WorldWideScience

Sample records for open endovascular procedures

  1. 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

  2. Basic Endovascular Skills Trainer: A surgical simulator for the training of novice practitioners of endovascular procedures.

    Science.gov (United States)

    Sinceri, S; Carbone, M; Marconi, M; Moglia, A; Ferrari, M; Ferrari, V

    2015-01-01

    In recent years the clinical interest for structured training in endovascular procedures has increased. Such procedures respect the physical integrity of the patient and at the same time ensure good therapeutic results. This study describes the development and testing of the B.E.S.T. (Basic Endovascular Skills Trainer) simulator. The B.E.S.T is an innovative physical endovascular simulator to learn basic skills of endovascular surgery. The simulator was tested by 25 clinicians with different levels of experience: novices, intermediates, and experts. All clinicians agree on affirming the importance of training in endovascular surgery; in particular they consider the B.E.S.T a valid simulator to learn specific basic skills of vascular surgery.

  3. Effectiveness of open versus endovascular abdominal aortic aneurysm repair in population settings: A systematic review of statewide databases.

    Science.gov (United States)

    Williams, Christopher R; Brooke, Benjamin S

    2017-10-01

    Patient outcomes after open abdominal aortic aneurysm and endovascular aortic aneurysm repair have been widely reported from several large, randomized, controlled trials. It is not clear whether these trial outcomes are representative of abdominal aortic aneurysm repair procedures performed in real-world hospital settings across the United States. This study was designed to evaluate population-based outcomes after endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair using statewide inpatient databases and examine how they have helped improve our understanding of abdominal aortic aneurysm repair. A systematic search of MEDLINE, EMBASE, and CINAHL databases was performed to identify articles comparing endovascular aortic aneurysm repair and open abdominal aortic aneurysm repair using data from statewide inpatient databases. This search was limited to studies published in the English language after 1990, and abstracts were screened and abstracted by 2 authors. Our search yielded 17 studies published between 2004 and 2016 that used data from 29 different statewide inpatient databases to compare endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair. These studies support the randomized, controlled trial results, including a lower mortality associated with endovascular aortic aneurysm repair extended from the perioperative period up to 3 years after operation, as well as a higher complication rate after endovascular aortic aneurysm repair. The evidence from statewide inpatient database analyses has also elucidated trends in procedure volume, patient case mix, volume-outcome relationships, and health care disparities associated with endovascular aortic aneurysm repair versus open abdominal aortic aneurysm repair. Population analyses of endovascular aortic aneurysm repair and open abdominal aortic aneurysm repair using statewide inpatient databases have confirmed short- and long-term mortality outcomes obtained from

  4. Open aortic surgery after thoracic endovascular aortic repair.

    Science.gov (United States)

    Coselli, Joseph S; Spiliotopoulos, Konstantinos; Preventza, Ourania; de la Cruz, Kim I; Amarasekara, Hiruni; Green, Susan Y

    2016-08-01

    In the last decade, thoracic endovascular aortic aneurysm repair (TEVAR) has emerged as an appealing alternative to the traditional open aortic aneurysm repair. This is largely due to generally improved early outcomes associated with TEVAR, including lower perioperative mortality and morbidity. However, it is relatively common for patients who undergo TEVAR to need a secondary intervention. In select circumstances, these secondary interventions are performed as an open procedure. Although it is difficult to assess the rate of open repairs after TEVAR, the rates in large series of TEVAR cases (>300) have ranged from 0.4 to 7.9 %. Major complications of TEVAR that typically necessitates open distal aortic repair (i.e., repair of the descending thoracic or thoracoabdominal aorta) include endoleak (especially type I), aortic fistula, endograft infection, device collapse or migration, and continued expansion of the aneurysm sac. Conversion to open repair of the distal aorta may be either elective (as for many endoleaks) or emergent (as for rupture, retrograde complicated dissection, malperfusion, and endograft infection). In addition, in select patients (e.g., those with a chronic aortic dissection), unrepaired sections of the aorta may progressively dilate, resulting in the need for multiple distal aortic repairs. Open repairs after TEVAR can be broadly classified as full extraction, partial extraction, or full salvage of the stent-graft. Although full and partial stent-graft extraction imply failure of TEVAR, such failure is generally absent in cases where the stent-graft can be fully salvaged. We review the literature regarding open repair after TEVAR and highlight operative strategies.

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

    DEFF Research Database (Denmark)

    Firwana, Belal; Ferwana, Mazen; Hasan, Rim;

    2014-01-01

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

  6. Endovascular thrombectomy and post-procedural headache

    DEFF Research Database (Denmark)

    Khan, Sabrina; Amin, Faisal Mohammad; Holtmannspötter, Markus

    2017-01-01

    BACKGROUND: We investigated the prevalence of post-procedural headache in patients who have undergone thrombectomy for ischemic stroke, and correlated history of migraine with risk of peri-procedural complications. A total of 314 patients underwent thrombectomy at the Danish National Hospital from...... persisted at interview time for subjects with migraine. Out of 12 subjects with peri-procedural complications, 2 had a history of migraine with aura. CONCLUSION: Thrombectomy leads to a significant decrease in previously known migraine, and new onset of headache in a small subset of patients. A history...... of migraine does not appear to predispose to peri-procedural complications....

  7. Open Surgical Repair After Endovascular Treatment with Endologix Stent Graft: A Case Report

    Directory of Open Access Journals (Sweden)

    Ižsa Coskun

    2016-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysm repair is increasingly being used today. We report a 72-year-old male patient who underwent open surgical repair due to separation of IntuTrak Powerlink XL (Endologix endovascular stent graft four months after endovascular intervention for abdominal aortic aneurysm with 9.5 cm diameter.

  8. Distal landing zone open fenestration facilitates endovascular elephant trunk completion and false lumen thrombosis.

    Science.gov (United States)

    Roselli, Eric E; Sepulveda, Edgardo; Pujara, Akshat C; Idrees, Jahanzaib; Nowicki, Edward

    2011-12-01

    Controversy surrounds the endovascular treatment of chronic dissection because of inconsistent remodeling of the aorta. The purpose of this study was to assess efficacy and safety of a novel technique for repairing aneurysmal change associated with chronic descending aortic dissection. From July 2007 to April 2011, 24 patients with descending aortic aneurysmal change, consequent to previously repaired ascending aortic dissection or medically treated descending dissection, underwent combined open first-stage elephant trunk (ET) insertion and fenestration of the descending aorta intimal flap. Second-stage ET endovascular completion was performed with the index operation in 4 patients and later in 20 patients (median, 62 days). Repair was elective in 14 patients and urgent in 10 patients. Concomitant procedures were aortic valve replacement in 3 patients and coronary revascularization in 3 patients, and 16 procedures were reoperations. Chart review and analysis of 3-dimensional computed tomography (CT) scans were performed. Imaging follow-up was complete in 89% of patients during a median of 18 months (interquartile range [IQR], 10 to 28 months). Technical success was achieved in all patients. Moderate reduction in aortic size occurred in most patients, with no retrograde false lumen flow. Late reintervention was required in 5 patients: endovascular for distal type I endoleak in 2 patients, type II endoleak in 1 patient, pseudoaneurysm of the abdominal aorta in 1 patient, and 1 open repair for aneurysm of the untreated distal segment in 1 patient. One patient died of pulmonary embolism on postoperative day 19 after 1-stage repair (4.0%) and 1 patient (4%) had a transient stroke, but there was no renal failure, respiratory failure, or permanent spinal cord injury. Median length of stay was 13 days (IQR, 8 to 16 days) after first-stage ET and 8 days (IQR, 5 to 12 days) after endovascular ET completion. One patient died during a mean of 23 ± 11 months of follow-up. Open

  9. 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

  10. 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.

  11. National trends for open and endovascular repair of aneurysms in Korea: 2004-2013.

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    Joh, Jin Hyun; Park, Yun-Young; Cho, Sung-Shin; Park, Ho-Chul

    2016-11-01

    The introduction of endovascular aneurysm repair has led to a dramatic decline in open aneurysm repair. The aim of this report was to evaluate Korean national trends for the treatment of aneurysms. A serial, cross-sectional study of time trends of patients who underwent aneurysm repair between 2004 and 2013 was conducted. Data from the Health Insurance Review and Assessment Service were used to evaluate the trends of aneurysm repair in the Korean population and to analyze the trends of open and endovascular aneurysm repair among Medicare beneficiaries. A linear-by-linear association was performed to determine alterations in the rates at which these aneurysm repair techniques were performed. A total of 32,130 patients underwent aneurysm repair between 2004 and 2013. The proportion of patients who underwent open repair decreased from 94.0% in 2004 to 54.9% in 2013; whereas the proportion of patients who underwent endovascular repair increased from 6.0% in 2004 to 45.1% in 2013. During the study period, the number of patients undergoing endovascular repair of aortic aneurysms significantly increased from 82 to 1,396 (relative risk, 16.17; 95% confidence interval: 12.94-20.21). Endovascular repair of abdominal aortic aneurysms (AAAs)overtook open repair between 2010 and 2011. The frequency of open aneurysm repair increased 1.2-fold, with an overall downward trend. The prevalence of endovascular repair markedly increased 15.3-fold. These findings indicated that, in Korea, the endovascular repair of AAAs overtook open repair as the most common technique between 2010 and 2011.

  12. Technical and Clinical Success and Long-Term Durability of Endovascular Treatment for Atherosclerotic Aortic Arch Branch Origin Obstruction : Evaluation of 144 Procedures

    NARCIS (Netherlands)

    van de Weijer, M. A. J.; Vonken, E. J. P. A.; de Vries, J-P. P. M.; Moll, F. L.; Vos, J. A.; de Borst, G. J.

    2015-01-01

    Objectives: Endovascular treatment of atherosclerotic obstruction of aortic arch branch origins (AABO) has largely replaced open surgery, but long-term outcome data are lacking. This study evaluated mid-term and long-term results of these procedures. Design: Retrospective cohort study. Materials and

  13. Endovascular procedures and new insights in diabetic limb salvage.

    Science.gov (United States)

    Peeters, P; Verbist, J; Keirse, K; Callaert, J; Deloose, K; Bosiers, M

    2012-02-01

    Critical limb ischemia (CLI) is affecting an increasing number of patients, mainly due to an ageing population and the growing number of diabetics. Clinically, CLI is characterized by rest pain, non-healing foot wounds and gangrene, due to insufficient arterial blood supply. Limb preservation should be the goal in patients with diabetic foot due to tibial occlusive disease. As surgery is associated with considerable morbidity and mortality rates, endovascular therapy can offer a valuable alternative. Small-diameter below-the-knee arteries that were previously unamenable to surgical methods, can now be reached and treated. Currently, many endovascular techniques are available, from regular PTA and bare metal stents to drug-coated balloons and drug-eluting stents. In our opinion the results of endovascular therapy for below-the-knee vessels will be further improved by the continuous technical evolution and new material developments. In the light of the current evolution towards minimally invasive techniques, an increasing number of experienced centers will be able to treat the vast majority of all below-the-knee arterial pathology by endovascular means.

  14. 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 i...

  15. Prediction of 30-day mortality after endovascular repair or open surgery in patients with ruptured abdominal aortic aneurysms.

    NARCIS (Netherlands)

    Visser, J.J.; Williams, M.A.; Kievit, J.; Bosch, J.L.; Hunink, M.G.M.; Teijink, J.A.; Verhoeven, E.L.; Smet, A.A. de; Geelkerken, R.H.; Steyerberg, E.W.; Sambeek, M.R. van

    2009-01-01

    OBJECTIVE: To validate the Glasgow Aneurysm Score (GAS) in patients with ruptured abdominal aortic aneurysms (AAAs) treated with endovascular repair or open surgery and to update the GAS so that it predicts 30-day mortality for patients with ruptured AAA treated with endovascular repair or open surg

  16. Headache in subarachnoid hemorrhage and headache attributed to intracranial endovascular procedures.

    Science.gov (United States)

    Agostoni, E; Zagaria, M; Longoni, M

    2015-05-01

    Headache is a critical problem in the emergency setting. In this paper we briefly review the epidemiological data regarding headache in Subarachnoid Hemorrhage (SAH), considering the role of headache as a warning symptom and the other clinical manifestation of SAH. We have also introduced a recent clinical entity, represented by headache associated to intracranial endovascular procedures (IEPs).

  17. Headache improvement after intracranial endovascular procedures in Chinese patients with unruptured intracranial aneurysm

    Science.gov (United States)

    Zhang, Linjing; Wang, Yunxia; Zhang, Qingkui; Ge, Wei; Wu, Xiancong; Di, Hai; Wang, Jun; Cao, Xiangyu; Li, Baomin; Liu, Ruozhuo; Yu, Shengyuan

    2017-01-01

    Abstract The aim of this study was to investigate whether there is a long-term improvement in headache of patients with unruptured intracranial aneurysms (UIAs) treated with intracranial endovascular procedures. Using a prospective design, consecutive patients with UIAs with neuroendovascular treatment from January 2014 to December 2014 were asked to participate. Headache outcomes were established before aneurysm treatment and for 6 months following treatment. Factors associated with different headache outcomes were investigated. Ultimately, 58 patients completed the 6-month follow-up. In total, 29 patients had preoperative headache. Six months after the intracranial endovascular procedure, 13 patients (44.8%) stated that their headaches were relieved after endovascular treatment; headache in 1 patient improved slightly, and 12 reported disappearance of headache and marked improvement. Overall, the mean headache scores of 29 patients improved on the self-reported Numeric Rating Scale (NRS) after endovascular treatment (6.00 vs. 2.30; P aneurysm were the important disadvantage for patients in improvement of post-procedure headache. Treatment of UIAs resulted in relief of headaches in about half of patients who had headaches pre-operatively. PMID:28178166

  18. Comparison of the Incidence of Complications and Secondary Surgical Interventions Necessary in Patients with Chronic Lower Limb Ischemia Treated by Both Open and Endovascular Surgeries

    Science.gov (United States)

    Janczak, Dariusz; Malinowski, Maciej; Bąkowski, Wojciech; Krakowska, Katarzyna; Marschollek, Karol; Marschollek, Paweł

    2017-01-01

    Background: Peripheral arterial disease (PAD) affects 3%–10% of the population before the age of 70 years and 15%–20% after that age. The aim of the study was to compare the incidence of complications and secondary interventions in patients who underwent each type of treatment. Methods: We analyzed 734 medical records of the Department of Surgery at the 4th Military Teaching Hospital in Wroclaw, In total, 394 were operated on with open surgery; an endarterectomy (59.39%), a vascular prosthesis implantation (31.01%), or both of these techniques (6.6%), and 340 patients had angioplasty with (50.59%) or without stenting (49.41%). Results: There were no statistically significant differences in the incidence of corresponding complications. The exception was the infection of the wound; significantly fewer were reported in the case of endovascular procedures (p = 0.0087). There were 12 occasions (3.53%) during endovascular surgeries when intraoperative conversion or re-operation using the open method occurred. In the case of open surgery, the mean hospital stay was 7.77 days (median: 8, mode: 8), while for endovascular management it was equal to 4.68 days (median: 4, mode: 3), p <0.0001. Conclusion: The endovascular method results in a similar re-operation rate and number of complications as open surgery. PMID:28496017

  19. The pros and cons of endovascular and open surgical treatments for patients with acute limb ischemia.

    Science.gov (United States)

    Branco, B C; Montero-Baker, M F; Mills, J L

    2015-06-01

    The present review addresses the pros and cons of the current, wide variety of therapeutic options available for the treatment of acute limb ischemia (ALI). Despite five prospective randomized controlled trials comparing catheter directed thrombolysis and open surgical revascularization, no single treatment strategy can yet be considered optimal for patients with ALI. This report includes 20 years of published data to evaluate the efficacy and safety profile of thrombolytic agents and adjunctive endovascular techniques when compared to open surgical revascularization.

  20. Endovascular procedures, carotid endarterectomies, and aortic surgery should preferentially be done by a vascular trainee rather than a general surgery resident.

    Science.gov (United States)

    Seabrook, Gary R; Sharp, John

    2005-03-01

    This article is the result of a debate. The motion proposed was that "endovascular procedures, carotid endarterectomies, and aortic surgery should be done preferentially by a vascular trainee rather than a general surgery resident.'' Arguments in favor of the motion were that with the development of endovascular surgery, there are now less open vascular procedures to perform and hence, vascular trainees needed to hone their skills on these limited cases rather than waste that experience on a general surgery resident. This focused training experience would allow vascular fellows to be become more highly skilled vascular surgeons. Additionally, endovascular procedures are an important component of modern vascular surgery, and it is important for the vascular fellow to develop significant experience with and acquire the appropriate numbers of endovascular cases to get the necessary credentials when going into a vascular practice. Arguments against the motion were that exposure to vascular cases will make a better general surgeon, one who will also be well equipped to deal with trauma cases and situations where the control of bleeding might be life saving. Additionally, the issue of exposure of general surgery residents to vascular cases might be a positive recruitment strategy for future vascular fellows. The motion was carried by a small majority vote.

  1. ''de novo'' aneurysms following endovascular procedures

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    Briganti, F.; Cirillo, S.; Caranci, F. [Department of Neurological Sciences, Services of Neuroradiology, ' ' Federico II' ' University, Naples (Italy); Esposito, F.; Maiuri, F. [Department of Neurological Sciences, Services of Neurosurgery, ' ' Federico II' ' University, Naples (Italy)

    2002-07-01

    Two personal cases of ''de novo'' aneurysms of the anterior communicating artery (ACoA) occurring 9 and 4 years, respectively, after endovascular carotid occlusion are described. A review of the 30 reported cases (including our own two) of ''de novo'' aneurysms after occlusion of the major cerebral vessels has shown some features, including a rather long time interval after the endovascular procedure of up to 20-25 years (average 9.6 years), a preferential ACoA (36.3%) and internal carotid artery-posterior communicating artery (ICA-PCoA) (33.3%) location of the ''de novo'' aneurysms, and a 10% rate of multiple aneurysms. These data are compared with those of the group of reported spontaneous ''de novo'' aneurysms after SAH or previous aneurysm clipping. We agree that the frequency of ''de novo'' aneurysms after major-vessel occlusion (two among ten procedures in our series, or 20%) is higher than commonly reported (0 to 11%). For this reason, we suggest that patients who have been submitted to endovascular major-vessel occlusion be followed up for up to 20-25 years after the procedure, using non-invasive imaging studies such as MR angiography and high-resolution CT angiography. On the other hand, periodic digital angiography has a questionable risk-benefit ratio; it may be used when a ''de novo'' aneurysm is detected or suspected on non-invasive studies. The progressive enlargement of the ACoA after carotid occlusion, as described in our case 1, must be considered a radiological finding of risk for ''de novo'' aneurysm formation. (orig.)

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

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    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.

  3. Post procedure headache in patients treated for neurovascular arteriovenous malformations and aneurysms using endovascular therapy

    DEFF Research Database (Denmark)

    Khan, Sabrina; Amin, Faisal Mohammad; Hauerberg, John

    2016-01-01

    BACKGROUND: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral arteriove......BACKGROUND: Though endovascular therapy (EVT) is increasingly applied in the treatment of intracranial vascular lesions, little is known about the effect of EVT on post-procedure headache. We aimed to investigate the prevalence of headache in patients who have undergone EVT for cerebral...... arteriovenous malformations (AVMs) and aneurysms. METHODS: A total of 324 patients underwent EVT treatment for aneurysms and AVMs at the Danish National Hospital from January 2012 to December 2014. We applied strict exclusion criteria in order to minimize the effect of other factors on headache occurrence, e.......g., craniotomy. Eligible subjects were phone-interviewed using a purpose-developed semi-structured questionnaire. Headaches were classified according to ICHD-III beta criteria. RESULTS: The 59 patients underwent treatment of aneurysms (n = 43), cranial dural fistulas (n = 11), and AVMs (n = 5...

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

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

    2015-02-15

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

  5. The creation of the optimal dedicated endovascular suite

    NARCIS (Netherlands)

    Sikkink, C. J. J. M.; Reijnen, M. M. P. J.; Zeebregts, C. J.

    2008-01-01

    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

  6. Aortoenteric Fistula as a Complication of Open Reconstruction and Endovascular Repair of Abdominal Aorta

    Directory of Open Access Journals (Sweden)

    Marek Tagowski

    2014-01-01

    Full Text Available The paper intends to present a review of imaging characteristics of secondary aortoenteric fistula (AEF. Mechanical injury, infection, and adherence of a bowel segment to the aorta or aortic graft are major etiologic factors of AEF after open aortic repair. The pathogenesis of AEF formation after endovascular abdominal aortic repair is related to mechanical failure of the stent-graft, to stent graft infection, and to persistent pressurization of the aneurysmal sac. The major clinical manifestations of AEF comprise haematemesis, melaena, abdominal pain, sepsis, and fever. CT is the initial diagnostic modality of choice in a stable patient. However, the majority of reported CT appearances are not specific. In case of equivocal CT scans and clinical suspicion of AEF, scintigraphy, 67Ga citrate scans or 18F-FDG PET/CT is useful. Diagnostic accuracy of endoscopy in evaluation of AEF is low; nevertheless it allows to evaluate other than AEF etiologies of gastrointestinal bleeding. Without adequate therapy, AEF is lethal. Conventional surgical treatment is associated with high morbidity and mortality. The endovascular repair may be an option in hemodynamically unstable and high-risk surgical patients. We also illustrate an example of a secondary AEF with highly specific albeit rare radiologic picture from our institution.

  7. Procedural Predictors of Outcome in Patients Undergoing Endovascular Therapy for Acute Ischemic Stroke

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    Rai, Ansaar T., E-mail: ansaar.rai@gmail.com; Jhadhav, Yahodeep; Domico, Jennifer [West Virginia University Health Sciences Center, Interventional Neuroradiology (United States); Hobbs, Gerald R. [West Virginia University Health Sciences Center, Department of Community Medicine (United States)

    2012-12-15

    Purpose: To identify factors impacting outcome in patients undergoing interventions for acute ischemic stroke (AIS). Materials and Methods: This was a retrospective analysis of patients undergoing endovascular therapy for AIS secondary during a 30 month period. Outcome was based on modified Rankin score at 3- to 6-month follow-up. Recanalization was defined as Thrombolysis in myocardial infarction score 2 to 3. Collaterals were graded based on pial circulation from the anterior cerebral artery either from an ipsilateral injection in cases of middle cerebral artery (MCA) occlusion or contralateral injection for internal carotid artery terminus (ICA) occlusion as follows: no collaterals (grade 0), some collaterals with retrograde opacification of the distal MCA territory (grade 1), and good collaterals with filling of the proximal MCA (M2) branches or retrograde opacification up to the occlusion site (grade 2). Occlusion site was divided into group 1 (ICA), group 2 (MCA with or without contiguous M2 involvement), and group 3 (isolated M2 or M3 branch occlusion). Results: A total of 89 patients were studied. Median age and National Institutes of health stroke scale (NIHSS) score was 71 and 15 years, respectively. Favorable outcome was seen in 49.4% of patients and mortality in 25.8% of patients. Younger age (P = 0.006), lower baseline NIHSS score (P = 0.001), successful recanalization (P < 0.0001), collateral support (P = 0.0008), distal occlusion (P = 0.001), and shorter procedure duration (P = 0.01) were associated with a favorable outcome. Factors affecting successful recanalization included younger age (P = 0.01), lower baseline NIHSS score (P = 0.05), collateral support (P = 0.01), and shorter procedure duration (P = 0.03). An ICA terminus occlusion (P < 0.0001), lack of collaterals (P = 0.0003), and unsuccessful recanalization (P = 0.005) were significantly associated with mortality. Conclusion: Angiographic findings and preprocedure variables can help

  8. Workflow for the use of a high-resolution image detector in endovascular interventional procedures

    Science.gov (United States)

    Rana, R.; Loughran, B.; Swetadri Vasan, S. N.; Pope, L.; Ionita, C. N.; Siddiqui, A.; Lin, N.; Bednarek, D. R.; Rudin, S.

    2014-03-01

    Endovascular image-guided intervention (EIGI) has become the primary interventional therapy for the most widespread vascular diseases. These procedures involve the insertion of a catheter into the femoral artery, which is then threaded under fluoroscopic guidance to the site of the pathology to be treated. Flat Panel Detectors (FPDs) are normally used for EIGIs; however, once the catheter is guided to the pathological site, high-resolution imaging capabilities can be used for accurately guiding a successful endovascular treatment. The Micro-Angiographic Fluoroscope (MAF) detector provides needed high-resolution, high-sensitivity, and real-time imaging capabilities. An experimental MAF enabled with a Control, Acquisition, Processing, Image Display and Storage (CAPIDS) system was installed and aligned on a detector changer attached to the C-arm of a clinical angiographic unit. The CAPIDS system was developed and implemented using LabVIEW software and provides a user-friendly interface that enables control of several clinical radiographic imaging modes of the MAF including: fluoroscopy, roadmap, radiography, and digital-subtraction-angiography (DSA). Using the automatic controls, the MAF detector can be moved to the deployed position, in front of a standard FPD, whenever higher resolution is needed during angiographic or interventional vascular imaging procedures. To minimize any possible negative impact to image guidance with the two detector systems, it is essential to have a well-designed workflow that enables smooth deployment of the MAF at critical stages of clinical procedures. For the ultimate success of this new imaging capability, a clear understanding of the workflow design is essential. This presentation provides a detailed description and demonstration of such a workflow design.

  9. The "open branch" technique: A new way to prevent paraplegia after total endovascular repair of thoracoabdominal aneurysm.

    Science.gov (United States)

    Krajcer, Zvonimir; Echeverria, Angela

    2016-03-01

    Spinal cord ischemia (SCI) has been one of the most concerning complications after surgical and endovascular thoracoabdominal aortic aneurysm repair "Open Branch" is an innovative technique to reduce the incidence of SCI Further studies in a larger number of patients with varying pathologies are needed to confirm the advantages of this technique.

  10. Feasibility and limitations of an automated 2D-3D rigid image registration system for complex endovascular aortic procedures.

    Science.gov (United States)

    Carrell, Tom W G; Modarai, Bijan; Brown, James R I; Penney, Graeme P

    2010-08-01

    To examine the feasibility of an automated 2-dimensional (2D) to 3- dimensional (3D) image registration system to simplify the navigational challenges faced in complex endovascular aortic procedures. An automated 2D-3D image registration system was used to overlay pre-acquired 3D computed tomography images onto fluoroscopy images taken during endovascular aneurysm repair. Errors between the 3D overlay and digital subtraction angiograms were measured and correlated with aortic neck angulation. A mean discrepancy r = 0.75). Aortas with a maximum neck angulation 30 degrees had a mean error of 6.2+/-2.5 mm (p<0.0001). The major source of registration errors is aortic deformation caused by the presence of the introducer and endovascular graft. Further work is required if this technology is to be routinely applied to severely angulated aortic anatomy.

  11. 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.

  12. Headache improvement after intracranial endovascular procedures in Chinese patients with unruptured intracranial aneurysm: A prospective observational study.

    Science.gov (United States)

    Zhang, Linjing; Wang, Yunxia; Zhang, Qingkui; Ge, Wei; Wu, Xiancong; Di, Hai; Wang, Jun; Cao, Xiangyu; Li, Baomin; Liu, Ruozhuo; Yu, Shengyuan

    2017-02-01

    The aim of this study was to investigate whether there is a long-term improvement in headache of patients with unruptured intracranial aneurysms (UIAs) treated with intracranial endovascular procedures.Using a prospective design, consecutive patients with UIAs with neuroendovascular treatment from January 2014 to December 2014 were asked to participate. Headache outcomes were established before aneurysm treatment and for 6 months following treatment. Factors associated with different headache outcomes were investigated.Ultimately, 58 patients completed the 6-month follow-up. In total, 29 patients had preoperative headache. Six months after the intracranial endovascular procedure, 13 patients (44.8%) stated that their headaches were relieved after endovascular treatment; headache in 1 patient improved slightly, and 12 reported disappearance of headache and marked improvement. Overall, the mean headache scores of 29 patients improved on the self-reported Numeric Rating Scale (NRS) after endovascular treatment (6.00 vs. 2.30; P aneurysm were the important disadvantage for patients in improvement of post-procedure headache.Treatment of UIAs resulted in relief of headaches in about half of patients who had headaches pre-operatively.

  13. Open and Endovascular Treatment of Trans-Atlantic Inter-Society Consensus Ⅱ D Aortoiliac Occlusive Lesions: What Determines the Rate of Restenosis?

    Institute of Scientific and Technical Information of China (English)

    Chen-Yang Shen; Yun-Feng Liu; Qing-Le Li; Yong-Bao Zhang; Yang Jiao; Miltiadis E Krokidis; Xiao-Ming Zhang

    2015-01-01

    Background: Open surgery is the preferred approach for the treatment of type D lesions according to the Trans-Atlantic Inter-Society Consensus (TASC) Ⅱ guideline, but endovascular solutions also appear to be a valid option in selected patients.The study aimed to identify the risk factors of restenosis after open and endovascular reconstruction of symptomatic TASC Ⅱ D aortoiliac occlusive lesions (AIOLs).Methods: Fifty-six patients (82 limbs) who underwent open repair and endovascular treatment (ET) for symptomatic TASC ⅡD AIOLs between March 2005 and December 2012 were retrospectively reviewed.Baseline characteristics, preoperative and postoperative imaging,and operation procedure reports were reviewed and analyzed.Restenosis after revascularization was assessed by duplex ultrasound or computed tomography angiogram.Kaplan-Meier survival analysis, Log-rank test, and multivariate Cox regression were used to evaluate the relevance between risk factors and patency.Results: The mean duration of follow-up was 42.8 ± 23.5 months (ranging from 3 to 90 months).Primary patency rates at 1-, 3-, 5-,and 7-year were 93.6%, 89.3%, 87.0%, and 70.3%, respectively.Restenosis after revascularization occurred in 11 limbs.Kaplan-Meier survival analysis and the Log-rank test revealed that diabetes, Rutherford classification ≥5th and concurrent femoropopliteal TASC Ⅱ type C/D lesions were significantly related to the duration of primary patency.According to the result of Cox regression, diabetes and femoropopliteal TASC Ⅱ type C/D lesions were identified as the risk factors for restenosis after revascularization.Conclusion: This study demonstrated that diabetes and femoropopliteal TASC Ⅱ type C/D lesions are risk factors associated with restenosis after open and ET of TASC Ⅱ D AIOLs.

  14. Emergent endovascular vs. open surgery repair for ruptured abdominal aortic aneurysms: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Chuan Qin

    Full Text Available OBJECTIVES: To systematically review studies comparing peri-operative mortality and length of hospital stay in patients with ruptured abdominal aortic aneurysms (rAAAs who underwent endovascular aneurysm repair (EVAR to patients who underwent open surgical repair (OSR. METHODS: The Medline, Cochrane, EMBASE, and Google Scholar databases were searched until Apr 30, 2013 using keywords such as abdominal aortic aneurysm, emergent, emergency, rupture, leaking, acute, endovascular, stent, graft, and endoscopic. The primary outcome was peri-operative mortality and the secondary outcome was length of hospital stay. RESULTS: A total of 18 studies (2 randomized controlled trials, 5 prospective studies, and 11 retrospective studies with a total of 135,734 rAAA patients were included. rAAA patients who underwent EVAR had significantly lower peri-operative mortality compared to those who underwent OSR (overall OR = 0.62, 95% CI = 0.58 to 0.67, P<0.001. rAAA patients with EVAR also had a significantly shorter mean length of hospital stay compared to those with OSR (difference in mean length of stay ranged from -2.00 to -19.10 days, with the overall estimate being -5.25 days (95% CI = -9.23 to -1.26, P = 0.010. There was no publication bias and sensitivity analysis showed good reliability. CONCLUSIONS: EVAR confers significant benefits in terms of peri-operative mortality and length of hospital stay. There is a need for more randomized controlled trials to compare outcomes of EVAR and OSR for rAAA.

  15. Endovascular treatment for hemothorax via contralateral internal thoracic artery branch after Nuss procedure – A case report

    Directory of Open Access Journals (Sweden)

    Daisuke Kanamori

    2017-02-01

    Full Text Available The Nuss procedure is performed widely as a standard surgical treatment for pectus excavatum. Compared to conventional methods, the Nuss procedure excels in cosmetic terms and involves fewer complications. A 14-year-old boy developed right hemothorax with a sudden shock one month after the Nuss procedure. We identified the bleeding from left internal thoracic artery (ITA branch and achieved hemostasis by endovascular coil embolization. To the best of our knowledge, this is the first to report that the ITA on the contralateral side of the hemothorax was responsible for the bleeding.

  16. Comparison of clinical curative effect between open surgery and endovascular repair of abdominal aortic aneurysm in China

    Institute of Scientific and Technical Information of China (English)

    WANG Si-wen; LIN Ying; YAO Chen; LIN Pei-liang; WANG Shen-ming

    2012-01-01

    Objective To compare clinical curative effects of open surgery (OS) or endovascular repair (EVAR) for patients with abdominal aortic aneurysm (AAA) in China.Data sources We performed a comprehensive search of both English and Chinese literatures involving case studies on retrograde OS or EVAR of AAA in China from January 1976 to December 2010.Study selection According to the inclusion criteria,76 articles were finally analyzed to compare patient characteristics,clinical success,complications,and prognosis.Results We analyzed a total of 2862 patients with 1757 undergoing OS (OS group) and 1105 undergoing EVAR (EVAR group).There was no significant difference in the success rate of the procedures.Operative time,length of ICU stay,fasting time,duration of total postoperative stay,blood loss,and blood transfusion requirements during the procedure were significantly lower in the EVAR group.A 30-day follow up revealed more cardiac,renal,pulmonary,and visceral complications in the OS group (P<0.01).Low-limb ischemia,however,was more common in the EVAR group (P<0.05).The 30-day mortality rate,including aorta-related and non-aorta related mortality,was significantly lower in the EVAR group (P<0.01).In the follow-up period,there were more patients with occlusions of artificial vessel and late endoleak in the EVAR group (P<0.01).The overall late mortality rate was higher in the OS group (P <0.01),especially non-aorta-related late mortality and mortality during the fourth to the sixth year (P<0.01).Conclusions EVAR was safer and less invasive for AAA patients.Patients suffered fewer complications and recovered sooner.However,complications such as artificial vessel occlusion,low-limb ischemia,and endoleak were common in EVAR.Clinicians should carry out further research to solve these complications and improve the efficacy of EVAR.

  17. Endovascular procedures in the treatment of obstructive lesions of brachiocephalic arteries

    Directory of Open Access Journals (Sweden)

    Sagić Dragan

    2002-01-01

    Full Text Available Background. To assess the early effects, possible risks, and long term results of percutaneous transluminal angioplasty (PTA of brachiocephalic trunk (BT and subclavian arteries (SA. Methods. During the period of 11 years, in 92 patients (57 males - 62%, mean age 53,5 ± 7,8 years 93 PTA of SA/BT were performed; 70 (75% lesions were stenosis, while 23 (25% lesions were occlusions with mean diameter stenosis percent of 83,1 ± 6,2%. Clinical indications were: vertebrobasilar insufficiency (n=57, upper limb ischemia (n=40, coronary steal syndrome (n=4 and scheduled aorto-coronary bypass, using internal thoracic artery (ITA (n=4 asymptomatic patients. Mean lesion length was 22 ± 8 mm. Results. Eighty one (87% out of 93 lesions were successfully dilated; all of 12 (13% failures were due to unsuccessful recanalisation of occluded arteries. In 10 patients 10 stents were implanted (2 in BT and 8 in left SA. There were 6 (6.5% procedural complications: 1 dissection, 1 thrombosis of the left SA, transient ischemic attack in 2 patients, and 2 cases of dislocation of atheromatous plaque from the right SA into the right common carotid artery. During the follow-up of 48 ± 3 months, 16 (20% restenoses were treated by PTA (n=7 or operatively (n=9. Primary and secondary patency for all lesions treated during 11 years was 87% and 80%, respectively (stenosis: 97% and 89%; occlusions: 58% and 58%. Conclusion. PTA with or without stenting was relatively simple, efficient and safe procedure. It required short hospitalization with low treatment costs. If any of suboptimal results or chronic occlusions were present, the implantation of endovascular stents should have been considered.

  18. Standard procedures of endovascular treatment for vascular access stenosis in our facility - clinical usefulness of ultrasonography.

    Science.gov (United States)

    Sato, Takashi; Tsuboi, Masato; Onogi, Takeshi; Miwa, Naofumi; Sakurai, Hiroshi; Ookubo, Kentarou; Matsubara, Chieko; Kasuga, Hirotake

    2015-11-01

    In Japan, the number of patients receiving dialysis is 314,180 at the end of 2013 and 97% are treated with hemodialysis. And the mean age of patients and the percentage of diabetes have been increasing. For this reason, preparations of a new vascular access (VA) and its long-term maintenance have become difficult. In the guidelines by the Japanese Society for Dialysis Therapy (JSDT), endovascular treatment (ET) is positioned as the first line for VA stenosis. The procedure of ET itself is very simple. The revision of Japanese health insurance set an expensive technical fee for ET in 2012. It also added a restriction by which the claims for both technical and material fees would be denied, if the treatment was performed within 3 months after a previous treatment. This makes determination of best treatment timing more important. The functional evaluation using ultrasonography (US) is a useful monitoring index for determination of the ET timing for patients with stenosis. We investigated the cumulative relative frequency of flow volume (FV) and resistant index (RI) of brachial artery in arteriovenous graft (AVG) and arteriovenous fistula (AVF) cases with access failures. As a result, the cut-off values of FV and RI in AVG were 480 mL/min and 0.57, and in AVF were 354 mL/min and 0.61, respectively. Therefore we determine the treatment timing based on these results. Since 2012, active monitoring using US could have decreased the number of treatment patients by 100 per year. This meant that objective evaluation by US enabled treatments at a more suitable time to promote the proper use of medical expenses for EV treatment.

  19. 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...... immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed...... over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula...

  20. Comparação entre os tratamentos aberto e endovascular dos aneurismas da aorta abdominal em pacientes de alto risco cirúrgico Comparison between open and endovascular treatment of abdominal aortic aneurysms in high surgical risk patients

    Directory of Open Access Journals (Sweden)

    Célio Teixeira Mendonça

    2005-09-01

    Full Text Available OBJETIVO: Comparar os resultados dos tratamentos aberto e endovascular de aneurismas da aorta abdominal em pacientes de alto risco cirúrgico. MÉTODOS: O tratamento aberto foi realizado em 31 pacientes, e o endovascular, em 18. Sucesso no tratamento endovascular foi definido como perviedade da endoprótese sem endoleaks ou conversão para tratamento aberto. RESULTADOS: Não houve diferença na mortalidade perioperatória entre o tratamento aberto (dois óbitos [6,45%] em 31 e o endovascular (um óbito [5,55%] em 18 (P = 0,899; também não houve diferença entre a mortalidade tardia no tratamento aberto (dois óbitos [6,9%] em 29 e no endovascular (dois óbitos [11,7%] em 17 (P = 0,572. A taxa de sucesso imediato foi de 100% (31/31 no tratamento aberto e de 66,7% (12/18 no endovascular (P = 0,0006; a taxa de sucesso tardio foi de 100% (27/27 no tratamento aberto e de 73,3% (11/15 no endovascular (P = 0,0047. Os valores médios do tempo de internação na UTI, tempo de internação hospitalar e da perda de sangue para os grupos dos tratamentos aberto e endovascular foram: 65,6 versus 34,1 horas*, 9 versus 5,6 dias* e 932 versus 225 ml*, respectivamente (*P OBJECTIVE: To compare the results of open repair and endoluminal repair of abdominal aortic aneurysms in high surgical risk patients. METHODS: Open repair was performed in 31 patients, and endoluminal repair was performed in 18. Success in the endoluminal repair group was defined as continuing graft function without endoleak or conversion to open repair. RESULTS: No significant difference was found between the perioperative mortality rate for open repair (two deaths [6.45%] in 31 patients and endoluminal repair (one death [5.55%] in 18 patients (P = 0.899; similarly, no significant difference was seen in late mortality between open repair (two deaths [6.9%] in 29 patients and endoluminal repair (two deaths [11.7%] in 17 patients (P = 0.572; The rate of immediate success was 100% (31/31 for

  1. Táticas e técnicas endovasculares para retirada de corpos estranhos intravenosos Endovascular techniques and procedures, methods for removal of intravascular foreign bodies

    Directory of Open Access Journals (Sweden)

    Joaquim Maurício da Motta-Leal Filho

    2010-06-01

    malfunction is the most likely signal of embolization, since patients are usually asymptomatic. OBJECTIVE: To report the method of removing intravascular foreign bodies, catheters with the use of various endovascular techniques and procedures. METHODS: This is a two-year retrospective study of 12 patients: seven women and five men. The average age was 29 years (ranging from two months to 65 years. RESULTS: Technical performance was 100% successful. Ten port-a-caths, one intra-cath and one PICC were extracted. The most common sites for the lodging of one of the ends of the intravascular foreign bodies were the right atrium (41.6% and the right ventricle (33.3%. In 100% of the cases, only one venous access was used for extraction of foreign bodies, and in 91.6% of the cases (11 catheters the femoral access was used. The loop-snare was used in 10 cases (83.3%. The most common cause of intravascular foreign body insertion was a catheter fracture, which occurred in 66.6% of the cases (eight cases. One major complication, the atrial fibrillation, occurred (8.3%, which was related to the intravascular foreign body extraction. The mortality rate in 30 days was zero. CONCLUSION: Percutaneous retrieval of intravascular foreign bodies is considered gold standard treatment because it is a minimally invasive, relatively simple, safe procedure, with low complication rates compared to conventional surgical treatment

  2. Arterial blood gas analysis of samples directly obtained beyond cerebral arterial occlusion during endovascular procedures predicts clinical outcome.

    Science.gov (United States)

    Flores, Alan; Sargento-Freitas, Joao; Pagola, Jorge; Rodriguez-Luna, David; Piñeiro, Socorro; Maisterra, Olga; Rubiera, Marta; Montaner, Joan; Alvarez-Sabin, Jose; Molina, Carlos; Ribo, Marc

    2013-04-01

    Real-time intra-procedure information about ischemic brain damage degree may help physicians in taking decisions about pursuing or not recanalization efforts. We studied gasometric parameters of blood samples drawn through microcatheter in 16 stroke patients who received endovascular reperfusion procedures. After crossing the clot with microcatheter, blood sample was obtained from the middle cerebral artery (MCA) segment distal to occlusion (PostOcc); another sample was obtained from carotid artery (PreOcc). An arterial blood gas (ABG) study was immediately performed. We defined clinical improvement as National Institutes of Health Stroke Scale (NIHSS) decrease of ≥4. The ABG analysis showed differences between PreOcc and PostOcc blood samples in mean oxygen partial pressure (Pre-PaO2: 78.9 ± 16 .3 vs. 73.9 ± 14 .9 mmHg; P  70 mmHg that better predicted further clinical improvement. Patients with Post-PaO2 > 70 mmHg had higher chances of clinical improvement (81.8% vs. 0%; P = .002) and lower disability (median mRS:3 vs. 6; P= .024). In the logistic regression the only independent predictor of clinical improvement was Post-PaO2 > 70 (OR: 5.21 95% CI: 1.38-67.24; P = .013). Direct local blood sampling from ischemic brain is feasible during endovascular procedures in acute stroke patients. A gradient in oxygenation parameters was demonstrated between pre- and post-occlusion blood samples. ABG information may be used to predict clinical outcome and help in decision making in the angio-suite. Copyright © 2011 by the American Society of Neuroimaging.

  3. Heparin-induced thrombocytopenia and endovascular procedures: report of two cases Trombocitopenia induzida por heparina e tratamento endovascular: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Christiane Campolina Furquim Werneck

    2009-09-01

    Full Text Available Heparin-induced thrombocytopenia (HIT is a transient disorder caused by platelet-activating antibodies against platelet factor 4 (PF4-heparin complexes. Clinically it translates into arterial or venous thrombosis and carries high morbidity and mortality. The use of large doses of heparin during endovascular repair of abdominal aortic aneurysm could increase the incidence of HIT. We report two cases associating the use of heparin during endovascular repair of abdominal aortic aneurysm with the development of HIT.Trombocitopenia induzida por heparina (TIH é um distúrbio transitório causado pela ativação de anticorpos anti-plaquetários contra o fator plaquetário 4 (FP4 combinado com a molécula de heparina, formando complexos que clinicamente se traduzem em tromboses arteriais ou venosas com alta morbimortalidade. O uso de altas doses de heparina durante procedimentos endovasculares para o tratamento de aneurisma de aorta abdominal pode aumentar a incidência de TIH. Relatamos dois casos em que o uso de heparina durante tratamento endovascular de aneurisma de aorta abdominal estava associado ao aparecimento de TIH.

  4. Endovascular stroke treatment now and then-procedural and clinical effectiveness and safety of different mechanical thrombectomy techniques over time.

    Science.gov (United States)

    von Gadow, Niels; Nikoubashman, Omid; Freiherr, Jessica; Block, Frank; Reich, Arno; Fesl, Gunther; Wiesmann, Martin

    2017-02-01

    The most essential development in endovascular stroke treatment (EST) was the shift from intra-arterial thrombolysis to endovascular thrombectomy with dedicated thrombectomy devices, most notably the introduction of stent-retrievers. We evaluated procedural and clinical effectiveness and safety of different EST techniques over time. We retrospectively analyzed EST cases that were treated by the same interventionalist before (n=36) and after (n=50) stent-retrievers were established as the treatment device of first choice. EST techniques in the first cohort comprised intra-arterial thrombolysis (n=24), manual thrombus aspiration (n=15), the use of the Penumbra thrombectomy system (n=13) and the Phenox clot retriever (n=3), intracranial stenting (n=10), and EST with stent-retrievers as a salvage procedure (n=11). In the second cohort, EST with stent-retrievers was the treatment option of first choice (n=47). Intra-arterial thrombolysis (n=15) and stenting of the occluded vessel (n=1) were performed, whenever EST with stent-retrievers failed. In both cohorts, revascularization rates (TICI ≥2b) were high (91.7% and 86.0%, respectively). A significantly lower number of interventional techniques per case were required in the second cohort (mean ± SD, 1.4±0.5 vs. 2.1±0.9, P<0.001). Recanalization was achieved almost twice as fast in the second cohort (85 vs. 163 minutes on average, P<0.001). The rate of patients achieving good functional outcome (mRS ≤2) was higher in the second cohort (40.0% vs. 22.2%, P=0.083). Our findings imply that when stent-retrievers were established as first-line the treatment device a significantly lower number of interventional techniques per case were required and recanalization was achieved almost twice as fast.

  5. [Comparative characteristics of the open and endovascular methods of treatment for carotid artery stenoses].

    Science.gov (United States)

    Krotovskiĭ, G S; Uchkin, I G; Shugushev, Z Kh; Zudin, A M; Kagdasarian, A G

    2010-01-01

    The article is dedicated to the problem concerning treatment for stenoses of the extracranial portions of carotid arteries. From March 2004 to November 2009 at the Department of Vascular Surgery No 2 of the N. A. Semashko Central Clinical Hospital No 2 we treated a total of 364 patients presenting with stenotic lesions of the extracranial portion of the carotid arteries. Of these, 176 patients underwent revascularization of the carotid basin: 120 patients endured open carotid endarterectomy (CEAE), 56 patients sustained carotid angioplasty and stenting (CAS), with a total of 128 CEAE and 67 CAS interventions performed. The following conclusion was made: with high skill of surgeons and broad experience in carrying out revascularization of the carotid basin, the CEAE and CAS procedures possess comparable efficacy and safety with CEAE possessing reliable advantage in terms of the parameters of the patient's quality of life.

  6. Efficacy of femoral vascular closure devices in patients treated with anticoagulant, abciximab or thrombolytics during percutaneous endovascular procedures

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ha Young; Choo, Sung Wook [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Roh, Hong Gee [Konkuk University School of Medicine, Seoul (Korea, Republic of)] (and others)

    2006-03-15

    This study assessed the outcomes of using vascular closure devices following percutaneous transfemoral endovascular procedures in the patients who were treated with heparin, abciximab thrombolytics (urokinase or t-PA) during the procedures. From March 28, 2003 to August 31, 2004, we conducted a prospective and randomized study in which 1,676 cases of 1.180 patients were treated with one of the two different closure devices (the collagen plug device was Angio-Seal{sup TM.}, the suture-mediated closure device was The Closer S{sup TM}) at the femoral access site after instituting percutaneous endovascular procedures. Among the 1,676 cases, 108 cases (the drug group) were treated with heparin only (n=94), thrombolytics only (n=10), heparin and thrombolytics (n=3), or abciximab and thrombolytics (n=1) during the procedures; 1,568 cases (the no-drug group) were treated without any medication. We compared the efficacy and complications between the two groups. Of the drug group, 42 cases underwent arterial closures with the collagen plug devices and 66 cases underwent arterial closures with the suture-mediated closure devices. We also compared the efficacy and complications between these two group. The immediate hemostasis rates were 92.9% (1,456/1,568) in the no drug group and 91.7% (99/108) in the drug group. Early complications occurred in four cases of the drug group. These included two episodes of rebleeding with using the Closer S, which required manual compression for at least 10 minutes, and two episodes of minor oozing with using one Angio-Seal and one Closer S, which required two hours of additional bed rest. There was no late complication. So, the total success rates were 90.8% (1,423/1,568) in the no-drug group and 88.0% (95/108) in the drug group. These results were not significantly different between the two groups ({rho}=0.34). In the drug group, the difference of the successful hemostasis rate between the collagen plug devices and the suture

  7. Application of MR technology to endovascular interventions in an XMR suite

    Energy Technology Data Exchange (ETDEWEB)

    Martin, A. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States); Philips Medical Systems, Best (Netherlands); Weber, O.; Saloner, D.; Higashida, R.; Wilson, M.; Saeed, M.; Higgins, C. [Dept. of Radiology, Univ. of California, San Francisco, CA (United States)

    2002-07-01

    In 2001, the University of California - San Francisco opened a unique interventional suite (Figure 1) coupling a fully functional X-ray catherization laboratory (Integries V5000) with a 1.5 T short-bore MR system (Interna I/T). Its hybrid nature, which is termed XMR, permits endovascular procedures to be performed in a conventional fashion but augmented with MR data, or permits part or all of an endovascular procedure to be performed under MR guidance while having the X-ray cath lab as an easy fall-back position. This paper describes the initial application of such a system to endovascular therapy. (orig.)

  8. Endovascular solutions for the management of penetrating trauma: an update on REBOA and axillo-subclavian injuries.

    Science.gov (United States)

    Branco, B C; DuBose, J J

    2016-12-01

    Endovascular procedures continue to gain acceptance as management options for penetrating traumatic injuries. Currently, several areas of potential endovascular application are being investigated. However, the bulk of the literature on this topic is still limited to case series or small retrospective studies. Therefore, we performed a review of the published experience involving the application of endovascular therapy to trauma patients who have sustained penetrating injuries with focus on outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) and endovascular repair of axillo-subclavian injuries. Published case reports, retrospective and prospective studies of REBOA and axillo-subclavian injuries were systematically reviewed. A total of 7 studies on REBOA and 10 studies on endovascular repair of axillo-subclavian injuries were included. Overall, REBOA was used as an adjunct for hemorrhage control and resuscitation in patients at risk of cardiopulmonary arrest, preventing further cardiovascular collapse successfully. For axillo-subclavian injuries, endovascular stent placement had efficacy comparable to the traditional open repair. REBOA is a safe and effective alternative to open thoracotomy in critically ill trauma patients at risk of death due to torso hemorrhage. Endovascular repair outcomes are comparable to open repair after axillo-subclavian injuries. Long-term results of endovascular repair remain to be defined in this patient population.

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

    LENUS (Irish Health Repository)

    Hynes, Niamh

    2007-12-01

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

  10. Open surgical procedures for incisional hernias

    NARCIS (Netherlands)

    D. den Hartog (Dennis); A.H.M. Dur (Alfons); W.E. Tuinebreijer (Wim); R.W. Kreis (Robert)

    2008-01-01

    markdownabstractBACKGROUND: Incisional hernias occur frequently after abdominal surgery and can cause serious complications. The choice of a type of open operative repair is controversial. Determining the type of open operative repair is controversial, as the recurrence rate may be as high as 54

  11. Multifactor Screener in OPEN: Scoring Procedures & Results

    Science.gov (United States)

    Scoring procedures were developed to convert a respondent's screener responses to estimates of individual dietary intake for percentage energy from fat, grams of fiber, and servings of fruits and vegetables.

  12. Mid-term results after endovascular repair of abdominal aortic aneurysms: a four-year experience.

    Science.gov (United States)

    Dalainas, I; Nano, G; Casana, R; Tealdi Dg, D g

    2004-03-01

    The purpose of this retrospective, single-institution study is to describe a 4-year experience of examining early and late clinical outcomes after endovascular repair of abdominal aortic aneurysm (AAA). Between October 1998 and January 2003, 455 patients were submitted for AAA treatment, of whom 269 underwent open repair and 186 were treated with an endovascular procedure. All endovascular-treated patients underwent preoperative arteriography, contrast enhanced CT scanning or spiral-CT to define the morphological characteristics of the aneurysm, including precise diameter and length measurements. Technical success was achieved in 182 (98%) of the endovascular procedures, as intraoperative conversions to open repair and/or aborted procedures occurred in four patients. The perioperative (30-day) mortality rate was 1% (two patients). During the follow-up period (9-60 months) CT, duplex ultrasound scanning and plain abdominal X-ray evaluation were performed at 3, 6, 12 months, and annually thereafter. Type I endoleak occurred in 12 patients (6.6%), required a further endovascular procedure (11) or late conversion to open repair (1). Type II endoleak occurred in five patients (3%). In our clinical experience the endovascular repair of AAA is a safe and effective technique with good mid-term results in patients at standard and high risk.

  13. Multicenter retrospective study of noncompressible torso hemorrhage: Anatomic locations of bleeding and comparison of endovascular versus open approach.

    Science.gov (United States)

    Chang, Ronald; Fox, Erin E; Greene, Thomas J; Eastridge, Brian J; Gilani, Ramyar; Chung, Kevin K; DeSantis, Stacia M; DuBose, Joseph J; Tomasek, Jeffrey S; Fortuna, Gerald R; Sams, Valerie G; Todd, S Rob; Podbielski, Jeanette M; Wade, Charles E; Holcomb, John B

    2017-07-01

    Rational development of technology for rapid control of noncompressible torso hemorrhage (NCTH) requires detailed understanding of what is bleeding. Our objectives were to describe the anatomic location of truncal bleeding in patients presenting with NCTH and compare endovascular (ENDO) management versus open (OPEN) management. This is a retrospective study of adult trauma patients with NCTH admitted to four urban Level I trauma centers in the Houston and San Antonio metropolitan areas in 2008 to 2012. Inclusion criteria include named axial torso vessel disruption, Abbreviated Injury Scale chest or abdomen score of 3 or higher with shock (base excess, <-4) or truncal operation in 90 minutes or less, or pelvic fracture with ring disruption. Exclusion criteria include isolated hip fractures, falls from standing, or prehospital cardiopulmonary resuscitation. After dichotomizing into OPEN, ENDO, and resuscitative thoracotomy (RT) groups based on the initial approach to control NCTH, a mixed-effects Poisson regression with robust error variance (controlling for age, mechanism, Injury Severity Score, shock, hypotension, and severe head injury as fixed effects and site as a random effect) was used to test the hypothesis that ENDO was associated with reduced in-hospital mortality in NCTH patients. Five hundred forty-three patients with NCTH underwent ENDO (n = 166, 31%), OPEN (n = 309, 57%), or RT (n = 68, 12%). Anatomic bleeding locations were 25% chest, 41% abdomen, and 31% pelvis. ENDO was used to treat relatively few types of vascular injuries, whereas OPEN and RT injuries were more diverse. ENDO patients had more blunt trauma (95% vs. 34% vs. 32%); severe injuries (median Injury Severity Score, 34 vs. 27 vs. 21), and increased time to intervention (median, 298 vs. 92 vs. 51 minutes) compared with OPEN and RT. Mortality was 15% versus 20% versus 79%. ENDO was associated with decreased mortality compared to OPEN (relative risk, 0.58; 95% confidence interval, 0

  14. Initial results of a thoracic aortic endovascular program: safer in high-risk patients.

    Science.gov (United States)

    Stouffer, Chadwick W; Mansour, M Ashraf; Ott, Mickey M; Hooker, Robert L; Gorsuch, Jill M; Cuff, Robert F; Davis, Alan T

    2009-01-01

    Results are presented from our single-institutional experience with thoracic endovascular aortic repair to confirm that it is safe in patients with significant comorbidities. A retrospective review of all patients undergoing endovascular or open thoracic aortic repair at our institution since 2002 was performed. Main outcome measures included clinical presentation, demographics, preoperative risk factors, operative details, and clinical outcomes. The endovascular group included 37 patients (22 males), whereas the open group included 19 patients (eight males). Eight patients per group were treated emergently for trauma or rupture (22% and 42%, respectively; p=0.11). Endovascular patients were significantly older with more comorbid conditions (p<0.05). However, the overall perioperative complication rate was similar in the two groups (32.4% and 31.6%, respectively). Postoperative renal failure occurred only in four open patients (21.1% vs. 0%, p < 0.05). Operative time, ventilator days, and total length of stay were also greater for open patients (p<0.05). There was one death in the endovascular group and three in the open group (2.7% and 15.8%, respectively; p=0.07). Endovascular patients had shorter operative time and length of stay, fewer ventilator days and intensive care unit days, and fewer transfusions. Although the endovascular patients were significantly older with more comorbidities, the complication rate was similar to the open group. Also, there was a trend toward lower mortality in the endovascular group (p=0.07). Endovascular repair is the procedure of choice for treating the descending thoracic aorta in high-risk patients even in the emergent setting.

