz, Orlando

    2014-03-01

    A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. A diffuse pseudophlebitic pattern of venous drainage indicating severe venous hypertension was also observed. The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension.

  8. Concepts to optimize stent-grafting of abdominal aortic aneurysms based on results of experimental studies; Konzepte zur Optimierung der Stentgraftversorgung von Bauchaortenaneurysmen auf der Basis tierexperimenteller Ergebnisse

    Energy Technology Data Exchange (ETDEWEB)

    Chavan, A.; Kirchhoff, T.; Baus, S.; Galanski, M. [Medizinische Hochschule Hannover (Germany). Abt. Diagnostische Radiologie 1; Pichlmaier, M. [Medizinische Hochschule Hannover (Germany). Leibniz Forschungslab. fuer Biotechnologie und Kuenstliche Organe an der Klinik fuer Thorax-, Herz- und Gefaesschirurgie

    2001-08-01

    Purpose. In the endoluminal therapy of abdominal aortic aneurysms, a short proximal aneurysm neck, endoleaks and the large size and stiffness of the introducer systems are responsible for many of the complications and sub-optimal outcomes. The purpose of the present review article is to to suggest strategies to minimize these complications based on the results of experimental studies in animals. Material and methods. After implanting various types of stents across the renal artery origins, the functional and morphological changes in the kidneys and renal vessels were studied by various authors. In order to prevent progressive widening of the proximal aneurysmal neck and graft dislocation, Sonesson et al. performed a laparoscopic banding around the proximal neck in pigs. To study the effects of endoleaks, Marty, Schurink and Pitton carried out pressure measurements in experimental aneurysms with and without endoleaks. Sakaguchi and Pavcnik developed the 'Twin-tube endografts' (TTEG) and the 'Bifurcated drum occluder endografts' (BDOEG) and tested them in dogs. Results. Up to 3 months after suprarenal stent placement, Chavan et al. detected no significant fall in the mean inulin clearance in sheep (140{+-}46 ml/min before, 137{+-}58 ml/min after). Nasim et al. and Malina et al. reported similar observations with respect to renal function. Suprarenal fixation may result in isolated thrombotic occlusions of the renal arteries and microinfarcts in the kidneys. Mean aortic diameters at the level of banding were significantly smaller in the animals with aortic banding as opposed to those in the control group without banding (8 mm vs 11 mm, p=0.004). The banding caused a secure proximal fixation of the stent-graft. Persistent endoleaks resulted in significantly higher intraaneurysmal pressures. Although the TTEG and the BDOEG stent-grafts required smaller sheaths, occlusions were observed in 8% (TTEG) and 60% (BDOEG) of the graft limbs. (orig.) [German

  9. Superiority of stent-grafts for in-stent restenosis in the superficial femoral artery: twelve-month results from a multicenter randomized trial.

    Science.gov (United States)

    Bosiers, Marc; Deloose, Koen; Callaert, Joren; Verbist, Jürgen; Hendriks, Jeroen; Lauwers, Patrick; Schroë, Herman; Lansink, Wouter; Scheinert, Dierk; Schmidt, Andrej; Zeller, Thomas; Beschorner, Ulrich; Noory, Elias; Torsello, Giovanni; Austermann, Martin; Peeters, Patrick

    2015-02-01

    To evaluate the short- and midterm outcomes of the Viabahn endoprosthesis with Propaten Bioactive Surface vs. standard balloon angioplasty for treatment of in-stent restenosis in the superficial femoral artery. Between June 2010 and February 2012, 83 patients with superficial femoral artery in-stent and Rutherford category 2 to 5 ischemia were enrolled at 7 sites participating in this prospective randomized controlled study (RELINE; ClinicalTrials.gov; identifier NCT01108861). The patients were randomized to treatment with either the heparin-bonded Viabahn endoprosthesis (n = 39: 29 men; mean age 67.7 ± 9.8 years) or a standard angioplasty balloon (n = 44: 32 men; mean age 69.0 ± 9.7 years). The primary effectiveness outcome was primary patency at 12 months, defined as no restenosis/occlusion within the target lesion based on duplex ultrasound and no target lesion revascularization. The primary safety endpoint was the incidence of serious device-related adverse events within 30 days of the procedure. All patients randomized to receive dilation or the Viabahn stent-graft were treated according to their assignment. The technical success was 100% for the Viabahn group and 81.8% for the angioplasty group (p = 0.002) owing to 9 patients requiring a bailout procedure after unsuccessful angioplasty. The 12-month primary patency rates were 74.8% for the Viabahn group and 28.0% for the angioplasty group (p < 0.001). Excluding the 9 angioplasty patients who received bailout stenting, the primary patency for optimal balloon angioplasty was 37.0% (p < 0.001). Three patients experienced device-related adverse events within 30 days: occlusion of the target lesion (Viabahn group), peripheral embolization (angioplasty group), and reocclusion of the target lesion (angioplasty group). In this study, the treatment of femoropopliteal in-stent restenosis with a Viabahn endoprosthesis showed significantly better results than treatment with a standard balloon at 1 year. © The Author

  10. Effects of Pulsatile Fatigue on In Situ Antegrade Fenestrated Polyester Stent Grafts Deployed in a Patient-Specific Phantom Model of Juxtarenal Aortic Aneurysm.

    Science.gov (United States)

    Ruthrauff, Alicia A; King, Martin W; Soulez, Gilles; Tan, Kong T; Crawford, Sean A; Roche-Nagle, Graham; Cloutier, Guy; Tse, Leonard W

    2015-10-01

    To evaluate the effects of in situ fenestration on the fabric of stent grafts deployed in a patient-specific phantom of a juxtarenal abdominal aortic aneurysm. Four patient-specific juxtarenal abdominal aortic aneurysm polyurethane models were created, and bifurcated Zenith (Cook, Inc, Bloomington, Indiana) and Endurant (Medtronic, Minneapolis, Minneapolis) endografts were deployed into the models, covering the renal arteries. Antegrade in situ fenestration was carried out with radiofrequency puncture followed by balloon dilation with either conventional or cutting balloons. Renal covered stents were deployed and flared. Specimens were mounted onto an accelerated fatigue tester for 40M cycles (1 patient life-year), and evaluated with microscopy, caliper measurements, and fabric counts. Cutting balloons resulted in more fabric fraying. None of the fenestrations grew beyond the targeted 6-mm diameter despite accelerated fatigue. Fluoroscopic images demonstrated a very prominent waist of the renal fenestration in the Cook device when a conventional balloon was used compared with a cutting balloon. The average fenestration diameter for the Cook device was only 3.1 mm with the conventional balloon compared with 4.8 mm with the cutting balloon. The average fenestration diameter for the Medtronic device was 3.8 mm with the conventional balloon compared with 5.1 mm with the cutting balloon. The fabric counts suggested crowding of yarns around the fenestrations with conventional balloons but less with cutting balloons. This experimental work suggests that the size of in situ renal fenestrations does not expand beyond the target diameter despite cyclic fatigue. Although the small number of devices tested and selected aortorenal anatomy in this study may limit conclusions, textile analysis suggests that cutting balloons should be used for the Cook Zenith device, whereas conventional balloons should be used for the Medtronic Endurant device when performing in situ fenestration

  11. Endovascular management of dural arteriovenous fistulas of the transverse and sigmoid sinus in 150 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, M. [Ernst-Moritz-Arndt-Universitaet Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Liebig, T. [TU Muenchen, Institut fuer Neuroradiologie, Klinikum Rechts der Isar, Munich (Germany); Kuehne, D. [Klinik fuer Radiologie und Neuroradiologie, Alfried-Krupp-Krankenhaus, Essen (Germany); Henkes, H. [Katharinenhospital-Klinikum Stuttgart, Klinik fuer Neuroradiologie, Stuttgart (Germany)

    2009-07-15

    This study aimed to evaluate the safety and efficiency of the endovascular treatment of transverse-sigmoid sinus dural arteriovenous fistulas (TS{sub d}AVF). A total of 150 consecutive patients and 348 procedures were evaluated. Pulsatile tinnitus (81%), headache (15%), and intracranial hemorrhage (10%) were the most frequent manifestations of the TS{sub d}AVFs. More than half of the affected sinuses were partially or completely thrombosed. Access-wise treatment was performed transarterial (n = 33), transvenous (n = 21), or a combination thereof (n = 96). A mean of 2.4 procedures per patient was required. Immediate postprocedural occlusion rate after transarterial embolization was 30% only. Transvenous treatment alone resulted in an early occlusion rate of 81%, with delayed complete obliteration of half of the remaining fistulas. After combined transarterial/transvenous treatment, the angiographic cure rate was 54%. At follow-up, 88% of patients with residual shunt after the treatment showed complete occlusion. The cumulative complication rate was 9% (n = 13), with minor adverse events in ten patients (7%) and major complications in three patients (2%). Transvenous coil occlusion of the sinus segment with the adjacent dAVF site, eventually combined with transarterial occlusion of supplying arteries, is a very effective and well-tolerated treatment method. In selected patients, variations of these methods (e.g., sinus stenting, compartmental sinus occlusion) can be useful. (orig.)

  12. Endovascular Treatment of Isolated Bilateral Internal Ili- ac Artery Aneurysms with a Branched Endograft: A Case Report

    Directory of Open Access Journals (Sweden)

    SeyedEbrahim Kassaian

    2015-10-01

    Full Text Available Isolated bilateral internal iliac artery (IIA aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery (CIA. Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery (EIA. Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic.Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support.

  13. 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.

  14. New development for aorto bifemoral bypass--a clampless and sutureless endovascular and laparoscopic technique.

    Science.gov (United States)

    Segers, Bernard; Horn, David; Bazi, Michel-Olivier; Lemaitre, Jean; Van Den Broeck, Vanessa; Stevens, Etienne; Roman, Alain; Bosschaerts, Thierry

    2014-06-01

    The classic procedure for aortobifemoral bypass is open surgery. Laparoscopy has been accepted by several authors as a minimal invasive alternative for aortoiliac occlusive disease. The totally retroperitoneal laparoscopic procedure has been described as an alternative to the transperitoneal approach. Whatever the approach, the aortoprosthetic anastomosis is a major difficulty making those techniques unpopular despite obvious advantages for the patients. We report a clampless and sutureless approach for the proximal anastomosis of a totally retroperitoneal laparoscopic aortobifemoral bypass using an EndoVascular REtroperitoneoScopic Technique (EVREST). This approach was proposed to a 56-year-old man with severe aortoiliac occlusive disease. There was no indication for endovascular re-vascularization. The patient was placed in a 30 degrees right lateral decubitus position. The dissection of the retroperitoneal space was performed and the infrarenal aorta was exposed. A bifurcated graft was inserted into the retroperitoneal space. Under videoscopic control the prosthetic limbs were brought to the groins. The main body of the graft was connected on the left side of the aorta by an intra and extra aortic covered stent-graft. This connection was performed without the use of an aortic clamp and without suture. The femoral anastomoses were performed by classic open surgery.

  15. Endovascular management of dural carotid-cavernous sinus fistulas in 141 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kirsch, M. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Universitaetsklinikum Greifswald, Institut fuer Diagnostische Radiologie und Neuroradiologie, Greifswald (Germany); Henkes, H.; Liebig, T.; Weber, W.; Golik, S.; Kuehne, D. [Alfried Krupp Krankenhaus, Klinik fuer Radiologie und Neuroradiologie, Essen (Germany); Esser, J. [Universitaetsklinikum Essen, Zentrum fuer Augenheilkunde, Essen (Germany)

    2006-07-15

    Introduction: The purpose of this study was to evaluate the single-centre experience with transvenous coil treatment of dural carotid-cavernous sinus fistulas. Methods: Between November 1991 and December 2005, a total of 141 patients (112 female) with dural carotid-cavernous sinus fistula underwent 161 transvenous treatment sessions. The patient files and angiograms were analysed retrospectively. Clinical signs and symptoms included chemosis (94%), exophthalmos (87%), cranial nerve palsy (54%), increased intraocular pressure (60%), diplopia (51%), and impaired vision (28%). Angiography revealed in addition cortical drainage in 34% of the patients. Partial arterial embolization was carried out in 23% of the patients. Transvenous treatment comprised in by far the majority of patients complete filling of the cavernous sinus and the adjacent segment of the superior and inferior ophthalmic vein with detachable coils. Complete interruption of the arteriovenous shunt was achieved in 81% of the patients. A minor residual shunt (without cortical or ocular drainage) remained in 13%, a significant residual shunt (with cortical or ocular drainage) remained in 4%, and the attempted treatment failed in 2%. There was a tendency for ocular pressure-related symptoms to resolve rapidly, while cranial nerve palsy and diplopia improved slowly (65%) or did not change (11%). The 39 patients with visual impairment recovered within the first 2 weeks after endovascular treatment. After complete interruption of the arteriovenous shunt, no recurrence was observed. The transvenous coil occlusion of the superior and inferior ophthalmic veins and the cavernous sinus of the symptomatic eye is a highly efficient and safe treatment in dural carotid-cavernous sinus fistulas. In the majority of patients a significant and permanent improvement in clinical signs and symptoms can be achieved. (orig.)

  16. Intensive care management of patients with severe intracerebral haemorrhage after endovascular treatment of brain arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Keller, E.; Yonekawa, Y.; Imhof, H.G. [Department of Neurosurgery, University Hospital, Zuerich (Switzerland); Tanaka, M.; Valavanis, Anton [Institute of Neuroradiology, University Hospital, Zuerich (Switzerland)

    2002-06-01

    We studied the impact of emergency neurosurgery and intensive care on the outcome for patients with severe intracerebral haemorrhage after endovascular treatment of brain arteriovenous malformations (AVMs). We reviewed the case notes of 18 patients with severe haemorrhage after embolisation of a brain AVM between 1986 and 2001. During this period the treatment changed: before 1993, these patients were not surgically treated, and they died, while after 1994, all patients underwent emergency surgery. We established a standardised protocol for emergency treatment and intensive care in May 1998, and emergency surgery was performed as soon as possible after the onset of symptoms of haemorrhage. Postoperative intensive care was according to a standardised regime. During these 15 years, 24 out of 605 patients undergoing 1066 interventions had a haemorrhage during or after the procedure, of which 18 were severe (3% of patients, 1.7% of interventions). All patients had a severe clinical deficit (mean Glasgow coma scale 4.2); eight had uni- or bilateral mydriasis. From 1989 to April 1998 four (31%) of 13 patients died, one (7.5%) remained in a vegetative state and eight (61.5%) made a good recovery. All five patients treated between 1998 and 2001 had a favourable outcome. The mean time from onset of the symptoms of haemorrhage to reaching the operation room was 129 min between 1989 and 1998 and 24 min between 1998 and 2001. Standardised emergency treatment and intensive care with early resuscitation, minimal radiological exploration before rapid surgery improved the outcome. A short time between the onset of the symptoms of haemorrhage and evacuation of the haematoma may be the most important factor for a favourable outcome. (orig.)

  17. Neuroprotective Strategies Can Prevent Permanent Paraplegia in the Majority of Patients Who Develop Spinal Cord Ischaemia After Endovascular Repair of Thoracoabdominal Aortic Aneurysms.

    Science.gov (United States)

    Rossi, S H; Patel, A; Saha, P; Gwozdz, A; Salter, R; Gkoutzios, P; Carrell, T; Abisi, S; Modarai, B

    2015-11-01

    Spinal cord ischaemia (SCI) following endovascular thoracoabdominal aortic aneurysm (TAAA) repair is a devastating and unpredictable complication. This study describes a single unit's experience of SCI in patients who have had endovascular TAAA repair. A prospectively maintained database of patients having endovascular TAAA repair using branched and fenestrated stent grafts between 2008 and 2014 at a single high volume centre was reviewed. Patients who developed neurological symptoms and signs related to SCI were identified and factors associated with onset and recovery of neurology were analysed. Sixty-nine patients (median age 73 years, 52 male; Crawford classification type I [n = 4], type II [n = 11], type III [n = 33], type IV [n = 14], type V [n = 7]) underwent endovascular TAAA repair. Twelve patients developed neurological symptoms/signs related to SCI but this was successfully reversed in eight patients, leaving four (5.8%) with permanent paraplegia. The median length of aorta covered was not significantly different in the 12 patients who developed SCI compared with the cohort that did not. Eleven of the patients who developed SCI had an intraoperative mean arterial pressure (MAP) below 80 mmHg. Cutaneous atheroemboli were noted in half of the patients in the SCI group compared with 11% of the non-SCI group (p paraplegia in the majority of cases. Copyright © 2015 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  18. Tratamento endovascular do aneurisma da aorta abdominal em paciente com insuficiência renal crônica Endovascular treatment of abdominal aortic aneurysm in a patient with chronic renal failure

    Directory of Open Access Journals (Sweden)

    Cleoni Pedron

    2006-12-01

    Full Text Available A insuficiência renal crônica não-dialítica é uma contra-indicação relativa ao tratamento endovascular dos aneurismas da aorta abdominal. O uso de contrastes alternativos, como o gadolínio, além de fornecer imagens de baixa qualidade, está relacionado à nefrotoxicidade. Relatamos um caso de tratamento endovascular de aneurisma da aorta abdominal guiado por eco-Doppler colorido. Um paciente masculino de 82 anos, com aneurisma da aorta abdominal de 55 mm de diâmetro e clearance de creatinina de 17 ml/min, recebeu implante de endoprótese aórtica modular bifurcada, utilizando este método de imagem associado à radioscopia. Não foi empregado contraste iodado. O resultado imediato e os controles de 1 e 6 meses revelam completa exclusão do aneurisma. A função renal permanece inalterada. Concluímos que o implante de endoprótese guiado por eco-Doppler colorido em pacientes com insuficiência renal crônica não terminal e com anatomia favorável é um método factível e seguro.Non-dialytic chronic renal failure is a contraindication related to the endovascular treatment of abdominal aortic aneurysms. The use of alternative contrast agents, such as gadolinium, provides good-quality images and is associated with nephrotoxicity. We report a case of endovascular treatment of an abdominal aortic aneurysm guided by color-flow Doppler ultrasonography. An 82-year-old male patient, with abdominal aortic aneurysm (55 mm in diameter and creatinine clearance of 17 ml/min, underwent implantation of modular bifurcated aortic stent-graft, using that imaging method associated with radioscopy. Iodinated contrast was not used. The immediate result and 1- and 6-month controls showed complete aneurysm exclusion. Renal function is still unaltered. We conclude that the stent-graft implantation guided by color-flow Doppler ultrasonography in patients with nonterminal chronic renal failure and with favorable anatomy is a feasible and safe method.

  19. USE OF OPEN AND ENDOVASCULAR SURGICAL TECHNIQUES TO MANAGE VASCULAR INJURIES IN THE TRAUMA SETTING: A REVIEW OF THE AAST PROOVIT REGISTRY.

    Science.gov (United States)

    Faulconer, Edwin R; Branco, Bernardino C; Loja, Melissa N; Grayson, Kevin; Sampson, James; Fabian, Timothy C; Holcomb, John B; Scalea, Thomas; Skarupa, David; Inaba, Kenji; Poulin, Nathaniel; Rasmussen, Todd E; Dubose, Joseph J

    2017-12-20

    Vascular trauma data have been submitted to the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial (PROOVIT) database since 2013. We present data to describe current use of endovascular surgery in vascular trauma. Registry data from March 2013 to December 2016 were reviewed. All trauma patients who had an injury to a named artery, except the forearm and lower leg, were included. Arteries were grouped into anatomic regions and by compressible and non-compressible region for analysis. This review focused on patients with non-compressible transection, partial transection, or flow limiting defect injuries. Bivariate and multivariate analyses were used to assess the relationships between study variables. 1143 patients from 22 institutions were included. Median age was 32 years (interquartile range IQR 23-48) and 76% (n=871) were male. Mechanisms of injury were 49% (n=561) blunt, 41% (n=464) penetrating, and 1.8% (n=21) of mixed aetiology. Gunshot wounds accounted for 73% (n=341) of all penetrating injuries. Endovascular techniques were used least often in limb trauma and most commonly in patients with blunt injuries to more than one region. Penetrating wounds to any region were preferentially treated with open surgery (74%, n=341/459). The most common indication for endovascular treatment was blunt non-compressible torso injuries (NCTI). These patients had higher injury severity scores and longer associated hospital stays, but required less packed red blood cells (PRBC), and had lower in hospital mortality than those treated with open surgery. On multivariate analysis, admission low hemoglobin concentration and abdominal injury were independent predictors of mortality. Our review of PROOVIT registry data demonstrates a high utilization of endovascular therapy among severely injured blunt trauma patients primarily with non-compressible torso hemorrhage. This is associated with decreased need for blood transfusion and improved

  20. Ingrowth of aorta wall into stent grafts impregnated with basic fibroblast growth factor: A porcine in vivo study of blood vessel prosthesis healing

    NARCIS (Netherlands)

    Bas, J.M.A. van der; Quax, P.H.A.; Berg, A.C. van den; Visser, M.J.T.; Linden, E. van der; Bockel, J.H. van

    2004-01-01

    Objective: Endovascular aneurysm repair is an alternative treatment of abdominal aortic aneurysm. The procedure is less invasive, and morbidity and most probably mortality are reduced. However, some problems, such as endoleakage, are yet to be resolved. Endoleakage can occur after graft migration,

  1. 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.

  2. Management options in the treatment of femoral pseudoaneurysms secondary to intravenous drug abuse: A case series

    Directory of Open Access Journals (Sweden)

    James Rammell

    2017-01-01

    Conclusion: With the identification of suitable patients and pre-operative optimisation, revascularisation can be performed in the emergency setting with an extra-anatomical bypass appearing to confer the best results. Currently endovascular approaches appear to be used only as a bridge to a future definitive revascularisation procedure, however, there are several case reports documenting successful outcomes when using a stent graft alongside a prolonged course of antibiotics. For the majority of patients, excision-ligation without revascularisation is both safe and effective as few are left with symptoms of limb ischaemia.

  3. Endovascular Treatment of Carotid Artery Blowout Syndrome Caused by Oropharyngeal Carcinoma

    Science.gov (United States)

    Ergun, Onur; Celtikci, Pinar; Durmaz, Hasan Ali; Birgi, Erdem; Hekimoglu, Baki

    2014-01-01

    Summary A 64-year-old man was admitted with massive hemoptysis caused by oropharyngeal carcinoma. Angiography revealed active extravasation from the left carotid bulb. Covered stent-graft placement resolved the bleeding, but the patient presented with recurrent hemorrhage two hours later and was treated with another stent-graft. PMID:25207916

  4. "Endovascular embolic hemispherectomy": a strategy for the initial management of catastrophic holohemispheric epilepsy in the neonate.

    Science.gov (United States)

    Oluigbo, Chima; Pearl, Monica S; Tsuchida, Tammy N; Chang, Taeun; Ho, Cheng-Ying; Gaillard, William D

    2017-03-01

    Conflicting challenges abound in the management of the newborn with intractable epilepsy related to hemimegalencephaly. Early hemispherectomy to stop seizures and prevent deleterious consequences to future neurocognitive development must be weighed against the technical and anesthetic challenges of performing major hemispheric surgery in the neonate. We hereby present our experience with two neonates with hemimegalencephaly and intractable seizures who were managed using a strategy of initial minimally invasive embolization of the cerebral blood supply to the involved hemisphere. Immediate significant seizure control was achieved after embolization of the cerebral blood supply to the involved hemisphere followed by delayed ipsilateral hemispheric resection at a later optimal age. The considerations and challenges encountered in the course of the management of these patients are discussed, and a literature review is presented.

  5. Endovascular Coil Embolization of Segmental Arteries Prevents Paraplegia After Subsequent TAAA Repair – An Experimental Model

    Science.gov (United States)

    Geisbüsch, S; Stefanovic, A; Koruth, JS; Lin, HM; Morgello, S; Weisz, DJ; Griepp, RB; Di Luozzo, G

    2013-01-01

    Objective To test a strategy for minimizing ischemic spinal cord injury (SCI) following extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly one week before simulated aneurysm repair in an experimental model. Methods 30 juvenile Yorkshire pigs (25.2±1.7kg) were randomized into three groups. All SAs—intercostal and lumbar—were sacrificed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting (TEVAR). 7–10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5±0.5 SAs in Group 1 (T13/L1), and 4.5±0.5 in Group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score: 0=paraplegia; 9=full recovery. After sacrifice, each segment of spinal cord was graded histologically using the 9-point Kleinman score: 0=normal, 8=complete necrosis. Results Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6/10 control pigs, but only 2/10 pigs in Group 1: no pigs in Group 2 had SCI. Tarlov scores were significantly better in Group 2 (Control vs 1 p=0.06; Control vs 2 p= 0.0002; 1 vs 2 p=0.05). A dramatic reduction in histologic damage—most prominently in the coiled region—was seen when SAs were embolized before simulated TAAA repair. Conclusions Endovascular coiling of 2–4 SAs prevents paraplegia in an experimental model of extensive hybrid TAAA repair, and helps protect the spinal cord from ischemic histopathological injury. A clinical trial in a selected patient population at high risk for postoperative SCI may be appropriate. PMID:24220154

  6. Estudo da resposta tissular à endoprótese recoberta de jugular bovina em veia cava inferior de suínos Bovine jugular covered stent-graft implanted in swine inferior vena cava - a study of tissue response

    Directory of Open Access Journals (Sweden)

    Cristina Ribeiro Riguetti Pinto

    2006-06-01

    aortic stent-graft deployment (Florida, USA. Ten handmade stent-grafts were implanted in 10 swine inferior venae cavae. All animals were submitted to perioperative venography. At necropsy, 2 months later, the stent-grafts were removed en bloc and histopathologic analysis was undertaken, in order to analyze its patency, adherence to neighboring tissues and incorporation to the venous wall, as well as tissue response. RESULTS: All stent-grafts were patent and adherent to venous wall, but six presented with gross trabeculation and four had some degree of perivascular fibrosis at macroscopy. Three animals developed lymphocele, one in the retroperitoneal space and the others in the abdominal wall. At histopathology, we observed chronic inflammatory reaction with foreign body granulomatous response in all cases, with prevalence of the tunica media (80%. CONCLUSION: The model presented low thrombogenicity, which corroborates the efficacy of the chosen means of preservation and material. However, there was low compatibility, probably due to the immunological obstacle of xenografts and exaggerated tissue response of the venous territory.

  7. Emergency endovascular treatment of acute aortic diseases; Endovaskulaere Behandlung akuter Erkrankungen der thorakalen Aorta

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Herber, S.; Thelen, M. [Mainz Univ. (Germany). Klinik fuer Radiologie; Schmiedt, W.; Neufang, A. [Klinik fuer Herz-, Thorax- und Gefaesschirurgie, Johannes Gutenberg-Univ. Mainz (Germany); Dueber, C. [Inst. fuer Klinische Radiologie, Klinikum Mannheim GmbH (Germany)

    2002-05-01

    Purpose: To investigate the safety and efficacy of emergency treatment of acute aortic diseases with endovascular stent grafts. Methods: In 11 patients (median age 55 years, range 18 - 85) with acute complications of descending aortic diseases endovascular emergency treatment was performed: traumatic aortic rupture (n = 4), penetrating ulcer with aortobronchial fistula or hematothorax (n = 4), acute type B dissection (n = 2, one with penetration, one with subacute mesenteric ischemia), and symptomatic aneurysm of the thoracic aorta (n = 1) with pain and diameter progression. 15 stent grafts were implanted (Talent n = 11, Vanguard/Stentor n = 4). Stent extension was necessary in 4 cases. In 2 cases graft extension was done during the first procedure (due to distal migration and due to the total length of the aortic aneurysm). In 2 cases graft extension was performed 5 days (due to a new aortic ulcer at the proximal stent struts) and 5 months after the initial procedure (recurrent aortobronchial fistula due to aneurysm progression). 14 of 15 implantations required general anesthesia, one symptomatic thoracic aneurysm was performed in local anesthesia and sedation. Results: 14 of 15 graft procedures were performed using the femoral or iliac approach. One procedure required aortofemoral bypass grafting due to extensive arteriosclerotic stenosis and the stent graft was inserted via the bypass graft. The orifice of the subclavian artery was crossed with bare stent struts in 4 cases without neurological complications. Median follow-up is 27 months (range 6 to 72 months). In traumatic aortic ruptures, immediate sealing of bleeding was achieved and follow-up is inconspicuous at a maximum of 72 months. In cases of aortobronchial fistulas, follow-up is satisfactory (maximum 72 months) despite the necessity for reintervention and graft extension. In one acute type B dissection retrograde dissection of the aortic arch occurred during stent release with stable disease during

  8. 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

  9. Mid-Term Outcomes of Endovascular Treatment for TASC-II D Femoropopliteal Occlusive Disease with Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Torres-Blanco, Álvaro, E-mail: atorres658@yahoo.es; Edo-Fleta, Gemma; Gómez-Palonés, Francisco; Molina-Nácher, Vicente; Ortiz-Monzón, Eduardo [Hospital Universitario Dr. Peset, Department of Angiology, Endovascular and Vascular Surgery (Spain)

    2016-03-15

    PurposeThe purpose of the study was to assess the safety and midterm effectiveness of endovascular treatment in Trans-Atlantic Inter-Society Consensus II (TASC-II) D femoropopliteal occlusions in patients with critical limb ischemia (CLI).MethodsPatients with CLI who underwent endovascular treatment for TASC-D de novo femoropopliteal occlusive disease between September 2008 and December 2013 were selected. Data included anatomic features, pre- and postprocedure ankle-brachial index, duplex ultrasound, and periprocedural complications. Sustained clinical improvement, limb salvage rate, freedom from target lesion revascularization (TLR), and freedom from target extremity revascularization (TER) were assessed by Kaplan–Meier estimation and predictors of restenosis/occlusion with Cox analysis.ResultsThirty-two patients underwent treatment of 35 TASC-D occlusions. Mean age was 76 ± 9. Mean lesion length was 23 ± 5 cm. Twenty-eight limbs (80 %) presented tissue loss. Seventeen limbs underwent treatment by stent, 13 by stent-graft, and 5 by angioplasty. Mean follow-up was 29 ± 20 months. Seven patients required major amputation and six patients died during follow-up. Eighteen endovascular and three surgical TLR procedures were performed due to restenosis or occlusion. Estimated freedom from TLR and TER rates at 2 years were 41 and 76 %, whereas estimated primary and secondary patency rates were 41 and 79 %, respectively.ConclusionsEndovascular treatment for TASC II D lesions is safe and offers satisfying outcomes. This patient subset would benefit from a minimally invasive approach. Follow-up is advisable due to a high rate of restenosis. Further follow-up is necessary to know the long-term efficacy of these procedures.

  10. Endovascular Management of Patients with Head and Neck Cancers Presenting with Acute Hemorrhage: A Single-Center Retrospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Vilas Boas, P. P.; Castro-Afonso, L. H. de; Monsignore, L. M.; Nakiri, G. S. [University of São Paulo, Division of Interventional Neuroradiology, Ribeirão Preto Medical School (Brazil); Mello-Filho, F. V. de [University of São Paulo, Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirão Preto Medical School (Brazil); Abud, D. G., E-mail: dgabud@fmrp.usp.br [University of São Paulo, Division of Interventional Neuroradiology, Ribeirão Preto Medical School (Brazil)

    2017-04-15

    PurposeAcute hemorrhage associated with cancers of the head and neck is a life-threatening condition that requires immediate action. The aim of this study was to assess the safety and efficacy of endovascular embolization for acute hemorrhage in patients with head and neck cancers.Materials and MethodsData were retrospectively collected from patients with head and neck cancers who underwent endovascular embolization to treat acute hemorrhage. The primary endpoint was the rate of immediate control of hemorrhage during the first 24 h after embolization. The secondary endpoints were technical or clinical complications, rate of re-hemorrhage 24 h after the procedure, time from embolization to re-hemorrhage, hospitalization time, mortality rate, and time from embolization to death.ResultsFifty-one patients underwent endovascular embolization. The primary endpoint was achieved in 94% of patients. The rate of technical complications was 5.8%, and no clinical complication was observed. Twelve patients (23.5%) had hemorrhage recurrence after an average time of 127.5 days. The average hospitalization time was 7.4 days, the mortality rate during the follow-up period was 66.6%, and the average time from embolization to death was 132.5 days.ConclusionEndovascular embolization to treat acute hemorrhage in patients with head and neck cancers is a safe and effective method for the immediate control of hemorrhage and results in a high rate of hemorrhage control. Larger studies are necessary to determine which treatment strategy is best for improving patient outcomes.

  11. Haemangiomas and venous malformations of the head and neck: A retrospective analysis of endovascular management in 358 patients

    Directory of Open Access Journals (Sweden)

    Kumbhar Sachin

    2013-01-01

    Full Text Available Background: Haemangioma (HM and venous malformations of the head and neck are formidable lesions as they cause cosmetic deformity and psychological problems. Their surgical excision is difficult and fraught with problems like operative blood loss, incomplete excision, disfigurement and recurrence. Endovascular techniques like sclerotherapy and embolization are increasingly being used in the treatment of these difficult lesions. Objectives: This study was undertaken to analyse the efficacy and safety of endovascular techniques in the treatment of HM and slow flow vascular malformations. Materials and Methods: We retrospectively reviewed the records and clinical photographs of 358 patients of HM and slow flow vascular malformations treated in our institute by endovascular approach over a 15 year period. Pre- and post-treatment photographs were compared and outcomes categorized as complete resolution (>90% reduction, considerable reduction (60-90% reduction, partial reduction (20-60% reduction and no change (<20% reduction. Results: Complete resolution of the lesion was seen in 30% of the patients while 50% patients showed considerable reduction of the swelling. Complications occurred in 6.4% of patients. Conclusion: We conclude that sclerotherapy is an effective and safe treatment modality for these lesions and may be considered as the primary modality in the treatment of these challenging lesions.

  12. Predictors of aortic growth in uncomplicated type B aortic dissection from the Acute Dissection Stent Grafting or Best Medical Treatment (ADSORB) database

    DEFF Research Database (Denmark)

    Kamman, Arnoud V; Brunkwall, Jan; Verhoeven, Eric L

    2017-01-01

    database. Furthermore, we looked for trends in outcome for aortic growth and remodeling after BMT and thoracic endovascular aortic repair (TEVAR) and BMT (TEVAR+BMT). METHODS: BMT patients with available baseline and a 1-year follow-up arterial computed tomography scan were identified. True lumen and false...... interval, 0.813-1.00; P = .0502). The proximal sections A and B showed complete thrombosis in 80.6% in the BMT+TEVAR group compared with 9.5% in the BMT group. In these sections, changes from patent to partial or partial to complete thrombosis were observed in 90.3% of the TEVAR+BMT group vs 31...

