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Sample records for aortic stent graft

  1. [Stent Grafting for Aortic Dissection].

    PubMed

    Uchida, Naomichi

    2016-07-01

    The purpose of stent graft for aortic dissection is to terminate antegrade blood flow into the false lumen through primary entry. Early intervention for primary entry makes excellent aortic remodeling and emergent stent grafting for complicated acute type B aortic dissection is supported as a class I. On the other hand stent grafting for chronic aortic dissection is controversial. Early stent grafting is considered with in 6 months after on-set if the diameter of the descending aorta is more than 40 mm. Additional interventions for residual false lumen on the downstream aorta are still required. Stent graft for re-entry, candy-plug technique, and double stenting, other effective re-interventions were reported. Best treatment on the basis of each anatomical and physical characteristics should be selected in each institution. Frozen elephant trunk is alternative procedure for aortic dissection without the need to take account of proximal anatomical limitation and effective for acute type A aortic dissection. PMID:27440026

  2. A Migrated Aortic Stent Graft Causing Erosive Spondylopathy

    SciTech Connect

    Gestrich, Christopher Probst, Chris; Wilhelm, Kai; Schiller, Wolfgang

    2013-12-15

    We report about a patient presenting with back pain 4 months after an uneventful endovascular implantation of an aortic stent graft. Computed tomography scan revealed a migration of the stent with consecutive endoleakage, kink formation, and movement of the stent toward the spine, which caused destruction of the aortic wall as well as vertebral necrosis. Explantation of the stent and replacement of the native aorta relieved the patient of his symptoms.

  3. Thoracic Endovascular Stent Graft Repair of Middle Aortic Syndrome.

    PubMed

    Kim, Joung Taek; Lee, Mina; Kim, Young Sam; Yoon, Yong Han; Baek, Wan Ki

    2016-09-01

    Middle aortic syndrome is a rare disease defined as a segmental narrowing of the distal descending thoracic or abdominal aorta. A thoracoabdominal bypass or endovascular treatment is the choice of treatment. Endovascular therapy consists of a balloon dilatation and stent implantation. Recently, thoracic endovascular aortic repair has been widely used in a variety of aortic diseases. We report a case of middle aortic syndrome treated with a thoracic endovascular stent graft. PMID:27549552

  4. Endovascular Stent-Graft Repair as a Late Secondary Procedure After Previous Aortic Grafts

    SciTech Connect

    Matsagas, Miltiadis I. Anagnostopoulos, Constantine E.; Papakostas, John C.; DeRose, Joseph J.; Siminelakis, Stavros; Katsouras, Christos S.; Toumpoulis, Ioannis K.; Drossos, George E.; Michalis, Lampros K.

    2006-08-15

    Thoracic and abdominal aortic endovascular procedures as alternatives to aortic reoperations were studied in three different cases. An anastomotic aneurysm after previous thoracic aortic graft for coarctation, a second-stage elephant trunk repair (descending thoracic aortic aneurysm), and a secondary aneurysm proximal to a previous abdominal aortic graft were successfully treated with endovascular stent-grafts. During the follow-up period no lethal events or major aortic or graft-related complications were observed, except a type II endoleak in the anastomotic aortic aneurysm case. An endovascular stent-graft can be safely deployed into a previously implanted vascular graft, avoiding repeat surgery.

  5. Stent-Grafts for Unruptured Abdominal Aortic Aneurysms: Current Status

    SciTech Connect

    Rose, John

    2006-06-15

    Aortic stent-grafts were introduced at the beginning of the 1990s as a less invasive method of dealing with aortic aneurysms in patients with poor cardiovascular reserve. The numbers of procedures performed worldwide has increased exponentially despite the current lack of any substantial evidence for long-term efficacy in comparison with the gold standard of open surgical grafting. This review summarizes the evolution of the abdominal aortic stent-graft, the techniques used for assessment and deployment, and the effect of the procedure on both the patient and the device. The recent publication of two national multicenter trials has confirmed that the endovascular technique confers a 2.5-fold reduction in 30-day mortality in comparison with open surgery. However, over 4 years of follow-up, there is a 3-fold increase in the risk of reintervention and the overall costs are 30% greater with endovascular repair. Although the improvement in aneurysm-related mortality persists in the mid-term, because of the initial reduction in perioperative mortality, the all-cause mortality rate at 4 years is actually no better than for open surgery. Longer-term data from the randomized trials are awaited as well as results from the latest trials utilizing state-of-the-art devices. Whilst the overall management of abdominal aortic aneurysms has undoubtedly benefited from the introduction of stent-grafts, open repair currently remains the gold standard treatment.

  6. Modification of an endovascular stent graft for abdominal aortic aneurysm

    NASA Astrophysics Data System (ADS)

    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.

  7. Endovascular Treatment of Mycotic Aortic Pseudoaneurysms with Stent-Grafts

    SciTech Connect

    Tiesenhausen, Kurt Hessinger, Michael; Tomka, Maurice; Portugaller, Horst; Swanidze, Shota; Oberwalder, Peter

    2008-05-15

    Mycotic aortic aneurysms remain a therapeutic challenge, especially in patients who are not suitable for open surgery. Endovascular treatment with stent-grafts in this indication is still disputed. Between January 2002 and January 2006, six patients with mycotic aneurysms of the thoracoabdominal or abdominal aorta were admitted to our department. All patients were male, aged 57-83 years (mean, 74.6 years). The mycotic aneurysms were diagnosed on the basis of clinical signs of infection, on CT, and, in four cases, on a positive blood culture. In all patients the mycotic aortic aneurysms were treated endovascularly by stent-graft implantation. Technical and clinical success was achieved in all patients. There was no in-hospital or 30-day mortality. In the follow-up period (range, 2-47 months) four patients died of cancer, cardiac failure, or unknown cause (one case). Two patients are still alive with nearly complete regression of the aneurysms. We conclude that treatment of mycotic aortic aneurysms with stent-grafts may be an alternative in selected patients.

  8. Late Pseudocoarctation Syndrome After Stent-Graft Implantation For Traumatic Aortic Rupture

    SciTech Connect

    Letocart, Vincent Fau, Georges Tirouvanziam, Ashok; Toquet, Claire; Al Habash, Oussama Guerin, Patrice; Rousseau, Herve; Crochet, Dominique

    2013-06-15

    The present observation illustrates an unusual complication occurring after stent-grafting (S-graft) for aortic isthmus rupture. A 22-year-old patient, treated by S-graft in the emergency department for traumatic aortic rupture, was readmitted 10 months later with pseudocoarctation syndrome. A membrane was found inside the stent-graft that had induced a pseudo-dissection, which caused the pseudocoarctation syndrome. Surgical treatment consisted of removing the stent-graft and membrane and replacing it with a vascular implant. The patient's clinical course was fair. The suggested mechanism was circumferential neoendothelialization of the stent-graft. Dehiscence caused the superior part of the membrane to drop into the lumen of the stent-graft creating a 'false channel' that compressed the 'true lumen' and induced 'pseudocoarctation' syndrome. The cause of the extensive neointimalization remains unexplained. Thoracic aortic stent-grafts require regular follow-up monitoring by angioscan or angio-magnetic resonance imaging.

  9. Arch to Descending Aorta Extra-anatomic Aortic Repair for Thoracic Stent Graft Infection.

    PubMed

    Gagné-Loranger, Maude; Dumont, Éric; Voisine, Pierre; Mohammadi, Siamak; Dagenais, François

    2016-01-01

    We report a case of a pedunculated mass of the aortic isthmus. The patient was treated with bilateral carotid-subclavian bypass and a stent graft to cover the thrombus within the distal arch. The postoperative course was complicated by a stent graft infection. The patient underwent graft explantation with aortic continuity using extra-anatomic bypass from the aortic arch to the distal descending aorta. PMID:26481087

  10. Aortic Stent-Graft Infection Following Septic Complications of a Kidney Stone

    SciTech Connect

    Berg, H. Rogier van den Leijdekkers, Vanessa J.; Vahl, Anco

    2006-06-15

    A 73-year-old man was treated because of a renal pelvis blowout of the left kidney for which he received a nephrostomy catheter without antibiotic prophylaxis. Almost a year previously this patient had undergone endovascular repair of a symptomatic infrarenal abdominal aorta aneurysm. Four weeks after the diagnosis and treatment of the ruptured renal pelvis, a new computed tomography scan and ultrasound-guided fine needle aspiration confirmed the diagnosis of infected aortic stent-graft. An extra-anatomic axillo-uniiliac bypass and graft excision was performed. Two weeks after discharge the patient returned to the hospital with an occlusion of his left renal artery and died of renal failure. This is the first time an infected aortic stent-graft after a renal pelvis blowout has been reported. Although infections of aortic stent-grafts occur rarely, one should be aware of the possibility in aortic stent-graft patients undergoing abdominal procedures without antibiotic prophylaxis.

  11. Inoue Stent-Graft Implantation for Thoracoabdominal Aortic Aneurysm Involving the Visceral Arteries.

    PubMed

    Imai, M; Kimura, T; Toma, M; Saito, N; Nakanoue, T; Tadamura, E; Kita, T; Inoue, K

    2008-04-01

    Purpose. To assess the efficacy of the Inoue stent-graft placement for thoracoabdominal aortic aneurysm (TAAA).Methods. Patients with TAAA underwent Inoue stent-graft placement with single branched stent-graft in 4 patients,straight graft in 3 patients and double branched stent-graft in 1 patient. Half the patients required additional open surgical revascularizations of involved visceral arteries (Hybrid procedures).Results. Stent-grafts were deployed successfully in all patients. One patient with Hybrid procedure developed major complications,required haemodialysis and died in hospital. In another patient the post-operative CT scan demonstrated a type I endoleak, but this had resolved by 3 months.Conclusion. Inoue stent-grafting for TAAA with or without adjunctive open surgical revascularization is feasible. PMID:18429349

  12. Helical CT Angiography of Abdominal Aortic Aneurysms Treated with Suprarenal Stent Grafting: A Pictorial Essay

    SciTech Connect

    Sun Zhonghua

    2003-06-15

    The endovascular repair of abdominal aorticaneurysm (AAA) with stent grafts is rapidly becoming an important alternative to open repair. Suprarenal stent grafting, recently modified from conventional infrarenal stent grafting, is a technique for the purpose of treating patients with inappropriate aneurysm necks.Unlike open repair, the success of endoluminal repair cannot be ascertained by means of direct examination and thus relies on imaging results. The use of conventional angiography for arterial imaging has become less dominant, while helical computed tomography angiography(CTA) has become the imaging modality of choice for both preoperative assessment and postoperative followup after treatment with stent graft implants. There is an increasing likelihood that radiologists will become more and more involved in the procedure of aortic stent grafting and in giving the radiological report on these patients treated with stent grafts. It is necessary for radiologists to be familiar with the imaging findings, including common and uncommon appearances following aortic stent grafting. The purpose of this pictorial essay is to describe and present normal and abnormal imaging appearances following aortic stent grafting based on helical CTA.

  13. Aortic Arch Aneurysms: Treatment with Extra anatomical Bypass and Endovascular Stent-Grafting

    SciTech Connect

    Kato, Noriyuki; Shimono, Takatsugu; Hirano, Tadanori; Mizumoto, Toru; Ishida, Masaki; Fujii, Hideki; Yada, Isao; Takeda, Kan

    2002-10-15

    Endovascular repair of thoracic aortic aneurysms is emerging as an attractive alternative to surgical graft replacement. However,patients with aortic arch aneurysms are often excluded from the target of endovascular repair because of lack of suitable landing zones, especially at the proximal ones. In this paper we describe our method for treating patients with aortic arch aneurysms using a combination of extra anatomical bypass surgery and endovascular stent-grafting.

  14. Branched endovascular stent–graft for suprarenal aortic aneurysm: the future of aortic stent-grafting?

    PubMed Central

    Tse, Leonard W.; Steinmetz, Oren K.; Abraham, Cherrie Z.; Valenti, David A.; MacKenzie, Kent S.; Obrand, Daniel I.; Chuter, Timothy A.

    2004-01-01

    The use of a branched endovascular stent–graft to repair an aneurysm of the visceral aorta is described. The evolving role of branched endovascular stent–grafts in the management of aortic aneurysms is discussed, and the literature reviewed. PMID:15362327

  15. Emergent Endovascular Stent Grafts for Ruptured Aortic Aneurysms.

    PubMed

    Montgomery, Jennifer P; Kolbeck, Kenneth J; Kaufman, John A

    2015-09-01

    Ruptured aortic aneurysms uniformly require emergent attention. Historically, urgent surgical repair or medical management was the only treatment options. The development of covered stent grafts has introduced a third approach in the care of these critical patients. The clinical status of the patient and local physician expertise drive the treatment modalities in the majority of cases. The goal of therapy in these patients is to stabilize the patient as quickly as possible, establish maximum survival with minimum morbidity, and provide a long lasting result. The endovascular approach has become an acceptable treatment option in an increasing number of patients presenting with ruptured aneurysmal disease of both the descending thoracic and abdominal aorta. Major factors influencing treatment include patient clinical status, characteristics of the aorta, physician preference, institutional experience, and availability of appropriate equipment. Planning, experience, and the ability to improvise effective solutions are keys to the success of the procedure when endovascular techniques are utilized. Three separate cases, requiring intraprocedural improvisation, are presented followed by a review of the literature. PMID:26327743

  16. Thoracic Aortic Stent-Graft Placement for Safe Removal of a Malpositioned Pedicle Screw

    SciTech Connect

    Hu Hongtao; Shin, Ji Hoon Hwang, Jae-Yeon; Cho, Young Jun; Ko, Gi-Young; Yoon, Hyun-Ki

    2010-10-15

    We describe a case of percutaneous placement of a thoracic aortic stent-graft for safe removal of a malpositioned pedicle screw in a 52-year-old man. The patient had undergone posterior thoracic spinal instrumentation for pyogenic spondylitis and spinal deformity 8 months previously. Follow-up CT images showed a malpositioned pedicle screw which was abutting the thoracic aorta at the T5 level. After percutaneous stent-graft placement, the malpositioned pedicle screw was safely and successfully removed.

  17. Feasibility study on the application of fenestrated stent grafts in canine aortic arches

    PubMed Central

    Xi, Er-Ping; Zhu, Jian; Zhu, Shui-Bo; Zhang, Yu; Xu, Gui-Hua

    2015-01-01

    Objective: To validate the feasibility and effectiveness of applying fenestrated stent grafts in canine aortic arches. Methods: According to the anatomic characteristics of the aortic arches from four adult beagle dogs, a straight-type aortic coated vascular stent system from Lifetech Scientific (Shenzhen) Co., Ltd. was released in vitro, after which a square window was burnt out at the back tendon of the coated vascular stent with an electrocautery pen, and the fenestrated stent grafts were then returned in the catheter and delivery sheath, following the original release path. Endovascular aortic repair (EVAR) was then performed in the canine aorta. Immediately after surgery, digital subtraction angiography (DSA) and computed tomography (CT) angiography were conducted. On day 3, the dressing was changed, and on day 7, the stitches were removed and CT angiography was reviewed. Animal autopsies were performed 2 weeks after surgery. Results: DSA and CT angiography were conducted in 4 beagles immediately after the experiments. The CT angiography reviewed on day 7 after surgery and the animal autopsy performed two weeks after surgery both revealed that the fenestrated stent grafts were anchored in the canine aortic arch, the openings were aligned against the branch vessels above the aortic arch, and in each branch vessel, the blood flow was smooth, without any obvious internal leakage phenomena. Conclusion: An ordinary straight-type coated vascular stent, fenestrated in vitro, followed by the performance of EVAR in the canine aortic arch for in vivo stent implantation, was technically feasible. When a branch coated vascular stent cannot meet the individual needs of the wound, this technology may provide a valuable strategy for clinical thoracic aortic trauma emergencies. PMID:25785052

  18. Stent-graft and multilayer stent for treatment of type II thoracoabdominal aortic aneurysm in a high-risk patient.

    PubMed

    Pane, B; Spinella, G; Salcuni, M; Palombo, D

    2013-08-01

    The aim of the present article was to present an alternative endovascular treatment for type II thoracoabdominal aortic aneurysm that would have the advantage of limiting the duration of the procedure and the use of contrast. A high-risk patient was admitted to our Vascular Unit for type II thoracoabdominal aneurysm according to Crawford's classification. Two thoracic stent-grafts (Valiant Captivia, Medtronic, Pewaukee, WI, USA), a bifurcated stent-graft (Endurant Medtronic) and two multilayer stents (Cardiatis SA, Isnes, Belgium) were deployed. No postoperative major complications were observed. Operative time and use of contrast material were 45 min and 80 mL, respectively. Computed angiography tomography at 1 and 6 months showed patency of visceral and renal arteries and progressive thrombosis of the aneurysmal sac. This stent-graft treatment in combination with multilayer stent could be an alternative treatment for thoracoabdominal aneurysm in high-risk patients. PMID:24013540

  19. Limitations of Endovascular Treatment with Stent-Grafts for Active Mycotic Thoracic Aortic Aneurysm

    SciTech Connect

    Ishida, Masaki; Kato, Noriyuki; Hirano, Tadanori; Shimono, Takatsugu; Yasuda, Fuyuhiko; Tanaka, Kuniyoshi; Yada, Isao; Takeda, Kan

    2002-06-15

    An 81-year-old woman with ruptured mycotic thoracic aortic aneurysm was treated with endovascular placement of stent-grafts fabricated from expanded polytetrafluoroethylene and Z-stents. Although exclusion of the aneurysm was achieved at the end of the procedure, a type I endoleak developed on the following day.Despite emergent surgical resection of the aneurysm and extra-anatomical reconstruction, the patient died 2 days later. Stent-graft repair may not be a suitable method for the treatment of ruptured mycotic aneurysm in the presence of active infection.

  20. In-Graft Endovascular Stenting Repair for Supravalvular Stenosis From Aortic Rupture After Balloon-Expanding Transcatheter Aortic Valve Implantation.

    PubMed

    Furukawa, Nobuyuki; Scholtz, Werner; Haas, Nikolaus; Ensminger, Stephan; Gummert, Jan; Börgermann, Jochen

    2015-01-01

    An 81-year-old man with high-grade aortic valve stenosis and status post-coronary artery bypass grafting and supracoronary replacement of the ascending aorta was referred for transcatheter aortic valve implantation. He was in New York Heart Association class III and had dyspnea. After appropriate screening, we implanted a 29-mm SAPIEN XT valve (Edwards Lifesciences, Irvine, CA USA) through a transapical approach because of severe peripheral arterial occlusive disease. Postinterventional aortography revealed correct positioning and function of the valve and free coronary ostia but contrast extravasation in the vicinity of the interposed vascular prosthesis, resulting in severe luminal narrowing. We chose to manage the stenosis with an endovascular stent. After stenting, extravascular compression was markedly reduced, and the pressure gradient disappeared. The patient was discharged home on the 20th postoperative day. Three months later, computed tomography depicted correct positioning of both grafts. The patient's general health is good, and he is now in New York Heart Association class II. This case illustrates a complication of transcatheter aortic valve implantation specific for patients with an ascending aortic graft. Although stenting may be a good solution, as depicted by this case, self-expanding transcatheter aortic valves should be preferred in patients with ascending aortic grafts to avoid the described complication. PMID:26355692

  1. Endovascular stent graft repair for thoracic aortic aneurysms: the history and the present in Japan.

    PubMed

    Kawaguchi, Satoshi; Shimizu, Hideyuki; Yoshitake, Akihiro; Shimazaki, Taro; Iwahashi, Toru; Ogino, Hitoshi; Ishimaru, Shin; Shigematsu, Hiroshi; Yozu, Ryohei

    2013-01-01

    Stent-grafts for endovascular repair of thoracic aortic aneurysms have been commercially available for more than ten years in the West, whereas, in Japan, a manufactured stent-graft was not approved for the use until March 2008. Nevertheless, endovascular thoracic intervention began to be performed in Japan in the early 1990s, with homemade devices used in most cases. Many researchers have continued to develop their homemade devices. We have participated in joint design and assessment efforts with a stent-graft manufacturer, focusing primarily on fenestrated stent-grafts used in repairs at the distal arch, a site especially prone to aneurysm. In March 2008, TAG (W.L. Gore & Associates, Inc., Flagstaff, Arizona, USA) was approved as a stent graft for the thoracic area first in Japan, which was major turning point in treatment for thoracic aortic aneurysms. Subsequently, TALENT (Medtronic, Inc., Minneapolis, Minnesota, USA) was approved in May 2009, and TX2 (COOK MEDICAL Inc., Bloomington, Indiana, USA) in March 2011. Valiant as an improved version of TALENT was approved in November 2011, and TX2 Proform as an improved version of TX2 began to be supplied in October 2012. These stent grafts are excellent devices that showed good results in Western countries, and marked effectiveness can be expected by making the most of the characteristics of each device. A clinical trial in Japan on Najuta (tentative name) (Kawasumi Labo., Inc., Tokyo, Japan) as a line-up of fenestrated stent grafts that can be applied to distal arch aneurysms showing a high incidence, and allow maintenance of blood flow to the arch vessel was initiated. This trial was completed, and Najuta has just been approved in January of 2013 in Japan, and further development is expected. In the U.S., great efforts have recently been made to develop and manufacture excellent stent grafts for thoracic aneurysms, and rapid progress has been achieved. In particular, in the area of the aortic arch, in which we

  2. Aneurysm of an Aberrant Right Subclavian Artery Successfully Excluded by a Thoracic Aortic Stent Graft with Supra-aortic Bypass of Three Arch Vessels

    SciTech Connect

    Munneke, Graham J. Loosemore, Thomas M.; Belli, Anna-Maria; Thompson, Matt M.; Morgan, Robert A.

    2005-06-15

    An aberrant right subclavian artery (ARSA) arising from a left-sided aortic arch is the fourth most common aortic arch anomaly. Aneurysmal dilatation of the ARSA requires treatment because of the associated risk of rupture. We present a case where supra-aortic bypass of the arch vessels was performed to facilitate exclusion of the aneurysm by a thoracic aortic stent graft.

  3. Stent-graft implantation for clinically diagnosed syphilitic aortic aneurysm in an HIV-infected patient.

    PubMed

    Yasuda, Shota; Imoto, Kiyotaka; Uchida, Keiji; Kawaguchi, Satoshi; Yokoi, Yoshihiko; Shigematsu, Hiroshi; Masuda, Munetaka

    2014-01-01

    We describe our experience with stent-graft placement in a patient with a clinically diagnosed syphilitic aortic aneurysm.The patient was a 43-year-old man with syphilitic and human immunodeficiency virus (HIV) co-infection. Computed tomography (CT) revealed an aortic aneurysm with 89 mm in maximum size which was located at distal aortic arch and was considered syphilis derived saccular aneurysm. The aneurysm was judged at high risk of rupture from its shape. We decided to perform stent-graft implantation. Before surgery, the patient was given antibacterial and anti-HIV agents. Hand-made fenestrated stent graft by Tokyo Medical University was implanted. The graft was placed from the ascending aorta to Th 9 level in the descending aorta. The aneurysm completely disappeared during follow-up, with no flare-up of syphilitic infection up to 2 years after surgery.The number of patients with syphilis and human immunodeficiency virus co-infection is now increasing. Stent-graft implantation may be an effective treatment in such immunocompromised patients. PMID:23774613

  4. Endovascular repair of an aortic arch pseudoaneurysm with double chimney stent grafts: a case report

    PubMed Central

    2013-01-01

    Aortic arch pseudoaneurysm is a rare condition but carries a high risk of rupture. We report a case of a 45-year-old man with aortic arch pseudoaneurysm between left common carotid artery (LCCA) and left subclavian artery (LSA), in which a endovascular stent graft combined with double chimneys covered stents were successfully placed. There were no any complaints and complications after 12 months follow-up. The CTA demonstrated thrombus formation in the pseudoaneurysm lumen, no endoleak and the aortic arch, LCCA and LSA were all patent. We feel that the combined endovascular and double chimneys may be a valuable therapeutic alternative when treating aortic arch lesion. However, long-term clinical efficacy and safety have yet to be confirmed. PMID:23577875

  5. A System for Computer-Assisted Design of Stent-Grafts for Aortic Aneurysms Using 3-D Morphological Models

    SciTech Connect

    Imai, Yasuhiro; Urayama, Shin-ich; Uyama, Chikao; Inoue, Kanji; Ueno, Katsuya; Kuribayashi, Sachio; Takamiya, Makoto; Hamada, Seiki; Hirane, Yoshihisa

    2001-07-15

    A three-dimensional model was constructed from helical CT images for abdominal aortic aneurysm (AAA) and thoracic aortic aneurysm (TAA). A stent-graft was designed and positioned endoluminally on the computer. One hundred and nine stent-grafts for 101 patients were designed by this method and deployed well in all patients. The design time was reduced from 4 to 0.5 hr.

  6. Endovascular Treatment of Descending Thoracic Aortic Aneurysms with the EndoFit Stent-Graft

    SciTech Connect

    Saratzis, N.; Saratzis, Athanasios Melas, N.; Ginis, G.; Lioupis, A.; Lykopoulos, D.; Lazaridis, J.; Kiskinis, Dimitrios

    2007-04-15

    Objective. To evaluate the mid-term feasibility, efficacy, and durability of descending thoracic aortic aneurysm (DTAA) exclusion using the EndoFit device (LeMaitre Vascular). Methods. Twenty-three (23) men (mean age 66 years) with a DTAA were admitted to our department for endovascular repair (21 were ASA III+ and 2 refused open repair) from January 2003 to July 2005. Results. Complete aneurysm exclusion was feasible in all subjects (100% technical success). The median follow-up was 18 months (range 8-40 months). A single stent-graft was used in 6 cases. The deployment of a second stent-graft was required in the remaining 17 patients. All endografts were attached proximally, beyond the left subclavian artery, leaving the aortic arch branches intact. No procedure-related deaths have occurred. A distal type I endoleak was detected in 2 cases on the 1 month follow-up CT scan, and was repaired with reintervention and deployment of an extension graft. A nonfatal acute myocardial infarction occurred in 1 patient in the sixth postoperative month. Graft migration, graft infection, paraplegia, cerebral or distal embolization, renal impairment or any other major complications were not observed. Conclusion. The treatment of DTAAs using the EndoFit stent-graft is technically feasible. Mid-term results in this series are promising.

  7. Endovascular Stent Grafts in Urgent Blunt and Penetrating Thoracic Aortic Trauma

    PubMed Central

    Kolbeck, Kenneth J.; Kaufman, John A.

    2011-01-01

    A traumatic thoracic aortic injury is fatal in the majority of cases. Surviving the aortic injury in addition to the myriad of associated trauma requires comprehensive medical management from many medical services. Balancing these services and coordinating the medical care requires free and open communication between services. Although one might assume a thoracic aortic injury takes precedence over other injuries, an organized plan of care in which the morbidity of the injury as well as the consequences of treatment of each injury helps provide an appropriate “rank order” in the treatment process. A patient with a thoracic aortic injury can be observed for several days while additional injuries are treated, as long as appropriate blood pressure controls are observed. The treatment order for multiple injuries must be reevaluated on a regular basis to adjust for changes in the overall clinical condition. This rank order to treatment and scheduled treatment plan allows for appropriate imaging, evaluation, and coordination of services in preparation for the placement of a thoracic aortic stent graft. The goal of treatment is to reduce the risk of aortic rupture and subsequent fatal hemorrhage. Choosing an open surgical repair versus an endovascular stent graft depends upon physician expertise and clinical status of the patient. In the appropriate clinical setting, endovascular repair of the thoracic aortic injury has become the treatment of choice at the authors' institution in patients with significant operative risks and extensive comorbid injuries. Specific characteristics of the injured aorta also dictate the type of endovascular device required for repair. Case reviews of a patient with blunt trauma and a patient with penetrating trauma used to demonstrate clinical parameters, imaging options, and details of stent graft choice and placement, are presented followed by a review of the literature. PMID:22379280

  8. Successful closure of a patent ductus arteriosus using an aortic stent graft.

    PubMed

    Fujii, Kosuke; Saga, Toshihiko; Kitayama, Hitoshi; Nakamoto, Susumu; Kaneda, Toshio; Nishino, Takako; Yukami, Shintaro

    2012-01-01

    Closure of patent ductus arteriosus (PDA) in the elderly is a high-risk procedure due to the fragility of the aorta and aneurysmal changes in the ductus. Stent grafting has emerged as a method for treating aortic disease. We describe a case in which this endovascular technique was successfully performed for closure of a PDA with aneurismal change in a high-risk patient. This approach may comprise the armamentarium for treating this pathology in adults. PMID:21881350

  9. Delayed Infrarenal Aortic Pseudoaneurysm Treated by Endovascular Stent Graft in Pyogenic Spondylitis

    PubMed Central

    Shin, Jae-Hyuk; Hwang, Dae-Hyun; Pang, Chae-Hyun; Wang, Shaobai; Kim, In-Sung; Ahn, Jung-Tae; Kim, Young-Woo

    2013-01-01

    A 61-year-old male patient with pyogenic spondylodiscitis and epidural and psoas abscesses underwent posterior decompression, debridement, and instrumented fusion, followed by anterior debridement and reconstruction. Sudden onset flank pain was diagnosed 7 weeks postoperatively and was determined to be a pseudoaneurysm located at the aorta inferior to the renal artery and superior to the aortic bifurcation area. An endovascular stent graft was applied to successfully treat the pseudoaneurysm. Postoperative recovery was uneventful and infection status was stabilized. PMID:24353853

  10. Use of an aortic stent graft extension for the treatment of urethral stricture in a dog.

    PubMed

    Bae, Jae Hyun; Kwon, Yong Hwan; Jung, Ye Chan; Jung, Ji Mo; Lee, Hae Beom; Lee, Ki Chang; Kim, Nam Soo; Kim, Min-Su

    2013-10-01

    A 2-year-old male mixed dog was referred to us for further evaluation and treatment of a 4-week-history of oliguria and abdominal distension after a surgical repair of urethral injury. To relieve the urethral stricture, we placed a self-expanding aortic stent graft extension with a partial coverage with an expanded polytetrafluoroethylene (ePTFE). After the placement of the stent, the dog presented with a normal urinary voiding, despite the presence of urinary incontinence. The current case indicates that the ePTFE-covered, self-expanding ASGE is an effective intervention for the treatment of severe urethral stricture in the dog. PMID:23676211

  11. [Perioperative management of endovascular stent graft placement for abdominal aortic aneurysm].

    PubMed

    Yamashita, A; Ishida, K; Aratake, K; Wakamatsu, H; Kawata, R; Kunihiro, M; Sakabe, T

    2000-09-01

    We retrospectively examined the changes in hemodynamics, oxygen index and renal function along with the complications in 25 patients who had undergone endovascular stent graft placement (ESG) surgery for abdominal aortic aneurysm. During stent graft placement, mean arterial pressure decreased to 58 +/- 8 mmHg by increasing the dose of anesthetics and/or using vasodilators. Except for this intended hypotensive period, mean arterial pressure and heart rate were relatively stable and adequately maintained during surgical manipulation. Oxygenation index was well maintained. A patient with a high preoperative creatinine level underwent prophylactic hemodialysis postoperatively. In other patients except one who died in early postoperative period, both BUN and creatinine levels were kept within normal ranges. Four patients died postoperatively and the causes of the death in two patients are related to the surgical procedure; one with multiple emboli possibly due to released atheloma from the aortic wall during procedure, the other with sepsis due to infected stent graft. Although ESG is a well tolerated procedure, embolism is the most serious complication. Careful preoperative evaluation of the ascending arch and descending aortic wall and monitoring with transcranial doppler are necessary. PMID:11025953

  12. Aortic stenting.

    PubMed

    Droc, Ionel; Calinescu, Francisca Blanca; Droc, Gabriela; Blaj, Catalin; Dammrau, Rolf

    2015-01-01

    The approach to aortic pathology is nowadays more and more endovascular at both thoracic and abdominal levels. Thoracic stenting has gained worldwide acceptance as first intention to treat pathologies of the descending thoracic aorta. Indications have been extended to aortic arch aneurysms and also to diseases of the ascending aorta. The current devices in use for thoracic endovascular repair (TEVAR) are Medtronic Valiant, Gore TAG, Cook Tx2 and Jotec. The choice of the endograft depends on the thoracic aortic pathology and the anatomical suitability. The technological evolution of the abdominal aortic endografts was very rapid, arriving now at the fourth generation. We report the results of 55 elective cases of endovascular abdominal aortic repair (EVAR) performed in two vascular surgical centers in Romania and Germany. The prostheses used were 16 E-vita Abdominal XT, 12 Excluder, eight Talent, seven PowerLink, three Endurant and nine custom-made, fenestrated or branched from Jotec. The mean follow-up was 18 months with CT-scan, duplex ultrasound and contrast-enhanced ultrasound. The mortality was 2%. EVAR tends to become the gold standard for abdominal aortic aneurysm repair. Technological development of the devices with lowest profile introduction systems will permit to extend the anatomical indications to new frontiers. PMID:26200430

  13. Clinical safety and efficacy of a next-generation stent-graft device for thoracic endovascular aortic repair.

    PubMed

    Eggebrecht, Holger; Schmermund, Axel; Voigtländer, Thomas

    2013-01-01

    Thoracic endovascular aortic repair has significantly improved the treatment of patients with acute and chronic diseases of the descending thoracic aorta. Retrograde transarterial implantation of a membrane-covered stent graft aims at excluding the aortic pathology at risk for complications (e.g., aneurysm, dissection) from the circulation to prevent expansion and ultimately rupture. Today, several stent grafts from different manufacturers are approved by the respective authorities and thus commercially available. The Medtronic Talent® stent graft used to be one of the initially available devices and has been broadly used to become the world-wide market leader at its time. In 2005, it has been replaced by the second-generation Medtronic Valiant® device, which features several technical improvements. In this article, we evaluate a recent publication investigating the clinical performance of this second-generation stent graft device, and discuss the results in the view of the current literature and developments. PMID:23259442

  14. Endovascular repair of thoracoabdominal aortic aneurysm using the off-the-shelf multibranched t-Branch stent graft.

    PubMed

    Mendes, Bernardo C; Oderich, Gustavo S

    2016-05-01

    Endovascular repair has been increasingly used to treat thoracoabdominal aortic aneurysms using patient-specific or off-the-shelf fenestrated and branched stent grafts. Device customization limits the application of patient-specific devices in patients who need urgent or emergency repair because of ruptured or large, rapidly expanding aneurysms. For these patients, an off-the-shelf multibranched stent graft, the t-Branch stent graft (Cook Medical, Bjaeverskov, Denmark) has been developed based on the relative predictability of visceral vessel anatomy, allowing incorporation and intraoperative customization of target vessels with four down-going directional branches. We used the t-Branch stent graft in a 66-year-old woman with a rapidly enlarging type III thoracoabdominal aortic aneurysm. Completion angiography and follow-up computed tomography angiography demonstrated successful exclusion of the aneurysm sac, patent target vessels, and nearly complete sac shrinkage at the 12-month follow-up. PMID:27109801

  15. Spiral CT During Selective Accessory Renal Artery Angiography: Assessment of Vascular Territory Before Aortic Stent-Grafting

    SciTech Connect

    Dorffner, Roland; Thurnher, Siegfried; Prokesch, Rupert; Youssefzadeh, Soraya; Hoelzenbein, Thomas; Lammer, Johannes

    1998-03-15

    We evaluated the vascular territory of accessory renal arteries in cases where the vessel might be overlapped by an aortic stent-graft. Spiral CT during selective accessory renal artery angiography was performed in four patients with abdominal aortic aneurysms (including one with a horseshoe kidney). The volume of the vascular territory of each renal artery was measured using a software program provided by the CT unit manufacturer. The supernumerary renal arteries perfused 32%, 37%, 15%, and 16% of the total renal mass, respectively. In two patients, stent-grafts were implanted, which resulted in occlusion of the supernumerary renal artery. The volume of the renal infarction was equal to the volume perfused by the artery as calculated before implantation of the stent-graft.The method proposed is accurate for estimating the size of the expected renal infarction. It might help to determine whether placement of a stent-graft is acceptable.

  16. Thoracic Stent Graft Implantation for Aortic Coarctation with Patent Ductus Arteriosus via Retroperitoneal Iliac Approach in the Presence of Small Sized Femoral Artery

    PubMed Central

    Korkmaz, Ozge; Beton, Osman; Goksel, Sabahattin; Kaya, Hakkı; Berkan, Ocal

    2016-01-01

    Endovascular stent graft implantation is a favorable method for complex aortic coarctation accompanied by patent ductus arteriosus. Herein, an 18-year-old woman with complex aortic coarctation and patent ductus arteriosus was successfully treated by endovascular thoracic stent graft via retroperitoneal approach. The reason for retroperitoneal iliac approach was small sized common femoral arteries which were not suitable for stent graft passage. This case is the first aortic coarctation plus patent ductus arteriosus case described in the literature which is treated by endovascular thoracic stent graft via retroperitoneal approach. PMID:27242935

  17. Hemodynamic Study of Flow Remodeling Stent Graft for the Treatment of Highly Angulated Abdominal Aortic Aneurysm

    PubMed Central

    Yeow, Siang Lin; Leo, Hwa Liang

    2016-01-01

    This study investigates the effect of a novel flow remodeling stent graft (FRSG) on the hemodynamic characteristics in highly angulated abdominal aortic aneurysm based on computational fluid dynamics (CFD) approach. An idealized aortic aneurysm with varying aortic neck angulations was constructed and CFD simulations were performed on nonstented models and stented models with FRSG. The influence of FRSG intervention on the hemodynamic performance is analyzed and compared in terms of flow patterns, wall shear stress (WSS), and pressure distribution in the aneurysm. The findings showed that aortic neck angulations significantly influence the velocity flow field in nonstented models, with larger angulations shifting the mainstream blood flow towards the center of the aorta. By introducing FRSG treatment into the aneurysm, erratic flow recirculation pattern in the aneurysm sac diminishes while the average velocity magnitude in the aneurysm sac was reduced in the range of 39% to 53%. FRSG intervention protects the aneurysm against the impacts of high velocity concentrated flow and decreases wall shear stress by more than 50%. The simulation results highlighted that FRSG may effectively treat aneurysm with high aortic neck angulations via the mechanism of promoting thrombus formation and subsequently led to the resorption of the aneurysm. PMID:27247612

  18. The Role of Stent-Grafts in the Management of Aortic Trauma

    SciTech Connect

    Rousseau, Herve Elaassar, Omar; Marcheix, Bertrand; Cron, Christophe; Chabbert, Valerie; Combelles, Sophie; Dambrin, Camille; Leobon, Bertrand; Moreno, Ramiro; Otal, Philippe; Auriol, Julien

    2012-02-15

    Stent graft has resulted in major advances in the treatment of trauma patients with blunt traumatic aortic injury (TAI) and has become the preferred method of treatment at many trauma centers. In this review, we provide an overview of the place of stent grafts for the management of this disease. As a whole, TEVAR repair of TAIs offers a survival advantage and reduction in major morbidity, including paraplegia, compared with open surgery. However, endovascular procedures in trauma require a sophisticated multidisciplinary and experienced team approach. More research and development of TAI-specific endograft devices is needed and large, multicenter studies will help to clarify the role of TEVAR compared with open repair of TAI.

  19. A Novel Attempt to Standardize Results of CFD Simulations Basing on Spatial Configuration of Aortic Stent-Grafts

    PubMed Central

    Polanczyk, Andrzej; Podyma, Marek; Trebinski, Lukasz; Chrzastek, Jaroslaw; Zbicinski, Ireneusz; Stefanczyk, Ludomir

    2016-01-01

    Currently, studies connected with Computational Fluid Dynamic (CFD) techniques focus on assessing hemodynamic of blood flow in vessels in different conditions e.g. after stent-graft’s placement. The paper propose a novel method of standardization of results obtained from calculations of stent-grafts' “pushing forces” (cumulative WSS—Wall Shear Stress), and describes its usefulness in diagnostic process. AngioCT data from 27 patients were used to reconstruct 3D geometries of stent-grafts which next were used to create respective reference cylinders. We made an assumption that both the side surface and the height of a stent-graft and a reference cylinder were equal. The proposed algorithm in conjunction with a stent-graft “pushing forces” on an implant wall, allowed us to determine which spatial configuration of a stent-graft predispose to the higher risk of its migration. For stent-grafts close to cylindrical shape (shape factor φ close to 1) WSS value was about 267Pa, while for stent-grafts different from cylindrical shape (φ close to 2) WSS value was about 635Pa. It was also noticed that deformation in the stent-graft’s bifurcation part impaired blood flow hemodynamic. Concluding the proposed algorithm of standardization proved its usefulness in estimating the WSS values that may be useful in diagnostic process. Angular bends or tortuosity in bifurcations of an aortic implant should be considered in further studies of estimation of the risk of implantation failure. PMID:27073907

  20. A Literature Review of the Numerical Analysis of Abdominal Aortic Aneurysms Treated with Endovascular Stent Grafts

    PubMed Central

    Roy, David; Kauffmann, Claude; Delorme, Sébastien; Lerouge, Sophie; Cloutier, Guy; Soulez, Gilles

    2012-01-01

    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. PMID:22997538

  1. Mid-Term Results After Endovascular Stent-Grafting of Descending Aortic Aneurysms in High-Risk Patients

    SciTech Connect

    Brandt, Michael Walluscheck, Knut P.; Jahnke, Thomas; Attmann, Tim; Heller, Martin; Cremer, Jochen; Mueller-Huelsbeck, Stefan

    2006-10-15

    Purpose. To analyze our experience with endovascular stent-grafting of descending aortic aneurysms in high-risk patients. Methods. Nineteen patients underwent endovascular stent-graft repair of descending aortic aneurysms using the Talent Stent Graft System (Medtronic). All patients were considered high-risk for open surgical repair due to their age, requirement for emergency surgery, and comorbidities. Computed tomography and/or MR tomography were performed at 3, 6 and 12 months postoperatively and thereafter every 12 months. Results. Secondary technical success was 100%. Thirty-day mortality was 5%. Incidence of postoperative stroke and paraplegia were 5% each. One patient required a second stent-graft due to a type I endoleak during the same hospital stay (primary technical success 95%). All patients have been followed for a median of 20 months. No migration, wire fractures or endoleak appeared during follow-up. Conclusion. Endovascular stent-grafting had a low 30-day mortality and morbidity in high-risk patients. One patient developed an aortoesophageal fistula 40 days after stent implantation. Stent-graft repair is a valuable supplement to surgical therapy in high-risk patients.

  2. Resolved Abdominal Aortic Aneurysms Following Stent Graft Treatment: A Report of Five Cases

    SciTech Connect

    Rimon, Uri; Garniek, Alexander; Golan, Gil; Bensaid, Paul; Galili, Yair; Schneiderman, Jacob; Morag, Benyamina

    2004-03-15

    Complete aneurysm resolution is the hallmark of successful endoluminal stent-graft treatment. We describe 5 patients in whom an abdominal aortic aneurysm (AAA) disappeared completely at mid-term follow-up after endovascular stent-graft placement. We reviewed 45 patients (43 men and 2 women) who underwent AAA repair using an endovascular technique, from April 1997 to December 2001. Mean AAA diameter was 58.3 mm. On 48-month follow-up, 12 aneurysms had not changed in size, 4 had grown, 16 had shrunk, and 5 had resolved completely. We describe these 5 patients in detail. The 5 patients were all men, mean age 68 years; their mean aneurysmal sac diameter was 54 mm. The only common finding in all of them was patency of lumbar and inferior mesenteric arteries at pre-procedure evaluation as well as at follow-up. Mean time to complete resolution was 18 months. No major complications were encountered. AAA may resolve completely after endovascular stent-graft implantation. Patent side branches may perhaps contribute to AAA disappearance by antegrade flow. A larger patient population should be reviewed, however, before any statistical conclusion can be drawn.

  3. Treatment with Aortic Stent Graft Placement for Stanford B-Type Aortic Dissection in a Patient with an Aberrant Right Subclavian Artery

    PubMed Central

    Kawatani, Yohei; Hayashi, Yujiro; Ito, Yujiro; Kurobe, Hirotsugu; Nakamura, Yoshitsugu; Suda, Yuji; Hori, Takaki

    2015-01-01

    A 71-year-old man visited our hospital with the chief complaint of back pain and was diagnosed with acute aortic dissection (Debakey type III, Stanford type B). He was found to have a variant branching pattern in which the right subclavian artery was the fourth branch of the aorta. We performed conservative management for uncomplicated Stanford type B aortic dissection, and the patient was discharged. An ulcer-like projection (ULP) was discovered during outpatient follow-up. Complicated type B aortic dissection was suspected, and we performed thoracic endovascular aortic repair (TEVAR). The aim of operative treatment was ULP closure; thus we placed two stent grafts in the descending aorta from the distal portion of the right subclavian artery. The patient was released without complications on postoperative day 5. Deliberate sizing and examination of placement location were necessary when placing the stent graft, but operative techniques allowed the procedure to be safely completed. PMID:26558132

  4. Safety of elective management of synchronous aortic disease with simultaneous thoracic and aortic stent graft placement

    PubMed Central

    Scali, Salvatore T.; Feezor, Robert J.; Chang, Catherine K.; Stone, David H.; Goodney, Philip P.; Nelson, Peter R.; Huber, Thomas S.; Beck, Adam W.

    2013-01-01

    Background Simultaneous treatment of multilevel aortic disease is controversial due to the theoretic increase in morbidity. This study was conducted to define the outcomes in patients treated electively with simultaneous thoracic endovascular aortic aneurysm repair (TEVAR) and abdominal aortic endovascular endografting for synchronous aortic pathology. Methods Patients treated with simultaneous TEVAR and endovascular aneurysm repair (T&E) at the University of Florida were identified from a prospectively maintained endovascular aortic registry and compared with those treated with TEVAR alone (TA). The study excluded patients with urgent or emergency indications, thoracoabdominal or mycotic aneurysm, and those requiring chimney stents, fenestrations, or visceral debranching procedures. Demographics, anatomic characteristics, operative details, and periprocedural morbidity were recorded. Mortality and reintervention were estimated using life-table analysis. Results From 2001 to 2011, 595 patients underwent TEVAR, of whom 457 had elective repair. Twenty-two (18 men, 82%) were identified who were treated electively with simultaneous T&E. Mean ± standard deviation age was 66 ± 9 years, and median follow-up was 8.8 months (range, 1–34 months). Operative indications for the procedure included dissection-related pathology in 10 (45%) and various combinations of degenerative etiologies in 12 (55%). Compared with TA, T&E patients had significantly higher blood loss (P < .0001), contrast exposure (P < .0001), fluoroscopy time (P < .0001), and operative time (P < .0001). The temporary spinal cord ischemia rate was 13.6% (n = 3) for the T&E group and 6.0% for TA (P = .15); however, the permanent spinal cord ischemia rate was 4% for both groups (P = .96). The 30-day mortality for T&E was 4.5% (n = 1) compared with 2.1% (n = 10) for TA. Temporary renal injury (defined by a 25% increase over baseline creatinine) occurred in two T&E patients (9.1%), with none requiring permanent

  5. Early prediction of acute kidney injury biomarkers after endovascular stent graft repair of aortic aneurysm: a prospective observational study

    PubMed Central

    2014-01-01

    Background Acute kidney injury (AKI) is a common and serious condition usually detected some time after onset by changes in serum creatinine (sCr). Although stent grafting to repair aortic aneurysms is associated with AKI caused by surgical procedures or the use of contrast agents, early biomarkers for AKI have not been adequately examined in stent graft recipients. We studied biomarkers including urinary neutrophil gelatinase-associated lipocalin (NGAL), blood NGAL, N-acetyl-β-d-glucosaminidase (NAG), microalbumin (Alb), and liver fatty acid-binding protein (L-FABP) as prospective early biomarkers for AKI in patients who had received stent graft repairs of aortic aneurysms. Methods In addition to pre-surgical sampling, at 2 to 6 h and at 1, 3 to 4, and 5 days or later (until stable) after surgery, urine and serum biomarkers were sampled from 47 patients who underwent stent graft repair of aortic aneurysms. Results Using Acute Kidney Injury Network criteria, 6 (14%) of 42 retained patients developed AKI. NGAL corrected with urine Cr (NGAL/Cr) values demonstrated the best predictive value for AKI (97% specificity, 83% sensitivity at a 65.1 μg/gCr cutoff). The area under the receiver-operator characteristic curve of NGAL/Cr value 2 h after surgery was 0.9. Although NGAL/Cr, L-FABP corrected with urine Cr (L-FABP/Cr), L-FABP, NAG, and Alb corrected by urine Cr (Alb/Cr) all reached peak values before AKI detection by sCr in AKI patients, all biomarkers reached the cutoff value before AKI detection after adaption of cutoff value. Conclusions After stent graft repair of aortic aneurysm, NGAL/Cr is a potentially useful early biomarker for AKI. PMID:25960881

  6. [Total aortic arch replacement in Stanford type A aortic dissection using a new method of implanting the stented graft].

    PubMed

    Kiyama, Hiroshi; Kaki, Nobuaki; Shiomi, Daisuke; Shimada, Naohiro

    2012-07-01

    In surgery for Stanford type A aortic dissection (SAAD) with intimal tear in the arch or proximal descending aorta, we performed total arch replacement with frozen elephant trunk technique for the purpose of achieving complete exclusion of the entry. To reduce the circulatory arrest time, we developed a quick stent graft placement method in the proximal descending aorta. We reported the early results and assessed the efficacy of our new method. Between March 2006 and February 2010, 52 consecutive patients with SAAD were divided into 2 groups:group A consisted of 17 patients who received total arch replacement with our new method;group B consisted of 35 patients who received ascending aorta or partial arch replacement. The duration of operation and cardiopulmonary bypass were significantly longer in group A. However, the duration of circulatory arrest time and postoperative factors including hospital mortality did not differ in both groups. In group A, thrombus obliteration of the residual false lumen in the descending aorta was observed in 75% at 19.2±13.1 months postoperatively. Shrinkage of false lumen in the aortic arch occurred in 15 patients( 93.8%). There was no reoperation for the residual false lumen and late death. Total aortic arch replacement with our new method for SAAD is technically feasible without increasing the operative risk and might reduce the necessity for further operations. PMID:22750824

  7. Fenestrated stent grafts for the treatment of complex aortic aneurysm disease: A mature treatment paradigm.

    PubMed

    Georgiadis, George S; van Herwaarden, Joost A; Antoniou, George A; Giannoukas, Athanasios D; Lazarides, Miltos K; Moll, Frans L

    2016-06-01

    The introduction of fenestrated stent grafts (SGs) to treat abdominal aortic aneurysms (AAAs) with short proximal necks began in 1999. Nowadays, the whole visceral aorta can be treated totally by endovascular means. The established use of fenestrated devices to treat complex AAAs as a first-line management option has been previously reported. An up-to-date evaluation of the literature was performed including all types of publications regarding the use of fenestrated technology to repair complex AAAs. Fenestrated repair is now an established alternative to hybrid/chimney/snorkel repairs. However, specific criteria and prerequisites are required for the use and improvement of this method. Multiple device morphologies have been used incorporating the visceral arteries in various combinations. This modular strategy connects different devices (bridging covered stents and bifurcated SGs) with the aortic main body, thus excluding the aneurysm from the circulation. Precise deployment of the fenestrated SG is mandatory for successful visceral vessel revascularization. Accurate SG sizing and customization, a high level of technical skill, and facilities with modern imaging techniques including 3D road mapping and dedicated hybrid rooms are required. Most experience has been with the custom-made Zenith Cook platform, although off-the-shelf devices have been recently implanted. More complex repairs have been performed over the last few years, but device complexity has also increased. Perioperative, mid-term, and a few recently reported long-term results are encouraging. Secondary interventions remain the main problem, similar to that observed after traditional endovascular abdominal aortic aneurysm repair (EVAR). PMID:27013644

  8. Techniques for preserving vertebral artery perfusion during thoracic aortic stent grafting requiring aortic arch landing.

    PubMed

    Woo, Edward Y; Bavaria, Joseph E; Pochettino, Alberto; Gleason, Thomas G; Woo, Y Joseph; Velazquez, Omaida C; Carpenter, Jeffrey P; Cheung, Albert T; Fairman, Ronald M

    2006-01-01

    Thoracic endografting offers many advantages over open repair. However, delivery of the device can be difficult and may necessitate adjunctive procedures. We describe our techniques for preserving perfusion to the left subclavian artery despite endograft coverage to obtain a proximal seal zone. We reviewed our experience with the Talent thoracic stent graft (Medtronic, Santa Rosa, CA). From 1999 to 2003, 49 patients received this device (29 men, 20 women). Seventeen patients required adjunctive procedures to facilitate proximal graft placement. We performed left subclavian-to-left common carotid artery transposition (6), left common carotid-to-left subclavian artery bypass with ligation proximal to the vertebral artery (7), and left common carotid-to-left subclavian artery bypass with proximal coil embolization (4). Patients who had anatomy unfavorable to transposition or bypass with proximal ligation (large aneurysms or proximal vertebral artery origin) were treated with coil embolization of the proximal left subclavian artery in order to prevent subsequent type II endoleaks. Technical success rate of the carotid subclavian bypass was 100%. Patient follow-up ranged from 3 to 48 months with a mean of 12 months. Six patients had follow-up <6 months owing to recent graft placement. Primary patency was 100%. No neurologic events occurred during the procedure or upon follow-up. One patient had a transient chyle leak that spontaneously resolved in 24 hours. Another patient had a phrenic nerve paresis that resolved after 3 weeks. We believe that it is important to maintain patency of the vertebral artery specifically when a patent right vertebral system and an intact basilar artery is not demonstrated. Furthermore, we describe a novel technique of coil embolization of the proximal left subclavian artery in conjunction with left common carotid-to-left subclavian artery bypass. This circumvents the need for potentially hazardous mediastinal dissection and ligation of the

  9. Tube Stent-Grafts for Infrarenal Aortic Aneurysm: A Matched-Paired Analysis Based on EUROSTAR Data

    SciTech Connect

    Ruppert, Volker Leurs, Lina J.; Hobo, Roel; Buth, Jacob; Rieger, Johannes; Umscheid, Thomas

    2007-07-15

    Objective. Tube stent-grafts for treatment of infrarenal aortic aneurysms (AAAs) are a nearly forgotten concept. For focal aortic pathologies tube stent-grafts may be a treatment option. We have performed a retrospective matched-paired analysis of the EUROSTAR registry regarding the outcome of tube vs. bifurcated stent-grafts for AAA. Tapered aortomonoiliac stent-grafts were not the objective of this study. Materials and methods. From July 1997 to June 2006, 7581 patients who underwent an endovascular AAA repair were entered in the EUROSTAR registry by 164 centers. One hundred fifty-three patients were treated with tube stent-grafts. For each of these 153 patients we selected one patient from a bifurcated stent-graft group (BGG-original, 7428 patients) matched according to gender, ASA, age, AAA diameter, and type of anesthesia. Differences in preoperative details between the two study groups were analyzed using chi-square test for discrete variables and Wilcoxon rank-sum test for continuous variables. Multivariate logistic regression analysis was performed on early complications. Midterm outcomes (>30 days) were analyzed by Kaplan-Meier and multivariate Cox proportional hazard model. Results. The duration of the procedure was shorter in the tube stent-graft group (TGG; 102.3 {+-} 52.2) than in BGG (128.3 {+-} 55.0; p 0.0002). Type II endoleak was less frequent in TGG (4.0%; mean follow-up, 23.12 {+-} 23.9 months) than in BGG (14.3%; mean follow-up, 20.77 {+-} 20.0 months; p = 0.0394). Type I endoleaks and migration were distributed equally, without significant differences between the groups. Combined 30-day and late mortality was higher for TGG (p = 0.0346) and was obviously not aneurysm related. Conclusions. We conclude that after selection of patients, tube stent-grafts for infrarenal aortic repair can be performed with great safety regarding endoleaks and migration. The combined higher 30-day mortality and non-aneurysm-related mortality during follow-up were

  10. Sun's procedure for complex aortic arch repair: total arch replacement using a tetrafurcate graft with stented elephant trunk implantation.

    PubMed

    Ma, Wei-Guo; Zhu, Jun-Ming; Zheng, Jun; Liu, Yong-Min; Ziganshin, Bulat A; Elefteriades, John A; Sun, Li-Zhong

    2013-09-01

    The Sun's procedure is a surgical technique proposed by Dr. Li-Zhong Sun in 2002 that integrates total aortic arch replacement using a tetrafurcated graft with implantation of a specially designed frozen elephant trunk (Cronus(®)) in the descending aorta. It is used as a treatment option for extensive aortic dissections or aneurysms involving the ascending aorta, aortic arch and the descending aorta. The technical essentials of Sun's procedure include implantation of the special open stented graft into the descending aorta, total arch replacement with a 4-branched vascular graft, right axillary artery cannulation, selective antegrade cerebral perfusion for brain protection, moderate hypothermic circulatory arrest at 25 °C, a special anastomotic sequence for aortic reconstruction (i.e., proximal descending aorta → left carotid artery → ascending aorta → left subclavian artery → innominate artery), and early rewarming and reperfusion after distal anastomosis to minimize cerebral and cardiac ischemia. The core advantage of Sun's procedure lies in the use of a unique stented graft, which has superior technical simplicity, flexibility, inherent mechanical durability and an extra centimeter of attached regular vascular graft at both ends. Since its introduction in 2003, the Sun's procedure has produced satisfactory early and long-term results in over 8,000 patients in China and more than 200 patients in South American countries. In a series of 1,092 patients, the authors have achieved an in-hospital mortality rate of 6.27% (7.98% in emergent or urgent vs. 3.98% in elective cases). Given the accumulating clinical experience and the consequent, continual evolution of surgical indications, the Sun's procedure is becoming increasingly applied/used worldwide as an innovative and imaginative enhancement of surgical options for the dissected (or aneurysmal) ascending aorta, aortic arch and proximal descending aorta, and may become the next standard treatment for type

  11. The ovation abdominal stent graft for the treatment of abdominal aortic aneurysms: current evidence and future perspectives.

    PubMed

    Georgakarakos, Efstratios; Ioannou, Christos V; Georgiadis, George S; Storck, Martin; Trellopoulos, George; Koutsias, Stylianos; Lazarides, Miltos K

    2016-01-01

    The Ovation Abdominal Stent Graft System is a trimodular endoprosthesis recently introduced for the endovascular repair of abdominal aortic aneurysm (AAA). It uncouples the stages of stent-graft fixation and sealing with the suprarenal fixation achieved with a long, rigid anchored stent while the sealing onto the neck is accomplished via a pair of polymer-filled inflatable rings that accommodate to each patient's individual anatomy. Moreover, the lack of Nitinol support enables lower profiles of the endograft's delivery system, thus facilitating the navigation through angulated and stenosed iliac vessels. Ovation's novel design expands further the AAA eligibility to endovascular repair. This article discusses the clinical and hemodynamic consequences of the Ovation design and contributes to better understanding of current and future implications. PMID:26822951

  12. Investigation of the Hemodynamic Effect of Stent Wires on Renal Arteries in Patients with Abdominal Aortic Aneurysms Treated with Suprarenal Stent-Grafts

    SciTech Connect

    Sun Zhonghua; Chaichana, Thanapong

    2009-07-15

    The purpose of the study was to investigate the hemodynamic effect of stent struts (wires) on renal arteries in patients with abdominal aortic aneurysms (AAAs) treated with suprarenal stent-grafts. Two sample patients with AAA undergoing multislice CT angiography pre- and postsuprarenal fixation of stent-grafts were selected for inclusion in the study. Eight juxtarenal models focusing on the renal arteries were generated from the multislice CT datasets. Four types of configurations of stent wires crossing the renal artery ostium were simulated in the segmented aorta models: a single wire crossing centrally, a single wire crossing peripherally, a V-shaped wire crossing centrally, and multiple wires crossing peripherally. The blood flow pattern, flow velocity, wall pressure, and wall shear stress at the renal arteries pre- and post-stent-grafting were analyzed and compared using a two-way fluid structure interaction analysis. The stent wire thickness was simulated with a diameter of 0.4, 1.0, and 2.0 mm, and hemodynamic analysis was performed at different cardiac cycles. The interference of stent wires with renal blood flow was mainly determined by the thickness of stent wires and the type of configuration of stent wires crossing the renal ostium. The flow velocity was reduced by 20-30% in most of the situations when the stent wire thickness increased to 1.0 and 2.0 mm. Of the four types of configuration, the single wire crossing centrally resulted in the highest reduction of flow velocity, ranging from 21% to 28.9% among three different wire thicknesses. Wall shear stress was also dependent on the wire thickness, which decreased significantly when the wire thickness reached 1.0 and 2.0 mm. In conclusion, our preliminary study showed that the hemodynamic effect of suprarenal stent wires in patients with AAA treated with suprarenal stent-grafts was determined by the thickness of suprarenal stent wires. Research findings in our study are useful for follow-up of

  13. Systemic Pulsatile Pressure in Type II Endoleaks After Stent Grafting of Experimental Abdominal Aortic Aneurysms

    SciTech Connect

    Pitton, Michael Bernhard Schmenger, Patrick; Dueber, Christoph; Neufang, Achim; Thelen, Manfred

    2003-06-15

    Purpose: To investigate pressure and maximum rate of rise of systolic pressure (peak dP/dt) in completely excluded aneurysms and endoleaks to determine the hemodynamic impact of endoleaks. Methods: In mongrel dogs (n =36) experimental aneurysms were created by insertion of a patch (portion of rectus abdomen is muscle sheath) into the infrarenalaorta. In group I (n 18), all aortic branches of the aneurysm were ligated and all aneurysms were completely excluded by stent grafts. Group II (n = 18) consisted of aneurysms with patent aortic side branches that represented sources of endoleaks.One week (n = 12), six weeks (n = 12),and six months (n = 12) after stent grafting,hemodynamic measurements were obtained in thrombosed aneurysms and proved endoleaks. Systemic blood pressure and intraaneurysmal pressure were simultaneously measured and the respective peak dP/dt were computed. Results: At the six-month follow-up, the systolic-pressure ratio (intraaneurysmatic pressure: systemic pressure)was significantly increased in endoleaks compared to non-perfused areas(0.879 {+-} 0.042 versus 0.438 {+-} 0.176, p <0.01, group II) or completely excluded aneurysms (0.385 {+-}0.221, group I). Peak dP/dt ratio (intraaneurysmal peak dP/dt: systemic peak dP/dt) was 0.922 {+-} 0.154 in endoleaks, compared to 0.084 {+-} 0.080 in non-perfused areas (group II, p <0.01), and was 0.146 {+-} 0.121 in completely excluded aneurysms (group I). The diastolic-pressure ratio was also increased inendoleaks compared to non-perfused areas (0.929 {+-} 0.088 versus 0.655 {+-} 0.231, p < 0.01, group II) or completely excluded aneurysms (0.641 {+-} 0.278, group I). In excluded aneurysms, pressure exposure declined as the length of the follow-up period increased. Conclusion: Type II endoleaks transmit pulsatile pressure of near systemic level and indicate insufficient treatment result. In contrast, complete endovascular exclusion of aneurysms results in significantly reduced pressure exposure.

  14. Multislice CT Angiography of Fenestrated Endovascular Stent Grafting for Treating Abdominal Aortic Aneurysms: a Pictorial Review of the 2D/3D Visualizations

    PubMed Central

    Mwipatayi, Bibombe P; Allen, Yvonne B; Hartley, David E; Lawrence-Brown, Michael M

    2009-01-01

    Fenestrated endovascular repair of an abdominal aortic aneurysm has been developed to treat patients with a short or complicated aneurysm neck. Fenestration involves creating an opening in the graft fabric to accommodate the orifice of the vessel that is targeted for preservation. Fixation of the fenestration to the renal arteries and the other visceral arteries can be done by implanting bare or covered stents across the graft-artery ostia interfaces so that a portion of the stent protrudes into the aortic lumen. Accurate alignment of the targeted vessels in a longitudinal aspect is hard to achieve during stent deployment because rotation of the stent graft may take place during delivery from the sheath. Understanding the 3D relationship of the aortic branches and the fenestrated vessel stents following fenestration will aid endovascular specialists to evaluate how the stent graft is situated within the aorta after placement of fenestrations. The aim of this article is to provide the 2D and 3D imaging appearances of the fenestrated endovascular grafts that were implanted in a group of patients with abdominal aortic aneurysms, based on the multislice CT angiography. The potential applications of each visualization technique were explored and compared with the 2D axial images. PMID:19412517

  15. Risk factors for distal stent graft-induced new entry following endovascular repair of type B aortic dissection

    PubMed Central

    Li, Qing; Wang, Long-Fei; Ma, Wei-Guo; Xu, Shang-Dong; Zheng, Jun; Xing, Xiao-Yan

    2015-01-01

    Background Distal stent graft-induced new entry (DSINE) has been increasingly observed following thoracic endovascular aortic repair (TEVAR) for type B aortic dissection (TBAD). We seek to identify the risk factors for DSINE following TEVAR in patients with TBAD. Methods Between January 2009 and January 2013, we performed TEVAR for 579 patients with TBAD. The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the risk factors for DSINE. Results Two patients (0.3%) died after the initial TEVAR. Morbidity included spinal cord injury in 2 (0.3%), stroke in 3 (0.5%) and endoleak in 12 (2.1%) patients. Clinical and radiological follow-up was complete in 100% (577/577) averaging 47±16 months. Late death occurred in 6 patients. DSINE occurred in 39 patients (6.7%) at mean 22±17 months after the initial TEVAR, which was managed with re-TEVAR in 25 and medically in 14. At 33±18 months after DSINE, 11 of patients managed medically (11/14) and all patients managed with re-TEVAR (25/25) survived (P=0.048). Freedom from DSINE was 92.7% at 5 years (95% CI: 90.0-94.7%). Using tapered stent grafts with a proximal end 4-8 mm larger than the distal end, TEVAR performed in the acute phase (≤14 days from onset) was associated with a significantly lower incidence of DSINE than TEVAR performed in the chronic phase (4.3%, 7/185 vs. 13.9%, 15/108; P=0.003). Risk factors for DSINE were stent grafts less than 145 mm in length [odds ratio (OR) 2.268; 95% CI: 1.121-4.587; P=0.023] and TEVAR performed in the chronic phase (OR 1.935; 95% CI: 1.004-3.731; P=0.049). Conclusions Our results show that TEVAR performed during the acute phase and using stent grafts longer than 145 mm could decrease the incidence of DSINE in patients with TBAD. Tapered stent grafts with a proximal end 4-8 mm larger than the distal end may be helpful in preventing DSINE after TEVAR performed in the acute phase than TEVAR performed in the chronic phase, due to the

  16. Size matters! A reliable endovascular method to avoid infolding and endoleaks when reconstructing aortic bifurcations using stent grafts.

    PubMed

    Matteo, Jerry; Cunningham, James

    2012-06-01

    Conventional revascularization of the lower extremities secondary to aortoiliac atherosclerotic vascular disease (ASVD) involves major intra-abdominal surgery with aortobifemoral bypass grafting. Complication rates are as high as 10% and perioperative mortality can be as high as 5%; therefore, careful patient selection is paramount. Endovascular aortobifemoral bypass repair with aortic bifurcation reconstruction is an emerging option in patients deemed unsuitable for conventional surgical management. Emerging techniques such as snorkel/chimney method are expanding the number of patients who can undergo endovascular repair of abdominal aortic aneurysms and/or revascularization of the lower extremities. However, until now, objective criteria for stent size selection used in these hybrid techniques have not been described. PMID:22700583

  17. Use of through-and-through guidewire for delivering large stent-grafts into the distal aortic arch

    SciTech Connect

    Shammari, Muhammad Al; Taylor, Peter; Reidy, John F.

    2000-05-15

    The availability of large diameter stent-grafts is now allowing the endovascular treatment of thoracic aortic aneurysms. Most aneurysms are closely related to the distal arch and it is thus necessary to pass the delivery systems into the arch to effectively cover the proximal neck. Even with extra-stiff guidewires in position, it may still be difficult to achieve this, as a result of tortuosity at the iliac arteries and the aorta. We detail a technique where a stiff guidewire is passed from a brachial entry point through the aorta and out at the femoral arteriotomy site. This allows extra-support and may enable the delivery system to be passed further into the aortic arch than it could with just the regular guidewire position.

  18. Endovascular repair of a ruptured descending thoracic aortic aneurysm in a patient with an ascending aortic aneurysm: hybrid open arch reconstruction with simultaneous thoracic stent-graft deployment within elephant trunk.

    PubMed

    Abou-Zamzam, Ahmed M; Zhang, Wayne; Wang, Nan; Razzouk, Anees

    2008-03-01

    Endovascular repair of the thoracic aorta is now widely practiced. The extension of this technique to emergent settings is in evolution. Pathology of the ascending and transverse aortic arch may preclude thoracic aortic stent grafting due to the lack of a proximal seal zone. Several hybrid open/endovascular approaches have been described. We recently encountered the difficult case of a contained rupture of a 6.8 cm descending thoracic aortic aneurysm in a 60-year-old patient with aneurysmal degeneration of the ascending and transverse aortic arch. This patient was treated with a hybrid approach of open ascending and transverse arch reconstruction along with simultaneous stent-graft repair of the descending thoracic aorta. The open repair established an excellent proximal landing zone by use of the "elephant trunk" technique. This technique also allowed direct suture fixation of the stent graft to the arch graft to prevent stent-graft migration. This hybrid surgical approach was successful and avoided the cumulative morbidity that a left thoracoabdominal approach would have added to the sternotomy. Further creative uses of these hybrid techniques will undoubtedly serve a larger role in the treatment of thoracic aortic pathology. PMID:18346569

  19. Fluid-structure interaction of a patient-specific abdominal aortic aneurysm treated with an endovascular stent-graft

    PubMed Central

    Molony, David S; Callanan, Anthony; Kavanagh, Eamon G; Walsh, Michael T; McGloughlin, Tim M

    2009-01-01

    Background Abdominal aortic aneurysms (AAA) are local dilatations of the infrarenal aorta. If left untreated they may rupture and lead to death. One form of treatment is the minimally invasive insertion of a stent-graft into the aneurysm. Despite this effective treatment aneurysms may occasionally continue to expand and this may eventually result in post-operative rupture of the aneurysm. Fluid-structure interaction (FSI) is a particularly useful tool for investigating aneurysm biomechanics as both the wall stresses and fluid forces can be examined. Methods Pre-op, Post-op and Follow-up models were reconstructed from CT scans of a single patient and FSI simulations were performed on each model. The FSI approach involved coupling Abaqus and Fluent via a third-party software - MpCCI. Aneurysm wall stress and compliance were investigated as well as the drag force acting on the stent-graft. Results Aneurysm wall stress was reduced from 0.38 MPa before surgery to a value of 0.03 MPa after insertion of the stent-graft. Higher stresses were seen in the aneurysm neck and iliac legs post-operatively. The compliance of the aneurysm was also reduced post-operatively. The peak Post-op axial drag force was found to be 4.85 N. This increased to 6.37 N in the Follow-up model. Conclusion In a patient-specific case peak aneurysm wall stress was reduced by 92%. Such a reduction in aneurysm wall stress may lead to shrinkage of the aneurysm over time. Hence, post-operative stress patterns may help in determining the likelihood of aneurysm shrinkage post EVAR. Post-operative remodelling of the aneurysm may lead to increased drag forces. PMID:19807909

  20. CT Imaging Findings and Their Relevance to the Clinical Outcomes After Stent Graft Repair of Penetrating Aortic Ulcers: Six-year, Single-center Experience

    SciTech Connect

    Shin, Ji Hoon; Angle, John F.; Park, Auh Whan; Anderson, Curtis; Sabri, Saher S.; Turba, Ulku C.; Kern, John A.; Cherry, Kenneth J.; Matsumoto, Alan H.

    2012-12-15

    Purpose: To present the computed tomographic (CT) imaging findings and their relevance to clinical outcomes related to stent graft placement in patients with penetrating aortic ulcers (PAUs). Methods: Medical and imaging records and imaging studies were reviewed for consecutive patients who underwent stent graft repair of a PAU. The distribution and characteristics of the PAU, technical success of stent graft repair, procedure-related complications, associated aortic wall abnormalities, and outcomes of the PAUs at follow-up CT scans were evaluated. Results: Fifteen patients underwent endovascular treatment for PAU. A total of 87% of the PAUs were in the proximal (n = 8) or distal (n = 5) descending thoracic aorta. There was a broad spectrum of PAU depth (mean, 7.9 {+-} 5.6 mm; range 1.5-25.0 mm) and diameter (mean, 13.5 {+-} 9.7 mm; range 2.2-41.0 mm). Atherosclerosis of the thoracic aorta and intramural hematoma were associated in 53 and 93% of the patients, respectively. Technical success was achieved in 100%. Two or more stent grafts were used in five patients. Endoleaks were observed in two patients within 2 weeks of the procedure, both of which resolved spontaneously. At follow-up CT scanning, regression and thrombosis of the PAUs were observed in all patients. The average patient survival was 61.8 months, with an overall mortality of 13% (2 of 15) at follow-up. Neither death was related to the endograft device or the PAU. Conclusion: Endovascular stent graft placement was safe and effective in causing regression and thrombosis of PAUs in this small series of patients. Two or more stent grafts were used in five patients (33%) with associated long-segmental atherosclerotic changes of the thoracic aorta or intramural hematoma.

