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Biomedical subjects

G Dorros

Publications and source records attributed to G Dorros.

At least 37 records · Page 2Linked to original sources
PubMed1997

Percutaneous endovascular stent-graft repair of iliac artery aneurysms.

PURPOSE: To report a percutaneous technique for endovascular repair of iliac artery aneurysms using commercially available materials. METHODS: Ten patients (9 males; mean age 65 +/- 11 years) presented with 11 isolated iliac artery aneurysms; 3 patients were asymptomatic. Stent-grafts were customized for each patient from polytetrafluoroethylene grafts with Palmaz stents sutured at either end of the tube. The devices were delivered percutaneously through standard 14F sheaths and deployed by balloon dilation. RESULTS: All iliac aneurysms were excluded without procedural incident. One patient with chronic renal insufficiency (baseline serum creatinine 1.9 mg/dL) experienced transient contrast-induced renal failure inhospital. The average hospital stay was 2.5 days (range 1 to 7). One vessel thrombosed 2 weeks following the procedure; the culprit stenosis at the site of arterial cannulation was dilated. One patient died of myocardial infarction at 6 weeks. The remaining eight grafts are patent and free of endoleak at a mean 14-month follow-up. CONCLUSIONS: This percutaneous technique appears to be an acceptable alternative to open surgical repair.

Aged↗
PubMed1997

Evaluation of endovascular abdominal aortic aneurysm repair: anatomical classification, procedural success, clinical assessment, and data collection.

PURPOSE: To detail a methodology for evaluation of endovascular abdominal aortic aneurysm (AAA) repair that has been achieved through consensus of an international multidisciplinary team of investigators. METHODS: This schema features an anatomical classification for AAAs, a definition of procedural success, and a procedure for clinical assessment, as well as the necessary data collection forms. Patient data include demographics, procedural and clinical success, complications, and follow-up. Procedural details can be related to anatomic situations, comorbid processes, devices, and effective aneurysmal exclusion. RESULTS: These data would allow assessment of the procedures, physician learning curves, procedural indications, techniques, methodologies, the relationship of indications to success and complications, devices and subsequent graft patency, and aneurysmal exclusion. CONCLUSIONS: The use of this standardized data collection system could enable physicians and industry to better understand endovascular AAA repair and ultimately improve patient care.

Aortic Aneurysm, Abdominal↗
PubMed1996

Intramural hematoma of the aorta caused by a penetrating atheromatous ulcer.

Aortic dissection is a life-threatening condition which is difficult to diagnose because of its variable clinical presentation and diverse pathophysiologic manifestations. We present a case in which intramural hematoma of the thoracic aorta occurred in the absence of an intimal flap. Computed tomography and magnetic resonance imaging both showed hemorrhage in the wall of the aorta. Transesophageal echocardiography also revealed a penetrating atherosclerotic ulcer in the transverse aorta as a cause of the hematoma. A high index of clinical suspicion and a combination of diagnostic procedures resulted in proper diagnosis and successful surgical treatment.

Aged↗
PubMed1996

Complications associated with extracranial carotid artery interventions.

Efforts to ameliorate the tremendous personal and financial ramifications of stroke in this country have focused on the recently validated stroke reduction potential of carotid endarterectomy. During the years in which numerous randomized trials compiled their evidence in favor of surgical treatment, the evolution of minimally invasive therapeutic alternatives to surgery spread to encompass nearly every vascular bed in the body. Only the fragile cerebrovascular system remains as the final challenge for interventionists. Any revascularization alternative to carotid endarterectomy should achieve the same initial and long-term outcomes as the surgical gold standard, with comparable morbidity and mortality. After years of cautious, circumspect application, carotid angioplasty is now a contender for this role. Assisted by the newer stent technology, minimally invasive carotid interventions are entering clinical trials. While it is premature to discuss the stroke reduction potential of these catheter-based techniques, it is imperative that we recognize and prepare to treat the myriad, sometimes catastrophic, complications of these therapeutic approaches to carotid obliterative disease.

Angiography↗
PubMed1996

Adenosine-induced transient cardiac asystole enhances precise deployment of stent-grafts in the thoracic or abdominal aorta.