  15. Differentiating intraparenchymal hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients undergoing endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Payabvash, Seyedmehdi [Zeenat Qureshi Stroke Institute, Minneapolis, MN (United States); University of Minnesota, Department of Radiology, Minneapolis, MN (United States); Qureshi, Mushtaq H.; Khan, Shayaan M.; Khan, Mahnoor; Majidi, Shahram; Pawar, Swaroop; Qureshi, Adnan I. [Zeenat Qureshi Stroke Institute, Minneapolis, MN (United States)

    2014-09-15

    This study aimed to identify the imaging characteristics that can help differentiate intraparenchymal hemorrhage from benign contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients after endovascular treatment. We reviewed the clinical and imaging records of all acute ischemic stroke patients who underwent endovascular treatment in two hospitals over a 3.5-year period. The immediate post-procedural CT scan was evaluated for the presence of hyperdense lesion(s). The average attenuation of the lesion(s) was measured. Intraparenchymal hemorrhage was defined as a persistent hyperdensity visualized on follow-up CT scan, 24 h or greater after the procedure. Of the 135 patients studied, 74 (55 %) patients had hyperdense lesion(s) on immediate post-procedural CT scan. Follow-up scans confirmed the diagnosis of intraparenchymal hemorrhage in 20 of these 74 patients. A receiver operating characteristic analysis showed that the average attenuation of the most hyperdense lesion can differentiate intraparenchymal hemorrhage from contrast extravasation with an area under the curve of 0.78 (p = 0.001). An average attenuation of <50 Hounsfield units (HU) in the most visually hyperattenuating hyperdense lesion had 100 % specificity and 56 % sensitivity for identification of contrast extravasations. Petechial hyperdensity was seen in 46/54 (85 %) patients with contrast extravasation versus 9/20 (45 %) patients with intraparenchymal hemorrhage on the immediate post-procedural CT scan (p < 0.001). An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment. (orig.)

  16. Trends and outcomes of endovascular therapy in the management of civilian vascular injuries.

    Science.gov (United States)

    Branco, Bernardino C; DuBose, Joseph J; Zhan, Luke X; Hughes, John D; Goshima, Kay R; Rhee, Peter; Mills, Joseph L

    2014-11-01

    The rapid evolution of endovascular surgery has greatly expanded management options for a wide variety of vascular diseases. Endovascular therapy provides a less invasive alternative to open surgery for critically ill patients who have sustained arterial injuries. The purpose of this study was to evaluate recent trends in the management of arterial injuries in the United States with specific reference to the use of endovascular strategies and to examine the outcomes of endovascular vs open therapy for the treatment of civilian arterial traumatic injuries. A 9-year analysis of the National Trauma Data Bank was performed to identify all patients who sustained arterial injuries. Demographics, clinical data, interventions, and outcomes were extracted. Propensity scores were used to match endovascular patients to those undergoing open operation. Patient outcomes were compared according to treatment approach. A total of 23,105 patients were available for analysis. Overall, there was a significant increase in the use of endovascular procedures during 9 years (from 0.3% in 2002 to 9.0% in 2010; P trauma patients (from 0.4% in 2002 to 13.2% in 2010; P trauma (42.9% in 2002 to 35.8% in 2010; P trauma patients. Endovascular therapy was associated with improved in-hospital mortality and lower rates of sepsis. Copyright © 2014 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  17. Mini-Open Latarjet Procedure for Recurrent Anterior Shoulder Instability

    OpenAIRE

    Numa Mercier; Dominique Saragaglia

    2011-01-01

    Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure.

  18. Mini-Open Latarjet Procedure for Recurrent Anterior Shoulder Instability

    Directory of Open Access Journals (Sweden)

    Numa Mercier

    2011-01-01

    Full Text Available Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure.

  19. Mini-Open Latarjet Procedure for Recurrent Anterior Shoulder Instability

    Science.gov (United States)

    Mercier, Numa; Saragaglia, Dominique

    2011-01-01

    Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure. PMID:22191039

  20. Mini-Open Latarjet Procedure for Recurrent Anterior Shoulder Instability

    OpenAIRE

    Numa Mercier; Dominique Saragaglia

    2011-01-01

    Anterior shoulder instability is a common problem. The Latarjet procedure has been advocated as an option for the treatment of anteroinferior shoulder instability. The purpose of this paper is to explain our surgical procedure titled “Mini-open Latarjet Procedure.” We detailed patient positioning, skin incision, subscapularis approach, and coracoid fixation. Then, we reviewed the literature to evaluate the clinical outcomes of this procedure.

  1. A Case of Iatrogenic Subclavian Artery Injury Successfully Treated with Endovascular Procedures

    Science.gov (United States)

    Yamagami, Takuji; Yoshimatsu, Rika; Tanaka, Osamu; Miura, Hiroshi; Kawahito, Yutaka; Oka, Katsuhiko; Yaku, Hitoshi; Nishimura, Tsunehiko

    2011-01-01

    We report a case of a life-threatening massive hemothorax caused by iatrogenic injury of the right subclavian artery. The patient was successfully treated with placement of a covered stent. During the procedure, occlusion balloon catheters rapidly controlled the massive bleeding. PMID:23555430

  2. Endovascular treatment of penetrating aortic ulcers: mid-term results.

    Science.gov (United States)

    Dalainas, I; Nano, G; Medda, M; Bianchi, P; Casana, R; Ramponi, F; Stegher, S; Malacrida, G; Inglese, L; Tealdi, D G

    2007-07-01

    The aim of this study was to evaluate mid-term results of endovascular treatment of penetrating aortic ulcers. Between February 2000 and November 2006, 18 consecutive patients underwent endovascular treatment of the descending thoracic aorta (N=16) and abdominal infrarenal aorta (N=2) for penetrating aortic ulcer, in a single University Hospital. Data were prospectively collected and retrospectively analyzed. Mean follow-up was 41 months (range 4 to 77 months). Technical success was achieved in all patients. No perioperative deaths occurred. No conversion to open repair or secondary procedures were required. Two patients died in the follow-up period for reasons not related to penetrating aortic ulcers. One type II endoleak was observed. It was still present, unchanged, twelve months after the procedure. Endovascular treatment of penetrating aortic ulcers of the descending thoracic and infrarenal aorta were safe and effective in the mid-term in this small series of patients.

  3. Adding an endovascular aortic surgery program to a rural regional medical centre

    Science.gov (United States)

    Marelli, Daniel; Woo, Edward; Watson, Michael; Fedalen, Paul; Wang, Grace; Stallings, Megan; Fairman, Ronald; Mannion, John

    2013-01-01

    Background Abdominal aortic aneurysms requiring surgical intervention are generally treated by endovascular means. Such procedures are not always offered in rural hospitals, possibly leaving patients underserved. We reviewed our experience initiating an endoaortic surgery program. Methods A surgeon in a rural centre was credentialed to perform endovascular aortic aneurysm repair through collaboration with a university centre and was proctored locally for the first 5 abdominal aneurysm repairs. Web-based image storage was used to review complex cases as part of an ongoing partnership. Referred patients were screened for multiple aneurysms and underwent long-term monitoring. Results In all, 160 patients were evaluated for 176 aortic pathologies. Twenty-five patients (17 men) aged 55–89 years underwent 26 endovascular abdominal (n = 23) or thoracic (n = 3) aortic procedures. Emergent endovascular procedures were not performed. There were no operative deaths, requirements for dialysis or conversions to open repair. Two endoleaks required early reintervention. The median length of stay in hospital for endovascular procedures was 2.5 days. Chronic endoleaks were observed in 7 patients. An additional 8 patients underwent open abdominal aneurysm repair locally and 15 patients were referred to the university program. Conclusion Creation of an endovascular aortic surgery program in a rural hospital is feasible through collaboration with a high-volume centre. Patient safety is enhanced by obtaining second opinions using web-based image review. Most interventions are for abdominal aortic aneurysms, but planning for a comprehensive aortic clinic is preferable. PMID:24067525

  4. Retrograde Tibiopedal Access as a Bail-Out Procedure for Endovascular Intervention Complications

    Directory of Open Access Journals (Sweden)

    Ahmed Amro

    2016-01-01

    Full Text Available Introduction. Retrograde pedal access has been well described in the literature as a secondary approach for limb salvage in critical limb ischemia (CLI patients. In this manuscript we are presenting a case where retrograde tibiopedal access has been used as a bail-out procedure for the management of superficial femoral artery (SFA intervention complications. Procedure/Technique. After development of a perforation while trying to cross the totally occluded mid SFA using the conventional CFA access, we were able to cross the mid SFA lesion after accessing the posterior tibial artery in a retrograde fashion and delivered a self-expanding stent which created a flap that sealed the perforation without the need for covered stent. Conclusion. Retrograde tibiopedal access is a safe and effective approach for delivery of stents from the distal approach and so can be used as a bail-out technique for SFA perforation.

  5. Endovascular Repair of a Ruptured Descending Thoracic Aortic Aneurysm

    Science.gov (United States)

    DeFrain, Michael; Strickman, Neil E.; Ljubic, Branimir J.; Dougherty, Kathryn G.; Gregoric, Igor D.

    2006-01-01

    Endovascular aneurysm repair has considerable potential advantages over the surgical approach as a treatment for thoracic aortic rupture, in part because open surgical repair of ruptured thoracic aortic aneurysms is associated with high mortality and morbidity rates. We describe the successful endovascular deployment of stent-grafts to repair a contained rupture of a descending thoracic aortic aneurysm in an 86-year-old man whose comorbidities prohibited surgery. Two months after the procedure, magnetic resonance angiography showed a patent stent-graft, a patent left subclavian artery, and complete exclusion of the aneurysm. PMID:16878637

  6. Canadian Cardiovascular Society/Canadian Society of Cardiac Surgeons/Canadian Society for Vascular Surgery Joint Position Statement on Open and Endovascular Surgery for Thoracic Aortic Disease.

    Science.gov (United States)

    Appoo, Jehangir J; Bozinovski, John; Chu, Michael W A; El-Hamamsy, Ismail; Forbes, Thomas L; Moon, Michael; Ouzounian, Maral; Peterson, Mark D; Tittley, Jacques; Boodhwani, Munir

    2016-06-01

    In 2014, the Canadian Cardiovascular Society (CCS) published a position statement on the management of thoracic aortic disease addressing size thresholds for surgery, imaging modalities, medical therapy, and genetics. It did not address issues related to surgical intervention. This joint Position Statement on behalf of the CCS, Canadian Society of Cardiac Surgeons, and the Canadian Society for Vascular Surgery provides recommendations about thoracic aortic disease interventions, including: aortic valve repair, perfusion strategies for arch repair, extended arch hybrid reconstruction for acute type A dissection, endovascular management of arch and descending aortic aneurysms, and type B dissection. The position statement is constructed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, and has been approved by the primary panel, an international secondary panel, and the CCS Guidelines Committee. Advent of endovascular technology has improved aortic surgery safety and extended the indications of minimally invasive thoracic aortic surgery. The combination of safer open surgery with endovascular treatment has improved patient outcomes in this rapidly evolving subspecialty field of cardiovascular surgery.

  7. Biomechanical comparison of open and arthroscopic Latarjet procedures.

    Science.gov (United States)

    Schulze-Borges, Johanna; Agneskirchner, Jens D; Bobrowitsch, Evgenij; Patzer, Thilo; Struck, Melena; Smith, Tomas; Wellmann, Mathias

    2013-04-01

    To biomechanically compare the effectiveness of the standard open and arthroscopic techniques of the Latarjet procedure to address a critical anterior glenoid defect in combination with a capsular insufficiency. Translation testing of 12 human cadaveric shoulder specimens was performed in a robot-assisted setup under 3 different conditions: (1) intact/vented shoulder joint, (2) combined anterior glenoid bone and capsular defect, and (3) open and arthroscopic Latarjet procedures. Testing was performed for each condition in 2 test positions: 60° of glenohumeral abduction with neutral rotation (ABD position) and 60° of abduction and external rotation (ABER position). Each position was tested with a passive humerus load of 30 N in the anterior, inferior, and anteroinferior directions. Translational movement of the humeral head was evaluated with and without the application of a 10-N load to the conjoint tendon (CJT). In the ABD position, translations after the open Latarjet procedure significantly differed from the arthroscopic technique in the anterior and anteroinferior directions when testing was performed with loading of the CJTs (CJT loading). Without CJT loading, the open Latarjet technique showed significantly lower translations in the anterior, inferior (P = .004), and anteroinferior (P = .001) testing directions in the ABD position. In the ABER position, the arthroscopic procedure showed no significant difference compared with the standard open procedure. We found a superior stabilization effect of the open Latarjet technique in the ABD position. The difference is ascribed to the anterior capsular repair, which was performed within the open technique and omitted during the arthroscopic procedure. The reduction of translation in a pure abduction position of the arm is more effectively performed with a conventional open Latarjet technique that includes a capsular repair. In combined ABER position, there was no difference found between the open and

  8. Validating Procedural Knowledge in the Open Virtual Collaboration Environment

    OpenAIRE

    Wickler, Gerhard

    2013-01-01

    This paper describes the OpenVCE system, which is an open-source environment that integrates Web 2.0 technology and a 3D virtual world space to support collaborative work, specifically in large-scale emergency response scenarios, where the system has been evaluated. The support is achieved through procedural knowledge that is available to the system. OpenVCE supports the distributed knowledge engineering of procedural knowledge in a semi-formal framework based on a wiki. For the formal aspect...

  9. Results of infrapopliteal endovascular procedures performed in diabetic patients with critical limb ischemia and tissue loss from the perspective of an angiosome-oriented revascularization strategy.

    Science.gov (United States)

    Acín, Francisco; Varela, César; López de Maturana, Ignacio; de Haro, Joaquín; Bleda, Silvia; Rodriguez-Padilla, Javier

    2014-01-01

    Our aim was to describe our experience with infrapopliteal endovascular procedures performed in diabetic patients with ischemic ulcers and critical ischemia (CLI). A retrospective study of 101 procedures was performed. Our cohort was divided into groups according to the number of tibial vessels attempted and the number of patent tibial vessels achieved to the foot. An angiosome anatomical classification of ulcers were used to describe the local perfusion obtained after revascularization. Ischemic ulcer healing and limb salvage rates were measured. Ischemic ulcer healing at 12 months and limb salvage at 24 months was similar between a single revascularization and multiple revascularization attempts. The group in whom none patent tibial vessel to the foot was obtained presented lower healing and limb salvage rates. No differences were observed between obtaining a single patent tibial vessel versus more than one tibial vessel. Indirect revascularization of the ulcer through arterial-arterial connections provided similar results than those obtained after direct revascularization via its specific angiosome tibial artery. Our results suggest that, in CLI diabetic patients with ischemic ulcers that undergo infrapopliteal endovascular procedures, better results are expected if at least one patent vessel is obtained and flow is restored to the local ischemic area of the foot.

  10. Aortic aneurysm repair - endovascular

    Science.gov (United States)

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... Endovascular aortic repair is done because your aneurysm is very large, growing quickly, or is leaking or bleeding. You may have ...

  11. Endovascular treatment of thoracic aortic diseases

    Directory of Open Access Journals (Sweden)

    Davidović Lazar

    2013-01-01

    Full Text Available Bacground/Aim. Endovascular treatment of thoracic aortic diseases is an adequate alternative to open surgery. This method was firstly performed in Serbia in 2004, while routine usage started in 2007. Aim of this study was to analyse initial experience in endovacular treatment of thoracic aortic diseses of three main vascular hospitals in Belgrade - Clinic for Vascular and Endovascular Surgery of the Clinical Center of Serbia, Clinic for Vascular Surgery of the Military Medical Academy, and Clinic for Vascular Surgery of the Institute for Cardiovascular Diseases “Dedinje”. Methods. Between March 2004. and November 2010. 41 patients were treated in these three hospitals due to different diseases of the thoracic aorta. A total of 21 patients had degenerative atherosclerotic aneurysm, 6 patients had penetrating aortic ulcer, 6 had posttraumatic aneurysm, 4 patients had ruptured thoracic aortic aneurysm, 1 had false anastomotic aneurysm after open repair, and 3 patients had dissected thoracic aneurysm of the thoracoabdominal aorta. In 15 cases the endovascular procedure was performed as a part of the hybrid procedure, after carotidsubclavian bypass in 4 patients and subclavian artery transposition in 1 patient due to the short aneurysmatic neck; in 2 patients iliac conduit was used due to hypoplastic or stenotic iliac artery; in 5 patients previous reconstruction of abdominal aorta was performed; in 1 patient complete debranching of the aortic arch, and in 2 patients visceral abdominal debranching were performed. Results. The intrahospital mortality rate (30 days was 7.26% (3 patients with ruptured thoracic aneurysms died. Endoleak type II in the first control exam was revealed in 3 patients (7. 26%. The patients were followed up in a period of 1-72 months, on average 29 months. The most devastating complication during a followup period was aortoesofageal fistula in 1 patient a year after the treatment of posttraumatic aneurysm. Conversion was

  12. Endovascular stent-graft placement and secondary intervention for abdominal aortic aneurysm in a patient who had a previously inserted iliac stent

    Energy Technology Data Exchange (ETDEWEB)

    Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun [Inha University College of Medicine, Incheon (Korea, Republic of)

    2007-04-15

    Endovascular repair of abdominal aortic aneurysm is associated with low morbidity and mortality rates when compared to open surgery, and this can be used in patients who are at a high risk for open surgical repair. Also, secondary intervention is an important for achieving intermediate and long term success of endovascular repair of abdominal aortic aneurysm as this can resolve complications. We report here on endovascular stent-graft placement and a secondary interventional procedure in the abdominal aortic aneurysm of a patient who had a previously inserted iliac stent.

  13. Endovascular stents: a review of their use in peripheral arterial disease.

    Science.gov (United States)

    Kudagi, Vinod S; White, Christopher J

    2013-06-01

    Technological advances in the past decade have shifted revascularization strategies from traditional open surgical approaches toward lower-morbidity percutaneous endovascular treatments for patients with lower extremity peripheral arterial disease (PAD). The continuing advances in stent design, more than any other advances, have fueled the growth of catheter-based procedures by improving the safety, durability, and predictability of percutaneous revascularization. Although the 2007 TransAtlantic Inter-Society Consensus (TASC) guidelines recommend endovascular therapy for type A and B aortoiliac and femoropopliteal lesions, recent developments in stent technology and increased experience of interventionists have suggested that a strategy of endovascular therapy first is appropriate in experienced hands for TASC type D lesions. The role of endovascular interventions is also expanding in the treatment of limb-threatening ischemia.

  14. In Vitro Study of a Superhydrophilic Thin Film Nitinol Endograft that is Electrostatically Endothelialized in the Catheter Prior to the Endovascular Procedure.

    Science.gov (United States)

    Shayan, Mahdis; Chen, Yanfei; Shridhar, Puneeth; Kealey, Colin P; Chun, YoungJae

    2016-11-29

    procedure could enhance the biocompatibility for low-profile endovascular applications.

  15. In Vitro Study of a Superhydrophilic Thin Film Nitinol Endograft that is Electrostatically Endothelialized in the Catheter Prior to the Endovascular Procedure

    Directory of Open Access Journals (Sweden)

    Mahdis Shayan

    2016-11-01

    the endovascular procedure could enhance the biocompatibility for low-profile endovascular applications.

  16. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair

    OpenAIRE

    Zhu, Kai; Lai, Hao; Guo, Changfa; Li, Jun; Wang, Chunsheng

    2014-01-01

    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report...

  17. 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.

  18. Endovascular therapy as the primary approach for limb salvage in patients with critical limb ischemia: experience with 443 infrapopliteal procedures.

    Science.gov (United States)

    Bosiers, Marc; Hart, Joseph P; Deloose, Koen; Verbist, Jurgen; Peeters, Patrick

    2006-01-01

    Endovascular strategies for the treatment of critical infrageniculate peripheral arterial occlusive disease exist and are becoming the primary methodology for such lesions at many centers. Although technically feasible for experienced operators, the evidence to support this strategy for below the knee (BTK) interventions is still evolving. We studied the 6-month and 1-year outcomes of percutaneous transluminal angioplasty (PTA) alone, PTA with stenting, and excimer laser recanalization for BTK lesions in patients with critical limb ischemia. Between September 2002 and June 2005, 443 patients (355 Rutherford category 4, 82 category 5, 6 category 6) underwent intervention for 681 BTK lesions. Follow-up was performed at 6-month intervals after index intervention: limb salvage data were recorded and duplex ultrasonography was performed to measure the patency of treated areas. The primary patency and limb salvage rates of the entire population were 85.2% and 97.0% and 74.2% and 96.6% at 6 months and 1 year, respectively. Stratified for the treatment strategy (PTA alone in 79, PTA with stenting in 300 patients, and excimer laser in 64), 1-year primary patency rates were 68.6%, 75.5%, and 75.4%, whereas the limb salvage rates were 96.7%, 98.6%, and 87.9% for each modality, respectively. Endovascular intervention will become the primary treatment for BTK lesions in patients with critical limb ischemia, with 1-year primary patency and limb salvage rates that compare favorably with published surgical data. Prospective, randomized, multicenter trials will be needed to further establish the role of endovascular intervention in this challenging patient group.

  19. Carbon dioxide contrast medium for endovascular treatment of ilio-femoral occlusive disease.

    Science.gov (United States)

    Mendes, Cynthia de Almeida; Martins, Alexandre de Arruda; Teivelis, Marcelo Passos; Kuzniec, Sergio; Varella, Andrea Yasbek Monteiro; Fioranelli, Alexandre; Wolosker, Nelson

    2015-10-01

    Compare the use of carbon dioxide contrast medium with iodine contrast medium for the endovascular treatment of ilio-femoral occlusive disease in patients without contraindications to iodine. From August 2012 to August 2014, 21 consecutive patients with ilio-femoral occlusive disease who were eligible for endovascular treatment and lacked contraindications to either iodine contrast or carbon dioxide were randomized into the carbon dioxide or iodine groups and subjected to ilio-femoral angioplasty.We analyzed the feasibility of the procedures, the surgical and clinical outcomes, the procedure lengths, the endovascular material costs, the contrast costs and the quality of the angiographic images in each group. No conversions to open surgery and no contrast media related complications were noted in either group. A post-operative femoral pulse was present in 88.9% of the iodine group and 80% of the carbon dioxide group. No differences in procedure length, endovascular material cost or renal function variation were noted between the groups. Four patients in the carbon dioxide group required iodine supplementation to complete the procedure. Contrast media expenses were reduced in the carbon dioxide group. Regarding angiographic image quality, 82% of the carbon dioxide images were graded as either good or fair by observers. The use of carbon dioxide contrast medium is a good option for ilio-femoral angioplasty in patients without contraindications to iodine and is not characterized by differences in endovascular material costs, procedure duration and surgical outcomes. In addition, carbon dioxide has lower contrast expenses compared with iodine.

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

    NARCIS (Netherlands)

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

    2017-01-01

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

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

    NARCIS (Netherlands)

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

    2017-01-01

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

  2. Mortalidade relacionada ao tratamento endovascular do aneurisma da aorta abdominal com o uso dos modelos revisados Procedure-related mortality of endovascular abdominal aortic aneurysm repair using revised reporting standards

    Directory of Open Access Journals (Sweden)

    Gosen Gabriel Konig

    2007-03-01

    Full Text Available OBJETIVO: O objetivo do estudo foi avaliar a definição da mortalidade relacionada ao procedimento após tratamento endovascular do aneurisma de aorta abdominal (EVAR como definido pelo Committee for Standardized Reporting Practices in Vascular Surgery. MÉTODO: Dados de pacientes com aneurisma de aorta abdominal foram analisados do banco de dados EUROSTAR. Os pacientes foram submetidos ao EVAR entre junho de 1996 a fevereiro de 2004 e foram estudados retrospectivamente. A probabilidade explicita da causa de morte foi registrada. O intervalo entre a operação, alta hospitalar ou intervenção secundária até a morte foi registrado. RESULTADOS: De um total de 5612 pacientes, 589 (10,5% faleceram após o EVAR em acompanhamento total e qualquer causa de morte foi inclusa. Cento e quarenta e um pacientes (12,5% morreram devido a causa relacionada ao aneurisma, sendo que 28 (4,8% foram rupturas, 25 (4,2% infecções do implante e 88 (14,9% foram pacientes que morreram num prazo de 30 dias após o procedimento inicial (definição atualmente utilizada, também conhecido como resultado clínico a curto prazo. Além disso, 25 pacientes faleceram após 30 dias, mas continuavam ainda hospitalizados (ou transferidos a home-care para reavaliação posterior, ou necessitaram intervenção secundária. Levando em conta a duração da admissão ao hospital e a mortalidade imediata após o procedimento relacionada a intervenções secundárias, 49 mortes tardias também podem ser relacionadas ao EVAR. CONCLUSÃO: Morte tardia compõe uma proporção considerável da mortalidade relacionada ao EVAR dentro do tempo de análise revisado.OBJECTIVE: The aim of this study was to evaluate the definition of Procedure-related mortality after endovascular aneurysm repair (EVAR as defined by the Committee for Standardized Reporting Practices in Vascular Surgery. METHODS: Data on patients with an AAA were taken from the EUROSTAR database. The patients underwent EVAR

  3. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair

    Science.gov (United States)

    Zhu, Kai; Guo, Changfa; Li, Jun

    2014-01-01

    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report suggests that the palliative strategy may be an option for RAD in some specific situation. PMID:25590002

  4. Palliative stent graft placement combined with subsequent open surgery for retrograde ascending dissection intra-thoracic endovascular aortic repair.

    Science.gov (United States)

    Zhu, Kai; Lai, Hao; Guo, Changfa; Li, Jun; Wang, Chunsheng

    2014-12-01

    Thoracic endovascular aortic repair (TEVAR) is an effective strategy for type B dissection. Retrograde ascending dissection (RAD) intra-TEVAR is a rare complication on clinic. In this case, a 48-year-old Chinese man with Stanford type B aortic dissection suffered acute RAD during the TEVAR. And palliative stent grafts placement was performed in a local hospital, which earned the time for transfer and subsequent total arch replacement surgery in Zhongshan Hospital Fudan University. This report suggests that the palliative strategy may be an option for RAD in some specific situation.

  5. Endovascular Therapy in Trauma

    Science.gov (United States)

    2014-11-23

    it is worth reviewing that endovascular techniques involve over-the- wire access (percutaneous or direct exposure) to the arte- rial or venous system...parameters such as serum lactate, pH, pCO2, and central , cerebral and coronary perfusion in animal models of hemorrhagic shock have been shown to improve...wire at its end point on a draped end table helps to keep wire position during the procedure. The arterial line catheter is removed and a 12Fr

  6. Hand muscle atrophy and digital ischemia as an unusual presentation of an occluded aberrant right subclavian artery: Endovascular or open approach?

    Science.gov (United States)

    Leenders, B; den Butter, G; Scheltinga, M R; Debonnaire, G

    2013-01-01

    An aberrant right subclavian artery (ARSA) or lusorian artery is one of the most common variations of the aortic arch. Although usually without symptoms, some ARSA's occasionally become symptomatic. A 51-year old woman presented with a painful right middle finger. Clinical examination showed thenar muscle hypotrophy and blue discoloration of the distal phalanx suggestive of embolization. Magnetic resonance angiography revealed a non-aneurysmal proximally occluded ARSA. A venous common carotid artery to subclavian artery bypass was combined with ARSA ligation proximal to the right vertebral artery. Occlusive symptomatic ARSA disease without aneurysmal dilatation is uncommon. Treatment may include bypass grafting by open surgery or angioplasty with stenting. Treatment for occlusive non-aneurysmal ARSA must be tailored to the individual. Whether an endovascular or surgical approach is preferred depends on localization of the lesion in relation to the esophagus and on the general condition of the patient. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  7. 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.

  8. 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

  9. Diffusion and perfusion MRI in patients with ruptured and unruptured intracranial aneurysms treated by endovascular coiling: complications, procedural results, MR findings and clinical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Cronqvist, M.; Ramgren, B.; Holtaas, S.; Larsson, E.-M. [Lund University Hospital, Department of Neuroradiology, Lund (Sweden); Wirestam, R. [Lund University Hospital, Department of Radiation Physics, Lund (Sweden); Brandt, L.; Nilsson, O.; Saeveland, H. [Lund University Hospital, Department of Neurosurgery, Lund (Sweden)

    2005-11-01

    Our purpose was to evaluate treatment safety as well as complications frequency and management in endovascular coiling of intracerebral aneurysms using MR diffusion and perfusion imaging. In this prospective study, 77 MR examinations were performed in conjunction with 43 procedures in 40 patients, 14 patients presented with ruptured and 26 with unruptured aneurysms. Mean time interval between treatment and post-procedure MRI was 29 and 25 h for the ruptured and unruptured aneurysm group, respectively. Peri-procedural complications, including five major events and five minor transient events, occurred in 10/43 procedures (23%), necessitating thrombolytic therapy in two patients and angioplasty in one, all three within the unruptured aneurysm group. Fifty-one new lesions were found on post-treatment DWI and 47 of them were regarded as of ischemic origin. Most lesions were small (<3 mm), ipsilateral to the treated aneurysm and asymptomatic (37/40 patients). Sixty-seven percent of the lesions were found in the ruptured and 33% in the unruptured aneurysm group. The ischemic lesions did occur more frequently in patients treated for aneurysm of large neck size and according to the remodelling technique. The overall morbidity and mortality rates were 14.6 and 7.3% whereas morbidity and mortality rates related to the technique were only 2.6 and 0%, respectively. (orig.)

  10. Custom Fenestration Templates for Endovascular Repair of Juxtarenal Aortic Aneurysms

    Science.gov (United States)

    Leotta, Daniel F.; Starnes, Benjamin W.

    2015-01-01

    Physician-modified endovascular grafts, with fenestrations added to accommodate major branch vessels, provide a means for endovascular treatment of abdominal aortic aneurysms that are adjacent to the renal arteries. Manual measurements of vessel origin locations from CT images, however, take time and can lead to errors in the positions of the fenestrations. To make the fenestration process faster and more accurate, we have developed a procedure to create custom templates that serve as patient-specific guides for graft fenestration. We use a 3D printer to create a clear rigid sleeve that replicates the patient’s aorta and includes holes placed precisely at the locations of the branch vessels. The sleeve is slipped over the graft, the locations of the openings are marked with a pen, and the fenestrations are created after removing the sleeve. Custom fenestration templates can potentially save procedural costs and make minimally-invasive aortic aneurysm repair available to more patients. PMID:25864045

  11. 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 ......-operative mortality and morbidity of RAAA can probably be reduced by implementation of RAAA....... shortly after the procedure. In the group with open repair, seven patients (30.7%) died within 30 days. This yields a mortality of all patients treated for rupture at our institution of 19% compared with 32% in Denmark at large. CONCLUSION: Endovascular treatment of RAAA is feasible, and the overall post...

  12. Endovascular treatment of blister aneurysms.

    Science.gov (United States)

    Peitz, Geoffrey W; Sy, Christopher A; Grandhi, Ramesh

    2017-06-01

    Blister aneurysms are rare cerebrovascular lesions for which the treatment methods are reviewed here, with a focus on endovascular options. The reported pathogenesis of blister aneurysms varies, and hemodynamic stress, arterial dissection, and arteriosclerotic ulceration have all been described. There is consensus on the excessive fragility of blister aneurysms and their parent vessels, which makes clipping technically difficult. Open surgical treatment is associated with high rates of complications, morbidity, and mortality; endovascular treatment is a promising alternative. Among endovascular treatment options, deconstructive treatment has been associated with higher morbidity compared with reconstructive methods such as direct embolization, stent- or balloon-assisted direct embolization, stent monotherapy, and flow diversion. Flow diversion has been associated with higher technical success rates and similar clinical outcomes compared with non-flow diverting treatment methods. However, delayed aneurysm occlusion and the need for antiplatelet therapy are potential drawbacks to flow diversion that must be considered when choosing among treatment methods for blister aneurysms.

  13. Endovascular treatment of thoracic aortic diseases: Follow-up and complications with multi-detector computed tomography angiography

    Energy Technology Data Exchange (ETDEWEB)

    Iezzi, Roberto [Department of Radiology, University ' G. D' Annunzio' , Chieti (Italy)], E-mail: r.iezzi@rad.unich.it; Cotroneo, Antonio Raffaele; Marano, Riccardo; Filippone, Antonella; Storto, Maria Luigia [Department of Radiology, University ' G. D' Annunzio' , Chieti (Italy)

    2008-03-15

    Endovascular procedures with placement of stent-graft has become an accepted alternative to traditional open surgery for treatment of descending thoracic aortic aneurysms, ulcers, post-traumatic rupture, or complications of type-B dissection, due to significant reduction in perioperative mortality, rate of complications and length of hospitalization. Moreover, increasing operator experience and continuous advances in stent-graft technology are making treatment of a wider range of cases possible with redefinition of guidelines for endovascular stent-graft. The feasibility of endovascular stent-graft is mainly dependent on anatomic factors which represent the important predictors of the success of this procedure as well as on strictly follow-up in order to obtain early detection and treatment of eventual complications. Multi-detector CT-angiography is a fast, safe, and minimally invasive imaging technique that represents the standard of reference in the follow-up of patients who have undergone endovascular stent-graft, as it is effective and specific in the detection of procedure-correlated complications. The purpose of this article is to give a brief review of those techniques most commonly used for endovascular treatment of thoracic aortic diseases together with a more detailed description of post-procedural complications and their appearance on multi-detector CT-angiography.

  14. A comparative study on the medium-long term results of endovascular repair and open surgical repair in the management of ruptured abdominal aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    HAN Yan-shuo; ZHANG Jian; XIA Qian; LIU Zhi-min; ZHANG Xiao-yu; WU Xiao-yu; LUN Yu

    2013-01-01

    Background Although it is generally acknowledged that patients with ruptured abdominal aortic aneurysm (rAAA)obtain the greatest benefit from endovascular repair (EVAR),convincing evidence on the medium-long term effect is lacking.The aim of this study was to compare and summarize published results of rAAA that underwent EVAR with open surgical repair (OSR).Methods A search of publicly published literature was performed.Based on an inclusion and exclusion criteria,a systematic meta-analysis was undertaken to compare patient characteristics,complications,short term mortality and medium-long term outcomes.A random-effects model was used to pool the data and calculate pooled odds ratios and weighted mean differences.A quantitative method was used to analyze the differences between these two methods.Results A search of the published literature showed that fourteen English language papers comprising totally 1213 patients with rAAA (435 EVAR and 778 OSR) would be suitable for this study.Furthermore,13 Chinese studies were included,including 267 patients with rAAA totally,among which 238 patients received operation.The endovascular method was associated with more respiratory diseases before treatment (OR=1.81,P=0.01),while there are more patients with hemodynamic instability before treatment in OSR group (OR=1.53,P=0.031).Mean blood transfusion was 1328 ml for EVAR and 2809 ml for OSR (weighted mean difference (WMD) 1500 ml,P=0.014).The endovascular method was associated with a shorter stay in intensive care (WMD 2.34 days,P <0.001) and a shorter total postoperative stay (WMD 6.27 days,P <0.001).The pooled post-operative complication rate of respiratory system and visceral ischemia seldom occurred in the EVAR group (OR=0.48,P <0.001 and OR=0.28,P=0.043,respectively).The pooled 30-day mortality was 25.7% for EVAR and 39.6% for OSR,and the odds ratio was 0.53 (95% confidence interval (CI) 0.41-0.70,P <0.001).There was not,however,any significant reduction in

  15. Efficacy of a Radiation Absorbing Shield in Reducing Dose to the Interventionalist During Peripheral Endovascular Procedures: A Single Centre Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Power, S.; Mirza, M.; Thakorlal, A.; Ganai, B.; Gavagan, L. D.; Given, M. F.; Lee, M. J., E-mail: mlee@rcsi.ie [Beaumont Hospital, Imaging and Interventional Radiology Department (Ireland)

    2015-06-15

    PurposeThis prospective pilot study was undertaken to evaluate the feasibility and effectiveness of using a radiation absorbing shield to reduce operator dose from scatter during lower limb endovascular procedures.Materials and MethodsA commercially available bismuth shield system (RADPAD) was used. Sixty consecutive patients undergoing lower limb angioplasty were included. Thirty procedures were performed without the RADPAD (control group) and thirty with the RADPAD (study group). Two separate methods were used to measure dose to a single operator. Thermoluminescent dosimeter (TLD) badges were used to measure hand, eye, and unshielded body dose. A direct dosimeter with digital readout was also used to measure eye and unshielded body dose. To allow for variation between control and study groups, dose per unit time was calculated.ResultsTLD results demonstrated a significant reduction in median body dose per unit time for the study group compared with controls (p = 0.001), corresponding to a mean dose reduction rate of 65 %. Median eye and hand dose per unit time were also reduced in the study group compared with control group, however, this was not statistically significant (p = 0.081 for eye, p = 0.628 for hand). Direct dosimeter readings also showed statistically significant reduction in median unshielded body dose rate for the study group compared with controls (p = 0.037). Eye dose rate was reduced for the study group but this was not statistically significant (p = 0.142).ConclusionInitial results are encouraging. Use of the shield resulted in a statistically significant reduction in unshielded dose to the operator’s body. Measured dose to the eye and hand of operator were also reduced but did not reach statistical significance in this pilot study.

  16. Fatal late multiple emboli after endovascular treatment of abdominal aortic aneurysm. Case report

    DEFF Research Database (Denmark)

    Lindholt, Jes Sanddal; Sandermann, Jes; Bruun-Petersen, J;

    1998-01-01

    The short term experience of endovascular treatment of abdominal aortic aneurysms (AAA) seems promising but long term randomised data are lacking. Consequently, cases treated by endovascular procedures need to be closely followed for potential risks and benefits....

  17. Mortality and complications after aortic bifurcated bypass procedures for chronic aortoiliac occlusive disease

    DEFF Research Database (Denmark)

    Bredahl, Kim; Jensen, Leif Panduro; Schroeder, Torben V

    2015-01-01

    skills, particularly because open surgery is increasingly used in those patients who are unsuitable for endovascular repair and hence technically more demanding. We assessed the early outcome after aortic bifurcated bypass procedures during two decades of growing endovascular activity and identified......OBJECTIVE: Open surgery has given way to endovascular grafting in patients with aortoiliac occlusive disease. The growing use of endovascular grafts means that fewer patients with aortoiliac occlusive disease have open surgery. The declining open surgery caseload challenges the surgeon's operative...... preoperative risk factors. METHODS: Data on patients with chronic limb ischemia were prospectively collected during a 20-year period (1993 to 2012). The data were obtained from the Danish Vascular Registry, assessed, and merged with data from The Danish Civil Registration System. RESULTS: We identified 3623...

  18. 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.

  19. 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.

  20. Endovascular Repair of Infrarenal Abdominal Aortic Aneurysm Results in Higher Hospital Expenses than Open Surgical Repair: Evidence from a Tertiary Hospital in Brazil.

    Science.gov (United States)

    Teivelis, Marcelo Passos; Malheiro, Daniel Tavares; Hampe, Marcio; Dalio, Marcelo Bellini; Wolosker, Nelson

    2016-10-01

    Endovascular aneurysm repair (EVAR) has become the preferred approach for the treatment of infrarenal abdominal aortic aneurysm (IRAAA) in detriment of open surgical repair (OSR). EVAR results in lower mortality rates within 30 days, but rates tend to be the same after longer periods. Moreover, reduced use of hospital resources with EVAR does not necessarily offset the costs of the endoprosthesis. We aimed, in this study, to estimate hospital expenses after OSR or EVAR, including early and late readmissions. Retrospective analysis of hospital expenses (2005-2012) with elective IRAAA surgeries performed in a tertiary hospital, including 127 patients divided into 2 groups, EVAR (n = 102) and OSR (n = 25). One perioperative death occurred in each group. EVAR interventions lasted 145 vs. 210 min of OSR (P hospitalization time differed significantly for EVAR (4 days) and OSR (8 days; P expenses with EVAR were US $53,080.95 and US $56,289.49, respectively. The median and mean expenses with OSR were US $37,116.04 and US $68,788.54, respectively. Early readmissions reached 11.2%. None of the OSR patients required late reinterventions, but 10 (9.9%) EVAR patients did, one of whom died. EVAR resulted in higher expenses with the exclusion of one outlier. Late reinterventions, with elevated costs, were only required by EVAR patients. Thus, when patients are eligible to undergo either intervention, OSR seems to have lower costs and better long-term results. Copyright © 2016 Elsevier Inc. All rights reserved.

  1. An intensive vascular surgical skills and simulation course for vascular trainees improves procedural knowledge and self-rated procedural competence.

    Science.gov (United States)

    Robinson, William P; Doucet, Danielle R; Simons, Jessica P; Wyman, Allison; Aiello, Francesco A; Arous, Elias; Schanzer, Andres; Messina, Louis M

    2017-03-01

    Surgical skills and simulation courses are emerging to meet the demand for vascular simulation training for vascular surgical skills, but their educational effect has not yet been described. We sought to determine the effect of an intensive vascular surgical skills and simulation course on the procedural knowledge and self-rated procedural competence of vascular trainees and to assess participant feedback regarding the course. Participants underwent a 1.5-day course covering open and endovascular procedures on high-fidelity simulators and cadavers. Before and after the course, participants completed a written test that assessed procedural knowledge concerning index open vascular and endovascular procedures. Participants also assessed their own procedural competence in open and endovascular procedures on a 5-point Likert scale (1: no ability to perform, 5: performs independently). Scores before and after the course were compared among postgraduate year (PGY) 1-2 and PGY 3-7 trainees. Participants completed a survey to rate the relevance and realism of open and endovascular simulations. Fifty-eight vascular integrated residents and vascular fellows (PGY 1-7) completed the course and all assessments. After course participation, procedural knowledge scores were significantly improved among PGY 1-2 residents (50% correct before vs 59% after; P educational effect. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  2. 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.

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

    NARCIS (Netherlands)

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

    2015-01-01

    Background: Access for endovascular repair of abdominal aortic aneurysms (EVAR) is obtained through surgical cutdown or percutaneously. The only devices suitable for percutaneous closure of the 20 French arteriotomies of the common femoral artery (CFA) are the Prostar (TM) and Proglide (TM) devices

  4. Estudo comparativo entre tratamento endovascular e cirurgia convencional na correção eletiva de aneurisma de aorta abdominal: revisão bibliográfica Endovascular elective treatment of the abdominal aortic aneurysm versus conventional open repair: a comparative study

    Directory of Open Access Journals (Sweden)

    Ana Carolina P. Simão

    2009-12-01

    Full Text Available O tratamento eletivo do aneurisma de aorta abdominal é recomendado pela alta morbiletalidade decorrente da eventual ruptura. O objetivo deste trabalho foi comparar o reparo endovascular eletivo com a cirurgia aberta e avaliar as mortalidades hospitalar e perioperatória, em 1 ano, por todas as causas e relacionadas ao aneurisma, a permanência hospitalar, as complicações, as taxas de sobrevida, conversão e reintervenção, a durabilidade do enxerto, o custo-benefício e a relação desses dados com o treinamento da equipe médica responsável pelo tratamento. Realizou-se uma revisão da literatura sobre reparo endovascular versus cirurgia convencional. Foram observados vantagem na sobrevivência perioperatória e menor estresse pós-cirúrgico; no entanto, os benefícios iniciais são perdidos por complicações e reintervenções tardias. Trabalhos baseados nas primeiras gerações de endopróteses superestimam as taxas de mortalidade em curto prazo, complicações e reintervenções. A durabilidade do enxerto, a real vantagem na sobrevida e o custo-benefício são incertos, e outros estudos são necessários para o seguimento em longo prazo.The elective treatment of the abdominal aortic aneurysm is recommended due to the high morbidity and mortality of a possible rupture. The objective of this study was to compare the elective endovascular aneurysm repair with open repair and to analyze the in-hospital and perioperative mortality rate during 1 year related to all causes and to the aneurysm, as well as the postoperative length of hospital stay, complications, survival rates, conversion and reintervention, graft durability, cost-benefit ratio, and relation with the medical team’s experience. A review of the scientific literature about endovascular versus open repair was carried out. We found a higher rate of perioperative survival and less postoperative stress; nevertheless, the initial benefits were lost due to late complications and

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

    Institute of Scientific and Technical Information of China (English)

    Grigorios Voulalas; Chrisostomos Maltezos

    2016-01-01

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

  6. 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.

  7. Endovascular techniques for the treatment of ruptured abdominal aortic aneurysms: 7-year intention-to-treat results.

    Science.gov (United States)

    Dalainas, Ilias; Nano, Giovanni; Bianchi, Paolo; Stegher, Silvia; Casana, Renato; Malacrida, Giovanni; Tealdi, Domenico G

    2006-10-01

    The purpose of this single-institution study was to describe our 7-year intention-to-treat results, obtained with the use of endovascular techniques for the treatment of ruptured abdominal aortic aneurysms (rAAA). From October 1998 until March 2005, a total of 28 patients were admitted or transferred to our department with an rAAA. They were all treated according to a management protocol of intention-to-treat with endovascular techniques. Twenty of the patients received endovascular treatment and the remaining 8 underwent an open surgery procedure. The mortality rate of the endovascularly treated patients was 40% (8 in 20), whereas of the 8 surgical patients 3 survived (mortality = 62.5%). The overall mortality rate of the 28 patients admitted with an rAAA was 46.4% (13 of 28 patients). In our experience the intension-to-treat protocol for rAAA offered acceptable results in terms of mortality rates. Multi-center studies are necessary to establish the role of endovascular treatment in patients with rAAA.

  8. General Surgery Resident Vascular Operative Experience in the Era of Endovascular Surgery and Vascular Fellowships.

    Science.gov (United States)

    Yan, Huan; Maximus, Steven; Kim, Jerry J; Smith, Brian; Kim, Dennis; Koopmann, Matthew; DeVirgilio, Christian

    2015-10-01

    Advances in endovascular surgery have resulted in a decline in major open arterial reconstructions nationwide. Our objective is to investigate the effect of endovascular surgery on general surgery resident experience with open vascular surgery. Between 2004 and 2014, 112 residents graduated from two academic institutions in Southern California. Residents were separated into those who graduated in 2004 to 2008 (period 1) and in 2009 to 2014 (period 2). Case volumes of vascular procedures were compared using two-sample t test. A total of 43 residents were in period 1 and 59 residents were in period 2. In aggregate, there was no significant difference in open cases recorded between the two periods (84 vs 87, P = 0.194). Subgroup analysis showed period 2 recorded significantly fewer cases of open aneurysm repair (5 vs 3, P surgery residents experienced a significant decline in several index open major arterial reconstruction cases. This decline was offset by maintenance of dialysis access procedures. If the trend continues, future general surgeons will not be proficient in open vascular procedures.

  9. 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.

  10. 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.

  11. Open Latarjet procedure for failed arthroscopic Bankart repair.

    Science.gov (United States)

    Flinkkilä, T; Sirniö, K

    2015-02-01

    This retrospective study assessed the functional results of open Latarjet operation for recurrence of instability after arthroscopic Bankart repair in a consecutive series of patients. Fifty two patients (mean age 28.4 [range 17-62] years, 45 men) were operated on using open Latarjet operation after one (n=46) or two (n=6) failed arthroscopic Bankart repairs. The indication for revision surgery was recurrent dislocation or subluxation. Fifty patients had a Hill-Sachs lesion and 32 patients had glenoid bone lesions on plain radiographs. No attempt was made to grade the severity of bony pathology. Functional outcome and stability of 49 shoulders were assessed after an average follow-up of 38 (range 24-85) months using Western Ontario Shoulder Instability (WOSI) score, Oxford shoulder instability score, and subjective shoulder value (SSV). Forty-two patients had a stable shoulder at follow-up. Seven of 49 (14%) had symptoms of instability; one patient had recurrent dislocation, and six patients had subluxations. Mean WOSI, Oxford, and SSV scores were 83.9, 19.9, and 84.9, respectively. All scores were significantly better in patients who had a stable shoulder compared with those who had an unstable shoulder (WOSI 86.8 vs. 64.3; Oxford 18.2 vs. 30.8; and SSV 88.3 vs. 61.7; PLatarjet operation is a good option for failed arthroscopic Bankart repair. The instability recurrence rate is acceptable and the reoperation rate was low. Level IV, retrospective case series. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  12. 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.

  13. 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.

  14. 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.

  15. Treatment of pectus excavatum recurring after open surgery using Nuss procedure: A case report

    Directory of Open Access Journals (Sweden)

    Yucel Akkas

    2016-12-01

    Full Text Available We would like to report a 14-year-old male patient with pectus excavatum that recurred 10 years later after Ravitch surgery who was successfully operated using Nuss procedure. The patient underwent pectus excavatum surgery using Nuss procedure. The patient was discharged from the hospital at post-operative 5.day. The bar is planned to be removed in post-operative 3.year. In conclusion, surgery of pectus excavatum that recurred after open surgery is risky. Nuss procedure, which is a minimally-invasive technique, is a safe procedure that can be successfully applied in recurring cases due to short time of surgery and minimal blood loss.

  16. 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.)

  17. Functional outcomes after open versus arthroscopic Latarjet procedure: A prospective comparative study.

    Science.gov (United States)

    Nourissat, G; Neyton, L; Metais, P; Clavert, P; Villain, B; Haeni, D; Walch, G; Lafosse, L

    2016-12-01

    The Latarjet procedure provides effective stabilization of chronically unstable shoulders. Since this procedure is mainly performed in a young athletic population, the functional impact is significant. Published data does not shed light on the time needed to recover work-related or sports-related function. Performing this procedure arthroscopically may improve functional recovery. This led us to carry out a prospective, multicenter study to compare the functional recovery after arthroscopic versus open Latarjet procedure. Between June and November 2014, 184 patients were included in a prospective multicenter study: 85 in the open group and 99 in the arthroscopy group. The patients were evaluated preoperatively with the WOSI score. The early postoperative pain was evaluated on D3, D7 and D30. The WOSI score was determined postoperatively at 1, 3, 6 and 12 months of follow-up. The functional scores of the shoulder in both cohorts were identical overall preoperatively. In the immediate postoperative period, the arthroscopy group had statistically lower pain levels on D3 and D7. The postoperative WOSI was improved in both groups at 3 months, then continued to improve until it reached a plateau at 1 year. The WOSI score was better in the arthroscopy group at 3 months, but better in the open group at 6 months. This study found that a Latarjet procedure performed arthroscopically generates less immediately postoperative pain than when it is performed as an open procedure. The Latarjet procedure (whether open or arthroscopic) improves shoulder function, with normal function returning after 1 year. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  18. Endovascular repair of ruptured abdominal aortic aneurysm

    Directory of Open Access Journals (Sweden)

    Šarac Momir

    2014-01-01

    Full Text Available Introduction. Rupture of an abdominal aortic aneurysm (AAA is a potentially lethal state. Only half of patients with ruptured AAA reach the hospital alive. The alternative for open reconstruction of this condition is endovascular repair (EVAR. We presented a successful endovascular reapir of ruptured AAA in a patient with a number of comorbidities. Case report. A 60-year-old man was admitted to our institution due to diffuse abdominal pain with flatulence and belching. Initial abdominal ultrasonography showed an AAA that was confirmed on multislice computed tomography scan angiography which revealed a large retroperitoneal haematoma. Because of patient’s comorbidites (previous surgery of laryngeal carcinoma and one-third laryngeal stenosis, arterial hypertension and cardiomyopathy with left ventricle ejection fraction of 30%, stenosis of the right internal carotid artery of 80% it was decided that endovascular repair of ruptured AAA in local anaesthesia and analgosedation would be treatment of choice. Endovascular grafting was achieved with aorto-bi-iliac bifurcated excluder endoprosthesis with complete exclusion of the aneurysmal sac, without further enlargment of haemathoma and no contrast leakage. The postoperative course of the patient was eventless, without complications. On recall examination 3 months after, the state of the patient was well. Conclusion. The alternative for open reconstruction of ruptured AAA in haemodynamically stable patients with suitable anatomy and comorbidities could be emergency EVAR in local anesthesia. This technique could provide greater chances for survival with lower intraoperative and postoperative morbidity and mortality, as shown in the presented patient.

  19. Developing practice recommendations for endovascular revascularization for acute ischemic stroke

    Science.gov (United States)

    Lazzaro, Marc A.; Alexandrov, Andrei V.; Darkhabani, Ziad; Edgell, Randall C.; English, Joey; Frei, Donald; Jamieson, Dara G.; Janardhan, Vallabh; Janjua, Nazli; Janjua, Rashid M.; Katzan, Irene; Khatri, Pooja; Kirmani, Jawad F.; Liebeskind, David S.; Linfante, Italo; Nguyen, Thanh N.; Saver, Jeffrey L.; Shutter, Lori; Xavier, Andrew; Yavagal, Dileep; Zaidat, Osama O.

    2012-01-01

    Guidelines have been established for the management of acute ischemic stroke; however, specific recommendations for endovascular revascularization therapy are lacking. Burgeoning investigation of endovascular revascularization therapies for acute ischemic stroke, rapid device development, and a diverse training background of the providers performing the procedures underscore the need for practice recommendations. This review provides a concise summary of the Society of Vascular and Interventional Neurology endovascular acute ischemic stroke roundtable meeting. This document was developed to review current clinical efficacy of pharmacologic and mechanical revascularization therapy, selection criteria, periprocedure management, and endovascular time metrics and to highlight current practice patterns. It therefore provides an outline for the future development of multisociety guidelines and recommendations to improve patient selection, procedural management, and organizational strategies for revascularization therapies in acute ischemic stroke. PMID:23008406

  20. Time Savings and Surgery Task Load Reduction in Open Intraperitoneal Onlay Mesh Fixation Procedure

    Directory of Open Access Journals (Sweden)

    Sanjoy Roy

    2015-01-01

    Full Text Available Background. This study assessed the reduction in surgeon stress associated with savings in procedure time for mechanical fixation of an intraperitoneal onlay mesh (IPOM compared to a traditional suture fixation in open ventral hernia repair. Study Design. Nine general surgeons performed 36 open IPOM fixation procedures in porcine model. Each surgeon conducted two mechanical (using ETHICON SECURESTRAPTM Open and two suture fixation procedures. Fixation time was measured using a stopwatch, and related surgeon stress was assessed using the validated SURG-TLX questionnaire. T-tests were used to compare between-group differences, and a two-sided 95% confidence interval for the difference in stress levels was established using nonparametric methodology. Results. The mechanical fixation group demonstrated an 89.1% mean reduction in fixation time, as compared to the suture group (p<0.00001. Surgeon stress scores measured using SURG-TLX were 55.5% lower in the mechanical compared to the suture fixation group (p<0.001. Scores in five of the six sources of stress were significantly lower for mechanical fixation. Conclusions. Mechanical fixation with ETHICON SECURESTRAPTM Open demonstrated a significant reduction in fixation time and surgeon stress, which may translate into improved operating efficiency, improved performance, improved surgeon quality of life, and reduced overall costs of the procedure.

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

    Directory of Open Access Journals (Sweden)

    Roberta C. A. Campos

    2009-06-01

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

  2. 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.)

  3. Results of the open surgery after endoscopic basketimpaction during ERCP procedure

    Institute of Scientific and Technical Information of China (English)

    Sezgin Yilmaz; Ogun Ersen; Taner Ozkececi; Kadir S Turel; Serdar Kokulu; Emre Kacar; Murat Akici; Murat Cilekar; Ozgur Kavak; Yuksel Arikan

    2015-01-01

    AIM: To report the results of open surgery for patientswith basket impaction during endoscopic retrogradecholangiopancreatography (ERCP) procedure.METHODS: Basket impaction of either classicalDormia basket or mechanical lithotripter basket with anentrapped stone occurred in six patients. These patientswere immediately operated for removal of stone(s) andimpacted basket. The postoperative course, length ofhospital stay, diameter of the stone, complication andthe surgical procedure of the patients were reportedretrospectively.RESULTS: Six patients (M/F, 0/6) were operateddue to impacted basket during ERCP procedure. Themean age of the patients was 64.33 ± 14.41 years.In all cases the surgery was performed immediatelyafter the failed ERCP procedure by making a right Yilmaz S et al . Surgery for basket impaction during ERCP subcostal incision. The baskets containing the stone were removed through longitudinal choledochotomy with the stone. The choledochotomy incisions were closed by primary closure in four patients and T tube placement in two patients. All patients were also performed cholecystectomy additionally since they had cholelithiasis. In patients with T-tube placement it was removed on the 13th day after a normal T-tube cholangiogram. The patients remained stable at postoperative period and discharged without any complication at median 7 d. CONCLUSION: Open surgical procedures can be applied in patients with basket impaction during ERCP procedure in selected cases.

  4. Laying open(deroofing) and curettage under local anesthesia for pilonidal disease: An outpatient procedure

    Institute of Scientific and Technical Information of China (English)

    Pankaj; Garg; Mahak; Garg; Vikas; Gupta; Sudhir; Kumar; Mehta; Paryush; Lakhtaria

    2015-01-01

    AIM: To test the efficacy of lay open(deroofing, not excision) with curettage under local anesthesia(LOCULA) for pilonidal sinus as an outpatient procedure. METHODS: LOCULA procedure was done for all types of pilonidal disease. The primary outcome measure was cure rate. The secondary outcome measures were hospital stay, operating time, return to work, healing time and complication rate.RESULTS: Thirty-three(M/F-30/3, mean age-23.4 ± 5.8 years) consecutive patients were operated and followed for 24 mo(6-46 mo). Eleven were pilonidal abscess and 22 were chronic pilonidal disease. Six had recurrent disease. Operating time and the hospital stay was 22.3 ± 5.6 min and 63.8 ± 22.3 min respectively. The patients could resume normal work in 4.3 ± 3.2 d and the healing time was 42.9 ± 8.1 d. Thirty(93.8%)patients had complete resolution of the disease and two(6.2%) had a recurrence. Both the recurrences happened in patients who had complete healing but ignored the prescribed recommendations. One out of these got cured after getting operated again with the same procedure. Thus the overall success rate of this procedure was 96.9%.CONCLUSION: Lay open(deroofing) with curettage procedure under local anesthesia is an effective procedure to treat both simple and complicated pilonidal sinus and abscess. It is a simple procedure, has a high cure rate(up to 97%), doesn’t require admission and is associated with minimal morbidity and scarring. Considering the distinct advantages, this procedure has the potential to become the first line procedure for treating pilonidal disease.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-04-15

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

  6. Emergency rescue endovascular stent grafting of ascending aorta to relieve life-threatening coronary obstruction in a case of acute aortic dissection.

