Science.gov

Sample records for flow modifying endovascular

  1. Endovascular blood flow measurement system

    NASA Astrophysics Data System (ADS)

    Khe, A. K.; Cherevko, A. A.; Chupakhin, A. P.; Krivoshapkin, A. L.; Orlov, K. Yu

    2016-06-01

    In this paper an endovascular measurement system used for intraoperative cerebral blood flow monitoring is described. The system is based on a Volcano ComboMap Pressure and Flow System extended with analogue-to-digital converter and PC laptop. A series of measurements performed in patients with cerebrovascular pathologies allows us to introduce “velocity-pressure” and “flow rate-energy flow rate” diagrams as important characteristics of the blood flow. The measurement system presented here can be used as an additional instrument in neurosurgery for assessment and monitoring of the operation procedure. Clinical data obtained with the system are used for construction of mathematical models and patient-specific simulations. The monitoring of the blood flow parameters during endovascular interventions was approved by the Ethics Committee at the Meshalkin Novosibirsk Research Institute of Circulation Pathology and included in certain surgical protocols for pre-, intra- and postoperative examinations.

  2. Endovascular embolization

    MedlinePlus

    Treatment - endovascular embolism; Coil embolization; Cerebral aneurysm - endovascular; Coiling - endovascular; Saccular aneurysm - endovascular; Berry aneurysm - endovascular repair; Fusiform aneurysm repair - endovascular; Aneurysm repair - endovascular

  3. Efficient simulation of blood flow past complex endovascular devices using an adaptive embedding technique.

    PubMed

    Cebral, Juan R; Löhner, Rainald

    2005-04-01

    The simulation of blood flow past endovascular devices such as coils and stents is a challenging problem due to the complex geometry of the devices. Traditional unstructured grid computational fluid dynamics relies on the generation of finite element grids that conform to the boundary of the computational domain. However, the generation of such grids for patient-specific modeling of cerebral aneurysm treatment with coils or stents is extremely difficult and time consuming. This paper describes the application of an adaptive grid embedding technique previously developed for complex fluid structure interaction problems to the simulation of endovascular devices. A hybrid approach is used: the vessel walls are treated with body conforming grids and the endovascular devices with an adaptive mesh embedding technique. This methodology fits naturally in the framework of image-based computational fluid dynamics and opens the door for exploration of different therapeutic options and personalization of endovascular procedures. PMID:15822805

  4. Swirling flow can suppress monocyte adhesion in the flow disturbance zones of the endovascular stent.

    PubMed

    Chen, Zengsheng; Zhang, Xiwen; Deng, Xiaoyan

    2012-01-01

    Adhesion of monocytes (U-937 cells) along a silicone tube deployed with circular ring stents was studied to test the hypothesis that by intentionally inducing swirling flow in an endovascular stent, the adhesion of monocytes would be suppressed. The results revealed that under a normal flow condition, the flow disturbance created by the circular ring stents enhanced the adhesion of U-937 cells in the silicone tube. By inducing a swirling flow in the silicone tube, the average wall shear stress (WSS) in the tube with the circular ring stents was elevated and significantly suppressed the adhesion density of U-937 cells to the surface in the disturbed flow zones to a level equal to that when no stents were deployed in the tube. The results also showed that, due to the attenuation of the swirling flow along the tube, the adhesion density of U-937 cells increased monotonically along the tube, indicating that the adhesion density was negatively correlated with the strength of the swirling flow. Thus, the present study suggests that intentionally introducing swirling flow in an artery deployed with stents may be a solution to solve the problem of stent restenosis by restraining the adhesion of monocytes. PMID:23380900

  5. Using a Surgeon-modified Iliac Branch Device to Preserve the Internal Iliac Artery during Endovascular Aneurysm Repair: Single-center Experiences and Early Results

    PubMed Central

    Wu, Wei-Wei; Lin, Chen; Liu, Bao; Liu, Chang-Wei

    2015-01-01

    Background: To evaluate the feasibility of a new surgeon-modified iliac branch device (IBD) technique to maintain pelvic perfusion in the management of common iliac artery (CIA) aneurysm during endovascular aneurysm repair (EVAR). Methods: From January 2011 to December 2013, a new surgeon-modified IBD technique was performed in department of vascular surgery of Peking Union Medical College Hospital in five patients treated for CIA aneurysm with or without abdominal aortic aneurysm. A stent-graft limb was initially deployed in vitro, anastomosed with vascular graft, creating a modified IBD reloaded into a larger sheath, with or without a guidewire preloaded into the side branch. The reloaded IBD was then placed in the iliac artery, with a covered stent bridging internal iliac artery and the branch. Finally, a bifurcated stent-graft was deployed, and a limb device was used to connect the main body and IBD. Results: Technical successes were obtained in all patients. The mean follow-up length was 24 months (range: 6–38 months). All grafts remained patent without any sign of endoleaks. There were no aneurysm ruptures, deaths, or other complications related to pelvic flow. Conclusions: Using the surgeon-modified IBD to preserve pelvic flow is a feasible endovascular technique and an appealing solution for personalized treatment of CIA aneurysm during EVAR. PMID:25698203

  6. The expanding realm of endovascular neurosurgery: flow diversion for cerebral aneurysm management.

    PubMed

    Krishna, Chandan; Sonig, Ashish; Natarajan, Sabareesh K; Siddiqui, Adnan H

    2014-01-01

    The worldwide prevalence of intracranial aneurysms is estimated to be between 5% and 10%, with some demographic variance. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm results in devastating neurological outcomes, leaving the majority of victims dead or disabled. Surgical clipping of intracranial aneurysms remained the definitive mode of treatment until Guglielmi detachable coils were introduced in the 1990s. This revolutionary innovation led to the recognition of neurointervention/neuroendovascular surgery as a bona fide option for intracranial aneurysms. Constant evolution of endovascular devices and techniques supported by several prospective randomized trials has catapulted the endovascular treatment of intracranial aneurysms to its current status as the preferred treatment modality for most ruptured and unruptured intracranial aneurysms. We are slowly transitioning from the era of coils to the era of flow diverters. Flow-diversion technology and techniques have revolutionized the treatment of wide-necked, giant, and fusiform aneurysms, where the results of microsurgery or conventional neuroendovascular strategies have traditionally been dismal. Although the Pipeline Embolization Device (ev3-Covidien, Irvine, CA) is the only flow-diversion device approved by the Food and Drug Administration for use in the United States, others are commercially available in Europe and South America, including the Silk (Balt Extrusion, Montmorency, France), Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, CA), Surpass (Stryker, Kalamazoo, MI), and p64 (Phenox, Bochum, Germany). Improvements in technology and operator experience and the encouraging results of clinical trials have led to broader acceptance for the use of these devices in cerebral aneurysm management. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden the

  7. The Expanding Realm of Endovascular Neurosurgery: Flow Diversion for Cerebral Aneurysm Management

    PubMed Central

    Krishna, Chandan; Sonig, Ashish; Natarajan, Sabareesh K.; Siddiqui, Adnan H.

    2014-01-01

    The worldwide prevalence of intracranial aneurysms is estimated to be between 5% and 10%, with some demographic variance. Subarachnoid hemorrhage secondary to ruptured intracranial aneurysm results in devastating neurological outcomes, leaving the majority of victims dead or disabled. Surgical clipping of intracranial aneurysms remained the definitive mode of treatment until Guglielmi detachable coils were introduced in the 1990s. This revolutionary innovation led to the recognition of neurointervention/neuroendovascular surgery as a bona fide option for intracranial aneurysms. Constant evolution of endovascular devices and techniques supported by several prospective randomized trials has catapulted the endovascular treatment of intracranial aneurysms to its current status as the preferred treatment modality for most ruptured and unruptured intracranial aneurysms. We are slowly transitioning from the era of coils to the era of flow diverters. Flow-diversion technology and techniques have revolutionized the treatment of wide-necked, giant, and fusiform aneurysms, where the results of microsurgery or conventional neuroendovascular strategies have traditionally been dismal. Although the Pipeline™ Embolization Device (ev3-Covidien, Irvine, CA) is the only flow-diversion device approved by the Food and Drug Administration for use in the United States, others are commercially available in Europe and South America, including the Silk (Balt Extrusion, Montmorency, France), Flow-Redirection Endoluminal Device (FRED; MicroVention, Tustin, CA), Surpass (Stryker, Kalamazoo, MI), and p64 (Phenox, Bochum, Germany). Improvements in technology and operator experience and the encouraging results of clinical trials have led to broader acceptance for the use of these devices in cerebral aneurysm management. Continued innovation and refinement of endovascular devices and techniques will inevitably improve technical success rates, reduce procedure-related complications, and broaden

  8. Flow modifying device

    NASA Technical Reports Server (NTRS)

    Kelm, J. S.; Vickers, E. C.; Williams, J. J.; Taylor, J. R. (Inventor)

    1985-01-01

    A swirler for a gas turbine engine combustor is disclosed for simultaneously controlling combustor flow rate, swirl angle, residence time and fuel-air ratio to provide three regimes of operation. A first regime is provided in which fuel-air ratio is less than stoichiometric, NOx is produced at one level, and combustor flow rate is high. In a second regime, fuel-air ratio is nearly stoichiometric, NOx production is less than that of the first regime, and combustor flow rate is low. In a third regime, used for example at highoff, fuel-air ratio is greater than stoichiometric and the combustor flow rate is less than in either of the other regimes.

  9. Numerical investigation of pulsatile flow in endovascular stents

    NASA Astrophysics Data System (ADS)

    Rouhi, A.; Piomelli, U.; Vlachos, P.

    2013-09-01

    The flow in a plane channel with two idealized stents (one Λ-shaped, the other X-shaped) is studied numerically. A periodic pressure gradient corresponding to one measured in the left anterior descending coronary artery was used to drive the flow. Two Reynolds numbers were examined, one (Re = 80) corresponding to resting conditions, the other (Re = 200) to exercise. The stents were implemented by an immersed boundary method. The formation and migration of vortices that had been observed experimentally was also seen here. In the previous studies, the compliance mismatch between stent and vessel was conjectured to be the reason for this phenomenon. However, in the present study we demonstrate that the vortices form despite the fact that the walls were rigid. Flow visualization and quantitative analysis lead us to conclude that this process is due to the stent wires that generate small localized recirculation regions that, when they interact with the near-wall flow reversal, result in the formation of these vortical structures. The recirculation regions grow and merge when the imposed waveform produces near-wall flow reversal, forming coherent quasi-spanwise vortices, that migrate away from the wall. The flow behavior due to the stents was compared with an unstented channel. The geometric characteristics of the Λ-stent caused less deviation of the flow from an unstented channel than the X-stent. Investigating the role of advection and diffusion indicated that at Re = 80 advection has negligible contribution in the transport mechanism. Advection plays a role in the generation of streamwise vortices created for both stents at both Reynolds numbers. The effect of these vortices on the near-wall flow behavior is more significant for the Λ-stent compared to the X-stent and at Re = 200 with respect to Re = 80. Finally, it was observed that increasing the Reynolds number leads to early vortex formation and the creation of the vortex in a stented channel is coincident with

  10. 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

  11. Effect of collateral blood flow on patients undergoing endovascular therapy for acute ischemic stroke

    PubMed Central

    Marks, Michael P.; Lansberg, Maarten G.; Mlynash, Michael; Olivot, Jean-Marc; Straka, Matus; Kemp, Stephanie; McTaggart, Ryan; Inoue, Manabu; Zaharchuk, Greg; Bammer, Roland; Albers, Gregory W.

    2014-01-01

    Background and Purpose Our aim was to determine the relationships between angiographic collaterals and diffusion/perfusion findings, subsequent infarct growth, and clinical outcome in patients undergoing endovascular therapy for ischemic stroke. Methods Sixty patients with a TICI score of 0, 1 and ICA/M1 occlusion at baseline were evaluated. A blinded reader assigned a collateral score using a prior 5 point scale, from 0 (no collateral flow) to 4 (complete/rapid collaterals to entire ischemic territory). Analysis was dichotomized to poor flow (0–2) versus good flow (3–4). Collateral score was correlated with baseline NIHSS, DWI volume, PWI volume (Tmax ≥ 6 sec), TICI reperfusion, infarct growth and mRS at day 90. Results Collateral score correlated with baseline NIHSS (p=0.002) and Tmax ≥ 6 sec volume (p=0.009). 29% of patients with poor collateral flow had TICI 2B-3 reperfusion versus 65.5% with good flow, p=0.009. Patients with poor collaterals who reperfused (TICI 2B-3) were more likely to have a good functional outcome (mRS 0–2 at 90 days) than patients who did not reperfuse, OR 12 (95% CI, 1.6–98). There was no difference in the rate of good functional outcome following reperfusion in the patients with poor collaterals versus good collaterals (p= 1.0). Patients with poor reperfusion (TICI 0–2a) showed a trend toward greater infarct growth if they had poor collaterals vs. good collaterals, p=0.06. Conclusion Collaterals correlate with baseline NIHSS, PWI volume, and good reperfusion. However, Target Mismatch patients who reperfuse, appear to have favorable outcomes at a similar rate, irrespective of the collateral score. PMID:24569816

  12. Endovascular Treatment of Intracranial Aneurysms in the Flow Diverter Era: Frequency of Use and Results in a Consecutive Series of 550 Treatments in a Single Centre

    PubMed Central

    Jan van Rooij, Willem; Bechan, Ratna S; Peluso, Jo P; Sluzewski, Menno

    2014-01-01

    Summary Flow diverter devices became available in our department in 2009. We considered treatment with flow diverters only in patients with aneurysms not suitable for surgery or conventional endovascular techniques. This paper presents our preliminary experience with flow diverters in a consecutive series of 550 endovascular aneurysm treatments. Between January 2009 and July 2013, 550 endovascular treatments for intracranial aneurysms were performed. Of these, 490 were first-time aneurysm treatments in 464 patients and 61 were additional treatments of previously coiled aneurysms in 51 patients. Endovascular treatments consisted of selective coiling in 445 (80.8%), stent-assisted coiling in 68 (12.4%), balloon-assisted coiling in 13 (2.4%), parent vessel occlusion in 12 (2.2%) and flow diverter treatment in 12 (2.2%). Eleven patients with 12 aneurysms were treated with flow diverters. Two patients had ruptured dissecting aneurysms. One patient with a basilar trunk aneurysm died of acute in stent thrombosis and another patient died of brain stem ischaemia at 32 months follow-up. One patient had ischaemia with permanent neurological deficit. Two aneurysms are still open at up to 30 months follow-up. Flow diversion was used in 2% of all endovascular treatments. Both our own poor results and the high complication rates reported in the literature have converted our initial enthusiasm to apprehension and hesitancy. The safety and efficacy profile of flow diversion should discourage the use of these devices in aneurysms that can be treated with other techniques. PMID:25207905

  13. Finite element modeling of endovascular coiling and flow diversion enables hemodynamic prediction of complex treatment strategies for intracranial aneurysm.

    PubMed

    Damiano, Robert J; Ma, Ding; Xiang, Jianping; Siddiqui, Adnan H; Snyder, Kenneth V; Meng, Hui

    2015-09-18

    Endovascular interventions using coil embolization and flow diversion are becoming the mainstream treatment for intracranial aneurysms (IAs). To help assess the effect of intervention strategies on aneurysm hemodynamics and treatment outcome, we have developed a finite-element-method (FEM)-based technique for coil deployment along with our HiFiVS technique for flow diverter (FD) deployment in patient-specific IAs. We tested four clinical intervention strategies: coiling (1-8 coils), single FD, FD with adjunctive coils (1-8 coils), and overlapping FDs. By evaluating post-treatment hemodynamics using computational fluid dynamics (CFD), we compared the flow-modification performance of these strategies. Results show that a single FD provides more reduction in inflow rate than low packing density (PD) coiling, but less reduction in average velocity inside the aneurysm. Adjunctive coils add no additional reduction of inflow rate beyond a single FD until coil PD exceeds 11%. This suggests that the main role of FDs is to divert inflow, while that of coils is to create stasis in the aneurysm. Overlapping FDs decreases inflow rate, average velocity, and average wall shear stress (WSS) in the aneurysm sac, but adding a third FD produces minimal additional reduction. In conclusion, our FEM-based techniques for virtual coiling and flow diversion enable recapitulation of complex endovascular intervention strategies and detailed hemodynamics to identify hemodynamic factors that affect treatment outcome. PMID:26169778

  14. Finite Element Modeling of Endovascular Intervention Enables Hemodynamic Prediction of Complex Treatment Strategies for Coiling and Flow Diversion

    PubMed Central

    Damiano, Robert J.; Ma, Ding; Xiang, Jianping; Siddiqui, Adnan H.; Snyder, Kenneth V.; Meng, Hui

    2016-01-01

    Endovascular interventions using coil embolization and flow diversion are becoming the mainstream treatment for intracranial aneurysms (IAs). To help assess the effect of intervention strategies on aneurysm hemodynamics and treatment outcome, we have developed a finite-element-method (FEM)-based technique for coil deployment along with our HiFiVS technique for flow diverter (FD) deployment in patient-specific IAs. We tested four clinical intervention strategies: coiling (1–8 coils), single FD, FD with adjunctive coils (1–8 coils), and overlapping FDs. By evaluating post-treatment hemodynamics using computational fluid dynamics (CFD), we compared the flow-modification performance of these strategies. Results show that a single FD provides more reduction in inflow rate than low PD coiling, but less reduction in average velocity inside the aneurysm. Adjunctive coils add no additional reduction of inflow rate beyond a single FD until coil PD exceeds 11%. This suggests that the main role of FDs is to divert inflow, while that of coils is to create stasis in the aneurysm. Overlapping FDs decreases inflow rate, average velocity, and average wall shear stress (WSS) in the aneurysm sac, but adding a third FD produces minimal additional reduction. In conclusion, our FEM-based techniques for virtual coiling and flow diversion enable recapitulation of complex endovascular intervention strategies and detailed hemodynamics to identify hemodynamic factors that affect treatment outcome. PMID:26169778

  15. The use of telescoped flow diverters as an endovascular bypass in the management of symptomatic chronic carotid occlusion.

