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At least 937 records · Page 52Linked to original sources
PubMed2005

Endovascular AAA repair with the aortomonoiliac EndoFit stent-graft: two years' experience.

PURPOSE: To evaluate the feasibility and efficacy of a specific aortomonoiliac endograft and the durability of the femorofemoral bypass for treatment of abdominal aortic aneurysm (AAA). METHODS: From 2002 to 2004, 39 high-risk (ASA III/IV) patients (36 men; median age 74 years, range 63-84) with AAA (n = 33) or AAA and common iliac artery aneurysm (n = 6) were treated with an EndoFit aortomonoiliac endograft and femorofemoral crossover bypass. The contralateral iliac axis was obstructed with an endoluminal occluder. Patients were followed with contrast-enhanced computed tomography at 1, 6, 12, and 24 months. RESULTS: EndoFit AMI stent-grafts were implanted successfully in all patients. Perioperative mortality was zero. Endoleak occurred in 3 (7.7%) cases. A proximal type I endoleak was identified at 1 month and was treated with a proximal cuff. Two type II endoleaks are under surveillance because the aneurysm sac shows no enlargement. Thrombosis of the femorofemoral graft occurred in 1 case during the immediate postoperative period due to insufficient inflow from a residual stenosis of the endograft (primary patency 97.5%). The deficit was treated successfully (secondary patency 100%). Two (5.1%) tunnel hematomas were treated conventionally. Median follow-up was 14 months (range 6-30). All patients are alive. None of the aneurysms has ruptured or been converted to an open procedure. Graft migration, serious infection, paraplegia, distal embolization, or any other serious complication has not been observed. CONCLUSIONS: In high surgical risk patients with complex iliac anatomy, aortomonoiliac endograft with femorofemoral crossover bypass is feasible and efficacious. Moreover, the midterm patency of the extra-anatomic bypass appears quite satisfactory.

Aged↗
PubMed2005

Color duplex ultrasonography is insensitive for the detection of endoleak after aortic endografting: a systematic review.

PURPOSE: To synthesize the available evidence regarding the diagnostic accuracy of color duplex ultrasonography (CDU) versus the accepted gold-standard of contrast-enhanced computed tomography (CT) for the detection and classification of endoleaks after aortic endografting. METHODS: A systematic search of the literature was conducted using electronic bibliographical databases and other means to gather articles published between 1991 and 2004. Articles were scrutinized against inclusion/exclusion criteria that broadly followed the QUADAS quality assessment guidelines. The results of diagnostic CDU were expressed for each study as a 2x2 contingency table, and summary statistics (sensitivity/specificity with 95% confidence intervals [CI]) were calculated. Pooled and random effects meta-analyses were performed. RESULTS: Eight published studies and 2 unpublished studies from Charing Cross and St. George's Hospitals (711 patients, 1355 paired scans performed > or = 1 month after endografting) were eligible for inclusion. From meta-analyses, the pooled sensitivity of CDU (versus CT as the gold standard) was 69% (95% CI 52% to 87%) and the specificity of CDU was 91% (95% CI 87% to 95%). These parameters did not appear to vary over time when a smaller dataset of 117 patients with 239 paired scans was used to compare CT and CDU specifically at 3, 12, and 24 months after endografting. Endoleak classification data, which was derived from only 5 small studies, indicated that CDU appeared to have better diagnostic accuracy in detecting type I or type III endoleaks compared with type II endoleaks; however, the data were insufficient for statistical analysis. CONCLUSIONS: CDU currently does not have sufficient diagnostic accuracy for the detection of all endoleaks in routine clinical practice. The diagnostic accuracy of CDU may improve if type II endoleaks are ignored.

Angioscopy↗
PubMed2005

Extension of dissection in stent-graft treatment of type B aortic dissection: lessons learned from endovascular experience.