    Science.gov (United States)

    Tauchi, Yuuya; Tanioka, Hideki; Kondoh, Haruhiko; Satoh, Hisashi; Matsuda, Hikaru

    2014-12-01

    Myocardial ischemia associated with acute aortic dissection is frequently a fatal complication, and the emergent management still remains a challenge. We report a patient with life-threatening myocardial ischemia due to acute aortic dissection managed by rescue stent grafting of the ascending aorta. Coronary blood flow improved immediately with this endovascular procedure, hemodynamic status was ameliorated dramatically, followed by uneventful open repair. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Ultra-low iodine concentrations iso-attenuating with diagnostic 0.5 M gadolinium in endovascular procedures to minimize the risk of contrast nephropathy: A phantom study

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    Swanberg, Jakob, E-mail: jakob.swanberg@radiol.uu.se [Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University Hospital, SE-751 85 Uppsala (Sweden); Åslund, Per-Erik J., E-mail: per-erik.aslund@akademiska.se [Department of Medical Physics, Uppsala University Hospital, SE-751 85 Uppsala (Sweden); Nyman, Rickard S. [Department of Radiology, Oncology and Radiation Sciences, Section of Radiology, Uppsala University Hospital, SE-751 85 Uppsala (Sweden); Nyman, Ulf R.O., E-mail: ulf.nyman@bredband.net [Institution of Clinical Sciences, Lund University, SE-221 00 Lund (Sweden)

    2015-06-15

    Purpose: To establish the concentrations of iodine contrast media (I-CM) iso-attenuating with 0.5 M gadolinium contrast media (Gd-CM), regarded diagnostic in catheter angiography and vascular interventions in azotemic patients, at various X-ray tube potentials with correlation to skin radiation dose. Materials and method: 20-mL syringes filled with 30, 40, 50, 70 and 90 mg I/mL, 0.5 M Gd-CM and air were placed in a water-equivalent phantom and exposed at about 50, 60, 70, 80 and 90 kV in an X-ray angiographic system. Relative contrast between the contrast materials and the background phantom material was measured on a PACS workstation. Radiation entrance dose, measured with a dose meter and estimated from the dose-area-product (DAP), was adjusted for radiation backscatter to simulate absorbed skin dose. Result: The iodine concentrations 30, 40, 50, 70 and 90 mg/mL resulted in the same relative contrast as 0.5 M gadolinium at 53, 57, 62, 71 and 85 kVp, respectively. Air had lower relative contrast than all iodine concentrations at all kVp-settings except for 30 mg I/mL above 84 kVp. The measured skin radiation dose was less than 1 mGy per exposure at all kVp-settings, and around 25–30% lower than the dose estimations derived from the angiographic system's in-built DAP meter. Conclusion: Low-kilovoltage X-ray technique and ultra-low concentrations of I-CM iso-attenuating with 0.5 M Gd-CM may be utilizable in peripheral arteriography and endovascular interventions, to minimize the total CM-dose to avoid CIN in azotemic patients.

  8. 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.

  9. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery

    Science.gov (United States)

    Melkonian, Ernesto; Heine, Claudio; Contreras, David; Rodriguez, Marcelo; Opazo, Patricio; Silva, Andres; Robles, Ignacio; Rebolledo, Rolando

    2017-01-01

    BACKGROUND: The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality. PATIENTS AND METHODS: The review of an institutional review board (IRB)-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality. RESULTS: Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery—49, open surgery—25). The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95), and there was a tendency to lower morbidity (3/49—7.3% vs 4/25—16%; P = 0.24) in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3%) were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44). CONCLUSIONS: The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay. PMID:27251820

  10. Reversal of the Hartmann's procedure: A comparative study of laparoscopic versus open surgery

    Directory of Open Access Journals (Sweden)

    Ernesto Melkonian

    2017-01-01

    Full Text Available Background: The Hartmann's operation, although less frequently performed today, is still used when initial colonic anastomosis is too risky in the short term. However, the subsequent procedure to restore gastrointestinal continuity is associated with significant morbidity and mortality. Patients and Methods: The review of an institutional review board (IRB-approved prospectively maintained database provided data on the Hartmann's reversal procedure performed by either laparoscopic or open technique at our institution. The data collected included: demographic data, operative approach, conversion for laparoscopic cases and perioperative morbidity and mortality. Results: Over a 14-year period from January 1997 to August 2011, 74 Hartmann's reversal procedures were performed (laparoscopic surgery—49, open surgery—25. The average age was 55 years for the laparoscopic and 57 years for the open surgery group, respectively. Male patients represent 61% of both groups. There was no significant difference in operative time between the two groups (149 min vs 151 min; P = 0.95, and there was a tendency to lower morbidity (3/49—7.3% vs 4/25—16%; P = 0.24 in the laparoscopic surgery group. In the laparoscopic group, eight patients (16.3% were converted to open surgery, mostly due to severe adhesions. The length of hospital stay was significantly shorter for the laparoscopic group (5 days vs 7 days; P = 0.44. Conclusions: The Hartmann's reversal procedure can be safely performed in the majority of the cases using a laparoscopic approach with a low morbidity rate and achieving a shorter hospital stay.

  11. Endovascular repair:alternative treatment of ruptured abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; YIN Tai; JIA Xin; LIANG Fa-qi; ZHANG Guo-hua

    2009-01-01

    Background As an alternative to open aneurysm repair,endovascular aortic repair(EVAR)has been applied to ruptured abdominal aortic aneurysm(rAAA).The aim of this study was to evaluate the immediate and long-term outcomes of EVAR for rAAA.Methods From July 1997 to September 2007,20 men and six women with rAAA(median age,68 years)were treated with EVAR.Most patients with suspected rAAA underwent emergency computed tomographic angiography(CTA).The procedure was performed under general or local anesthesia.Endovascular clamping was attempted in hemodynamically unstable patients.Bifurcated endografts and aorto-uni-iliac(AUI)endografts with crossover bypass were used.Patients had CT scan prior to discharge,3,6,12 months after discharge,and annually thereafter.Results Time between diagnosis and EVAR ranged from 1 hour to 5 days.EVAR was performed under general anesthesia in 21 patients,and under local anesthesia in five patients.Endovascular aortic clamping was performed in four patients.There was no conversion to open surgery during EVAR.Stent-graft insertion was successful in all patients.One patient died during EVAR from acute myocardial infarction.Ten patients had systolic blood pressure<80 mm Hg.Eleven patients received a blood transfusion.Mean aneurysm size was(47c12)mm.Mean ICU stay was(8±3)days,mean hospital stay(18±6)days,and mean procedure time(120±32)minutes.The 30-day mortality was 23%(6/26patients),and major morbidity 35%(9/26 patients).Early endoleak occurred in 8/26 patients(31%).The mean follow-up was(18±7)months.No patient demonstrated migration of the stent-graft.Conclusions EVAR is a safe and effective option for treatment of acute rAAA,independent of the patient's general condition.Immediate and mid-term outcomes are favorable,but long-term outcome is unknown.Multi-center studies are necessary to establish the role of EVAR for rAAA.

  12. Open abdomen procedure in managing abdominal compartment syndrome in a child with severe fungal peritonitis and sepsis after gastric perforation

    Directory of Open Access Journals (Sweden)

    Wei Lai

    2016-04-01

    Full Text Available Abdominal compartment syndrome with increased abdominal pressure resulted in multi-organ dysfunctions can be lethal in children. The open abdomen procedure intentionally leaves the abdominal cavity open in patients with severe abdominal sepsis and abdominal compartment syndrome by temporarily relieving the abdominal pressure. We reported our experience of open abdomen procedure in successfully treating a 4-year old boy with abdominal compartment syndrome caused by severe fungal peritonitis and sepsis after gastric perforation.

  13. 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.

  14. Endovascular management of postoperative pseudoaneurysms of the external carotid artery.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Moscovici, Samuel; Grigoriadis, Savvas; Ramirez de Noriega, Fernando; Itshayek, Eyal

    2012-05-01

    Hemorrhage secondary to postoperative pseudoaneurysm is a rare event, but may complicate the clinical course of straightforward and common interventions such as sinonasal procedures, tonsillectomy, and maxillofacial and plastic surgeries. We report our experience with the endovascular management of iatrogenic pseudoaneurysm in eight patients who had undergone recent craniomaxillofacial surgery. Computed tomography (CT), including CT-angiography, detected only three of the eight lesions. In all patients, endovascular embolization achieved successful occlusion of the pseudoaneurysm without local or general procedure-related complications. Immediate proximal arterial occlusion with detachable coils was performed in every case, and pseudoaneurysm coiling was performed in three cases presenting with active hemorrhage. Endovascular therapy proved to be safe and effective in the management of postoperative pseudoaneurysms. Surgeons involved in the craniomaxillofacial procedures should be aware of this complication and its management. Copyright © 2011 Elsevier Ltd. All rights reserved.

  15. Manual ventilation and open suction procedures contribute to negative pressures in a mechanical lung model

    Science.gov (United States)

    Nakstad, Espen Rostrup; Opdahl, Helge; Heyerdahl, Fridtjof; Borchsenius, Fredrik; Skjønsberg, Ole Henning

    2017-01-01

    Introduction Removal of pulmonary secretions in mechanically ventilated patients usually requires suction with closed catheter systems or flexible bronchoscopes. Manual ventilation is occasionally performed during such procedures if clinicians suspect inadequate ventilation. Suctioning can also be performed with the ventilator entirely disconnected from the endotracheal tube (ETT). The aim of this study was to investigate if these two procedures generate negative airway pressures, which may contribute to atelectasis. Methods The effects of device insertion and suctioning in ETTs were examined in a mechanical lung model with a pressure transducer inserted distal to ETTs of 9 mm, 8 mm and 7 mm internal diameter (ID). A 16 Fr bronchoscope and 12, 14 and 16 Fr suction catheters were used at two different vacuum levels during manual ventilation and with the ETTs disconnected. Results During manual ventilation with ETTs of 9 mm, 8 mm and 7 mm ID, and bronchoscopic suctioning at moderate suction level, peak pressure (PPEAK) dropped from 23, 22 and 24.5 cm H2O to 16, 16 and 15 cm H2O, respectively. Maximum suction reduced PPEAK to 20, 17 and 11 cm H2O, respectively, and the end-expiratory pressure fell from 5, 5.5 and 4.5 cm H2O to –2, –6 and –17 cm H2O. Suctioning through disconnected ETTs (open suction procedure) gave negative model airway pressures throughout the duration of the procedures. Conclusions Manual ventilation and open suction procedures induce negative end-expiratory pressure during endotracheal suctioning, which may have clinical implications in patients who need high PEEP (positive end-expiratory pressure). PMID:28725445

  16. The open latarjet procedure is more reliable in terms of shoulder stability than arthroscopic bankart repair.

    Science.gov (United States)

    Bessière, Charles; Trojani, Christophe; Carles, Michel; Mehta, Saurabh S; Boileau, Pascal

    2014-08-01

    Arthroscopic Bankart repair and open Latarjet bone block procedure are widely considered mainstays for surgical treatment of recurrent anterior shoulder instability. The choice between these procedures depends mainly on surgeon preference or training rather than published evidence. We compared patients with recurrent posttraumatic anterior shoulder instability treated with arthroscopic Bankart or open Latarjet procedure in terms of (1) frequency and timing of recurrent instability, (2) risk factors for recurrent instability, and (3) patient-reported outcomes. In this retrospective comparative study, we paired 93 patients undergoing open Latarjet procedures with 93 patients undergoing arthroscopic Bankart repairs over the same period for posttraumatic anterior shoulder instability by one of four surgeons at the same center. Both groups were comparable except that patients in the Latarjet group had more glenoid lesions and more instability episodes preoperatively. Minimum followup was 4 years (mean, 6 years; range, 4-10 years). Patients were assessed with a questionnaire, including stability, Rowe score, and return to sports. Recurrent instability was defined as at least one episode of recurrent dislocation or subluxation. Return to sports was evaluated using a 0% to 100% scale that patients completed after recovery from surgery. Various risk factors for recurrent instability were also analyzed. At latest followup, 10% (nine of 93) in the Latarjet group and 22% (20 of 93) in the Bankart group demonstrated recurrent instability (p = 0.026; odds ratio, 0.39; 95% CI, 0.17-0.91). Ten recurrences in the Bankart group (50%) occurred after 2 years, compared to only one (11%) in the Latarjet group. Reoperation rate was 6% and 7% in the Bankart and Latarjet groups, respectively. In both groups, patients younger than 20 years had higher recurrence risk (p = 0.019). In the Bankart group, independent factors predictive for recurrence were practice of competitive sports and

  17. 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.

  18. 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.

  19. [Successful endovascular treatment of thoracic aortic aneurysm secondary to infection of the umbilical artery catheter in preterm infants].

    Science.gov (United States)

    Borchert, Evelyn; Lema, Guillermo; Springmuller, Daniel; González, Katia; Chang, Win T; González, Rodrigo; Garay, Francisco

    2015-01-01

    Aortic aneurysms (AA) in the paediatric population are uncommon. The use of umbilical catheters in neonates has been associated with infections and, on some occasions, the formation of aortic aneurysms. The surgical repair of these aneurysms is one type of treatment; however, percutaneous intervention with stents could provide an alternative treatment route, with fewer complications. The aim of this report is to present the therapeutic scope of a hybrid procedure, in which the combined surgical and percutaneous technique offers a less invasive alternative to open surgery for the repair of aortic aneurysms or their main branches. The case concerns a pre-term newborn of 30 weeks weighing 1,335 g. An umbilical catheter was introduced, which was withdrawn at 14 days due to an infection. It developed as Staphylococcus aureus with sepsis. The echocardiogram and Angio-CT confirmed AA, which were managed using a hybrid procedure of surgery and the endovascular implantation of 2 coated stents (Atrium V12 XR Medical Corp, Hudson, NH). The post-procedure clinical follow-ups, including abdominal echo-tomography, confirmed the success of the treatment. The endovascular aortic aneurysm repair procedure in premature newborns may be considered when deciding treatment of this disease, and could avoid the risks associated with open surgery. However, follow-up and monitoring is required while the patient grows up, due to the possibility that the implanted stents require re-dilating. The outcomes of neonatal endovascular procedures in the future are unknown. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Combination of laparoscopic and open procedure in dismembered pyeloplasty: report of 51 cases

    Institute of Scientific and Technical Information of China (English)

    GAO Zhen-li; ZHANG Peng; SHI Lei; YANG Ming-shan; WANG Lin; YANG Dian-dong; SUN De-kang; LIU Qing-zuo; MEN Chang-ping; WU Ji-tao

    2006-01-01

    Background Laparoscopic dismembered pyeloplasty with less trauma than open surgery is commonly performed for ureteropelvic junction obstruction despite a longer operating time and a long learning curve. We describe in this paper a new technique, which combines laparoscopic and open procedure in dismembered pyeloplasty, that we have developed in 51 patients and achieved excellent results.Methods The surgical procedure can be divided into two steps: laparoscopic dissection of the renal pelvis and proximal ureter transperitoneally; then accomplishing the pyeloplasty through the extended port incision above the ureteropelvic junction as in open surgery.Results All 51 operations were successful without conversion to open surgery. No intraoperative complications were observed. The operating time was 40 minutes to 90 minutes with an average of 57.5 minutes. The estimated blood loss was 15 ml to 30 ml with an average of 21.2 ml. Aberrant artery vessel and primary stricture as the cause of ureteropelvic junction obstruction was noted in 2 and 49 patients, respectively. Thirty-nine patients had fever to differing extents in the 4 days postoperation and no severe infection was observed. Four patients had urinary leakage with their drains being retained for 6 days, 6 days, 5 days or 8 days after the operation. The mean followup was 10.8 months (range 3 months to 36 months). The followup showed good results with symptom resolution in all the patients. Renal ultrasonography demonstrated that the average separation of the collecting systems decreased from preoperative 2.7 cm (range 2.0 cm to 4.7 cm) to postoperative 1.5 cm (range 1.0 cm to 2.3 cm). Excretory urography at 3 months postoperatively showed improved drainage. Of the 51 patients, 35underwent two or more excretory urograms, demonstrating stable renal function, improved drainage and no evidence of recurrent obstruction. At the last followup visit, each patient was doing well.Conclusions Combination of laparoscopic and

  1. A RETROSPECTIVE CLINICAL STUDY OF LAPAROSCOPIC AND OPEN SURGERY FOR CHOLECYSTECTOMY PROCEDURE

    Directory of Open Access Journals (Sweden)

    Konduru Siva Prasada Raju

    2017-03-01

    Full Text Available BACKGROUND The gall stone is one of the commonest ailments for which the hospital doors are knocked in India. Recent statistics suggest that about 15 to 30 percent of women in the fourth and fifth decade of life commonly suffer from this. The gall bladder should not be removed just considering the fact that the stones are there but the stones are formed in it and one major problem is its recurrence. Recent non – operative procedures like shock wave therapy and drugs are non - promising. Minimal access surgery is now the trend in any kind of surgery and cholecystectomy is no exception. Initially there was a huge benefit seen but now more and more complications are reported. In this study an effort has been put to understand the complications involved in both the Laparoscopic and Open type of surgery. This study is intended to help the practicing surgeon to anticipate the commonly involved complications in both the type of surgeries and also to help them understand the pros and cons of each type especially in resource challenged settings. MATERIALS AND METHODS This study was done in the Department of General Surgery in RIMS Medical College at Ongole. This study was done from January 2014 to December 2016. A sample size of 131 patients was selected and the retrospective analysis was done. RESULTS The mean age of the population in the sample size was 44.18 years and the range of the patients included from 10 years to 81 years. There were thirty seven males and ninety four females in the total study population. Female preponderance was seen which was statistically significant. Open surgery is the method of choice in an emergencyod of choice in case of emergency.All twenty three patients who underwent open surgery had significant post operative pain complained of post - operative pain requiring analgesic intervention. Only two patients complained of post – operative pain in case of laparoscopic procedure and none of them needed analgesics. Other

  2. [Endovascular surgery in the war].

    Science.gov (United States)

    Reva, V A; Samokhvalov, I M

    2015-01-01

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

  3. Numerical study on dynamic characteristics for sharp opening procedure of boundary-layer suction slot

    Science.gov (United States)

    He, Yubao; Yin, Hang; Huang, Hongyan; Yu, Daren

    2017-08-01

    Based on the sharp forward of shock train and taking the forthcoming unstart for a background, the dynamic characteristics for sharp opening procedure of boundary-layer suction slot are investigated numerically using the dynamic mesh technique. Results indicate that the climbing path of shock train with the complex background waves exhibits a sharp and slow forward state at different time. The compression waves in the primary shock sweep the trailing edge of the separation bubble, and the recirculation within the shock train is communicated with the separation bubble, which reveals that the flow is in a critical state and is about to be unstart at the subsequent time. Furthermore, the dynamic pattern for sharp opening procedure of boundary-layer suction slot can be classified into four distinct stages, namely, the formation of the jet plume without suction mass loss, the formation of the barrier shock with suction mass loss characterized by gradient increase and subsequent two oscillations, the evolution of the barrier shock and jet plume with suction mass loss that ramps up via a series of discrete step increases, and the formation of the stable structure accompanied by the linear suction mass loss.

  4. An open source software project for obstetrical procedure scheduling and occupancy analysis.

    Science.gov (United States)

    Isken, Mark W; Ward, Timothy J; Littig, Steven J

    2011-03-01

    Increases in the rate of births via cesarean section and induced labor have led to challenging scheduling and capacity planning problems for hospital inpatient obstetrical units. We present occupancy and patient scheduling models to help address these challenges. These patient flow models can be used to explore the relationship between procedure scheduling practices and the resulting occupancy on inpatient obstetrical units such as labor and delivery and postpartum. The models capture numerous important characteristics of inpatient obstetrical patient flow such as time of day and day of week dependent arrivals and length of stay, multiple patient types and clinical interventions, and multiple patient care units with inter-unit patient transfers. We have used these models in several projects at different hospitals involving design of procedure scheduling templates and analysis of inpatient obstetrical capacity. In the development of these models, we made heavy use of open source software tools and have released the entire project as a free and open source model and software toolkit.

  5. Contemporary spinal cord protection during thoracic and thoracoabdominal aortic surgery and endovascular aortic repair

    DEFF Research Database (Denmark)

    Etz, Christian D; Weigang, Ernst; Hartert, Marc

    2015-01-01

    Ischaemic spinal cord injury (SCI) remains the Achilles heel of open and endovascular descending thoracic and thoracoabdominal repair. Neurological outcomes have improved coincidentially with the introduction of neuroprotective measures. However, SCI (paraplegia and paraparesis) remains the most...

  6. Complications of endovascular treatment of cerebral aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Orrù, Emanuele, E-mail: surgeon.ema@gmail.com [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Roccatagliata, Luca, E-mail: lroccatagliata@neurologia.unige.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy); Department of Health Sciences (DISSAL), University of Genoa (Italy); Cester, Giacomo, E-mail: giacomo.cester@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Causin, Francesco, E-mail: francesco.causin@sanita.padova.it [Neuroradiology Department, Padua University Hospital, Via Giustiniani 2, Padua 35128 (Italy); Castellan, Lucio, E-mail: lucio.castellan@hsanmartino.it [Neuroradiology Department, IRCCS San Martino University Hospital and IST, Largo Rosanna Benzi 10, Genoa 16132 (Italy)

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  7. Complications of endovascular treatment of cerebral aneurysms.

    Science.gov (United States)

    Orrù, Emanuele; Roccatagliata, Luca; Cester, Giacomo; Causin, Francesco; Castellan, Lucio

    2013-10-01

    The number of neuroendovascular treatments of both ruptured and unruptured aneurysms has increased substantially in the last two decades. Complications of endovascular treatments of cerebral aneurysms are rare but can potentially lead to acute worsening of the neurological status, to new neurological deficits or death. Some of the possible complications, such as vascular access site complications or systemic side effects associated with contrast medium (e.g. contrast medium allergy, contrast induced nephropathy) can also be encountered in diagnostic angiography. The most common complications of endovascular treatment of cerebral aneurysms are related to acute thromboembolic events and perforation of the aneurysm. Overall, the reported rate of thromboembolic complications ranges between 4.7% and 12.5% while the rate of intraprocedural rupture of cerebral aneurysms is about 0.7% in patients with unruptured aneurysms and about 4.1% in patients with previously ruptured aneurysms. Thromboembolic and hemorrhagic complications may occur during different phases of endovascular procedures and are related to different technical, clinical and anatomic reasons. A thorough knowledge of the different aspects of these complications can reduce the risk of their occurrence and minimize their clinical sequelae. A deep understanding of complications and of their management is thus part of the best standard of care.

  8. 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

  9. 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...... experienced operators performed a video-recorded simulated contra-lateral iliac-artery-stenting procedure. The virtual-patient case was a novel technically challenging procedure presenting the distal arteries below the knee. Methods Three experts assessed the performances blinded to operator identity...

  10. Influence of endovascular-laser irradiation of blood on the processis of lipoperoxidation and antioxidant protection in children with septico-purulent diseases

    Science.gov (United States)

    Cenusha, F.; Damaskin, I.; Okuni, C.; Terentieva, A.; Tsaran, N.

    1995-03-01

    Study of final produce of peroxide lipide oxidation--malon dialdehyde and the principal enzyme of antioxidant protection--superoxiddismutaza it was effectuated. Blood was taken before the procedure of endovascular laser irradiation, 24 hours after the procedure, 3 - 5 and 6 - 8 days after the first procedure of endovascular laser irradiation.

  11. Transanal opening of intersphincteric space (TROPIS) - A new procedure to treat high complex anal fistula.

    Science.gov (United States)

    Garg, Pankaj

    2017-04-01

    The sepsis in intersphincteric space has important role in pathogenesis of most complex fistula-in-ano. This sepsis is like a small abscess in a closed space. This closed space needs to be drained adequately and then kept open for the fistula-in-ano to heal properly. The aim was to lay open and drain the intersphincteric space through internal opening via transanal approach. This has been tried in submucosal and intersphincteric rectal abscesses but has never been tried in complex fistula-in-ano. All consecutive patients of complex high (involving >1/3 of sphincter complex) fistula-in-ano who were operated were included in the prospective cohort study. Preoperative MRI scan was done in all the patients. Transanal laying open of the intersphincteric space (TROPIS) was done through the internal opening. The external sphincter was not cut. The tracts in the ischiorectal fossa were curetted and cleaned. The incontinence scores were measured. 61 patients with high complex fistula-in-ano were included (follow-up:6-21 months). Male/Female:59/2, age-42.3 ± 9.5 years. 85.2% (52) were recurrent, 83.6% (51) had multiple tracts, 36.1% (22) had horseshoe tract, 34.4% (21) had supralevator extension and 26.2% (16) had associated abscess. 95.1% (58) were posterior fistula out of which 90.2% (55) were in posterior midline. Nine patients were excluded (due to tuberculosis, lost to follow-up). Fistula healed completely in 84.6% (44/52) and didn't heal in 15.4% (9/52). 4/9 of these were reoperated and fistula healed in three patients. Thus overall healing rate was 90.4% (47/52). There was no significant change in incontinence scores. TROPIS is a simple effective sphincter sparing procedure to treat high complex fistula-in-ano including supralevator and horseshoe fistula. Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  12. 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...

  13. The role of the open abdomen procedure in managing severe abdominal sepsis: WSES position paper.

    Science.gov (United States)

    Sartelli, Massimo; Abu-Zidan, Fikri M; Ansaloni, Luca; Bala, Miklosh; Beltrán, Marcelo A; Biffl, Walter L; Catena, Fausto; Chiara, Osvaldo; Coccolini, Federico; Coimbra, Raul; Demetrashvili, Zaza; Demetriades, Demetrios; Diaz, Jose J; Di Saverio, Salomone; Fraga, Gustavo P; Ghnnam, Wagih; Griffiths, Ewen A; Gupta, Sanjay; Hecker, Andreas; Karamarkovic, Aleksandar; Kong, Victor Y; Kafka-Ritsch, Reinhold; Kluger, Yoram; Latifi, Rifat; Leppaniemi, Ari; Lee, Jae Gil; McFarlane, Michael; Marwah, Sanjay; Moore, Frederick A; Ordonez, Carlos A; Pereira, Gerson Alves; Plaudis, Haralds; Shelat, Vishal G; Ulrych, Jan; Zachariah, Sanoop K; Zielinski, Martin D; Garcia, Maria Paula; Moore, Ernest E

    2015-01-01

    The open abdomen (OA) procedure is a significant surgical advance, as part of damage control techniques in severe abdominal trauma. Its application can be adapted to the advantage of patients with severe abdominal sepsis, however its precise role in these patients is still not clear. In severe abdominal sepsis the OA may allow early identification and draining of any residual infection, control any persistent source of infection, and remove more effectively infected or cytokine-loaded peritoneal fluid, preventing abdominal compartment syndrome and deferring definitive intervention and anastomosis until the patient is appropriately resuscitated and hemodynamically stable and thus better able to heal. However, the OA may require multiple returns to the operating room and may be associated with significant complications, including enteroatmospheric fistulas, loss of abdominal wall domain and large hernias. Surgeons should be aware of the pathophysiology of severe intra-abdominal sepsis and always keep in mind the option of using open abdomen to be able to use it in the right patient at the right time.

  14. Role of the latest endovascular technology in the treatment of intermittent claudication

    Directory of Open Access Journals (Sweden)

    Ichihashi S

    2014-06-01

    Full Text Available Shigeo Ichihashi, Kimihiko Kichikawa Department of Radiology, Nara Medical University, Kashihara, Nara, Japan Abstract: Intermittent claudication is a serious symptom in patients with peripheral arterial disease, and severely limits activities of daily living. Conservative treatment (optimal medical therapy and exercise rehabilitation programs and revascularization procedures (endovascular treatment [EVT] or open bypass surgery can relieve intermittent claudication. Among these treatment options, EVT has developed dramatically during the past decade, and has enabled physicians to offer less invasive treatment options with increasing durability. EVT for aortoiliac lesions has matured, and its long-term patency now approaches that of open bypass surgery. The latest EVT technologies include drug-eluting stents, stent grafts, drug-coated balloons, and bioresorbable stents. The recently reported patency of stent grafts in the femoropopliteal lesions was comparable with that of the prosthetic bypass graft. In the course of the paradigm shift from bypass surgery to EVT, evidence of any long-term benefit of EVT compared with supervised exercise is still inconclusive. EVT could improve walking performance in the short-term, while supervised exercise could improve walking performance more efficiently in the long-term. Combined treatment with EVT and exercise may offer the most sustainable and effective symptom relief. This paper reviews the relevant literature on the treatment of intermittent claudication, focusing on the latest EVT technologies, and outlines a strategy for achieving long-term benefits. Keywords: endovascular treatment, intermittent claudication, peripheral arterial disease, stent, exercise therapy

  15. Endovascular Access for Challenging Anatomies in Peripheral Vascular Interventions.

    Science.gov (United States)

    Vatakencherry, Geogy; Gandhi, Ripal; Molloy, Christopher

    2016-06-01

    Vascular interventionalists continue to expand the scope and breadth of endovascular procedures that we offer to our patients. However, we often have to overcome various anatomical and technical challenges to deliver an endovascular device. This article should give the modern interventionalist an array of technical tips and tricks to enable them to overcome various challenging anatomical features such as vessel tortuosity, vascular calcifications, and increasing abdominal pannus. We also hope to elucidate alternative accesses such as radial access, pedal access, popliteal access, and direct stent access as well as direct aortic access.

  16. Surgical management of intracranial aneurysms previously treated with endovascular therapy

    Directory of Open Access Journals (Sweden)

    Kumar Rajiv

    2010-01-01

    Full Text Available Endovascular treatment with coils of cerebral aneurysm is being increasingly used for definitive treatment. An increasing number of patients are coming for surgical intervention either for recurrences, incomplete coil embolization or its complications. Our objective was to assess the surgical management in such patients. This was a retrospective analysis of the patients who were initially treated with endovascular embolization and later managed surgically with clipping either for unsuccessful coiling, recurrence of aneurysm or post-procedural complication, between 2003 and 2007. Anatomical results were excellent in all five patients, and all the aneurysms were totally excluded from the circulation. All patients had good recovery. None of the patients suffered any major intraoperative or postoperative complication. Neurosurgical management of intracranial aneurysms previously treated with endovascular therapy is an emerging challenge, but with proper patient selection and careful planning, this subset of aneurysms can be managed with good results.

  17. Endovascular stent graft repair of multiple tuberculous thoracoabdominal aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Jung; Won, Je Hwan [Dept. of Radiology, Ajou University School of Medicine, Suwon (Korea, Republic of)

    2014-05-15

    We describe a case of multiple tuberculous aneurysms of the descending thoracic aorta and abdominal aorta repaired with endovascular stent graft. The case was a 47-year-old man who presented with three saccular pseudoaneurysms of aortoiliac bifurcation at computed tomography (CT) scan. Despite of antimycobacterial treatment, these aneurysms grew rapidly and saccular pseudoaneurysm of the descending thoracic aorta was newly seen. A bifurcated stent graft was successfully implanted in the aortoiliac bifurcation. Subsequently, endovascular stent graft was placed well in the descending thoracic aorta. Fourteen months after the procedure, the patient was stable and serial CT images showed regression of aneurysms with ongoing antimycobacterial treatment. Therefore, endovascular stent graft repair with antimycobacterial therapy may be a treatment option in patients with multiple tuberculous aneurysms.

  18. Critical evaluation of endovascular surgery for limb salvage.

    Science.gov (United States)

    Lucas, Layla C; Mills, Joseph L

    2011-01-01

    Rest pain, tissue loss, and gangrene are manifestations of critical limb ischemia caused by peripheral arterial disease and define a patient subgroup at highest risk for major limb amputation. Patients with nonhealing lower extremity wounds should be screened for the risk factors for peripheral arterial disease and offered noninvasive vascular testing. The diagnosis of critical limb ischemia mandates prompt institution of medical and surgical management to achieve the best chance of limb salvage. Surgical intervention has evolved from primary amputation to open bypass to the present era of endovascular therapy. The goals of surgical bypass and endovascular therapy are to improve perfusion sufficiently to permit healing. Despite poorer patency rates and the more frequent need for reintervention, endovascular therapy has been shown in multiple retrospective studies to achieve limb salvage similar to open bypass. Only one large, prospective, randomized controlled trial exists comparing open bypass with endovascular therapy: The Bypass versus Angioplasty in Severe Limb Ischemia of the Leg (BASIL) trial. Close clinical surveillance and serial monitoring of limb perfusion by means of noninvasive arterial studies are needed to determine the need for further vascular intervention. Limb salvage patients suffer from multiple comorbidities and benefit from a multidisciplinary, team approach to care.

  19. 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.

  20. Endovascular aortic graft infection resulting in retroperitoneal abscess: report of a case

    Directory of Open Access Journals (Sweden)

    Salvatore Di Somma

    2010-06-01

    Full Text Available Infection is a rare complication of aortoiliac endovascular procedures, with an incidence inferior to 0.5%, and it may result in a retroperitoneal abscess potentially evolving to sepsis and gastrointestinal bleeding. In more than 50% of cases endovascular aortoiliac prosthetic grafts infection occur months or years after the procedure. The growing number of endovascular procedures, and as the actually midterm follow up in most cases, septic sequelae will no doubt continue to occur with increased frequency and may represent an emerging problem in the ED for the emergency physician. Endovascular graft infection begins with unspecific clinical manifestations. An high index of suspicion in any patient with an aortic stent graft presenting prolonged or recurrent fever and or abdominal or back pain and a low threshold for obtaining CT scan should increase the clinician’s ability to make a timely diagnosis in the ED setting.

  1. Fine-motor skills testing and prediction of endovascular performance.

    Science.gov (United States)

    Bech, Bo; Lönn, Lars; Schroeder, Torben V; Ringsted, Charlotte

    2013-12-01

    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 candidates at entry to practice. To study the association between performance in a novel aptitude test of fine-motor skills and performance in simulated procedures. The test was based on manual course-tracking using a proprietary hand-operated roller-bar device coupled to a personal computer with monitor view rotation. A total of 40 test repetitions were conducted separately with each hand. Test scores were correlated with simulator performance. Group A (n = 14), clinicians with various levels of endovascular experience, performed a simulated procedure of contralateral iliac artery stenting. Group B (n = 19), medical students, performed 10 repetitions of crossing a challenging aortic bifurcation in a simulator. The test score differed markedly between the individuals in both groups, in particular with the non-dominant hand. Group A: the test score with the non-dominant hand correlated significantly with simulator performance assessed with the global rating scale SAVE (R = -0.69, P = 0.007). There was no association observed from performances with the dominant hand. Group B: there was no significant association between the test score and endovascular skills acquisition neither with the dominant nor with the non-dominant hand. Clinicians with increasing levels of endovascular technical experience had developed good fine-motor control of the non-dominant hand, in particular, that was associated with good procedural performance in the simulator. The aptitude test did not predict endovascular skills acquisition among medical students, thus, cannot be suggested for selection of novice candidates. Procedural experience and practice probably supplant the influence of innate

  2. Nursing and Coordination of Interventional Procedures for Endovascular Exclusion of Aortic Dissection Aneurysm%主动脉夹层动脉瘤腔内隔绝术的介入手术护理与配合

    Institute of Scientific and Technical Information of China (English)

    左玉琴

    2016-01-01

    目的:分析主动脉夹层动脉瘤腔内隔绝术的介入手术护理与配合方法及效果。方法随机选取我院2015年4月~2016年5月接收的6例主动脉夹层动脉瘤患者,所有患者采用主动脉夹层动脉瘤腔内隔绝术的介入手术,对所有患者进行了术前护理、术中护理以及术后护理,做好整个手术期间的配合工作,分析治疗效果及相关指标。结果6例主动脉夹层动脉瘤均顺利完成手术,所有患者均生存,没有出现严重的并发症,手术结束后经过(2.4±0.1)周的治疗,所有患者均顺利出院。结论对于主动脉夹层动脉瘤腔内隔绝术的介入手术应高度重视临床护理以及不同科室的配合工作,保证手术的顺利进行,为良好的治疗效果奠定基础。%Objective To analyze the methods of nursing and coordination in the surgical treatment of aortic dissection aneurysm.Methods 6 cases of aortic dissection patients were randomly selected in our hospital from April 2015 to May 2016, interventional surgery was conducted in all patients with aortic dissection aneurysm, all patients underwent preoperative nursing, preoperative nursing and postoperative nursing, therapeutic effect and relevant summary indicators were analysed.Results 6 cases of aortic dissecting aneurysm were successfully completed surgery, all patients were survival, there was no serious complications. At the end of surgery after (2.4±0.1) weeks of treatment, all patients were successfully discharged.Conclusion Interventional procedures for endovascular exclusion of aortic dissection should pay high attention to the clinical nursing and the coordination of different departments, so as to ensure the smooth operation of the operation, and lay the foundation for the good treatment effect.

  3. Visuospatial and psychomotor aptitude predicts endovascular performance of inexperienced individuals on a virtual reality simulator.

    Science.gov (United States)

    Van Herzeele, Isabelle; O'Donoghue, Kevin G L; Aggarwal, Rajesh; Vermassen, Frank; Darzi, Ara; Cheshire, Nicholas J W

    2010-04-01

    This study evaluated virtual reality (VR) simulation for endovascular training of medical students to determine whether innate perceptual, visuospatial, and psychomotor aptitude (VSA) can predict initial and plateau phase of technical endovascular skills acquisition. Twenty medical students received didactic and endovascular training on a commercially available VR simulator. Each student treated a series of 10 identical noncomplex renal artery stenoses endovascularly. The simulator recorded performance data instantly and objectively. An experienced interventionalist rated the performance at the initial and final sessions using generic (out of 40) and procedure-specific (out of 30) rating scales. VSA were tested with fine motor dexterity (FMD, Perdue Pegboard), psychomotor ability (minimally invasive virtual reality surgical trainer [MIST-VR]), image recall (Rey-Osterrieth), and organizational aptitude (map-planning). VSA performance scores were correlated with the assessment parameters of endovascular skills at commencement and completion of training. Medical students exhibited statistically significant learning curves from the initial to the plateau performance for contrast usage (medians, 28 vs 17 mL, P generic and procedure-specific rating scales improved significantly (10 vs 25, P generic skills at the end of training (r(s) = .587, P = .006). Simulator-based training in endovascular skills improved performance in medical students. There were significant correlations between initial endovascular skill and fine motor dexterity as well as with image recall at end of the training period. In addition to current recruitment strategies, VSA may be a useful tool for predictive validity studies.

  4. Long-Term Restoration of Anterior Shoulder Stability: A Retrospective Analysis of Arthroscopic Bankart Repair Versus Open Latarjet Procedure.

    Science.gov (United States)

    Zimmermann, Stefan M; Scheyerer, Max J; Farshad, Mazda; Catanzaro, Sabrina; Rahm, Stefan; Gerber, Christian

    2016-12-07

    Various operative techniques are used for treating recurrent anterior shoulder instability, and good mid-term results have been reported. The purpose of this study was to compare shoulder stability after treatment with the 2 commonly performed procedures, the arthroscopic Bankart soft-tissue repair and the open coracoid transfer according to Latarjet. A comparative, retrospective case-cohort analysis of 360 patients (364 shoulders) who had primary repair for recurrent anterior shoulder instability between 1998 and 2007 was performed. The minimum duration of follow-up was 6 years. Reoperations, overt recurrent instability (defined as recurrent dislocation or subluxation), apprehension, the subjective shoulder value (SSV), sports participation, and overall satisfaction were recorded. An open Latarjet procedure was performed in 93 shoulders, and an arthroscopic Bankart repair was done in 271 shoulders. Instability or apprehension persisted or recurred after 11% (10) of the 93 Latarjet procedures and after 41.7% (113) of the 271 arthroscopic Bankart procedures. Overt instability recurred after 3% of the Latarjet procedures and after 28.4% (77) of the Bankart procedures. In the Latarjet group, 3.2% of the patients were not satisfied with their result compared with 13.2% in the Bankart group (p = 0.007). Kaplan-Meier analysis of survivorship, with apprehension (p Latarjet procedure and the decreasing effectiveness of the arthroscopic Bankart repair over time. Twenty percent of the first recurrences after arthroscopic Bankart occurred no earlier than 91 months postoperatively, as opposed to the rare recurrences after osseous reconstruction, which occurred in the early postoperative period, with only rare late failures. In this retrospective cohort study, the arthroscopic Bankart procedure was inferior to the open Latarjet procedure for repair of recurrent anterior shoulder dislocation. The difference between the 2 procedures with respect to the quality of outcomes

  5. Validation tests of open-source procedures for digital camera calibration and 3D image-based modelling

    OpenAIRE

    I. Toschi; Rivola, R.; Bertacchini, E; Castagnetti, C.; M. Dubbini; Capra, A.

    2013-01-01

    Among the many open-source software solutions recently developed for the extraction of point clouds from a set of un-oriented images, the photogrammetric tools Apero and MicMac (IGN, Institut Géographique National) aim to distinguish themselves by focusing on the accuracy and the metric content of the final result. This paper firstly aims at assessing the accuracy of the simplified and automated calibration procedure offered by the IGN tools. Results obtained with this procedure were...

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

    Directory of Open Access Journals (Sweden)

    Rosario Parisi

    2015-07-01

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

  7. Neurogenic pulmonary edema after rupture of intracranial aneurysm during endovascular coiling

    Directory of Open Access Journals (Sweden)

    Ashish Bindra

    2011-01-01

    Full Text Available Neurogenic pulmonary edema (NPE is a well-known entity, occurs after acute severe insult to the central nervous system. It has been described in relation to different clinical scenario. However, NPE has rarely been mentioned after endovascular coiling of intracranial aneurysms. Here, we report the clinical course of a patient who developed NPE after aneurysmal rupture during endovascular surgery. There was significant cardiovascular instability possibly from stimulation of hypothalamus adjacent to the site of aneurysm. This case highlights the predisposition of minimally invasive procedures like endovascular coiling to life-threatening complications such as NPE.

  8. Open Data for Territorial Specialization Assessment Territorial Specialization in Attracting Local Development Funds: an Assessment. Procedure Based on Open Data and Open Tools

    Directory of Open Access Journals (Sweden)

    Giuseppe Las Casas

    2014-05-01

    Full Text Available The New Cohesion Policy opens to an integrated place-based approach for the improvement of territorial and social cohesion. The issue of territorial impact assessment of regional development policies highlight that data availability, open access to datasets in “near real-time”, participation, knowledge sharing, assumed importance within the development planning process. The contribution of ‘open data’ appears to be mature and in this paper we present an application of spatial analysis techniques for the evaluation of spatial effects of EU funds starting form open data by open-coesione. The application regards an internal areas of Basilicata Region: the Agri Valley. A complex contests in which an environmental and agricultural traditional vocation conflicts with a recent development of oil extraction industries. Conclusions regard further applications and perspectives for improving and supporting regional development planning considering the exploitation of open data sources and spatial analysis.

  9. No extensive experience in open procedures is needed to learn lobectomy by video-assisted thoracic surgery

    DEFF Research Database (Denmark)

    Konge, Lars; Petersen, René Horsleben; Hansen, Henrik Jessen;

    2012-01-01

    Lobectomies done by video-assisted thoracic surgery (VATS) result in fewer complications and less pain and save total costs compared with the traditional approach. However, the majority of procedures are still performed via open thoracotomies, because VATS lobectomy is considered difficult to learn......, requiring experience in open surgery, and causing complications in the initial phase of the learning curve. The aim of this study was to describe a training model appreciating patient safety during training and to explore the initial learning curve for a trainee rather inexperienced in open surgery....

  10. RELATIONSHIP BETWEEN TIMING OF EMERGENCY PROCEDURES AND LIMB AMPUTATION IN PATIENTS WITH OPEN TIBIA FRACTURE: UNITED STATES, 2003 – 2009

    Science.gov (United States)

    Sears, Erika Davis; Davis, Matthew M.; Chung, Kevin C.

    2012-01-01

    Background We aimed to characterize patterns in the timing of initial emergency procedures for patients with open tibia fracture and examine the relationship between initial procedure timing and in-hospital amputation. Study Design Data were analyzed from the Nationwide Inpatient Sample, 2003–2009. Adult patients were included if they had a primary diagnosis code of open tibia fracture. Patients were excluded for the following: transferred from or to another hospital, an immediate amputation was performed, more than one amputation was performed, no emergency procedure was documented, or treated at a facility that did not perform any amputations. We evaluated the association between timing of the first procedure and the outcome of amputation using multiple logistic regression, controlled for patient risk factors and hospital characteristics. Results Of 7,560 patients included in the analysis, 1.3% (n=99 patients) underwent amputation on hospital day 2 or later. The majority of patients (52.6%) underwent first operative procedure on day 0 or 1. In adjusted analyses, timing of first operative procedure beyond the day of admission is associated with more than three times greater odds of amputation (day 1 OR 3.81, 95% CI 1.80–8.07). Conclusions Delay of first operative procedure beyond the day of admission appears to be associated with a significantly increased probability of amputation in patients with open tibia fracture. All practitioners involved in the management of patients with open tibia fracture should seek a solution for any barrier, other than medical stability of the patient, of achieving early operative intervention. PMID:22842411

  11. Midterm experience with the endovascular treatment of isolated iliac aneurysms.

    Science.gov (United States)

    Casana, R; Nano, G; Dalainas, I; Stegher, S; Bianchi, P; Tealdi, D G

    2003-03-01

    The aim of this retrospective, single institution study was to describe our 4-year experience with the endovascular repair of isolated iliac artery aneurysms. Between May 1997 and June 2001, 16 patients (15 males; mean age 64+/-9 years), were treated with covered stent grafts. Twelve of the endovascular procedures were performed under epidural and 4 under local anaesthesia. The percutaneous approach was employed in 13 cases and the femoral artery had to be exposed in 3 cases that demanded simultaneous revascularization of the peripheral circulation (n=2) or required a 16 F sheath to employ a Baxter Lifepath stent graft (n=1). The mean size of the iliac aneurysms was 4.5 cm (range 3.5 to 5.2 cm). Four aneurysms involved the hypogastric ostium in absence of any distal neck. All the patients underwent initially successful endovascular treatment of isolated iliac aneurysms and were followed from 3 to 52 months (mean 18 months). No procedural deaths and no acute or late graft thrombosis occurred. The perioperative complications included 1 dissection of the external iliac artery that required a further endovacular procedure and 1 case of endovascular leak fed to the hypogastric artery. A CT scan 4 months later showed spontaneous thrombosis of aneurysm and no further leakage. Two patients had undergone combinated femoro-popliteal arterial bypass. In our early clinical experience the use of self-expandable covered stent graft successful treated isolated iliac artery aneurysms. Endovascular repair is a safe and effective technique with good midterm results in patients at standard and high risk.

  12. Endovascular management of intracranial blister aneurysms: spectrum and limitations of contemporary techniques.

    Science.gov (United States)

    Ashour, Ramsey; Dodson, Stephen; Aziz-Sultan, M Ali

    2016-01-01

    Intracranial blister aneurysms are rare lesions that are notoriously more difficult to treat than typical saccular aneurysms. High complication rates associated with surgery have sparked considerable interest in endovascular techniques, though not well-studied, to treat blister aneurysms. To evaluate our experience using various endovascular approaches to treat blister aneurysms. All consecutive blister aneurysms treated using an endovascular approach by the study authors over a 3-year period were retrospectively analyzed. A literature review was also performed. Nine patients with blister aneurysms underwent 11 endovascular interventions. In various combinations, stents were used in 8/11, coils in 5/11, and Onyx in 3/11 procedures. At mean angiographic follow-up of 200 days, 8/9 aneurysms were completely occluded by endovascular means alone requiring no further treatment and 1/9 aneurysms required surgical bypass/trapping after one failed surgical and two failed endovascular treatments. At mean clinical follow-up of 416 days, modified Rankin Scale scores were improved in six patients, stable in two, and worsened in one patient. One complication occurred in 11 procedures (9%), resulting in a permanent neurologic deficit. No unintended endovascular parent vessel sacrifice, intraprocedural aneurysmal ruptures, antiplatelet-related complications, post-treatment aneurysmal re-ruptures, or deaths occurred. This series highlights both the spectrum and limitations of endovascular techniques currently used to treat blister aneurysms, including a novel application of stent-assisted Onyx embolization. Long-term follow-up and experience in larger studies are required to better define the role of endovascular therapy in the management of these difficult lesions. 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/

  13. 40 CFR Appendix E to Part 63 - Monitoring Procedure for Nonthoroughly Mixed Open Biological Treatment Systems at Kraft Pulp...

    Science.gov (United States)

    2010-07-01

    ... constant, L/g mixed liquor volatile suspended solids (MLVSS)-hr KL=Liquid-phase mass transfer coefficient, m/s Ks=Monod biorate constant at half the maximum rate, g/m3 III. Test Procedure for Determination... of the open biological treatment unit. An appropriate value of the biorate constant, Ks,...

  14. 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.)

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

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hee Young; Do, Young Soo; Park, Hong Suk; Park, Kwang Bo [Dept. of Radiology, Samsugn Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of); Kim, Young Wook; Kim, Dong Ik [Dept. of Surgery, Samsugn Medical Center, Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)

    2011-08-15

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

  16. Endovascular treatment of ruptured abdominal aortic aneurysm with aortocaval fistula based on aortic and inferior vena cava stent-graft placement.

    Science.gov (United States)

    Silveira, Pierre Galvagni; Cunha, Josué Rafael Ferreira; Lima, Guilherme Baumgardt Barbosa; Franklin, Rafael Narciso; Bortoluzzi, Cristiano Torres; Galego, Gilberto do Nascimento

    2014-11-01

    A ruptured abdominal aortic aneurysm (RAAA), complicated by an aortocaval fistula (ACF), is usually associated with high morbidity and mortality during open operative repair. We report a case of endovascular treatment of an RAAA with ACF. After accessing both common femoral arteries, a bifurcated aortic stent graft was placed. Subsequently, we accessed the fistula from the right femoral vein and a cava vein angiography showed a persistent massive flow from the cava to the excluded aneurysm sac. We proceeded by covering the fistula with an Excluder aortic stent-graft cuff to prevent pressurization of the aneurysm sac and secondary endoleaks. This procedure is feasible and may reduce the chances of posterior endoleaks.

  17. Endovascular dialysis interventions in the era of DOQI.

    Science.gov (United States)

    Greenberg, Joshua I; Suliman, Ahmed; Angle, Niren

    2008-09-01

    The National Kidney Foundation Dialysis Outcomes and Quality Initiative (DOQI) recommends autogenous fistulae as the preferred access for new dialysis procedures. Unfortunately, despite superior patency rates compared to prosthetic grafts, even autogenous access durability is often undermined by venous stenosis due to intimal hyperplasia at the outflow vein or by central venous stenosis due to long-standing central venous catheters. Salvage interventions, in the form of endovascular treatments such as percutaneous transluminal angioplasty (PTA) and/or stenting, are increasingly utilized for access salvage and maintenance. The objective of this study was to evaluate the efficacy of endovascular dialysis interventions in the era of DOQI. A retrospective review of a database of endovascular interventions for dialysis access during 36 months at an academic medical center was performed. Both central venous and access outflow lesions were included in the analysis. Kaplan-Meier curves and log-rank analysis were used to assess and compare time-dependent variables. Forty-five patients with dialysis access underwent 72 endovascular interventions for access maintenance. There were 27 central venous and 32 outflow endovascular interventions with 98% follow-up. Primary and assisted primary patency rates for outflow balloon PTA were 50% and 72% at 12 months, respectively. There were 1.1 reinterventions required per index outflow PTA procedure. Postintervention primary patency rates for central venous PTA were 30% and 9% at 6 and 12 months, respectively. Postintervention assisted patency for central venous PTA was 100% at 12 months, requiring 1.8 reinterventions per index PTA. Central venous and venous outflow interventions extended overall access patency by 38.5 and 33 months, respectively (p dialysis access. Despite the need for multiple reinterventions and close surveillance, catheter-based interventions positively contribute to dialysis access durability in accordance with

  18. Endovascular Management of Central Retinal Arterial Occlusion.

    Science.gov (United States)

    Agarwal, Nitin; Gala, Nihar B; Baumrind, Benjamin; Hansberry, David R; Thabet, Ahmad M; Gandhi, Chirag D; Prestigiacomo, Charles J

    2016-11-01

    Central retinal artery occlusion (CRAO) is an ophthalmologic emergency due to the sudden cessation of circulation to the inner retinal layer. Without immediate treatment, permanent blindness may ensue. Several treatment options exist, ranging from noninvasive medical management to thrombolysis. Nonetheless, ongoing debate exists regarding the best therapeutic strategy. The authors present the case of a 78-year-old woman with a medical history of hypercholesterolemia and rheumatoid arthritis who experienced complete loss of vision in her left eye. Following ophthalmologic evaluation demonstrating left CRAO, anterior chamber paracentesis was performed. Endovascular intervention was performed via local intra-arterial fibrinolysis with alteplase. Her vision returned to 20/20 following the procedure. In general, conventional therapies have not significantly improved patient outcomes. Several management options exist for CRAO. In general, conservative measures have not been reported to yield better patient outcomes as compared to the natural history of this medical emergency. Endovascular approaches are another option as observed with this case reported. In cases of CRAO, therapeutic strategies such as intra-arterial fibrinolysis utilize a local infusion of reactive tissue plasminogen activator directly at the site of occlusion via catheterization of the ophthalmic artery. Although several case series do show promising results after treating CRAO with intra-arterial fibrinolysis, further studies are required given the reports of complications.

  19. Preoperative embolization of nasopharyngeal angiofibromas: The role of direct percutaneous injection of cyanoacrylate glue in conjunction with particulate endovascular approach

    Directory of Open Access Journals (Sweden)

    Mohamed Abdel Hakim Osman Kasem

    2016-12-01

    Conclusion: The embolization of nasopharyngeal angiofibromas before surgery using percutaneous cyanoacrylate glue with endovascular particulate material proved to efficiently devascularize these tumours with lower blood loss during surgery and no major procedural complications.

  20. A Prospective Comparative Study of Arthroscopic Versus Mini-Open Latarjet Procedure With a Minimum 2-Year Follow-up.

    Science.gov (United States)

    Marion, Blandine; Klouche, Shahnaz; Deranlot, Julien; Bauer, Thomas; Nourissat, Geoffroy; Hardy, Philippe

    2017-02-01

    To compare postoperative pain during the first postoperative week and the position of the coracoid bone block at the anterior aspect of the glenoid after the arthroscopic and the mini-open Latarjet procedure. The secondary purpose was to assess functional results and recurrence after at least 2 years of follow-up. This comparative prospective study included patients who underwent a Latarjet-Bristow procedure for anterior shoulder instability in 2012. The Latarjet procedure was performed by a mini-open approach (G1) in one center and by an arthroscopic approach (G2) in the other. The main evaluation criterion was average shoulder pain during the first postoperative week assessed by the patient on a standard 10-cm visual analog scale (0-10). Secondary criteria were consumption of analgesics during the first week, the position of the coracoid bone block on radiograph and computed tomography scan at the 3-month follow-up and clinical outcomes (Western Ontario Score Index and new surgery) after at least 2 years of follow-up. Fifty-eight patients were included, 22 G1 and 36 G2, 13 women and 45 men, mean age 26.9 ± 7.7 years. The mean follow-up was 29.8 ± 4.4 months. There was significantly less pain in the arthroscopic Latarjet group than in the mini-open group during the first postoperative week (2.5 ± 1.4 vs 1.2 ± 1.2, P = .002) with comparable consumption of analgesics (P > .05). The arthroscopic Latarjet procedure resulted in a more lateral coracoid bone block (P = .04) and a better equatorial position than the mini-open technique (P = .02). Three patients underwent revision surgery (1 recurrence [2.8%], 1 block fracture, 1 screw ablation) in the arthroscopic group, none in the mini-open group (P = .54). At the final follow-up, the Western Ontario Score Index score was good in all patients (G1: 78.5 ± 7.5% vs G2: 82.3 ± 7%, P = .03). This prospective comparative study showed that the arthroscopic Latarjet procedure was significantly less painful than

  1. Endovascular management of recurrent adult coarctation of the aorta.

    Science.gov (United States)

    Kpodonu, Jacques; Ramaiah, Venkatesh G; Rodriguez-Lopez, Julio A; Diethrich, Edward B

    2010-11-01

    Traditional open surgical repair has proven to be an effective treatment for the management of primary and recurrent coarctation of the thoracic aorta. Potential complications at short-term and long-term follow-up have included recurrent coarctation, hypertension, premature coronary artery disease, cerebrovascular disease, and anastomotic pseudoaneurysm. Endovascular repair of recurrent coarctation of the thoracic aorta offers a less invasive treatment approach in potential high-risk surgical patients.

  2. Endovascular strategy for the elective treatment of concomitant aortoiliac aneurysm and symptomatic large bowel diverticular disease.

    Science.gov (United States)

    Illuminati, Giulio; Ricco, Jean-Baptiste; Schneider, Fabrice; Caliò, Francesco G; Ceccanei, Gianluca; Pacilè, Maria A; Pizzardi, Giulia; Palumbo, Piergaspare; Vietri, Francesco

    2014-07-01

    The purpose of this study was to evaluate the strategy for treatment of patients presenting with asymptomatic diverticular disease of the large bowel associated with an asymptomatic aortoiliac aneurysmal (AAA) disease. Sixty-nine patients were included in this retrospective study. The patients were divided into 5 groups according to the type and sequence of the surgical treatment: 32 patients (47%) underwent colectomy followed by a staged open AAA repair (group A); 10 patients (14%) were treated with open AAA repair followed by a staged colectomy (group B); 13 patients (18%) received endovascular aneurysm repair (EVAR) followed by a staged bowel resection (group C); 8 patients (12%) had a bowel resection followed by staged EVAR (group D); and 6 patients (9%) underwent simultaneous open AAA repair and bowel resection (group E). Primary end points were mortality and complications after any of the procedures. Secondary end point was the time interval between the staged procedures. The cumulative death rate for delayed treatment of AAA was 6.5% and 0% for delayed treatment of diverticular disease [P=0.22]. The mean time interval between the staged procedures was 11 days for EVAR/colon resection (group C and group D) and 73 days for open AAA repair/colon resection (group A and group B; P<0.01). EVAR allows a significant reduction in the time required between AAA repair and colon resection, but no definite rule can be established regarding the sequence of staged procedures. Combined procedures should be reserved for selected cases. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. 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.

  4. Transradial approach to treating endovascular cerebral aneurysms: Case series and technical note

    Science.gov (United States)

    Goland, Javier; Doroszuk, Gustavo Fabián; Garbugino, Silvia Lina; Ypa, María Paula

    2017-01-01

    Background: Several benefits have been described over the years of the transradial versus femoral endovascular approach to cardiac interventions. Consequently, its use has become habitual at most centers that perform cardiac catheterizations. This paper details a right transradial approach, incorporating a variety of coils or flow diverters, which can be utilized for the endovascular treatment of different cerebral aneurysms. Methods: From 2014 to 2016, we performed 40 endovascular procedures to treat cerebral aneurysms adopting the same right transradial approach. Five aneurysms were treated with flow diverters and 35 were treated with coils. Seven of these aneurisms were asymptomatic, whereas 33 had already ruptured. Results: Satisfactory treatment was achieved in all cases through the same approach in the absence of any complications. Conclusions: A right transradial approach may be satisfactory for the endovascular treatment of different cerebral aneurysms, including aneurysms in either hemisphere. This is the largest series of cerebral aneurysms treated through a transradial approach. PMID:28584676

  5. Endovascular abdominal aortic aneurysm repair in the geriatric population

    Institute of Scientific and Technical Information of China (English)

    Athanasios Saratzis; Saif Mohamed

    2012-01-01

    Abdominal aortic aneurysm (AAA) is a relatively common pathology among the elderly. More people above the age of 80 will have to undergo treatment of an AAA in the future. This review aims to summarize the literature focusing on endovascular repair of AAA in the geriatric population. A systematic review of the literature was performed, including results from endovascular abdominal aortic aneurysm repair (EVAR) registries and studies comparing open repair and EVAR in those above the age of 80. A total of 15 studies were identified. EVAR in this population is efficient with a success rate exceeding 90% in all cases, and safe, with early mortality and morbidity being superior among patients undergoing EVAR against open repair. Late survival can be as high as 95% after 5 years. Aneurysm-related death over long-term follow-up was low after EVAR, ranging from 0 to 3.4%. Endovascular repair can be offered safely in the geriatric population and seems to compare favourably with open repair in all studies in the literature to date.