PURPOSE: To present a cardiac asystole technique that assists in the accurate deployment of stent-grafts during endovascular repair of thoracic or abdominal aortic aneurysms. TECHNIQUE: In the anesthetized patient, trial doses of intravenous adenosine are delivered until a > or = 20-second period of asystole is recorded. The endograft procedure then proceeds until the device is ready for deployment. The predetermined dose of adenosine is administered, and the device is deployed during asystole. Adenosine-induced transient asystole has been utilized in 16 patients undergoing balloon-expandable endograft exclusion of 6 thoracic aortic and 10 abdominal aortic aneurysms. Asystole lasted for 20 to 30 seconds, during which time the devices were accurately deployed without interference from the aortic flow. There were no clinical sequelae of this technique in any patient. CONCLUSIONS: Pharmacologically induced transient asystole appears to be a safe maneuver to preclude endograft movement by systolic blood flow. The technique permits precise placement of balloon-expandable stent-grafts and is applicable to self-expanding devices as well. Interventionists may wish to incorporate adenosine-induced asystole into their aortic aneurysm exclusion procedures.

Adenosine↗
PubMed1996

Endovascular covered stent repair of an intercostal artery patch dehiscence from a descending thoracic aortic aneurysm graft.

PURPOSE: To describe the use of endovascular techniques to repair a descending thoracic aortic pseudoaneurysm at a site of patch dehiscence. METHODS AND RESULTS: A 63-year-old hypertensive, diabetic female with a 4-cm aneurysm in the descending thoracic aorta underwent surgical repair with a 35-mm Dacron graft. Dehiscence of the intercostal arterial patch produced a large, 6-cm-diameter pseudoaneurysm that extended into the left thoracic cavity. An endovascular repair was planned using a Dacron stent-graft. Despite induced hypotension and an exteriorized, stiff exchange wire to enhance control of the delivery balloon catheter, the initial attempt failed to close the suture line defect. A customized polytetrafluoroethylene-covered, balloon-expandable stent was successfully deployed using the original stent-graft as a landmark. At 6 months, the contrast-enhanced spiral computed tomographic scan showed patency of the stent-graft and resorption of the pseudoaneurysm. CONCLUSIONS: This communication describes the management of a surgical complication using balloon-expandable covered stents in contrast to either conventional surgery or self-expanding stent-grafts. Transesophageal ultrasound monitoring delineated the suture line leak, identified the position of the stent-grafts, and accurately demonstrated closure of the defect.

Aneurysm, False↗
PubMed1996

Coronary perforation complicating rotational ablation: the U.S. multicenter experience.

This study retrospectively analyzed the data within the U.S. Multicenter Registry for Rotational Ablation to determine the incidence of coronary perforation during rotational ablation, its angiographic predictors and clinical outcomes during 2953 consecutive patients, 3717 lesions. Patients were categorized into Group A (without perforation, N = 2931) and Group B (with perforation, N = 22 patients). Perforation occurred in 0.7% of procedures, and in 0.6% of lesions treated and was more frequent within the right (12/ 1105, 1.1%) and circumflex (9/761, 1.2%) arteries than the left anterior descending artery [1/1727, 0.06%; (P < 0.001)]. Morphologic features associated with increased perforation rates were eccentricity, tortuousity, and lesion length > 10 mm. Group B was assessed with regard to major complications, including death, surgery, myocardial infarction, or tamponade (type I); and minor complications; sealing with balloon angioplasty and without clinical sequelae (type II). There were 15 type I: emergency surgery in nine, of whom two died, and six infarctions (5 non-Q wave and one Q wave); and 7 type II patients. Coronary perforation, although a rare complication of rotational ablation, is seen more frequently in the right and circumflex coronary arteries than the left anterior descending artery, and occurs more frequently with lesion eccentricity, tortuousity, and length > 10 mm.

Atherectomy, Coronary↗
PubMed1995

Follow-up of primary Palmaz-Schatz stent placement for atherosclerotic renal artery stenosis.

