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

{"title":"Angioplasty of lower limb arterial stenoses under ultrasound guidance: single-center experience.","authors":"G Ramaswami,&nbsp;A Al-Kutoubi,&nbsp;A N Nicolaides,&nbsp;S Dhanjil,&nbsp;D Vilkomerson,&nbsp;M Ferrara-Ryan,&nbsp;G Stansby","doi":"10.1583/1074-6218(1999)006<0052:AOLLAS>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0052:AOLLAS>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To examine the feasibility and utility of ultrasound-guided angioplasty for treating lower limb stenoses.</p><p><strong>Methods: </strong>Duplex ultrasonography was employed to guide 55 balloon dilation procedures (27 iliac, 26 superficial femoral, 1 profunda, and 1 vein graft) with the help of a special ultrasound catheter (EchoMark). Ultrasound was used to determine balloon size, monitor guidewire passage, direct the dilation, and judge procedural success. Angiography was performed prior to the procedure to confirm preprocedural ultrasound findings and afterward to compare with duplex visual and hemodynamic parameters of success (peak systolic velocity ratio < 2.0).</p><p><strong>Results: </strong>The balloon size determined from duplex measurements correlated in all cases with sizes selected based on the angiographic image. Guidewire visualization was possible in 95% of the cases. Angioplasty using ultrasound alone was feasible in 84%; inability to obtain a satisfactory image owing to vessel tortuosity, calcification, and bowel gas accounted for the failures. Against the duplex success criterion, initial completion angiograms had an accuracy of 76%, sensitivity of 76%, and specificity of 100%. The additional time for ultrasound guidance averaged 42 +/- 12 minutes for all cases.</p><p><strong>Conclusions: </strong>Our results show that ultrasound guidance is feasible in routine clinical practice. In this series of well-selected cases of arterial stenoses, angioplasty was performed safely using ultrasound guidance alone in over 80% of the cases. Fluoroscopic monitoring is needed when ultrasound visualization is suboptimal.</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":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20961099","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":"Stents in Endovascular Surgery: Basic Concepts and Techniques","authors":"F. Criado","doi":"10.1583/1074-6218(1999)006<0124B:SIESBC>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0124B:SIESBC>2.0.CO;2","url":null,"abstract":"","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":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67343997","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":"Stents in the treatment of renal artery stenosis: long-term follow-up.","authors":"M Henry,&nbsp;M Amor,&nbsp;I Henry,&nbsp;G Ethevenot,&nbsp;K Tzvetanov,&nbsp;A Courvoisier,&nbsp;B Mentre,&nbsp;Z Chati","doi":"10.1583/1074-6218(1999)006<0042:SITTOR>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0042:SITTOR>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate the role of percutaneous stenting in the treatment of renal arterial lesions after failure of balloon angioplasty.</p><p><strong>Methods: </strong>Two hundred ten patients (139 males; mean age 67.7 +/- 9.9 years, range 27 to 87) had 259 balloon-expandable stents (165 Palmaz and 94 Renal Bridge stents) implanted in 244 renal artery stenoses (171 ostial and 73 nonostial lesions). The patients were suffering from intractable hypertension (n = 210) and/or renal dysfunction (n = 48). The majority of the lesions (n = 234) were atheromatous in origin. Stents were implanted for suboptimal balloon dilation (n = 182, 75%), restenotic lesions (n = 27, 11%), or dissection (n = 9, 4%); 26 (11%) ostial lesions were stented primarily. Mean lesion length was 11.9 +/- 4.4 mm (range 5 to 30) and mean percent stenosis was 81.9% +/- 8.25% (range 70 to 100).</p><p><strong>Results: </strong>Immediate technical success was 99% (241 of 244). Three (1.2%) major complications included one intraprocedural stent thrombosis, one arterial perforation manifesting as a perirenal hematoma 24 hours after the procedure, and one renal arterial rupture. Follow-up over a mean 25.4 +/- 22.8 months (range 1 to 96) in 185 eligible patients (209 arteries) found 24 cases of restenosis (11.4%). Primary and secondary patencies for all lesions at 60 months were 79% and 98%, respectively, with no significant differences between ostial and nonostial lesions or stent types. Hypertension was reversed in 35 (19%), improved in 112 (61%), and remained unchanged in 37 (20%). Renal function was improved in 29% (14 of 48), unchanged in 67% (32 of 48), and worse in 4% (2 of 48).</p><p><strong>Conclusions: </strong>Renal artery stenting is safe, effective, and may be an alternative to surgery, particularly in ostial lesions. Our experience shows reduction in the restenosis rate compared to conventional angioplasty. All ostial stenoses should be stented.</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":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20961098","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":"The role of carotid duplex ultrasound in evaluating plaque morphology: potential use in selecting patients for carotid stenting.","authors":"A F AbuRahma,&nbsp;M A Covelli,&nbsp;P A Robinson,&nbsp;S M Holt","doi":"10.1583/1074-6218(1999)006<0059:TROCDU>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0059:TROCDU>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To study the role of duplex ultrasonography in evaluating plaque morphology and its correlation to neurological symptoms and cerebral infarctions on computed tomographic scans.