  6. Optimisation of a high-resolution whole-body MR angiography protocol with parallel imaging and biphasic administration of a single bolus of Gd-BOPTA: preliminary experience in the systemic evaluation of atherosclerotic burden in patients referred for endovascular procedures.

    Science.gov (United States)

    Napoli, A; Anzidei, M; Marincola, B Cavallo; Zaccagna, F; Geiger, D; Di Paolo, P L; Zini, C; Catalano, C; Passariello, R

    2009-06-01

    This study was performed to validate a high-resolution whole-body magnetic resonance angiography (MRA) protocol with parallel imaging and biphasic administration of a single bolus of contrast agent in the preliminary assessment of systemic atherosclerotic burden in patients referred for endovascular procedures. Forty patients referred for endovascular treatment of atherosclerotic disease of the carotid arteries (n=23), peripheral vessels (n=14) or aorta (n=3) on the basis of previous clinical and diagnostic examinations underwent high-resolution whole-body MRA at 1.5 T with 3D spoiled gradient recalled echo (GRE) sequences, featuring parallel imaging acquisition technique with x2 acceleration factor. Sixty-eight surface coil elements and a four-station imaging protocol were employed. Biphasic intravenous administration of a paramagnetic contrast agent [gadolinium benzyloxyproprionic-tetraacetic acid (Gd-BOPTA)] was performed with the following protocol: 10 ml at a speed of 1 ml/s followed by further 10 ml at a speed of 0.5 ml/s. For image analysis, the arterial system was divided into 42 segments for evaluation. The presence or absence of atherosclerotic lesions was evaluated by two observers in consensus; segments were classified as having clinically significant disease (>or=50% stenosis or an aneurysmal dilatation) or no significant disease (<50% stenosis). The presence of stenoocclusive disease, determined at all segments, was compared with findings on digital subtraction angiography (DSA), which were interpreted by a third independent reader. Sensitivity, specificity and concordance of whole-body MRA findings with DSA were calculated, and receiver operating characteristic (ROC) analysis was performed for all vascular territories. A total of 1,680 arterial segments was evaluated; 138 (8.3%) were affected by atherosclerotic alterations. Carotid lesions were confirmed in 23 patients (34 segments), involvement of peripheral vessels in 14 (57 segments) and abdominal

  7. Maximum opening of the mouth by mouth prop during dental procedures increases the risk of upper airway constriction

    Directory of Open Access Journals (Sweden)

    Hiroshi Ito

    2010-05-01

    Full Text Available Hiroshi Ito1, Hiroyoshi Kawaai1, Shinya Yamazaki1, Yosuke Suzuki21Division of Systemic Management, Department of Oral Function, 2Division of Radiology and Diagnosis, Department of Medical Sciences, Ohu University, Post Graduate School of Dentistry, Koriyama City, Fukushima Prefecture, JapanAbstract: From a retrospective evaluation of data on accidents and deaths during dental procedures, it has been shown that several patients who refused dental treatment died of asphyxia during dental procedures. We speculated that forcible maximum opening of the mouth by using a mouth prop triggers this asphyxia by affecting the upper airway. Therefore, we assessed the morphological changes of the upper airway following maximal opening of the mouth. In 13 healthy adult volunteers, the sagittal diameter of the upper airway on lateral cephalogram was measured between the two conditions; closed mouth and maximally open mouth. The dyspnea in each state was evaluated by a visual analog scale. In one subject, a computed tomograph (CT was taken to assess the three-dimensional changes in the upper airway. A significant difference was detected in the mean sagittal diameter of the upper airway following use of the prop (closed mouth: 18.5 ± 3.8 mm, maximally open mouth: 10.4 ± 3.0 mm. All subjects indicated upper airway constriction and significant dyspnea when their mouth was maximally open. Although a CT scan indicated upper airway constriction when the mouth was maximally open, muscular compensation was admitted. Our results further indicate that the maximal opening of the mouth narrows the upper airway diameter and leads to dyspnea. The use of a prop for the patient who has communication problems or poor neuromuscular function can lead to asphyxia. When the prop is used for patient refusal in dentistry, the respiratory condition should be monitored strictly, and it should be kept in mind that the “sniffing position” is effective for avoiding upper airway

  8. Endovascular treatment of hemodialysis access pseudoaneurysms.

    Science.gov (United States)

    Shah, Aamir S; Valdes, Jaime; Charlton-Ouw, Kristofer M; Chen, Zhongxue; Coogan, Sheila M; Amer, Hammad M; Estrera, Anthony L; Safi, Hazim J; Azizzadeh, Ali

    2012-04-01

    Pseudoaneurysm (PSA) formation is a complication of hemodialysis access. Open repair requires PSA resection, interposition graft placement, and insertion of a catheter as a bridge. Endovascular stent graft repair is an alternative that permits immediate use of the access site. The objective of this study was to determine the efficacy of stent grafts for repair of arteriovenous fistula and arteriovenous graft PSA. A retrospective review of medical records from October 2007 to March 2011 revealed 24 patients with a PSA who underwent endovascular repair using a stent graft. Indications for repair included PSA with symptoms (n = 11), PSA with skin erosion (n = 8), PSA with failed hemodialysis (n = 3), and PSA after balloon angioplasty of a stenosis (n = 2). Outcome measures were technical success, 30-day and 180-day patency, secondary interventions, and complications. All the statistical analyses were conducted by using software SAS 9.1 (SAS, SAS Institute, Gary, NC). Twenty-seven self-expanding stent grafts (Viabahn, W. L. Gore, n = 25; Fluency, Bard, n = 2) were used to treat hemodialysis access (arteriovenous graft, n = 13; arteriovenous fistula, n = 11) PSA in 24 patients (16 females; mean age, 55.7 years; mean body mass index, 28.4; mean PSA diameter, 19.5 mm). Comorbidities included hypertension (n = 22; 91.7%), diabetes mellitus (n = 8; 33.3%), and coronary artery disease (n = 4; 16.67%). The median time from access creation to repair was 455 days. The technical success rate was 100%. Balloon angioplasty of an outflow stenosis was performed in 56% of stent grafts. The 30- and 180-day patency rate was 100% and 69.2%, respectively. Three secondary interventions were performed for treatment of unrelated stenosis. Treatment failure occurred in five (18.5%) stent grafts due to infection (n = 3) and thrombosis (n = 2). Treatment of PSA with skin erosion was associated with failure due to infection (odds ratio, 5.0; 95% confidence interval, .38, 66.01). The remaining

  9. 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.

  10. Endovascular embolization of pulmonary arteriovenous malformations

    Institute of Scientific and Technical Information of China (English)

    LIU Feng-yong; WANG Mao-qiang; FAN Qing-sheng; DUAN Feng; WANG Zhi-jun; SONG Peng

    2010-01-01

    Background The major consequence of pulmonary arteriovenous malformations (PAVMs) is the direct inflow of blood from the pulmonary artery to the pulmonary vein which induces hypoxemia. Severe complications include transient ischemic attacks, paradoxical embolization in the central nervous system, massive hemoptysis or hemothorax, etc. The conventional treatment is surgical intervention. However, this can be very traumatic and dangerous. Endovascular embolization has advantages over surgery such as a faithful therapeutic effect, a low complication rate, repeatability, etc. Methods Patients (n=23) with symptomatic PAVMs underwent endovascular embolization; 11 were males and 12 were females, with ages ranging from 6 months to 58 years. During the embolization, microcoils were applied in 6 cases and standard steel coils were used in 17 cases.Results Multiple PAVMs lesions were found in 16 cases and single PAVMs lesion was found in 7 cases. Embolotherapy was carried out 28 times for 23 patients. The success rate was 100%. The results of pulmonary arteriography after treatment showed that single lesion disappeared completely while the main abnormal vessels in multiple lesions also disappeared. The mean blood oxygen saturation increased from (78.04±8.22)% to (95.13±3.67)% after the procedure. A correlated groups t test showed changes in blood oxygen saturation before and after embolization (fe=9.101, P <0.001). Symptoms of cardiac insufficiency disappeared in 5 cases and vascular murmur in the chest disappeared in 13 cases. After embolization, mild chest pain occurred in 11 cases, small amounts of pleural effusion occurred in 5 cases, and 1 patient died 2 months later because of a pyogenic infection secondary to the pulmonary infarction. Among the 22 remaining cases, with overall follow-up ranging from 18 months to 12 years, general conditions were fine, daily lives were normal and there were no neurologic symptoms or signs, except for 3 patients with diffused PAVMs who

  11. Suprarenal Fixation Resulting in Intestinal Ischemia after Endovascular Aortic Aneurysm Repair

    NARCIS (Netherlands)

    Pol, Robert A.; Keus, Frederick; Prins, Ted R.; Zeebregts, Clark J.

    2014-01-01

    Endovascular aneurysm repair (EVAR) may be associated with specific stent- and procedure-related complications. Hepatic artery anatomic variability may lead to dramatic consequences when unanticipated. A 64-year-old man presented with a 6-cm abdominal aortic aneurysm, suitable for an EVAR procedure.

  12. 78 FR 918 - Approval and Promulgation of Implementation Plans; Oregon: Open Burning and Enforcement Procedures

    Science.gov (United States)

    2013-01-07

    ... that allow ODEQ to delegate authority to issue and enforce open burning permits to a city, county, fire... delegation to local agencies, that the delegated authority will continue to be carried out under the SIP...'s authority to extinguish existing fires. As another example, revisions to OAR 340- 264-0040(3...

  13. Designing EEG Neurofeedback Procedures to Enhance Open-Ended versus Closed-Ended Creative Potentials

    Science.gov (United States)

    Lin, Wei-Lun; Shih, Yi-Ling

    2016-01-01

    Recent empirical evidence demonstrated that open-ended creativity (which refers to creativity measures that require various and numerous responses, such as divergent thinking) correlated with alpha brain wave activation, whereas closed-ended creativity (which refers to creativity measures that ask for one final correct answer, such as insight…

  14. Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy.

    Science.gov (United States)

    Ropars, Mickaël; Cretual, Armel; Kaila, Rajiv; Bonan, Isabelle; Hervé, Anthony; Thomazeau, Hervé

    2016-12-01

    There is a paucity of data detailing management of anterior capsular redundancy (ACR) when using the Latarjet procedure for unidirectional instability. This study aimed to describe the surgical management and to assess the clinical profile of patients presenting with anterior capsular redundancy [ACR(+)] with anterior shoulder instability. Seventy-seven patients who had a Latarjet procedure were followed for a 55-month period. Per-operative ACR was assessed during surgery. ACR was considered present if the inferior capsular flap of a Neer T-shaft capsulorrhaphy was able to cover the superior capsular flap with the arm in the neutral position. Patients with ACR(+) received an additional Neer capsulorrhaphy, while patients with ACR(-) did not. This per-operative finding was correlated with demographics, clinical, radiological pre-operative data and surgical outcome. Patients presenting with a per-operative ACR(+) were significantly associated with a sulcus sign (P 4 (P 85°. Open standard Latarjet procedures with Neer capsulorrhaphy in ACR(+) patients showed excellent or good results and stability rate of 95 %. All patients except four who presented with a new dislocation after surgery were satisfied with their outcome. Thirteen patients (16 %) had a persistent apprehension sign at the last follow-up. ACR(+) and ACR(-) groups did not show significant difference in the mean values of Rowe, Walch-Duplay and Constant-Murley scores. ACR correlated with a sulcus sign, Beighton score and instability history. In anterior shoulder instability associated with ACR, the Latarjet procedure with a Neer capsulorrhaphy appears a satisfactory treatment alternative to arthroscopic or open capsular shift. It decreased apprehension in comparison with Latarjet procedures without capsular repair. Cases series, treatment study, Level IV.

  15. Endovascular covered stent treatment for descending aorta pseudoaneurysm following coarctation of the aorta repair in an infant.

    Science.gov (United States)

    Takawira, Farirai F; Sinyangwe, Greenwood; Mooloo, Rene

    2010-12-01

    The development of a pseudoaneurysm is a rare complication following repair of a coarctation of the aorta. Surgical management of pseudoaneurysms is associated with high morbidity and mortality. We describe the successful endovascular deployment of a covered stent in a sick infant with a descending aorta pseudoaneurysm, following the repair of an aortic coarctation. We highlight the challenges we encountered. Endovascular repair is a safe palliative alternative to re-do open surgery in unstable infants with large pseudoaneurysms following aortic coarctation repair. The role of endovascular stents as the final definitive therapy will remain limited by the deployable, small-size stents in small, growing children.

  16. Hybrid Endovascular Aorta Repair with Simultaneous Supra-aortic Branch or Iliac Branch Revascularization

    Institute of Scientific and Technical Information of China (English)

    Yue-hong Zheng; Nim Choi; Hong-ru Deng; CU Kouk; Kun Yu; Furtado Rui

    2009-01-01

    Objective To describe a hybrid endovascular procedure for aorta repair with different kinds of bypass followed by concomitant placement of stent graft in the aorta.Methods From June 2007 to May 2008,5 consecutive patients who presented with aortic aneurysm or dissection were treated with a new hybrid aorta repair technique.Complete surgical rerouting of supra-aortic vessels was simultaneously created by endovascular repair of aortic arch aneurysm with stent graft.Hybrid left carotid-subclavian bypass with stent graft deployment covering the ostium of the left subclavian artery was performed in a Debakey type Ⅲ aortic dissection case.The supra-aortic branch was revascularized in 2 cases from ascending aorta to bilateral common carotid arteries using a 16-8 mm bifurcated graft,then total aortic arch and descending artery was occluded with stent-graft.The left carotid artery to the left subclavian artery bypass was created in 1 case,followed by stent-graft deployment.Two cases of infrarenal abdominal aortic aneurysm underwent left external iliac artery to left internal iliac artery bypass by a retroperineal route,then hybrid procedure was performed with bifurcated stent-graft.All stent grafts were deployed via a retrograde femoral artery approach in 5 patients.Results Technical success with complete aneurysmal exclusion was achieved in all patients.There was no incidence of endoleak.During a follow-up period of 2 to 10 months,documented perioperative neurologic events did not occur in all patients.One patient suffered from adult respiratory distress syndrome.After received tracheostomy,he recovered later.There was one death resulting from a postoperative myocardial infarction.Conclusion Hybrid arch repair provides an alternative therapy to patients otherwise considered prohibitively high risk for traditional open arch and thoracoabdominal aorta repair.

  17. Analysis of the Impact of Transparency, Corruption, Openness in Competition and Tender Procedures on Public Procurement in the Czech Republic

    Directory of Open Access Journals (Sweden)

    František Ochrana

    2014-01-01

    Full Text Available This study analyses the impact of transparency and openness to competition in public procurement in the Czech Republic. The problems of the Czech procurement market have been demonstrated on the analysis of a sample of contracts awarded by local government entities. From among a set of factors influencing the efficiency of public procurement, we closely analyse transparency, resilience against corruption, openness, effective administrative award procedure, and formulation of appropriate evaluation criteria for selecting the most suitable bid. Some assumptions were confirmed, including a positive effect of open procedures on the level of competition on the supply side as well as the dominant use of price criteria only. The latter case is probably often caused by low skills of workers at the contracting entities, as well as the lack of resources in public budgets. However, we have to reject the persistent legend of “undershooting” tender prices and subsequently increasing the final prices of public contracts. Increases of final prices are very limited. Based on the results of the analyses presented, we argue that the main problem of the Czech public procurement market lies in a rather low competence of administrators who are not able to use non-price criteria more often.

  18. 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.

  19. Hypersensitivity reactions associated with endovascular devices.

    Science.gov (United States)

    Honari, Golara; Ellis, Stephen G; Wilkoff, Bruce L; Aronica, Mark A; Svensson, Lars G; Taylor, James S

    2008-07-01

    Allergic reactions to endoprostheses are uncommon and reported in association with orthopaedic, dental, endovascular and other implanted devices. Hypersensitivity reactions to the biomaterials used in endovascular prostheses are among the infrequent reactions that may lead to local or systemic complications following cardiovascular therapeutic interventions. This article reviews potential immunotoxic effects of commonly used biomaterials. Reports of putative hypersensitivity reactions to endovascular devices, including coronary stents, perforated foramen occluders, pacemakers and implantable cardioverter defibrillators are also reviewed.

  20. Resuscitative Endovascular Balloon Occlusion of the Aorta: Pushing Care Forward.

    Science.gov (United States)

    Teeter, William; Romagnoli, Anna; Glaser, Jacob; Fisher, Andrew D; Pasley, Jason; Scheele, Brian; Hoehn, Melanie; Brenner, Megan

    Resuscitative endovascular balloon occlusion of the aorta (REBOA), used to temporize noncompressible and junctional hemorrhage, may be deployable to the forward environment. Our hypothesis was that nonsurgeon physicians and high-level military medical technicians would be able to learn the theory and insertion of REBOA. US Army Special Operations Command medical personnel without prior endovascular experience were included. All participants received didactic instruction of the Basic Endovascular Skills for Trauma Course™ together, with individual evaluation of technical skills. A pretest and a posttest were administered to assess comprehension. Four members of US Army Special Operations Command-two nonsurgeon physicians, one physician assistant, and one Special Operations Combat Medic-were included. REBOA procedural times moving from trial 1 to trial 6 decreased significantly from 186 ± 18.7 seconds to 83 ± 10.3 seconds (ρ < .0001). All participants demonstrated safe REBOA insertion and verbalized the indications for REBOA insertion and removal through all trials. All five procedural tasks were performed correctly by each participant. Comprehension and knowledge between the pretest and posttest improved significantly from 67.6 ± 7.3% to 81.3 ± 8.1% (ρ = .039). This study demonstrates that nonsurgeon and nonphysician providers can learn the steps required for REBOA after arterial access is established. Although insertion is relatively straightforward, the inability to gain arterial access percutaneously is prohibitive in providers without a surgical skillset and should be the focus of further training. 2017.

  1. Results of a multicenter, prospective trial of thoracic endovascular aortic repair for blunt thoracic aortic injury (RESCUE trial).

    Science.gov (United States)

    Khoynezhad, Ali; Azizzadeh, Ali; Donayre, Carlos E; Matsumoto, Alan; Velazquez, Omaida; White, Rodney

    2013-04-01

    adverse events related to the device were reported; a single death was conservatively adjudicated as device-, procedure-, and aorta-related because of insufficient information. No patient developed spinal cord injury, and there were no cerebrovascular accidents. However, one patient had an anoxic brain injury following aortic rupture. No patient underwent conversion to open repair or required an endovascular reintervention. Based on the early outcomes, the Medtronic Valiant Captivia stent graft appears to be a promising treatment modality for blunt thoracic aortic injuries. Long-term follow-up is necessary to substantiate the effectiveness of thoracic endovascular aortic repair in treatment of blunt thoracic aortic injuries. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

  2. Theory and practice of auditor procedures for opening balances during initial audit engagement

    Directory of Open Access Journals (Sweden)

    V.P. Bondar

    2016-06-01

    Full Text Available Increased international capital flows requires the adaptation of the corporative relationships mechanisms in domestic entities to the international financial disclosure practices for increase of their investment attractiveness. The professional audit development, increases transparency and fair disclosure of complete and accurate information about the company helps make it. The study proved the importance of predecessor auditor’s working papers for detection of misstatements in opening balances and assessment of the client’s accounting and internal control systems. Consequently a program of opening balances inspecting and other working papers forms have been elaborate for the audit process documentary providing. This provides optimization of the audit resources for obtaining audit evidence and monitoring the quality control in completed audit engagement. Review of the working papers of the predecessor auditor should be used for understanding the managerial staff attitude to making adjustments in terms of financial reporting on the results of its audits. It helps to avoid threats to the auditor independence, reduce the risk of not detecting material misstatement and allow the auditor to determine its confidence in opening balances.

  3. WE-DE-207A-04: Advances in Radiological Neuro-Endovascular Interventional Imaging.

    Science.gov (United States)

    Rudin, S

    2016-06-01

    1. Parallels in the evolution of x-ray angiographic systems and devices used for minimally invasive endovascular therapy Charles Strother - DSA, invented by Dr. Charles Mistretta at UW-Madison, was the technology which enabled the development of minimally invasive endovascular procedures. As DSA became widely available and the potential benefits for accessing the cerebral vasculature from an endovascular approach began to be apparent, industry began efforts to develop tools for use in these procedures. Along with development of catheters, embolic materials, pushable coils and the GDC coils there was simultaneous development and improvement of 2D DSA image quality and the introduction of 3D DSA. Together, these advances resulted in an enormous expansion in the scope and numbers of minimally invasive endovascular procedures. The introduction of flat detectors for c-arm angiographic systems in 2002 provided the possibility of the angiographic suite becoming not just a location for vascular imaging where physiological assessments might also be performed. Over the last decade algorithmic and hardware advances have been sufficient to now realize this potential in clinical practice. The selection of patients for endovascular treatments is enhanced by this dual capability. Along with these advances has been a steady reduction in the radiation exposure required so that today, vascular and soft tissue images may be obtained with equal or in many cases less radiation exposure than is the case for comparable images obtained with multi-detector CT.

  4. Endovascular treatment strategies for supra-aortic arterial occlusive disease.

    Science.gov (United States)

    Peeters, P; Verbist, J; Deloose, K; Bosiers, M

    2005-06-01

    Because of the focal nature of stenoses or occlusions in the supra-aortic vasculature, the high blood-pressures in this area and the very low morbidity rates related to percutaneous therapy have largely replaced surgical revascularization as the initial treatment of choice for patients with supra-aortic arterial occlusive disease. The initial technical success and durability of percutaneous angioplasty (PTA) and stenting in these lesions is excellent. Nevertheless several factors can make PTA and stenting a complex procedure that requires advanced endovascular skills for a successful outcome. Profound knowledge of surgical reconstruction techniques or extra-anatomic bypasses remains mandatory, as it is occasionally required for failure of endovascular techniques or if contraindications exist.

  5. Mechanical Thrombectomy-Ready Comprehensive Stroke Center Requirements and Endovascular Stroke Systems of Care: Recommendations from the Endovascular Stroke Standards Committee of the Society of Vascular and Interventional Neurology (SVIN)

    Science.gov (United States)

    English, Joey D.; Yavagal, Dileep R.; Gupta, Rishi; Janardhan, Vallabh; Zaidat, Osama O.; Xavier, Andrew R.; Nogueira, Raul G.; Kirmani, Jawad F.; Jovin, Tudor G.

    2016-01-01

    Five landmark multicenter, prospective, randomized, open-label, blinded end point clinical trials have recently demonstrated significant clinical benefit of endovascular therapy with mechanical thrombectomy in acute ischemic stroke (AIS) patients presenting with proximal intracranial large vessel occlusions. The Society of Vascular and Interventional Neurology (SVIN) appointed an expert writing committee to summarize this new evidence and make recommendations on how these data should guide emergency endovascular therapy for AIS patients. PMID:27051410

  6. Is the subscapularis normal after the open Latarjet procedure? An isokinetic and magnetic resonance imaging evaluation.

    Science.gov (United States)

    Caubère, Alexandre; Lami, Damien; Boileau, Pascal; Parratte, Sébastien; Ollivier, Matthieu; Argenson, Jean-Noël

    2017-10-01

    The Latarjet procedure is considered to be a violation of the subscapularis muscle. This study evaluated the postoperative status of the subscapularis through isokinetic and magnetic resonance imaging analysis after splitting. We hypothesized that compared with a healthy contralateral shoulder, there would be satisfactory recovery of subscapularis strength at the cost of some fatigability and some mild fatty infiltration. This was a case-control retrospective study of patients who underwent a Latarjet procedure between January 2013 and January 2015. A total of 20 patients were reviewed at 1 year postoperatively. With the patient seated, strength testing of both shoulders was done (concentric, eccentric, and fatigability) with a dynamometer. Trophicity and fatty infiltration were analyzed by magnetic resonance imaging. Strength of the internal rotators (IRs) and external rotators (ERs) of the injured shoulder was significantly lower compared with the healthy shoulder in concentric testing at 180°/s and 60°/s (13% for IR and 20% for E, P Latarjet procedure, isokinetic testing showed a combined strength deficit in both internal and external rotation with a conserved muscle balance. Although no significant subscapularis fatty infiltration or atrophy was noted, there was a significant deficit in endurance compared with the healthy shoulder. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  7. Arthroscopic Remplissage and Open Latarjet Procedure for the Treatment of Anterior Glenohumeral Instability With Severe Bipolar Bone Loss.

    Science.gov (United States)

    Katthagen, J Christoph; Anavian, Jack; Tahal, Dimitri S; Millett, Peter J

    2016-10-01

    Bipolar bone loss in patients with anterior glenohumeral instability is challenging to treat. The goal of the treatment is to restore stability by ensuring that the humeral head remains within the glenoid vault. This can be achieved either with the combination of an arthroscopic Bankart procedure and remplissage (glenoid bone loss Latarjet procedure (glenoid bone loss >25%). In cases with more severe bipolar bone loss of both the glenoid and the humeral head, the conventional approach has been to lengthen the articular arc of the glenoid and to ignore the Hill-Sachs lesion. However, it has recently been shown that this can still lead to an "off-track" situation with persistent shoulder instability from engagement of the Hill-Sachs on the anterior glenoid. In these cases, the combination of a Hill-Sachs remplissage and the Latarjet procedure can be effective in preventing persistent instability. In this technical note, the surgical technique of an arthroscopic Hill-Sachs remplissage in combination with an open Latarjet procedure is presented.

  8. 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.

  9. [Risk factors for long-term result of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm].

    Science.gov (United States)

    Ye, W; Di, X; Liu, Q; Li, Y J; Zheng, Y H; Zeng, R; Song, X J; Liu, Z L; Liu, C W

    2016-12-06

    Objective: To summarize results of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm(AIPA), and to analysis clinical predictors of long term major adverse clinical events(MACE). Methods: Retrospectively collected endovascular treatment for AIPA cases in Peking Union Medical College Hospital within 2000 to 2015. Twenty-nine cases with AIPA treated by endovascular therapy were enrolled in this study. Twenty five cases were male, range from 23 to 67 years old, mean age was (39.3±11.4) years old.Demographic characters, locations of aneurysms, type to auto-immune disease, immuno medical therapy, operation strategy and long term follow-up data were reported. Statistical analysis was made to verify clinical predictors of long-term MACE. Results: Among the 29 cases, 22 cases with bechet's disease, 4 cases with Takayasu's arteritis, 2 cases with systemic lupus erythematosus, 1 cases with polyarteritis nodosa. Eight cases had ruptured or pending ruptured pesudo-aneurysms, the rest 21 cases had dull pain or no overt symptome. Twenty-four cases had infra-renal artery aneurysms, two were para-and supra-renal artery, two were supra-celiac artery, and the rest one had multiple aneurysms involved thoracic and abdominal aorta.All the cases received regular immune medical therapy except the three emergency cases. All the operations were under general anaesthesia. Nineteen cases underwent classical Endovascular aortic aneurysm repair (EVAR), 5 cases underwent fenestration EVAR, the rest 5 cases underwent hybrid procedure. All the 29 operations were successful, without conversion to open surgery. Major peri-operation complication included 3 incision infection, 3 pulmonary infection. No death occurred. All the cases received regular follow-up from 1 to 120 months. There were five recurrence of pseudo-aneurysm, 1 case suffered from iliac limb occlusion. 5 cases received re-intervention procedure. No occlusion of revascularizal visceral artery was

  10. Anestesia para intervenção cirúrgica endovascular na aorta abdominal Anestesia para intervención quirúrgica endovascular en la aorta abdominal Anesthesia for endovascular surgery of the abdominal aorta

    Directory of Open Access Journals (Sweden)

    Michelle Nacur Lorentz

    2008-10-01

    potenciales. Además de eso, se abordaron los cuidados perioperatorios que el procedimiento exige y las técnicas anestésicas que pueden ser utilizadas. CONCLUSIONES: El conocimiento de las alteraciones provenientes del procedimiento endovascular posibilita una conducta anestésica más adecuada y la mejora de los resultados perioperatorios en esos pacientes.BACKGROUND AND OBJECTIVES: Endovascular surgery for aneurism of the aorta is less invasive than the conventional procedure besides other advantages such as the absence of abdominal incision, absence of ligature of the aorta, and reduced postoperative recovery time. Since it is a relatively new procedure and to presenting a series of changes that should be known by the anesthesiologist, the objective of this report was to review the most relevant aspects of endovascular surgery, allowing more adequate perioperative anesthetic management. CONTENTS: A brief description of the technique of endovascular aneurism repair, possible vantages and disadvantages of its use, as well as potential complications are discussed. CONCLUSIONS: Knowledge of the changes secondary to the endovascular procedure allows a more adequate anesthetic conduct and improves the postoperative results in those patients.

  11. Abdominal aortic aneurysm: Treatment options, image visualizations and follow-up procedures

    Institute of Scientific and Technical Information of China (English)

    Zhong-Hua Sun

    2012-01-01

    Abdominal aortic aneurysm is a common vascular disease that affects elderly population.Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm,however,endovaseular aneurysm repair has rapidly expanded since its first introduction in 1990s.As a less invasive technique,endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair,especially in patients with co-morbid conditions.Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up.2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair.CT has the disadvantage of high cummulative radiation dose,of particular concern in younger patients,since patients require regular imaging follow-ups after endovascular repair,thus,exposing patients to repeated radiation exposure for life.There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair.Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts,but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta.This article reviews the treatment options of abdominal aortic aneurysm,various image visualization tools,and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods.Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

  12. Endovascular management of symptomatic cerebral malperfusion due to carotid dissection after type A aortic dissection repair.

    Science.gov (United States)

    Casana, R; Tolva, V; Majnardi, A Robecchi; Bianchi, P G; Addobati, L; Bertoni, G B; Cireni, L V; Silani, V

    2011-10-01

    Type A acute aortic dissection is a surgical emergency, and supra-aortic trunk involvement may be complicated by stroke in 6% to 20% of cases. A 66-year-old Caucasian female patient underwent a composite repair of the ascending aorta for type A aortic dissection. Postoperative period was complicated by episodes of "drop attack." Doppler ultrasound of supra-aortic trunks revealed an intimal flap occluding right internal carotid artery. Multiple stenting was performed from carotid bifurcation to internal carotid artery in order to exclude the dissection intimal flap. After endovascular procedure physiatrist considered that motor functional improvement was better than expected, and we support that endovascular resolution of carotid malperfusion led to a better outcome. According to other experience, endovascular procedure resulted as a safe and effective way. Moreover, ultrasound monitoring of supra-aortic trunks in postoperative period is recommended.

  13. Using an Android application to assess registration strategies in open hepatic procedures: a planning and simulation tool

    Science.gov (United States)

    Doss, Derek J.; Heiselman, Jon S.; Collins, Jarrod A.; Weis, Jared A.; Clements, Logan W.; Geevarghese, Sunil K.; Miga, Michael I.

    2017-03-01

    Sparse surface digitization with an optically tracked stylus for use in an organ surface-based image-to-physical registration is an established approach for image-guided open liver surgery procedures. However, variability in sparse data collections during open hepatic procedures can produce disparity in registration alignments. In part, this variability arises from inconsistencies with the patterns and fidelity of collected intraoperative data. The liver lacks distinct landmarks and experiences considerable soft tissue deformation. Furthermore, data coverage of the organ is often incomplete or unevenly distributed. While more robust feature-based registration methodologies have been developed for image-guided liver surgery, it is still unclear how variation in sparse intraoperative data affects registration. In this work, we have developed an application to allow surgeons to study the performance of surface digitization patterns on registration. Given the intrinsic nature of soft-tissue, we incorporate realistic organ deformation when assessing fidelity of a rigid registration methodology. We report the construction of our application and preliminary registration results using four participants. Our preliminary results indicate that registration quality improves as users acquire more experience selecting patterns of sparse intraoperative surface data.

  14. Scapular position after the open Latarjet procedure: results of a computed tomography scan study.

    Science.gov (United States)

    Cerciello, Simone; Edwards, T Bradley; Cerciello, Giuliano; Walch, Gilles

    2015-02-01

    The aim of this study was to investigate, through a computed tomography (CT) scan analysis, the effects of the Latarjet procedure on scapular position in an axial plane. Twenty healthy young male subjects (mean age, 22 years; range, 18-27 years) were enrolled as a control group. Twenty young male patients (mean age, 23 years; range, 17-30 years) with recurrent anterior shoulder dislocation were enrolled as the study group. CT cuts at a proper level allowed the identification of an α angle, which defined the tilt of the scapula relative to the anterior-posterior axis. In the control population, the α angles on the right and left shoulders were 48° (44°-52°) and 48° (44°-54°), respectively. In the study group, the preoperative α angles at the affected and healthy shoulders were 49° (46°-52°) and 49° (44°-52°), respectively. At day 45, the corresponding angles were 45° (40°-50°) and 49° (46°-52°). At 6 months, the average α angle of the shoulder operated on was 52° (46°-58°). The α angle value was restored in 5 cases, increased in 9 cases (mean, 8°), and decreased in 6 cases (mean, 3°). A general symmetry of scapular position was observed during CT scan analysis. This balance was lost initially after the Latarjet procedure, with a decrease of the α angle and scapular protraction. Six months after surgery, a small trend toward scapular retraction was conversely observed; however, the data were not statistically significant. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  15. Surgical and endovascular treatment of visceral arteries aneurysms: single-institution experience.

    Science.gov (United States)

    Dalainas, Ilias; Nano, Giovanni; Casana, Renato; Bianchi, Paolo; Stegher, Silvia; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    Through a retrospective single-Institution study we report our experience on the treatment of the visceral arteries aneurysms, surgical or endovascular. Between February 1993 and February 2003, 17 patients were admitted to our Institution for treatment of an aneurysm of a visceral artery. In the pre-endovascular period for our Institution (1993-1998), 9 patients have been treated surgically. In the second period (1998-2003), 4 patients were treated surgically; and 4 with an endovascular procedure. Only 1 patient died in the operating room because of the advanced hypovolemic shock (rupture pancreatoduodenal artery aneurysm) that was admitted to the Institution. She was one of the surgically treated patients of the second period. No other complications occurred in the other patients. The endovascular procedures had favorable outcome. Actually, the treatment of choice in our Department is interventistic, preferring endovascular treatment when the clinical and anatomo-morphological conditions are favorable. When the morphologic conditions are not favorable, the surgical reconstruction should respect as much as possible the anatomic location of the lesion.

  16. [Arthroscopic coracoclavicular ligament reconstruction versus open modified Weaver-Dunn procedure for acromioclavicular joint dislocations:comparison of curative effect].

    Science.gov (United States)

    Li, F L; Jiang, C Y; Lu, Y; Zhu, Y M; Li, X

    2015-04-18

    To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dislocations. From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up. There were 49 men and 14 women with a mean age of (40.3±10.6) years. The mean time from injury to surgery was (10.3±5.3) d. According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with type III injury. All the patients with type III injury claimed high level of sport activity. The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken. All the patients were routinely followed up after the surgery. The visual analogue score (VAS), American shoulder and elbow surgeons(ASES) score and University of California Los Angeles(UCLA) score were employed to evaluate the postoperative shoulder function. The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint. The mean follow-up time was (29.6±6.0) months (range: 24 to 43 months). No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient's age [(41.0±10.5) years vs. (38.0± 10.8) years], gender (male/female,24/8 vs.25/6), classification (V/III,22/10 vs.23/8), time from injury to surgery [(10.6±4.9) d vs.(10.1±5.7) d], dominant involvement (19/32 vs.17/31)and mean follow-up time [(29.8±6.4) months vs.(29.5±5.5) months], P>0.05. At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward

  17. Validation Tests of Open-Source Procedures for Digital Camera Calibration and 3d Image-Based Modelling

    Science.gov (United States)

    Toschi, I.; Rivola, R.; Bertacchini, E.; Castagnetti, C.; Dubbini, M.; Capra, A.

    2013-07-01

    Among the many open-source software solutions recently developed for the extraction of point clouds from a set of un-oriented images, the photogrammetric tools Apero and MicMac (IGN, Institut Géographique National) aim to distinguish themselves by focusing on the accuracy and the metric content of the final result. This paper firstly aims at assessing the accuracy of the simplified and automated calibration procedure offered by the IGN tools. Results obtained with this procedure were compared with those achieved with a test-range calibration approach using a pre-surveyed laboratory test-field. Both direct and a-posteriori validation tests turned out successfully showing the stability and the metric accuracy of the process, even when low textured or reflective surfaces are present in the 3D scene. Afterwards, the possibility of achieving accurate 3D models from the subsequently extracted dense point clouds is also evaluated. Three different types of sculptural elements were chosen as test-objects and "ground-truth" data were acquired with triangulation laser scanners. 3D models derived from point clouds oriented with a simplified relative procedure show a suitable metric accuracy: all comparisons delivered a standard deviation of millimeter-level. The use of Ground Control Points in the orientation phase did not improve significantly the accuracy of the final 3D model, when a small figure-like corbel was used as test-object.

  18. 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.

  19. 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.

  20. Stab Incision Glaucoma Surgery: A Modified Guarded Filtration Procedure for Primary Open Angle Glaucoma.

    Science.gov (United States)

    Jacob, Soosan; Figus, Michele; Ashok Kumar, Dhivya; Agarwal, Ashvin; Agarwal, Amar; Areeckal Incy, Saijimol

    2016-01-01

    Purpose. To describe a modified guarded filtration surgery, stab incision glaucoma surgery (SIGS), for primary open angle glaucoma (POAG). Methods. This prospective, interventional case series included patients with POAG (IOP ≥21 mmHg with glaucomatous visual field defects). After sliding superior conjunctiva down over limbus, 2.8 mm bevel-up keratome was used to create conjunctival entry and superficial corneoscleral tunnel in a single step starting 1.5 mm behind limbus. Lamellar corneoscleral tunnel was carefully dissected 0.5-1 mm into cornea and anterior chamber (AC) was entered. Kelly Descemet's punch (1 mm) was slid along the tunnel into AC to punch internal lip of the tunnel, thereby compromising it. Patency of ostium was assessed by injecting fluid in AC and visualizing leakage from tunnel. Conjunctival incision alone was sutured. Results. Mean preoperative IOP was 27.41 ± 5.54 mmHg and mean postoperative IOP was 16.47 ± 4.81 mmHg (n = 17). Mean reduction in IOP was 38.81 ± 16.55%. There was significant reduction of IOP (p < 0.000). 64.7% had IOP at final follow-up of <18 mmHg without medication and 82.35% had IOP <18 mmHg with ≤2 medications. No sight threatening complications were encountered. Conclusion. Satisfactory IOP control was noted after SIGS in interim follow-up (14.18 ± 1.88 months).

  1. Stab Incision Glaucoma Surgery: A Modified Guarded Filtration Procedure for Primary Open Angle Glaucoma

    Directory of Open Access Journals (Sweden)

    Soosan Jacob

    2016-01-01

    Full Text Available Purpose. To describe a modified guarded filtration surgery, stab incision glaucoma surgery (SIGS, for primary open angle glaucoma (POAG. Methods. This prospective, interventional case series included patients with POAG (IOP ≥21 mmHg with glaucomatous visual field defects. After sliding superior conjunctiva down over limbus, 2.8 mm bevel-up keratome was used to create conjunctival entry and superficial corneoscleral tunnel in a single step starting 1.5 mm behind limbus. Lamellar corneoscleral tunnel was carefully dissected 0.5–1 mm into cornea and anterior chamber (AC was entered. Kelly Descemet’s punch (1 mm was slid along the tunnel into AC to punch internal lip of the tunnel, thereby compromising it. Patency of ostium was assessed by injecting fluid in AC and visualizing leakage from tunnel. Conjunctival incision alone was sutured. Results. Mean preoperative IOP was 27.41±5.54 mmHg and mean postoperative IOP was 16.47±4.81 mmHg (n=17. Mean reduction in IOP was 38.81±16.55%. There was significant reduction of IOP (p<0.000. 64.7% had IOP at final follow-up of <18 mmHg without medication and 82.35% had IOP <18 mmHg with ≤2 medications. No sight threatening complications were encountered. Conclusion. Satisfactory IOP control was noted after SIGS in interim follow-up (14.18±1.88 months.

  2. Newer endovascular tools: a review of experimental and clinical aspects.

    Science.gov (United States)

    Sorenson, Thomas; Brinjikji, Waleed; Lanzino, Giuseppe

    2016-03-01

    The history of treatment of intracranial aneurysms dates back to the late 18th century. These early physicians largely based their crude techniques around "wire insertion alone, galvanopuncture (electrothrombosis), and fili-galvanopuncture (wire insertion together with electrothrombosis)," albeit with overwhelmingly unfavorable outcomes. By the end of the 20th century, treatment options progressed to include two highly effective, and safe, procedures: surgical clipping and endovascular coiling. These methods have been found to be effective treatments for a large portion of aneurysms, but there still exists a subset of patients that do not respond well to these therapies. While much progress has been made in stent-assisted coiling including the development of newer stents aimed at keep the coil ball from protruding into the parent vessel, the introduction of flow diverters has characterized a new phase in the endovascular treatment of intracranial aneurysms. This treatment paradigm is rapidly becoming the treatment of choice for large and complex aneurysms internal carotid artery. Intrasaccular flow diverters such as the Woven EndoBridge device (WEB) and Luna device are showing promise in the treatment of wide neck bifurcation aneurysms. Other newer devices including the pCONus Bifurcating Aneurysm Implant and Endovascular Clip Systems (eCLIPs) are showing promise in small clinical and preclinical studies. As technology improves, newer devices with ingenious designs are constantly being introduced into the clinical arena. Most of these devices try to address the limitations of traditional endovascular methods in regard to providing a safe and effective treatment of wide-necked bifurcation aneurysms. Several large prospective studies are underway and once completed, the role of these newer devices will be better defined. It is easy to anticipate that with advances in 3D techniques and printing, a future in which customized devices are designed based on the individual

  3. 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.)

  4. 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.

  5. Fenestrated and branched endovascular techniques for thoraco-abdominal aneurysm repair

    NARCIS (Netherlands)

    Verhoeven, ELG; Zeebregts, CJ; Kapma, MR; Tielliu, IFJ; Prins, TR; Van Den Dungen, JJAM

    Since 1991, endovascular aortic aneurysm repair (EVAR) has been established as an alternative for open surgical repair of aortic aneurysms. one of the main limitations for EVAR is the need for a sufficient scaling zone below or above vital aortic side branches. Recently, efforts have been made to

  6. Cumulative Incidence of Graft Infection after Primary Prosthetic Aortic Reconstruction in the Endovascular Era

    NARCIS (Netherlands)

    Berger, P.; Vaartjes, I.; Moll, F. L.; De Borst, G. J.; Blankensteijn, J. D.; Bots, M. L.

    2015-01-01

    Objective: The introduction of endovascular techniques has had a major impact on the case mix of patients that undergo open aortic reconstruction. Hypothetically, this may also have increased the incidence of aortic graft infection (AGO. The aim of this study was to report on the short and mid-term

  7. 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; Moll, Frans L; 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 endovas

  8. Endovascular retrieval of an irrigation cannula from the thoracic aorta following cardiac surgery: A case report

    Directory of Open Access Journals (Sweden)

    Biju K. Thomas

    2015-01-01

    Conclusion: Endovascular retrieval of intravascular foreign bodies is minimally invasive, relatively simple, and carries minimal morbidity compared to conventional open surgical techniques. This unusual case demonstrates the importance of a working knowledge of techniques and instruments requisite for retrieval of intravascular foreign bodies

  9. Fenestrated and branched endovascular techniques for thoraco-abdominal aneurysm repair

    NARCIS (Netherlands)

    Verhoeven, ELG; Zeebregts, CJ; Kapma, MR; Tielliu, IFJ; Prins, TR; Van Den Dungen, JJAM

    2005-01-01

    Since 1991, endovascular aortic aneurysm repair (EVAR) has been established as an alternative for open surgical repair of aortic aneurysms. one of the main limitations for EVAR is the need for a sufficient scaling zone below or above vital aortic side branches. Recently, efforts have been made to ov

  10. New insights in (acute) endovascular abdominal aneurysm repair : when fenestrated devices fall short

    NARCIS (Netherlands)

    Pol, R. A.; Tielliu, I. F. J.; Zeebregts, C. J.

    2013-01-01

    The suitability for endovascular aneurysm repair (EVAR) is determined primarily by abdominal aortic aneurysm (AAA) anatomy. For patients unsuitable for standard EVAR, due to proximal neck anatomy, fenestrated aortic stent-grafting (FEVAR) is a viable alternative to open repair surgery. Initially FEV

  11. Thoracic aorta coarctation in the adults: open surgery is still the gold standard.

    Science.gov (United States)

    Bozzani, Antonio; Arici, Vittorio; Ragni, Franco

    2013-04-01

    Aortic coarctation (CoA) is the fifth most common congenital heart defect, accounting for 6% to 8% of live births with congenital heart disease. Traditional treatment for CoA consists of open surgical repair, and the endovascular procedures have been proposed as an alternative treatment. We describe the case of a 50-year-old man presented to our department with mild lower limbs claudication and hypertension. The computed tomography scan diagnosed an aortic postductal coarctation, which we treated with aortoplasty with Dacron patch. The open surgery, in our opinion, is nowadays still preferable due to the time-stable and effective outcome.

  12. Infection of endovascular abdominal aortic aneurysm stent graft after urosepsis: case report and review of the literature.

    Science.gov (United States)

    Veger, H T C; Hedeman Joosten, P Ph; Thoma, S R; Visser, M J T

    2013-02-01

    Infection of endovascular abdominal aneurysm stent grafts is an uncommon but known complication. Inoculation with bacteria of the endovascular abdominal aneurysm stent graft during the actual implantation, in the periprocedural hospitalization or later due to an aortoenteric fistula, has been described in the literature. We report a case of endovascular abdominal aortic aneurysm stent graft infection occurring 40 months after implantation in a patient doing well up to an episode of urosepsis. In conclusion, we postulate that poor intraluminal healing of stent grafts, as observed in several explant studies, may result in a higher susceptibility to episodes of bacteremia than prosthetic vascular grafts inserted during open repair. We therefore consider the administration of prophylactic antibiotics in patients with endovascular stent grafts during periods with a likelihood of bacteremia.

  13. Outcomes of Infrainguinal Revascularizations with Endovascular First Strategy in Critical Limb Ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Jens, Sjoerd, E-mail: s.jens@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands); Conijn, Anne P., E-mail: a.p.conijn@amc.uva.nl; Frans, Franceline A., E-mail: f.a.frans@amc.uva.nl [Academic Medical Center, Departments of Radiology and Surgery (Netherlands); Nieuwenhuis, Marieke B. B., E-mail: m.b.nieuwenhuis@amc.uva.nl; Met, Rosemarie, E-mail: rosemariemet@hotmail.com [Academic Medical Center, Department of Radiology (Netherlands); Koelemay, Mark J. W., E-mail: m.j.koelemaij@amc.uva.nl; Legemate, Dink A., E-mail: d.a.legemate@amc.uva.nl [Academic Medical Center, Department of Surgery (Netherlands); Bipat, Shandra, E-mail: s.bipat@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl [Academic Medical Center, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThis study was designed to study the outcome of infrainguinal revascularization in patients with critical limb ischemia (CLI) in an institution with a preference towards endovascular intervention first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age.MethodsA prospective, observational cohort study was conducted between May 2007 and May 2010 in patients presenting with CLI. At baseline, the optimal treatment was selected, i.e., endovascular or surgical treatment. In case of uncertainty about the preferred treatment, a multidisciplinary team (MDT) was consulted. Primary endpoints were quality of life and functional status 6 and 12 months after initial intervention, assessed by the VascuQol and AMC Linear Disability Score questionnaires, respectively.ResultsIn total, 113 patients were included; 86 had an endovascular intervention and 27 had surgery. During follow-up, 41 % underwent an additional ipsilateral revascularisation procedure. For the total population, and endovascular and surgery subgroups, the VascuQol sum scores improved after 6 and 12 months (p < 0.01 for all outcomes) compared with baseline. The functional status improved (p = 0.043) after 12 months compared with baseline for the total population. Functional status of the surgery subgroup improved significantly after 6 (p = 0.031) and 12 (p = 0.044) months, but not that of the endovascular subgroup.ConclusionsOverall, the strategy of performing endovascular treatment first in patients with poor condition, unfavourable anatomy for surgery, no venous material for bypass, and old age has comparable or even slightly better results compared with the BASIL trial and other cohort studies. All vascular groups should discuss whether their treatment strategy should be directed at treating CLI patients preferably endovascular first and consider implementing an MDT to optimize patient outcomes.

  14. 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.

  15. Endovascular management of an acquired aortobronchial fistula following aortic bypass for coarctation.

    Science.gov (United States)

    O'Sullivan, Katie E; Bolster, Ferdia; Lawler, Leo P; Hurley, John

    2014-01-01

    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.

  16. Endovascular treatment of aortic arch aneurysms Tratamento endovascular dos aneurismas de arco aórtico

    Directory of Open Access Journals (Sweden)

    Roberto Chiesa

    2008-06-01

    Full Text Available BACKGROUND: Endovascular approach to the aortic arch is an appealing solution for selected patients. OBJECTIVE: To compare the technical and clinical success recorded in the different anatomical settings of endografting for aortic arch disease. METHODS: Between June 1999 and October 2006, among 178 patients treated at our institution for thoracic aorta disease with a stent-graft, the aortic arch was involved in 64 cases. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 14 cases, zone 1 in 12 cases and zone 2 in 38 cases. A hybrid surgical procedure of supra-aortic debranching and revascularization was performed in 37 cases. RESULTS: Zone 0. Proximal neck length: 44±6 mm. Initial clinical success was 78.6%: two deaths (stroke, one type Ia endoleak. At a mean follow-up of 16.4±11 months the midterm clinical success was 85.7%. Zone 1. Proximal neck length: 28±5 mm. Initial clinical success was 66.7%: 0 deaths, four type Ia endoleaks. At a mean follow-up of 16.9±17.2 months the midterm clinical success was 75.0%. Zone 2. Proximal neck length: 30±5 mm. Initial clinical success was 84.2%: two deaths (one cardiac arrest, one multiorgan embolization, three type Ia endoleaks, one case of open conversion. Two cases of delayed transitory paraparesis/paraplegia were observed. At a mean follow-up of 28.0±17.2 months the midterm clinical success was 89.5%. CONCLUSIONS: This study and a literature review demonstrated that hybrid procedure for aortic arch pathology is feasible in selected patients at high risk for conventional surgery. Our experience is still limited by the relatively small sample size. We propose to reserve zone 1 for patients unfit for sternotomy or in cases with aortic neck length > 30 mm following left common carotid artery debranching. We recommend to perform complete aortic rerouting of the aortic arch in cases with lesser comorbidities and shorter aortic neck.CONTEXTO: O tratamento endovascular

  17. 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.

  18. [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.

  19. Biomechanical effectiveness of an arthroscopic posterior bankart repair versus an open bone block procedure for posterior shoulder instability.

    Science.gov (United States)

    Wellmann, Mathias; Bobrowitsch, Evgenij; Khan, Nicklas; Patzer, Thilo; Windhagen, Henning; Petersen, Wolf; Bohnsack, Michael

    2011-04-01

    The most effective surgical treatment for traumatic posterior shoulder instability remains unclear. An arthroscopic posterior Bankart repair is as effective as an open posterior bone block-capsulorrhaphy procedure regarding the restoration of humeral displacement with posterior and inferior forces. Controlled laboratory study. Biomechanical testing of 16 human shoulders was performed in 3 testing conditions: after ventilation (intact joint), after creation of a posteroinferior Bankart lesion with an additional cut of the posterior band of the inferior glenohumeral ligament, and after surgical shoulder stabilization. The shoulder stabilization was performed either by an open posterior bone block procedure and glenoid-based T-capsulorrhaphy or by an arthroscopic Bankart repair. Testing was performed in 2 positions-the sulcus test position and the jerk test position-with a passive humerus load of 50 N applied in the posterior, posteroinferior, and inferior directions. After the arthroscopic repair, there was no significant difference between the translation and the intact state for all tested directions. The bone block repair-capsulorrhaphy caused a significant decrease of posterior translation (sulcus test and jerk test positions) and posteroinferior translation (jerk test position). But the resulting posterior and posteroinferior translation was even significantly lower than the translation measured for the intact joints. However, the reduction of inferior translation, compared with that of the defect condition, was not significant after the bone block repair (sulcus test and jerk test positions). Compared with that of the intact joint, inferior translation after the bone block repair was significantly higher. The posterior bone block repair-capsulorrhaphy overcorrects posterior translation and does not effectively restore inferior stability, whereas the arthroscopic posterior Bankart repair restores posterior and inferior laxity of the intact joint. An arthroscopic

  20. Image-guided spinal injection procedures in open high-field MRI with vertical field orientation: feasibility and technical features

    Energy Technology Data Exchange (ETDEWEB)

    Streitparth, F.; Walter, T.; Wonneberger, U.; Wagner, M.; Hermann, K.G.; Hamm, B.; Teichgraeber, U. [Charite, Humboldt-Universitaet zu Berlin, Department of Radiology, Berlin (Germany); Chopra, S. [Charite-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Department of General, Visceral, and Transplantation Surgery, Berlin (Germany); Wichlas, F. [Charite-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Center for Musculoskeletal Surgery, Berlin (Germany)

    2010-02-15

    We prospectively evaluated the feasibility and technical features of MR-guided lumbosacral injection procedures in open high-field MRI at 1.0 T. In a CuSO{sub 4}.5H{sub 2}O phantom and five human cadaveric spines, fluoroscopy sequences (proton-density-weighted turbo spin-echo (PDw TSE), T1w TSE, T2w TSE; balanced steady-state free precession (bSSFP), T1w gradient echo (GE), T2w GE) were evaluated using two MRI-compatible 20-G Chiba-type needles. Artefacts were analysed by varying needle orientation to B{sub 0}, frequency-encoding direction and slice orientation. Image quality was described using the contrast-to-noise ratio (CNR). Subsequently, a total of 183 MR-guided nerve root (107), facet (53) and sacroiliac joint (23) injections were performed in 53 patients. In vitro, PDw TSE sequence yielded the best needle-tissue contrasts (CNR = 45, 18, 15, 9, and 8 for needle vs. fat, muscle, root, bone and sclerosis, respectively) and optimal artefact sizes (width and tip shift less than 5 mm). In vivo, PDw TSE sequence was sufficient in all cases. The acquisition time of 2 s facilitated near-real-time MRI guidance. Drug delivery was technically successful in 100% (107/107), 87% (46/53) and 87% (20/23) of nerve root, facet and sacroiliac joint injections, respectively. No major complications occurred. The mean procedure time was 29 min (range 19-67 min). MR-guided spinal injections in open high-field MRI are feasible and accurate using fast TSE sequence designs. (orig.)

  1. 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

  2. A Novel Technique for Endovascular Removal of Large Volume Right Atrial Tumor Thrombus

    Energy Technology Data Exchange (ETDEWEB)

    Nickel, Barbara, E-mail: nickel.ba@gmail.com [US Teleradiology and Quantum Medical Radiology Group (United States); McClure, Timothy, E-mail: tmcclure@gmail.com; Moriarty, John, E-mail: jmoriarty@mednet.ucla.edu [UCLA Medical Center, Department of Interventional Radiology (United States)

    2015-08-15

    Venous thromboembolic disease is a significant cause of morbidity and mortality, particularly in the setting of large volume pulmonary embolism. Thrombolytic therapy has been shown to be a successful treatment modality; however, its use somewhat limited due to the risk of hemorrhage and potential for distal embolization in the setting of large mobile thrombi. In patients where either thrombolysis is contraindicated or unsuccessful, and conventional therapies prove inadequate, surgical thrombectomy may be considered. We present a case of percutaneous endovascular extraction of a large mobile mass extending from the inferior vena cava into the right atrium using the Angiovac device, a venovenous bypass system designed for high-volume aspiration of undesired endovascular material. Standard endovascular methods for removal of cancer-associated thrombus, such as catheter-directed lysis, maceration, and exclusion, may prove inadequate in the setting of underlying tumor thrombus. Where conventional endovascular methods either fail or are unsuitable, endovascular thrombectomy with the Angiovac device may be a useful and safe minimally invasive alternative to open resection.

  3. Endovascular Broad-Neck Aneurysm Creation in a Porcine Model Using a Vascular Plug

    Energy Technology Data Exchange (ETDEWEB)

    Muehlenbruch, Georg, E-mail: gmuehlenbruch@ukaachen.de; Nikoubashman, Omid; Steffen, Bjoern; Dadak, Mete [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, University Hospital (Germany); Palmowski, Moritz [RWTH Aachen University, Department of Nuclear Medicine, University Hospital (Germany); Wiesmann, Martin [RWTH Aachen University, Department of Diagnostic and Interventional Neuroradiology, University Hospital (Germany)

    2013-02-15

    Ruptured cerebral arterial aneurysms require prompt treatment by either surgical clipping or endovascular coiling. Training for these sophisticated endovascular procedures is essential and ideally performed in animals before their use in humans. Simulators and established animal models have shown drawbacks with respect to degree of reality, size of the animal model and aneurysm, or time and effort needed for aneurysm creation. We therefore aimed to establish a realistic and readily available aneurysm model. Five anticoagulated domestic pigs underwent endovascular intervention through right femoral access. A total of 12 broad-neck aneurysms were created in the carotid, subclavian, and renal arteries using the Amplatzer vascular plug. With dedicated vessel selection, cubic, tubular, and side-branch aneurysms could be created. Three of the 12 implanted occluders, two of them implanted over a side branch of the main vessel, did not induce complete vessel occlusion. However, all aneurysms remained free of intraluminal thrombus formation and were available for embolization training during a surveillance period of 6 h. Two aneurysms underwent successful exemplary treatment: one was stent-assisted, and one was performed with conventional endovascular coil embolization. The new porcine aneurysm model proved to be a straightforward approach that offers a wide range of training and scientific applications that might help further improve endovascular coil embolization therapy in patients with cerebral aneurysms.