  13. Comparison of physiological and post-endovascular aneurysm repair infrarenal blood flow.

    Science.gov (United States)

    Raptis, Anastasios; Xenos, Michalis; Georgakarakos, Efstratios; Kouvelos, George; Giannoukas, Athanasios; Labropoulos, Nicos; Matsagkas, Miltiadis

    2017-02-01

    Endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms results in redirection of blood through the deployed endograft (EG). Even though EVAR is clinically effective, the absolute flow restoration is not warranted. Our purpose was to compare the physiological with the post-EVAR infrarenal flow conditions. We developed patient-specific models based on computed tomography data of five healthy volunteers and ten patients treated with the Endurant(®) stent-graft system. Wall shear stress (WSS), helicity, pressure and velocity fields were calculated using computational fluid dynamics. The results showed a decrease of peak WSS on the part of the EG that resides in the iliac arteries, compared to the physiological value (p = 0.01). At the abdominal part, the average helicity seems to increase after EVAR, while at the iliac arteries part, the intensity of helical flow seems physiological. Pressure drop and peak velocity in the iliac arteries part are lower than the physiological values (p = 0.04). The comparison revealed that most hemodynamic properties converge to normal levels at the abdominal part whereas statistically significant variations were observed in the iliac arteries part. The delineation of the differences between physiological and postoperative flow data could pave the way for the improvement of EG designs.

  14. Endovascular treatment of aneurysms of the popliteal artery by a covered endoprosthesis.

    Science.gov (United States)

    Wissgott, Christian; Lüdtke, Christopher W; Vieweg, Hendryk; Scheer, Fabian; Lichtenberg, Michael; Schlöricke, Erik; Andresen, Reimer

    2014-01-01

    The current gold standard of popliteal artery aneurysm (PAA) treatment is saphenous vein bypass grafting. The aim of this retrospective single-center study is to investigate the safety and efficacy in the treatment of PAA by an endovascular implanted covered endoprosthesis. Ten patients, mean age 64.6 (range, 52-78) years, with PAA were treated with an expanded Polytetrafluoroethylen (ePTFE)-covered stent graft (Viabahn(®), W.L. Gore and Associates Inc, Flagstaff, AZ, USA). In median, 1.4 prostheses were implanted with a median length of 180 mm. Follow-up visits included determination of ankle-brachial index (ABI) and color-coded duplex sonography. The technical success rate was 100% (10/10). Clinically, there was an increase in ABI from 0.62 ± 0.17 to 0.91 ± 0.15 postinterventionally and to 0.89 ± 0.16 after an average follow-up of 24.7 months. During the follow-up period, 2 (20%) stent occlusions occurred; both of them were treated with a bypass graft. The treatment of PAA with covered endoprosthesis is a safe and effective alternative to open surgical therapy, where open surgical therapy is contraindicated or patient refused open surgery.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

    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 [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Kim, Soo Hyun; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun (Korea, Republic of)

    2013-02-15

    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.

  17. Biomechanical implications of excessive endograft protrusion into the aortic arch after thoracic endovascular repair.

    Science.gov (United States)

    Rinaudo, Antonino; Raffa, Giuseppe Maria; Scardulla, Francesco; Pilato, Michele; Scardulla, Cesare; Pasta, Salvatore

    2015-11-01

    Endografts placed in the aorta for thoracic endovascular aortic repair (TEVAR) may determine malappositioning to the lesser curvature of the aortic wall, thus resulting in a devastating complication known as endograft collapse. This premature device failure commonly occurs in young individuals after TEVAR for traumatic aortic injuries as a result of applications outside the physical conditions for which the endograft was designed. In this study, an experimentally-calibrated fluid-structure interaction (FSI) model was developed to assess the hemodynamic and stress/strain distributions acting on the excessive protrusion extension (PE) of endografts deployed in four young patients underwent TEVAR. Endograft infolding was experimentally measured for different hemodynamic scenarios by perfusion testing and then used to numerically calibrate the mechanical behavior of endograft PE. Results evinced that the extent of endograft can severely alter the hemodynamic and structural loads exerted on the endograft PE. Specifically, PE determined a physiological aortic coarctation into the aortic arch characterized by a helical flow in the distal descending aorta. High device displacement and transmural pressure across the stent-graft wall were found for a PE longer than 21 mm. Finally, marked intramural stress and principal strain distributions on the protruded segment of the endograft wall may suggest failure due to material fatigue. These critical parameters may contribute to the endograft collapse observed clinically and can be used to design new devices more suitable for young individuals to be treated with an endoprosthesis for TEVAR of blunt traumatic aortic injuries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Endovascular Repair of Ruptured Thoracoabdominal Aortic Aneurysm with an Off-the-shelf Endoprosthesis.

    Science.gov (United States)

    Wolosker, Nelson; Fioranelli, Alexandre; Ferreira, Marcelo; Tachibana, Adriano; Lembrança, Lucas; Oliveira, Carlos

    2017-08-01

    flexibility and compatibility with the length of arteries. This is the first report of the use of a T-branch (Cook Medical) for treatment of a ruptured TAAA3. The development of an off-the-shelf endoprosthesis has many advantages: it is available for use in an emergency situation, and there is no time lapse for its preparation. The T-Branch stent graft is a valid option for the treatment of ruptured TAAA3. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Endovascular management of ruptured basilar artery dissection with two overlapping Low-profile Visualized Intraluminal Support stents.

    Science.gov (United States)

    Zhang, Xiaoxi; Li, Wenshuai; Lv, Nan; Zhang, Quanzhong; Huang, Qinghai

    2016-12-01

    The optimal endovascular treatment method of ruptured basilar artery dissection still remains controversial. We reported a case with ruptured basilar artery dissection involving the left anterior inferior cerebellar artery. The dissecting aneurysm was successfully treated with two overlapping Low-profile Visualized Intraluminal Support stents and the preservation of antegrade blood flow of the anterior inferior cerebellar artery was achieved. Three-month and six-month follow-ups revealed good clinical and angiographic results, although controversies regarding long-term stability remained to be addressed. © The Author(s) 2016.

  20. Thoracic Endovascular Repair of Complicated Penetrating Aortic Ulcer: An 11-Year Single-Center Experience.

    Science.gov (United States)

    Jánosi, Rolf Alexander; Gorla, Riccardo; Tsagakis, Konstantinos; Kahlert, Philipp; Horacek, Michael; Bruckschen, Florian; Dohle, Daniel-Sebastian; Jakob, Heinz; Schlosser, Thomas; Eggebrecht, Holger; Bossone, Eduardo; Erbel, Raimund

    2016-02-01

    To analyze an 11-year single-center experience of treating complicated penetrating aortic ulcer (PAU) using thoracic endovascular aortic repair (TEVAR). This study included 63 consecutive patients (mean age 69.1±11.5 years; 40 men) with complicated PAU (42 symptomatic, 22 with rupture) who underwent TEVAR between 2002 and 2013. The PAUs were located in the aortic arch (n=11), the descending thoracic aorta (n=43), and the thoracoabdominal aorta (n=9). TEVAR was performed within 14 days of diagnosis in 33 (52.3%) cases (19 ruptures treated immediately); the other 30 (47.6%) patients had an average interval between diagnosis and intervention of 40±39 days. Technical success was 98.4% (62/63). One patient had a type I endoleak after stent-graft repair of a PAU in the aortic arch without great vessel transposition; another procedure was required for carotid-subclavian bypass and proximal stent-graft extension. No patient experienced spinal cord ischemia after TEVAR. Five (7.9%) patients died in-hospital; 3 had severe cardiac complications, 1 died from complications of aortic rupture, and the other succumbed to septic shock. Mean follow-up was 45.6±47.2 months, during which 12 (19.0%) patients needed a secondary intervention because of late endoleaks (n=4, 6.3%) or new complications due to disease progression. Multivariate analysis indicated that a PAU depth >15 mm was an independent predictor of mortality (hazard ratio 6.92, p=0.03). In the biomarker analysis, symptomatic patients had significantly higher D-dimer and troponin levels compared to asymptomatic patients [559.5±460.7 vs 283.2±85.2 µg/L (p=0.016) and 0.22±0.61 vs 0.02±0.03 ng/mL (p=0.04), respectively]. Patients with PAU suffer from underlying severe atherosclerotic disease and have a significant number of cardiovascular comorbidities that lead to relevant mortality and morbidity after TEVAR. As a PAU diameter >15 mm represented high risk for disease progression, these patients may be candidates for

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  2. Endovascular therapy is effective and safe for patients with severe ischemic stroke : Pooled analysis of interventional management of Stroke III and multicenter randomized clinical trial of endovascular therapy for acute ischemic stroke in the Netherlands data

    NARCIS (Netherlands)

    J.P. Broderick (Joseph P.); O.A. Berkhemer (Olvert); Palesch, Y.Y. (Yuko Y.); D.W.J. Dippel (Diederik); Foster, L.D. (Lydia D.); Y.B.W.E.M. Roos (Yvo); A. van der Lugt (Aad); T.A. Tomsick (Thomas A.); C.B. Majoie (Charles); W.H. van Zwam (Wim); A.M. Demchuk (Andrew); R.J. van Oostenbrugge (Robert Jan); P. Khatri (Pooja); H.F. Lingsma (Hester); M. Hill (Michael); B. Roozenbeek (Bob); E. Jauch (Edward); T.G. Jovin (Tudor G.); Yan, B. (Bernard); R. von Kummer (Ruediger); C. Molina; M. Goyal (Mayank); W.J. Schonewille (W.); Mazighi, M. (Mikael); S.T. Engelter (Stefan); Anderson, C.S. (Craig S.); Spilker, J. (Judith); Carrozzella, J. (Janice); Ryckborst, K.J. (Karla J.); Janis, L.S. (L. Scott); Simpson, K.N. (Kit N.)

    2015-01-01

    textabstractBackground and Purpose - We assessed the effect of endovascular treatment in acute ischemic stroke patients with severe neurological deficit (National Institutes of Health Stroke Scale score, ≥20) after a prespecified analysis plan. Methods - The pooled analysis of the Interventional

  3. Clinical outcomes of endovascular treatment of TASC-II C and D femoropopliteal lesions with the Viabahn endoprosthesis.

    Science.gov (United States)

    Mohr, Peter J; Oyama, Jared K; Luu, Jane T; Stinis, Curtiss T

    2015-12-01

    The objective of this study was to evaluate clinical outcomes and patency rates using the Viabahn endoprosthesis in complex (TASC-II C and D) femoropopliteal lesions. Traditional treatment of symptomatic TASC-II C and D femoropopliteal lesions has mainly centered on open surgical options in patients deemed appropriate candidates. Endovascular treatment of these lesions with balloon angioplasty has been historically hampered by aggressive restenosis and relatively early clinical failure. The Viabahn endoprosthesis was developed with the intent of reducing restenosis while improving overall flexibility in the femoropopliteal segment. Between March 2009 and July 2011 a total of 51 limbs in 41 patients underwent implantation of one or more Viabahn endovascular stent grafts for the treatment of symptomatic TASC-II C or D lesions. Patients were followed clinically at regular intervals and also underwent routine surveillance duplex ultrasound at 1, 3, 6, and 12 months post-procedure. The average follow-up from the index procedure was 14.6 months (range 13-35.2 months). A total of 22 TASC-II C and 29 TASC-II D lesions were treated (51 limbs in 41 patients). The mean lesion length was 22.4 cm. The overall 1-year primary patency rate was 74.8% (95% CI: 61.2%-88.4%), assisted primary patency rate was 87.4% (95% CI: 70.9%-95.9%), and the secondary patency rate was 94.9% (95% CI: 88.0%-100.0%). The Viabahn endoprosthesis is a safe and effective option for the treatment of TASC-II C and D femoropopliteal lesions. Patency rates are favorable despite the complexity of these lesions, although multiple endovascular re-interventions may be necessary to achieve an acceptable long-term result. Copyright © 2015 Elsevier Inc. All rights reserved.

  4. Five-year outcomes of the PYTHAGORAS U.S. clinical trial of the Aorfix endograft for endovascular aneurysm repair in patients with highly angulated aortic necks.

    Science.gov (United States)

    Malas, Mahmoud B; Hicks, Caitlin W; Jordan, William D; Hodgson, Kim J; Mills, Joseph L; Makaroun, Michel S; Belkin, Michael; Fillinger, Mark F

    2017-06-01

    Early and midterm outcomes of the Prospective Aneurysm Trial: High Angle Aorfix Bifurcated Stent Graft (PYTHAGORAS) trial in patients with highly angulated aortic necks (≥60 degrees) have already been published and shown comparable outcomes to other endografts in normal anatomy. Herein, we present the long-term outcomes of the PYTHAGORAS trial of Aorfix (Lombard Medical, Irvine, Calif) for patients with highly angulated aortic neck anatomy. The Aorfix endograft is a highly conformable nitinol/polyester device designed for transrenal fixation. The U.S. trial enrolled 218 patients and observed all patients at 1 month, 6 months, and 12 months and then annually for a total of 5 years. Endovascular aneurysm repair (EVAR)-specific complications were compared between the standard-angle (PYTHAGORAS trial of the Aorfix endograft is the first EVAR clinical trial to include a majority of highly angulated (≥60 degrees) infrarenal aortic necks and is the first to produce evidence after 5 years of implantation. Despite predictors of worse short- and long-term outcomes, pertinent outcomes were better than or similar to those of trials with less severe anatomy. These results support the use of this "on-label" endovascular option, particularly in patients with highly angulated aortic neck anatomy. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  5. Focal stenosis of the sigmoid sinus causing intracranial venous hypertension: Case report, endovascular management, and review of the literature.

    Science.gov (United States)

    Honarmand, Amir R; Hurley, Michael C; Ansari, Sameer A; Alden, Tord D; Kuhn, Ryan; Shaibani, Ali

    2016-04-01

    Regardless of the underlying pathology, elevated intracranial pressure is the endpoint of any impairment in either cerebrospinal fluid (CSF) absorption (including arachnoid villi) or intracranial venous drainage. In all age groups, the predominant final common pathway for CSF drainage is the dural venous sinus system. Intracranial venous hypertension (ICVH) is an important vascular cause of intracranial hypertension (and its subsequent sequelae), which has often been ignored due to excessive attention to the arterial system and, specifically, arteriovenous shunts. Various anatomical and pathological entities have been described to cause ICVH. For the second time, we present a unique case of severe focal stenosis in the distal sigmoid sinus associated with concurrent hypoplasia of the contralateral transverse sinus causing a significant pressure gradient and intracranial hypertension, which was treated with endovascular stent placement and angioplasty. © The Author(s) 2016.

  6. Tratamento endovascular de aneurismas cirsoideos do couro cabeludo Endovascular treatment of scalp cirsoid aneurysms

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2010-08-01

    Full Text Available OBJETIVO: Relatar os resultados da aplicação de técnicas endovasculares no tratamento de aneurismas cirsoideos do couro cabeludo. MATERIAIS E MÉTODOS: Quatro pacientes com diagnóstico de aneurismas cirsoideos foram submetidos ao tratamento por via endovascular. Todos os quatro pacientes incluídos nesta série tinham malformações arteriovenosas e foram tratados apenas com embolização. RESULTADOS: Três pacientes foram submetidos a tratamento endovascular mediante embolização transarterial e um foi tratado por punção direta da porção venosa. Os resultados clínicos e cosméticos foram satisfatórios em todos os pacientes. Não houve recidiva clínica durante o período de acompanhamento. CONCLUSÃO: A via endovascular é uma alternativa segura e eficaz no tratamento dos aneurismas cirsoideos. Embora possa ser efetivamente utilizado como uma alternativa adjuvante ou complementar à cirurgia, especialmente quando é necessário lidar com aferências profundas, a maioria dos casos pode ser totalmente curada apenas com a terapêutica endovascular. A escolha do método de tratamento deve ser baseada em uma variedade de características próprias da lesão, incluindo sua angioarquitetura, tamanho e apresentação clínica.OBJECTIVE: To report results of the application of endovascular techniques in the management of scalp cirsoid aneurysms. MATERIALS AND METHODS: Four patients diagnosed with cirsoid aneurysms were submitted to treatment by endovascular approach. All the four patients included in the present series had arteriovenous malformations and were treated solely by embolization. RESULTS: Three of the patients underwent endovascular treatment by transarterial embolization and one was treated by direct puncture of the venous segment. Both clinical and cosmetic outcomes were satisfactory in all of the patients. Clinical relapse was not observed along the follow-up period. CONCLUSION: The endovascular approach is safe and effective in

  7. Endovascular treatment of thoracoabdominal aneurysm.

    Science.gov (United States)

    Mastracci, Tara M

    2010-06-01

    The use of endovascular modalities for the treatment of simple descending thoracic aneurysms has become standard of care. Expanding endovascular techniques for the treatment of thoracoabdominal aneurysms is now possible with the evolution of branched and fenestrated grafts.

  8. Minimally invasive percutaneous endovascular therapies in the management of complications of non-alcoholic fatty liver disease (NAFLD): A case report.

    Science.gov (United States)

    Salsamendi, Jason; Pereira, Keith; Kang, Kyungmin; Fan, Ji

    2015-09-01

    Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of disorders from simple steatosis to inflammation leading to fibrosis, cirrhosis, and even hepatocellular carcinoma. With the progressive epidemics of obesity and diabetes, major risk factors in the development and pathogenesis of NAFLD, the prevalence of NAFLD and its associated complications including liver failure and hepatocellular carcinoma is expected to increase by 2030 with an enormous health and economic impact. We present a patient who developed Hepatocellular carcinoma (HCC) from nonalcoholic steatohepatitis (NASH) cirrhosis. Due to morbid obesity, she was not an optimal transplant candidate and was not initially listed. After attempts for lifestyle modifications failed to lead to weight reduction, a transarterial embolization of the left gastric artery was performed. This is the sixth such procedure in humans in literature. Subsequently she had a meaningful drop in BMI from 42 to 36 over the following 6 months ultimately leading to her being listed for transplant. During this time, the left hepatic HCC was treated with chemoembolization without evidence of recurrence. In this article, we wish to highlight the use of minimally invasive percutaneous endovascular therapies such as transarterial chemoembolization (TACE) in the comprehensive management of the NAFLD spectrum and percutaneous transarterial embolization of the left gastric artery (LGA), a novel method, for the management of obesity.

  9. Endovascular management of iatrogenic cervical internal carotid artery pseudoaneurysm in a 9-year-old child: Case report and literature review.

    Science.gov (United States)

    Pinzón, Martín; Lobelo, Nelson Oswaldo; Rodríguez, María Claudia; Villamor, Perla; Otoya, Ana María

    2017-04-01

    Extracranial internal carotid artery (ICA) pseudoaneurysms are uncommon in the pediatric population and are usually secondary to direct trauma to the vessel. Treatment options include surgery (ligation), anticoagulation therapy and endovascular treatment. Endovascular covered stents have shown good results in adult populations, resulting in occlusion of the aneurysm and preservation of the artery without significant complications. However, there have been only limited reports in the literature reporting endovascular carotid stent placement in the pediatric population. We report a case of a 9-year-old boy patient, who developed a cervical ICA pseudoaneurysm after a parapharyngeal tumor resection. He was successfully treated by primary endovascular covered stent placement. During a follow-up of 6 months the patient has been asymptomatic, without any adverse event. Additionally, a literature review is done. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. An Approach to Endovascular and Percutaneous Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Dysfunction: A Pictorial Essay and Clinical Practice Algorithm.

    Science.gov (United States)

    Pereira, Keith; Baker, Reginald; Salsamendi, Jason; Doshi, Mehul; Kably, Issam; Bhatia, Shivank

    2016-05-01

    Transjugular intrahepatic portosystemic shunts (TIPS) have evolved as an effective and durable nonsurgical option in the treatment of portal hypertension (PH). It has been shown to improve survival in decompensated cirrhosis and may also serve as a bridge to liver transplantation. In spite of the technical improvements in the procedure, problems occur with the shunt which jeopardizes effective treatment of the PH. Appropriate management is vital to ensure the longevity of the conduit. Shunt revision techniques include endovascular revision techniques and new shunt creation or, in the appropriate patients, alternative/rescue therapies. The ability of interventional radiologists to restore adequate TIPS function has enormous implications for quality of life with palliation, morbidity/mortality related to variceal bleeding and survival if transplant candidates can live long enough to receive a new liver. As such, it is imperative that these treatment strategies are understood and employed when these patients are encountered. In this review, the restoration of appropriate shunt function using various techniques will be discussed as they apply to a variety of clinical scenarios, based on literature. In addition, illustrative case examples highlighting our experience at an academic tertiary medical center will be included. It is the intent to have this document serve as a concise and informative reference to be used by those who may encounter patients with suboptimal functioning TIPS.

  11. An Approach to Endovascular and Percutaneous Management of Transjugular Intrahepatic Portosystemic Shunt (TIPS) Dysfunction: A Pictorial Essay and Clinical Practice Algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Pereira, Keith, E-mail: keithjppereira@gmail.com; Baker, Reginald, E-mail: rbaker@med.miami.edu; Salsamendi, Jason; Doshi, Mehul; Kably, Issam; Bhatia, Shivank [Jackson Memorial Hospital/University of Miami Hospital, Department of Interventional Radiology (United States)

    2016-05-15

    Transjugular intrahepatic portosystemic shunts (TIPS) have evolved as an effective and durable nonsurgical option in the treatment of portal hypertension (PH). It has been shown to improve survival in decompensated cirrhosis and may also serve as a bridge to liver transplantation. In spite of the technical improvements in the procedure, problems occur with the shunt which jeopardizes effective treatment of the PH. Appropriate management is vital to ensure the longevity of the conduit. Shunt revision techniques include endovascular revision techniques and new shunt creation or, in the appropriate patients, alternative/rescue therapies. The ability of interventional radiologists to restore adequate TIPS function has enormous implications for quality of life with palliation, morbidity/mortality related to variceal bleeding and survival if transplant candidates can live long enough to receive a new liver. As such, it is imperative that these treatment strategies are understood and employed when these patients are encountered. In this review, the restoration of appropriate shunt function using various techniques will be discussed as they apply to a variety of clinical scenarios, based on literature. In addition, illustrative case examples highlighting our experience at an academic tertiary medical center will be included. It is the intent to have this document serve as a concise and informative reference to be used by those who may encounter patients with suboptimal functioning TIPS.

  12. Endovascular coil embolization of segmental arteries prevents paraplegia after subsequent thoracoabdominal aneurysm repair: an experimental model.

    Science.gov (United States)

    Geisbüsch, Sarah; Stefanovic, Angelina; Koruth, Jacob S; Lin, Hung-Mo; Morgello, Susan; Weisz, Donald J; Griepp, Randall B; Di Luozzo, Gabriele

    2014-01-01

    To test a strategy for minimizing ischemic spinal cord injury after extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly 1 week before simulated aneurysm repair in an experimental model. Thirty juvenile Yorkshire pigs (25.2 ± 1.7 kg) were randomized into 3 groups. All SAs, both intercostal and lumbar, were killed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting. Seven to 10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5 ± 0.5 SAs in group 1 (T13/L1), and 4.5 ± 0.5 SAs in group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score (0 = paraplegia, 9 = full recovery). After death, each segment of spinal cord was graded histologically using the 9-point Kleinman score (0 = normal, 8 = complete necrosis). Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6 of 10 control pigs, but in only 2 of 10 pigs in group 1; no pigs in group 2 had a spinal cord injury. Tarlov scores were significantly better in group 2 (control vs group 1, P = .06; control vs group 2, P = .0002; group 1 vs group 2, P = .05). A dramatic reduction in histologic damage, most prominently in the coiled region, was seen when SAs were embolized before simulated TAAA repair. Endovascular coiling of 2 to 4 SAs prevented paraplegia in an experimental model of extensive hybrid TAAA repair, and helped protect the spinal cord from ischemic histopathologic injury. A clinical trial in a selected patient population at high risk for postoperative spinal cord injury may be appropriate. Copyright © 2014 The American Association for Thoracic Surgery. All rights reserved.

  13. Algorithm for management of patients with X-ray endovascular artery embolization of the prostate for its benign hyperplasia

    Directory of Open Access Journals (Sweden)

    O. B. Zhukov

    2016-01-01

    Full Text Available X-ray endovascular prostatic artery embolization (XEPAE is a comparatively new alternative treatment for benign prostatic hyperplasia (BPH, which has shown good results in Russia and foreign countries. The dissimilarity from other treatments for this nosology is the use of superselective artery ischemia of the prostate, which leads to a decrease in its sizes and a progressive reduction in lower urinary tract symptoms. Twelve patients aged 59–71 years (mean age, 66 years with BPH have been operated on since 2014. The mean follow-up period was 8.4 months (3–17 months. The patients were divided into 3 groups in accordance with prostate volume: 1 60–100 cm3 (n = 3; 2 100–200 сm3 (n = 5; 3 ≥ 200 см3 (n = 4. The mean prostatic specific antigen level was 5.1 ± 2.7 ng/ml (2.7–6.3 ng/ml. Due to the increased pro static specific antigen level up to 4 ng/ml, 6 patients underwent transrectal and/or targeted biopsy of the prostate, which failed to reveal the morphological signs of its malignant process. The examination algorithm included all necessary laboratory and clinical examinations, as those during surgery for BPH, as well as multislice spiral computed tomography and/or magnetic resonance imaging, angiography of small pelvic vessels and organs.  Postoperative patient monitoring revealed that the total International Prognostic Scoring System scores decreased by 41.3 and 61.4 % at 3- and 6-month follow-ups, respectively; then these values were insignificant. The prostate volume substantially decreased at 3 months; but at 6 months it was 47 % of the baseline one. The urine flow rate rose from 6.7 to 15.9 ml/sec. The quality of life index became summarily quite satisfactory at 6-month follow-up and amounted to 3.3 ± 1.3. Thus, it may be stated that XEPAE is a safe and highly effective treatment for BPH if its medical treatment is ineffective. This surgical treatment performed for 3–6 months substantially decreases the prostate

  14. Emergency endovascular repair of ruptured visceral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Tang Tjun

    2007-07-01

    Full Text Available Abstract Background Visceral artery aneurysms although rare, have very high mortality if they rupture. Case presentation An interesting case of a bleeding inferior pancreaticduodenal artery aneurysm is reported in a young patient who presented with hypovolemic shock while being treated in the hospital after undergoing total knee replacement. Endovascular embolization was successfully employed to treat this patient, with early hospital discharge. Conclusion Prompt diagnosis and endovascular management of ruptured visceral aneuryms can decrease the associated mortality and morbidity.

  15. Endovascular treatment of symptomatic intracranial atherosclerotic disease

    Directory of Open Access Journals (Sweden)

    Syed I Hussain

    2011-02-01

    Full Text Available Abstract: Symptomatic intracranial atherosclerotic disease (ICAD is responsible for approximately 10% of all ischemic strokes in the United States. The risk of recurrent stroke may be as high as 35% in patient with critical stenosis greater than 70% in diameter narrowing. Recent advances in medical and endovascular therapy have placed ICAD at the forefront of clinical stroke research to optimize the best medical and endovascular approach to treat this important underlying stroke etiology. Analysis of symptomatic ICAD studies lead to the question that whether angioplasty and or stenting is a safe, suitable and efficacious therapeutic strategy in patients with critical stenoses that are deemed refractory to medical management. Most of the currently available data in support of angioplasty and or stenting in high risk patients with severe symptomatic ICAD is in the form of case series and randomized trial results of endovascular therapy versus medical treatment are awaited. This is a comprehensive review of the state of the art in the endovascular approach with angioplasty and or stenting of symptomatic intracranial atherosclerotic disease.

  16. Feasibility of three-dimensional magnetic resonance angiography-fluoroscopy image fusion technique in guiding complex endovascular aortic procedures in patients with renal insufficiency.

    Science.gov (United States)

    Schwein, Adeline; Chinnadurai, Ponraj; Shah, Dipan J; Lumsden, Alan B; Bechara, Carlos F; Bismuth, Jean

    2017-05-01

    fusion was 4:09 ± 01:31 min:sec. Total fluoroscopy time was 20.1 ± 6.9 minutes. Five of 10 patients (50%) underwent stent graft deployment without any predeployment DSA acquisition. Three of six vessels (50%) were cannulated under image fusion guidance without any precannulation DSA runs, and the remaining vessels were cannulated after one planning DSA acquisition. Qualitative evaluation showed 14 of 22 virtual landmarks (63.6%) from MRA overlaid on fluoroscopy were completely accurate, without the need for adjustment. Five of eight incorrect virtual landmarks (iliac and visceral arteries) resulted from vessel deformation caused by endovascular devices. Ferumoxytol or gadolinium-enhanced MRA imaging and image fusion with fluoroscopy using noncontrast CBCT is feasible and allows patients with renal insufficiency to benefit from optimal guidance during complex endovascular aortic procedures, while preserving their residual renal function. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  17. The role of inelastic deformations in the mechanical response of endovascular shape memory alloy devices.

    Science.gov (United States)

    Petrini, Lorenza; Bertini, Alessandro; Berti, Francesca; Pennati, Giancarlo; Migliavacca, Francesco

    2017-05-01

    Nickel-titanium alloys are commonly adopted for producing cardiovascular minimally invasive devices such as self-expandable stents, aortic valves and stent-grafts. These devices are subjected to cyclic loads (due to blood pulsatility, leg or heart movements), that can induce fatigue fracture, and may also be subjected to very large deformations (due to crimping procedure, a tortuous physiological path or overloads), that can induce material yield. Recently, the authors developed a new constitutive model that considers inelastic strains due to not-completed reverse phase transformation (not all the stress-induced martensite turns back to austenite) or/and plasticity and their accumulation during cyclic loads. In this article, the model is implemented in the finite element code ABAQUS/Standard and it is used to investigate the effects of inelastic strain accumulation on endovascular nickel-titanium devices. In particular, the behavior of a transcatheter aortic valve is studied considering the following steps: (1) crimping, (2) expansion in a tube resembling a durability test chamber and (3) cyclic loads due to pressure variation applied on the inner surface of the tube. The analyses are performed twice, activating and not activating that part of the new model which describes the development of irreversible strain. From the results, it is interesting to note that plasticity has a very significant effect on the local material response, inducing stress modification from compression to tension. However, permanent deformations are concentrated in few zones of the stent frame and their presence does not affect the global behavior of the device that maintains its capability of recovering the original shape. In conclusion, this work suggests that at least for cardiovascular devices where the crimping is high (local strain may reach values of 8%-9%), taking into account inelastic effects due to plasticity and not-completed reverse phase transformation can be important, and

  18. Sexual Dysfunction After Conventional and Endovascular AAA Repair: Results of the DREAM Trial.

    NARCIS (Netherlands)

    Prinssen, M.; Buskens, E.; Nolthenius, R.P.T.; Sterkenburg, S. van; Teijink, J.A.; Blankensteijn, J.D.