Endovascular treatment is becoming the most important treatment modality in the complex management of type B dissection, providing benefits to both acute and chronic patients. Growing technical experience and improving stent-graft devices have resulted in better patient outcome and expanded clinical indications. Nevertheless, similar to any treatment option, this less invasive method has its inherent risks. Several cases of iatrogenic dissection have been reported in the literature, underlying the need for guidelines to minimize this risk and improve procedural safety. Extension of the dissection after endovascular repair of type B dissection does not appear to be device-specific, but related primarily to aortic wall alterations or adverse anatomy that arise most frequently in hypertensive patients or those with challenging aortic configuration. An accurate examination of the aortic wall and dissection anatomy and careful intraprocedural device manipulation and balloon molding may help avoid this potentially life-threatening complication.

Aortic Dissection↗
PubMed2005

Endovascular treatment of aortoureteric fistula.

PURPOSE: To report successful endovascular treatment of massive hemorrhage from an aortoureteric fistula. CASE REPORT: An 82-year-old man who had undergone total cystectomy and bilateral ureterostomy for bladder cancer was transferred with massive hemorrhage from the ureterostomy. Angiography demonstrated an aortoureteric fistula between the terminal aorta and the left ureter. The patient had pancytopenia from unknown causes on admission, so a stent-graft made from a Gianturco Z-stent covered with Dacron graft was implanted; complete hemostasis was obtained immediately. He died of coexistent plasma cell leukemia 42 days after the operation; however, complete hemostasis had been maintained, and infection around the stent-graft was not recognized at autopsy. CONCLUSIONS: Stent-graft implantation can be a useful therapy for control of massive bleeding from an aortoureteric fistula.

Aged↗
PubMed2005

Endoluminal stent-graft stabilization for thoracic aortic dissection.

PURPOSE: To review our experience with thoracic endografting for type B aortic dissection using the TAG Endoprosthesis. METHODS: A retrospective analysis was performed of data collected prospectively from March 2000 to July 2004 under an investigational device exemption protocol for the TAG thoracic endograft. In this time period, 40 patients (29 women; mean age 67 years, range 39-91) were treated with this endograft for type B aortic dissection. RESULTS: Technical success was 95%. There was 1 (2.5%) perioperative death, and 1 (3%) endoleak was treated with an additional graft on postoperative day 2. Fifteen (38%) patients experienced postoperative complications, mainly renal or pulmonary, and 1 (3%) patient developed postoperative paraplegia that did not resolve. The 1-year survival was 85%. Follow-up computed tomography was available for 31 patients with an average 15-month follow-up. There was no significant change in size of the thoracic aorta in 22 patients; 8 aneurysmal segments were significantly reduced in size and 1 thoracic aortic aneurysm expanded. No thoracic aortic ruptures were seen in this series. CONCLUSIONS: These early results indicate type B thoracic aortic dissections can be treated with acceptable morbidity and mortality using endografts. Stent-graft repair of the thoracic aorta may decrease the incidence of thoracic aortic expansion and rupture.

Adult↗
PubMed2005

Endovascular delivery of vein segments with valves versus direct anastomosis.

PURPOSE: To demonstrate an experimental model designed to allow placement of a vein segment containing a valve into a femoral vein without the need for anastomoses or surgical incision on the target limbs. METHODS: Segments of jugular veins containing valves were harvested bilaterally from 7 female dogs weighing 30 to 40 kg. One of the vein segments was then interposed into one femoral vein, using a standard surgical end-to-end anastomosis. Another segment was loaded into a self-expanding nitinol stent, everted, and secured outside of the stent. This vein-coated stent was then deployed from the jugular approach into the opposite common femoral vein. The endpoint of the study was thrombosis of one of the veins segments or patency at 120 days. The function of the valves was tested prior to completion of the study by instilling dye under incremental pressures and recording the pressure necessary to cause reflux. Light microscopy and electron microscopy were utilized to evaluate structure of the valves at study endpoint. RESULTS: Both grafts in one dog occluded during the second week after surgery. Anastomotic and vein-stented sites remained patent in the remaining 6 animals for 120 days. Retrograde phlebography demonstrated valve competency bilaterally in all cases. The reflux pressures on the stented side averaged 70 mmHg while the transplanted vein segment averaged 55 mmHg. Light microscopy and electron microscopy showed intact vein valve structure in all segments at the completion of the study. CONCLUSIONS: This experimental work demonstrates that endovascular delivery of a native canine vein containing a competent valve is feasible and effective.