  4. Evaluation of cerebral oximetry during endovascular treatment of carotid-cavernous fistula

    Science.gov (United States)

    Dujovny, Manuel; Misra, Mukesh; Alp, M. Serdar; Debrun, Gerard; Charbel, F. T.; Aletich, Victor; Ausman, James I.

    1997-08-01

    Endovascular treatment of carotid cavernous fistula is done routinely in our institution. We have been monitoring these patients with transcranial cerebral oximetry. The transcranial cerebral oximeter is a reliable, low-cost, non-invasive device that provides real-time evaluation of regional brain oxygen saturation during and after endovascular treatment of cerebrovascular diseases. We used the INVOS 3100A (Somanetics, Troy, MI) in our study. We discuss seven patients with carotid-cavernous fistulas treated by endovascular balloon occlusion, each monitored continuously before, during, and after the procedure with transcranial cerebral oximetry. The cerebral oxygen saturation depicted was directly related to the side of the venous drainage of the fistula, with the brain oxygen saturation 15 - 20% higher on the side of the venous drainage. Following endovascular occlusion of the fistula, oxygen saturation gradually became equal on both sides. In our patients treated for carotid-cavernous fistula, we evaluated the sensitivity and usefulness of cerebral oximetry as an important non-invasive monitoring tool for the endovascular treatment of carotid-cavernous fistula.

  5. Introduction of endovascular embolization for intracranial aneurysms in a low-volume institution

    DEFF Research Database (Denmark)

    Lindekleiv, H M; Jacobsen, E A; Kloster, R

    2009-01-01

    BACKGROUND: Studies indicate a relationship between hospital caseload and health outcomes after both surgical and endovascular repair of intracranial aneurysms. PURPOSE: To evaluate outcomes after introduction of endovascular embolization for intracranial aneurysms in a low-volume regional...... university hospital. MATERIAL AND METHODS: Retrospective study of 243 consecutive patients treated for 284 intracranial aneurysms with endovascular embolization or surgical clipping from 2000 to 2006 at the University Hospital of North Norway. Postoperative complications were registered. The Glasgow Outcome...... Scale (GOS) was used for assessment of outcome. RESULTS: The mean annual number of procedures was 39 (microsurgery 23, embolization 16). Seventy-four percent of patients with ruptured aneurysms and all patients with unruptured aneurysms had a favorable outcome (GOS 4 or 5) at 1 year follow-up. Patients...

  6. Endovascular Sharp Recanalization for Calcified Femoropopliteal Artery Occlusion

    Directory of Open Access Journals (Sweden)

    Hsuan-Li Huang

    2012-01-01

    Full Text Available Endovascular intervention of peripheral chronic total occlusion (CTO is technically challenging and time consuming. Various techniques and devices are used to facilitate lesion crossing and improve the success rate of the procedure. However, these new devices are quite expensive and not readily available. We report 2 cases of peripheral CTO wherein the occlusions were successfully crossed by using stiff end of Terumo glidewire. This sharp recanalization may be a useful technique for the recanalization of calcified peripheral CTOs when conventional techniques fail and new devices are not readily available, but it is accompanied by the risk of distal atheroembolism.

  7. PERFORMANCE EVALUATION OF ENDOVASCULAR MYOCARDIUM REVASCULARIZATION IN RENAL TRANSPLANT RECIPIENTS

    Directory of Open Access Journals (Sweden)

    I. G. Ryadovoy

    2012-01-01

    Full Text Available Coronary artery stenting was performed at 75 renal transplant recipients. Diffuse multiple and expressed calcified coronary artery disease took place that created many difficulties during the procedures. In result of endovascular treatments positive dynamics of clinical condition in the nearest postoperative period was marked, tolerance to physical exercise was increased and according to this the functional class of angina was reduced. Cardiac and general mortality after treatment in comparison to the data of foreign authors was lower and comparable with demographic death rate of the population for persons of the same sex and age. 

  8. 中国血管外科医师在下肢动脉腔内治疗与静脉血栓栓塞症中的处方习惯调查%Prescribing patterns of antithrombotic therapy for lower extremity endovascular procedures and venous thromboembolism management in mainland China

    Institute of Scientific and Technical Information of China (English)

    岳嘉宁; 董智慧; 符伟国; 王玉琦; 郭大乔; 徐欣; 陈斌; 蒋俊豪; 杨珏; 史振宇; 竺挺

    2016-01-01

    vascular surgeons in China. Methods Attendees at a national vascular surgery meeting (CEC2012 with an attendance of 1453 vascular physicians) were asked to complete a voluntary survey indicating their prescribing patterns of antithrombotic drugs in patients undergoing infrainguinal endovascular procedures or suffering venous thromboembolism (VTE). Results A total of 155 valid responses were gathered, of which 80.6% were submitted by vascular surgeons. 93.5% of the responses were from physicians practicing in tertiary hospitals covering 25 provinces in China. For VTE prophylaxis , 80.0% of respondents would prescribe anticoagulation to high-risk nonorthopedic surgical patients. For VTE therapy , 76.1% of responding physicians would utilize extended bed rest strategy,and 77.4% would prescribe anticoagulation, of whom 11.2% would treat the patients for 3 months. The hospitals where the respondents practice had median monthly infrainguinal endovascular procedures of 21 (interquartile 13~41)cases. The rates of initial postoperative use of single, dual or triple antithrombotic treatment were 8.4%,72.3% and 11.7%, respectively. Among the latter two treatments,39.2%of respondents would ultimately transfer to mono antiplatelet therapy. Finally, 40.3% of respondents would adopt a life-long antithrombotic strategy. Cilostazol (63.4%) and prostacyclin analogue (61.4%) were the most commonly used adjunctive drugs prescribed following endovascular procedures. Proactive interventions against smoking cessation , hyperlipidemia and diabetes were offered by 90.2%, 80.5% and 77.3% respondents, respectively. Conclusions For VTE management, antithrombotic agents are chosen properly by most vascular surgeons in China , but the treatment duration is highly variable. Following infrainguinal endovascular procedures, a relative high proportion of combined antithrombotic therapy and low proportion of life-long antithrombotic therapy are prescribed.

  9. Preliminary Experience with the GORE(®) EXCLUDER(®) Iliac Branch Endoprosthesis for Common Iliac Aneurysm Endovascular Treatment.

    Science.gov (United States)

    Millon, Antoine; Della Schiava, Nellie; Arsicot, Matthieu; De Lambert, Alberic; Feugier, Patrick; Magne, Jean Luc; Lermusiaux, Patrick

    2016-05-01

    The aim of this study is to assess the safety and the short-term results of endovascular treatment of common iliac artery (CIA) aneurysms using the new GORE EXCLUDER iliac branch endoprosthesis (IBE) device. The study is a retrospective with prospective follow-up nonrandomized, single-arm evaluation. Patients with a CIA aneurysm (diameter >30 mm) extending to the iliac bifurcation underwent endovascular treatment with the Gore IBE. Anatomic and procedural data were collected. Computed tomography angiography (CTA) was performed within the 30 days after the procedure and every 6 month. Thirty-day and at least 6-months outcomes were investigated. From February 2014 to December 2014, 10 male patients with aneurysmal CIA (mean age 75 years old) underwent consecutive endovascular treatment with the Gore IBE. The CIA aneurysm (mean diameter 43.2 mm, range 32-49) treated with the Gore IBE was associated with an abdominal aortic aneurysm (AAA) in 5 patients. One patient had a previous AAA open repair. CIA aneurysm was bilateral in 5 patients. Preliminary procedure of internal iliac artery embolization was performed in 3 patients. Technical success rate of the Gore IBE implantation was 100% with a median fluoroscopy time of 35 min (range 12-64, ±16) and median contrast load of 150 mL (range 100-250, ±45). No perioperative complications were observed. Median length of stay was 4 days (range 3-7, ±2). One aortic type Ia endoleak was observed on the postoperative CT scan requiring an aortic extension at day 3. Branch patency was observed in all 10 patients at 1 month and 9 patients at 6 month. All CIA aneurysms were excluded without type Ib or type III endoleak. The technical success and short-term results demonstrate encouraging results and clinical benefits of the new GORE EXCLUDER IBE. A longer follow-up is needed to assess midterm and long-term results. Copyright © 2016 Elsevier Inc. All rights reserved.

  10. Vascular training and endovascular practice in Europe

    DEFF Research Database (Denmark)

    Liapis, C.D.; Avgerinos, E.D.; Sillesen, H.;

    2009-01-01

    OBJECTIVE: To evaluate the influence of the status of vascular surgery (VS) training paradigms on the actual practice of endovascular therapy among the European countries. METHODS: An email-based survey concerning vascular surgery training models and endovascular practices of different clinical...... specialties was distributed to a VS educator within 14 European countries. European Vascular and Endovascular Monitor (EVEM) data also were processed to correlate endovascular practice with training models. RESULTS: Fourteen questionnaires were gathered. Vascular training in Europe appears in 3 models: 1....... Mono-specialty (independence): 7 countries, 2. Subspecialty: 5 countries, 3. An existing specialty within general surgery: 2 countries. Independent compared to non-independent certification shortens overall training length (5.9 vs 7.9 years, p=0.006), while increasing overall training devoted...

  11. 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.

  12. A special type of endovascular stent repair with complicated thoracic aneurysm and chronic type B dissection aligned in tandem: double perfusion in true and false distal aorta lumen

    Institute of Scientific and Technical Information of China (English)

    GAN Hui-li; ZHANG Jian-qun

    2008-01-01

    @@ Aortic dissection and aortic aneurysm are two of the most common catastrophic events involving the aorta. Thoracic endovascular aortic repair is now considered as a promising alternative to open surgical graft replacement, The aim of endovascular repair of a thoracic aneurysm is to exclude, and thus depressurize, the aneurismal wall and the aim of the endovascular repair of type B aortic dissection is to obliterate all of the false lumen through thrombosis after sealing the primary entry tears, thus to ensure the true lumen perfusion.

  13. Antagonism of meta-chlorophenylpiperazine-induced inhibition of exploratory activity in an emergence procedure, the open field test, in rats.

    Science.gov (United States)

    Meert, T F; Melis, W; Aerts, N; Clincke, G

    1997-08-01

    The effects of meta-chlorophenylpiperazine (mCPP) were studied on exploratory behaviour in the open field test, using a procedure designed to evaluate the emergence of rats into a novel environment. mCPP reduced the exploratory activity in a dose-related manner after subcutaneous (s.c.), intraperitoneal (i.p.) and intravenous (i.v.) administration. The inhibition was manifest in all the parameters used to quantify the exploration of the open field area. Additional neuroendocrine experiments in a parallel group of rats revealed a dose-related increase in plasma prolactin and ACTH levels after i.v. mCPP, pointing to a general state of arousal in these mCPP-treated animals. A number of 5-HT antagonists were tested for their ability to prevent or reverse the behavioural inhibition induced by an i.v. injection of 1.0 g/kg mCPP given 15 min before testing in the open field. The antagonists were injected s.c. or given orally at various time intervals before mCPP, or they were injected i.v. 10 min after mCPP. The lowest active doses for the attentuation of the mCPP-induced behavioural inhibition after s.c., oral and i.v. administration, respectively, were 0.04, 40 and 10 mg/kg for pizotifen; 0.16, 0.16 and 0.16 mg/kg for mianserin; 0.63, 0.16 and 0.16 mg/kg for methysergide, and 0.16, 2.5 and 2.5 mg/kg for ritanserin. The lowest active doses of mirtazapine after s.c. and i.v. treatment were 0.01 and 0.16 mg/kg. These data indicate that mixed 5-HT1/5-HT2 receptor antagonists such as pizotifen and methysergide, and mixed 5-HT and catecholamine antagonists such as mianserin and mirtazapine are more potent antagonists of mCPP-induced behavioural inhibition in rats than the more selective 5-HT2A/5-HT2C antagonist ritanserin.

  14. Endovascular Radiofrequency Ablation for Varicose Veins

    Science.gov (United States)

    2011-01-01

    treatment plan. The RFA procedure involves the introduction of a guide wire into the target vein under ultrasound guidance followed by the insertion of an introducer sheath through which the RFA catheter is advanced. Once satisfactory positioning has been confirmed with ultrasound, a tumescent anaesthetic solution is injected into the soft tissue surrounding the target vein along its entire length. This serves to anaesthetize the vein, insulate the heat from damaging adjacent structures, including nerves and skin and compresses the vein increasing optimal contact of the vessel wall with the electrodes or expanded prongs of the RF device. The RF generator is then activated and the catheter is slowly pulled along the length of the vein. At the end of the procedure, hemostasis is then achieved by applying pressure to the vein entry point. Adequate and proper compression stockings and bandages are applied after the procedure to reduce the risk of venous thromboembolism and to reduce postoperative bruising and tenderness. Patients are encouraged to walk immediately after the procedure. Follow-up protocols vary, with most patients returning 1 to 3 weeks later for an initial follow-up visit. At this point, the initial clinical result is assessed and occlusion of the treated vessels is confirmed with ultrasound. Patients often have a second follow-up visit 1 to 3 months following RFA at which time clinical evaluation and ultrasound are repeated. If required, additional procedures such as phlebectomy or sclerotherapy may be performed during the RFA procedure or at any follow-up visits. Regulatory Status The Closure System® radiofrequency generator for endovascular thermal ablation of varicose veins was approved by Health Canada as a class 3 device in March 2005, registered under medical device license 67865. The RFA intravascular catheter was approved by Health Canada in November 2007 for the ClosureFast catheter, registered under medical device license 16574. The Closure System

  15. Contemporary open partial nephrectomy is associated with diminished procedure-specific morbidity despite increasing technical challenges: a single institutional experience.

    Science.gov (United States)

    Kava, Bruce R; De Los Santos, Rosely; Ayyathurai, Rajinikanth; Shirodkar, Samir; Manoharan, Murugesan; Leveillee, Raymond; Bird, Vincent; Ciancio, Gaetano; Soloway, Mark S

    2010-08-01

    To review trends in open partial nephrectomy (OPN) at our center, concentrating on patient selection, technique and perioperative complications. A comprehensive database was developed by chart review of consecutive patients undergoing OPN for renal masses at our center. Patient selection, technical modifications, perioperative morbidity, and histopathology were compared in patients undergoing OPN between 1992-1999, 2000-2003, and 2004-2008. Complications were divided into procedure-specific (PSCs) and nonspecific medical complications (NMCs). They were graded using the Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. One hundred and sixty-three OPNs were performed. Temporal trends identified include: an increase in the mean patient BMI (p = 0.04), an increase in the percentage of patients with central tumors (p analysis [odds ratio 1.067, CI 95% (1.002-1.136); p = 0.031]. Increasingly, OPN is being utilized for a cohort of challenging patients who are overweight and have centrally located tumors. Despite this, the risk of PSCs is low. Patients who are overweight are at increased risk for perioperative NMCs.

  16. Short-term curative effect of endovascular stent-graft treatment for aortic diseases in China: a systematic review.

    Directory of Open Access Journals (Sweden)

    Siwen Wang

    Full Text Available INTRODUCTION: We analyzed the short-term efficacy of endovascular treatment for aortic diseases by summarizing all available published data on endovascular stent-graft treatment for abdominal aortic aneurysm (AAA, thoracic aortic aneurysm (TAA, type A aortic dissection (type A AD and type B aortic dissection (type B AD in China. METHODS: We performed a systematic analysis of 935 published series on retrograde endovascular treatment for aortic diseases in China from January 1996 to November 2010. Based on the inclusion criteria, 159 studies, involving a total of 5531 patients, were included. RESULTS: There were no significant differences in procedural success among the studies (P>0.05. The rates of overall neurologic complications and stroke were significantly different in all two-group comparisons (P0.05. A significant difference was noted between the 30-day mortality rate of the type A AD patients and the AAA or type B AD patients (P<0.05. CONCLUSION: Endovascular stent-graft is a feasible and safe treatment for aortic diseases, with high procedural success and low incidences of post-procedural complications and short-term mortality. Endovascular treatment for AAA and type B AD is more efficient than for type A AD and TAA.

  17. Endovascular Aortic Repair of Primary Adult Coarctation: Implications and Challenges for Postoperative Nursing.

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    Sheppard, Christina E; Then, Karen L; Rankin, James A; Appoo, Jehangir J

    2015-01-01

    Endovascular aortic repair is a relatively new surgical technique used to treat a variety of aortic pathologies. Aortic coarctation traditionally has been managed with open surgical repair, involving a large posterolateral thoracotomy, cardiopulmonary bypass, and replacement of the narrowed section of the aorta with a dacron graft. Recent advances in minimally invasive aortic surgery have allowed for repair of the diseased section with an endovascular stent placed percutaneously through the groin under intraoperative fluoroscopic guidance. In this paper, the authors willfocus on the implicationsfor postoperative nursing care after endovascular repair of aortic coarctation using a case study of a 17-year-old male. This novel technique required education of the health care team with respect to implications for practice, understanding potential complications, discharge planning and follow-up. With any new surgical technique there are many questions and challenges that health care professionals raise. The main concerns expressed from the health care team stemmed from a lack of understanding of the disease pathology, and the different risk profile associated with an endovascular repair in contrast to an open repair. The authors will address these concerns in detail.

  18. Visceral hybrid reconstruction of thoracoabdominal aortic aneurysm after open repair of type a aortic dissection by the Bentall procedure with the elephant trunk technique: A case report

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    Marjanović Ivan

    2014-01-01

    Full Text Available Introduction. Reconstruction of chronic type B dissection and thoracoabdominal aortic aneurysm (TAAA remaining after the emergency reconstruction of the ascending thoracic aorta and aortic arch for acute type A dissection represents one of the major surgical challenges. Complications of chronic type B dissection are aneurysmal formation and rupture of an aortic aneurysm with a high mortality rate. We presented a case of visceral hybrid reconstruction of TAAA secondary to chronic dissection type B after the Bentall procedure with the elephant trunk technique due to acute type A aortic dissection in a high-risk patient. Case report. A 62 year-old woman was admitted to our institution for reconstruction of Crawford type I TAAA secondary to chronic dissection. The patient had had an acute type A aortic dissection 3 years before and undergone reconstruction by the Bentall procedure with the elephant trunk technique with valve replacement. On admission the patient had coronary artery disease (myocardial infarction, two times in the past 3 years, congestive heart disease with ejection fraction of 25% and chronic obstructive pulmonary disease. On computed tomography (CT of the aorta TAAA was revealed with a maximum diameter of 93 mm in the descending thoracic aorta secondary to chronic dissection. All the visceral arteries originated from the true lumen with exception of the celiac artery (CA, and the end of chronic dissection was below the origin of the superior mesenteric artery (SMA. The patient was operated on using surgical visceral reconstruction of the SMA, CA and the right renal artery (RRA as the first procedure. Postoperative course was without complications. Endovascular TAAA reconstruction was performed as the second procedure one month later, when the elephant trunk was used as the proximal landing zone for the endograft, and distal landing zone was the level of origin of the RRA. Postoperatively, the patient had no neurological deficit and

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

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    Nicolás I Jaramillo

    2005-08-01

    , probablemente llegue a ser la terapia preferida, aunque la técnica todavía está en proceso de refinamiento. A nivel mundial la experiencia viene en crecimiento y hoy se entienden mejor las indicaciones y las limitaciones de esta terapia innovadora. En este artículo se hace una revisión general sobre el diagnóstico clínico y el manejo de la disección aórtica y sus variantes: el hematoma intramural y la úlcera aórtica aterosclerótica.Treatment of thoracic aortic pathology is complicated by the morbidity associated to the surgical procedure and to the frailty of an elderly and difficult population. Surgical operation in this kind of population frequently bears a significant incidence of death and long term disability. In an effort to reduce the incidence of negative outcomes, minimally invasive techniques in the form of endovascular stenting have been introduced during the past decade. The technology, originally described by Parodi, and initially designed for its use in abdominal aortic aneurysms, has been adapted for the treatment of thoracic aortic aneurysms. Furthermore, an improved understanding of the pathophysiology and the natural history of thoracic aortic disease as well as the analysis of the outcomes has facilitated our treatment decisions in terms of the timing for an appropriate intervention. Treatment of thoracic aortic dissection using endovascular stent is one of the more recent advances in this condition and is receiving increasing attention as it is a less invasive alternative to an open surgical repair. Although this technology is still innovative, significant improvements have been made lately in the design and deployment of the endovascular stent-grafts. These prostheses have been increasingly used to treat aneurysms, dissections and traumatic ruptures, as well as giant penetrating ulcers and intramural hematomas of the descending thoracic aorta with good early and mid-term outcomes. The rareness, complexity and severity of the pathology and the

  20. 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

    2017-01-01

    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.

  1. Role of interventional endovascular therapy for delayed hemorrhage after pancreaticoduodenectomy

    Institute of Scientific and Technical Information of China (English)

    WANG Zhi-jun; WANG Mao-qiang; LIU Feng-yong; DUAN Feng; SONG Peng; FAN Qing-sheng

    2010-01-01

    Background Delayed massive hemorrhage (DMH) after pancreaticoduodenectomy (PD) is a sedous complication and one of the most common causes of mortality after PD. Its ideal management remains unclear. This paper is to present our experience in the endovascular treatment of patients with DMH after PD using different techniques and materials.Methods During a seven years period, 19 patients (fifteen men, four women) with DMH arter PD were treated with endovascular procedures, including transcatheter arterial embolization (TAE) with coils embolization in eight cases, with coils plus N-butyl-2-cyanoacrylate (NBCA)-Lipiodol mixture in six cases, and stent-graft placement in five cases. The mean age of the patients was 58.2 years. Follow-up, including clinical condition, liver function tests, and Doppler ultrasound examinations, was documented.Results The immediate technical success rate was 84.2% (16/19). There were no significant procedure-related complications. Hemostasis was not achieved with interventional procedures in three patients: one died of uncontrolled bleeding four days after the second TAE, and two patients required emergency laparotomy without re-angiography because of worsening clinical status. Among the 16 patients with successfully stopped bleeding who became hemodynamically stable after the procedure without evidence of further bleeding, two patients died during the peri-interventional procedure period because of multiple organ failure, and fourteen patients survived to hospital discharge. The mean length of follow-up was 14.6 months. Recurrent bleeding after discharge did not occur in any of these cases. Clinical and laboratory follow-up findings were unremarkable. Doppler ultrasound examinatation verified patency of the hepatic artery in the four patients with stent-graft placement during the follow-up period (5 months-29 months; mean, 15.3 months).Conclusions Interventional endovascular procedure is a safe and technically feasible solution to control

  2. Technical strategy in endovascular treatment of proximal anterior cerebral artery aneurysms.

    Science.gov (United States)

    Chang, Hyuk Won; Youn, Sung Won; Jung, Cheolkyu; Kang, Hyun-Seung; Sohn, Chul Ho; Kwon, Bae Ju; Han, Moon Hee

    2011-02-01

    There have been few reports on the endovascular treatment of aneurysms arising from A1 due to their rarity. We report the angiographic results, clinical outcomes, and technical aspects of endovascular treatment for 13 A1 aneurysms in 12 patients. From January 2002 to November 2007, 12 patients (9 females and 3 males) with 13 A1 aneurysms underwent endovascular treatment. Three of these patients presented with subarachnoid hemorrhage, and 10 unruptured aneurysms were detected in 9 patients. All of the aneurysms were successfully treated with coil embolization. Most of the aneurysms projected posteriorly (61.5%) and were located in the proximal A1 segment (69.2%). Procedural, clinical, and radiological follow-up data were reviewed. Procedure-related complications occurred in 3 patients (25%) and included 1 non-leaking aneurysmal perforation and 2 thromboembolic events; none of them were clinically significant. No bleeding or rebleeding occurred during the follow-up period in this cohort of patients. Endovascular coil embolization is an effective treatment modality for A1 aneurysms. Tailored microcatheter shaping according to aneurysm projection and location is necessary. Long-term follow-up studies involving a larger number of patients and further comparisons with surgical data are needed.

  3. Management with the insufficient proximal landing zone for endovascular repair in aortic dissection

    Institute of Scientific and Technical Information of China (English)

    MA Hao; YANG Hong-yu; ZOU Jun-jie; ZHANG Xi-wei

    2011-01-01

    Background Sufficient length of the proximal landing zone (PLZ) is the key for a successful thoracic endovascular aortic repair (TEVAR) of an aortic lesion. The aim of this research was to investigate the safety, feasibility, efficacy, and problems of endovascular repair for aortic dissection with insufficient PLZ.Methods The clinical data between August 2005 and February 2010 from patients with insufficient PLZ for endovascular repair of aortic dissection were retrospectively reviewed. According to the classification proposed by Ishimaru, aortic zone 0 was involved in 3 cases, zone 1 in 10 cases, and zone 2 in 11 cases. A hybrid surgical procedure of supraortic debranching and revascularization, directly coverage the orifice of left subclavian artery, or a left common carotid artery chimney graft technique were performed to obtain an adequate proximal aortic landing zone.Results There was no significant difference in risk factors and diameter of the PLZ between Zone 0, Zone 1, and Zone 2. But the length of the PLZ was significantly different in the three groups (P <0.01). There was no significant difference in technical and clinical success rate between the groups.Conclusions The procedure for extending an insufficient PLZ for endovascular repair for aortic arch pathology is feasible and relatively safe. The applicability of TEVAR in such aortic disorders may be expanded.

  4. Single center experience in endovascular aortic repair: review of technical and clinical aspects

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    Sinan Demirtaş

    2014-09-01

    Full Text Available Objective: The aim of this study is sharing of our endovascular aortic repair experiments in patients with high risk for surgery and contributing to literature with comparing previous report according to mortality complicationsand additional operations. Methods:Patients with endovascular aortic repair application were evaluated retrospectively. Perioperative one month mortality, additional applications during procedure, occurred complications, endoleak types, approaching anesthetical technique, diagnosis of disease, comorbid factors and demographical data registered. Results were compared with data in the literature Results: Abdominal endovascular aortic repair (EVAR applicated into 19 patients. Thoracic endovascular aor tic repair (TEVAR applicated into 11 patients. EVAR patients were operated with diagnosis of abdominal aortic aneurysm. Nine of these patients were emergely operated due to rupture. TEVAR applicated 8 patients were operated due to Type 3 Aortic Dissection and 1 patient was operated due to transsection. One month mortality of all patients were found as 10% (three atients. Endoleaks were occurred 6 patients: Three of them were Type 1a, two of them were Type1b and one of them was Type2. Balloon angioplasty applicated in two patients due to Type 1a endoleak and, in one patient due to Type 1b endoleak. Chronic renal failure was developed in one patient (3.3% due to contrast nephropathy. Reexploration was applicated in two patients (6.7% due to hematoma. Conclusion: Endovascular techniques are become frequently preferred treatment modality with the developing technology. We believed that endovascular approaches are safely preferable alternative in patients with high surgical risk as our series.

  5. Comparison of 30-Day Morbidity and Mortality After Arthroscopic Bankart, Open Bankart, and Latarjet-Bristow Procedures: A Review of 2864 Cases.

    Science.gov (United States)

    Bokshan, Steven L; DeFroda, Steven F; Owens, Brett D

    2017-07-01

    Surgical intervention for anterior shoulder instability is commonly performed and is highly successful in reducing instances of recurrent instability. To determine and compare the incidence of 30-day complications and patient and surgical risk factors for complications for arthroscopic Bankart, open Bankart, and Latarjet-Bristow procedures. Cohort study; Level of evidence, 3. All arthroscopic Bankart, open Bankart, and Latarjet-Bristow procedures from 2005 to 2014 from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) prospective database were analyzed. Baseline patient variables were assessed, including the Charlson Comorbidity Index (CCI). Outcomes measures included length of operation, length of hospital stay, need for hospital admission, 30-day readmission, and 30-day return to the operating room. Binary logistic regression was performed for the presence of any complications after all 3 procedures. There were 2864 surgical procedures (410 open Bankart, 163 Latarjet-Bristow, and 2291 arthroscopic Bankart) included. There was no significant difference with regard to age (P = .11), body mass index (P = .17), American Society of Anesthesiologists class (P = .423), or CCI (P = .479) for each group. The Latarjet-Bristow procedure had the highest overall complication rate (5.5%) compared with open (1.0%) and arthroscopic (0.6%) Bankart repairs. The Latarjet-Bristow procedure had significantly longer mean operative times (P Latarjet-Bristow. Surgical intervention for anterior shoulder instability has a low rate of complication (arthroscopic Bankart, 0.6%; open Bankart, 1.0%; Latarjet-Bristow, 5.5%) in the early postoperative period, with the most common being surgical site infection, deep vein thrombosis, and return to the operating room.

  6. Endovascular treatment of peripheral arterial injury with covered stents: an experimental study in pigs

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    Sergio Belczak

    2011-01-01

    Full Text Available OBJECTIVE: To evaluate the feasibility of using endovascular repair to treat penetrating arterial injuries with covered stents. Feasibility was examined according to the circumferential extent of the injury. INTRODUCTION: Surgical trauma often increases the risk of major morbidity and mortality associated with vascular injury, and endovascular repair has many advantages in such situations. METHODS: Twenty white male domestic pigs weighing 28-38 kg with controlled vascular injuries were divided into four equal groups according to the circumferential extent of their vascular lesion (i.e., no lesion, lesion 50%, and complete lesion. The left common carotid artery was dissected with proximal and distal control, and this procedure was followed by controlled sectioning of the arterial wall. Local manual compression was applied for 10 min and was followed by endovascular repair with the placement of a 5x50 mm VIABHAN TM covered stent using the femoral approach. We also monitored additional variables, such as the duration of the procedures (the mean was 56.3 ± 19.1 min, ultrasound parameters (e.g., maximum arterial diameter, peak systolic and diastolic velocity, and resistance index, arteriography findings, and fluctuations in vital signs (e.g., cardiac output, arterial pressure, and central venous pressure. RESULTS: The experimental procedure was found to be feasible and reproducible. Repairs were successful in all animals in the control (no lesion and 50% group and in one pig in the complete lesion group. DISCUSSION: The endovascular repair of an arterial injury is possible, but success depends on the circumferential extent of the arterial lesion. The present experimental model, which involved endovascular techniques, highlighted important factors that must be considered in future studies involving similar animals and materials.

  7. SU-E-I-53: Comparison of Kerma-Area-Product Between the Micro-Angiographic Fluoroscope (MAF) and a Flat Panel Detector (FPD) as Used in Neuro-Endovascular Procedures

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    Vijayan, S; Rana, V; Nagesh, S Setlur; Xiong, Z; Rudin, S; Bednarek, D [Toshiba Stroke and Vascular Research Center, University at Buffalo, Buffalo, NY (United States)

    2015-06-15

    Purpose: To determine the reduction of integral dose to the patient when using the micro-angiographic fluoroscope (MAF) compared to when using the standard flat-panel detector (FPD) for the techniques used during neurointerventional procedures. Methods: The MAF is a small field-of-view, high resolution x-ray detector which captures 1024 x 1024 pixels with an effective pixel size of 35μm and is capable of real-time imaging up to 30 frames per second. The MAF was used in neuro-interventions during those parts of the procedure when high resolution was needed and the FPD was used otherwise. The technique parameters were recorded when each detector was used and the kerma-area-product (KAP) per image frame was determined. KAP values were calculated for seven neuro interventions using premeasured calibration files of output as a function of kVp and beam filtration and included the attenuation of the patient table for the frontal projections to be more representative of integral patient dose. The air kerma at the patient entrance was multiplied by the beam area at that point to obtain the KAP values. The ranges of KAP values per frame were determined for the range of technique parameters used during the clinical procedures. To appreciate the benefit of the higher MAF resolution in the region of interventional activity, DA technique parameters were generally used with the MAF. Results: The lowest and highest values of KAP per frame for the MAF in DA mode were 4 and 50 times lower, respectively, compared to those of the FPD in pulsed fluoroscopy mode. Conclusion: The MAF was used in those parts of the clinical procedures when high resolution and image quality was essential. The integral patient dose as represented by the KAP value was substantially lower when using the MAF than when using the FPD due to the much smaller volume of tissue irradiated. This research was supported in part by Toshiba Medical Systems Corporation and NIH Grant R01EB002873.

  8. Thrombus Volume Change Visualization after Endovascular Abdominal Aortic Aneurysm Repair

    Science.gov (United States)

    Maiora, Josu; García, Guillermo; Macía, Iván; Legarreta, Jon Haitz; Boto, Fernando; Paloc, Céline; Graña, Manuel; Abuín, Javier Sanchez

    A surgical technique currently used in the treatment of Abdominal Aortic Aneurysms (AAA) is the Endovascular Aneurysm Repair (EVAR). This minimally invasive procedure involves inserting a prosthesis in the aortic vessel that excludes the aneurysm from the bloodstream. The stent, once in place acts as a false lumen for the blood current to travel down, and not into the surrounding aneurysm sac. This procedure, therefore, immediately takes the pressure off the aneurysm, which thromboses itself after some time. Nevertheless, in a long term perspective, different complications such as prosthesis displacement or bloodstream leaks into or from the aneurysmatic bulge (endoleaks) could appear causing a pressure elevation and, as a result, increasing the danger of rupture. The purpose of this work is to explore the application of image registration techniques to the visual detection of changes in the thrombus in order to assess the evolution of the aneurysm. Prior to registration, both the lumen and the thrombus are segmented

  9. Impacto da cirurgia endovascular sobre a cirurgia arterial convencional Impact of endovascular surgery upon standard arterial surgery

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    Jó Luis Andrade

    2005-02-01

    Full Text Available OBJETIVO: Avaliar o impacto da implantação da cirurgia endovascular (CEV em um serviço de cirurgia vascular convencional (CVC. MÉTODO: Análise retrospectiva dos procedimentos vasculares nos últimos 11 anos, dos procedimentos arteriais, anuais e por residente, entre 1999 (implantação da CEV e 2003, e das cirurgias com cirurgiões endovasculares e convencionais e por cirurgiões convencionais apenas. Foi também avaliado o percentual de encaminhamentos das CEV a serviço intervencionista. RESULTADOS: Houve uma queda inicial no número de procedimentos arteriais que foi recuperada após a implantação do serviço de CEV. O percentual das CEV no número total de cirurgias arteriais passou de 3,6% em 1999 para 25% em 2003 (pBACKGROUND: The aim of this study was to evaluate the impact of endovascular surgery (EVS upon a standard vascular surgical service. METHODS: Retrospective analysis of all vascular procedures of the last 11 years, the annual number of arterial procedures, the fellows surgical volume as well as the percentage of patients referred to radiology between 1999 (implantation of EVS and 2003, and the surgical volume of surgeons able to perform both operation and those who perform only standard surgery (SS. RESULTS: An initial decrease in the number of arterial procedures was observed, but recovered after EVS implantation. The percentage of EVS increased from 3.6% in 1999 to 25% in 2003 (p<0.05. There was no decrease in the number of fellows performing SS, yet an increase in their annual number of EVS was observed (2.6 in 1999 and 20 in 2003. All procedures were referred to radiology before 1999 versus none in 2003. Surgeons that perform both operations had an increase in their surgical volume compared to surgeons that perform only SS (p<0.05. CONCLUSION: Without implantation of EVS a decrease of vascular procedures can occur. On the other hand, EVS can lead to a recovery of surgical volume, including an increase in the SS. There

  10. Subarachnoid hemorrhage with blister aneurysms: Endovascular management

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    Swati Dayanand Chinchure

    2014-01-01

    Full Text Available Blister aneurysms of are rare lesions representing a real challenge for diagnosis and management. They typically show small size, hemispherical shape, fragile wall, broad neck, and are arising from non-branching sites of intracranial arteries. Materials and Methods: We retrospectively reviewed all aneurysms treated at our institution. Seventeen patients (6 male, 11 female with 17 blister aneurysms were identified (mean age 53.3, range 41-63 years. Clinical, procedural, angiographic data as well as follow up data were evaluated. Results: All patients presented with aneurysmal subarachnoid hemorrhage. Majority of the blister aneurysms were located in ICA while 1 was located at posterior cerebral artery, 1 at vertebral and 1 involving basilar artery. All patients were treated using single or overlapping stents and if possible additional coiling. There was no intra-operative rupture. Good outcome (mrs 0-2 was seen in 14 patients. Poor clinical outcome (mrs 3-5 was seen in 2 patients due to vasospasm induced ischemic deficits at discharge, both of them improved on follow up (mrs 1 on follow up. There were 3 mortalities, One patient died of rebleeding while other 2 died due to SAH induced complications. Follow-up angiography was available in 16 patients (one patient died before follow up angiogram and revealed complete or near complete aneurysm occlusion in 11, incomplete obliteration in 1 and no change in 2 cases. Two cases showed post-treatment angiographic aneurysm recurrence. Both cases were managed with repeat coiling and overlapping stent placement. Conclusion: Endovascular management using single/overlapping stent and if possible coil placement is technically safe and feasible in blister aneurysms. Overlapping stents lead to better aneurysm occlusion than a single stent. Blister aneurysm in dorso-medial ICA showed higher tendency of continued growth/recurrence, higher incidence of clinical vasospasm and in these cases early angiographic follow

  11. Endovascular thrombectomy for stroke: current best practice and future goals.

    Science.gov (United States)

    Campbell, Bruce C V; Donnan, Geoffrey A; Mitchell, Peter J; Davis, Stephen M

    2016-03-01

    Endovascular thrombectomy for large vessel ischaemic stroke substantially reduces disability, with recent positive randomised trials leading to guideline changes worldwide. This review discusses in detail the evidence provided by recent randomised trials and meta-analyses, the remaining areas of uncertainty and the future directions for research. The data from existing trials have demonstrated the robust benefit of endovascular thrombectomy for internal carotid and proximal middle cerebral artery occlusions. Uncertainty remains for more distal occlusions where the efficacy of alteplase is greater, less tissue is at risk and the safety of endovascular procedures is less established. Basilar artery occlusion was excluded from the trials, but with a dire natural history and proof of principle that rapid reperfusion is effective, it seems reasonable to continue treating these patients pending ongoing trial results. There has been no evidence of heterogeneity in treatment effect in clinically defined subgroups by age, indeed, those aged >80 years have at least as great an overall reduction in disability and reduced mortality. Similarly there was no heterogeneity across the range of baseline stroke severities included in the trials. Evidence that routine use of general anaesthesia reduces the benefit of endovascular thrombectomy is increasing and conscious sedation is generally preferred unless severe agitation or airway compromise is present. The impact of time delays has become clearer with description of onset to imaging and imaging to reperfusion epochs. Delays in the onset to imaging reduce the proportion of patients with salvageable brain tissue. However, in the presence of favourable imaging, rapid treatment appears beneficial regardless of the onset to imaging time elapsed. Imaging to reperfusion delays lead to decay in the clinical benefit achieved, particularly in those with less robust collateral flow. The brain imaging options to assess prognosis have

  12. 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.

  13. Infrarenal abdominal aortic aneurysm. Endovascular repair with stent grafts; Infrarenales Bauchaortenaneurysma. Endovaskulaere Stent-Graft-Therapie

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    Wagner, M.; Voshage, G.; Landwehr, P. [Klinik fuer Diagnostische und Interventionelle Radiologie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany); Busch, T. [Klinik fuer Gefaesschirurgie, Gefaesszentrum Hannover, Diakoniekrankenhaus Henriettenstiftung gGmbH, Hannover (Germany)

    2008-09-15

    As an alternative to surgery, endovascular therapy with stent grafts has become the second main treatment option for infrarenal abdominal aortic aneurysms. Unlike surgery, endovascular treatment with stent grafts is also applicable in patients unfit for open repair. Despite current improvements in endovascular repair devices, significant anatomic barriers still exclude this technique for a large number of patients. Computed tomography, magnetic resonance imaging, and ultrasound are essential for diagnostics, preintervention planning, and postintervention follow-up of abdominal aneurysms treated with stent grafts. This review covers etiology, pathology, and diagnostic aspects. Materials and methods for endovascular treatment of abdominal aortic aneurysms are presented in detail, and clinical results and complications are discussed. (orig.) [German] Die endovaskulaere Therapie des infrarenalen Bauchaortenaneurysmas hat sich als Alternative zur offenen chirurgischen Versorgung etabliert. Im Gegensatz zu Letzterer ist die Aneurysmatherapie mittels Stent-Grafts auch bei schwerkranken, nicht operationsfaehigen Patienten moeglich, wobei der Nutzen kontrovers diskutiert wird. Im Gegensatz zur klassischen transabdominellen Operation ist die Stent-Graft-Technik anatomischen Einschraenkungen unterworfen, die aber kuenftig aufgrund bereits abzusehender technischer Weiterentwicklungen eine geringere Rolle spielen werden. Die Diagnostik, die Entscheidung fuer eine endovaskulaere Therapie, die praeinterventionelle Planung und die Nachsorge erfordern den Einsatz bildgebender Verfahren, v. a. der Computer- und Magnetresonanztomographie sowie der Sonographie. Die fuer die endovaskulaere Aneurysmabehandlung relevanten Aspekte der Diagnostik werden dargestellt. Auf die Technik, die Materialien, die Ergebnisse und die Komplikationen der Stent-Graft-Behandlung wird ausfuehrlich eingegangen. (orig.)

  14. Postinterventional subarachnoid haemorrhage after endovascular stroke treatment with stent retrievers

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    Nikoubashman, Omid [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany); Institute for Neuroscience and Medicine 4, Juelich (Germany); Reich, Arno; Jungbluth, Michael [Uniklinik Aachen, Klinik fuer Neurologie, Aachen (Germany); Pjontek, Rastislav; Wiesmann, Martin [Uniklinik Aachen, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Aachen (Germany)

    2014-12-15

    The purpose of this paper is to investigate the clinical significance of postinterventional subarachnoid hyperdensities (PSH) after endovascular mechanical thrombectomy in acute ischemic stroke. We analysed clinical and radiological data of 113 consecutive patients who received postinterventional CT scans within 4.5 h after mechanical thrombectomy. PSH was present in 27 of 113 patients (24 %). Extravasation of contrast agent was observed during intervention in only 6 of 27 cases (22 %). There was consecutive haemorrhagic transformation in four patients with PSH (p = 0.209, Fisher's exact test). Preinterventional predictors for the occurrence of PSH in our series were a long interval between clinical onset and recanalization (p = 0.028), a long procedure time (p = 0.010), and a high number of recanalization attempts (p = 0.001). PSH had no significant impact on clinical outcome (modified Rankin Scale) at discharge (p = 0.419) or at 3 months (p = 0.396). There were no significant correlations between PSH and thrombectomy devices (Solitaire: p = 0.433, Trevo Pro: p = 0.124). PSH after endovascular mechanical thrombectomy in acute ischemic stroke are likely to occur in complicated cases in which more than one revascularisation attempt is performed. PSH per se do not appear to be associated with an impaired clinical outcome or an elevated risk for consecutive haemorrhage. (orig.)

  15. Enhanced segmentation and skeletonization for endovascular surgical planning

    Science.gov (United States)

    Cheng, Irene; Firouzmanesh, Amirhossein; Leleve, Arnaud; Shen, Rui; Moreau, Richard; Brizzi, Vicenzo; Pham, Minh-Tu; Redarce, Tanneguy; Lermusiaux, Patrick; Basu, Anup

    2012-02-01

    Endovascular surgery is becoming widely deployed for many critical procedures, replacing invasive medical operations with long recovery times. However, there are still many challenges in improving the efficiency and safety of its usage, and reducing surgery time; namely, regular exposure to radiation, manual navigation of surgical tools, lack of 3D visualization, and lack of intelligent planning and automatic tracking of a surgical end-effector. Thus, our goal is to develop hardware and software components of a tele-operation system to alleviate the abovementioned problems. There are three specific objectives in this project: (i) to reduce the need for a surgeon to be physically next to a patient during endovascular surgery; (ii) to overcome the difficulties encountered in manual navigation; and, (iii) to improve the speed and experience of performing such surgeries. To achieve (i) we will develop an electro-mechanical interface to accurately guide mechanically controlled surgical tools from a close distance, along with a 3D visualization interface; for (ii) we will replace the current surgical tools with an "intelligent wire" controlled by the electro-mechanical system; for (iii) we will segment 3D medical images to extract precise shapes of blood vessels, following which we will perform automatic path planning for a surgical end-effector.

  16. Endovascular Management of May-Thurner Syndrome

    Science.gov (United States)

    Al Safran, Zakareya; Hasan, Hosam; Zeid, Wael Abu

    2012-01-01

    May-Thurner syndrome or iliac vein compression syndrome is associated with deep vein thrombosis (DVT) resulting from chronic compression of the left iliac vein against lumbar vertebrae by the overlying right common iliac artery. Historically, May-Thurner syndrome has been treated with anticoagulation therapy. However, this therapy can be problematic when given alone, because it prevents the propagation of the thrombus without eliminating the existing clot. Furthermore, it does not treat the underlying mechanical compression. Consequently, syndrome who was managed by anticoagulation therapy alone, there is a significant chance that the patient will develop recurrent deep vein thrombosis or post thrombotic syndrome or both. Recently, both retrospective and prospective studies have suggested that endovascular management should be front-line treatment; endovascular management actively treats both the mechanical compression with stent placement and the thrombus burden with chemical dissolution. We report our case of 53 years old male patient with May Thurner syndrome who managed by endovascular treatment. PMID:23555515

  17. Endovascular treatment of very small intracranial aneurysms

    DEFF Research Database (Denmark)

    Iskandar, A; Nepper-Rasmussen, J

    2011-01-01

    The endovascular treatment of intracranial aneurysms 3 mm or less is considered controversial. The purpose of this study is to report angiographic and clinical results following coiling of such aneurysms and compare them to those of larger aneurysms (> 3 mm).Between November 1999 and November 2009...... endovascular treatment was attempted in 956 consecutive intracranial aneurysms. Of 956 aneurysms, 111 aneurysms were very small aneurysms with a maximal diameter of 3 mm or less. We conducted a retrospective analysis of angiographic and clinical outcome following coiling of very small aneurysms...... and subsequently comparing it to the results of larger aneurysms.Coiling initially failed in eight aneurysms. In the remaining 103 aneurysms endovascular treatment was accomplished and immediate angiographic results showed complete aneurysm occlusion in 43 aneurysms, nearly complete aneurysm occlusion in 54...

  18. Pneumatic compression for embolic protection during upper extremity endovascular intervention.

    Science.gov (United States)

    Cassar, Andrew; Barsness, Gregory W; Wysokinski, Waldemar E; Gifford, Shaun M; Bower, Thomas C; Edwards, William D; Gulati, Rajiv

    2014-01-01

    Embolic protection devices are occasionally employed during endovascular interventions to prevent complications caused by embolic debris. However, these devices have imperfect efficacy, confer risk of endovascular trauma, and are expensive. We report a patient with giant cell arteritis and symptomatic axillary artery stenosis, with a perceived elevated risk of distal embolization during endovascular intervention. We describe a straightforward embolic protection technique of brachial pressure cuff inflation during endovascular intervention and aspiration of displaced thrombotic material from the static column of blood. This novel, effective, and cost-free technique could also be employed in other vascular beds during endovascular intervention.

  19. Management of a delayed post-pancreatoduodenectomy haemorrhage using endovascular techniques

    Science.gov (United States)

    Asai, Kengo; Zaydfudim, Victor; Truty, Mark; Reid-Lombardo, KMarie; Kendrick, Michael; Que, Florencia; Nagorney, David; Andrews, James; Farnell, Michael

    2015-01-01

    Background A delayed post-pancreatoduodenectomy haemorrhage is associated with a significant increase in peri-operative mortality. Endovascular techniques are frequently used for a delayed haemorrhage. However, limited data exists on the short- and long-term outcomes of this approach. A retrospective review over a 10-year period at a quaternary-referral pancreatic centre was performed. Methods Between 2002–2012, 1430 pancreatoduodenectomies were performed, and 32 patients had a delayed haemorrhage (occurring >24 h post-operatively) managed by endovascular techniques. The clinicopathological variables related to a haemorrhage were investigated. Results A total of 42 endovascular procedures were performed at a median of 25 days, with the majority of delayed haemorrhages occurring after 7 days. There were four deaths (13%) with three occurring in patients with a grade C haemorrhage. Seven patients (22%) experienced rebleeding, and two patients developed hepatic abscesses. Conclusion A delayed haemorrhage post-pancreaticoduodenectomy can be managed by endovascular techniques with acceptable morbidity and mortality. Rebleeding and hepatic abscesses may occur and can be managed non-operatively in most cases. The association of a delayed haemorrhage with a pancreatic fistula makes this a challenging clinical problem. PMID:26235930

  20. Endovascular coil embolization for recurrence of intracranial aneurysms more than 10 years after clipping

    Directory of Open Access Journals (Sweden)

    Naoya Takeda

    2013-01-01

    Full Text Available We report three cases of endovascular coil embolization for recurrent cerebral aneurysm after neck clipping more than 10 years previously. In two cases, their first subarachnoid hemorrhage was treated in other hospitals and the details of follow-up after discharge were unknown. After their second subarachnoid hemorrhage recurred 15 and 30 years, respectively. The remaining patient, who was treated in our center, was followed by magnetic resonance imaging 5 years after surgery but since then she didn′t go to our center. She came to our center for follow-up examination 10 years after the first surgery. The digital subtraction angiography showed recurrence of clipped aneurysms in all patients. All of them underwent endovascular coil embolization and total obliteration of the aneurysms without complications related to the procedures. Endovascular coil embolization is an alternative modality to direct surgery for cerebral aneurysms, especially for recurrence after clipping. Endovascular coil embolization of residual aneurysms after surgery may be the treatment of choice because of the difficulties in second direct surgery. We conclude that it is necessary to perform follow-up evaluations after surgery, even if the complete obliteration of aneurysms is performed. Current medical literature does not provide recommendations for the duration of follow-up after aneurysm clipping. The authors suggest that this period perhaps be at least a decade.

  1. Early in vivo analysis of an endovascular stapler during endovascular aneurysm repair.

    Science.gov (United States)

    Murphy, Erin H; Arko, Frank R

    2009-01-01

    The objective of this article is to describe the use and technique of a novel endostapling device used in an in vivo animal model. Six ovine underwent implantation of a Dacron endograft into the thoracic aorta followed by placement of endoclips proximally and distally. The animals were survived 35 days to evaluate the performance and safety of the endoclip in an animal model prior to clinical trials. The mean time for securing both the proximal and the distal anastomosis was 22 minutes (range 17-31 minutes). All staples were deployed, without the need for repositioning, on the first attempt. There were no complications related to the implant procedure or indwelling clips. Additionally, no endograft migration occurred. At the time of explant, staples were evaluated for depth of penetration and accuracy of placement. The staples had fully penetrated the endograft and vessel wall through the adventitia in 89% (64 of 72) of clips deployed. The staples were placed accurately, within 10 mm of the endograft proximal and distal attachments in 94% (68 of 72) of the clips deployed. Furthermore, endothelialization of the staples was present without surrounding thrombus. Implant sites were scored as normal without surrounding tissue damage by an independent pathologist. The endoclip performed well in creating proximal and distal fixation of the endograft. There were no adverse outcomes related to the endostaple. Future clinical trials should be undertaken to assess its clinical utility during endovascular aneurysm repair.

  2. Endovascular Neurosurgery: Personal Experience and Future Perspectives.

    Science.gov (United States)

    Raymond, Jean

    2016-09-01

    From Luessenhop's early clinical experience until the present day, experimental methods have been introduced to make progress in endovascular neurosurgery. A personal historical narrative, spanning the 1980s to 2010s, with a review of past opportunities, current problems, and future perspectives. Although the technology has significantly improved, our clinical culture remains a barrier to methodologically sound and safe innovative care and progress. We must learn how to safely practice endovascular neurosurgery in the presence of uncertainty and verify patient outcomes in real time. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Direct cervical arterial access for intracranial endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Blanc, R. [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); APHP, Hopital Henri Mondor, Service de Neuroradiologie Diagnostique et Therapeutique, Creteil Cedex (France); Piotin, M.; Mounayer, C.; Spelle, L. [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); Moret, J. [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); Hopital de la Fondation Ophtalmologique Adolphe de Rothschild, Service de Neuroradiologie Interventionnelle, Paris Cedex 19 (France)

    2006-12-15

    Tortuous vasculature is a cause of failure of endovascular treatment of intracranial vascular lesions. We report our experience of direct cervical accesses in patients in whom the arterial femoral route was not attainable. In this retrospective study, 42 direct punctures of the carotid or the vertebral arteries at the neck were performed in 38 patients. The vessel harboring the intracranial lesion was punctured at the neck above the main tortuosity, a sheath was then positioned under fluoroscopic control to allow a stable access to the intracranial circulation. After the procedure, the sheath was removed and hemostasis was gained either by manual compression or by an arterial closure device (4 of 42, 9%). The cervical route allowed access to all intracranial lesions in all 42 procedures. A complication was encountered in six procedures (14%) related to the direct puncture. In 2 of the 42 procedures (4%), a transient vasospasm was encountered. A cervical hematoma formed in 3 of the 42 procedures (7%) after sheath withdrawal (one patient in whom an 8F sheath had been used, required surgical evacuation of a hematoma compressing the upper airways; the other patients did well without surgical evacuation). In the remaining patient (1 of 42 procedures, 2%), a small asymptomatic aneurysm at the puncture site was seen on the follow-up angiogram. Direct cervical arterial approaches to accessing the intracranial circulation is effective in patients in whom the femoral route does not allow the navigation and stabilization of guiding catheters. (orig.)

  4. Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

    OpenAIRE

    Miller, Larry E

    2012-01-01

    Blunt thoracic aortic injury (BTAI) is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR) has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less atte...

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

    Directory of Open Access Journals (Sweden)

    Swathy B

    2014-09-01

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

  6. 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

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

    Science.gov (United States)

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

    2010-01-01

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

  8. Fusion Guidance in Endovascular Peripheral Artery Interventions: A Feasibility Study

    Energy Technology Data Exchange (ETDEWEB)

    Sailer, Anna M., E-mail: anni.sailer@mumc.nl; Haan, Michiel W. de, E-mail: m.de.haan@mumc.nl; Graaf, Rick de, E-mail: r.de.graaf@mumc.nl; Zwam, Willem H. van, E-mail: w.van.zwam@mumc.nl [Maastricht University Medical Center, Department of Radiology (Netherlands); Schurink, Geert Willem H., E-mail: gwh.schurink@mumc.nl [Maastricht University Medical Center, Department of Surgery (Netherlands); Nelemans, Patricia J., E-mail: patty.nelemans@maastrichtuniversity.nl [Maastricht University Medical Centre, Department of Epidemiology (Netherlands); Wildberger, Joachim E., E-mail: j.wildberger@mumc.nl; Das, Marco, E-mail: m.das@mumc.nl [Maastricht University Medical Center, Department of Radiology (Netherlands)

    2015-04-15

    PurposeThis study was designed to evaluate the feasibility of endovascular guidance by means of live fluoroscopy fusion with magnetic resonance angiography (MRA) and computed tomography angiography (CTA).MethodsFusion guidance was evaluated in 20 endovascular peripheral artery interventions in 17 patients. Fifteen patients had received preinterventional diagnostic MRA and two patients had undergone CTA. Time for fluoroscopy with MRA/CTA coregistration was recorded. Feasibility of fusion guidance was evaluated according to the following criteria: for every procedure the executing interventional radiologists recorded whether 3D road-mapping provided added value (yes vs. no) and whether PTA and/or stenting could be performed relying on the fusion road-map without need for diagnostic contrast-enhanced angiogram series (CEAS) (yes vs. no). Precision of the fusion road-map was evaluated by recording maximum differences between the position of the vasculature on the virtual CTA/MRA images and conventional angiography.ResultsAverage time needed for image coregistration was 5 ± 2 min. Three-dimensional road-map added value was experienced in 15 procedures in 12 patients. In half of the patients (8/17), intervention was performed relying on the fusion road-map only, without diagnostic CEAS. In two patients, MRA roadmap showed a false-positive lesion. Excluding three patients with inordinate movements, mean difference in position of vasculature on angiography and MRA/CTA road-map was 1.86 ± 0.95 mm, implying that approximately 95 % of differences were between 0 and 3.72 mm (2 ± 1.96 standard deviation).ConclusionsFluoroscopy with MRA/CTA fusion guidance for peripheral artery interventions is feasible. By reducing the number of CEAS, this technology may contribute to enhance procedural safety.

  9. 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.

  10. Bladder distension: An unusual cause of reflux of blood and hemodynamic changes (autonomic dysreflexia during endovascular coiling

    Directory of Open Access Journals (Sweden)

    D P Sharma

    2011-01-01

    Full Text Available Autonomic dysreflexia due to distended bladder is well known. Reflux of blood during endovascular procedure is also a common observation. It happens due to difference in pressure gradient between arterial pressure and that of infusing solution. Generally it happens when the infusion bottle is empty or the pressure in infusion bottles fall. We present an uncommon situation where distended bladder mechanically resulted in reflux of blood into endovascular catheters as well as alteration in hemodynamic parameters. Both settled once the bladder was empty.

  11. [Late complication of surgical repair of aortic coarctation: ruptured pseudoaneurysm of the aorta treated by thoracic endovascular aortic repair].

    Science.gov (United States)

    Varejka, P; Lubanda, J C; Prochazka, P; Heller, S; Beran, S; Dostal, O; Charvat, F; Horejs, J; Semrad, M; Linhart, A

    2010-06-01

    Aortic coarctation is a frequent congenital defect requiring early surgical treatment. Late complications of these surgical procedures can be fatal as in the case of a ruptured anastomotic pseudoaneurysm. We present a case of a 49-year-old man presenting with hemorrhagic shock due to this complication who was successfully treated by endovascular techniques with implantation of two stent grafts. This case illustrates the fact that endovascular aortic repair is feasible, certainly less invasive and very efficient for this type of complication when used in an experienced center.

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

    Directory of Open Access Journals (Sweden)

    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.

  13. 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

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

  14. Endovascular treatment of a small infrarenal abdominal aortic aneurysm causing duodenal obstruction: Case report and literature review.