  1. Endovascular Aortic Aneurysm Repair with the Talent Stent-Graft: Outcomes in Patients with Large Iliac Arteries

    SciTech Connect

    England, Andrew; Butterfield, John S.; McCollum, Charles N.; Ashleigh, Raymond J.

    2008-07-15

    The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices. Departmental databases and patient records were reviewed to assess outcomes. Technical success, iliac-related outcome, and iliac-related reintervention (IRSI) were analyzed. Patients with EVAR extending into the external iliac artery were excluded. Median (range) follow-up for the study group was 24 (1-84) months. Initial technical success was 98% for CIAs <18 mm and 100% for CIAs {>=}18 mm (p = 0.551). There were three distal type I endoleaks (two in the ectatic group) and six iliac limb occlusions (one in an ectatic patient); there were no statistically significant differences between groups (p = 0.4). There were nine IRSIs (three stent-graft extensions, six femorofemoral crossover grafts); three of these patients had one or both CIAs {>=}18 mm (p = 0.232). One-year freedom from IRSI was 92% {+-} 3% and 84% {+-} 9% for the <18-mm and {>=}18-mm CIA groups, respectively (p = 0.232). We conclude that the treatment of AAA by EVAR in patients with CIAs 18-24 mm appears to be safe and effective, however, it may be associated with more frequent reinterventions.

  2. Aortic arch/elephant trunk procedure with Sienna(TM) graft and endovascular stenting of thoraco-abdominal aorta for treatment of complex chronic dissection.

    PubMed

    Wong, Randolph H L; Baghai, Max; Yu, Simon C H; Underwood, Malcolm J

    2013-05-01

    Aneurismal dilatation of the remaining thoracic aorta after ascending aortic interposition grafting for type 'A' aortic dissection is not uncommon. For such complex cases, one treatment option is total arch replacement and elephant trunk procedure with the Sienna(TM) collared graft (Vascutek, Inchinnan, UK) technique followed by a staged thoracic endovascular aortic repair (TEVAR). The video illustrates our technique in a 56-year-old man with an extensive aortic arch and descending thoracic aortic dissecting aneurysm. For the 'open' procedure femoral arterial and venous cannulation was used along with systemic cooling and circulatory arrest at 22 °C. Upon circulatory arrest, the aortic arch was incised and antegrade cerebral perfusion achieved via selective cannulation to the right brachiocephalic and left common carotid artery, keeping flow rates at 10-15 mL/kg/min and perfusion pressure at 50-60 mmHg. Arch replacement with an elephant trunk component was then performed and after completion of the distal aortic anastomosis antegrade perfusion via a side-arm in the graft was started and the operation completed using a variation of the 'sequential' clamping technique to maximize cerebral perfusion. The second endovascular stage was performed two weeks after discharge. Two covered stents were landing from the elephant trunk to the distal descending thoracic aorta, to secure the distal landing a bare stent of was placed to cover the aorta just distal to the origin of the celiac axis. The left subclavian artery was embolised with fibre coils. Post TEVAR angiogram showed no endoleak Although re-operative total arch replacement and elephant trunk procedure and subsequent TEVAR remained a challenging procedure, we believe excellent surgical outcome can be achieved with carefully planned operative strategy. PMID:23977606

  3. Abdominal Aortic Aneurysm with a Dilated Common Iliac Artery: Treatment Using a Handmade Bifurcated Stent-Graft with a Wide Iliac Limb End

    SciTech Connect

    Miyayama, Shiro; Matsui, Osamu; Akakura, Yukari; Yamamoto, Toru; Nishida, Hiroto; Yoneda, Kenji; Kawai, Keiichi; Murakami, Shinya

    2003-11-15

    The purpose of this study was to evaluate the usefulness of a bifurcated stent-graft with a wide iliac limb end (WILE) in the treatment of abdominal aortic aneurysm (AAA) with a dilated common iliac artery (CIA) to avoid occlusion of the internaliliac artery (IIA). The WILE, covered with an expanded polytetrafluoroethylene graft which was constructed of large diameter stents according to the individual CIA diameter, was connected to a two-piece bifurcated stent-graft covering a polyester graft. The WILE was placed in eight dilated CIAs of six patients. All but one WILE fitted the dilated CIA well. One did not fit, and coil embolization of the leak was needed. All eight IIA derived from the dilated CIA avoided occlusion. Perigraft leak due to other causes was identified in another two patients. Limb kinking was observed in two patients. Our stent is useful in the treatment of AAA with dilated CIA to avoid occlusion of the IIA, and may extend the indication of endoluminal repair of AAA.

  4. Primary Stenting in Infrarenal Aortic Occlusive Disease

    SciTech Connect

    Nyman, Ulf; Uher, Petr; Lindh, Mats; Lindblad, Bengt; Ivancev, Krasnodar

    2000-03-15

    Purpose: To evaluate the results of primary stenting in aortic occlusive disease.Methods: Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months).Results: Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented.Conclusions: Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.

  5. Endovascular aortic aneurysm repair with chimney and snorkel grafts: indications, techniques and results.

    PubMed

    Patel, Rakesh P; Katsargyris, Athanasios; Verhoeven, Eric L G; Adam, Donald J; Hardman, John A

    2013-12-01

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR. PMID:23674274

  6. Endovascular Aortic Aneurysm Repair with Chimney and Snorkel Grafts: Indications, Techniques and Results

    SciTech Connect

    Patel, Rakesh P.; Katsargyris, Athanasios Verhoeven, Eric L. G.; Adam, Donald J.; Hardman, John A.

    2013-12-15

    The chimney technique in endovascular aortic aneurysm repair (Ch-EVAR) involves placement of a stent or stent-graft parallel to the main aortic stent-graft to extend the proximal or distal sealing zone while maintaining side branch patency. Ch-EVAR can facilitate endovascular repair of juxtarenal and aortic arch pathology using available standard aortic stent-grafts, therefore, eliminating the manufacturing delays required for customised fenestrated and branched stent-grafts. Several case series have demonstrated the feasibility of Ch-EVAR both in acute and elective cases with good early results. This review discusses indications, technique, and the current available clinical data on Ch-EVAR.

  7. Unsuccessful treatment of a collapsed thoracic stent graft by Palmaz stent.

    PubMed

    Pirotte, Manuel; Lacroix, Valerie; Astarci, Parla; Nardella, Jane; Funken, Jean-Christophe; El Khoury, Gebrine; Noirhomme, Philippe; Verhelst, Robert

    2010-11-01

    A Gore TAG Excluder stent graft was deployed in a 35-year-old woman for an isthmic saccular aneurysm. At 12-hour follow-up, we diagnosed a proximal collapse. A Palmaz stent was used to reopen the proximal segment. Two months later, she presented with a transient ischemic attack (embolic process) related to a suboptimal apposition of the Palmaz stent in the distal aortic arch. This led to open surgical replacement of the ascending aorta and aortic arch with reimplantation of the supraaortic branches. Reopening of a stent graft collapse with a Palmaz stent might be a short-term solution; however, its presence can lead to embolic complications. PMID:21035713

  8. Successful treatment of an infected thoracic endovascular stent graft.

    PubMed

    Sueda, Taijiro; Takahashi, Shinya; Katayama, Keijiro; Imai, Katsuhiko

    2016-05-01

    A 70-year-old man with a chronic type B aortic dissection was treated with two stent grafts deployed in the descending thoracic aorta. The patient was re-admitted to the hospital at 16 months after thoracic endovascular stent grafting because of a high fever. A blood culture showed sepsis due to a Staphylococcus species. A CT scan showed an increase in the size of the thrombosed false lumen. Complete excision of the infected descending aortic wall and infected stent graft were performed. The descending thoracic aorta was reconstructed using a rifampicin-bonded Dacron graft and omental wrapping. The combination of in situ graft replacement using a rifampicin-bonded graft and omental wrapping is considered an effective treatment for thoracic stent graft infection. PMID:24990657

  9. Studying the interaction of stent-grafts and treated abdominal aortic aneurysms: time to move caudally!

    PubMed

    Georgakarakos, Efstratios; Raptis, Anastasios; Schoretsanitis, Nikolaos; Bisdas, Theodosios; Beropoulis, Efthymios; Georgiadis, George S; Matsagkas, Miltiadis; Xenos, Michalis

    2015-06-01

    Since the advent of endovascular repair of aortic aneurysms (EVAR), clinical focus has been on preventing loss of sealing at the level of the infrarenal neck, which leads to type I endoleak and repressurization of the aneurysm sac. Enhanced mechanisms for central fixation and seal have consequently lowered the incidence of migration and endoleaks. However, endograft limb thrombosis and its causal mechanisms have not been addressed adequately in the literature. This article reviews the pathophysiological mechanisms associated with limb thrombosis in order to facilitate better clinical judgment to prevent iliac adverse effects. PMID:25991770

  10. Endovascular stent-graft repair of spontaneous aorto-caval fistula secondary to a ruptured abdominal aortic aneurysm: An emergency management of hostile anatomy

    PubMed Central

    Liu, Mingyuan; Wang, Haofu

    2016-01-01

    Objectives: Although endovascular aneurysm repair of aorto-caval fistula offers a safe and efficient approach compared to traditional open repair, endovascular techniques for the treatment of aorto-caval fistula with ruptured abdominal aortic aneurysms in emergency circumstance are not well established. This study aims to evaluate the effect of endovascular repair of aorto-caval fistula of a patient with ruptured abdominal aortic aneurysm and hostile anatomy. Methods: we report a case of an aorto-caval fistula endovascular repaired in a 78-year-old male using a hybrid stent-graft technique. Results: The patient had an uneventful recovery and CTA follow up showed no sign of ACF or any endoleak. Conclusion: This case highlights ACF might be managed by composite endograft implantation with careful and solid sealing of anchoring zones on the two sides. PMID:27489717

  11. Bare Metal Stenting for Endovascular Exclusion of Aortic Arch Thrombi

    SciTech Connect

    Mahnken, Andreas H.; Hoffman, Andras; Autschbach, Ruediger; Damberg, Anneke L. M.

    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.

  12. Robot-assisted antegrade in-situ fenestrated stent grafting.

    PubMed

    Riga, Celia V; Bicknell, Colin D; Wallace, Daniel; Hamady, Mohamad; Cheshire, Nicholas

    2009-05-01

    To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged for a 4 x 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure. PMID:18972158

  13. Robot-Assisted Antegrade In-Situ Fenestrated Stent Grafting

    SciTech Connect

    Riga, Celia V. Bicknell, Colin D.; Wallace, Daniel; Hamady, Mohamad; Cheshire, Nicholas

    2009-05-15

    To determine the technical feasibility of a novel approach of in-situ fenestration of aortic stent grafts by using a remotely controlled robotic steerable catheter system in the porcine model. A 65-kg pig underwent robot-assisted bilateral antegrade in-situ renal fenestration of an abdominal aortic stent graft with subsequent successful deployment of a bare metal stent into the right renal artery. A 16-mm iliac extension covered stent served as the porcine aortic endograft. Under fluoroscopic guidance, the graft was punctured with a 20-G customized diathermy needle that was introduced and kept in place by the robotic arm. The needle was exchanged for a 4 x 20 mm cutting balloon before successful deployment of the renal stent. Robot-assisted antegrade in-situ fenestration is technically feasible in a large mammalian model. The robotic system enables precise manipulation, stable positioning, and minimum instrumentation of the aorta and its branches while minimizing radiation exposure.

  14. [Mycotic Aneurysm of Distal Aortic Arch, after Total Arch Replacement with Open-stent Graft;Report of a Case].

    PubMed

    Suzuki, Kotaro; Kawahara, Yu; Masaki, Naoki; Kobayashi, Yuriko; Takahara, Shingo; Nakamura, Ken; Toyama, Shuji; Fukasawa, Manabu

    2015-05-01

    The patient was a 72-year-old man, who had undergone total arch replacement with an open-stent graft due to saccular aneurysm of distal arch, 2 years before. He was admitted to a local hospital with the complaint of high fever, and was diagnosed as having pyothorax, after computed tomography (CT) scanning. After transferred to our hospital, he was treated by drainage, and antibiotic therapy. But CT scans showed the enlargement of distal arch aneurysm, and migration of the stent graft. Urgent operation was performed. We approached to the site by a full sternotomy, and left anterolateral thoracotomy. Segment 1+2 of the left lung was resected to avoid bleeding and lung injury. Graft replacement of distal arch and descending aorta was performed on cardiopulmonary bypass, with hypothermia, selective brain perfusion and systemic circulatory arrest. To protect from recurrence of infection, the omental flap was transposed to the graft site. Until now, there is no recurrence of infection. PMID:25963790

  15. Percutaneous Treatment of an Infected Aneurysmal Sac Secondary to Aortoesophageal Fistula with a History of Stent-Graft Treatment for Thoracic Aortic Aneurysm

    SciTech Connect

    Numan, Furuzan Gulsen, Fatih; Cantasdemir, Murat; Solak, Serdar; Arbatli, Harun

    2012-06-15

    A 68-year-old man who was subjected to stent-grafting of a descending thoracic aortic aneurysm (TAA) 4 months previously was admitted to our hospital with constitutional symptoms, including high fever, sweating, nausea, vomiting, weight loss, and backache. An infected aneurysmal sac was suspected based on computed tomography (CT) findings, and an aortoesophageal fistula (AEF) was identified during esophagoscopy. CT-guided aspiration was performed using a 20-G Chiba needle, confirming the presence of infection. For treatment of the infected aneurysmal sac, CT-guided percutaneous catheter drainage in a prone position was performed under general anesthesia with left endobronchial intubation. Drainage catheter insertion was successfully performed using the Seldinger technique, which is not a standard treatment of an infected aneurysmal sac. Improvement in the patient's clinical condition was observed at follow-ups, and CT showed total regression of the collection in the aneurysmal sac.

  16. Ruptured saphenous vein graft pseudoaneurysm successfully treated with covered stents.

    PubMed

    Yonezu, Keisuke; Funayama, Hiroshi; Katayama, Takuji; Yamaguchi, Atsushi; Ako, Junya; Momomura, Shin-Ichi

    2016-04-01

    Saphenous vein graft (SVG) pseudoaneurysms are rare complications following coronary bypass graft surgery. A 46-year-old man presented with streptococcal infectious endocarditis and needed sequential operations for aortic root reconstruction. Shortly after the surgeries, a composite SVG on the right coronary artery developed a ruptured pseudoaneurysm, which was successfully treated using covered stents. PMID:25917780

  17. Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design.

    PubMed

    Bischoff, Moritz S; Müller-Eschner, Matthias; Meisenbacher, Katrin; Peters, Andreas S; Böckler, Dittmar

    2015-01-01

    BACKGROUND The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). MATERIAL AND METHODS From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). RESULTS Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). CONCLUSIONS The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD. PMID:26718893

  18. Device Conformability and Morphological Assessment After TEVAR for Aortic Type B Dissection: A Single-Centre Experience with a Conformable Thoracic Stent-Graft Design

    PubMed Central

    Bischoff, Moritz S.; Müller-Eschner, Matthias; Meisenbacher, Katrin; Peters, Andreas S.; Böckler, Dittmar

    2015-01-01

    Background The aim of this study was to analyze device conformability in TEVAR of acute and chronic (a/c) type B aortic dissections (TBAD) using the Gore Conformable Thoracic Aortic Stent-graft (CTAG). Material/Methods From January 1997 to February 2014, a total of 90 out of 405 patients in our center received TEVAR for TBAD. Since November 2009, 23 patients (16 men; median age: 62 years) were treated with the CTAG. Indications were complicated aTBAD in 15 (65%) and expanding cTBAD in 8 (35%) patients. Primary endpoints were the assessment of device conformability by measuring the distance (D) from the radiopaque gold band marker (GM) at the proximal CTAG end to the inner curvature (IC) of the arch on parasagittal multiplanar reformations of CT angiography, as well as the evaluation of aortic diameter changes following TEVAR. Median follow-up was 13.3 months (range: 2 days to 35 months). Results Primary and secondary success rates were 91.3% (21/23) and 95.6% (22/23), respectively. There was 1 type Ia endoleak, retrograde dissection or primary conversion was not observed. Median GM-IC-D was 0 mm (range: 0 mm to 10 mm). GM-IC-D was associated with zone 2 placement compared to zone 3 (P=0.036). There was no association between GM-IC-D formation and arch type. In aTBAD cases the true lumen significantly increased after TEVAR (P=0.017) and the false lumen underwent shrinkage (P=0.025). In cTBAD patients the false lumen decreased after TEVAR (P=0.036). Conclusions The CTAG shows favorable conformability and wall apposition in challenging arch pathologies such as TBAD. PMID:26718893

  19. Two cases of misaligned deployment of Valiant Captivia thoracic stent graft.

    PubMed

    Mlynski, Amélie; Marzelle, Jean; Desgranges, Pascal; Becquemin, Jean-Pierre

    2012-11-01

    Thoracic aortic stent grafts have been widely used. We report two cases of proximal misaligned deployment of the Valiant Captivia stent graft after hybrid treatment of thoracic aneurysms. This complication has, to our knowledge, never been previously reported in the literature with this stent graft. We discuss the various factors that may explain this complication. We also describe the bailout technique that was carried out. PMID:22857811

  20. 3D Stereoscopic Visualization of Fenestrated Stent Grafts

    SciTech Connect

    Sun Zhonghua; Squelch, Andrew; Bartlett, Andrew; Cunningham, Kylie; Lawrence-Brown, Michael

    2009-09-15

    The purpose of this study was to present a technique of stereoscopic visualization in the evaluation of patients with abdominal aortic aneurysm treated with fenestrated stent grafts compared with conventional 2D visualizations. Two patients with abdominal aortic aneurysm undergoing fenestrated stent grafting were selected for inclusion in the study. Conventional 2D views including axial, multiplanar reformation, maximum-intensity projection, and volume rendering and 3D stereoscopic visualizations were assessed by two experienced reviewers independently with regard to the treatment outcomes of fenestrated repair. Interobserver agreement was assessed with Kendall's W statistic. Multiplanar reformation and maximum-intensity projection visualizations were scored the highest in the evaluation of parameters related to the fenestrated stent grafting, while 3D stereoscopic visualization was scored as valuable in the evaluation of appearance (any distortions) of the fenestrated stent. Volume rendering was found to play a limited role in the follow-up of fenestrated stent grafting. 3D stereoscopic visualization adds additional information that assists endovascular specialists to identify any distortions of the fenestrated stents when compared with 2D visualizations.

  1. Automatic segmentation of the wire frame of stent grafts from CT data.

    PubMed

    Klein, Almar; van der Vliet, J Adam; Oostveen, Luuk J; Hoogeveen, Yvonne; Kool, Leo J Schultze; Renema, W Klaas Jan; Slump, Cornelis H

    2012-01-01

    Endovascular aortic replacement (EVAR) is an established technique, which uses stent grafts to treat aortic aneurysms in patients at risk of aneurysm rupture. Late stent graft failure is a serious complication in endovascular repair of aortic aneurysms. Better understanding of the motion characteristics of stent grafts will be beneficial for designing future devices. In addition, analysis of stent graft movement in individual patients in vivo can be valuable for predicting stent graft failure in these patients. To be able to gather information on stent graft motion in a quick and robust fashion, we propose an automatic method to segment stent grafts from CT data, consisting of three steps: the detection of seed points, finding the connections between these points to produce a graph, and graph processing to obtain the final geometric model in the form of an undirected graph. Using annotated reference data, the method was optimized and its accuracy was evaluated. The experiments were performed using data containing the AneuRx and Zenith stent grafts. The algorithm is robust for noise and small variations in the used parameter values, does not require much memory according to modern standards, and is fast enough to be used in a clinical setting (65 and 30s for the two stent types, respectively). Further, it is shown that the resulting graphs have a 95% (AneuRx) and 92% (Zenith) correspondence with the annotated data. The geometric model produced by the algorithm allows incorporation of high level information and material properties. This enables us to study the in vivo motions and forces that act on the frame of the stent. We believe that such studies will provide new insights into the behavior of the stent graft in vivo, enables the detection and prediction of stent failure in individual patients, and can help in designing better stent grafts in the future. PMID:21719343

  2. Ten Years of Experience with the GORE EXCLUDER{sup Registered-Sign} Stent-Graft for the Treatment of Aortic and Iliac Aneurysms: Outcomes from a Single Center Study

    SciTech Connect

    Maleux, G. Claes, H.; Van Holsbeeck, A.; Janssen, R.; Laenen, A.; Heye, S.; Houthoofd, S.; Fourneau, I.

    2012-06-15

    Purpose: This study was designed to assess the long-term outcome of selected patients with aortic, aortoiliac, and isolated common iliac aneurysms treated with the GORE EXCLUDER{sup Registered-Sign} stent-graft. Methods: Between December 1998 and June 2010, 121 nonconsecutive patients underwent insertion of a GORE EXCLUDER{sup Registered-Sign} stent-graft to treat an aortic (n = 80; 66%), aortoiliac (n = 25; 21%), or isolated common iliac (n = 16; 13%) aneurysm. Procedural and follow-up data were collected prospectively. Primary endpoints are overall survival, intervention-free survival, and freedom from aneurysm rupture. Secondary endpoints are device- and procedure-related complications, including all types of endoleaks or endotension, and reintervention. Results: The mean follow-up is 4.98 years (standard deviation, 3.18; median follow-up, 4.05 years). The estimated percentage overall survival (with 95% confidence interval) after respectively 5 and 10 years of follow-up is 74.5% (65.8; 81.3) and 57.8% (47.7; 66.7). The estimated intervention-free survival after respectively 5 and 10 years is 90% (84.3; 96.1) and 77.7% (67; 88.4). There was no aneurysm rupture during follow-up. Early postoperative complications occurred in 16 patients (13%); none were fatal. Late reinterventions were performed in 18 patients (15%). Finally, throughout the follow-up period, endoleaks were identified: type I (n = 4; 3%); type II (n = 39; 32%); type III (n = 0; 0%); endotension was seen in 11 patients (9%). Conclusions: Aneurysm exclusion with use of the GORE EXCLUDER{sup Registered-Sign} stent-graft is durable through a mean follow-up of nearly 5 years. There was no postprocedural aneurysm rupture. Complications occurred throughout the follow-up period, requiring continued clinical and radiological surveillance.

  3. Patient-specific simulation of endovascular repair surgery with tortuous aneurysms requiring flexible stent-grafts.

    PubMed

    Perrin, David; Badel, Pierre; Orgeas, Laurent; Geindreau, Christian; du Roscoat, Sabine Rolland; Albertini, Jean-Noël; Avril, Stéphane

    2016-10-01

    The rate of post-operative complications is the main drawback of endovascular repair, a technique used to treat abdominal aortic aneurysms. Complex anatomies, featuring short aortic necks and high vessel tortuosity for instance, have been proved likely prone to these complications. In this context, practitioners could benefit, at the preoperative planning stage, from a tool able to predict the post-operative position of the stent-graft, to validate their stent-graft sizing and anticipate potential complications. In consequence, the aim of this work is to prove the ability of a numerical simulation methodology to reproduce accurately the shapes of stent-grafts, with a challenging design, deployed inside tortuous aortic aneurysms. Stent-graft module samples were scanned by X-ray microtomography and subjected to mechanical tests to generate finite-element models. Two EVAR clinical cases were numerically reproduced by simulating stent-graft models deployment inside the tortuous arterial model generated from patient pre-operative scan. In the same manner, an in vitro stent-graft deployment in a rigid polymer phantom, generated by extracting the arterial geometry from the preoperative scan of a patient, was simulated to assess the influence of biomechanical environment unknowns in the in vivo case. Results were validated by comparing stent positions on simulations and post-operative scans. In all cases, simulation predicted stents deployed locations and shapes with an accuracy of a few millimetres. The good results obtained in the in vitro case validated the ability of the methodology to simulate stent-graft deployment in very tortuous arteries and led to think proper modelling of biomechanical environment could reduce the few local discrepancies found in the in vivo case. In conclusion, this study proved that our methodology can achieve accurate simulation of stent-graft deployed shape even in tortuous patient specific aortic aneurysms and may be potentially helpful to

  4. Stent-Graft Treatment of Late Stenosis of the Left Common Carotid Artery Following Thoracic Graft Placement

    SciTech Connect

    Medda, Massimo; Lioupis, Christos Mollichelli, Nadia; Fantoni, Cecilia; Inglese, Luigi

    2008-03-15

    We report the case of a patient with subtotal occlusion of the origin of the left common carotid artery (CCA) following thoracic graft placement. Retrograde endovascular placement of a stent-graft by minimal cervical access was undertaken to repair the occlusive lesion of the left CCA and prevent future complications of endoluminal thoracic reconstruction. The retrograde endovascular repair of CCA lesions, as other authors have already suggested, may be the treatment of choice in 'high-surgical-risk' patients. In these cases where the ostium of supra-aortic trunks is compromised following thoracic aorta stent-graft migration, endoluminal placement of a stent-graft in the CCA can guarantee both maintenance of carotid flow and thoracic stent-graft fixation.

  5. A comparison of two methods to segment stent grafts in CT data

    NASA Astrophysics Data System (ADS)

    Klein, Almar; Klaassen, Michel; Oostveen, Luuk J.; van der Vliet, J. Adam; Hoogeveen, Yvonne; Schultze Kool, Leo J.; Renema, W. KlaasJan; Slump, Cornelis H.

    2012-03-01

    Late stent graft failure is a serious complication in endovascular repair of aortic aneurysms. Better understanding of the motion characteristics of stent grafts will be beneficial for designing future devices. In addition, analysis of stent graft movement in individual patients in vivo can be valuable for predicting stent graft failure in these patients. To be able to gather information on stent graft motion in a quick and robust fashion, an automatic segmentation method is required. In this work we compare two segmentation methods that produce a geometric model in the form of an undirected graph. The first method tracks along the centerline of the stent and segments the stent in 2D slices sampled orthogonal to it. The second method used a modified version of the minimum cost path (MCP) method to segment the stent directly in 3D. Using annotated reference data both methods were evaluated in an experiment. The results show that the centerline-based method and the MCP-based method have an accuracy of approximately 65% and 92%, respectively. The difference in accuracy can be explained by the fact that the centerline method makes assumptions about the topology of the stent which do not always hold in practice. This causes difficulties that are hard and sometimes impossible to overcome. In contrast, the MCP-based method works directly in 3D and is capable of segmenting a large variety of stent shapes and stent types.

  6. Peripheral Stent Placement in Hemodialysis Grafts

    SciTech Connect

    Kariya, Shuji Tanigawa, Noboru; Kojima, Hiroyuki; Komemushi, Atsushi; Shomura, Yuzo; Shiraishi, Tomokuni; Kawanaka, Toshiaki; Sawada, Satoshi

    2009-09-15

    The purpose of the present study was to evaluate the clinical outcome of peripheral stent placement after failed balloon angioplasty in patients with grafts who are on hemodialysis. We examined 30 Wallstents that were placed in 26 patients because balloon angioplasty failed or early restenosis (<3 months) occurred within 3 months. We retrospectively reviewed 267 consecutive balloon angioplasties performed in 71 patients with graft access between August 2000 and March 2007. Stent placements accounted for 30 (11.2%) of the 267 balloon angioplasties. The clinical success rate of stent placement was 93.3% (28 of 30 stent placements). The 3-, 6-, and 12-month primary patency rates were 73.3%, 39.3%, and 17.7%, respectively. The 1-, 2-, and 3-year secondary patency rates were 90.2%, 83.8%, and 83.8%, respectively. Primary patency was significantly prolonged by stent placement after early restenosis compared with previous balloon angioplasty alone (P = 0.0059). Primary patency after stent placement was significantly lower than after successful balloon angioplasty without indications for stent placement (P = 0.0279). Secondary patency rates did not significantly differ between stent placement and balloon angioplasty alone. The mean number of reinterventions required to maintain secondary patency after stent placement was significantly larger than that after balloon angioplasty alone (Mann-Whitney U test, P = 0.0419). We concluded that peripheral stent placement for graft access is effective for salvaging vascular access after failed balloon angioplasty and for prolonging patency in early restenosis after balloon angioplasty. However, reinterventions are required to maintain secondary patency after stent placement. Furthermore, peripheral stent placement for graft access cannot achieve the same primary patency as balloon angioplasty alone.

  7. [Retrograde type A dissection after endovascular stent grafting of type B dissection].

    PubMed

    Misfeld, M; Nötzold, A; Geist, V; Richardt, G; Sievers, H H

    2002-03-01

    Acute aortic dissection is a disease with high mortality. Whereas acute dissection of the ascending aorta (Standford type A) is treated surgically, acute dissection of Stanford type B (descending aorta) is principally treated conservatively, but surgically in case of complications. Recently, another therapeutical option for the treatment of type B dissection has been developed using endovascular stent-grafts. We report on a 64-year-old woman with typical signs of acute aortic dissection. Computer tomography and transesophageal echocardiography demonstrated Stanford type B dissection. The patient was treated with an endovascular stent-graft, because of malperfusion of the right leg and chest pain. After successful closure of the entry by the stent, the patient developed acute right-sided hemiplegia one day after the intervention due to retrograde dissection into the aortic arch and ascending aorta. Upon immediate operation, the origin of the initially type B dissection was still sufficiently occluded by the endovascular stent-graft; however, there was another entry between the innominate artery and the left carotic artery near one proximal end of the stent's strut. Using deep hypothermia and selective antegrade cerebral perfusion, the ascending aorta and proximal arch were replaced with a 28 mm Dacron-Velour tube and the aortic root was remodelled with a tongue-shaped Dacron graft preserving the valve cusps according to a modified Yacoub procedure. After the operation, neurological symptoms diminished and the patient could walk on the ward on day eleven. This case demonstrates retrograde type A dissection as a complication after interventional treatment of type B dissection using an endovascular stent-graft. The reason for this delayed complication is speculative. Aortic wall damage during stent inserting could be a possible cause. It is also likely that the patient initially had type B dissection with retrograde dissection of the distal part of the aortic arch

  8. Endovascular Stents and Stent-Grafts: Is Heparin Coating Desirable?

    SciTech Connect

    Nelson, Stephen R.; Souza, Nandita M. de; Allison, David J.

    2000-07-15

    Heparins are glycosaminoglycans that, in addition to their anticoagulant activity, have interactions with growth factors and other glycoproteins. These interactions may stimulate neointimal hyperplasia when heparin is delivered locally on stents and stent-grafts. Modifying the structure of heparin to retain anticoagulant activity while minimizing these stimulatory effects on the vascular endothelium is desirable and may be achieved by understanding the relationships between the structure and function of the various parts of the heparin molecule.

  9. Perioperative rupture of the LIMA graft leading to cardiogenic shock, emergency angiography, and stenting with a polytetrafluoroethylene-covered stent.

    PubMed

    Yeow, Wen-Loong; Edwards, Mark; Yong, Gerald

    2012-03-01

    A 58-year-old man underwent an elective coronary bypass graft for severe four-vessel stenosis. Cardiogenic shock developed just after coronary bypass grafting with a left internal mammary artery (LIMA) to left anterior descending (LAD) artery and superficial venous graft to 1st and 2nd obtuse marginal (OM1/OM2) arteries the posterior descending artery (PDA) was too small to graft. Despite significant inotropes and an intra-aortic balloon pump, the patient deteriorated in intensive care unit with cardiogenic shock and ventricular arrhythmia. Urgent coronary angiography revealed a rupture or torn LIMA graft with extravasation of contrast into the left pleural cavity. There was no distal LIMA to LAD flow probably due to graft thrombosis. Revascularisation was performed on the severe ostial native LAD stenosis with a drug eluting stent. The rupture graft was then stented with a polytetrafluoroethylene-covered stent, which stopped the bleeding, and latter, led to total graft thrombosis. The patient improved significantly and supportive inotropes could be weaned down. At 11 month follow-up, the patient had mild left ventricular dysfunction, widely patent ostial LAD stent and thrombosed LIMA graft. PMID:21542101

  10. Treatment of Secondary Stent-Graft Collapse After Endovascular Stent-Grafting for Iliac Artery Pseudoaneurysms

    SciTech Connect

    Clevert, D.-A. Stickel, M.; Steitz, H.-O.; Kopp, R.; Strautz, T.; Flach, P.; Johnson, T.; Jung, E.M.; Jauch, K.W.; Reiser, M.

    2007-02-15

    We report the case of a patient who developed an asymptomatic pseudoaneurysm in the left external iliac artery after transplant nephrectomy. The pseudoaneurysm most probably arose as a suture aneurysm from the external iliac artery after removal of the graft renal artery. Obviously we can not exclude the possibility it was a true aneurysm, although this seems much less likely. The pseudoaneurysm was detected during a routine CT scan and was treated interventionally with a stent-graft. One month later the asymptomatic patient underwent a vascular ultrasound examination including color Doppler, power Doppler, and B-flow as a routine control. An endoleak with collapse of the stent-graft was diagnosed. There was no evidence of stent infection. At a reintervention, the pseudoaneurysm was successfully treated using two uncovered Palmaz stents at the proximal and distal edge of the stent graft. Peri- and post-interventional ultrasound and CT angiography confirmed the exclusion of the aneurysm without an endoleak.

  11. Endovascular Repair of Acute Symptomatic Pararenal Aortic Aneurysm With Three Chimney and One Periscope Graft for Complete Visceral Artery Revascularization

    SciTech Connect

    Brechtel, Klaus Ketelsen, Dominik; Endisch, Andrea; Heller, Stephan; Heuschmid, Martin; Stock, Ulrich A.; Kalender, Guenay

    2012-04-15

    PurposeTo describe a modified endovascular technique for complete revascularization of visceral and renal arteries in symptomatic pararenal aortic aneurysm (PRAA).TechniqueArterial access was surgically established in both common femoral arteries (CFAs) and the left subclavian artery (LSA). Revascularization of the left renal artery, the celiac trunk, and the superior mesenteric artery was performed through one single sheath via the LSA. Suitable covered stents were put in the aortic branches but not deployed. The right renal artery was accessed over the left CFA. Due to the longitudinal extension of the presented aneurysm two stent-grafts were introduced via the right CFA. After deploying the aortic stent-grafts, all covered stents in the side branches were deployed consecutively with a minimum overlap of 5 mm over the cranial and caudal stent-graft edges. Simultaneous ballooning was performed to fully expand all stent-grafts and warranty patency. Conclusion: This is the first report in the literature of chimney grafting in PRAA for complete revascularization of visceral and renal branches by using more than two covered stents introduced from one side through one single sheath. However this technique is modified, it should be used only in bailout situations when branched stent-grafts are not available and/or surgery is not suitable.

  12. Hybrid in situ replacement for Samson group V Staphylococcus aureus aortic graft infection

    PubMed Central

    Karpenko, A A; Ignatenko, P V; Beliaev, A M

    2013-01-01

    Aortic prosthesis replacements including extra-anatomical bypass procedures, in situ revascularisations with the neoaortoiliac system, antibiotic bounded prostheses or allogeneic grafts have high graft reinfection rates. We described a case of a 68-year-old man with Samson group V Staphylococcus aureus infection of his aortobifemoral graft. He underwent an explantation of the infected graft, wound debridement and a hybrid in situ allogeneic aortoiliofemoral replacement. During surgery one of the limbs of the cryopreserved human aortic allogeneic graft was anastomosed with the endarterectomised left common iliac artery, which later was angioplastied and stented. The closed system Jackson-Pratt drains were used to prevent perigraft fluid collection. The groin wound was treated with the vacuum-assisted closure dressing. On review in 6 months he remained symptom free. We conclude that a hybrid management of infected aortic prosthesis may reduce graft reinfection. PMID:23897382

  13. Hybrid in situ replacement for Samson group V Staphylococcus aureus aortic graft infection.

    PubMed

    Karpenko, A A; Ignatenko, P V; Beliaev, A M

    2013-01-01

    Aortic prosthesis replacements including extra-anatomical bypass procedures, in situ revascularisations with the neoaortoiliac system, antibiotic bounded prostheses or allogeneic grafts have high graft reinfection rates. We described a case of a 68-year-old man with Samson group V Staphylococcus aureus infection of his aortobifemoral graft. He underwent an explantation of the infected graft, wound debridement and a hybrid in situ allogeneic aortoiliofemoral replacement. During surgery one of the limbs of the cryopreserved human aortic allogeneic graft was anastomosed with the endarterectomised left common iliac artery, which later was angioplastied and stented. The closed system Jackson-Pratt drains were used to prevent perigraft fluid collection. The groin wound was treated with the vacuum-assisted closure dressing. On review in 6 months he remained symptom free. We conclude that a hybrid management of infected aortic prosthesis may reduce graft reinfection. PMID:23897382

  14. External-to-Internal Iliac Stent-Graft: Medium-Term Patency Following Exclusion of a Retrogradely Perfused Common Iliac Aneurysm

    SciTech Connect

    Nicholls, Marcus John; McPherson, Simon

    2010-08-15

    Following complicated aortic aneurysm surgery a complete left iliac occlusion resulted in buttock claudication. A retrogradely perfused right common iliac aneurysm expanded. Exclusion was by external-to-internal iliac stent-graft. No deterioration in claudication occurred with medium-term stent-graft patency.

  15. Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting

    PubMed Central

    Tao, Mary; Shlomovitz, Eran; Darling, Gail; Roche-Nagle, Graham

    2016-01-01

    Thoracic endovascular aortic repair for thoracic aortic aneurysms is an accepted alternative to open surgery, especially in patients with significant comorbidities. The procedure itself has a low risk of complications and fistulas to surrounding organs are rarely reported. An 86-year-old patient was admitted to our hospital with gastro intestinal (GI) bleeding and a suspected aortoesophageal fistula. Eight months prior, the patient had undergone a stent graft repair of a mycotic thoracic aneurysm. Computerized tomography angiography and upper GI endoscopy confirmed an aortoesophageal fistula, which was treated by esophageal stenting. With early recognition, esophageal stenting may have a role in the initial emergency control of bleeding from and palliation of aortoesophageal fistula. PMID:27574612

  16. Secondary aorto-esophageal fistula after thoracic aortic aneurysm endovascular repair treated by covered esophageal stenting.

    PubMed

    Tao, Mary; Shlomovitz, Eran; Darling, Gail; Roche-Nagle, Graham

    2016-08-16

    Thoracic endovascular aortic repair for thoracic aortic aneurysms is an accepted alternative to open surgery, especially in patients with significant comorbidities. The procedure itself has a low risk of complications and fistulas to surrounding organs are rarely reported. An 86-year-old patient was admitted to our hospital with gastro intestinal (GI) bleeding and a suspected aortoesophageal fistula. Eight months prior, the patient had undergone a stent graft repair of a mycotic thoracic aneurysm. Computerized tomography angiography and upper GI endoscopy confirmed an aortoesophageal fistula, which was treated by esophageal stenting. With early recognition, esophageal stenting may have a role in the initial emergency control of bleeding from and palliation of aortoesophageal fistula. PMID:27574612

  17. CT Study of the Relationship Between the Common Iliac Artery and Vein and Their Juxtaposition: Implications for Conduit Construction Prior to Endosvascular Stent-Graft Repair of Aortic Aneurysms

    SciTech Connect

    Lenton, James; Homer-Vanniasinkam, Shervanthi; Kent, Patrick; Nicholson, Tony

    2008-11-15

    The objective of this study was to determine the anatomical relationship and juxtaposition between the common iliac artery and vein in a population of patients with aortic aneurysmal disease and a population clinically and radiologically free of atheroma. It was a retrospective study of 100 consecutive patients undergoing computed tomographic assessment of abdominal aortic aneurysm prior to endovascular or open surgical repair and 100 patients undergoing computed tomographic assessment for other pathologies who did not have clinical or imaging signs of aorto-iliac atheroma. In both groups the anatomical relationship between the right and left iliac artery and vein was studied, and the thickness of the fat plane separating the artery from the vein measured. The right iliac vein was posterolateral to the artery at the level of the common iliac artery bifurcation in 95% of patients in both groups. At the same level the left iliac vein was posterior in 23% (p {<=} 0.001). Eighty-three percent of patients in the aneurysm group had a fat plane between the right artery and vein that measured 0 mm (no visible fat plane = 52%) to 1 mm (= 31%). Ninety-eight percent of patients in the aneurysm group had a measurable fat plane between the left iliac artery and vein of up to 5 mm (p = 0.001). Six percent of the control group demonstrated no visible fat plane between the right iliac artery and vein (p {<=} 0.001), while the fat plane measured more than 1 mm (1-5 mm) on the left in 100%. We conclude that in patients where conduit construction is required for aortic stent-graft access, the anatomical configuration and intimate relationship of the iliac arteries and veins should be assessed and taken into account at CT scan evaluation. The distal right common iliac artery should not be used, as venous damage can be predicted from the anatomical and intimate relationship of the iliac artery and vein at this level in patients with atheroma and the difficulties this relationship

  18. Treatment of aneurysmal aberrant right subclavian artery with triple-barrel stent graft.

    PubMed

    Schwein, Adeline; Georg, Yannick; Ohana, Mickaël; Delay, Charline; Lejay, Anne; Thaveau, Fabien; Chakfe, Nabil

    2015-04-01

    Aneurysmal evolution of an aberrant right subclavian artery (ARSA) is an operative indication. Endovascular treatment is a minimally invasive procedure, which offers good short-term and midterm results. We describe a case of a 9-cm diameter ARSA aneurysm in a symptomatic man, treated with the triple-barrel technique using a thoracic aortic stent graft combined with surgical and endovascular revascularization of the supra-aortic trunks. Postoperatively, the patient developed a type III endoleak which was covered. The triple-barrel technique has been a proposed treatment approach for complex aortic arch pathologies and remains a less invasive option when compared with open surgery. PMID:25596407

  19. Fatal Saccharomyces Cerevisiae Aortic Graft Infection

    NASA Technical Reports Server (NTRS)

    Meyer, Michael (Technical Monitor); Smith, Davey; Metzgar, David; Wills, Christopher; Fierer, Joshua

    2002-01-01

    Saccharomyces cerevisiae is a yeast commonly used in baking and a frequent colonizer of human mucosal surfaces. It is considered relatively nonpathogenic in immunocompetent adults. We present a case of S. cerevisiae fungemia and aortic graft infection in an immunocompetent adult. This is the first reported case of S. cerevisiue fungemia where the identity of the pathogen was confirmed by rRNA sequencing.

  20. Relay NBS Graft with the Plus Delivery System to Improve Deployment in Aortic Arch with Small Radius Curve

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Seitun, Sara; Guastavino, Andrea; Scarano, Flavio; Passerone, Gian Carlo

    2011-04-15

    The purpose of this report is to describe deployment of the Relay NBS Thoracic Stent Graft with the Plus Delivery System (Bolton Medical, Sunrise, FL) in a flexible resin arch model with a 15-mm radius curve as well as our preliminary clinical results. The Relay NBS graft with the Plus Delivery System was evaluated by way of bench testing, which was performed with stent grafts with diameters ranging from 24 to 46 mm and lengths ranging from 100 to 250 mm in flexible resin arch models with a 15-mm arch radius of curvature. The deployment sequence was analyzed. The Relay NBS graft with the Plus Delivery System was deployed in two patients, respectively, having a 6.5-cm penetrating aortic ulcer of the proximal third of the descending thoracic aorta and a DeBakey type-I aortic dissection with chronic false lumen dilatation after surgery due to an entry site at the distal thoracic aorta. Bench tests showed proper conformation and apposition of the Relay NBS graft with the Plus Delivery System in the flexible resin model. This stent graft was deployed successfully into the two patients with a correct orientation of the first stent and without early or late complications. The Relay NBS graft with the Plus Delivery System ensures an optimal conformation and apposition of the first stent in the aortic arch with a small radius of curvature.

  1. Outcomes of AV Fistulas and AV Grafts after Interventional Stent-Graft Deployment in Haemodialysis Patients

    SciTech Connect

    Schmelter, Christopher Raab, Udo; Lazarus, Friedrich; Ruppert, Volker; Vorwerk, Dierk

    2015-08-15

    PurposeThe study was designed to assess outcomes of arteriovenous (AV) accesses after interventional stent-graft deployment in haemodialysis patients.Materials and Methods63 haemodialysis patients with 66 AV fistulas and AV grafts were treated by interventional stent-graft deployment from 2006 to 2012 at our hospital. Data of these patients were retrospectively analysed for location of deployed stent-grafts, occurrence and location of (re-)stenosis and (re-)thrombosis. Complex stenosis was the most frequent indication for stent-graft deployment (45.5 %), followed by complications of angioplasty with vessel rupture or dissection (31.8 %).ResultsA high rate of procedural success was achieved (98.5 %). The most frequent location of the deployed stent-graft was the draining vein (66.7 %). Stent-graft deployment was more frequent in AV grafts than in AV fistulas. Primary patency was 45.5 % at 6 month, 31.3 % at 12 month and 19.2 % at 24 month. Primary patency was significantly better for AV fistulas than for AV grafts with deployed stent-grafts. Patency of the deployed stent-graft was much better than overall AV access primary patency with deployed stent-graft. Re-stenosis with thrombosis was the most frequent indication for re-intervention. Most frequent location of re-stenosis was the draining vein (37.1 %), followed by stenosis at the AV access (29.5 %) and the deployed stent-graft (23.5 %).ConclusionRe-stenosis and re-thrombosis remain frequent in AV fistulas and AV grafts in haemodialysis patients despite stent-graft deployment. Re-stenosis of the deployed stent-graft is, only in the minority of the cases, responsible for AV access dysfunction.

  2. Severe compression of a bailout self-expanding chimney stent for rescuing the miscoverage of left common carotid artery during TEVAR of a type B aortic dissection.

    PubMed

    Wang, Lixin; Guo, Daqiao; Jiang, Junhao; Shi, Zhenyu; Fu, Weiguo; Wang, Yuqi

    2014-04-01

    A 54-year-old man who suffered from paraplegia due to type B aortic dissection was treated with a Valiant stent-graft. However, attempts to gain secure proximal sealing resulted in an inadvertent coverage of the left common carotid artery by the endograft. The blood flow in the left common carotid artery was restored by a transcarotid Smart Control stent in a chimney fashion. At 6- and 18-month follow-up, computed tomography scan showed that the chimney stent was severely compressed by the stent graft, although the patient remained neurologically asymptomatic. PMID:24309751

  3. Adult Patent Ductus Arteriosus: Treatment with a Stent-Graft

    SciTech Connect

    Munoz, J.J. Urbaneja, A.; Gonzalez, N.; Martinez, J.L.

    2008-03-15

    We present the case of a 63-year-old woman with a short patent ductus arteriosus and aneurysmal pulmonary arteries who was treated by placement of a stent-graft. The technique proved simple and safe. Further research is required to improve the design of stent-grafts and their release system for use of this technique in adult patients with this disorder.

  4. Iatrogenic Portobiliary Fistula Treated by Stent-Graft Placement

    SciTech Connect

    Lorenz, Jonathan M.; Zangan, Steven M. Leef, Jeffrey A.; Ha, Thuong G. Van

    2010-04-15

    Stent-graft exclusion of an ischemic, hilar portobiliary fistula after liver transplantation has not been reported. Isolated reports have described peripheral or nonischemic fistulas, and alternative treatment options have ranged from balloon tamponade to surgical repair. We present a unique case of a hilar portobiliary fistula successfully treated to resolution by unilateral placement of a stent-graft.

  5. Aorto-Uni-Iliac Stent Grafts with and without Crossover Femorofemoral Bypass for Treatment of Abdominal Aortic Aneurysms: A Parallel Observational Comparative Study

    PubMed Central

    Elkassaby, Mohammed; Alawy, Mahmoud; Ali, Mohamed Zaki; Tawfick, Wael A.; Sultan, Sherif

    2015-01-01

    We investigated the safety and efficacy of primary aorto-uni-iliac (AUI) endovascular aortic repair (EVAR) without fem-fem crossover in patients with abdominal aortic aneurysm (AAA) and concomitant aortoiliac occlusive disease. 537 EVARs were implemented between 2002 and 2015 in University Hospital Galway, a tertiary referral center for aortic surgery and EVAR. We executed a parallel observational comparative study between 34 patients with AUI with femorofemoral crossover (group A) and six patients treated with AUI but without the crossover (group B). Group B patients presented with infrarenal AAAs with associated total occlusion of one iliac axis and high comorbidities. Technical success was 97% (n = 33) in group A and 85% (n = 5) in group B (P = 0.31). Primary and assisted clinical success at 24 months were 88% (n = 30) and 12% (n = 4), respectively, in group A, and 85% (n = 5) and 15% (n = 1), respectively, in group B (P = 0.125). Reintervention rate was 10% (n = 3) in group A and 0% in group B (P = 0.084). No incidence of postoperative critical lower limb ischemia or amputations occurred in the follow-up period. AUI without crossover bypass is a viable option in selected cases. PMID:26770825

  6. Multiple multilayer stents for thoracoabdominal aortic aneurysm: a possible new tool for aortic endovascular surgery

    PubMed Central

    Tolva, Valerio Stefano; Bianchi, Paolo Guy; Cireni, Lea Valeria; Lombardo, Alma; Keller, Guido Carlo; Parati, Gianfranco; Casana, Renato Maria

    2012-01-01

    Purpose Endovascular surgery data are confirming the paramount role of modern endovascular tools for a safe and sure exclusion of thoracoabdominal lesions. Case report A 57-year-old female presented with severe comorbidity affected by a 58 mm thoracoabdominal aortic aneurysm (TAAA). After patient-informed consent and local Ethical Committee and Italian Public Health Ministry authorization, three multilayer stents were implanted in the thoracoabdominal aortic tract, obtaining at a 20-month computed tomography scan follow up, a complete exclusion of the TAAA, with normal patency of visceral vessels. Conclusion Multilayer stents can be used in thoracoabdominal aortic aneurysm, with positive results. PMID:22866014

  7. Aortic rupture due to pneumococcal infection in aortoiliac stents.

    PubMed

    Mlynski, Amélie; Mordant, Pierre; Dufour, Guillaume; Augustin, Pascal; Lesèche, Guy; Castier, Yves

    2011-06-01

    We report a rare case of pneumococcal aortitis secondary to endovascular bare-metal stent infection. The patient was a 70-year-old man presenting with back pain 1 year after aortoiliac implantation of bare-metal kissing stents. Final diagnosis was microbial aortitis due to Streptococcus pneumoniae involving the stents that resulted in a contained aortic rupture requiring urgent surgical treatment. Emergency extra-anatomic revascularization, excision of the infected tissues, and appropriate antibiotic therapy led to a favorable outcome. A high index of suspicion is required in such a situation because the mortality rate is very high in the absence of appropriate treatment. PMID:21498029

  8. [Extracorporeal lung support and endovascular stent in traumatic aortic rupture and severe lung failure].

    PubMed

    Schmid, F X; Philipp, A; Faltermeier, H; Schädinger, U; Link, J; Birnbaum, D

    2002-07-01

    Blunt thoracic injury in association with aortic rupture represents a life-threatening situation. Surgical repair used to be the preferred method of treatment. Because most patients are multiple trauma patients including head injuries, bone fractures and respiratory failure, urgent surgical procedures portend excessively high morbidity and mortality rates. Delay in operative management bears the risk of exsanguinating hemorrhage, secondary complications, prolonged hospital stay with increased costs. We present here an alternative treatment protocol including pumpless extracorporal lung assist and endovascular aortic stent graft placement in a 20-year old traffic accident victim. This procedure may be an especially useful treatment option in managing patients with complex lung and aortic pathology primarily not suitable for transportation or surgery. PMID:12219652

  9. Quantification of biomechanical interaction of transcatheter aortic valve stent deployed in porcine and ovine hearts.

    PubMed

    Mummert, Joseph; Sirois, Eric; Sun, Wei

    2013-03-01

    Success of the deployment and function in transcatheter aortic valve replacement is heavily reliant on the tissue-stent interaction. The present study quantified important tissue-stent contact variables of self-expanding transcatheter aortic valve stents when deployed into ovine and porcine aortic roots, such as the stent radial expansion force, stent pullout force, the annulus deformation response and the coefficient of friction on the tissue-stent contact interface. Braided Nitinol stents were developed, tested to determine stent crimped diameter vs. stent radial force from a stent crimp experiment, and deployed in vitro to quantify stent pullout, aortic annulus deformation, and the coefficient of friction between the stent and the aortic tissue from an aortic root-stent interaction experiment. The results indicated that when crimped at body temperature from 26 mm to 19, 21 and 23 mm stent radial forces were approximately 30-40% higher than those crimped at room temperature. Coefficients of friction leveled to approximately 0.10 ± 0.01 as stent wire diameter increased and annulus size decreased from 23 to 19 mm. Regardless of aortic annulus size and species tested, it appeared that a minimum of about 2.5 mm in annular dilatation, caused by about 60 N of radial force from stent expansion, was needed to anchor the stent against a pullout into the left ventricle. The study of the contact biomechanics in animal aortic tissues may help us better understand characteristics of tissue-stent interactions and quantify the baseline responses of non-calcified aortic tissues. PMID:23161165

  10. [Emergency stent placement after descending aortic replacement with chronic aortic dissection].

    PubMed

    Shiraishi, Manabu; Muraoka, Arata; Aizawa, Kei; Sakano, Yasuhito; Kaminishi, Yuichiro; Ohki, Shinichi; Saito, Tsutomu; Misawa, Yoshio

    2011-09-01

    A 49-year-old man with asymptomatic chronic aneurysmal dissection was admitted to our hospital. He had undergone ascending aortic replacement for type A aortic dissection 7 months before. We performed descending aortic replacement for chronic aneurysmal dissection. Renal dysfunction appeared 1 day after the operation. Contrast-enhanced computed tomography indicated that the true lumen was severely compressed by a false lumen, and that the origins of the renal artery were occluded. We performed emergency endovascular stent placement to dilate the true lumen. Immediately after this procedure, renal ischemia improved. The postoperative course was uneventful. An endovascular approach using bare stent can be a treatment option that is less invasive and prompter for a patient with renal ischemia resulting from aortic dissection. PMID:21899124

  11. Penetrating Atherosclerotic Ulcer of the Descending Thoracic Aorta: Treatment by Endovascular Stent-Graft

    SciTech Connect

    Murgo, Salvatore; Dussaussois, Luc; Golzarian, Jafar; Cavenaile, Jean Christophe; Abada, Hicham Tarik; Ferreira, Jose; Struyven, Julien

    1998-11-15

    Purpose: To present four cases of penetrating ulcer of the descending thoracic aorta treated by transfemoral insertion of an endoluminal stent-graft. Methods: Four patients with penetrating aortic ulcers were reviewed. Three cases were complicated by rupture, false aneurysm, or retrograde dissection. All patients were treated by endovascular stent-graft and were followed by helical computed tomography (CT). Results: Endovascular stent-graft deployment was successful in all patients. However, in one case we observed a perigraft leak that spontaneously disappeared within the first month, and two interventions were needed for another patient. Following treatment, one episode of transient spinal ischemia was observed. The 30-day survival rate was 100%, but one patient died from pneumonia with cardiac failure 34 days after the procedure. In one patient, helical CT performed at 3 months showed a false aneurysm independent of the first ulcer. This patient refused any further treatment and suddenly died at home (unknown cause) after a 6-month follow-up period. Conclusion: Transluminal placement of endovascular stent-grafts for treatment of penetrating ulcers of the descending thoracic aorta appears to be a possible alternative to classical surgery. After treatment, follow-up by CT is essential to detect possible complications of the disease.

  12. Turbulence downstream of subcoronary stentless and stented aortic valves.

    PubMed

    Funder, Jonas Amstrup; Frost, Markus Winther; Wierup, Per; Klaaborg, Kaj-Erik; Hjortdal, Vibeke; Nygaard, Hans; Hasenkam, J Michael

    2011-08-11

    Regions of turbulence downstream of bioprosthetic heart valves may cause damage to blood components, vessel wall as well as to aortic valve leaflets. Stentless aortic heart valves are known to posses several hemodynamic benefits such as larger effective orifice areas, lower aortic transvalvular pressure difference and faster left ventricular mass regression compared with their stented counterpart. Whether this is reflected by diminished turbulence formation, remains to be shown. We implanted either stented pericardial valve prostheses (Mitroflow), stentless valve prostheses (Solo or Toronto SPV) in pigs or they preserved their native valves. Following surgery, blood velocity was measured in the cross sectional area downstream of the valves using 10MHz ultrasonic probes connected to a dedicated pulsed Doppler equipment. As a measure of turbulence, Reynolds normal stress (RNS) was calculated at two different blood pressures (baseline and 50% increase). We found no difference in maximum RNS measurements between any of the investigated valve groups. The native valve had significantly lower mean RNS values than the Mitroflow (p=0.004), Toronto SPV (p=0.008) and Solo valve (p=0.02). There were no statistically significant differences between the artificial valve groups (p=0.3). The mean RNS was significantly larger when increasing blood pressure (p=0.0006). We, thus, found no advantages for the stentless aortic valves compared with stented prosthesis in terms of lower maximum or mean RNS values. Native valves have a significantly lower mean RNS value than all investigated bioprostheses. PMID:21696741

  13. A biomimetic approach for designing stent-graft structures: Caterpillar cuticle as design model.

    PubMed

    Singh, Charanpreet; Wang, Xungai

    2014-02-01

    Stent-graft (SG) induced biomechanical mismatch at the aortic repair site forms the major reason behind postoperative hemodynamic complications. These complications arise from mismatched radial compliance and stiffness property of repair device relative to native aortic mechanics. The inability of an exoskeleton SG design (an externally stented rigid polyester graft) to achieve optimum balance between structural robustness and flexibility constrains its biomechanical performance limits. Therefore, a new SG design capable of dynamically controlling its stiffness and flexibility has been proposed in this study. The new design is adopted from the segmented hydroskeleton structure of a caterpillar cuticle and comprises of high performance polymeric filaments constructed in a segmented knit architecture. Initially, conceptual design models of caterpillar and SG were developed and later translated into an experimental SG prototype. The in-vitro biomechanical evaluation (compliance, bending moment, migration intensity, and viscoelasticity) revealed significantly better performance of hydroskeleton structure than a commercial SG device (Zenith(™) Flex SG) and woven Dacron(®) graft-prosthesis. Structural segmentation improved the biomechanical behaviour of new SG by inducing a three dimensional volumetric expansion property when the SG was subjected to hoop stresses. Interestingly, this behaviour matches the orthotropic elastic property of native aorta and hence proposes segmented hydroskeleton structures as promising design approach for future aortic repair devices. PMID:24216309

  14. Image-based mechanical analysis of stent deformation: concept and exemplary implementation for aortic valve stents.

    PubMed

    Gessat, Michael; Hopf, Raoul; Pollok, Thomas; Russ, Christoph; Frauenfelder, Thomas; Sündermann, Simon Harald; Hirsch, Sven; Mazza, Edoardo; Székely, Gábor; Falk, Volkmar

    2014-01-01

    An approach for extracting the radial force load on an implanted stent from medical images is proposed. To exemplify the approach, a system is presented which computes a radial force estimation from computer tomography images acquired from patients who underwent transcatheter aortic valve implantation (TAVI). The deformed shape of the implanted valve prosthesis' Nitinol frame is extracted from the images. A set of displacement vectors is computed that parameterizes the observed deformation. An iterative relaxation algorithm is employed to adapt the information extracted from the images to a finite-element model of the stent, and the radial components of the interaction forces between the stent and the tissue are extracted. For the evaluation of the method, tests were run using the clinical data from 21 patients. Stent modeling and extraction of the radial forces were successful in 18 cases. Synthetic test cases were generated, in addition, for assessing the sensitivity to the measurement errors. In a sensitivity analysis, the geometric error of the stent reconstruction was below 0.3 mm, which is below the image resolution. The distribution of the radial forces was qualitatively and quantitatively reasonable. An uncertainty remains in the quantitative evaluation of the radial forces due to the uncertainty in defining a radial direction on the deformed stent. With our approach, the mechanical situation of TAVI stents after the implantation can be studied in vivo, which may help to understand the mechanisms that lead to the complications and improve stent design. PMID:24626769

  15. Innovative chimney-graft technique for endovascular repair of a pararenal abdominal aortic aneurysm.

    PubMed

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A; Krajcer, Zvonimir

    2015-02-01

    After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta. PMID:25873796

  16. Innovative Chimney-Graft Technique for Endovascular Repair of a Pararenal Abdominal Aortic Aneurysm

    PubMed Central

    Galiñanes, Edgar Luis; Hernandez-Vila, Eduardo A.

    2015-01-01

    After abdominal aortic aneurysm repair, progressive degeneration of the aneurysm can be challenging to treat. Multiple comorbidities and previous operations place such patients at high risk for repeat surgery. Endovascular repair is a possible alternative; however, challenging anatomy can push the limits of available technology. We describe the case of a 71-year-old man who presented with a 5.3-cm pararenal aneurysm 4 years after undergoing open abdominal aortic aneurysm repair. To avoid reoperation, we excluded the aneurysm by endovascular means, using visceral-artery stenting, a chimney-graft technique. Low-profile balloons on a monorail system enabled the rapid exchange of coronary wires via a buddy-wire technique. This novel approach facilitated stenting and simultaneous angioplasty of multiple visceral vessels and the abdominal aorta. PMID:25873796

  17. Postcatheterization Femoral Arteriovenous Fistulas: Endovascular Treatment with Stent-Grafts

    SciTech Connect

    Onal, Baran Kosar, Sule; Gumus, Terman; Ilgit, Erhan T.; Akpek, Sergin

    2004-09-15

    Purpose: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein.Methods: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach.Results: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs.Conclusion: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

  18. [Evaluation of Radiation Dose during Stent-graft Treatment Using a Hybrid Operating Room System].

    PubMed

    Haga, Yoshihiro; Chida, Kouichi; Kaga, Yuji; Saitou, Kazuhisa; Arai, Takeshi; Suzuki, Shinichi; Iwaya, Yoshimi; Kumasaka, Eriko; Kataoka, Nozomi; Satou, Naoto; Abe, Mitsuya

    2015-12-01

    In recent years, aortic aneurysm treatment with stent graft grafting in the X-ray fluoroscopy is increasing. This is an endovascular therapy, because it is a treatment which includes the risk of radiation damage, having to deal with radiation damage, to know in advance is important. In this study, in order to grasp the trend of exposure stent graft implantation in a hybrid operating room (OR) system, focusing on clinical data (entrance skin dose and fluoroscopy time), was to count the total. In TEVAR and EVAR, fluoroscopy time became 13.40 ± 7.27 minutes, 23.67 ± 11.76 minutes, ESD became 0.87 ± 0.41 mGy, 1.11 ± 0.57 mGy. (fluoroscopy time of EVAR was 2.0 times than TEVAR. DAP of EVAR was 1.2 times than TEVAR.) When using the device, adapted lesions and usage are different. This means that care changes in exposure-related factors. In this study, exposure trends of the stent graft implantation was able to grasp. It can be a helpful way to reduce/optimize the radiation dose in a hybrid OR system. PMID:26685833

  19. Computerized tomographic evaluation of aortic prosthetic graft complications

    SciTech Connect

    Kay, D.; Kalmar, J.A.

    1985-03-01

    Computerized tomography has been found to be an accurate and sensitive method of diagnosing complications of synthetic aortic grafts. Complications in this series of four cases included aortoesophageal fistula, aortoduodenal fistula, pseudoaneurysm, and retroperitoneal hematoma. 6 references, 5 figures.

  20. Management of Failing Prosthetic Bypass Grafts with Metallic Stent Placement

    SciTech Connect

    Siskin, Gary P.; Stainken, Brian F.; Mandell, Valerie S.; Darling, R. Clement; Dowling, Kyran; Herr, Allen

    1999-09-15

    Purpose: To evaluate the role of metallic stents in treating stenoses involving prosthetic arterial bypass grafts. Methods: Patients undergoing stent placement within a failing prosthetic bypass graft, during a 41-month period, were reviewed for treatment outcome and complications. The indications for stent placement in 15 patients included severe claudication (n= 3), rest pain (n= 9), and minor or major tissue loss (n= 3). Lesions were at the proximal anastomosis (n= 6), the distal anastomosis (n= 3), or within the graft (n= 6). Results: Treatment with metallic stents was successful in all patients. There was one acute stent thrombosis, successfully treated with thrombolytic therapy. Follow-up data are available for a mean duration of 12.3 months. The mean duration of primary patency was 9.4 months with 6- and 12-month primary patency rates of 51.9% and 37.0%, respectively. The mean duration of secondary patency was 12.1 months with 6- and 12-month secondary patency rates of 80.0% and 72.7%, respectively. Two patients with discontinuous runoff and preexisting gangrene required a below-knee amputation. Six patients were revised surgically after stent placement (at a mean of 10.8 months). Three late deaths occurred during follow-up. Conclusion: Given the mortality risks of surgical revision and the reduced life expectancy of this patient population, metallic stent placement represents a viable, short-term treatment option for stenoses within or at the anastomoses of prosthetic grafts. Further evaluation is warranted to compare intragraft stent placement with surgical graft revision.

  1. Fatal Aortic Rupture Complicating Stent Plasty in a Case of Aortoarteritis

    SciTech Connect

    Deshmukh, Hemant L.; Rathod, Krantikumar R. Sheth, Rahul J.; Garg, Ashwin

    2003-09-15

    Endovascular stenting has emerged as an effective alternative for unsuccessful angioplasty of the aorta in aortoarteritis. This is a single case report of fatal aortic rupture following balloon angioplasty of post-patch aortoplasty restenosis in aortoarteritis. We report a fatal aortic rupture during angioplasty of the primarily stented stenotic segment of the aorta in a case of aortoarteritis.

  2. Successful endovascular treatment using a covered stent for artery–ureteral fistula after surgery for abdominal aortic aneurysm

    PubMed Central

    Takase, Yasukazu; Kodama, Koichi; Motoi, Isamu

    2015-01-01

    Artery–ureteral fistula (AUF) is a rare condition but there is an increase in the number of reported cases. It is frequently difficult to treat. A 63-year-old male who had undergone a Dacron Y-graft placement for an infrarenal aortic aneurysm 3 years earlier, presented with hematuria. Contrast-enhanced computed tomography revealed a fistula located between the right common iliac artery and the right ureter at graft anastomosis. Endovascular treatment using a covered stent was performed successfully. PMID:26166974

  3. Reliable and cost-effective system for surgical stent graft insertion.

    PubMed

    Nomura, F; Mukai, S; Fumimoto, Y; Shimazutsu, K; Ihara, K

    2000-12-01

    For intraoperative stented graft implantation, we use a half-inch translucent soft polyvinyl tube as a sheath and an obturator from a two-stage venous cannula as a pushing rod. Ten centimeters of any kind of graft can be used for the stent graft itself. The stent we used was a self-expandable Gianturco double Z stent and was sutured inside the graft. PMID:11156152

  4. Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.

    PubMed

    Zierer, Andreas; Sanchez, Luis A; Moon, Marc R

    2009-07-01

    We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta. PMID:19559261

  5. Branched stent-grafts deployed in the true and false lumen to exclude a post dissecting thoracoabdominal aneurysm.

    PubMed

    Bertoglio, Luca; Marone, Enrico M; Civilini, Efrem; Cambiaghi, Tommaso; Mascia, Daniele; Chiesa, Roberto

    2016-10-01

    The aim of this case report was to present an endovascular treatment of a residual post-dissection Crawford type III thoracoabdominal aneurysm (TAA). A 60-year-old man, who had suffered from acute type B aortic dissection (TBAD) 8 years ago and had already been treated for both descending thoracic and infrarenal aortic aneurysm with open repair, presented with a 61mm post-dissection TAA. The aneurysm was successfully excluded with a staged fully endovascular procedure by employing two multibranched custom-made stent grafts deployed into the false lumen. The first stent-graft with a proximal monobranch was created to perfuse the right renal artery via the true lumen. The latter, with a triple branch design, was meant to perfuse the visceral arteries and left renal artery arising from the false lumen. Available branched custom-made stent-grafts for the treatment of degenerative TAA can be employed also in post TBAD aneurysms so as to simplify the procedure. The branched stent-grafts could be deployed within an enlarged false lumen provided that a suitable distal landing zone is available as well as that the visceral vessels can be perfused from the false lumen. A proximal branch for perfusing one of the lumens of the dissection from the proximal tear can be an alternative solution to creating neofenestrations. PMID:26337013

  6. Endovascular Tubular Stent-Graft Placement for Isolated Iliac Artery Aneurysms

    SciTech Connect

    Okada, Takuya Yamaguchi, Masato; Kitagawa, Atsushi; Kawasaki, Ryota; Nomura, Yoshikatsu; Okita, Yutaka; Sugimura, Kazuro; Sugimoto, Koji

    2012-02-15

    Purpose: To evaluate the safety, efficacy, and mid-term outcomes of endovascular tubular stent-graft placement for repair of isolated iliac artery aneurysms (IAAs). Materials and Methods: Between January 2002 and March 2010, 20 patients (7 women and 13 men; mean age 74 years) underwent endovascular repair of 22 isolated IAAs. Two patients underwent endovascular repair for bilateral aneurysms. Ten para-anastomotic aneurysms (45%) developed after open abdominal aortic aneurysm (AAA) repair with an aorto-iliac graft, and 12 were true aneurysms (55%). Eleven straight and 11 tapered stent-grafts were placed. Contrast-enhanced computed tomography (CT) was performed to detect complications and evaluate aneurysmal shrinkage at week 1, 3, 6, and 12 months and once every year thereafter. Non-contrast-enhanced CT was performed in seven patients with chronic kidney disease. Results: All procedures were successful, without serious complications, during the mean (range) follow-up period of 746 days (47-2651). Type II endoleak not requiring treatment was noted in one patient. The mean (SD) diameters of the true and para-anastomotic aneurysms significantly (p < 0.05) decreased from 42.0 (9.3) to 36.9 (13.6) mm and from 40.1 (13.0) to 33.6 (15.8) mm, respectively; the mean (SD) shrinkage rates were 15.1% (20.2%) and 18.9% (22.4%), respectively. The primary patency rate was 100%, and no secondary interventions were required. Four patients (21%) developed transient buttock claudication, and one patient (5%) developed colorectal ischaemia, which was treated conservatively. Conclusion: Endovascular tubular stent-graft placement for the repair of isolated IAAs is safe and efficacious. Tapered stent-grafts of various sizes are required for accurate placement.

  7. Internal iliac artery aneurysmo-colonic fistula after endovascular stent-graft repair: a case report.

    PubMed

    Yanase, Yohsuke; Fukada, Johji; Tamiya, Yukihiko

    2015-01-01

    We describe rare ilio-enteric fistula that developed after endovascular repair of a left internal iliac artery aneurysm (IIAA). An 83-year-old man with a history of previous surgeries via laparotomies suddenly developed a high fever 3 years after undergoing endovascular abdominal aortic repair (EVAR) with a stent-graft to treat a left isolated IIAA. Computed tomography imaging revealed a fistula between the IIAA and the sigmoid colon. A colostomy was created because severe intraperitoneal adhesions prevented resection of the IIAA. The postoperative course was uneventful and the patient remained free of infection without antibiotics. Residual aneurysms can cause complications after EVAR. PMID:25848433

  8. Internal Iliac Artery Aneurysmo–Colonic Fistula after Endovascular Stent-Graft Repair: A Case Report

    PubMed Central

    Fukada, Johji; Tamiya, Yukihiko

    2015-01-01

    We describe rare ilio-enteric fistula that developed after endovascular repair of a left internal iliac artery aneurysm (IIAA). An 83-year-old man with a history of previous surgeries via laparotomies suddenly developed a high fever 3 years after undergoing endovascular abdominal aortic repair (EVAR) with a stent-graft to treat a left isolated IIAA. Computed tomography imaging revealed a fistula between the IIAA and the sigmoid colon. A colostomy was created because severe intraperitoneal adhesions prevented resection of the IIAA. The postoperative course was uneventful and the patient remained free of infection without antibiotics. Residual aneurysms can cause complications after EVAR. PMID:25848433

  9. Hybrid Repair of Complex Thoracic Aortic Arch Pathology: Long-Term Outcomes of Extra-anatomic Bypass Grafting of the Supra-aortic Trunk

    SciTech Connect

    Lotfi, S. Clough, R. E.; Ali, T.; Salter, R.; Young, C. P.; Bell, R.; Modarai, B.; Taylor, P.