</p><p><strong>Methods: </strong>The hospital records of 181 patients (107 males; average age 66 years, range 41 to 89) with > 50% carotid stenosis (29 bilateral lesions) who had undergone duplex ultrasonography, carotid arteriography, and cerebral computed tomography were studied retrospectively. Of 210 duplex examinations, 139 were appropriate for morphological analysis of surface characteristics and echogenicity.</p><p><strong>Results: </strong>Over half of the plaques examined had irregular surfaces (81, 58%) and displayed mixed (i.e., heterogeneous) echogenic patterns (74, 53%). Irregular (68 of 81, 84%) and heterogeneous (65 of 74, 88%) plaques were associated with ipsilateral neurological symptoms (p < 0.0001). Similarly, 44 (54%) of 81 irregular plaques and 42 (57%) of 74 heterogeneous plaques were found in patients with cerebral infarctions in the carotid territory (p < 0.0001).</p><p><strong>Conclusions: </strong>Heterogeneous and/or irregular plaques were more often associated with both neurological symptoms and infarctions than smooth or homogeneous plaques. These findings may have implications in patient selection for endoluminal therapy.</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":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20961100","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":"Time-related alterations in shape, position, and structure of self-expanding, modular aortic stent-grafts: a 4-year single-center follow-up.","authors":"T Umscheid,&nbsp;W J Stelter","doi":"10.1583/1074-6218(1999)006<0017:TRAISP>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0017:TRAISP>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To report the nature and ramifications of structural and positional changes over time in tube and modular bifurcated aortic stent-grafts.</p><p><strong>Methods: </strong>Two hundred ninety-one patients received endovascular aortic grafts (primarily Stentor/Vanguard) between August 1994 and August 1998. Follow-up surveillance (clinical and laboratory examination, biplanar noncontrast radiography, and contrast-enhanced computed tomography) has been maintained on all patients for 4 years. Changes in the configuration and position of endografts have been noted and their sequelae charted.</p><p><strong>Results: </strong>Three types of endograft shape changes have been documented: mild -- slight distortions visible on plain radiographs (n = 90, 31.0%), significant -- angulations reaching 60 degrees to 90 degrees (n = 65, 22.3%), and severe -- angulations > or = 90 degrees (n = 10, 3.4%). Changes in position never gave rise to late migration at the proximal attachment site, whereas at the distal ends, the endograft easily retracted from the iliac arteries (n = 8). Structural alterations (rupture of the stent frame, sutures, or fabric, and total graft disintegration) were more common in the original Stentor model. Shape, position, and structural alterations were mutually dependent and led to secondary endoleaks (n = 26) and graft limb thrombosis (n = 37). Late surgical conversion was necessary in 3 (1.0%) patients.</p><p><strong>Conclusions: </strong>Tortuosity of the native vessels is a source of complication in long-term follow-up just as it is during implantation. Given the late appearance of complications in this patient cohort, it would seem that the durability of an endograft cannot be evaluated with < 3 years of follow-up.</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":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20961834","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":"Percutaneous transluminal angioplasty of the subclavian arteries.","authors":"M Henry,&nbsp;M Amor,&nbsp;I Henry,&nbsp;G Ethevenot,&nbsp;K Tzvetanov,&nbsp;Z Chati","doi":"10.1583/1074-6218(1999)006<0033:PTAOTS>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1999)006<0033:PTAOTS>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To review the feasibility, risks, and long-term results of subclavian artery angioplasty with and without Palmaz stent placement.</p><p><strong>Methods: </strong>Over a 9-year period, 113 patients (67 males; mean age 63 +/- 13 years) underwent percutaneous balloon angioplasty of subclavian occlusive lesions for a variety of indications: vertebrobasilar insufficiency (n = 70), upper limb ischemia (n = 50), coronary steal syndrome (n = 6), or anticipated coronary artery bypass grafting using the internal mammary artery in 12 asymptomatic patients. There were 94 (83%) stenoses and 19 (17%) occlusions with a mean percent stenosis of 80.1% +/- 7.4% (range 70 to 100). Mean lesion length was 24 +/- 8 mm (range 10 to 50). Beginning in 1989, stents were implanted for suboptimal dilation; in 1995, stenting became routine.</p><p><strong>Results: </strong>Overall, 103 (91%) of 113 lesions were successfully treated; 10 (53%) occlusions could not be recanalized. Fifty-one stents were implanted in 46 patients. There were 3 (2.6%) procedural complications: a transient ischemic attack, one major (fatal) stroke, and an arterial thrombosis 24 hours after the procedure (treated medically) (0.9% major stroke and death rate). During a mean 4.3-year follow-up (range to 10), 16 (15.5%) restenoses were treated with angioplasty (n = 4), stenting (n = 7), or surgery (n = 5). Primary and secondary patencies for all treated lesions (n = 113) at 8 years were 75% and 81%, respectively; in patients without initial stent placement, the rates were 69% and 76%, while in those with stents, the rates rose slightly to 87% and 94% at 2.5 years (NS). Patency rates for all 103 recanalized lesions were 83% and 90% at 8 years (81% and 90% without stent and 87% and 94% with stent at 2.5 years, respectively [NS]).