    Science.gov (United States)

    Esposito, Andrea; Menna, Danilo; Mansour, Wassim; Sirignano, Pasqualino; Capoccia, Laura; Speziale, Francesco

    2015-06-01

    Duodenal obstruction caused by abdominal aortic aneurysm was first described by Osler in 1905 and is named "aortoduodenal syndrome." This condition has always been treated by open surgical repair. We report the first case of aortoduodenal syndrome successfully treated by endovascular aneurysm repair. A 74-year-old male patient referred to our hospital complaining postprandial vomit, reporting a consistent weight loss in the latest weeks. Enhanced computed tomography scans showed a small saccular abdominal aortic aneurysm compressing duodenum and inferior vena cava without any other evident pathological finding. As the patient underwent a successful endovascular treatment of the abdominal aortic aneurysm, symptoms immediately resolved so that he started back to feed and progressively gained body weight. Despite aortoduodenal syndrome is generally caused by large abdominal aortic aneurysm, this condition has to be suspected also in case of small abdominal aortic aneurysm. Differently from what has been reported in literature, endovascular aneurysm repair could be effective in the treatment of aortoduodenal syndrome.

  15. Endovascular treatment of a triple paraanastomotic aneurysm after aortobiiliac reconstruction Tratamento endovascular de triplo aneurisma para-anastomótico após derivação aorto-biilíaca

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2008-09-01

    Full Text Available We report a case of a 72-year-old patient considered unfit for open surgery, presenting with paraanastomotic aneurysms of all three anastomoses, 13 years after an open aortobiiliac reconstruction for abdominal aortic aneurysm. This patient was successfully treated with an endovascular approach using a left aortouniiliac endograft and a right iliac tubular endograft, followed by crossover femorofemoral bypass. This report illustrates the usefulness of a minimally invasive approach for solving this complication of aortic open surgery and discusses technical issues related to endovascular devices in this particular setting.Relatamos um caso de um paciente de 72 anos não considerado elegível para cirurgia aberta, apresentando aneurismas para-anastomóticos das três anastomoses, 13 anos após uma reconstrução aberta aorto-biilíaca para aneurisma aórtico abdominal. Este paciente foi tratado com sucesso através de abordagem endovascular usando uma endoprótese aorto-uniilíaca esquerda e uma endoprótese tubular ilíaca direita, seguida por derivação cruzada fêmoro-femoral. Este relato ilustra a utilidade de uma abordagem minimamente invasiva para o tratamento desta complicação da cirurgia aórtica aberta e discute questões técnicas relacionadas a dispositivos endovasculares neste contexto em especial.

  16. Endovascular Treatment of Infrarenal Abdominal Aortic Aneurysm with Short and Angulated Neck in High-Risk Patient

    Directory of Open Access Journals (Sweden)

    Stylianos Koutsias

    2013-01-01

    Full Text Available Endovascular treatment of abdominal aortic aneurysms (AAA is an established alternative to open repair. However lifelong surveillance is still required to monitor endograft function and signal the need for secondary interventions (Hobo and Buth 2006. Aortic morphology, especially related to the proximal neck, often complicates the procedure or increases the risk for late device-related complications (Hobo et al. 2007 and Chisci et al. 2009. The definition of a short and angulated neck is based on length (60° (Hobo et al. 2007 and Chisci et al. 2009. A challenging neck also offers difficulties during open repairs (OR, necessitating extensive dissection with juxta- or suprarenal aortic cross-clamping. Patients with extensive aneurysmal disease typically have more comorbidities and may not tolerate extensive surgical trauma (Sarac et al. 2002. It is, therefore, unclear whether aneurysms with a challenging proximal neck should be offered EVAR or OR (Cox et al. 2006, Choke et al. 2006, Robbins et al. 2005, Sternbergh III et al. 2002, Dillavou et al. 2003, and Greenberg et al. 2003. In our case the insertion of a thoracic endograft followed by the placement of a bifurcated aortic endograft for the treatment of a very short and severely angulated neck proved to be feasible offering acceptable duration of aneurysm exclusion. This adds up to our armamentarium in the treatment of high-risk patients, and it should be considered in emergency cases when the fenestrated and branched endografts are not available.

  17. Current status of endovascular aneurysm repair: 20 years of learning.

    Science.gov (United States)

    Arko, Frank R; Murphy, Erin H; Boyes, Christopher; Nussbaum, Tzvi; Lalka, Stephen G; Holleman, Jeremiah; Roush, Timothy S

    2012-09-01

    Parodi first introduced endovascular aneurysm repair (EVAR) in 1991 and since that time it has been shown to have a lower 30-day morbididty and mortality compared to open surgery. Anatomic constraints governed by the need for adequate access vessels, and sufficient proximal and distal landing zones, as well as the need for long-term surveillance, have been the main limitations of this technology. Anatomic factors were initially estimated to exclude 40% of patients with abdominal aortic aneurysm (AAA). The rapid extension of EVAR technology has been complimented by improved access to both high-quality imaging modalities and a variety of endografts. These developments have led EVAR to become a more practical alternative for patients with ruptured AAA. Early data in this setting is encouraging with even more profound reductions in morbidity and mortality than seen in the elective repair.

  18. Invasive radiologic management of hemodialysis fistulas: measuring flow with an endovascular catheter.

    Science.gov (United States)

    García-Medina, J

    2015-01-01

    To analyze the values of flow obtained with an endovascular catheter, and to determine whether they are more reliable than angiographic and clinical findings for planning and for determining the outcome of invasive radiologic treatment of hemodialysis fistulas, as well as to determine the safety of this technique during interventional radiology procedures. We used endovascular catheters to measure flow in 341 vascular accesses for hemodialysis (162 [47.6%] distal fistulas, 132 [38.4%] humeral fistulas, and 47 [14%] arteriovenous grafts) in 598 procedures (a total of 3,051 flow measurements). Dysfunction was most commonly due to high pressures and flow deficits. The catheter was used to measure the results of radiologic treatment in 419 (70%) cases and only to measure the control of flow in the hemodialysis access in 179 (30%) cases. In the cases where lesions of the access had been treated radiologically, the flow improved by a mean of 1,232ml/min. In 2 (0.35%) cases, the tip of the catheter perforated the wall of the vein; this complication was resolved by inflating a low pressure balloon. Endovascular catheters are useful for measuring flow in invasive vascular radiology procedures for hemodialysis. In assessing the hemodynamic status of a vascular access, they are most helpful in determining whether stenosis is present. Copyright © 2013 SERAM. Published by Elsevier España, S.L.U. All rights reserved.

  19. Failure of aneurysm sac shrinkage after endovascular repair; the effect of mural calcification

    Energy Technology Data Exchange (ETDEWEB)

    Love, M. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom)]. E-mail: mark.love@royalhospitals.n-i.nhs.uk; Wray, A. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom); Worthington, M. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom); Ellis, P. [Department of Radiology, Royal Victoria Hospital, Belfast (United Kingdom)

    2005-12-15

    AIM: To evaluate the effect of abdominal aortic aneurysm wall calcification on subsequent sac shrinkage after endovascular repair. MATERIALS AND METHODS: Seventy-three patients underwent endovascular aneurysm repair. The degree of sac wall calcification on pre-procedural computed tomography (CT) examination was graded from 1 to 4 according to the degree of circumferential involvement. On follow-up CT imaging, the maximum transverse diameter (MTD) of the sac was recorded, as well as the presence or absence of endoleak. In those patients with a non-shrinking aneurysm, but no CT evidence of endoleak, contrast-enhanced ultrasound (USS) was performed. Any patient with an endoleak, however diagnosed, was excluded from the study. Kruskal-Wallis and Spearman's rank correlation coefficient testing was applied to compare the degree of calcification and change in MTD. RESULTS: Sixty-three pre-procedural CT images were available for calcification grading. Six of this group had endoleaks resulting in 57 sets of data being available for the study. A reduction in MTD occurred in 68.25% of these patients by 1 year post-procedure. Our figures show aortic calcification is inversely associated with MTD reduction at 6 months (p=0.01), 1 year (p=0.05) and 2 years (p=0.05). CONCLUSION: This study indicates that the degree of aortic wall calcification is significant in predicting MTD reduction post-endovascular repair. The possible mechanisms and implications of this are discussed.

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

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    Nathan Finnerty

    2014-01-01

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

  1. New devices for a better endovascular approach.

    Science.gov (United States)

    Bosiers, M; Deloose, K; Callaert, J; Maene, L; Beelen, R; Keirse, K; Verbist, J; Peeters, P

    2013-12-01

    The endovascular approach has known a great evolution in terms of vessel patency and treatment possibilities. Longer and more complex lesions with a difficult anatomy can be addressed by a range of endovascular tools. However, to maintain the patency of the treated lesion is the true challenge. In order to fulfill these long-term expectations, newer devices have been developed. The drug-coated balloon combines local drug uptake with no residual material after treatment. To maintain patency and prevent recoil of the arterial wall, the drug-eluting stent has been created to offer stent support with an antiproliferative drug. The main drawbacks of the drug-coated balloon and the drug-eluting stent are being addressed by the drug-eluting absorbable scaffold. The initial scaffolding support in combination with the drug release during a prolonged period, poses the same advantages while the scaffold is being metabolized over time. This continuing evolution in endovascular tools paves the way to an endovascular treatment for the majority of peripheral artery diseases.

  2. Endovascular management of carotid-cavernous fistulas

    Institute of Scientific and Technical Information of China (English)

    GAO Bu-lang; LI Ming-hua; LI Yong-dong; FANG Chun; WANG Jue; DU Zhuo-ying

    2007-01-01

    Objective To investigate endovascular treatment of traumatic direct carotid-cavernous fistulas (CCF) and their complications such as pseudoaneurysms. Methods: Over a five-year period, 22 patients with traumatic direct CCFs were treated endovascularly in our institution. Thirteen patients were treated once with the result of CCF occluded, 8 twice and 1 three times. Treatment modalities included balloon occlusion of the CCF, sacrifice of the ipsilateral internal carotid artery with detachable balloon, coil embolization of the cavernous sinus and secondary pseudoaneurysms, and covered-stent management of the pseudoaneurysms. Results All the direct CCFs were successfully managed endovascularly. Four patients developed a pseudoaneurysm after the occlusion of the CCF with an incidence of pseudoaneurysm formation of 18.2% (4/22). A total number of 8 patients experienced permanent occlusion of the ICA with a rate of ICA occlusion reaching 36.4% (8/22). Followed up through telephone consultation from 6 months to 5 years, all did well with no recurrence of CCF symptoms and signs. Conclusion Traumatic direct CCFs can be successfully managed with endovascular means. The pseudoaneurysms secondary to the occlusion of the CCFs can be occluded with stent-assisted coiling and implantation of covered stents.

  3. Endovascular treatment of symptomatic intracranial atherosclerotic disease

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    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.

  4. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V;

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...

  5. Endovascular Laser Therapy for Varicose Veins

    Science.gov (United States)

    2010-01-01

    back pain and arthritis. Lower limb VV is a common disease affecting adults and estimated to be the seventh most common reason for physician referral in the US. There is a strong familial predisposition to VV with the risk in offspring being 90% if both parents affected, 20% when neither is affected, and 45% (25% boys, 62% girls) if one parent is affected. Globally, the prevalence of VV ranges from 5% to 15% among men and 3% to 29% among women varying by the age, gender and ethnicity of the study population, survey methods and disease definition and measurement. The annual incidence of VV estimated from the Framingham Study was reported to be 2.6% among women and 1.9% among men and did not vary within the age range (40-89 years) studied. Approximately 1% of the adult population has a stasis ulcer of venous origin at any one time with 4% at risk. The majority of leg ulcer patients are elderly with simple superficial vein reflux. Stasis ulcers are often lengthy medical problems and can last for several years and, despite effective compression therapy and multilayer bandaging are associated with high recurrence rates. Recent trials involving surgical treatment of superficial vein reflux have resulted in healing and significantly reduced recurrence rates. Endovascular Laser Therapy for VV ELT is an image-guided, minimally invasive treatment alternative to surgical stripping of superficial venous reflux. It does not require an operating room or general anesthesia and has been performed in outpatient settings by a variety of medical specialties including surgeons (vascular or general), interventional radiologists and phlebologists. Rather than surgically removing the vein, ELT works by destroying, cauterizing or ablating the refluxing vein segment using heat energy delivered via laser fibre. Prior to ELT, colour-flow Doppler ultrasonography is used to confirm and map all areas of venous reflux to devise a safe and effective treatment plan. The ELT procedure involves the

  6. Comparison of endovascular coiling and surgical clipping for the treatment of intracranial aneurysms: A prospective study.

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    Zeinab Taheri

    2015-03-01

    Full Text Available Management of intracranial aneurysms has made debates about the best treatment modality in recent years. The aim of this study was to compare the interventional outcomes between two groups of patients, one treated with endovascular coiling and the other treated with surgical clipping.This prospective study included 48 patients with intracranial aneurysms who underwent endovascular coiling (27 patients or surgical clipping (21 patients from July 2011 to August 2013. A neurologist examined patients in admission and followed them by phone call 1-year after intervention.Mean modified Rankin Scale (MRS score at the time of admission in endovascular group was 2.86 ± 0.974 whereas it was 3.81 ± 1.078 in surgical clipping group (P = 0.0040. Focal neurologic signs were higher in clipping during procedures (P = 0.0310. Of 37 patients who followed up for a year, 19 were in endovascular group and 18 in surgical clipping group. At 1 year follow-up, MRS improvement was statistically significant in coiling group (P = 0.0090, but not in clipping group (P = 0.8750. Mean difference of MRS score at the time of admission and at one year later, was 0.947 ± 1.224 in endovascular group and 0.111 ± 2.083 in surgical group (P = 0.3000.There was no statistically significant difference at 1 year outcome between two groups. We recommend further interventional studies with larger sample sizes for better evaluation of the modalities.

  7. Changes in inflammatory response after endovascular treatment for type B aortic dissection.

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    Bernice L Y Cheuk

    Full Text Available This present study aims to investigate the changes in the inflammatory markers after elective endovascular treatment of Type B aortic dissection with aneurysm, as related to different anatomical features of the dissection flap in the paravisceral perfusion. Consecutive patients with type B aortic dissections with elective endovascular stent graft repair were recruited and categorized into different groups. Serial plasma levels of cytokines (Interleukin-1β, -6, -8, -10, TNF-α, chemokines (MCP-1, and serum creatinine were monitored at pre-, peri- and post-operative stages. The length of stent graft employed in each surgery was retrieved and correlated with the change of all studied biochemical parameters. A control group of aortic dissected patients with conventional medication management was recruited for comparing the baseline biochemical parameters. In total, 22 endovascular treated and 16 aortic dissected patients with surveillance were recruited. The endovascular treated patients had comparable baseline levels as the non-surgical patients. There was no immediate or thirty day-mortality, and none of the surgical patients developed post-operative mesenteric ischaemia or clinically significant renal impairment. All surgical patients had detectable pro-inflammatory mediators, but none of the them showed any statistical significant surge in the peri-operative period except IL-1β and IL-6. Similar results were obtained when categorized into different groups. IL-1β and IL-6 showed maximal levels within hours of the endovascular procedure (range, 3.93 to 27.3 higher than baseline; p = 0.001, but returned to baseline 1 day post-operatively. The change of IL-1β and IL-6 at the stent graft deployment was statistically greater in longer stent graft (p>0.05. No significant changes were observed in the serum creatinine levels. In conclusion, elective endovascular repair of type B aortic dissection associated with insignificant changes in

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

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    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.

  9. Multivariate Analysis of Risk Factors of Cerebral Infarction in 439 Patients Undergoing Thoracic Endovascular Aneurysm Repair.

    Science.gov (United States)

    Kanaoka, Yuji; Ohki, Takao; Maeda, Koji; Baba, Takeshi; Fujita, Tetsuji

    2016-04-01

    The aim of the study is to identify the potential risk factors of cerebral infarction associated with thoracic endovascular aneurysm repair (TEVAR). TEVAR was developed as a less invasive surgical alternative to conventional open repair for thoracic aortic aneurysm treatment. However, outcomes following TEVAR of aortic and distal arch aneurysms remain suboptimal. Cerebral infarction is a major concern during the perioperative period. We included 439 patients who underwent TEVAR of aortic aneurysms at a high-volume teaching hospital between July 2006 and June 2013. Univariate and multivariate logistic regression analyses were performed to identify perioperative cerebral infarction risk factors. Four patients (0.9%) died within 30 days of TEVAR; 17 (3.9%) developed cerebral infarction. In univariate analysis, history of ischemic heart disease and cerebral infarction and concomitant cerebrovascular disease were significantly associated with cerebral infarction. "Shaggy aorta" presence, left subclavian artery coverage, carotid artery debranching, and pull-through wire use were identified as independent risk factors of cerebral infarction. In multivariate analysis, history of ischemic heart disease (odds ratio [OR] 6.49, P = 0.046) and cerebral infarction (OR 43.74, P = 0.031), "shaggy aorta" (OR 30.32, P < 0.001), pull-through wire use during surgery (OR 7.196, P = 0.014), and intraoperative blood loss ≥800 mL (OR 24.31, P = 0.017) were found to be independent risk factors of cerebral infarction. This study identified patient- and procedure-related risk factors of cerebral infarction following TEVAR. These results indicate that patient outcomes could be improved through the identification and management of procedure-related risk factors.

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

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    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

  11. Immediate and early complications of the open Latarjet procedure: a retrospective review of a large consecutive case series.

    Science.gov (United States)

    Gartsman, Gary M; Waggenspack, Wame N; O'Connor, Daniel P; Elkousy, Hussein A; Edwards, T Bradley

    2017-01-01

    Immediate and early postoperative complications of the Latarjet procedure are not well documented in the literature. The purpose of this study was to report the procedure-related complications of our large consecutive case series of 3 surgeons at a single high-volume center. We conducted a retrospective chart review of 416 Latarjet procedures performed on 400 patients (16 patients had bilateral procedures) who underwent surgery by the 3 senior authors from October 2002 to July 2015. Immediate and early complications included hardware problems, infection, and neurologic injury. In addition, the patient's age and history of prior instability surgery were noted and evaluated as risk factors for complication. The overall complication rate was 5.0% (21 complications in 19 procedures). Thirteen neurologic injuries (3.1%) occurred to the axillary (7), musculocutaneous (4), and suprascapular (2) nerves, including 2 patients with multiple nerves affected. All but 2 patients had complete resolution of symptoms at time of last follow-up. Six infections (1.4%) developed, including 3 superficial infections treated with oral antibiotics and 3 deep infections requiring irrigation and débridement with intravenous antibiotics. Two early hardware-related complications (0.05%) were also noted. Increased age was associated with a higher complication rate. History of prior surgery was not associated with increased complications in our series. This study highlights the procedural complications of the Latarjet procedure. Neurologic injury was the most common complication in our series, with complete or near-complete recovery in 11 of 13 patients. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  12. Endovascular Treatment of Visceral Aneurysms and Pseudoaneurysms: Long-term Outcomes from a Multicenter European Study

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    Spiliopoulos, Stavros, E-mail: stavspiliop@upatras.gr; Sabharwal, Tarun [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom); Karnabatidis, Dimitrios [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Brountzos, Elias [Attikon University Hospital, 2nd Radiology Department (Greece); Katsanos, Konstantinos [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Krokidis, Miltiadis; Gkoutzios, Panagiotis [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom); Siablis, Dimitrios [Patras University Hospital, Department of Diagnostic and Interventional Radiology (Greece); Adam, Andreas [Guy' s and St Thomas' Hospitals NHS Trust, Department of Interventional Radiology (United Kingdom)

    2012-12-15

    Purpose: To investigate the percutaneous endovascular management of visceral aneurysms (VA) and visceral pseudoaneurysms (VPA) treated in three European interventional radiology departments. Methods: Patient archives from the department's databases were examined and retrospectively analyzed. Patients diagnosed between 2000 and 2010 with VA and/or VPA, confirmed by computed tomography angiography, magnetic resonance angiography, or digital subtraction angiography and treated exclusively with percutaneous endovascular methods, were included in the study. The study's primary end points were procedural technical success, target lesion reintervention rate, and periprocedural mortality rate. Secondary end points included major and minor complications rates. Results: The medical records of 54 patients (41 male, mean age 55 {+-} 18.1 years) with 58 VAs or VPAs and treated with various percutaneous endovascular therapeutic modalities were analyzed. In total, 21 VAs (mean diameter 49.4 {+-} 21 mm, range 20-100 mm) and 37 VPAs (mean diameter 25.1 {+-} 14.6 mm, range 8-60 mm) were treated. Procedural technical success was achieved in 100% of the cases, while target lesion reintervention rate was 6.1% (2 of 33) and 14.2% (3 of 21) in the VPA and VA groups, respectively. Mean clinical follow-up period was 19.1 {+-} 21.4 months. Overall periprocedural mortality rate was 3% (1 of 33) in the VPA group and 0% (0 of 21) in the VA group. Conclusion: Percutaneous endovascular treatment of VAs and VPAs is safe and effective with low morbidity and mortality. There is a small but significant reintervention rate, particularly for true aneurysms; dedicated follow-up imaging is recommended. Successful aneurysm exclusion was achieved in all cases with a second procedure.

  13. Cancer risk estimation caused by radiation exposure during endovascular procedure

    Science.gov (United States)

    Kang, Y. H.; Cho, J. H.; Yun, W. S.; Park, K. H.; Kim, H. G.; Kwon, S. M.

    2014-05-01

    The objective of this study was to identify the radiation exposure dose of patients, as well as staff caused by fluoroscopy for C-arm-assisted vascular surgical operation and to estimate carcinogenic risk due to such exposure dose. The study was conducted in 71 patients (53 men and 18 women) who had undergone vascular surgical intervention at the division of vascular surgery in the University Hospital from November of 2011 to April of 2012. It had used a mobile C-arm device and calculated the radiation exposure dose of patient (dose-area product, DAP). Effective dose was measured by attaching optically stimulated luminescence on the radiation protectors of staff who participates in the surgery to measure the radiation exposure dose of staff during the vascular surgical operation. From the study results, DAP value of patients was 308.7 Gy cm2 in average, and the maximum value was 3085 Gy cm2. When converted to the effective dose, the resulted mean was 6.2 m Gy and the maximum effective dose was 61.7 milliSievert (mSv). The effective dose of staff was 3.85 mSv; while the radiation technician was 1.04 mSv, the nurse was 1.31 mSv. All cancer incidences of operator are corresponding to 2355 persons per 100,000 persons, which deemed 1 of 42 persons is likely to have all cancer incidences. In conclusion, the vascular surgeons should keep the radiation protection for patient, staff, and all participants in the intervention in mind as supervisor of fluoroscopy while trying to understand the effects by radiation by themselves to prevent invisible danger during the intervention and to minimize the harm.

  14. Microsurgical versus endovascular interventions for blood-blister aneurysms of the internal carotid artery: systematic review of literature and meta-analysis on safety and efficacy.

    Science.gov (United States)

    Shah, Sumedh S; Gersey, Zachary C; Nuh, Mohamed; Ghonim, Hesham T; Elhammady, Mohamed Samy; Peterson, Eric C

    2017-02-17

    OBJECTIVE Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) have a poor natural history associated with high morbidity and mortality. Currently, both surgical and endovascular techniques are employed to treat BBAs; thus, the authors sought to perform a meta-analysis to compare the efficacy and safety of these approaches. METHODS A literature search of PubMed, MEDLINE, and Google Scholar online databases was performed to include pertinent English-language studies from 2005 to 2015 that discussed the efficacy and safety of either surgical or endovascular therapies to treat BBAs. RESULTS Thirty-six papers describing 256 patients with BBAs treated endovascularly (122 procedures) or surgically (139 procedures) were examined for data related to therapeutic efficacy and safety. Pooled analysis of 9 papers demonstrated immediate and late (mean 20.9 months) aneurysm occlusion rates of 88.9% (95% CI 77.6%-94.8%) and 88.4% (95% CI 76.7%-94.6%), respectively, in surgically treated patients. Pooled analysis of 12 papers revealed immediate and late aneurysm obliteration rates of 63.9% (95% CI 52.3%-74.1%) and 75.9% (95% CI 65.9%-83.7%), respectively, in endovascularly treated aneurysms. Procedure-related complications and overall poor neurological outcomes were slightly greater in the surgically treated cases than in the endovascularly treated cases (27.8% [95% CI 19.6%-37.8%] vs 26.2% [95% CI 18.4%-35.8%]), indicating that endovascular therapy may provide better outcomes. CONCLUSIONS Blood-blister aneurysms are rare, challenging lesions with a poor prognosis. Although surgical management potentially offers superior aneurysm obliteration rates immediately after treatment and at the long-term follow-up, endovascular therapy may have a better safety profile and provide better functional outcomes than surgery. A registry of patients treated for BBAs may be warranted to better document the natural course of the disease as well as treatment outcomes.

  15. Endovascular treatment of hepatic artery aneurysm in a patient with Ehlers-Danlos syndrome. Case report.

    Science.gov (United States)

    Casana, R; Nano, G; Dalainas, I; Tealdi, D G

    2004-09-01

    Ehlers-Danlos syndrome (EDS) is a rare, variably inherited disorder affecting connective tissue. Patients with EDS often develop aneurysms of the thoracic and abdominal aorta as well as the visceral arteries. We report our experience with an elective endovascular exclusion of an hepatic artery aneurysm in a 26-year-old female patient with EDS type IV. A balloon-expandable 4x26 mm stent-graft was placed in the common hepatic artery, excluding the aneurysm. The follow-up at the 2, 6 and 18 months showed the patency of the common hepatic artery, the absence of endo-leak and the right location of the stent-graft. In EDS patients, the endovascular treatment could be preferable to open surgery because of the minimum trauma.

  16. Midterm results of endovascular treatment of iliac artery lesions: analysis of 59 cases

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    Leonardo Ghizoni Bez

    2013-06-01

    Full Text Available BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89. Thirty seven were male (62.72% and 22 female (37.28%. The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84% and rest pain or trophic lesions (critical ischemia in 29 cases (49.15%. Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years, with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.

  17. Endovascular aneurysm repair utilizing the AneuRx and Talent stent grafts.

    Science.gov (United States)

    Arko, Frank R; Murphy, Erin H

    2008-06-01

    Favorable clinical results combined with increased patient demand for minimally invasive surgery have resulted in an increased application of endovascular aneurysm repair, and this treatment modality is now being extended to younger, healthier patients. While it seems that endovascular aneurysm repair is becoming a desirable option for many patients, it is essential to realize that the feasibility of the procedure may be limited at times by patient anatomy and technical difficulties. Specific anatomical difficulties can be imposed by difficult access, short, tortuous and calcified aortic and iliac landing zones, and the presence of coincident complex iliac aneurysms. This manuscript will discuss the use of 2 approved devices from a single manufacturer (Medtronic, Santa Rosa, Calif) and their clinical results in the treatment of infrarenal abdominal aortic aneurysms. We will discuss technical maneuvers and considerations when encountering difficult anatomical situations and how to avoid long-term complications.

  18. Endovascular treatment of distal thoracic aortic transection associated with severe thoracolumbar spinal fracture.

    Science.gov (United States)

    Chock, Megan M; Aho, Johnathon; Naik, Nimesh; Clarke, Michelle; Heller, Stephanie; Oderich, Gustavo S

    2015-10-01

    Endovascular repair has become the first line of treatment in most patients with blunt aortic injury. The most common mechanism is deceleration injury affecting the aortic isthmus distal to the origin of the left subclavian artery. Injuries of the distal thoracic aorta are uncommon. We report the case of a 25-year-old male patient who presented with paraplegia and distal thoracic aortic pseudoaneurysm associated with severe thoracolumbar vertebral fracture and displacement after a motocross accident. Endovascular repair was performed using total percutaneous technique and conformable C-TAG thoracic stent-graft (WL Gore, Flagstaff, AZ). Following stent-graft placement and angiographic confirmation of absence of endoleak, thoracolumbar spinal fixation was performed in the same operative procedure. This case illustrates a multispecialty approach to complex aortic and vertebral injury and the high conformability of newer thoracic stent-grafts to adapt to tortuous anatomy. © The Author(s) 2014.

  19. Thoracic endovascular aortic repair for patent ductus arteriosus in an elderly patient with congestive heart failure.

    Science.gov (United States)

    Kato, Gentaro; Nakai, Mikizo; Tokunaga, Noriyuki; Shimizu, Shuji; Okada, Masahiro

    2016-05-01

    In elderly patients, open surgery for patent ductus arteriosus (PDA) is more difficult than that in children and often requires a cardiopulmonary bypass. We report the case of a 67-year-old patient with a PDA that was successfully treated with thoracic endovascular aortic repair (TEVAR). The patient was diagnosed with congestive heart failure (ejection fraction, 36 %) and PDA (9.7 mm in diameter). TEVAR was successfully performed to exclude the PDA. After TEVAR, the patient's heart failure was well controlled by diuretics. TEVAR may be a good alternative to open surgery.

  20. 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

    2017-09-15

    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.

  1. Endovascular treatment of hemodialysis arteriovenous fistulas

    DEFF Research Database (Denmark)

    Heerwagen, Søren T; Hansen, Marc A; Schroeder, Torben V

    2012-01-01

    Purpose: The purpose of this study was to investigate if the immediate hemodynamic outcome of an endovascular intervention on a dysfunctional hemodialysis arteriovenous fistula is a prognostic factor for primary patency. Methods: This was a prospective observational study including 61 consecutive...... patients with dysfunctional arteriovenous fistulas referred to our endovascular unit. Patients were treated in accordance with institutional standard protocol including immediate pre- and post-interventional blood flow measurements using an intravascular catheter system. The primary endpoint was primary...... potential predictor variables. Results: Post interventional flow did not significantly influence primary patency (p = 0.76). Primary patency was found to be affected by having a history of previous intervention(s) (p = 0.008, hazard ratio 2.9) or low fistula age (P=.038, hazard ratio 0.97 [one...

  2. Online tracking of interventional devices for endovascular aortic repair.

    Science.gov (United States)

    Volpi, Daniele; Sarhan, Mhd H; Ghotbi, Reza; Navab, Nassir; Mateus, Diana; Demirci, Stefanie

    2015-06-01

    The continuous integration of innovative imaging modalities into conventional vascular surgery rooms has led to an urgent need for computer assistance solutions that support the smooth integration of imaging within the surgical workflow. In particular, endovascular interventions performed under 2D fluoroscopic or angiographic imaging only, require reliable and fast navigation support for complex treatment procedures such as endovascular aortic repair. Despite the vast variety of image-based guide wire and catheter tracking methods, an adoption of these for detecting and tracking the stent graft delivery device is not possible due to its special geometry and intensity appearance. In this paper, we present, for the first time, the automatic detection and tracking of the stent graft delivery device in 2D fluoroscopic sequences on the fly. The proposed approach is based on the robust principal component analysis and extends the conventional batch processing towards an online tracking system that is able to detect and track medical devices on the fly. The proposed method has been tested on interventional sequences of four different clinical cases. In the lack of publicly available ground truth data, we have further initiated a crowd sourcing strategy that has resulted in 200 annotations by unexperienced users, 120 of which were used to establish a ground truth dataset for quantitatively evaluating our algorithm. In addition, we have performed a user study amongst our clinical partners for qualitative evaluation of the results. Although we calculated an average error in the range of nine pixels, the fact that our tracking method functions on the fly and is able to detect stent grafts in all unfolding stages without fine-tuning of parameters has convinced our clinical partners and they all agreed on the very high clinical relevance of our method.

  3. Role of heparin during endovascular therapy for acute ischemic stroke.

    Science.gov (United States)

    Farook, Naureen; Haussen, Diogo; Sur, Samir; Snelling, Brian; Gersey, Zachary; Yavagal, Dileep; Peterson, Eric

    2016-06-01

    Systemic heparinization has become the mainstay anticoagulant in neurointerventional procedures to prevent thromboembolic complications. Its benefit during endovascular therapy for acute stroke however has not been established. The purpose of this study is to retrospectively evaluate the impact of heparin during endovascular therapy for acute ischemic stroke (AIS). We performed a retrospective review of our interventional stroke database from February 2009 to September 2012 for patients with anterior circulation AIS with ICA-T or MCA M1 occlusions. 76 patients were categorized into 2 groups: intraprocedural vs. no intraprocedural heparin use. Outcomes measured included reperfusion (modified TICI scale), cerebral hemorrhages (ECASS criteria), and 90-day outcomes (modified Rankin scale). Baseline characteristics were similar between heparin and non-heparin treated patients, except for presence of CAD (6% vs. 30%, p=0.01), Coumadin (0% vs. 11%, p=0.04), and NIHSS (15.6±5.0 vs. 18.1±4.6, p=0.03). There was a nonsignificantly higher reperfusion rate achieved in heparin-treated patients compared to non heparin-treated patients (63% vs. 50%, p=0.35). Patients who received heparin had significantly lower rates of hemorrhage (p=0.02). Multivariate logistic regression for good outcome revealed only age (OR 0.86; 95% CI 0.78-0.95; p<0.01), ASPECTS (OR 2.14; 95% CI 1.01-4.50; p=0.04), and successful reperfusion (OR 19.25; 95% CI 2.37-155.95; p<0.01) independently associated with mRS 0-2 at 90 days. The use of intraprocedural heparin in patients with AIS from MCA M1 or ICA-T occlusion was found safe. The impact of heparinization is unclear and warrants further evaluation. Copyright © 2016 Elsevier B.V. All rights reserved.

  4. Novel technique for placement of hemodialysis catheters using a combined open procedure with the Seldinger micropuncture technique.

    Science.gov (United States)

    Maa, J; Gosnell, J E; Chuter, T A M

    2005-03-01

    Percutaneous placement of large-diameter dialysis catheters via the Seldinger technique can be technically challenging in patients with coagulopathy, difficult anatomy, or several previous central line insertions. We describe a method for achieving safer access by combining an open approach to delineate the venous anatomy of the chest wall, with a micropuncture device and smaller diameter guidewire to gain intravascular access to the cephalic vein or its major tributaries. Serial dilation of otherwise unusable vessels can then permit successful and safer hemodialysis catheter insertion in these difficult cases.

  5. 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.

  6. A national Vascular Quality Initiative database comparison of hybrid and open repair for aortoiliac-femoral occlusive disease.

    Science.gov (United States)

    Zavatta, Marco; Mell, Matthew W

    2017-08-16

    We sought to analyze the outcomes of revascularization for aortoiliac-femoral occlusive disease by comparing hybrid repair by endovascular revascularization and open common femoral endarterectomy (ER-CFE) with open aortoiliac reconstruction and CFE (OR-CFE). Using the national Society for Vascular Surgery Vascular Quality Initiative database from 2009 to 2015, we identified all patients receiving open or endovascular revascularization of the aortoiliac system and who additionally underwent CFE. Patients with concomitant infrainguinal procedures were excluded, as were procedures performed at centers with CFE group and 1472 in the ER-CFE group with follow-up of at least 9 months. Patients with ER-CFE were older (68 ± 9 years vs 63 ± 9 years; P CFE were more likely to have received a previous inflow procedure (27% vs 21%; P CFE (5.2 ± 1.6 vs 2.9 ± 1.0; P CFE was associated with lower 30-day mortality (1.8% vs 3.4%; P = .01), shorter length of stay (median 3 vs 7 days; P CFE had greater ABI improvement at long-term follow-up (0.39 ± 0.37 vs 0.26 ± 0.23; P CFE appeared to have improved short-term outcomes and equivalent freedom from major amputation compared with open surgical repair with CFE. Conversely, open repair with CFE was associated with better long-term improvement in ABI and ambulatory status. Open repair should therefore be considered for patients with aortoiliac-femoral occlusive disease and reasonable surgical risk. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  7. One-year pivotal trial outcomes of the Nellix system for endovascular aneurysm sealing.

    Science.gov (United States)

    Carpenter, Jeffrey P; Cuff, Robert; Buckley, Clifford; Healey, Christopher; Hussain, Sajjad; Reijnen, Michel M P J; Trani, Jose; Böckler, Dittmar

    2017-02-01

    The Nellix EndoVascular Aneurysm Sealing (EVAS) System (Endologix, Inc, Irvine, Calif) is a novel approach to abdominal aortic aneurysm (AAA) treatment whereby polymer is used to fill the AAA sac. We report 1-year results of the investigational device exemption pivotal trial. Eligible patients were treated at 30 sites in the United States and Europe. Inclusion criteria required an asymptomatic infrarenal AAA, with a neck length ≥10 mm and ≤60° angle, iliac artery blood lumen diameter 9 to 35 mm, access artery diameter ≥6 mm, and serum creatinine ≤2 mg/dL. Follow-up included computed tomography angiography scans at 30 days, 6 months, and 1 year that were evaluated by a core laboratory. The primary safety end point was 30-day major adverse events (MAEs), which were compared with a performance goal of year, which was compared with a performance goal of >80%. Treatment success required procedural technical success and absence of AAA rupture during follow-up, conversion to open surgical repair, endoleak (type I or III) at 1 year, migration >10 mm causing complications or requiring secondary intervention, aneurysm enlargement, or secondary procedures through 1 year for resolution of endoleak, device obstruction or occlusion, or device defect. Of 150 treated patients, 149 (99.3%) completed 1-year follow-up. The MAEs rate at 30 days was 2.7% (95% confidence interval, 0.7%-6.7%), satisfying the primary safety end point (year treatment success was 94% (95% confidence interval, 88.6%-97.4%), achieving the primary effectiveness end point (>80%). At 1 year, key secondary outcomes included 6.7% MAEs, 4.7% serious device-related events, 1.3% AAA-related mortality, 3.7% secondary interventions, and 0.7% surgical conversions. MAEs through 1 year included death (n = 6), stroke (n = 3), bowel ischemia (n = 2), renal failure (n = 2), respiratory failure (n = 2), and myocardial infarction (n =1). One iatrogenic AAA rupture occurred and one AAA rupture

  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. Anesthetic strategy during endovascular therapy: General anesthesia or conscious sedation? (GOLIATH - General or Local Anesthesia in Intra Arterial Therapy) A single-center randomized trial.

    Science.gov (United States)

    Simonsen, Claus Z; Sørensen, Leif H; Juul, Niels; Johnsen, Søren P; Yoo, Albert J; Andersen, Grethe; Rasmussen, Mads

    2016-12-01

    Endovascular therapy after acute ischemic stroke due to large vessel occlusion is now standard of care. There is equipoise as to what kind of anesthesia patients should receive during the procedure. Observational studies suggest that general anesthesia is associated with worse outcomes compared to conscious sedation. However, the findings may have been biased. Randomized clinical trials are needed to determine whether the choice of anesthesia may influence outcome. The objective of GOLIATH (General or Local Anestesia in Intra Arterial Therapy) is to examine whether the choice of anesthetic regime during endovascular therapy for acute ischemic stroke influence patient outcome. Our hypothesis is that that conscious sedation is associated with less infarct growth and better functional outcome. GOLIATH is an investigator-initiated, single-center, randomized study. Patients with acute ischemic stroke, scheduled for endovascular therapy, are randomized to receive either general anesthesia or conscious sedation. The primary outcome measure is infarct growth after 48-72 h (determined by serial diffusion-weighted magnetic resonance imaging). Secondary outcomes include 90-day modified Rankin Scale score, time parameters, blood pressure variables, use of vasopressors, procedural and anesthetic complications, success of revascularization, radiation dose, and amount of contrast media. Choice of anesthesia may influence outcome in acute ischemic stroke patients undergoing endovascular therapy. The results from this study may guide future decisions regarding the optimal anesthetic regime for endovascular therapy. In addition, this study may provide preliminary data for a multicenter randomized trial. © 2016 World Stroke Organization.

  10. Impact of Hospital Volume on Outcomes of Endovascular Stenting for Adult Aortic Coarctation.

    Science.gov (United States)

    Bhatt, Parth; Patel, Nileshkumar J; Patel, Achint; Sonani, Rajesh; Patel, Aashay; Panaich, Sidakpal S; Thakkar, Badal; Savani, Chirag; Jhamnani, Sunny; Patel, Nilay; Patel, Nish; Pant, Sadip; Patel, Samir; Arora, Shilpkumar; Dave, Abhishek; Singh, Vikas; Chothani, Ankit; Patel, Jay; Ansari, Mohammad; Deshmukh, Abhishek; Bhimani, Ronak; Grines, Cindy; Cleman, Michael; Mangi, Abeel; Forrest, John K; Badheka, Apurva O

    2015-11-01

    Use of transcatheter endovascular stenting has been increasing in the treatment of coarctation of aorta (CoA). The present study was undertaken on adults with CoA who underwent stent placement from 2000 to 2011 to analyze the relation of hospital volumes to the outcomes of stenting in adults with CoA. It was a retrospective study based on Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (NIS) database from 2000 to 2011 and identified subjects using the International Classification of Diseases, Ninth Revision, Clinical Modification procedure code of 747.10 (CoA). Annual hospital volume was calculated using unique hospital identifiers. Weights provided by the Nationwide Inpatient Sample were used to generate national estimates. A total of 105 (weighted 521) subjects were identified with International Classification of Diseases, Ninth Revision, code of 39.90 (Endovascular stent). Hospital volumes were divided into tertiles. We compared the highest tertile (≥3 procedures annually) with other tertiles (<3 procedure annually). The composite outcomes of the analysis were procedure-related complications, length of stay (LOS), and cost in relation to the hospital volume. No inhospital death was reported in either group. Hospitals with ≥3 procedures annually had significantly lower incidence of complications (9.5% vs 23.0%) compared to the hospitals with <3 procedures annually (p-value 0.002). Similar results were obtained after multivariate regression analysis in relation to hospital volume. Shorter LOS and lower cost were observed with annual hospital volume of ≥3 procedures. In conclusion, stenting adults for CoA is remarkably safe, and the outcomes of the procedure have improved in centers with annual hospital volume of ≥3 procedures. There is also decreasing trend of procedure-related complications, shorter LOS, and lower costs compared to centers with annual volume <3 procedures.

  11. Endovascular treatment of late thoracic aortic aneurysms after surgical repair of congenital aortic coarctation in childhood.

    Directory of Open Access Journals (Sweden)

    Robert Juszkat

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

  12. 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...

  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

    The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair.......The aim of this study was to estimate the incidence of the post-implantation syndrome/systemic inflammatory response syndrome (SIRS) after endovascular aortic repair....

  14. Outcomes of Endovascular Repair of Ruptured Descending Thoracic Aortic Aneurysms

    NARCIS (Netherlands)

    Jonker, Frederik H. W.; Verhagen, Hence J. M.; Lin, Peter H.; Heijmen, Robin H.; Trimarchi, Santi; Lee, W. Anthony; Moll, Frans L.; Athamneh, Husam; Muhs, Bart E.

    2010-01-01

    Background-Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and the factors t

  15. Outcomes of endovascular repair of ruptured descending thoracic aortic aneurysms

    NARCIS (Netherlands)

    F.H.W. Jonker; H.J.M. Verhagen (Hence); P.H. Lin (Peter); R.H. Heijmen (Robin); S. Trimarchi (Santi); W.A. Lee (Anthony); F.L. Moll (Frans); H. Athamneh (Husam); B.E. Muhs (Bart)

    2010-01-01

    textabstractBackground-: Thoracic endovascular aortic repair offers a less invasive approach for the treatment of ruptured descending thoracic aortic aneurysms (rDTAA). Due to the low incidence of this life-threatening condition, little is known about the outcomes of endovascular repair of rDTAA and

  16. Biomechanical and Clinical Studies in EndoVascular Aortic Repair

    NARCIS (Netherlands)

    Nauta, FJH

    2016-01-01

    Objectives This thesis investigates biomechanical and clinical performances of endovascular repair for thoracic aortic dissection (AD) and aneurysm. Insights from both medical and bio-engineering perspectives are pursued with the aim of providing scientific data that will help guide endovascular aor

  17. Endovascular exclusion of a large external iliac vein aneurysm.

    Science.gov (United States)

    Todorov, Mina; Hernandez, Diego

    2013-07-01

    Iliac vein aneurysms are uncommon, and there is no consensus on optimal treatment. We present a case of venous exclusion using an endovascular approach. To our knowledge, this is the first reported case of a large external iliac vein aneurysm treated endovascularly. We have demonstrated the feasibility of this approach with satisfactory 1-year follow-up.

  18. Application of occluders in endovascular repair of aortic aneurysms

    Institute of Scientific and Technical Information of China (English)

    SHI Zhen-yu; FU Wei-guo; WANG Yu-qi; GUO Da-qiao; CHEN Bin; JIANG Jun-hao; XU Xin; YANG Jue; ZHU Ting

    2007-01-01

    @@ Since Parodi et al1 reported the first successful case of endovascular treatment for abdominal aortic aneurysm (AAA) in 1991, the endovascular repair has become an important option for the surgical treatment of aortic aneurysms.2-4 The occluder is a newly-developed device introduced intraluminally to block the blood flow in certain arteries.

  19. Assessment of mouse anxiety-like behavior in the light-dark box and open-field arena: role of equipment and procedure.

    Science.gov (United States)

    Kulesskaya, Natalia; Voikar, Vootele

    2014-06-22

    Light-dark box and open field are conventional tests for assessment of anxiety-like behavior in the laboratory mice, based on approach-avoidance conflict. However, except the basic principles, variations in the equipment and procedures are very common. Therefore, contribution of certain methodological issues in different settings was investigated. Three inbred strains (C57BL/6, 129/Sv, DBA/2) and one outbred stock (ICR) of mice were used in the experiments. An effect of initial placement of mice either in the light or dark compartment was studied in the light-dark test. Moreover, two tracking systems were applied - position of the animals was detected either by infrared sensors in square box (1/2 dark) or by videotracking in rectangular box (1/3 dark). Both approaches revealed robust and consistent strain differences in the exploratory behavior. In general, C57BL/6 and ICR mice showed reduced anxiety-like behavior as compared to 129/Sv and DBA/2 strains. However, the latter two strains differed markedly in their behavior. DBA/2 mice displayed high avoidance of the light compartment accompanied by thigmotaxis, whereas the hypoactive 129 mice spent a significant proportion of time in risk-assessment behavior at the opening between two compartments. Starting from the light side increased the time spent in the light compartment and reduced the latency to the first transition. In the open field arena, black floor promoted exploratory behavior - increased time and distance in the center and increased rearing compared to white floor. In conclusion, modifications of the apparatus and procedure had significant effects on approach-avoidance behavior in general whereas the strain rankings remained unaffected.

  20. Giant vertebral artery aneurysm in a child treated with endovascular parent artery occlusion and coil embolization.

    Science.gov (United States)

    Park, Hun-Soo; Nakagawa, Ichiro; Wada, Takeshi; Nakagawa, Hiroyuki; Hironaka, Yasuo; Kichikawa, Kimihiko; Nakase, Hiroyuki

    2014-01-01

    Intracranial giant vertebral artery aneurysms are extremely rare in the pediatric population and are associated with significant morbidity and mortality. The present report describes a case of a pediatric patient with giant vertebral artery aneurysm who presented with intracranial mass effect. This patient was successfully treated with endovascular parent artery occlusion and coil embolization. A 7-year-old girl presented with tetraparesis, ataxia, dysphagia, and dysphonia. Cerebral angiography revealed intracranial giant aneurysm arising from the right vertebral artery. The patient underwent endovascular parent artery occlusion alone to facilitate aneurysmal thrombosis as an initial treatment. This was done to avoid a coil mass effect to the brainstem. However, incomplete thrombosis occurred in the vicinity of the vertebral artery union. Therefore, additional coil embolization for residual aneurysm was performed. Two additional coil embolization procedures were performed in response to recurrence. Mass effect and clinical symptoms gradually improved, and the patient had no associated morbidity or recurrence at 2 years after the last fourth coil embolization. Intracranial giant vertebral artery aneurysms are rare and challenging in pediatric patients. Staged endovascular strategy can be a safe and effective treatment option.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2010-02-15

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

  2. Advanced Endovascular Approaches in the Management of Challenging Proximal Aortic Neck Anatomy: Traditional Endografts and the Snorkel Technique

    Science.gov (United States)

    Quatromoni, Jon G.; Orlova, Ksenia; Foley, Paul J.

    2015-01-01

    Advances in endovascular technology, and access to this technology, have significantly changed the field of vascular surgery. Nowhere is this more apparent than in the treatment of abdominal aortic aneurysms (AAAs), in which endovascular aneurysm repair (EVAR) has replaced the traditional open surgical approach in patients with suitable anatomy. However, approximately one-third of patients presenting with AAAs are deemed ineligible for standard EVAR because of anatomic constraints, the majority of which involve the proximal aneurysmal neck. To overcome these challenges, a bevy of endovascular approaches have been developed to either enhance stent graft fixation at the proximal neck or extend the proximal landing zone to allow adequate apposition to the aortic wall and thus aneurysm exclusion. This article is composed of two sections that together address new endovascular approaches for treating aortic aneurysms with difficult proximal neck anatomy. The first section will explore advancements in the traditional EVAR approach for hostile neck anatomy that maximize the use of the native proximal landing zone; the second section will discuss a technique that was developed to extend the native proximal landing zone and maintain perfusion to vital aortic branches using common, off-the-shelf components: the snorkel technique. While the techniques presented differ in terms of approach, the available clinical data, albeit limited, support the notion that they may both have roles in the treatment algorithm for patients with challenging proximal neck anatomy. PMID:26327748

  3. 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.

  4. Evaluation of Exercise-Induced Hypertension Post Endovascular Stenting of Coarctation of Aorta

    Directory of Open Access Journals (Sweden)

    Akbar Shah Mohammadi

    2010-08-01

    Full Text Available Background: Coarctation of the aorta (COA is a defect that accounts for 5-8% of all congenital heart diseases. Balloon angioplasty as a treatment for COA is increasingly performed, with endovascular stents having been proposed as a means of improving the efficacy and safety of the procedure. The aim of this study was to evaluate the systolic blood pressure gradient at rest and during maximal exercise at follow-up in patients post endovascular stenting of COA.Methods: Thirteen patients (4 native and 9 re-coarctation cases of COA after surgery or balloon angioplasty with a mean age of 11.1 ± 4.7 years underwent endovascular stenting between November 2007 and December 2009 via standard techniques for native COA as an alternative to surgical repair. Doppler echocardiography was performed pre and post stenting. Resting and exercise assessment of blood pressure was performed at follow-up.Results: Post stent implantation, no angiographic major complications were evident. Systolic blood pressure gradient decreased from 42 ± 8.8 mm Hg before stent placement to 7 ± 10 mm Hg at follow-up (p value < 0.001. Peak Doppler pressure gradient decreased from 30 ± 14 mm Hg to 14 ± 10 mm Hg at follow-up (p value < 0.007. One case of exerciseinduced hypertension was seen in patients.Conclusion: Endovascular stenting for native COA in older children and post-surgical COA repair in patients with residual COA and re-coarctation is a reasonable alternative to surgical correction. During early follow-up, stenting effectively alleviates the aortic arch obstruction with normalization of the systemic blood pressure both at rest and during maximal exercise.

  5. Endovascular treatment of ruptured proximal pica aneurysms: A single-center 5-years experience

    Directory of Open Access Journals (Sweden)

    Vivek Gupta

    2014-01-01

    Full Text Available Background and Purpose: Posterior inferior cerebellar artery (PICA like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA - PICA junction and the proximal segment of the PICA. The use of endovascular treatment as an alternative treatment to surgery has been increasing. We present our last 5 years experience in treating the ruptured proximal PICA aneurysms. Materials and Methods: Retrospective analysis of records of all patients with ruptured VA-PICA junction aneurysms treated at our referral center between July 2008 and July 2013 was performed. Over the last 5 years, we came across 17 patients who had aneurysms of proximal PICA or VA-PICA junction out of which 13 patients underwent endovascular treatment for ruptured saccular VA-PICA junction aneurysms and were the focus of this research. Follow-up studies ranged from 6 months to 3 years. Results: All the patients presented with an acute intracranial hemorrhage on NCCT. All the aneurysms were at VA-PICA junction with partial or complete incorporation of PICA origin in the sac. Endovascular treatment of all the 13 aneurysm was successful in the first attempt. Aneurysms were treated with balloon assisted coiling either by placing the balloon across the VA-PICA junction (n = 3 or in the vertebral artery proper (n = 9. Stent assisted coiling VA-PICA was performed in one aneurysm (n = 1. There was no intra-procedural rupture of the aneurysms. Conclusion: Endovascular therapy of ruptured proximal PICA aneurysms is possible and safe with the use of adjuvant devices and should be considered as first line treatment.

  6. Endovascular Therapy is Effective Treatment for Focal Stenoses in Failing Infrapopliteal Vein Grafts

    Science.gov (United States)

    Westin, Gregory G.; Armstrong, Ehrin J.; Javed, Usman; Balwanz, Christopher R.; Saeed, Haseeb; Pevec, William C.; Laird, John R.; Dawson, David L.

    2014-01-01

    Objective To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts. Methods We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3-6 month intervals for graft surveillance. Results Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan-Meier analysis, 37% were free from graft restenosis at 12 months and 31% were at 24 months. Receiver operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis (P=0.03), patency without reintervention (P=0.01), and assisted patency with secondary intervention (P=0.02) rates were superior for short lesions compared to long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions. Conclusions In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that

  7. 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.

  8. The "Lantern" Procedure to Simplify Treatment of Retrograde Type A Dissection After Thoracic Endograft Stenting.

    Science.gov (United States)

    Tsai, Chung-Lin

    2016-04-01

    The emergency repair of retrograde type A aortic dissection after thoracic endovascular aortic repair is a complex and challenging surgical procedure and carries a surgical challenge. Previous studies have reported a significant mortality in the complex repair of retrograde type A aortic dissection after thoracic endovascular aortic repair. We devised a simplified hybrid method-the "Lantern" procedure-to solve this retrograde type A aortic dissection complication.

  9. Endovascular internal carotid artery trapping for ruptured blood blister-like aneurysms: long-term results from a single centre

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Byong-Cheol [Dongguk University Ilsan Hospital, Department of Neurosurgery, Goyang (Korea, Republic of); Kwon, O-Ki; Oh, Chang Wan; Bang, Jae Seung; Hwang, Gyojun [Seoul National University Bundang Hospital, Department of Neurosurgery, Seongnam, Gyeonggi (Korea, Republic of); Jin, Sung-Chul [Inje University Haeundae Paik Hospital, Department of Neurosurgery, Busan (Korea, Republic of); Park, Hyun [Gyeongsang National University Hospital, Department of Neurosurgery, Gyeongsangnam-do (Korea, Republic of)

    2014-03-15

    Endovascular internal carotid artery (ICA) trapping was performed to treat ruptured blood blister-like aneurysms (BBAs). The aim of this study was to evaluate the procedural risks and long-term follow-up results. The records of 11 consecutive patients with BBAs who underwent endovascular ICA trapping between 2005 and 2010 were reviewed. Clinical outcomes were assessed with modified Rankin Scale (mRS) scores. Endovascular ICA trapping was performed in 11 patients as either the primary treatment (7 patients) or the secondary treatment (4 patients) after the patient underwent other treatments. Three patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass when balloon test occlusion (BTO) revealed inadequate collateral circulation. In the primary ICA trapping group (seven patients), six patients had good outcomes (mRS 0 in five, mRS 1 in one), and one patient had a poor outcome (mRS 6: dead). In the secondary ICA trapping group (four patients), two patients had good outcomes (mRS 0), and two patients had poor outcomes (mRS 4, 5). All ten of the surviving patients were clinically stable during the follow-up period (mean 39 months). A radiological follow-up of nine patients (mean 22 months) demonstrated stable occlusion, with the exception of one reopening of the ICA because of coil migration. Perfusion studies of nine patients (mean: 23 months) demonstrated no perfusion decrease. Endovascular ICA trapping is an effective and durable treatment for BBAs. (orig.)

  10. Angiographic outcome of endovascular stroke therapy correlated with MR findings, infarct growth, and clinical outcome in the DEFUSE 2 trial.

    Science.gov (United States)

    Marks, Michael P; Lansberg, Maarten G; Mlynash, Michael; Kemp, Stephanie; McTaggart, Ryan A; Zaharchuk, Greg; Bammer, Roland; Albers, Gregory W

    2014-10-01

    DEFUSE 2 demonstrated that patients with magnetic resonance imaging mismatch had a favorable clinical response to tissue reperfusion assessed by magnetic resonance imaging. This study reports the endovascular results and correlates angiographic reperfusion with clinical and imaging outcomes. Prospectively enrolled ischemic stroke patients underwent baseline magnetic resonance imaging and started endovascular therapy within 12 h of onset. Patients were classified as either target mismatch or no target mismatch using magnetic resonance imaging. The pre- and postprocedure angiogram was evaluated to determine thrombolysis in cerebral infarction scores. Favorable clinical response was determined at day 30, and good functional outcome was defined as a modified Rankin Scale 0-2 at day 90. One-hundred patients had attempted endovascular treatment. At procedure end, 23% were thrombolysis in cerebral infarction 0-1, 31% thrombolysis in cerebral infarction 2A, 28% thrombolysis in cerebral infarction 2B, and 18% thrombolysis in cerebral infarction 3. More favorable thrombolysis in cerebral infarction-reperfusion scores were associated with greater magnetic resonance imaging reperfusion (Pmagnetic resonance imaging reperfusion (P=0·004) and poorer clinical outcome at 90 days (P=0·01) compared with thrombolysis in cerebral infarction 2B-3 patients. Thrombolysis in cerebral infarction reperfusion following endovascular therapy for ischemic stroke is highly correlated with magnetic resonance imaging reperfusion, infarct growth, and clinical outcome. © 2014 The Authors. International Journal of Stroke © 2014 World Stroke Organization.

  11. Endovascular internal carotid artery trapping for ruptured blood blister-like aneurysms: long-term results from a single centre.

    Science.gov (United States)

    Kim, Byong-Cheol; Kwon, O-Ki; Oh, Chang Wan; Bang, Jae Seung; Hwang, Gyojun; Jin, Sung-Chul; Park, Hyun

    2014-03-01

    Endovascular internal carotid artery (ICA) trapping was performed to treat ruptured blood blister-like aneurysms (BBAs). The aim of this study was to evaluate the procedural risks and long-term follow-up results. The records of 11 consecutive patients with BBAs who underwent endovascular ICA trapping between 2005 and 2010 were reviewed. Clinical outcomes were assessed with modified Rankin Scale (mRS) scores. Endovascular ICA trapping was performed in 11 patients as either the primary treatment (7 patients) or the secondary treatment (4 patients) after the patient underwent other treatments. Three patients underwent superficial temporal artery (STA)-middle cerebral artery (MCA) bypass when balloon test occlusion (BTO) revealed inadequate collateral circulation. In the primary ICA trapping group (seven patients), six patients had good outcomes (mRS 0 in five, mRS 1 in one), and one patient had a poor outcome (mRS 6: dead). In the secondary ICA trapping group (four patients), two patients had good outcomes (mRS 0), and two patients had poor outcomes (mRS 4, 5). All ten of the surviving patients were clinically stable during the follow-up period (mean 39 months). A radiological follow-up of nine patients (mean 22 months) demonstrated stable occlusion, with the exception of one reopening of the ICA because of coil migration. Perfusion studies of nine patients (mean: 23 months) demonstrated no perfusion decrease. Endovascular ICA trapping is an effective and durable treatment for BBAs.