    2004-01-01

    Purpose: To assess sexual function in the first postoperative year after elective endovascular aneurysm repair (EVAR) and open repair (OR) of abdominal aortic aneurysm (AAA).Methods: In the Dutch Randomized Endovascular Aneurysm Management (DREAM) trial, 153 patients (141 men; mean age 71 years,

  19. Patterns and management of blunt abdominal aortic injury.

    Science.gov (United States)

    Harris, Donald G; Drucker, Charles B; Brenner, Megan L; Sarkar, Rajabrata; Narayan, Mayur; Crawford, Robert S

    2013-11-01

    Blunt abdominal aortic injury (BAAI) is historically associated with significant morbidity and mortality. Our institutional experience was analyzed to define current patterns of injury and to help guide management. Adult patients with BAAI between January 2000 and July 2011 were identified from our trauma registry. Medical, radiographic, and autopsy records were reviewed for relevant clinical data. Management and outcomes were compared between patients with minimal aortic injury limited to the intima (MAI) compared to more significant aortic injury (SAI). Nine patients had MAI and 8 had SAI, including 2 dissections, 2 pseudoaneurysms, 2 branch avulsions, 1 thrombosis, and 1 transection. The MAI and SAI groups had similar demographics and patterns of injury, and all patients had significant polytrauma, with a mean injury severity score of 42. More MAI than SAI patients were managed nonoperatively (100% vs. 38%; P=0.01). All observed patients underwent repeat imaging during the index admission, 85% within 72 hours, and no observed lesions led to malperfusion, death, or progression during the index admission. One MAI progressed to a pseudoaneurysm within 8 months. Five SAI patients underwent aortic-related repairs, including 2 endovascular stent grafts, 2 open primary repairs, and 1 axillobifemoral bypass. Overall, 15 (88%) patients underwent procedures for any injury-9 required laparotomy (53%) and 2 underwent thoracotomy. There were 6 (35%) deaths, 2 attributable to aortic injury-1 from hemorrhage and 1 from hyperkalemic cardiac arrest after prolonged ischemia from infrarenal aortic occlusion. Among patients who survived the initial resuscitation, SAI was associated with a significantly higher mortality rate compared to MAI (50% vs. 0%; P=0.03). Patients with MAI are at low risk of complications and may be considered for observation. Patients with SAI requiring intervention manifest clinically and/or radiographically at presentation. Those not associated with

  20. Early experience with a modified preloaded system for fenestrated endovascular aortic repair.

    Science.gov (United States)

    Maurel, Blandine; Resch, Tim; Spear, Rafaelle; Roeder, Blayne; Bracale, Umberto M; Haulon, Stephan; Mastracci, Tara M

    2017-04-01

    Preloaded endovascular delivery systems expand the anatomic eligibility for complex aortic repair by requiring only one iliac access vessel and providing a stable platform for guiding sheaths into challenging target vessels. This article reports the lessons learned and early clinical outcomes using a modified preloaded delivery system for fenestrated endovascular aneurysm repair (FEVAR) in three aortic centers in Europe. From October 2015 to March 2016, consecutive patients presenting with extensive aortic aneurysm treated with a modified preloaded FEVAR were prospectively enrolled from three high volume European aortic centers. The new design is a modification of previous designs of preloaded fenestrated stent grafts and of the p-branch device platform. The technical details of implantation are described and perioperative outcomes, including the learning curve, are collected and reported. All patients (30 patients; 80% men; 70.2 years old) presented for nonurgent repair of either a type Ia endoleak (3/30; 10%), a type I-II-III thoracoabdominal (8/30; 27%), or a type IV thoracoabdominal or pararenal (19/30; 63.%) aneurysm repair of a mean size of 64 ± 13 mm using a custom made device. Primary technical success was achieved in 28 of 30 patients (93%) and assisted primary technical success in 29 of 30 patients (97%). The two technical failures included open conversion to repair a ruptured iliac artery and restenting of a dissected superior mesenteric artery which was recognized hours after the index procedure had finished. The mean procedure time was 277 ± 153 minutes, fluoroscopy time 79 ± 36 minutes, dose area product 112 ± 90 Gy cm2, and contrast volume 87 ± 46 mL. All renal fenestrations were successfully stented without type III endoleak on completion angiogram; the preloaded guiding sheaths were used for 53 of 58 renal arteries (91%). Challenges related to learning to the use of the modified preloaded system were experienced early and had no

  1. Virtual reality simulation for the optimization of endovascular procedures: current perspectives

    Directory of Open Access Journals (Sweden)

    Rudarakanchana N

    2015-03-01

    Full Text Available Nung Rudarakanchana,1 Isabelle Van Herzeele,2 Liesbeth Desender,2 Nicholas JW Cheshire1 1Department of Surgery, Imperial College London, London, UK; 2Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, BelgiumOn behalf of EVEREST (European Virtual reality Endovascular RESearch TeamAbstract: Endovascular technologies are rapidly evolving, often requiring coordination and cooperation between clinicians and technicians from diverse specialties. These multidisciplinary interactions lead to challenges that are reflected in the high rate of errors occurring during endovascular procedures. Endovascular virtual reality (VR simulation has evolved from simple benchtop devices to full physic simulators with advanced haptics and dynamic imaging and physiological controls. The latest developments in this field include the use of fully immersive simulated hybrid angiosuites to train whole endovascular teams in crisis resource management and novel technologies that enable practitioners to build VR simulations based on patient-specific anatomy. As our understanding of the skills, both technical and nontechnical, required for optimal endovascular performance improves, the requisite tools for objective assessment of these skills are being developed and will further enable the use of VR simulation in the training and assessment of endovascular interventionalists and their entire teams. Simulation training that allows deliberate practice without danger to patients may be key to bridging the gap between new endovascular technology and improved patient outcomes.Keywords: virtual reality, simulation, endovascular, aneurysm

  2. Endovascular treatment for intracranial infectious aneurysms Tratamento endovascular de aneurismas infecciosos intracranianos

    Directory of Open Access Journals (Sweden)

    Eduardo Wajnberg

    2008-12-01

    Full Text Available OBJETIVE: To re-enforce an alternative, less aggressive treatment modality in the management of intracranial infectious aneurysms. METHOD: We present a series of five patients with infectious endocarditis and intracranial infectious aneurysms (mycotic aneurysms managed by means of endovascular treatment. RESULTS: Endovascular treatment was executed technically uneventfully in all patients. Three patients had favorable clinical outcome: two were classified as Glasgow Outcome Scale 4/5, and one had total neurological recovery (GOS 5/5. Two patients died (GOS 1/5, one in consequence of the initial intracranial bleeding and the other after cardiac complications from endocarditis and open-heart surgery. CONCLUSION: Endovascular techniques are an expanding option for the treatment of IIAs. It has been especially useful for infectious endocarditis patients with IIA, who will be submitted to cardiac surgery with cardiopulmonary bypass and anticoagulation, with the risk of intracranial bleeding.OBJETIVO: Enfatizar o método endovascular como uma opção de tratamento alternativa e menos agressiva no tratamento de aneurismas infecciosos intracranianos. MÉTODO: Apresentamos uma série de cinco pacientes com endocardite infecciosa e aneurismas infecciosos intra-cranianos (aneurismas micóticos tratados através da via endovascular. RESULTADOS: O tratamento endovascular teve sucesso técnico e sem intercorrências relacionadas ao cateterismo em todos os casos. Três pacientes tiveram desfecho clínico favorável: dois com escala de regeneração de Glasgow 4/5 e um com recuperação neurológica completa (GOS 5/5. Dois pacientes tiveram desfecho desfavorável (GOS 1/5, um devido às conseqüências do sangramento intracraniano inicial e outro devido a complicações cardíacas da endocardite e cirurgia de troca valvar. CONCLUSÃO: As técnicas endovasculares são uma nova opção de tratamento dos aneurismas infecciosos intracranianos. Ela é especialmente

  3. Fístula aortoesofágica após correção endovascular da dissecção de aorta torácica tipo B de Stanford Aortic-esophageal fistula after endovascular repair of Stanford type B thoracic aortic dissection

    Directory of Open Access Journals (Sweden)

    Cláudia Gurgel Marques

    2010-01-01

    Full Text Available A correção endovascular da dissecção de aorta tipo B tem se mostrado como uma nova alternativa para reduzir o trauma cirúrgico. No entanto, as complicações de médio e longo prazo, tais como a fístula aortoesofágica, são ainda pouco conhecidas e pouco relatadas. O objetivo deste trabalho é descrever três casos de fístula aortoesofágica após o tratamento endovascular de 23 casos de dissecção de aorta descendente conduzidos pela equipe de Cirurgia Vascular da Santa Casa de São Paulo em um estudo retrospectivo. Esses pacientes apresentavam características em comum, como dissecção crônica, pós-operatório imediato sem intercorrências, necessidade de reintervenções, oclusão de troncos arteriais como a artéria subclávia, mesentérica, tronco celíaco, e, ainda, uma rápida evolução para o óbito após os primeiros sinais de fístula. Portanto, embora raramente descrita na literatura, a ocorrência de fístula aortoesofágica é uma complicação de causa até o momento indefinida do tratamento endovascular da dissecção de aorta descendente que merece atenção, dada sua recorrência e evolução fatal.Endoluminal stent-graft for type B aortic dissection is a new alternative to reduce surgical trauma. However, medium- and long-term complications are still little known and poorly reported, such as the aortic-esophageal fistula. The objective of this study is to describe three cases of aortic-esophageal fistula after the endovascular treatment of 23 cases of descending aortic dissection conducted by the vascular surgery team of Santa Casa de São Paulo in a retrospective study. These patients presented some common characteristics: chronic dissection, successful early outcome, need of reinterventions, occlusion of arterial trunks such as subclavian artery, mesenteric artery, celiac trunk, and finally, a fast fatal course after the first fistula-related symptoms. Therefore, despite rarely described in the literature, aortic

  4. New insights regarding the incidence, presentation and treatment options of aorto-oesophageal fistulation after thoracic endovascular aortic repair

    DEFF Research Database (Denmark)

    Czerny, Martin; Eggebrecht, Holger; Sodeck, Gottfried

    2014-01-01

    To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR).......To review the incidence, clinical presentation, definite management and 1-year outcome in patients with aorto-oesophageal fistulation (AOF) following thoracic endovascular aortic repair (TEVAR)....

  5. [Standardize the endovascular treatment for arteriosclerosis obliterans].

    Science.gov (United States)

    Wang, S M; Yao, C

    2016-08-01

    Endovascular therapy has become the first-line strategy for most peripheral artery disease cases. Currently, many guidelines recommend endovascular therapy as the first choice for arteriosclerosis obliterans. Recently, drug-eluting stent and drug-coated balloon are available. The clinical outcomes have been greatly improved with the evolution of devices. However, the long-term outcomes of endovascular therapy for arteriosclerosis obliterans are still not satisfied. Many centers treat arteriosclerosis obliterans using endovascular therapy in appropriately. In this editorial, an evidence-based approach and some strategies will be discussed to standardize the endovascular treatment and improve the result of endovascular therapy for arteriosclerosis obliterans.

  6. Management of giant middle cerebral artery aneurysms with incorporated branches: partial endovascular coiling or combined extracranial-intracranial bypass--a team approach.

    Science.gov (United States)

    Shi, Zhong-Song; Ziegler, Jordan; Duckwiler, Gary R; Jahan, Reza; Frazee, John; Ausman, James I; Martin, Neil A; Viñuela, Fernando

    2009-12-01

    Our goal was to assess the long-term anatomic and clinical outcomes in patients with giant middle cerebral artery (MCA) aneurysms treated by endovascular coil embolization alone or in combination with cerebral revascularization. One hundred twenty-six patients with giant intracranial aneurysms were endovascularly treated at the University of California, Los Angeles, between 1990 and 2007. Of these, 9 patients had partially thrombosed MCA aneurysms with incorporated branches. Five patients presented with symptoms of mass effect, 3 had seizures, 2 had episodes of brain ischemia, and 1 presented with acute subarachnoid hemorrhage. Three wide-neck saccular aneurysms were almost completely coil occluded, leaving only small neck remnants that were intended to preserve the patency of incorporated MCA branches. The other 6 fusiform aneurysms were effectively treated by superficial temporal artery-MCA or occipital artery-MCA bypass, followed by complete coil occlusion of these aneurysms. Immediate angiograms and mid- or long-term neuroradiological imaging follow-up examinations revealed complete obliteration or near-complete occlusion (90%-99%) of the aneurysms in all 9 patients. Seven patients had a favorable long-term clinical outcome, and 1 patient died as a result of unrelated congestive heart failure. One patient required emergent surgical aneurysm thrombectomy because of inadvertent coil occlusion of the frontal opercular artery, which was not protected by the bypass, and the patient subsequently sustained a moderate neurological disability. Giant MCA aneurysms with branch incorporations and other unfavorable features such as intraluminal thrombus, mural calcification, and fusiform configuration can be effectively treated with a team approach, using coil embolization after protective surgical bypass. When aneurysms with MCA branches incorporated into the neck rather than the dome are treated by endovascular techniques alone, long-term angiographic follow-up is

  7. Comparison between endovascular repair and open surgery for isolated iliac artery aneurysms.

    Science.gov (United States)

    Igari, Kimihiro; Kudo, Toshifumi; Toyofuku, Takahito; Jibiki, Masatoshi; Inoue, Yoshinori

    2015-03-01

    This study was performed to compare endovascular repair with conventional open repair of isolated iliac artery aneurysms (IAAs). We retrospectively reviewed the charts of all patients who underwent repair of isolated IAAs between January 2008 and June 2012. Patients with infected, mycotic and ruptured iliac aneurysms and those with concurrent infrarenal abdominal aortic aneurysms greater than 30 mm in diameter were excluded from this analysis. A total of 32 patients were treated with isolated IAAs. There were 20 open and 12 endovascular repairs. A comparison of the length of the operation (238 ± 84 min in the open group vs 176 ± 72 min in the endovascular group, P = 0.03) and intraoperative blood loss (1,735 ± 1,177 ml in the open group vs 503 ± 711 ml in the endovascular group, P = 0.01), revealed significant differences in favor of the endovascular procedure. Postoperative complications were less common in the endovascular group, although the difference did not reach statistical significance. The management of isolated IAAs with both endovascular and open repair can be accomplished with very low morbidity rates. Therefore, endovascular repair can be considered an alternative treatment for isolated IAAs.

  8. Endovascular therapy for vasculogenic erectile dysfunction.

    Science.gov (United States)

    Rogers, Jason H; Rocha-Singh, Krishna J

    2012-04-01

    Erectile dysfunction (ED) is an important clinical condition that affects a significant proportion of men. Although there are many etiologies for ED, many cases have a vascular basis that is related to inadequate arterial inflow, veno-occlusive dysfunction, or abnormalities in smooth muscle (cavernosal tissue) relaxation. These vascular abnormalities can exist in isolation or combination. Since the advent of phosphodiesterase-5 inhibitor (PDE5i) therapy, the initial management of ED in most cases consists of a brief medical evaluation followed by a trial of PDE5i therapy. However, up to 50% of men have an inadequate response to PDE5i therapy and discontinue therapy. Subsequent therapies for ED are increasingly invasive, including penile injection of vasodilators, vacuum pumps, and penile implants. With increased awareness of ED among clinicians and the growing mechanistic link between ED and atherosclerotic vascular disease, there has been renewed interest in the diagnosis and management of arteriogenic ED. Prior reports in the 1980s described the existence of arterial inflow lesions in patients with ED, and there are a modest number of reports describing the feasibility of revascularization with balloon angioplasty. Despite initial clinical success, enthusiasm for this technique waned, presumably because ED frequently recurred due to restenosis and lack of small vessel endovascular therapies. Recent investigation and the availability of newer tools such as drug-eluting stents have renewed interest in this field. Although conceptually attractive, endovascular therapy for ED presents significant challenges related to unanswered questions such as the prevalence and appropriate diagnostic evaluation of arteriogenic ED, and the safety and feasibility of stent-based therapies in this population. In addition, the evaluation, management, and follow-up of patients with vascular ED require a multi-disciplinary team with specialists in urology, sexual medicine, and vascular

  9. Embolization of a deep orbital varix through endovascular route

    Directory of Open Access Journals (Sweden)

    R Ravi Kumar

    2015-01-01

    Full Text Available We report a case of the primary deep orbital venous varix treated by endovascular coil embolization procedure by transfemoral catheterization. This method of treatment has the advantage of image-guided localization of the pathology, real-time management and confirmation of the success of the procedure in the sitting.

  10. 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.

  11. Hygroma following endovascular femoral aneurysm exclusion

    DEFF Research Database (Denmark)

    Wad, Morten; Pedersen, Brian Lindegaard; Lönn, Lars

    2013-01-01

    Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory.......Endovascular treatment of aneurysms in the superficial femoral artery (SFA) and popliteal segments is a suggested alternative to open surgical repair. Careful selection of patients for endovascular treatment of SFA aneurysms is mandatory....

  12. Noninvasive vascular ultrasound elastography applied to the characterization of experimental aneurysms and follow-up after endovascular repair

    Energy Technology Data Exchange (ETDEWEB)

    Fromageau, Jeremie; Maurice, Roch Listz; Cloutier, Guy [Laboratory of Biorheology and Medical Ultrasonics, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, H2L 2W5 (Canada); Lerouge, Sophie [Laboratory of Endovascular Biomaterials, University of Montreal Hospital Research Center (CRCHUM), Montreal, Quebec, H2L 2W5 (Canada) and Department of Mechanical Engineering, Ecole de Technologie Superieure, Montreal, Quebec, H3C 1K3 (Canada); Soulez, Gilles [Department of Radiology, University of Montreal Hospital, Montreal, Quebec, H2L 4M1 (Canada)], E-mail: guy.cloutier@umontreal.ca

    2008-11-21

    Experimental and simulation studies were conducted to noninvasively characterize abdominal aneurysms with ultrasound (US) elastography before and after endovascular treatment. Twenty three dogs having bilateral aneurysms surgically created on iliac arteries with venous patches were investigated. In a first set of experiments, the feasibility of elastography to differentiate vascular wall elastic properties between the aneurismal neck (healthy region) and the venous patch (pathological region) was evaluated on six dogs. Lower strain values were found in venous patches (p < 0.001). In a second set of experiments, 17 dogs having endovascular repair (EVAR) by stent graft (SG) insertion were examined three months after SG implantation. Angiography, color Doppler US, examination of macroscopic sections and US elastography were used. The value of elastography was validated with the following end points by considering a solid thrombus of a healed aneurysm as a structure with small deformations and a soft thrombus associated with endoleaks as a more deformable tissue: (1) the correlation between the size of healed organized thrombi estimated by elastography and by macroscopic examinations; (2) the correlation between the strain amplitude measured within vessel wall elastograms and the leak size; and (3) agreement on the presence and size of endoleaks as determined by elastography and by combined reference imaging modalities (angiography + Doppler US). Mean surfaces of solid thrombi estimated with elastography were found correlated with those measured on macroscopic sections (r = 0.88, p < 0.001). Quantitative strain values measured within the vessel wall were poorly linked with the leak size (r = 0.12, p = 0.5). However, the qualitative evaluation of leak size in the aneurismal sac was very good, with a Kappa agreement coefficient of 0.79 between elastography and combined reference imaging modalities. In summary, complementing B-scan and color Doppler, noninvasive US

  13. 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.)

  14. Aortoesophageal fistula secondary to mycotic thoracic aortic aneurysm: Endovascular repair and transhiatal esophagectomy

    NARCIS (Netherlands)

    van Doorn, Ruth C.; Reekers, Jim; de Mol, Bas A. J. M.; Obertop, Huug; Balm, Ron

    2002-01-01

    Purpose: To report a case of aortoesophageal fistula secondary to a mycotic thoracic aortic aneurysm (TAA) successfully repaired by stent-grafting of the descending thoracic aorta. Case Report: A 66-year-old woman with a recent history of hemicolectomy for colon cancer complicated by postoperative

  15. Outcome and quality of life after endovascular abdominal aortic aneurysm repair in octogenarians

    NARCIS (Netherlands)

    Pol, Robert A.; Zeebregts, Clark J.; van Sterkenburg, Steven M. M.; Ferreira, Luis M.; Goktay, Yigit; Reijnen, Michel M. P. J.

    Objective: This study determined outcome and quality of life (QOL) in octogenarians, compared with patients aged Methods: From March 2009 until April 2011, 1263 patients in the Endurant Stent Graft Natural Selection Global Postmarket Registry (ENGAGE) registry with an abdominal aortic aneurysm were

  16. Intracranial pediatric aneurysms: endovascular treatment and its outcome.

    Science.gov (United States)

    Saraf, Rashmi; Shrivastava, Manish; Siddhartha, Wuppalapati; Limaye, Uday

    2012-09-01

    The aim of this study was to analyze the location, clinical presentation, and morphological characteristics of pediatric aneurysms and the safety, feasibility, and durability of endovascular treatment. The authors conducted a retrospective study of all cases involving patients 18 years old or younger who underwent endovascular treatment for pediatric aneurysms at their institution between July 1998 and July 2010. The clinical presentation, aneurysm location, endovascular management, and treatment outcome were studied. During the study period, 23 pediatric patients (mean age 13 years, range 2 months-18 years) were referred to the authors' department and underwent endovascular treatment for aneurysms. The aneurysms were saccular in 6 cases, dissecting in 4, infectious in 5, and giant partially thrombosed lesions in 8. Fourteen of the aneurysms were ruptured, and 9 were unruptured. Thirteen were in the anterior circulation and 10 in the posterior circulation. The most common location in the anterior circulation was the anterior communicating artery; in the posterior circulation, the most common location was the basilar artery. Saccular aneurysms were the most common type in the anterior circulation; and giant partially thrombosed and dissecting aneurysms were the most common types in the posterior circulation. Coil embolization was performed in 7 cases, parent vessel sacrifice in 10, flow reversal in 3, glue embolization in 2, and stent placement in 1. Immediate angiographic cure was seen in 21 (91%) of 23 patients. Complications occurred in 4 patients, 3 of whom eventually had a good outcome. No patient died. Overall, a favorable outcome was seen in 22 (96%) of 23 patients. Follow-up showed stable occlusion of aneurysms in 96% of the patients. Pediatric aneurysms are rare. Their clinical presentation varies from intracranial hemorrhage to mass effect. They may also be found incidentally. Among pediatric patients with aneurysms, giant aneurysms are relatively common

  17. Aneurisma de aorta abdominal justa-renal: correção endovascular combinada com derivação ilíaco-renal direita para criar colo proximal adequado Juxtarenal abdominal aortic aneurysm: combined endovascular and open repair with right iliorenal bypass to create adequate proximal neck

    Directory of Open Access Journals (Sweden)

    Matheus Bredarioli

    2007-06-01

    Full Text Available Homem de 78 anos de idade, portador de múltiplas morbidades clínicas deu entrada na emergência com um aneurisma de aorta abdominal justa-renal em condições hemodinâmicas estáveis. A tomografia computadorizada caracterizou aneurisma de 6 cm de diâmetro, e a distância do colo proximal do aneurisma era de 5 mm em relação à artéria renal direita e 28 mm à esquerda. Em virtude das condições clínicas do paciente, optou-se pelo reparo endovascular, mas previamente fez-se uma derivação ilíaco-renal direita com enxerto de politetrafluoretileno, via retroperitoneal para se criar um colo proximal adequado. Após quatro dias, o aneurisma de aorta abdominal foi corrigido colocando-se uma endoprótese Excluder® sem intercorrências. O seguimento pós-operatório evidenciou boa perfusão do rim esquerdo e ausência de migração ou endoleak da endoprótese. Este caso ilustra a combinação de técnicas para tornar possível o reparo de aneurisma de aorta abdominal justa-renal em pacientes de alto risco cirúrgico e anatomia desfavorável.A 78-year-old man with a juxtarenal abdominal aortic aneurysm and several comorbid conditions was admitted at the emergency room in hemodynamically stable conditions. Computed tomography revealed an aneurysm measuring 6 cm in diameter beginning 28 mm below the left renal artery and 5 mm below the right renal artery. Because of the patient's clinical status, a bypass from the right iliac artery to the right renal artery was performed through a retroperitoneal approach using a polytetrafluoroethylene vascular graft. Four days later, an endovascular aneurysm repair was successfully performed using an Excluder® stent-graft. Postoperative follow-up showed good left renal perfusion and no migration or endoleak. This case illustrates the effectiveness of combining open and endovascular techniques to repair juxtarenal abdominal aortic aneurysm in high-risk patients with unfavorable anatomy.

  18. Endovascular treatment of a chronically occluded limb of endograft with combination TNK pharmacological and EKOS thrombolytic catheter system

    Energy Technology Data Exchange (ETDEWEB)

    Stambo, Glenn W., E-mail: xraydoc2@yahoo.co [SDI Radiologists, Department of Vascular and Interventional Radiology, St. Joseph' s Hospital and Medical Center, 4516 N. Armenia Ave., Tamp, FL 33603 (United States); Gabriel, Yves [Department of Vascular Surgery, St Joseph' s Hospital and Medical Center, 4516 N. Armenia Ave., Tamp, FL 33603 (United States)

    2011-02-15

    Arterial occlusion is a common and sometimes devastating medical condition related to peripheral vascular and cardiovascular disease. These patients are at severe risk of limb loss and death. Those patients with embolic phenomena are at significantly higher mortality risk than those with thrombosis. Catheter directed therapies have been used routinely for restoration of perfusion to a limb removing the thrombosis or embolic material. Limb thrombosis following endovascular graft placement is a known complication occurring within the first year of the endograft. In many institutions, endovascular treatment of aortic limb occlusions has become the initial management for acute occlusions. We describe the endovascular treatment of a chronic occluded limb utilizing a combination of pharmacological and mechanical thrombolysis using the new ultrasound enhanced EKOS catheter system. Endovascular specialists should be aware that chronically occluded endograft limbs can be successfully treated in the endovascular suite with the EKOS system without requiring more invasive surgical therapies.

  19. Current status of endovascular stroke treatment.

    Science.gov (United States)

    Meyers, Philip M; Schumacher, H Christian; Connolly, E Sander; Heyer, Eric J; Gray, William A; Higashida, Randall T

    2011-06-07

    The management of acute ischemic stroke is rapidly developing.Although acute ischemic stroke is a major cause of adult disability and death, the number of patients requiring emergency endovascular intervention remains unknown, but is a fraction of the overall stroke population. Public health initiatives endeavor to raise public awareness about acute stroke to improve triage for emergency treatment, and the medical community is working to develop stroke services at community and academic medical centers throughout the United States. There is an Accreditation Council for Graduate Medical Education–approved pathway for training in endovascular surgical neuroradiology, the specialty designed to train physicians specifically to treat cerebrovascular diseases. Primary and comprehensive stroke center designations have been defined, yet questions remain about the best delivery model. Telemedicine is available to help community medical centers cope with the complexity of stroke triage and treatment. Should comprehensive care be provided at every community center, or should patients with complex medical needs be triaged to major stroke centers with high-level surgical,intensive care, and endovascular capabilities? Although the answers to these and other questions about stroke care delivery remain unanswered owing to the paucity of empirical data, we are convinced that stroke care regionalization is crucial for delivery of high-quality comprehensive ischemic stroke treatment. A stroke team available 24 hours per day, 7 days per week requires specialty skills in stroke neurology, endovascular surgical neuroradiology, neurosurgery, neurointensive care, anesthesiology, nursing, and technical support for optimal success. Several physician groups with divergent training backgrounds (i.e., interventional neuroradiology, neurosurgery,neurology, peripheral interventional radiology, and cardiology) lay claim to the treatment of stroke patients,particularly the endovascular or

  20. Cerebrovascular neurosurgery in evolution: the endovascular paradigm.

    Science.gov (United States)

    Sorkin, Grant C; Dumont, Travis M; Eller, Jorge L; Mokin, Maxim; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H; Hopkins, L Nelson

    2014-02-01

    Endovascular technique represents an important, minimally invasive approach to treating cerebrovascular disease. In this article, we discuss the origins of endovascular neurosurgery as a discipline in the context of important technical milestones, evidence-based medicine, and future cerebrovascular neurosurgical training. Cerebrovascular neurosurgery has seen a steady, convergent evolution toward the surgeon capable of seamless incorporation of open and endovascular approaches to any complex vascular disease affecting the central nervous system. Neurosurgery must assume the leadership role in the multidisciplinary neurovascular team.

  1. Perioperative and mid-term results of endovascular management of complicated type B aortic dissection using a proximal thoracic endoprosthesis and selective distal bare stenting.

    Science.gov (United States)

    Kische, Stephan; D'Ancona, Giuseppe; Belu, Ioan Christian; Stoeckicht, Yannik; Agma, Umut; Ortak, Jasmin; Ince, Hüseyin

    2015-10-01

    To present results of endovascular treatment of complicated type B aortic dissection. Patients with acutely complicated type B aortic dissection extending from the left sub-clavian artery to the abdominal aorta were treated. The strategy involved the placement of a covered endoprosthesis to seal the primary entry tear and, in cases where malperfusion persisted, distal extension with uncovered stents, to enhance true lumen (TL) expansion and reperfusion of the ischaemic arterial branches originating from the TL. Thirty-five patients were included. Mean age was 63.1 (37-79) years and malperfusion syndrome occurred in 71.4%. Average aortic coverage with endoprostheses was 220.6 mm (136-355 mm). In 17 cases (48.5%), distal extension with uncovered stents was necessary. Thirty-day major morbidity was 28.5%, and mortality 2.8%. At follow-up (25.6 ± 19.5 months; 4-73 months), overall mortality was 15.2%, and aortic mortality 12.1%. Additional aortic intervention was necessary in 18.2%. Although patients undergoing distal extension with bare metal stents suffered most often from preoperative malperfusion, no significant differences were noted in the 30-day and follow-up clinical results. Follow-up angio-computed tomography showed complete thrombosis of the false lumen in the proximal half of the thoracic aorta in 76.4%. Patients treated with bare stents had significantly larger aortic TL sizes, at the different abdominal aorta levels. In patients with complicated type B aortic dissection, tailored elongation with uncovered stents is a safe treatment of persistent malperfusion. Although the results presented are encouraging, randomized data and a longer follow-up are required to confirm benefits and complications of this strategy. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  2. 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.

  3. Endovascular blood flow measurement system

    Science.gov (United States)

    Khe, A. K.; Cherevko, A. A.; Chupakhin, A. P.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    In this paper an endovascular measurement system used for intraoperative cerebral blood flow monitoring is described. The system is based on a Volcano ComboMap Pressure and Flow System extended with analogue-to-digital converter and PC laptop. A series of measurements performed in patients with cerebrovascular pathologies allows us to introduce “velocity-pressure” and “flow rate-energy flow rate” diagrams as important characteristics of the blood flow. The measurement system presented here can be used as an additional instrument in neurosurgery for assessment and monitoring of the operation procedure. Clinical data obtained with the system are used for construction of mathematical models and patient-specific simulations. The monitoring of the blood flow parameters during endovascular interventions was approved by the Ethics Committee at the Meshalkin Novosibirsk Research Institute of Circulation Pathology and included in certain surgical protocols for pre-, intra- and postoperative examinations.

  4. A look into the endovascular crystal ball

    DEFF Research Database (Denmark)

    Schroeder, T V

    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...

  5. Simultaneous Endovascular Treatment of Ruptured Cerebral Aneurysms and Vasospasm

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Young Dae; Han, Moon Hee; Kang, Hyun Seung; Kim, Jeong Eun [Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Ahn, Jun Hyoung [Dept. of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of); Jung, Seung Chai [Dept. of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul (Korea, Republic of); Kim, Chang Hun [Dept. of Neurology, Stroke Center, Myongji Hospital, Goyang (Korea, Republic of); Lim, Jeong Wook [Dept. of Neurosurgery, Sun Hospital, Daejeon (Korea, Republic of)

    2015-02-15

    The management of patients with ruptured cerebral aneurysms and severe vasospasm is subject to considerable controversy. We intended to describe herein an endovascular technique for the simultaneous treatment of aneurysms and vasospasm. A series of 11 patients undergoing simultaneous endovascular treatment of ruptured aneurysms and vasospasm were reviewed. After placement of a guiding catheter within the proximal internal carotid artery for coil embolization, an infusion line of nimodipine was wired to one hub, and of a microcatheter was advanced through another hub (to select and deliver detachable coils). Nimodipine was then infused continuously during the coil embolization. This technique was applied to 11 ruptured aneurysms accompanied by vasospasm (anterior communicating artery, 6 patients; internal carotid artery, 2 patients; posterior communicating and middle cerebral arteries, 1 patient each). Aneurysmal occlusion by coils and nimodipine-induced angioplasty were simultaneously achieved, resulting in excellent outcomes for all patients, and there were no procedure-related complications. Eight patients required repeated nimodipine infusions. Our small series of patients suggests that the simultaneous endovascular management of ruptured cerebral aneurysms and vasospasm is a viable approach in patients presenting with subarachnoid hemorrhage and severe vasospasm.

  6. The compatibility of p-branch "off-the-shelf" fenestrated endovascular graft in Asian patients with juxtarenal aortic aneurysm.

    Science.gov (United States)

    Ou, Jiale; Cheng, Stephen W K; Chan, Yiu Che

    2015-06-01

    The Zenith pivot branch (p-branch) fenestrated endovascular graft (Cook Medical, Bloomington, Ind) is a new "off-the-shelf" device to treat patients with juxtarenal aortic aneurysms (JRAs). Two options are currently available, which appear to suit >70% of white patients. This study investigates the anatomic applicability of the p-branch fenestrated graft in a cohort of Asian patients with JRA. Computed tomography images of 51 consecutive Asian patients with JRA (43 men; mean age, 76.8 years) were analyzed on an Aquarius workstation (TeraRecon, San Mateo, Calif) and matched to two current configurations of the p-branch (options A and B: single superior mesenteric artery [SMA] and two renal fenestrations, and a celiac axis scallop). With use of the SMA as reference, the anatomic positions of both renal arteries and the celiac axis were figured together with their diameters on a template generated on MATLAB (MathWorks, Natick, Mass), and then they were matched with two graft configurations. The renal artery origins were assessed for three classes of "closeness of fit" based on diameter: perfect match, marginal match, and mismatch, respectively, defined as the renal artery origins being located entirely inside, partially inside, and completely outside their corresponding fenestrations. The suitability of the p-branch graft design to the aneurysms was then evaluated. A total of 31 JRA patients (60.8%) were regarded as suitable candidates for one or both p-branch stent grafts (20 with option A, 22 with option B, and 11 with both options). In 35 patients (68.6%), both renal arteries could be aligned with the fenestrations. Among them, 16 patients (31.4%) were perfectly matched, whereas 19 patients (37.2%) were only marginally suitable. The major reason for exclusion was the misalignment of the renal fenestrations. In 16 patients with unsuitable renal fenestrations, 8 were attributed to the right renal origins being located too distally compared with their corresponding

  7. Carotid Stump Syndrome: Case Report and Endovascular Treatment.

    Science.gov (United States)

    Dakhoul, Lara Toufic; Tawk, Rabih

    2014-01-01

    Objectives. To highlight the case of a patient with multiple transient ischemic attacks and visual disturbances diagnosed with carotid stump syndrome and managed with endovascular approach. Case Presentation. We present the case of a carotid stump syndrome in an elderly patient found to have moderate left internal carotid artery stenosis in response to an advertisement for carotid screening. After a medical therapeutic approach and a close follow-up, transient ischemic attacks recurred. Computed tomographic angiography showed an occlusion of the left internal carotid artery and the presence of moderate stenosis in the right internal carotid artery, which was treated by endovascular stenting and balloon insertion. One month later, the patient presented with visual disturbances due to the left carotid stump and severe stenosis of the left external carotid artery that was reapproached by endovascular stenting. Conclusion. Considerations should be given to the carotid stump syndrome as a source of emboli for ischemic strokes, and vascular assessment could be used to detect and treat this syndrome.

  8. Endovascular uterine artery interventions

    Directory of Open Access Journals (Sweden)

    Chandan J Das

    2017-01-01

    Full Text Available Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs, as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH, placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes.

  9. Endovascular uterine artery interventions

    Science.gov (United States)

    Das, Chandan J; Rathinam, Deepak; Manchanda, Smita; Srivastava, D N

    2017-01-01

    Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes. PMID:29379246

  10. Acquisition of endovascular skills for uterine artery embolization using a simulator

    DEFF Research Database (Denmark)

    McLucas, Bruce; Coats, Richard; Lönn, Lars Birger

    2009-01-01

    This study addresses endovascular training using simulators for uterine artery embolization. A review of endovascular skill training for surgeons using simulators was performed. Surgeons possess varying levels of proficiency in endovascular techniques. A simulator will improve endovascular skills...