    PubMed

    Cohen, José E; Gomori, John M; Ben-Hur, Tamir; Moscovici, Samuel; Itshayek, Eyal

    2012-07-01

    Flow diverters constitute a new generation of flexible self-expanding, stent-like devices with a high-metal surface-area coverage for the endovascular management of wide-necked, fusiform, large, and giant unruptured intracranial aneurysms. They achieve aneurysm occlusion through endoluminal reconstruction of the dysplastic segment of the parent artery that gives rise to the aneurysm. To our knowledge, there is no report on the use of flow diverters for the management of occlusive cerebrovascular disease. We describe the novel use of telescoped flow diverters in a construct that acts as an endovascular bypass for the management of symptomatic chronic carotid occlusion. In long carotid occlusions with a burden of extensive clots and atherosclerotic plaque, we found that the reduced porosity of the diverter mesh serves as an effective barrier to in-stent clot protrusion and distal embolization. Diverter implantation allows subsequent angioplasty. With this patient report, we propose a new potential application for flow diverters in the management of occlusive cerebrovascular disease. The optimal application of these devices will continue to be defined as clinical experience evolves. PMID:22555126

  16. Endovascular repair of traumatic aortic injury using a modified, commercially available endograft to preserve aortic arch branches.

    PubMed

    Kawajiri, Hidetake; Oka, Katsuhiko; Sakai, Osamu; Watanabe, Taiji; Kanda, Keiichi; Yaku, Hitoshi

    2014-05-01

    A 25-year-old woman was admitted to our hospital after being involved in a high-speed motorcycle accident. Computed tomography angiography revealed a blunt traumatic aortic injury of the lesser curvature of the distal aortic arch accompanied by splintered fractures of the seventh thoracic vertebra and left clavicle. If the pseudoaneurysm had been treated with open surgical repair, then arch replacement under cardiopulmonary bypass, which was considered to be too invasive, would have been necessary. Therefore, thoracic endovascular aortic repair (TEVAR) was preferred as a first-line treatment to prevent pulmonary complications and hemorrhaging. Because the proximal landing zone for TEVAR was insufficient, we used a modified (fenestrated) commercially available endograft to preserve the branches of the aortic arch. Postoperative computed tomography scans confirmed that the pseudoaneurysm had been excluded without the endoleaks, and the aortic arch branches were patent. The patient's postoperative course was uneventful, and she was discharged from the hospital to have surgery for a vertebral fracture on postoperative day 6. PMID:24184496

  17. Emergency Endovascular Treatment of an Acute Traumatic Rupture of the Thoracic Aorta Complicated by a Distal Low-Flow Syndrome

    SciTech Connect

    Bruninx, Guy; Wery, Didier; Dubois, Eric; El Nakadi, Badih; Dueren, Eric van; Verhelst, Guy; Delcour, Christian

    1999-11-15

    We report the case of a patient who suffered major trauma following a motorcycle accident that resulted in multiple fractures, bilateral hemopneumothorax, pulmonary contusions, and an isthmic rupture of the aorta with a pseudoaneurysm compressing the descending aorta. This compression was responsible for distal hypotension and low flow, leading to acute renal insufficiency and massive rhabdomyolysis. Due to the critical clinical status of the patient, which prevented any type of open thoracic surgery, endovascular treatment was performed. An initial stent-graft permitted alleviation of the compression and the re-establishment of normal hemodynamic conditions, but its low position did not allow sufficient coverage of the rupture. A second stent-graft permitted total exclusion of the pseudoaneurysm while preserving the patency of the left subclavian artery.

  18. Endovascular treatment of cerebral venous thrombosis: Contemporary multicenter experience

    PubMed Central

    Mokin, Maxim; Lopes, Demetrius K; Binning, Mandy J; Veznedaroglu, Erol; Liebman, Kenneth M; Arthur, Adam S; Doss, Vinodh T; Levy, Elad I

    2015-01-01

    Endovascular therapy of cerebral venous thrombosis using modern approaches to intracranial recanalization, such as stent retrievers and aspiration thrombectomy, is not well described. We performed a retrospective review of data for consecutive patients with venous sinus thrombosis who underwent endovascular treatment between 1 January 2010 and 31 December 2013 at participating institutions. We identified a total of 13 patients with a diagnosis of cerebral venous thrombosis. The most frequently utilized type of endovascular intervention was the Penumbra aspiration system (Penumbra Inc., Alameda, California, USA) (nine cases), followed by local infusion of tissue plasminogen activator (bolus and/or drip in six cases) and stent retrievers (Solitaire FR (Covidien, Irvine, California, USA) in three cases and Trevo (Stryker, Kalamazoo, Michigan, USA) in one case). Overall, multimodality treatment (two or more different types of devices or approaches) was performed in 62% of cases. Follow-up data were available for 11 patients; of those, five had a favorable clinical outcome (defined as modified Rankin Scale score of 0–2) and three patients died. Various endovascular approaches are utilized in current clinical practice. A multimodal approach to endovascular therapy for the treatment of cerebral venous thrombosis resulted in partial or complete restoration of flow in all cases, yet the mortality rate of 27% indicates the need for improvement in recanalization strategies for this disorder. PMID:26055685

  19. Aortic aneurysm repair - endovascular

    MedlinePlus

    ... Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  20. Aortic aneurysm repair - endovascular

    MedlinePlus

    EVAR; Endovascular aneurysm repair - aorta; AAA repair - endovascular; Repair - aortic aneurysm - endovascular ... leaking or bleeding. You may have an abdominal aortic aneurysm that is not causing any symptoms or problems. ...

  1. Early Experience in the Treatment of Intra-Cranial Aneurysms by Endovascular Flow Diversion: A Multicentre Prospective Study

    PubMed Central

    Byrne, James V.; Beltechi, Radu; Yarnold, Julia A.; Birks, Jacqueline; Kamran, Mudassar

    2010-01-01

    Introduction Flow diversion is a new approach to the endovascular treatment of intracranial aneurysms which uses a high density mesh stent to induce sac thrombosis. These devices have been designed for the treatment of complex shaped and large size aneurysms. So far published safety and efficacy data on this approach is sparse. Material and Methods Over 8 months, standardized clinical and angiographic data were collected on 70 patients treated with a flow diverter device (SILK flow diverter (SFD)) in 18 centres worldwide. Treatment and early follow up details were audited centrally. SFDs were deployed alone in 57 (81%) or with endosaccular coils in 10 (14%) aneurysms, which included: 44 (63%) saccular, 26 (37%) fusiform shapes and 18 (26%) small, 37 (53%) large, 15 (21%) giant sizes. Treatment outcome data up to 30 days were reported for all patients, with clinical (50 patients) and imaging (49 patients) follow up (median 119 days) data available. Results Difficulties in SFD deployment were reported in 15 (21%) and parent artery thrombosis in 8 (11%) procedures. Procedural complications caused stroke in 1 and serious extracranial bleeding in 3 patients; 2 of whom developed fatal pneumonias. Delayed worsening of symptoms occurred in 5 patients (3 transient, 1 permanent neurological deficit, and 1 death) and fatal aneurysm bleeding in 1 patient. Overall permanent morbidity rates were 2 (4%) and mortality 4 (8%). Statistical analysis revealed no significant association between complications and variables related to treated aneurysm morphology or rupture status. Conclusion This series is the largest reporting outcome of the new treatment approach and provides data for future study design. Procedural difficulties in SFD deployment were frequent and anti-thrombosis prophylaxis appears to reduce the resulting clinical sequelae, but at the cost of morbidity due to extracranial bleeding. Delayed morbidity appears to be a consequence of the new approach and warrants care in

  2. Rapid in vitro biocompatibility assay of endovascular stents by flow cytometry using platelet activation and platelet-leukocyte aggregation.

    PubMed

    Tárnok, A; Mahnke, A; Müller, M; Zotz, R J

    1999-02-15

    Clinical studies suggest that stent design and surface texture are responsible for differences in biocompatibility of metallic endovascular stents. A simple in vitro experimental setup was established to test stent-induced degree of platelet and leukocyte activation and platelet-leukocyte aggregation by flow cytometry. Heparin-coated tantalum stents and gold-coated and uncoated stainless steel stents were tested. Stents were implanted into silicone tubes and exposed to blood from healthy volunteers. Platelet and leukocyte activation and percentage of leukocyte-platelet aggregates were determined in a whole-blood assay by subsequent staining for activation-associated antigens (CD41a, CD42b, CD62p, and fibrinogen binding) and leukocyte antigens (CD14 and CD45) and flow cytometric analysis. Blood taken directly after venous puncture or exposed to the silicone tube alone was used as negative controls. Positive control was in vitro stimulation with thrombin receptor activating peptide (TRAP-6). Low degree of platelet activation and significant increase in monocyte- and neutrophil-platelet aggregation were observed in blood exposed to stents (P < 0.05). In addition, leukocyte activation was induced as measured by increased CD45 and CD14 expression. Heparin coated stents continuously induced less platelet activation and leukocyte-platelet aggregation than uncoated stainless steel stents of the same length and shorter stents of the same structure. Stent surface coating and texture plays a role in platelet and leukocyte activation and leukocyte-platelet aggregation. Using this simple in vitro assay and whole blood and flow cytometry, it seems possible to differentiate stents by their potency to activate platelets and/or leukocytes. This assay could be applied for improving the biocompatibility of coronary stents. PMID:10088974

  3. Flow Changes after Endovascular Treatment of a Wide-Neck Anterior Communicating Artery Aneurysm by using X-configured Kissing Stents (Cross-Kissing Stents) Technique

    SciTech Connect

    Zelenak, Kamil; Zelenakova, Jana; DeRiggo, Julius; Kurca, Egon; Boudny, Jaroslav; Polacek, Hubert

    2011-12-15

    Endovascular treatment for a wide-neck anterior communicating artery (AcomA) aneurysm remains technically challenging. Stent-assisted embolization has been proposed as an alternative of treatment of complex aneurysms. The X-configuration double-stent-assisted technique was used to achieve successful coiling of wide-neck AcomA aneurysm. Implanted stent can alter intra-arterial flow. Follow-up angiograms 4 months later showed flow changes due to used X-technique of stents implantation and filling of the anterior cerebral artery from the opposite internal carotid artery.

  4. Gene Flow in Genetically Modified Wheat

    PubMed Central

    Rieben, Silvan; Kalinina, Olena; Schmid, Bernhard; Zeller, Simon L.

    2011-01-01

    Understanding gene flow in genetically modified (GM) crops is critical to answering questions regarding risk-assessment and the coexistence of GM and non-GM crops. In two field experiments, we tested whether rates of cross-pollination differed between GM and non-GM lines of the predominantly self-pollinating wheat Triticum aestivum. In the first experiment, outcrossing was studied within the field by planting “phytometers” of one line into stands of another line. In the second experiment, outcrossing was studied over distances of 0.5–2.5 m from a central patch of pollen donors to adjacent patches of pollen recipients. Cross-pollination and outcrossing was detected when offspring of a pollen recipient without a particular transgene contained this transgene in heterozygous condition. The GM lines had been produced from the varieties Bobwhite or Frisal and contained Pm3b or chitinase/glucanase transgenes, respectively, in homozygous condition. These transgenes increase plant resistance against pathogenic fungi. Although the overall outcrossing rate in the first experiment was only 3.4%, Bobwhite GM lines containing the Pm3b transgene were six times more likely than non-GM control lines to produce outcrossed offspring. There was additional variation in outcrossing rate among the four GM-lines, presumably due to the different transgene insertion events. Among the pollen donors, the Frisal GM line expressing a chitinase transgene caused more outcrossing than the GM line expressing both a chitinase and a glucanase transgene. In the second experiment, outcrossing after cross-pollination declined from 0.7–0.03% over the test distances of 0.5–2.5 m. Our results suggest that pollen-mediated gene flow between GM and non-GM wheat might only be a concern if it occurs within fields, e.g. due to seed contamination. Methodologically our study demonstrates that outcrossing rates between transgenic and other lines within crops can be assessed using a phytometer approach and

  5. Aortic aneurysm repair - endovascular- discharge

    MedlinePlus

    ... page: //medlineplus.gov/ency/patientinstructions/000236.htm Aortic aneurysm repair - endovascular - discharge To use the sharing features ... enable JavaScript. AAA repair - endovascular - discharge; Repair - aortic aneurysm - endovascular - discharge; EVAR - discharge; Endovascular aneurysm repair - discharge ...

  6. Endovascular management of renal artery aneurysms using the multilayer flow modulator

    PubMed Central

    Sultan, Sherif; Basuoniy Alawy, Mahmoud; Flaherty, Rita; Kavanagh, Edel P; Elsherif, Mohamed; Elhelali, Ala; Stefanov, Florian; Lundon, Violet; Hynes, Niamh

    2016-01-01

    Objective Our aim was to describe our experience of the Multilayer Flow Modulator (MFM, Cardiatis, Isnes, Belgium) used in the treatment of type III renal artery aneurysms (RAA). Methods This is a single-centre study. 3 patients (2 men and 1 woman; mean age 59 years; range 41–77 years) underwent treatment of a type III renal artery aneurysm using the MFM. The indications were a 23.9 mm type III RAA at the bifurcation of the upper and lower pole vessels, with 4 side branches; a 42.4 mm type III saccular RAA at the renal hilum; and a 23 mm type III RAA at the origin of the artery, supplying the upper pole. Results Patients had a mean follow-up of 27 months, and were assessed by perioperative renal function tests, and repeat postoperative CT scan. There were no immediate postoperative complications or mortality. The first patient's aneurysm shrank by 8.6 mm, from 23.9 to 15.3 mm over 19 months, with all 4 side branches remaining patent. The largest aneurysm at 42.4 mm completely thrombosed, while the renal artery remained patent to the kidney. The final patient refused to have any follow-up scans but had no deterioration in renal function below 30 mL/min, and no further symptoms reported. Conclusions The MFM is safe and effective in the management of patients with complex renal artery aneurysms. The MFM can be used to treat branched or distal renal artery aneurysms with exclusion of the aneurysm from the circulation, while successfully preserving the flow to the side branches and kidney. Initial results are promising, however, longer follow-up and a larger cohort are required to prove the effectiveness of this emerging technology. PMID:27042315

  7. Modified Beer-Lambert law for blood flow

    PubMed Central

    Baker, Wesley B.; Parthasarathy, Ashwin B.; Busch, David R.; Mesquita, Rickson C.; Greenberg, Joel H.; Yodh, A. G.

    2014-01-01

    We develop and validate a Modified Beer-Lambert law for blood flow based on diffuse correlation spectroscopy (DCS) measurements. The new formulation enables blood flow monitoring from temporal intensity autocorrelation function data taken at single or multiple delay-times. Consequentially, the speed of the optical blood flow measurement can be substantially increased. The scheme facilitates blood flow monitoring of highly scattering tissues in geometries wherein light propagation is diffusive or non-diffusive, and it is particularly well-suited for utilization with pressure measurement paradigms that employ differential flow signals to reduce contributions of superficial tissues. PMID:25426330

  8. Modified Beer-Lambert law for blood flow.

    PubMed

    Baker, Wesley B; Parthasarathy, Ashwin B; Busch, David R; Mesquita, Rickson C; Greenberg, Joel H; Yodh, A G

    2014-11-01

    We develop and validate a Modified Beer-Lambert law for blood flow based on diffuse correlation spectroscopy (DCS) measurements. The new formulation enables blood flow monitoring from temporal intensity autocorrelation function data taken at single or multiple delay-times. Consequentially, the speed of the optical blood flow measurement can be substantially increased. The scheme facilitates blood flow monitoring of highly scattering tissues in geometries wherein light propagation is diffusive or non-diffusive, and it is particularly well-suited for utilization with pressure measurement paradigms that employ differential flow signals to reduce contributions of superficial tissues. PMID:25426330

  9. Modified Beer-Lambert law for blood flow

    NASA Astrophysics Data System (ADS)

    Baker, Wesley B.; Parthasarathy, Ashwin B.; Busch, David R.; Mesquita, Rickson C.; Greenberg, Joel H.; Yodh, A. G.