Anastomosis, Surgical↗
PubMed1999

Prevention of spinal cord ischemia in an ovine model of abdominal aortic aneurysm treated with a self-expanding stent-graft.

PURPOSE: To present novel techniques to prevent spinal ischemia during aneurysm creation and chronic bifurcated stent-graft implantation in an ovine model of abdominal aortic aneurysm (AAA). METHOD: Experimental AAAs were created in 38 sheep. To prevent spinal ischemia, an internal aortic shunt was used during aneurysm creation. In the animals designated to receive bifurcated stent-grafts, a left external iliac-to-internal iliac bypass was performed to revascularize the caudal artery and prevent postdeployment spinal cord ischemia. Specimens were harvested at 1 week, 1, 3, and 6 months, and 1 year. RESULTS: Aneurysms were successfully created without paralysis in 35 animals. Two died due to aspiration pneumonia. Of the 33 animals implanted with endografts, 16 (94%) of 17 with straight devices and 15 (94%) of 16 with bifurcated stent-grafts survived with well-functioning, patent stent-grafts. Paralysis developed in 2 animals after endografting due to technical failures. CONCLUSIONS: The use of an internal shunt during aneurysm creation and internal iliac-to-external iliac transposition prior to bifurcated stent-graft deployment prevented spinal ischemia in an ovine AAA model. Chronically deployed stent-grafts were well tolerated.

Anastomosis, Surgical↗
PubMed2003

Identification of vulnerable atherosclerotic plaques.

There has been great interest in the possibility of identifying plaques that might be the site of future acute coronary events. These plaques are termed vulnerable and the majority are lipid-rich with an abundance of inflammatory cells and a thin fibrous cap. Several techniques developed to identify these plaques are in various stages of development and in the near future, one might employ a strategy to potentially identify and therapeutically modify such lesions during percutaneous intervention to avoid future acute events. Although this approach of identifying the vulnerable plaque seems promising, there are significant potential limitations. The natural history of a vulnerable plaque is unknown and clinical trials utilizing this strategy of identification and therapeutic intervention are lacking. Moreover, in any given patient, multiple vulnerable plaques are likely to be present. This article reviews some of the techniques for identifying a vulnerable plaque and discusses the potential advantages and limitations of this strategy.

Angioscopy↗
PubMed2004

Correlation between serum E-selectin levels and panoramic nailfold capillaroscopy in systemic sclerosis.

E-selectin is expressed by the activated endothelium and its plasma levels are increased in patients with systemic sclerosis. Eighteen patients fulfilling the American Rheumatism Association criteria for systemic sclerosis, 15 females and 3 males, 42-70 years old, 9 with diffuse and 9 with limited forms, were sequentially recruited for this study. Serum E-selectin levels were determined by commercially available ELISA and their association with nailfold capillaroscopic abnormalities was investigated. Nailfold capillaries were analyzed by 16X magnification wide-field capillaroscopy. Two parameters on capillaroscopy were used to correlate to serum E-selectin: deletion and ectasia. Data were analyzed statistically by the Student t-test and Spearman correlation. Two-tailed P values below 0.05 were considered significant. E-selectin range was 38 to 200 ng/ml (80 +/- 39.94). There was a correlation between serum E-selectin levels and the deletion capillaroscopic score (r = 0.50, P < 0.035). This correlation was even stronger within the first 48 months of diagnosis (r = 0.63, P < 0.048). On the other hand, no association was observed between selectin and ectasia. Patients with diffuse disease presented higher serum E-selectin levels than patients with limited disease, although the difference was not statistically significant (96.44 +/- 48.04 vs 63.56 +/- 21.77 ng/dl; P = 0.08). The present study is the first showing a correlation between soluble serum E-selectin levels and alterations in capillaroscopy. The stronger correlation of deletion score in capillaroscopy in early disease suggests that serum E-selectin levels might be a useful biochemical marker of disease activity in systemic sclerosis.