  11. Multimodal endovascular treatment for traumatic carotidcavernous fistula

    Directory of Open Access Journals (Sweden)

    ZENG Tao

    2013-12-01

    Full Text Available 【Abstract】Objective: To present our experience in treating traumatic carotid-cavernous fistula (TCCF by multimodal endovascular treatment. Methods: The management of 28 patients with TCCF between January 2004 and October 2012 in our hospital was retrospectively analyzed. According to imaging charateristics, 24 cases were categorized into Type I, 3 Type II and 1 Type III. Totally 30 endovascular treatments were performed: Type I TCCFs were obliterated via transvenous approach (7/25, or transarterial approach (18/25 including 6 by detachable balloon occlusion, 6 by microcoil embolization, 3 by Hyperglide balloon-assisted coil embo- lization and 3 by a combination of detachable balloon and coil embolization. Two patients were treated with closure of internal carotid artery (ICA. Type II TCCFs were treated with transvenous embolotherapy (2/3 or carotid artery com- pression therapy (1/3. The Type III patient underwent de- tachable balloon embolization. Results: Immediate postoperative angiography showed recovery in 26 cases. One recurrent TCCF was found 2 weeks after detachable balloon embolization, and then re- Chin J Traumatol 2013;16(6:334-338 obliterated by transarterial coils. Reexamination found bal- loon deflation and fistula recanalization in 1 patient one month after combination of detachable balloons and coil embolization, which was cured by a second treatment via transvenous approach. The immediate angiography revealed residual blood flow in 4 patients. Among them, 2 patients with delayed symptoms at follow-up needed a second treatment, 1 patient recovered after carotid artery compres- sion therapy, and the remaining patient’s symptoms disap- peared on digital subtraction angiography at five-month follow-up. CT angiography revealed anterior communicat- ing artery aneurysm in the patient who was treated with closure of ICA 4 years later. Conclusion: According to results of images, characteristics of the fistula and type of drainage

  12. Endovascular embolisation of a cervical spinal AVF in a patient with ...

    African Journals Online (AJOL)

    Vascular abnormalities associated with neurofibromatosis type 1 (NF1) are well described. Spinal arterio-venous fistula (AVF) is a rare finding in NF1 and may present with neurological symptoms that require treatment. Management of spinal AVFs can be endovascular or surgical. We present a patient with known NF1 and ...

  13. Prospective, multicenter study of endovascular repair of aortoiliac and iliac aneurysms using the Gore Iliac Branch Endoprosthesis.

    Science.gov (United States)

    Schneider, Darren B; Matsumura, Jon S; Lee, Jason T; Peterson, Brian G; Chaer, Rabih A; Oderich, Gustavo S

    2017-09-01

    The GORE EXCLUDER Iliac Branch Endoprosthesis (IBE; W. L. Gore and Associates, Flagstaff, Ariz) is an iliac branch stent graft system designed to preserve internal iliac artery perfusion during endovascular repair of aortoiliac aneurysms (AIAs) and common iliac artery (CIA) aneurysms (CIAAs). We report the 6-month primary end point results of the IBE 12-04 United States pivotal trial for endovascular treatment of AIAs and CIAAs using the IBE device. The trial prospectively enrolled 63 patients with AIA or CIAA who underwent implantation of the IBE device at 28 centers in the United States from 2013 to 2015. All patients underwent placement of a single IBE device. Twenty-two patients (34.9%) with bilateral CIAs were enrolled after undergoing staged coil or plug embolization (21 of 22) or surgical revascularization (1 of 22) of the contralateral internal iliac artery. Follow-up at 30 days and 6 months included clinical assessment and computed tomography angiography evaluation as assessed by an independent core laboratory. The primary effectiveness end point was freedom from IBE limb occlusion and reintervention for type I or III endoleak and ≥60% stenosis at 6 months, and the secondary effectiveness end point was freedom from new onset of buttock claudication on the IBE side at 6 months. Mean CIA diameter on the IBE side was 41.0 ± 11.4 mm (range, 25.2-76.3 mm). There were no procedural deaths, and technical success, defined as successful deployment and patency of all IBE components and freedom from type I or III endoleak, was 95.2% (60 of 63). Data for 61 patients were available for primary and secondary effectiveness end point analysis. Internal iliac limb patency was 95.1% (58 of 61), and no new type I or III endoleaks or device migrations were observed at 6 months. The three patients with loss of internal iliac limb patency were asymptomatic, and freedom from new-onset buttock claudication on the IBE side was 100% at 6 months. New-onset buttock

  14. 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

  15. Therapeutic hypothermia after cardiac arrest: a retrospective comparison of surface and endovascular cooling techniques.

    Science.gov (United States)

    Gillies, Michael A; Pratt, Rosalie; Whiteley, Craig; Borg, Jamie; Beale, Richard J; Tibby, Shane M

    2010-09-01

    Therapeutic hypothermia (32-34 degrees C) is recommended for comatose survivors of cardiac arrest; however, the optimal technique for cooling is unknown. We aimed to compare therapeutic hypothermia using either surface or endovascular techniques in terms of efficacy, complications and outcome. Retrospective cohort study. Thirty-bed teaching hospital intensive care unit (ICU). All patients (n=83) undergoing therapeutic hypothermia following cardiac arrest over a 2.5-year period. The mean age was 61+/-16 years; 88% of arrests occurred out of hospital, and 64% were ventricular fibrillation/tachycardia. Therapeutic hypothermia was initiated in the ICU using iced Hartmann's solution, followed by either surface (n=41) or endovascular (n=42) cooling; choice of technique was based upon endovascular device availability. The target temperature was 32-34 degrees C for 12-24 h, followed by rewarming at a rate of 0.25 degrees Ch(-1). Endovascular cooling provided a longer time within the target temperature range (p=0.02), less temperature fluctuation (p=0.003), better control during rewarming (0.04), and a lower 48-h temperature load (p=0.008). Endovascular cooling also produced less cooling-associated complications in terms of both overcooling (p=0.05) and failure to reach the target temperature (p=0.04). After adjustment for known confounders, there were no differences in outcome between the groups in terms of ICU or hospital mortality, ventilator free days and neurological outcome. Endovascular cooling provides better temperature management than surface cooling, as well as a more favorable complication profile. The equivalence in outcome suggested by this small study requires confirmation in a randomized trial. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  16. Neck diameter and inner curve seal zone predict endograft-related complications in highly angulated necks after endovascular aneurysm repair using the Aorfix endograft.

    Science.gov (United States)

    Wang, Sophie; Hicks, Caitlin W; Malas, Mahmoud B

    2018-03-01

    Many studies have found that preoperative aneurysm anatomy can determine the postoperative complication rates for endovascular aneurysm repair (EVAR). With continual improvement in endograft technology, patients with challenging anatomy are increasingly able to undergo successful treatment with EVAR. This study aimed to quantify the influence of proximal neck anatomy on contemporary outcomes in a cohort of abdominal aortic aneurysm patients with highly angulated aneurysm necks. The study included 205 patients originally enrolled in the Prospective Aneurysm Trial: High Angle Aorfix Bifurcated Stent Graft (PYTHAGORAS) trial, the largest study to date to enroll patients with aortic aneurysm neck angles >60 degrees. Anatomic parameters included measurements of the proximal aneurysm neck as well as seal zones modeled in preoperative computed tomography scans. Follow-up up to 5 years postoperatively was available, for which stent-related complications (defined as sac expansion, stent migration, and type Ia endoleak) were assessed. Predictive anatomic parameters were assessed by Cox regression models, and a final multivariate model was created to predict complications. The cohort was also stratified by neck diameter for further comparison of complication rates. Of 205 patients enrolled in the trial, 67 stent-related complications occurred in 36 patients (17.6%) at 5 years after EVAR. Median follow-up was 48 months. Demographic and medical comorbidities did not predict risk of complications, nor did proximal neck length or neck angle. Independent predictors of post-EVAR complications included increasing proximal neck diameter (hazard ratio, 1.14; 95% confidence interval, 1.03-1.27; P < .05) and decreasing seal zone inner curve length (hazard ratio, 1.03; 95% confidence interval, 1.01-1.06; P < .05), which yielded a fair discriminatory utility (concordance, 0.67). Stratification by median neck diameter of 22.5 mm yielded two groups; patients with larger aortic necks

  17. Endovascular therapy of abdominal aortic aneurysm: results of a mid-term follow-up; Endovaskulaere Therapie von abdominellen Aortenaneurysmen: Klinisch-radiologishe Ergebnisse im mittelfristigen Verlauf

    Energy Technology Data Exchange (ETDEWEB)

    Pitton, M.B.; Schweitzer, H.; Herber, S.; Thelen, M. [Universitaetsklinik Mainz (Germany). Klinik fuer Radiologie; Schmiedt, W.; Neufang, A. [Universitaetsklinik Mainz (Germany). Klinik fuer Herz-, Thorax-, und Gefaesschirurgie; Dueber, C. [Universitaetsklinikum Mannheim (Germany). Inst. fuer Diagnostische Radiologie

    2003-10-01

    Prospective study to evaluate clinical results and complications of endovascular abdominal aortic aneurysm treatment in a mid-term follow-up. Materials and methods: A total of 122 patients (9 females, 113 males, average age 70.0{+-}7,9 years) with abdominal aortic aneurysms were treated with stent grafts (53 Vanguard or Stentor endografts, 69 Talent endografts). Group I consisted of 40 patients who had all aortic tributaries of the aneurysm sac occluded prior to endovalscular grafting, either spontaneously by parietal thrombosis or by selective coil embolization of the respective ostia preserving collateral circulation distal to the vessel occlusion. Group II consisted of 82 patients and included all cases without or with incomplete coil embolization with at least one patent vessel. Stent grafting was performed in general anesthesia in the first 21 patients, followed by peridural anesthesia in 15 cases, and local anesthesia with conscious sedation in 86 cases. The results were evaluated with Spiral-CT, MRI and radiographs of the endovascular graft, with follow-up examinations obtained at 3, 6, 12 months, and every year - Implantation was successfully completed in all cases without primary conversion surgery, laparotomy or any significant complication. Mean follow-up was 29{+-}21 months (maximum 82 months). The 30-day mortality was 0,8% due to a myocardial infarction 3 days after discharge from the hospital. A total of 47 re-interventions were performed in 29 patients (23.8%), with 35 re-interventions in 18 cases with Vanguard or Stentor endografts and 12 re-interventions in 11 patients with Talent endografts. 23 percutaneous re-interventions included distal graft extension (n=11), Wallstent for kinking and limb stenosis (n=3), and secondary coil embolization of collateral vessels (n=9). 24 surgical re-interventions included proximal graft extension (n=6), new endovascular grafts (n=3), surgical clipping of lumbar and mesenteric artery branches for type-II endoleaks

  18. Endovascular repair of blunt popliteal arterial injuries

    Energy Technology Data Exchange (ETDEWEB)

    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.

  19. A look into the endovascular crystal ball

    DEFF Research Database (Denmark)

    Schroeder, Torben Veith

    2009-01-01

    of this meeting followed the previous events with sessions on carotid artery disease and abdominal and thoracic aortic aneurysms topped up with clinical cases, lower limb ischemia and venous disease. Generally the session takes off by summarising new evidence, followed by questions and discussion. This workshops......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...

  20. Endovascular treatment of hepatic artery stenosis after liver transplantation.

    Science.gov (United States)

    Hamby, Blake A; Ramirez, Daniel E; Loss, George E; Bazan, Hernan A; Smith, Taylor A; Bluth, Edward; Sternbergh, W Charles

    2013-04-01

    Hepatic artery stenosis (HAS) after orthotopic liver transplantation is a significant risk factor for subsequent hepatic artery thrombosis (HAT). HAT is associated with a 30%-50% risk of liver failure culminating in retransplantation or death. Traditional treatment of hepatic artery complications has been surgical, with hepatic artery revision or retransplantation. Endovascular therapy of HAS, described primarily in the interventional radiology literature, may provide a less-invasive treatment option. This was a retrospective review of all endovascular interventions performed for HAS after orthotopic liver transplantation over a 31-month period (August 2009 to January 2012). Patients with duplex ultrasound imaging evidence of severe main HAS (peak systolic velocity of >400 cm/s, resistive index of ultrasound imaging to assess for treatment success and late restenosis. Reintervention was performed if significant restenosis occurred. Thirty-five hepatic artery interventions were performed in 23 patients. Over the 31-month study period, 318 orthotopic liver transplantations were performed, yielding a 7.4% (23/318) rate of hepatic artery intervention. Primary technical success was achieved in 97% (34/35) of cases. Initial treatment was with PTA alone (n = 10) or primary stent placement (n = 13). The initial postintervention ultrasound images revealed improvements in hepatic artery peak systolic velocity (267 ± 118 [posttreatment] vs 489.9 ± 155 cm/s [pretreatment]; P hepatic artery resistive index (0.61 ± 0.08 [posttreatment] vs 0.41 ± 0.07 [pretreatment]; P arterial rupture managed endovascularly and one artery dissection that precipitated HAT and required retransplantation. The overall rate of HAT in the entire cohort was 4.3% (1/23). Endovascular treatment of HAS can be performed with high technical success, excellent primary-assisted patency, and acceptable morbidity. Initial use of a stent may improve primary patency when compared with PTA. The need for

  1. EVAR: Benefits of CEUS for monitoring stent-graft status

    Energy Technology Data Exchange (ETDEWEB)

    Cantisani, Vito, E-mail: vito.cantisani@uniroma1.it [Department of Radiological, Oncological and Anatomo-Pathological Sciences, Università Sapienza di Roma, Policlinico Umberto I, Rome (Italy); Grazhdani, Hektor [Department of Radiological, Oncological and Anatomo-Pathological Sciences, Università Sapienza di Roma, Policlinico Umberto I, Rome (Italy); Clevert, Dirk-André [Interdisciplinary Ultrasound Center, Munich University, Hospital Grosshadern, Munich (Germany); Iezzi, Roberto [Policlinico A. Gemelli, Catholic University, Rome (Italy); Aiani, Luca; Martegani, Alberto [Ospedale Valduce, Como (Italy); Fanelli, Fabrizio; Di Marzo, Luca; Wlderk, Andrea; Cirelli, Carlo; Catalano, Carlo; Di Leo, Nicola; Di Segni, Mattia; Malpassini, Flavio; D’Ambrosio, Ferdinando [Department of Radiological, Oncological and Anatomo-Pathological Sciences, Università Sapienza di Roma, Policlinico Umberto I, Rome (Italy)

    2015-09-15

    Highlights: • In the last two decades several studies have shown the role of contrast enhanced ultrasound [CEUS] in post-EVAR surveillance, with very good diagnostic performance, absence of renal impairment, and no radiation, accompanied by low costs, in comparison with CTA. • In numerous prospective studies and meta-analyses the detection and characterization of endoleaks with CEUS is comparable to that of CTA imaging. • Nowadays in the EVAR surveillance novel strategies which involve CEUS with a central role, are suggested by several authors and applied in many institutions. • CEUS technique, findings, diagnostic accuracy, and its role in the follow up program are discussed in this review article. - Abstract: Endo vascular aortic repair [EVAR] is performed with low peri-operative morbidity and mortality rate and short hospital stay. However, EVAR needs a close and lifelong imagining surveillance for a timely detection of possible complications including endoleaks, graft migration, fractures, and enlargement of aneurysm sac size with eventual rupture. Contrast enhanced computed tomography [CTA] is actually considered the gold-standard in EVAR follow-up, but it is accompanied with radiation burden and renal injury due to the use of contrast media. In the last two decades several studies have shown the role of contrast enhanced ultrasound [CEUS] in post-EVAR surveillance, with very good diagnostic performance, absence of renal impairment, and no radiation, accompanied by low costs, in comparison with CTA. In numerous prospective studies and meta-analyses the detection and characterization of endoleaks with CEUS is comparable to that of CTA imaging. Nowadays, in the EVAR surveillance novel strategies which involve CEUS with a central role, are suggested by several authors and applied in many institutions. In this review article we will present a comprehensive overview and analyses of the literature on the CEUS state-of-art imagining of EVAR follow-up, with its technique, findings, diagnostic accuracy, and its role in the follow up program.

  2. Endovascular repair of type II and type III thoracoabdominal aneurysms.

    Science.gov (United States)

    Mastracci, Tara M; Eagleton, Matthew J

    2011-09-01

    Thoracoabdominal aortic aneurysms (TAAA) remain a challenging problem to manage. Operative care for patients afflicted with this devastating problem is associated with significant risks, including renal failure and paraplegia. Several techniques have been developed to help limit the risk for these complications, yet they still remain some of the greatest hurdles associated with these procedures. Endovascular technology is rapidly advancing and may provide an alternate approach to patients with TAAA. Endograft treatment of TAAA is possible with the use of fenestrated and/or branched aortic endografts. Although still early in its evolution, we are beginning to understand some of the risks and benefits of this approach to complex aortic disease. Fenestrated and branched aortic endografting may provide an option that has lower risk to patients. Spinal cord ischemia, however, still remains a critical problem in patients who require treatment of a significant portion of their aorta. In addition, renal failure is also still observed. The mechanisms leading to the development of these complications following endograft repair, however, may not be the same as observed with open TAAA repair. This review will highlight some of our current understandings of endovascular repair of thoracoabdominal aortic aneurysms.

  3. Surgical and Endovascular Treatment for Spinal Arteriovenous Malformations

    Science.gov (United States)

    ENDO, Toshiki; ENDO, Hidenori; SATO, Kenichi; MATSUMOTO, Yasushi; TOMINAGA, Teiji

    2016-01-01

    Spinal arteriovenous malformation (AVM) is a broad term that constitutes diverse vascular pathologies. To date, various classification schemes for spinal AVM have been proposed in literature, which helped neurosurgeons understand the pathophysiology of the disease and determine an optimal treatment strategy. To discuss indications and results of surgical and endovascular interventions for spinal AVM, this article refers to the following classification proposed by Anson and Spetzler in 1992: type I, dural arteriovenous fistula (AVF); type II, glomus intramedullary AVM; type III, juvenile malformations; and type IV, perimedullary AVF. In general, complete obliteration of the fistula is a key for better outcome in type I dural and type IV perimedullary AVFs. On the other hand, in type II glomus and type III juvenile malformations, functional preservation, instead of pursuing angiographical cure, is the main goal of the treatment. In such cases, reduction of the shunt flow can alleviate clinical symptoms. Proper management of spinal AVM should start with neurological examination and understanding of angioarchitectures, which provide critical information that guides the indication and modality of intervention. Finally, close collaboration of the microsurgical and endovascular teams are mandatory for successful treatment. PMID:26948701

  4. Endovascular Aneurysm Repair Treatment of Aortoiliac Aneurysms

    DEFF Research Database (Denmark)

    Taudorf, Mikkel; Rasmussen, John Bøje Grønvall; Schroeder, Torben V

    2016-01-01

    PURPOSE: To compare the risk of gluteal claudication after endovascular aneurysm repair (EVAR) of aortoiliac aneurysms by interventional exclusion of the internal iliac artery (IIA) with plugs or coils versus a branch iliac device to maintain pelvic blood supply and to identify risk factors...

  5. ORIGINAL ARTICLES Endovascular cerebral aneurysm treatment ...

    African Journals Online (AJOL)

    Corresponding author: D E Le Feuvre (davidlefeuvre@hotmail.com). Introduction. The International Subarachnoid Aneurysm Trial confirmed endovascular treatment as the treatment of choice for intracranial 'berry' aneurysms. The durability of coiling and the relevance of stable neck remnants needed to be addressed next.

  6. 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

  7. Endovascular treatment of ruptured distal posterior inferior ...

    African Journals Online (AJOL)

    2014-03-01

    Mar 1, 2014 ... the dissection point is not occlusive. Besides, the parent artery is narrow while the aneurysms are relative wide- neck. As a result, some normal assistant measures for saccular aneurysms, including balloon angioplasty and stent, cannot be applied to the endovascular treatment of the kinds of aneurysms.

  8. ORIGINAL ARTICLES Endovascular treatment of cerebral ...

    African Journals Online (AJOL)

    for a large proportion of the increased cost in the surgically treated group. However, the reality is that within our setting the problems we describe are real and difficult to overcome. We have found that being able to treat aneurysms endovascularly and especially under local anaesthetic has paradoxically freed up theatre time ...

  9. Endovascular treatment of ruptured distal posterior inferior ...

    African Journals Online (AJOL)

    Objective: To investigate the clinical characteristics and endovascular treatment of ruptured distal posterior inferior cerebellar artery (PICA) aneurysms. Methods: 11 consecutive patients (7 women, 4 men, mean age of 49.2 years) with ruptured distal PICA aneurysms were studied retrospectively. All had onset of acute ...

  10. Surgery of intracranial aneurysms previously treated endovascularly.

    Science.gov (United States)

    Tirakotai, Wuttipong; Sure, Ulrich; Yin, Yuhua; Benes, Ludwig; Schulte, Dirk Michael; Bien, Siegfried; Bertalanffy, Helmut

    2007-11-01

    To perform a retrospective study on the patients who underwent aneurysmal surgery following endovascular treatment. We performed a retrospective study on eight patients who underwent aneurysmal surgery following endovascular treatment (-attempts) with gugliemi detachable coils (GDCs). The indications for surgery, surgical techniques and clinical outcomes were analyzed. The indications for surgical treatment after GDC coiling of aneurysm were classified into three groups. First group: surgery of incompletely coiled aneurysms (n=4). Second group: surgery of mass effect on the neural structures due to coil compaction or rebleeding (n=2). Third group: surgery of vascular complications after endovascular procedure due to parent artery occlusion or thrombus propagation from aneurysm (n=2). Aneurysm obliterations could be performed in all cases confirmed by postoperative angiography. Six patients had an excellent outcome and returned to their profession. Patient's visual acuity was improved. One individual experienced right hemiparesis (grade IV/V) and hemihypesthesia. Microsurgical clipping is rarely necessary for previously coiled aneurysms. Surgical treatment is uncommonly required when an acute complication arises during endovascular treatment, or when there is a dynamic change of a residual aneurysm configuration over time that is considered to be insecure.

  11. ORIGINAL ARTICLES Endovascular treatment of intractable epistaxis

    African Journals Online (AJOL)

    Enrique

    patients with nasal haemorrhage was first described by. Sokoloff et al.4 in 1974. Currently, endovascular embolisation is ... unrelated causes since the embolisation; telephonic interviews were conducted with the remaining 36. ... rate was 0%, the major morbidity rate was 2% (1 stroke) and the minor morbidity rate was 25%.

  12. [Endovascular treatment in acute ischaemic stroke. A stroke care plan for the region of Madrid].

    Science.gov (United States)

    Alonso de Leciñana, M; Díaz-Guzmán, J; Egido, J A; García Pastor, A; Martínez-Sánchez, P; Vivancos, J; Díez-Tejedor, E

    2013-09-01

    Endovascular therapies (intra-arterial thrombolysis and mechanical thrombectomy) after acute ischaemic stroke are being implemented in the clinical setting even as they are still being researched. Since we lack sufficient data to establish accurate evidence-based recommendations for use of these treatments, we must develop clinical protocols based on current knowledge and carefully monitor all procedures. After review of the literature and holding work sessions to reach a consensus among experts, we developed a clinical protocol including indications and contraindications for endovascular therapies use in acute ischaemic stroke. The protocol includes methodology recommendations for diagnosing and selecting patients, performing revascularisation procedures, and for subsequent patient management. Its objective is to increase the likelihood of efficacy and treatment benefit and minimise risk of complications and ineffective recanalisation. Based on an analysis of healthcare needs and available resources, a cooperative inter-hospital care system has been developed. This helps to ensure availability of endovascular therapies to all patients, a fast response time, and a good cost-to-efficacy ratio. It includes also a prospective register which serves to monitor procedures in order to identify any opportunities for improvement. Implementation of endovascular techniques for treating acute ischaemic stroke requires the elaboration of evidence-based clinical protocols and the establishment of appropriate cooperative healthcare networks guaranteeing both the availability and the quality of these actions. Such procedures must be monitored in order to improve methodology. Copyright © 2012 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  13. Endovascular Embolization of Distal Anterior Choroidal Artery Aneurysms Associated with Moyamoya Disease

    Science.gov (United States)

    Yang, S.; Yu, J.-L.; Wang, H.-L.; Wang, B.; Luo, Q.

    2010-01-01

    Summary We evaluated the feasibility of endovascular embolization for the management of distal anterior choroidal artery (AChA) aneurysms associated with moyamoya disease and performed a literature review to summarize their clinical features and treatment. We describe two cases of moyamoya disease-associated distal AChA aneurysms treated by endovascular embolization. In both cases, a good outcome was observed. We performed a MEDLINE (1980-2010) search which identified 13 similar cases. Our analysis of the clinical data from these 15 cases led us to conclude that (i) endovascular embolization is an effective and feasible treatment for distal AChA aneurysms associated with moyamoya disease; (ii) aneurysm location and the preservation of the parent artery are two major prognostic factors for moyamoya disease-associated distal AChA aneurysms subjected to craniotomy or endovascular therapy; (iii) the parent artery should be preserved when the aneurysm is located in the temporal horn of the lateral ventricle, but sacrificed when it is located in the trigone of the lateral ventricle. PMID:21162774

  14. Cardiovascular and Interventional Radiological Society of Europe Guidelines on Endovascular Treatment in Aortoiliac Arterial Disease

    Energy Technology Data Exchange (ETDEWEB)

    Rossi, Michele, E-mail: michele.rossi@uniroma1.it [Sant’Andrea University Hospital, Interventional Radiology Unit (Italy); Iezzi, Roberto, E-mail: roberto.iezzi.md@gmail.com [“Sacro Cuore” Catholic University, Radiology Department (Italy)

    2013-11-06

    PurposeThese guidelines are intended for use in assessing the standard for technical success and safety in aorto-iliac percutaneous endovascular interventions.MethodsAny recommendation contained in the text comes from the highest level and extension of literature review available to date.ResultsThe success of endovascular procedures is strictly related to an accurate planning based mainly on CT- or MR-angiography. TASC II A through C lesions have an endovascular-first option Pre-procedure ASA antiplatelet therapy is advisable in all cases. The application of stents improves the immediate hemodynamic and most likely long-term clinical results. Cumulative mean complication rate is 7.51 % according to the most relevant literature. Most of the complications can be managed by means of percutaneous techniques.ConclusionThe design and quality of devices, as well as the easy and accuracy of performing these procedures, have improved over the last decades, leading to the preferential treatment of aorto-iliac steno-obstructive disease via endovascular means, often as first-line therapy, with high technical success rate and low morbidity. This is mirrored by the decreasing number of patients undergoing surgical grafts over the last years with patency, limb salvage, and survival rates equivalent to open reconstruction.

  15. Cephalic arch stenosis in dialysis patients: review of clinical relevance, anatomy, current theories on etiology and management.

    Science.gov (United States)

    Sivananthan, Gajan; Menashe, Leo; Halin, Neil J

    2014-01-01

    Arteriovenous hemodialysis fistulas (AVFs) serve as a lifeline for many individuals with end-stage renal failure. A common cause of AVF failure is cephalic arch stenosis. Its high prevalence compounded with its resistance to treatment makes cephalic arch stenosis important to understand. Proposed etiologies include altered flow in a fistulized cephalic vein, external compression by fascia, the unique morphology of the cephalic arch, large number of valves in the cephalic outflow tract and biochemical changes that accompany renal failure. Management options are also in debate and include angioplasty, cutting balloon angioplasty, bare metal stents, stent grafts and surgical techniques including flow reduction with minimally invasive banding as well as more invasive venovenostomy with transposition surgeries for refractory cases. In this review, the evidence for the clinical relevance of cephalic arch stenosis, its etiology and management are summarized.

  16. Aorfix™ device for abdominal aortic aneurysm with challenging anatomy.

    Science.gov (United States)

    Sbarzaglia, P; Grattoni, C; Oshoala, K; Castriota, F; D'Alessandro, G; Cremonesi, A

    2014-02-01

    Anatomical characteristics of abdominal aortic aneurysms (AAA) are the most critical factors for successful endovascular aortic repair (EVAR). Of these, severe proximal aortic neck angulation and iliac axis tortuosity increase the complexity of EVAR. Neck angulation seems to have a pivotal potential for fixation failure, a situation that may lead to complications, including endoleak and late rupture. Bench-test studies identified that the relative stiffness of a stent-graft was responsible for its inability to conform to neck angulation, therefore creating leaks through gaps between the stent graft and the neck. Aorfix™ stent graft (Lombard Medical, Didcot, UK) is a flexible stent-graft designed and manufactured with the purpose of overcoming the issue of stent-graft stiffness. Many studies have shown good results in term of procedural success and mid-term type-I endoleak. PYTHAGORAS trial evaluated mainly patients with highly angulated infrarenal neck and showed that high performance of Aorfix™ stent graft did not present any significant difference between neck >60° and <60°. In the series of 27 patients treated at our Institution we had a primary technical success of 96.3% and an assisted primary technical success of 100%. In this review we will analyze the available data in literature regarding Aorfix™ stent graft and will discuss the outcome of the patients treated with Aorfix™ stent graft at our centre.

  17. From puncture to closure of the common femoral artery in endovascular aortic repair

    DEFF Research Database (Denmark)

    Lönn, Lars; Larzon, Thomas; Van Den Berg, Jos C

    2010-01-01

    of today. The traditional approach in EVAR involves surgical exposure of the femoral arteries with bilateral groin incisions. Through the groin access, and under fluoroscopy, a special insertion sheath introducer is used to position a stent graft in the desired location with the patient in general...... or epidural anesthesia. The evolving stent-technology with smaller sheath sizes has broadened the scenario for alternative approaches for access and closure of the common femoral arteries. The following review presents an introduction on technical aspects of puncture of the femoral artery and closure...

  18. Acute haemorrhage in patients with advanced head and neck cancer: value of endovascular therapy as palliative treatment option.

    Science.gov (United States)

    Sesterhenn, Andreas M; Iwinska-Zelder, Joanna; Dalchow, Carsten V; Bien, Siegfried; Werner, Jochen A

    2006-02-01

    Acute or subacute haemorrhage is one of the most frightening complications in patients suffering from advanced head and neck cancer. Few articles report experience with superselective endovascular therapy for this purpose. Is endovascular therapy underestimated in the field of palliative head and neck cancer therapy? This study set out to investigate this question. A review was undertaken of the clinical courses of seven patients (six men, one woman) suffering from incurable, advanced head and neck cancer (four pharyngeal, two laryngeal, one neck) and treated with superselective endovascular strategies as an emergency procedure for acute bleeding. All patients were successfully treated without evidence of neurological complication. Patients reached a median survival of 20 weeks (range eight-168 weeks). Following endovascular treatment all patients were discharged from the hospital within several days. Three patients survived almost free of symptoms for several weeks and were able to stay at home with their families until their death. We conclude that in the field of palliative care, superselective endovascular therapy deserves to be considered alongside standard treatment options for the management of acute haemorrhage from advanced head and neck cancer.

  19. Short vs prolonged dual antiplatelet treatment upon endovascular stenting of peripheral arteries

    Directory of Open Access Journals (Sweden)

    Kronlage M

    2017-10-01

    Full Text Available Mariya Kronlage,1 Maximilian Wassmann,1 Britta Vogel,1 Oliver J Müller,1 Erwin Blessing,2 Hugo Katus,1,3 Christian Erbel1 1Department of Cardiology, Angiology and Pneumology, University Hospital Heidelberg, Heidelberg, 2SRH Klinikum Karlsbad Langensteinbach, Karlsbad, 3DZHK German Center for Cardiovascular Research, Partner Site Heidelberg/Mannheim, Mannheim, Germany Introduction: Peripheral artery disease (PAD is a highly prevalent disorder with a substantial economical burden. Dual antiplatelet treatment (DAPT upon endovascular stenting to prevent acute thrombotic reocclusions is an universally accepted practice for postinterventional management of PAD patients. However, the optimal period of time for DAPT upon endovascular stenting is not known.Methods: In the current nonrandomized, retrospective monocentric study, we evaluated the duration of DAPT upon endovascular stenting. A total of 261 endovascular SFA and iliac stenting procedures were performed on 214 patients and these patients were subdivided into a short (4–6 weeks or a prolonged (8–12 weeks DAPT regime group. More than 65% of the patients included were male, approximately 35% were diabetic, and 61% had a history of smoking. Of all the patients, 90% exhibited a Rutherford stage 2–3, and approximately half of the patients had a moderate-to-severe calcified target lesion with a length of >13 cm. Major safety end points were defined as any bleeding, compartment syndrome, and ischemic events. In addition to this, patency, all-cause mortality, as well as amputation were followed up over a period of 12 months upon intervention.Results: Twelve months after endovascular stenting, primary patency in our cohort was comparable between the groups (83.94% short vs 79.8% long DAPT, P>0.05. Major bleeding occurred in 18 cases without any difference between the groups (P>0.05. In addition, during the 12-month follow-up, 6 (3.4% patients in the short and 3 (3.5% in the prolonged DAPT regime

  20. Delayed massive hemorrhage due to external iliac artery pseudo-aneurysm and uretero-iliac artery fistula following robotic radical cystectomy and intracorporeal Studer pouch reconstruction: Endovascular management of an unusual complication

    Science.gov (United States)

    Atmaca, Ali Fuat; Canda, Abdullah Erdem; Gumus, Mehmet; Asil, Erem; Balbay, Mevlana Derya

    2013-01-01

    We report a very unusual complication of uretero-iliac artery fistula that developed following robotic radical cystectomy (RARC), bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction. Our patient was a 54-year-old male who was admitted 1 month after undergoing robotic surgery due to intermittently occurring massive transurethral bleeding necessitating blood transfusion that stopped by itself. Angiography showed a right external iliac artery pseudo-aneurysm and a fistula tract between the pseudo-aneurysm and Wallace type ureteral anostomosis that was successfully treated by an angiographic endovascular stent insertion at this level. Uretero-iliac artery fistula might occur following RARC, bilateral extended pelvic lymph node dissection and intracorporeal Studer pouch reconstruction leading to intermittently massive transurethral bleeding. Angiography and stenting are important for diagnosis and successful treatment of this rare entity. PMID:24069106

  1. Endovascular treatment of a large ruptured middle cerebral artery bifurcation aneurysm in a 5-week-old infant: case report.

    Science.gov (United States)

    Lyon, Kristopher A; Arrey, Eliel N; Haider, Ali S; Jeevan, Dhruve S; Benardete, Ethan A

    2017-10-01

    Ruptured intracranial aneurysms are extremely rare in infants. The optimal treatment strategy is not well established. Both microsurgical and endovascular techniques and strategies have been tried, and in the literature there is a significant variability in outcome. The authors report the presentation and successful endovascular treatment of a large, ruptured, middle cerebral artery bifurcation aneurysm in a 5-week-old girl, one of only a few reported in the literature. Clinical and radiological findings at follow-up are also presented. The authors then review the literature on aneurysmal subarachnoid hemorrhage in infants, with particular regard to outcome after either endovascular or open surgical management. They also provide recommendations for follow-up in pediatric patients whose intracranial aneurysms have been treated with coil embolization.