    2015-03-01

    The modified Beer-Lambert law is among the most widely used approaches for analysis of near-infrared spectroscopy (NIRS) reflectance signals for measurements of tissue blood volume and oxygenation. Briefly, the modified Beer-Lambert paradigm is a scheme to derive changes in tissue optical properties based on continuous-wave (CW) diffuse optical intensity measurements. In its simplest form, the scheme relates differential changes in light transmission (in any geometry) to differential changes in tissue absorption. Here we extend this paradigm to the measurement of tissue blood flow by diffuse correlation spectroscopy (DCS). In the new approach, differential changes of the intensity temporal auto-correlation function at a single delay-time are related to differential changes in blood flow. The key theoretical results for measurement of blood flow changes in any tissue geometry are derived, and we demonstrate the new method to monitor cerebral blood flow in a pig under conditions wherein the semi-infinite geometry approximation is fairly good. Specifically, the drug dinitrophenol was injected in the pig to induce a gradual 200% increase in cerebral blood flow, as measured with MRI velocity flow mapping and by DCS. The modified Beer-Lambert law for flow accurately recovered these flow changes using only a single delay-time in the intensity auto-correlation function curve. The scheme offers increased DCS measurement speed of blood flow. Further, the same techniques using the modified Beer-Lambert law to filter out superficial tissue effects in NIRS measurements of deep tissues can be applied to the DCS modified Beer-Lambert law for blood flow monitoring of deep tissues.

  10. Modifying shale oil to improve flow characteristics

    SciTech Connect

    Seitzer, W.H.; Lovell, P.F.

    1982-05-01

    Shale oil, which forms a viscous, wax slurry below 25 C, was treated in several different ways to try to improve its flow characteristics as measured in a concentric cylinder viscometer. Removing the wax does not greatly improve the pumpability of the oil. Hydrotreatment of the whole oil to take out nitrogen, sulfur, and oxygen can lower the viscosity by a factor of five or more, even though the pour point is not greatly affected. Apparently hydrogenolysis of the nitrogen, sulfur, and oxygen lowers the molecular weight of the oil without much modification of the paraffinic wax. The pour point of the shale oil can be decreased with various commercial pour improvers. Sometimes an accompanying drop in viscosity is observed, but most of this decrease is not stable to shear in the viscometer.

  11. Endovascular treatment of intracranial aneurysms.

    PubMed

    Diaz, Orlando; Rangel-Castilla, Leonardo

    2016-01-01

    Intracranial aneurysms are abnormal dilations of the intracranial vessels, in which all the layers of the vascular wall are affected by degenerative changes that lead to distension of the vessel. Intracranial aneurysms can be classified based on their anatomic location, size, and morphology. Subarachnoid hemorrhage is the most devastating clinical presentation. The goal of preventing hemorrhage or rehemorrhage can only be achieved by excluding the aneurysm from the cerebral circulation. Endovascular or surgical clipping can achieve this goal. Multiple surgical and endovascular approaches have been described for treatment of intracranial aneurysm. Surgical approaches for anterior-circulation intracranial aneurysms include: pterional, orbitozygomatic, and lateral supraorbital craniotomies. Modern microsurgical techniques involve skull base dissection to achieve adequate exposure with minimal brain retraction. Endovascular techniques can be divided into: parent artery reconstruction with coil deposition (primary coil, balloon-assisted coiling, stent-assisted coiling, and other new techniques such as neck reconstruction devices and intraluminal occlusion devices); reconstruction with flow diversion; and deconstructive techniques with involving parent artery sacrifice with or without bypass. PMID:27430470

  12. A new stent with streamlined cross-section can suppress monocyte cell adhesion in the flow disturbance zones of the endovascular stent.

    PubMed

    Chen, Zengsheng; Zhan, Fan; Ding, Jun; Zhang, Xiwen; Deng, Xiaoyan

    2016-01-01

    We proposed a new stent with streamlined cross-sectional wires, which is different from the clinical coronary stents with square or round cross-sections. We believe the new stent might have better hemodynamic performance than the clinical metal stents. To test the hypothesis, we designed an experimental study to compare the performance of the new stent with the clinical stents in terms of monocyte (U-937 cells) adhesion. The results showed that when compared with the clinical stents, the adhesion of U-937 cells were much less in the new stent. The results also showed that, when Reynolds number increased from 180 (the rest condition for the coronary arteries) to 360 (the strenuous exercise condition for the coronary arteries), the flow disturbance zones in the clinical stents became larger, while they became smaller with the new stent. The present experimental study therefore suggests that the optimization of the cross-sectional shape of stent wires ought to be taken into consideration in the design of endovascular stents. PMID:25434694

  13. CONDIF - A modified central-difference scheme for convective flows

    NASA Technical Reports Server (NTRS)

    Runchal, Akshai K.

    1987-01-01

    The paper presents a method, called CONDIF, which modifies the CDS (central-difference scheme) by introducing a controlled amount of numerical diffusion based on the local gradients. The numerical diffusion can be adjusted to be negligibly low for most problems. CONDIF results are significantly more accurate than those obtained from the hybrid scheme when the Peclet number is very high and the flow is at large angles to the grid.

  14. Assessment of hand blood flow: A modified technique

    SciTech Connect

    Kirsh, J.C.; Tepperman, P.S.

    1985-05-01

    Radionuclide blood flow studies are frequently used in conjunction with static bone imaging of the hands to obtain valuable information regarding relative vascularity. This study was undertaken to demonstrate; a significant blood flow artefact with the conventional bolus injection technique (Tc-99m MDP) used in dynamic hand imaging, and a modified technique which virtually eliminates this artefact. The artefact is presumably due to reactive hyperemia induced by the tourniquet used to occlude venous return prior to injection. A modified technique was developed using intermittent injections of saline via a butterfly needle to maintain venous patency. This allows time for the reflex hyperemia to return to the basal state before injecting the radiopharmaceutical. Only 1 of 23 additional subject (4%) demonstrated significant artefactual asymmetry with the modified technique. A highly significant different (rho < .001) was observed between the two techniques. Additionally, there was no significant difference (rho = .50) between the observed pattern with the modified technique and the expected normal symmetrical pattern. Therefore, use of this technique will eliminate a potentially seriously misleading artefact.

  15. Angiographic analysis for phantom simulations of endovascular aneurysm treatments with a new fully retrievable asymmetric flow diverter

    NASA Astrophysics Data System (ADS)

    Yoganand, Aradhana; Wood, Rachel P.; Jimenez, Carlos; Siddiqui, Adnan; Snyder, Kenneth; Setlur Nagesh, S. V.; Bednarek, D. R.; Rudin, S.; Baier, Robert; Ionita, Ciprian N.

    2015-03-01

    Digital Subtraction Angiography (DSA) is the main diagnostic tool for intracranial aneurysms (IA) flow-diverter (FD) assisted treatment. Based on qualitative contrast flow evaluation, interventionists decide on subsequent steps. We developed a novel fully Retrievable Asymmetric Flow-Diverter (RAFD) which allows controlled deployment, repositioning and detachment achieve optimal flow diversion. The device has a small low porosity or solid region which is placed such that it would achieve maximum aneurysmal in-jet flow deflection with minimum impairment to adjacent vessels. We tested the new RAFD using a flow-loop with an idealized and a patient specific IA phantom in carotid-relevant physiological conditions. We positioned the deflection region at three locations: distally, center and proximally to the aneurysm orifice and analyzed aneurysm dome flow using DSA derived maps for mean transit time (MTT) and bolus arrival times (BAT). Comparison between treated and untreated (control) maps quantified the RAFD positioning effect. Average MTT, related to contrast presence in the aneurysm dome increased, indicating flow decoupling between the aneurysm and parent artery. Maximum effect was observed in the center and proximal position (~75%) of aneurysm models depending on their geometry. BAT maps, correlated well with inflow jet direction and magnitude. Reduction and jet dispersion as high as about 50% was observed for various treatments. We demonstrated the use of DSA data to guide the placement of the RAFD and showed that optimum flow diversion within the aneurysm dome is feasible. This could lead to more effective and a safer IA treatment using FDs.

  16. Endovascular Repair of Blunt Popliteal Arterial Injuries

    PubMed Central

    Zhong, Shan; Chen, Zhong; Dong, Peng; Sun, Yequan; Zhu, Wei; Pan, Xiaolin; Qi, Deming

    2016-01-01

    Objective To evaluate the feasibility and effectiveness of endovascular repair for blunt popliteal arterial injuries. Materials and Methods A retrospective analysis of seven patients with clinical suspicion of popliteal arterial injuries that were confirmed by arteriography was performed from September 2009 to July 2014. Clinical data included demographics, mechanism of injury, type of injury, location of injury, concomitant injuries, time of endovascular procedures, time interval from trauma to blood flow restoration, instrument utilized, and follow-up. All patients were male (mean age of 35.9 ± 10.3 years). The type of lesion involved intimal injury (n = 1), partial transection (n = 2), complete transection (n = 2), arteriovenous fistula (n = 1), and pseudoaneurysm (n = 1). All patients underwent endovascular repair of blunt popliteal arterial injuries. Results Technical success rate was 100%. Intimal injury was treated with a bare-metal stent. Pseudoaneurysm and popliteal artery transections were treated with bare-metal stents. Arteriovenous fistula was treated with bare-metal stent and coils. No perioperative death and procedure-related complication occurred. The average follow-up was 20.9 ± 2.3 months (range 18–24 months). One patient underwent intra-arterial thrombolysis due to stent thrombosis at 18 months after the procedure. All limbs were salvaged. Stent migration, deformation, or fracture was not found during the follow-up. Conclusion Endovascular repair seems to be a viable approach for patients with blunt popliteal arterial injuries, especially on an emergency basis. Endovascular repair may be effective in the short-term. Further studies are required to evaluate the long-term efficacy of endovascular repair. PMID:27587969

  17. Comparative study of novel endovascular treatment techniques for intracranial aneurysms

    NASA Astrophysics Data System (ADS)

    Cantón, Gádor; Lasheras, Juan C.; Levy, David I.; Sparks, Steven R.

    2002-11-01

    Intracranial aneurysms are life-threatening vascular lesions, which are potentially treatable to avoid the consequences of their rupture. Current treatments, either surgical or endovascular, are all guided to reduce the hemodynamic forces acting on the aneurysm wall in an effort to minimize the risk of rupture. Surgical clipping is still the most used technique to treat this type of aneurysm but there is a continued demand for less invasive approaches. This has led to the development of several endovascular techniques. We report here a comparative study of the reduction in the hemodynamic stresses and the modification of the flow in the parent vessel resulting from the use of three different techniques. The first one consists of endosaccular packing with platinum coils (GDC, Target Therapeutics), which is already widely used but its long-term efficacy has not yet been determined. The second one consists of the embolization of the aneurismal sac with Onyx, a polymer which hardens when in contact with the blood (being developed by Micro Therapeutics, Inc.). The third one involves the packing of the sac with hydrocoils, platinum wires coated with a gel which quickly hydrates when in contact with blood (developed by MicroVention). A Digital Particle Image Velocimetry (DPIV) system is used to measure in vitro the velocity field inside a model of an ACOM aneurysm (an aneurysm forming in the anterior communicating artery). Physiological accurate pulsatile flow conditions are input to the arterial model through a programmable pump. The measurements show that although all treatment techniques lead to a reduction in both normal and tangential shear stresses on the aneurismal sac, each one of them also leads to different modifications of the flow in the parent vessel which may have consequences related to potential for clotting. Comparison of the untreated aneurysm with the above three treated cases also showed that the characteristics of the wall shear stresses on the parent

  18. Comparison of Orbiter PRCS Plume Flow Fields Using CFD and Modified Source Flow Codes

    NASA Technical Reports Server (NTRS)

    Rochelle, Wm. C.; Kinsey, Robin E.; Reid, Ethan A.; Stuart, Phillip C.; Lumpkin, Forrest E.

    1997-01-01

    The Space Shuttle Orbiter will use Reaction Control System (RCS) jets for docking with the planned International Space Station (ISS). During approach and backout maneuvers, plumes from these jets could cause high pressure, heating, and thermal loads on ISS components. The object of this paper is to present comparisons of RCS plume flow fields used to calculate these ISS environments. Because of the complexities of 3-D plumes with variable scarf-angle and multi-jet combinations, NASA/JSC developed a plume flow-field methodology for all of these Orbiter jets. The RCS Plume Model (RPM), which includes effects of scarfed nozzles and dual jets, was developed as a modified source-flow engineering tool to rapidly generate plume properties and impingement environments on ISS components. This paper presents flow-field properties from four PRCS jets: F3U low scarf-angle single jet, F3F high scarf-angle single jet, DTU zero scarf-angle dual jet, and F1F/F2F high scarf-angle dual jet. The RPM results compared well with plume flow fields using four CFD programs: General Aerodynamic Simulation Program (GASP), Cartesian (CART), Unified Solution Algorithm (USA), and Reacting and Multi-phase Program (RAMP). Good comparisons of predicted pressures are shown with STS 64 Shuttle Plume Impingement Flight Experiment (SPIFEX) data.

  19. Endovascular Treatment of Venous Occlusive Disease

    PubMed Central

    2008-01-01

    Endovascular treatment of acute and chronic iliac vein occlusions has proven to be safe and effective. Recanalization of chronic occlusions with balloon angioplasty and stenting can re-establish normal venous flow in the iliac veins and the IVC and relieve symptoms in the majority of treated patients. CDT with recanalization and stenting of underlying chronically obstructed iliofemoral segments is becoming the treatment of choice for patients with acute iliofemoral thrombosis, as anticoagulation and compression therapy alone are not satisfactory in preventing PTS. The new treatment modalities offer stimulating options for a patient group that is not adequately treated, neither by medical nor open surgical therapy. The substantial effort and additional costs of endovascular treatment appear to be justified by the encouraging mid-term results both for patients with acute and chronic occlusive iliofemoral disease. However, multi-center randomized prospective studies are required to further validate the role of these techniques. PMID:23555345

  20. Rat Endovascular Perforation Model

    PubMed Central

    Sehba, Fatima A.

    2014-01-01

    Experimental animal models of aneurysmal subarachnoid hemorrhage (SAH) have provided a wealth of information on the mechanisms of brain injury. The Rat endovascular perforation model (EVP) replicates the early pathophysiology of SAH and hence is frequently used to study early brain injury following SAH. This paper presents a brief review of historical development of the EVP model, details the technique used to create SAH and considerations necessary to overcome technical challenges. PMID:25213427

  1. [Endovascular surgery in the war].

    PubMed

    Reva, V A; Samokhvalov, I M

    2015-01-01

    Rapid growth of medical technologies has led to implementation of endovascular methods of diagnosis and treatment into rapidly developing battlefield surgery. This work based on analysing all available current publications generalizes the data on using endovascular surgery in combat vascular injury. During the Korean war (1950-1953) American surgeons for the first time performed endovascular balloon occlusion of the aorta - the first intravascular intervention carried out in a zone of combat operations. Half a century thereafter, with the beginning of the war in Afghanistan (2001) and in Iraq (2003) surgeons of central hospitals of the USA Armed Forces began performing delayed endovascular operations to the wounded. The development of technologies, advent of mobile angiographs made it possible to later on implement high-tech endovascular interventions in a zone of combat operations. At first, more often they performed implantation of cava filters, somewhat afterward - angioembolization of damaged accessory vessels, stenting and endovascular repair of major arteries. The first in the theatre of war endovascular prosthetic repair of the thoracic aorta for severe closed injury was performed in 2008. Russian experience of using endovascular surgery in combat injuries is limited to diagnostic angiography and regional intraarterial perfusion. Despite the advent of stationary angiographs in large hospitals of the RF Ministry of Defence in the early 1990s, endovascular operations for combat vascular injury are casuistic. Foreign experience in active implementation of endovascular technologies to treatment of war-time injuries has substantiated feasibility of using intravascular interventions in tertiary care military hospitals. Carrying out basic training courses on endovascular surgery should become an organic part of preparing multimodality general battlefield surgeons rendering care on the theatre of combat operations. PMID:26035580

  2. Endovascular Intervention in the Treatment of Peripheral Artery Disease.

    PubMed

    Couto, Marian; Figueróa, Alejandro; Sotolongo, Antonio; Pérez, Reynerio; Ojeda, José Martinez

    2015-01-01

    Endovascular therapy has emerged as an essential part of the management we can offer patients suffering from peripheral arterial disease. The AHA/ACCF guidelines deemed ballon angioplasty as a reasonable alternative for patients with limb threatening lower extremity ischemia who are not candidates for an autologus venous graft. Endovascular treatment is most useful for the treatment of critical limb ischemia and should ensure adequate proximal flow before engaging in interventions of distal disease.To increase procedure success rate, a thorough diagnostic evaluation is fundamental. This evaluation must take into account amount of calcium, no flow occlusion, length of occlusion, and presence of collaterals. There are different tools and procedure techniques available. Among these are the medicated ballon angioplasty and atherectomy by laser or high-speed drill, among others. Further studies may consolidate endovascular intervention as a safe and effective management for patients with lower extremity arterial disease and possibly cause a change in the actual practice guidelines. PMID:26742196

  3. Endovascular reconstruction of aneurysms with a complex geometry.

    PubMed

    Gupta, Vipul; Parthasarathy, Rajsrinivas; Jha, Ajaya Nand

    2016-01-01

    Conventional endovascular coiling remains the mainstay of treatment for most aneurysms; however, it may not be suitable for aneurysms with a complex geometry and there remains the risk of recanalization. Aneurysms with an unfavorable morphology are difficult to treat through both endovascular and surgical means. Progress in endovascular technology has allowed for the emergence of newer strategies to treat aneurysms with a complex geometry. Better packing density in wide-necked and large aneurysms can be achieved through the balloon remodeling technique. Similarly, a self-expanding stent cannot only act as a scaffold that helps to retain coils but also aids in diverting the blood flow away from the aneurysm sac. Lately, focus has shifted from endosaccular occlusion to endoluminal reconstruction; flow diverters are being increasingly used to treat aneurysms with an unfavorable geometry. However, there is no clear consensus on the best endovascular management strategy in certain subset of aneurysms - large and giant internal carotid aneurysms, blister aneurysms, and fusiform/dissecting aneurysms of the vertebrobasilar artery. We present a review of literature and discuss the current evidence for the various endovascular strategies to treat complex aneurysms. PMID:26954964

  4. TOPICAL REVIEW: Endovascular interventional magnetic resonance imaging

    NASA Astrophysics Data System (ADS)

    Bartels, L. W.; Bakker, C. J. G.