    2013-02-15

    Hybrid repair constitutes supra-aortic debranching before thoracic endovascular aortic repair (TEVAR). It offers improved short-term outcome compared with open surgery; however, longer-term studies are required to assess patient outcomes and patency of the extra-anatomic bypass grafts. A prospectively maintained database of 380 elective and urgent patients who had undergone TEVAR (1997-2011) was analyzed retrospectively. Fifty-one patients (34 males; 17 females) underwent hybrid repair. Median age was 71 (range, 18-90) years with mean follow-up of 15 (range, 0-61) months. Perioperative complications included death: 10 % (5/51), stroke: 12 % (6/51), paraplegia: 6 % (3/51), endoleak: 16 % (8/51), rupture: 4 % (2/51), upper-limb ischemia: 2 % (1/51), bypass graft occlusion: 4 % (2/51), and cardiopulmonary complications in 14 % (7/51). Three patients (6 %) required emergency intervention for retrograde dissection: (2 aortic root repairs; 2 innominate stents). Early reintervention was performed for type 1 endoleak in two patients (2 proximal cuff extensions). One patient underwent innominate stenting and revision of their bypass for symptomatic restenosis. At 48 months, survival was 73 %. Endoleak was detected in three (6 %) patients (type 1 = 2; type 2 = 1) requiring debranching with proximal stent graft (n = 2) and proximal extension cuff (n = 1). One patient had a fatal rupture of a mycotic aneurysm and two arch aneurysms expanded. No bypass graft occluded after the perioperative period. Hybrid operations to treat aortic arch disease can be performed with results comparable to open surgery. The longer-term outcomes demonstrate low rates of reintervention and high rates of graft patency.

  10. Successful in situ treatment of an infected ascending aortic graft.

    PubMed

    Mathes, D W; Yaremchuk, M J; Isselbacher, E M; Madsen, J C

    2000-10-01

    Infection of an ascending aortic prosthesis is a grave complication associated with a high mortality. In most cases, extraanatomic bypass and removal of the infected vascular graft are not possible. Furthermore, the standard approach to this problem, which includes excision and replacement or debridement and repair of infected thoracic aortic grafts, carries a high early mortality. We report the successful treatment of this life-threatening complication using a conservative strategy in which the aortic prosthesis was salvaged by in situ disinfection followed by coverage with tissue flaps. PMID:11081915

  11. Evaluation of spinal cord ischemia with a retrievable stent graft is useful for determining the type of repair for a case of patch aneurysm.

    PubMed

    Akasaka, Junetsu; Takase, Kei; Tabayashi, Koichi

    2014-07-01

    Patch aneurysms after thoracoabdominal aortic aneurysm repair are a serious late complication. We treated a patient with patch aneurysm (originating at the artery of Adamkiewicz) involving a portion of an implanted graft from a previous operation. First, thoracic endovascular aneurysm repair was planned. A retrievable stent graft was inserted, and motor-evoked potentials were monitored to evaluate spinal cord ischemia. Significant changes in the motor-evoked potentials were observed, and permanent stent graft placement was abandoned. Later, open surgery was performed. The patient showed no postoperative paraplegia and was discharged in good condition. PMID:24333526

  12. Fenestrated Endovascular Grafts for the Repair of Juxtarenal Aortic Aneurysms

    PubMed Central

    2009-01-01

    Executive Summary Endovascular repair of abdominal aortic aneurysm (AAA) allows the exclusion of the dilated aneurismal segment of the aorta from the systematic circulation. The procedure requires, however, that the endograft extends to the healthy parts of the aorta above and below the aneurysm, yet the neck of a juxtarenal aortic aneurysm (JRA) is too short for a standard endovascular repair. Fenestrated endovascular aortic repair (f—EVAR) provides a solution to overcome this problem by enabling the continuation of blood flow to the renal and visceral arteries through holes or ‘fenestrations’ in the graft. These fenestrations are designed to match the ostial diameter of the renal and visceral arteries. There are three varieties fenestration, small, large, and scallop, and their location needs to be customized to fit the anatomy of the patient. If the device is not properly designed, if the alignment is inaccurate, or if the catheterization of the visceral arteries is not possible, the procedure may fail. In such cases, conversion to open surgery may become the only option as fenestrated endografts are not retrievable. It is recommended that a stent be placed within each small fenestration to the target artery to prevent shuttering of the artery or occlusion. Many authors have noted an increased risk of vessel occlusion in unstented fenestrations and scallops. Once placed in a patient, life-long follow-up at regular intervals is necessary to ensure the graft remains in its intended location, and that the components have adequate overlap. Should the need arise, routine follow-up allows the performance of timely and appropriate intervention through detection of events that could impact the long-term outcomes. Alternative Technology The technique of fenestrated endovascular grafting is still in evolution and few studies have been with published mid-term outcome data. As the technique become more common in vascular surgery practices, it will be important to

  13. Treatment of Venous Aortorenal Bypass Graft Aneurysm Using a Stent-Graft

    SciTech Connect

    Novotny, Jiri Peregrin, Jan H.; Stribrna, Jarmila; Janousek, Radim

    2010-02-15

    We present the case of a 77-year-old male patient who had undergone a bilateral venous aortorenal bypass graft 30 years previously. Thirteen years previously, the patient was shown to have a decrease in renal function, with mild shrinking of both kidneys; additionally, a stenosis was found in the left proximal anastomosis. At the most recent follow-up visit (1 year previously), ultrasound revealed an aneurysm (42 mm in diameter) of the left renal bypass graft; the finding was confirmed by CT angiography. A significant ostial stenosis of the left renal bypass graft was also confirmed. It was decided to place a self-expandable stent-graft into the aneurysm while also attempting to dilate the stenosis. Proximal endoleak after stent-graft placement necessitated the implantation of another, balloon-expandable stent-graft into the bypass graft ostium. Postprocedural angiography and follow-up by CT angiography at 3 months confirmed good patency of the stent-grafts and complete thrombosis of the aneurysmal sac, with preserved kidney perfusion. Renal function remained unaltered, while the hypertension is better controlled.

  14. Outcome of Renal Stenting for Renal Artery Coverage During Endovascular Aortic Aneurysm Repair

    PubMed Central

    Hiramoto, Jade S.; Chang, Catherine K.; Reilly, Linda M.; Schneider, Darren B.; Rapp, Joseph H.; Chuter, Timothy A.M.

    2009-01-01

    Objective To determine the outcome of adjunctive renal artery stenting for renal artery coverage at the time of endovascular abdominal aortic aneurysm repair (EVAR). Methods Between 8/2000 to 8/2008, 29 patients underwent elective EVAR using bifurcated Zenith stent-grafts and simultaneous renal artery stenting. Renal artery stenting during EVAR was performed with endograft “encroachment” on the renal artery ostium (n = 23) or placement of a renal stent parallel to the main body of the endograft (“snorkel”, n = 8). Follow-up included routine contrast-enhanced computed tomography (CT), multi-view abdominal x-rays, and creatinine measurement at 1, 6, and 12 months, and then yearly thereafter. Results 31 renal arteries were stented successfully in 29 patients. All patients with planned renal artery stent placement (n=18) had a proximal neck length < 15mm. Mean proximal neck length was shorter in patients who underwent the “snorkel” technique (6.9 ± 3.1 mm) compared to those with planned endograft encroachment (9.9 ± 2.6 mm). None of the patients with unplanned endograft encroachment had neck lengths < 15mm (mean length: 26.3±10.2 mm). Mean proximal neck angulation was 42.8 ± 24.0 degrees and did not differ between the groups. One patient had a type I endoleak on completion angiography, and 2 additional patients had a type I endoleak on the first postoperative CT scan. All type I endoleaks resolved by the one-month postoperative CT scan. Primary-assisted patency of renal artery stents was 100% at a median follow-up of 12.5 months (range 2 days to 77.4 months). One patient had near occlusion of a renal artery stent noted on follow-up CT scan at 9 months; patency was restored by placement of an additional stent. One patient required dialysis following sustained hypotension from a right external iliac artery injury which resulted in prolonged post-operative bleeding. Mean creatinine at baseline was 1.1 ± 0.3 mg/dl, 1.2 ± 0.5 mg/dl at 1 month follow

  15. Ten-Year Follow-Up of Endovascular Aneurysm Treatment with Talent Stent-Grafts

    SciTech Connect

    Pitton, Michael B. Scheschkowski, Tobias; Ring, Markus; Herber, Sascha; Oberholzer, Katja; Leicher-Dueber, Annegret; Neufang, Achim; Schmiedt, Walther; Dueber, Christoph

    2009-09-15

    The purpose of this study was to evaluate the clinical results, complications, and secondary interventions during long-term follow-up after endovascular aneurysm repair (EVAR) and to investigate the impact of endoleak sizes on aneurysm shrinkage. From 1997 to March 2007, 127 patients (12 female, 115 male; age, 73.0 {+-} 7.2 years) with abdominal aortic aneurysms were treated with Talent stent-grafts. Follow-up included clinical visits, contrast-enhanced MDCT, and radiographs at 3, 6, and 12 months and then annually. Results were analyzed with respect to clinical outcome, secondary interventions, endoleak rate and management, and change in aneurysm size. There was no need for primary conversion surgery. Thirty-day mortality was 1.6% (two myocardial infarctions). Procedure-related morbidity was 2.4% (paraplegia, partial infarction of one kidney, and inguinal bleeding requiring surgery). Mean follow-up was 47.7 {+-} 34.2 months (range, 0-123 months). Thirty-nine patients died during follow-up; three of the deaths were related to aneurysm (aneurysm rupture due to endoleak, n = 1; secondary surgical reintervention n = 2). During follow-up, a total of 29 secondary procedures were performed in 19 patients, including 14 percutaneous procedures (10 patients) and 15 surgical procedures (12 patients), including 4 cases with late conversion to open aortic repair (stent-graft infection, n = 1; migration, endoleak, or endotension, n = 3). Overall mean survival was 84.5 {+-} 4.7 months. Mean survival and freedom from any event was 66.7 {+-} 4.5 months. MRI depicted significantly more endoleaks compared to MDCT (23.5% vs. 14.3%; P < 0.01). Patients in whom all aneurysm side branches were occluded prior to stent-grafting showed a significantly reduced incidence of large endoleaks. Endoleaks >10% of the aneurysm area were associated with reduced aneurysm shrinkage compared to no endoleaks or <10% endoleaks ({Delta} at 3 years, -1.8% vs. -12.0%; P < 0.05). In conclusion, endovascular

  16. Open Stented Grafts for Frozen Elephant Trunk Technique: Technical Aspects and Current Outcomes

    PubMed Central

    Ma, Wei-Guo; Zheng, Jun; Sun, Li-Zhong; Elefteriades, John A.

    2015-01-01

    With growing experience in patients with aneurysms and dissections in the arch and proximal descending aorta, the frozen elephant trunk (FET) technique has been shown to be safe and effective, and has achieved favorable short to mid-term outcomes. As the FET technique is gaining wider acceptance, there is a growing need for versatile, technically simple, and highly durable open stented grafts involving less complicated deployment mechanisms enabling use in various indications. This paper gives a brief review on the technical aspects and clinical outcomes of currently available open stented grafts used in the FET technique, including the E-vita Open Plus, Thoraflex Hybrid, Cronus, and J Graft. While none of these grafts can claim to be an ideal device, technology continues to improve towards this goal. As newer devices and systems are developed, more widespread use of the FET technique can be expected; such progress promises to improve the clinical outcomes and quality of life for patients with complex aortic diseases. PMID:27069943

  17. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft

    PubMed Central

    Duvnjak, Stevo

    2016-01-01

    Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the “bell-bottom” technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the “snorkel and sandwich” technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bell-bottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the “snorkel and sandwich” technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications. PMID:27027393

  18. Endovascular treatment of aortoiliac aneurysms: From intentional occlusion of the internal iliac artery to branch iliac stent graft.

    PubMed

    Duvnjak, Stevo

    2016-03-28

    Approximately 20%-40% of patients with abdominal aortic aneurysms can have unilateral or bilateral iliac artery aneurysms and/or ectasia. This influences and compromises the distal sealing zone during endovascular aneurysm repair. There are a few endovascular techniques that are used to treat these types of aneurysms, including intentional occlusion/over-stenting of the internal iliac artery on one or both sides, the "bell-bottom" technique, and the more recent method of using an iliac branch stent graft. In some cases, other options include the "snorkel and sandwich" technique and hybrid interventions. Pelvic ischemia, represented as buttock claudication, has been reported in 16%-55% of cases; this is followed by impotence, which has been described in 10%-17% of cases following internal iliac artery occlusion. The bell-bottom technique can be used for a common iliac artery up to 24 mm in diameter given that the largest diameter of the stent graft is 28 mm. There is a paucity of data and evidence regarding the "snorkel and sandwich" technique, which can be used in a few clinical scenarios. The hybrid intervention is comprised of a surgical operation, and is not purely endovascular. The newest branch stent graft technology enables preservation of the anterograde flow of important side branches. Technical success with the newest technique ranges from 85%-96.3%, and in some small series, technical success is 100%. Buttock claudication was reported in up to 4% of patients treated with a branch stent graft at 5-year follow-up. Mid- and short-term follow-up results showed branch patency of up to 88% during the 5-6-year period. Furthermore, branch graft occlusion is a potential complication, and it has been described to occur in 1.2%-11% of cases. Iliac branch stent graft placement represents a further development in endovascular medicine, and it has a high technical success rate without serious complications. PMID:27027393

  19. Percutaneous Endoluminal Stent and Stent-Graft Placement for the Treatment of Femoropopliteal Aneurysms: Early Experience

    SciTech Connect

    Mueller-Huelsbeck, Stefan; Link, Johann; Schwarzenberg, Helmut; Walluscheck, Knut P.; Heller, Martin

    1999-03-15

    Purpose: To determine the efficacy of percutaneous endoluminal stents and stent-grafts for the treatment of isolated femoropopliteal aneurysms. Methods: Seven men (age 51-69 years) with femoropopliteal occlusions (n= 6) related to aneurysms and a patent femoropopliteal aneurysm (n= 1) were treated percutaneously. In two patients uncovered Wallstents and in five patients polyester-covered nitinol stents were implanted. Assessment was performed with Doppler ultrasound and duplex ultrasonography 24 hr, 1, 3, 6, 12, and 24 months after the intervention. Additionally, intraarterial angiography was performed at 6 months. Results: Stent placement succeeded in all cases. No immediate adjunctive surgical treatment was necessary. Ankle-brachial index (ABI) improved from 0.29 {+-} 0.29 (SD) before to 0.78 {+-} 0.23 (SD) 24 hr after the intervention. One patient was lost to follow-up. Stent-graft occlusion occurred in four patients: after 2 days (n1), 1 month (n= 2), and 3 months (n= 1). One of the patients, whose stent occluded at 1 month, underwent successful recanalization with local fibrinolysis therapy. Three of the seven, all with three-vessel run-off, demonstrated patency of the stent, which was assessed by duplex ultrasonography at 29, 31, and 34 months. Breaking of the stent struts or significant stent migration was not observed. Conclusions: These results in a small number of patients warrant further investigation to evaluate the role of percutaneous stents in femoropopliteal aneurysms. Until further data of clinical studies are available, this method cannot be recommended, and it cannot replace surgical treatment.

  20. Long-term outcome following stent reconstruction of the aortic bifurcation and the role of geometric determinants.

    PubMed

    Sharafuddin, Melhem J; Hoballah, Jamal J; Kresowik, Timothy F; Sharp, William J; Golzarian, Jafar; Sun, Shiliang; Corson, John D

    2008-01-01

    We assessed the long-term patency of kissing stent reconstruction of the aortoiliac bifurcation and identified variables that may influence it. We retrospectively reviewed our experience with stent-reconstruction procedures of the aortoiliac bifurcation from January 1998 through June 2005. The impact of demographic variables, vascular risk factors, disease location and characteristics, stent material and design, and stenting configuration on stent patency was assessed using univariate and multivariate analysis. In particular, we evaluated the effect of geometric mismatch between the protruding segment of the stents and the distal aortic lumen. Sixty-six patients underwent aortobi-iliac stent reconstruction. Indications were bifurcation or bilateral proximal iliac disease in 52 patients and unilateral ostial disease requiring contralateral protection in 14 patients. Limited disease (TASC A and B) was present in 40 limbs in 19 patients; extensive/diffuse disease (TASC C and D) was present in 78 limbs in 47 patients. Complete occlusions were present in 37 limbs in 28 patients (bilateral in nine patients). Self-expanding stents were used in 56 procedures and balloon-expandable stents in 10. Crossing configuration was used in 43 procedures, while abutting configuration was used in 23 procedures. Technical success was achieved in 62 patients (94%), with all four failures due to inability to cross a chronically occluded limb. Three of these patients underwent aortomono-iliac stenting with a crossover femoral-femoral bypass graft, with the remaining one opting for no further interventions. Median combined follow-up was 37 +/- 27 months (range 0-102). Hemodynamically significant restenosis developed in nine patients (14%). The management of restenosis was endovascular in eight patients and was successful in all (balloon dilation in four, restenting in three, thrombolysis and stenting in one) and operative in one patient who developed aortic occlusion and underwent

  1. Management of Complicated Aortic Aneurysms Using Multiple Overlapping Uncovered Stents

    PubMed Central

    Zhang, Yongxue; Teng, Zhongzhao; Lu, Qingsheng; Zhao, Zhiqing; Bao, Junmin; Feng, Xiang; Feng, Rui; Chen, Zengsheng; Huang, Yuan; Sadat, Umar; Gillard, Jonathan H; Jing, Zaiping

    2014-01-01

    Abstract This study sought to report the mid-term outcome of a modified flow-diverting strategy in the treatment of complicated aortic aneurysms of different morphology. Historical data suggested aortic aneurysm expansion and rupture after endovascular treatment with current commercial flow-diverters, indicating the essentiality of further investigation of this technique prior to its large-scale clinical application. An alternative flow-diverting strategy using layer-by-layer assembled multiple overlapping uncovered stents was employed in this study. The treatment outcome in aneurysms of different morphology (saccular, fusiform, and dissecting) was assessed during a mid-term follow-up period. Of 42 patients enrolled in this study (30 male, mean age: 63.3 years), technical success was achieved in 40 cases. During an average follow-up period of 20.9 months, mean aneurysm diameter shrunk from 53.4 ± 13.6 mm to 48.8 ± 13.9 mm (P < 0.001), while stent-induced sac thrombosis ratio increased significantly (18.1 ± 14.9% to 93.6 ± 9.5%, P < 0.001). The majority of side branches (74/76 major visceral branches, 237/244 minor segmental arteries), covered by 3.3 stents on average, maintained their patency after stenting. Saccular aneurysms manifested the highest thrombus deposition speed (18/20 were totally thrombosed within 12 months) and most significant shrinkage (51.4 ± 13.3 mm pre-operatively vs 43.5 ± 10.2 mm during follow-up, P < 0.001) compared with fusiform and dissecting aneurysms. This modified flow-diverting strategy could be a feasible alternative in the management of complicated aortic aneurysms where vital branches need to be preserved. The treatment outcome may depend on the aneurysm type. Further studies with larger patient cohort and longer follow-up are required to substantiate these results. PMID:25501077

  2. Endovascular Stent-Grafting for Infected Iliac Artery Pseudoaneurysms

    SciTech Connect

    Sanada, Junichiro Matsui, Osamu; Arakawa, Fumitaka; Tawara, Mari; Endo, Tamao; Ito, Hiroshi; Ushijima, Satoshi; Endo, Masamitsu; Ikeda, Masahiro; Miyazu, Katsuyuki

    2005-01-15

    We report two cases of acutely infected pseudoaneurysms of the iliac arteries, successfully treated with endovascular stent-grafting. Two patients underwent stent-graft treatment for erosive rupture of the iliac artery caused by surrounding infection. The first case is that of a 61-year-old man who had undergone Miles' operation for an advanced rectal cancer. Postoperatively, he developed intrapelvic abscess formation, from which methicillin-resistant Staphylococcus aureus was cultured, followed by rupture of the right external iliac artery. The second case is that of a 60-year-old man who had a pseudoaneurysm of the left common iliac artery, which was contiguous with a left psoas muscle abscess, from which Streptococcus agalactiae was cultured. Both patients were successfully treated with only a stent-graft and antibiotic therapy, and remained symptom-free 12 months and 10 months later. Although endovascular stent-grafting should not be considered standard therapy for infected aneurysms, our cases suggest that it can result in repair of infected aneurysms even in the uncontrolled active stage.

  3. Stent-Graft Repair of Peroneal Arteriovenous Fistula

    SciTech Connect

    Piffaretti, Gabriele Tozzi, Matteo; Lomazzi, Chiara; Rivolta, Nicola; Lagana, Domenico; Carrafiello, Gianpaolo; Caronno, Roberto; Castelli, Patrizio

    2007-02-15

    Arteriovenous fistulas (AVFs) are infrequently seen in the civilian health-care system; traditionally, these lesions have been treated with ligation, or direct surgical repair with concomitant revascularization. We describe a rare case of a peroneal AVF treated with a stent-graft.

  4. Endovascular Treatment of Proximal Anastomotic Aneurysms After Aortic Prosthetic Reconstruction

    SciTech Connect

    Tiesenhausen, Kurt; Hausegger, Klaus A.; Tauss, Josef; Amann, Wilfried; Koch, Guenter

    2001-01-15

    Purpose: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudoaneurysms.Methods: Three patients with proximal aortic anastomotic pseudoaneurysms 8-15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n = 1), bifurcated graft (n = 1)]. In one patient an uni iliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed.Results: All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft.Conclusion: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.

  5. Endovascular treatment of proximal arsastomotic aneurysms after aortic prosthetic reconstruction

    SciTech Connect

    Tiesenhausen, Kurt; Hausegger, Klaus A.; Tauss, Josef; Amann, Wilfried; Koch, Guenter

    2001-01-15

    Purpose: To describe the efficacy and value of endovascular stent-grafts for the treatment of aortic anastomotic pseudo-aneurysms.Methods: Three patients with proximal aortic anastomotic pseudoaneurysms 8-15 years after prosthetic reconstruction were treated by transfemoral stent-graft implantation. In two patients the pseudoaneurysms were excluded by Talent prostheses [tube graft (n=1), bifurcated graft (n=s1)]. In one patient an uniiliac Zenith stent-graft was implanted and an extra-anatomic crossover bypass for revascularization of the contralateral lower extremity was performed.Results: All procedures were successful with primary exclusion of the pseudoaneurysms. During the follow-up (mean 16 months) one endoleak occurred due to migration of the tube stent-graft. The endoleak was sealed successfully by implanting an additional bifurcated stent-graft.Conclusion: Stent-graft exclusion of aortic pseudoaneurysms offers a minimally invasive and safe alternative to open surgical reconstruction.

  6. Dilatation of Stent-Grafts by Luminal Pressures: Experimental Evaluation of Polytetrafluoroethylene (PTFE) and Woven Polyester Grafts

    SciTech Connect

    Suzuki, Kojiro; Ishiguchi, Tsuneo; Kawatsu, Shoji; Iwai, Hiroyoshi; Maruyama, Kunihiro; Ishigaki, Takeo

    2001-03-15

    Purpose: To evaluate the effect on dilatation of three types of covering materials used for endovascular stent-grafts.Methods: Stent-grafts with three types of covering material [0.1-mm polytetrafluoroethylene (PTFE), 0.2-mm PTFE, and 0.15-mm woven polyester] were placed in a fluid circuit. For the pulsatile pressure test, the luminal pressure of 190/130 mmHg was loaded up to 300,000 pulses. For the static pressure test, the luminal pressure was increased from 50 to 300 mmHg at 50-mmHg increments. The percent of dilatation of each stent-graft was compared.Results: The 0.1-mm PTFE stent-graft was significantly more dilated than the 0.2-mm PTFE and the 0.15-mm woven polyester stent-graft (p < 0.005) in both examinations. There was no significant difference between the 0.2-mm PTFE and the 0.15-mm woven polyester stent-grafts. The dilatation of the 0.1-mm PTFE stent-graft was irreversible.Conclusion: The 0.15-mm woven polyester and the 0.2-mm PTFE stent-grafts may be preferable to the 0.1-mm PTFE stent-graft with regard to dilatation and deformity.

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

    PubMed Central

    Kawatani, Yohei; Nakamura, Yoshitsugu; Mochida, Yoshihiko; Yamauchi, Naoya; Hayashi, Yujiro; Taneichi, Tetsuyoshi; Ito, Yujiro; Kurobe, Hirotsugu; Suda, Yuji; Hori, Takaki

    2016-01-01

    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. PMID:27069685

  8. Exclusion of Atherosclerotic Plaque from the Circulation Using Stent-Grafts: Alternative to Carotid Stenting with a Protection Device?

    SciTech Connect

    Peynircioglu, Bora Geyik, Serdar; Yavuz, Kivilcim; Cil, Barbaros E.; Saatci, Isil; Cekirge, Saruhan

    2007-09-15

    Purpose. To retrospectively assess the feasibility, safety, and clinical mid-term outcome of patients undergoing carotid artery stenting with stent-grafts. Methods. Over a 4 year period stent-grafts were used in the endovascular treatment of symptomatic internal carotid artery stenosis in 12 patients (2 women, 10 men, aged 47-83 (mean 64) years). Protection devices were not used. Possible microembolic complications were evaluated by magnetic resonance imaging (MRI) examinations of the brain before and the day after the procedure in all patients. Mean follow-up was 22 months (range 1-42 months), by Doppler ultrasonography and conventional angiography as well as clinical examination .Results. The technical success rate was 100%. A total of 13 coronary stent-grafts were used. The mean stenosis rate (in terms of diameter) was 85% and the mean length of stent-grafts used was 20.9 mm. The mean diameter to which the stent-grafts were dilated was 4.66 mm. In-hospital complications occurred in 1 patient who suffered a minor femoral access hematoma that did not require transfusion or surgical decompression. Post-stenting diffusion-weighted MRI revealed several ipsilateral silent microemboli in only 1 case, which was completely asymptomatic. Two patients had a major stroke after 2 years of follow-up. Restenosis was found in 2 patients who underwent successful balloon dilatation followed by placement of a self-expandable bare stent within the stent-grafts. Conclusions. Stent-grafts may prevent microembolic complications during stenting of atherosclerotic carotid lesions in selected cases, offering immediate exclusion of the atherosclerotic lesion from the circulation by pressing the plaque against the vessel wall. Comparative, randomized studies in larger series of patients are needed with carotid-dedicated stent-graft designs.

  9. [Endoprosthetic repair with stent grafts in coronary artery restenosis].

    PubMed

    Pokrovsky, A V; Tsygankov, V N; Sidorov, A A

    2016-01-01

    Timely performed reconstructive operations on carotid arteries considerably decrease the incidence rate of ischaemic-type acute impairments of cerebral circulation. Nevertheless, restenoses developing in the zone of reconstruction of carotid arteries level the positive result of the primary operation in remote terms of follow up. In such cases it is more preferable to perform stenting of the damaged portions. The article deals with cases of successful use of self-expandable stent grafts in restenoses of carotid arteries after carotid endarterectomy and operations of prosthetic repair of carotid arteries. The analysis was carried out by international publications concerning this problem. PMID:27100541

  10. Two-Stage Procedure for Infected Aortic Graft Pseudoaneurysm

    PubMed Central

    von Aspern, Konstantin; Etz, Christian D.; Mohr, Friedrich W.; Battellini, Roberto R.

    2015-01-01

    Prosthetic graft infections with mediastinitis following aortic surgery are rare, yet represent grave complications yielding high morbidity and mortality. We present the case of a 57-year-old female patient with past history of emergent surgery for iatrogenic Type A dissection treated by supracoronary ascending aortic replacement. Four months after the initial surgery, a sternal fistula had formed and due to severe bleeding emergent reoperation was required. Imaging and pathology on admission revealed an infected pseudoaneurysm at the distal aortic prosthesis and mediastinitis with methicillin-resistant Staphylococcus aureus. Rescue surgery was performed by means of a two-stage approach, with extensive debridement, graft replacement and continuous antiseptic lavage in a first step and an omental wrapping of the new prosthesis in a second stage 24 hours later. During 10 years of follow-up, no recurrent infection occurred. The operative approach and general considerations for management of infected pseudoaneurysms are discussed. PMID:27069945

  11. Multifaceted prospects of nanocomposites for cardiovascular grafts and stents

    PubMed Central

    Vellayappan, Muthu Vignesh; Balaji, Arunpandian; Subramanian, Aruna Priyadarshini; John, Agnes Aruna; Jaganathan, Saravana Kumar; Murugesan, Selvakumar; Supriyanto, Eko; Yusof, Mustafa

    2015-01-01

    Cardiovascular disease is the leading cause of death across the globe. The use of synthetic materials is indispensable in the treatment of cardiovascular disease. Major drawbacks related to the use of biomaterials are their mechanical properties and biocompatibility, and these have to be circumvented before promoting the material to the market or clinical setting. Revolutionary advancements in nanotechnology have introduced a novel class of materials called nanocomposites which have superior properties for biomedical applications. Recently, there has been a widespread recognition of the nanocomposites utilizing polyhedral oligomeric silsesquioxane, bacterial cellulose, silk fibroin, iron oxide magnetic nanoparticles, and carbon nanotubes in cardiovascular grafts and stents. The unique characteristics of these nanocomposites have led to the development of a wide range of nanostructured copolymers with appreciably enhanced properties, such as improved mechanical, chemical, and physical characteristics suitable for cardiovascular implants. The incorporation of advanced nanocomposite materials in cardiovascular grafts and stents improves hemocompatibility, enhances antithrombogenicity, improves mechanical and surface properties, and decreases the microbial response to the cardiovascular implants. A thorough attempt is made to summarize the various applications of nanocomposites for cardiovascular graft and stent applications. This review will highlight the recent advances in nanocomposites and also address the need of future research in promoting nanocomposites as plausible candidates in a campaign against cardiovascular disease. PMID:25897223

  12. Hemodynamic study of overlapping bare-metal stents intervention to aortic aneurysm.

    PubMed

    Zhang, Peng; Sun, Anqiang; Zhan, Fan; Luan, Jingyuan; Deng, Xiaoyan

    2014-11-01

    To investigate the hemodynamic performance of overlapping bare-metal stents intervention treatment to thoracic aortic aneurysms (TAA), three simplified TAA models, representing, no stent, with a single stent and 2 overlapped stents deployed in the aneurismal sac, were studied and compared in terms of flow velocity, wall shear stress (WSS) and pressure distributions by means of computational fluid dynamics. The results showed that overlapping stents intervention induced a flow field of slow velocity near the aneurismal wall. Single stent deployment in the sac reduced the jet-like flow formed prior to the proximal neck of the aneurysm, which impinged on the internal wall of the aneurysm. This jet-like flow vanished completely in the overlapping double stents case. Overlapping stents intervention led to an evident decrease in WSS; meanwhile, the pressure acting on the wall of the aneurysm was reduced slightly and presented more uniform distribution. The results therefore indicated that overlapping stents intervention may effectively isolate the thoracic aortic aneurysm, protecting it from rupture. In conclusion, overlapping bare-metal stents may serve a purpose similar to that of the multilayer aneurysm repair system (MARS) manufactured by Cardiatis SA (Isnes, Belgium). PMID:25262876

  13. Percutaneous bail-out treatment of vein graft rupture with a polytetrafluoroethylene-covered stent.

    PubMed

    Pavlidis, Antonios N; Karamasis, Grigorios V; Clapp, Brian R

    2013-12-01

    Vessel perforation is an undesirable and life-threatening complication during vein graft angioplasty. We report on a case of vein graft rupture during angioplasty, which was successfully managed with deployment of a polytetrafluoroethylene-covered stent. PMID:24160712

  14. Successful Endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm.

    PubMed

    Comer, David; Bedi, Amit; Kennedy, Peter; McManus, Kieran; McIlwaine, Werner

    2010-01-01

    A case of bronchial occlusion caused by a thoracic aortic aneurysm and the relief of this obstruction by the implantation of expandable metallic stents is described. Stent deployment provided an immediate improvement in lung ventilation and chest radiograph appearances. Stent insertion was uncomplicated, but weaning from mechanical ventilation was unsuccessful and the patient died from a ventilator-associated pneumonia, unrelated to the procedure. Endobronchial stenting should be considered as a non-invasive therapy for the treatment of bronchial obstruction, with respiratory compromise, caused by a thoracic aortic aneurysm when vascular surgery is not an option. The medium to long term survival of this patient group is poor. This can be attributed to complications related to the stent and also to the poor performance status of these patients. PMID:24946305

  15. [Graft Replacement for Adult Aortic Coarctation].

    PubMed

    Fuke, Megumi; Nishimura, Kazunori; Kehara, Hiromu; Terasaki, Takamitsu; Sakaguchi, Masayuki; Takano, Tamaki

    2015-07-01

    Case 1:a 47-year-old woman who complained of sweating, finger tremor, and chest pain was diagnosed with coarctation of the aorta and hyperthyroidism. She had been diagnosed with hypertension at 25 years of age but had not undergone further examination. Graft replacement was performed without cardiopulmonary or temporary bypass. Case 2:a 30-year-old woman was diagnosed with coarctation during infertility treatment. Although health screening had revealed hypertension 8 years previously, no further assessment took place. She underwent graft replacement with partial cardiopulmonary bypass. In both cases, we conducted a clamp test to decide whether cardiopulmonary or partial bypass was necessary for graft replacement. Blood pressure discrepancy between upper and lower extremities disappeared immediately after surgery, and no ischemic complications were observed. Hypertension in young adults should prompt further scrutiny for anatomical disorders such as coarctation. A clamp test is considered helpful regarding the surgical approach to graft replacement for coarctation. PMID:26197824

  16. Stent

    MedlinePlus

    ... kinds of stents. Most are made of a metal or plastic mesh-like material. However, stent grafts are made of fabric. They are used in larger arteries. An intraluminal coronary artery ... self-expanding, metal mesh tube. It is placed inside a coronary ...

  17. Magnetic Resonance Angiography of Nonferromagnetic Iliac Artery Stents and Stent-Grafts: A Comparative Study in Sheep

    SciTech Connect

    Schuermann, Karl; Vorwerk, Dierk; Buecker, Arno; Neuerburg, Joerg; Grosskortenhaus, Stefanie; Haage, Patrick; Piroth, Werner; Hunter, David W.; Guenther, Rolf W.

    1999-09-15

    Purpose: To compare nonferromagnetic iliac artery prostheses in their suitability for patency monitoring with magnetic resonance angiography (MRA) using conventional angiography as a reference. Methods: In experiment 1, three Memotherm stents were inserted into the iliac arteries of each of six sheep: two 'tandem' stents on one side and a single stent on the other side. In experiment 2, four prostheses (normal and low-porosity Corvita stent-grafts, Memotherm, ZA-stent) were inserted in each of 11 sheep. Patency was monitored before and 1, 3, and 6 months after insertion with 3D phase-contrast and two 2D time-of-flight sequences (TOF-1: TR/TE = 18/6.9, TOF-2: 13/2.5) with and without contrast at 1.5 T. On 206 coronal MIP images (72 pre-, 134 post-stenting), three readers analyzed 824 iliac segments (206 x 4) for patency and artifacts. Results: There was no difference in the number of artifacts between tandem and single iliac Memotherm stents. The ZA-stent induced significantly fewer artifacts than the other prostheses (p < 0.00001). With MRA, patency of the ZA-stent was correctly diagnosed in 88% of cases, which was almost comparable to nonstented iliac segments (95%), patency of the Memotherm stent in 59%, and of the Corvita stent-grafts in 57% and 55%. The TOF-2 sequence with contrast yielded the best images. Conclusion: MRA compatibility of nonferromagnetic prostheses depends strongly on the design of the device. MRA may be used to monitor the patency of iliac ZA-stents, whereas iliac Memotherm stents and Corvita stent-grafts appear to be less suited for follow-up with MRA.

  18. Optimal Covering Material for Stent-Grafts Placed in the Portal Vein in a Canine Model

    SciTech Connect

    Ishii, Seigo; Sato, Morio Sonomura, Tetsuo; Yamada, Katsuyuki; Tanihata, Hirohiko; Ishikawa, Hime; Terada, Masaki; Sahara, Shinya; Kawai, Nobuyuki; Kimura, Masashi; Mori, Ichiro

    2005-06-15

    Purpose. We evaluated the suitability of Dacron, polytetrafluoroethylene (PTFE), and small intestinal submucosa (SIS) as a covering material for stent-grafts placed in the portal vein as compared with a bare stent. Methods. Using 24 beagle dogs, either bare stents or stent-grafts covered with Dacron, PTFE, or SIS were placed in the main trunk of the portal vein in 6 animals each. Portography was performed immediately after stent placement, and at 2, 4, and 12 weeks thereafter. Next, the extracted stents or stent-grafts were examined histopathologically. Neointimal thickness adjacent to the stent wire and at the midportion between the stent wires was compared among the groups. Then, the neointimal thickness at the sub- and supragraft sites was compared between each stent-graft group. Serial changes in the histologic features of the thickened neointima were also investigated. Results. No significant difference was noted in the mean stenotic ratio of the portal vein diameter between the bare stent and PTFE groups, whereas it was significantly higher in the Dacron and SIS groups compared with the bare stent group. In neither of the studies on neointimal thickness adjacent to the stent wire and at the midportion between the stent wires were any significant differences noted between the neointimal thickness of the bare stent group and the sum of the neointimal thickness of the PTFE group, whereas the sum of the neointimal thickness of the Dacron and SIS groups was significantly greater than that of the bare stent group at both sites. In the comparison of the supragraft neointimal thickness, the SIS group showed significantly greater thickness than the PTFE group, while the difference between the Dacron and PTFE groups was not significant. In the comparison of the subgraft neointimal thickness, the Dacron and SIS groups showed significantly greater thickness than the PTFE group. Conclusion. The present results indicate that of the three covering materials examined here

  19. Percutaneous Femoral Closure Following Stent-Graft Placement: Use of the Perclose Device

    SciTech Connect

    Quinn, Stephen F.; Kim, Jinho

    2004-09-15

    Purpose: To describe our early clinical experience using the Prostar Perclose device for arterial closure after placement of a stent-graft.Methods: Sixty-three patients had stent-graft devices placed for iliac (n = 7), abdominal aortic (n = 43) or thoracic applications (n = 13). The devices were introduced through 18 Fr (22 Fr O.D.) (n = 3), 16 Fr (20 Fr O.D.) (n = 15), 14 Fr (18 Fr O.D.) (n = 44) or 12 Fr (14 Fr O.D.) (n = 38) sheaths. After Perclose deployment, the arteriotomies were dilated to the appropriate sizes for the deployment sheaths. All patients were anticoagulated during the procedure. After stent-graft deployment, hemostasis was achieved by the Perclose sutures that were in place. All the femoral sites were followed with physical examination and CT angiography (CTA).Results:The follow-up periods have ranged from 2 to 18 months (mean 7.5 months). All 100 femoral sites were closed without the need for surgical closure. In 4% (4/100) of the femoral sites, the Perclose sutures were pulled out while securing the knots and these patients required manual compression. In 2% (2/100) of the sites, additional manual compression was required after successful deployment of the Perclose devices. In 1% (1/100) of the femoral sites, there was acute femoral popliteal thrombosis perhaps related to common femoral artery narrowing at the site of Perclose deployment. In 5% (5/100) of the femoral sites, pseudoaneurysms were seen on follow-up CTA examinations. In 1% (1/100) of patients, there was infection at the puncture site requiring surgical bypass. In 1% (1/100) of patients, there was a stable, asymptomatic intimal dissection at the puncture site. By CTA criteria, none of the patients have developed stenotic lesions at the sites of Perclose deployment with follow-up periods limited to 6 months. Fifty-one of 63 patients (81%) patients ambulated within 4-6 hr.Conclusion: The Perclose device, when placed prior to arterial dilatation, can be used to achieve hemostasis for

  20. Uninfected Para-Anastomotic Aneurysms after Infrarenal Aortic Grafting

    PubMed Central

    Nano, Giovanni; Cusmai, Francesco; Ramponi, Fabio; Stegher, Silvia; Dell'Aglio, Daniela; Malacrida, Giovanni; Tealdi, Domenico G.

    2009-01-01

    Purpose This single-institution retrospective review examines the management of uninfected para-anastomotic aneurysms of the abdominal aorta (PAAA), developed after infrarenal grafting. Materials and Methods From October 1979 to November 2005, 31 PAAA were observed in our Department. Twenty-six uninfected PAAA of degenerative etiology, including 24 false and 2 true aneurysms, were candidates for intervention and retrospectively included in our database for management and outcome evaluation. Six (23%) patients were treated as emergencies. Surgery included tube graft interposition (n = 12), new reconstruction (n = 8), and graft removal with extra-anatomic bypass (n = 3). Endovascular management (n = 3) consisted of free-flow tube endografts. Results The mortality rate among the elective and emergency cases was 5% and 66.6%, respectively (p = 0.005). The morbidity rate in elective cases was 57.8%, whereas 75% in emergency cases (p = 0.99). The survival rate during the follow-up was significantly higher for elective cases than for emergency cases. Conclusion Uninfected PAAA is a late complication of aortic grafting, tends to evolve silently and is difficult to diagnose. The prevalence is underestimated and increases with time since surgery. The mortality rate is higher among patients treated as an emergency than among patients who undergo elective surgery, therefore, elective treatment and aggressive management in the case of pseudoaneurysm are the keys to obtain a good outcome. Endovascular treatment could reduce mortality. Patients who undergo infrarenal aortic grafting require life-long surveillance after surgery. PMID:19430556

  1. Treatment of a Hepatic Artery Aneurysm by Endovascular Stent-Grafting

    SciTech Connect

    Jenssen, Guttorm L. Wirsching, Jan; Pedersen, Gustav; Amundsen, Svein Roar; Aune, Steinar; Dregelid, Einar; Jonung, Torbjorn; Daryapeyma, Alireza; Laxdal, Elin

    2007-06-15

    Aneurysms of the visceral arteries are rare. Traditional treatment has been surgical or endovascular with coil embolization. Recently, however, reports on endovascular therapy with stent-grafts have been published. We report the case of a 61-year-old man who was successfully treated with a stent-graft for a symptomatic combined celiac/hepatic artery aneurysm.

  2. Feasibility of Angioplasty and Stenting for Abdominal Aortic Lesions Adjacent to Previously Stented Visceral Artery Lesions in Patients with Takayasu Arteritis

    SciTech Connect

    Joseph, George George, Paul V.; Pati, Purendra Kumar; Chandy, Sunil Thomas

    2007-04-15

    Two young female patients with Takayasu arteritis presented with symptomatic long-segment abdominal aortic stenosis in the vicinity of previously deployed celiac and renal artery stents that projected markedly into the narrowed aortic lumen. Crushing or distortion of the visceral artery stents during aortic angioplasty was avoided by performing simultaneous or alternating balloon dilatations in the aorta and in the visceral artery stents. Consequently, the visceral artery stents remained patent and shortened longitudinally, allowing unhindered deployment of Wallstents in the adjacent aorta and abolition of a pressure gradient across the aortic lesions. Access to side branches covered by the Wallstent was obtained without difficulty, enabling the performance of balloon dilatation in multiple side branches and ostial stent deployment in a renal artery. These techniques could increase the scope of endovascular therapy in the treatment of patients with Takayasu arteritis.

  3. Adolescent External Iliac Artery Trauma: Recurrent Aneurysmal Dilatation of an Iliofemoral Saphenous Vein Graft Treated by Stent-Grafting

    SciTech Connect

    Lenton, James; Davies, John; Homer-Vanniasinkam, S.; McPherson, Simon

    2008-09-15

    An adolescent male sustained a severe penetrating injury to the external iliac artery. Emergency surgical revascularization was with a reversed long saphenous vein interposition graft. The primary graft and the subsequent revision graft both became aneurysmal. The second graft aneurysm was successfully excluded by endovascular stent-grafts with medium-term primary patency. A venous graft was used initially rather than a synthetic graft to reduce the risk of infection and the potential problems from future growth. Aneurysmal dilatation of venous grafts in children and adolescents is a rare but recognized complication. To the best of our knowledge, exclusion of these aneurysms with stent-grafts has not been previously reported in the adolescent population.

  4. Aortoesophageal fistula as a complication of thoracic aorta aneurism stent grafting – a case report and literature review

    PubMed Central

    Dołęga-Kozierowski, Bartosz; Sokratous, Kyriakous; Dyś, Krzysztof; Lis, Michał; Ferenc, Stanisław; Drelichowski, Stanisław; Witkiewicz, Wojciech

    2012-01-01

    Summary Background: Endovascular stent grafting is performed in patients with aneurysms of aorta or other major vessels. The procedure is considered to be generally safe, with a low risk of complications, the most common of which include endoleaks, stenosis or thrombosis at the stagraft and itsmigration. Very rare complications include aortoesophageal and aortobronchial fistulas (0.5–1.7% cases). Case Report: A 64-year-old patient was admitted to our hospital with suspected aortoesophageal fistula. Two years prior, the patient had undergone a stent graft repair of the thoracic aorta at the local vascular surgery clinic. Both laboratory results and CT angiography revealed aortoesophageal fistula, which was also detected in endoscopic examination. Despite intensive treatment and preparation for surgery, the patient died 6 days after admission. Conclusions: Aortoesophageal and aortobronchial fistulas are among the most dangerous and difficult-to-treat complications in the treatment of thoracic aortic aneurysms by endovascular stent-grafting. This clearly indicates that preventive care and regular medical examinations are important to prevent their occurrence. PMID:23269943

  5. Mathematical Model analysis of Wallstent and Aneurx: dynamic responses of bare-metal endoprosthesis compared with those of stent-graft.

    PubMed

    Canic, Suncica; Ravi-Chandar, K; Krajcer, Zvonimir; Mirkovic, Dragan; Lapin, Serguei

    2005-01-01

    We performed this study in order to analyze the mechanical properties of bare-metal Wallstent endoprostheses and of AneuRx stent-grafts and to compare their responses to hemodynamic forces. Mathematical modeling, numerical simulations, and experimental measurements were used to study the 2 structurally different types of endoprostheses. Our findings revealed that a single bare-metal Wallstent endoprosthesis is 10 times more flexible (elastic) than is the wall of the aneurysmal abdominal aorta. Graphs showing the changes in the diameter and length of the stent when exposed to a range of internal and external pressures were obtained. If the aorta is axially stiff and resists length change, a force as large as 1 kg can act in the axial direction on the aortic wall. If the stent is not firmly anchored, it will migrate. In contrast, a fabric-covered, fully supported, stent-graft such as the AneuRx is significantly less compliant than the aorta or the bare-metal stent. During each cardiac cycle, the stent frame tends to move due to its higher elasticity, while the fabric resists movement, which might break the sutures that join the fabric to the frame. Elevated local transmural pressure, detected along the prosthesis graft, can contribute to material fatigue. PMID:16429893

  6. Temporary Placement of Stent Grafts in Postsurgical Benign Biliary Strictures: a Single Center Experience

    PubMed Central

    Willatt, Jonathon M; Arabi, Mohammad; Cwikiel, Wojciech B

    2011-01-01

    Objective To evaluate the effect of temporary stent graft placement in the treatment of benign anastomotic biliary strictures. Materials and Methods Nine patients, five women and four men, 22-64 years old (mean, 47.5 years), with chronic benign biliary anastomotic strictures, refractory to repeated balloon dilations, were treated by prolonged, temporary placement of stent-grafts. Four patients had strictures following a liver transplantation; three of them in bilio-enteric anastomoses and one in a choledocho-choledochostomy. Four of the other five patients had strictures at bilio-enteric anastomoses, which developed after complications following laparoscopic cholecystectomies and in one after a Whipple procedure for duodenal carcinoma. In eight patients, balloon-expandable stent-grafts were placed and one patient was treated by insertion of a self-expanding stent-graft. Results In the transplant group, treatment of patients with bilio-enteric anastomoses was unsuccessful (mean stent duration, 30 days). The patient treated for stenosis in the choledocho-choledochostomy responded well to consecutive self-expanding stent-graft placement (total placement duration, 112 days). All patients with bilio-enteric anastomoses in the non-transplant group were treated successfully with stent-grafts (mean placement duration, 37 days). Conclusion Treatment of benign biliary strictures with temporary placement of stent-grafts has a positive effect, but is less successful in patients with strictures developed following a liver transplant. PMID:22043153

  7. Coronary stenting with cardiogenic shock due to acute ascending aortic dissection

    PubMed Central

    Hanaki, Yuichi; Yumoto, Kazuhiko; I, Seigen; Aoki, Hajime; Fukuzawa, Tomoyuki; Watanabe, Takahiro; Kato, Kenichi

    2015-01-01

    A 65-year-old man developed chest pain under cardiogenic shock. Coronary angiography revealed severe stenosis from the ostium of the left main coronary artery (LMCA) to the left anterior descending artery (LAD). Intravascular ultrasound (IVUS) identified a large hematoma that originated from the aorta and extended into the LAD, thereby compressing the true lumen. Type A aortic dissection (TAAD) that involved the LMCA was diagnosed by IVUS. Coronary stenting was performed via the LMCA to the proximal LAD, which resulted in coronary blood flow restoration and no further propagation of dissection. Elective surgical aortic repair was performed 2 wk after the stenting. LMCA stenting under IVUS guidance is effective for prompt diagnosis and precise stent deployment in patients with cardiogenic shock due to TAAD with LMCA dissection. PMID:25717358

  8. Coronary stenting with cardiogenic shock due to acute ascending aortic dissection.

    PubMed

    Hanaki, Yuichi; Yumoto, Kazuhiko; I, Seigen; Aoki, Hajime; Fukuzawa, Tomoyuki; Watanabe, Takahiro; Kato, Kenichi

    2015-02-26

    A 65-year-old man developed chest pain under cardiogenic shock. Coronary angiography revealed severe stenosis from the ostium of the left main coronary artery (LMCA) to the left anterior descending artery (LAD). Intravascular ultrasound (IVUS) identified a large hematoma that originated from the aorta and extended into the LAD, thereby compressing the true lumen. Type A aortic dissection (TAAD) that involved the LMCA was diagnosed by IVUS. Coronary stenting was performed via the LMCA to the proximal LAD, which resulted in coronary blood flow restoration and no further propagation of dissection. Elective surgical aortic repair was performed 2 wk after the stenting. LMCA stenting under IVUS guidance is effective for prompt diagnosis and precise stent deployment in patients with cardiogenic shock due to TAAD with LMCA dissection. PMID:25717358

  9. Detection of abdominal aortic graft infection: comparison of CT and In-labeled white blood cell scans

    SciTech Connect

    Mark, A.S.; McCarthy, S.M.; Moss, A.A.; Price, D.

    1985-02-01

    Aortic graft infections are a rare but potentially lethal complication of aortic graft surgery. The diagnosis and assessment of the extent of a graft infection is difficult on clinical grounds. A prospective study compared CT and indium-labeled white blood cell (In-WBC) scans in the diagnosis of aortic graft infection. Five patients with aortic graft infection and three patients without aortic graft infection were studied by both methods. CT correctly detected the retroperitoneal extension of the infection in three patients with groin infection; In-WBC scans diagnosed the extension only in one patient. Both CT and In-WBC were positive in two patients with aortic graft infection but no groin infection. Both studies were negative in the three patients without evidence of aortic graft infection. The study suggests that CT is more sensitive than In-WBC in evaluating the extent of aortic graft infection and should be the imaging method of choice.

  10. Primary Implantation of Polyester-Covered Stent-Grafts for Transjugular Intrahepatic Portosystemic Stent Shunts (TIPSS): A Pilot Study

    SciTech Connect

    Cejna, Manfred; Thurnher, Siegfried; Pidlich, Johann; Kaserer, Klaus; Schoder, Maria; Lammer, Johannes

    1999-07-15

    Purpose: To investigate whether placement of a polyester-covered stent-graft increases the primary patency of transjugular intrahepatic portosystemic stent shunts (TIPSS). Methods: Between 1995 and 1997 Cragg Endopro or Passager MIBS stent-grafts were used for the creation of TIPSS in eight male patients, 35-59 years of age (mean 48 years). All patients suffered from recurrent variceal bleeding and/or refractory ascites due to liver cirrhosis. Seven stent-grafts were dilated to a diameter of 10 mm, one to 12 mm. Follow-up was performed with duplex ultrasound, clinical assessment, and angiography. Results: The technical success rate for creation of a TIPSS was 100%. The mean portosystemic pressure gradient decreased from 25 mmHg to 12 mmHg. In seven of eight patients TIPSS dysfunction occurred between 2 days and 3 years after stent-graft placement. In one patient the TIPSS is still primarily patent (224 days after creation). The secondary patency rates are 31 days to 3 years. Conclusion: The primary use of polyester-covered stent-grafts for TIPSS did not increase primary patency rates in our small series.

  11. Endovascular Repair of an Anastomotic Leak Following Open Repair of Abdominal Aortic Aneurysm

    SciTech Connect

    Mofidi, R. Flett, M.; Milne, A.; Chakraverty, S.

    2007-09-15

    This report describes the case of an early postoperative anastomotic leak following elective open repair of an infrarenal abdominal aortic aneurysm which was successfully treated by endovascular stent-grafting. A 71-year-old man underwent open tube graft repair of abdominal aortic aneurysm. Twelve days later he presented with a contained leak from the distal anastomosis, which was confirmed on CT scan. This was successfully treated with a bifurcated aortic stent-graft. This case illustrates the usefulness of the endovascular approach for resolving this rare surgical complication of open repair of abdominal aortic aneurysm and the challenges associated with the deployment of such a device within an aortic tube graft.

  12. Computational blood flow and vessel wall modeling in a CT-based thoracic aorta after stent-graft implantation

    NASA Astrophysics Data System (ADS)

    Hazer, Dilana; Stoll, Markus; Schmidt, Eduard; Richter, Goetz-M.; Dillmann, Rüdiger

    2010-03-01

    Abnormal blood flow conditions and structural fatigue within stented vessels may lead to undesired failure causing death to the patient. Image-based computational modeling provides a physical and realistic insight into the patientspecific biomechanics and enables accurate predictive simulations of development, growth and failure of cardiovascular diseases as well as associated risks. Controlling the efficiency of an endovascular treatment is necessary for the evaluation of potential complications and predictions on the assessment of the pathological state. In this paper we investigate the effects of stent-graft implantation on the biomechanics in a patient-specific thoracic aortic model. The patient geometry and the implanted stent-graft are obtained from morphological data based on a CT scan performed during a controlling routine. Computational fluid dynamics (CFD) and computational structure mechanics (CSM) simulations are conducted based on the finite volume method (FVM) and on the finite element method (FEM) to compute the hemodynamics and the elastomechanics within the aortic model, respectively. Physiological data based on transient pressure and velocity profiles are used to set the necessary boundary conditions. Further, the effects of various boundary conditions and definition of contact interactions on the numerical stability of the blood flow and the vessel wall simulation results are also investigated. The quantification of the hemodynamics and the elastomechanics post endovascular intervention provides a realistic controlling of the state of the stented vessel and of the efficiency of the therapy. Consequently, computational modeling would help in evaluating individual therapies and optimal treatment strategies in the field of minimally invasive endovascular surgery.

  13. Successful Antibiotic Treatment of Severe Staphylococcal Infection of a Long Stent Graft in the Superficial Femoral Artery with Graft Preservation in the Long Term

    SciTech Connect

    Treitl, Marcus; Rademacher, Antje; Becker-Lienau, Johanna; Reiser, Maximilian F.; Hoffmann, Ulrich; Czihal, Michael

    2011-06-15

    Introduction: Bacterial infection of endovascular stent grafts is a serious condition, regularly leading to graft replacement by open bypass surgery.Case ReportWe describe the case of a staphylococcal infection of a 150-mm covered stent graft (Gore Viabahn), placed in the superficial femoral artery. Stent graft infection was successfully treated by oral administration of penicillinase-resistant flucloxacillin and the lipopeptide daptomycin with complete graft preservation, not requiring surgical treatment. During 1-year follow-up, the graft infection did not reappear. However, the patient developed restenosis at the proximal margin of the stent with recurrence of mild claudication, so far treated conservatively. Conclusion: With the increased use of covered stent grafts in the peripheral vasculature, the frequency of graft infection will increase. We demonstrate that with newly developed antibiotics, it is possible to treat this severe complication conservatively, with complete graft preservation and without the need for bypass surgery in selected cases.

  14. Primary Stenting for Complex Atherosclerotic Plaques in Aortic and Iliac Stenoses

    SciTech Connect

    Onal, Baran; Ilgit, Erhan T.; Yuecel, Cem; Ozbek, Erdal; Vural, Murat; Akpek, Sergin

    1998-09-15

    Purpose: To evaluate the efficacy of primary stenting for complex atherosclerotic plaques in aortic and iliac stenoses that are not amenable to balloon angioplasty alone. Methods: Nineteen patients with complex atherosclerotic plaques were treated with a Palmaz stent (n= 19), Wallstent (n= 1), Strecker stent (n= 1), or Memotherm stent (n= 1). A total of 22 stenoses presenting with complex plaque morphology including ulcerated plaques, ulcerated plaques with focal aneurysms, plaques with heavy calcification, severely eccentric plaques, plaques with overhanging edge, and plaques with spontaneous dissection were stented. The lesions were in the aorta (n= 1), common iliac artery (n= 19), or external iliac artery (n= 2). Results: Immediate angiography after stent placement revealed restoration of patency of the stented segment. Focal aneurysms and ulcerated areas were occluded in the follow-up angiographies obtained 4-12 weeks after the procedure. In one case with poor distal runoff and multiple complex lesions of the iliac artery, subacute occlusion occurred. Clinical and angiographic follow-up (3-46 months) revealed patency of all other stented segments. Conclusion: Primary stenting is an effective and reliable approach for complex plaques in stenoses. Patency of the arterial segment with a smooth lumen can be created without the risk of acute complications such as distal embolization, dissection, or occlusion.

  15. Tracheo-innominate artery fistula successfully treated by endovascular stent-graft repair.

    PubMed

    Nakai, Motoki; Sato, Hirotatsu; Sato, Morio; Ikoma, Akira; Sanda, Hiroki; Nakata, Kohei; Minamiguchi, Hiroki; Kawai, Nobuyuki; Sonomura, Tetsuo; Nishimura, Yoshiharu; Okamura, Yoshitaka

    2013-01-01

    We report two patients who developed a tracheo-innominate artery fistula (TIF) after tracheostomy. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the innominate artery protruding into the trachea. Stent grafts were deployed for the innominate artery via two different access routes: the transfemoral approach and the right carotid artery approach. Endovascular stent-graft repair resulted in complete exclusion of the TIF and control of the bleeding from the tracheal stoma. At 12- and 16-month follow-ups, neither patient had clinical signs of graft infection, recurrent fistulization, or ischemic complications. It is feasible and useful to employ the carotid artery approach for stent-graft implantation in patients who have vascular anatomical limitations for the transfemoral approach. Endovascular repair of TIF by stent grafting is a minimally invasive treatment that can be tolerated by patients in poor clinical condition, and is a feasible alternative to surgical treatment. PMID:23065488

  16. Utility of Stent-Grafts in Treatment of Porto-Biliary Fistula

    SciTech Connect

    Peynircioglu, Bora; Cwikiel, Wojciech

    2006-12-15

    A porto-biliary fistula causing hemobilia is a known complication of percutaneous transhepatic biliary drainage (PTBD). We present two patients with hemobilia secondary to porto-biliary fistula, treated successfully by percutaneous placement of stent-grafts. In one case, the stent-graft was placed in the bile duct, and in the other case, it was placed in the intrahepatic portal vein branch. Hemobilia stopped and there were no complications except a small area of hepatic infarction, distal to the stent-graft in the portal vein.

  17. Strategies to treat thoracic aortitis and infected aortic grafts.

    PubMed

    Kahlberg, A; Melissano, G; Tshomba, Y; Leopardi, M; Chiesa, R

    2015-04-01

    Infectious thoracic aortitis is a rare disease, especially since the incidence of syphilis and tuberculosis has dropped in western countries. However, the risk to develop an infectious aortitis and subsequent mycotic aneurysm formation is still present, particularly in case of associated endocarditis, sepsis, and in immunosuppressive disorders. Moreover, the number of surgical and endovascular thoracic aortic repairs is continuously increasing, and infective graft complications are observed more frequently. Several etiopathogenetic factors may play a role in thoracic aortic and prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination. Also, fistulization of the esophagus or the bronchial tree is commonly associated with these diseases, and it represents a critical event requiring a multidisciplinary management. Knowledge on underlying micro-organisms, antibiotic efficacy, risk factors, and prevention strategies has a key role in the management of this spectrum of infectious diseases involving the thoracic aorta. When the diagnosis of a mycotic aneurysm or a prosthetic graft infection is established, treatment is demanding, often including a number of surgical options. Patients are usually severely compromised by sepsis, and in most cases they are considered unfit for surgery for general clinical conditions or local concerns. Thus, results of different therapeutic strategies for infectious diseases of the thoracic aorta are still burdened with very high morbidity and mortality. In this manuscript, we review the literature regarding the main issues related to thoracic infectious aortitis and aortic graft infections, and we report our personal series of patients surgically treated at our institution for these conditions from 1993 to 2014. PMID:25608572

  18. Equine pericardial roll graft replacement of infected pseudoaneurysm of the aortic arch

    PubMed Central

    2012-01-01

    Resection of the infected aorta, debridement of the surrounding tissue, in situ graft replacement, and omentopexy is the standard procedure for treating infected aortic aneurysms, but the question of which graft material is optimal is still a matter of controversy. We recently treated a patient with an infected thoracic aortic aneurysm. The aneurysm was located in the proximal aortic arch. Because the patients had previously undergone abdominal surgery, the aortic arch were replaced in situ with a branched equine pericardial roll grafts. The patient is alive and well 23 months after the operation. PMID:22583570

  19. Off-Pump Coronary Artery Bypass Grafting and Transaortic Transcatheter Aortic Valve Replacement.

    PubMed

    Dellis, Sophia L; Akujuo, Adanna C; Bennett, Edward V; Britton, Lewis W

    2016-07-01

    We sought to demonstrate the effectiveness of off-pump coronary artery bypass grafting and transcatheter aortic valve replacement in two patients with porcelain aortas and lesions that could not be optimally treated with percutaneous coronary intervention. Patients with aortic stenosis and coronary artery disease who are too high-risk for conventional surgical aortic valve replacement and coronary artery bypass grafting due to comorbidities and porcelain aorta, and who do not have the appropriate anatomy for percutaneous coronary intervention should be considered for concomitant transcatheter aortic valve replacement and off-pump coronary artery bypass grafting. doi: 10.1111/jocs.12762 (J Card Surg 2016;31:435-438). PMID:27196956

  20. Results of "elephant trunk" total aortic arch replacement using a multi-branched, collared graft prosthesis.

    PubMed

    Schneider, Stefan R B; Dell'Aquila, Angelo M; Akil, Ali; Schlarb, Dominik; Panuccio, Guiseppe; Martens, Sven; Rukosujew, Andreas

    2016-03-01

    We report on our experience with a simplified elephant trunk (ET) procedure with a multi-branched prosthesis (Vascutek(®) Siena™ Collared Graft). It consists of a proximal portion (20 cm) with prefabricated side branches, a collar and a distal portion (30 cm). The collar, which can be trimmed into any desired diameter, constitutes the suture portion to the descending aorta. Radiopaque markers in the distal portion indicate the landing zone. Between January 2011 and June 2013, 20 consecutive patients (10 women; mean age, 66 ± 9.3 years) underwent ET procedure, including 6 re-do cases. Underlying aortic diseases were acute dissection (n = 6), chronic dissection (n = 4), aneurysm (n = 8) and PAU (n = 2). Mean preoperative diameter of the descending aorta was 49.1 ± 12.9 mm (range 74.7-29.7 mm). Concomitant procedures included ascending aortic replacement in 16 patients; root replacement in 2; AVR in 2, CABG in 3 and mitral repair in 1 patient. CPB time was 263 ± 94 min; mean duration of ACP was 65 ± 14 min. Two patients died on POD 8 and 78, respectively. Major adverse events included stroke (n = 1), resternotomy for bleeding (n = 2), renal failure requiring temporary dialysis (n = 1) and recurrent nerve paresis (n = 2). After a mean follow-up of 10 ± 8 months, all discharged patients were alive. Seven patients underwent stent-graft implantation of the descending aorta and one patient underwent open descending aortic replacement. The last generation of multi-branched arch prosthesis and especially the Vascutek(®) Siena™ Collared Graft make ET procedure a reasonable treatment option even in patients with acute aortic dissection. PMID:25491933

  1. Surgical Repair of Retrograde Type A Aortic Dissection after Thoracic Endovascular Aortic Repair

    PubMed Central

    Kim, Chang-Young; Kim, Yeon Soo; Ryoo, Ji Yoon

    2014-01-01

    It is expected that the stent graft will become an alternative method for treating aortic diseases or reducing the extent of surgery; therefore, thoracic endovascular aortic repair has widened its indications. However, it can have rare but serious complications such as paraplegia and retrograde type A aortic dissection. Here, we report a surgical repair of retrograde type A aortic dissection that was performed after thoracic endovascular aortic repair. PMID:24570865

  2. Multiple endovascular aortic aneurysm repair graft failures and re-interventions over 15 years

    PubMed Central

    Belchos, Jessica; Wheatcroft, Mark; Moloney, Tony

    2015-01-01

    Re-intervention on abdominal aortic aneurysm treated by endovascular aortic aneurysm repair for complications such as endoleak, graft migration, and graft failure is relatively common. However, re-do endovascular aortic aneurysm repair can be complex, as the failed graft still resides within the vessel. In addition, some re-do endovascular aortic aneurysm repairs call for an advanced custom graft, which can further increase the complexity and technical skill required. We describe a case of a 15-year-old endovascular aortic aneurysm repair originally implanted in a 71-year-old man, followed by three separate complications requiring intervention. We describe important procedural decisions taken into consideration when presented with failure of an older graft. PMID:27489701

  3. Coronary stent fracture in a saphenous vein graft to right coronary artery--successful treatment by the novel use of the Jomed coronary stent graft: case report and review of the literature.

    PubMed

    Koh, T W; Mathur, A

    2007-07-10

    Coronary stents ultimately owe their success to the mechanical scaffolding effect that they provide. The mechanical properties of these metallic stents were designed not only to provide radial strength so as to prevent vessel recoil, but also to be able to resist the mechanical stress of vessel movement over millions of cardiac cycles. We present a case whereby the latter mechanical stresses may have contributed to the fracture of a stent implanted in the saphenous vein graft to the right coronary artery. We demonstrated that the point at which the stent fracture occurred coincided with an area of maximal graft movement. Our patient presented with acute myocardial infarction due to graft occlusion 3 months after stent implantation. We re-intervened by deploying a Jomed coronary stent graft, consisting of 2 layers of stent, to cover the stent fracture, thereby providing optimal support to this area of high mechanical stress, resulting in a good long-term clinical outcome. The novel use of a Jomed coronary stent graft for this indication has not been previously described. Review of the literature indicates that factors that may predispose to stent fracture include location in the right coronary vein graft, long stents, overlapping stents and stent over-expansion. PMID:17467086

  4. Late Complication after Superficial Femoral Artery (SFA) Aneurysm: Stent-graft Expulsion Outside the Skin

    SciTech Connect

    Pecoraro, Felice Sabatino, Ermanno R.; Dinoto, Ettore; Rosa, Giuliana La; Corte, Giuseppe; Bajardi, Guido

    2015-10-15

    A 78-year-old man presented with a 7-cm aneurysm in the left superficial femoral artery, which was considered unfit and anatomically unsuitable for conventional open surgery for multiple comorbidities. The patient was treated with stent-graft [Viabhan stent-graft (WL Gore and Associates, Flagstaff, AZ)]. Two years from stent-graft implantation, the patient presented a purulent secretion and a spontaneous external expulsion through a fistulous channel. No claudication symptoms or hemorrhagic signs were present. The pus and device cultures were positive for Staphylococcus aureus sensitive to piperacillin/tazobactam. Patient management consisted of fistula drainage, systemic antibiotic therapy, and daily wound dressing. At 1-month follow-up, the wound was closed. To our knowledge, this is the first case of this type of stent-graft complication presenting with external expulsion.

  5. The influences of curvature and torsions on flows in a helical bifurcated stent-graft

    NASA Astrophysics Data System (ADS)

    Shim, Jeong Hyun; Eun Lee, Kyung; Yoo, Jung Yul

    2008-11-01

    A bifurcated stent-graft signifies an improvement in surgical technique for treatment of a lesion in the branched blood vessel. However, there still remains a high failure rate regarding bifurcated stent-graft due to the occurrence of thrombosis or re-stenosis. The objectives of this study are to understand the effect of torsion in helical bifurcated geometries, to explain how the mixing of flows there may be advantageous to the prevention of the occurrence of thrombosis, and to keep the patency of stent-graft in the aspect of hemodynamics. For clinical applications, flows in a helical bifurcated stent-graft are simulated three-dimensionally using an incompressible Navier-Stokes solver. In this study, the hemodynamics is investigated in terms of mechanical factors, i.e., velocity profiles, vortex patterns and wall shear stress distributions.

  6. Replacement of the vena cava with aortic graft for living donor liver transplantation in Budd-Chiari syndrome associated with hydatid cyst surgery: a case report.

    PubMed

    Sakçak, I; Eriş, C; Ölmez, A; Kayaalp, C; Yılmaz, S

    2012-01-01

    A 12-year-old girl, operated because of a hydatid cyst of the liver, with Budd-Chiari syndrome was evaluated for postoperative development of ascites and paraumbilical varicose veins. A vena caval stent was placed for the relief of inferior vena caval obstruction. The patient was admitted because of progressive deterioration in ascites and liver functions. Imaging techniques showed degeneration adjacent to the right hepatic vein in liver segments 7 to 8, a partially calcified 5-cm hydatid cyst, and a thrombosis in the inferior vena cava was that addressed with a 10-cm metal stent. A living donor segments 2 to 3 liver transplantation was obtained from the patient's mother. After completion of the donor operation without complications, the vena caval stent was removed following the recipient hepatectomy. Suprarenal flow continued after resection of the fibrotic vena cava and placement of a cadaveric cryopreserved aortic graft for the vena cava, anastomosed between the suprarenal and subdiaphragmatic segments of the vena cava. An end-to-side anastomosis was performed between the left hepatic vein of the donor liver and the aortic graft. There was no complication and the patient was discharged on postoperative day 19. Follow-up Doppler ultrasonography showed the aortic vena caval graft to be open, along with the hepatic/portal vein and hepatic artery. This case demonstrated that operations for liver hydatid cyst surgeries can iatrogenically induce Budd-Chiari syndrome; a cryopreserved aortic graft can be an alternative to ensure the continuity of the vena cava in living donor liver transplantation. PMID:22841264

  7. Vein Graft-Coated Vascular Stents: A Feasibility Study in a Canine Model

    SciTech Connect

    Schellhammer, Frank; Haberstroh, Joerg; Wakhloo, Ajay K.; Gottschalk, Eva; Schumacher, Martin

    1998-03-15

    Purpose: To evaluate different vein grafts for luminal coating of endovascular stents in normal canine arteries. Methods: Twenty-four tantalum Strecker stents were coated with either autologous (n= 10), denatured heterologous (n= 11), or denatured homologous vein grafts (n= 3). The carotid artery (n= 11) and the iliac artery (n= 13) were stented using a transfemoral approach. Angiograms were performed at days 0, 7, and 21, and months 3, 6, and 9. All grafts underwent histological examination. Results: Eight of 10 autologous vein grafts showed patency during the whole observation period of 9 months, without histological signs of inflammation. Denatured heterologous vein grafts revealed acute (n= 3), subacute (n= 5), or delayed (n= 3) vessel occlusion. Hyaloid transformation of the vein graft and lympho-plasmacellular formations were seen. Denatured homologous vein grafts showed acute vessel occlusion. Although significant inflammatory tissue response was seen, no host-versus-graft reaction was present. Conclusion: Autologous vein graft-coated stents showed good biocompatibility in canine arteries. Preparation was cumbersome and required surgical venae-sectio. Denatured vein grafts, however, were limited by inflammatory reactions.

  8. Endovascular stent graft for traumatic splenic vein aneurysm via percutaneous transsplenic access

    PubMed Central

    Kwon, Oh Sang; Kim, Joong Suck; Kim, Ji Dae

    2016-01-01

    Traumatic splenic vein aneurysm (SVA) is an extremely rare entity. Traditionally, treatment varied from noninvasive followup to aneurysm excision with splenectomy. However, there has been no prior report of traumatic SVA treated with endovascular stent graft for SVA via percutaneous transsplenic access. Therefore, we report the case of a 56-year-old man successfully treated with endovascular stent graft for traumatic SVA via percutaneous transsplenic access. PMID:27433466

  9. Treatment of Portosystemic Shunt Myelopathy with a Stent Graft Deployed through a Transjugular Intrahepatic Route

    SciTech Connect

    Jain, Deepak Arora, Ankur; Deka, Pranjal; Mukund, Amar Bhatnagar, Shorav; Jindal, Deepti Kumar, Niteen Pamecha, Viniyendra

    2013-08-01

    A case of surgically created splenorenal shunt complicated with shunt myelopathy was successfully managed by placement of a stent graft within the splenic vein to close the portosystemic shunt and alleviate myelopathy. To our knowledge, this is the first report of a case of shunt myelopathy in a patient with noncirrhotic portal fibrosis without cirrhosis treated by a novel technique wherein a transjugular intrahepatic route was adopted to deploy the stent graft.

  10. Stent-Graft Repair of a Large Cervical Internal Carotid Artery Pseudoaneurysm Causing Dysphagia

    SciTech Connect

    Gupta, Vivek Niranjan, Khandelwal; Rawat, Lokesh; Gupta, A. K.