  2. Persistent type I endoleak after endovascular treatment with Chimney technique

    Directory of Open Access Journals (Sweden)

    Ana Isabel Azevedo

    2016-09-01

    Full Text Available Thoracic endovascular aortic repair (TEVAR is increasingly used in the treatment of acute type B aortic dissection. Type Ia endoleaks are a common complication of the procedure, but its clinical significance as well as the best treatment strategy remain poorly defined. We present a case of a type Ia endoleak following TEVAR in the treatment of acute type B aortic dissection. Chimney technique approach was used in an attempt to seal the endoleak. Although technical success was suboptimal, the patient remained clinically stable and event free. Data regarding the natural course and management of type Ia endoleaks following TEVAR for aortic dissection are sparse. Future research is required to establish the clinical and technical determinants of the need to treat these endoleaks as well as the best treatment strategy.

  3. Celiac Injury Due to Arcuate Ligament: An Endovascular Approach

    Energy Technology Data Exchange (ETDEWEB)

    Zini, Chiara, E-mail: zini.chiara@gmail.com; Corona, Mario, E-mail: mario.corona@uniroma.it; Boatta, Emanuele, E-mail: emanuele.boatta@yahoo.it; Wlderk, Andrea, E-mail: a.wlderk@virgilio.it; Salvatori, Filippo Maria, E-mail: filippomaria.salvatori@uniroma1.it; Fanelli, Fabrizio, E-mail: fabrizio.fanelli@uniroma1.it [' Sapienza,' -University of Rome, Vascular and Interventional Radiology Unit, Radiology, Oncology and Pathology Department (Italy)

    2013-06-15

    Celiac trunk injures are rare events, with high mortality rates and difficult management. Endovascular treatment may be considered to avoid bleeding. We report a case of severe bleeding in a 37-year-old man resulting from celiac trunk stretching after a motorcycle crash. Because direct celiac trunk catheterization was not possible, a retrograde catheterization of the common hepatic artery was performed via the superior mesenteric artery. Two vascular plugs (type IV) were released, and the exclusion of the celiac trunk origin was completed with the deployment of an aortic cuff. The patient's clinical condition immediately improved, and after 6 months' follow-up, imaging confirmed the complete exclusion of the celiac trunk.

  4. Endovascular treatment of carotid cavernous sinus fistula: A systematic review

    Science.gov (United States)

    Korkmazer, Bora; Kocak, Burak; Tureci, Ercan; Islak, Civan; Kocer, Naci; Kizilkilic, Osman

    2013-01-01

    Carotid cavernous sinus fistulas are abnormal communications between the carotid system and the cavernous sinus. Several classification schemes have described carotid cavernous sinus fistulas according to etiology, hemodynamic features, or the angiographic arterial architecture. Increased pressure within the cavernous sinus appears to be the main factor in pathophysiology. The clinical features are related to size, exact location, and duration of the fistula, adequacy and route of venous drainage and the presence of arterial/venous collaterals. Noninvasive imaging (computed tomography, magnetic resonance, computed tomography angiography, magnetic resonance angiography, Doppler) is often used in the initial work-up of a possible carotid cavernous sinus fistulas. Cerebral angiography is the gold standard for the definitive diagnosis, classification, and planning of treatment for these lesions. The endovascular approach has evolved as the mainstay therapy for definitive treatment in situations including clinical emergencies. Conservative treatment, surgery and radiosurgery constitute other management options for these lesions. PMID:23671750

  5. Hypothenar hammer syndrome in a computer programmer: CTA diagnosis and surgical and endovascular treatment.

    Science.gov (United States)

    Abdel-Gawad, Ehab A; Bonatti, Hugo; Housseini, Ahmed M; Maged, Ismaeel M; Morgan, Raymond F; Hagspiel, Klaus D

    2009-01-01

    Finger ischemia due to embolic occlusion of digital arteries resulting from trauma to the palmar ulnar artery has been termed hypothenar hammer syndrome (HHS). In HHS, arterial thrombosis and/or aneurysm formation with embolization to the digital arteries causes symptoms of ischemia. We describe a patient in whom the initial diagnosis was made on multidetector computed tomographic angiography (CTA), as well as his endovascular and surgical management.

  6. [APPLICATIONS ENDOVASCULAR HEMOSTASIS TREATMENT OF PULMONARY HEMORRHAGE].

    Science.gov (United States)

    Severgin, V E; Shipulin, P P; Agrahari, A; Tronina, E Yu; Kyrylyuk, A A; Polyak, S D; Kozyar, N

    2015-06-01

    Rentgenoendovascular embolization of bronchial arteries was performed in 222 patients about pulmonary hemorrhage (PH) of different nature. Resistant hemostasis was achieved in 198 (89.9%) patients. The possibility of endovascular hemostasis in patients in advanced lung cancer complicated by PH. Hemostasis was ineffective in 24 (10.8%) patients. Died 5 (2.2%) patients due to unresectable lung cancer. The reasons for ineffective hemostasis were analysed.

  7. Endovascular treatment for ruptured basilar apex aneurysm

    Directory of Open Access Journals (Sweden)

    Sheng LI

    2011-12-01

    Full Text Available Objective The present study aims to prove the effectiveness and safety of endovascular interventional therapy for ruptured basilar apex aneurysm.Methods The imaging data,methods of endovascular treatment,and clinical results of 12 patients suffering from ruptured basilar apex aneurysms from January 2001 to December 2009 were retrospectively analyzed.The 12 patients were composed of 5 males and 7 females,and their ages ranged from 21 years to 58 years.Results Nine patients suffered from narrow-necked aneurysms,which were directly embolized,and the other three suffered from wide-necked aneurysms,which were embolized using a microstent.Eight aneurysms were completely embolized,and the other four were partly embolized.No rebleeding occurred within the follow-up period of 12 months to 36 months,and all patients recovered well without neurological defects.Conclusions Therefore,endovascular treatment for ruptured basilar apex aneurysm is a semi-invasive,safe,and effective method.

  8. Influence and critique of the INSTEAD Trial (TEVAR versus medical treatment for uncomplicated type B aortic dissection).

    Science.gov (United States)

    Nienaber, Christoph A

    2011-09-01

    Endovascular stent-grafting represents a novel nonsurgical therapeutic concept for type B aortic dissection in both the acute and subacute/chronic settings with unknown impact on outcomes. In a prospective trial, 140 patients with clinically stable type B dissection were randomly subjected to elective stent-graft placement in addition to optimal medical therapy (n = 72) or to optimal medical therapy (n = 68) with surveillance (arterial pressure according to World Health Organization guidelines, ≤120/80 mm Hg) and recurrent computed tomography imaging. Primary endpoint was 2-year all-cause mortality, while aorta-related mortality, progression of disease (with need for crossover to stent-graft or additional endovascular or open surgery), and aortic remodeling were secondary endpoints. There was no difference in all-cause mortality at 2 years, with cumulative survival of 95.6% ± 2.5% with optimal medical therapy versus 88.9% ± 3.7% with thoracic endovascular aortic repair (TEVAR) (P = .15). Considering, however, that only 40% of the expected events occurred within 2 years (based on registry data), the trial turned out to be underpowered for all-cause mortality. Moreover, aorta-related mortality was also not different (P = .44) within the first 2 years of follow-up, and risk for the combined endpoints of aorta-related death (rupture) and progression (including conversion or additional endovascular or open surgery) was similar (P = .65); three neurological adverse events occurred in the TEVAR group (one paraplegia, one stroke, and one transient paraparesis) versus one paraparesis with medical treatment. Finally, and as expected, aortic remodeling (with true lumen recovery and thoracic false lumen thrombosis) occurred in 91.3% with TEVAR, but only in 19.4%with medical treatment alone (P type B aortic dissection, elective stent-graft placement on top of optimized medical management fails to improve survival and adverse events within an observation period of 2 years

  9. The past, present and future of minimally invasive therapy in endovascular interventions: a review and speculative outlook.

    Science.gov (United States)

    Wendt, Daniel; Thielmann, Matthias; Melzer, Andreas; Benedik, Jaroslav; Droc, Ionel; Tsagakis, Konstantinos; Dohle, Daniel S; Jakob, Heinz; Abele, John E

    2013-08-01

    Cardiovascular disease is a leading cause of death in all developed countries. In response to this need, endovascular management techniques have been developed across a large range of medical specialties. Minimally invasive percutaneous interventions were initially complex and challenging, but with the continued development of equipment and expertise their use has become routine in many fields. With routine use, it has become important to establish the safety and efficacy of endovascular treatments against the respective "gold standard" procedures, especially in light of their initial intended use for the management of patients at unacceptably high risk for standard therapy only. Such evaluation has to take into account the variety and diversity of devices and techniques, as well as the effects of operator dependability. Endovascular techniques are increasingly recognised as valid alternative management options for a variety of conditions, and it is anticipated that the current trend towards minimally invasive techniques will continue in the future, with moves towards increasingly complex endovascular techniques and hybrid interventions.

  10. Current role of endovascular therapy in Marfan patients with previous aortic surgery

    Directory of Open Access Journals (Sweden)

    Ibrahim Akin

    2008-02-01

    Full Text Available Ibrahim Akin, Stephan Kische, Tim C Rehders, Tushar Chatterjee, Henrik Schneider, Thomas Körber, Christoph A Nienaber, Hüseyin InceDepartment of Medicine, Division of Cardiology at the University Hospital Rostock, Rostock School of Medicine, Ernst-Heydemann-Str. 6, 18057 Rostock, GermanyAbstract: The Marfan syndrome is a heritable disorder of the connective tissue which affects the cardiovascular, ocular, and skeletal system. The cardiovascular manifestation with aortic root dilatation, aortic valve regurgitation, and aortic dissection has a prevalence of 60% to 90% and determines the premature death of these patients. Thirty-four percent of the patients with Marfan syndrome will have serious cardiovascular complications requiring surgery in the first 10 years after diagnosis. Before aortic surgery became available, the majority of the patients died by the age of 32 years. Introduction in the aortic surgery techniques caused an increase of the 10 year survival rate up to 97%. The purpose of this article is to give an overview about the feasibility and outcome of stent-graft placement in the descending thoracic aorta in Marfan patients with previous aortic surgery.Keywords: Marfan syndrome, aortic dissection, root replacement, stent-graft, previous aortic surgery

  11. The creation of the optimal dedicated endovascular suite

    NARCIS (Netherlands)

    Sikkink, C. J. J. M.; Reijnen, M. M. P. J.; Zeebregts, C. J.

    Background. During the last decade endovascular therapy has been established as an alternative treatment for a variety of vascular diseases. Neither the classic operating room (OR), nor the conventional angiography suite is optimal for both open surgery and endovascular procedures. Important issues

  12. 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.

  13. Pathogenic Characteristics of Staphylococcus aureus Endovascular Infection Isolates from Different Clonal Complexes

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    Dafne Pérez-Montarelo

    2017-05-01

    Full Text Available Staphylococcus aureus is a major cause of bacteremia and, even with appropriate clinical management, causes high morbidity, and mortality due to its involvement in endovascular complications and metastatic infections. Through different pathogenic in vivo and in vitro models we investigated the behavior of S. aureus most relevant clonal complexes (CCs causing endovascular complications. We analyzed 14 S. aureus strains representing CC5, CC8, CC15, CC30, and CC45 that caused endovascular complications, including methicillin susceptible and resistant isolates and strains with different functionality of the agr global regulator. Their adherence to collagen, interaction with the endothelium, resistance to immune attack, capacity to form biofilm and virulence in the Galleria mellonella model were analyzed. CC30 and CC45 showed greater adhesion to collagen and CC8 showed a trend towards higher rate of intracellular persistence in endothelial cells. All CCs exhibited similar tolerance to neutrophil antimicrobial peptide hNP-1 and were capable of forming biofilms under static conditions. The virulence assay in the G. mellonella model demonstrated that CC15 and CC30 were the most and least virulent, respectively. The analysis of the genomic sequences of the most relevant virulence genes identified some CC15 specific gene patterns (absence of enterotoxins and sak gene and variants (mainly in leucocidins and proteases, but did not reveal any gene or variant that could be responsible for the increased virulence detected for CC15 strains. Even though all the CCs were capable of causing endovascular complications, our results showed that different CCs are likely to produce these complications through different mechanisms which, if confirmed in more sophisticated models, would indicate the need to more specific management and therapeutic approaches.

  14. Defining high risk in endovascular aneurysm repair.

    Science.gov (United States)

    Mastracci, Tara M; Greenberg, Roy K; Hernandez, Adrian V; Morales, Catherine

    2010-05-01

    Long-term survival benefit contrasted with rupture risk should determine which patients are suitable for abdominal aortic aneurysm (AAA) intervention. Our aim was to develop a model capable of predicting long-term survival based on preoperative characteristics. A prospective cohort study using Cox regression modeling. We aimed to associate preoperative characteristics with long-term mortality, and create a predictive nomogram, which was then externally validated on an independent cohort (697 patients) who underwent endovascular abdominal aortic aneurysm (AAA) repair. We pooled the results of 412 patients undergoing endovascular repair of infrarenal and juxtarenal aneurysm who were high risk (average Glasgow aneurysm scores of 72.8 [SD 10.4]). Despite anatomic differences, there were no statistically significant differences in perioperative or long-term outcomes between infrarenal and juxtarenal aneurysms (log rank test, P = .5). Data from this group (64% infrarenal aneurysms and 36% juxtarenal aneurysms) were randomly and evenly split into a model development and test group. Independent predictors of mortality included in the model are age, aneurysm diameter, history of peripheral artery disease, chronic obstructive pulmonary disease (COPD), or congestive heart failure, requirement for supplemental home oxygen, and use of salicylates. Internal validation reveals good calibration and discriminative ability (c-statistic 0.68 [95% confidence interval 0.65-0.71]). External validation confirms good calibration. In the context of acceptable perioperative results, long-term mortality risk can be predicted in endovascular AAA repair and must be balanced against risk of rupture to determine which patients should be offered treatment. Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  15. Modeling Endovascular Coils as Heterogeneous Porous Media

    Science.gov (United States)

    Yadollahi Farsani, H.; Herrmann, M.; Chong, B.; Frakes, D.

    2016-12-01

    Minimally invasive surgeries are the stat-of-the-art treatments for many pathologies. Treating brain aneurysms is no exception; invasive neurovascular clipping is no longer the only option and endovascular coiling has introduced itself as the most common treatment. Coiling isolates the aneurysm from blood circulation by promoting thrombosis within the aneurysm. One approach to studying intra-aneurysmal hemodynamics consists of virtually deploying finite element coil models and then performing computational fluid dynamics. However, this approach is often computationally expensive and requires extensive resources to perform. The porous medium approach has been considered as an alternative to the conventional coil modeling approach because it lessens the complexities of computational fluid dynamics simulations by reducing the number of mesh elements needed to discretize the domain. There have been a limited number of attempts at treating the endovascular coils as homogeneous porous media. However, the heterogeneity associated with coil configurations requires a more accurately defined porous medium in which the porosity and permeability change throughout the domain. We implemented this approach by introducing a lattice of sample volumes and utilizing techniques available in the field of interactive computer graphics. We observed that the introduction of the heterogeneity assumption was associated with significant changes in simulated aneurysmal flow velocities as compared to the homogeneous assumption case. Moreover, as the sample volume size was decreased, the flow velocities approached an asymptotical value, showing the importance of the sample volume size selection. These results demonstrate that the homogeneous assumption for porous media that are inherently heterogeneous can lead to considerable errors. Additionally, this modeling approach allowed us to simulate post-treatment flows without considering the explicit geometry of a deployed endovascular coil mass

  16. Advances in peripheral arterial disease endovascular revascularization.

    Science.gov (United States)

    Panico, Ambrose; Jafferani, Asif; Shah, Falak; Dieter, Robert S

    2015-02-01

    Significant advances have been made in the endovascular treatment of lower extremity arterial occlusive disease. Since the 2011 update, technologies has developed and allowed for the revascularization of complex vascular lesions. Although this technical success is encouraging, these technologies must provide measurable long-term clinical success at a reasonable cost. Large, randomized, controlled trials need to be designed to focus on clinical outcomes and success rates for treatment. These future studies will serve as the guide by which clinicians can provide the most successful clinical and cost effect care in treating patients with lower-extremity peripheral artery disease. Published by Elsevier Inc.

  17. Open versus endovascular aneurysm repair trial review.

    Science.gov (United States)

    Weinkauf, Craig; George, Elizabeth; Zhou, Wei

    2017-11-01

    The Open versus Endovascular Aneurysm Repair trial is the only randomized controlled trial that is funded by the federal government to evaluate the treatment outcomes of infrarenal abdominal aortic aneurysms. Since the initial publication, multiple post-hoc analyses have become available. This review summarizes these data, focusing on the primary outcome measures (ie, overall survival) and several key secondary outcomes including aneurysm-related death, age consideration, secondary procedures, and endoleaks. Cost-effectiveness of each treatment modality and the limitations of OVER trial also are discussed critically in this review. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Radial artery access for peripheral endovascular procedures.

    Science.gov (United States)

    Kumar, Avnee J; Jones, Lauren E; Kollmeyer, Kenneth R; Feldtman, Robert W; Ferrara, Craig A; Moe, Michelle N; Chen, Julia F; Richmond, Jasmine L; Ahn, Sam S

    2017-09-01

    The radial artery is often used for coronary angiography, with a demonstrated decrease in local complications and an increase in postoperative mobility of the patient. Data on radial artery access for peripheral endovascular procedures, however, are limited. We describe our experience with radial artery access for diagnostic and endovascular interventions. Between February 2012 and March 2015, there were 95 endovascular procedures performed using radial artery access in 80 unique patients. Demographic and clinical data were recorded. Perioperative, postoperative, and 30-day follow-up data were evaluated retrospectively for major and minor complications. Major adverse events included any immediate hospitalization admission, stroke, hand amputation, bleeding requiring transfusion, hematoma requiring surgery, and death. Minor complications included superficial bleeding and hematoma. The patients (52.6% male, 47.4% female) had a mean age of 72.1 ± 9.4 years. Radial artery access was used for diagnostic purposes in 15.8% of all procedures and for therapeutic intervention, including angioplasty and stenting, in 84.2%. The radial artery was the only access point in 80% of patients and was accessed in conjunction with other sites in 20%. Percutaneous access was achieved in 100% of patients with a 100% technical success rate. Hemostasis after catheterization was achieved by manual compression (22.1%) and TR band (Terumo Medical, Tokyo, Japan; 77.9%). Major adverse events occurred in three cases (3.2%) and were unrelated to radial artery access. Radial artery access site-related complications occurred in three cases (3.2%), all of which were minor hematomas that required no treatment. The risk of radial artery complication was not associated with procedure type, vessels treated, or use of heparin. The incidence of stroke, hand ischemia, and upper extremity limb or finger loss was 0%. Radial artery access for peripheral endovascular procedures appears to be safe and

  19. 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.

  20. Application of a Novel Brain Arteriovenous Malformation Endovascular Grading Scale for Transarterial Embolization.

    Science.gov (United States)

    Bell, D L; Leslie-Mazwi, T M; Yoo, A J; Rabinov, J D; Butler, W E; Bell, J E; Hirsch, J A

    2015-07-01

    The advent of modern neuroendovascular techniques has highlighted the need for a simple, effective, and reliable brain arteriovenous malformation endovascular grading scale. A novel scale of this type has recently been described. It incorporates the number of feeding arteries, eloquence, and the presence of an arteriovenous fistula component. Our aim is to assess the validity of this grading scale. We retrospectively reviewed all suspected brain arteriovenous malformations at Massachusetts General Hospital from 2005 to 2013, identifying 126 patients who met the inclusion criteria. Spearman correlations between endovascular and Spetzler-Martin grading scales and long-term outcomes were performed. Median endovascular grades were compared between treatment modalities and endovascular outcomes. Binary regression analysis was performed with major endovascular complications as a dichotomized dependent variable. Intraclass correlation coefficients were calculated for interobserver reliability of the endovascular grading scale. A significant Spearman correlation between the endovascular grade and the Spetzler-Martin grade was demonstrated (ρ = 0.5, P < .01). Differences in the median endovascular grades between the endovascular cure (median = 2) and endovascular complication groups (median = 4) (P < .05) and between the endovascular cure and successful multimodal treatment groups (median = 3) (P < .05) were demonstrated. The endovascular grade was the only independent predictor of complications (OR = 0.5, P < .01). The intraclass correlation coefficient of the endovascular grade was 0.71 (P < .01). Validation of a brain arteriovenous malformation endovascular grading scale demonstrated that endovascular grades of ≤II were associated with endovascular cure, while endovascular grades of ≤III were associated with multimodal cure or significant lesion reduction and favorable outcome. The endovascular grade provides useful information to refine risk stratification for

  1. Endovascular aortic repair: First twenty years

    Directory of Open Access Journals (Sweden)

    Končar Igor

    2012-01-01

    Full Text Available Endovascular aortic/aneurysm repair (EVAR was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives – engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method.

  2. 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.

  3. Endovascular Therapy Research in Lower Limb Peripheral Arterial Disease Published Over a 5-Year Period: Who is Publishing and Where?

    Science.gov (United States)

    Asadi, H; Lee, R J; Sheehan, M; Thanaratam, P; Lee, D M; Lee, A M; Lee, M J

    2017-03-01

    Peripheral arterial disease (PAD) is being increasingly managed by endovascular therapies. In this study, we identified the clinical services publishing research as well as the journals of publication over a 5-year period. Twenty keywords and phrases related to endovascular intervention were identified, and a literature search was performed through the PubMed database from January 2009 to January 2014. Inclusion criteria were English language, study population more than five patients, and matching the keyword search. Eligible studies were collated into a database and classified by journal of publication, PubMed number, article title, publishing clinical service, type of publication, country of origin, and authors. 825 studies from 114 different journals were identified. 297 papers were excluded. Of the 528 included papers, 204 (39%) were published by Vascular Surgery (VS), 157 (30%) by Interventional Radiology (IR), 101 (19%) by Cardiology, 43 (8%) by Angiology, 6 (1%) by Vascular Medicine, and 17 (3%) from miscellaneous services. 283 (54%) studies originated from Europe, 157 (30%) from North America, 76 (14%) from Asia, 6 from Australia, 3 each from South America and Africa. IR published the most papers on PAD endovascular intervention in Europe with VS second while this trend was reversed in the USA. The 528 papers were published in 98 different journals with retrospective case series (72%), the majority. IR continues to play a significant research role in endovascular intervention in PAD, particularly in Europe, and specifically in below the knee intervention, pedal intervention, and drug-eluting technologies.

  4. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    OpenAIRE

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    BACKGROUND: To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. MATERIAL AND METHODS: Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, ...

  5. A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine.

    Science.gov (United States)

    Barnard, Ed B G; Manning, James E; Smith, Jason E; Rall, Jason M; Cox, Jennifer M; Ross, James D

    2017-07-01

    Survival rates remain low after hemorrhage-induced traumatic cardiac arrest (TCA). Noncompressible torso hemorrhage (NCTH) is a major cause of potentially survivable trauma death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) at the thoracic aorta (Zone 1) can limit subdiaphragmatic blood loss and allow for IV fluid resuscitation when intrinsic cardiac activity is still present. Selective Aortic Arch Perfusion (SAAP) combines thoracic aortic balloon hemorrhage control with intra-aortic oxygenated perfusion to achieve return of spontaneous circulation (ROSC) when cardiac arrest has occurred. Male Yorkshire Landrace cross swine (80.0 ± 6.0 kg) underwent anesthesia, instrumentation for monitoring, and splenectomy. TCA was induced by laparoscopic liver lobe resection combined with arterial catheter blood withdrawal to achieve a sustained systolic blood pressure cardiac arrest. After 3 min of arrest, swine were allocated to one of three interventions: (1) REBOA plus 4 units of IV fresh whole blood (FWB), (2) SAAP with oxygenated lactated Ringer's (LR), 1,600 mL/2 min, or (3) SAAP with oxygenated FWB 1,600 mL/2 min. Primary endpoint was survival to the end of 60 min of resuscitation, a simulated prehospital phase. Thirty animals were allocated to 3 groups (10 per group)-5 protocol exclusions resulted in a total of 35 animals being used. Baseline measurements and time to cardiac arrest were not different amongst groups. ROSC was achieved in 0/10 (0%, 95% CI 0.00-30.9) REBOA, 6/10 (60%, 95% CI 26.2-87.8) SAAP-LR and 10/10 (100%, 95% CI 69.2-100.0) SAAP-FWB animals, p Cardiac arrest in this study was defined by intra-aortic pressure monitoring that is not feasible in clinical practice, and as such limits the generalizability of findings. Clinical trials are needed to determine if the beneficial effects of SAAP-FWB observed in this laboratory study will translate into improved survival in clinical practice. SAAP conferred a superior short-term survival

  6. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment.

    Science.gov (United States)

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery.

  7. Percutaneous Endovascular Treatment for Hepatic Artery Stenosis after Liver Transplantation: The Role of Percutaneous Endovascular Treatment

    Science.gov (United States)

    Vidjak, Vinko; Novačić, Karlo; Matijević, Filip; Kavur, Lovro; Slavica, Marko; Mrzljak, Anna; Filipec-Kanižaj, Tajana; Leder, Nikola Ivan; Škegro, Dinko

    2015-01-01

    Summary Background To retrospectively analyze the outcomes of interventional radiology treatment of patients with hepatic artery stenosis (HAS) after liver transplantation at our Institution. Material/Methods Hepatic artery stenosis was diagnosed and treated by endovascular technique in 8 (2.8%) patients, who underwent liver transplantation between July 2007 and July 2011. Patients entered the follow-up period, during which we analyzed hepatic artery patency with Doppler ultrasound at 1, 3, 6, and 12 months after percutaneous endovascular treatment (PTA), and every six months thereafter. Results During the 12-month follow-up period, 6 out of 8 patients (75%) were asymptomatic with patent hepatic artery, which was confirmed by multislice computed tomography (MSCT) angiography, or color Doppler (CD) ultrasound. One patient had a fatal outcome of unknown cause, and one patient underwent orthotopic liver retransplantation (re-OLT) procedure due to graft failure. Conclusions Our results suggest that HAS angioplasty and stenting are minimally invasive and safe endovascular procedures that represent a good alternative to open surgery, with good 12-month follow-up patency results comparable to surgery. PMID:26150902

  8. [Femoral artery pseudoaneurysms encountered in orthopedics and traumatology].

    Science.gov (United States)

    Raherinantenaina, F; Rajaonanahary, T M A; Rakoto Ratsimba, H N

    2015-12-01

    Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  9. 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?

  10. 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...

  11. Endovascular Thrombin Injection for a Pulmonary Artery Pseudoaneurysm: Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Shin, Jin Ho; Shin, Ji Hoon; Yoon, Hyun Ki [Dept. of Radiology and Research Institute of Radiology, Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)

    2011-12-15

    Massive hemoptysis caused by pulmonary artery pseudoaneurysms is uncommon, and endovascular treatment such as coil embolization is the first choice for treating pulmonary artery pseudoaneurysms. Various embolic agents could be used according to the angiographic findings, yet embolization with thrombin injection is very rare. Herein, we describe a case of a pulmonary artery pseudoaneurysm that was successfully treated by endovascular thrombin injection using a microcatheter because of the difficulty in performing a coil embolization due to a short feeding artery.

  12. 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.

  13. A comparison of Selective Aortic Arch Perfusion and Resuscitative Endovascular Balloon Occlusion of the Aorta for the management of hemorrhage-induced traumatic cardiac arrest: A translational model in large swine.

    Directory of Open Access Journals (Sweden)

    Ed B G Barnard

    2017-07-01

    Full Text Available Survival rates remain low after hemorrhage-induced traumatic cardiac arrest (TCA. Noncompressible torso hemorrhage (NCTH is a major cause of potentially survivable trauma death. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA at the thoracic aorta (Zone 1 can limit subdiaphragmatic blood loss and allow for IV fluid resuscitation when intrinsic cardiac activity is still present. Selective Aortic Arch Perfusion (SAAP combines thoracic aortic balloon hemorrhage control with intra-aortic oxygenated perfusion to achieve return of spontaneous circulation (ROSC when cardiac arrest has occurred.Male Yorkshire Landrace cross swine (80.0 ± 6.0 kg underwent anesthesia, instrumentation for monitoring, and splenectomy. TCA was induced by laparoscopic liver lobe resection combined with arterial catheter blood withdrawal to achieve a sustained systolic blood pressure <10 mmHg, cardiac arrest. After 3 min of arrest, swine were allocated to one of three interventions: (1 REBOA plus 4 units of IV fresh whole blood (FWB, (2 SAAP with oxygenated lactated Ringer's (LR, 1,600 mL/2 min, or (3 SAAP with oxygenated FWB 1,600 mL/2 min. Primary endpoint was survival to the end of 60 min of resuscitation, a simulated prehospital phase. Thirty animals were allocated to 3 groups (10 per group-5 protocol exclusions resulted in a total of 35 animals being used. Baseline measurements and time to cardiac arrest were not different amongst groups. ROSC was achieved in 0/10 (0%, 95% CI 0.00-30.9 REBOA, 6/10 (60%, 95% CI 26.2-87.8 SAAP-LR and 10/10 (100%, 95% CI 69.2-100.0 SAAP-FWB animals, p < 0.001. Survival to end of simulated 60-minute prehospital resuscitation was 0/10 (0%, 95% CI 0.00-30.9 for REBOA, 1/10 (10%, 95% CI 0.25-44.5 for SAAP-LR and 9/10 (90%, 95% CI 55.5-99.7 for SAAP-FWB, p < 0.001. Total FWB infusion volume was similar for REBOA (2,452 ± 0 mL and SAAP-FWB (2,250 ± 594 mL. This study was undertaken in laboratory conditions, and as such may have

  14. Endovascular Repair of Descending Thoracic Aorta in Loeys-Dietz II Syndrome.

    Science.gov (United States)

    Kalra, Ankur; Harris, Kevin M; Kische, Stephan; Alden, Peter; Schumacher, Clark; Nienaber, Christoph A

    2015-10-01

    Loeys-Dietz syndrome (LDS) is an autosomal dominant disorder that is predominantly characterized by involvement of the aorta, manifesting as aneurysmal dilatation or aortic dissection. Patients with LDS manifest with spontaneous aneurysms and dissections of central and peripheral arterial beds. We present 2 cases of young male patients with Loeys-Dietz II aortopathy, who manifested with spontaneous intimal tear of descending thoracic aorta and contained aortic rupture. Both patients were managed by endovascular repair, with collaborative efforts of teams comprising interventional cardiologists and radiologists, and a vascular surgeon. Copyright © 2015 Elsevier Inc. All rights reserved.

  15. Are there fewer complications with third generation endografts in endovascular aneurysm repair?

    DEFF Research Database (Denmark)

    Jayia, P; Constantinou, J; Morgan-Rowe, L

    2013-01-01

    compared to open surgery in short and mid-term follow-up. The first pioneer devices had a high failure rate due to stent migration. This led to the creation of the first generation stent-grafts, which were associated with complications such as thrombosis of the limbs, graft migration and major endoleaks...... branches and fenestrations in order to best accommodate the aortic anatomy of the patient. However, many issues remain with the development of this technology. There is a need for durable systems with less complicated deployment mechanics in order to be applied and more widespread. In conclusion, the third...... generation endografts in challenging anatomy has yielded encouraging results. With regards to short and midterm outcome and need for secondary interventions, evaluations shows comparable results with all devices performing well....

  16. 2015 American Heart Association/American Stroke Association Focused Update of the 2013 Guidelines for the Early Management of Patients With Acute Ischemic Stroke Regarding Endovascular Treatment: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association.

    Science.gov (United States)

    Powers, William J; Derdeyn, Colin P; Biller, José; Coffey, Christopher S; Hoh, Brian L; Jauch, Edward C; Johnston, Karen C; Johnston, S Claiborne; Khalessi, Alexander A; Kidwell, Chelsea S; Meschia, James F; Ovbiagele, Bruce; Yavagal, Dileep R

    2015-10-01

    The aim of this guideline is to provide a focused update of the current recommendations for the endovascular treatment of acute ischemic stroke. When there is overlap, the recommendations made here supersede those of previous guidelines. This focused update analyzes results from 8 randomized, clinical trials of endovascular treatment and other relevant data published since 2013. It is not intended to be a complete literature review from the date of the previous guideline publication but rather to include pivotal new evidence that justifies changes in current recommendations. Members of the writing committee were appointed by the American Heart Association/American Stroke Association Stroke Council's Scientific Statement Oversight Committee and the American Heart Association/American Stroke Association Manuscript Oversight Committee. Strict adherence to the American Heart Association conflict of interest policy was maintained throughout the consensus process. Recommendations follow the American Heart Association/American Stroke Association methods of classifying the level of certainty of the treatment effect and the class of evidence. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statement Oversight Committee and Stroke Council Leadership Committee. Evidence-based guidelines are presented for the selection of patients with acute ischemic stroke for endovascular treatment, for the endovascular procedure, and for systems of care to facilitate endovascular treatment. Certain endovascular procedures have been demonstrated to provide clinical benefit in selected patients with acute ischemic stroke. Systems of care should be organized to facilitate the delivery of this care. © 2015 American Heart Association, Inc.

  17. Capturing the essence of developing endovascular expertise for the construction of a global assessment instrument

    DEFF Research Database (Denmark)

    Bech, B.; Lönn, L.; Schroeder, T. V.

    2010-01-01

    To explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument.......To explore what characterises the development of endovascular expertise and to construct a novel global assessment instrument....

  18. 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.)

  19. [Endovascular versus surgical treatment in subarachnoid haemorrhage: Cost analysis].

    Science.gov (United States)

    Horcajadas Almansa, Angel; Jouma Katati, Majed; Román Cutillas, Ana; Jorques Infante, Ana; Cordero Tous, Nicolás

    2015-01-01

    To analyse costs of endovascular versus surgical treatment in 80 patients with aneurysmal subarachnoid haemorrhage (aSAH). We analysed data on 80 consecutive patients with aSAH between January 2010 and June 2011. Endovascular treatment was used in 57 patients and surgical in 23 patients. Demographic (gender and age) and clinical data (Hunt-Hess and Fisher scales), length of stay (ICU and ward) and results at 6 months (Glasgow outcome scale,[GOS]) were collected. Costs including stay, follow-up, complications and retreatments were calculated. Age was higher in the endovascular group (statistically significant). There were no differences between the 2 groups in Hunt-Hess and Fisher scales. Results at 6 months were also similar, although slightly better in the surgical group. Length of stay was longer in surgical patients, both in ICU (mean 1.4 days) and ward (1.7 days). Hospitalisation length was also related to age and Hunt-Hess and Fisher scales. Costs from embolisation devices, follow-up and retreatment (12% in this series) made final endovascular treatment 4.1% more expensive than surgical treatment (€35,835 versus €34,404). Endovascular procedure (including retreatments) was 110% more expensive than surgical treatment (€8,015 versus €3,817). There are no differences between the 2 treatments in terms of morbidity and mortality. Stability of surgical treatment was higher than that of endovascular, with better occlusion and lower retreatment rates. Endovascular treatment is more expensive in ruptured aneurysms, principally due to embolisation device costs, long-term follow-up and retreatments, in retreatments, in spite of shorter hospital stay. In incidental aneurysms, which usually need shorter hospitalisation, differences between the 2 treatments could be even larger. Copyright © 2013 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  20. Prehospital triage for endovascular clot removal in acute stroke patients.