    2003-07-01

    Minimally invasive interventional radiological procedures, such as balloon angioplasty, stent placement or coiling of aneurysms, play an increasingly important role in the treatment of patients suffering from vascular disease. The non-destructive nature of magnetic resonance imaging (MRI), its ability to combine the acquisition of high quality anatomical images and functional information, such as blood flow velocities, perfusion and diffusion, together with its inherent three dimensionality and tomographic imaging capacities, have been advocated as advantages of using the MRI technique for guidance of endovascular radiological interventions. Within this light, endovascular interventional MRI has emerged as an interesting and promising new branch of interventional radiology. In this review article, the authors will give an overview of the most important issues related to this field. In this context, we will focus on the prerequisites for endovascular interventional MRI to come to maturity. In particular, the various approaches for device tracking that were proposed will be discussed and categorized. Furthermore, dedicated MRI systems, safety and compatibility issues and promising applications that could become clinical practice in the future will be discussed.

  5. Combined Endovascular and Microsurgical Management of Complex Cerebral Aneurysms

    PubMed Central

    Choudhri, Omar; Mukerji, Nitin; Steinberg, Gary K.

    2013-01-01

    Cerebral aneurysms are associated with a 50% mortality rate after rupture and patients can suffer significant morbidity during subsequent treatment. Neurosurgical management of both ruptured and unruptured aneurysms has evolved over the years. The historical practice of using microsurgical clipping to treat aneurysms has benefited in the last two decades from tremendous improvement in endovascular technology. Microsurgery and endovascular therapies are often viewed as competing treatments but it is important to recognize their individual limitations. Some aneurysms are considered complex, due to several factors such as aneurysm anatomy and a patient’s clinical condition. A complex aneurysm often cannot be completely excluded with a single approach and its successful treatment requires a combination of microsurgical and endovascular techniques. Planning such an approach relies on understanding aneurysm anatomy and thus should routinely include 3D angiographic imaging. In patients with ruptured aneurysms, endovascular coiling is a well-tolerated early treatment and residual aneurysms can be treated with intervals of definitive clipping. Microsurgical clipping also can be used to reconstruct the neck of a complex aneurysm, allowing successful placement of coils across a narrow neck. Endovascular techniques are assisted by balloons, which can be used in coiling and testing parent vessel occlusion before sacrifice. In some cases microsurgical bypasses can provide alternate flow for planned vessel sacrifice. We present current paradigms for combining endovascular and microsurgical approaches to treat complex aneurysms and share our experience in 67 such cases. A dual microsurgical–endovascular approach addresses the challenge of intracranial aneurysms. This combination can be performed safely and produces excellent rates of aneurysm obliteration. Hybrid angiographic operating-room suites can foster seamless and efficient complementary application of these two

  6. Magnetic Resonance-Guided Passive Catheter Tracking for Endovascular Therapy.

    PubMed

    Settecase, Fabio; Martin, Alastair J; Lillaney, Prasheel; Losey, Aaron; Hetts, Steven W

    2015-11-01

    The use of MR guidance for endovascular intervention is appealing because of its lack of ionizing radiation, high-contrast visualization of vessel walls and adjacent soft tissues, multiplanar capabilities, and potential to incorporate functional information such as flow, fluid dynamics, perfusion, and cardiac motion. This review highlights state-of-the-art imaging techniques and hardware used for passive tracking of endovascular devices in interventional MR imaging, including negative contrast, passive contrast, nonproton multispectral, and direct current techniques. The advantages and disadvantages of passive tracking relative to active tracking are also summarized. PMID:26499277

  7. Percutaneous and Endovascular Embolization of Ruptured Hepatic Artery Aneurysm

    SciTech Connect

    Little, Andrew F.; Lee, Wai Kit

    2002-06-15

    A 72-year-old woman presented with an intraperitoneal hemorrhage from a ruptured intrahepatic arteryaneurysm, with an associated pseudoaneurysm developing a high-flow arteriovenous fistula. Persistent coagulopathy and a median arcuate ligament stenosis of the celiac axis further complicated endovascular management. Aneurysm thrombosis required percutaneous embolization with coils, a removable core guidewire and polyvinyl alcohol particles.

  8. Emergency endovascular revascularization of tandem occlusions: Internal carotid artery dissection and intracranial large artery embolism.

    PubMed

    Cohen, José E; Leker, Ronen R; Eichel, Roni; Gomori, Moshe; Itshayek, Eyal

    2016-06-01

    Internal carotid artery dissection (ICAD) with concomitant occlusive intracranial large artery emboli is an infrequent cause of acute stroke, with poor response to intravenous thrombolysis. Reports on the management of this entity are limited. We present our recent experience in the endovascular management of occlusive ICAD and major intracranial occlusion. Consecutive anterior circulation acute stroke patients meeting Medical Center criteria for endovascular management of ICAD from June 2011 to June 2015 were included. Clinical, imaging, and procedure data were collected retrospectively under Institutional Review Board approval. The endovascular procedure for carotid artery revascularization and intracranial stent thrombectomy is described. Six patients met inclusion criteria (National Institutes of Health Stroke Scale score 12-24, time from symptom onset 2-8hours). Revascularization of the extracranial carotid dissection and stent thrombectomy were achieved in 5/6 patients, resulting in complete recanalization (Thrombolysis in Myocardial Infarction flow grade 3 in a mean 2.7hours), and modified Rankin Scale score 0-2 at 90 day follow-up. In one patient, attempts to microcatheterize the true arterial lumen failed and thrombectomy was therefore not feasible. No arterial dissection, arterial rupture or accidental stent detachment occurred, and there was no intracerebral hemorrhage or hemorrhagic transformation. Our preliminary data on this selected subgroup of patients suggest the presented approach is safe, feasible in a significant proportion of patients, and efficacious in achieving arterial recanalization and improving patient outcome. Crossing the dissected segment remains the most important limiting factor in achieving successful ICA recanalization. Further evaluation in larger series is warranted. PMID:26924182

  9. Imaging equipment and techniques for optimal intraoperative imaging during endovascular interventions.

    PubMed

    Fillinger, M F; Weaver, J B

    1999-12-01

    Because endovascular procedures represent an ever-increasing portion of many vascular surgery practices, many surgeons are faced with difficult choices. Endovascular procedures often require open surgery, and open surgical techniques increasingly require fluoroscopic imaging. Without good intraoperative imaging, endovascular procedures are difficult and endovascular aneurysm repair is impossible. How does one balance the need for optimal imaging without sacrificing the ability to safely perform open surgical procedures, especially in the early stages of a developing endovascular program? Strategies include the use of a portable c-arm and carbon fiber table in the operating room (OR), adding a fixed imaging platform to an OR, gaining access to an angiography suite that does not meet OR requirements, and modifying it into an interventional suite that does meet operating room standards. Once the optimal equipment and facilities have been chosen, other choices must be considered. Should a radiology technician be hired? Should an interventional radiologist be available to assist or be incorporated as a routine member of the team? How will typical operating room procedures and technique need to be altered in an effort to optimize intraoperative imaging for endovascular procedures? This article gives an overview of the many issues that arise as a vascular surgery practice evolves to incorporate complex endovascular procedures. PMID:10651460

  10. Towards an entirely endovascular aortic world: an update of techniques and outcomes for endovascular and open treatment of type I, II, and III endoleaks.

    PubMed

    Mangialardi, Nicola; Orrico, Matteo; Ronchey, Sonia; Praquin, Barbara; Alberti, Vittorio; Setacci, Carlo

    2016-10-01

    Endovascular aneurysm repair (EVAR) is largely the most adopted strategy for aneurysmal disease of the aorta. Nevertheless, the high incidence of reintervention makes it difficult to identify EVAR as a definitive solution; in particular, the most frequent indication of reintervention is endoleak, which is defined as persistent flow into the aneurysmal sac from different sources. Several treatment strategies are described. A contemporary literature search was performed with the intent of describing techniques and outcomes of endovascular and open strategies to type I, II, and III endoleak. Described techniques and outcomes were organized by indication (type I, II, and III endoleak) and by type of approach (endovascular, open, and laparoscopic) to give an overview of the current status of the treatment for the three most frequent types of endoleak. Several endovascular means are described in the literature for the treatment of endoleak. PMID:27465391

  11. Thoracoabdominal aortic aneurysm repair: current endovascular perspectives

    PubMed Central

    Orr, Nathan; Minion, David; Bobadilla, Joseph L

    2014-01-01

    Thoracoabdominal aneurysms account for roughly 3% of identified aneurysms annually in the United States. Advancements in endovascular techniques and devices have broadened their application to these complex surgical problems. This paper will focus on the current state of endovascular thoracoabdominal aneurysm repair, including specific considerations in patient selection, operative planning, and perioperative complications. Both total endovascular and hybrid options will be considered. PMID:25170271

  12. Effect of reference conditions on flow rate, modifier fraction and retention in supercritical fluid chromatography.

    PubMed

    De Pauw, Ruben; Shoykhet Choikhet, Konstantin; Desmet, Gert; Broeckhoven, Ken

    2016-08-12

    When using compressible mobile phases such as fluidic CO2, the density, the volumetric flow rates and volumetric fractions are pressure dependent. The pressure and temperature definition of these volumetric parameters (referred to as the reference conditions) may alter between systems, manufacturers and operating conditions. A supercritical fluid chromatography system was modified to operate in two modes with different definition of the eluent delivery parameters, referred to as fixed and variable mode. For the variable mode, the volumetric parameters are defined with reference to the pump operating pressure and actual pump head temperature. These conditions may vary when, e.g. changing the column length, permeability, flow rate, etc. and are thus variable reference conditions. For the fixed mode, the reference conditions were set at 150bar and 30°C, resulting in a mass flow rate and mass fraction of modifier definition which is independent of the operation conditions. For the variable mode, the mass flow rate of carbon dioxide increases with system pump operating pressure, decreasing the fraction of modifier. Comparing the void times and retention factor shows that the deviation between the two modes is almost independent of modifier percentage, but depends on the operating pressure. Recalculating the set volumetric fraction of modifier to the mass fraction results in the same retention behaviour for both modes. This shows that retention in SFC can be best modelled using the mass fraction of modifier. The fixed mode also simplifies method scaling as it only requires matching average column pressure. PMID:27401813

  13. A method of calibrating wind velocity sensors with a modified gas flow calibrator

    NASA Technical Reports Server (NTRS)

    Stump, H. P.

    1978-01-01

    A procedure was described for calibrating air velocity sensors in the exhaust flow of a gas flow calibrator. The average velocity in the test section located at the calibrator exhaust was verified from the mass flow rate accurately measured by the calibrator's precision sonic nozzles. Air at elevated pressures flowed through a series of screens, diameter changes, and flow straighteners, resulting in a smooth flow through the open test section. The modified system generated air velocities of 2 to 90 meters per second with an uncertainty of about two percent for speeds below 15 meters per second and four percent for the higher speeds. Wind tunnel data correlated well with that taken in the flow calibrator.

  14. Endovascular approach to Leriche syndrome.

    PubMed

    Setacci, C; Galzerano, G; Setacci, F; De Donato, G; Sirignano, P; Kamargianni, V; Cannizzaro, A; Cappelli, A

    2012-06-01

    The chronic obstruction of the aortic bifurcation and iliac axis was definide by the French surgeon Rene Leriche, whose name it bears today. The advancing age of the population move the definition from a syndrome, as reported from Leriche, to complex aortoiliac vascular lesions current multidisciplinary guidelines recommend to treat extensive aortoiliac occlusive disease by surgical revascularization. Surgery provides good long-term patency, but at the cost of substantial perioperative morbidity. Development of new technologies and techniques has led to increased use of endovascular therapy for extensive aortoiliac disease. This review article summarized current multidisciplinary guidelines indication in endovascular treatment of extensive aorto-iliac disease and the various worldwide single centre experience published on endovascular treatment of Leriche Syndrome. PMID:22695262

  15. Signal quality of endovascular electroencephalography

    NASA Astrophysics Data System (ADS)

    He, Bryan D.; Ebrahimi, Mosalam; Palafox, Leon; Srinivasan, Lakshminarayan

    2016-02-01

    Objective, Approach. A growing number of prototypes for diagnosing and treating neurological and psychiatric diseases are predicated on access to high-quality brain signals, which typically requires surgically opening the skull. Where endovascular navigation previously transformed the treatment of cerebral vascular malformations, we now show that it can provide access to brain signals with substantially higher signal quality than scalp recordings. Main results. While endovascular signals were known to be larger in amplitude than scalp signals, our analysis in rabbits borrows a standard technique from communication theory to show endovascular signals also have up to 100× better signal-to-noise ratio. Significance. With a viable minimally-invasive path to high-quality brain signals, patients with brain diseases could one day receive potent electroceuticals through the bloodstream, in the course of a brief outpatient procedure.

  16. Insights on a Giant Aneurysm Treated Endovascularly.

    PubMed

    Graziano, Francesca; Iacopino, Domenico Gerardo; Ulm, Arthur John

    2016-07-01

    Background Endovascular treatment with stent-assisted Guglielmi detachable coils is an accepted method for treating intracranial giant aneurysms that otherwise would require more invasive or destructive treatment or could not be treated at all. Nevertheless, there is a paucity of information concerning inner postcoiling aneurysmal changes in human subjects over the long term. We report a postmortem analysis of a patient with a giant aneurysm at the vertebrobasilar junction (VBJ) who was treated endovascularly and studied pathologically 24 months after treatment. Materials and Method The head was removed at autopsy and prefixed in a 10% neutral buffered formalin solution. The brain was gently removed from the skull base after cutting the intracranial nerves and vascular structures. The giant VBJ aneurysm and its relationship with the brainstem, cranial nerves, and vessels were captured photographically and analyzed. Afterward, under operating microscope guidance, the vertebrobasilar system with the aneurysm was gently and carefully detached from the brainstem and carefully analyzed. Results No complete fibrous obliteration of the aneurysm lumen could be detected in our case, and no endothelialization had taken place 24 months after treatment. Conclusions Our findings agree with those of previous similar reports. Coiling, in particular in large or giant aneurysms, may be burdened by the risk of coil compaction and recanalization, but it has the advantage of not affecting the flow in the perforating arteries. PMID:26296255

  17. A modified NaSch model with density-dependent randomization for traffic flow

    NASA Astrophysics Data System (ADS)

    Zhu, H. B.; Ge, H. X.; Dong, L. Y.; Dai, S. Q.

    2007-05-01

    Based on the Nagel-Schreckenberg (NaSch) model of traffic flow, a modified cellular automaton (CA) traffic model with the density-dependent randomization (abbreviated as the DDR model) is proposed to simulate traffic flow. The fundamental diagram obtained by simulation shows the ability of this modified NaSch model to capture the essential features of traffic flow, e.g., synchronized flow, metastable state, hysteresis and phase separation at higher densities. Comparisons are made between this DDR model and the NaSch model, also between this DDR model and the VDR model. And the underlying mechanism is analyzed. All these results indicate that the presented model is reasonable and more realistic.

  18. A modified Darcy's law . Large eddy simulation of turbulent flows through a fractal model city

    NASA Astrophysics Data System (ADS)

    Gisinger, Sonja; Dörnbrack, Andreas; Schröttle, Josef

    2015-08-01

    An approach to describe the turbulent flow through a complex geometry (e.g., urban area) by means of an analogy to flows through porous media is presented. Therefore, a modification of the original Darcy's law is proposed, and its application is tested in a prototype problem with an idealized complex geometry using large eddy simulations. The numerical results indicate the validity of the modified Darcy's law for the chosen setup.