  12. SELENA - An open-source tool for seismic risk and loss assessment using a logic tree computation procedure

    Science.gov (United States)

    Molina, S.; Lang, D. H.; Lindholm, C. D.

    2010-03-01

    The era of earthquake risk and loss estimation basically began with the seminal paper on hazard by Allin Cornell in 1968. Following the 1971 San Fernando earthquake, the first studies placed strong emphasis on the prediction of human losses (number of casualties and injured used to estimate the needs in terms of health care and shelters in the immediate aftermath of a strong event). In contrast to these early risk modeling efforts, later studies have focused on the disruption of the serviceability of roads, telecommunications and other important lifeline systems. In the 1990s, the National Institute of Building Sciences (NIBS) developed a tool (HAZUS ®99) for the Federal Emergency Management Agency (FEMA), where the goal was to incorporate the best quantitative methodology in earthquake loss estimates. Herein, the current version of the open-source risk and loss estimation software SELENA v4.1 is presented. While using the spectral displacement-based approach (capacity spectrum method), this fully self-contained tool analytically computes the degree of damage on specific building typologies as well as the associated economic losses and number of casualties. The earthquake ground shaking estimates for SELENA v4.1 can be calculated or provided in three different ways: deterministic, probabilistic or based on near-real-time data. The main distinguishing feature of SELENA compared to other risk estimation software tools is that it is implemented in a 'logic tree' computation scheme which accounts for uncertainties of any input (e.g., scenario earthquake parameters, ground-motion prediction equations, soil models) or inventory data (e.g., building typology, capacity curves and fragility functions). The data used in the analysis is assigned with a decimal weighting factor defining the weight of the respective branch of the logic tree. The weighting of the input parameters accounts for the epistemic and aleatoric uncertainties that will always follow the necessary

  13. Management of giant intracranial ICA aneurysms with combined extracranial-intracranial anastomosis and endovascular occlusion.

    Science.gov (United States)

    Serbinenko, F A; Filatov, J M; Spallone, A; Tchurilov, M V; Lazarev, V A

    1990-07-01

    Nine patients with giant internal carotid artery (ICA) aneurysms (greater than 2.5 cm in diameter) were subjected to a combined extracranial-intracranial (EC-IC) bypass procedure and endovascular ICA occlusion during 1987 and 1988. The procedures were performed under one anesthetic. In all cases the collateral circulation had been judged insufficient on the basis of a strict preoperative testing protocol including: cerebral panangiography, electroencephalography, somatosensory potential recording, and cerebral blood flow monitoring during manual compression of the ICA in the neck. There were four intracavernous ICA aneurysms, four carotid-ophthalmic artery aneurysms, and one supraclinoid ICA aneurysm. All patients showed symptoms and signs of compression of the surrounding nervous structures. In the five cases of intradural lesions, the artery was occluded at the level of the aneurysm neck, so the ophthalmic artery had to be occluded. There was, nevertheless, no case of worsening of vision following surgery, and all nine patients showed significant improvement following the combined procedure. A combined EC-IC bypass procedure and endovascular ICA occlusion allows for immediate verification of the surgical results and appears to be a worthwhile method for treating giant intracranial aneurysms.

  14. 主动脉腔内覆膜支架置入术与开放手术治疗急性B型主动脉夹层的meta分析%Endovascular stent versus open surgery in the acute type B aortic dissection: a meta-analysis

    Institute of Scientific and Technical Information of China (English)

    张浩; 王志维; 郭毅; 戴小峰; 赵磊; 吴红兵; 胡小平

    2011-01-01

    目的 评价主动脉腔内覆膜支架置入术(支架置入术)与开放手术治疗急性B犁胸主动脉夹层(acute type B aortic dissection,ATBAD)的疗效.方法 系统检索Cochrane图书馆的临床对照试验中心注册库(Cochrane Central Register of Controlled Trials,CENTRAL)、MEDLINE、EMBASE、CINAHL、Web of Science、OpenSIGLE、National Technical Information Service(NTIS)和中国知网(CNKI)、中国生物文献数据库(CBM)、维普数据库(VIP)、万方数据库(WanFang Data)里的主动脉腔内覆膜支架置入术和开放手术治疗急性B型主动脉夹层的临床对照试验.文献检索起止时间均为从建库到201 1年1月18日.由研究人员根据Cochrane偏倚评价和GRADE系统推荐分级方法,对证据质量进行严格评价和资料提取,对符合质量标准的临床对照试验进行meta分析.统计学分析采用RevMan 5.0软件和GRAED profiler 3.2.2软件.结果 5个临床试验共318例患者纳入研究.GRADE评价分析发现30天病死率的证据质量是低级,其他结局均为极低级.急性B型主动脉夹层患者主动脉腔内覆膜支架置入术组与手术组治疗的短期病死率差异有统计学意义,OR 0.19、95% CI [0.09,0.39],P<0.001,但围术期并发症和远期病死率两组比较差异无统计学意义,OR 1.40、95% CI [0.24,8.18].结论 主动脉腔内覆膜支架置入术只能作为治疗急性B型主动脉夹层的一种选择,目前的证据尚不能证明其可完全替代开放手术.%Objective Acute type B aortic dissection (ATBAD) is a life-threatening condition.Open surgical (OS) repair with a prosthetic graft has been a conventional treatment for ATBAD.Thoracic endovascular aortic repair (TEVAR),as a less invasive and potentially safer technique,has been used increasingly in recent decade.Evidence to support the use of TEVARin these patients is needed.This meta-analysis was to assess the efficacy of TEVAR versus conventional OS in patients with ATBAD.Methods We

  15. Endovascular treatment of the carotid stump syndrome.

    Science.gov (United States)

    Nano, Giovanni; Dalainas, Ilias; Casana, Renato; Malacrida, Giovanni; Tealdi, Domenico G

    2006-01-01

    In patients with an occluded internal carotid artery, the carotid stump syndrome is a potential source of microemboli that pass through the ipsilateral external carotid artery and the ophthalmic artery to the territory of the middle cerebral artery. Thus, the syndrome is associated with carotid territory symptoms although the internal carotid artery is occluded. Surgical exclusion of the internal carotid artery associated with endarterectomy of the external carotid artery has been described as the gold standard of treatment by many authors. This report is the second case, to our knowledge, of endovascular treatment of the carotid stump syndrome with the use of a stent-graft.

  16. [The endovascular correction of aortic coarctation].

    Science.gov (United States)

    Barkov, E D; Silin, V A; Sukhov, V K

    1992-03-01

    The endovascular balloon dilatation of the aorta coarctation performed on indications and at the optimal terms is the radical correction of the defect with a pronounced positive effect in 90% of 43 patients. No aneurysms and restenoses were found. Retained collaterals allow avoidance of the abdominal syndrome and paradoxical hypertension. Contraindications for catheter angioplasty are thought to include agenesia or considerable hypoplasia of the aorta, the absence of the aorta lumen in the zone of coarctation, its considerable length and the presence of prestenotic aneurysms. A short and noncomplicated postoperative period makes the method sufficiently economical.

  17. Long-term success of endovascular treatment of benign superior vena cava occlusion with chylothorax and chylopericardium

    Energy Technology Data Exchange (ETDEWEB)

    Veroux, Pierfrancesco; Veroux, Massimiliano; Bonanno, Maria Giovanna; Tumminelli, Maria Giuseppina [Department of Surgery and Transplantation, University Hospital, Via S. Sofia, 78, 95123 Catania (Italy); Baggio, Elda [Department of Surgery and Gastroenterological Sciences, University Hospital of Verona (Italy); Petrillo, Giuseppe [Department of Radiology, University Hospital, Via S. Sofia, 78, 95123 Catania (Italy)

    2002-07-01

    The most likely etiology of benign obstruction of the superior vena cava (SVC) include fibrosing mediastinitis and iatrogenic etiologies such as sclerosis and obstruction caused by pacemakers and central venous catheter. Percutaneous stenting of SVC has been used with success both in malignant and benign superior vena cava syndrome; however, long-term follow-up of endovascular procedures is not well known. We present a case of a patient with complete occlusion of SVC of benign etiology, presenting dramatically with bilateral chylothorax and chylopericardium with cardiac tamponade, who underwent successful vena caval revascularization with thrombolytic therapy and placement of self-expanding metallic stent. The 42-month follow-up could encourage endovascular procedures even in SVC syndrome of benign etiology. (orig.)

  18. Endovascular treatment of chronic cerebro spinal venous insufficiency in patients with multiple sclerosis modifies circulating markers of endothelial dysfunction and coagulation activation: a prospective study.

    Science.gov (United States)

    Napolitano, Mariasanta; Bruno, Aldo; Mastrangelo, Diego; De Vizia, Marcella; Bernardo, Benedetto; Rosa, Buonagura; De Lucia, Domenico

    2014-10-01

    We performed a monocentric observational prospective study to evaluate coagulation activation and endothelial dysfunction parameters in patients with multiple sclerosis undergoing endovascular treatment for cerebro-spinal-venous insufficiency. Between February 2011 and July 2012, 144 endovascular procedures in 110 patients with multiple sclerosis and chronical cerebro-spinal venous insufficiency were performed and they were prospectively analyzed. Each patient was included in the study according to previously published criteria, assessed by the investigators before enrollment. Endothelial dysfunction and coagulation activation parameters were determined before the procedure and during follow-up at 1, 3, 6, 9, 12, 15 and 18 months after treatment, respectively. After the endovascular procedure, patients were treated with standard therapies, with the addition of mesoglycan. Fifty-five percent of patients experienced a favorable outcome of multiple sclerosis within 1 month after treatment, 25% regressed in the following 3 months, 24.9% did not experience any benefit. In only 0.1% patients, acute recurrence was observed and it was treated with high-dose immunosuppressive therapy. No major complications were observed. Coagulation activation and endothelial dysfunction parameters were shown to be reduced at 1 month and stable up to 12-month follow-up, and they were furthermore associated with a good clinical outcome. Endovascular procedures performed by a qualified staff are well tolerated; they can be associated with other currently adopted treatments. Correlations between inflammation, coagulation activation and neurodegenerative disorders are here supported by the observed variations in plasma levels of markers of coagulation activation and endothelial dysfunction.

  19. Open Tracheostomy after Aborted Percutaneous Approach due to Tracheoscopy Revealing Occult Tracheal Wall Ulcer

    Directory of Open Access Journals (Sweden)

    John Schweiger

    2013-01-01

    Full Text Available Tracheostomy is a common procedure for intensive care patients requiring prolonged mechanical ventilation. In this case report, we describe a 78-year-old female patient admitted for an aneurysm of the cerebral anterior communicating artery. Following immediate endovascular coiling, she remained ventilated and was transferred to the neurological intensive care unit. On postoperative day ten, a percutaneous tracheostomy (PCT was requested; however, a large ulcer or possible tracheoesophageal fistula was identified on the posterior tracheal wall following bronchoscopic assessment of the trachea. Therefore, the requested PCT procedure was aborted. An open tracheostomy in the operating room was completed; however, due to the position and depth of the ulcer, a reinforced endotracheal tube (ETT was placed via the tracheostomy. Four days later, the reinforced ETT was replaced with a Shiley distal extended tracheostomy tube to bypass the ulceration. Careful inspection and evaluation of the tracheostomy site before PCT prevented a potentially life-threatening issue in our patient.

  20. Early Stent Graft Perforation after Endovascular Repair for Pseudoaneurysm That Was Associated with Clavicle Nonunion

    Science.gov (United States)

    Touma, Masanao; Ohno, Nobuhisa; Yoshikawa, Eiji; Yoshizawa, Kousuke; Fujiwara, Keiichi

    2015-01-01

    We report the case of a 62-year-old man who experienced a left axillary artery pseudoaneurysm that was secondary to nonunion of a 30-year-old left midshaft clavicle fracture. He initially underwent endovascular repair using a self-expanding nitinol stent graft, which was perforated at postoperative day 5. Therefore, we performed open repair with concomitant clavicle resection, and no complications were observed during an approximately 6-year follow-up. We recommend performing clavicle resection with vascular repair to prevent recurrence in similar cases. PMID:26421082

  1. Outcomes and Complications After Endovascular Treatment of Brain Arteriovenous Malformations: A Prognostication Attempt Using Artificial Intelligence.

    Science.gov (United States)

    Asadi, Hamed; Kok, Hong Kuan; Looby, Seamus; Brennan, Paul; O'Hare, Alan; Thornton, John

    2016-12-01

    To identify factors influencing outcome in brain arteriovenous malformations (BAVM) treated with endovascular embolization. We also assessed the feasibility of using machine learning techniques to prognosticate and predict outcome and compared this to conventional statistical analyses. A retrospective study of patients undergoing endovascular treatment of BAVM during a 22-year period in a national neuroscience center was performed. Clinical presentation, imaging, procedural details, complications, and outcome were recorded. The data was analyzed with artificial intelligence techniques to identify predictors of outcome and assess accuracy in predicting clinical outcome at final follow-up. One-hundred ninety-nine patients underwent treatment for BAVM with a mean follow-up duration of 63 months. The commonest clinical presentation was intracranial hemorrhage (56%). During the follow-up period, there were 51 further hemorrhagic events, comprising spontaneous hemorrhage (n = 27) and procedural related hemorrhage (n = 24). All spontaneous events occurred in previously embolized BAVMs remote from the procedure. Complications included ischemic stroke in 10%, symptomatic hemorrhage in 9.8%, and mortality rate of 4.7%. Standard regression analysis model had an accuracy of 43% in predicting final outcome (mortality), with the type of treatment complication identified as the most important predictor. The machine learning model showed superior accuracy of 97.5% in predicting outcome and identified the presence or absence of nidal fistulae as the most important factor. BAVMs can be treated successfully by endovascular techniques or combined with surgery and radiosurgery with an acceptable risk profile. Machine learning techniques can predict final outcome with greater accuracy and may help individualize treatment based on key predicting factors. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. Preservação das artérias hipogástricas com endoprótese ramificada no tratamento endovascular de aneurismas aorto-ilíacos The Zenith iliac bifurcation Device (IBD for preservation of the internal iliac arteries during endovascular repair of aortic-iliac aneurysms

    Directory of Open Access Journals (Sweden)

    Emanuel Dias

    2010-12-01

    Full Text Available Introdução: Os doentes com indicação para tratamento endovascular de aneurismas da aorta abdominal (EVAR apresentam frequentemente artérias ilíacas comuns ectasiadas ou aneurismáticas, o que impossibilita a sua utilização como zona de encoragem distal da endoprótese. Em cerca de 15 a 30% dos casos pode existir necessidade de oclusão/embolização de uma ou de ambas as hipogástricas, com extensão da endoprótese para a artéria ilíaca externa. Isto tem sido associado a casos de claudicação glútea, isquémia intestinal, deficits neurológicos, e de disfunção vesical, intestinal e eréctil. O uso de endopróteses com ramo para a artéria hipogástrica apresenta-se como uma recente inovação que permite a preservação desta artéria e evitar estas complicações. Caso clínico: Homem de 63 anos, com antecedentes de cirurgia aórtica com interposição protésica aorto-aórtica em 2008 por aneurisma da aorta abdominal (AAA infra-renal, admitido para tratamento endovascular de aneurisma das artérias ilíaca comum e hipogástrica direitas, com 3,3 cm de maior diâmetro. O doente foi submetido a colocação por via femoral de endoprótese Zenith® ramificada para bifurcação ilíaca com preservação da artéria hipogástrica. Conclusões: A utilização de endopróteses ramificadas para a bifurcação ilíaca durante a correcção endovascular de aneurismas aorto-ilíacos para ser uma forma segura e pouco complexa de garantir a preservação das artérias hipogástricas e minimizar as complicações associadas à sua oclusão.Introduction: A significant portion of patients presenting for endovascular aneurysm repair of the abdominal aorta (EVAR have aneurysmatic or ectasied common iliac arteries, raising distal anchorage issues. In these cases, it may be necessary occlusion / embolization of one or both hipo gastric arteries with extension of the endoprothesis to the external iliac artery. This procedure has been associated to

  3. In vivo geometry of the kissing stent and covered endovascular reconstruction of the aortic bifurcation configurations in aortoiliac occlusive disease.

    Science.gov (United States)

    Groot Jebbink, Erik; Ter Mors, Thijs G; Slump, Cornelis H; Geelkerken, Robert H; Holewijn, Suzanne; Reijnen, Michel Mpj

    2017-01-01

    Objectives Various configurations of kissing stent (KS) configurations exist and patency rates vary. In response the covered endovascular reconstruction of the aortic bifurcation configuration was designed to minimize mismatch and improve outcome. The aim of the current study is to compare geometrical mismatch of kissing stent with the covered endovascular reconstruction of the aortic bifurcation configuration in vivo. Methods Post-operative computed tomographic data and patient demographics from 11 covered endovascular reconstruction of the aortic bifurcation and 11 matched kissing stent patients were included. A free hand region of interest and ellipse fitting method were applied to determine mismatch areas and volumes. Conformation of the stents to the vessel wall was expressed using the D-ratio. Results Patients were mostly treated for Rutherford category 2 and 3 (64%) with a lesion classification of TASC C and D in 82%. Radial mismatch area and volume for the covered endovascular reconstruction of the aortic bifurcation group was significantly lower compared to the kissing stent configuration ( P < 0.05). The D-ratio did not significantly differ between groups. Measurements were performed with good intra-class correlation. There were no significant differences in the post-procedural aortoiliac anatomy. Conclusions The present study shows that radial mismatch exists in vivo and that large differences in mismatch exist, in favour of the covered endovascular reconstruction of the aortic bifurcation configuration. Future research should determine if the decreased radial mismatch results in improved local flow profiles and subsequent clinical outcome.

  4. Open heart surgery

    Science.gov (United States)

    Heart surgery - open ... lung machine is used in most cases during open heart surgery. While the surgeon works on the ... with these procedures, the surgeon may have to open the chest to do the surgery.

  5. 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.

  6. One-step endovascular treatment of bilateral traumatic carotid-cavernous fistulae with atypical clinical course.

    Science.gov (United States)

    Chiriac, Alexandru; Iliescu, Bogdan F; Dobrin, Nicolae; Poeata, Ion

    2014-01-01

    Traumatic carotid-cavernous fistula (TCCF) is a rare neurovascular pathologic entity. The bilateral form occurs even rarer and given the potential risk for both optic tracts presents an urgent indication for quick and effective treatment. We present a patient with a bilateral Barrow type A TCCF with a fulminant development of symptoms, who was successfully treated with bilateral detachable balloons in a single session endovascular procedure. The patient experienced complete relief of symptoms, however the complete neurological deficit in the left optic nerve was persistent.

  7. Endovascular treatment of iliac vein compression syndrome

    Institute of Scientific and Technical Information of China (English)

    MENG Qing-you; LI Xiao-qiang; QIAN Ai-min; SANG Hong-fei; RONG Jian-jie; ZHU Li-wei

    2011-01-01

    Background Iliac vein compression syndrome (IVCS),the symptomatic compression of the left common iliac vein between the right common iliac artery and the vertebrae,is not an uncommon condition.The aim of this research was to retrospectively evaluate long-term outcome and the significance of endovascular treatment in patients with left IVCS.Methods Between January 1997 and September 2008,296 patients received interventional therapy in the left common iliac vein.In the second stage,170 cases underwent saphenous vein high ligation and stripping.Two hundred and thirty-one cases were followed up over a period of 6 to 120 months (average 46 months) and evaluated for symptom improvement with color ultrasound and ascending venography.Results The stenotic or occlusive segments of the left iliac vein were successfully dilated in 285 cases,of whom 272 received stent implantation therapy.Most of the patients achieved satisfactory results on discharge.During the follow-up period,varicose veins were alleviated in 98.7% of the patients,and leg swelling disappeared or was obviously relieved in 84% of cases.About 85% of leg ulcers completely healed.The total patency rate was 91.7% as evaluated with color ultrasound and 91.5% with ascending venography.Conclusions Endovascular treatment of IVCS provides effective symptomatic improvement and good long-term patency in most patients.

  8. Insights on a Giant Aneurysm Treated Endovascularly.

    Science.gov (United States)

    Graziano, Francesca; Iacopino, Domenico Gerardo; Ulm, Arthur John

    2016-07-01

    Background Endovascular treatment with stent-assisted Guglielmi detachable coils is an accepted method for treating intracranial giant aneurysms that otherwise would require more invasive or destructive treatment or could not be treated at all. Nevertheless, there is a paucity of information concerning inner postcoiling aneurysmal changes in human subjects over the long term. We report a postmortem analysis of a patient with a giant aneurysm at the vertebrobasilar junction (VBJ) who was treated endovascularly and studied pathologically 24 months after treatment. Materials and Method The head was removed at autopsy and prefixed in a 10% neutral buffered formalin solution. The brain was gently removed from the skull base after cutting the intracranial nerves and vascular structures. The giant VBJ aneurysm and its relationship with the brainstem, cranial nerves, and vessels were captured photographically and analyzed. Afterward, under operating microscope guidance, the vertebrobasilar system with the aneurysm was gently and carefully detached from the brainstem and carefully analyzed. Results No complete fibrous obliteration of the aneurysm lumen could be detected in our case, and no endothelialization had taken place 24 months after treatment. Conclusions Our findings agree with those of previous similar reports. Coiling, in particular in large or giant aneurysms, may be burdened by the risk of coil compaction and recanalization, but it has the advantage of not affecting the flow in the perforating arteries.

  9. 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.

  10. Expanded eggshell procedure combined with closing-opening technique (a modified vertebral column resection) for the treatment of thoracic and thoracolumbar angular kyphosis.

    Science.gov (United States)

    Liu, Xinyu; Yuan, Suomao; Tian, Yonghao; Wang, Lianlei; Zheng, Yanping; Li, Jianmin

    2015-07-01

    The purpose of this study was to determine the efficacy of a modified vertebral column resection for the treatment of thoracolumbar angular kyphosis. A total of 13 patients (8 male, 5 female) with thoracolumbar kyphosis (kyphotic angle > 60°) were included in this study (Group A). There were 3 patients with failure of spinal formation (Type 1 deformity), 6 patients with old thoracic or lumbar compression fracture, and 4 patients with old spinal tuberculosis (including 1 case of T3-5 vertebral malunion). The average preoperative kyphotic angle was 67.3° (range 62°-75°). Each patient underwent an expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar angular kyphosis. Sixteen patients who were previously treated with a closing-opening wedge osteotomy in the same spine classification group (kyphotic angle > 60°) were used as a control group (Group B). In Group A, the average (± SD) operative time was 400 ± 60 minutes, and the average blood loss was 960 ± 120 ml. There were no surgery-related complications observed during or after the operations. The average local kyphotic angle was 20.3° (range 18°-24.5°), and the average correction rate was 68.7%. In Group B, the average operative time was 470 ± 90 minutes, and the average blood loss was 2600 ± 1600 ml (range 1200-8200 ml). There were segmental vessels and spinal canal venous plexus injury in 1 case, spinal cord injury in 1 case, dural tearing in 2 cases, pleural rupture in 2 cases, and hemothorax and pneumothorax in 1 case. Each patient had more than 2 years of follow-up. At the latest follow-up examination, the average regional kyphotic angle was 19.9° ± 9.1° (range 19°-34°), and there was no significant loss of correction (p > 0.05). There was greater blood loss and a higher complication rate in Group B than in Group A (p < 0.05). An expanded eggshell procedure combined with the closing-opening technique for the treatment of thoracolumbar

  11. [Endovascular repair for coarctation of the aorta in an adult].

    Science.gov (United States)

    Hayashi, Jun; Abe, Kazuo; Hata, Masaki; Nagano, Naoko; Hamasaki, Azumi; Suzuki, Kenji

    2013-09-01

    A 27-year-old woman with Turner's syndrome who underwent successful endovascular treatment for coarctation of the aorta is presented. She was admitted to our hospital complaining of upper extremity hypertension. Computed tomography revealed discrete stenosis of the proximal descending aorta and developed collateral circulation. After endovascular repair with a balloon expandable stent, her transcoarctation gradient fell from 44 mmHg preoperatively to less than 10 mmHg. She was discharged with no complications on the 7th postoperative day. Coarctation of the aorta in an adult patient could be safely and effectively managed by endovascular treatment.

  12. 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

  13. Comparison of open and closed U-Pu equilibrium fuel cycles for Generation-IV fast reactors with the EQL3D procedure

    Energy Technology Data Exchange (ETDEWEB)

    Krepel, Jiri, E-mail: Jiri.Krepel@psi.ch [Laboratory for Reactor Physics and Systems Behaviour, Paul Scherrer Institut, 5232 Villigen PSI (Switzerland); Pelloni, Sandro; Mikityuk, Konstantin [Laboratory for Reactor Physics and Systems Behaviour, Paul Scherrer Institut, 5232 Villigen PSI (Switzerland)

    2012-09-15

    Highlights: Black-Right-Pointing-Pointer We analyze open and closed fuel cycle of GFR, SFR, and LFR cores by means of ERANOS based EQL3D procedure. Black-Right-Pointing-Pointer Equilibrium of open and closed fuel cycles were compared in terms of their performance and safety parameters. Black-Right-Pointing-Pointer All three cores act in equilibrium closed cycle as iso-breeder and have similar fuel composition. Black-Right-Pointing-Pointer In spite of the same fuel composition the Dopper constants and void reactivities strongly differ between the cores. Black-Right-Pointing-Pointer All three systems seem capable, from neutronics point of view, for the fuel cycle closure. - Abstract: The advanced fast reactors of the fourth generation should enable an indirect burning of poorly fissile {sup 238}U through {sup 239}Pu breeding and recycling of the actinides from their own spent fuel. The recycling or actually the fuel cycle closure can significantly reduce the amount of long-lived radioactive waste and the {sup 238}U burning can multiply the sustainability of the uranium fueled reactors. Regular periodic operation with the fuel recycling converges to an equilibrium cycle. To enable its simulation a numerical tool named equilibrium fuel cycle procedure for fast reactors (EQL3D) was developed in the FAST group of LRS at Paul Scherrer Institut. The procedure is based on the ERANOS code and can be used to yield the description of two basic situations: the equilibrium of an open fuel cycle and the equilibrium of a closed fuel cycle. The goals of the present study are (i) to apply EQL3D to the Gas-cooled Fast Reactor (GFR), Sodium-cooled Fast Reactor (SFR), and Lead-cooled Fast Reactor (LFR), (ii) to simulate and confirm the GFR, SFR, and LFR neutronics capability for closed fuel cycle, and (iii) to evaluate and compare the equilibrium cycle safety and performance parameters. The EQL3D capability enables to characterize the equilibrium cycle for complex reloading patterns

  14. Prophylactic endovascular management of peripheral artery disease in elderly candidates prior to cardiac surgery

    Institute of Scientific and Technical Information of China (English)

    Gianluca Rigatelli; Paolo Cardaioli; Massimo Giordan; Loris Roncon; Emiliano Bedendo; Tranquillo Milan; Giorgio Rigatelli

    2006-01-01

    Background and objectives Peripheral vascular disease (PVD) is a major risk factor in candidates for cardiac surgery and can impact morbidity and mortality in the perioperative and follow-up period. Elderly patients with PVD may benefit from endovascular treatment prior to cardiac surgery. We sought to assess the common clinical settings requiring prophylactic endovascular treatment before coronary surgery in elderly patients, the results, and the mid-term impact on subsequent revascularization. Methods Between November 2002 and June 2006, 37 patients (25 males, mean age 79.9±8.3 years, mean serum creatinine 1.9±0.6 mg/dl) underwent endovascular repair of PVD before cardiac surgery. For each patient, diagnostic methods, indications for intervention, types of interventions, procedural success, and complications were recorded. Results Four clinical settings were identified: renal artery stenting prior to coronary surgery (7 patients), iliac artery angioplasty and stenting (10 patients) in order to facilitate aortic balloon pump insertion after surgery, subclavian artery angioplasty and stenting prior to utilization of ipsilateral arterial conduits bypass surgery (5patients), and carotid artery stenting before coronary surgery (15 patients). Technical success was achieved in all patients (100%);complications included brachial artery occlusion (1 patient), minor stroke (2 patients), contrast nephropathy (1 patient), and minor bleeding at the puncture site (3 patients). All patients underwent successful coronary or valvular surgery; no patients died in the perioperative period. After a mean follow-up of 26.6±3.1 months, all patients are alive and free from anginal symptoms or valvular dysfunction without clinical or Doppler ultrasonography evidence of restenosis of the implanted peripheral vascular stents. Conclusions It is not unusual for elderly patients who are candidates for cardiac surgery to require endovascular intervention for significant PVD prior to

  15. Percutaneous Endovascular Salvage Techniques for Implanted Venous Access Device Dysfunction

    Energy Technology Data Exchange (ETDEWEB)

    Breault, Stéphane, E-mail: stephane.breault@chuv.ch [Lausanne University Hospital, Diagnostic and Interventional Radiology Department (Switzerland); Glauser, Frédéric, E-mail: frederic.glauser@chuv.ch [Lausanne University Hospital, Angiology and Diagnostic and Interventional Radiology Departments (Switzerland); Babaker, Malik, E-mail: malik.babaker@chuv.ch; Doenz, Francesco, E-mail: francesco.doenz@chuv.ch; Qanadli, Salah Dine, E-mail: salah.qanadli@chuv.ch [Lausanne University Hospital, Diagnostic and Interventional Radiology Department (Switzerland)

    2015-06-15

    PurposeImplanted venous access devices (IVADs) are often used in patients who require long-term intravenous drug administration. The most common causes of device dysfunction include occlusion by fibrin sheath and/or catheter adherence to the vessel wall. We present percutaneous endovascular salvage techniques to restore function in occluded catheters. The aim of this study was to evaluate the feasibility, safety, and efficacy of these techniques.Methods and MaterialsThrough a femoral or brachial venous access, a snare is used to remove fibrin sheath around the IVAD catheter tip. If device dysfunction is caused by catheter adherences to the vessel wall, a new “mechanical adhesiolysis” maneuver was performed. IVAD salvage procedures performed between 2005 and 2013 were analyzed. Data included clinical background, catheter tip position, success rate, recurrence, and rate of complication.ResultsEighty-eight salvage procedures were performed in 80 patients, mostly women (52.5 %), with a mean age of 54 years. Only a minority (17.5 %) of evaluated catheters were located at an optimal position (i.e., cavoatrial junction ±1 cm). Mechanical adhesiolysis or other additional maneuvers were used in 21 cases (24 %). Overall technical success rate was 93.2 %. Malposition and/or vessel wall adherences were the main cause of technical failure. No complications were noted.ConclusionThese IVAD salvage techniques are safe and efficient. When a catheter is adherent to the vessel wall, mechanical adhesiolysis maneuvers allow catheter mobilization and a greater success rate with no additional risk. In patients who still require long-term use of their IVAD, these procedures can be performed safely to avoid catheter replacement.

  16. Percutaneous access for endovascular abdominal aortic aneurysm repair: can selection criteria be expanded?

    Science.gov (United States)

    Smith, Stephen T; Timaran, Carlos H; Valentine, R James; Rosero, Eric B; Clagett, G Patrick; Arko, Frank R

    2009-01-01

    Previous reports suggest that percutaneous access for endovascular abdominal aortic aneurysm repair (P-EVAR) is as safe as open access (O-EVAR) in patients with favorable femoral anatomy. Severe femoral artery calcification and obesity have been considered relative contraindications to P-EVAR, but these criteria have not been evaluated. The purpose of this study was to assess the postoperative anatomic changes associated with P-EVAR versus O-EVAR using three-dimensional (3-D) computed tomographic (CT) reconstruction and to evaluate the overall results of the two procedures in a group of patients with suboptimal femoral anatomy. During a recent 26-month period, 173 patients underwent EVAR at our institutions, including 35 P-EVARs. Of these, 22 (63%) had complete pre- and postoperative CT imaging of the femoral arteries. These subjects were compared to 22 matched controls who underwent O-EVAR during the same period. Automated 3-D reconstructions were used to measure the following anatomic femoral artery parameters before and after EVAR: arterial depth, calcification score, minimum diameter and area, and maximum diameter and area. Of the 88 study arteries, 50 underwent open access and 38 percutaneous access (Proglide, n=11; Prostar XL, n=27). Both groups were similar regarding sheath size, number of components, operative time, blood loss, and length of stay. Significantly more O-EVAR subjects suffered groin complications (p=0.02), including five hematomas, two wound infections, two femoral thromboses, and one vessel which required patch repair. In the P-EVAR group there was only one hematoma, which was managed conservatively. There was no difference between the P-EVAR and O-EVAR groups with respect to femoral artery calcification (Agatston scores 667+/-719 vs. 945+/-1,248, p=0.37). Obesity (body mass index >30) was documented in six (27%) of both the P-EVAR and O-EVAR groups (p=nonsignificant). Pre- and postoperative CT-derived anatomic data showed a significant

  17. Comparative Study between Robotic Total Thyroidectomy with Central Lymph Node Dissection via Bilateral Axillo-breast Approach and Conventional Open Procedure for Papillary Thyroid Microcarcinoma

    Institute of Scientific and Technical Information of China (English)

    Qing-Qing He; Jian Zhu; Da-Yong Zhuang; Zi-Yi Fan; Lu-Ming Zheng; Peng Zhou; Lei Hou

    2016-01-01

    Background:A large proportion of the patients with papillary thyroid microcarcinoma are young women.Therefore,minimally invasive endoscopic thyroidectomy with central neck dissection (CND) emerged and showed well-accepted results with improved cosmetic outcome,accelerated healing,and comforting the patients.This study aimed to evaluate the safety and effectiveness of robotic total thyroidectomy with CND via bilateral axillo-breast approach (BABA),compared with conventional open procedure in papillary thyroid microcarcinoma.Methods:One-hundred patients with papillary thyroid microcarcinoma from March 2014 to January 2015 in Jinan Military General Hospital of People's Liberation Army (PLA) were randomly assigned to robotic group or conventional open approach group (n =50 in each group).The total operative time,estimated intraoperative blood loss,numbers of lymph node removed,visual analog scale (VAS),postoperative hospital stay time,complications,and numerical scoring system (NSS,used to assess cosmetic effect) were analyzed.Results:The robotic total thyroidectomy with CND via BABA was successfully performed in robotic group.There were no conversion from the robotic surgeries to open or endoscopic surgery.The subclinical central lymph node metastasis rate was 35%.The mean operative time of the robotic group was longer than that of the conventional open approach group (118.8 ± 16.5 min vs.90.7 ± 10.3 min,P < 0.05).The study showed significant differences between the two groups in terms of the VASs (2.1 ± 1.0 vs.3.8 ± 1.2,P < 0.05) and NSS (8.9 ± 0.8 vs.4.8 ± 1.7,P < 0.05).The differences between the two groups in the estimated intraoperative blood loss,postoperative hospital stay time,numbers of lymph node removed,postoperative thyroglobulin levels,and complications were not statistically significant (all P > 0.05).Neither iatrogenic implantation nor metastasis occurred in punctured porous channel or chest wall in both groups.Postoperative cosmetic

  18. Clinical and angioarchitectural factors influencing the endovascular approach to galenic dural arteriovenous fistulas in adults: case series and review of the literature.

    Science.gov (United States)

    Cohen, José E; Gomori, John Moshe; Rajz, Gustavo; Paldor, Iddo; Moscovici, Samuel; Itshayek, Eyal

    2017-05-01

    Galenic dural arteriovenous fistulas (DAVF) are rare; however, they are the most frequent type of DAVF to manifest aggressive clinical behavior and usually represent a diagnostic and therapeutic challenge for clinicians. We retrospectively reviewed clinical and imaging data of patients managed with neuroendovascular techniques for the treatment of galenic DAVFs from 2000 to 2016. We searched the 2000-2016 English-language literature for papers discussing neuroendovascular management of galenic DAVFs, with or without companion surgical procedures. Five patients were treated for galenic DAVFs during the study period (four males; mean age, 61 years). Three presented with progressive neurological deterioration due to venous congestion, two with acute intracranial hemorrhage. Three were treated by staged transarterial embolization procedures (three procedures in two, four procedures in one); two underwent a single transvenous embolization procedure. Four out of five fistulas were completely occluded. All patients improved clinically; the patient whose fistula was partially occluded remains angiographically stable at 2-year follow-up. Six reports describing 17 patients are reviewed. Embolization was performed via transvenous approach in 1/17 and transarterial approach in 16/17 with additional open surgery in 9/16. The trend toward the use of transarterial approaches is based primarily on advances on embolization techniques that allow better and more controllable penetration of the embolizing agents with improved clinical and angiographic results, as well as the technical complexity of the transvenous approach. Although transarterial embolization is the preferred endovascular route for the management of most galenic DAVFs, selected cases can be successfully treated by transvenous approach.

  19. Lack of Association Between Limb Hemodynamics and Response to Infrapopliteal Endovascular Therapy in Patients With Critical Limb Ischemia.

    Science.gov (United States)

    Mustapha, J A; Diaz-Sandoval, Larry J; Adams, George; Jaff, Michael R; Beasley, Robert; McGoff, Theresa; Finton, Sara; Miller, Larry E; Ansari, Mohammad; Saab, Fadi

    2017-05-01

    Non-invasive limb hemodynamics may aid in diagnosis of critical limb ischemia (CLI), although the relationship with disease severity and response to endovascular therapy is unclear. This prospective, single-center study enrolled 100 CLI patients (Rutherford class 4-6) who underwent infrapopliteal endovascular revascularization (175 lesions) in the Peripheral RegIstry of Endovascular Clinical OutcoMEs (PRIME) registry. Hemodynamic measures included ankle-brachial index (ABI), toe-brachial index (TBI), and toe pressure (TP). Procedure success following revascularization was defined as stenosis ≤30%. Hemodynamic success was defined as an increase >0.15 in ABI or TBI relative to baseline. Freedom from amputation was defined as no major or minor amputation during follow-up. Clinical success was defined as a decrease of at least one Rutherford class during follow-up. Treatment success was defined as procedure success, freedom from amputation, and clinical improvement. Median baseline hemodynamic values were 0.90 for ABI, 0.39 for TBI, and 54 mm Hg for TP. Twenty-nine patients (29%) did not meet the common hemodynamic diagnostic criterion for eligibility in CLI trials (ABI ≤0.5, TBI ≤0.5, or TP <50 mm Hg). Main outcomes included 96% procedure success, 95% freedom from amputation, 64% clinical success, and 62% treatment success. There was no relationship between baseline (or with the pretreatment to posttreatment change) limb hemodynamic values and the response to infrapopliteal endovascular therapy. Non-invasive hemodynamic studies may have limited clinical usefulness in patients with CLI. The usefulness of these parameters to confirm eligibility and to assess response to therapy in interventional CLI clinical trials should be re-evaluated.

  20. 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?

  1. Transjugular Endovascular Recanalization of Splenic Vein in Patients with Regional Portal Hypertension Complicated by Gastrointestinal Bleeding

    Energy Technology Data Exchange (ETDEWEB)

    Luo, Xuefeng; Nie, Ling; Wang, Zhu; Tsauo, Jiaywei; Tang, Chengwei; Li, Xiao, E-mail: simonlixiao@126.com [West China Hospital, Sichuan University, Department of Gastroenterology (China)

    2013-05-02

    PurposeRegional portal hypertension (RPH) is an uncommon clinical syndrome resulting from splenic vein stenosis/occlusion, which may cause gastrointestinal (GI) bleeding from the esophagogastric varices. The present study evaluated the safety and efficacy of transjugular endovascular recanalization of splenic vein in patients with GI bleeding secondary to RPH.MethodsFrom December 2008 to May 2011, 11 patients who were diagnosed with RPH complicated by GI bleeding and had undergone transjugular endovascular recanalization of splenic vein were reviewed retrospectively. Contrast-enhanced computed tomography revealed splenic vein stenosis in six cases and splenic vein occlusion in five. Etiology of RPH was chronic pancreatitis (n = 7), acute pancreatitis with pancreatic pseudocyst (n = 2), pancreatic injury (n = 1), and isolated pancreatic tuberculosis (n = 1).ResultsTechnical success was achieved in 8 of 11 patients via the transjugular approach, including six patients with splenic vein stenosis and two patients with splenic vein occlusion. Two patients underwent splenic vein venoplasty only, whereas four patients underwent bare stents deployment and two covered stents. Splenic vein pressure gradient (SPG) was reduced from 21.5 ± 7.3 to 2.9 ± 1.4 mmHg after the procedure (P < 0.01). For the remaining three patients who had technical failures, splenic artery embolization and subsequent splenectomy was performed. During a median follow-up time of 17.5 (range, 3–34) months, no recurrence of GI bleeding was observed.ConclusionsTransjugular endovascular recanalization of splenic vein is a safe and effective therapeutic option in patients with RPH complicated by GI bleeding and is not associated with an increased risk of procedure-related complications.

  2. Endovascular Management of Superior Mesenteric Artery (SMA) Aneurysm - Adequate Access is Essential for Success - Case Report.

    Science.gov (United States)

    Tkalčić, Lovro; Budiselić, Berislav; Kovačević, Miljenko; Knežević, Siniša; Kovačić, Slavica; Miletić, Damir; Tomulić, Vjekoslav; Kuhelj, Dimitrij

    2017-01-01

    An aneurysm of the superior mesenteric artery (SMA) with a diameter of 2.2 cm was found incidentally on an ultrasound (US) examination in a 26-year-old woman. The only known risk factor was an intracranial aneurysm that was found on her grandmother's autopsy. Based on pregnancy planning and the current literature, endovascular management with a covered stent was proposed. Self-expandable, covered stent (Bard, Fluency(®)) was implanted using a single transfemoral approach. A stiff guidewire and a large sheath distorted the anatomy, which resulted in an incomplete aneurysmal neck covering. In the absence of additional covered stents, the procedure was terminated. Two weeks later, computed tomographic angiography (CTA) confirmed persistent aneurysmal perfusion due to the incomplete neck coverage. A multidisciplinary board opted for a second endovascular attempt, this time with a longer covered stent via the transaxillary approach in order to reduce anatomical distortion. Balloon, expandable, cobalt-chrome covered stent (Jotec, E-ventus BX(®)) was implanted in the SMA, covering the aneurysmal neck and overlapping the previously implanted covered stent. Angiography confirmed a complete exclusion of the aneurysm. A control US performed three weeks later confirmed a patent covered stent and complete aneurysmal exclusion. There was a mild median nerve damage periprocedurally that resolved in three months. The most recent US control examination, performed eleven months after the procedure, showed an excluded aneurysm and a patent covered stent. There were no clinical signs of bowel ischaemia during the follow-up period. Endovascular management of SMAA proved to be safe and efficient. The "access from above" is probably safer and should be considered in the majority of cases with acceptable sizes of access vessels. Mid-term results in our patient are good and life-long follow-up is planned to prevent late complications.

  3. Endovascular approach for isolated common iliac aneurysm and severe kyphoscoliosis Tratamento endovascular de aneurisma isolado de artéria ilíaca comum e cifoescoliose grave

    Directory of Open Access Journals (Sweden)

    Alexandre Campos Moraes Amato

    2009-09-01

    Full Text Available We report the case of a 72-year-old patient presenting with an isolated common iliac aneurysm with occlusion of contralateral common iliac artery and severe kyphoscoliosis. Because of high risk for open surgery due to chronic obstructive pulmonary disease, this patient was treated with an endovascular approach using an aortomonoiliac stent graft, followed by a femoro-femoral crossover bypass. This report illustrates the usefulness of a minimally invasive approach, and feasibility even for patients with difficult anatomy.Relatamos o caso de um paciente de 72 anos com aneurisma isolado de ilíaca, oclusão contralateral de artéria ilíaca comum e cifoescoliose grave. Devido ao alto risco para cirurgia convencional em razão de doença pulmonar obstrutiva crônica, o paciente foi tratado com abordagem endovascular, utilizando uma endoprótese aortomonoilíaca, seguida de uma derivação fêmoro-femoral cruzada. Este relato ilustra a utilidade de uma abordagem minimamente invasiva e demonstra que, mesmo para pacientes com anatomia difícil, é factível.

  4. Transient cortical blindness after thoracic endovascular aneurysm repair.

    Science.gov (United States)

    Vallabhaneni, Raghuveer; Jim, Jeffrey; Derdeyn, Colin P; Sanchez, Luis A

    2011-05-01

    We report a patient who presented with transient cortical blindness 12 hours after completion of a thoracic endovascular aneurysm repair. Computed tomography of the brain demonstrated no acute findings. The patient's symptoms resolved spontaneously after 72 hours. To our knowledge, this is the first report of transient cortical blindness after endovascular aortic aneurysm repair. This is an uncommon diagnosis that is important to recognize in a modern vascular surgery practice.

  5. 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.

  6. Intracranial Aneurysm with Systemic Lupus Erythematosus Treated by Endovascular Intervention

    Directory of Open Access Journals (Sweden)

    P Shrestha

    2010-03-01

    Full Text Available Systemic lupus erythematosus (SLE is a chronic disease with multiple pathologies that can affect every organ system of the body including central nervous system. Intracerebral aneurysms and subarachnoid hemorrhage (SAH are one of comparatively rarer manifestations of central nervous system SLE. Here we present a case of known SLE complicated by the rupture of intra cerebral aneurysm at basilar artery tip which was successfully treated with endovascular coiling. Keywords: cerebral aneurysm, endovascular surgery, SAH, SLE

  7. Endovascular vs medical management of acute ischemic stroke.

    Science.gov (United States)

    Chen, Ching-Jen; Ding, Dale; Starke, Robert M; Mehndiratta, Prachi; Crowley, R Webster; Liu, Kenneth C; Southerland, Andrew M; Worrall, Bradford B

    2015-12-01

    To compare the outcomes between endovascular and medical management of acute ischemic stroke in recent randomized controlled trials (RCT). A systematic literature review was performed, and multicenter, prospective RCTs published from January 1, 2013, to May 1, 2015, directly comparing endovascular therapy to medical management for patients with acute ischemic stroke were included. Meta-analyses of modified Rankin Scale (mRS) and mortality at 90 days and symptomatic intracranial hemorrhage (sICH) for endovascular therapy and medical management were performed. Eight multicenter, prospective RCTs (Interventional Management of Stroke [IMS] III, Local Versus Systemic Thrombolysis for Acute Ischemic Stroke [SYNTHESIS] Expansion, Mechanical Retrieval and Recanalization of Stroke Clots Using Embolectomy [MR RESCUE], Multicenter Randomized Clinical Trial of Endovascular Treatment for Acute Ischemic Stroke in the Netherlands [MR CLEAN], Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness [ESCAPE], Extending the Time for Thrombolysis in Emergency Neurological Deficits-Intra-Arterial [EXTEND-IA], Solitaire With the Intention For Thrombectomy as Primary Endovascular Treatment [SWIFT PRIME], and Endovascular Revascularization With Solitaire Device Versus Best Medical Therapy in Anterior Circulation Stroke Within 8 Hours [REVASCAT]) comprising 2,423 patients were included. Meta-analysis of pooled data demonstrated functional independence (mRS 0-2) at 90 days in favor of endovascular therapy (odds ratio [OR] = 1.71; p = 0.005). Subgroup analysis of the 6 trials with large vessel occlusion (LVO) criteria also demonstrated functional independence at 90 days in favor of endovascular therapy (OR = 2.23; p acute ischemic stroke in the setting of LVO. © 2015 American Academy of Neurology.

  8. 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.

  9. Endovascular therapy for acute stroke: Quo vadis?

    Directory of Open Access Journals (Sweden)

    Venkatesh S Madhugiri

    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.

  10. Pathogenesis of Thromboembolism and Endovascular Management

    Directory of Open Access Journals (Sweden)

    Sasan Behravesh

    2017-01-01

    Full Text Available Venous thromboembolism (VTE, a disease that includes deep venous thrombosis (DVT and pulmonary embolism (PE, is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted.

  11. Pathogenesis of Thromboembolism and Endovascular Management

    Science.gov (United States)

    Behravesh, Sasan; Hoang, Peter; Nanda, Alisha; Wallace, Alex; Sheth, Rahul A.; Deipolyi, Amy R.; Memic, Adnan; Naidu, Sailendra

    2017-01-01

    Venous thromboembolism (VTE), a disease that includes deep venous thrombosis (DVT) and pulmonary embolism (PE), is associated with high mortality, morbidity, and costs. It can result in long-term complications that include postthrombotic syndrome (PTS) adding to its morbidity. VTE affects 1/1000 patients, costs $13.5 billion annually to treat, and claims 100,000 lives annually in the US. The current standard of care for VTE is anticoagulation, though thrombolysis may be performed in patients with PE and threatened limb. This review discusses pathogenesis and medical treatment of VTE and then focuses on endovascular treatment modalities. Mechanical- and catheter-directed thrombolysis (CDT) is discussed, as well as patient selection criteria, and complications. The first prospective study (CaVenT) comparing CDT with anticoagulation alone in acute DVT, despite study shortcomings, corroborates the existing literature indicating improved outcomes with CDT. The potential of the ongoing prospective, multicenter, randomized ATTRACT trial is also highlighted. PMID:28154761

  12. [The treatment of abdominal aortic aneurysms by use of endovascular prosthesis and classic vascular prosthesis].

    Science.gov (United States)

    Pupka, Artur; Szyber, Przemysław P; Janczak, Dariusz; Pawłowski, Stanisław; Szyber, Piotr

    2006-01-01

    The abdominal aortic aneurysm is a dilatation of infrarenal part of aorta. Its ethiology is still unknown. An infection and congenital disorders of conjunctive tissue are regarded as the main risc factors. Other factors could be a perimural thrombus and elastin and colagen degradation. It's not proved that atheromatosis is a risc factor. The disease concerns mainly the old males. Not treated aneurysm grows until rupture. The aneurysms are usually asympthomatic. Majority of them are found incidentally. Ultrasonography and computed tomography are used to extended diagnosis. The open surgery or endovascular surgery are only possible ways of treatment. The aneurysm with diameter over 55 milimeters, sympthomatic or rupted is an indication for surgery. The aim of the open surgery is implantation of the vascular prosthesis into retroperitoneal space. Endovascular method consist in placement of stent-graft in the lumen of aneurysm through small incision in a peripherial vessel. Stent-graft consists of metal chassis covered by classic vascular prosthesis. This method still requires the long-term assessment.

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

    Energy Technology Data Exchange (ETDEWEB)

    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.

  14. 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.

  15. Endovascular repair of an abdominal aortic aneurysm in a patient with horseshoe kidney: report of a case.

    Science.gov (United States)

    Volpe, Piero; Nano, Giovanni; Dalainas, Ilias; Palazzo, Vincenzo; Casana, Renato; Paroni, Giovanni

    2006-01-01

    A horseshoe kidney poses special problems during treatment of an abdominal aortic aneurysm (AAA), and there is much controversy about the most suitable method of repair. We report the case of a 65-year-old man with a horseshoe kidney, in whom an AAA was treated with a unibody bifurcated endograft. During the procedure, the two anomalous renal arteries were sacrificed. Although there was transient elevation of the creatinine levels, the patient was discharged with normal renal function and no endoleak from the accessory renal arteries. Thus, when two normal and two accessory renal arteries arise from the non-aneurysmatic proximal aortic neck, providing that preoperative kidney function is normal, it seems that the treatment can be safely carried out using an endovascular technique and excluding the accessory renal arteries. This case supports the feasibility of endovascular surgery for the treatment of AAA in the presence of a horseshoe kidney.

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

    Science.gov (United States)

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

    2015-07-01

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

  17. Assessment of Competence in EVAR Procedures

    DEFF Research Database (Denmark)

    Strøm, M; Lönn, L; Bech, B

    2017-01-01

    items with tentative anchors. Iterative Delphi rounds were executed. The panellists rated the importance of each item on a 5 point Likert scale. Consensus was defined as 80% of the panel rating an item 4 or 5 in the primary round and 90% in subsequent rounds. Consensus on the final assessment tool......, and superior performance on a 5 point Likert scale. CONCLUSION: The Delphi methodology allowed for international consensus on a new procedure specific global rating scale for assessment of competence in EVAR. The resulting scale, EndoVascular Aortic Repair Assessment of Technical Expertise (EVARATE......OBJECTIVE/BACKGROUND: To develop a procedure specific global rating scale for assessment of operator competence in endovascular aortic repair (EVAR). METHODS: A Delphi approach was used to achieve expert consensus. A panel of 32 international experts (median 300 EVAR procedures, range 200...

  18. Endovascular Retrieval of Migrated Distal End of Ventriculoperitoneal Shunt from Bilateral Pulmonary Arteries: A Technical Note.

    Science.gov (United States)

    Dossani, Rimal Hanif; Maiti, Tanmoy Kumar; Patra, Devi Prasad; Nanda, Anil; Cuellar, Hugo

    2017-06-21

    Ventriculoperitoneal (VP) shunting of cerebrospinal fluid is one of the most common procedures performed by neurosurgeons around the world. Migration of distal VP shunt catheter into bilateral segmental pulmonary arteries is an extremely rare complication of VP shunt placement. In the present case, a 30-year-old male underwent VP shunting complicated by migration of distal VP shunt catheter into the bilateral pulmonary arteries. Despite manual attempt at externalizing the distal VP shunt catheter at the level of the clavicle, a small piece of distal VP shunt catheter in bilateral pulmonary arteries was noted on computed tomography of the chest obtained after manual externalization. This persistent distal VP shunt catheter was likely left behind after a break in the distal VP shunt catheter during manual externalization procedure. Given the small size of the segmental pulmonary arteries, a novel endovascular technique was used to move the distal VP shunt catheter from the bilateral segmental pulmonary arteries to the main pulmonary trunk. Once in the main pulmonary trunk, a snare device was used to retrieve the distal shunt catheter through the femoral vein. In this technical note, the authors highlight the relevant endovascular technical details to first move the VP shunt catheter from the bilateral segmental arteries followed by successful catheter retrieval using snare device. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. 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.

  20. Imaging and management of complications of open surgical repair of abdominal aortic aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Nayeemuddin, M. [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Pherwani, A.D. [Department of Vascular Surgery, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom); Asquith, J.R., E-mail: john.asquith@uhns.nhs.uk [Department of Interventional Radiology, City General Hospital, University Hospital of North Staffordshire NHS Trust, Stoke-On-Trent (United Kingdom)

    2012-08-15

    Open repair is still considered the reference standard for long-term repair of abdominal aortic aneurysms (AAA). In contrast to endovascular aneurysm repair (EVAR), patients with open surgical repair of AAA are not routinely followed up with imaging. Although complications following EVAR are widely recognized and routinely identified on follow-up imaging, complications also do occur following open surgical repair. With frequent use of multi-slice computed tomography (CT) angiography (CTA) in vascular patients, there is now improved recognition of the potential complications following open surgical repair. Many of these complications are increasingly being managed using endovascular techniques. The aim of this review is to illustrate a variety of potential complications that may occur following open surgical repair and to demonstrate their management using both surgical and endovascular techniques.

  1. 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....

  2. Endovascular treatment of the vertebral artery origin in patients with symptoms of vertebrobasilar ischemia

    Energy Technology Data Exchange (ETDEWEB)

    Dabus, Guilherme; Gerstle, Ronald J.; Derdeyn, Colin P.; Cross, DeWitte T.; Moran, Christopher J. [Washington University School of Medicine, Division of Interventional Neuroradiology, Mallinckrodt Institute of Radiology, Barnes-Jewish Hospital, P.O. Box 8131, St. Louis, MO (United States)

    2006-12-15

    We report our experience with the endovascular treatment of the vertebral artery origin in patients presenting with symptomatic vertebrobasilar ischemia and compare our results with those reported in the literature. In 25 patients, 28 procedures were performed. Patients presented with posterior circulation ischemic symptoms despite optimal medical therapy with antiplatelet drugs and had a digital subtraction angiogram demonstrating stenosis of the origin of the vertebral artery greater than 50%. Retrospective review of the medical records, clinical notes and radiologic-procedural reports was performed. Of the 25 patients, 18 were male and 7 female. Their ages ranged from 50 to 84 years. In 23 of the 25 patients the contralateral vertebral artery was occluded, hypoplastic, absent, or had greater than 50% stenosis. In 13 of the 25 patients angiographic evidence of significant anterior circulation disease was demonstrated. In 18 of the 25 patients the left vertebral artery was affected. The mean stenosis was 82.6%. Follow-up records were available in 19 patients. The mean follow-up was 24 months. Five of the 19 patients had recurrent symptoms of vertebrobasilar ischemia and three patients were retreated. Of the 28 procedures performed, 23 were angioplasty/stenting and 5 were angioplasties alone. Overall technical success was achieved in 26 of the 28 procedures (92.8%). No procedure-related transient ischemic attack, stroke or death was noted. Endovascular treatment of the vertebral artery origin in this patient population is feasible, safe, and effective. There are some questions regarding the long-term follow-up and rate of restenosis and clinical recurrences that are yet to be answered. (orig.)

  3. Thromboembolic Complications after Zenith{sup ®} Low Profile Endovascular Graft for Infrarenal Abdominal Aneurysms

    Energy Technology Data Exchange (ETDEWEB)

    Urlings, T. A. J., E-mail: t-urlings@hotmail.com [Medical Center Westeinde, Department of Radiology (Netherlands); Vries, A. C. de, E-mail: a.de.vries@mchaaglanden.nl; Mol van Otterloo, J. C. A. de, E-mail: a.de.molvanotterloo@mchaaglanden.nl; Eefting, D., E-mail: d.eefting@mchaaglanden.nl [Medical Center Westeinde, Department of Vascular Surgery (Netherlands); Linden, E. van der, E-mail: e.van.der.linden@mchaaglanden.nl [Medical Center Westeinde, Department of Radiology (Netherlands)

    2015-06-15

    PurposeThe purpose of this study was to objectify and evaluate risk factors for thromboembolic complications after treatment with a Zenith{sup ®} Low Profile Endovascular Graft (Zenith LP). Results were compared with those in the recent literature on endovascular aortic repair (EVAR) and with the thromboembolic complications in the patient group treated with a Zenith Flex Endovascular Graft in our institute in the period before the use of the Zenith LP.Materials and MethodsAll consecutive patients who were suitable for treatment with a Zenith LP endograft between October 2010 and December 2011 were included. The preprocedural computed tomography scan (CT), procedural angiographic images, and the postprocedural CT scans were evaluated for risk factors for and signs of thromboembolic complications. All patients treated between December 2007 and November 2012 with a Zenith Flex endograft were retrospectively evaluated for thromboembolic complications.ResultsIn the study period 17 patients were treated with a LP Zenith endograft. Limb occlusion occurred in 35 % of the patients. Limb occlusions occurred in 24 % of the limbs at risk (one limb occluded twice). In one patient two risk factors for limb occlusion were identified. Between December 2007 and November 2012, a total of 43 patients were treated with a Zenith Flex endograft. No limb occlusion or distal embolization occurred.ConclusionDespite that this was a small retrospective study, the Zenith LP endograft seems to be associated with more frequent thromboembolic complications compared with the known limb occlusion rates in the literature and those of the patients treated with a Zenith Flex endograft in our institute.