    Science.gov (United States)

    Suzuki, Yu; Hasegawa, Yasuhiro; Tsumura, Kohtaro; Ueda, Toshihiro; Suzuki, Kazunari; Sugiyama, Makoto; Nozaki, Hiroyuki; Kawaguchi, Shojiro; Nakane, Makoto; Nagashima, Goro; Kitamura, Takayuki; Yokomine, Kengo; Sasanuma, Jinichi

    2017-01-01

    To establish prehospital triage in accordance with the new guidelines for endovascular therapy, we retrospectively analyzed the monitoring data of the city-wide transportation system using the Maria Prehospital Stroke Scale (MPSS), a novel prehospital stroke scale for emergency medical technicians (EMTs) to predict the likelihood of thrombolytic therapy after transportation. Kawasaki City, Japan, has six comprehensive stroke centers (CSCs) and six primary stroke centers (PSCs). In CSCs, endovascular therapy can be carried out 24 h a day, 7 days a week, but not in PSCs. There is no "drip and ship" protocol for further endovascular therapy from PSCs to CSCs. We determined the predictive value of MPSS scoring by the EMTs for the performance of endovascular therapy after transportation. There were 2031 patients (mean age, 71.1 ± 13.3 years) registered from April 2012 to March 2015. Multivariate logistic regression analysis indicated that the MPSS score and type of stroke center were independent predictors for performance of endovascular therapy. In particular, the odds ratio (OR) for endovascular therapy was significant for MPSS score 3 (OR, 2.914; 95% confidence interval (CI), 1.152-7.372; P = 0.024), MPSS score 4 (OR, 5.474; 95%CI, 2.300-13.029; P = 0.000), and MPSS score 5 (OR, 11.459; 95%CI, 4.334-30.296; P = 0.000) when MPSS score 1 was set as a reference. The diagnostic accuracy of the MPSS score evaluated by EMTs was 0.689 (95%CI, 0.627-0.751). Prehospital triage using MPSS scores evaluated by EMTs can predict the likelihood of performance of endovascular therapy after transportation, and may become a tool offering a flexible solution for designing a new transportation protocol.

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

    Science.gov (United States)

    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.

  2. The role of endovascular therapy in acute mesenteric ischemia

    Science.gov (United States)

    Ierardi, Anna Maria; Tsetis, Dimitrios; Sbaraini, Sara; Angileri, Salvatore Alessio; Galanakis, Nikolaos; Petrillo, Mario; Patella, Francesca; Panella, Silvia; Balestra, Federica; Lucchina, Natalie; Carrafiello, Gianpaolo

    2017-01-01

    Background Endovascular therapy, including aspiration thrombectomy and local thrombolytic therapy, often associated with angioplasty and stent placement, has been described in the literature. The purpose of this study was to review case series of patients with acute mesenteric ischemia treated with endovascular therapy and evaluate their outcomes. Methods An online review using PubMed was carried out to identify all English articles about this topic in the time interval from 2005 to 2016. The following variables were extracted number of patients, cause of occlusion, symptoms, arteries involved, number of sessions of treatment, technical success, clinical success, recurrence rate, complications, mortality rate, number of patients who underwent diagnostic laparoscopy or surgical resection of ischemic bowel. Results Eighteen papers met the inclusion criteria and were included. Among the patients with arterial mesenteric ischemia treated with endovascular approach, the technical success rate was high (up to 100%) and data regarding clinical success are encouraging, even though they are few and heterogeneous. Technical success rate and clinical success of patients with acute venous mesenteric ischemia approached with endovascular treatment was 74-100% and 87.5-100% respectively. Conclusions Current advances in endovascular therapies have made these treatments feasible for mesenteric ischemia. PMID:28845108

  3. 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 CO(2) (PaCO(2), 35%) and decreases in pH (1.35%) during EDVH. These were associated with increases in heart rate, mean blood pressure, and cardiac output. Within the EDVH group, greater elevations (>10 mmHg) in PaCO2 were more likely during difficult harvest procedures, and these patients exhibited greater increase in heart rate. Elevated CO(2) persisted during CPB, requiring higher systemic gas flows and greater use of phenylephrine to maintain desired hemodynamics. EDVH was associated with systemic absorption of CO(2). Greater absorption was more likely in difficult procedures and was associated with greater hemodynamic changes requiring medical therapy.

  4. Endovascular treatment paradigm of carotid blowout syndrome: Review of 8-years experience

    Energy Technology Data Exchange (ETDEWEB)

    Wan, Wing Suet, E-mail: wws351@ha.org.hk [Department of Radiology, Tuen Mun Hospital, Tuen Mun (Hong Kong); Lai, Vincent, E-mail: vincentlai@hkcr.org [Department of Radiology, Tuen Mun Hospital, Tuen Mun (Hong Kong); Lau, Hin Yue, E-mail: lhy460@ha.org.hk [Department of Radiology, Tuen Mun Hospital, Tuen Mun (Hong Kong); Wong, Yiu Chung, E-mail: wongyc6@ha.org.hk [Department of Radiology, Tuen Mun Hospital, Tuen Mun (Hong Kong); Poon, Wai Lun, E-mail: poonwl@ha.org.hk [Department of Radiology, Tuen Mun Hospital, Tuen Mun (Hong Kong); Tan, Chong Boon, E-mail: tancb@ha.org.hk [Department of Radiology, Tuen Mun Hospital, Tuen Mun (Hong Kong)

    2013-01-15

    Objectives: Endovascular treatment is effective in treating carotid blowout syndrome (CBS). We reviewed our experience in addressing CBS over eight years and presented an account of the treatment paradigm and management algorithm. Method: All cases of CBS from 2003 to 2010 with endovascular treatment performed in our center were reviewed. 15 CBS in 14 patients were recruited. Based on our management algorithm, treatment regimen was stratified into deconstructive or constructive methods. Their clinical presentations, angiographic features, angiographic and clinical outcomes were reviewed. Results: 10 patients were treated with deconstructive method by means of permanent vessel occlusion (PVO) and 4 patients were treated with constructive method by means of placement of covered stent (n = 3) or flow diverting device (n = 1). Immediate hemostasis was achieved in all cases. 7 (50%) patients, in whom 5 treated with PVO and 2 with covered stent, had favorable outcomes and survived at a median follow-up period of 4 months (range: 1–84 months). Conclusion: Permanent vessel occlusion remains the gold standard of treatment and tends to show a favorable long-term outcome. Off-label use of covered stent and flow-diverting device can produce satisfactory results should balloon occlusion test fail, but long-term follow up would be required for definitive assessment.

  5. Failures and Lessons in the Endovascular Treatment of Symptomatic Isolated Dissection of the Superior Mesenteric Artery.

    Science.gov (United States)

    Dong, Zhihui; Ning, Junjie; Fu, Weiguo; Guo, Daqiao; Xu, Xin; Chen, Bin; Jiang, Junhao; Wang, Yuqi

    2016-02-01

    To discuss failures and lessons in the endovascular treatment of symptomatic isolated dissection of the superior mesenteric artery (SIDSMA). Data from 33 patients with SIDSMA treated between July 2007 and September 2013 were retrospectively collected. The technical failures in and lessons from endovascular management were analyzed in terms of causes and prophylaxis. Eighteen patients were successfully treated medically, 13 underwent stent placement, 1 underwent a hybrid procedure, and 1 had open fenestration. Full follow-ups (37 ± 21 months) were achieved in 28 patients. Failures to cannulate the true lumen occurred in 8 patients. Among these patients, femoral and brachial approaches were taken in 6 and 2 patients, respectively, and a 2-sided Fisher's exact test revealed no significant differences (P = 0.204). Among the 6 femoral failures, the true lumina were cannulated after conversion to the brachial approach in 3 cases. The perfusion of the distal SMA was not improved until the second stent was distally placed to cover the entire expanded false lumen in 1 case. Numerous branches originating from the false lumen were overlooked in 1 patient and were apparently compromised after stenting. Consequently, the patient died of intestinal necrosis. In a patient with a huge dissecting aneurysm, a stent was misplaced across the false lumen. Fortunately, a remarkable aneurysmal thrombosis formed at 3 months. In a patient who received a hybrid procedure, the stent was occluded at 2 weeks, most likely because the thrombus protruded into the stent. Difficulty in cannulating the true lumen is not uncommon in the endovascular treatment of SIDSMA, and the selection of the arterial approach would benefit from being based on the morphology of the SMA arch. The lengths and branches of the involvement of the false lumen should be evaluated beforehand. Covered stents would be a reasonable option for lumina that contain thrombi. Copyright © 2016 Elsevier Inc. All rights

  6. Endovascular Intervention for Acute Ischemic Stroke in Light of Recent Trials

    Directory of Open Access Journals (Sweden)

    Kenan Alkhalili

    2014-01-01

    Full Text Available Three recently published trials, MR RESCUE, IMS III, and SYNTHESIS Expansion, evaluating the efficacy and safety of endovascular treatment of acute ischemic stroke have generated concerns about the future of endovascular approach. However, the tremendous evolution that imaging and endovascular treatment modalities have undergone over the past several years has raised doubts about the validity of these trials. In this paper, we review the role of endovascular treatment strategies in acute ischemic stroke and discuss the limitations and shortcomings that prevent generalization of the findings of recent trials. We also provide our experience in endovascular treatment of acute ischemic stroke.

  7. Advances in endovascular treatment of critical limb ischemia.

    LENUS (Irish Health Repository)

    Yan, Bryan P

    2011-04-01

    Critical limb ischemia (CLI) represents the most severe clinical manifestation of peripheral arterial disease. In the absence of timely revascularization, CLI carries high risk of mortality and amputation. Over the past decade, endovascular revascularization has rapidly become the preferred primary treatment strategy for CLI, especially for the treatment of below-the-knee disease. Advances in percutaneous devices and techniques have expanded the spectrum of patients with CLI who are deemed candidates for revascularization. This review will focus on advances in endovascular options for the treatment of CLI, in particular for below-the-knee disease.

  8. The Management of Cephalic Arch Stenosis in Arteriovenous Fistulas for Hemodialysis: A Systematic Review

    Energy Technology Data Exchange (ETDEWEB)

    Vasanthamohan, Lakshman, E-mail: lakshman.vasanthamohan@medportal.ca; Gopee-Ramanan, Prasaanthan, E-mail: Prasa.gopee@medportal.ca; Athreya, Sriharsha, E-mail: sathreya@stjoes.ca [McMaster University, Faculty of Health Sciences (Canada)

    2015-10-15

    AimTo conduct a systematic review of management of current cephalic arch stenosis (CAS) and associated outcomes in the context of dysfunctional hemodialysis access.Materials and MethodsPubMed, Web of Science, and Cochrane Library were searched to retrieve literature on the management of CAS. Studies had to focus on management of access stenosis solely in the cephalic arch. Case reports and literature reviews were excluded. Studies were categorized by intervention, and primary and secondary patency data were compiled. Studies were aggregated, and meta-analyses were performed where possible.ResultsNine papers satisfied the aforementioned criteria: five were retrospective studies and four were prospective studies. CAS management strategies have included percutaneous transluminal balloon angioplasty (PTA), peripheral cutting balloons, surgical cephalic vein transpositions, bare stents, and stent grafts. Reporting strategies varied between studies. Meta-analyses showed that results were variable even within studies using the same modality, particularly for PTA.ConclusionNo singular, definitive management strategy exists for CAS. Current studies are limited by being primarily single-center retrospective trials featuring heterogenous patient populations, interventions, and endpoints. Priorities for future studies should include larger randomized trials, more uniform management strategies and endpoints, and a longer duration of follow-up.

  9. Endovascular treatment of fusiform intracranial aneurysms.

    Science.gov (United States)

    Devulapalli, Kavi K; Chowdhry, Shakeel A; Bambakidis, Nicholas C; Selman, Warren; Hsu, Daniel Pierce

    2013-03-01

    Endovascular treatment (EVT) has emerged as an alternative therapeutic strategy for the treatment of intracranial fusiform aneurysms (IFAs), but little is known about the safety and efficacy of deconstructive and reconstructive methods, especially in patients presenting with subarachnoid hemorrhage (SAH). The purpose of this study is to describe the radiological and clinical outcomes in patients with IFAs undergoing EVT. A retrospective analysis was conducted of 18 patients undergoing EVT of IFAs, 13 of whom (72.2%) presented with SAH. Radiological outcomes were characterized by the presence of parent vessel opacification and aneurysmal remnants for patients undergoing deconstructive and reconstructive EVT, respectively. Clinical outcomes were characterized by the Glasgow Outcome Scale. Contingency analysis of factors associated with clinical outcomes in patients with ruptured aneurysms was conducted. Technical success was achieved in 17 of the 18 patients (94.4%), with 10 (55.6%) undergoing reconstructive EVT and eight (44.4%) undergoing deconstructive EVT. For patients with SAH, favorable clinical outcomes were achieved in 9/13 (69.2%), with 3/6 (50.0%) undergoing reconstructive EVT and 6/7 (85.7%) undergoing deconstructive EVT. Among patients with ruptured aneurysms, only Hunt-Hess grade ≥3 was associated with an unfavorable clinical outcome (p=0.007). Favorable clinical outcomes were seen in all five patients with unruptured aneurysms. Both deconstructive and reconstructive EVT were found to be safe and effective in patients with unruptured aneurysms. Reconstructive EVT may be associated with a higher incidence of poor clinical outcomes in patients presenting with high-grade SAH.

  10. 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)

  11. Endovascular Therapy Research in Lower Limb Peripheral Arterial Disease Published Over a 5-Year Period: Who is Publishing and Where?

    Energy Technology Data Exchange (ETDEWEB)

    Asadi, H.; Lee, R. J.; Sheehan, M.; Thanaratam, P.; Lee, D. M.; Lee, A. M.; Lee, M. J., E-mail: mlee@rcsi.ie [Beaumont Hospital, Interventional Radiology Service, Department of Radiology, Royal College of Surgeons in Ireland Medical School (Ireland)

    2017-03-15

    IntroductionPeripheral arterial disease (PAD) is being increasingly managed by endovascular therapies. In this study, we identified the clinical services publishing research as well as the journals of publication over a 5-year period.MethodsTwenty keywords and phrases related to endovascular intervention were identified, and a literature search was performed through the PubMed database from January 2009 to January 2014. Inclusion criteria were English language, study population more than five patients, and matching the keyword search. Eligible studies were collated into a database and classified by journal of publication, PubMed number, article title, publishing clinical service, type of publication, country of origin, and authors.Results825 studies from 114 different journals were identified. 297 papers were excluded. Of the 528 included papers, 204 (39%) were published by Vascular Surgery (VS), 157 (30%) by Interventional Radiology (IR), 101 (19%) by Cardiology, 43 (8%) by Angiology, 6 (1%) by Vascular Medicine, and 17 (3%) from miscellaneous services. 283 (54%) studies originated from Europe, 157 (30%) from North America, 76 (14%) from Asia, 6 from Australia, 3 each from South America and Africa. IR published the most papers on PAD endovascular intervention in Europe with VS second while this trend was reversed in the USA. The 528 papers were published in 98 different journals with retrospective case series (72%), the majority.ConclusionIR continues to play a significant research role in endovascular intervention in PAD, particularly in Europe, and specifically in below the knee intervention, pedal intervention, and drug-eluting technologies.

  12. Cateteres intravenosos fraturados: retirada por técnicas endovasculares Intravenous catheter fragments: endovascular retrieval

    Directory of Open Access Journals (Sweden)

    Gustavo Andrade

    2006-06-01

    Full Text Available OBJETIVO: A colocação de cateter para acesso venoso central é uma prática médica cada vez mais comum, sendo a fratura e embolização de fragmentos do cateter raras, porém correspondem aos corpos estranhos intravasculares mais comuns. O objetivo é demonstrar nossa experiência na retirada desses corpos estranhos intravasculares utilizando técnicas endovasculares. MATERIAIS E MÉTODOS: Análise retrospectiva dos últimos cinco anos permitiu a avaliação de dez casos consecutivos, com a idade variando entre nove meses e 67 anos. RESULTADOS: O procedimento foi realizado com sucesso em todos os casos, por diferentes técnicas, sem complicações. Os locais mais comuns de alojamento dos fragmentos foram átrio direito, veia cava superior e artéria pulmonar esquerda. A retirada desses corpos estranhos por técnicas endovasculares é procedimento relativamente simples quando comparado à alternativa cirúrgica, tendo sido utilizada com segurança e sucesso em inúmeros pacientes. Os dispositivos disponíveis mostraram-se bastante eficazes, sendo o laço o mais versátil. CONCLUSÃO: A alta taxa de sucesso com poucas complicações relatadas, mesmo em crianças, permite a afirmação que os corpos estranhos intravenosos devem ser extraídos por técnicas percutâneas sempre que possível. Contudo, a familiarização com as diversas técnicas é fundamental, permitindo combinações e modificações, adaptando-as à situação do caso.OBJECTIVE: Central venous access is an increasingly frequent procedure and intravenous catheter fractures and fragments embolization, although being rare, correspond to the most common intravascular foreign bodies. This study purpose is to show our experience in the removal of these foreign bodies, employing endovascular techniques. MATERIALS AND METHODS: Retrospective analysis of ten consecutive cases in the last five years, including patients with ages ranging from 9 months to 67 years. RESULTS: The procedure

  13. 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

  14. Effects of Workflow Optimization in Endovascularly Treated Stroke Patients - A Pre-Post Effectiveness Study.

    Science.gov (United States)

    Schregel, Katharina; Behme, Daniel; Tsogkas, Ioannis; Knauth, Michael; Maier, Ilko; Karch, André; Mikolajczyk, Rafael; Hinz, José; Liman, Jan; Psychogios, Marios-Nikos

    2016-01-01

    Endovascular treatment of acute ischemic stroke has become standard of care for patients with large artery occlusion. Early restoration of blood flow is crucial for a good clinical outcome. We introduced an interdisciplinary standard operating procedure (SOP) between neuroradiologists, neurologists and anesthesiologists in order to streamline patient management. This study analyzes the effect of optimized workflow on periprocedural timings and its potential influence on clinical outcome. Data were extracted from a prospectively maintained university hospital stroke database. The standard operating procedure was established in February 2014. Of the 368 acute stroke patients undergoing endovascular treatment between 2008 and 2015, 278 patients were treated prior to and 90 after process optimization. Outcome measures were periprocedural time intervals and residual functional impairment. After implementation of the SOP, time from symptom onset to reperfusion was significantly reduced (median 264 min prior and 211 min after SOP-introduction (IQR 228-32 min and 161-278 min, respectively); Pworkflow optimization as measured with the modified Rankin Scale (common odds ratio (OR) 0.56; 95% CI 0.32-0.98; P = 0.038). Optimization of workflow and interdisciplinary teamwork significantly improved the outcome of patients with acute ischemic stroke due to a significant reduction of in-hospital examination, transportation, imaging and treatment times.

  15. Administration of eptifibatide during endovascular treatment of ruptured cerebral aneurysms reduces the rate of thromboembolic events.

    Science.gov (United States)

    Sedat, Jacques; Chau, Yves; Gaudard, Jean; Suissa, Laurent; Lachaud, Sylvain; Lonjon, Michel

    2015-02-01

    Thromboembolic complications are the most frequent complications of endovascular treatment of ruptured intracranial aneurysms. The optimal protocol to prevent thromboembolic complications during coil embolization does not yet exist. The aim of this study was to investigate the effectiveness and safety of eptifibatide for the prevention of thromboembolic complications during elective coil embolization of ruptured cerebral aneurysms. A consecutive series of 100 patients (group 1) with ruptured intracranial aneurysm were treated using endovascular coil embolization. At the beginning of the procedure, all patients received an intra-arterial bolus (0.2 mg/kg) of eptifibatide. The following data were collected: degree of aneurysmal occlusion after treatment, thromboembolic and hemorrhagic complications and other intraoperative adverse events. The results were compared with those from a control group (group 2) which were analyzed retrospectively. Group 2 consisted of 100 previous patients with ruptured aneurysm managed with coil embolization who had received heparin and/or aspirin at the beginning of the procedure. (1) Patient populations in groups 1 and 2 were considered statistically comparable, except that group 1 (eptifibatide) included more wide-necked aneurysms (p = 0.011). (2) There were less thromboembolic complications in group 1 (p = 0.011): seven intraoperative complications in group 1 versus 20 in group 2. (3) Intraoperative hemorrhagic complications were statistically comparable in both groups (p = 1). Eptifibatide was effective in lowering the intraoperative thromboembolic complication rate in ruptured aneurysms treated with coil embolization and did not increase the hemorrhagic risk.

  16. MRI-based Assessment of Endovascular Abdominal Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Laan, M.J. van der

    2007-01-01

    Imaging techniques play a key role in the Endovascular Abdominal Aortic Aneurysm Repair (EVAR) follow-up. The most important parameters monitored after EVAR are the aneurysm size and the presence of endoleaks. Currently, computed tomographic angiography (CTA) is the most commonly used imaging

  17. Endovascular foreign objects retrieved by inter- ventional radiolo ...

    African Journals Online (AJOL)

    Enrique

    Endovascular foreign objects retrieved by inter- ventional radiolo- gists at Universitas. Hospital. H F Potgieter. MB ChB. E Loggenberg. MMedRad (D). Department of Diagnostic Radiology. University of the Free State and. Universitas Hospital. Bloemfontein. Fig. 1a. Infusoport without catheter. Fig. 1b. Lost central venous line ...

  18. Fine-motor skills testing and prediction of endovascular performance

    DEFF Research Database (Denmark)

    Bech, Bo; Lönn, Lars; Schroeder, Torben V

    2013-01-01

    Performing endovascular procedures requires good control of fine-motor digital movements and hand-eye coordination. Objective assessment of such skills is difficult. Trainees acquire control of catheter/wire movements at various paces. However, little is known to what extent talent plays for novice...

  19. Endovascular treatment of ruptured true posterior communicating artery aneurysms.

    Science.gov (United States)

    Yang, Yonglin; Su, Wandong; Meng, Qinghai

    2015-01-01

    Although true posterior communicating artery (PCoA) aneurysms are rare, they are of vital importance. We reviewed 9 patients with this fatal disease, who were treated with endovascular embolization, and discussed the meaning of endovascular embolization for the treatment of true PCoA aneurysms. From September 2006 to May 2012, 9 patients with digital substraction angiography (DSA) confirmed true PCoA aneurysms were treated with endovascular embolization. Patients were followed-up with a minimal duration of 17 months and assessed by Glasgow Outcome Scale (GOS) score. All the patients presented with spontaneous subarachnoid hemorrhage from the ruptured aneurysms. The ratio of males to females was 1:2, and the average age of onset was 59.9 (ranging from 52 to 72) years. The preoperative Hunt-Hess grade scores were I to III. All patients had recovered satisfactorily. No permanent neurological deficits were left. Currently, endovascular embolization can be recommended as the top choice for the treatment of most true PCoA aneurysms, due to its advanced technique, especially the application of the stent-assisted coiling technique, combined with its advantage of mininal invasiveness and quick recovery. However, the choice of treatment methods should be based on the clinical and anatomical characteristics of the aneurysm and the skillfulness of the surgeon.

  20. Critical Limb Ischemia : Prognostic Factors and Endovascular Strategies

    NARCIS (Netherlands)

    Spreen, Marlon I

    2016-01-01

    Critical limb ischemia (CLI) is the final stage of peripheral arterial disease (PAD). Endovascular infrapopliteal treatment of patients with CLI using percutaneous transluminal angioplasty (PTA) and bail-out bare metal stenting (BMS) is hampered by restenosis. The PADI (Percutaneous transluminal

  1. 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...

  2. Early endovascular aneurysm repair after percutaneous coronary interventions.

    Science.gov (United States)

    Pecoraro, Felice; Wilhelm, Markus; Kaufmann, Angela R; Bettex, Dominique; Maier, Willibald; Mayer, Dieter; Veith, Frank J; Lachat, Mario

    2015-05-01

    The objective of this study was to report long-term results of early endovascular aortic aneurysm repair after percutaneous coronary intervention (PCI). This was a retrospective analysis of all patients presenting with abdominal aortic aneurysm and coronary artery disease treated during the same hospitalization by endovascular aortic aneurysm repair performed soon after PCI. Primary outcomes were perioperative mortality, perioperative complications, survival after treatment, and freedom from reintervention. A total of 20 patients were included, and all completed both procedures. No deaths or abdominal aortic aneurysm ruptures occurred between the PCI and the aortic intervention. Perioperative mortality was 5% as one patient died of mesenteric ischemia after endovascular aneurysm repair. Major cardiovascular vascular complications occurred in four patients (20%) and included non-ST-segment elevation myocardial infarction (one) and access vessel complication (three). Mean follow-up was 94 (range, 1-164; standard deviation, 47) months. Estimated survival at 1 year, 2 years, 5 years, and 10 years was 90%, 90%, 90%, and 60%, respectively. A reoperation was required in six patients. Estimated freedom from reintervention at 1 year, 2 years, 5 years, and 10 years was 83%, 83%, 78%, and 72%, respectively. Our study indicates that early endovascular aneurysm repair performed within a week after PCI may be a reasonable approach in patients with large or symptomatic aneurysms. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  3. Endovascular treatment of carotid-cavernous vascular lesions

    Directory of Open Access Journals (Sweden)

    GUILHERME BRASILEIRO DE AGUIAR

    Full Text Available ABSTRACT Objective: to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA performed at our institution. Methods: we conducted a descriptive, retrospective and prospective study of patients with aneurysms of the cavernous portion of the ICA or with direct carotid-cavernous fistulas (dCCF undergoing endovascular treatment. Results: we included 26 patients with intracavernous aneurysms and ten with dCCF. All aneurysms were treated with ICA occlusion. Those with dCCF were treated with occlusion in seven cases and with selective fistula occlusion in the remaining three. There was improvement of pain and ocular proptosis in all patients with dCCF. In patients with intracavernous aneurysms, the incidence of retro-orbital pain fell from 84.6% to 30.8% after treatment. The endovascular treatment decreased the dysfunction of affected cranial nerves in both groups, especially the oculomotor one. Conclusion: the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction.

  4. Endovascular treatment of intractable epistaxis - results of a 4-year ...

    African Journals Online (AJOL)

    A total of 57 endovascular embolisation procedures were performed for intractable epistaxis in 51 patients during this period. Eight patients (15.7%) developed a re-bleed between 1 and 33 days after embolisation of whom 5 were re- embolised, giving a primary short-term success rate of 86.3% and secondary assisted ...

  5. Brazilian guidelines for endovascular treatment of patients with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Octávio Marques Pontes-Neto

    Full Text Available ABSTRACT These guidelines are the result of a joint effort from writing groups of the Brazilian Stroke Society, the Scientific Department of Cerebrovascular Diseases of the Brazilian Academy of Neurology, the Brazilian Stroke Network and the Brazilian Society of Diagnostic and Therapeutic Neuroradiology. Members from these groups participated in web-based discussion forums with predefined themes, followed by videoconference meetings in which controversies and position statements were discussed, leading to a consensus. This guidelines focuses on the implications of the recent clinical trials on endovascular therapy for acute ischemic stroke due to proximal arterial occlusions, and the final text aims to guide health care providers, health care managers and public health authorities in managing patients with this condition in Brazil.

  6. Association between hemorrhagic transformation after endovascular therapy and poststroke seizures.

    Science.gov (United States)

    Thevathasan, Arthur; Naylor, Jillian; Churilov, Leonid; Mitchell, Peter J; Dowling, Richard J; Yan, Bernard; Kwan, Patrick

    2017-12-30

    Endovascular therapy has recently become standard therapy for select patients with acute ischemic stroke. Infarcted brain tissue may undergo hemorrhagic transformation (HT) after endovascular therapy. We investigated the association between HT and occurrence of poststroke seizures in patients treated with endovascular therapy. Consecutive patients treated with endovascular therapy for acute anterior circulation ischemic stroke were included. HT was assessed with computed tomography/magnetic resonance imaging (CT/MRI) at 24 h after stroke onset. Patients were followed for up to 2 years for seizure occurrence. A total of 205 (57.1% male) patients were analyzed. Median age was 69 years (interquartile range [IQR] 57-78). Among patients with HT, 17.9% (10/56) developed poststroke seizures compared with 4.0% (6/149) among those without HT (hazard ratio [HR] 5.52; 95% confidence interval [CI] 2.00-15.22; P = .001). The association remained significant after adjustment for cortical involvement, baseline National Institutes of Health Stroke Scale score, age and use of intravenous tissue plasminogen activator and clot retrieval (HR 4.85; 95% CI 1.60-14.76; P = .005). In patients who developed seizures within the follow-up period, median time to first seizure was 111 days (IQR 28-369) in patients with HT and 36 days (IQR 0.5-183) in patients without HT. A patient who develops HT following endovascular therapy for acute ischemic stroke had a nearly 5 times higher rate of developing poststroke seizures within 2 years. HT may be used as an imaging biomarker for poststroke seizures. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  7. Occupational Radiation Exposure During Endovascular Aortic Repair

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    Sailer, Anna M., E-mail: anni.sailer@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands); Schurink, Geert Willem H., E-mail: gwh.schurink@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Surgery (Netherlands); Bol, Martine E., E-mail: m.bol@maastrichtuniversity.nl; Haan, Michiel W. de, E-mail: m.de.haan@mumc.nl; Zwam, Willem H. van, E-mail: w.van.zwam@mumc.nl; Wildberger, Joachim E., E-mail: j.wildberger@mumc.nl; Jeukens, Cécile R. L. P. N., E-mail: cecile.jeukens@mumc.nl [Maastricht University Medical Centre (MUMC), Department of Radiology (Netherlands)

    2015-08-15

    PurposeThe aim of the study was to evaluate the radiation exposure to operating room personnel and to assess determinants for high personal doses during endovascular aortic repair.Materials and MethodsOccupational radiation exposure was prospectively evaluated during 22 infra-renal aortic repair procedures (EVAR), 11 thoracic aortic repair procedures (TEVAR), and 11 fenestrated or branched aortic repair procedures (FEVAR). Real-time over-lead dosimeters attached to the left breast pocket measured personal doses for the first operators (FO) and second operators (SO), radiology technicians (RT), scrub nurses (SN), anesthesiologists (AN), and non-sterile nurses (NSN). Besides protective apron and thyroid collar, no additional radiation shielding was used. Procedural dose area product (DAP), iodinated contrast volume, fluoroscopy time, patient’s body weight, and C-arm angulation were documented.ResultsAverage procedural FO dose was significantly higher during FEVAR (0.34 ± 0.28 mSv) compared to EVAR (0.11 ± 0.21 mSv) and TEVAR (0.06 ± 0.05 mSv; p = 0.003). Average personnel doses were 0.17 ± 0.21 mSv (FO), 0.042 ± 0.045 mSv (SO), 0.019 ± 0.042 mSv (RT), 0.017 ± 0.031 mSv (SN), 0.006 ± 0.007 mSv (AN), and 0.004 ± 0.009 mSv (NSN). SO and AN doses were strongly correlated with FO dose (p = 0.003 and p < 0.001). There was a significant correlation between FO dose and procedural DAP (R = 0.69, p < 0.001), iodinated contrast volume (R = 0.67, p < 0.001) and left-anterior C-arm projections >60° (p = 0.02), and a weak correlation with fluoroscopy time (R = 0.40, p = 0.049).ConclusionAverage FO dose was a factor four higher than SO dose. Predictors for high personal doses are procedural DAP, iodinated contrast volume, and left-anterior C-arm projections greater than 60°.

  8. Endovascular recanalization of occluded superior mesenteric artery using retrograde access through the inferior mesenteric artery

    Directory of Open Access Journals (Sweden)

    Eduardo Keller Saadi, MD

    2017-09-01

    Full Text Available Symptomatic occlusion of the superior mesenteric artery can be treated by open repair, hybrid procedure, or endovascular revascularization. In most cases, endovascular procedures are done by the antegrade approach. We report a case of a 67-year-old woman who presented with acute-on-chronic mesenteric ischemia successfully treated by retrograde endovascular recanalization of an occluded common hepatomesenteric trunk through the inferior mesenteric artery and arc of Riolan.

  9. Paediatric Stroke: Review of the Literature and Possible Treatment Options, including Endovascular Approach

    Directory of Open Access Journals (Sweden)

    Elisa F. Ciceri

    2011-01-01

    Full Text Available Stroke is among the top 10 causes of death in childhood. More than half of the surviving children have long-term neurological sequelae. Ischemic stroke (IS includes arterial ischemic stroke and cerebral venous thrombosis with venous infarction. Haemorrhagic stroke (HS includes intracerebral haematoma or subarachnoid haemorrhage. Risk factors for stroke are different in children and in adults. 10–30% of IS have no identified risk factors. However, multiple risk factors are recognizable in the majority of stroke in children; thus, a comprehensive diagnostic evaluation is crucial. Vascular abnormalities, such as arteriovenous malformations, aneurysms, vessel dissection, stenosis, and moyamoya disease, are frequently associated with both IS and HS and lead to high recurrence rates. Endovascular and surgical treatment options are sometimes indicated, performed on the basis of expert opinion, and extrapolated from the adult procedures. In the present paper, we review the recent literature and we discuss the treatment in five cases managed at our institutions.