  19. Vertebro-Basilar Junction Aneurysms: A Single Centre Experience and Meta-Analysis of Endovascular Treatments

    PubMed Central

    Graziano, Francesca; Ganau, Mario; Iacopino, Domenico Gerardo; Boccardi, Edoardo

    2014-01-01

    Summary Vascular lesions of the vertebrobasilar junction (VBJ) are challenging in neurosurgical practice, and their gold-standard therapy is still under debate. We describe the operative strategies currently in use for the management of these complex vascular lesions and discuss their rationale in a literature meta-analysis and single centre blinded retrospective study. The single centre study included a review of initial presentation, angiographic features and clinical outcome (with modified Rankin Scale [mRS] scores) over a long-term follow-up. In our series, small aneurysms were effectively treated by endosaccular coil embolization, whereas a strategy including flow-diverter devices combined with endosaccular coil embolization was the option of choice in large and giant aneurysms, leading to satisfactory outcomes in most cases. Our Medline review showed that endovascular treatment was chosen in most VBJ cases, whereas the microsurgical option was assigned to only a few cases. Among the endovascular treatments, the most common techniques used for the treatment of VBJ aneurysms were: coiling, stent-assisted coiling and flow diversion. Our study highlights that aneurysm morphology, location and patient-specific angio-architecture are key factors to be considered in the management of VBJ aneurysms. Most case series, including our own, show that parent artery reconstruction using a flow-diverter device is a feasible and successful technique in some cases of giant and complex aneurysms (especially those involving the lower third of the basilar artery) while a "sit back, wait and see" approach may represent the safest and most reasonable option. PMID:25489898

  20. Modified ion-acoustic solitary waves in plasmas with field-aligned shear flows

    SciTech Connect

    Saleem, H.; Haque, Q.

    2015-08-15

    The nonlinear dynamics of ion-acoustic waves is investigated in a plasma having field-aligned shear flow. A Korteweg-deVries-type nonlinear equation for a modified ion-acoustic wave is obtained which admits a single pulse soliton solution. The theoretical result has been applied to solar wind plasma at 1 AU for illustration.

  1. Listeria monocytogenes Endovascular Graft Infection

    PubMed Central

    Heysell, Scott K.; Hughes, Molly A.

    2016-01-01

    Although best managed by surgical resection, we present a case of Listeria monocytogenes endovascular graft infection alternatively treated with graft retention and antibiotic induction followed by a lifelong suppressive course. The epidemiological, pathological, and clinical features of this unique entity are reviewed. PMID:26835477

  2. Complete regression of a symptomatic, mycotic juxtarenal abdominal aortic aneurysm after treatment with fenestrated endovascular aneurysm repair.

    PubMed

    Durgin, Jonathan M; Arous, Edward J; Kumar, Shivani; Robinson, William P; Simons, Jessica P; Schanzer, Andres

    2016-09-01

    Mycotic abdominal aortic aneurysms are rare and present unique challenges when potential treatment options are considered. Although aortic resection with in situ grafting techniques or extra-anatomic reconstruction are the treatments of choice, endovascular aortic repair has emerged as a suitable alternative in critically ill patients. We report the successful endovascular repair of a symptomatic, mycotic juxtarenal aortic aneurysm using a physician-modified fenestrated endograft. In this patient, with >6 months of follow-up, the aneurysm has completely regressed, illustrating that in select patients with complex mycotic aneurysms, endovascular repair combined with appropriate medical management is a viable treatment strategy. PMID:26747681

  3. Modified finite-element model for application to terrain-induced mesoscale flows

    SciTech Connect

    Lee, R.L.; Leone, J.M. Jr.; Gresho, P.M.

    1982-11-01

    Terrain-induced mesoscale flows are localized atmospheric motions generated primarily by surface inhomogeneities such as differential heating and irregular terrain. Well-known examples of such flows are sea-and-land breeze circulations, mountain-valley flows, urban heat island circulations and mountain lee waves. A numerical model capable of capturing the details of these frequently complicated flow patterns must often contain a realistic and rather accurate representation of the relevant terrain. Over the last decade, mesoscale models have been developed in which various approaches were used to incorporate variable terrain. In this study, a somewhat unique approach, based on a modified finite element procedure, was used to solve the nonhydrostatic planetary boundary layer equations. The nonhydrostatic and finite element features of the model are particularly advantageous for modeling flows over complex topography. The numerical aspects of the model, the parameterizations currently used, and a few preliminary results are presented.

  4. Custom fenestration templates for endovascular repair of juxtarenal aortic aneurysms.

    PubMed

    Leotta, Daniel F; Starnes, Benjamin W

    2015-06-01

    Physician-modified endovascular grafts, with fenestrations added to accommodate major branch vessels, provide a means for endovascular treatment of abdominal aortic aneurysms that are adjacent to the renal arteries. Manual measurements of vessel origin locations from computed tomography images, however, take time and can lead to errors in the positions of the fenestrations. To make the fenestration process faster and more accurate, we have developed a procedure to create custom templates that serve as patient-specific guides for graft fenestration. We use a three-dimensional printer to create a clear rigid sleeve that replicates the patient's aorta and includes holes placed precisely at the locations of the branch vessels. The sleeve is slipped over the graft, the locations of the openings are marked with a pen, and the fenestrations are created after the sleeve is removed. Custom fenestration templates can potentially save procedural costs and make minimally invasive aortic aneurysm repair available to more patients. PMID:25864045

  5. Echo-acoustic flow dynamically modifies the cortical map of target range in bats.

    PubMed

    Bartenstein, Sophia K; Gerstenberg, Nadine; Vanderelst, Dieter; Peremans, Herbert; Firzlaff, Uwe

    2014-01-01

    Echolocating bats use the delay between their sonar emissions and the reflected echoes to measure target range, a crucial parameter for avoiding collisions or capturing prey. In many bat species, target range is represented as an orderly organized map of echo delay in the auditory cortex. Here we show that the map of target range in bats is dynamically modified by the continuously changing flow of acoustic information perceived during flight ('echo-acoustic flow'). Combining dynamic acoustic stimulation in virtual space with extracellular recordings, we found that neurons in the auditory cortex of the bat Phyllostomus discolor encode echo-acoustic flow information on the geometric relation between targets and the bat's flight trajectory, rather than echo delay per se. Specifically, the cortical representation of close-range targets is enlarged when the lateral passing distance of the target decreases. This flow-dependent enlargement of target representation may trigger adaptive behaviours such as vocal control or flight manoeuvres. PMID:25131175

  6. Endovascular treatment of posterior condylar canal dural arteriovenous fistula.

    PubMed

    Maus, Volker; Söderman, Michael; Rodesch, Georges; Kabbasch, Christoph; Mpotsaris, Anastasios

    2016-01-01

    Posterior condylar canal dural arteriovenous fistulas (PCC DAVFs) are rare lesions that may present with pulse-synchronous bruit. In cases with venous reflux there is a risk of haemorrhage or even dementia. Diagnosis and endovascular treatment require a profound knowledge of the vascular anatomy of the craniocervical junction and comprehensive neurovascular imaging. We describe the clinical presentation, angiographic imaging and endovascular treatment of a PCC DAVF in a female patient with pulse-synchronous bruit as the presenting symptom. The fistula drained almost exclusively into the sigmoid sinus and internal jugular vein. There was no intracranial reflux. The PCC DAVF was treated with transvenous coil occlusion of the fistulous pouch in the condylar canal. Symptoms resolved immediately after intervention and the patient recovered quickly without any neurological deficits. MR angiography confirmed occlusion of the DAVF. The dural sinus was patent with normal blood flow. PMID:27247204

  7. The analysis of MHD blood flows through porous arteries using a locally modified homogenous nanofluids model.

    PubMed

    Akbarzadeh, Pooria

    2016-05-12

    In this paper, magneto-hydrodynamic blood flows through porous arteries are numerically simulated using a locally modified homogenous nanofluids model. Blood is taken into account as the third-grade non-Newtonian fluid containing nanoparticles. In the modified nanofluids model, the viscosity, density, and thermal conductivity of the solid-liquid mixture (nanofluids) which are commonly utilized as an effective value, are locally combined with the prevalent single-phase model. The modified governing equations are solved numerically using Newton's method and a block tridiagonal matrix solver. The results are compared to the prevalent nanofluids single-phase model. In addition, the efficacies of important physical parameters such as pressure gradient, Brownian motion parameter, thermophoresis parameter, magnetic-field parameter, porosity parameter, and etc. on temperature, velocity and nanoparticles concentration profiles are examined. PMID:27175464

  8. Endovascular treatment of popliteal aneurysm.

    PubMed

    de Donato, G; Setacci, F; Galzerano, G; Borrelli, M P; Mascolo, V; Mazzitelli, G; Ruzzi, U; Setacci, C

    2015-08-01

    Although traditional surgical repair by aneurysm exclusion and bypass is still considered the gold standard in the treatment of popliteal artery aneurysms (PAAs), the endovascular repair (ER) has been gaining great interest in the last decades. ER offers several advantages over open bypass, including lower morbidity and mortality, and faster functional recovery, but some concerns about migration, occlusion, or fracture remain when a stent graft is deployed across a joint that undergo constant flexion. This review summarizes the current evidence on ER for PAAs. Level I evidence is still very limited, while the majority of published data come from retrospective studies. Moreover the heterogeneity of PAA morphology seems to play a major role in the outcomes after popliteal endografts placement, so that many anatomical criteria should be taken into account to determine which patient is best treated endovascularly. In conclusion, while it is unlike that endovascular treatment may displace open surgical bypass in the near future, it indeed does provide a feasible option for selected patients with high surgical risk and good anatomical features. PMID:25742934

  9. Assessing Skin Blood Flow Dynamics in Older Adults Using a Modified Sample Entropy Approach

    PubMed Central

    Liao, Fuyuan; Jan, Yih-Kuen

    2015-01-01

    The aging process may result in attenuated microvascular reactivity in response to environmental stimuli, which can be evaluated by analyzing skin blood flow (SBF) signals. Among various methods for analyzing physiological signals, sample entropy (SE) is commonly used to quantify the degree of regularity of time series. However, we found that for temporally correlated data, SE value depends on the sampling rate. When data are oversampled, SE may give misleading results. To address this problem, we propose to modify the definition of SE by using time-lagged vectors in the calculation of the conditional probability that any two vectors of successive data points are within a tolerance r for m points remain within the tolerance at the next point. The lag could be chosen as the first minimum of the auto mutual information function. We tested the performance of modified SE using simulated signals and SBF data. The results showed that modified SE is able to quantify the degree of regularity of the signals regardless of sampling rate. Using this approach, we observed a more regular behavior of blood flow oscillations (BFO) during local heating-induced maximal vasodilation period compared to the baseline in young and older adults and a more regular behavior of BFO in older adults compared to young adults. These results suggest that modified SE may be useful in the study of SBF dynamics. PMID:25570060

  10. Newer endovascular tools: a review of experimental and clinical aspects.

    PubMed

    Sorenson, Thomas; Brinjikji, Waleed; Lanzino, Giuseppe

    2016-03-01

    The history of treatment of intracranial aneurysms dates back to the late 18th century. These early physicians largely based their crude techniques around "wire insertion alone, galvanopuncture (electrothrombosis), and fili-galvanopuncture (wire insertion together with electrothrombosis)," albeit with overwhelmingly unfavorable outcomes. By the end of the 20th century, treatment options progressed to include two highly effective, and safe, procedures: surgical clipping and endovascular coiling. These methods have been found to be effective treatments for a large portion of aneurysms, but there still exists a subset of patients that do not respond well to these therapies. While much progress has been made in stent-assisted coiling including the development of newer stents aimed at keep the coil ball from protruding into the parent vessel, the introduction of flow diverters has characterized a new phase in the endovascular treatment of intracranial aneurysms. This treatment paradigm is rapidly becoming the treatment of choice for large and complex aneurysms internal carotid artery. Intrasaccular flow diverters such as the Woven EndoBridge device (WEB) and Luna device are showing promise in the treatment of wide neck bifurcation aneurysms. Other newer devices including the pCONus Bifurcating Aneurysm Implant and Endovascular Clip Systems (eCLIPs) are showing promise in small clinical and preclinical studies. As technology improves, newer devices with ingenious designs are constantly being introduced into the clinical arena. Most of these devices try to address the limitations of traditional endovascular methods in regard to providing a safe and effective treatment of wide-necked bifurcation aneurysms. Several large prospective studies are underway and once completed, the role of these newer devices will be better defined. It is easy to anticipate that with advances in 3D techniques and printing, a future in which customized devices are designed based on the individual

  11. Developing a complex endovascular fenestrated and branched aortic program.

    PubMed

    Schanzer, Andres; Baril, Donald; Robinson, William P; Simons, Jessica P; Aiello, Francesco A; Messina, Louis M

    2015-03-01

    In 2008, the top priority in our division's 5-year strategic plan was "to become an internationally recognized center of excellence for the endovascular treatment of complex aortic pathology extending from the aortic valve to the external iliac artery." Five components were identified as "most critical" to achieve this strategic priority: (1) training at centers of excellence in complex endovascular repair; (2) industry partnership to improve access to developing technologies; (3) a fully integrated team approach with one leader involved in all steps of all cases; (4) prospective data collection; and (5) development and implementation of a physician-sponsored investigational device exemption for juxtarenal, pararenal, and thoracoabdominal aneurysms. We have now performed 49 repairs (16 commercially manufactured devices, 33 physician-modified devices) for 3 common iliac, 20 juxtarenal, 9 pararenal, and 17 thoracoabdominal aneurysms, using 142 fenestrations, branches, and scallops. All patients had complete 30-day follow-up for calculation of 30-day events. Kaplan-Meier analysis was used to calculate 1-year events. In 5 years, we developed a successful complex endovascular aortic program that uses fenestrated/branched repair techniques. A focused team strategic planning approach to program development is an effective way for vascular surgery divisions to gain experience and expertise with new complex technologies while ensuring acceptable patient outcomes. PMID:25595400

  12. Experimental and numerical study of electrically driven magnetohydrodynamic flow in a modified cylindrical annulus. I. Base flow

    NASA Astrophysics Data System (ADS)

    Stelzer, Zacharias; Cébron, David; Miralles, Sophie; Vantieghem, Stijn; Noir, Jérôme; Scarfe, Peter; Jackson, Andrew

    2015-07-01

    Shear layers in confined liquid metal magnetohydrodynamic (MHD) flow play an important role in geo- and astrophysical bodies as well as in engineering applications. We present an experimental and numerical study of liquid metal MHD flow in a modified cylindrical annulus that is driven by an azimuthal Lorentz force resulting from a forced electric current under an imposed axial magnetic field. Hartmann and Reynolds numbers reach Mmax ≈ 2000 and Remax ≈ 1.3 × 104, respectively, in the steady regime. The peculiarity of our model geometry is the protruding inner disk electrode which gives rise to a free Shercliff layer at its edge. The flow of liquid GaInSn in the experimental device ZUCCHINI (ZUrich Cylindrical CHannel INstability Investigation) is probed with ultrasound Doppler velocimetry. We establish the base flow in ZUCCHINI and study the scaling of velocities and the free Shercliff layer in both experiment and finite element simulations. Experiment and numerics agree well on the mean azimuthal velocity uϕ(r) following the prediction of a large-M theoretical model. The large-M limit, which is equivalent to neglecting inertial effects, appears to be reached for M ≳ 30 in our study. In the numerics, we recover the theoretical scaling of the free Shercliff layer δS ˜ M-1/2 whereas δS appears to be largely independent of M in the experiment.

  13. Shallow subsurface storm flow in a forested headwater catchment: Observations and modeling using a modified TOPMODEL

    NASA Astrophysics Data System (ADS)

    Scanlon, Todd M.; Raffensperger, Jeff P.; Hornberger, George M.; Clapp, Roger B.

    2000-09-01

    Transient, perched water tables in the shallow subsurface are observed at the South Fork Brokenback Run catchment in Shenandoah National Park, Virginia. Crest piezometers installed along a hillslope transect show that the development of saturated conditions in the upper 1.5 m of the subsurface is controlled by total precipitation and antecedent conditions, not precipitation intensity, although soil heterogeneities strongly influence local response. The macroporous subsurface storm flow zone provides a hydrological pathway for rapid runoff generation apart from the underlying groundwater zone, a conceptualization supported by the two-storage system exhibited by hydrograph recession analysis. A modified version of TOPMODEL is used to simulate the observed catchment dynamics. In this model, generalized topographic index theory is applied to the subsurface storm flow zone to account for logarithmic storm flow recessions, indicative of linearly decreasing transmissivity with depth. Vertical drainage to the groundwater zone is required, and both subsurface reservoirs are considered to contribute to surface saturation.

  14. Echo-acoustic flow dynamically modifies the cortical map of target range in bats

    NASA Astrophysics Data System (ADS)

    Bartenstein, Sophia K.; Gerstenberg, Nadine; Vanderelst, Dieter; Peremans, Herbert; Firzlaff, Uwe

    2014-08-01

    Echolocating bats use the delay between their sonar emissions and the reflected echoes to measure target range, a crucial parameter for avoiding collisions or capturing prey. In many bat species, target range is represented as an orderly organized map of echo delay in the auditory cortex. Here we show that the map of target range in bats is dynamically modified by the continuously changing flow of acoustic information perceived during flight (‘echo-acoustic flow’). Combining dynamic acoustic stimulation in virtual space with extracellular recordings, we found that neurons in the auditory cortex of the bat Phyllostomus discolor encode echo-acoustic flow information on the geometric relation between targets and the bat’s flight trajectory, rather than echo delay per se. Specifically, the cortical representation of close-range targets is enlarged when the lateral passing distance of the target decreases. This flow-dependent enlargement of target representation may trigger adaptive behaviours such as vocal control or flight manoeuvres.