Adult↗
PubMed2005

Periodontal microcirculatory abnormalities in patients with systemic sclerosis.

BACKGROUND: The aim of this study was to observe the differences in periodontal microcirculation between healthy patients and patients with systemic sclerosis (SSc). METHODS: Fifteen healthy patients and 15 patients with SSc were examined. Periodontal capillaroscopy was used to investigate the characteristics of microcirculation. The visibility, course, tortuosity, possible presence of microhemorrhages, average caliber of the capillary loops, and number of visible capillary loops per square millimeter were evaluated for each patient. RESULTS: The investigation was simple, non-invasive, and repeatable for each patient. In patients with SSc, it was possible to observe a reduced number of capillaries and a greater capillary diameter and tortuosity. CONCLUSIONS: Capillary alterations in patients with SSc are not limited to the nailfold bed but also occur in periodontal mucosa microcirculation. Such evidence could be extremely important in the pathogenesis and treatment of periodontal diseases in patients with SSc.

Adult↗
PubMed2003

New technological developments in the clinical imaging of atherosclerotic plaque.

Direct visualization of the composition of the atherosclerotic plaque during its natural history and after therapeutic intervention may be helpful in detecting lesions with high risk of acute events and in understanding progression and regression of the disease. A wide variety of invasive and non-invasive imaging techniques is available to detect clue aspects of atherosclerosis from the early stage to the clinical evidence appearance. We will firstly review the ongoing technological and clinical research on both invasive and non-invasive techniques. Afterward, we will discuss in detail the use of high-resolution, multi-contrast magnetic resonance imaging for non-invasive imaging of the plaque and its characterization in terms of its various components (i.e., thickness, lipid, fibrous, calcium, or thrombus). Finally, we will describe the potential of quantitative analysis in describing of plaque constituents with improved reproducibility.

Angioscopy↗
PubMed2001

Transluminal imaging with perspective volume rendering of computed tomographic angiography for the delineation of cerebral aneurysms.

Transluminal imaging with perspective volume rendering of computed tomographic angiography was used to investigate three patients with unruptured cerebral aneurysms. Selective changes in the opacity chart of computed tomography values, based on a spiked peak curve, represented the contour of the vessel and aneurysmal walls as a series of rings, and allowed a transluminal view from outside or inside the vessel lumen through the spaces between the rings. This imaging technique provided direct visualization of the underlying structures and an extensive perspective view of the cerebral aneurysms, including the parent arteries and surrounding bony structures, through the overlying vessel and aneurysmal walls. Transluminal imaging may be a useful method for the extra- and intraluminal diagnosis of a cerebral aneurysm, and for simulation of the interventional and surgical procedures considered for cerebral aneurysms.

Adult↗
PubMed2005

New device for endoscopic image display during microsurgical clipping of cerebral aneurysms--technical note--.

Endoscopy in microsurgery is most effective when a single surgeon can monitor both endoscopic and microscopic images simultaneously. However, monitoring systems of this kind, such as a contemporary microscope equipped with a picture-in-mode function, are expensive. The present display system is connected to the endoscope video camera and mounted on the surgeon's head. The liquid crystal display is positioned just under the microscope eyepieces, so reducing the need for the surgeon to refocus and redirect the gaze during surgery. This system allows nearly simultaneous endoscopic and microscopic monitoring. No changes to the surgical microscope are necessary.

Angioscopy↗