    2009-05-15

    Pseudoaneurysms of the cervical internal carotid artery (ICA) are rare and most frequently result from trauma, infection, or sometimes spontaneously. They have the potential to cause life-threatening hemorrhage; thus, their immediate management is necessary. Endovascular treatment by stent graft placement in the affected artery appears to be a safe and effective treatment option. We present a case of a child who presented with neck swelling and dysphagia caused by a ruptured cervical ICA pseudoaneurysm which was managed by stent graft placement.

  11. Construction of Transjugular Intrahepatic Portosystemic Shunt: Bare Metal Stent/Stent-graft Combination versus Single Stent-graft, a Prospective Randomized Controlled Study with Long-term Patency and Clinical Analysis

    PubMed Central

    Wang, Chang-Ming; Li, Xuan; Fu, Jun; Luan, Jing-Yuan; Li, Tian-Run; Zhao, Jun; Dong, Guo-Xiang

    2016-01-01

    Background: Balanced adjustment of the portal vein shunt volume during a transjugular intrahepatic portosystemic shunt (TIPS) is critical for maintaining liver perfusion and decreasing the incidence of liver insufficiency. A stent-graft is proved to be superior to a bare metal stent (BMS) for the construction of a TIPS. However, the clinical results of the combination application of stents and stent-grafts have not been determined. This study aimed to compare the technique of using a combination of stents and stent-grafts with using a single stent-graft to construct a TIPS. Methods: From April 2011 to November 2014, a total of fifty patients were randomly assigned to a stents-combination group (Group I, n = 28) or a stent-graft group (Group II, n = 22). Primary patency rates were calculated. Clinical data, including the technical success rate, bleeding control results, incidence of encephalopathy, liver function preservation, and survival rate, were assessed. Results: Technically, the success rate was 100% for both groups. The primary patency rates at 1, 2, and 3 years for Group I were 96%, 84%, and 77%, respectively; for Group II, they were 90%, 90%, and 78%, respectively. The survival rates at 1, 2, and 3 years for Group I were 79%, 74%, and 68%, respectively; for Group II, they were 82%, 82%, and 74%, respectively. The incidence of hepatic encephalopathy was 14.3% for Group I and 13.6% for Group II. The Child-Pugh score in Group I was stable at the end of the follow-up but had significantly increased in Group II (t = −2.474, P = 0.022). Conclusions: The construction of a TIPS with either the single stent-graft or BMS/stent-graft combination is effective for controlling variceal bleeding. The BMS/stent-graft combination technique is superior to the stent-graft technique in terms of hepatic function preservation indicated by the Child-Pugh score. However, considering the clinical results of the TIPS, the two techniques are comparable in their primary shunt

  12. A completely fractured zotarolimus-eluting stent in an aortocoronary saphenous vein bypass graft.

    PubMed

    Venero, Carmelo V; Aligeti, Venkata R; Wortham, Dale C

    2013-01-01

    Drug-eluting stents (DES) have significantly improved the rate of target vessel revascularization in comparison with bare metal stents. DES fracture was not reported in multicenter randomized clinical trials, but several case reports of DES fracture have been published, mostly with sirolimus-eluting stents. DES fracture is associated with stent restenosis and thrombosis. We report a zotarolimus-eluting stent fracture in an aortocoronary saphenous vein graft (SVG) bypass. The patient presented with chest pain and a non-ST-elevation myocardial infarction. He underwent cardiac catheterization that showed a complete fracture of a zotarolimus-eluting stent in the ostium of a sequential SVG to the diagonal and obtuse coronary arteries. His management included coronary angioplasty and retrieval of the proximal fractured segment. We discuss the potential causes for this stent fracture and suggest caution when using a DES in an ostial location of a SVG bypass, especially in a highly mobile vessel. PMID:22553171

  13. Aneurysms of Hemodialysis Access Grafts: Treatment with Covered Stents: A Report of Three Cases

    SciTech Connect

    Hausegger, Klaus A.; Tiessenhausen, Kurt; Klimpfinger, Martin; Raith, Johann; Hauser, Hubert; Tauss, Josef

    1998-07-15

    Three patients with dialysis access graft shunts, having a symptomatic pseudoaneurysm and a hemodynamically significant stenosis at the anastomosis between the graft shunt and the subclavian vein, were treated with percutaneous transluminal angioplasty and insertion of a Wallstent. Pseudoaneurysms were excluded by percutaneous insertion of a Cragg Endo-Pro stent-graft with a diameter of 6 mm and a length of 6-10 cm. All three aneurysms were excluded successfully. In two patients, the stent-graft was punctured repeatedly during follow-up and the aneurysms recurred after 7 and 8 months, respectively. The patency of the dialysis shunt after stent-graft insertion was 8 (n= 1) and 9 months (n= 2). Due to the recurrence of the aneurysm (n= 2) or recurrent thrombosis (n= 1) the use of these shunts was discontinued.

  14. Renal Artery Stent Placement Complicated by Development of a Type B Aortic Dissection

    SciTech Connect

    Haesemeyer, Scott W.; Vedantham, Suresh Braverman, Alan

    2005-01-15

    Percutaneous renal artery angioplasty and stent placement have demonstrated safety and effectiveness in the treatment of selected patients with renovascular hypertension and ischemic nephropathy. Major complications have been predominantly confined to the affected renal artery and kidneys, including renal artery dissection and/or thrombosis, distal embolization, and contrast-related nephropathy. We report a case in which treatment of an ostial renal artery lesion with placement of a balloon-expandable stent was complicated by the development of an acute Type B aortic dissection.

  15. Embolization of experimental aneurysms using a heparin-loaded stent graft with micropores

    SciTech Connect

    Nishi, Shogo; Nakayama, Yasuhide; Ueda-Ishibashi, Hatsue; Matsuda, Takehisa

    2003-03-01

    Purpose: For percutaneous transluminal angioplasty (PTA), a heparin-loaded stent graft, composed of a commercially available metallic stent with a microporous and surface-modified thin film, has been developed. Early controlled endothelialization is promoted by a regular array of micropores produced by an excimer laser ablation technique. Early thrombus is prevented by a drug delivery system established by impregnation of photoreactive gelatin with heparin. Our stent grafts were used for embolization of experimental carotid aneurysms with an autologous external jugular vein patch in dogs. Materials and methods: At 1 month after formation, the aneurysms were occluded with stent grafts. Affected arteries were removed with the aneurysms, immediately (two aneurysms in one dog), 1 week (four aneurysms in two dogs), 1 month (three aneurysms in two dogs) and 3 months (four aneurysms in two dogs) after embolization, and were studied histologically to evaluate patency and endothelialization over the intraluminal surface of the thin film. Results: Treated carotid arteries were all patent with occluded aneurysms completely at any periods. Even at 1 week after embolization, endothelialization was confirmed on the surface of the stent graft on the lumen side. At 1 and 3 months, all treated aneurysms with enough patent parent arteries were filled with organized tissues and completely occluded. Conclusion: Our developed stent graft appears to be promising for the treatment of aneurysms, especially with respect to immediate termination of blood inflow and early endothelialization in the neck of the aneurysm.

  16. Finite Element Modeling of A Novel Self-Expanding Endovascular Stent Method in Treatment of Aortic Aneurysms

    NASA Astrophysics Data System (ADS)

    Arokiaraj, Mark C.; Palacios, Igor F.

    2014-01-01

    A novel large self-expanding endovascular stent was designed with strut thickness of 70 μm × 70 μm width. The method was developed and investigated to identify a novel simpler technique in aortic aneurysm therapy. Stage 1 analysis was performed after deploying it in a virtual aneurysm model of 6 cm wide × 6 cm long fusiform hyper-elastic anisotropic design. At cell width of 9 mm, there was no buckling or migration of the stent at 180 Hg. Radial force of the stents was estimated after parametric variations. In stage 2 analysis, a prototype 300 μm × 150 μm stent with a cell width of 9 mm was chosen, and it was evaluated similarly after embedding in the aortic wall, and also with a tissue overgrowth of 1 mm over the stent. The 300/150 μm stent reduced the peak wall stress by 70% in the aneurysm and 50% reduction in compliance after embedding. Stage 3 analysis was performed to study the efficacy of stents with struts (thickness/width) 70/70, 180/100 and 300/150 μm after embedding and tissue overgrowth. The adjacent wall stresses were very minimal in stents with 180/100 and 70/70 μm struts after embedding. There is potential for a novel stent method in aortic aneurysm therapy.

  17. "Kissing stents" as an adjunct to thoracic endovascular aortic repair: warts and all.

    PubMed

    Karmy-Jones, Riyad; Nicholls, Stephen C

    2012-01-01

    A 75-year-old man presented with symptomatic thoracic aneurysm involving the origin of the left subclavian artery. To obtain an adequate landing zone, a simultaneous stent was placed in the left common carotid artery. Until fenestrated and branch graft technology is more available, snorkel approaches may be an acceptable approach for patients with contraindications to open repair. PMID:23123998

  18. Lethal Hemorrhage Caused by Aortoesophageal Fistula Secondary to Stent-Graft Repair of the Thoracic Aorta

    SciTech Connect

    Sager, Hendrik B.; Wellhoener, Peter; Wermelt, Johanna A.; Schunkert, Heribert; Kurowski, Volkhard

    2011-02-15

    Aortoesophageal fistula (AEF) is a rare but life-threatening complication after endovascular or surgical aortic repair. Here we report a patient with AEF secondary to aortic stent-placement 2 years earlier who presented with hematemesis and died from hemorrhagic shock. By means of this case and the literature, we highlight potential bleeding sources in such a scenario because this is of crucial importance for the management strategy.

  19. Acute myocardial infarction due to left main compression aortic dissection treated by direct stenting.

    PubMed

    Cardozo, Carlos; Riadh, Rihani; Mazen, Moukahal

    2004-02-01

    We describe a case of acute myocardial infarction (AMI) due to compression of the left main coronary artery (LMCA) by a false channel created by an acute aortic dissection (AAD). The dynamic pattern of artery obstruction is detailed as a key element to the diagnosis of extrinsic coronary compression throughout the angiography. Treatment by direct stenting restored complete anterograde coronary flow and improved myocardial perfusion. PMID:14760201

  20. Aortic Bifurcation Reconstruction: Use of the Memotherm Self-Expanding Nitinol Stent for Stenoses and Occlusions

    SciTech Connect

    Houston, J. Graeme; McCollum, Peter T.; Stonebridge, Peter A.; Raza, Zahid; Shaw, J. William

    1999-03-15

    Purpose: To assess the technical success, initial clinical outcome, and intermediate follow-up of the Memotherm nitinol self-expanding stent in aortic bifurcation reconstruction. Methods: Thirty-three patients (13 male, 20 female), mean age 64 years, were treated, who had symptoms classified by the Surgical Vascular Society/International Society of Cardiovascular Surgery (SVS/ICVS) classification as grade 2 in 11 (33%), grade 3 in 19 (58%) and grade 4 in 3 (9%) patients. Lesions were classified according to severity and type. Indications for placement of a Memotherm nitinol self-expanding stent were failed angioplasty in 14 (42%), chronic occlusions in 12 (37%), and complex stenoses in seven (21%) patients. Results: Sixty-seven stents were technically successfully placed in 66 aorto-iliac segments in 33 patients, with one major complication. Initial clinical outcome was improvement in 25 (81%), no change in four (13%), and a worsening in two (6%) patients by Rutherford criteria. Mean early ankle/brachial pressure index (ABI) gain was 0.27 for occlusions and 0.05 for stenoses. Clinical follow-up was obtained in all patients, with retrospective angiographic follow-up in 28 (85%) at a mean of 16 months (range 12-26 months). The decrease in ABI and the decrease in angiographic luminal diameter at follow-up was determined as the 'late loss.' The mean ABI late losses were -0.06, 0.00, and 0.09, and the mean angiographic late losses were 6.7%, 10% and 14% for occlusions, stenoses, and normal segments respectively. Primary clinical patency was 96%, primary angiographic patency was 89%, and secondary angiographic patency was 93%. Conclusion: The high technical success of stent placement, the low complication rates for aortic bifurcation reconstruction using the Memotherm self-expanding stent, and high clinical and angiographic patency maintained at intermediate follow-up support their use in aortic bifurcation reconstruction.

  1. Endovascular Treatment of Ruptured Abdominal Aneurysm into the Inferior Vena Cava in Patient After Stent Graft Placement

    SciTech Connect

    Juszkat, Robert; Pukacki, Fryderyk; Zarzecka, Anna; Kulesza, Jerzy; Majewski, Waclaw

    2009-07-15

    We report the case of a patient who underwent endovascular repair and then reintervention as a result of the presence of a persistent endoleak complicated by an aortocaval fistula. A 76-year-old patient with a history of endovascular treatment for abdominal aortic aneurysm 2 years earlier had a palpable abdominal mass, high-output cardiac failure, and renal failure. A computed tomographic scan and angiography revealed bending of the right iliac limb, a type I endoleak, and rupture of the aneurysm into the inferior vena cava with aortocaval fistula formation. An iliac extension was positioned in the right external iliac artery. The procedure was finished successfully. Control angiography showed normal flow within the endoprosthesis, and both iliac arteries were without signs of endoleakage and aortocaval fistula. Ectatic common iliac artery may lead to a late distal attachment site endoleak. The application of a stent graft in cases of secondary aortocaval fistula after stent graft repair is a good option, particularly in emergency cases.

  2. Outcomes of Prosthetic Hemodialysis Grafts after Deployment of Bare Metal versus Covered Stents at the Venous Anastomosis

    SciTech Connect

    Kim, Charles Y. Tandberg, Daniel J.; Rosenberg, Michael D.; Miller, Michael J.; Suhocki, Paul V.; Smith, Tony P.

    2012-08-15

    Purpose: To compare postintervention patency rates after deployment of bare metal versus covered stents across the venous anastomosis of prosthetic arteriovenous (AV) grafts. Methods: Review of our procedural database over a 6 year period revealed 377 procedures involving stent deployment in an AV access circuit. After applying strict inclusion criteria, our study group consisted of 61 stent deployments in 58 patients (median age 58 years, 25 men, 33 women) across the venous anastomosis of an upper extremity AV graft circuit that had never been previously stented. Both patent and thrombosed AV access circuits were retrospectively analyzed. Within the bare metal stent group, 20 of 32 AV grafts were thrombosed at initial presentation compared to 18 of 29 AV grafts in the covered stent group. Results: Thirty-two bare metal stents and 29 covered stents were deployed across the venous anastomosis. The 3, 6, and 12 months primary access patency rates for bare metal stents were not significantly different than for covered stents: 50, 41, and 22 % compared to 59, 52, and 29 %, respectively (p = 0.21). The secondary patency rates were also not significantly different: 78, 78, and 68 % for bare metal stents compared to 76, 69, and 61 % for covered stents, respectively (p = 0.85). However, covered stents demonstrated a higher primary stent patency rate than bare metal stents: 100, 85, and 70 % compared to 75, 67, and 49 % at 3, 6, and 12 months (p < 0.01). Conclusion: The primary and secondary access patency rates after deployment of bare metal versus covered stents at the venous anastomosis were not significantly different. However, bare metal stents developed in-stent stenoses significantly sooner.

  3. Endovascular Exclusion of Visceral Artery Aneurysms with Stent-Grafts: Technique and Long-Term Follow-up

    SciTech Connect

    Rossi, Michele; Rebonato, Alberto Greco, Laura; Citone, Michele; David, Vincenzo

    2008-01-15

    This paper describes four cases of visceral artery aneurysms (VAAs) successfully treated with endovascular stent-grafts and discusses the endovascular approach to VAAs and the long-term results. Four balloon expandable stent-grafts were used to treat three splenic artery aneurysms and one bleeding common hepatic artery pseudoaneurysm. The percutaneous access site and the materials were chosen on the basis of CT angiography findings. In all cases the aneurysms were successfully excluded. In one case a splenic infarction occurred, with nonrelevant clinical findings. At 16- to 24-month follow-up three patients had patent stents and complete exclusion and shrinkage of the aneurysms. One patient died due to pancreatitis and sepsis, 16 days after successful stenting and exclusion of a bleeding pseudoaneurysm. We conclude that endovascular treatment using covered stent-grafts is a valid therapeutic option for VAAs. Multislice CT preoperative study helps in planning stent-graft positioning.

  4. Endovascular Repair of Thoracic Aortic Aneurysms

    PubMed Central

    Findeiss, Laura K.; Cody, Michael E.

    2011-01-01

    Degenerative aneurysms of the thoracic aorta are increasing in prevalence; open repair of descending thoracic aortic aneurysms is associated with high rates of morbidity and mortality. Repair of isolated descending thoracic aortic aneurysms using stent grafts was introduced in 1995, and in an anatomically suitable subgroup of patients with thoracic aortic aneurysm, repair with endovascular stent graft provides favorable outcomes, with decreased perioperative morbidity and mortality relative to open repair. The cornerstones of successful thoracic endovascular aneurysm repair are appropriate patient selection, thorough preprocedural planning, and cautious procedural execution, the elements of which are discussed here. PMID:22379281

  5. The Results of Self-Expandable Kissing Stents in Aortic Bifurcation

    PubMed Central

    Moon, Jae Young; Hwang, Hong Pil; Kwak, Hyo Sung; Han, Young Min; Yu, Hee Chul

    2015-01-01

    Purpose: Kissing stent reconstruction is a widely used technique for the management of aortoiliac occlusive disease involving the aortic bifurcation or proximal common iliac arteries. The purpose of this study was to evaluate the results of self-expandable kissing stents in the aortic bifurcation. Materials and Methods: We reviewed medical records of the patients treated with a kissing stent retrospectively from January 2007 to December 2012. The primary and secondary patencies were determined with Kaplan-Meier analysis, and Cox regression was used to determine the factors associated with patency. Results: A total of 21 patients were included, and all were male (median age 53±15 years, range 48–78 years). Major symptoms were claudication (n=16, 61.9%), rest pain (n=5, 23.8%) and gangrene (n=5, 23.8%). Tans-Atlantic Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) II classification was A 2 (9.5%), B 5 (23.8%), C 7 (33.3%) and D 8 (38%). The mean follow-up was 40.7 months. Major complication occurred in only one case which consisted of distal limb ischemia by emboli. Six patients developed symptomatic restenosis or occlusion. There was no major amputation, but minor amputation occurred in 3 patients. There were 2 mortalities not associated with the procedure (lung cancer and intracranial hemorrhage). Primary patency was 89.6% at 1 year, 74.7% at 3 years and 64.0% at 5 years. Secondary patency was 94.1% at 1 year, 88.2% at 3 years and 68.6% at 5 years. No risk factors for restenosis or occlusion were identified. Conclusion: Self-expandable kissing stents can be used successfully with comparable patency for endovascular treatment of symptomatic atherosclerotic occlusive lesions in the aortic bifurcation area. PMID:26217639

  6. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    PubMed

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2015-01-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25636626

  7. Emergency placement of stent-graft for symptomatic acute carotid artery occlusion after endarterectomy.

    PubMed

    Ko, Jun Kyeung; Choi, Chang Hwa; Lee, Sang Weon; Lee, Tae Hong

    2016-03-01

    A patient underwent a left-sided carotid endarterectomy (CEA) for an asymptomatic 80% carotid artery (CA) stenosis. There were no signs of intolerance during the carotid cross-clamping and an initially uneventful awakening was observed. However, in the third postoperative hour he experienced left amaurosis and dysarthria. An urgent MRI showed an occluded internal CA on the operated site without evidence of acute infarction. To recanalize the occluded internal CA and minimize leakage from the arteriotomy site, a self-expandable stent-graft was placed, covering the dissection and the distal atherosclerotic lesions. Complete recanalization of the left internal CA was achieved and the patient showed a dramatic improvement of his preoperative deficits. To our knowledge, this is the first case of stent-graft implantation for a symptomatic acute CA occlusion following CEA. Stent-graft placement should be considered as an alternative method of treatment for acute CA occlusion or dissection following CEA. PMID:25653229

  8. Fenestrated endovascular repair of abdominal aortic aneurysms: a less invasive option for the treatment of juxtarenal aortic aneurysms.

    PubMed

    Ehlert, Bryan A; Abularrage, Christopher J

    2016-05-01

    Endovascular aortic aneurysm repair has become the predominant surgical therapy for abdominal aortic aneurysms. Whereas anatomical limitations had become the major contraindication to endovascular treatment, fenestrated stent grafts were developed to overcome such obstacles. Fenestrated endovascular aortic aneurysm repair now provides an additional treatment option for patients felt to be unsuitable for an invasive open repair whose anatomy is not compatible with more traditional stent grafts. We review the evolution of fenestrated endovascular aortic aneurysm repair and compare its safety and efficacy to other endovascular options. PMID:27092859

  9. Retrieval of a subintimal fractured guide wire from the brachial artery following saphenous vein graft stenting.

    PubMed

    Danson, Edward J; Ward, Michael

    2015-06-01

    We present a case of a 58-year-old woman with diabetes mellitus with a history of angina, coronary artery bypass 24 years previously and who underwent retrieval of a fractured coronary buddy wire from the right brachial artery following attempted coronary intervention to a saphenous vein graft via the right radial route. Attempted removal of the guide wire had caused guide catheter-induced dissection of the vein graft in addition to a distal stent edge dissection before fracture in the brachial artery. The fractured end of the buddy wire was found to be in the subintimal space and could only be retrieved by advancing the wire into the subclavian artery by means of wrapping its free portion around the guiding catheter. Its fractured end could then be snared into the guiding catheter but could only be withdrawn from behind the stented segment in the vein graft by means of a trap balloon in the guiding catheter. Successful stenting of a guide catheter-induced dissection and distal stent edge dissection within the vein graft was then performed. This case highlights the hazards of deploying stents over buddy wires and of fractured guide wires in coronary intervention. © 2015 Wiley Periodicals, Inc. PMID:25345676

  10. Cephalic Arch Stenosis in Autogenous Haemodialysis Fistulas: Treatment With the Viabahn Stent-Graft

    SciTech Connect

    Shawyer, Andrew; Fotiadis, Nicos I.; Namagondlu, Girish; Iyer, Arun; Blunden, Mark Raftery, Martin Yaqoob, Magdi

    2013-02-15

    Cephalic arch stenosis (CAS) is an important and common cause of dysfunction in autogenous haemodialysis fistulas that requires multiple reinterventions and aggressive surveillance. We evaluated the safety and efficacy of the Viabahn stent-graft for the management of CAS. Between April 2005 and October 2011, 11 consecutive patients [four men and seven women (mean age 56.7 years)] with CAS and dysfunctional fistulas were treated with insertion of 11 Viabahn stent-grafts. Six stent-grafts were inserted due to residual stenosis after angioplasty and five for fistuloplasty-induced rupture. No patient was lost to follow-up. The technical and clinical success rate was 100 %. Primary access patency rates were 81.8 % [95 % confidence interval (CI) 0.482-0.977] at 6 months and 72.7 % (95 % CI 0.390-0.939) at 12 months. Secondary access patency rates were 90.9 % at 6 months (95 % CI 0.587-0.997). There were no procedure-related complications. Mean follow-up was 543.8 days (range 156-2,282). The use of the Viabahn stent-graft in the management of CAS is technically feasible and, in this small series, showed patency rates that compare favorably with historical data of angioplasty and bare stents.

  11. Successful management of tracheo-innominate artery fistula with endovascular stent graft repair.

    PubMed

    Deguchi, J; Furuya, T; Tanaka, N; Nobori, M; Seki, Y; Nomura, Y; Umehara, I; Saito, H; Miyata, T

    2001-06-01

    Tracheo-innominate artery fistula is a highly lethal complication after tracheostomy. A 37-year-old man who had undergone a tracheostomy 14 years earlier because of dysphagia after brain surgery had a tracheo-innominate artery fistula with exsanguinating hemorrhage from his tracheostomy site. After temporary control of the bleeding, a stent graft was implanted in the innominate artery through the brachial artery. The patient recovered uneventfully and remained well 14 months after the procedure, with no sign of infection. Endovascular stent grafting may be the treatment of choice for patients with tracheo-innominate artery fistula. PMID:11389430

  12. Percutaneous Endoluminal Stent-Graft Repair of an Old Traumatic Femoral Arteriovenous Fistula

    SciTech Connect

    Uflacker, Renan; Elliott, Bruce M.

    1996-03-15

    A stent-graft was custom made to close a high-flow traumatic arteriovenous fistula of the left superficial femoral artery, present for 30 years, in a 60-year-old man with congestive heart failure and ischemic ulceration in the left foot. A balloon expandable Palmaz stent (P394; 2.5 mm x 3.9 cm) was covered with a polytetrafluoroethylene (PTFE) graft and was inserted percutaneously through an 11 Fr vascular sheath. Follow-up Doppler ultrasound at 6 months demonstrated occlusion of the arteriovenous fistula, patency of the artery, and luminal integrity of the artery and vein.

  13. Stent-Graft Treatment for Bleeding Superior Mesenteric Artery Pseudoaneurysm After Pancreaticoduodenectomy

    SciTech Connect

    Suzuki, Kojiro Mori, Yoshine; Komada, Tomohiro; Matsushima, Masaya; Ota, Toyohiro; Naganawa, Shinji

    2009-07-15

    We report two cases of intraperitoneal bleeding from superior mesenteric artery (SMA) pseudoaneurysm after pancreaticoduodenectomy for pancreatic head carcinoma. In both cases, a stent-graft was deployed on the main SMA to exclude pseudoaneurysm and to preserve blood flow to the bowel. Bleeding stopped after the procedure. One patient was able to be discharged but died from carcinoma recurrence 4 months later. The other patient died of sepsis and stent-graft infection 5 months later. These patients remained free of intraperitoneal rebleeding during the follow-up period.

  14. Infective endocarditis complicated by aortic graft infection and osteomyelitis: case report and review of literature

    PubMed Central

    Zouein, Elie; Wetz, Robert; Mobarakai, Neville; Hassan, Samer; Tong, Iris

    2012-01-01

    Primary aortic graft infection early after aortic graft insertion is well described in the literature. Here, we present a unique case of late aortic graft infection 5 years after insertion secondary to mitral valve endocarditis, resulting from cellulitis in a patient with severe venous varicosities. A 63-year-old male presented for severe low back pain, constipation, and low-grade fever. An abdominal computed tomography scan with oral and intravenous contrast showed a normal spine and urinary tract. Blood and urine cultures, done at the same time, grew Staphylococcus aureus. A transesophageal echocardiogram confirmed the diagnosis of endocarditis. Subsequently, a gallium scan showed increased uptake in the vertebral bodies, aortic graft, left patella, and left ankle. After 3 months of antibiotic therapy, the patient’s low back pain resolved with normalization of his laboratory values. He remained free of infection at a 2-year follow-up. We reviewed the literature concerning the atypical presentation of infective endocarditis, with a focus on distant metastases at initial presentation, such as osteomyelitis and aortic graft infection, as well as the different treatment modalities. This report describes successful medical treatment with intravenous followed by oral antibiotics for an infected endovascular graft without any surgical intervention. PMID:22866008

  15. Long-term Results of Endovascular Stent Graft Placement of Ureteroarterial Fistula

    SciTech Connect

    Okada, Takuya Yamaguchi, Masato; Muradi, Akhmadu Nomura, Yoshikatsu; Uotani, Kensuke; Idoguchi, Koji; Miyamoto, Naokazu Kawasaki, Ryota; Taniguchi, Takanori; Okita, Yutaka; Sugimoto, Koji

    2013-08-01

    PurposeTo evaluate the safety, efficacy, and long-term results of endovascular stent graft placement for ureteroarterial fistula (UAF).MethodsWe retrospectively analyzed stent graft placement for UAF performed at our institution from 2004 to 2012. Fistula location was assessed by contrast-enhanced computed tomography (CT) and angiography, and freedom from hematuria recurrence and mortality rates were estimated.ResultsStent graft placement for 11 UAFs was performed (4 men, mean age 72.8 {+-} 11.6 years). Some risk factors were present, including long-term ureteral stenting in 10 (91 %), pelvic surgery in 8 (73 %), and pelvic radiation in 5 (45 %). Contrast-enhanced CT and/or angiography revealed fistula or encasement of the artery in 6 cases (55 %). In the remaining 5 (45 %), angiography revealed no abnormality, and the suspected fistula site was at the crossing area between urinary tract and artery. All procedures were successful. However, one patient died of urosepsis 37 days after the procedure. At a mean follow-up of 548 (range 35-1,386) days, 4 patients (36 %) had recurrent hematuria, and two of them underwent additional treatment with secondary stent graft placement and surgical reconstruction. The hematuria recurrence-free rates at 1 and 2 years were 76.2 and 40.6 %, respectively. The freedom from UAF-related and overall mortality rates at 2 years were 85.7 and 54.9 %, respectively.ConclusionEndovascular stent graft placement for UAF is a safe and effective method to manage acute events. However, the hematuria recurrence rate remains high. A further study of long-term results in larger number of patients is necessary.

  16. Long-Term Results after Placement of Aortic Bifurcation Self-Expanding Stents: 10 Year Mortality, Stent Restenosis, and Distal Disease Progression

    SciTech Connect

    Houston, J. Graeme Bhat, Raj; Ross, Rose; Stonebridge, Peter A.

    2007-02-15

    Purpose. To retrospectively evaluate the 10 year follow-up results in patients who had 'kissing' self-expanding stent aortic bifurcation reconstruction. Methods. Forty-three patients were treated with 'kissing' self-expanding stents for aortoiliac occlusive disease. Early follow-up with clinical and ankle brachial pressure indices (ABPI) was performed at 3, 6, 12, and 24 months and with intra-arterial digital subtraction angiography at 12-24 months; clinical and angiographic follow-up was performed for symptom recurrence up to 10 years after treatment. Retrospective record review was performed to assess mortality, clinical patency, angiographic patency, and secondary assisted patency of both stents and downstream peripheral vessels at 5 and 10 years follow-up. Results. The 2 year primary angiographic and secondary assisted stent patencies were 89% and 93%, respectively. At 10 years follow-up in 40 patients the mortality was 38% (due to myocardial infarction, stroke, chronic renal failure, malignancy, and liver failure). At 5 and 10 years follow-up the primary clinical stent patency was 82% and 68%, and the secondary assisted stent patency 93% and 86%, respectively. At 5 and 10 years, the distal vessel patency was 86% and 72%, and the secondary assisted distal vessel patency treated by surgical or endovascular techniques was 94% and 88%, respectively. At 10 years there was no limb loss. Conclusion. The long-term (10 year) results of aortic bifurcation arterial self-expanding stent placement in patients with arterial occlusive disease show a 10 year primary stent patency rate of 68% but a secondary assisted patency rate of 86%. In addition there is a high overall mortality due to other cardiovascular causes and the rate of distal disease progression and loss of patency is similar to the loss of stent patency rate.

  17. Endovascular Treatment of Blunt Traumatic Abdominal Aortic Occlusion With Kissing Stent Placement

    SciTech Connect

    Idoguchi, Koji Yamaguchi, Masato; Okada, Takuya; Nomura, Yoshikatsu; Sugimura, Kazuro; Okita, Yutaka; Sugimoto, Koji

    2012-10-15

    Blunt traumatic abdominal aortic dissection is extremely rare and potentially deadly. We present the case of a 62-year-old man involved in a frontal car crash. After emergency undergoing laparotomy for bowel injuries, he was referred to our hospital due to acute ischemia of bilateral lower extremities on day 3 after the trauma. Computed tomography and aortography showed an aortobiiliac dissection with complete occlusion. This injury was successfully treated by endovascular treatment with 'kissing'-technique stent placement, which appears to be a safe, effective, and minimally invasive treatment.

  18. Percutaneous Treatment of Iliac Aneurysms and Pseudoaneurysms with Cragg Endopro System 1 Stent-Grafts

    SciTech Connect

    Gasparini, Daniele; Lovaria, Andrea; Saccheri, Silvia; Nicolini, Antonio; Favini, Giorgio; Inglese, Luigi; Giorgetti, Pier Luigi; Basadonna, Pier Tommaso

    1997-09-15

    Purpose: To evaluate the feasibility and short-term follow-up results of treating iliac aneurysms by the Cragg Endopro System 1 stent-graft. Methods: Nine lesions (two pseudoaneurysms and seven atherosclerotic aneurysms) were treated in eight patients by percutaneous implantation of a total of 10 stent-grafts. The procedure was followed by anticoagulation with heparin for 6 days, then antiplatelet therapy. Follow-up was by color Doppler ultrasound scan at 2 days and 3 months after the procedure for all patients, and by venous digital subtraction angiography and/or angio-CT up to 12 months later for four patients. Results: Initial clinical success rate was 100% and there were two minor complications. In one case the delivery system was faulty resulting in failure to deploy the stent-graft. An additional device had to be used. At 3-12 months all prostheses were patent but one patient (12.5%) had a minimal pergraft leak. Conclusion: Percutaneous stent-grafting with this device is a safe and efficacious treatment of iliac artery aneurysms.

  19. Application of stent-graft is the optimal therapy for traumatic internal carotid artery pseudoaneurysms

    PubMed Central

    Pan, Li; Liu, Peng; Yang, Ming; Ma, Lianting; Li, Jun; Chen, Gang

    2015-01-01

    Background: Traumatic pseudoaneurysm of the internal carotid artery (ICA) is an uncommon but serious complication, and difficult to repair surgically. Minimally invasive endovascular treatment of traumatic injuries of the ICA with a stent graft has become increasingly popular over the past decade. The efficacy of the stent graft appears satisfactory, but most if not all reported studies have involved small patient cohorts (less than 10) with short follow-up periods (less than 3 years). Methods: In this prospective study, 13 patients with traumatic pseudoaneurysm of the ICA were recruited from June 2008 to June 2012. All the patients were examined using whole-brain cerebral angiography and followed up for as long as five years. Willis intracranial vascular stent grafts, manufactured by Shanghai Microport, were chosen as embolism material. Results: All 13 patients achieved good clinical outcome. Pseudoaneurysm recurred in one patient and this patient was treated by balloon occlusion of the parent artery. No patient suffered recurrent bleeding or death. Conclusion: Based on the outcomes of this relatively large cohort and long follow-up period, we believe that stent graft is an optimal therapy for patients with traumatic pseudoaneurysms of the ICA. PMID:26309597

  20. Utility of a preloaded fenestrated graft in thoracoabdominal aneurysm repair.

    PubMed

    Unno, Naoki; Yamamoto, Naoto; Higashiura, Wataru; Inuzuka, Kazunori; Sano, Masaki; Konno, Hiroyuki

    2016-09-01

    An 84-year-old man with a thoracoabdominal aortic aneurysm was treated using a fenestrated stent graft with a preloaded guidewire system under local anesthesia. He suffered from severe chronic obstructive pulmonary disease. We successfully placed 4 bridging stent grafts for perfusion of the celiac artery, superior mesenteric artery, and bilateral renal arteries via the 4 fenestrations. A preloaded wire system was used to insert a catheter into the celiac artery from the left brachial artery. Our findings indicate that a fenestrated stent graft with a preloaded wire system may expand the indication for treating thoracoabdominal aortic aneurysms in high-risk patients. PMID:26113732

  1. Effect of technical parameters on transjugular intrahepatic portosystemic shunts utilizing stent grafts

    PubMed Central

    Andring, Brice; Kalva, Sanjeeva P; Sutphin, Patrick; Srinivasa, Rajiv; Anene, Alvin; Burrell, Marc; Xi, Yin; Pillai, Anil K

    2015-01-01

    AIM: To assess the effect of technical parameters on outcomes of transjugular intrahepatic portosystemic shunt (TIPS) created using a stent graft. METHODS: The medical records of 68 patients who underwent TIPS placement with a stent graft from 2008 to 2014 were reviewed by two radiologists blinded to the patient outcomes. Digital Subtraction Angiographic images with a measuring catheter in two orthogonal planes was used to determine the TIPS stent-to-inferior vena cava distance (SIVCD), hepatic vein to parenchymal tract angle (HVTA), portal vein to parenchymal tract angle (PVTA), and the accessed portal vein. The length and diameter of the TIPS stent and the use of concurrent variceal embolization were recorded by review of the patient’s procedure note. Data on re-intervention within 30 d of TIPS placement, recurrence of symptoms, and survival were collected through the patient’s chart. Cox proportional regression analysis was performed to assess the effect of these technical parameters on primary patency of TIPS, time to recurrence of symptoms, and all-cause mortality. RESULTS: There was no significant association between the SIVCD and primary patency (P = 0.23), time to recurrence of symptoms (P = 0.83), or all-cause mortality (P = 0.18). The 3, 6, and 12-mo primary patency rates for a SIVCD ≥ 1.5 cm were 82.4%, 64.7%, and 50.3% compared to 89.3%, 83.8%, and 60.6% for a SIVCD of < 1.5 cm (P = 0.29). The median time to stenosis for a SIVCD of ≥ 1.5 cm was 19.1 mo vs 15.1 mo for a SIVCD of < 1.5 cm (P = 0.48). There was no significant association between the following factors and primary patency: HVTA (P = 0.99), PVTA (P = 0.65), accessed portal vein (P = 0.35), TIPS stent diameter (P = 0.93), TIPS stent length (P = 0.48), concurrent variceal embolization (P = 0.13) and reinterventions within 30 d (P = 0.24). Furthermore, there was no correlation between these technical parameters and time to recurrence of symptoms or all-cause mortality. Recurrence of

  2. Techniques for aortic arch endovascular repair.

    PubMed

    kHONGKU, Kiattisak; Dias, Nuno; Sonesson, Bjorn; Resch, Timothy

    2016-06-01

    This article reviews endovascular strategies for aortic arch repair. Open repair remains the gold standard particularly for good risk patients. Endovascular treatment potentially offers a less invasive repair. Principles, technical considerations, devices and outcomes of each technique are discussed and summarized. Hybrid repair combines less invasive revascularization options, instead of arch replacement while extending stent-graft into the arch. Outcomes vary with regard to extent of repair and aortic arch pathologies treated. Results of arch chimney and other parallel graft techniques perhaps make it a less preferable choice for elective cases. However, they are very appealing options for urgent or bailout situations. Fenestrated stent-grafting is subjected to many technical challenges in aortic arch due to difficulties in stent-graft orientation and fenestration positioning. In situ fenestration techniques emerge to avoid these problems, but durability of stent-grafts after fenestration and ischemic consequences of temporary carotid arteries coverage raises some concern total arch repair using this technique. Arch branched graft is a new technology. Early outcomes did not meet the expectation; however the results have been improving after its learning curve period. Refining stent-graft technologies and implantation techniques positively impact outcomes of endovascular approaches. PMID:26940011

  3. Restoration of the pelvic circulation in patients with abdominal aortic aneurysms receiving aortobifemoral grafts.

    PubMed

    Cardia, G; Tumolo, R; Cafagna, L

    1998-04-01

    When operating on abdominal aortic aneurysms associated with stenoses or occlusions of iliac vessels, surgeons may face the problem of reestablishing circulation to pelvic or gluteal territories. A new technique consists of anastomosing a posterior opening in the body or one of the branches of a bifurcated graft, distally sutured to the femoral artery, to the distal aortic stump, which contains all the patent vessels arising from the end of the aorta, such as inferior mesenteric and lumbar arteries. This technique, successfully performed in two cases, has the advantages of avoiding closure of the distal aortic stump and a possible backflow leak and of ensuring adequate pelvic circulation. PMID:9576094

  4. ePTFE-Covered Stent-Grafts for Revision of Obstructed Transjugular Intrahepatic Portosystemic Shunt

    SciTech Connect

    Cejna, Manfred; Peck-Radosavljevic, Markus; Thurnher, Siegfried; Schoder, Maria; Rand, Thomas; Angermayr, Bernhard; Lammer, Johannes

    2002-10-15

    Purpose: To determine whether transjugular intrahepatic portosystemic shunt (TIPS) revisions with the Hemobahn stent-graft or the Viatorr endoprosthesis increase secondary patency rates. Methods: Between 1998 and June 1999,Hemobahn endoprostheses (W.L. Gore, Flagstaff, AZ, USA) were used for the revision of obstructed TIPS in seven patients, 51-67 years of age(mean 59 years). From June 1999 to 2000, the Viatorr endoprosthesis(W.L. Gore, Flagstaff, AZ, USA) was used for revision of obstructed TIPS in nine patients, 33-64 years of age (mean 49 years). Follow-up included duplex ultrasound, clinical assessment and venousportography. Results: The technical success rate of TIPS revision with the Hemobahn stent-graft was 100%. The pressure gradient decreased from a mean of 20 mmHg to 10 mmHg. The mean follow-up was 407 days (range 81-868 days). In two patients TIPS occlusion occurred at 62 and 529 days after stent-graft placement, respectively; in another two patients outflow tract stenosis occurred at 275 and 393 days,respectively. The technical success rate of TIPS revision with the Viatorr endoprosthesis was also 100%. The pressure gradient decreased from a mean of 27 mmHg to 11 mmHg. At a mean follow-up of 201 days(range 9-426 days), all Viatorr endoprostheses are still patent without in-graft stenosis, but angioplasty was required in two patients to treat a portosystemic pressure gradient > 15 mmHg. Four of the nine patients in the Viatorr group suffered from new encephalopathy after TIPS revision. Conclusion: The Viatorrendoprosthesis yielded optimal results with 100% in-graft patency rates at follow-up but had a high incidence of new encephalopathy,whereas the use of Hemobahn stent-graft for TIPS revision did not appear to improve the secondary patency rates in our series.

  5. ALD mediated heparin grafting on nitinol for self-expanded carotid stents.

    PubMed

    Wang, Fei; Zhang, Yan; Chen, Xiumian; Leng, Bing; Guo, Xin; Zhang, Tao

    2016-07-01

    Carotid-artery atherosclerosis is a common cause of ischemic stroke. Carotid-artery stenting (CAS) is one of the most effective treatments. However, In-stent restenosis (ISR) and re-endothelialization delay are two major issues of intravascular stent which affect clinical safety and reduce effects. In this study, atomic layer deposition (ALD) technology was applied to deposit a layer (10nm) of Al2O3 on Nitinol surface as an intermediate functional layer. The alumina covered surface was then modified with a coupling agent 3-aminopropyltriethoxysilane (APS) and heparin sequentially in order to improve the hemocompatibility of Nitinol stents. The successful graft of APS and heparin onto Nitinol was proven by X-ray photoelectron spectroscopy. Furthermore, the predicted improvement in the biocompatibilities of modified Nitinol was confirmed by water contact angle measurement, protein adsorption, platelet adhesion, and plasma recalcification time determination. The results of hemolysis assay, cell proliferation and cytotoxicity tests revealed that the grafting of heparin on NiTi kept the original positive performance of nitinol material. The results indicate that ALD technology is of great potential for the manufacture of medical devices, especially for surface modifications and functionalization. ALD technology can help with modifications of inert metallic surfaces and therefore benefit implantable medical devices, especially intravascular stents. PMID:27022879

  6. Ascending aortic graft thrombosis and diffuse embolization from early endoluminal Aspergillus infection.

    PubMed

    Calcaterra, Domenico; Bashir, Mohammad; Gailey, Michael P

    2012-10-01

    We present a 43-year-old man who underwent emergent replacement of the ascending aorta for type A dissection and hemiarch reconstruction with a 28-mm prosthetic graft. Dramatic neurologic symptoms, renal failure, and bowel ischemia developed on postoperative day 5. A computed tomography scan showed a large floating thrombus in the ascending aortic graft and massive peripheral embolization throughout the body. PMID:23006693

  7. Utility of Covered Stents for Revision of Aging Failing Synthetic Hemodialysis Grafts: A Report of Three Cases

    SciTech Connect

    Silas, Anne M. Bettmann, Michael A.

    2003-11-15

    Three aging failing hemodialysis polytetrafluoroethylene bypass shunts, average age 44 months, previously percutaneously revised with balloon angioplasty, presented with pseudoaneurysms and recurrent thrombosis. All were treated with percutaneous covered stent placement within their affected limbs. One graft was ligated 1 month after treatment for infected overlying skin ulcer, though this graft was subsequently surgically revised with interposition graft and the covered stent portion remains functional at 19 month follow-up. The 18- and 13- month follow- up of the remaining 2 patients shows that the covered stents remained patent and they are functional and being successfully and routinely punctured for dialysis. In this elderly population, the use of covered stents may prolong the functional life of failing hemodialysis bypass grafts, reducing the number of percutaneous and surgical interventions and further sparing other vascular access sites.

  8. Aortoiliac Aneurysm with Arteriocaval Fistula Treated by a Bifurcated Endovascular Stent-Graft

    SciTech Connect

    Beveridge, Carolyn J.; Pleass, Henry C.C.; Chamberlain, John; Wyatt, Michael G.; Rose, John D.G.

    1998-05-15

    A 71-year-old patient with high-output cardiac failure was found to have an aneurysmal distal aorta with evidence of an arteriocaval fistula on ultrasound scanning. CT demonstrated an aneurysm of the distal aorta and right common iliac artery and an intraarterial digital subtraction angiogram confirmed an arteriocaval fistula. In view of the patient's cardiac failure and general condition an endovascular stent was considered. The right internal iliac artery was occluded with Tungsten coils prior to the insertion of a bifurcated stent-graft. This resulted in total occlusion of the aneurysm and obliteration of the arteriocaval fistula. To our knowledge such a case has not been previously reported.

  9. Decision-making in aortic valve replacement: bileaflet mechanical valves versus stented bioprostheses

    PubMed Central

    Takkenberg, J.J.M.; Puvimanasinghe, J.P.A.; van Herwerden, L.A.; Eijkemans, M.J.C.; Steyerberg, E.W.; Habbema, J.D.F.; Bogers, A.J.J.C.

    2003-01-01

    Background Valve prosthesis selection for patients who require aortic valve replacement is dependent on several interrelated factors. Often, more than one valve type seems suitable for the individual patient and selection of a valve type may be difficult. Methods The application of an evidence-based microsimulation model as an objective tool to support the choice between a bileaflet mechanical prosthesis and a stented bioprosthesis in the individual patient is described. In addition, a pilot study investigating the effect of knowledge gained by this microsimulation model on prosthetic valve choice by cardiothoracic surgeons and cardiologists is presented for two hypothetical patients. Results After implantation of a mechanical valve, bleeding and thromboembolism are common, especially in the elderly. After implantation of a bioprosthesis, reoperation for structural failure is the most important valve-related complication, especially in younger patients. Life expectancy after aortic valve replacement is markedly reduced compared with the general Dutch age-matched population, regardless of the type of valve implanted. In the pilot study knowledge gained by the microsimulation model caused a shift in the preference towards a mechanical prosthesis in clinical experts. Conclusion Microsimulation incorporating current epidemiological data provides an objective tool to estimate prognosis for individual patients after aortic valve replacement with different valve prostheses. It may develop towards a useful clinical decision support system for valve prosthesis selection. ImagesFigure 6 PMID:25696138

  10. Atomic layer deposition enhanced grafting of phosphorylcholine on stainless steel for intravascular stents.

    PubMed

    Zhong, Qi; Yan, Jin; Qian, Xu; Zhang, Tao; Zhang, Zhuo; Li, Aidong

    2014-09-01

    In-stent restenosis (ISR) and re-endothelialization delay are two major issues of intravascular stent in terms of clinical safety and effects. Construction of mimetic cell membrane surface on stents using phosphorylcholine have been regarded as one of the most powerful strategies to resolve these two issues and improve the performance of stents. In this study, atomic layer deposition (ALD) technology, which is widely used in semiconductor industry, was utilized to fabricate ultra-thin layer (10nm) of alumina (Al2O3) on 316L stainless steel (SS), then the alumina covered surface was modified with 3-aminopropyltriethoxysilane (APS) and 2-methacryloyloxyethyl phosphorylcholine (MPC) sequentially in order to produce phosphorylcholine mimetic cell membrane surface. The pristine and modified surfaces were characterized using X-ray photoelectron spectroscopy, atomic force microscope and water contact angle measurement. Furthermore, the abilities of protein adsorption, platelet adhesion and cell proliferation on the surfaces were investigated. It was found that alumina layer can significantly enhance the surface grafting of APS and MPC on SS; and in turn efficiently inhibit protein adsorption and platelet adhesion, and promote the attachment and proliferation of human umbilical vein endothelial cells (HUVEC) on the surfaces. In association with the fact that the deposition of alumina layer is also beneficial to the improvement of adhesion and integrity of drug-carrying polymer coating on drug eluting stents, we expect that ALD technology can largely assist in the modifications on inert metallic surfaces and benefit implantable medical devices, especially intravascular stents. PMID:25016426

  11. Tracheo-Bronchial Obstruction and Esophageal Perforation after TEVAR for Thoracic Aortic Rupture

    PubMed Central

    Fukui, Daisuke; Tanaka, Haruki; Komatsu, Kazunori; Ohtsu, Yoshinori; Terasaki, Takamitsu; Wada, Yuko; Takano, Tamaki; Koike, Shoichiro; Amano, Jun

    2014-01-01

    A 67-year-old man was referred to our hospital for an ascending aortic aneurysm, thoracoabdominal aortic aneurysm and aortic regurgitation. Graft repair of the thoracic aortic arch and aortic valve replacement was given priority and completed, however he developed descending aortic rupture before the second scheduled surgery, and endovascular stent grafting was performed. He subsequently developed tracheobronchial obstruction and esophageal perforation. The patient underwent urgent esophagectomy and enterostomy with continuity later reestablished. However, he died of sepsis 5 months after surgery. Despite the less invasive nature of endovascular treatment, esophageal perforation can nevertheless occur and postoperative vigilance is well warranted. PMID:25593630

  12. Embolisation of a Proximal Type I Endoleak Post-Nellix Aortic Aneurysm Repair Complicated by Reflux of Onyx into the Nellix Endograft Limb

    SciTech Connect

    Ameli-Renani, S. Das, R. Weller, A. Chung, R. Morgan, R. A.

    2015-06-15

    We report the first case of intervention for a proximal type 1 endoleak following Nellix endovascular aneurysm sealing repair of an aortic aneurysm. This was complicated by migration of Onyx into one of the Nellix graft limbs causing significant stenosis. Subsequent placement of a covered stent to affix the Onyx between the stent and the wall of the Nellix endograft successfully restored stent patency.

  13. Management of aortic graft infections - the present strategy and future perspectives.

    PubMed

    Treska, V; Certik, B; Molacek, J

    2016-01-01

    Aortic graft infections (AGI) are serious complications of open and endovascular types of surgery with an incidence rate of 0.6-3 %. AGI are associated with 30-60 % perioperative mortality and 40-60 % morbidity rate with limb amputation rates between 10 % and 40 %. The economic cost of AGI is substantial. At the time of aortic reconstruction, almost 90 % of patients have one or more predisposing factors for AGI. The diagnosis is based on clinical symptomatology, laboratory markers, microbial cultures, and imaging modalities. The general principle of surgical treatment lies in the removal of infected graft, debridement of infected periprosthetic tissues, and vascular reconstruction by in situ or extra-anatomic bypass with long-term antibiotic therapy. The conservative treatment is used only for selected patients with endograft infection. This review summarizes the current knowledge about the incidence, predisposing factors, etiology, diagnosis, treatment options, and prevention of aortic vascular graft and endograft infections. With the growing number of endovascular procedures we can expect more cases of infected aortic endografts in patients with severe comorbidities in the near future, where the recent radical surgical approach (graft excision, debridement, and new revascularization) cannot be used. Therefore the less invasive, sophisticated and individualized treatment strategies will have to be used in search of the best therapeutic approach to each specific patient (Fig. 4, Ref. 82). PMID:26925740

  14. Primary Infrarenal Aortic Stenting With or Without Iliac Stenting for Isolated and Aortoiliac Stenoses: Single-Centre Experience With Long-Term Follow-Up

    SciTech Connect

    Tapping, C. R.; Ahmed, M.; Scott, P. M.; Lakshminarayan, R.; Robinson, G. J.; Ettles, D. F.; Shrivastava, V.

    2013-02-15

    The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 {+-} 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 {+-} -0.15 (right) and 0.61 {+-} -0.16 (left). After the procedure they were 0.86 {+-} -0.07 (right) and 0.90 {+-} -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic

  15. Analysis of indium-111 platelet kinetics and imaging in patients with aortic grafts and abdominal aortic aneurysms

    SciTech Connect

    Hanson, S.R.; Kotze, H.F.; Pieters, H.; Heyns, A.D. )

    1990-11-01

    To quantitatively characterize processes of platelet thrombus formation in vivo, the kinetics and incorporation into thrombus of autologous In-111-labeled platelets were compared in six patients with aortic aneurysms and in seven patients with prosthetic aortic grafts. Although platelet survival was comparably shortened in both patient groups (mean, 5.8 days), the maximum radioactivity as determined by gamma camera imaging was higher in the aneurysms than in the grafts (3.3% +/- 1.6% vs. 1.6% +/- 1.1%, p = 0.05). Maximum In-111 uptake was also attained more quickly in the aneurysm patients (2.3 +/- 0.8 days vs. 3.5 +/- 1.3 days; p = 0.07). The experimental platelet kinetic and imaging data were subsequently evaluated by compartmental analysis to estimate both normal and disease-related components of platelet destruction. This analysis indicated that deposited platelet radioactivity had a longer residence time on grafts (2.9 +/- 1.7 days vs. 1.4 +/- 0.9 days, p = 0.07) but accumulated at a faster rate in aneurysms (5.0% +/- 3.4% per day vs. 1.4% +/- 0.9% per day, p = 0.02). As determined by imaging, only a proportion of increased platelet destruction was specifically due to the aneurysms (55% +/- 38%) or grafts (17% +/- 11%, p = 0.03). This result indicates additional components of platelet destruction unrelated to graft and aneurysm thrombus formation which, in some graft patients, may reflect a greater severity of vascular disease or other mechanisms causing a preferential shortening of platelet survival. Thus, the analytical approach described may be a useful one for discriminating components of in vivo platelet utilization including platelet removal due to normal hemostatic and senescent mechanisms, localized thrombus formation, and more generalized vascular disease.

  16. Polymer coating of porcine decellularized and cross-linked aortic grafts.

    PubMed

    Heidenhain, Christoph; Weichert, Wilko; Schmidmaier, Gerhard; Wildemann, Britt; Hein, Moritz; Neuhaus, Peter; Heise, Michael

    2010-07-01

    This article investigates a method of modifying and optimizing the biocompatibility of decellularized vascular bioimplants when treated with a specialized, drug eluting coating. For this purpose, we carried out aortic transplantations using a porcine model. Decellularized, cross-linked aortic grafts were coated with poly(D,L-lactide) (PDLLA). To this coating, we added the anticoagulant drug lepirudin which, following transplantation, would be linearly eluted. These aortic grafts are easily manipulated in surgery. It was shown that, as a result of the lepirudin-eluting coating, the rate of thrombogenesis was reduced and the patency rate was significantly improved. However, lumen-stenosing pseudointima developed in all of the transplants and was not effected by PDLLA coating. Furthermore, no evidence of recellularisation was documented. This trial demonstrates that polymer coating of decellularized tissue is possible. Neointimal hyperplasia and the absence of cellular repopulation mark the negative consequences of this concept. PMID:20524202

  17. Overall Essen’s experience with the E-vita open hybrid stent graft system and evolution of the surgical technique

    PubMed Central

    Dohle, Daniel; Benedik, Jaroslav; Lieder, Helmut; Jakob, Heinz

    2013-01-01

    Background The hybrid stent graft prosthesis E-vita open was designed and introduced by us in 2005 to avoid a two-stage surgical approach in the surgical treatment of complex thoracic aortic disease. Experience in ascending aortic and arch replacement with simultaneous stent grafting of the descending aorta was accumulated over the past 8 years. Facilitation of surgical technique by moving the distal suture line from Zone 3 into Zone 2 took place in 2009. We report our mid-term single-center experience comparing both surgical periods. Methods Between January 2005 and July 2013 a total of 132 patients (mean age 59±11 years) underwent one stage surgery for acute (AAD, n=74), chronic aortic dissection (CAD, n=35) or an extensive thoracic aortic aneurysm (TAA, n=23). Patients were separated in two groups according to distal anastomosis level in Zone 2 (Z2, 41/132) and Zone 3 (Z3, 91/132). Outcome, ischemic and operative times as well as adverse events were monitored during follow up. Results Overall in-hospital mortality was 13% (17/132) without difference between the groups. However, Zone 2 anastomosis resulted in reduction of cardioplegic arrest (117±39 vs. 147±35 minutes; P<0.001), selective cerebral perfusion (52±15 vs. 68±18 minutes; P<0.001) and visceral ischemic time (51±19 vs. 72±23 minutes; P<0.001). The incidence of postoperative temporary hemodialysis decreased from 40% to 20% in Z2 (P=0.028), postoperative re-exploration rate from 15% to 2% (P=0.037). No difference was found in dissection with complete false lumen thrombosis in 83% (90/109) within 10 days, as well as in TAA, where 100% aneurysm exclusion was observed. Three-year survival, freedom from thoracoabdominal aortic surgery and endovascular repair was 93%, 88%, 88%, respectively. Overall 5-year survival was 76% in AAD, 85% in CAD and 79% in TAA patients. Conclusions The dimension of surgery could be successfully reduced, indicated by significantly shortened ischemic times and postoperative

  18. Hybrid procedure for a traumatic aortic rupture consisting of endovascular repair and minimally invasive arch vessel transposition without sternotomy.

    PubMed

    Ryu, Yang Gi; Choo, Suk Jung; Lim, Ju Yong; Yoon, Hyun Ki; Chung, Cheol Hyun

    2010-01-01

    Emergency surgical repair for acute traumatic aortic ruptures has been associated with a high peri-procedural mortality rate. Endovascular stent-grafting, as a less invasive procedure, has shown encouraging results. This report describes a patient with a short landing zone, who was treated by transposing the supra-aortic branch without sternotomy, followed by covered stent-grafting with an extended proximal bare portion to enhance fixation. PMID:20052360

  19. Transcatheter stent implantation for the treatment of abdominal aortic coarctation and right renal artery stenosis in takayasu's arteritis: a case with a 4-year follow up.

    PubMed

    Ghazi, Payam; Haji-Zeinali, Ali-Mohammad; Ghasemi, Masuood; Pour, Manijeh Zargham

    2011-01-01

    We describe a Takayasu arteritis patient who was admitted because of an abdominal aortic stenosis, further complicated by the presence of a stenotic right renal artery located in the area of the aortic stenosis. After treatment of the renal stenosis with a 4 × 15 mm Driver stent, a 16 × 60 self-expandable nitinol stent (OptiMed) was deployed through the stenosis of the abdominal aorta. Even though the right renal artery was initially compromised after stent deployment through the aortic stenosis, the patient was successfully treated with renal artery re-dilation by a balloon passed through open cells of the aortic stent. During follow up, the patient suffered no procedure-related complications. PMID:21478132

  20. [Stent graft for rapidly growing thoracic mycotic aneurysm in a patient with advanced lung cancer].

    PubMed

    Ikeuchi, Masaki; Ando, Makoto; Hisano, Kumi; Nakamura, Ryo; Urabe, Yoshitoshi; Uchida, Takayuki

    2015-02-01

    We report a compromised patient with mycotic aneurysm, who was successfully treated by urgent placement of a stent graft. A man in his seventies was admitted to our hospital with relapsing high fever and back pain during chemotherapy for advanced squamous cell carcinoma of the lung. Contrast CT demonstrated a saccular aneurysm of the thoracic aorta and left pleural effusion. Blood cultures were positive for Escherichia coli producing extended spectrum beta-lactamase (ESBL). Therefore, thoracic mycotic aneurysm was diagnosed. Because of rapid growth on consecutive examinations, absolute bed rest was required. Therefore, we performed antibiotic therapy combined with stent graft placement, which achieved complete exclusion of the aneurysm. He was discharged in an ambulatory state, and his quality of life remained good at home until just before death from terminal state of the cancer. PMID:26021128

  1. Paraplegic Neurodeficit Management Post Endovascular Graft: A Rare Case of Aortic Dissection

    PubMed Central

    Kanse, Vilas Yadavarao; Chongtham, Dhanaraj Singh; Nemichandra, S C; Salam, Kenny Singh

    2013-01-01

    Acute aortic dissection is a catastrophic episode that usually presents as a sudden, painful, ripping sensation in the chest or back. It is associated with neurologic sequelae in as many as one-third of patients. We report a case of aortic dissection, presenting as acute paraplegia. A 50-year-old patient presented to us with chief complaints of paraplegia and back pain. On examination, strength was 5/5 in both upper extremities and 0/5 in both lower extremities. Deep tendon reflexes were absent in her legs. CT angiogram of aorta Aortic Dissection Stanford type B / De-Bakey type –III. Patient was treated with endovascular graft for aortic dissection, paraplegia recovered completely. PMID:24298506

  2. Primary Stenting of Focal Atherosclerotic Infrarenal Aortic Stenoses: Long-Term Results in 13 Patients and a Literature Review

    SciTech Connect

    Yilmaz, Saim Sindel, Timur; Yegin, Arif; Erdogan, Abdullah; Lueleci, Ersin

    2004-03-15

    We conducted this study to investigate the value of primary stent implantation for the endovascular treatment of focal atherosclerotic stenoses of the infrarenal abdominal aorta. The data of 13 patients with a localized complex infrarenal aortic stenosis who underwent primary stenting was retrospectively evaluated. The patients (6 females, 7 males) had a mean age of 57.3 {+-} 9.1 years (mean {+-} SD). In all patients, the aortic diameter was measured on CT sections, and a self-expanding endoprosthesis was primarily implanted followed by dilatation with single or double balloons. In 3 patients, additional distal stenoses were also endovascularly treated. The procedure was technically successful in all patients. No complications occurred except for 2 minor groin hematomas. During the 43 {+-} 23 months (mean {+-} SD) follow-up (range: 12-96 months), all stented aortic segments remained patent. Clinical patency was lost in 4 patients, which was due to atherosclerosis or restenosis distal to the aorta. In view of the excellent early and long-term results, we believe that primary stenting should be considered the first line treatment in properly selected patients with focal atherosclerotic infrarenal stenoses of the abdominal aorta.

  3. Changes in the Distribution of Hepatic Arterial Blood Flow Following TIPS with Uncovered Stent and Stent-Graft: An Experimental Study

    SciTech Connect

    Keussen, Inger; Song, Ho-Young; Bajc, Marika; Cwikiel, Wojciech

    2002-08-15

    Purpose: To evaluate changes in distribution of hepatic arterial blood flow in the liver following insertion of an uncovered stent and subsequently a stent-graft in the transjugular intrahepatic portosystemic shunt (TIPS) channel.Methods: The experiments were performed in eight healthy pigs under general anesthesia. In a pilot study in one pig, scintigraphic evaluation of arterial perfusion to the liver was done before and after inflation of a balloon in the right hepatic vein. In the other pigs, outflow from the right liver vein was checked repeatedly by contrast injection through a percutaneously inserted catheter. The arterial perfusion through the liver was examined by scintigraphy, following selective injection of macro-aggregate of 99Tcm-labeled human serum albumin 99Tcm-HSA) into the hepatic artery. This examination was done before and after creation of a TIPS with an uncovered stent and subsequently after insertion of a covered stent-graft into the cranial portion of the shunt channel. Results: In the pilot study changes in the arterial perfusion to the liver were easily detectable by scintigraphy. One pig died during the procedure and another pig was excluded due to dislodgement of the hepatic artery catheter. The inserted covered stent obstructed venous outflow from part of the right liver lobe. The 99Tcm-HSA activity in this part remained unchanged after TIPS creation with an uncovered stent. A reduction in activity was seen after insertion of a stent-graft (p0.06).Conclusion: The distribution of the hepaticarterial blood flow is affected by creation of a TIPS with a stent-graft, in the experimental pig model.

  4. Heparin-Induced Thrombocytopenia Associated with a Heparin-Bonded Stent Graft.

    PubMed

    Blas, Joseph-Vincent V; Carsten, Christopher G; Gray, Bruce H

    2016-05-01

    We describe a case of heparin-induced thrombocytopenia (HIT) in association with heparin-bonded stent grafts. A 61-year-old man with claudication secondary to a left superficial femoral artery (SFA) occlusion was treated with 2 heparin-bonded polytetrafluorethylene (hep-PTFE) grafts. Despite the use of antiplatelet medication, he presented with thrombosed hep-PTFE grafts 1 week after initial treatment. An additional hep-PTFE graft was placed at the SFA origin because of migration of the first graft. He was discharged on anticoagulation; however, he presented again 2 weeks later with recurrent SFA thrombosis and a platelet count of 60,000, raising suspicion for HIT. All exogenous forms of heparin were discontinued, and he was started on an alternative anticoagulant. The patient returned again 5 days after being discharged with recurrent symptoms of acute limb ischemia. He underwent a left femoropopliteal artery bypass with autogenous conduit and removal of the grafts. He has since had an uneventful recovery. We believe HIT should be considered as a potential cause of hep-PTFE graft thrombosis. Diagnosis and management of these patients is complex and may require explantation of the graft. PMID:26902939

  5. Custom stent fabrication for free gingival grafts around osseointegrated abutment fixtures.

    PubMed

    Brygider, R M; Bain, C A

    1989-09-01

    The Branemark system of osseointegrated dental implants offers a viable treatment alternative for patients whose conventional prostheses have not been successful. However, the unkeratinized, loosely attached nature of the oral mucosa through which the fixtures may pass often presents a region of easy trauma. A free gingival graft of keratinized tissue from the hard palate can be substituted for these tissues. The success of the graft is dependent upon early healing and protection of the recipient site. This protection can be accomplished by fabrication and use of a custom acrylic resin tissue stent extended beyond the borders of the surgical site. PMID:2681702

  6. Surgical Repair of a Post-traumatic Arteriovenous Fistula Complicated by Stent-Graft Misplacement

    SciTech Connect

    Sahin, Sinan Ciinar, Bayer; Bilgin, Sule N.; Celik, Levent; Eren, Ergin E.

    2005-01-15

    An arteriovenous fistula (AVF) is an abnormal connection between an artery and a vein which may result from a traumatic injury or occur as a congenital abnormality. It may be asymptomatic or may present with a variety of symptoms. Surgical or endovascular treatment can be preferred. We present a case of unsuccessful percutaneous treatment of a femoral AVF due to misplacement of the stent-grafts, necessitating surgical correction.

  7. Irreversible Electroporation of a Hepatocellular Carcinoma Lesion Adjacent to a Transjugular Intrahepatic Portosystemic Shunt Stent Graft

    PubMed Central

    Jung, Ernst Michael; Wohlgemuth, Walter A.; Trabold, Benedikt; Haimerl, Michael; Schreyer, Andreas; Stroszczynski, Christian; Wiggermann, Philipp

    2013-01-01

    We report in a 65-year-old man hepatocellular carcinoma adjacent to a transjugular intrahepatic portosystemic shunt stent-graft which was successfully treated with irreversible electroporation (IRE). IRE is a new non-thermal tissue ablation technique which uses electrical pulses to induce cell necrosis by irreversible membrane poration. IRE proved to be more advantageous in the ablation of perivascular tumor with little injury to the surrounding structures. PMID:24043975

  8. Covered Stent-Graft Treatment of Traumatic Internal Carotid Artery Pseudoaneurysms: A Review

    SciTech Connect

    Maras, Dimitrios; Lioupis, Christos Magoufis, George; Tsamopoulos, Nikolaos; Moulakakis, Konstantinos; Andrikopoulos, Vasilios

    2006-12-15

    Objective. To review the literature concerning the management with placement of covered stent-grafts of traumatic pseudoaneurysms of the extracranial internal carotid artery (ICA) resulting from penetrating craniocervical injuries or skull base fractures. Method. We have reviewed, from the Medline database, all the published cases in the English literature since 1990 and we have added a new case. Results. We identified 20 patients with traumatic extracranial ICA pseudoaneurysms due to penetrating craniocervical injuries or skull base fractures who had been treated with covered stent-graft implantation. Many discrepancies have been ascertained regarding the anticoagulation therapy. In 3 patients the ICA was totally occluded in the follow-up period, giving an overall occlusion rate 15%. No serious complication was reported as a result of the endovascular procedure. Conclusion. Preliminary results suggest that placement of stent-grafts is a safe and effective method of treating ICA traumatic pseudoaneurysms resulting from penetrating craniocervical injuries or skull base fractures. The immediate results are satisfactory when the procedure takes place with appropriate anticoagulation therapy. The periprocedural morbidity and mortality and the early patency are also acceptable. A surveillance program with appropriate interventions to manage restenosis may improve the long-term patency.

  9. An Infected Aneurysm of the Vertebral Artery Treated with a Stent-graft: A Case Report

    PubMed Central

    HASHIMOTO, Kenji; ISAKA, Fumiaki; YAMASHITA, Kohsuke

    2015-01-01

    In a 75-year-old man, a growing vertebral artery aneurysm at the C3/4 intervertebral level was found at postoperative evaluation of cervical abscess, which was diagnosed as a complication of sepsis subsequent to cholangitis. Even after a successful antibiotic treatment and a surgical drainage, the aneurysm grew enough to cause compression of esophagus and trachea. The aneurysm was judged to be infection-related, based on the clinical course and the anatomical vicinity to the abscess. Following a dual antiplatelet treatment (clopidogrel 75 mg and aspirin 100 mg per day) for a week, the patient underwent endovascular treatment of the aneurysm with a stent-graft. Postoperative angiography showed complete obliteration of the aneurysm with preserving patency of the vertebral artery. A dual antiplatelet treatment was continued for 6 months and was changed to a single antiplatelet treatment (clopidogrel 75 mg per day) thereafter. Neither recurrence of the aneurysm nor stent-graft infection was observed for 4 years of follow-up. This case illustrates the potential use of a stent-graft in the treatment of an infected aneurysm. PMID:26437795

  10. Relief of Mesenteric Ischemia by Z-Stent Placement into the Superior Mesenteric Artery Compressed by the False Lumen of an Aortic Dissection

    SciTech Connect

    Yamakado, Koichiro; Takeda, Kan; Nomura, Yoshiyuki; Kato, Noriyuki; Hirano, Tadanori; Matsumura, Kaname; Nakagawa, Tsuyoshi; Yuasa, Hiroshi; Yada, Isao

    1998-01-15

    In a 58-year-old man acute aortic dissection compromised the origin of the superior mesenteric artery (SMA), resulting in mesenteric ischemia. After failed balloon angioplasty a Gianturco Z-stent was placed. The stenosis improved immediately, followed by resolution of the clinical signs of mesenteric ischemia. SMA flow was well preserved 1 year after stenting.

  11. Associated bare stenting of distal aorta with a Djumbodis® system versus conventional surgery in type A aortic dissection

    PubMed Central

    Sirota, Dmitry; Nader, Joseph; Lyashenko, Maxim; Chernyavsky, Alexander

    2016-01-01

    Background The effectiveness of additional stenting of the distal aorta as compared to conventional surgery alone in type A aortic dissection (TAD) has yet to be proven. Methods We conducted this multicenter comparative study to evaluate the effects of antegrade bare stenting of the dissected aorta beyond the distal anastomosis with a Djumbodis® device system (DDS). Outcomes that were measured included early outcomes, overall mortality from aortic cause and late aortic events including re-interventions. A consecutive series of 134 patients operated on in two participating centers were distributed into study and control groups according to the treatment received: conventional surgery with DDS (DJ group, n=42) or without (control group, n=92). Results Operative mortality was 21.4% and 17.6% in the DJ and control groups, respectively (P=0.9), and was within pre-specified alarm lines for both groups. In multivariate analysis, the only independent predictor of operative mortality was the presence of any complication (cardiac tamponade or malperfusion, P=0.05), which occurred more in the DJ group (OR =1.3; non-significant). Sixty patients were included into the matched survivors cohorts study (propensity scoring). The aortic event-free survival at 7 years for early survivors was 77%±10% and 48%±11% in the matched DJ group and control group, respectively (HR =0.66). Late mortality from an aortic cause was 10% and 20% in the matched DJ group and control group, respectively (RR =0.5). Actuarial freedom from aortic or vascular interventions was 71%±10% and 67%±9% in the matched DJ and control group, respectively. Operative mortality was not influenced by the use of DDS as compared to conventional surgery alone for TAD. Conclusions We observed a trend towards better organ perfusion in the DJ group postoperatively, and more aortic events and deaths of aortic cause in the control group during follow-up. PMID:27563546

  12. Use of PTFE Stent Grafts for Hemodialysis-related Central Venous Occlusions: Intermediate-Term Results

    SciTech Connect

    Kundu, Sanjoy Modabber, Milad; You, John M.; Tam, Paul; Nagai, Gordon; Ting, Robert

    2011-10-15

    Purpose: To assess the safety and effectiveness of a polytetrafluoroethylene (PTFE) encapsulated nitinol stents (Bard Peripheral Vascular, Tempe, AZ) for treatment of hemodialysis-related central venous occlusions. Materials and Methods: Study design was a single-center nonrandomized retrospective cohort of patients from May 2004 to August 2009 for a total of 64 months. There were 14 patients (mean age 60 years, range 50-83 years; 13 male, 1 female). All patients had autogenous fistulas. All 14 patients had central venous occlusions and presented with clinical symptoms of the following: extremity swelling (14%, 2 of 14), extremity and face swelling (72%, 10 of 14), and face swelling/edema (14%, 2 of 14). There was evidence of access dysfunction with decreased access flow in 36% (5 of 14) patients. There were prior interventions or previous line placement at the site of the central venous lesion in all 14 patients. Results were assessed by recurrence of clinical symptoms and function of the access circuit (National Kidney Foundation recommended criteria). Results: Sixteen consecutive straight stent grafts were implanted in 14 patients. Average treated lesion length was 5.0 cm (range, 0.9-7 cm). All 14 patients had complete central venous occlusion (100% stenosis). The central venous occlusions were located as follows: right subclavian and brachiocephalic vein (21%, 3 of 14), right brachiocephalic vein (36%, 5 of 14), left brachiocephalic vein (36%, 5 of 14), and bilateral brachiocephalic vein (7%, 1 of 14). A total of 16 PTFE stent grafts were placed. Ten- or 12-mm-diameter PTFE stent grafts were placed. The average stent length was 6.1 cm (range, 4-8 cm). Technical (deployment), anatomic (<30% residual stenosis), clinical (resolution of symptoms), and hemodynamic (resolution of access dysfunction) success were 100%. At 3, 6, and 9 months, primary patency of the treated area and access circuit were 100% (14 of 14). Conclusions: This PTFE encapsulated stent graft

  13. Intravascular stenting following bypass grafting in terminal coronary artery disease.

    PubMed Central

    Vecht, R J; Sigwart, U

    1995-01-01

    Reoperation after coronary artery bypass grafting in terminal coronary artery disease is associated with a substantial risk. Advances in coronary artery angioplasty offer alternative treatment with low morbidity and acceptable mortality. Images Figure 1 (a) Figure 1 (b) Figure 2 (a) Figure 2 (b) Figure 1 PMID:7884772

  14. [Completion pneumonectomy combined with graft replacement of thoracic aortic aneurysm by simple clamping].

