Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery最新文献

{"title":"Endovascular AAA repair: prevention of side branch endoleaks with thrombogenic sponge.","authors":"S R Walker,&nbsp;J Macierewicz,&nbsp;B R Hopkinson","doi":"10.1583/1074-6218(1999)006<0350:EARPOS>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0350:EARPOS>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To report a technique that might decrease the incidence of lumbar artery endoleaks following endovascular repair (EVR) of abdominal aortic aneurysms (AAAs).</p><p><strong>Methods: </strong>Ninety-three patients (86 males, median age 72 years, range 56 to 88) undergoing EVR with the aortomonoiliac technique were entered into a study to detect and then occlude patent side branches before completion of the endografting procedure. Prior to deploying the iliac occluder, an aneurysmogram was performed to detect patent aortic side branches. If these side branches were found, an absorbable gelatin sponge was inserted into the aneurysm sac via the occluder introducer sheath. The patients were followed with contrast-enhanced spiral computed tomography (CT) at 1 week and 3, 6, and 12 months to detect the presence of endoleaks.</p><p><strong>Results: </strong>Forty-eight (52%) patients demonstrated patent side branches that were occluded by the insertion of gelatin sponges into the aneurysm sac. The remaining 45 patients without evidence of side branch flow were untreated. Ten (10.7%) patients died in the perioperative period, and 15 (16.1%) primary endoleaks (13 proximal, 2 distal) were detected. This left 68 (73.1%) patients for follow-up, 33 (48.5%) of whom had patent branch vessels treated with the thrombogenic sponge. The median follow-up was 4 months (range 1 to 17), during which time no side branch endoleak was detected on surveillance CT scans in any of the 68 patients, which included all patients treated with the thrombogenic sponge technique and those in whom no patent side branches had been identified.</p><p><strong>Conclusions: </strong>We have demonstrated a safe and reliable method of preventing lumbar artery endoleaks following endovascular AAA repair.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21735026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Concurrent multivessel stenting in a patient with multifocal arterial disease.","authors":"P Vlahopoulos,&nbsp;G Papageorgiou,&nbsp;P Balas,&nbsp;N Ioannou,&nbsp;E Masouridou","doi":"10.1583/1074-6218(1999)006<0370:CMSIAP>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0370:CMSIAP>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To report the concurrent endovascular treatment of multiple stenoses in different vascular territories.</p><p><strong>Methods and results: </strong>A 45-year-old male presented with an aortic arch syndrome, renovascular hypertension, and Leriche syndrome. Intra-arterial digital arteriography disclosed occlusion of the left subclavian artery and stenoses in the left common carotid artery (CCA), the right CCA at the bifurcation, the left renal artery, and both iliac arteries. In a single procedure, the patient received 5 stents in 2 carotid, 1 renal, and 2 iliac arteries. At 3-month follow-up, color flow duplex imaging confirmed continued patency of all stented arteries.</p><p><strong>Conclusions: </strong>This case illustrates the feasibility, safety, and cost effectiveness of treating multivessel stenoses using a single-session endovascular approach executed by experienced interventionists.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21735030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Carotid stenting with cerebral protection: first clinical experience using the PercuSurge GuardWire system.","authors":"M. Henry, M. Amor, I. Henry, C. Klonaris, Z. Chati, I. Masson, S. Kownator, F. Luizy, M. Hugel","doi":"10.1583/1074-6218(1999)006<0321:CSWCPF>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0321:CSWCPF>2.0.CO;2","url":null,"abstract":"PURPOSE: To study the feasibility and safety of carotid angioplasty and stenting using a new cerebral protection device that temporarily occludes the distal internal carotid artery (ICA). METHODS: Forty-eight high-risk patients (39 men, mean age 69.1 +/- 8 years, range 54 to 86) with 53 ICA stenoses underwent percutaneous angioplasty and stenting via the femoral approach under cerebral protection afforded by a 0.014-inch GuardWire balloon occlusion device. Mean stenosis was 82.1% +/- 9.65% (range 70 to 96) and mean lesion length was 16.0 +/- 7.5 mm (range 6 to 50). Thirty-three (62%) lesions were calcified, and 38 (72%) were ulcerated. Thirty-two (60%) of the lesions were asymptomatic. With the occlusion balloon inflated in the distal ICA, the lesion was dilated and stented. The area was cleaned by aspiration and flushed via an aspiration catheter advanced over the wire. Blood samples were collected from the external carotid artery (ECA) and analyzed to measure the size and number of particles collected. Computed tomography and neurological examinations were performed the day after