A Palmaz-Schatz stent was successfully placed in 92 stenotic renal arteries (76 patients) for (1) hypertension in 62 (82%), and/or (2) chronic renal failure (serum creatinine > or = 1.5 mg/dl) and preservation of renal function in 39 (51%). Patients were followed to assess clinical and angiographic 6-month outcome. Angiography, performed in 45 of 62 eligible patients (73%) and in 56 of 74 treated arteries (76%), showed restenosis occurring in 14 renal arteries (25%). Serum creatinine improved or remained stable in 78% of patients. In patients with chronic renal failure, improvement or stability was observed in 55%. Blood pressure recordings significantly decreased for the entire cohort (systolic: 168 +/- 25 to 156 +/- 22 mm Hg, p < 0.0001; diastolic: 87 +/- 11 to 81 +/- 11 mm Hg, p < 0.005), and for hypertensive patients with normal creatinine (systolic: 179 +/- 20 to 155 +/- 23 mm Hg, p < 0.0001; diastolic: 92 +/- 9 to 83 +/- 12 mm Hg, p < 0.002). These follow-up data of a prospective, nonrandomized, observational study showed that stent recanalization of atherosclerotic renal artery stenoses was beneficial with regard to renal function and blood pressure response, and had a restenosis incidence of 25%.

Aged↗
PubMed1995

Primary stent deployment in occlusive subclavian artery disease.

Primary (without antecedent balloon dilation) Palmaz stent implantation was successfully performed in 27 consecutive patients entering with 31 obstructed subclavian arteries. Stents (n = 50) were successfully deployed, using the brachial (n = 7), femoral (n = 16), or combined (n = 8) approach, to revascularize 31 subclavian vessels [8 occluded (26%); 23 stenotic (74%)], using a 6 or 7.5 French delivery system. The indications for intervention were arm claudication in 8 patients (30%), subclavian steal syndrome in 11 patients (41%), angina pectoris secondary to impaired blood flow to the left internal mammary artery coronary bypass in 6 patients (22%), and recanalization of a left subclavian occlusion to permit central arterial access and performance of a second interventional procedure 2 patients (7%). The percent diameter stenosis improved from 85 +/- 12% to 6 +/- 7% (P < 0.001); and, the peak and mean translesion gradients decreased, respectively, from 56 +/- 35 mm Hg to 3 +/- 4 mm Hg (P < 0.01), and 29 +/- 18 mm Hg to 2 +/- 2 mm Hg (P < 0.01). Procedural complications encountered were one stent dislodgement with migration into and uneventful deployment within the right external iliac artery, and two brachial artery repairs. No acute vessel closures, deaths, myocardial infarctions, cerebrovascular accidents, transient ischemic attacks, or need for transfusions occurred. Therefore, primary subclavian artery stent deployment can be performed using low-profile sheath systems with excellent success (100%), resulting in immediate restoration of pulsatile flow, and few complications. The incidence of lesion recurrence remains for follow-up studies.

Adult↗
PubMed1995

Juxtaposed "kissing" stents as a technique to preserve both limbs of a bifurcating renal artery.

Percutaneous revascularization with balloon expandable stent placement and/or balloon angioplasty has been proven to be an effective alternative for renal artery bypass surgery for management of renal artery stenosis. Endovascular stent deployment has been proven to be superior to balloon angioplasty alone, especially for ostial lesions in terms of maintaining long-term patency. Here we describe a case report for deployment of two Palmaz stents with simultaneous utilization of brachial and femoral routes. Technical aspects for this procedure, especially adaptation of coronary guide wire systems in management of renal artery stenosis were discussed.

Aged↗
PubMed1995

Management of coronary artery rupture: covered stent or microcoil embolization.

The management of three cases of coronary artery rupture is described: (1) after high-pressure balloon angioplasty following uneventful placement of three Gianturco-Roubin stents, (2) following balloon angioplasty of an occluded diagonal branch, and (3) subsequent to rotational ablation of a left main and proximal circumflex arteries. Placement of an autologous vein-covered Palmaz stent or microcoil embolic vessel occlusion solved each problem. In each case, emergency surgery was avoided; subsequent management, including anticoagulation (when indicated), was performed without incident. This is the first communication detailing correction of a coronary vessel rupture with an autologous vein-covered stent or by microcoil embolic vessel occlusion.

Aged↗
PubMed1995

Closure of a popliteal arteriovenous fistula using an autologous vein-covered Palmaz stent.