    PubMed

    Shimamoto, A; Takao, M; Kanemitsu, S; Fujinaga, K; Yan, G; Cruz, B P; Onoda, K; Shimono, T; Shimpo, H; Namikawa, S; Yuasa, H; Yada, I

    1999-01-01

    A 59-years-old male patient who had left upper lobe partial resection 30 years ago. He was seen at the family physician because of cough. A chest X-ray was showing an abnormal mass shadow measuring 3 x 4 cm in left lower lobe like honey comb. And squamous cell carcinoma (SCC) was detected in his sputum. He was diagnosed as primary lung cancer and introduced to our department to have operation. Chest CT-scan was showing lung tumor suspected SCC measuring 4.3 x 2.6 cm in segment 8 faced chest wall. At the same time, we detected thoracic aortic aneurysm and subcarinal lymph node, but could not see where the boundary is, so it was hard to distinguish between parietal thrombus with thoracic aortic aneurysm and swelling subcarinal lymph node. We decided it swelling subcarinal lymph node by three-dimensional treated CT-scan. Aortic angiography was showing proximal descending aortic aneurysm measuring diameter was 4.5 cm. Abdominal CT-scan was showing infrarenal abdominal aortic aneurysm measuring diameter was 5.5 cm. He was diagnosed as primary lung cancer (It. S8, SCC) (cT2N2M0, Stage IIIB), thoracic aortic aneurysm, abdominal aortic aneurysm, and idiopathic pulmonary fibrosis, and had completion pneumonectomy (R 2 b) for primary lung cancer and graft replacement with aneurysm dissection for thoracic aortic aneurysm without extracorporeal circulation. In this operation, we could find swelling subcarinal lymph node measuring 5 x 3 cm instead of parietal thrombus with thoracic aortic aneurysm. Pathological examination diagnosed middle differential SCC and no metastasis from dissected lymph node (PT2N0M0, Stage I A). PMID:10024802

  15. Renal flow studies after abdominal aortic aneurysmectomy and axillo-bifemoral bypass graft: case report

    SciTech Connect

    LaManna, M.M.; Yussen, P.S.

    1988-03-01

    Vascular disorders affecting the kidneys are either acquired or congenital. Included in this category are common multiplicity of renal arteries, the rare arteriovenous malformation, stresses due to fibromuscular disease or atherosclerosis including abdominal aortic aneurysms, arterial thrombosis, venous thrombosis, and infarction. In contrast to the group of cystic and neoplastic kidneys where scintigraphic or pathologic are not diagnostic, scintigraphic or pathologic anatomy in vascular disease is often diagnostic by nuclear medicine techniques. The authors present an interesting case of evaluation of acute renal failure in a patient abdominal aortic aneurysmectomy and axillo-bifemoral bypass graft.

  16. The chimney-graft technique for preserving supra-aortic branches: a review.

    PubMed

    Moulakakis, Konstantinos G; Mylonas, Spyridon N; Dalainas, Ilias; Sfyroeras, George S; Markatis, Fotis; Kotsis, Thomas; Kakisis, John; Liapis, Christos D

    2013-05-01

    Evolution in the endovascular era has influenced the management of aortic arch pathologies. "Chimney" or "snorkel" graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate. PMID:23977603

  17. The chimney-graft technique for preserving supra-aortic branches: a review

    PubMed Central

    Mylonas, Spyridon N.; Dalainas, Ilias; Sfyroeras, George S.; Markatis, Fotis; Kotsis, Thomas; Kakisis, John; Liapis, Christos D.

    2013-01-01

    Evolution in the endovascular era has influenced the management of aortic arch pathologies. “Chimney” or “snorkel” graft technique has been used as an alternative in high risk patients unfit for open repair. We reviewed the published literature on the chimney graft technique for preservation of the supra-aortic branches in order to provide an extensive insight of its feasibility and efficacy and investigate its outcomes. 18 reports were identified, with a total of 124 patients and 136 chimney. Primary technical success was achieved in 123/124 patients (99.2%). The perioperative mortality rate was 4.8% and the stroke rate was 4%, while events of spinal cord ischemia were rare. The overall endoleak rate was 18.5%; 13 patients (10.5%) developed a type I endoleak and 10 (8%) patients a type II endoleak. During a median follow-up period of 11.4 months (range, 0.87-20.1 months) all implanted chimney grafts remained patent. From this, we conclude that endovascular aortic arch repair with chimney grafts is associated with a lower mortality rate compared to totally open or hybrid reconstruction. However, the stroke rate remains noteworthy, and requires longterm data to elucidate. PMID:23977603

  18. The management of impending myocardial infarction using coronary artery by-pass grafting and an intra-aortic balloon pump.

    PubMed

    Harris, P L; Woollard, K; Bartoli, A; Makey, A R

    1980-01-01

    Of 33 patients with impending myocardial infarction 25 were treated using a combination of coronary artery by-pass grafting and intra-aortic balloon pumping. Eight patients were treated with coronary artery by-pass grafting alone. Twenty-two of the 25 patients who were treated with the combined technique made a full recovery. Three patients sustained definite myocardial infarctions and one of these died. Five of the 8 patients treated by grafting alone suffered infarction and of these 3 died. The value of intra-aortic balloon pumping in combination with coronary artery by-pass grafting in the management of impending myocardial infarction is discussed. PMID:6968314

  19. Importance of dynamic aortic evaluation in planning TEVAR

    PubMed Central

    van Herwaarden, Joost A.; Conti, Michele; Auricchio, Ferdinando; Rampoldi, Vincenzo; Trimarchi, Santi; Moll, Frans L.

    2014-01-01

    Dynamic aortic evaluation in planning thoracic endovascular aortic repair (TEVAR) is important to provide optimal stent graft sizing. Static imaging protocols do not consider normal aortic dynamics and may lead to stent graft to aorta mismatch, causing stent graft related complications, such as type I endoleak and stent graft migration. Dynamic imaging can assist in accurate stent graft selection and sizing preoperatively, and evaluate stent graft performance during follow-up. To create new imaging technologies, integration of knowledge between diverse scientific fields is essential (i.e., engineering, informatics and medicine). Different dynamic imaging modalities, such as electrocardiographic-gated computed tomography angiography (ECG-gated CTA) and four-dimensional phase-contrast MRI (4D PC-MRI), are progressively investigated and implemented into clinical practice as important instruments in preoperative planning for TEVAR. In time, further application of dynamic imaging tools for preoperative screening and follow-up after TEVAR might lead to better outcomes for patients. The advances in dynamic imaging for evaluation of the thoracic aorta using new imaging modalities and their future perspectives are addressed in this manuscript. PMID:24967170

  20. Limitation of imaging in identifying iatrogenic aortic coarctation following thoracic endovascular aortic repair.

    PubMed

    Thakkar, Rajiv N; Thomaier, Lauren; Qazi, Umair; Verde, Franco; Malas, Mahmoud B

    2015-04-01

    A 21-year-old male suffered blunt trauma from a motor vehicle accident causing thoracic aorta tear. The smallest available stent graft was deployed. Definitive repair was later performed using a 22 × 22 × 116 mm Talent Thoracic Stent Graft. The postoperative course was uneventful. Seventeen months later, he presented with dizziness, chest pain, acute renal failure, malignant hypertension, and troponin elevation. Computed tomography (CT) angiogram and transesophageal echocardiogram did not reveal any dissection, stent stenosis or collapse. Cardiac catheterization showed normal coronary arteries but a 117 mm Hg gradient across the stent graft. Iatrogenic coarctation of the aorta was confirmed with a second measurement during arch angiogram. A Palmaz stent was deployed over the distal end of the previous stent graft with complete resolution of symptoms and gradual normalization of kidney function. This case report demonstrates a need for wider availability and selecting appropriate stent graft in treating traumatic aortic injuries in young patients. It is the first case report of the inability of current imaging modalities in confirming stent collapse. Pressure gradient is a useful tool in confirming stent collapse when clinical scenario does not match CT findings. PMID:25637574

  1. Extra-anatomic autologous reconstruction with hepatic-iliac artery bypass graft for aortic endograft infection.

    PubMed

    Buora, Adelaide; Floriani, Marco; Gabrielli, Livio

    2015-01-01

    We present a new intra-abdominal extra-anatomic bypass graft for a 64-year-old man treated with an abdominal aortic endograft and with signs of endograft infection. We performed surgical removal of the endograft and intra-abdominal extra-anatomic reconstruction of a hepatic-to-right external iliac artery bypass with autologous superficial femoral vein and a crossover graft between the right and left external iliac artery with the great saphenous vein. The later occlusion of the saphenous vein graft led us to perform a femoral-femoral prosthetic crossover. At 42 months from the intervention, the patient was in good health, and duplex scanning confirmed the patency of all grafts. PMID:24176632

  2. Surgical strategy for aortic prosthetic graft infection with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography.

    PubMed

    Yamanaka, Katsuhiro; Matsueda, Takashi; Miyahara, Shunsuke; Nomura, Yoshikatsu; Sakamoto, Toshihito; Morimoto, Naoto; Inoue, Takeshi; Matsumori, Masamichi; Okada, Kenji; Okita, Yutaka

    2016-09-01

    A 30-year-old man with Marfan syndrome who underwent Crawford type II extension aneurysm repair about 9 years ago was referred to our hospital with persistent fever. Computed tomography (CT) showed air around the mid-descending aortic prosthetic graft. Because the air did not disappear in spite of intravenous antibiotics, (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) was performed. FDG-PET/CT revealed four high-uptake lesions. After dissecting the aortic graft particularly focusing on the high-uptake lesions, this patient underwent in situ graft re-replacement of descending aortic graft with a rifampicin-bonded gelatin-impregnated Dacron graft and omentopexy. The patient remains well without recurrent infection at 3 months after surgery. PMID:25563707

  3. Acute Effects of Liver Vein Occlusion by Stent-Graft Placed in Transjugular Intrahepatic Portosystemic Shunt Channel: An Experimental Study

    SciTech Connect

    Keussen, Inger Bergqvist, Lennart; Rissler, Pehr; Cwikiel, Wojciech

    2006-02-15

    The purpose of this study was to evaluate the effects of hepatic vein occlusion by stent-graft used in transjugular intrahepatic portosystemic shunt (TIPS). The experiments were performed in six healthy pigs under general anesthesia. Following percutaneous transhepatic implantation of a port-a-cath in the right hepatic vein, TIPS was created with a stent-graft (Viatorr; W L Gore, Flagstaff, AZ, USA). The outflow from the hepatic vein, blocked by the stent-graft was documented by injection of contrast medium and repeated injections of {sup 99}Tc{sup m}-labeled human serum albumin through the port-a-cath. After 2 weeks, the outflow was re-evaluated, the pigs were sacrificed, and histopathologic examination of the liver was performed. Occlusion of the hepatic vein by a stent-graft had a short and temporary effect on the outflow. Histopathological examination from the affected liver segment showed no divergent pattern. Stent-grafts used in TIPS block the outflow from the liver vein, but do not have a prolonged circulatory effect and do not affect the liver parenchyma.

  4. Square Stent: A New Self-Expandable Endoluminal Device and Its Applications

    SciTech Connect

    Pavcnik, Dusan; Uchida, Barry; Timmermans, Hans; Keller, Frederick S.; Roesch, Josef

    2001-07-15

    The square stent is a new, simply constructed, self-expanding device that has recently been described. Compared with other stents, the square stent has a minimal amount of metal and thus requires a smaller-diameter catheter for introduction. Despite the small amount of metal present, the square stent has adequate expansile force. We have been evaluating the square stent for various interventional applications. In addition to the basic square stent, combinations of square stents and coverings for square stents were developed and evaluated to expand its uses and indications. One of the coverings tested is a new biomaterial: small intestinal submucosa (SIS). This paper will discuss the various applications of the square stent, which include a retrievable inferior vena cava filter, vascular occluder, graft adapter, and venous and aortic valves. In addition, we will review the important properties of SIS as a covering for the square stent.

  5. Complete fracture and restenosis of sirolimus-eluting stent in ostial saphenous vein graft.

    PubMed

    Ohgo, Takeshi; Otsuka, Yoritaka; Furuno, Takashi

    2008-08-29

    Although the use of a sirolimus-eluting stents (SES) have markedly reduced neointimal proliferation, in-stent restenosis still occurs in some cases. SES fracture was recently suggested as a new potential mechanism of restenosis. We described a rare case of complete SES fracture combined with significant restenosis, due to failure of drug delivery to the vessel wall, in the ostial saphenous vein graft (SVG). The curvature of the SVG during cardiac contractions with perivascular adhesion and fibrosis in the limited intra-thoracic space may induce high mechanical stresses at the ostial SVG. The cause of complete SES fracture in the present case was most likely mechanical stresses resulting from cardiac contractions. PMID:17761313

  6. Mycotic Pseudoaneurysm Complicating Stent Placement for Native Aortic Coarctation in a Child.

    PubMed

    Perez, Michael; Naik, Ronak; Sathanandam, Shyam; Knott-Craig, Christopher J

    2016-05-01

    Mycotic aneurysms of the aorta are uncommon life-threatening lesions. Sporadic cases have been reported in adults after surgical intervention for native and recurrent coarctation of the aorta. We report a case of a rapidly progressive, large mycotic pseudoaneurysm in a 13-year-old boy 3 months after a bare-metal stent was used to treat native coarctation. The boy presented with slurred speech, bacteremia, and systemic septic embolization. During an emergency operation, the pseudoaneurysm was resected, and the infected aorta was replaced with an interposition graft. This rare complication may occur early or late after stent placement for coarctation of the aorta. PMID:27106463

  7. Stent-Grafts in the Management of Hemorrhagic Complications Related to Hemostatic Closure Devices: Report of Two Cases

    SciTech Connect

    Giansante Abud, Daniel; Mounayer, Charbel; Saint-Maurice, Jean Pierre; Salles Rezende, Marco Tulio; Houdart, Emmanuel; Moret, Jacques

    2007-02-15

    We report 2 cases of hemorrhagic complications related to use of the Angio-Seal hemostatic closure device that were successfully managed with stent-grafts. Two patients with subarachnoid hemorrhage were referred to our departments for endovascular treatment of ruptured intracranial aneurysms. The treatment was performed through a femoral access; the sheaths were removed immediately after the procedures, and the punctures sites closed by Angio-Seals. Both patients presented clinical signs of hypovolemic shock after treatment. The diagnosis of active bleeding through the puncture site was made by emergency digital subtraction angiography. The lesions were managed with stent-grafts. The use of stent-grafts proved to be efficient in the management of these life-threatening hemorrhagic complications following the use of the Angio-Seal hemostatic closure device.

  8. Ruptured mycotic common femoral artery pseudoaneurysm: fatal pulmonary embolism after emergency stent-grafting in a drug abuser.

    PubMed

    Karkos, Christos D; Kalogirou, Thomas E; Giagtzidis, Ioakeim T; Papazoglou, Konstantinos O

    2014-12-01

    The rupture of a mycotic femoral artery pseudoaneurysm in an intravenous drug abuser is a limb- and life-threatening condition that necessitates emergency intervention. Emergency stent-grafting appears to be a viable, minimally invasive alternative, or a bridge, to subsequent open surgery. Caution is required in cases of suspected concomitant deep vein thrombosis in order to minimize the possibility of massive pulmonary embolism during stent-grafting, perhaps by omitting stent-graft postdilation or by inserting an inferior vena cava filter first. We describe the emergency endovascular management, in a 60-year-old male intravenous drug abuser, of a ruptured mycotic femoral artery pseudoaneurysm, which was complicated by a fatal pulmonary embolism. PMID:25593530

  9. Leg ulcer as a complication of a posttraumatic tibial arteriovenous fistula treated by endovascular approach with stent-graft placement.

    PubMed

    Rabellino, Martín; Shinzato, Sergio; Aragón-Sánchez, Javier; Peralta, Oscar; Marenchino, Ricardo; García-Mónaco, Ricardo

    2012-09-01

    Endovascular treatment of posttraumatic arteriovenous fistulae (AVFs) in the lower extremities by means of covered stent-grafts is widely accepted, and many cases have been reported in the iliac-femoral region. However, few reports exist on the treatment of infrapopliteal AVFs, with or without a pseudoaneurysm, using this method. The authors present this case report dealing with a patient who had undergone a tibial and peroneal open fracture in his left limb 34 years ago. He developed a leg ulcer as a consequence of AVF between the tibialis posterior artery and vein, which resulted in venous insufficiency, which was treated by the endovascular approach with the placement of a stent-graft. Total healing was achieved over a period of 3 months. Angio-CT was performed, showing stent-graft patency 6 months after the endovascular procedure. PMID:22843636

  10. [Multiple brain abscesses in the territory of the vertebral-basilar artery resulting from an infected aortic arch graft].

    PubMed

    Otani, Yoshihiro; Inoue, Satoshi; Kawauchi, Satoshi; Uneda, Atsuhito; Kajitani, Takumi; Watanabe, Kyoichi; Deguchi, Kentaro; Kiriyama, Hideki; Tokunaga, Koji; Matsumoto, Kengo

    2015-03-01

    A 62-year-old man with high fever and in a state of disorientation was transferred to our hospital. One year before this transfer, he had undergone total arch replacement surgery for thoracic aortic dissection. On admission to our hospital, head MRI revealed multiple brain abscesses in the territory of the vertebral-basilar artery, and chest CT showed gas around the aortic graft, in particular, at the origin of the left subclavian artery. We diagnosed him with brain abscesses in the left vertebral-basilar artery resulting from an infected aortic graft. We immediately began administration of intravenous antibiotics. Although his blood, urine, and cerebrospinal fluid cultures were negative, fortunately, the brain abscesses and ectopic gas disappeared. Since reports of only antibiotic use for treating brain abscesses due to aortic graft infection are rare, the appropriate duration of antibiotic administration has not been established yet. Therefore, careful observation is required in this case. PMID:25748809

  11. Use of a Stent Graft for Patent Ductus Arteriosus in an Octogenarian Eliminates Ductus Flow.

    PubMed

    Tatsuishi, Wataru; Kataoka, Go; Asano, Ryota; Sato, Atsuhiko; Nakano, Kiyoharu

    2016-06-20

    Closure of a patent ductus arteriosus (PDA) in the elderly is a high-risk procedure because of tissue fragility and many possible complications. The patient in our case was an 81-year-old woman with a window-type PDA caused by cardiac failure. Based on the anatomy of the PDA and aorta and to minimize invasion, we used a stent graft to close the PDA. This approach was successful; hemodynamics improved and ductus flow was eliminated during the follow-up period without intervention from the pulmonary artery side. PMID:26345436

  12. Added Value of Dual-Time-Point 18F-FDG PET/CT With Delayed Imaging for Detecting Aortic Graft Infection: An Observational Study.

    PubMed

    Chang, Chih-Yung; Chang, Cheng-Pei; Shih, Chun-Che; Yang, Bang-Hung; Cheng, Cheng-Yi; Chang, Chi-Wei; Chu, Lee-Shing; Wang, Shyh-Jen; Liu, Ren-Shyan

    2015-07-01

    F-FDG PET/CT is a promising tool in detecting aortic graft infection. Present study investigated the value of dual-time-point F-FDG PET/CT imaging (DTPI) with delayed imaging in assessing aortic graft infection.Twenty-nine patients with suspected aortic graft infection were prospectively enrolled in this DTPI study. Two nuclear medicine physicians read all the images and achieved consensus about the measurement of maximal standardized uptake value (SUVmax) and grading of image quality. The percentages of SUVmax change between initial and delayed images were recorded as retention index (RI); sensitivity, specificity, and accuracy were calculated based on reference standard.All the 5 infected aortic grafts had positive RIs, which were generally higher than that of noninfected grafts. Those noninfected grafts had variable RIs. Seven patients had improved image quality in delayed imaging. DTPI with delayed image detected all the infected grafts with improved specificity (88%) and accuracy (90%), providing conspicuous delineation of the infected graft extent.In conclusion, noninfected aortic grafts had more variable RIs than infected ones. DTPI might be useful for detecting aortic graft infection, improving image quality, and enhancing delineation of the infected aortic grafts. PMID:26166113

  13. Treatment of symptomatic coral reef aorta with an uncovered stent graft.

    PubMed

    Bosanquet, D C; Wood, A; Williams, I M

    2015-10-01

    Coral reef aorta is a rare condition characterised by extreme calcific growths affecting the juxta and suprarenal aorta. It can cause symptoms due to visceral ischaemia, lower limb hypoperfusion, and distal embolisation. We present a case of a 61-year-old man with unresponsive hypertension, who was found to have an occluded right renal artery, and an extensive coral reef aorta with a marked pressure gradient across the lesion. Renal hypoperfusion secondary to aortic coral reef aorta was thought to be the cause for his hypertension. Endovascular placement of a balloon expandable uncovered stent resolved his hypertension within one month, with no adverse effects noted at subsequent follow-up. Endovascular treatment of coral reef aorta is technically possible and avoids a major vascular procedure. PMID:25394887

  14. First Magnetic Resonance Imaging-Guided Aortic Stenting and Cava Filter Placement Using a Polyetheretherketone-Based Magnetic Resonance Imaging-Compatible Guidewire in Swine: Proof of Concept

    SciTech Connect

    Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H.; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M.; Borm, Paul J. A.; Jacob, Augustinus L.; Bilecen, Deniz

    2009-05-15

    The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

  15. Combined Endovascular Repair of a Celiac Trunk Aneurysm Using Celiac-Splenic Stent Graft and Hepatic Artery Embolization

    SciTech Connect

    Carrafiello, Giampaolo; Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele; Mariscalco, Giovanni; Bracchi, Elena; Ferrario, Massimo

    2010-04-15

    Celiac trunk aneurysms are rare and usually asymptomatic lesions. However, treatment is generally warranted to avoid catastrophic rupture. We report a case of a 70-year-old man who sought care for a celiac trunk aneurysm close to the hepatosplenic bifurcation managed endovascularly by using a combined treatment of celiac-splenic stent-graft implantation and hepatic artery embolization.

  16. Superior Mesenteric Artery Pseudoaneurysm Following Pancreaticoduodenectomy: Management by Endovascular Stent-Graft Placement and Transluminal Thrombin Injection

    SciTech Connect

    Wallace, Michael J. Choi, Eugene; McRae, Stephen; Madoff, David C.; Ahrar, Kamran; Pisters, Peter

    2007-06-15

    Superior mesenteric artery (SMA) pseudoaneurysm formation is a rare and potentially fatal postoperative complication. Herein we present a case of a large post-pancreaticoduodenectomy SMA pseudoaneurysm that required thrombin injection after initial stent-graft deployment to accomplish complete pseudoaneurysm occlusion.

  17. Endovascular stent grafting of a posterior tibial artery pseudoaneurysm secondary to penetrating trauma: case report and review of the literature.

    PubMed

    de Troia, Alessandro; Biasi, Lukla; Iazzolino, Luigi; Azzarone, Matteo; Tecchio, Tiziano; Rossi, Cristina; Salcuni, Pierfranco

    2014-10-01

    Endovascular treatment of posttraumatic pseudoaneurysms has become a viable less-invasive option when compared with open repair. In this study, we present a case of a posttraumatic pseudoaneurysm of the posterior tibial artery in a 34-year-old man treated with endovascular stent grafting. An extensive review of the literature has been performed. PMID:24530718

  18. Successful endovascular treatment of a 13 cm abdominal aortic aneurysm. Case report.

    PubMed

    Santagata, A; Giribono, A M; Ferrara, D; Viviani, E; Narese, D; Midiri, F; Albano, D; Padricelli, A; Del Guercio, L

    2016-01-01

    There is increasing evidence in the literature that endovascular aneurysm repair is the first-line approach for most of abdominal aortic aneurysms (AAAs). Furthermore aortouniiliac stent graft placement is, in high risk patients or during emergency setting, a safe procedure over the mid- and long-term period and compares well with the results of bifurcated stent grafts. We present a case of a 66 -year-old gentleman, with pneumothorax after therapeutic thoracentesis and a giant AAA, successfully treated with an aortomonoiliac stent grafting and femoro-femoral crossover bypass. PMID:27212572

  19. The interactions between bloodstream and vascular structure on aortic dissecting aneurysmal model: A numerical study

    NASA Astrophysics Data System (ADS)

    Chen, Zeng-Sheng; Fan, Zhan-Ming; Zhang, Xi-Wen

    2013-06-01

    Stent-graft implantation is an important means of clinical treatment for aortic dissecting aneurysm (ADA). However, researches on fluid dynamics effects of stent were rare. Computer simulation was used to investigate the interactions between bloodstream and vascular structure in a stented ADA, which endures the periodic pulse velocity and pressure. We obtained and analyzed the flow velocity distribution, the wall displacement and wall stress in the ADA. By comparing the different results between a non-stented and a stented ADA, we found that the insertion of a vascular graft can make the location of maximum stress and displacement move from the aneurysm lumen wall to the artery wall, accompanied with a greatly decrease in value. These results imply that the placement of a stent-graft of any kind to occlude ADA will result in a decreased chance of rupture.

  20. Effect of graft material on loss of erythrocytes after aortic operations.

    PubMed

    Fisher, J B; Dennis, R C; Valeri, C R; Woodson, J; Doyle, J E; Walsh, L M; Pivacek, L; Giorgio, A; LaMorte, W W; Menzoian, J O

    1991-08-01

    It has been suggested that loss of erythrocytes after abdominal aortic grafting is influenced by the type of synthetic graft used. A prospective randomized study was done to compare loss of erythrocytes in patients receiving Dacron (polyester fiber, Meadox woven double velour) and Gore-Tex (polytetrafluoroethylene [PTFE]) grafts during the perioperative period. A total of 25 patients (13 Dacron and 12 PTFE) was studied, including 21 with abdominal aortic aneurysms and four with aortoiliac occlusive disease. Erythrocyte volume (EV) was measured using 51Cr-labeled autologous erythrocytes on the day prior to the operation, one to two hours after the operation when the patients were hemodynamically stable and 24 hours postoperatively. In addition to measurements of 51Cr EV and the volume of intraoperatively salvaged washed erythrocytes, the length of storage of the units of homologous liquid preserved erythrocytes at 4 degrees C. prior to transfusion were recorded. The mean intraoperative erythrocyte loss (+/- S.D.) for the Dacron group was 892 +/- 543 milliliters and for the PTFE group, 842 +/- 403 milliliters (p = NS). Patients in the Dacron group received intraoperatively 2.2 +/- 1.6 (units +/- S.D.) milliliters with a range of zero to 4 units of homologous liquid preserved erythrocytes and patients in the PTFE group received 1.2 +/- 1.2 milliliters with a range of zero to 3 units of homologous liquid preserved erythrocytes (p = NS). The mean total loss of erythrocytes (+/- S.D.) was 1,055 +/- 649 milliliters for the Dacron group and 978 +/- 503 milliliters for the PTFE group (p = NS). Despite inherent differences in graft material, there were no significant differences in intraoperative or post-operative loss of erythrocytes or in the number of homologous units of liquid preserved erythrocytes transfused with a p value of less than 0.05 considered significant. PMID:1833839

  1. Endovascular repair of a type B aortic dissection with a right-sided aortic arch: case report

    PubMed Central

    2013-01-01

    Right-sided aortic arch is a rare anomaly, and aortic dissection involving a right-sided aortic arch is extremely rare. We report the case of a 65-year-old man with a right-sided aortic arch and a right descending aortic dissection and a stent-graft was accurately deployed without perioperative complications. There were no any complaints and complications after 18 months follow-up. The CTA demonstrated that the false lumen was largely thrombosed only with a mild type II endoleak and a mild descending aortic expansion. We feel that endovascular repair is feasible to patient of type B aortic dissection with a right-sided aortic arch. However, long-term clinical efficacy and safety have yet to be confirmed. PMID:23343010

  2. Open aortic surgery after thoracic endovascular aortic repair.

    PubMed

    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. PMID:27314956

  3. Aortic vascular graft infection caused by Cardiobacterium valvarum: a case report.

    PubMed

    Hagiya, Hideharu; Kokeguchi, Susumu; Ogawa, Hiroko; Terasaka, Tomohiro; Kimura, Kosuke; Waseda, Koichi; Hanayama, Yoshihisa; Oda, Kaori; Mori, Hisatoshi; Miyoshi, Toru; Otsuka, Fumio

    2014-12-01

    A 53-year-old man with a past medical history of total arch replacement surgery and severe aortic regurgitation presented with a 1-month history of persistent general malaise, anorexia, body weight loss and night sweats. His recent history included gingival hyperplasia for 6 years, gingivitis after tooth extraction 3 years before, prolonged inflammatory status for 4 months, fundal hemorrhage and leg tenderness for 2 months. A pathogen was detected from blood culture, but conventional microbiological examination failed to identify the pathogen. The organism was eventually identified as Cardiobacterium valvarum by 16S rRNA analysis, and the patient was diagnosed with infective endocarditis and prosthetic vascular graft infection. The patient received intravenous antibiotic therapy using a combination of ceftriaxone and levofloxacin for 5 weeks and was discharged with a good clinical course. C. valvarum is a rare human pathogen in clinical settings. Only 10 cases have been reported to date worldwide, and therefore, the clinical characteristics of C. valvarum infection are not fully known. This is a first well-described case of C. valvarum infection in Japan, and further, a first report of aortic prosthetic vascular graft infection worldwide. Identification of C. valvarum is usually difficult due to its phenotypic characteristics, and molecular approaches would be required for both clinicians and microbiologists to facilitate more reliable diagnosis and uncover its clinical picture more clearly. PMID:25242585

  4. Successful Covering of a Hepatic Artery Aneurysm with a Coronary Stent Graft

    SciTech Connect

    Sakai, Hidetsugu; Urasawa, Kazushi; Oyama, Naotsugu; Kitabatake, Akira

    2004-09-15

    In a 54-year-old woman with liver cirrhosis who underwent orthotopic liver transplantation, the postoperative course was complicated by aneurysm formation in the hepatic artery. Abdominal ultrasonography showed a daily increase in the size of the aneurysm in spite of careful management including strict rest and continuous intravenous infusion of antihypertensive agents. Since the patient's poor systemic status was a major obstruction to operative resection, transcatheter therapy was thought more preferable. We evaluated the lesion with intravascular ultrasonography as an adjunct to angiography and a dissection with a flap was well visualized. The aneurysm was covered with a commercially available stent-graft, designed for treatment of the coronary artery. This is a rare case in which a Jostent was implanted into the hepatic artery after liver transplantation.

  5. Bronchobiliary Fistula Treated by Self-expanding ePTFE-Covered Nitinol Stent-Graft

    SciTech Connect

    Gandini, Roberto; Konda, Daniel Tisone, Giuseppe; Pipitone, Vincenzo; Anselmo, Alessandro; Simonetti, Giovanni

    2005-12-15

    A 71-year-old man, who had undergone right hepatectomy extended to the caudate lobe with terminolateral Roux-en-Y left hepatojejunostomy for a Klatskin tumor, developed bilioptysis 3 weeks postoperatively due to bronchobiliary fistula. Percutaneous transhepatic cholangiography revealed a non-dilated biliary system with contrast medium extravasation to the right subphrenic space through a resected anomalous right posterior segmental duct. After initial unsuccessful internal-external biliary drainage, the fistula was sealed with a VIATORR covered self-expanding nitinol stent-graft placed with its distal uncovered region in the hepatojejunal anastomosis and the proximal ePTFE-lined region in the left hepatic duct. A 10-month follow-up revealed no recurrence of bilioptysis and confirmed the complete exclusion of the bronchobiliary fistula.

  6. Stent graft exclusion of a ruptured mycotic popliteal pseudoaneurysm complicating sternoclavicular joint infection.

    PubMed

    Ghassani, Afif; Delva, Jean-Cristophe; Berard, Xavier; Deglise, Sebastien; Ducasse, Eric; Midy, Dominique

    2012-07-01

    A mycotic pseudoaneurysm of the popliteal artery is usually a consequence of septic embolization and often a result of bacterial endocarditis. Conventional treatment is surgical and avoids the placement of foreign material in infected sites. Here we report our treatment of a 59-year-old man who presented with a rupture of a mycotic pseudoaneurysm of the popliteal artery due to septic embolism from sternoclavicular infectious arthritis. Radiological investigations are included. This is the first documented case of septic arthritis complicated by a rupture of a mycotic popliteal false aneurysm and treated using an endovascular procedure. Combining endovascular stent grafts with evacuation of the joint abscess and antibiotic therapy can offer a safe alternative for frail and unstable patients. PMID:22664287

  7. Are TIPS Stent-Grafts a Contraindication for Future Liver Transplantation?

    SciTech Connect

    Maleux, Geert; Pirenne, Jacques; Vaninbroukx, Johan; Aerts, Raymond; Nevens, Frederik

    2004-03-15

    Our purpose was to assess the feasibility of orthotopic liver transplantation (OLT) in patients priorly having undergone transjugular intrahepatic portosystemic shunt (TIPS) with an expanded tetrafluoroethylene (e-PTFE)-covered endoprosthesis. In 48 patients an e- PTFE-covered endoprosthesis was inserted to treat severe complications of portal hypertension. In 36 patients the endoprosthesis was inserted during TIPS creation (de novo TIPS); in the other 12 patients the endoprosthesis was placed to repermeabilize the previously created, but occluded bare stent (revision TIPS). Eight of them (5 de novo and 3 revision cases) later underwent an OLT. The hospital records of these patients were reviewed from initial admission, through TIPS, the pre-OLT period, and OLT to current postoperative status. Five de novo and 3 revision cases underwent OLT 4-279 days (mean delay: 80.8 days) after TIPS procedure. All OLT's were performed under veno-venous bypass surgery. De visu surgical inspection confirmed correct positioning of the fully patent stent graft, starting in the portal vein and ending at the junction of the hepatic vein to the inferior caval vein. No surgical difficulty was observed during proximal or distal clamping or during resection of the diseased liver. Correctly positioned e-PTFE-covered nitinol endoprostheses do not interfere with a later OLT and may not be considered as a contraindication in patients who need a TIPS as a bridge to OLT.

  8. Does really previous stenting affect graft patency following CABG? A 5-year follow-up: The effect of PCI on graft survival.

    PubMed

    Songur, Murat Çetin; Özyalçin, Sertan; Özen, Anıl; Şimşek, Erdal; Kervan, Ümit; Taşoğlu, İrfan; Kaplan, Sadi; Köse, Kenan; Ulus, Ahmet Tulga

    2016-04-01

    The aim of this study was to compare the graft patency rates among patients who had a previous history of percutaneous coronary intervention (PCI) followed by coronary artery bypass grafting surgery (CABG) with the patients who had experienced CABG surgery alone. The 69 patients who were included in the study had a history of bare metal stent implantation prior to CABG (group 1). The coronary angiography results were compared with 69 patients who had a previous history of CABG (group 2). Graft patency rates of the left anterior descending artery and circumflex anastomoses are statistically significant for both groups, whereas the right coronary artery anastomoses are not statistically significant (p = 0.008; 0.009; 0.2). Graft patency rate of LIMA-LAD anastomoses was 43.9 ± 10.8 % in group 1 and 86.2 ± 6 % in group 2 for means of 60 months (p = 0.0001) and circumflex coronary artery anastomosis is 28.9 ± 0.9 % in group 1, 65.7 ± 10.8 % in group 2 (p = 0.0001) and the right coronary artery anastomosis is 37.2 ± 13.6 % in group 1, 56.4 ± 8.9 % in group 2 (p = 0.0001). The graft patency rates of coronary arteries without previous stent implantation were higher than the patients with previous stent implantation and experienced CABG. The results suggest that prior PCI may induce atherosclerotic events in the vessel that can adversely affect graft patency after surgery. PMID:25637043

  9. Endovascular management of a ruptured thoracoabdominal aneurysm-damage control with superior mesenteric artery snorkel and thoracic stent-graft exclusion.

    PubMed

    Riesenman, Paul J; Reeves, James G; Kasirajan, Karthikeshwar

    2011-05-01

    We report a case of a large ruptured thoracoabdominal aortic aneurysm, which was stabilized with endovascular aortic exclusion and snorkel bypass of the superior mesenteric artery (SMA). An 80-year-old African American woman with multiple medical comorbidities and previous open infrarenal abdominal aortic aneurysm repair presented with a ruptured 10.7 × 7.3 cm thoracoabdominal aortic aneurysm involving the origins of the renal and mesenteric vessels. The patient underwent emergent endovascular aortic repair with placement of a covered stent into the SMA coursing parallel to the aortic endograft. This technique was initially successful in clinically stabilizing the patient; however; 3 weeks after the initial procedure, she presented with recurrent rupture necessitating proximal extension of her snorkeled SMA bypass and aortic endograft into the mid-descending thoracic aorta. The patient stabilized and was successfully discharged home. PMID:21549926

  10. Endograft collapse following endovascular repair of traumatic aortic injury.

    PubMed

    Annamalai, Ganesan; Cook, Richard; Martin, Michael

    2011-03-01

    The advent of endovascular treatment of traumatic thoracic aortic injuries offers a valuable, minimally invasive alternative to open surgical repair. However, there are limitations of the current endovascular stent graft technology for this group of patients. After endovascular repair meticulous follow-up is required with a high index of suspicion for potential complications including the lethal complication of endograft collapse. PMID:19784919

  11. Total ellipse of the heart valve: the impact of eccentric stent distortion on the regional dynamic deformation of pericardial tissue leaflets of a transcatheter aortic valve replacement.

    PubMed

    Gunning, Paul S; Saikrishnan, Neelakantan; Yoganathan, Ajit P; McNamara, Laoise M

    2015-12-01

    Transcatheter aortic valve replacements (TAVRs) are a percutaneous alternative to surgical aortic valve replacements and are used to treat patients with aortic valve stenosis. This minimally invasive procedure relies on expansion of the TAVR stent to radially displace calcified aortic valve leaflets against the aortic root wall. However, these calcium deposits can impede the expansion of the device causing distortion of the valve stent and pericardial tissue leaflets. The objective of this study was to elucidate the impact of eccentric TAVR stent distortion on the dynamic deformation of the tissue leaflets of the prosthesis in vitro. Dual-camera stereophotogrammetry was used to measure the regional variation in strain in a leaflet of a TAVR deployed in nominal circular and eccentric (eccentricity index = 28%) orifices, representative of deployed TAVRs in vivo. It was observed that (i) eccentric stent distortion caused incorrect coaptation of the leaflets at peak diastole resulting in a 'peel-back' leaflet geometry that was not present in the circular valve and (ii) adverse bending of the leaflet, arising in the eccentric valve at peak diastole, caused significantly higher commissure strains compared with the circular valve in both normotensive and hypertensive pressure conditions (normotension: eccentric = 13.76 ± 2.04% versus circular = 11.77 ± 1.61%, p = 0.0014, hypertension: eccentric = 15.07 ± 1.13% versus circular = 13.56 ± 0.87%, p = 0.0042). This study reveals that eccentric distortion of a TAVR stent can have a considerable impact on dynamic leaflet deformation, inducing deleterious bending of the leaflet and increasing commissures strains, which might expedite leaflet structural failure compared to leaflets in a circular deployed valve. PMID:26674192

  12. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection.

    PubMed

    Lee, Jae-Hong; Na, Bubse; Hwang, Yoohwa; Kim, Yong Han; Park, In Kyu; Kim, Kyung-Hwan

    2016-02-01

    A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient's postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up. PMID:26889449

  13. Two-Stage Procedure for Infected Aortic Graft Pseudoaneurysm: 10-Year Follow Up after Omental Prosthesis Wrapping.

    PubMed

    von Aspern, Konstantin; Etz, Christian D; Mohr, Friedrich W; Battellini, Roberto R

    2015-08-01

    Prosthetic graft infections with mediastinitis following aortic surgery are rare, yet represent grave complications yielding high morbidity and mortality. We present the case of a 57-year-old female patient with past history of emergent surgery for iatrogenic Type A dissection treated by supracoronary ascending aortic replacement. Four months after the initial surgery, a sternal fistula had formed and due to severe bleeding emergent reoperation was required. Imaging and pathology on admission revealed an infected pseudoaneurysm at the distal aortic prosthesis and mediastinitis with methicillin-resistant Staphylococcus aureus. Rescue surgery was performed by means of a two-stage approach, with extensive debridement, graft replacement and continuous antiseptic lavage in a first step and an omental wrapping of the new prosthesis in a second stage 24 hours later. During 10 years of follow-up, no recurrent infection occurred. The operative approach and general considerations for management of infected pseudoaneurysms are discussed. PMID:27069945

  14. Transjugular Intrahepatic Portosystemic Shunt Occlusion Complicated with Biliary Fistula Successfully Treated with a Stent Graft: A Case Report

    PubMed Central

    Kim, Eunyoung; Lee, Sung Won; Kim, Woo Hyeon; Bae, Si Hyun; Han, Nam Ik; Oh, Jung Suk; Chun, Ho Jong; Lee, Hae Giu

    2016-01-01

    A 43-year-old man with liver cirrhosis received transjugular intrahepatic portosystemic shunt (TIPS) for the treatment of recurrent variceal bleeding and F3 esophageal varices. During routine follow up liver ultrasound examination, six months after the implantation, TIPS occlusion was suspected and TIPS revision was performed. During the revision, moderate to severe stenosis at the hepatic venous segment of the tract and a total occlusion at the parenchymal segment of TIPS tract near the portal vein with biliary-TIPS fistula were identified with a clear visualization of the common bile duct. After the successful TIPS revision with the placement of an additional stent-graft, the biliary fistula and common bile duct were no more delineated. We herein report a rare case with an obvious visualization of biliary-TIPS fistula associated with obstruction of TIPS shunt on the tractogram and recanalization with an additional stent-graft. PMID:27127576

  15. Endovascular repair of thoracic aortic aneurysms.

    PubMed

    Cartes-Zumelzu, F; Lammer, J; Kretschmer, G; Hoelzenbein, T; Grabenwöger, M; Thurnher, S

    2000-03-01

    The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times and a variety of peri- and postoperative complications. This and the success of the first endoluminal treatment of abdominal aortic aneurysms by Parodi et al. prompted the attention to be thrown on the treatment of descending thoracic aortic aneurysms with endoluminal stent-grafts in many large centres. The aim of this new minimally invasive technique is to exclude the aneurysm from blood flow and in consequence to avoid pressure stress on the aneurysmatic aortic wall, by avoiding a large open operation with significant perioperative morbidity. The potentially beneficial effect of this new treatment approach was evaluated in the course of this study. PMID:10875224

  16. Treatment of a TIPS-Biliary Fistula by Stent-Graft in a 9-Year-Old Boy

    SciTech Connect

    Boyvat, Fatih; Cekirge, Saruhan; Balkanci, Ferhun; Besim, Aytekin

    1999-01-15

    We report a 9-year-old male cirrhotic patient with acute occlusion of a transjugular intrahepatic portosystemic shunt (TIPS) due to a biliary-to-TIPS fistula which occurred 9 hr after the TIPS procedure. Immediate TIPS revision was performed and the fistula was treated by placement of an endoluminal stent-graft. At 12-month follow-up color Doppler examination demonstrated a patent shunt.

  17. [Thoracic Endovascular Aortic Aneurysm Repair in a Young Patient with Descending Aortic Injury;Report of a Case].

    PubMed

    No, Hironari; Nishida, Satoru; Takagi, Takeshi; Mohri, Ryosuke

    2016-08-01

    A 15-year-old boy was referred to our emergency room due to a penetrating injury of the back. Computed tomography( CT) demonstrated a descending aortic injury at the Th9/10 level, bilateral hemothorax, and spinal cord injury. Although surgical treatment was indicated, multiple organ injury complicated open surgical repair, which required cardiopulmonary bypass with full heparinization. Therefore, the patient was scheduled to undergo thoracic endovascular aortic repair (TEVAR). A 23×33-mm Excluder aortic extension cuff was chosen for the small, 15-mm diameter aorta. The aortic extension was delivered and deployed in the descending aorta. Postoperative CT demonstrated neither endoleak nor collapse of the stent-graft. TEVAR for traumatic aortic aneurysm appears to be safe and effective, and an aortic extension for an abdominal aortic aneurysm may be utilized as an alternative device if the patient is young and the aorta is small. PMID:27476569

  18. Use of the Viatorr Expanded Polytetrafluoroethylene-Covered Stent-Graft for Transjugular Intrahepatic Portosystemic Shunt Creation in Children: Initial Clinical Experience

    SciTech Connect

    Mermuys, Koen; Maleux, Geert Heye, Sam; Lombaerts, Rita; Nevens, Frederik

    2008-07-15

    Four children, three boys and one girl, with a median age of 9 years 8 months, underwent transjugular intrahepatic portosystemic shunt creation with an expanded polytetrafluoroethylene (e-PTFE)-covered nitinol stent. The stent-graft was successfully placed in all four patients without any complication. Clinical and biochemical improvement was noted in all four patients during follow-up. Radiological follow-up with use of duplex ultrasound showed a recurrent stenosis of the shunt 180 days after stent-graft implantation in one patient. This was treated with placement of an additional stent-graft, re-expanding completely the recurrent stenosis. In the other three patients, the stent-graft remained fully patent until the end of the study or until orthotopic liver transplantation. These preliminary results suggest that use of the Viatorr ePTFE-covered stent-graft in children is safe and feasible, with potentially the same high patency rate and improved clinical outcome as reported in adult patients.

  19. Endovascular treatment of abdominal aortic aneurysms.

    PubMed

    Buck, Dominique B; van Herwaarden, Joost A; Schermerhorn, Marc L; Moll, Frans L

    2014-02-01

    Patients with abdominal aortic aneurysms (AAAs) are usually treated with endovascular aneurysm repair (EVAR), which has become the standard of care in many hospitals for patients with suitable anatomy. Clinical evidence indicates that EVAR is associated with superior perioperative outcomes and similar long-term survival compared with open repair. Since the randomized, controlled trials that provided this evidence were conducted, however, the stent graft technology for infrarenal AAA has been further developed. Improvements include profile downsizing, optimization of sealing and fixation, and the use of low porosity fabrics. In addition, imaging techniques have improved, enabling better preoperative planning, stent graft placement, and postoperative surveillance. Also in the past few years, fenestrated and branched stent grafts have increasingly been used to manage anatomically challenging aneurysms, and experiments with off-label use of stent grafts have been performed to treat patients deemed unfit or unsuitable for other treatment strategies. Overall, the indications for endovascular management of AAA are expanding to include increasingly complex and anatomically challenging aneurysms. Ongoing studies and optimization of imaging, in addition to technological refinement of stent grafts, will hopefully continue to broaden the utilization of EVAR. PMID:24343568

  20. Endovascular Treatment of Multiple HIV-related Aneurysms Using Multilayer Stents

    SciTech Connect

    Euringer, Wulf; Suedkamp, Michael; Rylski, Bartosz; Blanke, Philipp

    2012-08-15

    Complex peripheral aneurysm anatomy with major artery branches in the immediate vicinity and mycotic aneurysm often impede endovascular management using covered stent grafts. The Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) is a recently approved innovative stent system for peripheral aneurysm management. Its multilayer design aims at decreasing mean velocity and vorticity within the aneurysm sac to cause thrombus formation while maintaining patency of branching vessels due to laminar flow. We present a case of bilateral subclavian artery aneurysms and perivisceral aortic aneurysms in an AIDS patient successfully treated with the Cardiatis Multilayer Stent at 18 months' follow-up.

  1. Billowing Of Endologix Powerlink Stent Mimicking Endoleaks

    PubMed Central

    Wu, Alex; Karuppasamy, Karunakaravel; Wang, Weiping

    2016-01-01

    Introduction: Endoleaks remains one of the primary concerns of endovascular aortic aneurysm repair (EVAR) and is routinely followed with CT angiography (CTA). However, certain imaging findings can mimic endoleaks. Case Presentation: A 65-year-old woman who had endovascular aortic repair (EVAR) of an abdominal aortic aneurysm with Endologix Powerlink system developed marked new circumferential cauliflower-like bulging of contrast-filled sacs at mid-stent-graft with enlargement of the excluded aneurysm at 3-year follow-up. Conclusions: Considering the unique construct of the Powerlink stents, this is thought to represent aneurysmal degeneration of the outer fabric material from the metal struts and may potentially pressurize the excluded sac with risk for rupture. PMID:26949697

  2. Contemporary Role of Computational Analysis in Endovascular Treatment for Thoracic Aortic Disease

    PubMed Central

    van Bogerijen, Guido H.W.; Tolenaar, Jip L.; Conti, Michele; Auricchio, Ferdinando; Secchi, Francesco; Sardanelli, Francesco; Moll, Frans L.; van Herwaarden, Joost A.; Rampoldi, Vincenzo; Trimarchi, Santi

    2013-01-01

    In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure. Different techniques of medical imaging, like computed tomography or magnetic resonance imaging, can be used to evaluate dynamics in the thoracic aorta. Such information can also be combined with dedicated patient-specific computer-based simulations, to provide a further insight into the biomechanical aspects. In clinical practice, computational analysis might show the development of aortic disease, such as the aortic wall segments which experience higher stress in places where rupture and dissection may occur. In aortic dissections, the intimal tear is usually located at the level of the sino-tubular junction and/or at the origin of the left subclavian artery. Besides, computational models may potentially be used preoperatively to predict stent graft behavior, virtually testing the optimal stent graft sizing, deployment, and conformability, in order to provide the best endovascular treatment. The present study reviews the current literature regarding the use of computational tools for TEVAR biomechanics, highlighting their potential clinical applications. PMID:26798690

  3. Contemporary Role of Computational Analysis in Endovascular Treatment for Thoracic Aortic Disease.

    PubMed

    van Bogerijen, Guido H W; Tolenaar, Jip L; Conti, Michele; Auricchio, Ferdinando; Secchi, Francesco; Sardanelli, Francesco; Moll, Frans L; van Herwaarden, Joost A; Rampoldi, Vincenzo; Trimarchi, Santi

    2013-08-01

    In the past decade, thoracic endovascular aortic repair (TEVAR) has become the primary treatment option in descending aneurysm and dissection. The clinical outcome of this minimally invasive technique is strictly related to an appropriate patient/stent graft selection, hemodynamic interactions, and operator skills. In this context, a quantitative assessment of the biomechanical stress induced in the aortic wall due to the stent graft may support the planning of the procedure. Different techniques of medical imaging, like computed tomography or magnetic resonance imaging, can be used to evaluate dynamics in the thoracic aorta. Such information can also be combined with dedicated patient-specific computer-based simulations, to provide a further insight into the biomechanical aspects. In clinical practice, computational analysis might show the development of aortic disease, such as the aortic wall segments which experience higher stress in places where rupture and dissection may occur. In aortic dissections, the intimal tear is usually located at the level of the sino-tubular junction and/or at the origin of the left subclavian artery. Besides, computational models may potentially be used preoperatively to predict stent graft behavior, virtually testing the optimal stent graft sizing, deployment, and conformability, in order to provide the best endovascular treatment. The present study reviews the current literature regarding the use of computational tools for TEVAR biomechanics, highlighting their potential clinical applications. PMID:26798690

  4. Direct distal aortic arch graft cannulation after the elephant trunk procedure: technique for central cannulation during second-stage repair.

    PubMed

    Quintana, Eduard; Pochettino, Alberto

    2015-07-01

    Arterial cannulation after the elephant trunk (ET) procedure at the time of second-stage distal repair can be achieved through multiple routes. Common strategies for arterial perfusion at the time of second-stage aortic repair include retrograde perfusion (femoral/iliac vessels), transapical or left subclavian artery cannulation. In the event these cannulation options are not practical or advisable, we offer an alternative approach through cannulation of the distal aortic arch Dacron graft through the left thorax. Advantages include forward distal perfusion, minimal proximal ischaemic time, prevention of thromboembolic events from thrombus attached to the ET and avoidance of malperfusion syndromes. PMID:25281849

  5. Endovascular Management of Delayed Complete Graft Thrombosis After Endovascular Aneurysm Repair

    SciTech Connect

    Thurley, Peter D.; Glasby, Michael J.; Pollock, John G.; Bungay, Peter; Nunzio, Mario De; El-Tahir, Amin M.; Quarmby, John W.

    2010-08-15

    Graft thrombosis rates after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms vary widely in published series. When thrombosis does occur, it usually involves a single limb and occurs within 3 months of stent-graft insertion. If the entire endoprosthesis is thrombosed, treatment may be challenging because femoro-femoral crossover graft insertion is not an option and a greater volume of thrombus is present, thus making thrombolysis more difficult. We present two cases of delayed thrombosis after EVAR involving the entire stent-graft. These were successfully treated by a combined surgical and endovascular technique, and patency has been maintained in both cases to date.

  6. Early and Long-Term Results of Stent Implantation for Aortic Coarctation in Pediatric Patients Compared to Adolescents: A Single Center Experience

    PubMed Central

    Bondanza, Sara; Calevo, Maria Grazia; Marasini, Maurizio

    2016-01-01

    Background. Stents have become the treatment of choice for native aortic coarctation in adults and adolescents, but in pediatric patients insufficient data are currently available to identify the best therapeutic option. Methods. To compare the outcomes of pediatric and adolescent patients, we retrospectively evaluated early and long-term results of stenting for aortic coarctation in 34 patients divided into 2 groups (A and B) composed, respectively, of 17 children (mean age 8.2 ± 2.3, weight ≤30 kg) and 17 adolescents (mean age 14.3 ± 1.7, weight >30 kg). Results. No significant differences in outcome were found between groups immediately after the procedure. In all of our patients, peak systolic gradient pressure significantly decreased after stenting from 43.7 ± 12 to 1.7 ± 3.1 mmHg in group A and from 39.4 ± 16.8 to 1.6 ± 3 in group B (p < 0.0001). We observed early and late adverse events in both groups: early femoral vessel injury or thrombosis was more frequent in younger patients, as well as restenosis due to vessel growth requiring stent redilatations, often complicated by stent fractures. Data from long-term follow-up showed that, in younger patients, stress-related hypertension was more frequent. Conclusions. The procedure was immediately safe and effective in both groups. Pediatric patients must be accurately selected before stenting because they could probably need reinterventions and stents could impact on their future therapeutic perspectives. PMID:26925287

  7. Early and Long-Term Results of Stent Implantation for Aortic Coarctation in Pediatric Patients Compared to Adolescents: A Single Center Experience.

    PubMed

    Bondanza, Sara; Calevo, Maria Grazia; Marasini, Maurizio

    2016-01-01

    Background. Stents have become the treatment of choice for native aortic coarctation in adults and adolescents, but in pediatric patients insufficient data are currently available to identify the best therapeutic option. Methods. To compare the outcomes of pediatric and adolescent patients, we retrospectively evaluated early and long-term results of stenting for aortic coarctation in 34 patients divided into 2 groups (A and B) composed, respectively, of 17 children (mean age 8.2 ± 2.3, weight ≤30 kg) and 17 adolescents (mean age 14.3 ± 1.7, weight >30 kg). Results. No significant differences in outcome were found between groups immediately after the procedure. In all of our patients, peak systolic gradient pressure significantly decreased after stenting from 43.7 ± 12 to 1.7 ± 3.1 mmHg in group A and from 39.4 ± 16.8 to 1.6 ± 3 in group B (p < 0.0001). We observed early and late adverse events in both groups: early femoral vessel injury or thrombosis was more frequent in younger patients, as well as restenosis due to vessel growth requiring stent redilatations, often complicated by stent fractures. Data from long-term follow-up showed that, in younger patients, stress-related hypertension was more frequent. Conclusions. The procedure was immediately safe and effective in both groups. Pediatric patients must be accurately selected before stenting because they could probably need reinterventions and stents could impact on their future therapeutic perspectives. PMID:26925287

  8. Bilateral Renal Artery Aneurysm: Percutaneous Treatment with Stent-Graft Placement

    SciTech Connect

    Gandini, R.; Spinelli, A.; Pampana, E.; Fabiano, S.; Pendenza, G. Simonetti, G.

    2006-10-15

    A 51-year-old man with an 8-year history of hypertension (170/115 mmHg with two drugs) and altered renal function (5.6 mg/dl serum creatinine, 101 mg/dl BUN) was referred to our Department to evaluate the renal arteries and rule out renovascular hypertension. Doppler ultrasound and magnetic resonance angiography revealed significant bilateral renal artery stenosis and the presence of bilateral renal artery aneurysms. A self-expandable polytetrafluoroethylene (PTFE)-covered nitinol stent-graft was deployed in each renal artery to treat the stenoses and to exclude the aneurysm. Postprocedural digital subtraction angiography confirmed the resolution of the renal artery stenoses and the complete exclusion of the aneurysms. At the 6 month follow-up, color Doppler confirmed normal patency of the renal arteries with complete exclusion of the aneurysms and significant reduction of the blood pressure (130/85 mmHg with one drug) and serum creatinine levels (2.1 mg/dl)

  9. Registration of preoperative CTA and intraoperative fluoroscopic image sequence for assisting endovascular stent grafting

    NASA Astrophysics Data System (ADS)

    Imamura, Hiroshi; Sugimoto, Naozo; Eiho, Shigeru; Urayama, Shin-ichi; Ueno, Katsuya; Inoue, Kanji

    2002-05-01

    We have investigated a registration method between pre-operative 3D CT angiography (3D-CTA) and intra-operative fluoroscopic image sequence (with/without contrast injection) during intervention. Most registration methods are developed for assisting neurosurgery or orthopedic surgery, but our method is developed for interventional procedure such as endovascular stent grafting. In our method, DRR (Digitally Reconstructed Radiograph) are generated by voxel projection of 3D-CTA after extracting an aorta region. By increasing/decreasing CT value in the aorta region of CTA, DRR with/without contrast media injection are obtained. Subsequently we calculate distance (or similarity) measures between DRR and fluoroscopic image iteratively by changing imaging parameters. The most similar DRR to fluoroscopy is selected. We validated our algorithm by using simulated/clinical fluoroscopic images and DRR (with/without contrast media injection) of thorax and abdomen. Several distance (or similarity) measures were investigated in this experiment. Validation results show that M-estimator of residual is good as matching measure, and registration is well performed for almost all cases. However, accuracy is not enough for non-contrasted thoracic images, and calculation time should be reduced for all cases.

  10. Long-Term Follow-Up After Endovascular Treatment of Acute Aortic Emergencies

    SciTech Connect

    Pitton, M. B. Herber, S.; Schmiedt, W.; Neufang, A.; Dorweiler, B.; Dueber, C.

    2008-01-15

    Purpose. To investigate the long-term outcome and efficacy of emergency treatment of acute aortic diseases with endovascular stent-grafts. Methods. From September 1995 to April 2007, 37 patients (21 men, 16 women; age 53.9 {+-} 19.2 years, range 18-85 years) with acute complications of diseases of the descending thoracic aorta were treated by endovascular stent-grafts: traumatic aortic ruptures (n = 9), aortobronchial fistulas due to penetrating ulcer or hematothorax (n = 6), acute type B dissections with aortic wall hematoma, penetration, or ischemia (n = 13), and symptomatic aneurysm of the thoracic aorta (n = 9) with pain, penetration, or rupture. Diagnosis was confirmed by contrast-enhanced CT. Multiplanar reformations were used for measurement of the landing zones of the stent-grafts. Stent-grafts were inserted via femoral or iliac cut-down. Two procedures required aortofemoral bypass grafting prior to stent-grafting due to extensive arteriosclerotic stenosis of the iliac arteries. In this case the bypass graft was used for introduction of the stent-graft. Results. A total of 46 stent-grafts were implanted: Vanguard/Stentor (n = 4), Talent (n = 31), and Valiant (n = 11). Stent-graft extension was necessary in 7 cases. In 3 cases primary graft extension was done during the initial procedure (in 1 case due to distal migration of the graft during stent release, in 2 cases due to the total length of the aortic aneurysm). In 4 cases secondary graft extensions were performed-for new aortic ulcers at the proximal stent struts (after 5 days) and distal to the graft (after 8 months) and recurrent aortobronchial fistulas 5 months and 9 years after the initial procedure-resulting in a total of 41 endovascular procedures. The 30-day mortality rate was 8% (3 of 37) and the overall follow-up was 29.9 {+-} 36.6 months (range 0-139 months). All patients with traumatic ruptures demonstrated an immediate sealing of bleeding. Patients with aortobronchial fistulas also

  11. Total Percutaneous Aortic Repair: Midterm Outcomes

    SciTech Connect

    Bent, Clare L. Fotiadis, Nikolas; Renfrew, Ian; Walsh, Michael; Brohi, Karim; Kyriakides, Constantinos; Matson, Matthew

    2009-05-15

    The purpose of this study was to examine the immediate and midterm outcomes of percutaneous endovascular repair of thoracic and abdominal aortic pathology. Between December 2003 and June 2005, 21 patients (mean age: 60.4 {+-} 17.1 years; 15 males, 6 females) underwent endovascular stent-graft insertion for thoracic (n = 13) or abdominal aortic (n = 8) pathology. Preprocedural computed tomographic angiography (CTA) was performed to assess the suitability of aorto-iliac and common femoral artery (CFA) anatomy, including the degree of CFA calcification, for total percutaneous aortic stent-graft repair. Percutaneous access was used for the introduction of 18- to 26-Fr delivery devices. A 'preclose' closure technique using two Perclose suture devices (Perclose A-T; Abbott Vascular) was used in all cases. Data were prospectively collected. Each CFA puncture site was assessed via clinical examination and CTA at 1, 6, and 12 months, followed by annual review thereafter. Minimum follow-up was 36 months. Outcome measures evaluated were rates of technical success, conversion to open surgical repair, complications, and late incidence of arterial stenosis at the site of Perclose suture deployment. A total of 58 Perclose devices were used to close 29 femoral arteriotomies. Outer diameters of stent-graft delivery devices used were 18 Fr (n = 5), 20 Fr (n = 3), 22 Fr (n = 4), 24 Fr (n = 15), and 26 Fr (n = 2). Percutaneous closure was successful in 96.6% (28/29) of arteriotomies. Conversion to surgical repair was required at one access site (3.4%). Mean follow-up was 50 {+-} 8 months. No late complications were observed. By CT criteria, no patient developed a >50% reduction in CFA caliber at the site of Perclose deployment during the study period. In conclusion, percutaneous aortic stent-graft insertion can be safely performed, with a low risk of both immediate and midterm access-related complications.

  12. Crater-Like Ulceration of Aortic Arch.

    PubMed

    Simon, Caterina; Calabrese, Alice; Canu, Gianluca; Merlo, Maurizio; Galletti, Lorenzo

    2014-12-01

    We report the case of a 78-year-old female who presented to our hospital with signs of hemorrhagic shock and breathlessness. A transthoracic echocardiography demonstrated pericardial effusion. Computed tomography of the chest showed a penetrating atherosclerotic ulcer of the aortic arch with an intramural hematoma of the ascending and descending aorta. Endovascular repair with stent-grafting was urgently performed and a pericardial window placement was done to reduce mediastinal bleeding. PMID:26798748

  13. Successful Endovascular Repair of Ruptured Abdominal Aortic Aneurysm in a Renal Transplant Recipient

    SciTech Connect

    Kaskarelis, Ioannis S. Koukoulaki, Maria; Lappas, Ioannis; Karkatzia, Fani; Dimopoulos, Nikitas; Filias, Vasilios; Bellenis, Ion; Vougas, Vasilios; Drakopoulos, Spiros

    2006-04-15

    A renal transplant recipient presented in the early post-transplantation period with rupture of an abdominal aortic aneurysm. The high mortality rate of the surgical repair of ruptured aneurysm in addition to the concern of preserving the renal graft prompted us to seek alternative approaches, such as repairing the aneurysm by means of endovascular techniques. The ruptured aneurysm was confirmed by performing computed tomography and digital angiography and thereafter was successfully repaired by endovascular stenting technique (Talent stent-graft), which seems to be a safe and effective method of preserving a renal graft.

  14. Hybrid two-stage repair of thoracoabdominal aortic aneurysm.

    PubMed

    Di Bartolomeo, Roberto; Murana, Giacomo; Cefarelli, Mariano; Alfonsi, Jacopo; Di Marco, Luca; Francesco, Buia; Lovato, Luigi; Pacini, Davide

    2016-01-01

    Thoracoabdominal aortic aneurysm is a challenging disease that often requires an invasive surgical repair. Recently, a less invasive hybrid approach has been proposed to improve postoperative outcomes in high-risk patients. It consists of an open first stage where arterial visceral rerouting is obtained, using a vascular graft followed by a second stage where the remaining thoracoabdominal aorta is covered with a stent graft. Initial results using this approach seem promising. Here, we sought to describe the hybrid two-stage technique that is most frequently used in this extensive aortic pathology. PMID:27188444

  15. Aneurysm growth after late conversion of thoracic endovascular aortic repair

    PubMed Central

    Hayashi, Ichiro; Haijima, Norimasa

    2015-01-01

    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. PMID:27489673

  16. Dissecting thoracic aortic aneurysm associated with tuberculous pleural effusion

    PubMed Central

    Im, Kyong Shil; Choi, Min Kyung; Jeon, Yong Kyoung

    2016-01-01

    We present the case of thoracic aortic aneurysm associated with the tuberculous pleural effusion. An 82-year-old woman underwent emergency stent graft under a diagnosis of dissecting thoracic aortic aneurysm. Preoperative computed tomography revealed right pleural effusion supposed to the hemothorax caused by the dissecting aneurysm. But, the effusion was sanguineous color fluid and it was determined to result from pulmonary tuberculosis. The medical team was exposed to the pulmonary tuberculosis; fortunately no one became infected. Physicians should be aware of the possibility of an infected aortic aneurysm and prepare for pathogen transmission. PMID:27499987

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

    PubMed

    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. PMID:26471501

  18. Aortoesophageal Fistula and Aortic Pseudoaneurysm Induced by Swallowed Fish Bone: A Report of Two Cases

    SciTech Connect

    Chen Aiping Yu Hong; Li Huimin; Xiao Xiangsheng Liu Shiyuan

    2011-02-15

    Esophageal perforation caused by accidental swallowing of fish bones can lead to rare complications, such as aortoesophageal fistula accompanied by aortic pseudoaneurysm, which can be fatal if not properly handled. We report two rare cases of aortoesophageal fistula and aortic pseudoaneurysm caused by esophagus perforation after accidental swallow of fish bone; the patients also had purulent mediastinitis and esophagitis. The treatment of aortic pseudoaneurysm was successful in both cases, with one patient undergoing surgical resection and aortic neoplasty and the other patient undergoing endovascular stent graft placement. Long-term antibiotic treatment was administered to both patients after surgery. There were no postsurgical complications, and the patients recovered without incident.

  19. Current surgical results of acute type A aortic dissection in Japan.

    PubMed

    Okita, Yutaka

    2016-07-01

    Current surgical results of acute type A aortic dissection in Japan are presented. According to the annual survey by the Japanese Association of Thoracic Surgery, 4,444 patients with acute type A aortic dissection underwent surgical procedures and the overall hospital mortality was 9.1% in 2013. The prevalence of aortic root replacement with a valve sparing technique, total arch replacement (TAR), and frozen stent graft are presented and strategies for thrombosed dissection or organ malperfusion syndrome secondary to acute aortic dissection are discussed. PMID:27563550

  20. Current surgical results of acute type A aortic dissection in Japan

    PubMed Central

    2016-01-01

    Current surgical results of acute type A aortic dissection in Japan are presented. According to the annual survey by the Japanese Association of Thoracic Surgery, 4,444 patients with acute type A aortic dissection underwent surgical procedures and the overall hospital mortality was 9.1% in 2013. The prevalence of aortic root replacement with a valve sparing technique, total arch replacement (TAR), and frozen stent graft are presented and strategies for thrombosed dissection or organ malperfusion syndrome secondary to acute aortic dissection are discussed. PMID:27563550

  1. Delayed Development of Brain Abscesses Following Stent-Graft Placement in a Head and Neck Cancer Patient Presenting with Carotid Blowout Syndrome

    SciTech Connect

    Oweis, Yaseen; Gemmete, Joseph J. Chaudhary, Neeraj; Pandey, Aditya; Ansari, Sameer

    2011-02-15

    We describe the delayed development of intracranial abscesses following emergent treatment with a covered stent-graft for carotid blowout syndrome (CBS) in a patient with head and neck cancer. The patient presented with hemoptysis and frank arterial bleeding through the tracheostomy site. A self-expandable stent-graft was deployed across a small pseudoaneurysm arising from the right common carotid artery (RCCA) and resulted in immediate hemostasis. Three months later, the patient suffered a recurrent hemorrhage. CT of the neck demonstrated periluminal fluid around the caudal aspect of the stent-graft with intraluminal thrombus and a small pseudoaneurysm. Subsequently, the patient underwent a balloon test occlusion study and endovascular sacrifice of the RCCA and right internal carotid artery. MRI of the brain demonstrated at least four ring-enhancing lesions within the right cerebral hemisphere consistent with intracranial abscesses that resolved with broad-spectrum antibiotic coverage.

  2. Moderate Aortic Stenosis and Coronary Artery Bypass Grafting: Clinical Update for the Perioperative Echocardiographer.

    PubMed

    Maldonado, Yasdet; Singh, Saket; Augoustides, John G; MacKnight, Brenda; Zhou, Elizabeth; Gutsche, Jacob T; Ramakrishna, Harish

    2015-10-01

    Incidental aortic stenosis in the setting of coronary artery bypass surgery may be a perioperative challenge. The accurate assessment of the degree of aortic stenosis remains an important determinant. Although severe aortic stenosis is an indication for valve replacement, current guidelines advise a balanced approach to the management of moderate aortic stenosis in this setting. Multiple factors should be considered in a team discussion to balance risks versus benefits for the various management options in the given patient. The rapid progress in aortic valve technologies also offer alternatives for definitive management of moderate aortic stenosis in this setting that will likely become even safer in the near future. PMID:26275517

  3. Early Results with the Use of Heparin-bonded Stent Graft to Rescue Failed Angioplasty of Chronic Femoropopliteal Occlusive Lesions: TASC D Lesions Have a Poor Outcome

    SciTech Connect

    Kuhan, Ganesh Abisi, Said; Braithwaite, Bruce D.; MacSweeney, Shane T. R.; Whitaker, Simon C.; Habib, Said B.

    2012-10-15

    Purpose: To evaluate early patency rate of the heparin-bonded stent grafts in atherosclerotic long femoropopliteal occlusive disease, and to identify factors that affect outcome. Methods: Heparin-bonded Viabahn stent grafts were placed in 33 limbs in 33 patients during 2009-2010. The stents were deployed to rescue failed conventional balloon angioplasty. Mean age was 69 (range 44-88) years, and 67 % (22 of 33) were men. Most procedures (21 of 33, 64 %) were performed for critical limb ischemia (33 % for rest pain, 30 % tissue loss). Kaplan-Meier plots and Cox regression analysis were used to identify significant risk factors. Results: The average length of lesions treated was 25 {+-} 10 cm, and they were predominantly TASC (Transatlantic Intersociety Consensus) D (n = 13) and C (n = 17) lesions. The median primary patency was 5.0 months (95 % confidence interval 1.22-8.77). The mean secondary patency was 8.6 months (95 % confidence interval 6.82-10.42). Subsequently, 4 patients underwent bypass surgery and 5 patients underwent major amputation. One patient died. There were 5 in-stent or edge-stent stenoses. Cox multivariate regression analysis identified TASC D lesions to be a significant risk factor for early occlusion (p = 0.035). Conclusion: TASC D lesions of femoropopliteal occlusions have poor patency rates with the use of heparin-bonded stent grafts after failed conventional angioplasty. Alternative options should be considered for these patients.