the procedure. RESULTS: Immediate technical success was achieved in all patients with the implantation of 38 Palmaz stents, 8 Expander stents, and 11 Wallstents. Carotid occlusion was well tolerated in all patients but 1 who had multiple, severe carotid lesions and poor collateralization. Mean cerebral flow occlusion time was 346 +/- 153 seconds during predilation and 303 +/- 143 seconds during stent placement. Total mean flow occlusion time was 542 +/- 243 seconds. One immediate neurological complication (transient amaurosis) occurred in a patient who had an anastomosis between the external carotid (EC) and ICA territories. Debris was removed in all patients with a mean 0.8-mm diameter catheter. CONCLUSION: Cerebral protection with the GuardWire device is easy, safe, and effective in protecting the brain from cerebral embolism. Larger studies are warranted.","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67344192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraventricular hemorrhage after carotid stenting.","authors":"T. Mori, M. Fukuoka, K. Kazita, T. Mima, K. Mori","doi":"10.1583/1074-6218(1999)006<0337:IHACS>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0337:IHACS>2.0.CO;2","url":null,"abstract":"PURPOSE: To report an important complication related to carotid stenting. METHODS AND RESULTS: A 71-year-old man with symptomatic subtotal occlusion of the left internal carotid artery had a 30-mm lesion treated percutaneously with implantation of 2 stents. Although the procedure was completed satisfactorily, left intraventricular hemorrhage occurred 4 hours later, possibly related to hyperperfusion injury. The patient expired 30 days after the stent procedure. Preoperative single-photon emission computed tomography revealed severely reduced vasoreactivity in the affected territory after acetazolamide challenge. CONCLUSIONS: The risk of hyperperfusion injury must be considered and minimized in patients with significant restriction of regional vasoreactivity. We recommend that cerebral hemodynamic status be determined prior to carotid stenting.","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1583/1074-6218(1999)006<0337:IHACS>2.0.CO;2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67343970","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient carotid artery stenting: a case report.","authors":"G New,&nbsp;G S Roubin,&nbsp;S S Iyer,&nbsp;E J Lawrence,&nbsp;M Oetgen,&nbsp;N Al-Mubarek,&nbsp;I Moussa,&nbsp;J W Moses,&nbsp;J J Vitek","doi":"10.1583/1074-6218(1999)006<0316:OCASAC>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0316:OCASAC>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To report a case of carotid artery stenting for asymptomatic carotid restenosis performed in an outpatient setting.</p><p><strong>Methods and results: </strong>A 68-year-old man with right carotid restenosis after repeat carotid endarterectomy underwent carotid angioplasty and stenting on an ambulatory basis. The procedure to implant a Smart stent required 45 minutes; the femoral access site was closed with a puncture closure device. The patient experienced no sequelae to this procedure and is well 6 months after treatment.</p><p><strong>Conclusions: </strong>Outpatient delivery of percutaneous carotid stenting may be feasible in appropriately selected patients.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21735097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular repair of an aortoenteric fistula in a high-risk patient.","authors":"A Deshpande,&nbsp;M Lovelock,&nbsp;P Mossop,&nbsp;M Denton,&nbsp;J Vidovich,&nbsp;J Gurry","doi":"10.1583/1074-6218(1999)006<0379:EROAAF>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0379:EROAAF>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the endovascular repair of an aortoenteric fistula in a high-risk patient.</p><p><strong>Methods and results: </strong>A Vanguard tube stent-graft was deployed at the upper anastomotic suture line of a secondary aortoenteric fistula, successfully sealing the communication between the aorta and the third part of the duodenum without occlusion of the renal arteries.</p><p><strong>Conclusions: </strong>Endovascular stent-graft repair of aortoenteric fistulae is possible, but further evaluation of this technique will determine its role in the management of this complication.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21734920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular repair of abdominal aortic aneurysm using a pararenal fenestrated stent-graft.","authors":"R M Faruqi,&nbsp;T A Chuter,&nbsp;L M Reilly,&nbsp;R Sawhney,&nbsp;S Wall,&nbsp;C Canto,&nbsp;L M Messina","doi":"10.1177/152660289900600411","DOIUrl":"https://doi.org/10.1177/152660289900600411","url":null,"abstract":"<p><strong>Purpose: </strong>To report an unusual case of endovascular abdominal aortic aneurysm (AAA) exclusion in which a fenestrated stent-graft was used to seal a proximal Type I endoleak.