  15. Shallow subsurface storm flow in a forested headwater catchment: Observations and modeling using a modified TOPMODEL

    USGS Publications Warehouse

    Scanlon, T.M.; Raffensperger, J.P.; Hornberger, G.M.; Clapp, R.B.

    2000-01-01

    Transient, perched water tables in the shallow subsurface are observed at the South Fork Brokenback Run catchment in Shenandoah National Park, Virginia. Crest piezometers installed along a hillslope transect show that the development of saturated conditions in the upper 1.5 m of the subsurface is controlled by total precipitation and antecedent conditions, not precipitation intensity, although soil heterogeneities strongly influence local response. The macroporous subsurface storm flow zone provides a hydrological pathway for rapid runoff generation apart from the underlying groundwater zone, a conceptualization supported by the two-storage system exhibited by hydrograph recession analysis. A modified version of TOPMODEL is used to simulate the observed catchment dynamics. In this model, generalized topographic index theory is applied to the subsurface storm flow zone to account for logarithmic storm flow recessions, indicative of linearly decreasing transmissivity with depth. Vertical drainage to the groundwater zone is required, and both subsurface reservoirs are considered to contribute to surface saturation.

  16. Using ion flows parallel and perpendicular to gravity to modify dust acoustic waves

    NASA Astrophysics Data System (ADS)

    Thomas, E.; Fisher, R.

    2008-11-01

    Recent studies of dust acoustic waves have shown that the dust kinetic temperature can play an important role in determining the resulting dispersion relation [M. Rosenberg, et al., Phys. Plasmas, 15, 073701 (2008)]. In these studies, it is believed that ion flows play a dominant role in determining both the kinetic temperature of the charged microparticles as well as providing the source of energy for triggering the waves. In this presentation, results will be presented on the effects of ion flow on spatial structure and velocity distribution of dust acoustic waves. Here, the waves will be formed in dusty plasmas consisting of 3 ± 1 micron diameter silica microspheres. Two separate electrodes will be used to modify the ion flow in the plasma -- one parallel to the direction of gravity and one perpendicular to the direction of gravity. Particle image velocimetry (PIV) techniques will be used to observe the particles and to measure their velocity distributions.

  17. Regional blood flows measured in Mongolian gerbil by a modified microsphere method.

    PubMed

    Matsumoto, M; Kimura, K; Fujisawa, A; Matsuyama, T; Asai, T; Uyama, O; Yoneda, S; Abe, H

    1982-06-01

    Regional blood flow to major organs and regional cerebral blood flow were determined in seven anesthetized male gerbils by a modified microsphere method. Carbonized microspheres, 15 micrometers in diameter and labeled with 85Sr or 141Ce, were injected into the left ventricle by cardiac puncture through the closed thorax, and reference samples of known volume were withdrawn from tail-artery cannula. No significant hemodynamic alterations were observed during microsphere administration, and extraction of 15-micrometers microspheres by the pulmonary or systemic capillary beds was nearly 100%. The adequacy of mixing of microspheres in the left ventricle was also validated. The absolute regional blood flow to various organs and regional cerebral blood flow were expressed in terms of milliliters per minute per gram tissue weight, and the values mostly agreed with those reported previously in rats. The results indicate that the reference sample method can be applied to the gerbil. This method should allow the gerbil, which is an animal widely used in stroke research, to be conveniently used for hemodynamic studies when organ blood flow and regional cerebral blood flow are necessary. PMID:7091359

  18. An overview of thin film nitinol endovascular devices.

    PubMed

    Shayan, Mahdis; Chun, Youngjae

    2015-07-01

    Thin film nitinol has unique mechanical properties (e.g., superelasticity), excellent biocompatibility, and ultra-smooth surface, as well as shape memory behavior. All these features along with its low-profile physical dimension (i.e., a few micrometers thick) make this material an ideal candidate in developing low-profile medical devices (e.g., endovascular devices). Thin film nitinol-based devices can be collapsed and inserted in remarkably smaller diameter catheters for a wide range of catheter-based procedures; therefore, it can be easily delivered through highly tortuous or narrow vascular system. A high-quality thin film nitinol can be fabricated by vacuum sputter deposition technique. Micromachining techniques were used to create micro patterns on the thin film nitinol to provide fenestrations for nutrition and oxygen transport and to increase the device's flexibility for the devices used as thin film nitinol covered stent. In addition, a new surface treatment method has been developed for improving the hemocompatibility of thin film nitinol when it is used as a graft material in endovascular devices. Both in vitro and in vivo test data demonstrated a superior hemocompatibility of the thin film nitinol when compared with commercially available endovascular graft materials such as ePTFE or Dacron polyester. Promising features like these have motivated the development of thin film nitinol as a novel biomaterial for creating endovascular devices such as stent grafts, neurovascular flow diverters, and heart valves. This review focuses on thin film nitinol fabrication processes, mechanical and biological properties of the material, as well as current and potential thin film nitinol medical applications. PMID:25839120

  19. Chronic Fluid Flow Is an Environmental Modifier of Renal Epithelial Function

    PubMed Central

    Resnick, Andrew

    2011-01-01

    Although solitary or sensory cilia are present in most cells of the body and their existence has been known since the sixties, very little is been known about their functions. One suspected function is fluid flow sensing- physical bending of cilia produces an influx of Ca++, which can then result in a variety of activated signaling pathways. Autosomal Dominant Polycystic Kidney Disease (ADPKD) is a progressive disease, typically appearing in the 5th decade of life and is one of the most common monogenetic inherited human diseases, affecting approximately 600,000 people in the United States. Because ADPKD is a slowly progressing disease, I asked how fluid flow may act, via the primary cilium, to alter epithelial physiology during the course of cell turnover. I performed an experiment to determine under what conditions fluid flow can result in a change of function of renal epithelial tissue. A wildtype epithelial cell line derived the cortical collecting duct of a heterozygous offspring of the Immortomouse (Charles River Laboratory) was selected as our model system. Gentle orbital shaking was used to induce physiologically relevant fluid flow, and periodic measurements of the transepithelial Sodium current were performed. At the conclusion of the experiment, mechanosensitive proteins of interest were visualized by immunostaining. I found that fluid flow, in itself, modifies the transepithelial sodium current, cell proliferation, and the actin cytoskeleton. These results significantly impact the understanding of both the mechanosensation function of primary cilia as well as the understanding of ADPKD disease progression. PMID:22046444

  20. On a Modified Form of Navier-Stokes Equations for Three-Dimensional Flows

    PubMed Central

    Venetis, J.

    2015-01-01

    A rephrased form of Navier-Stokes equations is performed for incompressible, three-dimensional, unsteady flows according to Eulerian formalism for the fluid motion. In particular, we propose a geometrical method for the elimination of the nonlinear terms of these fundamental equations, which are expressed in true vector form, and finally arrive at an equivalent system of three semilinear first order PDEs, which hold for a three-dimensional rectangular Cartesian coordinate system. Next, we present the related variational formulation of these modified equations as well as a general type of weak solutions which mainly concern Sobolev spaces. PMID:25918743

  1. Cerebrovascular neurosurgery in evolution: the endovascular paradigm.

    PubMed

    Sorkin, Grant C; Dumont, Travis M; Eller, Jorge L; Mokin, Maxim; Snyder, Kenneth V; Levy, Elad I; Siddiqui, Adnan H; Hopkins, L Nelson

    2014-02-01

    Endovascular technique represents an important, minimally invasive approach to treating cerebrovascular disease. In this article, we discuss the origins of endovascular neurosurgery as a discipline in the context of important technical milestones, evidence-based medicine, and future cerebrovascular neurosurgical training. Cerebrovascular neurosurgery has seen a steady, convergent evolution toward the surgeon capable of seamless incorporation of open and endovascular approaches to any complex vascular disease affecting the central nervous system. Neurosurgery must assume the leadership role in the multidisciplinary neurovascular team. PMID:24402487

  2. Endovascular Management of Posttraumatic Arteriovenous Fistulae

    SciTech Connect

    Koshy, Chiramel George Keshava, Shyamkumar Nigudala; Surendrababu, Narayanam R. S.; Moses, Vinu; Stephen, Edwin; Agarwal, Sunil

    2009-09-15

    Surgery is considered to be the treatment of choice for vascular injuries caused by trauma. However, endovascular techniques are emerging as an alternative means of treatment. In this article, we describe three patients with posttraumatic arteriovenous fistulae in different body regions that were managed using endovascular techniques. Each case had its unique set of associated problems requiring innovative methods and a multidisciplinary approach. While the short-term results are encouraging, long-term follow-up of posttraumatic arteriovenous fistulae that have been treated with endovascular techniques is still required.

  3. Flow injection catalase activity measurement based on gold nanoparticles/carbon nanotubes modified glassy carbon electrode.

    PubMed

    El Nashar, Rasha Mohamed

    2012-07-15

    Amperometric flow injection method of hydrogen peroxide analysis was developed based on catalase enzyme (CAT) immobilization on a glassy carbon electrode (GC) modified with electrochemically deposited gold nanoparticles on a multiwalled carbon nanotubes/chitosan film. The resulting biosensor was applied to detect hydrogen peroxide with a linear response range 1.0×10(-7)-2.5×10(-3)M with a correlation coefficient 0.998 and response time less than 10s. The optimum conditions of film deposition such as potential applied, deposition time and pH were tested and the flow injection conditions were optimized to be: flow rate of 3ml/min, sample volume 75μl and saline phosphate buffer of pH 6.89. Catalase enzyme activity was successfully determined in liver homogenate samples of rats, raised under controlled dietary plan, using a flow injection analysis system involving the developed biosensor simultaneously with spectrophotometric detection, which is the common method of enzymatic assay. PMID:22817944

  4. Endovascular treatment of acute ischemic stroke.

    PubMed

    Leslie-Mazwi, Thabele; Rabinov, James; Hirsch, Joshua A

    2016-01-01

    Endovascular thrombectomy is an effective treatment for major acute ischemic stroke syndromes caused by major anterior circulation artery occlusions (commonly referred to as large vessel occlusion) and is superior to intravenous thrombolysis and medical management. Treatment should occur as quickly as is reasonably possible. All patients with moderate to severe symptoms (National Institutes of Health stroke scale >8) and a treatable occlusion should be considered. The use of neuroimaging is critical to exclude hemorrhage and large ischemic cores. Very shortly after stroke onset (<3 hours) computed tomography (CT) and CT angiography provide sufficient information to proceed; diffusion magnetic resonance imaging (MRI) is less reliable during this early stage. After 3 hours from onset diffusion MRI is the most reliable method to define ischemic core size and should be used in centers that can offer it rapidly. Recanalization is highly effective with a stentriever or using a direct aspiration technique, with the patient awake or under conscious sedation rather than general anesthesia, if it may be performed safely. After thrombectomy the patient should be admitted to an intensive care setting and inpatient rehabilitation undertaken as soon as feasible. Patient outcomes should be assessed at 3 months, preferably using the modified Rankin score. PMID:27430469

  5. Continuous 'Passive' flow-proportional monitoring of drainage using a new modified Sutro weir (MSW) unit.

    PubMed

    Vendelboe, Anders Lindblad; Rozemeijer, Joachim; de Jonge, Lis Wollesen; de Jonge, Hubert

    2016-03-01

    In view of their crucial role in water and solute transport, enhanced monitoring of agricultural subsurface drain tile systems is important for adequate water quality management. However, existing monitoring techniques for flow and contaminant loads from tile drains are expensive and labour intensive. The aim of this study was to develop a cost-effective and simple method for monitoring loads from tile drains. The Flowcap is a modified Sutro weir (MSW) unit that can be attached to the outlet of tile drains. It is capable of registering total flow, contaminant loads and flow-averaged concentrations. The MSW builds on a modern passive sampling technique that responds to hydraulic pressure and measures average concentrations over time (days to months) for various substances. Mounting the samplers in the MSW allowed a flow-proportional part of the drainage to be sampled. Laboratory testing yielded high linear correlation between the accumulated sampler flow, q total, and accumulated drainage flow, Q total (r (2) > 0.96). The slope of these correlations was used to calculate the total drainage discharge from the sampled volume, and therefore contaminant load. A calibration of the MSW under controlled laboratory condition was needed before interpretation of the monitoring results was possible. The MSW does not require a shed, electricity, or maintenance. This enables large-scale monitoring of contaminant loads via tile drains, which can improve contaminant transport models and yield valuable information for the selection and evaluation of mitigation options to improve water quality. Results from this type of monitoring can provide data for the evaluation and optimisation of best management practices in agriculture in order to produce the highest yield without water quality and recipient surface waters being compromised. PMID:26914326

  6. Preservation of pelvic circulation in one-stage endovascular repair of bilateral hypogastric artery aneurysms.

    PubMed

    Christos, Karathanos; Dimitrios, Xanthopoulos; Elias, Kaperonis; Theophanis, Konstantopoulos; Maria, Exarchou; Vasilios, Papavassiliou

    2014-10-01

    Bilateral hypogastric artery aneurysms (HAAs) are relatively rare conditions that pose increased management difficulties. We report a case of one-stage endovascular repair of bilateral HAAs preserving pelvic circulation. A 67-year-old asymptomatic man with bilateral HAAs (4-cm right and 3.9-cm left) was successfully treated with an endovascular approach. The aneurysmal sac of the right hypogastric artery (HA) was embolized first and 2 covered stent grafts were deployed into the HA. Coil embolization of the left HAA was then performed followed by deployment of a covered stent graft to the common and external iliac arteries. Final angiography revealed complete exclusion of the aneurysms without endoleaks and with preservation of the pelvic flow. At the 18-month follow-up, the patient remained asymptomatic with good patency of the stent grafts. This case demonstrates an alternative endovascular approach for the treatment of bilateral HAAs that minimizes the risk of ischemic complications by preserving pelvic circulation. PMID:24858586

  7. Endovascular optical coherence tomography intensity kurtosis: visualization of vasa vasorum in porcine carotid artery

    PubMed Central

    Cheng, Kyle H. Y.; Sun, Cuiru; Vuong, Barry; Lee, Kenneth K. C.; Mariampillai, Adrian; Marotta, Thomas R.; Spears, Julian; Montanera, Walter J.; Herman, Peter. R.; Kiehl, Tim-Rasmus; Standish, Beau A.; Yang, Victor X. D.

    2012-01-01

    Application of speckle variance optical coherence tomography (OCT) to endovascular imaging faces difficulty of extensive motion artifacts inherently associated with arterial pulsations in addition to other physiological movements. In this study, we employed a technique involving a fourth order statistical method, kurtosis, operating on the endovascular OCT intensity images to visualize the vasa vasorum of carotid artery in vivo and identify its flow dynamic in a porcine model. The intensity kurtosis technique can distinguish vasa vasorum from the surrounding tissues in the presence of extensive time varying noises and dynamic motions of the arterial wall. Imaging of vasa vasorum and its proliferation, may compliment the growing knowledge of structural endovascular OCT in assessment and treatment of atherosclerosis in coronary and carotid arteries. PMID:22435088

  8. METHODS FOR DETERMINING EXPOSURE TO AND POTENTIAL ECOLOGICAL EFFECTS OF GENE FLOW FROM GENETICALLY MODIFIED CROPS TO COMPATIBLE RELATIVES

    EPA Science Inventory

    SCIENCE QUESTIONS:

    -Does gene flow occur from genetically modified (GM) crop plants to compatible plants?

    -How can it be measured?

    -Are there ecological consequences of GM crop gene flow to plant communities?



    RESEARCH:

    The objectives ...

  9. Acute Endovascular Reperfusion Therapy in Ischemic Stroke: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Osanai, Toshiya; Pasupuleti, Vinay; Deshpande, Abhishek; Thota, Priyaleela; Roman, Yuani; Hernandez, Adrian V.; Uchino, Ken

    2015-01-01

    Background Randomized controlled trials (RCTs) of endovascular therapy for acute ischemic stroke have had inconsistent results. We evaluated the efficacy and safety of endovascular therapy in published RCTs. Methods We performed a systematic review of RCTs of endovascular therapy with thrombolytic or mechanical reperfusion compared with interventions without endovascular therapy. Primary outcome was the frequency of good functional outcome (modified Rankin scale (mRS) of 0-2 at 90 days) and secondary outcomes were mortality at 90 days and symptomatic intracranial hemorrhage (sICH). Random-effects meta-analysis was performed and the Cochrane risk of bias assessment was used to evaluate quality of evidence. Results Ten studies involving 1,612 subjects were included. Endovascular therapy was not significantly associated with good functional outcome (Relative Risk [RR] =1.17; 95% CI, 0.97 to 1.42; p=0.10 and Absolute Risk Difference [ARD] =7%; 95%CI -0.1% to 14%; p=0.05); heterogeneity was moderate among studies (I2=30%). Mortality was unchanged with endovascular therapy (RR=0.92; 95 % CI, 0.75 to 1.13; p=0.45) and there was no difference in sICH (RR=1.20; 95 % CI, 0.79 to 1.82; p=0.39). The quality of evidence was low for all outcomes and the recommendation is weak for the use of endovascular therapy as per GRADE methodology. Conclusions Intra-arterial therapy did not show significant increase in good outcomes and no changes in either mortality or sICH in patients with acute ischemic stroke. We need further RCTs with better design and quality to evaluate the true efficacy of endovascular therapy. PMID:25915905

  10. A modified fluorescent microsphere-based approach for determining resting and hyperemic blood flows in individual murine skeletal muscles

    PubMed Central

    Cardinal, Trevor R.; Hoying, James B.