  4. Endovascular Repair of Complex Aortic Aneurysms: Intravascular Ultrasound Guidance with an Intracardiac Probe

    SciTech Connect

    Zanchetta, Mario Rigatelli, Gianluca; Pedon, Luigi; Zennaro, Marco; Ronsivalle, Salvatore; Maiolino, Pietro

    2003-09-15

    To assess the accuracy and efficacy of intravascular ultrasound guidance obtained by an intracardiac ultrasound probe during complex aortic endografting. Between November 1999 and July 2002, 19 patients (5 female, 14 male; mean age 73.5 {+-} 2.1 years) underwent endovascular repair of thoracic (n = 10), complex abdominal (n = 6) and concomitant thoraco-abdominal (n = 3) aortic aneurysm. The most suitable size and configuration of the stent-graft were chosen on the basis of preoperative computed tomographic angiography (CTA) or magnetic resonance angiography (MRA). Intraoperative intravascular ultrasound imaging was obtained using a 9 Fr, 9 MHz intracardiac echocardiography (ICE) probe, 110 cm in length, inserted through a 10 Fr precurved long sheath. The endografts were deployed as planned by CTA or MRA. Before stent-graft deployment, the ICE probe allowed us to view the posterior aortic arch and descending thoraco-abdominal aorta without position-related artifacts, and to identify both sites of stent-graft positioning. After stent-graft deployment, the ICE probe allowed us to detect the need for additional modular components to internally reline the aorta in 11 patients, and to discover 2 incomplete graft expansions subsequently treated with adjunctive balloon angioplasty. In 1 patient, the ICE probe supported the decision that the patient was ineligible for the endovascular exclusion procedure. The ICE probe provides accurate information on the anatomy of the posterior aortic arch and thoracic and abdominal aortic aneurysms and a rapid identification of attachment sites and stent-graft pathology, allowing refinement and improvement of the endovascular strategy.

  5. Coronary Artery Bypass Grafting Versus Drug-Eluting Stents Implantation for Previous Myocardial Infarction.

    PubMed

    Chang, Mineok; Lee, Cheol Whan; Ahn, Jung-Min; Cavalcante, Rafael; Sotomi, Yohei; Onuma, Yoshinobu; Zeng, Yaping; Park, Duk-Woo; Kang, Soo-Jin; Lee, Seung-Whan; Kim, Young-Hak; Park, Seong-Wook; Serruys, Patrick W; Park, Seung-Jung

    2016-07-01

    Patients with previous myocardial infarction (MI) have a high risk of recurrence. Little is known about the effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in patients with a previous MI and left main or multivessel coronary artery disease (CAD). We compared long-term outcomes of these 2 strategies in 672 patients with previous MI and left main or multivessel CAD, who underwent CABG (n = 349) or PCI with DES (n = 323). A pooled database from the BEST, PRECOMBAT, and SYNTAX trials was analyzed, and the primary outcome was a composite of death from any causes, MI, or stroke. Baseline characteristics were similar between the 2 groups. The median follow-up duration was 59.8 months. The rate of the primary outcome was significantly lower with CABG than PCI (hazard ratio [HR] 0.59, 95% CI 0.42 to 0.82; p = 0.002). This difference was driven by a marked reduction in the rate of MI (HR 0.29, 95% CI 0.16 to 0.55, p <0.001). The benefit of CABG over PCI was consistent across all major subgroups. The individual risks of death from any causes or stroke were comparable between the 2 groups. Conversely, the rate of repeat revascularization was significantly lower with CABG than PCI (HR 0.34, 95% CI 0.22 to 0.51, p <0.001). In conclusion, in the patients with previous MI and left main or multivessel CAD, compared to PCI with DES, CABG significantly reduces the risk of death from any causes, MI, or stroke. PMID:27181565

  6. Hemodynamic Functions of Fenestrated Stent Graft under Resting, Hypertension, and Exercise Conditions

    PubMed Central

    Kandail, Harkamaljot Singh; Hamady, Mohamad; Xu, Xiao Yun

    2016-01-01

    The aim of this study was to assess the hemodynamic performance of a patient-specific fenestrated stent graft (FSG) under different physiological conditions, including normal resting, hypertension, and hypertension with moderate lower limb exercise. A patient-specific FSG model was constructed from computed tomography images and was discretized into a fine unstructured mesh comprising tetrahedral and prism elements. Blood flow was simulated using Navier–Stokes equations, and physiologically realistic boundary conditions were utilized to yield clinically relevant results. For a given cycle-averaged inflow of 2.08 L/min at normal resting and hypertension conditions, approximately 25% of flow was channeled into each renal artery. When hypertension was combined with exercise, the cycle-averaged inflow increased to 6.39 L/min but only 6.29% of this was channeled into each renal artery, which led to a 438.46% increase in the iliac flow. For all the simulated scenarios and throughout the cardiac cycle, the instantaneous flow streamlines in the FSG were well organized without any notable flow recirculation. This well-organized flow led to low values of endothelial cell activation potential, which is a hemodynamic metric used to identify regions at risk of thrombosis. The displacement forces acting on the FSG varied with the physiological conditions, and the cycle-averaged displacement force at normal rest, hypertension, and hypertension with exercise was 6.46, 8.77, and 8.99 N, respectively. The numerical results from this study suggest that the analyzed FSG can maintain sufficient blood perfusion to the end organs at all the simulated conditions. Even though the FSG was found to have a low risk of thrombosis at rest and hypertension, this risk can be reduced even further with moderate lower limb exercise. PMID:27379242

  7. Hemodynamic Functions of Fenestrated Stent Graft under Resting, Hypertension, and Exercise Conditions.

    PubMed

    Kandail, Harkamaljot Singh; Hamady, Mohamad; Xu, Xiao Yun

    2016-01-01

    The aim of this study was to assess the hemodynamic performance of a patient-specific fenestrated stent graft (FSG) under different physiological conditions, including normal resting, hypertension, and hypertension with moderate lower limb exercise. A patient-specific FSG model was constructed from computed tomography images and was discretized into a fine unstructured mesh comprising tetrahedral and prism elements. Blood flow was simulated using Navier-Stokes equations, and physiologically realistic boundary conditions were utilized to yield clinically relevant results. For a given cycle-averaged inflow of 2.08 L/min at normal resting and hypertension conditions, approximately 25% of flow was channeled into each renal artery. When hypertension was combined with exercise, the cycle-averaged inflow increased to 6.39 L/min but only 6.29% of this was channeled into each renal artery, which led to a 438.46% increase in the iliac flow. For all the simulated scenarios and throughout the cardiac cycle, the instantaneous flow streamlines in the FSG were well organized without any notable flow recirculation. This well-organized flow led to low values of endothelial cell activation potential, which is a hemodynamic metric used to identify regions at risk of thrombosis. The displacement forces acting on the FSG varied with the physiological conditions, and the cycle-averaged displacement force at normal rest, hypertension, and hypertension with exercise was 6.46, 8.77, and 8.99 N, respectively. The numerical results from this study suggest that the analyzed FSG can maintain sufficient blood perfusion to the end organs at all the simulated conditions. Even though the FSG was found to have a low risk of thrombosis at rest and hypertension, this risk can be reduced even further with moderate lower limb exercise. PMID:27379242

  8. Pseudoaneurysm of the aortic arch

    PubMed Central

    Lu, Yuan-Qiang; Yao, Feng; Shang, An-Dong; Pan, Jian

    2016-01-01

    Abstract Background: Pseudoaneurysm of the aortic arch is uncommonly associated with cancer, and is extremely rare in pulmonary cancer. Here, we report an unusual and successfully treated case of aortic arch pseudoaneurysm in a male patient with lung squamous cell carcinoma. Methods: A 64-year-old male patient was admitted to the Emergency Department, presenting with massive hemoptysis (>500 mL blood during the 12 hours prior to treatment). The diagnosis of aortic arch pseudoaneurysm was confirmed after inspection of computed tomographic angiography and three-dimensional reconstruction. We processed the immediate endovascular stent-grafting for this patient. Results: This patient recovered with no filling or enlargement of the pseudoaneurysm, no episodes of hemoptysis, and no neurological complications during the 4-week follow-up period. Conclusion: Herein, we compare our case with other cancer-related pseudoaneurysms in the medical literature and summarize the clinical features and treatment of this unusual case. PMID:27495079

  9. Comparison of results of endovascular stenting and bypass grafting for TransAtlantic Inter-Society (TASC II) type B, C and D iliac occlusive disease

    PubMed Central

    Benetis, Rimantas; Antusevas, Aleksandras; Kaupas, Rytis Stasys; Inciura, Donatas; Kinduris, Sarunas

    2016-01-01

    Introduction The priority use of endovascular techniques in the management of aortoiliac occlusive disease has increased in the last decade. The aim of the present article is to report 1- and 2-year results of iliac artery stenting (IAS) and aortoiliac grafting in the management of patients with TASC II type B, C and D iliac lesions and chronic limb ischaemia. Material and methods In this prospective, non-randomised, one-centre clinical study, iliac artery stents and vascular grafts used for the treatment of patients with symptomatic lesions in the iliac artery were evaluated. This study enrolled 2 groups: 54 patients in the stent group and 47 patient in the surgery group. Results The primary patency rates at 1 and 2 years were 83% and 79.9% after IAS and 97.1% and 97.1% after surgical reconstruction, respectively (p = 0.015). The assisted primary stent patency at 1 and 2 years was 87.9% and 78.2%, respectively. The complication rate was 7.4% in the stent group and 6.3% in the surgery group. There was no perioperative mortality in either group. Conclusions Our results reveal that patients with severe aortoiliac occlusive disease (TASC II types B, C and D) can be treated with IAS or surgically with satisfactory results. Iliac artery stenting is associated with decreased primary patency compared with the surgery group. Iliac artery stenting should be considered with priority in elderly patients or in patients with severe comorbidities. PMID:27186180

  10. Spontaneous Rupture of Superficial Femoral Artery Repaired with Endovascular Stent-Grafting with use of Rendez-Vous Technique, Followed by Delayed Infection

    SciTech Connect

    Fanelli, Fabrizio Cannavale, Alessandro; Gazzetti, Marianna; Fantozzi, Cristiano; Taurino, Maurizio; Speziale, Francesco

    2013-02-15

    This is the case of a 72-year-old man with lower limb ischemia due to spontaneous rupture of nonaneurysmal superficial femoral artery that developed into thigh hematoma. After failure of a Fogarty revascularization, an emergency endovascular procedure was performed to restore the arterial continuity. A rendezvous procedure was performed with a double femoral and popliteal approach and two covered stent-grafts were deployed. Patient's clinical conditions immediately improved, but 4 months later the stent-grafts were surgically removed for infection and exteriorization. A femoropopliteal bypass was performed. After 1 year follow-up, the patient is in good clinical condition.

  11. Performance Measurements in Endolaparoscopic Infrarenal Aortic Graft Implantation using Computer-enhanced Instrumentation: a Laboratory Model for Training

    PubMed Central

    Martinez, Bernardo D.; Mendez, Jose

    2007-01-01

    Background: Performance measurements in an endolaparoscopic aortic animal laboratory model have been reported since Dion's work (1995). The purpose of this paper is to report performance measurements using computer-enhanced surgical instrumentation in a porcine model. Methods: From February 2000 to December 2002, training in robotic instrumentation consisted of implantation of infrarenal aortic grafts in 3 groups of 5 animals each. The time frame to complete all 15 procedures reflects 2 major difficulties: the need to schedule procedures based on the surgeon's time off from his solo practice and the availability of laboratory sites to complete the procedures. A full endolaparoscopic technique was used to perform 2 endto-end anastomoses through an intraperitoneal approach. A different method of computer-enhanced instrumentation was used for each group of animals as follows: (1) AESOP robotic arm and HERMES integrated voice control instrumentation, (2) AESOP-HERMES-ZEUS robotic systems, (3) da Vinci robotic system. The aortic clamp time, total operative time, and blood loss were recorded for each procedure. Secondary endpoints included spinal cord ischemia, graft thrombosis, and bleeding. Results: All animals tolerated the procedure. All grafts were patent and suture anastomoses intact. Two instances of bleeding, both of which were controlled laparoscopically, occurred. Aortic clamping time was significantly improved in Group 3 compared with that in Group 2 (P=0.008). Conclusion: The results of the first group reflect previous experience with the AESOP-HERMES instrumentation. However, the times of the ZEUS group and da Vinci group reflect initial exposure to the technology. The remote position of the surgeon at the console did not appear to affect the performance as shown in the last group. The da Vinci group provides an advantage compared with the ZEUS group. Both systems showed adaptability and versatility in controlling adverse bleeding encounters. PMID:17931515

  12. Magnetically guided recellularization of decellularized stented porcine pericardium-derived aortic valve for TAVI.

    PubMed

    Ghodsizad, Ali; Bordel, Viktor; Wiedensohler, Herrman; Elbanayosy, Ali; Koerner, Michael Martin; Gonzalez Berjon, Jose M; Barrios, Roberto; Farag, Mina; Zeriouh, Mohamad; Loebe, Matthias; Noon, George Peter; Koegler, Gesine; Karck, Matthias; Ruhparwar, Arjang

    2014-01-01

    Application of somatic stem cells for growth, proliferation, and differentiation in a three-dimensional pattern is an important aspect in tissue engineering. Here, we report on our bioreactor, which we applied for magnetically guided recellularization of nitinol-stented valve. Human-derived unrestricted somatic stem cells were cultured in medium in our pulsatile dynamic bioreactor for 4-6 days. Stented valves were prepared by decellularization of porcine pericardium and construction of stented tissue-engineered valves (n = 8). A magnetic field was created around the bioreactor to prevent the loss of cells. In the control group, no magnetic device was used (n = 4). Morphological characterization was assessed by immunohistochemical staining of paraffin sections and electron microscopy. The bioreactor enabled the preservation of physiologic culture conditions with aerobic cell metabolism and physiological pH values. Histological analysis showed homogeneous seeding of the pericardium with progenitor cells in the recellularized samples, whereas no cell seeding could be observed in the nonmagnetic group. Our magnetically guided multifunctional bioreactor allows for an efficient three-dimensional culturing of somatic stem cells on decellularized organ-specific matrix. PMID:25000385

  13. Venous Covered Stent: Successful Occlusion of a Symptomatic Internal Iliac Arteriovenous Fistula

    SciTech Connect

    Cronin, P.; McPherson, S.; Meaney, J.F.; Mavor, A.

    2002-08-15

    We report the placement of a covered stent within the internal iliac vein (IIV) to occlude a symptomatic iatrogenic internal iliac arteriovenous fistula following an abdominal aortic graft. Angiography revealed a direct communication between an internal iliac graft to artery anastomosis and the right IIV with rapid shunting into the inferior vena cava and a small associated pseudoaneurysm. Femoral, brachial or axillary arterial access was precluded. The fistula was successfully occluded by a stent-graft placed in the IIV. Arteriovenous fistula can be treated in a number of ways including covered stent placement on the arterial side. To the best of our knowledge this is the first time placement in a vein has been described. Where access is difficult or the procedure carries a high risk of complication, avenous covered stent may offer an alternative.

  14. Preservation of Internal Iliac Artery after Endovascular Repair of Common Iliac Artery Dissection Using Modified Fenestrated Stent Graft

    PubMed Central

    Zha, Binshan; Liu, Bin; Ye, Yusheng; Li, Jun

    2016-01-01

    Standard endovascular repair of iliac/aortoiliac pathologies can lead to complications, such as buttock claudication, colon ischemia and erectile dysfunction. Branch grafts have been developed but require at least 6 weeks for customization and are not currently available in China; they are also quite expensive. To our knowledge, modified fenestrated stent grafts (MFSGs) are a safe and effective alternative for treating patients with juxtarenal aneurysms. Most MFSGs are used for the preservation of renal and left subclavian arteries. Few cases of MFSGs have been reported in the treatment of iliac pathologies. The use of an MFSG is decided on a case-by-case basis. This report presents our first clinical use of an MFSG for preservation of the internal iliac artery. PMID:27275179

  15. Efficacy of thoracic endovascular stent repair for chronic type B aortic dissection with aneurysmal degeneration

    PubMed Central

    Scali, Salvatore T.; Feezor, Robert J.; Chang, Catherine K.; Stone, David H.; Hess, Philip J.; Martin, Tomas D.; Huber, Thomas S.; Beck, Adam W.

    2014-01-01

    Background The Food and Drug Administration has approved devices for endovascular management of thoracic endovascular aortic aneurysm repair (TEVAR); however, limited data exist describing the outcomes of TEVAR for aneurysms attributable to chronic type B aortic dissection (cTBAD). This study was undertaken to determine the results of endovascular treatment of cTBAD with aneurysmal degeneration. Methods A retrospective analysis of all patients treated for cTBAD with aneurysmal degeneration at the University of Florida from 2004 to 2011 was performed. Computed tomograms with centerline reconstruction were analyzed to determine change in aortic diameter, relative proportions of aortic treatment lengths, and false lumen perfusion status. Reintervention and mortality were estimated using life-tables. Cox regression analysis was completed to predict mortality. Results Eighty patients underwent TEVAR for aneurysm due to cTBAD (mean age [± standard deviation], 60 ± 13 years [male, 87.5%; n = 70]; median follow-up, 26 [range, 1–74] months). Median time from diagnosis of TBAD to TEVAR was 16 (range, 1–72) months. Prior aortic root/arch replacement had been performed in 29% (n = 23) at a median interval of 28.5 (range, 0.5–312) months. Mean preoperative aneurysm diameter was 62.0 ± 9.9 mm. In 75% (n = 60) of cases, coverage was proximal to zone 3, and 24% (n = 19) underwent carotid-subclavian bypass or other arch debranching procedure. Spinal drains were used in 78% (pre-op 71%, n = 57; post-op 6%, n = 5). Length of stay was 6.5 ± 4.7 days with a composite morbidity of 26% and in-hospital mortality of 2.5% (n = 2). Overall neurologic event rate was 17% (spinal cord ischemia 10% [n = 8], with a permanent deficit observed in 6.2% [n = 5]; stroke 7.5%). Aneurysm diameter reduced or stabilized in 65%. The false lumen thrombosed completely within the thoracic aorta in 52%, and reintervention within the treated aortic segment was required in 16% (n = 13). One- and 3-year

  16. Development of a New Intravascular Low-Profile Device for Exclusion of Aortic Aneurysm: An Experimental Pilot Study

    SciTech Connect

    Strecker, Ernst-Peter; Haberstroh, Joerg; Boos, Irene; Metz, Stephan; Langer, Mathias; Moliner, Manuel Maynar

    2004-09-15

    Purpose: To present a new intravascular device for the treatment of aorto-iliac aneurysms. Methods: This new device was tested in five dogs with abdominal aortic aneurysm created experimentally by overdilation of a balloon-expandable stent with a 16 or 18 mm wide PTA balloon catheter. The design of the device is based on a self-expanding aortic stent which consists of two stretchable circular frames filled with a textile Dacron mesh membrane that is suspended horizontally into the infrarenal abdominal aorta proximally to the aneurysm. The frames are part of a preshaped double helical structure that is introduced longitudinally through a catheter in a parallel fashion and forming the desired shape at the vessel site to be occluded. Two iliac stent-grafts are introduced in a low-profile status through the membrane sealing the aneurysm sac and holding the stent-grafts in place. After stent-graft expansion, a new bifurcation located more proximally than the natural one is created. The follow-up of the dogs was performed clinically and angiographically, and specimens were evaluated histomorphologically. Results: The membrane device can be introduced through a 9 Fr vascular sheath. Technical success was achieved in four of five dogs. Nine of ten stent-grafts could be fixed securely within the membrane, thus preventing dislocation. Aneurysms were excluded immediately, and blood flow to the external iliac arteries was restored by the stent-grafts. At 6-9 months follow-up of technically successful implanted devices, there were no endoleaks, no migration, no stenoses at contact sites between the implant material and vascular wall, and no stenosis or occlusion of the stent-grafts. At microscopic evaluation, the interspace between the membranes was filled with thrombotic material, thus ensuring exclusion of the aneurysm. Conclusion: This new device was found to be flexible, low profile and useful in excluding abdominal aortic aneurysm in the experimental setting.

  17. Surgical Management of Aorto-Esophageal Fistula as a Late Complication after Graft Replacement for Acute Aortic Dissection

    PubMed Central

    Lee, Jae-Hong; Na, Bubse; Hwang, Yoohwa; Kim, Yong Han; Park, In Kyu; Kim, Kyung-Hwan

    2016-01-01

    A 49-year-old male presented with chills and a fever. Five years previously, he underwent ascending aorta and aortic arch replacement using the elephant trunk technique for DeBakey type 1 aortic dissection. The preoperative evaluation found an esophago-paraprosthetic fistula between the prosthetic graft and the esophagus. Multiple-stage surgery was performed with appropriate antibiotic and antifungal management. First, we performed esophageal exclusion and drainage of the perigraft abscess. Second, we removed the previous graft, debrided the abscess, and performed an in situ re-replacement of the ascending aorta, aortic arch, and proximal descending thoracic aorta, with separate replacement of the innominate artery, left common carotid artery, and extra-anatomical bypass of the left subclavian artery. Finally, staged esophageal reconstruction was performed via transthoracic anastomosis. The patient’s postoperative course was unremarkable and the patient has done well without dietary problems or recurrent infections over one and a half years of follow-up. PMID:26889449

  18. [Abdominal secondary aorto-enteric fistulae complicating aortic graft replacement: postoperative and long-term outcomes in 32 patients].

    PubMed

    Vaillant, Jean-christophe; Schoell, Thibaut; Karoui, Mehdi; Chiche, Laurent; Gaudric, Julien; Gibert, Hadrien; Tresallet, Christophe; Koskas, Fabien; Hannoun, Laurent

    2013-01-01

    Management of patients with abdominal secondary aorto-entericfistulae (SAEF) complicating aortic graft replacement is controversial. We retrospectively analyzed the postope- rative and long-term outcomes of all consecutive patients operated on for SAEF betwveen 2002 and2012. All were managed by in situ replacement with a cryopreserved allograft and treatment of the affected digestive tract. Thirty-two patients (median age 65 years) underwent aortic replacement for SAEFa median of 5 years after initial aortic surgery. The fistulae were located in the duodenum (n = 20), small bowel (n = 6), colon (n = 5) or stomach (n = 1). Treatment of the digestive tract included suture (n = 16), resection with anastomosis (n = 12) covered by a defunctioning stoma (n = 1), and Hartmann's procedure (n = 3). Omentoplasty was performed in 18 patients (56 %), and 17 patients (53 %) had afeedingjejunostomy. Eight patients (25 %) died post-operatively, 3 with a recurrent aorto-enteric fistula. Fifteen (62.5 %) of the remaining patients developed 27 complications, including 6 patients (19 %) with severe morbidity (Dindo III-IV). The reoperation rate was 21 %. The median hospital stay was 33 days. During follow-up (median 15 months), no further patients had a recurrent aorto-enteric fistula. We conclude that surgery for SAEF is a major procedure associated with high mortality and morbidity. Good long-term results can be obtained by excision of the prosthetic graft with cryopreserved allograft replacement, and by management in a tertialy referral center with expertise in both vascular and digestive surgery. PMID:25518163

  19. Dual-artery stenting of a type III single coronary artery from right aortic sinus.

    PubMed

    Patil, Shivanad; Kharge, Jayashree; Ramlingam, Rangaraj; Kasamsetty, Subramanyam

    2015-12-01

    A single coronary artery presenting with stenosis in two of the three vessels arising from a common ostium is a rare anomaly Lipton et al. proposed a classification, which was modified by Yamanaka and Hobbs. In our case, a single coronary artery was giving rise to the LAD, left circumflex (LCx), and the right coronary artery (RCA). There was 80% stenosis in the ostium of the LCx. The RCA in the mid and distal segment had stenosis of 80% and 70%, respectively. We were able to successfully stent the three stenotic segments. PMID:26995427

  20. TIPS for refractory ascites: a 6-year single-center experience with expanded polytetrafluoroethylene-covered stent-grafts.

    PubMed

    Bercu, Zachary L; Fischman, Aaron M; Kim, Edward; Nowakowski, F Scott; Patel, Rahul S; Schiano, Thomas D; Chang, Charissa Y; Lookstein, Robert A

    2015-03-01

    OBJECTIVE. This single-center study evaluated the use of expanded polytetrafluoroethylene (ePTFE)-covered stent-grafts for transjugular intrahepatic portosystemic shunt (TIPS) placement to manage portal hypertension-related refractory ascites. MATERIALS AND METHODS. One hundred patients at a single tertiary care center in a major metropolitan hospital underwent TIPS placement with an ePTFE-covered stent-graft (Viatorr TIPS Endoprosthesis). Patients with portal hypertension-related ascites and preexisting hepatocellular carcinoma or liver transplant were excluded from the analysis. Records were reviewed for demographic characteristics, technical success of the TIPS procedures, and stent follow-up findings. Clinical results were assessed at 90- and 180-day intervals. RESULTS. Immediate technical success of the TIPS procedure was 100%. Of the 61 patients with documented follow-up, 55 (90.2%) had a partial or complete ascites response to TIPS creation. Of these 55 patients, nine experienced severe encephalopathy. Six of 61 patients (9.8%) did not experience a significant ascites response. Overall survival was 78.7% at 365-day follow-up. The 365-day survival was 84.2% for patients with a model for end-stage liver disease (MELD) score of less than 15, 67.0% for those with a score of 15-18, and 53.8% for those with a score of greater than 18 (p = 0.01). For patients with a MELD score of less than 18, the 365-day survival was 88.0% for those with an albumin value of 3 mg/dL or greater and 72.8% for those with an albumin value of less than 3 mg/dL (p = 0.04). CONCLUSION. TIPS placement using an ePTFE-covered stent-graft is an efficacious therapy for refractory ascites. Patients with preserved liver function-characterized by a MELD score of less than 15 or a MELD score of less than 18 and an albumin value of 3 mg/dL or greater-experience the greatest survival benefit. PMID:25714299

  1. Emergency Stent Grafting After Unsuccessful Surgical Repair of a Mycotic Common Femoral Artery Pseudoaneurysm in a Drug Abuser

    SciTech Connect

    Lupattelli, Tommaso; Garaci, Francesco Giuseppe; Basile, Antonio; Minnella, Daniela Paola; Casini, Andrea; Clerissi, Jacques

    2009-03-15

    Mycotic false aneurysm caused by local arterial injury from attempted intravenous injections in drug addicts remains a challenging clinical problem. The continued increase in drug abuse has resulted in an increased incidence of this problem, particularly in high-volume urban centres. In the drug-abusing population, mycotic arterial pseudoaneurysms most often occur because of missed venous injection and are typically seen in the groin, axilla, and antecubital fossa. Mycotic aneurysms may lead to life-threatening haemorrhage, limb loss, sepsis, and even death. Any soft-tissue swelling in the vicinity of a major artery in an intravenous drug abuser should be suspected of being a false aneurysm until proven otherwise and should prompt immediate referral to a vascular surgeon for investigation and management. We report a case of rupturing mycotic pseudoaneurysm of the left common femoral artery treated by surgical resection followed by vessel reconstruction with autologous material. Unfortunately, at the time of discharge a sudden leakage from the vein graft anastomosis occurred, with subsequent massive bleeding, and required emergent endovascular covered stenting. To the best of our knowledge, this is the first reported case of femoral artery bleeding in a drug abuser treated by stent graft placement.

  2. Customized covered stent graft for percutaneous closure of Fontan baffle leak.

    PubMed

    Binder, Ronald K; Nietlispach, Fabian; Carere, Ronald G

    2013-05-01

    We report the innovation of both a partly-covered and completely-covered, variable-diameter, balloon-expandable stent that was custom-designed by NuMed, Inc for percutaneous closure of a baffle leak after total caval pulmonary connection (TCPC). A 50-year-old patient, born with tricuspid atresia, who had undergone TCPC, developed severe persistent cyanosis due to a right-to-left shunt through a TCPC baffle leak. Re-operation was deemed too high risk. Therefore, considering his complex anatomy, a custom-made, partly-covered, tapered, balloon-expandable stent was designed and successfully deployed. Months later, the shunt recurred at the junction of the covered to uncovered stent cells; subsequently, a second fully-covered, custom-made, tapered stent was implanted with an excellent outcome. The use of covered or partly-covered customized variable-diameter stents for closure of baffle leak after TCPC is feasible and resulted in marked clinical improvement. Customized balloon-expandable stents may be superior to traditional cylindrical stents because of better anchoring and apposition. PMID:23645059

  3. Assessment of a Polyester-Covered Nitinol Stent in the Canine Aorta and Iliac Arteries

    SciTech Connect

    Castaneda, Flavio; Ball-Kell, Susan M.; Young, Kate; Li Ruizong

    2000-09-15

    Purpose: To evaluate the patency and healing characteristics of a woven polyester fabric-covered stent in the canine model.Methods: Twenty-four self-expanding covered stents were placed in the infrarenal aorta and bilateral common iliac arteries of eight dogs and evaluated at 1 (n = 2), 3 (n = 2), and 6 (n = 4) months. Stent assessment was done using angiography prior to euthanasia, and light and scanning electron microscopy.Results: Angiographically, just prior to euthanasia, 8 of 8 aortic and 14 of 16 iliac endovascular covered stents were patent. Histologically, the stented regions showed complete endothelialization 6 months after graft implantation. A neointima had formed inside the stented vessel regions resulting in complete encasement of the fabric-covered stent by 3 months after graft implantation. Medial compression with smooth muscle cell atrophy was present in all stented regions. Explanted stent wires, examined by scanning electron microscopy, showed pitting but no cracks or breakage.Conclusion: The covered stent demonstrated predictable healing and is effective in preventing stenosis in vessels 10.0 mm or greater in diameter but does not completely preclude stenosis in vessels 6.0 mm or less in diameter.

  4. Investigation on an RFID planar coil for a wireless communicative aortic stent

    NASA Astrophysics Data System (ADS)

    Talleb, Hakeim; Faci, Salim; Lautru, David; Hanna, Victor Fouad; Wiart, Joe

    2013-05-01

    This paper presents an investigation on a potential biomedical RFID planar coil operating at 13.56 MHz for measuring the blood pressure level, mounted inside an abdominal aortic aneurysm. The results show that a wireless communication is achieved in a perimeter of 60 cm, while respecting the ISO 15693 standard for vicinity contactless cards. Measurement and electromagnetic simulation results show that the inductive coupling is deteriorating if the planar coil is in direct contact with water without correctly encapsulating this coil. An electric model is given for our proposed RFID planar coil immersed in water.

  5. Treatment of a Celiac Trunk Aneurysm Close to the Hepato-splenic Bifurcation by Using Hepatic Stent-graft Implantation and Splenic Artery Embolization

    SciTech Connect

    Basile, Antonio Lupattelli, Tommaso; Magnano, Marco; Giulietti, Giorgio; Privitera, Giambattista; Battaglia, Giuseppe; Monaca, Vincenzo; Ettorre, Giancarlo

    2007-02-15

    We present a case of a 73-year-old man in whom a celiac trunk aneurysm close to the hepato-splenic bifurcation was discovered and treated by using celiac-hepatic stent-grafts implantation and splenic artery embolization.

  6. Endovascular Stent Graft Placement in the Treatment of Ruptured Tuberculous Pseudoaneurysm of the Descending Thoracic Aorta: Case Report and Review of the Literature

    SciTech Connect

    Dogan, Sozen Memis, Ahmet; Kale, Arzum Buket, Suat

    2009-05-15

    We report a successful repair of a ruptured tuberculous pseudoaneurysm of the descending thoracic aorta by endovascular stent graft placement. This procedure is starting to be accepted as an alternative method to surgery, and we review similar cases in the literature.

  7. Graft Patency in Long-term Survivors after Renovisceral Debranching with VORTEC

    SciTech Connect

    Winklehner, Anna Nguyen-Kim, Thi Dan Linh Pfammatter, Thomas; Rancic, Zoran Mayer, Dieter Lachat, Mario; Frauenfelder, Thomas

    2015-06-15

    PurposeThis study was designed to evaluate retrospectively the long-term stent-graft patency after renovisceral revascularization with Viabahn Open Revascularization Technique (VORTEC) using computed tomography angiography (CTA) and magnetic resonance angiography (MRA).MethodsIn 34 patients (seven women; mean age 72 ± 8 years) with aortic aneurysm, 63 renovisceral vessels (i.e., 54 renal, nine visceral arteries) were revascularized with VORTEC between 2004 and 2009. All patients obtained a pre- and postinterventional CTA and at least one follow-up CTA or MRA after 6 or more months following intervention (median follow up: 43 months). Detection of bypass occlusion, bypass stenosis, infolding, stent-graft fractures and dislocations, and kidney shrinkage were noted by two readers in consensus. Furthermore, mortality during follow-up was assessed using the medical report.ResultsDuring follow-up, 12.6 % of stent-grafts occluded. Cumulative patency rate was 95.2 ± 2.7 % at 12 months, 87.7 ± 4.4 % at 24 and 36 months, and 84.7 ± 5.2 % at 48, 60, 72, 84, and 89 months, respectively. Overall, 19 % of stent-grafts (12/63) developed bypass stenosis (<50 %, 10 stent-grafts; > 50 %, 2 stent-grafts), in one case stenosis (>70 %) was suspected to be hemodynamically significant. No secondary dislocation, no infolding of renovisceral stent-grafts, and no stent-graft fracture occurred. Kidney shrinkage occurred in nine patients, primarily in patients with an occluded Viabahn (n = 7). Eleven patients (32.3 %) died within the follow-up time period.ConclusionsIn long-term survivors after VORTEC cumulative patency rate remained high, and no stent-graft fractures or secondary dislocations occurred.

  8. Clinical and angiographic outcome following implantation of the new Less Shortening Wallstent in aortocoronary vein grafts: introduction of a second generation stent in the clinical arena.

    PubMed

    Keane, D; Buis, B; Reifart, N; Plokker, T H; Ernst, J M; Mast, E G; Renkin, J; Heyndrickx, G; Morel, M; de Jaegere, P

    1994-12-01

    One of the factors felt to have contributed to the high rate of stent occlusion in the European registry of the coronary Wallstent in the 1980s was the frequent deployment of more than one stent to cover the target lesion. This resulted from a high degree of shortening of the Wallstent upon expansion. To overcome this limitation the design of the Wallstent was modified to reduce the degree of shortening. We report the results of a study of the first patients to undergo implantation of the new Less Shortening Wallstent. Thirty-five Wallstents were electively deployed in aortocoronary vein grafts in 29 patients. Stent deployment was successful in 35 of 36 attempts in 30 lesions. In five of the 30 lesions, a second stent was required to cover the proximal portion of the lesion. Angiographic success (< 50% residual diameter stenosis as determined by off-line quantitative coronary angiography) was achieved in all 29 patients. During the in-hospital phase, no major adverse cardiac event occurred (reintervention, re-CABG, myocardial infarction, or death) and five patients had hemorrhagic complications. Following hospital discharge, one patient had a subacute stent occlusion associated with symptoms and elevated cardiac enzymes at 11 days, another patient had symptoms and elevated cardiac enzymes (CK 300 U/I) at 22 days with a patent stent, five patients required balloon angioplasty within the 6 month follow-up period (four for restenosis and one for stent occlusion), one patient underwent re-CABG for a native artery stenosis distal to the anastomosis of the patent stented vein graft.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:10155204

  9. [Thoracic Endovascular Aortic Repair Via Internal Iliac Artery Conduit].

    PubMed

    Hayashi, Taro; Tobe, Satoshi; Sugiyama, Hironobu; Ijyuin, Shinichi; Yamaguchi, Masahiro; Yamaguchi, Masato; Oka, Takanori; Misato, Takuya; Tsunemi, Kotaro; Tanimura, Nobuhiro

    2016-09-01

    A 77-year-old man with a history of stent implantation in the right common iliac artery(CIA) and the left external iliac artery(EIA) was admitted to our hospital for a rapid growth of an aneurysm( max 53 mm) at Th11 level of the descending aorta. Although thoracic endovascular aortic repair (TEVAR) was required, there were many problems about access rout. The infrarenal abdominal aorta and the left EIA were severely calcified, and the lumens of the right CIA stent(5.3 mm) and the left EIA stent( 4.3 mm) were small in size. Besides, the left CIA was short(13 mm). Therefore, TEVAR was performed by retrograde approach from the left internal iliac artery( IIA) with a tube graft conduit in the hybrid operation room. IIA is a useful option for an access rout in endovascular aortic repair. PMID:27586313

  10. Pre-emptive positioning of a coronary stent in the left anterior descending artery for left main protection: a prerequisite for transcatheter aortic valve-in-valve implantation for failing stentless bioprostheses?

    PubMed

    Chakravarty, Tarun; Jilaihawi, Hasan; Nakamura, Mamoo; Kashif, Mohammad; Kar, Saibal; Cheng, Wen; Makkar, Raj

    2013-10-01

    Transcatheter aortic valve-in-valve (VIV) implantation in high-risk patients with degenerative surgical bioprosthetic aortic valves is a novel application of transcatheter aortic valve replacement technology. Although transcatheter aortic VIV procedure is clinically effective in most patients, it is a more demanding procedure in terms of the technical aspects of procedural planning. VIV carries a higher risk of coronary occlusion which is associated with a higher rate of in-hospital mortality. We hereby report a technique of pre-emptive left main (LM) protection, by positioning a coronary stent in the proximal left anterior descending artery prior to VIV implantation. The patient treated was considered to be at an increased risk of LM occlusion as a result of the procedure. The technique was performed in anticipation of emergent bailout stenting of the LM. As predicted, the LM occluded during the procedure and LM protection facilitated the safe and effective treatment of an otherwise life-threatening procedure. PMID:23729203

  11. Update in the management of type B aortic dissection.

    PubMed

    Nauta, Foeke Jh; Trimarchi, Santi; Kamman, Arnoud V; Moll, Frans L; van Herwaarden, Joost A; Patel, Himanshu J; Figueroa, C Alberto; Eagle, Kim A; Froehlich, James B

    2016-06-01

    Stanford type B aortic dissection (TBAD) is a life-threatening aortic disease. The initial management goal is to prevent aortic rupture, propagation of the dissection, and symptoms by reducing the heart rate and blood pressure. Uncomplicated TBAD patients require prompt medical management to prevent aortic dilatation or rupture during subsequent follow-up. Complicated TBAD patients require immediate invasive management to prevent death or injury caused by rupture or malperfusion. Recent developments in diagnosis and management have reduced mortality related to TBAD considerably. In particular, the introduction of thoracic stent-grafts has shifted the management from surgical to endovascular repair, contributing to a fourfold increase in early survival in complicated TBAD. Furthermore, endovascular repair is now considered in some uncomplicated TBAD patients in addition to optimal medical therapy. For more challenging aortic dissection patients with involvement of the aortic arch, hybrid approaches, combining open and endovascular repair, have had promising results. Regardless of the chosen management strategy, strict antihypertensive control should be administered to all TBAD patients in addition to close imaging surveillance. Future developments in stent-graft design, medical therapy, surgical and hybrid techniques, imaging, and genetic screening may improve the outcomes of TBAD patients even further. We present a comprehensive review of the recommended management strategy based on current evidence in the literature. PMID:27067136

  12. Coronary Ostial Stenosis after Aortic Valve Replacement

    PubMed Central

    Ziakas, Antonios G.; Economou, Fotios I.; Charokopos, Nicholas A.; Pitsis, Antonios A.; Parharidou, Despina G.; Papadopoulos, Thomas I.; Parharidis, Georgios E.

    2010-01-01

    Coronary ostial stenosis is a rare but potentially serious sequela after aortic valve replacement. It occurs in the left main or right coronary artery after 1% to 5% of aortic valve replacement procedures. The clinical symptoms are usually severe and may appear from 1 to 6 months postoperatively. Although the typical treatment is coronary artery bypass grafting, patients have been successfully treated by means of percutaneous coronary intervention. Herein, we present the cases of 2 patients in whom coronary ostial stenosis developed after aortic valve replacement. In the 1st case, a 72-year-old man underwent aortic valve replacement and bypass grafting of the saphenous vein to the left anterior descending coronary artery. Six months later, he experienced a non-ST-segment-elevation myocardial infarction. Coronary angiography revealed a critical stenosis of the right coronary artery ostium. In the 2nd case, a 78-year-old woman underwent aortic valve replacement and grafting of the saphenous vein to an occluded right coronary artery. Four months later, she experienced unstable angina. Coronary angiography showed a critical left main coronary artery ostial stenosis and occlusion of the right coronary artery venous graft. In each patient, we performed percutaneous coronary intervention and deployed a drug-eluting stent. Both patients were asymptomatic on 6-to 12-month follow-up. We attribute the coronary ostial stenosis to the selective ostial administration of cardioplegic solution during surgery. We conclude that retrograde administration of cardioplegic solution through the coronary sinus may reduce the incidence of postoperative coronary ostial stenosis, and that stenting may be an efficient treatment option. PMID:20844624

  13. Percutaneous stenting of a dissected superior mesenteric artery in a patient with previous surgical repair of Stanford type A aortic dissection.

    PubMed Central

    Hatzidakis, A; Krokidis, M; Androulakakis, Z; Rossi, M

    2015-01-01

    Background/Aim We report a case of a 54-year-old male patient with background history of hypertension, which suffered a Stanford type A thoraco-abdominal aortic dissection with extension to the visceral arteries. Description of case The patient initially underwent surgical repair with replacement of the ascending aorta and of the hemiarch in the acute phase of the dissection. Postoperatively, he developed non-specific abdominal pain that was not related to meals but led to weight loss of 20 kg within the first five post-operative months. Follow-up computerized tomography scan revealed a chronic subphrenic aortic dissection extending to the celiac axis (with involvement of the left gastric and the splenic artery), the left renal artery and the superior mesenteric artery (SMA). The hepatic artery took origin from the SMA and received blood from the true lumen of the vessel, and the right renal artery was entirely supplied from the true aortic lumen. After exclusion of other causes of abdominal pain, the patient was treated with percutaneous stent placement in the dissected SMA with significant improvement of his symptoms. Conclusion This case report emphasizes the role of visceral artery endovascular techniques in the management of patients with complicated chronic aortic dissection. Hippokratia 2015; 19 (3): 270-273. PMID:27418791

  14. Endovascular Treatment of a Mycotic Intracavernous Carotid Artery Aneurysm Using a Stent Graft

    PubMed Central

    Gupta, Vivek; Jain, Vikash; Mathuria, SN; Khandelwal, N

    2013-01-01

    Summary Intracavernous carotid artery mycotic aneurysms are rare and management is determined by clinical presentation. We describe the first documented proximal intracranial mycotic aneurysm treated by a balloon expandable Aneugraft PCS covered stent. An 11-year-old female child presented with acute onset fever, headache, chemosis followed by diplopia, right-sided ptosis with ophthalmoplegia. Magnetic resonance imaging revealed bilateral cavernous sinus thrombosis. Subsequent work-up included serial computed tomographic arteriography and digital subtraction angiography which revealed a progressively enlarging intracavernous carotid aneurysm. An Aneugraft PCS covered stent was successfully deployed endovascularly, and complete exclusion of the aneurysm was achieved while maintaining the patency of the parent artery. The use of covered stents in intracranial vasculature can be an effective and safe treatment modality for exclusion of the mycotic aneurysm in selected cases. PMID:24070080

  15. A Perspective Review on Numerical Simulations of Hemodynamics in Aortic Dissection

    PubMed Central

    Wan Ab Naim, Wan Naimah; Ganesan, Poo Balan; Hashim, Shahrul Amry

    2014-01-01

    Aortic dissection, characterized by separation of the layers of the aortic wall, poses a significant challenge for clinicians. While type A aortic dissection patients are normally managed using surgical treatment, optimal treatment strategy for type B aortic dissection remains controversial and requires further evaluation. Although aortic diameter measured by CT angiography has been clinically used as a guideline to predict dilation in aortic dissection, hemodynamic parameters (e.g., pressure and wall shear stress), geometrical factors, and composition of the aorta wall are known to substantially affect disease progression. Due to the limitations of cardiac imaging modalities, numerical simulations have been widely used for the prediction of disease progression and therapeutic outcomes, by providing detailed insights into the hemodynamics. This paper presents a comprehensive review of the existing numerical models developed to investigate reasons behind tear initiation and progression, as well as the effectiveness of various treatment strategies, particularly the stent graft treatment. PMID:24672348

  16. Treatment of a Traumatic Celiac Trunk Detachment by Bridging with a Stent Graft

    SciTech Connect

    Choi, In Young; Chung, Hwan Hoon Lee, Seung Hwa Cho, Sung Bum Kim, Yun Hwan Seo, Bo Kyoung Seo, Hyung-Seok

    2012-04-15

    Traumatic detachment of the celiac trunk from the abdominal aorta is a rare clinical situation, and proper treatment options have not been established. We report a patient with traumatic separation of the celiac trunk treated by bridging with a covered stent between the celiac trunk and abdominal aorta.

  17. Single Stage Repair for Aortic Coarctation associated with Intracardiac Defects Using Extra-Anatomic Bypass Graft in Adults

    PubMed Central

    Ates, Mehmet Sanser; Onuk, Burak Emre; Bakkaloglu, Beyhan; Sungur, Umit Pinar; Kurtoglu, Murat; Karagoz, Yahya Halidun

    2016-01-01

    Background and Objectives Coarctation of the aorta in adulthood is generally associated with other cardiovascular disorders requiring surgical management. An extra anatomic bypass grafting from the ascending to descending aorta by posterior pericardial approach via median sternotomy could be a reasonable single stage surgical strategy for these patients. Subjects and Methods Seven male patients aged between 14-41 years underwent an extra anatomic bypass grafting for coarctation repair concomitantly with the surgical management of the associated cardiovascular disorders via median sternotomy. Preoperative mean systolic arterial blood pressure was 161.8±24.5 mmHg, although the patients were under treatment of different combinations of antihypertensive agents. Additional surgical procedures were: aortic valve replacement (n=4), ventricular septal defect (VSD) closure (n=2), ascending aortic replacement (n=3) and Bentall procedure (n=1). None of our patients have been previously diagnosed or operated on for coarctation. Data were evaluated during their hospital stay and in post-operative follow-up. Results The post-operative course was uneventful in all but one patient was re-operated on due to bleeding. There was neither mortality nor significant morbidity during the in-hospital period and all patients were discharged within 5-9 (mean: 6.3±1.5) days. The mean follow up period was 71.83±23 months (range: 23-95 months). Unfortunately one of our patients could not be contacted for a follow up period because of invalid personal data. Conclusion Coarctation of the aorta in adulthood associated with other cardiovascular disorders can be operated on simultaneously via an extra anatomic bypass grafting technique with low morbidity and mortality. PMID:27482266

  18. Transaortic Intra-Aortic Balloon Pump Catheter Insertion through a Separate Saphenous Vein Graft in Patients with Severe Aortoiliac Disease

    PubMed Central

    Toktas, Faruk; Surer, Suleyman

    2014-01-01

    Background. Intra-aortic balloon pump (IABP) is the most widely used mechanical assist device for hemodynamic support in high risk patients undergoing cardiac surgery. The aim of our study was to confirm whether transaortic route is a suitable alternative to allow IABP insertion in patients with severe aortoiliac diseases. Methods. This study included 7 consecutive patients undergoing coronary artery bypass grafting for severe coronary artery disease associated with severe aortoiliac disease. These patients could not be weaned from cardiopulmonary bypass and required the IABP support, which were placed through the ascending aorta. IABP catheter was inserted indirectly through a separate saphenous vein graft anastomosed to the ascending aorta by an end-to-side manner under a partial occluding clamp and advanced to the desired position in the descending thoracic aorta and exteriorly brought into the subcutaneous tissues in the jugulum. Results. The procedure was successfully performed in all the patients. The mean duration of IABP support was 54.0 ± 13.4 hours. There were no in-hospital mortality and complications related to transaortic route. IABP removal did not require repeat sternotomy. At postoperative 6th month, multislice CT examination showed thrombotic occlusion at the remnant of the saphenous vein graft. Conclusions. This technique is a simple, reliable, and reproducible option in patients with severe aortoiliac disease in whom retrograde femoral route is not possible. PMID:24516360

  19. Stent-Graft for the Management of Hepatic Artery Rupture Subsequent to Transcatheter Thrombolysis and Angioplasty in a Liver Transplant Recipient

    SciTech Connect

    Yamakado, Koichiro Nakatsuka, Atsuhiro; Takaki, Haruyuki; Usui, Masanobu; Sakurai, Hiroyuki; Isaji, Shuji; Uemoto, Shinji; Takeda, Kan

    2008-07-15

    Arterial rupture subsequent to angioplasty occurs in about 5% of cases. Thrombolysis with re-establishment of flow without resolving underlying anatomic defects such as hepatic arterial stenosis leads to re-thrombosis. We present a case of arterial anastomotic rupture after thrombolysis and angioplasty of an underlying anastomotic hepatic arterial stenosis. Both the underlying anatomic defect and the rupture were resolved successfully with placement of a stent-graft, with a resultant patent artery for 1 year after the procedure.

  20. Multidetector-Row Computed Tomography in the Evaluation of Transjugular Intrahepatic Portosystemic Shunt Performed with Expanded-Polytetrafluoroethylene-Covered Stent-Graft

    SciTech Connect

    Fanelli, Fabrizio Bezzi, Mario; Bruni, Antonio; Corona, Mario; Boatta, Emanuele; Lucatelli, Pierleone; Passariello, Roberto

    2011-02-15

    We assessed, in a prospective study, the efficacy of multidetector spiral computed tomography (MDCT) in the evaluation of transjugular intrahepatic portosystemic shunt (TIPS) patency in patients treated with the Viatorr (Gore, Flagstaff, AZ) expanded-polytetrafluoroethylene (e-PTFE)-covered stent-graft. Eighty patients who underwent TIPS procedure using the Viatorr self-expanding e-PTFE stent-graft were evaluated at follow-up of 1, 3, 6, and 12 months with clinical and laboratory tests as well as ultrasound-color Doppler (USCD) imaging. In case of varices, upper gastrointestinal endoscopy was also performed. In addition, the shunt was evaluated using MDCT at 6 and 12 months. In all cases of abnormal findings and discrepancy between MDCT and USCD, invasive control venography was performed. MDCT images were acquired before and after injection of intravenous contrast media on the axial plane and after three-dimensional reconstruction using different algorithms. MDCT was successfully performed in all patients. No artefacts correlated to the Viatorr stent-graft were observed. A missing correlation between UCSD and MDCT was noticed in 20 of 80 (25%) patients. Invasive control venography confirmed shunt patency in 16 (80%) cases and shunt malfunction in 4 (20%) cases. According to these data, MDCT sensitivity was 95.2%; specificity was 96.6%; and positive (PPV) and negative predictive values (NPV) were 90.9 and 98.2%, respectively. USCD sensitivity was 90%; specificity was 75%; and PPV and NPV were 54.5 and 95.7%, respectively. A high correlation (K value = 0.85) between MDCT and invasive control venography was observed. On the basis of these results, MDCT shows superior sensitivity and specificity compared with USCD in those patients in whom TIPS was performed with the Viatorr stent-graft. MDCT can be considered a valid tool in the follow-up of these patients.

  1. Minimally Invasive Techniques for Total Aortic Arch Reconstruction

    PubMed Central

    Faulds, Jason; Sandhu, Harleen K.; Estrera, Anthony L.; Safi, Hazim J.

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction. PMID:27127562

  2. Minimally Invasive Techniques for Total Aortic Arch Reconstruction.

    PubMed

    Faulds, Jason; Sandhu, Harleen K; Estrera, Anthony L; Safi, Hazim J

    2016-01-01

    The cumulative experience with endovascular aortic repair in the descending thoracic and infrarenal aorta has led to increased interest in endovascular aortic arch reconstruction. Open total arch replacement is a robust operation that can be performed with excellent results. However, it requires cardiopulmonary bypass and circulatory arrest and, therefore, may not be tolerated by all patients. Minimally invasive techniques have been considered as an alternative and include hybrid arch debranching, parallel stent graft deployment in the chimney and snorkel configurations, and complete endovascular branched reconstruction with multi-branched devices. This review discusses the evolving use of endovascular techniques in the management of aortic arch pathology and considers their relevance in an era of safe and durable open aortic arch reconstruction. PMID:27127562

  3. Endograft Collapse After Endovascular Treatment for Thoracic Aortic Disease

    SciTech Connect

    Bandorski, Dirk Brueck, Martin; Guenther, Hans-Ulrich; Manke, Christoph

    2010-06-15

    Endovascular treatment is an established therapy for thoracic aortic disease. Collapse of the endograft is a potentially fatal complication. We reviewed 16 patients with a thoracic endograft between 2001 and 2006. Medical records of the treated patients were studied. Data collected include age, gender, diagnosis, indication for endoluminal treatment, type of endograft, and time of follow up. All patients (n = 16; mean age, 61 years; range, 21-82 years) underwent computed tomography (CT) for location of the lesion and planning of the intervention. Time of follow-up with CT scan ranged from 1 to 61 months. Indications for endovascular treatment were degenerative aneurysm (n = 7; 44%), aortic dissection (n = 2; 12%), perforated aortic ulcer (n = 4; 25%), and traumatic aortic injury (n = 3; 19%). Three patients suffered from a collapse of the endograft (one patient distal, two patients proximal) between 3 and 8 days after endovascular treatment. These patients were younger (mean age, 37 {+-} 25 years vs. 67 {+-} 16 years; P < 0.05) and showed more oversizing (proximal, 36 {+-} 19.8% vs. 29 {+-} 20.7% [P > 0.05]; distal, 45 {+-} 23.5% vs. 38 {+-} 21.7% [P > 0.05]). Proximal collapse was corrected by placing a bare stent. In conclusion, risk factors for stent-graft collapse are a small lumen of the aorta and a small radius of the aortic arch curvature (young patients), as well as oversizing, which is an important risk factor and is described for different types of endografts and protheses (Gore TAG and Cook Zenith). Dilatation of the collapsed stent-graft is not sufficient. Following therapy implantation of a second stent or surgery is necessary in patients with a proximal endograft collapse. Distal endograft collapse can possibly be treated conservatively under close follow-up.

  4. Customized Tapered Stent-Grafts in the Endovascular Management of Internal Iliac Artery Aneurysms: A Useful Adjunct to Conventional Endovascular Options

    SciTech Connect

    Haslam, J. Elizabeth Hardman, John; Horrocks, Michael; Fay, Dominic

    2009-01-15

    The endovascular exclusion of an isolated iliac artery aneurysm is recognized as a safe and favorable alternative to open surgical repair, with low associated morbidity and mortality. It has particular advantages in the treatment of internal iliac artery aneurysm (IIAA) given the technical difficulties associated with open surgical repair deep within the pelvis. We describe the use of customized tapered stent-grafts in the exclusion of wide-necked IIAA in five male patients considered high-risk for conventional surgical repair, in whom the common and external iliac artery morphology precluded the use of standard endovascular devices. In each case, IIAA outflow was selectively embolized and the aneurysm neck excluded by placement of a customized tapered stent-graft across the internal iliac artery origin. This technique was extremely effective, with 100% technical success, no serious associated morbidity, and zero mortality. In all five patients sac size was stable or reduced on computed tomography follow-up of up to 3 years (mean, 24.4 months), with a primary patency rate of 100%. We therefore advocate the use of customized tapered stent-grafts as a further endovascular option in the management of IIAA unsuitable for conventional endovascular repair.

  5. Stent-Graft Placement with Early Debridement and Antibiotic Treatment for Femoral Pseudoaneurysms in Intravenous Drug Addicts

    SciTech Connect

    Fu, Qining Meng, Xiyun Li, Fenghe Wang, Xuehu Cheng, Jun Huang, Wen Ren, Wei Zhao, Yu

    2015-06-15

    PurposeExplore the application of endovascular covered stent-graft (SG) placement in femoral pseudoaneurysms in intravenous drug addicts.Materials and MethodsWe evaluated a consecutive series of pseudoaneurysm in intravenous drug addicts treated with SGs from August 2010 to December 2013.Results15 patients with 16 arterial pseudoaneurysms were enrolled in this study. All were males with a mean age of 36.9 years. Hemorrhage was the most common reason (93.8 %) for seeking medical care, and 3 of these patients were in hemorrhagic shock at admission. All patients received broad-spectrum antibiotics, and debridement and drainage were implemented after SG placement. 7 of the 13 cases which had microbiologic results showed mixed infections, while gram-negative bacteria were the major pathogens. Except for 2 patients, who were lost to follow-up, two new pseudoaneurysms formed due to delayed debridement, and one stent thrombosis occurred, none of the remaining cases had SG infection or developed claudication.ConclusionsSG placement controls massive hemorrhage rapidly, gives enough time for subsequent treatment for pseudoaneurysms due to intravenous drug abuse, and reduces the incidence of postoperative claudication. With appropriate broad-spectrum antibiotics and early debridement, the incidence of SG infection is relatively low. It is an effective alternative especially as temporary bridge measure for critical patients. However, the high cost, uncertain long-term prospects, high demand for medical adherence, and the risk of using the conduits for re-puncture call for a cautious selection of patients. More evidence is required for the application of this treatment.

  6. Delayed aortic rupture after aortic endograft placement in patient with spinal hardware.

    PubMed

    Bavare, Charudatta; Kim, Min; Blackmon, Shanda; Ellsworth, Warren; Davies, Mark G; Reardon, Michael J

    2011-10-01

    Aortic injuries presenting in a delayed fashion after attempted repair of an acute injury are uncommon. We report a case of a patient presenting with an initial aortic injury associated with thoracic spinal hardware placement, which was repaired with an open and endovascular approach, and 5 months later presented with hemoptysis. The cause of hemoptysis was erosion of the descending thoracic aorta between the spinal hardware and the thoracic endograft. The patient underwent descending aorta replacement with a Dacron tube graft, removal of the hardware, and coverage with a pedicled omental flap. This is a unique presentation of erosion of the aorta between the spinal hardware and the earlier placed endovascular stent-graft. PMID:21958807

  7. Thoracic endovascular repair for acute type A aortic dissection: operative technique

    PubMed Central

    Shah, Aamir

    2016-01-01

    Acute type A aortic dissection is a potentially lethal condition which requires immediate diagnostic and therapeutic intervention. Open surgical repair remains the standard of care as survival rates continue to improve in the modern surgical era. Unfortunately, up to twenty percent of patients are denied surgical therapy because they are deemed medically unfit to undergo open repair. The application of thoracic endovascular aortic repair (TEVAR) has changed the treatment paradigm for aortic disease involving the descending thoracic aorta and may be a viable rescue option for patients with type A dissection who are not eligible for open surgical repair. New endovascular devices and advanced image-guided procedures are continually evolving. This article summarizes the pathology of aortic dissection and focuses on currently available endovascular solutions for transapical and transfemoral stent graft deployment for acute aortic dissection involving the ascending aorta for selected patients who are ineligible for open surgical repair. PMID:27563553

  8. Thoracic endovascular repair for acute type A aortic dissection: operative technique.

    PubMed

    Shah, Aamir; Khoynezhad, Ali

    2016-07-01

    Acute type A aortic dissection is a potentially lethal condition which requires immediate diagnostic and therapeutic intervention. Open surgical repair remains the standard of care as survival rates continue to improve in the modern surgical era. Unfortunately, up to twenty percent of patients are denied surgical therapy because they are deemed medically unfit to undergo open repair. The application of thoracic endovascular aortic repair (TEVAR) has changed the treatment paradigm for aortic disease involving the descending thoracic aorta and may be a viable rescue option for patients with type A dissection who are not eligible for open surgical repair. New endovascular devices and advanced image-guided procedures are continually evolving. This article summarizes the pathology of aortic dissection and focuses on currently available endovascular solutions for transapical and transfemoral stent graft deployment for acute aortic dissection involving the ascending aorta for selected patients who are ineligible for open surgical repair. PMID:27563553

  9. Transvenous Embolization of a Spontaneous Femoral AVF 5 Years After an Incomplete Treatment with Arterial Stent-Grafts

    SciTech Connect

    Peynircioglu, Bora Ozkan, Murat; Dogan, Omer Faruk; Cil, Barbaros E.; Dogan, Riza

    2008-03-15

    A 66-year-old man with complex left femoral arterio-venous fistula (AVF) was first diagnosed after a deep venous thrombosis incident approximately 5 years ago. Partial treatment was performed by means of endografts along the superficial femoral artery, which remained patent for 5 years. The patient had been doing well until a couple of months ago when he developed severe venous stasis and ulcers of the left cruris, due to a high-flow nonhealing complex AVF with additional iliac vein occlusion. Therefore; the definitive treatment was performed by a unique endovascular technique combined with surgical venous bypass (femoro-femoral crossover saphenous bypass, the Palma operation). A novel percutaneous transvenous technique for occlusion of a complex high-flow AVF is reported with a review of the literature. The case is unique with spontaneous AVF, transvenous embolization with detachable coils and ONYX, and the hybrid treatment technique as well as the long-term patency of superficial femoral artery stent-grafts.

  10. Intraoperative Endovascular Stent-graft Repair of a Popliteal Artery Laceration and Occlusion during Total Knee Arthroplasty.

    PubMed

    Kehagias, Elias; Ioannou, Christos V; Kontopodis, Nikolaos; Balalis, Constatinos; Tsetis, Dimitrios

    2015-10-01

    Injury to the popliteal vessels during total knee arthroplasty is a rare but serious complication that can cause permanent loss of function. Its incidence has been reported to be on the rise with an incidence ranging from 0.03% to 0.51%. Although rare, these complications deserve attention as they may have dire consequences, with mortality reaching 7%, amputation in up to 42%, and other morbidities such as ischemic nerve injury (foot drop). We present a case of a 78-year-old female with a pulseless limb after intraoperative injury of the popliteal artery during total knee replacement surgery who was immediately investigated with digital subtraction angiography and found to have a popliteal artery laceration with significant bleeding and a distal occlusion of the artery that was repaired endovascularly. A covered stent graft was used to simultaneously exclude the arterial laceration and to recanalize the localized popliteal occlusion. To our knowledge, this is the first report of an iatrogenic popliteal artery laceration and occlusion treated endovascularly in the intraoperative time. PMID:26133992

  11. Endovascular Treatment of a Giant Superior Mesenteric Artery Pseudoaneurysm Using a Nitinol Stent-Graft

    SciTech Connect

    Gandini, Roberto; Pipitone, Vincenzo; Konda, Daniel Pendenza, Gianluca; Spinelli, Alessio; Stefanini, Matteo; Simonetti, Giovanni

    2005-01-15

    A 68-year-old woman presenting with gastrointestinal bleeding (hematocrit 19.3%) and in a critical clinical condition (American Society of Anesthesiologists grade 4) from a giant superior mesenteric artery pseudoaneurysm (196.0 x 131.4 mm) underwent emergency endovascular treatment. The arterial tear supplying the pseudoaneurysm was excluded using a 5.0 mm diameter and 31 mm long monorail expanded polytetrafluoroethylene (ePTFE)-covered self-expanding nitinol stent. Within 6 days of the procedure, a gradual increase in hemoglobin levels and a prompt improvement in the clinical condition were observed. Multislice CT angiograms performed immediately, 5 days, 30 days and 3 months after the procedure confirmed the complete exclusion of the pseudoaneurysm.

  12. Tuberculous aortic pseudoaneurysm treated with in situ silver-impregnated vascular inlay graft.

    PubMed

    Hussein, Hanif; Azizi, Zainal A

    2008-04-01

    A 62-year-old man presented with continuous, persistent backache shortly after completion of antituberculosis medication for tuberculosis (TB) of the spine. Computed tomography scan revealed a pseudoaneurysm involving the infrarenal aorta. He was restarted on anti-TB medication and underwent repair of the pseudoaneurysm with an in situ silver-coated bifurcated Dacron graft. His postoperative recovery was uneventful and he remained well up to 12 months of follow up. To our knowledge, this is the first case in the literature where an in situ silver-impregnated vascular graft has been successfully used in treating a tuberculous pseudoaneurysm. PMID:18490221

  13. Aspirate from human stented saphenous vein grafts induces epicardial coronary vasoconstriction and impairs perfusion and left ventricular function in rat bioassay hearts with pharmacologically induced endothelial dysfunction.

    PubMed

    Lieder, Helmut R; Baars, Theodor; Kahlert, Philipp; Kleinbongard, Petra

    2016-08-01

    Stent implantation into aortocoronary saphenous vein grafts (SVG) releases particulate debris and soluble vasoactive mediators, for example, serotonin. We now analyzed effects of the soluble mediators released into the coronary arterial blood during stent implantation on vasomotion of isolated rat epicardial coronary artery segments and on coronary flow and left ventricular developed pressure in isolated perfused rat hearts. Coronary blood was retrieved during percutaneous SVG intervention using a distal occlusion/aspiration protection device in nine symptomatic patients with stable angina pectoris and a flow-limiting SVG stenosis. The blood was separated into particulate debris and plasma. Responses to coronary plasma were determined in isolated rat epicardial coronary arteries and in isolated, constant pressure-perfused rat hearts (±nitric oxide synthase [NOS] inhibition and ±serotonin receptor blockade, respectively). Coronary aspirate plasma taken after stent implantation induced a stronger vasoconstriction of rat epicardial coronary arteries (52 ± 8% of maximal potassium chloride induced vasoconstriction [% KClmax = 100%]) than plasma taken before stent implantation (12 ± 8% of KClmax); NOS inhibition augmented this vasoconstrictor response (to 110 ± 15% and 24 ± 9% of KClmax). Coronary aspirate plasma taken after stent implantation reduced in isolated perfused rat hearts only under NOS inhibition coronary flow by 17 ± 3% and left ventricular developed pressure by 25 ± 4%. Blockade of serotonin receptors abrogated these effects. Coronary aspirate plasma taken after stent implantation induces vasoconstriction in isolated rat epicardial coronary arteries and reduces coronary flow and left ventricular developed pressure in isolated perfused rat hearts with pharmacologically induced endothelial dysfunction. PMID:27482071

  14. Influence of virtual intervention and blood rheology on mass transfer through thoracic aortic aneurysm.

    PubMed

    Lei, Yu; Chen, Ming; Xiong, Guanglei; Chen, Jie

    2015-09-18

    Computational fluid dynamics tools have been used to investigate blood flow through the human thoracic aortic models with aneurysm before and after virtual stent graft operation. The impact of blood rheology and aortic geometry on the wall shear stress (WSS), luminal surface low-density lipoproteins (LDL) concentration, and oxygen flux along the arterial wall is investigated. The stent graft at the aneurysm has significant effects on WSS and mass transport in blood flow. Due to the low flow rate, Newtonian blood assumption generally under-estimates the WSS. The non-Newtonian blood rheology play an important role in the LDL transport as well as oxygen transport. It is found that WSS alone is insufficient to correctly predict the location with high risk of atherogenesis. The results suggest that WSS, luminal surface LDL concentration, and the oxygen flux on the wall have to be considered together to evaluate the performance of virtual operation. PMID:26303169

  15. Mycotic aortic arch aneurysm coexistent with constrictive pericarditis: is surgery a dangerous resort?

    PubMed

    Yu, Peter S Y; Yu, Simon C H; Chu, Cheuk-Man; Kwok, Micky W T; Lam, Yuk-Hoi; Underwood, Malcolm J; Wong, Randolph H L

    2016-08-01

    An elderly man presented with fever and evidence of Salmonella infection, and was diagnosed to have coexisting constrictive pericarditis and mycotic aneurysm of the aortic arch. Pericardiectomy was performed under cardiopulmonary bypass with good result. To avoid deep hypothermic circulatory arrest, an aorto-brachiocephalic bypass, instead of total arch replacement, was performed. This was followed by a staged carotid-carotid bypass, thoracic endovascular stent graft placement. He was subsequently treated with prolonged antibiotics, and inflammatory marker normalized afterwards. He was last seen well 2 years after the operation. Follow-up computer tomography (CT) scan at 18 months post-op showed no evidence of endoleak or fistulation. Our case demonstrated that a hybrid treatment of open pericardiectomy and aortic debranching followed by thoracic endovascular stent graft placement is feasible and associated with satisfactory mid-term outcome. PMID:27621905

  16. Mycotic aortic arch aneurysm coexistent with constrictive pericarditis: is surgery a dangerous resort?

    PubMed Central

    Yu, Peter S. Y.; Yu, Simon C. H.; Chu, Cheuk-Man; Kwok, Micky W. T.; Lam, Yuk-Hoi; Underwood, Malcolm J.

    2016-01-01

    An elderly man presented with fever and evidence of Salmonella infection, and was diagnosed to have coexisting constrictive pericarditis and mycotic aneurysm of the aortic arch. Pericardiectomy was performed under cardiopulmonary bypass with good result. To avoid deep hypothermic circulatory arrest, an aorto-brachiocephalic bypass, instead of total arch replacement, was performed. This was followed by a staged carotid-carotid bypass, thoracic endovascular stent graft placement. He was subsequently treated with prolonged antibiotics, and inflammatory marker normalized afterwards. He was last seen well 2 years after the operation. Follow-up computer tomography (CT) scan at 18 months post-op showed no evidence of endoleak or fistulation. Our case demonstrated that a hybrid treatment of open pericardiectomy and aortic debranching followed by thoracic endovascular stent graft placement is feasible and associated with satisfactory mid-term outcome. PMID:27621905

  17. Endovascular Treatment of Acute and Chronic Thoracic Aortic Injury

    SciTech Connect

    Raupach, Jan Ferko, Alexander; Lojik, Miroslav; Krajina, Antonin; Harrer, Jan; Dominik, Jan

    2007-11-15

    Our aim is to present midterm results after endovascular repair of acute and chronic blunt aortic injury. Between December 1999 and December 2005, 13 patients were endovascularly treated for blunt aortic injury. Ten patients, 8 men and 2 women, mean age 38.7 years, were treated for acute traumatic injury in the isthmus region of thoracic aorta. Stent-graftings were performed between the fifth hour and the sixth day after injury. Three patients (all males; mean age, 66 years; range, 59-71 years) were treated due to the presence of symptoms of chronic posttraumatic pseudoaneurysm of the thoracic aorta (mean time after injury, 29.4 years, range, 28-32). Fifteen stent-grafts were implanted in 13 patients. In the group with acute aortic injury one patient died due to failure of endovascular technique. Lower leg paraparesis appeared in one patient; the other eight patients were regularly followed up (1-72 months; mean, 35.6 months), without complications. In the group with posttraumatic pseudoaneurysms all three patients are alive. One patient suffered postoperatively from upper arm claudication, which was treated by carotidosubclavian bypass. We conclude that the endoluminal technique can be used successfully in the acute repair of aortic trauma and its consequences. Midterm results are satisfactory, with a low incidence of neurologic complications.

  18. Endovascular interventions for descending thoracic aortic aneurysms: The pivotal role of the clinical nurse in postoperative care.

    PubMed

    Dolinger, Cami; Strider, David V

    2010-12-01

    Descending thoracic aortic aneurysms (dTAA) comprise 40% of all aneurysms arising from the thoracic aorta. Because rupture of thoracic aneurysms is associated with a 94% mortality rate, timely detection, surveillance and treatment is imperative. Endovascular stent-graft repair of thoracic aneurysms was first performed in 1992 and has become an accepted treatment option for this condition in select candidates. There is an abundance of information for the care of patients after open surgical repair of dTAA. However, still relatively few written guidelines exist in the nursing literature for postoperative care and complications associated with endovascular stent-graft repair. The prevalence of aortic endografting, however, now makes it necessary for nurses to have a solid knowledge base in the operative procedure, complications and postoperative care for this patient population. Ideal candidates for aortic endografting undergo CTA or MRI preoperatively and fit a set of strict anatomic criteria to ensure proper delivery and fixation of the device. The early postoperative care focuses on minimizing pulmonary complications, paraplegia, renal failure and embolic complications such as stroke and limb ischemia through skilled nursing assessment and interventions. Late complications such as stent-graft migration, kinking, stent fracture and endoleak are often without symptoms, making it necessary for patients to be educated about these potential complications and to be encouraged to comply with lifelong follow up. This overview provides a sound cognitive framework for nurses practicing in a vascular surgery milieu. PMID:21074117

  19. Predictive factors for increased aortic pulse wave velocity in renal transplant recipients and its relation to graft outcome.