  4. Early Experiences of Sandwich Technique to Preserve Pelvic Circulation during Endovascular Aneurysm Repair.

    Science.gov (United States)

    Kim, Daehwan; Chung, Jung Kee; Park, Hyung Sub; Jung, In Mok; Lee, Taeseung

    2017-06-01

    To report experiences of the sandwich technique (ST) for preservation of pelvic flow during endovascular repair of complex aortic or aortoiliac aneurysms. Eight patients underwent elective endovascular aneurysm repair (EVAR) using the ST between March 2013 and February 2017. The anatomic indications for the ST were complex aortoiliac aneurysms (5 cases), abdominal aortic aneurysms (AAA) with non-diseased short common iliac arteries (2 cases) and AAA with unilateral occluded iliac artery (1 case). The ST was performed through both femoral and brachial approach. Patient clinical and radiologic data were collected and analyzed. Eight patients (7 male; mean age, 73.4 years) were followed over a mean period of 277 days (range, 9-1,106 days). The technical success rate was 100%. The primary patency rate of the iliac stent-grafts was 88% (14/16 cases). One internal iliac and 1 external iliac stent-graft occlusion was observed during the early postoperative period. There was 1 gutter endoleak which disappeared spontaneously within 4 days, and there were 2 type II endoleaks: one treated by coil embolization after 13 months, and the other observed without treatment. There were no cases of sac growth or aneurysm-related deaths, and no cases of buttock claudication or impotence. The ST is a safe and feasible technique to preserve pelvic circulation during endovascular treatment of complex aortoiliac aneurysms. The need to expand the indications for complex EVARs with adjunctive procedures, such as the ST is highlighted in situations where branched/fenestrated device availability is limited.

  5. Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Radiology and Interventional Radiology (Italy); Scarano, Flavio; Passerone, Giancarlo [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Cardiac Surgery (Italy); Williams, David M. [University of Michigan Medical Center, Department of Radiology, Division of Vascular and Interventional Radiology (United States)

    2013-04-15

    To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up. Sixty-one patients (39 men; mean {+-} standard deviation age 66.1 {+-} 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 {+-} 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III). Among the 48 patients, 26 (54 %; 17 men, aged 64.3 {+-} 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 {+-} 9.5 months (range 12-42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved. Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.

  6. Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Itshayek, Eyal; Spektor, Sergey; Shoshan, Yigal; Rosenthal, Guy; Moscovici, Samuel

    2012-01-01

    Traumatic internal carotid artery dissection (CAD) has a potentially grave outcome. Anticoagulant therapy may be ineffective or contraindicated; surgery impractical. We present our experience with endovascular stenting in CAD patients. From 2004 to 2011, 23 patients with angiographically proven traumatic CAD underwent endovascular stent-assisted arterial reconstruction based on clinical and radiographic criteria: contraindication or failure of anticoagulation, evidence of impending ischemic stroke, or need for urgent intracranial revascularization. Dissections were graded based on degree of stenosis and extent of injury. Seventeen patients (73.9%) presented with stroke or transient ischemic attack. Carotid revascularization was achieved with one (11 patients, 48%) or multiple stents (12 patients, 52%); distal protection was used rarely (three patients, 13%). No complications were directly attributed to stenting. Mean dissection-related stenosis improved from 72% ± 28.87% to 4% ± 8.29%. At a mean clinical follow-up of 28.7 months ± 31.9 months, 16 patients (69.6%) improved, six (26.1%) remained stable, and one (4.3%) had died secondary to multiple traumatic injuries. At long-term follow-up, no patient had a transient ischemic attack or stroke or presented evidence of de novo in-stent stenosis or stent thrombosis. There were no neurologic sequelae after partial or total discontinuation of antiplatelet therapy in seven patients undergoing trauma-related surgeries. Selected cases of traumatic CAD can be safely managed by endovascular stent-assisted angioplasty. Procedural complications are infrequent; the need for postprocedure antiplatelet therapy is a concern. Early detection is essential to avoid stroke. Stenting restores the integrity of the vessel lumen immediately, efficiently prevents the occurrence or recurrence of ischemic events, and avoids the need of long-term anticoagulation.

  7. Acute deep vein thrombosis and endovascular techniques: It is time for a new aggiornamento!

    Science.gov (United States)

    Pernès, J-M; Auguste, M; Kovarski, S; Borie, H; Renaudin, J-M; Coppe, G

    2012-10-01

    The stated aims of treating acute deep vein thrombosis (DVT) are to prevent a pulmonary embolism, stop the clot from spreading, reduce the risk of a recurrence; they are less concerned with the late morbidity associated with post-thrombotic syndrome (PTS). In accordance with the French (Afssaps, 2009) and North American (ACCP, 2008) recommendations, anticoagulants (LMWH, heparin, AVK) form the cornerstone for treating DVT. These treatments appear to be far less effective in preventing post-thrombotic syndrome (PTS), associated with venous hypertension, residual occlusion, and with reflux caused by valve incompetence. Given that, the new aim is to optimise the prevention of PTS, the ACCP guidelines, unlike those of Afssaps, "suggest" for selected patients suffering from acute iliofemoral DVT, the use of both classic anticoagulants, and in situ percutaneous administration of thrombolytic drugs (recommendation grade 2B) and simultaneous correction of any underlying anatomical anomalies using angioplasty and stenting (recommendation 2C). Contemporary endovascular methods, referred to collectively as "facilitated" thrombolysis, combine low doses of rtPa or Urokinase administered locally, and the removal of the clot using various mechanical, rotating, rheolytic systems, or using ultrasound. The results of non-randomised, heterogeneous studies objectivised a lysis rate of 80%, a 50% lower risk of haemorrhage complications compared with systemic thrombolysis (<4%), and a clear reduction in treatment time (one-shot methods possible for procedures lasting less than 2 hours). This data ties in with the modern "open vein" concept which underpins the hope of an improvement in the late prognosis of acute DVT, through the removal of a clot, thereby improving permeability and valve integrity; this hypothesis is supported by the results at 24 months of a randomised CaVent objectifying absolute risk reduction of 15% in the thrombolysis in situ. The current randomised study (ATTRACT

  8. Determinants of survival and major amputation after peripheral endovascular intervention for critical limb ischemia

    Science.gov (United States)

    Vierthaler, Luke; Callas, Peter W.; Goodney, Philip P.; Schanzer, Andres; Patel, Virenda I.; Cronenwett, Jack; Bertges, Daniel J.

    2017-01-01

    Objective Our objective was to analyze periprocedural and 1-year outcomes of peripheral endovascular intervention (PVI) for critical limb ischemia (CLI). Methods We reviewed 1244 patients undergoing 1414 PVIs for CLI (rest pain, 29%; tissue loss, 71%) within the Vascular Study Group of New England (VSGNE) from January 2010 to December 2011. Overall survival (OS), amputation-free survival (AFS), and freedom from major amputation at 1 year were analyzed using the Kaplan-Meier method. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). Results The number of arteries treated during each procedure were 1 (49%), 2 (35%), 3 (12%), and ≥4 (5%). Target arterial segments and TransAtlantic Inter-Society Consensus classifications were aortoiliac, 27% (A, 48%; B, 28%; C, 12%; and D, 12%); femoral-popliteal, 48% (A, 29%; B, 34%; C, 20%; and D, 17%); and infrapopliteal, 25% (A, 17%; B, 14%; C, 25%; D, 44%). Technical success was 92%. Complications included access site hematoma (5.0%), occlusion (0.3%), and distal embolization (2.4%). Mortality and major amputation rates were 2.8% and 2.2% at 30 days, respectively. Overall percutaneous or open reintervention rate was 8.0% during the first year. At 1-year, OS, AFS, and freedom from major amputation were 87%, 87%, and 94% for patients with rest pain and 80%, 71%, and 81% for patients with tissue loss. Independent predictors of reduced 1-year OS (C index = .74) included dialysis (HR, 3.8; 95% CI, 2.8–5.1; P 80 years (HR, 2.2; 95% CI, 1.7–2.8; P 1.8 mg/dL (HR, 1.9; 95% CI, 1.3–2.8; P PVI for CLI are associated with different patient characteristics. Dialysis dependence is a common predictor that portends especially poor outcomes. These data may facilitate efforts to improve patient selection and, after further validation, enable risk-adjusted outcome reporting for CLI patients undergoing PVI. (J Vasc Surg 2015;62:655–64.) PMID:26215708

  9. Endovascular treatment of Budd-Chiari syndrome

    Institute of Scientific and Technical Information of China (English)

    MENG Qing-yi; SUN Nian-feng; WANG Jia-xiang; WANG Rui-hua; LIU Zhao-xuan

    2011-01-01

    Background Budd-Chiari syndrome (BCS) is a posthepatic portal hypertension caused by the obstruction of the lumen of the hepatic veins or the proximal inferior vena cava (IVC).This study aimed to evaluate the clinical experience of interventional therapy for Budd-Chiari syndrome.Methods IVC venography was carried out first,the obliteration or stenosis in the IVC was opened or dilated with the hard guided wire or Rups100 puncture needle and balloon,then a stent was routinely implanted for the type of obliteration or stenosis.Results The procedure was successful in 821 out of 903 cases including IVC intervention in 760 cases,and hepatic vein intervention in 61 cases.An IVC stent was used in 517 cases and hepatic vein stent in 19 cases.There were no pulmonary embolisms,but acute renal failure occurred in eight cases,hepatic coma in two cases and acute heart failure in 43 cases.Two patients died in this group and five cases were complicated with acute IVC thrombosis.Follow up of 7 to 124 months was made in 679 cases with recurrence found in 59 cases.Conclusions Interventional therapy is safe and effective with a fast recovery for most types of BCS.It is gradually becoming the first therapeutic choice.

  10. Short- and midterm results of the fascia suture technique for closure of femoral artery access sites after endovascular aneurysm repair.

    Science.gov (United States)

    Montán, Carl; Lehti, Leena; Holst, Jan; Björses, Katarina; Resch, Timothy A

    2011-12-01

    To evaluate the midterm outcomes and potential risk factors associated with the fascia suture technique (FST) for closure of femoral artery access sites after percutaneous endovascular aneurysm repair (EVAR). Between April 2007 and April 2008, 100 consecutive EVAR cases were evaluated retrospectively. A third of the procedures were emergent (16 ruptured aneurysms). Of the 187 femoral access sites, 160 (85.5%) were closed by the FST as a first choice. Pre- and postoperative chart and imaging data were collected from computerized medical records for analysis of demographics and the rate of complications (bleeding, infection, thrombosis, pseudoaneurysms, and stenosis). Preoperative risk factors for FST failure were analyzed with regard to obesity (based on the subcutaneous fat layer), plaque at the femoral access site, and stenosis based on the pre- and 1-year postoperative computed tomography scans. Of the 160 FST closures, 146 (91.3%) were technically successful. The 14 (8.8%) technical failures were converted to open cutdown intraoperatively because of bleeding (11, 6.8%), inadequate limb perfusion (2, 1.2%), and a broken guidewire (1, 0.6%). Two (1.2%) pseudoaneurysms required surgical repair after 2 weeks. Data from the 1-year follow-up showed no signs of increased stenosis, thrombosis, or formation of plaque. Nine small (<1 cm(3)) pseudoaneurysms were detected and managed conservatively. No preoperative risk factors were associated with FST failure. The fascia suture technique seems to be safe, effective, and simple to use for closing percutaneous access sites after EVAR. Complications are rare, and the outcome is not affected by obesity, femoral calcification, or femoral artery stenosis.

  11. 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.

  12. Endovascular reconstruction of aneurysms with a complex geometry

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    Vipul Gupta

    2016-01-01

    Full Text Available Conventional endovascular coiling remains the mainstay of treatment for most aneurysms; however, it may not be suitable for aneurysms with a complex geometry and there remains the risk of recanalization. Aneurysms with an unfavorable morphology are difficult to treat through both endovascular and surgical means. Progress in endovascular technology has allowed for the emergence of newer strategies to treat aneurysms with a complex geometry. Better packing density in wide-necked and large aneurysms can be achieved through the balloon remodeling technique. Similarly, a self-expanding stent cannot only act as a scaffold that helps to retain coils but also aids in diverting the blood flow away from the aneurysm sac. Lately, focus has shifted from endosaccular occlusion to endoluminal reconstruction; flow diverters are being increasingly used to treat aneurysms with an unfavorable geometry. However, there is no clear consensus on the best endovascular management strategy in certain subset of aneurysms - large and giant internal carotid aneurysms, blister aneurysms, and fusiform/dissecting aneurysms of the vertebrobasilar artery. We present a review of literature and discuss the current evidence for the various endovascular strategies to treat complex aneurysms.

  13. Vascular interventional radiology. Current evidence in endovascular surgery. 2. ed.

    Energy Technology Data Exchange (ETDEWEB)

    Cowling, Mark G. (ed.) [Univ. Hospital North Staffordshire, Stoke-on-Trent (United Kingdom). Dept. of Radiology

    2012-11-01

    Succinct chapters that will allow readers to identify quickly the information that they need. Ideally sized book for storage and use in the interventional suite. Contains sufficient detail for trainees in endovascular therapy/interventional radiology to gain a thorough grasp of the relevant issues. Fully updated to reflect recent advances. This new edition of Vascular Interventional Radiology: Current Evidence in Endovascular Surgery provides a thorough yet succinct and accessible review of the latest knowledge in the field of endovascular surgery. All chapters have been updated to reflect the advances that have occurred during the past five years, and new chapters are included on carotid artery stenting and day case intervention. The chapter on lower limb veno-occlusive disease has been expanded to include management of deep venous thrombosis. Among the other topics considered are the endovascular treatment options in different arterial territories, aneurysm repair techniques, and the management of venous stenosis and venous insufficiency. The aim throughout is to tackle issues of evidence-based practice in order to assist trainees and experienced practitioners in making and implementing treatment decisions. This book will be an invaluable source of information for both interventional radiologists and vascular surgeons with an interest in endovascular techniques.

  14. Endovascular therapy: new alternative for treatment of cerebral vasospasm associated with spontaneous subarachnoid hemorrhage La trapia endovascular: una nueva alternativa en el tratamiento del vasoespasmo cerebral asociado a la hemorragia subaracnoidea espontánea

    Directory of Open Access Journals (Sweden)

    Sergio Vargas

    1998-04-01

    Full Text Available Cerebral vasospasm is the first treatable cause of death and disability secondary to spontaneous subarachnoid hemorrhage due to ruptured cerebral aneurysms. However, its treatment has been disapointing with poor results. Despite the fact that the physiopathologic mechanisms governing this phenomenon are largely unknown, during the last nine years, simultaneously with the development of endovascular therapy techniques for treatment of cerebrovascular diseases, two new alternatives have emerged in order to alleviate cerebral vasospasm: intraarterial papaverine and cerebral balloon angioplasty. We report the use of intraarterial papaverine in one case to treat cerebral vasospasm presented during the endovascular therapy procedure; a review of literature is included. EI vaso espasmo cerebral es la principal causa tratable de muerte e incapacidad por hemorragia subaracnoidea espontánea secundaria a la ruptura de un aneurisma cerebral. Sin embargo, su tratamiento ha sido tradicionalmente frustrante, con resultados desalentadores. A pesar de que aún no se han aclarado del todo los mecanismos fisiopatológicos a través de los cuales ocurre este intrigante fenómeno, en los últimos 9 años, paralelamente al desarrollo de las técnicas endovasculares para el tratamiento de las enferm~dades cerebrovasculares, han surgido nuevas alternativas en el manejo del vasoespasmo cerebral. Entre ellas se destacan el uso intraarterial de papaverina y la angioplastia con balón de los vasos cerebrales. Se presenta una revisión del estado actual de estos novedosos instrumentos terapéuticos, así como el reporte de un caso en el cual usamos la papaverina intraarterial en el tratamiento del vasoespasmo quese presentó durante un procedimiento endovascular para excluir un aneurisma de la arteria cerebral media.

  15. Endovascular transplantation of stem cells to the injured rat CNS

    Energy Technology Data Exchange (ETDEWEB)

    Lundberg, Johan; Soederman, Mikael; Andersson, Tommy; Holmin, Staffan [Karolinska University Hospital, Department of Clinical Neuroscience, Karolinska Institutet, Department of Neuroradiology, Stockholm (Sweden); Le Blanc, Katarina [Karolinska University Hospital, Department of Stem Cell Research, Karolinska Institutet, Department of Clinical Immunology, Stockholm (Sweden)

    2009-10-15

    Transplantation procedures using intraparenchymal injection of stem cells result in tissue injury in addition to associated surgical risks. Intravenous injection of mesenchymal stem cells gives engraftment to lesions, but the method has low efficiency and specificity. In traumatic brain injuries (TBI), there is a transient breakdown of the blood-brain barrier and an inflammatory response, which increase migration of cells from blood to parenchyma. The aim of this investigation was to analyze the effect of intra-arterial administration on cellular engraftment. Experimental TBI was produced in a rat model. Endovascular technique was used to administer human mesenchymal stem cells in the ipsilateral internal carotid artery. Evaluation of engraftment and side effects were performed by immunohistochemical analysis of the brain and several other organs. The results were compared to intravenous administration of stem cells. Intra-arterial transplantion of mesenchymal stem cells resulted in central nervous system (CNS) engraftment without thromboembolic ischemia. We observed a significantly higher number of transplanted cells in the injured hemisphere after intra-arterial compared to intravenous administration both 1 day (p<0.01) and 5 days (p<0.05) after the transplantation. Some cells were also detected in the spleen but not in the other organs analyzed. Selective intra-arterial administration of mesenchymal stem cells to the injured CNS is a minimally invasive method for transplantation. The method is significantly more efficient than the intravenous route and causes no side effects in the current model. The technique can potentially be used for repeated transplantation to the CNS after TBI and in other diseases. (orig.)

  16. Fenestrated endovascular aortic repair for juxtarenal abdominal aortic aneurysm

    Institute of Scientific and Technical Information of China (English)

    GUO Wei; ZHANG Hong-peng; LIU Xiao-ping; JIA Xin; XIONG Jiang; MA Xiao-hui

    2013-01-01

    Background Endovascular stent-graft with fenestration can improve proximal sealing in patients with juxtarenal abdominal aortic aneurysm (JAAA).The purpose of this study was to describe our primary experience and evaluate the safety and efficacy of fenestrated device for JAAA in high-risk patients.Methods Between March 2011 and May 2012,nine male patients (mean age,(79.6±8.6) years) with asymptomatic JAAAs underwent elective deployment of the Zenith fenestrated stent-grafts at a single institution.All patients were treated in the hybrid operating room under general anesthesia.Follow-up computed tomography angiography (CTA) was routinely performed before discharge,at 3,6,and 12 months and annually thereafter.Results Procedural success was achieved in all cases.Total sixteen small fenestrations,two large fenestrations and eight scallops were used.Intra-operative complications occurred in four patients,which included one proximal type Ⅰ endoleak,two type Ⅱ endoleaks,and one renal artery dissection.The mean hospital stay was (8.9±1.4) days,mean blood loss was (360.5±46.8) ml,and mean iodinated contrast volume was (230.6±58.3) ml.The mean follow-up time was (7.6±4.2) months.The visceral graft patency was 100% until now.One patient had an increase of serum creatinine of more than 30%,but did not require dialysis.No patients died,no stent fractured,and migration were diagnosed during the follow-up.Conclusions The early results of fenestrated device for high-risk patients with complex JAAAs are satisfactory.However,long-term fenestrated graft durability and branch vessel patency remain to be determined.

  17. Sandwich Technique for Endovascular Repair of Acute Type A Aortic Dissection.

    Science.gov (United States)

    Gao, Feng; Zeng, Qian; Lin, Fangming; Ge, Xiaohu

    2017-07-01

    To describe a new endovascular procedure for acute type A aortic dissection (TAAD) repair. Between 2013 and 2016, 12 patients (average age 54±9.6 years; 10 men) with acute TAAD (mean EURO score 11.4%±3.2%, range 5-17) and unfit for surgery underwent thoracic endovascular aortic repair (TEVAR) with 2 periscope grafts to preserve blood supply to supra-aortic branches plus bypass grafting as needed. If the ascending aorta was dilated to >40 mm, sternotomy was performed to wrap the ascending aorta and reduce its diameter to accommodate the aortic stent-grafts. All patients were successfully treated. Seven patients required bypass grafting, and most of the patients had periscope grafts to the innominate/right common carotid artery and left common carotid artery; only 3 patients had the left subclavian artery preserved. All patients exhibited good hemodynamics and normal pressures after the procedure. The mean procedure time and blood loss were 4.5±1.0 hours and 217±111.5 mL, respectively. Two patients treated emergently died shortly after surgery from multiorgan failure. The average follow-up duration was 17±14.5 months (range 2-42) in the 10 survivors. The remaining patients recovered and none experienced stent-graft thrombosis, stroke, or peripheral artery embolism during follow-up. A procedure that combines sandwich/periscope grafting with TEVAR, wrapping of the aorta, and supra-arch bypass grafting can be used to treat patients with acute TAAD.

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

    Science.gov (United States)

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

    2016-01-01

    Objective To compare duplex ultrasound and computed tomography (CT) angiography in terms of their performance in detecting endoleaks, as well as in determining the diameter of the aneurysm sac, in the postoperative follow-up of endovascular abdominal aortic aneurysm repair. Materials and Methods This was a prospective study involving 30 patients who had undergone endovascular repair of infrarenal aortoiliac aneurysms. Duplex ultrasound and CT angiography were performed simultaneously by independent radiologists. Measurements of the aneurysm sac diameter were assessed, and the presence or absence of endoleaks was determined. Results The average diameter of the aneurysm sac, as determined by duplex ultrasound and CT angiography was 6.09 ± 1.95 and 6.27 ± 2.16 cm, respectively. Pearson's correlation coefficient showing a statistically significant correlation (R = 0.88; p < 0.01). Comparing the duplex ultrasound and CT angiography results regarding the detection of endoleaks, we found that the former had a negative predictive value of 92.59% and a specificity of 96.15%. Conclusion Our results show that there is little variation between the two methods evaluated, and that the choice between the two would have no significant effect on clinical management. Duplex ultrasound could replace CT angiography in the postoperative follow-up of endovascular aneurysm repair of the infrarenal aorta, because it is a low-cost procedure without the potential clinical complications related to the use of iodinated contrast and exposure to radiation. PMID:27777476

  19. 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)

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

    Directory of Open Access Journals (Sweden)

    Alex Aparecido Cantador

    Full Text Available Abstract 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.

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

    Directory of Open Access Journals (Sweden)

    Bruno Lorenção de Almeida

    2014-12-01

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

  2. Hybrid procedure combining clip on wrapping and stent placement for ruptured supraclinoid blood blister-like aneurysm of the internal carotid artery.

    Science.gov (United States)

    Nagasaki, Hirokazu; Narikiyo, Michihisa; Nagayama, Gota; Nagao, Seiya; Tsuboi, Yoshifumi; Kambayashi, Chisaku

    2017-03-01

    Blood blister-like aneurysms of the supraclinoid portion of the internal carotid artery are rare, fragile, and thin-walled lesions with a higher rate of rebleeding. Our case underwent a hybrid procedure combining direct surgical and endovascular approach.

  3. Endovascular treatment of coarctation and related aneurysms.

    Science.gov (United States)

    Galiñanes, E L; Krajcer, Z

    2014-06-11

    Today,surgical repair has almost doubled the 30year survival rate in patients with coarctation of the aorta (CoA), and 72% to 98% of patients now reach adulthood. Possible late complications include malignant hypertension, left ventricular dysfunction, aortic valve dysfunction, recurrent CoA, and aneurysm formation with risk of rupture. Treating postoperative CoA-related aneurysms with observation alone is associated with a mortality rate of 36%, compared with 9% for surgical repair. Even in the best surgeons' hands, aortic surgery has associated complications, and the complexity of reoperative surgery makes the risks substantially greater. For patients with CoA-related aneurysm, endovascular treatment constitutes a good alternative to reoperative surgery because it poses a lower risk of morbidity and mortality. Implanting an endograft has been shown to be successful in treating CoA and related aneurysms, producing excellent intermediate outcomes and minimal morbidity and mortality. Despite evidence that using covered stents improves outcomes, the superiority of any particular stent type has yet to be established. With a variety of endografts available, the decision of which stent to use depends on anatomy, availability, and operator preference.

  4. Biomechanical issues in endovascular device design.

    Science.gov (United States)

    Moore, James E

    2009-02-01

    The biomechanical nature of the arterial system and its major disease states provides a series of challenges to treatment strategies. Endovascular device design objectives have mostly centered on short-term challenges, such as deployability and immediate restoration of reliable flow channels. The resulting design features may be at odds with long-term clinical success. In-stent restenosis, endoleaks, and loss of device structural integrity (e.g., strut fractures) are all manifestations of a lack of compatibility between the host vessel biomechanical environment and the implant design. Initial attempts to adapt device designs for increased compatibility, including drug-eluting and bioabsorbable stents, barely begin to explore the ways in which implant design can be modulated in time to minimize risk of failure. Biomechanical modeling has the potential to provide a virtual vascular environment in which new designs can be tested for their implications on long-term tissue reaction. These models will be based on high quality, highly resolved imaging information, as well as mechanobiology experiments from the cellular to the whole tissue level. These models can then be extended to incorporate biodegradation mechanics, facilitating the next generations of devices whose designs (including drug delivery profiles) change with time to enhance healing. The possibility of initiating changes in device design or drug release according to information on vascular healing (through clinical intervention or automated methods) provides the opportunity for truly individualized dynamic device design optimization.

  5. Safety and efficacy of transhepatic and transsplenic access for endovascular management of portal vein complications after liver transplantation.

    Science.gov (United States)

    Ohm, Joon-Young; Ko, Gi-Young; Sung, Kyu-Bo; Gwon, Dong-Il; Ko, Heung Kyu

    2017-09-01

    The purpose of this article is to evaluate and compare the safety and efficacy of endovascular management of the portal vein (PV) via percutaneous transsplenic access versus percutaneous transhepatic access in liver transplantation (LT) recipients. A total of 18 patients who underwent endovascular management of PV via percutaneous transhepatic (n = 8) and transsplenic (n = 10) access were enrolled. Transsplenic access was chosen if the spleen was located in a normal position, the splenic vein (SpV) was preserved, and the target lesion did not involve confluence of the superior mesenteric and SpVs. Accessibility of the percutaneous transsplenic puncture was confirmed via ultrasound (US) in the angiography suite. All procedures were performed under local anesthesia. Percutaneous transhepatic or transsplenic access was performed using a 21-gauge Chiba needle under US and fluoroscopic guidance, followed by balloon angioplasty, stent placement, or variceal embolization. The access tract was embolized using coils and a mixture (1:2) of glue and ethiodized oil. Transhepatic or transsplenic access was successfully achieved in all patients. A total of 12 patients underwent stent placement; 3 had balloon angioplasty only; 2 had variceal embolization only; and 1 had variceal embolization followed by successful stent placement. Regarding major complications, 1 patient experienced a SpV tear with extravasation during transsplenic balloon angioplasty, which was successfully managed using temporary balloon inflation, followed by transfusion. Clinical success was achieved in 9 of 11 (82%) patients who exhibited clinical manifestations. The remaining 7 patients who underwent prophylactic endovascular management were healthy. In conclusion, endovascular management of PV via percutaneous transsplenic access is a relatively safe and effective alternative that does not damage the liver grafts of LT recipients. Liver Transplantation 23 1133-1142 2017 AASLD. © 2017 by the American

  6. Drug delivering technology for endovascular management of infrainguinal peripheral artery disease.

    Science.gov (United States)

    Sarode, Karan; Spelber, David A; Bhatt, Deepak L; Mohammad, Atif; Prasad, Anand; Brilakis, Emmanouil S; Banerjee, Subhash

    2014-08-01

    Endovascular intervention has become a well-recognized treatment modality for peripheral artery disease; however, mid- and long-term outcomes have been plagued by limited durability. Plain balloon angioplasty and bare-metal stents have historically suffered from high restenosis rates leading to the need for frequent repeat revascularization procedures. The innovation of locally administered, drug-delivering balloons and stents has been a direct result of technological innovations directed toward prevention and treatment of this limitation. Over the last 5 years, numerous clinical trials investigating the use of drug-coated stents and drug-coated balloons indicate a significant improvement in endovascular treatment durability and outcomes. This review provides an up-to-date assessment of the current evidence for the use of drug-coated stents and drug-coated balloons in the treatment of femoropopliteal and infrapopliteal peripheral artery disease. Additionally, it provides an overview of the development of this technology, highlights landmark ongoing and completed clinical trials, examines evidence to support the use of drug-coated technologies in combination with other modalities, and examines promising new technological developments. Last, it summarizes the challenges and safety concerns that have delayed U.S. Food and Drug Administration approval of these devices.

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

    Directory of Open Access Journals (Sweden)

    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.

  8. Combined stent and coil in endovascular treatment of intracranial wide-necked and fusiform aneurysms

    Institute of Scientific and Technical Information of China (English)

    刘建民; 黄清海; 许奕; 洪波; 张珑; 张鑫

    2004-01-01

    Background Wide-necked and fusiform aneurysms are challenges for interventional neuroradiologists and neurosurgeons since they may involve entire vessels or be irregular in shape, making is possible for Guglielmi detachable coil to protrude into the parent arteries. This study was to evaluate the endovascular treatment of intracranial wide-necked and fusiform aneurysms by using a combination of stents and coils.Methods From October 2000 to July 2001, eighteen patients with intracranial wide-necked or fusiform aneurysms were treated with intraluminal stenting in combination with endosaccular coiling.Results Stent placement and coil packing were technically successful in all patients. There were no complications related to the procedure except for the migration of the stent in four cases. The aneurysms were embolized with the coils after precise stenting, and total occlusion was obtained in 13 cases, neck remnants in 3, and loose occlusion in 2. All the patients recovered well. Short-term follow-up angiograms suggested patency of the parent arteries without recanalization.Conclusions A combination of endovascular stenting and coil packing may be a favorable alternative for the treatment of intracranial aneurysms that are unsuitable for surgical clipping or coil embolization. Further study is necessary to assess the long-term outcome.

  9. Effect of radioactivity on stent-graft incorporation after endovascular treatment of aneurysms: An animal study.

    Science.gov (United States)

    Lerouge, Sophie; Raymond, Jean; Schloesser, Klaus; Gaboury, Louis; Soulez, Gilles

    2006-12-01

    Poor stent-graft (SG) incorporation into the vessel wall, following endovascular repair of abdominal aortic aneurysms (EVAR), can lead to endoleaks and SG migration. Low-dose radiation can prevent aneurysm recurrence after coil embolization, and has been associated with a "paradoxical" increase in neointima formation after stenting in a few studies. It was hypothesized that in situ beta radiation emitted from SG could improve its incorporation by preventing the persistence of circulating channels between the implant and the vessel wall and increasing neointima formation around the SG. Phosphorus 32 ((32)P, 200 or 400 kBq per SG (n = 6 each)) was ion implanted on the external surface of balloon-expandable SGs. Twelve radioactive and six non-radioactive SGs were deployed in iliac arteries of nine Mongrel dogs. Neointima formation inside the graft and the persistence of circulating flow through an artificial groove created during the endovascular procedure were assessed by follow-up imaging and by blinded, computerized histomorphometric analysis after animal sacrifice at 3 months. Occlusion occurred in four radioactive SGs. A lesser number of patent grooves was observed along high-activity SGs than along control SGs (1/3 versus 4/4). No difference in neointima formation was observed in radioactive and non-radioactive SGs. Alteration of external graft surface was observed after ion implantation. Ion implantation of (32)P on SGs does not seem to be a viable strategy to improve incorporation and prevent type-I endoleak after EVAR.

  10. Endovascular obliteration of bleeding duodenal varices in patients with liver cirrhosis

    Energy Technology Data Exchange (ETDEWEB)

    Zamora, Carlos Armando; Sugimoto, Koji; Tsurusaki, Masakatsu; Izaki, Kenta; Fukuda, Tetsuya; Matsumoto, Shinichi; Kawasaki, Ryota; Taniguchi, Takanori; Sugimura, Kazuro [Kobe University School of Medicine, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Kuwata, Yoichiro [Nishi-Kobe Medical Center, Department of Radiology, Kobe-shi, Hyogo-ken (Japan); Hirota, Shozo [Hyogo Medical College, Department of Radiology, Nishinomiya-shi, Hyogo-ken (Japan)

    2006-01-01

    The purpose of this paper is to describe our experience with endovascular obliteration of duodenal varices in patients with liver cirrhosis and portal hypertension. Balloon-occluded transvenous retrograde and percutaneous transhepatic anterograde embolizations were performed for duodenal varices in five patients with liver cirrhosis, portal hypertension, and decreased liver function. All patients had undergone previous endoscopic treatments that failed to stop bleeding and were poor surgical candidates. Temporary balloon occlusion catheters were used to achieve accumulation of an ethanolamine oleate-iopamidol mixture inside the varices. Elimination of the varices was successful in all patients. Retrograde transvenous obliteration via efferent veins to the inferior vena cava was enough to achieve adequate sclerosant accumulation in three patients. A combined anterograde-retrograde embolization was used in one patient with balloon occlusion of afferent and efferent veins. Transhepatic embolization through the afferent vein was performed in one patient under balloon occlusion of both efferent and afferent veins. There was complete variceal thrombosis and no bleeding was observed at follow-up. No major complications were recorded. Endovascular obliteration of duodenal varices is a feasible and safe alternative procedure for managing patients with portal hypertension and hemorrhage from this source. (orig.)

  11. Endovascular reperfusion therapies for acute ischemic stroke: dissecting the evidence.

    Science.gov (United States)

    Tsivgoulis, Georgios; Safouris, Apostolos; Krogias, Christos; Arthur, Adam S; Alexandrov, Andrei V

    2016-05-01

    Ischemic stroke is a major cause of death and disability and intravenous thrombolysis has been the only approved acute reperfusion therapy (RT) for many years. Seven randomized-controlled clinical trials (RCTs) evaluating the safety and efficacy of endovascular therapy in patients with acute ischemic stroke (AIS) due to emergent large vessel occlusion (ELVO) have been recently published. These studies have changed the treatment paradigm by establishing mechanical thrombectomy (MT) as the most effective acute stroke therapy for improving functional outcome in anterior circulation ELVO with a NNT of 6. The present review will critically evaluate the results of these RCTs and of the existing meta-analyses investigating the safety and efficacy of endovascular therapy for AIS. Points of debate such as acute stroke imaging, posterior circulation stroke and general anesthesia will be addressed. We will also discuss health policies aiming to increase the availability of endovascular treatment for stroke patients.

  12. Endovascular treatment for acute ischemic stroke patients: implications and interpretation of IMS III, MR RESCUE, and SYNTHESIS EXPANSION trials: A report from the Working Group of International Congress of Interventional Neurology

    Science.gov (United States)

    Qureshi, Adnan I.; Abd-Allah, Foad; Aleu, Aitziber; Connors, John J.; Hanel, Ricardo A.; Hassan, Ameer E.; Hussein, Haitham M.; Janjua, Nazli A.; Khatri, Rakesh; Kirmani, Jawad F.; Mazighi, Mikael; Mattle, Heinrich P.; Miley, Jefferson T.; Nguyen, Thanh N.; Rodriguez, Gustavo J.; Shah, Qaisar A.; Siddiqui, Adnan H.; Suarez, Jose I.; Suri, M. Fareed K.; Tolun, Reha

    2014-01-01

    Objective: The results of Interventional Management of Stroke (IMS) III, Magnetic Resonance and REcanalization of Stroke Clots Using Embolectomy (MR RESCUE), and SYNTHESIS EXPANSION trials are expected to affect the practice of endovascular treatment for acute ischemic stroke. The purpose of this report is to review the components of the designs and methods of these trials and to describe the influence of those components on the interpretation of trial results. Methods: A critical review of trial design and conduct of IMS III, MR RESCUE, and SYNTHESIS EXPANSION is performed with emphasis on patient selection, shortcomings in procedural aspects, and methodology of data ascertainment and analysis. The influence of each component is estimated based on published literature including multicenter clinical trials reporting on endovascular treatment for acute ischemic stroke and myocardial infarction. Results: We critically examined the time interval between symptom onset and treatment and rates of angiographic recanalization to differentiate between “endovascular treatment” and “parameter optimized endovascular treatment” as it relates to the IMS III, MR RESCUE, and SYNTHESIS EXPANSION trials. All the three trials failed to effectively test “parameter optimized endovascular treatment” due to the delay between symptom onset and treatment and less than optimal rates of recanalization. In all the three trials, the magnitude of benefit with endovascular treatment required to reject the null hypothesis was larger than could be expected based on previous studies. The IMS III and SYNTHESIS EXPANSION trials demonstrated that rates of symptomatic intracerebral hemorrhages subsequent to treatment are similar between IV thrombolytics and endovascular treatment in matched acute ischemic stroke patients. The trials also indirectly validated the superiority/equivalence of IV thrombolytics (compared with endovascular treatment) in patients with minor neurological deficits

  13. 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.

  14. Endovascular treatment of carotid-cavernous vascular lesions.

    Science.gov (United States)

    Aguiar, Guilherme Brasileiro DE; Silva, João Miguel; Paiva, Aline Lariessy; Jory, Maurício; Conti, Mario Luiz; Veiga, José Carlos

    2017-01-01

    to evaluate the endovascular treatment of vascular lesions of the cavernous segment of the internal carotidartery (ICA) performed at our institution. 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. 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. the endovascular treatment significantly improved the symptoms in the patients studied, especially those related to pain and oculomotor nerve dysfunction. avaliar o tratamento endovascular de lesões vasculares da artéria carótida interna (ACI), segmento cavernoso, realizado na Santa Casa de São Paulo. estudo descritivo, retrospectivo e prospectivo, de pacientes com aneurisma da porção cavernosa da ACI ou com fístulas carótido-cavernosas diretas (FCCd) submetidos a tratamento endovascular. foram incluídos 26 pacientes com aneurismas intracavernosos e dez com FCCd. Todos os aneurismas foram tratados com oclusão da ACI. Os com FCCd foram tratados com oclusão, em sete casos, e com oclusão seletiva da fístula nos outros três. Houve melhora da dor e proptose ocular em todos os pacientes com FCCd. Nos pacientes com aneurisma intracavernoso, a incidência de dor retro-orbitária caiu de 84,6% para 30,8% após o tratamento. Após o tratamento endovascular houve uma melhora importante da disfunção de nervos cranianos afetados em ambos os grupos

  15. Enhancing brain lesions after endovascular treatment of aneurysms

    DEFF Research Database (Denmark)

    Cruz, J P; Marotta, T; O'Kelly, C

    2014-01-01

    Complications of endovascular therapy of aneurysms mainly include aneurysm rupture and thromboembolic events. The widespread use of MR imaging for follow-up of these patients revealed various nonvascular complications such as aseptic meningitis, hydrocephalus, and perianeurysmal brain edema. We...... 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...

  16. Endovascular treatment of traumatic carotid cavernous fistula with trapping technique

    Directory of Open Access Journals (Sweden)

    Benny Young

    2013-08-01

    Full Text Available Conventional endovascular treatment for carotid cavernous fistula (CCF involves a direct delivery of either coils, detachable balloon or both to the fistula with end point of CCF resolution and carotid artery preservation. But in few cases with severe laceration of carotid artery, the feasible endovascular technique applicable is by blocking the filling of fistula from cerebral circulation. This method known as trapping technique which implicates carotid artery occlusion, was performed in our present case with good result. (Med J Indones. 2013;22:178-82. doi: 10.13181/mji.v22i3.588Keywords: Carotid cavernous fistula (CCF, carotid occlusion, trapping technique

  17. 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.

  18. 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

  19. Endovascular recanalization of a thrombosed native arteriovenous fistula complicated with an aneurysm: Technical aspects and outcomes

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Su Yeon [Dept. of Radiology, Seoul National University Hospital, College of Medicine, Seoul National University, Seoul (Korea, Republic of); So, Young Ho; Choi, Young Ho; Jung, In Mok; Chung, Jung Kee [Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul (Korea, Republic of)

    2015-04-15

    To evaluate the technical aspects and outcomes of endovascular recanalization of a thrombosed native arteriovenous fistula (AVF) complicated with an aneurysm. Sixteen patients who had a thrombosed AVF complicated with an aneurysm (two radiocephalic and 14 brachiocephalic) were included in this study. Recanalization procedures were performed by mechanical thrombectomy using the Arrow-Trerotola percutaneous thrombectomy device and adjunctive treatments. We evaluated dose of thrombolytic agent, underlying stenosis, procedure time, technical and clinical success, and complications. The primary and secondary patency rates were calculated using the Kaplan-Meier analysis. The thrombolytic agents used were 100000 U urokinase mixed with 500 IU heparin (n = 10) or a double dose of the mixture (n = 6). The thrombi in aneurysms were removed in all but two patients with non-flow limiting residual thrombi. One recanalization failure occurred due to a device failure. Aspiration thrombectomy was performed in 87.5% of cases (n = 14). Underlying stenoses were found in the outflow draining vein (n = 16), arteriovenous anastomosis or juxtaanastomosis area (n = 5), and the central vein (n = 3). Balloon angioplasty was performed for all stenoses in 15 patients. Two patients with a symptomatic central vein stenosis underwent insertion of a stent after balloon angioplasty. Mean procedure time was 116.3 minutes. Minor extravasation (n = 1) was resolved by manual compression. Both technical and clinical success rates were 93.8% (n = 15). The primary patency rates at 3, 6, and 12 months were 70.5%, 54.8%, and 31.3%, respectively. The secondary patency rates at 3, 6, and 12 months were 70.5%, 70.5%, and 47.0%, respectively. Thrombosed AVF complicated with an aneurysm can be successfully recanalized, and secondary patency can be prolonged with endovascular treatment.

  20. Acquired post-traumatic aortic coarctation presenting as new-onset congestive heart failure: treatment with endovascular repair.

    Science.gov (United States)

    Thompson, Norris B; Hamidian Jahromi, Alireza; Ballard, David H; Rao, Vyas R; Samra, Navdeep S

    2015-01-01

    Acquired coarctation of the thoracic aorta is a rare phenomenon in adults. The etiology is often idiopathic, but severe stenosis can develop from prior surgery, blunt thoracic aortic injuries, or severe atherosclerotic/atheroembolic disease. Common symptomatic presentations include refractory upper extremity hypertension and new-onset congestive heart failure. We present the case of a 52-year-old man who developed acquired thoracic aortic coarctation 30 years after a blunt trauma and deceleration injuries to the aorta requiring open surgical aortic repair. He presented with poorly controlled hypertension and new-onset heart failure and was treated surgically with endovascular repair.

  1. Endovascular Exclusion of Aortobronchial Fistula and Distal Anastomotic Aneurysm after Extra-Anatomic Bypass for Aortic Coarctation

    Science.gov (United States)

    Arici, Vittorio; Rodolico, Giuseppe; Brunetto, Massimo Borri; Argenteri, Angelo

    2017-01-01

    The treatment of choice for aortic coarctation in adults remains open surgical repair. Aortobronchial fistula is a rare but potentially fatal late sequela of surgical correction of isthmic aortic coarctation via the interposition of a graft. The endovascular treatment of aortobronchial fistula is still under discussion because of its high risk for infection, especially if the patient has a history of cardiovascular prosthetic implantation. Patients need close monitoring, most notably those with secondary aortobronchial fistula. We discuss the case of a 65-year-old man who presented with the combined conditions, and we briefly review the relevant medical literature. PMID:28265214

  2. Four-year experience with a regional program providing simulation-based endovascular training for vascular surgery fellows.

    Science.gov (United States)

    Dawson, David L; Lee, Eugene S; Hedayati, Nasim; Pevec, William C

    2009-01-01

    High-fidelity procedure simulation has been found useful for training vascular surgery residents in endovascular procedures, but the costs of acquiring, maintaining, and operating simulators represent a barrier to routine use of endovascular simulation in vascular surgery programs. Providing simulation training opportunities through regional centers may make simulation more cost effective, but the costs and benefits of this approach have not been reported previously. We reviewed participation costs in a regional simulation program to provide a benchmark for comparison with other training options. Simulation-based training was offered annually from 2004 to 2007 to the 11 vascular surgery fellowships in Washington, Oregon, California, Arizona, and Utah. Participation was at the discretion of the program directors and fellows. Sessions were designed to offer individualized, hands-on training with 2-4 participants per 2-day session. SimSuite (Medical Simulation Corporation, Denver, Colorado) simulators were used. During the 4-year period, participation by invited programs averaged 75%. Ten of 11 programs in the western United States region participated, with 34 fellows participating during the 4 years of the program. In addition, 2 program directors or faculty attended sessions to participate as learners, and 8 other individuals were allowed to participate (including 7 senior surgery residents and 1 vascular surgery fellow from out of the region). The average participant costs for travel, which include transportation, lodging, and meals, were $571. Simulation facility expenses, which included use of the simulator, computer-based training modules, and instructional support by an educational specialist, averaged $1055 per participant. Surgical faculty spent 12 hours per 2-day session instructing and in other direct educational activities. Costs for this time were not calculated separately. Vascular surgery fellows' participation in simulation training at regional centers

  3. Endovascular management of central thoracic veno-occlusive diseases in hemodialysis patients: a single institutional experience in 69 consecutive patients.

    Science.gov (United States)

    Nael, Kambiz; Kee, Stephen T; Solomon, Houman; Katz, Steven G

    2009-01-01

    To assess the functional status and long-term outcomes of endovascular management for the treatment of central veno-occlusive disease in patients undergoing hemodialysis. Retrospective chart evaluation of 600 patients with threatened upper extremity dialysis access showed central veno-occlusive disease in 69 patients (11%; 30 women and 39 men; mean age, 63.9 years; age range, 26-92 years). A total of 92 venous segments were involved with disease. Initial endovascular procedures consisted of transvenous angioplasty (n = 88) and stent placement (n = 6); there were 134 repeat interventions (14 stents). The mean follow-up was 14.5 months (range, 1-44 months). Angiographic data were reviewed prospectively by two independent observers for the extent of veno-occlusive disease. Technical failures were defined as residual stenosis of at least 30% or lesions that were unable to be dilated or crossed. Statistical analysis, including interobserver agreement and Kaplan-Meier analysis, was performed. Technical success rates for initial and follow-up interventional procedures were 90% (81 of 92 segments) and 96% (129 of 134 interventions), respectively. Two complications required treatment with interventional procedures. There was excellent interobserver agreement (kappa = 0.84; 95% confidence interval: 0.67, 0.93) for grading the degree of venous stenoses. Primary patency rates of hemodialysis access at 1, 6, and 12 months were 81%, 46%, and 22%, respectively, which significantly (P = .001) improved to assisted patency rates of 91%, 77%, and 63% at 1, 6, and 12 months, respectively. Endovascular management including a combination of angioplasty and selective stent placement can be effectively used to treat central veno-occlusive disease and preserve functional access in patients with threatened upper extremity dialysis access.

  4. Potential Long-Term Complications of Endovascular Stent Grafting for Blunt Thoracic Aortic Injury

    Directory of Open Access Journals (Sweden)

    Larry E. Miller

    2012-01-01

    Full Text Available Blunt thoracic aortic injury (BTAI is a rare, but lethal, consequence of rapid deceleration events. Most victims of BTAI die at the scene of the accident. Of those who arrive to the hospital alive, expedient aortic intervention significantly improves survival. Thoracic endovascular aortic repair (TEVAR has been accepted as the standard of care for BTAI at many centers, primarily due to the convincing evidence of lower mortality and morbidity in comparison to open surgery. However, less attention has been given to potential long-term complications of TEVAR for BTAI. This paper focuses on these complications, which include progressive aortic expansion with aging, inadequate stent graft characteristics, device durability concerns, long-term radiation exposure concerns from follow-up computed tomography scans, and the potential for (Victims of Modern Imaging Technology VOMIT.

  5. A Proficiency Based Stepwise Endovascular Curricular Training (PROSPECT) Program Enhances Operative Performance in Real Life: A Randomised Controlled Trial.

    Science.gov (United States)

    Maertens, H; Aggarwal, R; Moreels, N; Vermassen, F; Van Herzeele, I

    2017-09-01

    Healthcare evolution requires optimisation of surgical training to provide safe patient care. Operating room performance after completion of proficiency based training in vascular surgery has not been investigated. A randomised controlled trial evaluated the impact of a Proficiency based Stepwise Endovascular Curricular Training program (PROSPECT) on the acquisition of endovascular skills and the transferability of these skills to real life interventions. All subjects performed two endovascular interventions treating patients with symptomatic iliac and/or superficial femoral artery stenosis under supervision. Primary outcomes were technical performances (Global Rating Scale [GRS]; Examiner Checklist), operative metrics, and patient outcomes, adjusted for case difficulty and trainee experience. Secondary outcomes included knowledge and technical performance after 6 weeks and 3 months. Thirty-two general surgical trainees were randomised into three groups. Besides traditional training, the first group (n = 11) received e-learning and simulation training (PROSPECT), the second group (n = 10) only had access to e-learning, while controls (n = 11) did not receive supplementary training. Twenty-nine trainees (3 dropouts) performed 58 procedures. Trainees who completed PROSPECT showed superior technical performance (GRS 39.36 ± 2.05; Checklist 63.51 ± 3.18) in real life with significantly fewer supervisor takeovers compared with trainees receiving e-learning alone (GRS 28.42 ± 2.15; p = .001; Checklist 53.63 ± 3.34; p = .027) or traditional education (GRS 23.09 ± 2.18; p = .001; Checklist 38.72 ± 3.38; p = .001). Supervisors felt more confident in allowing PROSPECT trained physicians to perform basic (p = .006) and complex (p = .003) procedures. No differences were detected in procedural parameters (such as fluoroscopy time, DAP, procedure time, etc.) or complications. Proficiency levels were maintained up to 3 months. A structured

  6. Tratamento endovascular da síndrome de compressão da veia ilíaca (May-Thurner: relato de caso Endovascular treatment of iliac vein compression syndrome (May-Thurner: a case report

    Directory of Open Access Journals (Sweden)

    Jorge Ribeiro da Cunha Júnior

    2011-03-01

    Full Text Available A Síndrome de May-Thurner é uma causa pouco comum de sinais e sintomas venosos relacionados ao membro inferior esquerdo. Esta síndrome é caracterizada pela compressão da veia ilíaca comum esquerda pela artéria ilíaca comum direita e, quando tal alteração anatômica causa sintomas que venham a prejudicar a qualidade de vida do paciente, existe a indicação de tratamento cirúrgico ou endovascular para correção desta alteração anatômica. Este artigo é o relato de um caso, no qual optou-se pelo tratamento endovascular com resultado satisfatório e as indicações, as nuances e os resultados esperados para esta técnica no tratamento da Síndrome de May-Thurner são discutidos. Foi concluído que, nesta síndrome, há eficácia do tratamento endovascular com melhora dos sintomas pela recanalização do sistema venoso, sem grandes riscos inerentes ao procedimento e com curto período de internação hospitalar.May-Thurner Syndrome is an uncommon cause of venous symptoms and signs related to the left lower limb. It is characterized by compression of the left common iliac vein by the right common iliac artery and, when such anatomical change causes symptoms that may impair the patients' quality of life, surgical treatment is indicated. This article addresses a case of May-Thurner syndrome in which we opted for endovascular treatment with satisfactory outcome, as well as a discussion about indications, nuances, and expected results. We concluded that endovascular treatment is effective in treating this syndrome, for it resolves the symptoms by recanalization of the venous system with little risks during the procedure and with short hospital stay.

  7. 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 modali

  8. Local anesthesia for endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    Verhoeven, ELG; Cina, CS; Tielliu, IFJ; Zeebregts, CJ; Prins, TR; Eindhoven, GB; Span, MM; Kapma, MR; van den Dungen, JJAM

    2005-01-01

    Objectives: This study reports the results of a prospective continuous cohort of patients treated for endovascular aneurysm repair (EVAR) with a unified anesthetic strategy based on the use of local anesthesia (LA) in all patients, while reserving regional (RA) or general anesthesia (GA) only for th

  9. Endovascular nonthermal irreversible electroporation: a finite element analysis.

    Science.gov (United States)

    Maor, Elad; Rubinsky, Boris

    2010-03-01

    Tissue ablation finds an increasing use in modern medicine. Nonthermal irreversible electroporation (NTIRE) is a biophysical phenomenon and an emerging novel tissue ablation modality, in which electric fields are applied in a pulsed mode to produce nanoscale defects to the cell membrane phospholipid bilayer, in such a way that Joule heating is minimized and thermal damage to other molecules in the treated volume is reduced while the cells die. Here we present a two-dimensional transient finite element model to simulate the electric field and thermal damage to the arterial wall due to an endovascular NTIRE novel device. The electric field was used to calculate the Joule heating effect, and a transient solution of the temperature is presented using the Pennes bioheat equation. This is followed by a kinetic model of the thermal damage based on the Arrhenius formulation and calculation of the Henriques and Moritz thermal damage integral. The analysis shows that the endovascular application of 90, 100 mus pulses with a potential difference of 600 V can induce electric fields of 1000 V/cm and above across the entire arterial wall, which are sufficient for irreversible electroporation. The temperature in the arterial wall reached a maximum of 66.7 degrees C with a pulse frequency of 4 Hz. Thermal damage integral showed that this protocol will thermally damage less than 2% of the molecules around the electrodes. In conclusion, endovascular NTIRE is possible. Our study sets the theoretical basis for further preclinical and clinical trials with endovascular NTIRE.

  10. MRI-Compatible Endovascular Instruments: Improved Maneuverability during Navigation

    NARCIS (Netherlands)

    Clogenson, H.C.M.

    2014-01-01

    Endovascular diagnostics and interventions are performed using long, thin and flexible instruments that are inserted in the blood vessel and manipulated toward a target in the vasculature. This technique has proven to be successful with the millions of patients diagnosed and treated worldwide every

  11. Intrarenal pseudoaneurysm after percutaneous nephrolithotomy: angiotomographic assessment and endovascular management

    Directory of Open Access Journals (Sweden)

    M. F. Massulo-Aguiar

    2006-08-01

    Full Text Available We report a case of intrarenal pseudoaneurysm of the right kidney after percutaneous nephrolithotomy (PCNL in supine position. Diagnosis was established by angiotomography with a 3-D reconstruction. Treatment was successfully achieved by endovascular occlusion using N-butyl-2-cyanoacrylate.

  12. Device-specific outcomes after endovascular abdominal aortic aneurysm repair

    NARCIS (Netherlands)

    F.B. Gonçalves (Frederico Bastos); E.V. Rouwet (Ellen); R. Metz (Roderik); J.M. Hendriks (Joke); M.P.F.V. Peeters; B.E. Muhs (Bart); H.J.M. Verhagen (Hence)

    2010-01-01

    textabstractOver the last decade, endovascular aneurysm repair (EVAR) has been used extensively for the elective treatment of infra-renal abdominal aneurysms. However, it remains unclear how specific devices perform and how they compare to others. We provide an overview of currently used endografts,

  13. A safe and efficacious alternative: sonographically guided internal jugular vein puncture for intracranial endovascular intervention.

    Science.gov (United States)

    Yeh, C-H; Wu, Y-M; Toh, C-H; Chen, Y-L; Wong, H-F

    2012-01-01

    Transvenous interventions for intracranial vascular lesions are usually performed via venous access of a femoral vein puncture. However, the transjugular route is an alternative with a shorter and less tortuous vascular access for intracranial lesions. Although puncture of the internal jugular vein is generally believed to be too dangerous owing to potential hazardous complications, the safety of the sonographically guided retrograde internal jugular vein puncture technique for intracranial intervention has not been fully evaluated in the English literature. We present our experience with a total of 44 transjugular intervention procedures between April 1999 and June 2010. We believe sonographically guided internal jugular vein puncture is a safe and efficacious technique for establishing transvenous access for an intracranial endovascular intervention.

  14. Treatment of internal carotid artery dissections with endovascular stent placement: report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Deok Hee; Hur, Seung Ho; Kim, Hyeon Gak; Jung, Seung Mun; Ryu, Dae Sik; Park, Man Soo [Kangnung Hospital, Kangnung (Korea, Republic of)

    2000-03-01

    Extracranial carotid artery dissection may manifest as arterial stenosis or occlusion, or as dissecting aneurysm formation. Anticoagulation and/or antiplatelet therapy is the first-line treatment, but because it is effective and less invasive than other procedures, endovascular treatment of carotid artery dissection has recently attracted interest. We encountered two consecutive cases of trauma-related extracranial internal carotid artery dissection, one in the suprabulbar portion and one in the subpetrosal portion. We managed the patient with suprabulbar dissection using a self-expandable metallic stent and managed the patient with subpetrosal dissection using a balloon-expandable metallic stent. In both patients the dissecting aneurysm disappeared, and at follow-up improved luminal patency was observed.

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

    Science.gov (United States)

    Sica, Giacomo; Rea, Gaetano; Bocchini, Giorgio; Lombardi, Romilda; Muto, Massimo; Valente, Tullio

    2017-08-01

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

  16. Endovascular treatment of congenital arteriovenous fistulae of the internal maxillary artery

    Energy Technology Data Exchange (ETDEWEB)

    Kim, B.S. [Department of Radiology, Catholic University of Korea, Seoul (Korea); Lee, S.K.; terBrugge, K.G. [Department of Medical Imaging, Toronto Western Hospital, Fell Pavilion 3-210, 399 Bathurst St, Toronto, Ontario M5T2S8 (Canada)

    2003-07-01

    Congenital arteriovenous fistulae (AVF) of the internal maxillary artery (IMA) are rare. We present the angiographic findings and management of six AVF of the IMA, selected from 147 patients with facial vascular malformations. The fistula was thought to be congenital in all six in view of a life-long history, with no recorded trauma. Our analysis included angioarchitecture, treatment modality, embolic material, treatment results and follow-up. All patients had angiography showing an AVF originating from the IMA and draining to the jugular vein. Five patients underwent endovascular treatment with detachable balloons; a combination of Guglielmi detachable coils and N-acetyl-2-cyanoacrylate (NBCA) was used in one child. We successfully closed the AVF in all cases, without procedure-related complications, except for delayed transient facial numbness in one patient. No recurrence was observed on follow-up of 5 months to 7 years (mean 44 months). (orig.)

  17. 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