    2007-01-01

    The goal of this study was to develop a modified fluorescent microsphere-based approach for measuring resting and hyperemic blood flows in individual mouse skeletal muscles. Absolute resting blood flow in the left gracilis posterior was 1.04±0.12 ml·min−1·g−1, while functional hyperemia following muscle activity was 5.94±1.33 ml·min−1·g−1. Measuring absolute blood flow requires sampling arterial blood that serves as a flow-rate and concentration reference to the fluorescent microsphere (FMS) content in the tissue-of-interest for calculating the flow value. Because sampling arterial blood can impair cardiovascular function in the mouse, we also modified our FMS approach to determine relative blood flows in the left gracilis posterior by using the contralateral muscle as our reference in blood flow calculations. Absolute and relative hyperemia measurements detect similar increases in blood flow — 521.93±216.76% and 555.24±213.82%, respectively. However, sampling arterial blood during absolute blood flow measurements significantly decreased mean arterial pressure from the beginning to the end of our experiments, from 102.7±2.18 to 75.5±9.71 mm Hg. This decrease was not seen when measuring relative blood flows. This approach provides critical advantages over contemporary blood flow measurement approaches by allowing blood flow measurements in small and non-superficial tissues. PMID:17500044

  11. Tensile flow and work-hardening behavior of a Ti-modified austenitic stainless steel

    SciTech Connect

    Sivaprasad, P.V.; Venugopal, S.; Venkadesan, S.

    1997-01-01

    The flow-stress data of a 15Cr-15Ni-2.2Mo-Ti modified austenitic stainless steel in the temperature range 300 to 1,023 K was analyzed in terms of Ludwigson and Voce equations. The parameters of these equations were critically examined with respect to the effect of Ti/C ratio and test temperature. It was found that the Ludwigson equation described the flow behavior adequately up to the test temperature of 923 K, whereas the Voce equation could be employed in the full temperature range. The peaks/plateaus observed in the variation of these parameters as a function of temperature in the intermediate temperature range have been identified as one of the manifestations of dynamic strain aging (DSA). Also, the variation of these parameters with temperature clearly could bring out the different domains of DSA observed in this alloy. The work-hardening analysis of the flow-stress data revealed that in the DSA regime, the onset of stage III hardening is athermal.

  12. Effects of modified pharmacologic stress approaches on hyperemic myocardial blood flow

    SciTech Connect

    Czernin, J.; Auerbach, M.; Sun, K.T.

    1995-04-01

    Pharmacologic stress testing with 0.56 mg/kg of intravenous dipyridamole is frequently used to noninvasively detect coronary artery disease (CAD). However, high-dose dipyridamole (0.80 mg/kg) or the combination of standard-dose dipyridamole (0.56 mg/kg) with the isometric handgrip maneuver might evoke a greater coronary hyperemic response. To evaluate the effect of modified pharmacologic stress tests, myocardial blood flow was quantified in 11 male subjects (mean age: 27 {plus_minus} 7 yr) during standard-dose dipyridamole (0.56 mg/kg), high-dose dipyridamole (0.80 mg/kg) and standard-dose dipyridamole combined with the isometric handgrip exercise using dynamic PET and a two-compartment model for {sup 13}N-ammonia. Systolic blood pressure, heart rate and rate pressure product remained unchanged from standard to high-dose dipyridamole but increased with the addition of the isometric handgrip. Myocardial blood flow was unchanged from standard to high-dose dipyridamole but was lower with the addition of the isometric handgrip. The hyperemic response induced by standard-dose dipyridamole cannot be further enhanced by high-dose dipyridamole. The addition of the isometric handgrip exercise results in a modest, but significant decline in hyperemic blood flow possibly due to increased extravascular resistive forces or an increase in a mediated coronary vasoconstriction associated with exercise. 31 refs., 2 figs., 1 tab.

  13. Study on the flow characteristics and the wastewater treatment performance in modified internal circulation reactor.

    PubMed

    Wang, Jiade; Xu, Weijun; Yan, Jingjia; Yu, Jianming

    2014-12-01

    A modified internal circulation (MIC) reactor with an external circulation system was proposed and the performance of treating dyeing wastewater using both MIC and typical IC reactor were compared. Utilization of the external circulation system in the MIC reactor could dramatically improve the mixing intensity of the biomass with the wastewater and resulted in better performance. The COD removal efficiency, biogas production, volatile fatty acids and effluent color were approximately 87%, 98 L d−1, 180 mg L−1 and 100 times, respectively, in the MIC reactor with a hydraulic retention time of 5 h and organic loading rate of 15 kg COD m−3 d−1. The hydrodynamics of the MIC reactor under different flows rate of external circulation were also analyzed using computational fluid dynamics (CFD) method. The optimal flow rate of external circulation was 12 L min−1, which resulted in a corresponding up-flow velocity of 40 m h−1. The consistency of the result between experiment and simulation validated the scientificity of CFD technique applied to numerical simulation of the MIC reactor. PMID:25461928

  14. Percutaneous endovascular stents: an experimental evaluation.

    PubMed

    Wright, K C; Wallace, S; Charnsangavej, C; Carrasco, C H; Gianturco, C

    1985-07-01

    Percutaneous, expanding, endovascular stents were constructed of stainless steel wire formed in a zig-zag pattern. Stents were placed for varying periods of time in the jugular vein, vena cava, and abdominal aorta in each of five adult dogs. The dilating force of the stents could be controlled by different wire size, number and angle of wire bends, and stent length. In addition, multiple stents could be placed one inside the other or one after the other, depending on the circumstance. The stents distended the vessels and increased their diameter. No flow defects, luminal narrowing, or occlusion were noted in any of the stented vessels, even after 6 months. Side branches bridged by the stents remained patent and showed no indication of narrowing. Stent wires became encased by a proliferation of the tunica intima where they contacted the vessel wall. Encasement was slower and less extensive in the abdominal aorta. No vascular erosion or clot formation was found to be associated with any of the stents. PMID:4001423

  15. Biomechanical Issues in Endovascular Device Design

    PubMed Central

    Moore, James E.

    2009-01-01

    The biomechanical nature of the arterial system and its major disease states provides a series of challenges to treatment strategies. Endovascular device design objectives have mostly centered on short-term challenges, such as deployability and immediate restoration of reliable flow channels. The resulting design features may be at odds with long-term clinical success. In-stent restenosis, endoleaks, and loss of device structural integrity (e.g., strut fractures) are all manifestations of a lack of compatibility between the host vessel biomechanical environment and the implant design. Initial attempts to adapt device designs for increased compatibility, including drug-eluting and bioabsorbable stents, barely begin to explore the ways in which implant design can be modulated in time to minimize risk of failure. Biomechanical modeling has the potential to provide a virtual vascular environment in which new designs can be tested for their implications on long-term tissue reaction. These models will be based on high quality, highly resolved imaging information, as well as mechanobiology experiments from the cellular to the whole tissue level. These models can then be extended to incorporate biodegradation mechanics, facilitating the next generations of devices whose designs (including drug delivery profiles) change with time to enhance healing. The possibility of initiating changes in device design or drug release according to information on vascular healing (through clinical intervention or automated methods) provides the opportunity for truly individualized dynamic device design optimization. PMID:19317580

  16. A modified flow/field model of the solar wind interaction with Mars

    SciTech Connect

    Stewart, B.K.

    1992-01-01

    A modified steady state flow/field model is applied to the direct interaction of the solar wind with the Martian ionosphere. The original flow/field model (Cloutier et al., 1987) is a one-dimensional, self-consistent derivation of differentials in vertical velocity, magnetic field, and ion densities from the coupled MHD equations. While successful in reproducing features of the ionosphere of Venus (Cloutier et al., 1987; McGary 1987) and of Mars (Stewart, 1989), the flow/field model required an independently specified heating term (Q). The requirement of this term implies the presence of an energy source not accounted for in conventional calculations. This source was previously simulated with the inclusion of Q, but an unrecognized momentum or pressure term the inclusion of Q, but an unrecognized momentum or pressure term may also provide the coupling with the solar wind without the need of the free parameter Q. An in-depth analysis of Pioneer Venus data in relation to the total conservation of momentum of the system led to the discovery that the total momentum was in most cases not entirely accounted for, and that this [open quotes]missing[close quotes] term was correlated with solar wind dynamic pressure. By including this missing pressure, a new set of differential equations, which were also extended to include horizontal velocity terms, was derived. Extrapolation of the missing pressure to Mars gave results that faithfully reproduced the ionospheric features associated with previous flow/field models while maintaining agreement with Viking 1 and 2 observations. Finally, the author suggests that the source of P[sub missing] could be a population of suprathermal particles within the ionosphere. The missing pressures in the Viking simulations are consistent with measured suprathermal pressures at Mars (Hanson and Mantas, 1988).

  17. Flow Injection Analysis of 5-(Hydroxymethyl)-2-furaldehyde in Honey by a Modified Winkler Method.

    PubMed

    Castoldi, Karine; Milani, Maria Izabel; Rossini, Eduardo L; Pezza, Leonardo; Pezza, Helena R

    2016-01-01

    One of the quality indicators for honey is 5-(hydroxymethyl)-2-furaldehyde (HMF), which is formed during the heating or aging of honey. The International Honey Commission recommends three methods for the determination of HMF in honey: the Winkler method, the White method, and determination by HPLC. The Winkler method uses the carcinogenic substance p-toluidine, which is not in accordance with the principles of Green Chemistry. The present work describes the determination of HMF in honey by flow injection analysis (FIA) using a modified Winkler method, replacing p-toluidine with p-aminobenzoic acid. The linear range was 1.00 to 40.0 mg L(-1), the limit of detection (LOD) was 0.43 mg L(-1), and the limit of quantification (LOQ) was 1.32 mg L(-1). The method is an efficient and environmentally friendly technique for the analysis of HMF in honey. PMID:27063713

  18. Flow and heat transfer to modified second grade fluid over a non-linear stretching sheet

    NASA Astrophysics Data System (ADS)

    Khan, Masood; Rahman, Masood ur

    2015-08-01

    The objective of the present work is to analyze the two-dimensional boundary layer flow and heat transfer of a modified second grade fluid over a non-linear stretching sheet of constant surface temperature. The modelled momentum and energy equations are deduced to a system of ordinary differential equations by employing suitable transformations in boundary layer region and integrated numerically by fourth and fifth order Runge-Kutta Fehlberg method. Additionally, the analytic solutions of the governing problem are presented for some special cases. The secured results make it clear that the power-law index reduces both the momentum and thermal boundary layers. While the incremented values of the generalized second grade parameter leads to an increase in the momentum boundary layer and a decrease in the thermal boundary layer. To see the validity of the present results we have made a comparison with the previously published results as a special case with an outstanding compatibility.

  19. Group Invariance Properties of the Inviscid Compressible Flow Equations for a Modified Tait Equation of State

    NASA Astrophysics Data System (ADS)

    Ramsey, Scott; Baty, Roy

    2015-11-01

    This work considers the group invariance properties of the inviscid compressible flow equations (Euler equations) under the assumptions of one-dimensional symmetry and a modified Tait equation of state (EOS) closure model. When written in terms of an adiabatic bulk modulus, a transformed version of these equations is found to be identical to that for an ideal gas EOS. As a result, the Lie group invariance structure of these equations - and their subsequent reduction to a lower-order system - is identical to the published results for the ideal gas case. Following the reduction of the Euler equations to a system of ordinary differential equations, a variety of elementary closed-form solutions are derived. These solutions are then used in conjunction with the Rankine-Hugoniot conditions to construct discontinuous shock wave and free surface solutions that are analogous to the classical Noh, Sedov, Guderley, and Hunter similarity solutions of the Euler equations for an ideal gas EOS. The versions of these problems for the modified Tait EOS are found to be semi-analytic in that a transcendental root extraction (and in some cases numerical integration of ordinary differential equations) enables solution of the relevant equations.

  20. 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

  1. Analysis of dynamic nonlinearity of flow control loop through modified relay test probing

    NASA Astrophysics Data System (ADS)

    Boiko, I.; Sayedain, S.

    2010-12-01

    Most of the controller tuning methods in process control are based on linear models. Through the development of a detail model of the actuator-pneumatic valve dynamics, we show that even if the static characteristic of the valve is linear (including possible linearity of the flow dependence on the valve opening) the actuator-valve dynamics are strongly nonlinear. Therefore, tuning of the flow loop will be affected by the selection of the operating point and the amplitude of the relay in the relay feedback test (RFT) or modifications of this test. It is shown that Lyapunov linearisation around an equilibrium point fails to provide a local linear model of the system, and modified RFT probing is used for investigation of the system dynamics. The same test is used for the proportional-integral controller tuning in various operating points. It is recommended that the difference in the dynamic response of the loop for different relay amplitudes and operating points should be accounted for by larger stability margins.

  2. Endovascular Intervention for Peripheral Artery Disease

    PubMed Central

    Thukkani, Arun K.; Kinlay, Scott

    2015-01-01

    Advances in endovascular therapies during the past decade have broadened the options for treating peripheral vascular disease percutaneously. Endovascular treatment offers a lower risk alternative to open surgery in many patients with multiple comorbidities. Noninvasive physiological tests and arterial imaging precede an endovascular intervention and help localize the disease and plan the procedure. The timing and need for revascularization are broadly related to the 3 main clinical presentations of claudication, critical limb ischemia, and acute limb ischemia. Many patients with claudication can be treated by exercise and medical therapy. Endovascular procedures are considered when these fail to improve quality of life and function. In contrast, critical limb ischemia and acute limb ischemia threaten the limb and require more urgent revascularization. In general, endovascular treatments have greater long-term durability for aortoiliac disease than femoral popliteal disease. Infrapopliteal revascularization is generally reserved for critical and acute limb ischemia. Balloon angioplasty and stenting are the mainstays of endovascular therapy. New well-tested innovations include drug-eluting stents and drug-coated balloons. Adjunctive devices for crossing chronic total occlusions or debulking plaque with atherectomy are less rigorously studied and have niche roles. Patients receiving endovascular procedures need a structured surveillance plan for follow-up care. This includes intensive treatment of cardiovascular risk factors to prevent myocardial infarction and stroke, which are the main causes of death. Limb surveillance aims to identify restenosis and new disease beyond the intervened segments, both of which may jeopardize patency and lead to recurrent symptoms, functional impairment, or a threatened limb. PMID:25908731

  3. Endovascular Management of Acute Bleeding Arterioenteric Fistulas

    SciTech Connect

    Leonhardt, Henrik Mellander, Stefan; Snygg, Johan; Loenn, Lars

    2008-05-15

    The objective of this study was to review the outcome of endovascular transcatheter repair of emergent arterioenteric fistulas. Cases of abdominal arterioenteric fistulas (defined as a fistula between a major artery and the small intestine or colon, thus not the esophagus or stomach), diagnosed over the 3-year period between December 2002 and December 2005 at our institution, were retrospectively reviewed. Five patients with severe enteric bleeding underwent angiography and endovascular repair. Four presented primary arterioenteric fistulas, and one presented a secondary aortoenteric fistula. All had massive persistent bleeding with hypotension despite volume substitution and transfusion by the time of endovascular management. Outcome after treatment of these patients was investigated for major procedure-related complications, recurrence, reintervention, morbidity, and mortality. Mean follow-up time was 3 months (range, 1-6 months). All massive bleeding was controlled by occlusive balloon catheters. Four fistulas were successfully sealed with stent-grafts, resulting in a technical success rate of 80%. One patient was circulatory stabilized by endovascular management but needed immediate further open surgery. There were no procedure-related major complications. Mean hospital stay after the initial endovascular intervention was 19 days. Rebleeding occurred in four patients (80%) after a free interval of 2 weeks or longer. During the follow-up period three patients needed reintervention. The in-hospital mortality was 20% and the 30-day mortality was 40%. The midterm outcome was poor, due to comorbidities or rebleeding, with a mortality of 80% within 6 months. In conclusion, endovascular repair is an efficient and safe method to stabilize patients with life-threatening bleeding arterioenteric fistulas in the emergent episode. However, in this group of patients with severe comorbidities, the risk of rebleeding is high and further intervention must be considered

  4. 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

  5. Microembolism after Endovascular Treatment of Unruptured Cerebral Aneurysms: Reduction of its Incidence by Microcatheter Lumen Aspiration

    PubMed Central

    Kim, Dae Yoon; Park, Jung Cheol; Kim, Jae Kyun; Sung, Yu Sub; Park, Eun Suk; Kwak, Jae Hyuk; Choi, Choong-Gon