  10. Endovascular Management of Recurrent Spontaneous Hemarthrosis After Arthroplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kolber, Marcin K.; Shukla, Pratik A.; Kumar, Abhishek; Zybulewski, Adam; Markowitz, Todd; Silberzweig, James E., E-mail: jsilberzweig@chpnet.org [Mount Sinai Beth Israel, Division of Vascular and Interventional Radiology, Department of Radiology (United States)

    2017-02-15

    PurposeRecurrent spontaneous hemarthrosis is an infrequent but debilitating late complication of joint replacement, affecting up to 1.6% of patients with arthroplasty of the affected joint. Repeated episodes of bleeding result in an inflammatory cascade that further propagates bleeding events. Open and arthroscopic synovectomy are often performed when conservative treatments fail. Transarterial embolization is increasingly utilized as a less invasive option; however, its role is not widely established. We performed a systematic literature review to report the safety and efficacy of transarterial embolization in treating recurrent hemarthrosis in the setting of prior arthroplasty.Materials and MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A structured search was performed in PubMed, Web of Science, Embase, and SCOPUS databases of patients undergoing embolization for recurrent hemarthrosis after arthroplasty. Patients immediately post-operative, those embolized at first bleeding episode, and those with hemophilia were excluded. Demographic data, clinical information, angiographic findings, treatment, and outcomes were tabulated.ResultsThe search identified 119 titles of which 24 were deemed relevant, comprising 91 patients undergoing 99 embolization procedures. Mean time from prosthesis implantation was 32.2 months. Technical success was 99%. Mean follow-up time was 24.9 months. There were 10 recurrences (10%). Two cases were complicated by joint infection requiring arthroplasty revision.ConclusionsTransarterial embolization for recurrent spontaneous hemarthrosis may be safe and effective in patients having undergone arthroplasty of the affected joint.

  11. Predictors of aneurysmal rebleed before definitive surgical or endovascular management.

    Science.gov (United States)

    Solanki, Chirag; Pandey, Paritosh; Rao, K V L N

    2016-06-01

    Aneurysmal rebleed is the most dreaded complication following subarachnoid hemorrhage. Being a cause of devastating outcome, the stratification of risk factors can be used to prioritize patients, especially at high volume centers. A total of 99 patients with aneurysmal rebleed were analyzed in this study both prospectively and retrospectively from August 2010 to July 2014. In the control group, 100 patients were selected randomly from the patient registry. A total of 25 variables from the demographic, historical, clinical and radiological data were compared and analyzed by univariate and multivariate logistic regression analysis. Significant independent predictors of aneurysm rebleed were the presence of known hypertension (p = 0.023), diastolic blood pressure of >90 mmHg on admission (p = 0.008); presence of loss of consciousness (p = 0.013) or seizures (p = 0.002) at first ictus; history of warning headaches (p = 0.005); higher Fisher grade (p < 0.001); presence of multiple aneurysms (p = 0.021); irregular aneurysm surface (0.002). Identification of high risk factors can help in stratifying patients in the high risk group. The risk stratification strategy with early intervention can prevent rebleeds. This in turn may translate into better outcomes of patients with intracranial aneurysms.

  12. Periprocedural management of acute ischemic stroke intervention.

    Science.gov (United States)

    Tarlov, Nicholas; Nien, Yih Lin; Zaidat, Osama O; Nguyen, Thanh N

    2012-09-25

    Periprocedural medical management is an important aspect in optimizing the outcome of patients who undergo endovascular treatment for acute ischemic stroke. Blood pressure, fluid hydration, and antithrombotics are some of the elements that need to be tailored carefully to the patient according to the patency of his or her cerebral vasculature, the extent of his or her infarct, and the potential for hemorrhagic transformation. This article reviews the medical care of acute stroke patients before and after endovascular therapy.

  13. 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

    AIM: The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair. METHODS: All patients, undergoing elective primary endovascular repair of an asymptomatic infrarenal abdominal aortic aneurysm...... of the contrast media used, type of groin access, adjunctive procedures and duration of surgery. In total, 11 (28%) patients in the SIRS group and 4 (15%) patients in the non-SIRS group underwent re-interventions. Median follow-up period was 26 (range 20-32) months. Thirty-day mortality did not differ...... 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....

  14. Role for endovascular therapy in chronic mesenteric ischemia

    Science.gov (United States)

    Loffroy, Romaric; Steinmetz, Eric; Guiu, Boris; Molin, Valérie; Kretz, Benjamin; Gagnaire, Alice; Bouchot, Olivier; Cercueil, Jean-Pierre; Brenot, Roger; Krausé, Denis

    2009-01-01

    Chronic mesenteric ischemia is a rare condition that is caused by stenosis or occlusion of the mesenteric arteries and usually manifests as abdominal pain. While surgical revascularization has been the standard treatment for symptomatic patients, recent advances in interventional devices and techniques have made endovascular treatment feasible and effective. Percutaneous transluminal angioplasty with stent placement is now recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate; consequently, the technique is suggested for the primary treatment of chronic mesenteric ischemia. The present article discusses the indications and principles of endovascular treatment, and reviews the literature, with emphasis on short- and long-term outcomes, particularly morbidity and mortality rates. PMID:19440568

  15. The engineering of endovascular stent technology: a review.

    Science.gov (United States)

    Whittaker, David R; Fillinger, Mark F

    2006-01-01

    The evolution of minimally invasive endovascular technology has initiated a significant paradigm shift in the treatment of vascular disease. A fundamental understanding of the science and engineering behind the technology of endovascular stents is a key to their appropriate implementation in practice. Furthermore, the rapid influx of new devices into the field requires practitioners to make their decisions on a foundation of the relative strengths and weaknesses of the various products. Although the principles of their use are not complex, the device design can have a profound effect on the device's functionality. Shape, thickness, coating, material selection, and imaging are just a few of the factors to consider in stent design. Subtle differences may have profound results. This review is designed to provide the reader with an overview of fundamental concepts that will aide the assessment of new technology.

  16. Endovascular treatment of cerebral aneurysms at Altai Regional Vascular Center

    Directory of Open Access Journals (Sweden)

    Д. А. Долженко

    2015-10-01

    Full Text Available A retrospective analysis of the results of endovascular treatment of patients with the brain aneurysms was carried out at the Neurosurgical Department of Regional Clinical Hospital in Barnaul over a period from 2009 to 2011. 52 patients with 57 cerebral aneurysms were included in the study and 55 endovascular interventions were performed. Total embolization (type A was used in 77% of patients, embolization type B was performed in 19% of cases, incomplete embolization (type C occurred in 4% of cases. 14 (26,9% patients were operated in the acute period of SAH. Conclusions are made relating to the effectiveness and relative safety of intravascular treatment of aneurysms, the need for differentiated approaches to the tactics of surgical treatment of patients in the acute period of hemorrhagic stroke due to the rupture of a cerebral aneurysm.

  17. Treatment of Cervical Artery Dissection: Antithrombotics, Thrombolysis, and Endovascular Therapy

    Directory of Open Access Journals (Sweden)

    Jing Peng

    2017-01-01

    Full Text Available Cervical artery dissection (CAD is an important cause of stroke for young patients, accounting for 5–22% of strokes in patients <45 years of age, which presents not only a great burden to the stroke victims but also a financial burden to the family and society. Because CAD can lead to different clinical lesions, including neuropathy, acute ischemic stroke, and subarachnoid hemorrhage, and is an arterial dissection with a self-healing tendency, the treatment options depend on the clinical manifestations. The main purpose of the treatment is to control CAD-induced neuronal damage and to restore blood flow. The treatment programs include drug treatment and endovascular treatment. However, antithrombotic treatment is crucial. Both antiplatelet drugs and anticoagulant drugs are used to reduce the risk of stroke, but whether one treatment strategy is more effective than the other is unknown. The efficacy and timing of the endovascular treatment of CAD remain controversial.

  18. Unipuncture double-access method in emergent endovascular procedures

    DEFF Research Database (Denmark)

    Hörer, Tal M; Hammo, Sari; Lönn, Lars

    2013-01-01

    We describe a technique to gain an additional endovascular access in acute situations in which a large-bore introducer is already inserted or in situations in which multiple accesses are impaired because of other reasons. Using an existing percutaneous femoral artery access, a second guide wire...... is inserted into the introducer, which is later withdrawn and applied onto one of the two guide wires. A double-wire access is then achieved. This access can be used, for example, for angiography or embolization catheters. This method might be useful in situations in which a quick and unplanned extra access...... is needed. It is, for example, applicable in hemodynamically unstable patients in whom percutaneous access can be difficult to obtain or in aortic endovascular procedures when an unplanned access is needed to insert an additional catheter for angiography and embolization....

  19. Endovascular treatment of pulmonary embolism: Selective review of available techniques

    Science.gov (United States)

    Nosher, John L; Patel, Arjun; Jagpal, Sugeet; Gribbin, Christopher; Gendel, Vyacheslav

    2017-01-01

    Acute pulmonary embolism (PE) is the third most common cause of death in hospitalized patients. The development of sophisticated diagnostic and therapeutic modalities for PE, including endovascular therapy, affords a certain level of complexity to the treatment of patients with this important clinical entity. Furthermore, the lack of level I evidence for the safety and effectiveness of catheter directed therapy brings controversy to a promising treatment approach. In this review paper, we discuss the pathophysiology and clinical presentation of PE, review the medical and surgical treatment of the condition, and describe in detail the tools that are available for the endovascular therapy of PE, including mechanical thrombectomy, suction thrombectomy, and fibrinolytic therapy. We also review the literature available to date on these methods, and describe the function of the Pulmonary Embolism Response Team. PMID:29354208

  20. Role for endovascular therapy in chronic mesenteric ischemia.

    Science.gov (United States)

    Loffroy, Romaric; Steinmetz, Eric; Guiu, Boris; Molin, Valérie; Kretz, Benjamin; Gagnaire, Alice; Bouchot, Olivier; Cercueil, Jean-Pierre; Brenot, Roger; Krausé, Denis

    2009-05-01

    Chronic mesenteric ischemia is a rare condition that is caused by stenosis or occlusion of the mesenteric arteries and usually manifests as abdominal pain. While surgical revascularization has been the standard treatment for symptomatic patients, recent advances in interventional devices and techniques have made endovascular treatment feasible and effective. Percutaneous transluminal angioplasty with stent placement is now recognized as a minimally invasive means of obtaining good long-term results with an acceptable recurrence rate; consequently, the technique is suggested for the primary treatment of chronic mesenteric ischemia. The present article discusses the indications and principles of endovascular treatment, and reviews the literature, with emphasis on short- and long-term outcomes, particularly morbidity and mortality rates.

  1. Chronic mesenteric ischemia: efficacy and outcome of endovascular therapy.

    Science.gov (United States)

    Loffroy, Romaric; Guiu, Boris; Cercueil, Jean-Pierre; Krausé, Denis

    2010-06-01

    Chronic mesenteric ischemia is a rare condition caused by occlusive disease of the mesenteric vessels and manifested most commonly as abdominal pain. While the traditional therapy in symptomatic patients has been surgery, recent improvements in interventional devices and refinement in techniques have increased the popularity of endovascular treatment. The high procedural success and the low complication rate make the catheter-based approach an interesting alternative to surgery. Percutaneous angioplasty and stenting is now recognized as a minimally invasive means of obtaining good long-term results and is consequently suggested for the primary treatment of chronic mesenteric ischemia. This article presents a review of the literature on indications and technical aspects of endovascular treatment, with emphasis on short- and long-term outcomes.

  2. Endovascular treatment of basilar tip aneurysms associated with moyamoya disease

    Energy Technology Data Exchange (ETDEWEB)

    Arita, K.; Kurisu, K.; Ohba, S.; Shibukawa, M.; Kiura, H.; Sakamoto, S. [Department of Neurosurgery, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, 734-8551, Hiroshima (Japan); Uozumi, T. [Hibino Hospital, Hiroshima (Japan); Nakahara, T. [Division of Neuroendovascular Treatment, Mazda Hospital, Hiroshima (Japan)

    2003-07-01

    We report the efficacy and safety of endovascular treatment of basilar tip aneurysms (BTA) in five patients with moyamoya disease. The patients underwent intra-aneurysmal embolisation with detachable platinum coils. Three BTA presented with subarachnoid haemorrhage (SAH); the other two were asymptomatic. In four cases, one embolisation procedure produced >95% angiographic obliteration of the aneurysm. In the other patient, 80-90% obliteration was achieved initially, but due to growth of the residual aneurysm, the procedure was repeated 7 months later. Two patients experienced transient oculomotor paresis as a procedure-related complication. Mean follow-up was 43.6{+-}34.0 months (range 8-92 months). One patient died of putaminal haemorrhage unrelated to the aneurysm 15 months after embolisation. The other four had no subsequent SAH and survived without sequelae. Endovascular embolisation using detachable platinum coils proved to be a safe and efficient treatment modality for BTA associated with moyamoya disease. (orig.)

  3. 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.

  4. Balloons in endovascular neurosurgery: history and current applications.

    Science.gov (United States)

    Alaraj, Ali; Wallace, Adam; Dashti, Reza; Patel, Prasad; Aletich, Victor

    2014-02-01

    The use of balloons in the field of neurosurgery is currently an essential part of our clinical practice. The field has evolved over the last 40 years since Serbinenko used balloons to test the feasibility of occluding cervical vessels for intracranial pathologies. Since that time, indications have expanded to include sacrificing cervical and intracranial vessels with detachable balloons, supporting the coil mass in wide-necked aneurysms (balloon remodeling technique), and performing intracranial and cervical angioplasty for atherosclerotic disease, as well as an adjunct to treat arteriovenous malformations. With the rapid expansion of endovascular technologies, it appears that the indications and uses for balloons will continue to expand. In this article, we review the history of balloons, the initial applications, the types of balloons available, and the current applications available for endovascular neurosurgeons.

  5. ENDOVASCULAR HEMOSTASIS IN UTERINE BLEEDING IN PATIENTS WITH UTERINE LEIOMYOMA

    Directory of Open Access Journals (Sweden)

    M. M. Damirov

    2017-01-01

    Full Text Available We report results of treatment for 72 patients with uterine leiomyoma (LM of various sizes and location, who had arrived with excessive uterine bleeding. All patients underwent urgent or urgently-delayed endovascular hemostasis by performing uterine arteries embolization (UAE. We analyzed clinical features of the disease after UAE in various sizes of tumors and studied immediate and long-term results of UAE in patients with LM.

  6. Endovascular treatment of posterior cerebral artery aneurysms using detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Roh, Hong Gee [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Konkuk University Hospital, Department of Radiology, Seoul (Korea); Kim, Sam Soo; Han, Heon [Kangwon National University Hospital, Department of Radiology, Chuncheon, Kangwon-do (Korea); Kang, Hyun-Seung [Konkuk University Hospital, Department of Neurosurgery, Seoul (Korea); Moon, Won-Jin [Konkuk University Hospital, Department of Radiology, Seoul (Korea); Byun, Hong Sik [Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea)

    2008-03-15

    Aneurysms of the posterior cerebral artery (PCA) are rare, and most of the studies reported in the literature in which the endovascular approach was applied were carried out on a limited number of patients with PCA aneurysms. We retrospectively reviewed our cases of PCA aneurysms - at various locations and of differing shapes - that received endovascular treatment and evaluated the treatment outcome. From January 1996 to December 2006, 13 patients (eight females and five males) with 17 PCA aneurysms (nine fusiform and eight saccular) were treated using the endovascular approach. The age of the patients ranged from 20 to 67 years, with a mean age of 44 years. Of the 13 patients, ten presented with intracranial hemorrhage, and one patient, with a large P2 aneurysm, presented with trigeminal neuralgia; the aneurysms were asymptomatic in the remaining two patients. All 13 patients were successfully treated, with only one procedure-related symptomatic complication. Seven patients were treated by occlusion of the aneurysm and parent artery together; five patients, by selective embolization of the aneurysm; one patient, by partial coiling. Although infarctions were found in two patients treated with selective embolization and in three patients treated with parent artery occlusion, only one patient with a ruptured P2 aneurysm treated with parent artery occlusion developed transient amnesia as an ischemic symptom. Posterior cerebral artery aneurysms can be treated safely with either occlusion of the aneurysm together with the PCA or with a selective coil embolization. Infarctions may occur after endovascular treatment, but they are rarely the cause of a disabling symptom. (orig.)

  7. Efficacy of Endovascular Therapy for Direct Occlusion of Intracranial Aneurysms

    Directory of Open Access Journals (Sweden)

    K Tamrakar

    2011-09-01

    Full Text Available Introduction: Our purpose was to evaluate the effectiveness of endovascular therapy using detachable coils and balloons for the direct occlusion of intracranial aneurysms. Methods: We retrospectively reviewed 563 patients undergoing digital subtraction angiography from January 2007 to July 2009. Two hundred and fi fty patients with 323 embolized intracranial aneurysms were studied. Results: Among 250 patients, 66 % were female and 34 % male, the age ranging from 19 - 83 years (mean 50.66 ± 12.92. One hundred and seventy-seven had a single aneurysm while 73 showed multiple aneurysms. Seventeen (9.6 % had giant aneurysms. Three hundred and eleven aneurysms were treated using detachable coils, and 12 giant aneurysms were embolized by detachable balloons for the parent vessel occlusion. Of 323 aneurysms treated via the endovascular approach, total occlusion was seen in 93 % of the aneurysms, near total occlusion in 5.2 % and incomplete embolization in 1.5 %. Among patients presenting with sub-arachnoid hemorrhage, 62 improved to the Glasgow outcome score (GOS of 5, 93 improved to GOS 4, 14 improved to GOS 3, 10 improved to GOS 2 at the time of discharge and 5 patients died. Angiographic follow-up was scheduled between 6 - 12 months post-embolization. The aneurysm recurred in 1.2 % and were re-embolized using additional coils. Statistically, Hunt and Hess Grade and GOS indicated clinical signifi cance (P 0.05. Conclusions: Hunt and Hess VI and V are considered as poor clinical gradings in aneurysmal SAH. However, endovascular treatment has been established as an effective method to obliterate intracranial aneurysms allowing subsequent decrease in mortality and morbidity. Keywords: detachable coils, detachable balloons, endovascular therapy, intracranial aneurysms.

  8. Endovascular treatment of unruptured posterior circulation intracranial aneurysms

    Directory of Open Access Journals (Sweden)

    Xianli Lv

    2016-01-01

    Full Text Available Background and Purpose: Endovascular treatment of unruptured posterior circulation intracranial aneurysms (UPCIAs is limited in the International Study of Unruptured Intracranial Aneurysms (ISUIA. The aim of this study is to evaluate the periprocedural morbidity, mortality, and midterm clinical and angiographic follow-ups of endovascular treatment of UPCIAs. Materials and Methods: Retrospective analysis of all patients treated in a 2-year period (89 patients: 10-78 years of age, mean: 45.5 ± 14.3/92 UPCIAs. Fifty-eight aneurysms were found incidentally, 12 in association with mass effect symptoms and 22 with stroke. Results: A clinical improvement or stable outcome was achieved in 84 patients (94.4%. The two cases of permanent morbidity included a patient with paralysis and another patient with hemianopia. One patient died after treatment of a giant fusiform vertebrobasilar aneurysm. In one patient, the aneurysm ruptured during treatment, resulting in death. Another patient suffered a fatal aneurysm rupture 4 days after treatment. Giant size (P = 0.005 and mass effect presentation (P = 0.029 were independent predictors of unfavorable outcomes in UPCIAs. Angiographic follow-up was available in 76 of the 86 surviving patients (88.4% with a mean of 6.8 months (range: 1-36 months. Recanalization in six patients (7.9% at 3 months, 4 months, 4 months, 24 months, and 36 months required retreatment in three patients. In-stent stenosis of >50% was found in three patients. Conclusion: Endovascular therapy is an attractive option for UPCIAs with stable midterm outcome. However, the current endovascular option seems to have a limitation for the treatment of the aneurysm with giant size or mass effect presentation.

  9. Endovascular embolization of thyroid arteries with grave’s disease

    OpenAIRE

    Arzykulov Zh.A.; Zhuraev Sh. Sh.; Shokebayev A.A.; Ormanov B.K.; Lee A.I.; Imammyrzayev N.E.; Aliev A.K.

    2014-01-01

    Background: The purpose of this study is to improve the results of treatment of patients with Graves’ disease by applying Roentgen endovascular embolization (REE) thyroid arteries. Materials and methods: REE thyroid arteries, we used as an independent method of treatment GD. Following this procedure the treatment of 27 patients received for the period from 2012 to July 2014 y. All patients hospitalized with a confirmed diagnosis. Among the 27 patients had 5 (18.5%) men and 22 (81.5%) of women...

  10. Tratamiento endovascular del accidente vascular encefálico agudo

    Directory of Open Access Journals (Sweden)

    Dr. G. Francisco Mena

    2013-01-01

    Full Text Available La alternativa de terapia neuroendovascular para un tratamiento del accidente vascular encefálico agudo es una área de la medicina en rápida expansión. El rescate endovascular del infarto cerebral agudo tiene como principal objetivo la rápida reperfusión del vaso ocluido utilizando la trombolisis intra-arterial cerebral y distintos métodos de trombectomía mecánica o colocación permanente de neurostent. El tratamiento neuro-endovascular de la hemorragia subaracnoidea aguda aneurismática también se ha establecido como la terapia de elección e incluye la embolización convencional con coils del aneurisma cerebral roto o utilizando técnica de embolización balón o stent asistido o colocación primaria de stent con tecnología de divertidor de flujo. Además, con la terapia endovascular se puede efectuar angioplastía farmacológica y mecánica del vasoespasmo cerebral.

  11. Developing a complex endovascular fenestrated and branched aortic program.

    Science.gov (United States)

    Schanzer, Andres; Baril, Donald; Robinson, William P; Simons, Jessica P; Aiello, Francesco A; Messina, Louis M

    2015-03-01

    In 2008, the top priority in our division's 5-year strategic plan was "to become an internationally recognized center of excellence for the endovascular treatment of complex aortic pathology extending from the aortic valve to the external iliac artery." Five components were identified as "most critical" to achieve this strategic priority: (1) training at centers of excellence in complex endovascular repair; (2) industry partnership to improve access to developing technologies; (3) a fully integrated team approach with one leader involved in all steps of all cases; (4) prospective data collection; and (5) development and implementation of a physician-sponsored investigational device exemption for juxtarenal, pararenal, and thoracoabdominal aneurysms. We have now performed 49 repairs (16 commercially manufactured devices, 33 physician-modified devices) for 3 common iliac, 20 juxtarenal, 9 pararenal, and 17 thoracoabdominal aneurysms, using 142 fenestrations, branches, and scallops. All patients had complete 30-day follow-up for calculation of 30-day events. Kaplan-Meier analysis was used to calculate 1-year events. In 5 years, we developed a successful complex endovascular aortic program that uses fenestrated/branched repair techniques. A focused team strategic planning approach to program development is an effective way for vascular surgery divisions to gain experience and expertise with new complex technologies while ensuring acceptable patient outcomes. Copyright © 2015 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  12. An injectable shear-thinning biomaterial for endovascular embolization.

    Science.gov (United States)

    Avery, Reginald K; Albadawi, Hassan; Akbari, Mohsen; Zhang, Yu Shrike; Duggan, Michael J; Sahani, Dushyant V; Olsen, Bradley D; Khademhosseini, Ali; Oklu, Rahmi

    2016-11-16

    Improved endovascular embolization of vascular conditions can generate better patient outcomes and minimize the need for repeat procedures. However, many embolic materials, such as metallic coils or liquid embolic agents, are associated with limitations and complications such as breakthrough bleeding, coil migration, coil compaction, recanalization, adhesion of the catheter to the embolic agent, or toxicity. Here, we engineered a shear-thinning biomaterial (STB), a nanocomposite hydrogel containing gelatin and silicate nanoplatelets, to function as an embolic agent for endovascular embolization procedures. STBs are injectable through clinical catheters and needles and have hemostatic activity comparable to metallic coils, the current gold standard. In addition, STBs withstand physiological pressures without fragmentation or displacement in elastomeric channels in vitro and in explant vessels ex vivo. In vitro experiments also indicated that STB embolization did not rely on intrinsic thrombosis as coils did for occlusion, suggesting that the biomaterial may be suitable for use in patients on anticoagulation therapy or those with coagulopathy. Using computed tomography imaging, the biomaterial was shown to fully occlude murine and porcine vasculature in vivo and remain at the site of injection without fragmentation or nontarget embolization. Given the advantages of rapid delivery, in vivo stability, and independent occlusion that does not rely on intrinsic thrombosis, STBs offer an alternative gel-based embolic agent with translational potential for endovascular embolization. Copyright © 2016, American Association for the Advancement of Science.

  13. Browse Title Index

    African Journals Online (AJOL)

    Items 151 - 200 of 392 ... Vol 42, No 2 (2004), Immediate endovascular stent-graft repair of an acute traumatic rupture of the thoracic aorta, Abstract PDF. IC Duncan, NC Wright, LM Fingleson, JIC Coetzee. Vol 44, No 1 (2006), Impaired anastomotic healing after preoperative radiotherapy followd by anterior resection for ...

  14. Effects of electrocautery to provoke endovascular thermal injury Efeitos do eletrocautério para provocar lesão térmica endovascular

    Directory of Open Access Journals (Sweden)

    Fabio Henrique Rossi

    2011-10-01

    Full Text Available PURPOSE: To investigate the effects of a new electrocautery device to provoke endovascular venous thermal injury. METHODS: An experimental endovascular electrocautery was placed inside eight ex-vivo bovine saphenous veins models. Each one was divided in eight segments and progressive intensities of electric energy liberated. The macroscopic and microscopic effects were analyzed. RESULTS: Forty bovine saphenous veins segments were studied. The higher the electric energy applied the greater the nuclear picnosis and more intense the cytoplasmatic shrinkage and electrocoagulation effects. CONCLUSION: The experimental endovascular electrocautery device demonstrated to be both capable of inducing the destruction of the intimal layers of the studied vein model and provoke endovascular thermal injury.OBJETIVO: Investigar os efeitos de um modelo experimental de eletrocautério em provocar lesão venosa térmica endovascular. MÉTODOS: O eletrocautério endovascular foi colocado dentro de oito modelos experimentais de veia safena bovina. Cada uma foi dividida em oito segmentos e intensidades progressivas de energia elétrica liberada. Os efeitos macroscópicos e microscópicos foram analisados. RESULTADOS: Foram estudados quarenta segmentos de veia safena bovina. Quanto maior a energia elétrica aplicada pelo eletrocauterizador endovascular maiores foram as alteraçoes de picnose nuclear e mais intensa a retração citoplasmática observada. CONCLUSÃO: O eletrocautério endovascular experimental demonstrou ser capaz de induzir a destruição da camada íntima e provocar lesão térmica endovascular.

  15. Novel image-guided management of a uterine arteriovenous malformation.

    Science.gov (United States)

    Przybojewski, Stefan J; Sadler, David J

    2011-02-01

    The investigators present a novel image-guided embolization, not previously described, of a uterine arteriovenous malformation (AVM) resistant to endovascular management. The uterus was exposed surgically, and Histoacryl (Braun, Fulda, Germany) was injected directly into the nidus using ultrasound guidance and fluoroscopy. The patient had a successful full-term pregnancy after this procedure. This technique may be a useful alternative management strategy in patients with uterine AVM who fail traditional endovascular embolization and who still desire fertility.

  16. Endovascular therapy in acute ischemic stroke: The way forward after results from the IMS 3, SYNTHESIS and MR Rescue trials

    Directory of Open Access Journals (Sweden)

    Bijoy K Menon

    2013-01-01

    Full Text Available Endovascular therapy (EVT has gained vogue in the management of patients with acute stroke. Newer stent-retriever devices have led to better recanalization rates. In many centers, EVT is slowly being used as an add on to or in some instances, even as an alternative to intravenous tissue plasminogen activator (IV tPA. The publication of the results of the SYNTHESIS expansion, Interventional Management of Stroke III and Mechanical Retrieval Recanalization of Stroke Clots Using Embolectomy trials in 2013 has questioned the enthusiastic use of EVT in acute stroke. They demonstrate that EVT (using a variety of devices is no superior to IV tPA in the management of acute stroke. In the light of these controversial findings, we review the current status of EVT in the management of acute stroke.

  17. Tratamiento de aorta abdominal e ilíacas con técnica endovascular: Experiencia quirúrgica Treatment of abdominal aorta and iliac arteries with endovascular technique

    Directory of Open Access Journals (Sweden)

    Juan G Barrera

    2007-08-01

    Full Text Available Antecedentes: desde 1991 la técnica endovascular se ha aplicado con éxito en el manejo de los aneurismas de aorta infrarrenal, y se ha perfeccionado de manera tal que rápidamente se ha convertido en una alternativa para pacientes de alto riesgo para la cirugía convencional. Objetivo: describir los resultados institucionales en el manejo de las patologías de aorta abdominal e ilíacas mediante técnica endovascular desde 2003 a 2005. Diseño-Método: estudio descriptivo, longitudinal, retrospectivo, en el que se analizaron las historias clínicas de los pacientes sometidos a procedimiento endovascular de aorta abdominal e ilíacas. El análisis se realizó en Stata 8,0 S/E. Resultados: a 9 pacientes se les realizó exclusivamente manejo de lesiones en aorta abdominal e ilíacas. Todos los pacientes del estudio fueron hombres con edad media de 68,9 + 8,1 años. Los diagnósticos fueron aneurisma de aorta infrarrenal en 6 pacientes y aneurismas anastomóticos en los 3 restantes. Se evidenció requerimiento de endoprótesis en promedio de 1,9 + 0,8. Se realizó puente femoro-femoral como procedimiento simultáneo en 4 de los 9 pacientes. El 77,8% de los pacientes no tuvo complicaciones. La mortalidad por el procedimiento alcanzó el 22% (2 pacientes, si bien cabe anotar que las complicaciones se presentaron sólo en esos dos pacientes. Conclusiones: la exclusión de aneurismas de aorta y de ilíacas con endoprótesis modulares, se está implementando ampliamente como una opción válida de tratamiento, con resultados excelentes que evitan los riesgos de la intervención convencional y la morbilidad asociada.Antecedents: since 1991 endovascular technique has been successfully used in the management of infra-renal aortic aneurysms and it has been improved in such a way that it has quickly turned into an alternative for patients considered having high risk for conventional surgery. Objective: describe the institutional results in the management of

  18. The Technique of Endovascular Intracranial Revascularization

    Directory of Open Access Journals (Sweden)

    John J. Connors

    2014-11-01

    Full Text Available Intracranial atherosclerosis was traditionally believed to carry a risk of stroke of 8% to 22% per annum. The annualized stroke rate in the recent Stenting and Aggressive Medical Management for Preventing Stroke in Intracranial Stenosis trial medical management arm was 12.2%. This trial was halted due to excessive periprocedural events in the stent arm. This stroke rate Is still Unacceptably high and a treatment strategy is still needed. SAMMPRIS has no bearing on angioplasty alone. Angioplasty alone has always been our primary intervention for intracranial atherosclerosis and remains so to this day due to its relative simplicity, low complication rate, and efficacy. We have, however, made adjustments to our patient management regimen based on the results of SAMMPRIS. This paper outlines our current patient selection, procedural technique, and post-procedure management. The complications we have encountered while developing our technique are described along with how to avoid them and how to manage them. Our most recent results (since previous publications are also discussed.

  19. 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...

  20. [Endovascular treatment of 4 patients with a traumatic rupture of the thoracic aorta

    NARCIS (Netherlands)

    Dinkelman, M.K.; Leenen, L.P.H.; Verhagen, H.; Blankensteijn, J.D.

    2003-01-01

    OBJECTIVE: To present our initial results with the endovascular treatment of traumatic rupture of the thoracic aorta. DESIGN: Retrospective. METHOD: Between April and October, 2002, 4 men between the ages of 22 and 46 were treated endovascularly for a traumatic rupture of the thoracic aorta. The

  1. A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia

    National Research Council Canada - National Science Library

    Arthurs, Zachary M; Titus, Jessica; Bannazadeh, Mohsen; Eagleton, Matthew J; Srivastava, Sunita; Sarac, Timur P; Clair, Daniel G

    2011-01-01

    ... with chronic mesenteric ischemia, 6,7 and even treating patients with asymptomatic high-grade three-vessel disease. 8 Endovascular therapy has several theoretic advantages for the treatment of AMI. Avoiding urgent laparotomy may limit the secondary injury after the initial ischemic insult. In addition, endovascular revascularization could potentiall...

  2. Endovascular navigation based on real/virtual environments cooperation for computer-assisted TEAM procedures

    Science.gov (United States)

    Goksu, Cemil; Haigron, Pascal; Acosta, Oscar; Lucas, Antoine

    2004-05-01

    Transfemoral Endovascular Aneurysm Management, the less invasive treatment of Aortic Abdominal Aneurysms (AAA), is a highly specialized procedure, using advanced devices and requiring a high degree of clinical expertise. There is a great need for a navigation guidance system able to make this procedure safer and more precise. In this context of computer-assisted minimally invasive interventional procedures, we propose a new framework based on the cooperation between the real environment where the intervention takes place and a patient-specific virtual environment, which contains a virtual operating room including a C-arm model as well as the 3D preoperative patient data. This approach aims to deal with the problem of lack of knowledge about soft tissue behavior by better exploiting available information before and during the intervention through a cooperative approach. In order to assist the TEAM procedure in standard interventional conditions, we applied this framework to design a 3D navigation guidance system, which has been successfully used during three TEAM interventions in the operating room. Intra-operatively, anatomical feature-based 2D/3D registration between a single 2D fluoroscopic view, reproduced from the pose planned in the virtual environment, and the preoperative CT volume, is performed by means of a chamfer distance map. The 3D localization of the endovascular devices (sheath, guide wire, prosthesis) tracked either interactively or automatically on 2D sequences, is constrained to either the 3D vascular tree or a 3D device model. Moreover, we propose a first solution to take into account the tissue deformations during this particular intervention and to update the virtual environment with the intraoperative data.

  3. [Femoral artery pseudo-aneurysms--changes in treatment, report of 7 years].

    Science.gov (United States)

    Szendro, G; Klimov, A; Lennox, A; Jonathan, B; Avrahami, L; Yechieli, B; Griffin, M; Yurfest, S; Charach, Y; Golcman, L; Nicolaides, A N

    2000-09-01

    The femoral artery remains the most used peripheral site for radiological catheter access. With a greater number of both diagnostic and therapeutic procedures being performed by interventional radiologists and cardiologists, and with larger catheters being used for stenting and endovascular grafting, the incidence of iatrogenic pseudo-aneurysms reported has reached as high as 0.5-2%. Ideally, they should thrombus spontaneously. However, when this does not occur, management options include: observation, ultrasound-guided obliterative compression, direct thrombin injection, embolization, stent graft insertion, and very rarely-surgery. During a 7-year period (1992-1999) we treated 131 cases of femoral artery false aneurysms. Until 1998 ultrasound-guided compression-obliteration, with a 95% success rate, was our method of choice. Since 1998, direct thrombin injection, with 100% success in 24 cases, has become our preferred method. It is pain-free, fully successful even in anticoagulated patients, and is currently our treatment of choice.