    PubMed

    Ayub, Muazam; Ullah, Kifayat; Masroor, Imtiaz; Butt, Ghias Uddin

    2015-11-01

    To evaluate aortic stiffness in renal transplant patients and to determine the correlation of renal insufficiency and estimated glomerular filtration rate (eGFR) with aortic pulse wave velocity (APWV), we studied 96 renal transplant patients followed-up at our center. We measured the APWV using transcutaneous Doppler flow recordings and the foot-to-foot method, and calculated the eGFR using the Modification of Diet in Renal Disease equation. The study included 81 (84.4%) males and 15 (15.6%) females. The mean age of the patients was 37.84 ± 10.10 years. The mean duration of transplant was 47.90 ± 34.40 months. The eGFR of the patients ranged from 1 to 120 mL/min, with a mean GFR of 72.6 ± 23.2 mL/min. Sixty-seven (69.8%) patients had eGFR > 60 mL/min and hence had stages 1 and 2 chronic kidney disease (CKD), 27 (28.1%) patients had eGFR 30-60 mL/min and hence had stage 3 CKD and two (2.1%) patients had eGFR <30 mL/min and hence had stages 4 and 5 CKD. The APWV of the patients ranged from 4 to 14.2 m/s, with a mean of 7.49 ± 2.47 m/s. A significant inverse correlation was found between the APWV and eGFR (Pearson correlation coefficient, -0.427, P = 0.00). The mean APWV was significantly higher among patients with higher CKD stage, P = 0.004. We conclude that the APWV is related to the renal graft dysfunction as measured by eGFR. The poorer the renal function, the higher was the APWV. Determination of the APWV may be helpful in predicting the outcome in renal transplant recipients. PMID:26586049

  20. Results and challenges for the endovascular repair of aortic arch aneurysms.

    PubMed

    Lioupis, Christos; Abraham, Cherrie Z

    2011-09-01

    Endovascular aortic arch reconstruction provides an attractive alternative to treat aortic arch disease in high-risk patients who would otherwise be unsuitable for open repair. Success with multibranched stent grafts in the thoracoabdominal aorta along with recent advances in design such as the precurved inner nitinol cannula have simplified the endovascular reconstruction of aortic arch aneurysms with multibranched stent grafts. These devices allow for greater flexibility in conforming to difficult anatomy and preserving important side branches. During the first surgical stage, a left carotid -subclavian bypass or left subclavian artery transposition is performed. The second stage is the endovascular procedure. The device is inserted through a transfemoral approach, and crossing of the aortic valve with the device is necessary. The stent graft is deployed during brief periods of rapid pacing. Bridging from the branches to the innominate and left common carotid arteries requires a suitable covered stent. In the case of a large-diameter innominate artery, a custom-made bridging limb has to be used to ensure that adequate length and size are available. Direct flow to the innominate and left common carotid arteries do not cease for any significant time during the procedure. Initial experience with mean follow up more than 6 months is encouraging. The method is not suitable for patients with extensive atheromatous involvement of the aortic arch. Careful preoperative planning (preoperative imaging, device construction, and access issues), high endovascular skills, and appropriate imaging equipment are imperative for a successful result. Long-term follow-up is necessary to evaluate the efficacy and safety of these new devices. PMID:21821619

  1. Spondylodiscitis concurrent with infectious aortic aneurysm caused by Candida tropicalis: a case report.

    PubMed

    Oichi, Takeshi; Sasaki, Satoru; Tajiri, Yasuhito

    2015-08-01

    We report a case of spondylodiscitis concurrent with infectious aortic aneurysm caused by Candida tropicalis in a 79-year-old immunocompromised man. The patient underwent percutaneous drainage of the abscess and endoluminal exclusion of the aneurysm using a bifurcated stent graft. Micafungin was administered intravenously for 8 weeks, followed by a prolonged course of oral fluconazole. At the one-year follow-up, no recurrence was noted, and the patient could walk with a cane without low back pain. PMID:26321563

  2. [Emergency Thoracic Endovascular Aortic Repair of Ruptured Kommerell's Diverticulum with an Acute Aortic Dissection].

    PubMed

    Seguchi, Ryuta; Ohtake, Hiroshi; Yoshimura, Takahiro; Shintani, Yoshiko; Nishida, Yuji; Kiuchi, Ryuta; Yamaguchi, Shojiro; Tomita, Shigeyuki; Sanada, Junichiro; Matsui, Osamu; Watanabe, Go

    2016-06-01

    This case report describes emergency thoracic endovascular aortic repair (TEVAR) of a ruptured Kommerell's diverticulum associated with a type B acute aortic dissection in a patient with a right aortic arch. A 64-year-old male was admitted with symptoms of sudden paraplegia and shock. The computed tomography imaging showed right aortic arch anomaly, with mirror image branching of the major arteries. The aorta was dissected from the origin of the right subclavian artery to the terminal aorta, with a thrombosed false lumen. Rupture was found in a 6.3 cm aneurysm located in the distal arch, which was diagnosed as Kommerell's diverticulum. We performed emergency TEVAR, and the aneurysm was successfully excluded using deployment of a Gore Tag stent-graft. At 3 months' follow-up, the patient was doing well and showed shrinkage of the aneurysm was confirmed. TEVAR is considered to be a suitable procedure for an emergency aortic catastrophe even in patients with aortic anomaly. PMID:27246128

  3. A Novel 'Cheese Wire' Technique for Stent Positioning Following Difficult Iliac Artery Subintimal Dissection and Aortic Re-Entry

    SciTech Connect

    Watkinson, A. F.

    2009-07-15

    Subintimal wire dissection is a well-established method for traversing difficult vascular occlusions. This technique relies on re-entry of the true lumen distal to the occlusion, which may be difficult in diseased vessels with significant calcification. This case report describes a novel 'cheese wire' technique to allow stent positioning without the use of proprietary re-entry devices.

  4. Treatment of acute thoracic aortic syndromes using endovascular techniques

    PubMed Central

    Uğuz, Emrah; Canyiğit, Murat; Hıdıroğlu, Mete; Şener, Erol

    2016-01-01

    PURPOSE Acute thoracic aortic syndrome (ATAS) is a novel term to define emergency aortic conditions with common clinical features and challenges. Traditional management of ATAS includes surgical replacement of the aorta and is correlated with high perioperative mortality and morbidity. We aimed to evaluate our experience and outcomes in patients presenting with ATAS, managed by endovascular techniques. METHODS This cohort consisted of 31 consecutive patients (24 males; mean age, 57.5±13.81 years; range, 19–84 years) with acute thoracic aortic pathologies who underwent endovascular repair between January 2011 and January 2015. The study was designed as a retrospective analysis of prospectively maintained data. RESULTS Complicated acute type-B aortic dissection was the most common pathology (35.5%). All aortic stent-grafts (n=37) and dissection stents (n=9) were implanted with 100% procedural success. The overall in-hospital mortality was 9.7%. The mean follow-up duration of patients who were alive at 30 days was 25.9±11.49 months (3–53 months). So far, there have been no late deaths after 30 days. CONCLUSION In the high-risk setting of ATAS, endovascular procedures come forward as novel therapeutic strategies with promising results. Endovascular repair of ATAS can be considered as a first-line treatment alternative under emergency conditions with encouraging results, particularly when conventional surgical repair cannot be implemented due to prohibitive comorbidities. PMID:27113420

  5. Combined Interventional and Surgical Treatment for Acute Aortic Type A Dissection

    SciTech Connect

    Liu Jincheng; Zhang Jinzhou Yang Jian; Zuo Jian; Zhang Jinbao; Yu Shiqiang; Chen Tao; Xu Xuezeng; Wei Xufeng; Yi Dinghua

    2008-07-15

    Surgical repair and endovascular stent-graft placement are both therapies for thoracic aortic dissection. A combination of these two approaches may be effective in patients with type A dissection. In this study, we evaluated the prognosis of this combined technique. From December 2003 to December 2006, 15 patients with type A dissection were admitted to our institute; clinical data were retrospectively reviewed. Follow-up was performed at discharge and approximately 12 months after operation. Endovascular stent-graft placement by interventional radiology and surgical repair for reconstruction of aortic arch was performed in all patients. Total arch replacement for distal arch aneurysm was carried out under deep hypothermia with circulatory arrest; antegrade-selected cerebral perfusion was used for brain protection. Four patients concomitantly received a coronary artery bypass graft. Hospital mortality rate was 6.7%; the patient died of cerebral infarction. Neurological complications developed in two patients. Multi-detector-row computed tomography scans performed before discharge revealed complete thrombosis of the false lumen in six patients and partial thrombosis in eight patients. At the follow-up examination, complete thrombosis was found in another three patients, aortic rupture, endoleaks, or migration of the stent-graft was not observed and injuries of peripheral organs or anastomotic endoleaks did not occur. For patients with aortic type A dissection, combining intervention and surgical procedures is feasible, and complete or at least partial thrombosis of the false lumen in the descending aorta can be achieved. This combined approach simplified the surgical procedures and shortened the circulatory arrest time, minimizing the necessity for further aortic operation.

  6. How to prevent spinal cord injury during endovascular repair of thoracic aortic disease.

    PubMed

    Uchida, Naomichi

    2014-07-01

    The incidence of spinal cord injury in thoracic endovascular aortic repair (TEVAR) has been 3-5 % from recent major papers where sacrifice of the critical intercostal arteries is inevitable by a stent graft. Hemodynamic stability, which depends on a network of blood vessels around the cord is most important not only during but also after stent-graft deployment. High risk factors of spinal cord injury during endovascular aortic repair are (1) coverage of the left subclavian artery, (2) extensive coverage of long segments of the thoracic aorta, (3) prior downstream aortic repair, (4) compromising important intercostal (T8-L1), vertebral, pelvic and hypogastric collaterals, and (5) shaggy aorta. Preoperative, intraoperative, and postoperative managements have been required to prevent spinal cord injury with TEVAR. For imaging assessment of blood supply to spinal cord including Adamkiewicz artery, prophylactic cerebrospinal fluid drainage is mandatory, and monitoring motor-evoked potential is recommended for high risk factors of spinal cord injury. Mean arterial pressure should be maintained over 90 mmHg after stent-graft placement for a while to prevent delayed spinal cord ischemia in high-risk patients of spinal cord ischemia. Finally, because spinal cord injury during TEVAR is not rare and negligible, perioperative care during TEVAR should be strictly performed according to the protocol proposed by each cardiovascular team. PMID:24696427

  7. Thoracic endovascular aortic repair for complicated chronic type B aortic dissection in a patient on hemodialysis with recurrent ischemic colitis.

    PubMed

    Miyazaki, Yuko; Furuyama, Tadashi; Matsubara, Yutaka; Yoshiya, Keiji; Yoshiga, Ryosuke; Inoue, Kentaro; Matsuda, Daisuke; Aoyagi, Yukihiko; Kato, Masaaki; Matsumoto, Takuya; Maehara, Yoshihiko

    2016-12-01

    We present a successful case of thoracic endovascular aortic repair (TEVAR) for chronic Stanford type B aortic dissection (B-AD) with recurrent ischemic colitis. The patient was a 56-year-old woman with abdominal pain as the main complaint who had two operations previously: the total arch replacement 8 years ago and the Bentall 7 years ago for acute Stanford type A aortic dissection. Her abdominal pain worsened as her blood pressure became low during her hemodialysis treatment. An enhanced computed tomography scan was performed on the patient and showed chronic B-AD that occurred from the distal anastomotic part of the total arch graft to the bilateral common iliac arteries. The celiac artery and superior mesenteric artery (SMA) arose from the true lumen, and these were compressed by the expanded false lumen. Her complicated chronic B-AD was treated with the Zenith Dissection Endovascular System, and its procedure was performed as her proximal entry tear was covered by a proximal tapered Zenith TX2 stent graft, supplemented by a noncovered aortic stent extending across both renal arteries, the SMA, and the celiac artery. Seven days after this operation, enhanced computed tomography showed that the patient's true lumen was expanded and her blood flow to the true lumen and SMA was improved. On the other hand, her false lumen tended to be thrombosed. Consequently, she was discharged 10 days after the operation without any postoperative complications as she had no abdominal complaints even though she underwent hemodialysis three times per week after the operation. We believe that TEVAR supplemented by a noncovered aortic stent is an effective treatment, even for highly chronic B-AD in dialysis patients. PMID:27090121

  8. Thrombin Injection Failure with Subsequent Successful Stent-Graft Placement for the Treatment of an Extracranial Internal Carotid Pseudoaneurysm in a 5-Year-Old Child

    SciTech Connect

    Garcia-Monaco, R. D.; Kohan, A. A.; Martinez-Corvalan, M. P.; Cacchiarelli, N.; Peralta, O.; Wahren, C. G.

    2012-06-15

    Internal carotid artery pseudoaneurysm is a rare life-threatening condition that may develop in different clinical situations. We report the case of an extracranial internal carotid artery pseudoaneurysm secondary to a throat infection in a pediatric patient that was initially treated with percutaneous thrombin injection under ultrasound guidance. However, recanalization occurred at 48 h, and definitive treatment was then performed by endovascular stent-graft placement. We briefly review the clinical characteristics of this uncommon clinical condition as well as the treatment options.

  9. Spinal cord protection in aortic endovascular surgery.

    PubMed

    Scott, D A; Denton, M J

    2016-09-01

    A persistent neurological deficit, such as paraplegia or paraparesis, secondary to spinal cord injury remains one of the most feared complications of surgery on the descending thoracic or abdominal aorta. This is despite sophisticated advances in imaging and the use of less invasive endovascular procedures. Extensive fenestrated endovascular aortic graft prostheses still carry a risk of spinal cord injury of up to 10%; thus, this risk should be identified and strategies implemented to protect the spinal cord and maintain perfusion. The patients at highest risk are those undergoing extensive thoracic aortic stenting including thoracic, abdominal, and pelvic vessels. Although many techniques are available, lumbar cerebrospinal fluid drainage remains the most frequent intervention, along with maintenance of perfusion pressure and possibly staged procedures to allow collateral vessel stabilization. Many questions remain regarding other technical aspects, spinal cord monitoring and cooling, pharmacological protection, and the optimal duration of interventions into the postoperative period. PMID:27566805

  10. Comparison between three types of stented pericardial aortic valves (Trivalve trial): study protocol for a randomized controlled trial

    PubMed Central

    2013-01-01

    Background Aortic valve stenosis is one of the most common heart diseases in older patients. Nowadays, surgical aortic valve replacement is the ‘gold standard’ treatment for this pathology and the most implanted prostheses are biological ones. The three most implanted bovine bioprostheses are the Trifecta valve (St. Jude Medical, Minneapolis, MN, USA), the Mitroflow valve (Sorin Group, Saluggia, Italy), and the Carpentier-Edwards Magna Ease valve (Edwards Lifesciences, Irvine, CA, USA). We propose a randomized trial to objectively assess the hemodynamic performances of these bioprostheses. Methods and design First, we will measure the aortic annulus diameter using CT-scan, echocardiography and by direct sizing in the operating room after native aortic valve resection. The accuracy of information, in terms of size and spatial dimensions of each bioprosthesis provided by manufacturers, will be checked. Their hemodynamic performances will be assessed postoperatively at the seventh day and the sixth month after surgery. Discussion This prospective controlled randomized trial aims to verify and compare the hemodynamic performances and the sizing of these three bioprostheses. The data obtained may help surgeons to choose the best suitable bioprosthesis according to each patient’s morphological characteristics. Trial registration ClinicalTrials.gov Identifier: NCT01522352 PMID:24299218

  11. Imaging of abdominal aortic aneurysms.

    PubMed

    Sparks, Amy R; Johnson, Philip L; Meyer, Mark C

    2002-04-15

    Given the high rate of morbidity and mortality associated with abdominal aortic aneurysms (AAAs), accurate diagnosis and preoperative evaluation are essential for improved patient outcomes. Ultrasonography is the standard method of screening and monitoring AAAs that have not ruptured. In the past, aortography was commonly used for preoperative planning in the repair of AAAs. More recently, computed tomography (CT) has largely replaced older, more invasive methods. Recent advances in CT imaging technology, such as helical CT and CT angiography, offer significant advantages over traditional CT. These methods allow for more rapid scans and can produce three-dimensional images of the AAA and important adjacent vascular structures. Use of endovascular stent grafts has increased recently and is less invasive for the repair of AAAs in selected cases. Aortography and CT angiography can precisely determine the size and surrounding anatomy of the AAA to identify appropriate candidates for the use of endovascular stent grafts. Helical CT and CT angiography represent an exciting future in the preoperative evaluation of AAAs. However, this technology is not the standard of care because of the lack of widespread availability, the cost associated with obtaining new equipment, and the lack of universal protocols necessary for acquisition and reconstruction of these images. PMID:11989632

  12. Monoparesis after graft replacement of non-ruptured abdominal aortic aneurysm.

    PubMed

    Matsuda, Hitoshi; Ogino, Hitoshi; Saito, Shunsuke; Sasaki, Hiroaki; Minatoya, Kenji; Kobayashi, Junjiro; Yagihara, Toshikatsu; Kitamura, Soichiro

    2006-10-01

    A 67-year-old man was admitted with a saccular aneurysm of the abdominal aorta. Preoperative CT revealed cylindrical calcification of the abdominal aorta and the patent internal iliac arteries (IIAs). At the elective surgery, a cylinder-shaped and severely calcified intimal layer was found, and the lumbar arteries were totally occluded. Hypotension caused by the loose iliac clamp due to severe calcification continued for 15 minutes and long-time cross clamp was necessary. Monoparesis of the left lower extremity and dysuria occurred postoperatively. Spinal MRI revealed small infarction at the Th10 level. Symptoms improved and he could walk with a cane and within a few months no uninary catheter support was needed. Thoracic spinal cord infarction after abdominal aortic aneurysm (AAA) surgery and a severely calcified abdominal aorta indicated the importance of the blood flow in the IIA as the significant source of spinal blood supply. To prevent spinal cord injury (SCI) which is rare but significant complication of AAA surgery, understanding of the spinal blood supply, quick surgery, and complete revascularization of pelvic arteries are important. PMID:17095985

  13. Assessing a strategy of initial stand-alone extractional atherectomy followed by staged stent placement in degenerated saphenous vein graft lesions.

    PubMed

    Ahmed, J M; Hong, M K; Mehran, R; Pichard, A D; Satler, L F; Kent, K M; Mintz, G S; Wu, H; Leon, M B

    2000-11-01

    To assess whether a staged strategy (initial stand alone transluminal extraction atherectomy and coumadin therapy followed by stenting six weeks later) could reduce ischemic complications in degenerated saphenous vein graft (SVG) interventions, we studied 72 patients undergoing percutaneous interventions of degenerated SVG. Patients were divided into two groups; 28 were treated with a staged strategy (group I) and 44 with similar lesion characteristics were treated with a definitive initial procedure with transluminal extraction atherectomy +/- adjunctive balloon angioplasty and stenting (group II). Procedural success, major in-hospital complications (death, Q-wave myocardial infarction, and emergent coronary bypass surgery), and incidence of distal embolization were compared between the 2 groups. Procedural success was lower (92% vs 100%, p = 0.14) and major in-hospital complications were higher (0% vs 11%, p = 0.14) in group II. Distal embolization occurred in 11% of the patients in group I compared with 23% of the patients in group II (p = 0.19). At 6 week follow-up (group I), 9 patients (33%) had negative symptoms, 11 (41%) underwent stent implantation, 3 (11%) did not require any further therapy (without significant stenosis), and 4 (14%) had total occlusions. We therefore conclude that this staged strategy in degenerated SVG appears to reduce distal embolization but most importantly avoids major in-hospital complications, including any deaths either at the time of initial procedure or during the 6-week follow-up period. PMID:11053700

  14. [Hybrid surgical intervention in a patient with an aortic arch aneurysm and coronary artery disease].

    PubMed

    Charchan, E R; Abugov, S A; Puretsky, M V; Kim, S Yu; Skvortsov, A A; Khachatryan, Z R

    2015-01-01

    Presented herein is a clinical case report regarding the use of hybrid technology in surgical treatment of a patient with an aneurysm of the distal portion of the aortic arch and coronary artery disease. The patient underwent a hybrid operation, i.e. debranching of the aortic arch branches, exoprosthetic repair of the ascending aorta, autovenous prosthetic coronary bypass grafting of the branch of the blunt edge of the anterior interventricular artery, stenting of the ascending portion, arch and descending portion of the aorta (stent graft "Medtronic Valiant"). In doing so, we used a non-standard approach to connecting the artificial circulation unit and to choosing the place for establishing proximal anastomoses of autovenous coronary bypass grafts. The early postoperative period was complicated by the development of respiratory insufficiency requiring continuation artificial pulmonary ventilation. The duration of the hospital stay of the patient amounted to 15 days. The check-up multispiral computed tomography showed normal functioning of the reconstruction zones, the stent graft is expanded, with no leak observed. The conclusion was made that hybrid interventions may be considered as an alternative to the classical surgical treatment associated in patients of older age group with a severe course of the postoperative period and high lethality. PMID:26035581

  15. Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis.

    PubMed

    Sakamoto, Shigeyuki; Kiura, Yoshihiro; Okazaki, Takahito; Ichinose, Nobuhiko; Kurisu, Kaoru

    2015-03-01

    Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications. PMID:25874182

  16. Endovascular Stenting under Cardiac and Cerebral Protection for Subclavian Steal after Coronary Artery Bypass Grafting Due to Right Subclavian Artery Origin Stenosis

    PubMed Central

    Kiura, Yoshihiro; Okazaki, Takahito; Ichinose, Nobuhiko; Kurisu, Kaoru

    2015-01-01

    Coronary-subclavian steal (CSS) can occur after coronary artery bypass grafting (CABG) using the internal thoracic artery (ITA). Subclavian artery (SA) stenosis proximal to the ITA graft causes CSS. We describe a technique for cardiac and cerebral protection during endovascular stenting for CSS due to right SA origin stenosis after CABG. A 64-year-old man with a history of CABG using the right ITA presented with exertional right arm claudication. Angiogram showed a CSS and retrograde blood flow in the right vertebral artery (VA) due to severe stenosis of the right SA origin. Endovascular treatment of the right SA stenosis was planned. For cardiac and cerebral protection, distal balloon protection by inflating a 5.2-F occlusion balloon catheter in the SA proximal to the origin of the right VA and ITA through the right brachial artery approach and distal filter protection of the right internal carotid artery (ICA) through the left femoral artery (FA) approach were performed. Endovascular stenting for SA stenosis from the right FA approach was performed under cardiac and cerebral protection by filter-protection of the ICA and balloon-protection of the VA and ITA. Successful treatment of SA severe stenosis was achieved with no complications. PMID:25874182

  17. Spontaneous Subcapsular Renal Hematoma: Strange Case in an Anticoagulated Patient with HWMH after Aortic and Iliac Endovascular Stenting Procedure

    PubMed Central

    Greco, Michele; Benedetto, Filippo; Spinelli, Francesco; Traxer, Olivier; Tefik, Tzevat; Pappalardo, Rosa

    2016-01-01

    Spontaneous subcapsular renal hematoma is a rare condition in clinical practice. It is caused by renal cysts, benign and malignant renal tumors, vascular lesions, and antiplatelet or anticoagulant therapy. In this paper we report an unusual case of rupture of a renal cyst of a 66-year-old male patient during an aortic and iliac endovascular procedure for a massive calcified atheroma above the iliac bifurcation. We suspected that the bolus of high weight molecular heparin given during the procedure caused the rupture of the cyst. According to the literature, this is the first case of renal cyst rupture during an endovascular aortic procedure after administering a high weight molecular heparin bolus. PMID:27579210

  18. Spontaneous Subcapsular Renal Hematoma: Strange Case in an Anticoagulated Patient with HWMH after Aortic and Iliac Endovascular Stenting Procedure.

    PubMed

    Greco, Michele; Butticè, Salvatore; Benedetto, Filippo; Spinelli, Francesco; Traxer, Olivier; Tefik, Tzevat; Pappalardo, Rosa; Magno, Carlo

    2016-01-01

    Spontaneous subcapsular renal hematoma is a rare condition in clinical practice. It is caused by renal cysts, benign and malignant renal tumors, vascular lesions, and antiplatelet or anticoagulant therapy. In this paper we report an unusual case of rupture of a renal cyst of a 66-year-old male patient during an aortic and iliac endovascular procedure for a massive calcified atheroma above the iliac bifurcation. We suspected that the bolus of high weight molecular heparin given during the procedure caused the rupture of the cyst. According to the literature, this is the first case of renal cyst rupture during an endovascular aortic procedure after administering a high weight molecular heparin bolus. PMID:27579210

  19. 21 CFR 884.3900 - Vaginal stent.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... stent. (a) Identification. A vaginal stent is a device used to enlarge the vagina by stretching, or to support the vagina and to hold a skin graft after reconstructive surgery. (b) Classification. Class...

  20. Open Repair Versus Thoracic Endovascular Aortic Repair in Multiple-Injured Patients: Observations From a Level-1 Trauma Center

    PubMed Central

    Brand, Stephan; Breitenbach, Ingo; Bolzen, Philipp; Petri, Maximilian; Krettek, Christian; Teebken, Omke

    2015-01-01

    Background: Blunt trauma of the thoracic aorta is a rare but potentially life-threatening entity. Intimal tears are a domain of non-operative management, whereas all other types of lesions should be repaired urgently. There is now a clear trend favoring minimally invasive stent grafting over open surgical repair. Objectives: The aim of the present study was to retrospectively evaluate the mortality and morbidity with either treatment option. Therefore, a retrospective observational study was performed to compare two different treatment methods at two different time periods at one trauma center. Patients and Methods: Between 1977 and 2012, all severely injured patients referred to our level 1 trauma center were screened for blunt aortic injuries. We compared baseline characteristics, 30-day and overall mortality, morbidity, duration of intensive care treatment, procedure time, and transfusion of packed red blood between patients who underwent open surgical or stent repair. Results: During the observation period, 45 blunt aortic injuries were recorded. The average Injury Severity Score (ISS) was 41.8 (range 29 - 68). Twenty-five patients underwent Open Repair (OR), and another 20 patients were scheduled to emergency stent grafting. The 30-day mortality in the surgical and stent groups were 5/25 (20%) and 2/20 (10%), respectively. The average time for open surgery was 151 minutes; the mean time for stent grafting was 67 minutes (P = 0.001). Postoperative stay on the intensive care unit was between one and 59 days (median 10) in group one and between four and 50 days in group two (median 26)(P = 0.03). Patients undergoing OR required transfusion of 6.0 units of packed red cells in median; patients undergoing stent grafting required a median of 2.0 units of packed red cells (P < 0.001). In the stent grafting group, 30-day mortality was 10% (2/20). Conclusions: Due to more sophisticated diagnostic tools and surgical approaches, mortality and morbidity of blunt aortic

  1. Retrograde dissection of the ascending aorta during diagnostic coronary angiography in a patient who previously had resection of the aortic adventitia tumor and coronary bypass grafting.

    PubMed

    Olędzki, Szymon; Czechowska, Małgorzata; Chlasta, Jacek; Gorący, Jarosław

    2016-03-01

    Retrograde dissection of ascending aorta is a very rare but life threating complication of coronary catheterization. Despite the seriousness of the complication, there is little data on the subject. Majority of case reports in literature includes patients without comorbidities that may affect the management. We experienced the retrograde dissection of the ascending aorta in a patient who previously had resection of the tumor originating from aortic root and coronary bypass grafting. No similar case has been reported in literature. The data from literature does not include the patients with comorbidities like previous coronary bypass grafting. For that reason we had hesitation in decision making. Wherefore, the aim of this article is to share our experience in this matter. PMID:27088202

  2. Endovascular Treatment of Thoracic Aortic Dissection: Hemodynamic Shear Stress Study

    NASA Astrophysics Data System (ADS)

    Tang, Yik Sau; Lai, Siu Kai; Cheng, Stephen Wing Keung; Chow, Kwok Wing

    2012-11-01

    Thoracic Aortic Dissection (TAD), a life threatening cardiovascular disease, occurs when blood intrudes into the layers of the aortic wall, creating a new artificial channel (the false lumen) beside the original true lumen. The weakened false lumen wall may expand, enhancing the risk of rupture and resulting in high mortality. Endovascular treatment involves the deployment of a stent graft into the aorta, thus blocking blood from entering the false lumen. Due to the irregular geometry of the aorta, the stent graft, however, may fail to conform to the vessel curvature, and would create a ``bird-beak'' configuration, a wedge-shaped domain between the graft and the vessel wall. Computational fluid dynamics analysis is employed to study the hemodynamics of this pathological condition. With the `beaking' configuration, the local hemodynamic shear stress will drop below the threshold of safety reported earlier in the literature. The oscillating behavior of the shear stress might lead to local inflammation, atherosclerosis and other undesirable consequences. Supported by the Innovation and Technology Fund of the Hong Kong Government.

  3. Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia

    PubMed Central

    Kfoury, Elias; Almanfi, Abdelkader; Dougherty, Kathryn G.

    2016-01-01

    Crossed fused renal ectopia, a congenital anomaly in 1 of 7,000 individuals, presents a challenge during endovascular treatment of abdominal aortic aneurysm. Most treatment approaches in these patients have involved open surgical repair of the aneurysm or endovascular repair with coverage of the ectopic renal artery. We present what we think is the first case of endovascular abdominal aortic aneurysm repair with use of the chimney technique (parallel stent-grafting) to preserve an ectopic renal artery, in an 88-year-old man who was at high risk for open surgery. In addition to the patient's case, we discuss the relevant medical literature. PMID:27303239

  4. Endovascular Abdominal Aortic Aneurysm Repair by Means of the Chimney Technique in a Patient with Crossed Fused Renal Ectopia.

    PubMed

    Kfoury, Elias; Almanfi, Abdelkader; Dougherty, Kathryn G; Krajcer, Zvonimir

    2016-06-01

    Crossed fused renal ectopia, a congenital anomaly in 1 of 7,000 individuals, presents a challenge during endovascular treatment of abdominal aortic aneurysm. Most treatment approaches in these patients have involved open surgical repair of the aneurysm or endovascular repair with coverage of the ectopic renal artery. We present what we think is the first case of endovascular abdominal aortic aneurysm repair with use of the chimney technique (parallel stent-grafting) to preserve an ectopic renal artery, in an 88-year-old man who was at high risk for open surgery. In addition to the patient's case, we discuss the relevant medical literature. PMID:27303239

  5. An unusual duplication of the inferior vena cava in a patient with endovascular repair for abdominal aortic aneurysm.

    PubMed

    Polguj, Michał; Szubert, Wojciech; Topol, Mirosław; Stefańczyk, Ludomir

    2015-01-01

    A 66-year-old Caucasian male, with sensation of abdominal pulsation was admitted to our hospital. In multidetector 64-row computed tomography (CT) angiography, an abdominal aortic aneurysm was observed. Endovascular aortic repair was performed. Control CT confirmed prosperity with stent graft fixation and absence of any vascular complications. Investigation also showed asymmetrical duplication of the inferior vena cava (IVC). Right (RIVC) and left (LIVC) inferior vena cava arose from the confluence of the right and left iliac veins. The LIVC continued as left renal vein. PMID:26429190

  6. Endovascular thoracic aortic repair and risk of spinal cord ischemia: the role of previous or concomitant treatment for aortic aneurysm.

    PubMed

    Setacci, F; Sirignano, P; De Donato, G; Chisci, E; Galzerano, G; Massaroni, R; Setacci, C

    2010-04-01

    Spinal cord ischemia (SCI) is one of the most devastating complications undergoing surgical or endovascular repair of the thoracic aorta. The incidence of SCI after thoracic aorta open repair varies from 2% to 21%, depending on the extent of the descending thoracic aorta replacement compared with as high as 12% of cases after endovascular aortic repair. Endoluminal repair allows the avoidance of aortic cross clamping and its sequelae; however, the intercostal arteries covered by the stent graft cannot be reimplanted. Perioperative risk factors contributing to SCI have been reported to include length of aortic coverage, prior abdominal aortic aneurysm (AAA) repair, hypotension, and left subclavian artery coverage. Although the putative mechanism of loss of lumbar collateral perfusion in those who had prior aortic repairs appears reasonable, occurrence of SCI in this subset of patients has not been consistent. Spinal cord perfusion is dependent on the net pressure of the mean arterial pressure minus the mean intrathecal pressure. Systemic pressure can be maximized by volume resuscitation and vasopressors. Intrathecal spinal pressure can be minimized by drainage of the spinal cord, although this is not without its potential risks. More recently, there have been attempts at attenuating the cellular damage caused by SCI, either with systemic or intrathecal administration of pharmacologic agents, which attempt to mitigate the inflammatory response of cellular reperfusion. This is a review of the risk factors for SCI during TEVAR in patients with previous or concomitant treatment for aortic aneurysm. PMID:20354486

  7. [Hybrid operation for a posttraumatic saccular aneurysm of the aortic arch].

    PubMed

    Ignat'ev, I M; Volodiukhin, M Iu; Zanochkin, A V; Terekhin, S V

    2013-01-01

    The article deals with a case report of successful hybrid surgical treatment of a patient presenting with a posttraumatic large false saccular aneurysm of the aortic arch with mediastinal displacement and compression of the left recurrent laryngeal nerve and trachea. The patient was subjected to a hybrid operation, i. e., bypass grafting of the brachiocephalic trunk and the left common carotid artery with a bifurcation prosthesis from the ascending aorta through sternotomy, carotid-vertebral and carotid-subclavian bypass grafting on the left in a combination with endoprosthetic repair of the aortic arch with the stent graft Valiant Thoracic 40 × 224 mm (VAMF 4040c200TE) manufactured by the Medtronic Company. The postoperative period was uneventful followed by rather rapid rehabilitation of the patient. One month after the operation, the clinical state improved considerably. His voice restored virtually completely, and breathlessness disappeared. According to the findings of MSCT angiography, the aneurysmatic cavity is thrombosed, with the stent graft showing no evidence of either dislocation or endoleak. The bifurcation bypass graft is functioning. According to the data of duplex scanning, the anastomoses established on the neck are patent. PMID:23531669

  8. Hybrid treatment of a true thyreocervical trunk aneurysm in a patient with Type B aortic dissection

    PubMed Central

    Baikoussis, Nikolaos G.; Argiriou, Orestis; Argiriou, Michalis; Psevdi, Aikaterini; Kratimenos, Theodoros; Dedeilias, Panagiotis

    2016-01-01

    We would like to describe a case with a complex aortic disease treated in hybrid fashion. We present an interesting case of a 65-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease percutaneously treated. An acute Type B aortic dissection occurred and treated with the implantation of a stent-graft which occluded the left subclavian artery due to its extension to the aortic arch. This event required a carotid-subclavian artery bypass due to ischemia of the left arm. An aneurysm in the innominate artery also detected, was treated with another stent-graft implantation 3 months later. At 5-year follow-up, an aneurysm of the thyreocervical trunk was found while the stent-graft of the aorta was well-tolerated without endoleak and the carotid-subclavian graft was patent. The aneurysm was asymptomatic but considering the risk of spontaneous rupture of an aneurysm of this size, elective surgery was indicated. Because the aneurysm was very close to the brachiocephalic bifurcation, open surgical repair would require a sternotomy. The right common carotid artery and right subclavian artery were exposed. The thyrocervical trunk, right internal mammary artery and right vertebral artery were occluded by ligations to isolate the aneurysm. An 8-mm Dacron graft was anastomosed end-to-end to the distal part of subclavian artery. We would like through this case, discuss the role of the hybrid cardiovascular surgery to minimize the postoperative complications in complex cardiovascular pathology. We also discuss the international bibliography about the thyreocervical trunk aneurysm and the treatment options. PMID:27052087

  9. Hybrid treatment of a true thyreocervical trunk aneurysm in a patient with Type B aortic dissection.

    PubMed

    Baikoussis, Nikolaos G; Argiriou, Orestis; Argiriou, Michalis; Psevdi, Aikaterini; Kratimenos, Theodoros; Dedeilias, Panagiotis

    2016-01-01

    We would like to describe a case with a complex aortic disease treated in hybrid fashion. We present an interesting case of a 65-year-old man with a medical history of hypertension, hyperlipidemia, and coronary artery disease percutaneously treated. An acute Type B aortic dissection occurred and treated with the implantation of a stent-graft which occluded the left subclavian artery due to its extension to the aortic arch. This event required a carotid-subclavian artery bypass due to ischemia of the left arm. An aneurysm in the innominate artery also detected, was treated with another stent-graft implantation 3 months later. At 5-year follow-up, an aneurysm of the thyreocervical trunk was found while the stent-graft of the aorta was well-tolerated without endoleak and the carotid-subclavian graft was patent. The aneurysm was asymptomatic but considering the risk of spontaneous rupture of an aneurysm of this size, elective surgery was indicated. Because the aneurysm was very close to the brachiocephalic bifurcation, open surgical repair would require a sternotomy. The right common carotid artery and right subclavian artery were exposed. The thyrocervical trunk, right internal mammary artery and right vertebral artery were occluded by ligations to isolate the aneurysm. An 8-mm Dacron graft was anastomosed end-to-end to the distal part of subclavian artery. We would like through this case, discuss the role of the hybrid cardiovascular surgery to minimize the postoperative complications in complex cardiovascular pathology. We also discuss the international bibliography about the thyreocervical trunk aneurysm and the treatment options. PMID:27052087

  10. New Technique for the Preservation of the Left Common Carotid Artery in Zone 2a Endovascular Repair of Thoracic Aortic Aneurysm

    SciTech Connect

    Juszkat, Robert Kulesza, Jerzy; Zarzecka, Anna; Jemielity, Marek; Staniszewski, Ryszard; Majewski, Waclaw

    2011-02-15

    To describe a technique for the preservation of the left common carotid artery (CCA) in zone 2 endovascular repair of thoracic aortic aneurysm. This technique involves the placement of a guide wire into the left CCA via the right brachial artery before stent graft deployment to enable precise visualization and protection of the left CCA during the whole procedure. Of the 107 patients with thoracic endovascular aortic repair in our study, 32 (30%) had the left subclavian artery intentionally covered (landing zone 2). Eight (25%) of those 32 had landing zone 2a-the segment distally the origin of the left CCA, halfway between the origin of the left CCA and the left subclavian artery. In all patients, a guide wire was positioned into the left CCA via the right brachial artery before stent graft deployment. It is a retrospective study in design. In seven patients, stent grafts were positioned precisely. In the remaining patient, the positioning was imprecise; the origin of the left CCA was partially covered by the graft. A stent was implanted into the left CCA to restore the flow into the vessel. All procedures were performed successfully. The technique of placing a guide wire into the left CCA via the right brachial artery before stent graft deployment is a safe and effective method that enables the precise visualization of the left CCA during the whole procedure. Moreover, in case of inadvertent complete or partial coverage of the origin of the left CCA, it supplies safe and quick access to the artery for stent implantation.

  11. The prevalence of Chlamydia pneumoniae in the aortic wall and in peripheral blood of patients scheduled for coronary artery bypass grafting.

    PubMed

    Kuczaj, A; Stryjewski, P J; Fudal, M; Domal-Kwiatkowska, D; Ryfiński, B; Sliupkas-Dyrda, E; Smolik, S; Węglarz, L; Mazurek, U; Nowalany-Kozielska, E

    2016-01-01

    Some reports confirm a potential role of Chlamydia pneumoniae (ChP) in atherogenesis. In order to explore possible association between ChP and atherosclerosis, investigations were carried out in which the frequency of ChP in the arterial wall and peripheral blood was assessed in a group of patients with chronic coronary artery disease (CAD). Fifty-seven patients were enrolled in the study, 13 women and 44 men aged 61.8±6.5 (47-74), with previously diagnosed CAD, scheduled for planned coronary artery bypass grafting due to clinical indications. Vessel specimens retrieved from the ascending aorta (as a part of routine proximal venous graft development procedure) and peripheral blood mononuclear cells (PBMCs) from venous blood were evaluated for the presence of ChP DNA. Genomic DNA was extracted from PBMCs and vessel specimens. Quantitative real-time polymerase chain reaction (qPCR) was performed to detect ChP DNA. A statistically more frequent occurrence of ChP was observed in aortic tissues compared to blood samples (70.2% vs 56.1%, respectively). Similarly, the number of ChP DNA genomic copies [n/1μg genomic DNA] was significantly higher in tissue specimens compared to blood samples (89±91 vs 41±77, respectively; p=0.0046). In patients without ChP in blood specimens, we observed significantly higher amounts of ChP in tissue specimens compared to patients with ChP in blood specimens (156±71 vs 107±88, respectively; p=0.0453). No correlation was found between the number of ChP DNA copies [n/1μg genomic DNA] in blood and in aortic specimens. The infection of ChP in the aortic wall was connected with hypercholesterolemia (p=0.029) and diabetes (p=0.03). We conclude that Chlamydia pneumoniae is a pathogen frequently occurring in the aortic wall of patients with CAD. The occurrence of ChP DNA in the aortic tissue is related to classic CAD risk factors such as diabetes and dyslipidemia. PMID:27358129

  12. Chimney grafts: is there a need and will they work?

    PubMed

    Resch, Timothy A; Sonesson, Björn; Dias, Nuno; Malina, Martin

    2011-09-01

    Endovascular repair has become the primary treatment option for abdominal aortic aneurysms over the past decade. The favorable results as well as technical evolution have led endovascular repair to include fenestrated and branched technology for complex juxtarenal, suprarenal, and thoracoabdominal aneurysms. These grafts are, however, extensively customized and patient tailored at present precluding their use in emergency situations. Certain aspect of aneurysm anatomy also limits them. The chimney technique uses standard, off-the-shelf endovascular devices that extend the use of standard aortic stent grafts for aneurysms without suitable proximal landing zones particularly in acute situations. Early results are promising and warrant a continued development of the technique until such time that dedicated devices are available for the treatment of these complex aneurysms. PMID:21810801

  13. Resolution of Large Azygos Vein Aneurysm Following Stent-Graft Shunt Placement in a Patient with Ehlers-Danlos Syndrome Type IV

    SciTech Connect

    D'Souza, Estelle S.; Williams, David M.; Deeb, G.M.; Cwikiel, Wojciech

    2006-10-15

    Ehlers-Danlos syndrome (EDS) type IV is a rare connective tissue disorder associated with thin-walled, friable arteries and veins predisposing patients to aneurysm formation, dissection, fistula formation, and vessel rupture. Azygos vein aneurysm is an extremely rare condition which has not been reported in association with EDS in the literature. We present a patient with EDS type IV and interrupted inferior vena cava (IVC) with azygos continuation who developed an azygos vein aneurysm. In order to decrease flow through the azygos vein and reduce the risk of aneurysm rupture, a stent-graft shunt was created from the right hepatic vein to the azygos vein via a transhepatic, retroperitoneal route. At 6 month follow-up the shunt was open and the azygos vein aneurysm had resolved.

  14. Gene Silencing In Human Aortic Smooth Muscle Cells Induced by PEI siRNA Complexes Released From Dip-Coated Electrospun Poly(ethylene Terephthalate) Grafts

    PubMed Central

    Nabzdyk, Christoph S.; Chun, Maggie; Oliver-Allen, Hunter; Pathan, Saif G.; Phaneuf, Matthew D.; You, Jin-Oh; Pradhan-Nabzdyk, Leena; LoGerfo, Frank W.

    2014-01-01

    An excessive tissue response to prosthetic arterial graft material leads to intimal hyperplasia (IH), the leading cause of late graft failure. Seroma and abnormal capsule formation may also occur after prosthetic material implantation. The matricellular protein Thrombospondin-2 (TSP-2) has shown to be upregulated in response to biomaterial implantation. This study evaluates the uptake and release of small interfering RNA (siRNA) from unmodified and surface functionalized electrospun PET graft materials. ePET graft materials were synthesized using electrospinning technology. Subsets of the ePET materials were then chemically modified to create surface functional groups. Unmodified and surface-modified ePET grafts were dip-coated in siRNAs alone or siRNAs complexed with transfection reagents polyethyleneimine (PEI) or Lipofectamine RNAiMax. Further, control and TSP-2 siRNA-PEI complex treated ePET samples were placed onto a confluent layer of human aortic smooth muscle cells (AoSMCs). Complexation of all siRNAs with PEI led to a significant increase in adsorption to unmodified ePET. TSP-2 siRNA-PEI released from unmodified-ePET silenced TSP-2 in AoSMC. Regardless of the siRNA-PEI complex evaluated, AoSMC migrated into the ePET. siRNA-PEI complexes delivered to AoSMC from dip-coated ePET can result in gene knock-down. This methodology for siRNA delivery may improve the tissue response to vascular and other prosthetics. PMID:24397987

  15. Detection and visualization of endoleaks in CT data for monitoring of thoracic and abdominal aortic aneurysm stents

    NASA Astrophysics Data System (ADS)

    Lu, J.; Egger, J.; Wimmer, A.; Großkopf, S.; Freisleben, B.

    2008-03-01

    In this paper we present an efficient algorithm for the segmentation of the inner and outer boundary of thoratic and abdominal aortic aneurysms (TAA & AAA) in computed tomography angiography (CTA) acquisitions. The aneurysm segmentation includes two steps: first, the inner boundary is segmented based on a grey level model with two thresholds; then, an adapted active contour model approach is applied to the more complicated outer boundary segmentation, with its initialization based on the available inner boundary segmentation. An opacity image, which aims at enhancing important features while reducing spurious structures, is calculated from the CTA images and employed to guide the deformation of the model. In addition, the active contour model is extended by a constraint force that prevents intersections of the inner and outer boundary and keeps the outer boundary at a distance, given by the thrombus thickness, to the inner boundary. Based upon the segmentation results, we can measure the aneurysm size at each centerline point on the centerline orthogonal multiplanar reformatting (MPR) plane. Furthermore, a 3D TAA or AAA model is reconstructed from the set of segmented contours, and the presence of endoleaks is detected and highlighted. The implemented method has been evaluated on nine clinical CTA data sets with variations in anatomy and location of the pathology and has shown promising results.

  16. [Combined Open and Endovascular Repair of Multiple Aortic Aneurysms due to Syphilitic Aortitis].

    PubMed

    Shima, Shotaro; Okamura, Kennichi; Morizumi, Sei; Kawata, Mitsuhiro; Suematsu, Yoshihiro

    2015-06-01

    The patient was a 69-year-old man who presented with low-grade fever and appetite loss. Thoracoabdominal computed tomography revealed multiple aneurysms in the distal arch and descending thoracic and infrarenal aortic regions combined with a right common iliac artery aneurysm. After endovascular stent grafting for a right iliac artery aneurysm, he underwent total arch replacement and open stent grafting for the descending thoracic aneurysms. Pathological microscopic examination revealed an inflammatory infiltrate within the adventitia and destruction of the elastic fibers in the media, which are classical features of syphilitic aortitis. Endovascular aneurysm repair is contraindicated in mycotic infected aneurysms. However, endovascular repair is useful for treating mycotic infected aneurysm, if multiple aneurysms have the possibility of rupture and a high risk of surgery. PMID:26066872

  17. Endovascular strategies for treatment of embolizing thoracoabdominal aortic lesions

    PubMed Central

    Jeyabalan, Geetha; Wallace, Justin R.; Chaer, Rabih Antoine; Leers, Steven A.; Marone, Luke Keith; Makaroun, Michel S.

    2014-01-01

    Objective Aortic sources of peripheral and visceral embolization remain challenging to treat. The safety of stent graft coverage continues to be debated. This study reports the outcomes of stent coverage of these complex lesions. Methods Hospital records were retrospectively reviewed for patients undergoing aortic stenting between 2006 and 2013 for visceral and peripheral embolic disease. Renal function, method of coverage, and mortality after stent grafting were reviewed. Results Twenty-five cases of embolizing aortic lesions treated with an endovascular approach were identified. The mean age was 65 ± 13 years (range, 45–87 years), and 64% were female. Sixteen (64%) patients presented with peripheral embolic events, six with concomitant renal embolization. Five patients presented with abdominal or flank pain, and two were discovered incidentally. Three patients had undergone an endovascular procedure for other indications within the preceding 6 months of presentation. Nineteen patients had existing chronic kidney disease (stage II or higher), but only three had stage IV disease. Of the eight patients tested, four had a diagnosed hypercoagulable state. Eight of the patients had lesions identified in multiple aortic segments, and aortic aneurysm disease was present in 24%. Coverage of both abdominal and thoracic sources occurred in eight patients, whereas 17 had only one segment covered. Minimal intraluminal catheter and wire manipulation was paired with the use of intravascular ultrasound in an effort to reduce embolization and contrast use. Intravascular ultrasound was used in the majority of cases and transesophageal echo in 28% of patients. Two patients with stage IV kidney disease became dialysis-dependent within 3 months of the procedure. No other patients had an increase in their postoperative or predischarge serum creatinine levels. No embolic events were precipitated during the procedure, nor were there any recurrent embolic events detected on follow

  18. Transluminal aortic valve placement. A feasibility study with a newly designed collapsible aortic valve.

    PubMed

    Moazami, N; Bessler, M; Argenziano, M; Choudhri, A F; Cabreriza, S E; Allendorf, J D; Rose, E A; Oz, M C

    1996-01-01

    Percutaneous stents are used in vascular applications in conjunction with angioplasty and in combination with graft material for repair of abdominal aneurysms. The authors have designed a collapsible bioprosthetic aortic valve for placement by a transluminal catheter technique. This trileaflet stent valve is composed of stainless steel and bovine pericardium. Stent valves, 23 and 29 mm, were tested in a pulse duplicator system with rigid rings from 21 to 31 mm in 2 mm increments. At a mean flow of 3.1 L/min (+/-0.7), normal systemic aortic pressure was generated with a transvalvular gradient of 14.9 +/- 7 mmHg (mean +/- SD). Regurgitation fraction ranged from 10 to 18% (mean 13.8 +/- 3%) in the best ring size. Valves with the best hemodynamic profile were used for implantation in three 70 kg pigs in an open chest model. The valve was collapsed in a 24 Fr catheter designed to allow slow, controlled release. After resection of the native leaflets, the new valve was placed in the subcoronary position. No additional sutures were used for securing the valve. Two animals were successfully weaned from cardiopulmonary bypass and maintained systemic pressures of 100/45 (+/-10) and 116/70 (+/-15) mmHg, respectively. Intraoperative color echocardiography revealed minimal regurgitation, central flow, full apposition of all leaflets, and no interference with coronary blood flow. Both animals were sacrificed after being off bypass for 2 hr. Postmortem examination revealed the valves to be securely anchored. The third animal was weaned from cardiopulmonary bypass but developed refractory ventricular fibrillation because of valve dislodgment due to structural failure. Although long term survival data are needed, development of a hemodynamically acceptable prosthetic aortic valve for transluminal placement is feasible. PMID:8944912

  19. Aortic angiography

    MedlinePlus

    ... with the aorta or its branches, including: Aortic aneurysm Aortic dissection Congenital (present from birth) problems AV ... Abnormal results may be due to: Abdominal aortic aneurysm Aortic dissection Aortic regurgitation Aortic stenosis Congenital (present ...

  20. Morphological and stent design risk factors to prevent migration phenomena for a thoracic aneurysm: a numerical analysis.

    PubMed

    Altnji, H-E; Bou-Saïd, B; Walter-Le Berre, H

    2015-01-01

    The primary mechanically related problems of endovascular aneurysm repair are migration and type Ia endoleaks. They occur when there is no effective seal between the proximal end of the stent-graft and the vessel. In this work, we have developed several deployment simulations of parameterized stents using the finite element method (FEM) to investigate the contact stiffness of a nitinol stent in a realistic Thoracic Aortic Aneurysm (TAA). Therefore, we evaluated the following factors associated with these complications: (1) Proximal Attachment Site Length (PASL), (2) stent oversizing value (O%), (3) different friction conditions of the stent/aorta contact, and (4) proximal neck angulation α. The simulation results show that PASL>18 mm is a crucial factor to prevent migration at a neck angle of 60°, and the smoothest contact condition with low friction coefficient (μ=0.05). The increase in O% ranging from 10% to 20% improved the fixation strength. However, O%≥25% at 60° caused eccentric deformation and stent collapse. Higher coefficient of friction μ>0.01 considerably increased the migration risk when PASL=18 mm. No migration was found in an idealized aorta model with a neck angle of 0°, PASL=18 mm and μ=0.05. Our results suggest carefully considering the stent length and oversizing value in this neck morphology to strengthen the contact and prevent migration. PMID:25456396

  1. Current management of aortic arch lesions with hybrid procedures: a tailored approach to a progressive disease.

    PubMed

    Plichta, Ryan P; Aftab, Muhammad; Roselli, Eric E

    2016-06-01

    In the current era of cardiac and aortic surgery lines between open and endovascular approaches are becoming blurred. Hybrid techniques emerged with the availability of endovascular devices and the idea that combining open operations with a stent graft might provide a treatment option to those patients deemed too high-risk for conventional surgery. As these procedures evolved, it became clear that they still carried significant risk especially for the "inoperable" or "high-risk" patients, but they also offered new options for treating complex pathologies involving multiple segments of the aorta. Hybrid techniques not only provide the potential for less invasive aortic repair, but must be considered as an important complementary treatment option for patients with aortic disease, allowing for a potentially more effective and complete repair. The objective of this article is to review the current options for hybrid arch repair and the indications for choosing the various techniques based on pathologic presentation. PMID:26939046

  2. Coronary artery bypass grafting associated to aortic valve replacement in the elderly: survival and quality of life

    PubMed Central

    2012-01-01

    Myocardial ischemia is often associated to aortic valve stenosis in the elderly. Aim of this study was to evaluate the impact on survival and quality of life of CABG associated to aortic valve replacement in the septuagenarians and octogenarians. Between January 1991 and January 2010, 520 patients ageing > 70 years underwent aortic valve replacement with a mechanical prosthesis in two Institutions. They were divided into 2 groups: Group A included 406 patients undergoing isolated aortic valve replacement; Group B 114 patients receiving aortic valve replacement and CABG. A comparative analysis of long-term survival and quality of life (SF-36 test) was performed. Mean age was 74.2 ± 3.6 years (74.3 ± 3.6 in Group A, 74 ± 3.3 in Group B; p = 0.33). Hospital mortality was 9.5% (46 patients). Twenty-nine (7.8%) in Group A and 17 in Group B (15.2%)(p = 0.019). Actuarial survival was 88.5% ± 0.015 at 1 year, 81.9% ± 0.02 at 5 years, 76.6% ± 0.032 at 10 and 57.3 ± 0.1 at 15 years. Ten-year survival was 77% ± 0.034 in Group A and 77.8% ± 0.045 in Group B (p = 0.2). Multivariate analysis did not reveal associated CABG as a predictor of long term mortality. The scores obtained in the SF-36 test were similar in the two groups and significantly higher than those of the general population matched for country, age and sex (p < 0.001 in all domains). Associated CABG determines a significant increase of hospital mortality in the elderly undergoing aortic valve replacement. Survivors did not show differences in long-term outcome and quality of life according to the presence of associated CABG. PMID:22309837

  3. A patent ductus arteriosus complicating cardiopulmonary bypass for combined coronary artery bypass grafting and aortic valve replacement only discovered by computed tomography 3D reconstruction.

    PubMed

    van Middendorp, Lars B; Maessen, Jos G; Sardari Nia, Peyman

    2014-12-01

    We describe the case of a 59-year old male patient undergoing combined coronary artery bypass grafting and aortic valve replacement. Manipulation of the heart during cardiopulmonary bypass significantly decreased venous return. Several measures were necessary to improve venous return to a level at which continuation of the procedure was safe. Based on the initial troubles with venous return, we decided to selectively cross-clamp the aorta. This resulted in a large amount of backflow of oxygenated blood from the left ventricle, necessitating additional vents in the pulmonary artery and directly in the left ventricle. The procedure was continued uneventfully, and postoperative recovery was without significant complications. Postoperative 2D computed tomography did not show any signs of a shunt, but 3D reconstruction showed a small patent ductus arteriosus. PMID:25164136

  4. Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results

    PubMed Central

    Haji Zeinali, Ali Mohammad; Marzban, Mehrab; Zafarghandi, Mohammadreza; Shirzad, Mahmood; Shirani, Shapour; Mahmoodian, Roshanak; Sheikhvatan, Mehrdad; Lotfi-Tokaldany, Masoumeh

    2016-01-01

    Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain. Objectives: The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran. Patients and Methods: A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed. Results: The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD. Conclusion: The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients. PMID:27110330

  5. Endovascular Repair of a Right-Sided Descending Thoracic Aortic Aneurysm Associated with a Right Aortic Arch and a Left Subclavian Artery Arising from a Kommerell's Diverticulum

    SciTech Connect

    Klonaris, Chris Avgerinos, Efthimios D.; Katsargyris, Athanasios; Matthaiou, Alexandros; Georgopoulos, Sotirios; Psarros, Vasileios; Bastounis, Elias

    2009-07-15

    This case report describes the endovascular repair of a right-sided descending thoracic aortic aneurysm associated with a right aortic arch and an aberrant left subclavian artery. A 76-year-old male with multiple comorbidities was incidentally found to have a right-sided descending thoracic aortic aneurysm with a maximum diameter of 6.2 cm. Additionally, there was a right aortic arch with a retroesophageal segment and separate arch branches arising in the following order: left common carotid artery, right common carotid artery, right subclavian artery, and left subclavian artery that was aberrant, arising from a Kommerrell's diverticulum. The aneurysm was successfully excluded by deployment of a Zenith TX1 36 x 32 x 20-mm stent-graft using wire traction technique via the left femoral and right brachial arteries in order to deal with two severe aortic angulations. At 18-month follow-up the patient was doing well, with aneurysm sac shrinkage to 5.9 cm and no signs of endoleak or migration. Endovascular repair of right-sided descending thoracic aortic aneurysms with a right arch and aberrant left subclavian artery is feasible, safe, and effective. In such rare configurations, which demand considerably increased technical dexterity and center experience, endovascular repair emerges as an attractive therapeutic option.

  6. Caesarean delivery in a parturient with a femoro-femoral crossover graft and congenital aortic stenosis repaired by the Ross procedure.

    PubMed

    Richardson, P; Whittaker, S; Rajesh, U; Bonduelle, M; Morgan, J; Garry, M; Weston, C; Ferguson, C; Fligelstone, L

    2009-10-01

    We report a case of a patient with congenital aortic stenosis previously repaired using the Ross procedure, who presented to our unit for urgent caesarean delivery. Management was complicated by moderate residual cardiac disease and the presence of a suprapubic femoro-femoral crossover graft. Following application of five-lead electrocardiogram and invasive blood pressure monitoring, anaesthesia was induced via combined spinal-epidural with epidural volume extension. A high transverse surgical approach avoided the course of the vascular graft, while further precautions included the immediate availability of vascular surgeons and cell salvage. Our anaesthetic technique was tailored to minimise disruption to cardiovascular function, and in particular to limit regurgitant flow across the pulmonary valve. This case highlights the value of early identification of high-risk parturients and multidisciplinary involvement at delivery. Risk stratification in the patient with grown-up congenital heart disease is based upon timely evaluation of the underlying congenital pathology, surgical history and subsequent functional status. PMID:19703763

  7. Beveled reversed elephant trunk procedure for complex aortic aneurysm.

    PubMed

    Fujikawa, Takuya; Yamamoto, Shin; Sekine, Yuji; Oshima, Susumu; Kasai, Reo; Sasaguri, Shiro

    2016-03-01

    The reversed elephant trunk procedure uses an inverted graft for distal aortic replacement before aortic arch replacement in patients with mega aorta, to reduce the risk in the second stage. However, the conventional technique restricts the maximum diameter of the inverted graft to the aortic graft diameter. We employed a beveled reversed elephant trunk procedure to overcome the discrepancy between graft diameters in a 54-year-old woman with a severely twisted ascending aortic graft and enlarging chronic dissection of the aortic arch and descending thoracic aorta. The patient was discharged with a satisfactory repair and no neurologic deficit. PMID:25406402

  8. Thoracic Endovascular Aortic Repair for Chronic DeBakey IIIb Aortic Dissection

    PubMed Central

    Hughes, G. Chad; Ganapathi, Asvin M.; Keenan, Jeffrey E.; Englum, Brian R.; Hanna, Jennifer M.; Schechter, Matthew A.; Wang, Hanghang; McCann, Richard L.

    2015-01-01

    Background Thoracic endovascular aortic repair (TEVAR) for chronic DeBakey IIIb dissection with associated descending aneurysm remains controversial. This study examines long-term results of TEVAR for this disorder including examination of anatomic features associated with TEVAR outcomes. Methods Between July 2005 and January 2013, 32 patients underwent TEVAR for chronic (>30 days) DeBakey IIIb dissection involving the descending thoracic aorta at a single institution and constituted the study cohort. Results The mean interval from dissection to TEVAR was 32 ± 44 months (range, 1 to 146 months). There were no 30-day or in-hospital deaths, strokes, or paraplegia. During a 54-month median follow-up, there were no aortic-related deaths. Significant thoracic aneurysm sac regression (>1 cm) in the intervened segment was observed in 89%. Thoracic remodeling was not correlated with the number of visceral vessels arising from the true lumen or the number or size of residual distal fenestrations; failure of thoracic remodeling was associated with fenestrations distal to the endograft(s) in the descending thoracic aorta, most often stent graft-induced new entry tears. Complete resolution of the thoracic and abdominal false lumen after TEVAR was observed in 15.6% (n = 5). All patients in this group had all visceral vessels arising from the true lumen and fewer than three residual distal fenestrations. Conclusions Thoracic endovascular aortic repair is effective for chronic DeBakey IIIb dissection with associated descending aneurysm, with excellent 30-day and long-term outcomes and significant aortic remodeling in the vast majority of patients. Thoracic remodeling does not appear dependent on distal anatomic characteristics of the true and false lumens, although care should be taken to cover all thoracic fenestrations and avoid creation of stent graft-induced new entry tears to ensure clinical success. Complete aortic remodeling was observed only in the setting of all

  9. [Metaplasia of aortic tissue into tracheal tissue. Surgical perspectives].

    PubMed

    Martinod, E; Zakine, G; Fornes, P; Zegdi, R; d'Audiffret, A; Aupecle, B; Goussef, N; Azorin, J; Chachques, J C; Fabiani, J N; Carpentier, A

    2000-05-01

    Tracheal reconstruction after extensive resection remains an unsolved surgical problem. Numerous attempts have been made using tracheal grafts or prosthetic conduits with disappointing results. In this study, we propose a new alternative using an aortic autograft as tracheal substitute. In a first series of experiments, a half circumference of two rings was replaced with an autologous carotid artery patch. In a second series, a complete segment of trachea was replaced with an autologous aortic graft supported by an endoluminal tracheal stent. No dehiscence or stenosis was observed. Microscopic examinations at 3 and 6 months showed the replacement of the aortic tissue by tracheal tissue comprising neoformation of cartilage and mucociliary or non-keratinizing metaplastic polystratified squamous epithelium. Although these results need to be confirmed by a larger series of experiments, they showed that a vascular tissue placed in a different environment with a different function can be submitted to a metaplastic transformation which tends to restore a normal structure adapted to its new function. These remarkable findings offer new perspectives in tracheal reconstruction in human. PMID:10879293

  10. Well-organized neointima of large-pore poly(l-lactic acid) vascular graft coated with poly(l-lactic-co-ε-caprolactone) prevents calcific deposition compared to small-pore electrospun poly(l-lactic acid) graft in a mouse aortic implantation model

    PubMed Central

    Tara, Shuhei; Kurobe, Hirotsugu; Rocco, Kevin A.; Maxfield, Mark W.; Best, Cameron A.; Yi, Tai; Naito, Yuji; Breuer, Christopher K.; Shinoka, Toshiharu

    2014-01-01

    Objective Tissue engineering techniques have emerged that allow bioresorbable grafts to be implanted that restore function and transform into biologically active arteries. However, these implants are susceptible to calcification during the remodeling process. The objective of this study was to evaluate the role of pore size of bioabsorbable grafts in the development of calcification. Methods Two types of grafts were prepared: a large-pore graft constructed of poly(l-lactic acid) (PLA) fibers coated with poly(l-lactide-co-ε-caprolactone) (PLCL) (PLA-PLCL), and a small-pore graft made of electrospun PLA nanofibers (PLA-nano). Twenty-eight PLA-PLCL grafts and twenty-five PLA-nano grafts were implanted as infra-renal aortic interposition conduits in 8-week-old female SCID/Bg mice, and followed for 12 months after implantation. Results Large-pore PLA-PLCL grafts induced a well-organized neointima after 12 months, and Alizarin Red S staining showed neointimal calcification only in the thin neointima of small-pore PLA-nano grafts. At 12 months, macrophage infiltration, evaluated by F4/80 staining, was observed in the thin neointima of the PLA-nano graft, and there were few vascular smooth muscle cells (VSMCs) in this layer. On the other hand, the neointima of the PLA-PLCL graft was composed of abundant VSMCs, and a lower density of macrophages (F4/80 positive cells, PLA-PLCL; 68.1±41.4/mm2 vs PLA-nano; 188.3±41.9/mm2, p = 0.007). The VSMCs of PLA-PLCL graft expressed transcription factors of both osteoblasts and osteoclasts. Conclusion These findings demonstrate that in mouse arterial circulation, large-pore PLA-PLCL grafts created a well-organized neointima and prevented calcific deposition compared to small-pore, electrospun PLA-nano grafts. PMID:25463106

  11. Blunt thoracic aortic injury: old problem and new technology.

    PubMed

    Britt, L D; Campbell, Matthew M

    2003-01-01

    The lethal nature of transmural aortic injuries has remained constant; however, both the diagnostic and therapeutic interventional options have improved. Although aortography is still the "gold standard" against which all other diagnostic modalities are measured, contrast-enhanced spiral thoracic computed tomography has emerged as the diagnostic study that could potentially supplant aortography. The advent of the fast spiral computed tomography scanners offer several advantages, including being less affected by patient motion and volume-averaging artifacts than the earlier generation CT scanners. The operative has broadened from primary repair and interposition prosthetic graft placement (with possible use of shunt or roller vs. centrifugal bypass) to the potential widespread use of endovascular stents. The Eastern Virginia Medical School (EVMS) experience during the first 10-year period (see table below) highlights the majority of patients undergoing interposition prosthetic graft placement. There was no use of shunts during this period. At the midpoint of the second 10-year period (1997-2007), the method of repair is exclusively interposition graft placement. The role of endovascular stent insertion in the management of these injuries is currently being debated. [table: see text] PMID:14649580

  12. Endovascular Repair of Abdominal Aortic Aneurysms in the Presence of a Transplanted Kidney

    SciTech Connect

    Silverberg, Daniel Yalon, Tal; Halak, Moshe

    2015-08-15

    PurposeTo present our experience performing endovascular repair of abdominal aortic aneurysms in kidney transplanted patients.MethodsA retrospective review of all patients who underwent endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAA) performed at our institution from 2007 to 2014. We identified all patients who had previously undergone a kidney transplant. Data collected included: comorbidities, preoperative imaging modalities, indication for surgery, stent graft configurations, pre- and postoperative renal function, perioperative complications, and survival rates.ResultsA total of 267 EVARs were performed. Six (2 %) had a transplanted kidney. Mean age was 74 (range, 64–82) years; five were males. Mean time from transplantation to EVAR was 7.5 (range, 2–12) years. Five underwent preoperative planning with noncontrast modalities only. Devices used included bifurcated (n = 3), aortouniiliac (n = 2), and tube (n = 1) stent grafts. Technical success was achieved in all patients. None experienced deterioration in renal function. Median follow-up was 39 (range, 6–51) months. Four patients were alive at the time of the study. Two patients expired during the period of follow-up from unrelated causes.ConclusionsEVAR is an effective modality for the management of AAAs in the coexistence of a transplanted kidney. It can be performed with minimal morbidity and mortality without harming the transplanted kidney. Special consideration should be given to device configuration to minimize damage to the renal graft.

  13. Endovascular Management of Ruptured Abdominal Aortic Aneurysms: An 8-year Single-Centre Experience

    SciTech Connect

    Gerassimidis, Thomas S.; Karkos, Christos D. Karamanos, Dimitrios G.; Papazoglou, Konstantinos O.; Papadimitriou, Dimitrios N.; Demiropoulos, Filippos P.; Malkotsis, Dimitrios P.; Kamparoudis, Apostolos G.

    2009-03-15

    We aimed to review our experience with the endovascular treatment of ruptured abdominal aortic aneurysm (RAAA). During an 8-year period, 69 patients with a RAAA presented to our department; 67 underwent assessment by computed axial tomography, and 2 died on arrival before any evaluation was possible. A total of 42 patients (63%) were suitable for stent-grafting, and all but 1 (c-arm failure) proceeded to endovascular repair. Of these, 27 underwent surgery with local anaesthesia; 3 did so under general anaesthesia; and a further 11 procedures were commenced with the patient under local anaesthesia and then converted to general anaesthesia. A total of 28 bifurcated and 14 aorto-uni-iliac stent-grafts were implanted. Aortic occlusion balloons were used in 2 (5%) patients. The in-hospital and the 30-day mortality rates were 36% and 41%, respectively. After surgery, 21 complications were encountered in 17 patients. Two patients required reintervention during their hospital stay (1 type I endoleak and 1 limb occlusion). During the follow-up (median 730 days [range 90 to 580 days]), the 1-year and 5-year cumulative survival probabilities were 53% (SE 7.9%) and 50% (SE 8.0%), respectively. Three reinterventions were necessary during follow-up (2 type I endoleaks and 1 graft occlusion). We conclude that endovascular treatment is feasible in the emergency setting, and the early experience is promising. Whether such an approach is superior to open surgery remains to be determined.

  14. Technical tips for successful outcomes using adjunctive procedures during endovascular aortic aneurysm repair.

    PubMed

    Kasirajan, Karthikeshwar; Gupta, Naren

    2012-09-01

    The inability to obtain proximal or distal seal continues to remain one of the main challenges of endovascular aneurysm repair. This is particularly relevant when endografts are used in patients with unsuitable proximal or distal landing zones. A variety of techniques can be used to achieve a seal in these difficult situations. Two specific techniques that can help intraoperatively to resolve the lack of adequate graft to aortic wall opposition are discussed in this article. These include the use of Palmaz stents for proximal seal and hypogastric snorkel for distal seal with internal iliac flow preservation. PMID:23062496

  15. JAG Tearing Technique with Radiofrequency Guide Wire for Aortic Fenestration in Thoracic Endovascular Aneurysm Repair

    SciTech Connect

    Ricci, Carmelo; Ceccherini, Claudio Leonini, Sara; Cini, Marco; Vigni, Francesco; Neri, Eugenio; Tucci, Enrico; Benvenuti, Antonio; Tommasino, Giulio; Sassi, Carlo

    2012-02-15

    An innovative approach, the JAG tearing technique, was performed during thoracic endovascular aneurysm repair in a patient with previous surgical replacement of the ascending aorta with a residual uncomplicated type B aortic dissection who developed an aneurysm of the descending thoracic aorta with its lumen divided in two parts by an intimal flap. The proximal landing zone was suitable to place a thoracic stent graft. The distal landing zone was created by cutting the intimal flap in the distal third of the descending thoracic aorta with a radiofrequency guide wire and intravascular ultrasound catheter.

  16. A Floating Thrombus Anchored at the Proximal Anastomosis of a Woven Thoracic Graft Mimicking a Genuine Aortic Dissection.

    PubMed

    Li, Bin; Liu, Bing; Fu, Yijun; Bondarenko, Olexandr; Verdant, Alain; Rochette-Drouin, Olivier; Lin, Jing; Bourget, Jean-Michel; Guzman, Randolph; Wang, Lu; Zhang, Ze; Douville, Yvan; Germain, Lucie; Jing, Zaiping; Guidoin, Robert

    2015-01-01

    An aortoesophageal fistula following surgery for a ruptured 6.6-cm thoracic aneurysm in a 69-year-old female was repaired using a 34-mm woven prosthetic graft. A follow-up computed tomography (CT) scan at 10 days postoperatively revealed a dissection-like picture in the region of the graft, which was treated conservatively. The patient eventually died from sepsis and multiorgan failure. At autopsy, the graft was retrieved in situ and studied by detailed gross, microscopy, and scanning electron microscopy (SEM) examination. Gross observation confirmed that the dissection resulted from the rolling of the internal capsule downstream. A massive thrombus anchored at the proximal anastomosis and held by a narrow head was also noted. The thrombus demonstrated reorganization in the area of the anastomosis, with a false lumen in its distal half. The reminder of the thrombus consisted of layered fibrin. After gross examination, the fabric graft was found to be flawless. Additional detailed studies were also done using microscopy, SEM, and gross examination. PMID:26756557

  17. A simulation framework for estimating wall stress distribution of abdominal aortic aneurysm.

    PubMed

    Qin, Jing; Zhang, Jing; Chui, Chee-Kong; Huang, Wei-Min; Yang, Tao; Pang, Wai-Man; Sudhakar, Venkatesh; Chang, Stephen

    2011-01-01

    Abdominal aortic aneurysm (AAA) rupture is believed to occur when the mechanical stress acting on the wall exceeds the strength of the wall tissue. In endovascular aneurysm repair, a stent-graft in a catheter is released at the aneurysm site to form a new blood vessel and protect the weakened AAA wall from the pulsatile pressure and, hence, possible rupture. In this paper, we propose a framework to estimate the wall stress distribution of non-stented/stented AAA based on fluid-structure interaction, which is utilized in a surgical simulation system (IRAS). The 3D geometric model of AAA is reconstructed from computed tomography angiographic (CTA) images. Based on our experiments, a combined logarithm and polynomial strain energy equation is applied to model the elastic properties of arterial wall. The blood flow is modeled as laminar, incompressible, and non-Newtonian flow by applying Navier-Stokes equation. The obtained pressure of blood flow is applied as load on the AAA meshes with and without stent-graft and the wall stress distribution is calculated by fluid-structure interaction (FSI) solver equipped in ANSYS. Experiments demonstrate that our analytical results are consistent with clinical observations. PMID:22254456

  18. Arterial Stiffness Alterations and Inflammatory Response Following Endovascular Aortic Repair: Based on a Presentation at the 2013 VEITH Symposium, November 19-23, 2013 (New York, NY, USA).