</p><p><strong>Conclusions: </strong>Balloon angioplasty with or without stenting is safe and effective for treating subclavian artery occlusive diseases with good long-term patency. Recanalization of occlusions is more difficult to achieve. Stents (implanted only for suboptimal dilation) do not seem to improve long-term patency.</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":"1999-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20961835","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":"A grading scale to predict the degree of difficulty for endovascular AAA graft procedures.","authors":"G H White,&nbsp;J May,&nbsp;P Petrasek,&nbsp;W Yu,&nbsp;R C Waugh,&nbsp;X Chaufour","doi":"10.1583/1074-6218(1998)005<0380:AGSTPT>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1998)005<0380:AGSTPT>2.0.CO;2","url":null,"abstract":"","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":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20774510","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 AAA exclusion: will stents with hooks and barbs prevent stent-graft migration?","authors":"M Malina,&nbsp;B Lindblad,&nbsp;K Ivancev,&nbsp;M Lindh,&nbsp;J Malina,&nbsp;J Brunkwall","doi":"10.1177/152660289800500404","DOIUrl":"https://doi.org/10.1177/152660289800500404","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta.</p><p><strong>Methods: </strong>Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force.</p><p><strong>Results: </strong>The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects.</p><p><strong>Conclusions: </strong>Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.</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":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/152660289800500404","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20775329","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 treatment of internal iliac artery aneurysms.","authors":"M Henry,&nbsp;M Amor,&nbsp;I Henry,&nbsp;K Tzvetanov,&nbsp;J M Buniet,&nbsp;C Amicabile","doi":"10.1583/1074-6218(1998)005<0345:ETOIIA>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1998)005<0345:ETOIIA>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a technique for percutaneous endovascular repair of internal iliac artery aneurysms.</p><p><strong>Technique: </strong>In a patient with an isolated internal iliac artery aneurysm and combined tight stenoses at the origins of the external and internal iliac arteries, interventional treatment consisted of coil embolization of the internal iliac artery and branches using the contralateral femoral approach. Balloon dilation of the external iliac stenosis occluded the internal iliac artery, and Palmaz stents were placed in the external iliac stenosis to overcome residual luminal narrowing.</p><p><strong>Conclusions: </strong>This one-step percutaneous technique allows total exclusion of the internal iliac artery aneurysm using coil embolization. This treatment may be an alternative to surgery in isolated internal iliac artery aneurysms with small orifices.</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":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20774504","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":"Renal complications following endovascular repair of abdominal aortic aneurysms.","authors":"S R Walker,&nbsp;S W Yusuf,&nbsp;P W Wenham,&nbsp;B R Hopkinson","doi":"10.1583/1074-6218(1998)005<0318:RCFERO>2.0.CO;2","DOIUrl":"https://doi.org/10.1583/1074-6218(1998)005<0318:RCFERO>2.0.CO;2","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the renal complications associated with endovascular repair of abdominal aortic aneurysms (AAAs).</p><p><strong>Methods: </strong>Data were prospectively collected on 164 AAA patients (154 males; median age 72 years; interquartile range 51 to 88) undergoing endovascular grafting. Any history of renal failure and diabetes mellitus was recorded. Serum urea and creatinine levels were measured preoperatively and at regular intervals postoperatively. Renal impairment was defined as serum creatinine > 130 micromol/L.</p><p><strong>Results: </strong>There were no significant differences in pre- and 1-day postoperative serum urea and creatinine levels. Among 15 (9.1%) patients with preoperative renal failure, 7 (47%) died, 4 (27%) in the perioperative period. Of the 149 patients with normal renal function preoperatively, 4 (2.7%) developed renal failure as part of multisystem organ failure. Another 9 (6.2%) developed significant postoperative elevations (> 20%) in their creatinine levels compared to baseline; 4 of these patients died, 2 in the perioperative period. There was no significant difference in the median dose of intravascular contrast used for those patients that did and did not have a deterioration in their renal function (250 mL versus 300 mL).</p><p><strong>Conclusions: </strong>In this study, approximately 6% of patients with normal preoperative renal function who undergo endovascular AAA repair develop renal dysfunction. For patients with preoperative renal impairment, the perioperative mortality rate is high, 27%, following endovascular aortic aneurysm 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":"1998-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20775330","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}