  4. A сase of obstruction of SVC-right atrium appendage anastomosis after procedure Warden

    Directory of Open Access Journals (Sweden)

    Е. А. Связов

    2017-04-01

    Full Text Available The analysis of a 6-year patient’s medical history after correction of congenital heart disease (partial anomalous drainage of the right superior pulmonary vein into the superior vena cava complicated by obstruction of the anastomosis between the SVC and the appendage right atrium is presented. The article discusses the stages of diagnosis and patient management features, as well as the choice of treatment.Received 12 December 2016. Accepted 14 February 2017.Financing: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Svyazov E.A.: data analysis, article writing and editing. Podoksenov A.U.: article editing. Varvarenko V.I.: implantation of the stent-graft in superior vena cava.Martsinkevich G.I.: echocardiographic examination of the patient before and after endograft implantation, article editing. Krivoshchyokov E.V.: organizational work and referral of the patient to endovascular treatment, article editing.

  5. Thoracic aortic catastrophes : towards the endovascular solution

    NARCIS (Netherlands)

    Jonker, F.H.W.

    2010-01-01

    Descending thoracic aortic catastrophes include a variety of acute pathologies of the descending thoracic aorta, which are all associated with high morbidity and mortality rates, requiring immediate intervention. For this thesis, we explored the management and outcomes of several thoracic aortic

  6. Aneurisma de la aorta abdominal: Tratamiento endovascular con una endoprótesis fenestrada Abdominal aortic aneurysm: Endovascular treatment with fenestrated endoprothesis

    Directory of Open Access Journals (Sweden)

    Román Rostagno

    2008-12-01

    Full Text Available El tratamiento endovascular de los aneurismas de aorta abdominal es una alternativa a la cirugía abierta para pacientes de alto riesgo. Consiste en la exclusión del saco aneurismático mediante la interposición de una endoprótesis colocada por vía femoral. El tratamiento endovascular no puede ser utilizado en todos los pacientes. Una limitación frecuente la constituye el nacimiento de una arteria visceral desde el saco aneurismático. Para contrarrestar esta limitación recientemente se han desarrollado endoprótesis fenestradas que presentan orificios que se corresponden con el nacimiento de las arterias involucradas en el aneurisma evitando su oclusión, permitiendo de esta manera el tratamiento endovascular. En esta comunicación se presenta un caso de tratamiento endovascular de un aneurisma de aorta abdominal mediante la colocación de una endoprótesis fenestrada en un paciente cuya arteria renal izquierda nacía directamente del saco aneurismático.Endovascular treatment of the abdominal aortic aneurysm is consider an alternative to open surgery for high risk patients. Its goal is to exclude the aneurysm from the circulation by using an endoprothesis introduced from a femoral approach. Patients must be strictly selected to avoid possible complications. The most frequent limitation is related to anatomic contraindications such as visceral arteries involved in the aneurysm. Fenestrated endograft have been recently developed to allow endovascular treatment when anatomic features contraindicate classic endovascular procedures. Fenestrated endograft have holes that match with the origin of the visceral arteries maintaining its potency. In this paper we report the endovascular treatment of an abdominal aortic aneurysm by using a fenestrated endoprothesis in a patient whose left renal artery is originated from the aneurysm.

  7. Feasibility of endovascular and surface cooling strategies in acute stroke

    DEFF Research Database (Denmark)

    Ovesen, Christian Hjerrild; Brizzi, M; Pott, F C

    2012-01-01

    BACKGROUND: Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies - endovascular...... patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0 days (24, 9) in TH and 22.5 days (20.6) in control...

  8. Técnicas terapéuticas endovasculares

    OpenAIRE

    Bilbao, J.I. (José I.); Martinez-de-la-Cuesta, A. (Antonio); Dominguez-Echavarri, P. (Pablo); Cosin, O. (Octavio); Desloques, L. (L.); Zudaire, B. (B.)

    2005-01-01

    Las técnicas percutáneas y endovasculares han demostrado su eficacia en el tratamiento de una gran variedad de patologías. Los avances en la imagen diagnóstica así como en el desarrollo de nuevos materiales han posibilitado la realización de nuevos procedimientos, impensables hace no mucho años. La irrupción de esta nueva forma de tratar a los pacientes ha tenido, tiene y tendrá, aún más, un claro impacto en el enfoque multidisciplinar de múltiples enfermedades.

  9. The Natural History and Outcomes of Endovascular Therapy for Claudication.

    Science.gov (United States)

    Saraidaridis, Julia T; Ergul, Emel A; Clouse, W Darrin; Patel, Virendra I; Cambria, Richard P; Conrad, Mark F

    2017-10-01

    The natural history of claudication is well-characterized and traditional therapy includes risk factor modification and exercise protocols with revascularization reserved for patients who are severely impaired. However, the reduced periprocedural morbidity with endovascular therapy has led physicians to broaden the indications for intervention for peripheral artery disease, and more claudicants are undergoing procedures for disease that is moderately limiting to their lifestyle. This study sought to assess the natural history of patients who have undergone peripheral vascular intervention for claudication. All patients who underwent at least 1 peripheral vascular intervention (PVI) for claudication at a single institution from January 2007 to December 2013 were identified. Patient demographics were assessed using the hospital record. Outcomes included secondary endovascular intervention, secondary bypass intervention, amputation, and survival. Cox proportional hazards models were created to assess risk factors for further intervention. Five hundred fifteen patients were identified as having undergone PVI for claudication during the study period. Forty-three percent were female, 37% had diabetes, 31% had coronary artery disease, 26% were current smokers, 6.6% had congestive heart failure, 8.2% had a tibial lesion that was intervened upon, and 35% had a Trans-Atlantic Inter-Society Consensus Document (TASC) II C/D lesion. Actuarial survival at 5 years was 79.9% and 62.5% of patients had primary patency. The limb salvage rate was 97.2%. Over the follow-up period, 21.8% required some type of further intervention: either endovascular (17.7%) or open bypass (7.2%). A Cox proportional hazards model adjusting for age, sex, and other comorbidities showed that the two largest risk factors for requiring reintervention were angioplasty only (no stent; hazard ratio [HR] 1.36, P = 0.02) and TASC C/D lesion (HR 1.52, P = 0.03). With 5-year follow-up, patients have a primary

  10. 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

  11. Enhancing brain lesions after endovascular treatment of aneurysms

    DEFF Research Database (Denmark)

    Cruz, J P; Marotta, T; O'Kelly, C

    2014-01-01

    present 7 patients from 5 different institutions that developed MR imaging-enhancing brain lesions after endovascular therapy of aneurysms, detected after a median time of 63 days. The number of lesions ranged from 4-46 (median of 10.5), sized 2-20 mm, and were mostly in the same vascular territory used...... for access. Three patients presented with symptoms attributable to these lesions. After a median follow-up of 21.5 months, the number of lesions increased in 2, was stable in 1, decreased in 3, and disappeared in 1. The imaging and clinical characteristics suggested a foreign body reaction. We could find...

  12. Radiation-Induced Alopecia after Endovascular Embolization under Fluoroscopy

    Directory of Open Access Journals (Sweden)

    Vipawee Ounsakul

    2016-01-01

    Full Text Available Radiation-induced alopecia after fluoroscopically guided procedures is becoming more common due to an increasing use of endovascular procedures. It is characterized by geometric shapes of nonscarring alopecia related to the area of radiation. We report a case of a 46-year-old man presenting with asymptomatic, sharply demarcated rectangular, nonscarring alopecic patch on the occipital scalp following cerebral angiography with fistula embolization under fluoroscopy. His presentations were compatible with radiation-induced alopecia. Herein, we also report a novel scalp dermoscopic finding of blue-grey dots in a target pattern around yellow dots and follicles, which we detected in the lesion of radiation-induced alopecia.

  13. 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.

  14. Successful endovascular treatment for simultaneous multiple thromboemboli following myocardial infarction.

    Science.gov (United States)

    Sakai, Akiko; Hara, Hidehiko; Nakamura, Masato

    2013-06-01

    An 81-year-old female was referred for myocardial infarction with heart failure. She was successfully treated with percutaneous coronary intervention (PCI), and left ventriculogram revealed an apical thrombus 20 mm in diameter. Multiple simultaneous thromboemboli occurred in her right renal artery, supramesenteric artery (SMA), and right popliteal artery on the fifth day after PCI despite anticoagulant therapy. Emergency endovascular therapy (EVT) with an aspiration catheter and ballooning were performed to the popliteal and renal artery, in addition to additional stenting of the SMA because of an intramural hematoma. This one session of emergency EVT was sufficient to save this patient, and no sequelae were observed after this treatment.

  15. Radiation exposure to eye lens and operator hands during endovascular procedures in hybrid operating rooms.

    Science.gov (United States)

    Attigah, Nicolas; Oikonomou, Kyriakos; Hinz, Ulf; Knoch, Thomas; Demirel, Serdar; Verhoeven, Eric; Böckler, Dittmar

    2016-01-01

    The purpose of this study was to evaluate the radiation exposure of vascular surgeons' eye lens and fingers during complex endovascular procedures in modern hybrid operating rooms. Prospective, nonrandomized multicenter study design. One hundred seventy-one consecutive patients (138 male; median age, 72.5 years [interquartile range, 65-77 years]) underwent an endovascular procedure in a hybrid operating room between March 2012 and July 2013 in two vascular centers. The dose-area product (DAP), fluoroscopy time, operating time, and amount of contrast dye were registered prospectively. For radiation dose recordings, single-use dosimeters were attached at eye level and to the ring finger of the hand next to the radiation field of the operator for each endovascular procedure. Dose recordings were evaluated by an independent institution. Before the study, precursory investigations were obtained to simulate the radiation dose to eye lens and fingers with an Alderson phantome (RSD, Long Beach, Calif). Interventions were classified into six treatment categories: endovascular repair of infrarenal abdominal aneurysm (n = 65), thoracic endovascular aortic repair (n = 32), branched endovascular aortic repair for thoracoabdominal aneurysms (n = 17), fenestrated endovascular aortic repair for complex abdominal aortic aneurysm, (n = 25), iliac branched device (n = 8), and peripheral interventions (n = 24). There was a significant correlation in DAP between both lens (P exposure to the eyes can be obtained. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  16. Pittsburgh Response to Endovascular therapy (PRE) score: optimizing patient selection for endovascular therapy for large vessel occlusion strokes.

    Science.gov (United States)

    Rangaraju, Srikant; Aghaebrahim, Amin; Streib, Christopher; Sun, Chung-Huan; Ribo, Marc; Muchada, Marion; Nogueira, Raul; Frankel, Michael; Gupta, Rishi; Jadhav, Ashutosh; Jovin, Tudor G

    2015-11-01

    Endovascular therapy seems to benefit a subset of patients with large vessel occlusion strokes. We aimed to develop a clinically useful tool to identify patients who are likely to benefit from endovascular therapy. In a derivation cohort of consecutively treated patients with anterior circulation large vessel occlusion (Grady Memorial Hospital, N=247), independent predictors (pPittsburgh Response to Endovascular therapy (PRE) score as a predictor of good outcome. The PRE score was validated in two institutional cohorts (University of Pittsburgh Medical Center (UPMC): N=393; Unitat d'Ictus Vall d'Hebron: N=204) and its discriminative power for good outcome was compared with other validated tools. Benefit of successful recanalization was assessed in PRE score groups. Independent predictors of good outcome in the derivation cohort (age, baseline National Institute of Health Stroke Scale (NIHSS) score and Alberta Stroke Program Early CT Score (ASPECTS)) were used in the model: PRE score=age (years)+2×NIHSS-10 × ASPECTS. PRE score was highly predictive of good outcome in the derivation cohort (area under the curve (AUC)=0.79) and validation cohorts (UPMC: AUC=0.79; UIVH: AUC=0.72) with comparable rates of good outcome in all PRE risk quartiles. PRE was superior to Totaled Health Risks In Vascular Events (THRIVE) (p=0.03) and Stroke Prognostication using Age and NIHSS (SPAN) (p=0.007), with a trend towards superiority to Houston Intra-Arterial Therapy 2 (HIAT2) (p=0.06) and iSCORE (p=0.051) in predicting good outcomes. Better outcomes were associated with successful recanalization in patients with PRE scores -24 to +49 but not in patients with PRE scores <-24 or ≥ 50. The PRE score is a validated tool that predicts outcomes and may facilitate patient selection for endovascular therapy in anterior circulation large vessel occlusions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  17. Endovascular Proximal Forearm Arteriovenous Fistula for Hemodialysis Access: Results of the Prospective, Multicenter Novel Endovascular Access Trial (NEAT).

    Science.gov (United States)

    Lok, Charmaine E; Rajan, Dheeraj K; Clement, Jason; Kiaii, Mercedeh; Sidhu, Ravi; Thomson, Ken; Buldo, George; Dipchand, Christine; Moist, Louise; Sasal, Joanna

    2017-10-01

    Hemodialysis arteriovenous fistulas (AVFs) are suboptimally used primarily due to problems with maturation, early thrombosis, and patient nonacceptance. An endovascular approach to fistula creation without open surgery offers another hemodialysis vascular access option. Prospective, single-arm, multicenter study (Novel Endovascular Access Trial [NEAT]). Consecutive adult non-dialysis-dependent and dialysis-dependent patients referred for vascular access creation at 9 centers in Canada, Australia, and New Zealand. Using catheter-based endovascular technology and radiofrequency energy, an anastomosis was created between target vessels, resulting in an endovascular AVF (endoAVF). Safety, efficacy, functional usability, and patency end points. Safety as percentage of device-related serious adverse events; efficacy as percentage of endoAVFs physiologically suitable (brachial artery flow ≥ 500mL/min, vein diameter ≥ 4mm) for dialysis within 3 months; functional usability of endoAVFs to provide prescribed dialysis via 2-needle cannulation; primary and cumulative endoAVF patencies per standardized definitions. 80 patients were enrolled (20 roll-in and 60 participants in the full analysis set; the latter are reported). EndoAVFs were created in 98% of participants; 8% had a serious procedure-related adverse event (2% device related). 87% were physiologically suitable for dialysis (eg, mean brachial artery flow, 918mL/min; endoAVF vein diameter, 5.2mm [cephalic vein]). EndoAVF functional usability was 64% in participants who received dialysis. 12-month primary and cumulative patencies were 69% and 84%, respectively. Due to the unique anatomy and vessels used to create endoAVFs, this was a single-arm study without a surgical comparator. An endoAVF can be reliably created using a radiofrequency magnetic catheter-based system, without open surgery and with minimal complications. The endoAVF can be successfully used for hemodialysis and demonstrated high 12-month

  18. Feasibility and Safety of Repeat Instant Endovascular Interventions in Patients with Refractory Cerebral Vasospasms.

    Science.gov (United States)

    Andereggen, L; Beck, J; Z'Graggen, W J; Schroth, G; Andres, R H; Murek, M; Haenggi, M; Reinert, M; Raabe, A; Gralla, J

    2017-03-01

    For patients with cerebral vasospasm refractory to medical and hemodynamic therapies, endovascular therapies often remain the last resort. Data from studies in large cohorts on the efficacy and safety of multiple immediate endovascular interventions are sparse. Our aim was to assess the feasibility and safety of multiple repeat instant endovascular interventions in patients with cerebral vasospasm refractory to medical, hemodynamic, and initial endovascular interventions. This was a single-center retrospective study of prospectively collected data on patients with cerebral vasospasm refractory to therapies requiring ≥3 endovascular interventions during the course of treatment following aneurysmal subarachnoid hemorrhage. The primary end point was functional outcome at last follow-up (mRS ≤2). The secondary end point was angiographic response to endovascular therapies and the appearance of cerebral infarctions. During a 4-year period, 365 patients with aneurysmal subarachnoid hemorrhage were treated at our institution. Thirty-one (8.5%) met the inclusion criteria. In 52 (14%) patients, ≤2 endovascular interventions were performed as rescue therapy for refractory cerebral vasospasm. At last follow-up, a good outcome was noted in 18 (58%) patients with ≥3 interventions compared with 31 (61%) of those with ≤2 interventions (P = .82). The initial Hunt and Hess score of ≤2 was a significant independent predictor of good outcome (OR, 4.7; 95% CI, 1.2-18.5; P = .03), whereas infarcts in eloquent brain areas were significantly associated with a poor outcome (mRS 3-6; OR, 13.5; 95% CI, 2.3-81.2; P = .004). Repeat instant endovascular intervention is an aggressive but feasible last resort treatment strategy with a favorable outcome in two-thirds of patients with refractory cerebral vasospasm and in whom endovascular treatment has already been initiated. © 2017 by American Journal of Neuroradiology.

  19. Endovascular therapy of arteriovenous fistulae with electrolytically detachable coils

    Energy Technology Data Exchange (ETDEWEB)

    Jansen, O.; Doerfler, A.; Forsting, M.; Hartmann, M.; Kummer, R. von; Tronnier, V.; Sartor, K. [Dept. of Neuroradiology, University of Heidelberg Medical School (Germany)

    1999-12-01

    We report our experience in using Guglielmi electrolytically detachable coils (GDC) alone or in combination with other materials in the treatment of intracranial or cervical high-flow fistulae. We treated 14 patients with arteriovenous fistulae on brain-supplying vessels - three involving the external carotid or the vertebral artery, five the cavernous sinus and six the dural sinuses - by endovascular occlusion using electrolytically detachable platinum coils. The fistula was caused by trauma in six cases. In one case Ehlers-Danlos syndrome was the underlying disease, and in the remaining seven cases no aetiology could be found. Fistulae of the external carotid and vertebral arteries and caroticocavernous fistulae were reached via the transarterial route, while in all dural fistulae a combined transarterial-transvenous approach was chosen. All fistulae were treated using electrolytically detachable coils. While small fistulae could be occluded with electrolytically detachable coils alone, large fistulae were treated by using coils to build a stable basket for other types of coil or balloons. In 11 of the 14 patients, endovascular treatment resulted in complete occlusion of the fistula; in the remaining three occlusion was subtotal. Symptoms and signs were completely abolished by this treatment in 12 patients and reduced in 2. On clinical and neuroradiological follow-up (mean 16 months) no reappearance of symptoms was recorded. (orig.)

  20. Augmented reality system for freehand guide of magnetic endovascular devices.

    Science.gov (United States)

    Parrini, S; Cutolo, F; Freschi, C; Ferrari, M; Ferrari, V

    2014-01-01

    Magnetic guide of endovascular devices or magnetized therapeutic microparticles to the specific target in the arterial tree is increasingly studied, since it could improve treatment efficacy and reduce side effects. Most proposed systems use external permanent magnets attached to robotic manipulators or magnetic resonance imaging (MRI) systems to guide internal carriers to the region of treatment. We aim to simplify this type of procedures, avoiding or reducing the need of robotic arms and MRI systems in the surgical scenario. On account of this we investigated the use of a wearable stereoscopic video see-through augmented reality system to show the hidden vessel to the surgeon; in this way, the surgeon is able to freely move the external magnet, following the showed path, to lead the endovascular magnetic device towards the desired position. In this preliminary study, we investigated the feasibility of such an approach trying to guide a magnetic capsule inside a vascular mannequin. The high rate of success and the positive evaluation provided by the operators represent a good starting point for further developments of the system.

  1. Chronic mesenteric ischaemia: 28-year experience of endovascular treatment.

    Science.gov (United States)

    Turba, Ulku Cenk; Saad, Wael E; Arslan, Bulent; Sabri, Saher S; Trotter, Stacey; Angle, John F; Hagspiel, Klaus D; Kern, John A; Cherry, Kenneth J; Matsumoto, Alan H

    2012-06-01

    To report the outcomes associated with endovascular therapy for patients with chronic mesenteric ischemia (CMI). A retrospective review of patients who underwent endovascular therapy for CMI between April 1981 and September 2009 at a single institution was performed. Procedural details, mesenteric arteries treated, technical and clinical success rates, outcomes per patient and per vessel were assessed. In 166 patients treatment was attempted using a variety of balloon and stent platforms during the 28-year period. The technical success rate was 97% per patient and 94% per vessel. The technical success rate of stenting (99.4%) was higher than for percutaneous transluminal angioplasty (PTA; 86%; P = 0.0001). Immediate clinical improvement was seen in 146 out of 166 (88.2%). The type of guidewire or device platform, brachial vs. femoral artery access, balloon and/or stent diameters used, and stenosis vs. occlusion had no statistical impact on mortality or the primary patency of any mesenteric artery outcomes. The outcome of the superior mesenteric artery (SMA) with PTA appears to be superior to that of stenting (P = 0.014). Technical success rates are improved with the use of stents; however, PTA use in the SMA seems to offer better primary patency rates. • Superior mesenteric artery (SMA) stenosis is often responsible for ischaemic symptoms. • Treatment with percutaneous transluminal angioplasty (PTA) seems superior to stenting • Although technical success rates are improved with the use of stents. • Higher mortality in the elderly and those presenting with nausea/vomiting/bloody stools.

  2. Mesenchymal stem cell seeding promotes reendothelialization of the endovascular stent.

    Science.gov (United States)

    Wu, Xue; Wang, Guixue; Tang, Chaojun; Zhang, Dechuan; Li, Zhenggong; Du, Dingyuan; Zhang, Zhengcai

    2011-09-01

    This study is designed to make a novel cell seeding stent and to evaluate reendothelialization and anti-restenosis after the stent implantation. In comparison with cell seeding stents utilized in previous studies, Mesenchymal stem cells (MSCs) have advantages on promoting of issue repair. Thus it was employed to improve the reendothelialization effects of endovascular stent in present work. MSCs were isolated by density gradient centrifugation and determined as CD29(+) CD44(+) CD34(-) cells by immunofluorescence and immunocytochemistry; gluten and polylysine coated stents were prepared by ultrasonic atomization spray, and MSCs seeded stents were made through rotation culture according to the optimized conditions that were determined in previous studies. The results from animal experiments, in which male New Zealand white rabbits were used, show that the reendothelialization of MSCs coated stents can be completed within one month; in comparison with 316L stainless steel stents (316L SS stents) and gluten and polylysine coated stents, the intimal hyperplasia and in-stent restenosis are significantly inhibited by MSCs coated stents. Endovascular stent seeded with MSCs promotes reendothelialization and inhibits the intimal hyperplasia and in-stent restenosis compared with the 316L SS stents and the gluten and polylysine coated stents. Copyright © 2011 Wiley Periodicals, Inc.

  3. A new murine model of endovascular aortic aneurysm repair.

    Science.gov (United States)

    Rouer, Martin; Meilhac, Olivier; Delbosc, Sandrine; Louedec, Liliane; Pavon-Djavid, Graciela; Cross, Jane; Legagneux, Josette; Bouilliant-Linet, Maxime; Michel, Jean-Baptiste; Alsac, Jean-Marc

    2013-07-07

    Endovascular aneurysm exclusion is a validated technique to prevent aneurysm rupture. Long-term results highlight technique limitations and new aspects of Abdominal aortic aneurysm (AAA) pathophysiology. There is no abdominal aortic aneurysm endograft exclusion model cheap and reproducible, which would allow deep investigations of AAA before and after treatment. We hereby describe how to induce, and then to exclude with a covered coronary stentgraft an abdominal aortic aneurysm in a rat. The well known elastase induced AAA model was first reported in 1990(1) in a rat, then described in mice(2). Elastin degradation leads to dilation of the aorta with inflammatory infiltration of the abdominal wall and intra luminal thrombus, matching with human AAA. Endovascular exclusion with small covered stentgraft is then performed, excluding any interactions between circulating blood and the aneurysm thrombus. Appropriate exclusion and stentgraft patency is confirmed before euthanasia by an angiography thought the left carotid artery. Partial control of elastase diffusion makes aneurysm shape different for each animal. It is difficult to create an aneurysm, which will allow an appropriate length of aorta below the aneurysm for an easy stentgraft introduction, and with adequate proximal and distal neck to prevent endoleaks. Lots of failure can result to stentgraft introduction which sometimes lead to aorta tear with pain and troubles to stitch it, and endothelial damage with post op aorta thrombosis. Giving aspirin to rats before stentgraft implantation decreases failure rate without major hemorrhage. Clamping time activates neutrophils, endothelium and platelets, and may interfere with biological analysis.

  4. Endovascular treatment of posterior condylar canal dural arteriovenous fistula.

    Science.gov (United States)

    Maus, Volker; Söderman, Michael; Rodesch, Georges; Kabbasch, Christoph; Mpotsaris, Anastasios

    2017-02-01

    Posterior condylar canal dural arteriovenous fistulas (PCC DAVFs) are rare lesions that may present with pulse-synchronous bruit. In cases with venous reflux there is a risk of haemorrhage or even dementia. Diagnosis and endovascular treatment require a profound knowledge of the vascular anatomy of the craniocervical junction and comprehensive neurovascular imaging. We describe the clinical presentation, angiographic imaging and endovascular treatment of a PCC DAVF in a female patient with pulse-synchronous bruit as the presenting symptom. The fistula drained almost exclusively into the sigmoid sinus and internal jugular vein. There was no intracranial reflux. The PCC DAVF was treated with transvenous coil occlusion of the fistulous pouch in the condylar canal. Symptoms resolved immediately after intervention and the patient recovered quickly without any neurological deficits. MR angiography confirmed occlusion of the DAVF. The dural sinus was patent with normal blood flow. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. Chopstick Injury: Successful Stent-Graft Therapy for Traumatic Left Subclavian Artery Aneurysm

    National Research Council Canada - National Science Library

    Ueda, Tatsuo; Tajima, Hiroyuki; Murata, Satoru; Takagi, Ryo; Yokota, Hiroyuki; Kumita, Shin-ichiro

    2017-01-01

    Traumatic chopstick injury is very rare, especially in the vascular system. We present an unusual case of a 19-year-old man who presented at the emergency department after being stabbed with a chopstick by his elder brother...

  6. Endovascular stenting of mid-aortic syndrome due to Takayasu arteritis.

    Science.gov (United States)

    Dogan, Ali; Sever, Kenan; Ozdemir, Emrah; Mansuroglu, Denyan; Kurtoglu, Nuri

    2017-09-13

    Introduction-patients: Takayasu arteritis may involve various parts of the aorta and its major branches. It leads to occlusive or aneurysmal disease of the vessel. It can be treated either with surgery or percutaneous intervention. We report a successful endovascular treatment of stenosis of the descending thoracic and abdominal aorta in a 19-year-old female. Methods-results-conclusions: Self-expandable nitinol stent was deployed and adequate opening of the aorta was obtained in this patient. Long-term durability of endovascular approach is a matter of debate. We also reviewed the sufficiency of endovascular treatment versus surgery.

  7. Endovascular Treatment In Acute Ischemic Stroke: What Has Changed Over The Last One Year?

    Directory of Open Access Journals (Sweden)

    Hesna Bektaş

    2016-04-01

    Full Text Available Despite the absence of sufficent data from randomised controlled trials, endovascular treatment has always been considered as a therapeutic option in the setting of acute ischemic stroke. Our knowledge regarding in this field has dramatically expanded over the last three years. Following the initial dissapointing and negative trials, the subsequent positive results observed in a series of studies has consolidated the role of endovascular treatment in patients with acute ischemic stroke. In this review we will comment on the recent developments in the field of endovascular treatment and discuss the messages that underlie the controversial findings observed in these trials.

  8. Endovascular angioplasty before resection of a sphenoidal meningioma with vascular encasement.

    Science.gov (United States)

    Chivoret, N; Fontaine, D; Lachaud, S; Chau, Y; Sedat, J

    2011-09-01

    We describe a case of sphenoid wing meningioma presenting with cerebral infarction due to extended vascular encasement in which endovascular angioplasty was performed before surgery to avoid perioperative ischemia. A severe stenosis involved the intracranial internal carotid artery and the proximal segments of the middle and anterior cerebral arteries. Endovascular dilatation was followed by complete surgical resection. Preoperative mild aphasia and hemiparesia resolved completely after surgery. Endovascular angioplasty of arterial trunks and their branches can be proposed before the resection of skull base meningiomas encasing these arteries to decrease the risk of perioperative brain ischemia related to their surgical manipulation or vasospasm.

  9. Treatment of Endovascular Coil and Stent Migration Using the Merci Retriever: Report of Three Cases

    Directory of Open Access Journals (Sweden)

    David K. Kung

    2012-01-01

    Full Text Available Background. Coil and stent migration is a potentially catastrophic complication in endovascular neurosurgery, which may lead to cerebral thromboembolism. Techniques for removing migrated coil and stent are not well established. Methods and Results. We present three cases in which coil or stent migration occurred during endovascular embolization of a cerebral aneurysm. The Merci Retrievers were used successfully in all cases to remove the displaced foreign bodies. Technical details are described. Conclusion. The Merci Retriever device can be utilized successfully for removal of migrated coils and stents in endovascular neurosurgery.

  10. Construct validity and reliability of structured assessment of endovascular expertise in a simulated setting

    DEFF Research Database (Denmark)

    Bech, B.; Lönn, L.; Falkenberg, M.

    2011-01-01

    Objectives To study the construct validity and reliability of a novel endovascular global rating scale, Structured Assessment of endoVascular Expertise (SAVE). Design A Clinical, experimental study. Materials Twenty physicians with endovascular experiences ranging from complete novices to highly....... Validity was analysed by correlating experience with performance results. Reliability was analysed according to generalisability theory. Results The mean score on the 29 items of the SAVE scale correlated well with clinical experience (R = 0.84, P ... with clinical experience (R = -0.53, P validity and reliability of assessment with the SAVE scale was high when applied to performances in a simulation setting with advanced realism. No ceiling effect...

  11. 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.

  12. Radiological Changes in Infantile Dissecting Anterior Communicating Artery Aneurysm Treated Endovascularly

    Science.gov (United States)

    Yatomi, Kenji; Oishi, Hidenori; Yamamoto, Munetaka; Suga, Yasuo; Nonaka, Senshu; Yoshida, Kensaku; Arai, Hajime

    2014-01-01

    Summary Intracranial aneurysms are extremely rare in infants, and to our knowledge only seven infants treated for ruptured spontaneous dissecting aneurysms have been reported. Good outcomes have been achieved with endovascular treatment of infantile aneurysm. We the endovascular treatment of a one-month-old girl for ruptured dissecting aneurysm located in the anterior communicating artery, and the unique radiological changes that were observed during the perioperative and follow-up periods. These changes suggest that blood coagulation and fibrinolytic response play a part in the repair and healing processes of dissecting aneurysms. Careful neuroradiological surveys are needed for pediatric dissecting aneurysms treated endovascularly. PMID:25496693

  13. Ultrasound findings after endovascular stent deployment in transplant liver hepatic artery stenosis

    National Research Council Canada - National Science Library

    Lall, Neil U; Bluth, Edward I; Sternbergh, 3rd, W C

    2014-01-01

    Endovascular stenting is a safe, effective treatment of hepatic artery stenosis after liver transplant, but no detailed evaluation has been completed of changes in ultrasound monitoring parameters after stenting...

  14. Current state in tracking and robotic navigation systems for application in endovascular aortic aneurysm repair

    NARCIS (Netherlands)

    De Ruiter, Quirina M B; Moll, Frans L.; Van Herwaarden, Joost A.

    2015-01-01

    Objective This study reviewed the current developments in manual tracking and robotic navigation technologies for application in endovascular aortic aneurysm repair (EVAR). Methods EMBASE and MEDLINE databases were searched for studies reporting manual tracking or robotic navigation systems that are

  15. An augmented reality framework for optimization of computer assisted navigation in endovascular surgery.

    Science.gov (United States)

    Cheng, Irene; Shen, Rui; Moreau, Richard; Brizzi, Vicenzo; Rossol, Nathaniel; Basu, Anup

    2014-01-01

    Endovascular surgery is performed by placing a catheter through blood vessels. Due to the fragility of arteries and the difficulty in controlling a long elastic wire to reach the target region, training plays an extremely important role in helping a surgeon acquire the required complex skills. Virtual reality simulators and augmented reality systems have proven to be effective in minimally invasive surgical training. These systems, however, often employ pre-captured or computer-generated medical images. We have developed an augmented reality system for ultrasound-guided endovascular surgical training, where real ultrasound images captured during the procedure are registered with a pre-scanned phantom model to give the operator a realistic experience. Our goal is to extend the planning and training environment to deliver a system for computer assisted remote endovascular surgery where the navigation of a catheter can be controlled through a robotic device based on the guidance provided by an endovascular surgeon.

  16. Infectious intracranial aneurysms in the pediatric population: endovascular treatment with Onyx.

    Science.gov (United States)

    Eddleman, Christopher S; Surdell, Daniel; DiPatri, Arthur; Tomita, Tadanori; Shaibani, Ali

    2008-08-01

    Infectious intracranial aneurysms present a treatment challenge in the pediatric population. Current endovascular strategies and tools have been developed, which make treatment of infectious intracranial aneurysms with liquid embolics safe and effective. This study reviews the use of the liquid embolic Onyx in the treatment of infectious intracranial aneurysms in the pediatric population. We used an endovascular approach to treat ruptured infectious intracranial aneurysms. We embolized the aneurysms with either Onyx alone or in combination with platinum coils. Endovascular therapy with liquid embolics (Onyx) has been shown to be a safe and effectual treatment option in the case of pediatric infectious intracranial aneurysms. The combination of endovascular modalities can also be used to tailor the therapeutic goal of exclusion of infectious aneurysms with good results. Further studies are needed to assess the long-term effectiveness of this approach to pediatric infectious intracranial aneurysms.

  17. Low mortality and morbidity after endovascular repair of ruptured aortic aneurism

    DEFF Research Database (Denmark)

    Duvnjak, Stevo; Balezantis, Tomas; Lindholt, Jes Sanddal

    2015-01-01

    INTRODUCTION: The objective of this study was to describe the implementation and to evaluate the short-term outcome of the first Danish experience with endovascular repair of ruptured abdominal aortic aneurysm (RAAA). METHODS: This was a historical prospective cohort study including all patients...... with endovascular aneurysm repair and 26 (49%) with open repair. Two patients (7%) died within the first 30 days post-operatively in the endovascular group. One patient died perioperatively due to myocardial infarction verified by autopsy. The other patient died due to massive coagulopathy and multiorgan failure...... shortly after the procedure. In the