</p><p><strong>Methods and results: </strong>An 84-year-old man with a 6.0-cm AAA underwent an aortomonoiliac aneurysm exclusion procedure that was complicated by a proximal endoleak. Because the patient had no right kidney, an additional stent-graft was designed to cover the right renal artery stump while preserving left renal perfusion through a fenestration in the graft material. This approach was successful in obliterating the endoleak around the proximal attachment site, but flow through the lumbar arteries remained.</p><p><strong>Conclusions: </strong>The use of a fenestrated stent-graft is feasible, but the type of fenestration in this case has limited applicability owing to the rarity of patients with suitable anatomy.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/152660289900600411","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21735027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response of renal and femoropopliteal arteries to Palmaz stent implantation assessed with intravascular ultrasound.","authors":"T C Leertouwer,&nbsp;E J Gussenhoven,&nbsp;W van Lankeren,&nbsp;H van Overhagen","doi":"10.1583/1074-6218(1999)006<0359:RORAFA>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0359:RORAFA>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To establish the processes responsible for late lumen loss in renal and femoropopliteal Palmaz stents using intravascular ultrasound (IVUS).</p><p><strong>Methods: </strong>The first 7 consecutive patients treated with stents for renal (n = 4) and femoropopliteal (n = 3) arterial occlusive disease were studied with IVUS immediately after angiographically successful stent placement (< 10% residual stenosis) and periodically during follow-up. Images of both stent edges and the most stenotic site inside the stent at followup were matched to the same cross sections captured immediately after stent placement for quantitative analysis.</p><p><strong>Results: </strong>Late lumen loss in renal artery stents at 5 to 34 months was considerably less than in femoropopliteal stents (17% versus 62%, respectively). In the renal location, late lumen loss (3.0 +/- 1.3 mm2) was due to neointimal hyperplasia, whereas stent area remained unchanged (3% decrease). Late lumen loss (7.4 +/- 8.2 mm2) in femoropopliteal stents was due to neointimal hyperplasia and stent area reduction (26%). Overall, in both types of arteries, neointimal development and stent area reduction were larger at the most stenotic site than at the stent edges.</p><p><strong>Conclusions: </strong>These data suggest that there may be differences between renal and femoropopliteal arteries in the extent of hyperplastic response to stents.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21735028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotension after endovascular aneurysm repair: definition, classification, and strategies for surveillance and intervention.","authors":"G Gilling-Smith,&nbsp;J Brennan,&nbsp;P Harris,&nbsp;A Bakran,&nbsp;D Gould,&nbsp;R McWilliams","doi":"10.1177/152660289900600401","DOIUrl":"https://doi.org/10.1177/152660289900600401","url":null,"abstract":"<p><p>In the ongoing evolution of a categorization system for endoleak, the authors propose the term endotension to define persistent or recurrent pressurization of the aortic aneurysm sac after endovascular repair. Endotension is evidence that the aneurysm remains at risk of rupture and should, therefore, be considered an indication for secondary intervention. Management strategies and a grading system for endotension are offered.</p>","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/152660289900600401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21735095","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relocation of the iliac artery bifurcation to facilitate endoluminal treatment of abdominal aortic aneurysms.","authors":"J. Parodi, Mariano Ferreira","doi":"10.1583/1074-6218(1999)006<0342:ROTIAB>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0342:ROTIAB>2.0.CO;2","url":null,"abstract":"Purpose:To report a surgical technique to preserve the internal iliac arteries (IIAs) and facilitate endovascular repair of abdominal aortic aneurysms (AAAs) with extensive iliac artery involvement.Technique:A new iliac artery bifurcation is created surgically through an 8-cm lower left abdominal incision by implanting the IIA onto the distal external iliac artery either directly or by using a tube graft interposition. Careful technique is required to avoid embolic complications, but after relocating the bifurcation, aortic endografting can be performed, either simultaneously or staged, depending upon patient characteristics.Conclusions:Relocation of the iliac artery bifurcation appears to be a good alternative to preserve pelvic arterial flow in selected candidates for endoluminal AAA repair.","PeriodicalId":79443,"journal":{"name":"Journal of endovascular surgery : the official journal of the International Society for Endovascular Surgery","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"1999-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67344083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}