    PubMed

    Moulakakis, Konstantinos G; Mylonas, Spyridon N; Kakisis, John; Kadoglou, Nikolaos P E; Papadakis, Ioannis; Sfyroeras, George S; Antonopoulos, Constantine C N; Mantas, George; Ikonomidis, Ignatios; Liapis, Christos D

    2015-04-01

    Endovascular abdominal aortic aneurysm repair (EVAR) and thoracic aortic aneurysm repair (TEVAR) have been widely incorporated into clinical practice. However, changes in arterial stiffness and post-implantation syndrome after aortic endografting remain important issues under investigation. The aneurysm sac wall motion after successful EVAR and TEVAR reflects complex interactions between all the components of the excluded aneurysm, including true compliance of the aneurysm wall itself, intra-aneurysm sac pressure, remodeling of the thrombus, and mechanical characteristics of the endograft. Experimental and clinical studies have shown that aortic endografting results in increased arterial stiffness in animal models. It can be assumed that the alterations of aortic mechanical properties can have a direct impact on heart output. The long-term impact of these mechanical changes on cardiovascular outcomes and the potential effects of different endografts on hemodynamics are important issues under investigation. Post-implantation syndrome (PIS) is a systemic inflammatory response frequently observed after endovascular treatment of aortic pathologies. The main features of PIS include fever, leukocytosis, elevated C-reactive protein levels, and coagulation disturbances. Endograft design appears to influence this inflammatory response following aortic endografting; woven polyester endografts have been shown to be associated with greater inflammatory response compared to PTFE stent grafts. The purpose of this paper is to review the literature to elucidate arterial stiffness alterations and inflammatory response after EVAR and TEVAR and the impact of endograft design on aortic stiffness and the post-inflammatory response. PMID:26798761

  19. The impact of coronary artery disease severity on late survival after combined aortic valve replacement and coronary artery bypass grafting – experience of a single cardiac surgery center

    PubMed Central

    Misterski, Marcin; Stachowiak, Wojciech; Buczkowski, Piotr; Stefaniak, Sebastian; Puślecki, Mateusz; Urbanowicz, Tomasz; Budniak, Wiktor; Jemielity, Marek

    2014-01-01

    Introduction The severity of coronary artery disease (CAD) may have an impact on the outcomes of patients (pts) after aortic valve replacement (AVR) and coronary artery bypass grafting (CABG). Aim The aim of the study was to analyze survival after simultaneous AVR and CABG with respect to CAD severity. Material and methods The study involved 143 consecutive pts (40 women and 103 men) with a mean age of 65.1 ± 7.7 years treated between 2006 and 2009. The indication for surgery was aortic stenosis accompanied by left main or three-vessel disease (group A; n = 43) and by single- or two-vessel disease (group B; n = 100). In-hospital and late mortality were analyzed. Post-discharge survival was estimated using the Kaplan-Meier method. Moreover, selected preoperative clinical and echocardiographic data as well as intraoperative variables were compared between the groups. Results In-hospital mortality was 4.7% in group A and 3.0% in group B (NS). The 12-month and 48-month survival probability rates were 0.88 ± 0.05 and 0.83 ± 0.06 in group A, and 0.97 ± 0.01 and 0.92 ± 0.03 in group B, respectively (p < 0.05). Patients in group A and B differed (p < 0.05) with respect to the preoperative prevalence of arterial hypertension (65.1% vs. 42.0%) and atrial fibrillation (18.6% vs. 6.0%) as well as with regard to the rate of complete revascularization (20.9% vs. 85.0%, group A and B, respectively). Conclusions Coronary artery disease severity impacts long-term survival after combined AVR and CABG. Patients with left main or three-vessel disease more often undergo incomplete surgical revascularization, and this fact may be one of the predictors of an unfavorable outcome. PMID:26336450

  20. High Spinal Anesthesia Enhances Anti-Inflammatory Responses in Patients Undergoing Coronary Artery Bypass Graft Surgery and Aortic Valve Replacement: Randomized Pilot Study

    PubMed Central

    Lee, Trevor W. R.; Kowalski, Stephen; Falk, Kelsey; Maguire, Doug; Freed, Darren H.; HayGlass, Kent T.

    2016-01-01

    Background Cardiac surgery induces many physiologic changes including major inflammatory and sympathetic nervous system responses. Here, we conducted a single-centre pilot study to generate hypotheses on the potential immune impact of adding high spinal anaesthesia to general anaesthesia during cardiac surgery in adults. We hypothesized that this strategy, previously shown to blunt the sympathetic response and improve pain management, could reduce the undesirable systemic inflammatory responses caused by cardiac surgery. Methods This prospective randomized unblinded pilot study was conducted on 14 patients undergoing cardiac surgery for coronary artery bypass grafting and/or aortic valve replacement secondary to severe aortic stenosis. The primary outcome measures examined longitudinally were serum pro-inflammatory (IL-6, IL-1b, CCL2), anti-inflammatory (IL-10, TNF-RII, IL-1Ra), acute phase protein (CRP, PTX3) and cardiovascular risk (sST2) biomarkers. Results The kinetics of pro- and anti-inflammatory biomarker was determined following surgery. All pro-inflammatory and acute phase reactant biomarker responses induced by surgical stress were indistinguishable in intensity and duration between control groups and those who also received high spinal anaesthesia. Conversely, IL-10 levels were markedly elevated in both intensity and duration in the group receiving high spinal anesthesia (p = 0.005). Conclusions This hypothesis generating pilot study suggests that high spinal anesthesia can alter the net inflammatory response that results from cardiac surgery. In appropriately selected populations, this may add incremental benefit by dampening the net systemic inflammatory response during the week following surgery. Larger population studies, powered to assess immune, physiologic and clinical outcomes in both acute and longer term settings, will be required to better assess potential benefits of incorporating high spinal anesthesia. Trial Registration Clinical

  1. Heparin-bonded stent-graft for the treatment of TASC II C and D femoropopliteal lesions: the Viabahn-25 cm trial.

    PubMed

    Zeller, Thomas; Peeters, Patrick; Bosiers, Marc; Lammer, Johannes; Brechtel, Klaus; Scheinert, Dierk; Rastan, Aljoscha; Noory, Elias; Beschorner, Ulrich

    2014-12-01

    Purpose: To confirm the performance and safety of the 25-cm Viabahn endoprosthesis with Propaten bioactive surface when used in the treatment of de novo and/or restenotic TransAtlantic Inter-Society Consensus II C and D lesions of the superficial femoral artery and proximal popliteal artery. Methods: The 25-cm Gore Viabahn Endoprosthesis study (ClinicalTrials.gov identifier NCT01263665) is a prospective, multicenter, single-arm study that enrolled 71 patients (50 men; mean age 66.7 ± 8.34 years) with lifestyle-limiting claudication (Rutherford class 2 to 4) and lesions longer than 20 cm (mean length 26.5 ± 5.31 cm, range 20-40). The majority of lesions (92.9%) were total occlusions. The primary performance outcome was post-deployment stent length within ± 10% of the pre-deployment stent length determined angiographically by quantitative vascular analysis. The primary safety outcome was device- and procedure-related serious adverse events occurring within 30 days of the procedure. The patients underwent follow-up examinations at 1 month and 1 year. Results : The median follow-up was 12.3 months (mean 12.3 ± 0.6). Nine (12.7%) patients discontinued the study due to different reasons including 2 bypass surgeries. Angiography was available in 60 patients to determine the primary performance outcome, which was met in all cases. Two (2.8%) patients experienced a procedure-/device-related adverse event (dissection) during the 30-day follow-up. Kaplan-Meier estimates for 1-year primary and secondary patency were 67.0% [95% confidence interval (CI) 53.5% to 77.3%] and 96.9% (95% CI 88.0% to 99.2%), respectively. Changes in ankle-brachial index and Rutherford category at 1 and 12 months each showed sustained improvement. Conclusion : This study confirms that the 25-cm Viabahn endoprosthesis acutely performs as intended and is safe when used as indicated in complex femoropopliteal lesions. One-year primary and secondary patency rates are satisfying and comparable to

  2. Dual stent migration to the heart and pulmonary artery.

    PubMed

    Balasubramaniyam, Nivas; Garg, Jalaj; Rawat, Naveen; Chugh, Savneek; Mittal, Varun; Baby, Banessaa; Aronow, Wilbert S; Lehrman, Stuart G

    2014-01-01

    The practice of intravascular stenting largely grew out of the concept of stenting the coronaries in acute myocardial infarction. According to the recent United States Renal Data System data registry, there has been a significant increase in endovascular intervention (1.8-fold increase-from 52,380 to 98,148) with a 2.2-fold increase in stent deployment in hemodialysis access (3792-8514). With the increasing use of endovascular stents in the management of dialysis access stenosis, the incidence of stent-related complications has increased significantly. Stent-related complications include stent restenosis, thrombosis (narrowing of the vessel lumen and being a nidus for thombus formation), stent shortening, stent fracture, stent infection, and stent migration. Physiologic variation in the diameter of veins due to respiration, which along with the geometry of the stent, can lead to a shortening lengthening of the stent-resulting in poor wall contact or high-speed impact of shock; in the case of trauma, mechanical bucking can result in tortuous blood vessels thereby resulting in stent migration (however proving this association was not the aim of this article). We report a case of a 44-year-old female with end-stage renal disease on hemodialysis, with stent placement to treat a compromised arteriovenous graft. There have been many cases of stent migration in the past; however, this is the first case of dual stent migration to the heart and pulmonary artery from an unusual (lower extremity) arteriovenous graft location. PMID:23567791

  3. Treating patients with abdominal aortic aneurysm with endovascular repair and the crossover chimney technique in the internal iliac artery to protect the unilateral internal iliac artery

    PubMed Central

    Guo, Xi; Li, Peng; Liu, Guang-Rui; Huang, Xiao-Yong; Huang, Lian-Jun

    2015-01-01

    This study aims to explore the treatment methods for patients with abdominal aortic aneurysms (AAAs) that required occlusion of the openings of the bilateral internal iliac arteries (IIAs) in endovascular aneurysm repair (EVAR) and to evaluate the efficacy of these treatments. Four patients with AAA were treated with endovascular aneurysm repair (EVAR) and the crossover chimney technique in the bilateral internal iliac arteries (IIAs). We inserted and released the abdominal aortic stent as usual and implanted the bypass stent graft simultaneously. The intraoperative immediate angiography showed complete isolation of the AAA and patency of the bypass. One month after surgery, it showed contrast engorgement in the bypass stent in three patients. The IIA on the bypass side and its branches had good developing. Another case in which we utilized a COOK stent, occlusion started at the opening of the bypass stent, with no occurrence of other complications. For patients in whom AAAs involve bilateral iliac arteries and the openings of the bilateral IIAs need to be occluded, EVAR and a crossover chimney technique can protect the unilateral IIA. PMID:26885136

  4. Abdominal aortic aneurysm.

    PubMed

    Setacci, Francesco; Galzerano, Giuseppe; De Donato, Gianmarco; Benevento, Domenico; Guerrieri, Massimiliano W; Ruzzi, Umberto; Borrelli, Maria P; Setacci, Carlo

    2016-02-01

    Endovascular repair of abdominal aortic aneurysms has become a milestone in the treatment of patients with abdominal aortic aneurysm. Technological improvement allows treatment in more and more complex cases. This review summarizes all grafts available on the market. A complete review of most important trial on this topic is provided to the best of our knowledge, and technical tips and tricks for standard cases are also included. PMID:26771730

  5. Chronic type B aortic dissection: indications and strategies for treatment.

    PubMed

    Rohlffs, F; Tsilimparis, N; Diener, H; Larena-Avellaneda, A; Von Kodolitsch, Y; Wipper, S; Debus, E S; Kölbel, T

    2015-04-01

    Chronic type B aortic dissection is a distinctive condition that needs individual treatment strategies and different considerations than in therapy of acute or subacute type B aortic dissection. The most common indication for treatment of this complex disease is aneurysmal dilatation of the dissected aortic segment. While open repair of the enlarged dissected aorta remains the best option for good-risk patients and patients with connective tissue disorders in high-volume centers with respective expertise, endovascular management of chronic type B aortic dissection with postdissection aneurysms has significantly gained ground in the past years. But the concept of TEVAR with implantation of a tubular stent-graft into the thoracic aorta to seal the proximal entry tear and reroute the blood flow into the true lumen alone, is not associated with satisfactory results. This is mainly due to the sparse remodeling capacity of the aortic tissue compared to earlier stages of the disease as the aortic wall and the dissection membrane are thickened and more rigid. On the other hand, it is restricted by the most limiting factor for endovascular success in chronic type B aortic dissection: persistent false lumen perfusion. This problem also affects patients with residual dissection after surgical repair of a DeBakey type I aortic dissection or dissection after ascending aortic repair for other pathologies. Hence, it is evident that strategies to achieve endovascular false lumen occlusion are of increasing importance and novel techniques have been introduced to solve the problem of persisting false lumen flow. Thus, the evolution of a large variety of techniques to address the false lumen perfusion issue indicates that complicated chronic type B dissection involves a high diversity in clinical presentation and morphology. A large armamentarium of catheter skills as well as critical individualized treatment strategies are required to address the heterogenous morphological disease

  6. Preoperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients

    PubMed Central

    Yang, Feng; Wang, Jinhong; Hou, Dengbang; Xing, Jialin; Liu, Feng; Xing, Zhi chen; Jiang, Chunjing; Hao, Xing; Du, Zhongtao; Yang, Xiaofang; Zhao, Yanyan; Miao, Na; Jiang, Yu; Dong, Ran; Gu, Chengxiong; Sun, Lizhong; Wang, Hong; Hou, Xiaotong

    2016-01-01

    Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. The efficacy and safety of the preoperative prophylactic intra-aortic balloon pump (IABP) insertion is not well established. 416 consecutive patients with severe LV dysfunction (ejection fraction ≤35%) undergoing isolated OPCAB were enrolled in a retrospective observational study. 191 patients was enrolled in the IABP group; the remaining 225 patients was in control group. A total of 129 pairs of patients were propensity-score matched. No significant differences in demographic and preoperative risk factors were found between the two groups. The postoperative 30-day mortality occurred more frequently in the control group compared with the IABP group (8.5% vs. 1.6%, p = 0.02). There was a significant reduction of low cardiac output syndrome in the IABP group compared with the control group (14% vs. 6.2%, p = 0.04). Prolonged mechanical ventilation (≥48 h) occurred more frequently in the control group (34.9% vs. 20.9%, p = 0.02). IABP also decreased the postoperative length of stay. Preoperative IABP was associated with a lower 30-day mortality, suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB. PMID:27279591

  7. Preoperative intra-aortic balloon pump improves the clinical outcomes of off-pump coronary artery bypass grafting in left ventricular dysfunction patients.

    PubMed

    Yang, Feng; Wang, Jinhong; Hou, Dengbang; Xing, Jialin; Liu, Feng; Xing, Zhi Chen; Jiang, Chunjing; Hao, Xing; Du, Zhongtao; Yang, Xiaofang; Zhao, Yanyan; Miao, Na; Jiang, Yu; Dong, Ran; Gu, Chengxiong; Sun, Lizhong; Wang, Hong; Hou, Xiaotong

    2016-01-01

    Severe left ventricular (LV) dysfunction patients undergoing off-pump coronary artery bypass grafting (OPCAB) are often associated with a higher mortality. The efficacy and safety of the preoperative prophylactic intra-aortic balloon pump (IABP) insertion is not well established. 416 consecutive patients with severe LV dysfunction (ejection fraction ≤35%) undergoing isolated OPCAB were enrolled in a retrospective observational study. 191 patients was enrolled in the IABP group; the remaining 225 patients was in control group. A total of 129 pairs of patients were propensity-score matched. No significant differences in demographic and preoperative risk factors were found between the two groups. The postoperative 30-day mortality occurred more frequently in the control group compared with the IABP group (8.5% vs. 1.6%, p = 0.02). There was a significant reduction of low cardiac output syndrome in the IABP group compared with the control group (14% vs. 6.2%, p = 0.04). Prolonged mechanical ventilation (≥48 h) occurred more frequently in the control group (34.9% vs. 20.9%, p = 0.02). IABP also decreased the postoperative length of stay. Preoperative IABP was associated with a lower 30-day mortality, suggesting that it is effective in patients with severe LV dysfunction undergoing OPCAB. PMID:27279591

  8. Free-floating left atrial ball thrombus after mitral valve replacement with patent coronary artery bypass grafts: successful removal by a right minithoracotomy approach without aortic cross-clamp.

    PubMed

    Hisatomi, Kazuki; Hashizume, Koji; Tanigawa, Kazuyoshi; Miura, Takashi; Matsukuma, Seiji; Yokose, Shogo; Kitamura, Tessho; Shimada, Takashi; Eishi, Kiyoyuki

    2016-06-01

    A free-floating thrombus in the left atrium without attachment to either the atrial wall or the mitral valve is extremely rare. We describe a case in a 79-year-old woman with chronic atrial fibrillation and a recent stroke who had undergone mitral valve replacement 25 years previously and coronary artery bypass grafting 5 years previously. Redo cardiac surgery represents a clinical challenge due to a higher rate of peri-operative morbidity and mortality. Median re-sternotomy can be particularly difficult in patients with functioning coronary artery grafts, where the risk of graft injury is a significant concern. Prompt surgical intervention was carried out, and to avoid the challenge of re-sternotomy in this patient with two prior thoracotomies, we successfully removed the thrombus by a right minithoracotomy approach without aortic cross-clamping. There was no postoperative occurrence of a new stroke or aggravation of the pre-existing stroke. PMID:25098689

  9. Endovascular Surgery for Traumatic Thoracic Aortic Injury: Our Experience with Five Cases, Two of Whom were Young Patients

    PubMed Central

    Matsumoto, Takashi; Matsuyama, Sho; Fukumura, Fumio; Ando, Hiromi; Tanaka, Jiro; Uchida, Takayuki

    2014-01-01

    Objectives: We present our experience of endovascular surgery for traumatic aortic injury and the results of our procedures. Materials and Methods: From January 2009 to December 2013, we performed endovascular repairs of traumatic thoracic aortic injury on 5 male patients 16–75 years old (mean, 50.8), two of whom were young. Three of the patients had multiple organ injuries. The mean interval time to the operation is 22.0 hours (range, 10–36). All patients underwent endovascular repair with heparinization. The isthmus regions were seen in three cases and all of them were needed left subclavian artery (LSA) coverage. In the two young patients, the deployed stent graft was 22 mm (22.2% oversizing for diameter of aorta) and 26 mm (36.8% oversizing), respectively. Results: The procedures were successful in all patients, with no early mortality, paraplegia or stroke. During 3–63 months (mean, 30.8) follow-up period, no one experienced stent graft-related complications. One patient with LSA coverage experienced arm ischemia but the symptom improved with time. Conclusion: Endovascular surgery for traumatic thoracic aortic injury can be performed safely with low mortality or morbidity even in young small aorta. Accumulation of clinical experience and evaluation of long-term outcomes are necessary. PMID:25298833

  10. Juxtarenal aortic occlusion.

    PubMed Central

    Tapper, S S; Jenkins, J M; Edwards, W H; Mulherin, J L; Martin, R S; Edwards, W H

    1992-01-01

    The authors' experience with 113 aortic occlusions in 103 patients during a 26-year period (1965 to 1991) is reviewed. The authors found three distinct patterns of presentation: group I (n = 26) presented with acute aortic occlusion, group II (n = 66) presented with chronic aortic occlusion, and group III (n = 21) presented with complete occlusion of an aortic graft. Perioperative mortality rates were 31%, 9%, and 4.7% for each respective group and achieved statistical significance when comparing group I with group II (p = 0.009) and group I with group III (p = 0.015). Group I presented with profound metabolic insults due to acute ischemia and fared poorly. Group II presented with chronic claudication and did well long-term. Group III presented with acute ischemia but did well because of established collateral circulation. The treatment and expected outcome of aortic occlusion depends on the cause. PMID:1616381

  11. Emergency Endovascular Treatment of Abdominal Aortic Aneurysms: Feasibility and Results

    SciTech Connect

    Lagana, Domenico Carrafiello, Gianpaolo; Mangini, Monica; Fontana, Federico; Caronno, Roberto; Castelli, Patrizio; Cuffari, Salvatore; Fugazzola, Carlo

    2006-04-15

    Purpose. To assess the feasibility and effectiveness of emergency endovascular treatment of abdominal aortic aneurysms (AAAs). Methods. During 36 months we treated, on an emergency basis, 30 AAAs with endovascular exclusion. In 21 hemodynamically stable patients preoperative CT angiography (CTA) was performed to confirm the diagnosis and to plan the treatment; 9 patients with hemorrhagic shock were evaluated with angiography performed in the operating room. Twenty-two Excluder (Gore) and 8 Zenith (Cook) stent-grafts (25 bifurcated and 5 aorto-uni-iliac) were used. The follow-up was performed by CTA at 1, 3, 6, and 12 months. Results. Technical success was achieved in 100% of cases with a 10% mortality rate. The total complication rate was 23% (5 increases in serum creatinine level and 2 wound infections). During the follow-up, performed in 27 patients (1-36 months, mean 15.2 months), 4 secondary endoleaks (15%) (3 type II, 2 spontaneously thrombosed and 1 under observation, and 1 type III treated by iliac extender insertion) and 1 iliac leg occlusion (treated with femoro-femoral bypass) occurred. We observed a shrinkage of the aneurysmal sac in 8 of 27 cases and stability in 19 of 27 cases; we did not observe any endotension. Conclusions. Endovascular repair is a good option for emergency treatment of AAAs. The team's experience allows correct planning of the procedure in emergency situations also, with technical results comparable with elective repair. In our experience the bifurcated stent-graft is the device of choice in patients with suitable anatomy because the procedure is less time-consuming than aorto-uni-iliac stent-grafting with surgical crossover, allowing faster aneurysm exclusion. However, further studies are required to demonstrate the long-term efficacy of endovascular repair compared with surgical treatment.

  12. Endovascular Management of Thoracic Aortic Aneurysms

    SciTech Connect

    Fattori, Rossella Russo, Vincenzo; Lovato, Luigi; Buttazzi, Katia; Rinaldi, Giovanni

    2011-12-15

    The overall survival of patients with thoracic aortic aneurysm (TAA) has improved significantly in the past few years. Endovascular treatment, proposed as an alternative to surgery, has been considered a therapeutic innovation because of its low degree of invasiveness, which allows the treatment of even high-surgical risk patients with limited complications and mortality. A major limitation is the lack of adequate evidence regarding long-term benefit and durability because follow-up has been limited to just a few years even in the largest series. The combination of endovascular exclusion with visceral branch revascularization for the treatment of thoraco-abdominal aortic aneurysms involving the visceral aorta has also been attempted. As an alternative, endografts with branches represent a technological evolution that allows treatment of complex anatomy. Even if only small numbers of patients and short follow-up are available, this technical approach, which has with limited mortality (<10%) and paraplegia rates, to expand endovascular treatment to TAA seems feasible. With improved capability to recognize proper anatomy and select clinical candidates, the choice of endovascular stent-graft placement may offer a strategy to optimize management and improve prognosis.

  13. Suprarenal fixation barbs can induce renal artery occlusion in endovascular aortic aneurysm repair.

    PubMed

    Subedi, Shree K; Lee, Andy M; Landis, Gregg S

    2010-01-01

    Renal artery occlusion following endovascular abdominal aortic aneurysm repair with suprarenal fixation is uncommon. We report one patient who was found to develop renal artery occlusion and parenchymal infarction 6 months after repair using an endovascular graft with suprarenal fixation. Our patient underwent emergent endovascular repair of a symptomatic 6 cm abdominal aortic aneurysm. The covered portion of the endograft was inadvertently deployed well below the renal artery orifices. At the completion of the procedure both renal arteries were confirmed to be patent. One month postoperatively, a computed tomographic (CT) scan showed exclusion of the aortic sac and normal enhancement of both kidneys. At 6 months, the patient was found to have elevated serum creatinine levels despite having no clinical symptoms. CT scanning revealed a nonenhancing left kidney, and angiography demonstrated an occlusion of the left renal artery. A barb welded to the bare metal stent appeared to be impinging on the renal artery. We believe that renal artery occlusion after endovascular repair can occur due to repetitive injury to the renal artery orifice from barbs welded to the bare metal stent. To our knowledge, this is the first reported case of renal artery occlusion caused by repetitive injury from transrenal fixation systems. PMID:19540715

  14. Management of Acute Aortic Syndrome and Chronic Aortic Dissection

    SciTech Connect

    Nordon, Ian M. Hinchliffe, Robert J.; Loftus, Ian M.; Morgan, Robert A.; Thompson, Matt M.

    2011-10-15

    Acute aortic syndrome (AAS) describes several life-threatening aortic pathologies. These include intramural hematoma, penetrating aortic ulcer, and acute aortic dissection (AAD). Advances in both imaging and endovascular treatment have led to an increase in diagnosis and improved management of these often catastrophic pathologies. Patients, who were previously consigned to medical management or high-risk open surgical repair, can now be offered minimally invasive solutions with reduced morbidity and mortality. Information from the International Registry of Acute Aortic Dissection (IRAD) database demonstrates how in selected patients with complicated AAD the 30-day mortality from open surgery is 17% and endovascular stenting is 6%. Despite these improvements in perioperative deaths, the risks of stroke and paraplegia remain with endovascular treatment (combined outcome risk 4%). The pathophysiology of each aspect of AAS is described. The best imaging techniques and the evolving role of endovascular techniques in the definitive management of AAS are discussed incorporating strategies to reduce perioperative morbidity.

  15. Valve-Like and Protruding Calcified Intimal Flap Complicating Common Iliac Arteries Kissing Stenting

    PubMed Central

    Georgiadis, George S.; Georgakarakos, Efstratios I.; Schoretsanitis, Nikolaos; Argyriou, Christos C.; Antoniou, George A.; Lazarides, Miltos K.

    2015-01-01

    Endovascular therapy for iliac artery chronic total occlusions is nowadays associated with low rates of procedure-related complications and improved clinical outcomes, and it is predominantly used as first-line therapy prior to aortobifemoral bypass grafting. Herein, we describe the case of a patient presenting with an ischemic left foot digit ulcer and suffering complex aortoiliac lesions, who received common iliac arteries kissing stents, illustrating at final antegrade and retrograde angiograms the early recognition of a blood flow obstructing valve-like calcified intimal flap protruding through the stent struts, which was obstructing antegrade but not retrograde unilateral iliac arterial axis blood flow. The problem was resolved by reconstructing the aortic bifurcation at a more proximal level. Completion angiogram verified normal patency of aorta and iliac vessels. Additionally, a severe left femoral bifurcation stenosis was also corrected by endarterectomy-arterioplasty with a bovine patch. Postintervention ankle brachial pressure indices were significantly improved. At the 6-month and 2-year follow-up, normal peripheral pulses were still reported without intermittent claudication suggesting the durability of the procedure. Through stent-protruding calcified intimal flap, is a very rare, but existing source of antegrade blood flow obstruction after common iliac arteries kissing stents. PMID:26783493

  16. Popliteal pseudoaneurysm caused by stent fracture.

    PubMed

    Tsuji, Yoshihiko; Kitano, Ikuro; Iida, Osamu; Kajita, Satoru; Sawada, Katsuhiro; Nanto, Shinsuke

    2011-08-01

    Stent fracture with pseudoaneurysm formation in the femoropopliteal artery has uncommonly been reported. We present the case of a 72-year-old man with a fracture of self-expanding nitinol stent and a pseudoaneurysm formation in the suprageniculate popliteal artery. The popliteal artery was successfully reconstructed with a small saphenous vein graft interposition. PMID:21620667

  17. Elephant trunk technique for hybrid aortic arch repair.

    PubMed

    Miyamoto, Yuji

    2014-03-01

    The original elephant trunk technique was developed by Borst in 1983 for the treatment of aortic arch aneurysms. This technique reduced operative risks, but was associated with cumulative mortality rates of 6.9 % for the first stage and 7.5 % for the second stage. Patients also waited a long time between two major surgical procedures. Only 50.4 % of patients underwent the second-stage surgery, and there was a significant interval mortality rate of 10.7 %. With the advent of stent-graft techniques, two different hybrid elephant trunk techniques were developed. One technique is first-stage elephant trunk graft placement followed by second-stage endovascular completion. The conventional elephant trunk graft provides a good landing zone for the stent-graft, and endovascular completion is a useful alternative to conventional second-stage surgery. This method has few major complications, and a postoperative paraplegia rate of 1.1 %. The other technique is the frozen elephant trunk technique. This technique eliminates the need for subsequent endovascular completion, and is particularly useful for the treatment of acute type A dissection because it can achieve a secure seal. However, it is associated with a higher rate of spinal cord ischemia than other methods such as the original elephant trunk technique. The left subclavian artery (LSA) is often lost when performing a hybrid elephant trunk procedure. Revascularization of the LSA should be performed to prevent arm ischemia and neurological complications such as paraplegia or stroke, although the level of evidence for this recommendation is low. PMID:23943042

  18. Aortic insufficiency

    MedlinePlus

    ... Heart valve - aortic regurgitation; Valvular disease - aortic regurgitation; AI - aortic insufficiency ... BA. Valvular heart disease. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine . 25th ed. Philadelphia, PA: ...

  19. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms - these occur in the part of the aorta ...

  20. Aortic Aneurysm

    MedlinePlus

    ... chest and abdomen. There are two types of aortic aneurysm: Thoracic aortic aneurysms (TAA) - these occur in the part of the aorta running through the chest Abdominal aortic aneurysms (AAA) - these occur in the part of the ...

  1. Aortic insufficiency

    MedlinePlus

    Aortic valve prolapse; Aortic regurgitation ... Any condition that prevents the aortic valve from closing completely can cause this problem. When the valve doesn't close all the way, a small amount of blood comes ...

  2. Aortic Root Enlargement with Ascending-to-Descending Aortic Bypass in Repair of Coarctation.

    PubMed

    Perry, Paul A; Young, Nilas

    2015-07-01

    Ascending-to-descending aortic bypass is a valuable technique for addressing coarctation of the aorta when additional cardiac procedures are indicated in adults. Among these, aortic valve replacement is one of the most commonly performed concomitant procedures, and there are instances in which aortic root enlargement is required. Herein, a novel technique is described for performing simultaneous ascending-to-descending aortic bypass in conjunction with aortic root enlargement which incorporates the bypass graft as part of the aortic root enlargement. PMID:26897826

  3. Acute contained ruptured aortic aneurysm presenting as left vocal fold immobility.

    PubMed

    Gnagi, Sharon H; Howard, Brittany E; Hoxworth, Joseph M; Lott, David G

    2015-01-01

    Objective. To recognize intrathoracic abnormalities, including expansion or rupture of aortic aneurysms, as a source of acute onset vocal fold immobility. Methods. A case report and review of the literature. Results. An 85-year-old female with prior history of an aortic aneurysm presented to a tertiary care facility with sudden onset hoarseness. On laryngoscopy, the left vocal fold was immobile in the paramedian position. A CT scan obtained that day revealed a new, large hematoma surrounding the upper descending aortic stent graft consistent with an acute contained ruptured aortic aneurysm. She was referred to the emergency department for evaluation and treatment by vascular surgery. She was counseled regarding surgical options and ultimately decided not to pursue further treatment. Her vocal fold immobility was subsequently treated via office-based injection medialization two weeks after presentation and again 5 months after the initial injection which dramatically improved her voice. Follow-up CT scan at 8 months demonstrated a reduction of the hematoma. The left vocal cord remains immobile to date. Conclusion. Ortner's syndrome, or cardiovocal syndrome, is hoarseness secondary to left recurrent laryngeal nerve palsy caused by cardiovascular pathology. It is a rare condition and, while typically presenting gradually, may also present with acute symptomatology. PMID:25648215

  4. Hybrid approach in an acute type B aortic dissection in a female patient after having a renal transplant.

    PubMed

    Janczak, Dariusz; Krajewska, Magdalena; Garcarek, Jerzy; Gancarek, Jerzy; Chabowski, Mariusz

    2014-04-01

    This study describes our experiences with a 44-year-old woman who developed acute type B aortic dissection and elected emergency surgery 3 years after a renal transplant. This led to acute ischemia in the right lower extremity. The first stage of surgery was to implant an extra-anatomic (pretracheal) bypass with a GORE-TEX prosthesis from the brachiocephalic trunk to the left common carotid artery. The second stage was implanting a stent graft into the aortic arch that covered the left common carotid artery and the left subclavian artery. The third stage was to insert a stent graft that involved the entire thoracic aorta and proximal segment of the abdominal aorta to the celiac trunk, with the right axillary and left femoral approach. The fourth stage was an extra-anatomic (suprapubic) bypass with the GORE-TEX prosthesis from the left femoral artery to the right femoral artery. Surgery resulted in normal blood supply to the organs and restored renal function. PMID:23647485

  5. Abdominal Aortic Aneurysms

    PubMed Central

    Fortner, George; Johansen, Kaj

    1984-01-01

    Aneurysms are common in our increasingly elderly population, and are a major threat to life and limb. Until the advent of vascular reconstructive techniques, aneurysm patients were subject to an overwhelming risk of death from exsanguination. The first successful repair of an abdominal aortic aneurysm using an interposed arterial homograft was reported by Dubost in 1952. A milestone in the evolution of vascular surgery, this event and subsequent diagnostic, operative and prosthetic graft refinements have permitted patients with an unruptured abdominal aortic aneurysm to enjoy a better prognosis than patients with almost any other form of major systemic illness. Images PMID:6702193

  6. Hydatid cyst involving the aortic arch.

    PubMed

    Apaydin, Anil Z; Oguz, Emrah; Zoghi, Mehdi

    2007-03-01

    We report a very rare case of primary mediastinal hydatid cyst which invaded the ascending aorta and the aortic arch which initially presented as a cranial mass. Aortic wall is a very unusual site for the hydatid cysts. To the best of our knowledge, this is the first reported case of hydatid cyst located within the aortic arch lumen. Patient underwent ascending aortic and hemiarch replacement under hypothermic circulatory arrest and removal of the cyst. Patient had an uneventful recovery and has been on follow-up. Although the literature data are very limited, we believe that the aortic procedure of choice should be graft interpositon rather than patch repair. PMID:17215134

  7. Endovascular exclusion of an external carotid artery pseudoaneurysm using a covered stent.

    PubMed

    Riesenman, Paul J; Mendes, Robert R; Mauro, Matthew A; Farber, Mark A

    2007-01-01

    Aneurysmal lesions of the external carotid artery are extremely rare. A case is presented of a 3.8 cm right external carotid artery pseudoaneurysm treated by transluminal exclusion using an endovascular stent-graft. Following stent-graft placement, complete occlusion of the aneurysmal sac and main vessel lumen patency was successfully demonstrated. This report demonstrates the technical feasibility of utilizing stent-grafts to treat aneurysmal lesions involving the external carotid artery. PMID:17497068

  8. A Case of Late Femoral Pseudoaneurysm Caused by Stent Disconnection

    SciTech Connect

    Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele Tozzi, Matteo; Carrafiello, Gianpaolo

    2010-10-15

    We present the case of a late superficial femoral artery stent disconnection causing an asymptomatic pseudoaneurysm successfully treated with a stent-graft. A 67-year-old female was referred to our department for evaluation of claudication of the left lower limb and was diagnosed to have a total occlusion of the superficial femoral artery. Three nitinol stents were used to revascularize this artery. At 48 months, duplex-ultrasonography control revealed the presence of a 45-mm saccular femoral dilatation; X-rays and CT angiography showed fractures of the proximal stents and the presence of a pseudoaneurysm at the site of the distal stents disconnection. The pseudoaneurysm was excluded using two stent-grafts. We conclude that patients and surgeons should be aware of structural complications with all stents. Rigorous follow-up controls should be mandatory. Endovascular repair proved to be feasible and durable to manage a previous endovascular procedure.

  9. Intraoperative Sac Pressure Measurement During Endovascular Abdominal Aortic Aneurysm Repair

    SciTech Connect

    Ishibashi, Hiroyuki; Ishiguchi, Tsuneo; Ohta, Takashi; Sugimoto, Ikuo; Iwata, Hirohide; Yamada, Tetsuya; Tadakoshi, Masao; Hida, Noriyuki; Orimoto, Yuki; Kamei, Seiji

    2010-10-15

    PurposeIntraoperative sac pressure was measured during endovascular abdominal aortic aneurysm repair (EVAR) to evaluate the clinical significance of sac pressure measurement.MethodsA microcatheter was placed in an aneurysm sac from the contralateral femoral artery, and sac pressure was measured during EVAR procedures in 47 patients. Aortic blood pressure was measured as a control by a catheter from the left brachial artery.ResultsThe systolic sac pressure index (SPI) was 0.87 {+-} 0.10 after main-body deployment, 0.63 {+-} 0.12 after leg deployment (P < 0.01), and 0.56 {+-} 0.12 after completion of the procedure (P < 0.01). Pulse pressure was 55 {+-} 21 mmHg, 23 {+-} 15 mmHg (P < 0.01), and 16 {+-} 12 mmHg (P < 0.01), respectively. SPI showed no significant differences between the Zenith and Excluder stent grafts (0.56 {+-} 0.13 vs. 0.54 {+-} 0.10, NS). Type I endoleak was found in seven patients (15%), and the SPI decreased from 0.62 {+-} 0.10 to 0.55 {+-} 0.10 (P = 0.10) after fixing procedures. Type II endoleak was found in 12 patients (26%) by completion angiography. The SPI showed no difference between type II endoleak positive and negative (0.58 {+-} 0.12 vs. 0.55 {+-} 0.12, NS). There were no significant differences between the final SPI of abdominal aortic aneurysms in which the diameter decreased in the follow-up and that of abdominal aortic aneurysms in which the diameter did not change (0.53 {+-} 0.12 vs. 0.57 {+-} 0.12, NS).ConclusionsSac pressure measurement was useful for instant hemodynamic evaluation of the EVAR procedure, especially in type I endoleaks. However, on the basis of this small study, the SPI cannot be used to reliably predict sac growth or regression.

  10. Medium-Term Outcomes Following Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms with an Unfavourable Proximal Neck

    SciTech Connect

    Saha, Prakash Hughes, John Patel, Ashish S. Donati, Tommaso Sallam, Morad Patel, Sanjay D. Bell, Rachel E.; Katsanos, Konstantinos; Modarai, Bijan Zayed, Hany A.

    2015-08-15

    PurposeThe purpose of this study was to evaluate medium-term outcomes following endovascular repair of abdominal aortic aneurysms (EVAR) with unfavourable neck anatomy using stent grafts with a 36 mm or larger proximal diameter.Materials and MethodsA retrospective review of 27 patients who underwent elective EVAR between 2006 and 2008 using a stent graft with a 36 mm or larger proximal diameter was carried out. All patients had computed tomography angiography (CTA) for procedure planning, and detailed assessment of the aneurysm neck was performed using a three-dimensional CTA workstation. Patients were followed up with CTA at 3 and 12 months and annual duplex thereafter.ResultsThe median aneurysm diameter was 7 cm, and the median aneurysm neck diameter was 31 mm. Cook Zenith stent grafts were used in all patients, with a proximal diameter of 36 mm (n = 25) and 40 mm (n = 2). Primary and assisted primary technical success rates were 74 and 93 %, respectively. The follow-up period ranged from 62 to 84 months, with a median of 72 months. 15 patients died during follow-up. Two patients died from aortic rupture, and the remaining patients died from cardiac disease (n = 4), chest sepsis (n = 6), cancer (n = 2) and renal failure (n = 1). Complications included type I endoleak (n = 5), limb occlusion (n = 2), limb stenosis (n = 2), limb kinking (n = 1), dissection of an artery (n = 1), occlusion of a femorofemoral cross-over graft (n = 1) and poor attachment of a distal limb (n = 1).ConclusionsEVAR using stent grafts in the presence of an unfavourable neck has a high risk of complications. Medium-term survival in this group is low but mainly due to patient co-morbidities.

  11. Evolution of surgical therapy for Stanford acute type A aortic dissection

    PubMed Central

    Chiu, Peter

    2016-01-01

    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results. PMID:27563541

  12. Evolution of surgical therapy for Stanford acute type A aortic dissection.

    PubMed

    Chiu, Peter; Miller, D Craig

    2016-07-01

    Acute type A aortic dissection (AcA-AoD) is a surgical emergency associated with very high morbidity and mortality. Unfortunately, the early outcome of emergency surgical repair has not improved substantially over the last 20 years. Many of the same debates occur repeatedly regarding operative extent and optimal conduct of the operation. The question remains: are patients suffering from too large an operation or too small? The pendulum favoring routine aortic valve resuspension, when feasible, has swung towards frequent aortic root replacement. This already aggressive approach is now being challenged with the even more extensive valve-sparing aortic root replacement (V-SARR) in selected patients. Distally, open replacement of most of the transverse arch is best in most patients. The need for late aortic re-intervention has not been shown to be affected by more extensive distal operative procedures, but the contemporary enthusiasm for a distal frozen elephant trunk (FET) only seems to build. It must be remembered that the first and foremost goal of the operation is to have an operative survivor; additional measures to reduce late morbidity are secondary aspirations. With increasing experience, true contraindications to emergency surgical operation have dwindled, but patients with advanced age, multiple comorbidities, and major neurological deficits do not fare well. The endovascular revolution, moreover, has spawned innovative options for modern practice, including ascending stent graft and adaptations of the old flap fenestration technique. Despite the increasingly complex operations and ever expanding therapies, this life-threatening disease remains a stubborn challenge for all cardiovascular surgeons. Development of specialized thoracic aortic teams and regionalization of care for patients with AcA-AoD offers the most promise to improve overall results. PMID:27563541

  13. Auxetic oesophageal stents: structure and mechanical properties.

    PubMed

    Ali, Murtaza Najabat; Busfield, James J C; Rehman, Ihtesham U

    2014-02-01

    Oesophageal cancer is the ninth leading cause of malignant cancer death and its prognosis remains poor, ranking as the sixth most frequent cause of death in the world. This research work aims to adopt an Auxetic (rotating-squares) geometry device, that had previously been examined theoretically and analysed by Grima and Evans (J Mater Sci Lett 19(17):1563-1565, 2000), to produce a novel Auxetic oesophageal stent and stent-grafts relevant to the palliative treatment of oesophageal cancer and also for the prevention of dysphagia. This paper discusses the manufacture of a small diameter Auxetic oesophageal stent and stent-graft. The oral deployment of such an Auxetic stent would be simplest if a commercial balloon dilatational catheter was used as this obviates the need for an expensive dedicated delivery system. A novel manufacturing route was employed in this research to develop both Auxetic films and Auxetic oesophageal stents, which ranged from conventional subtractive techniques to a new additive manufacturing method. Polyurethane was selected as a material for the fabrication of Auxetic films and Auxetic oesophageal stents because of its good biocompatibility and non-toxicological properties. The Auxetic films were later used for the fabrication of seamed Auxetic oesophageal stents. The flexible polyurethane tubular grafts were also attached to the inner luminal side of the seamless Auxetic oesophageal stents, in order to prevent tumour in-growth. Scanning electron microscopy was used to conduct surface morphology study by using different Auxetic specimens developed from different conventional and new additive manufacturing techniques. Tensile testing of the Auxetic films was performed to characterise their mechanical properties. The stent expansion tests of the Auxetic stents were done to analyse the longitudinal extension and radial expansion of the Auxetic stent at a range of radial pressures applied by the balloon catheter, and to also identify the pressure

  14. Intraoperative aortic dissection

    PubMed Central

    Singh, Ajmer; Mehta, Yatin

    2015-01-01

    Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication. PMID:26440240

  15. A multimodality vascular imaging phantom of an abdominal aortic aneurysm with a visible thrombus

    SciTech Connect

    Allard, Louise; Chayer, Boris; Qin Zhao; Soulez, Gilles; Roy, David; Cloutier, Guy

    2013-06-15

    Purpose: With the continuous development of new stent grafts and implantation techniques, it has now become technically feasible to treat abdominal aortic aneurysms (AAA) with challenging anatomy using endovascular repair with standard, fenestrated, or branched stent-grafts. In vitro experimentations are very useful to improve stent-graft design and conformability or imaging guidance for stent-graft delivery or follow-up. Vascular replicas also help to better understand the limitation of endovascular approaches in challenging anatomy and possibly improve surgical planning or training by practicing high risk clinical procedures in the laboratory to improve outcomes in the operating room. Most AAA phantoms available have a very basic anatomy, which is not representative of the clinical reality. This paper presents a method of fabrication of a realistic AAA phantom with a visible thrombus, as well as some mechanical properties characterizing such phantom. Methods: A realistic AAA geometry replica of a real patient anatomy taken from a multidetector computed tomography (CT) scan was manufactured. To demonstrate the multimodality imaging capability of this new phantom with a thrombus visible in magnetic resonance (MR) angiography, CT angiography (CTA), digital subtraction angiography (DSA), and ultrasound, image acquisitions with all these modalities were performed by using standard clinical protocols. Potential use of this phantom for stent deployment was also tested. A rheometer allowed defining hyperelastic and viscoelastic properties of phantom materials. Results: MR imaging measurements of SNR and CNR values on T1 and T2-weighted sequences and MR angiography indicated reasonable agreement with published values of AAA thrombus and abdominal components in vivo. X-ray absorption also lay within normal ranges of AAA patients and was representative of findings observed on CTA, fluoroscopy, and DSA. Ultrasound propagation speeds for developed materials were also in

  16. Aortic regurgitation after transcatheter aortic valve replacement.

    PubMed

    Werner, Nikos; Sinning, Jan-Malte

    2014-01-01

    Paravalvular aortic regurgitation (AR) negatively affects prognosis following transcatheter aortic valve replacement (TAVR). As transcatheter heart valves (THV) are anchored using a certain degree of oversizing at the level of the aortic annulus, incomplete stent frame expansion because of heavily annular calcifications, suboptimal placement of the prosthesis, and/or annulus-prosthesis size-mismatch can contribute to paravalvular AR with subsequent increased mortality risk. Echocardiography is essential to differentiate between transvalvular and paravalvular AR and to further elucidate the etiology of AR during the procedure. However, because echocardiographic quantification of AR in TAVR patients remains challenging, especially in the implantation situation, a multimodal approach to the evaluation of AR with use of hemodynamic measurements and imaging modalities is useful to precisely quantify the severity of AR immediately after valve deployment. "Next-generation" THVs are already on the market and first results show that paravalvular AR related to design modifications (eg, paravalvular space-fillers, full repositionability) are rarely seen in these valve types.  PMID:24632758

  17. Comparison of David V valve-sparing root replacement and bioprosthetic valve conduit for aortic root aneurysm

    PubMed Central

    DeNino, Walter F.; Toole, John Matthew; Rowley, Christopher; Stroud, Martha R.; Ikonomidis, John S.

    2015-01-01

    Objective Valve sparing root replacement (VSRR) is an attractive option for the management of aortic root aneurysms with a normal native aortic valve. Therefore, we reviewed our experience with a modification of the David V VSRR and compared it with stented pericardial bioprosthetic valve conduit (BVC) root replacement in an age-matched cohort of older patients. Methods A total of 48 VSRRs were performed at our institution, excluding those on bicuspid aortic valves. We compared these cases with 15 aortic root replacements performed using a BVC during the same period. Subgroup analysis was performed comparing 16 VSRR cases and 15 age-matched BVC cases. Results The greatest disparity between the VSRR and BVC groups was age (53 vs 69 years, respectively; P < .0005). The matched patients were similar in terms of baseline demographics and differed only in concomitant coronary artery bypass grafting (2 VSRR vs 7 BVC patients; P = .036). None of the VSRR and 3 of the BVC procedures were performed for associated dissection (P = .101). Postoperative aortic insufficiency grade was significantly different between the 2 groups (P = .004). The cardiopulmonary bypass, crossclamp, and circulatory arrest times were not different between the VSRR and BVC groups (174 vs 187 minutes, P = .205; 128 vs 133 minutes, P = .376; and 10 vs 13 minutes, respectively; P = .175). No differences were found between the 2 groups with respect to postoperative complications. One postoperative death occurred in the BVC group and none in the VSRR group. The postoperative length of stay and aortic valve gradients were less in the VSRR group (6 vs 8 days, P = .038; 6 vs 11.4 mm Hg, P = .001). The intensive care unit length of stay was significantly less in the VSRR group (54 vs 110 hours, P = .001). Conclusions VSRR is an effective alternative to the BVC for aortic root aneurysm. PMID:25173127

  18. Successful Exclusion of Subclavian Aneurysms with Covered Nitinol Stents

    SciTech Connect

    Szeimies, Ulrike; Kueffer, Georg; Stoeckelhuber, Beate; Steckmeier, Bernd

    1998-05-15

    Two cases of percutaneous endoluminal exclusion of a subclavian aneurysm with a Dacron-coated nitinol stent are presented. One subclavian aneurysm followed trauma; the other was due to thoracic outlet stenosis which was caused by a cervical rib. In both patients the aneurysm was excluded successfully. The follow-up periods were 22 and 14 months, respectively. Stenoses at the stent graft occurred in both patients; one was treated by balloon angioplasty. In selected patients, endoluminal grafting could be an alternative to surgery; however, stent graft designs need to be improved and long-term follow-up is awaited.

  19. Carotid stenting and endarterectomy.

    PubMed

    Yip, Hon-Kan; Sung, Pei-Hsun; Wu, Chiung-Jen; Yu, Cheuk-Man

    2016-07-01

    Stroke, either ischemic or hemorrhagic, remains the second commonest cause of death worldwide in the last decade. Etiologies for ischemic stroke (IS) vary widely. Atherothrombotic occlusion is an essential cause to which carotid artery stenosis (CAS) is a major contributor. Administration of anti-platelet agent to patients with CAS has been shown to reduce incidence of long-term IS. In additional, in patients with symptomatic CAS, clinical trials have demonstrated that carotid endarterectomy (CEA) is superior to medical therapy for prevention of future CAS-related IS. However, CEA is not suitable for CAS post-radiotherapy or those located at higher level of the internal carotid artery; and major complications of this procedure including cranial nerve injuries have stimulated the interest of using percutaneous transfemoral carotid stenting as an alternative approach. Although transfemoral arterial approach of carotid stenting is not inferior to CEA in improving clinical outcomes, it has been reported to be associated with vascular complication and has its limitations in patients with athero-occlusive disease of abdominal aorta or bilateral iliac arteries, level II or III aortic arch, or bovine type carotid arterial anatomy. Therefore, transradial/transbrachial arterial approach has emerged as a novel method for carotid stenting. This article provides a critical review on interventional approaches for the treatment of CAS. PMID:27061654

  20. [Thoracoabdominal aortic aneurysm].

    PubMed

    Kalder, J; Kotelis, D; Jacobs, M J

    2016-09-01

    Thoracoabdominal aortic aneurysms (TAAA) are rare events with an incidence of 5.9 cases per 100,000 persons per year. In Germany approximately 940 TAAA procedures are performed annually. The cause of TAAA is mostly degenerative but they can also occur on the basis of an aortic dissection or connective tissue disease (e. g. Marfan's syndrome). Patients often have severe comorbidities and suffer from hypertension, coronary heart disease or chronic obstructive pulmonary disease, mostly as a result of smoking. Operative treatment is indicated when the maximum aortic diameter has reached 6 cm (> 5 cm in patients with connective tissue disease) or the aortic diameter rapidly increases (> 5 mm/year). Treatment options are open surgical aortic repair with extracorporeal circulation, endovascular repair with branched/fenestrated endografts and parallel grafts (chimneys) or a combination of open and endovascular procedures (hybrid procedures). Mortality rates after both open and endovascular procedures are approximately 8 % depending on the extent of the repair. Furthermore, there are relevant risks of complications, such as paraplegia (up to 20 %) and the necessity for dialysis. In recent years several approaches to minimize these risks have been proposed. Besides cardiopulmonary risk evaluation, clinical assessment of patients by the physician with respect to the patient-specific anatomy influences the allocation of patients to one treatment option or another. Surgery of TAAA should ideally be performed in high-volume centers in order to achieve better results. PMID:27558261

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

    PubMed

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

    2015-09-01

    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

  2. [Absorbable coronary stents. New promising technology].

    PubMed

    Erbel, Raimund; Böse, Dirk; Haude, Michael; Kordish, Igor; Churzidze, Sofia; Malyar, Nasser; Konorza, Thomas; Sack, Stefan

    2007-06-01

    revascularization rate of 23.8% which was below the 30% cut point of the study protocol. No myocardial Q wave infarction or death were reported. The primary endpoint was reached. During the follow-up period, vasomotion was tested in some of the patients. The proof of principle was confirmed: restoration of vasomotion during acetylcholine testing. The development of the absorbable magnesium stent, which was pushed forward by B. Heublein, Hanover, Germany, has been successful and opens new possibilities for treatment of coronary arteries. Permanent foreign-body implantation is avoided allowing further revascularization procedures in the future, bypass grafting, and restoration of vasomotion. Even prophylactic stenting in nonsignificant stenosis, like vulnerable lesions, may become a regular procedure. Noninvasive coronary imaging by CT and MRI is now possible. Stenting of children and in peripheral arteries may become a standard procedure. Currently, the degradation process of the magnesium stent has to be prolonged, and the neointima proliferation rate has to be reduced so that the DREAM (Drug-Eluting Absorbable Magnesium Stent) concept of Ron Waksman, Washington, DC, USA, can be realized. PMID:17607538

  3. Syphilitic aortic aneurysm presenting with upper airway obstruction.

    PubMed

    Waikittipong, Somchai

    2012-10-01

    Syphilitic aortic aneurysms are uncommon today. A rare case of syphilitic aortic arch aneurysm with successful surgical treatment is reported. A 42-year-old man presented with upper airway obstruction. Chest radiography showed a superior mediastinal mass, and computed tomography revealed a large saccular aortic arch aneurysm that compressed the trachea. Dacron graft replacement of the aortic arch was successfully performed under circulatory arrest with antegrade cerebral perfusion. PMID:23087303

  4. Percutaneous Treatment of Sac Rupture in Abdominal Aortic Aneurysms Previously Excluded with Endovascular Repair (EVAR)

    SciTech Connect

    Lagana, Domenico Mangini, Monica Fontana, Federico; Nicotera, Paolo; Carrafiello, Gianpaolo; Fugazzola, Carlo

    2009-01-15

    The purpose of this study was to assess the feasibility and effectiveness of percutaneous endovascular repair of ruptured abdominal aortic aneurysms (AAAs) previously treated by EVAR. In the last year, two male patients with AAAs, treated 8 and 23 months ago with bifurcated stent-graft, were observed because of lumbar pain and hemorragic shock. Multidetector computed tomography (MDCT) showed a retroperitoneal hematoma; in both cases a type III endoleak was detected, in one case associated with a type II endoleak from the iliolumbar artery. The procedures were performed in the theater, in emergency. Type II endoleak was treated with transcatheter superselective glue injection; type III endoleaks were excluded by a stent-graft extension. The procedures were successful in both patients, with immediate hemodynamic stabilization. MDCT after the procedure showed complete exclusion of the aneurysms. In conclusion, endovascular treatment is a safe and feasible option for the treatment of ruptured AAAs previously treated by EVAR; this approach allows avoidance of surgical conversion, which is technical very challenging, with a high morbidity and mortality rate.

  5. Endovascular treatment of supra-celiac aortic pseudoaneurysms following liver transplantation.

    PubMed

    Heidenhain, Christoph; Werk, Michael; Gebauer, Bernhard; Gerlach, Undine; Puhl, Gero; Neuhaus, Peter; Heise, Michael

    2010-01-01

    The development of supra-celiac pseudoaneurysms following aorto-hepatic reconstruction during liver transplantation represents a major and surgically challenging complication. However, the use of endovascular stent grafts for the exclusion of aortic aneurysms is now a standard procedure with low morbidity and mortality. We demonstrate the successful endovascular repair of three cases of supra-celiac pseudoaneurysms, which developed after liver transplantation. A 40-yr-old woman, a 61-yr-old man, and a 45-yr-old woman underwent liver transplantation for end-stage liver disease. Between three months and five yr after the transplantation the patients developed large supra-celiac pseudoaneurysms leading to thrombosis of the hepatic artery and biliary complications. The stent graft implantation was uneventful, one endoleak Type I occluded spontaneously. There were no intervention-related complications. Unfortunately, one patient died one month after the procedure due to progressive liver failure and one died after five months due to multiple organ failure. One patient is still alive and in good condition. PMID:19659512

  6. Computed tomography angiography of hybrid thoracic endovascular aortic repair of the aortic arch.

    PubMed

    Akhtar, Nila J; Oderich, Gustavo S; Vrtiska, Terri J; Williamson, Eric E; Araoz, Philip A

    2013-05-01

    Endovascular repair of the aorta has traditionally been limited to the abdominal aorta and, more recently, the descending thoracic aorta. However, recently hybrid repairs (a combination of open surgical and endovascular repair) have made endovascular repair of the aortic arch possible. Hybrid repair of the aortic arch typically involves an open surgical debranching procedure that allows for revascularization of the aortic arch vessels and subsequent endovascular stent placement. These approaches avoid the deep hypothermic circulatory arrest required for full, open surgical repair of the aortic arch. In hybrid repairs, the stent landing zone determines which branch vessels will be covered and therefore need revascularization. This article will review the preprocedure assessment with computed tomography angiography, techniques for revascularization and postprocedure complications. PMID:23621141

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

    PubMed Central

    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. PMID:24057860

  8. Stenting in Acute Lower Limb Arterial Occlusions

    SciTech Connect

    Raja, Jowad; Munneke, Graham; Morgan, Robert; Belli, Anna-Maria

    2008-07-15

    Management of critical limb ischemia of acute onset includes surgical embolectomy, bypass grafting, aspiration thrombectomy, thrombolysis, and mechanical thrombectomy followed by treatment of the underlying cause. We present our experience with the use of stents to treat acute embolic/thrombotic occlusions in one iliac and three femoropopliteal arteries. Although this is a small case series, excellent immediate and midterm results suggest that stenting of acute occlusions of the iliac, superficial femoral, and popliteal arteries is a safe and effective treatment option.

  9. Laparoscopically assisted total daVinci aorto bifemoral graft bypass with a unique system of graft delivery.

    PubMed

    Martinez, B D; George, P M; Ameer, A; Gerhardinger, A M; Moses, J T; Hansen, J M

    2009-03-01

    We report the first known example of a fully robotic aortobifemoral graft and aortic endarterectomy using the daVinci Surgical System and a unique method for graft delivery using the Endo-Vein Harvester. PMID:18657387

  10. Suprarenal fixation resulting in intestinal malperfusion after endovascular aortic aneurysm repair.

    PubMed

    Siani, Andrea; Accrocca, Federico; De Vivo, Gennaro; Marcucci, Giustino

    2016-05-01

    Superior mesenteric artery (SMA) and coeliac axis (CA) occlusion after endovascular abdominal aneurysm aortic repair (EVAR-AAA), using endograft with suprarenal fixation, are uncommon. However, we are reporting a case of visceral malperfusion, which occurred 7 days after successful EVAR with suprarenal fixation for symptomatic AAA. Endograft metal stent barbs caused severe stenosis of SMA and CA. A successful recovery of SMA was carried out by means of a balloon-expandable stent released through bare metal stent barbs. We believe that an unfavourable anatomy of a proximal aortic neck and visceral aorta may have caused a wrong stent strut deployment with the coverage of CA and SMA. PMID:26826712

  11. [Successful endovascular repair of a ruptured thoracoabdominal aortic aneurysm with severe mural thrombus].

    PubMed

    Nakao, Yoshihisa; Akagi, Haruhiko; Irie, Hiroshi; Sakaguchi, Shoji; Sakai, Kei

    2014-11-01

    A 51-year-old man was transferred to our hospital on an emergency basis complaining of a sudden onset of severe left lumbar back pain. An emergency contrasted computed tomography showed a ruptured thoracoabdominal aortic aneurysm( rTAAA:Crawford classification type III). The ruptured site was near the aortic bifurcation, and the aneurysm had a relatively narrow segment with an extensive mural thrombus just below the renal arteries. Considering the high mortality of open surgery for the rTAAA and the poor general condition of the patient, we decided to perform endovascular aneurysm repair (EVAR) as a rescue procedure using the narrowed segment by the thrombus for a proximal landing zone. The abdominal part of the thoracoabdominal aortic aneurysm (TAAA) was successfully excluded with a stent graft to obtain complete hemostasis. The postoperative course was uneventful except for the need for hemodialysis. Even though there is a risk of developing late type 1 endoleak, this procedure can be a feasible option as a rescue procedure or a bridge to radical open surgery for ruptured TAAA in a specially anatomical setting like this case. PMID:25391465

  12. [Analysis of endovascular treatment strategies on in-stent restenosis of femoropopliteal artery lesions].

    PubMed

    Fu, W G; Yue, J N

    2016-08-01

    Over the last few years, the treatment of complex femoropopliteal lesions led to the increasing use of stents in this challenging anatomical area. Whereas in-stent restenosis remains the Achilles' heel of stenting this segment, and leads to recurrent ischemia and repeated interventions. A majority of endovascular techniques have been evaluated to repair this complication, including plain balloon angioplasty, new stent deployment, cutting balloons but without satisfactory mid- and long-term results. More recently debulking and drug-eluting devices have been applied in femoropopliteal in-stent restenosis with promising results. And relining with a stent graft or drug-eluting stent of femoropopliteal in-stent restenosis can be considered in cases of stent fracture as this strategy has showed relatively optimal outcomes. The aim of this article is to analyze the evidence of those endovascular techniques for the treatment of femoropopliteal in-stent restenosis. PMID:27502131

  13. Endovascular repair of an abdominal aortic aneurysm in the presence of a hydronephrotic horseshoe kidney.

    PubMed

    Krivoshei, Lian; Akin-Olugbade, Yemi; McWilliams, Glen; Halak, Moshe; Silverberg, Daniel

    2012-02-01

    The aim of this paper is to report an unusual case of a patient with an abdominal aortic aneurysm (AAA) and a hydronephrotic horseshoe kidney (HSK) that was repaired by endovascular means. An 81-year-old male patient with a known HSK was found to have hydronephrosis and an AAA. The patient's aneurysm was treated with an endovascular stent graft which required the covering of accessory renal arteries. He had an uneventful recovery with complete resolution of the hydronephrosis evident on a computed tomography scan performed seven months after the surgery. In conclusion, endovascular aneurysm repair is a feasible therapeutic option for an AAA coexisting with an HSK and may be considered as a valid alternative to open repair when concomitant hydronephrosis is present. PMID:22328622

  14. Neurological Complications Following Endoluminal Repair of Thoracic Aortic Disease

    SciTech Connect

    Morales, J. P.; Taylor, P. R.; Bell, R. E.; Chan, Y. C.; Sabharwal, T.; Carrell, T. W. G.; Reidy, J. F.

    2007-09-15

    Open surgery for thoracic aortic disease is associated with significant morbidity and the reported rates for paraplegia and stroke are 3%-19% and 6%-11%, respectively. Spinal cord ischemia and stroke have also been reported following endoluminal repair. This study reviews the incidence of paraplegia and stroke in a series of 186 patients treated with thoracic stent grafts. From July 1997 to September 2006, 186 patients (125 men) underwent endoluminal repair of thoracic aortic pathology. Mean age was 71 years (range, 17-90 years). One hundred twenty-eight patients were treated electively and 58 patients had urgent procedures. Anesthesia was epidural in 131, general in 50, and local in 5 patients. Seven patients developed paraplegia (3.8%; two urgent and five elective). All occurred in-hospital apart from one associated with severe hypotension after a myocardial infarction at 3 weeks. Four of these recovered with cerebrospinal fluid (CSF) drainage. One patient with paraplegia died and two had permanent neurological deficit. The rate of permanent paraplegia and death was 1.6%. There were seven strokes (3.8%; four urgent and three elective). Three patients made a complete recovery, one had permanent expressive dysphasia, and three died. The rate of permanent stroke and death was 2.1%. Endoluminal treatment of thoracic aortic disease is an attractive alternative to open surgery; however, there is still a risk of paraplegia and stroke. Permanent neurological deficits and death occurred in 3.7% of the patients in this series. We conclude that prompt recognition of paraplegia and immediate insertion of a CSF drain can be an effective way of recovering spinal cord function and improving the prognosis.

  15. A computational framework for investigating the positional stability of aortic endografts.

    PubMed

    Prasad, Anamika; Xiao, Nan; Gong, Xiao-Yan; Zarins, Christopher K; Figueroa, C Alberto

    2013-10-01

    Endovascular aneurysm repair (Greenhalgh in N Engl J Med 362(20):1863-1871, 2010) techniques have revolutionized the treatment of thoracic and abdominal aortic aneurysm disease, greatly reducing the perioperative mortality and morbidity associated with open surgical repair techniques. However, EVAR is not free of important complications such as late device migration, endoleak formation and fracture of device components that may result in adverse events such as aneurysm enlargement, need for long-term imaging surveillance and secondary interventions or even death. These complications result from the device inability to withstand the hemodynamics of blood flow and to keep its originally intended post-operative position over time. Understanding the in vivo biomechanical working environment experienced by endografts is a critical factor in improving their long-term performance. To date, no study has investigated the mechanics of contact between device and aorta in a three-dimensional setting. In this work, we developed a comprehensive Computational Solid Mechanics and Computational Fluid Dynamics framework to investigate the mechanics of endograft positional stability. The main building blocks of this framework are: (1) Three-dimensional non-planar aortic and stent-graft geometrical models, (2) Realistic multi-material constitutive laws for aorta, stent, and graft, (3) Physiological values for blood flow and pressure, and (4) Frictional model to describe the contact between the endograft and the aorta. We introduce a new metric for numerical quantification of the positional stability of the endograft. Lastly, in the results section, we test the framework by investigating the impact of several factors that are clinically known to affect endograft stability. PMID:23143353

  16. A Computational Framework for Investigating the Positional Stability of Aortic Endografts

    PubMed Central

    Prasad, Anamika; Xiao, Nan; Gong, Xiao-Yan; Zarins, Christopher K.; Figueroa, C. Alberto

    2012-01-01

    Endovascular aneurysm repair (Greenhalgh, Brown et al.) techniques have revolutionized the treatment of thoracic and abdominal aortic aneurysm disease, greatly reducing the perioperative mortality and morbidity associated with open surgical repair techniques. However, EVAR is not free of important complications such as late device migration, endoleak formation and fracture of device components that may result in adverse events such as aneurysm enlargement, need for long-term imaging surveillance and secondary interventions or even death. These complications result from the device inability to withstand the hemodynamics of blood flow and to keep its originally intended post-operative position over time. Understanding the in vivo biomechanical working environment experienced by endografts is a critical factor in improving their long-term performance. To date, no study has investigated the mechanics of contact between device and aorta in a three-dimensional setting. In this work, we developed a comprehensive Computational Solid Mechanics and Computational Fluid Dynamics framework to investigate the mechanics of endograft positional stability. The main building blocks of this framework are: i) Three-dimensional non-planar aortic and stent-graft geometrical models, ii) Realistic multi-material constitutive laws for aorta, stent, and graft, iii) Physiological values for blood flow and pressure and iv) Frictional model to describe the contact between the endograft and the aorta. We introduce a new metric for numerical quantification of the positional stability of the endograft. Lastly, in the results section, we test the framework by investigating the impact of several factors that are clinically known to affect endograft stability. PMID:23143353

  17. Endovascular Repair of Abdominal Aortic Aneurysm: Follow-up with Noninvasive Vascular Elastography in a Canine Model.

    PubMed

    Salloum, Eli; Bertrand-Grenier, Antony; Lerouge, Sophie; Kauffman, Claude; Héon, Hélène; Therasse, Eric; Salazkin, Igor; Roy Cardinal, Marie-Hélène; Cloutier, Guy; Soulez, Gilles

    2016-05-01

    Purpose To assess the ability of noninvasive vascular elastography (NIVE) to help characterize endoleaks and thrombus organization in a canine model of abdominal aortic aneurysm after endovascular aneurysm repair with stent-grafts, in comparison with computed tomography (CT) and pathologic examination findings. Materials and Methods All protocols were approved by the Animal Care Committee in accordance with the guidelines of the Canadian Council of Animal Care. Stent-grafts were implanted in a group of 18 dogs with aneurysms created in the abdominal aorta. Type I endoleak was created in four aneurysms; type II endoleak, in 13 aneurysms; and no endoleak, in one aneurysm. Doppler ultrasonography and NIVE examinations were performed at baseline and at 1-week, 1-month, 3-month, and 6-month follow-up. Angiography, CT, and macroscopic tissue examination were performed at sacrifice. Strain values were computed by using the Lagrangian speckle model estimator. Areas of endoleak, solid organized thrombus, and fresh thrombus were identified and segmented by comparing the results of CT and macroscopic tissue examination. Strain values were compared by using the Wilcoxon rank-sum and Kruskal-Wallis tests. Results All stent-grafts were successfully deployed, and endoleaks were clearly depicted in the last follow-up elastography examinations. Maximal axial strains over consecutive heart cycles in endoleak, organized thrombus, and fresh thrombus areas were 0.78% ± 0.22, 0.23% ± 0.02, 0.10% ± 0.04, respectively. Strain values were significantly different between endoleak and organized or fresh thrombus areas (P < .000) and between organized and fresh thrombus areas (P < .0002). No correlation was found between strain values and type of endoleak, sac pressure, endoleak size, and aneurysm size. Conclusion NIVE may be able to help characterize endoleak and thrombus organization, regardless of the size, pressure, and type of endoleak. (©) RSNA, 2015. PMID:26690905

  18. Initial experience with transluminally placed endovascular grafts for the treatment of complex vascular lesions.

    PubMed Central

    Marin, M L; Veith, F J; Cynamon, J; Sanchez, L A; Lyon, R T; Levine, B A; Bakal, C W; Suggs, W D; Wengerter, K R; Rivers, S P

    1995-01-01

    OBJECTIVES: Complex arterial occlusive, traumatic, and aneurysmal lesions may be difficult or impossible to treat successfully by standard surgical techniques when severe medical or surgical comorbidities exist. The authors describe a single center's experience over a 2 1/2-year period with 96 endovascular graft procedures performed to treat 100 arterial lesions in 92 patients. PATIENTS AND METHODS: Thirty-three patients had 36 large aortic and/or peripheral artery aneurysms, 48 had 53 multilevel limb-threatening aortoiliac and/or femoropopliteal occlusive lesions, and 11 had traumatic arterial injuries (false aneurysms and arteriovenous fistulas). Endovascular grafts were placed through remote arteriotomies under local (16[17%]), epidural (42[43%]), or general (38[40%]) anesthesia. RESULTS: Technical and clinical successes were achieved in 91% of the patients with aneurysms, 91% with occlusive lesions, and 100% with traumatic arterial lesions. These patients and grafts have been followed from 1 to 30 months (mean, 13 months). The primary and secondary patency rates at 18 months for aortoiliac occlusions were 77% and 95%, respectively. The 18-month limb salvage rate was 98%. Immediately after aortic aneurysm exclusion, a total of 6 (33%) perigraft channels were detected; 3 of these closed within 8 weeks. Endovascular stented graft procedures were associated with a 10% major and a 14% minor complication rate. The overall 30-day mortality rate for this entire series was 6%. CONCLUSIONS: This initial experience with endovascular graft repair of complex arterial lesions justifies further use and careful evaluation of this technique for major arterial reconstruction. Images Figure 1. Figure 4. Figure 5. Figure 5. Figure 6. Figure 7. Figure 8. Figure 9. Figure 11. PMID:7574926

  19. Wire-Loop Technique for Stabilizing Catheters over the Aortic Bifurcation for Endovascular Intervention

    SciTech Connect

    Viner, Stuart Kessel, David

    2008-07-15

    We describe a simple technique to perform difficult endovascular interventions safely by using a wire-loop guidewire over the aortic bifurcation. This guidewire is then used to stabilize catheters for stenting or embolization.

  20. [Treatment with the placement of carotid stent of jugular-carotid fistula after the insertion of hemodialysis catheter].

    PubMed

    Vera, M; Quintana, L; Blasco, J; Real, M; Macho, J M

    2005-01-01

    The use of jugular temporary catheters as vascular access for hemodialysis, entails a risk of various complications. The most frequent problems are the arterial puncture and haematoma. However, there are other less frequent potentially serious complications, which constitute a therapeutic and diagnostic challenge for the nephrologists. We present a case of a patient that developed an acute renal failure in the context of cellulites for E. Coli treated with aminoglycosid, who required renal treatment with haemodialysis. After the placement of a polyurethane double-lumen catheter with ultrasound guidance at the level of the internal jugular vein, arterial blood streaming was observed through the lumen of the catheter. The angiographic study showed the tipo of the catheter placed at the level of the aortic arch. Ultrasound exam clearly despicted the track between the internal jugular vein and the internal carotid artery. An effective closing of the fistula was achieved with the placement of a covered stent-graft with the simultaneous withdrawal of the catheter. Reviewing the literature this is the first reported case of an iatrogenic jugulo-carotid fistula secundary to placement of hemodialysis catheter resolved by the implantation of carotid stent-graft. PMID:16392309