PURPOSE: To report the use of autologous vein to cover a stainless steel stent designated for repair of a traumatic popliteal arteriovenous (AV) fistula. METHODS AND RESULTS: Autologous cephalic vein was harvested to cover a Palmaz biliary stent selected to close a traumatic popliteal AV fistula that persisted despite reparative attempts with balloon occlusion and coil embolization. The vein-covered stent was delivered percutaneously and deployed, successfully obliterating the vascular communication. Patency of the popliteal artery was documented arteriographically at 5 months, and symptomatic improvement continues at 10 months. CONCLUSION: The simplicity of this percutaneous approach and the use of autologous vein to cover endovascular prostheses create the possibility for evaluating this technique in myriad anatomical situations.

Aged↗
PubMed1995

Endovascular repair of an ascending aorta-to-left common femoral artery graft with aneurysmal degeneration.

PURPOSE: To report the use of endovascular grafting to repair degenerative aneurysmal changes in an extra-anatomic bypass graft. METHODS: A 14-year-old extra-anatomic ascending aorta-to-left common femoral bypass graft ("ventral aorta") had undergone aneurysmal degeneration, producing symptoms of progressive claudication and local abdominal swelling. The aneurysmal graft dilatation began within the thoracic cavity and extended through the entire extraperitoneal abdominal segment. The option for minimally invasive repair using a customized stent-graft device was offered to the patient as an alternative to standard reoperation. RESULTS: An 8-mm x 42-cm endovascular graft was constructed by polytetrafluoroethylene with 30-mm Palmaz stents sutured to each end. With balloon occlusion of antegrade and retrograde blood flow, the stent-graft was delivered retrograde through an incision in the distal end of the existing bypass graft. The device was successfully positioned and deployed with complete exclusion of the aneurysm. No complications occurred, and the patient's symptoms abated. Follow-up arteriography at 1 months showed a pseudoaneurysm at the distal graft incision site; surgical repair was necessary. At 6 months, angiography demonstrated continued patency of the extra-anatomic bypass graft. CONCLUSIONS: Intraluminal aneurysm exclusion techniques in degenerated extra-anatomic bypass grafts may evolve into a viable therapeutic alternative to complex reoperative surgery.

Aged↗
PubMed1995

Magnetic resonance acquisition to determine the lumen length of a tortuous phantom aorta.

PURPOSE: Endovascular abdominal aortic aneurysm repair is a technique that requires an accurate measurement of the aneurysm's lumen length prior to the procedure. This study examines the accuracy of luminal length measurement in an aortic phantom using magnetic resonance angiography (MRA) axial source images. METHODS AND RESULTS: Tortuous phantom aortas were constructed using water-filled plastic tubing (7 mm in diameter with lengths of 80 to 160 mm). The tubes were molded into three-dimensional "S" or "C" shapes that simulated the luminal course of a tortuous aorta. Phantoms were imaged at angles of 0 degrees, 15 degrees, 30 degrees, and 45 degrees to the image slice direction on a 1.5T Signa MR scanner using a transaxial two-dimensional time-of-flight (TOF) and a T1-weighted spin-echo acquisition. The luminal length of the phantom was calculated after establishing the lumen center coordinates in axial source images and then measuring the distance between two sequential slices using the Pythagorean theorem. The accuracy of this measurement in the phantom was 89% to 99.6%, proportional to the length of the tubing. Accuracy was not affected by angulation of < 45 degrees. CONCLUSION: Two-dimensional TOF MRA source images can provide an accurate measurement of the phantom aorta's lumen length.

Aorta↗
PubMed1994

Percutaneous deployment of a polytetrafluoroethylene (PTFE) graft to repair a pseudoaneurysm produced by a graft to graft anastomotic dehiscence.

Arterial injuries, creating a pseudonauerysm or arteriovenous fistula have, in the main, been managed through surgical ligation of the involved segments, arterial reconstruction, embolization of the involved artery, and percutaneous placement of a stented graft [Marin ML, et al: J Vasc Surg 18:299-302, 1993]. This communication describes the percutaneous repair of a large popliteal pseudoaneurysm, created by dehiscence of the anastomotic suture line of a composite polytetrafluoroethylene (PTFE) femoropopliteal and a popliteal-posterior tibial graft using a PTFE graft without stent assistance.

Aged↗