    2015-01-01

    Purpose Diffusion-weighted MR images (DWI) obtained after endovascular treatment of cerebral aneurysms frequently show multiple high-signal intensity (HSI) dots. The purpose of this study was to see whether we could reduce their incidence after embolization of unruptured cerebral aneurysms by modification of our coiling technique, which involves the deliberate aspiration of the microcatheter lumen right after delivery of each detachable coil into the aneurysm sac. Materials and Methods From January 2011 to June 2011, all 71 patients with unruptured cerebral aneurysms were treated using various endovascular methods. During the earlier period, 37 patients were treated using our conventional embolization technique (conventional period). Then 34 patients were treated with a modified coiling technique (modified period). DWI was obtained on the following day. We compared the occurrence of any DWI HSI lesions and the presence of the symptomatic lesions during the two time periods. Results The incidence of the DWI HSI lesions differed significantly at 89.2% (33/37) during the conventional period and 26.5% (9/34) during the modified period (p < 0.0001). The incidence of symptomatic lesions differed between the two periods (29.7% during the conventional period vs. 2.9% during the modified period, p < 0.003). Conclusion Aspiration of the inner content of the microcatheter right after detachable coil delivery was helpful for the reduction of the incidence of microembolisms after endovascular coil embolization for the treatment of unruptured cerebral aneurysms. PMID:26389009

  6. Flow in experimental berry aneurysms: method and model.

    PubMed

    Kerber, C W; Heilman, C B

    1983-01-01

    This study addresses two basic questions: What are the flow dynamics in aneurysms? Can these flows be modified to enhance retention of adhesive? Using Pyrex glass bifurcations, fluid flow was studied in a variety of aneurysms placed at varying positions around the bifurcations. Indicators injected into the slipstreams were recorded and studied both by stop-frame high-speed movie analysis and with 35 mm slides. Even at low-flow rates, a central slipstream strikes the apex of bifurcations, and may be partly responsible for the initial production of berry aneurysms. A low-pressure zone occurs at the lateral angle of bifurcations, probably explaining the formation of endovascular cushions. Flow into symmetrically placed narrow neck aneurysms did not occur. Indicator entered the aneurysm in a turbulent fashion only when there was orifice (lip) asymmetry. Both lip asymmetry and rapid flow favor intraaneurysmal turbulent flow. PMID:6410748

  7. Radiation exposure to anaesthetists during endovascular procedures.

    PubMed

    Arii, T; Uchino, S; Kubo, Y; Kiyama, S; Uezono, S

    2015-01-01

    Medical radiation exposure increases the likelihood of cataract formation. A personal dosimeter was attached to the left temple of 77 anaesthetists during 45 endovascular aortic aneurysm repairs and 32 interventional neuroradiology procedures. Compared with interventional neuroradiology, the median (IQR [range]) total radiation dose emitted by fluoroscopic equipment was significantly lower during endovascular aortic aneurysm repair (4175 (3127-5091 [644-9761]) mGy than interventional neuroradiology (1420 (613-2424 [165-10,840]) mGy, p < 0.001). However, radiation exposure to the anaesthetist's temple was significantly greater during endovascular aortic aneurysm repair (15 (6-41 [1-109]) μSv) than interventional neuroradiology (4 (2-8 [0-67]) μSv, p < 0.001). These data suggest that anaesthetists at our institution would have to deliver anaesthesia for ~1300 endovascular aortic aneurysm repairs and ~5000 interventional neuroradiology cases annually to exceed the general occupational limits, and ~10,000 endovascular aortic aneurysm repairs and ~37,500 interventional neuroradiology cases to exceed the ocular exposure limits recommended by the International Commission on Radiological Protection. Nevertheless, anaesthetists should be aware of the risk of ocular radiation exposure, and reduce this by limiting the time of exposure, increasing the distance from the source of radiation, and shielding. PMID:25267714

  8. Reinterventions after open and endovascular AAA repair.

    PubMed

    Malina, M

    2015-04-01

    Reinterventions seem to occur more frequently after endovascular aneurysm repair than after open surgical repair and are encountered in about 20% versus 10% of the cases, respectively. However, reinterventions following endovascular repair are predominantly endoluminal and early reinterventions are more frequent after open repair. The indications for reintervention after EVAR have changed over time. The incidence and type of reintervention depends on the complexity of the primary procedure, irrespective of whether it was open or endovascular. The use of a device outside instructions for use is associated with a higher complication rate but it may nevertheless be fully justified. Advanced stent-grafts such as fenestrated and branched devices require secondary procedures more often than a standard stent-graft. Similarly, more complex open repair, e.g. a bifurcated bypass, reimplantation of visceral arteries or a redo procedure, is also associated with more reinterventions than a simple tube graft. This manuscript presents some of the most common complications of open and endovascular aortic aneurysm repair and the reinterventions they require. Many of the complications are similar with both open and endovascular techniques. Limb thrombosis, infections and endoleaks are the most frequent indications for reintervention. PMID:25644827

  9. Treatment of fenestrated vertebrobasilar junction-related aneurysms with endovascular techniques.

    PubMed

    Zhu, De-Yuan; Fang, Yi-Bin; Wu, Yi-Na; Li, Qiang; Duan, Guo-Li; Liu, Jian-Min; Xu, Yi; Hong, Bo; Zhao, Wen-Yuan; Huang, Qing-Hai

    2016-06-01

    Fenestrated vertebrobasilar junction-related aneurysms (fVBJ-AN) are uncommon and endovascular management strategies have become the first options for the treatment of these lesions. This clinical study aimed to report our experience in the endovascular management of these lesions and to review the literature. We retrospectively reviewed 10 consecutive patients harboring 12 fVBJ-AN between January 2007 and December 2014. The demographic, angiographic and clinical data were reviewed. Additionally, a literature review was performed. Endovascular management strategies were successfully applied in all 10 patients. Post-procedural angiograms indicated total occlusion in eight (66.7%) aneurysms, a residual neck in one (8.3%) aneurysm, and three residual aneurysms (25%). No procedure-related complications were observed. Follow-up angiograms were obtained in eight patients and revealed nine occluded aneurysms and one improved aneurysm; two patients were lost to angiographic follow-up. Clinical follow-ups were obtained in all patients (until July 2015), and the modified Rankin Scale scores at 69.5months (range 17-101months) of follow-up were 0 in eight patients and 1 in two patients. Endovascular management strategies provided a high occlusion rate and an acceptable complication rate and are thus efficacious in the treatment of fVBJ-AN. Further studies are necessary to validate the utility of these treatments due to the low incidence of fVBJ-AN. PMID:26778513

  10. Paradoxical cerebral air embolism causing large vessel occlusion treated with endovascular aspiration.

    PubMed

    Belton, Patrick J; Nanda, Ashish; Alqadri, Syeda L; Khakh, Gurpreet S; Chandrasekaran, Premkumar Nattanmai; Newey, Christopher; Humphries, William E

    2016-01-01

    Cerebral air embolism is a dreaded complication of invasive medical procedures. The mainstay of therapy for patients with cerebral air embolism has been hyperbaric oxygen therapy, high flow oxygen therapy, and anticonvulsants. We present a novel therapeutic approach for treatment of cerebral air embolism causing large vessel occlusion, using endovascular aspiration. Our patient developed a cerebral air embolism following sclerotherapy for varicose veins. This caused near total occlusion of the superior division of the M2 segment of the right middle cerebral artery. Symptoms included unilateral paralysis, unintelligible speech, and hemianopia; National Institutes of Health Stroke Scale (NIHSS) on presentation was 16. The air embolism was treated using a distal aspiration technique. Angiography following aspiration showed Thrombolysis in Cerebral Infarction 2B reperfusion. Following aspiration, the patient was re-examined; NIHSS at that time was 4. At 1 month follow-up, the modified Rankin Scale score was 1 and NIHSS was 1. Treatment of cerebral air embolism is discussed. PMID:27435840

  11. Endovascular Aneurysm Repair: Current and Future Status

    SciTech Connect

    Hinchliffe, R. J. Ivancev, K.

    2008-05-15

    Endovascular aneurysm repair has rapidly expanded since its introduction in the early 1990s. Early experiences were associated with high rates of complications including conversion to open repair. Perioperative morbidity and mortality results have improved but these concerns have been replaced by questions about long-term durability. Gradually, too, these problems have been addressed. Challenges of today include the ability to roll out the endovascular technique to patients with adverse aneurysm morphology. Fenestrated and branch stent-graft technology is in its infancy. Only now are we beginning to fully understand the advantages, limitations, and complications of such technology. This paper outlines some of the concepts and discusses the controversies and challenges facing clinicians involved in endovascular aneurysm surgery today and in the future.

  12. Renal interventions during endovascular aneurysm repair.

    PubMed

    Davies, Mark G

    2013-12-01

    Renal insufficiency is a risk factor for mortality and morbidity during endovascular aneurysm repair. Multiple changes in practice have occurred to mitigate renal injury and renal dysfunction. Transrenal fixation does carry an increased risk of a decline in renal function in the medium term. Renal stenting for athero-occlusive disease during endovascular aneurysm repair needs careful consideration, as indications have changed and there are unexpected consequences with early vessel occlusion. The growing number of renal interventions during complex endovascular aneurysm repair with the advent of chimney snorkel/periscope techniques and the introduction of fenestrated grafts has shown the resilience of the intervention with relatively low renal issues (approximately 10%), but has also illustrated the need for additional device development. PMID:25220325

  13. ZrO2-Nanoparticle-Modified Graphite Felt: Bifunctional Effects on Vanadium Flow Batteries.

    PubMed

    Zhou, Haipeng; Shen, Yi; Xi, Jingyu; Qiu, Xinping; Chen, Liquan

    2016-06-22

    To improve the electrochemical performance of graphite felt (GF) electrodes in vanadium flow batteries (VFBs), we synthesize a series of ZrO2-modified GF (ZrO2/GF) electrodes with varying ZrO2 contents via a facile immersion-precipitation approach. It is found that the uniform immobilization of ZrO2 nanoparticles on the GF not only significantly promotes the accessibility of vanadium electrolyte, but also provides more active sites for the redox reactions, thereby resulting in better electrochemical activity and reversibility toward the VO(2+)/VO2(+) and V(2+)/V(3+) redox reactions as compared with those of GF. In particular, The ZrO2/GF composite with 0.3 wt % ZrO2 displays the best electrochemical performance with voltage and energy efficiencies of 71.9% and 67.4%, respectively, which are much higher than those of 57.3% and 53.8% as obtained from the GF electrode at 200 mA cm(-2). The cycle life tests demonstrate that the ZrO2/GF electrodes exhibit outstanding stability. The ZrO2/GF-based VFB battery shows negligible activity decay after 200 cycles. PMID:27229444

  14. Assessment of urinary tract biomaterial encrustation using a modified Robbins device continuous flow model.

    PubMed

    Tunney, M M; Keane, P F; Gorman, S P

    1997-01-01

    Encrustation of biomaterials employed in the urinary tract remains a major problem resulting in obstruction or blockage of catheters and stents. Therefore, resistance to encrustation is a desirable feature of biomaterials employed in such devices. The novel assessment of biomaterial encrustation employing a continuous flow model based on a modified Robbins device is described. Artificial urine was used in conjunction with 5% CO2 to simulate the physiological environment within the upper urinary tract. The widely used urinary device biomaterials, silicone and polyurethane, were investigated in the model for hydroxyapatite and struvite encrustation. Scanning electron microscopy, energy dispersive X-ray analysis, and atomic absorption spectroscopy all showed that silicone was less prone to encrustation than polyurethane and that hydroxyapatite deposition was predominant on both surfaces. The model has the advantage that a large number of biomaterials may be investigated simultaneously because several Robbins devices may be placed in parallel. The model is recommended for comparative evaluation of biomaterial candidates for use in urinary tract devices. PMID:9178735

  15. 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

  16. Emergency Endovascular Treatment of Sac Rupture for Type IIIa Endoleak in Thoracic Aortic Aneurysm Previously Excluded with Endovascular Repair

    SciTech Connect

    Carrafiello, Gianpaolo Mangini, Monica Bracchi, Elena Recaldini, Chiara; Cocozza, Eugenio; Piffaretti, Gabriele; Pellegrino, Carlo Lagana, Domenico Fugazzola, Carlo

    2010-08-15

    Elective endovascular treatment of thoracic aortic pathology has been applied in a variety of conditions. The complications of thoracic aortic stenting are also well recognized. Endoleak after endovascular repair of thoracic aortic aneurysms is the most frequent complication; among them, type III is the least frequent. Endovascular treatment of type III endoleak is generally performed under elective conditions; less frequently, in emergency. We report a successful emergency endovascular management of post-thoracic endovascular repair for thoracic aortic aneurysm rupture due to type IIIa endoleak.

  17. Surgical and Endovascular Treatment for Spinal Arteriovenous Malformations

    PubMed Central

    ENDO, Toshiki; ENDO, Hidenori; SATO, Kenichi; MATSUMOTO, Yasushi; TOMINAGA, Teiji

    2016-01-01

    Spinal arteriovenous malformation (AVM) is a broad term that constitutes diverse vascular pathologies. To date, various classification schemes for spinal AVM have been proposed in literature, which helped neurosurgeons understand the pathophysiology of the disease and determine an optimal treatment strategy. To discuss indications and results of surgical and endovascular interventions for spinal AVM, this article refers to the following classification proposed by Anson and Spetzler in 1992: type I, dural arteriovenous fistula (AVF); type II, glomus intramedullary AVM; type III, juvenile malformations; and type IV, perimedullary AVF. In general, complete obliteration of the fistula is a key for better outcome in type I dural and type IV perimedullary AVFs. On the other hand, in type II glomus and type III juvenile malformations, functional preservation, instead of pursuing angiographical cure, is the main goal of the treatment. In such cases, reduction of the shunt flow can alleviate clinical symptoms. Proper management of spinal AVM should start with neurological examination and understanding of angioarchitectures, which provide critical information that guides the indication and modality of intervention. Finally, close collaboration of the microsurgical and endovascular teams are mandatory for successful treatment. PMID:26948701

  18. High-Resolution Angioscopic Imaging During Endovascular Neurosurgery

    PubMed Central

    McVeigh, Patrick Z.; Sacho, Raphael; Weersink, Robert A.; Pereira, Vitor M.; Kucharczyk, Walter; Seibel, Eric J.; Wilson, Brian C.

    2014-01-01

    BACKGROUND: Endoluminal optical imaging, or angioscopy, has not seen widespread application during neurointerventional procedures, largely as a result of the poor imaging resolution of existing angioscopes. Scanning fiber endoscopes (SFEs) are a novel endoscopic platform that allows high-resolution video imaging in an ultraminiature form factor that is compatible with currently used distal access endoluminal catheters. OBJECTIVE: To test the feasibility and potential utility of high-resolution angioscopy with an SFE during common endovascular neurosurgical procedures. METHODS: A 3.7-French SFE was used in a porcine model system to image endothelial disruption, ischemic stroke and mechanical thrombectomy, aneurysm coiling, and flow-diverting stent placement. RESULTS: High-resolution, video-rate imaging was shown to be possible during all of the common procedures tested and provided information that was complementary to standard fluoroscopic imaging. SFE angioscopy was able to assess novel factors such as aneurysm base coverage fraction and side branch patency, which have previously not been possible to determine with conventional angiography. CONCLUSION: Endovascular imaging with an SFE provides important information on factors that cannot be assessed fluoroscopically and is a novel platform on which future neurointerventional techniques may be based because it allows for periprocedural inspection of the integrity of the vascular system and the deployed devices. In addition, it may be of diagnostic use for inspecting the vascular wall and postprocedure device evaluation. ABBREVIATIONS: CFB, coherent fiber bundle F, French SFE, scanning fiber endoscope PMID:24762703

  19. Endovascular and Surgical Treatment of Spinal Dural Arteriovenous Fistulas: Assessment of Post-treatment Clinical Outcome

    PubMed Central

    ZOGOPOULOS, Panagiotis; NAKAMURA, Hajime; OZAKI, Tomohiko; ASAI, Katsunori; IMA, Hiroyuki; KIDANI, Tomoki; KADONO, Yoshinori; MURAKAMI, Tomoaki; FUJINAKA, Toshiyuki; YOSHIMINE, Toshiki

    2016-01-01

    Spinal dural arteriovenous fistulas (DAVFs) are the most commonly encountered vascular malformation of the spinal cord and a treatable cause of progressive para- or tetraplegia. It is an elusive pathology that tends to be under-diagnosed, due to lack of awareness among clinicians, and affects males more commonly than females, typically between the fifth and eighth decades. Early diagnosis and treatment may significantly improve outcome and prevent permanent disability and even mortality. The purpose of our retrospective, single-center study was to determine the long-term clinical and radiographic outcome of patients who have received endovascular or surgical treatment of a spinal DAVF. In particular, during a 6-year period (2009–2014) 14 patients with a spinal DAVF were treated at our department either surgically (n = 4) or endovascularly (n = 10) with detachable coils and/or glue. There was no recurrence in the follow-up period (mean: 36 months, range 3–60 months) after complete occlusion with the endovascular treatment (n = 9; 90%), while only one patient (10%) had residual flow both post-treatment and at 3-month follow-up. All four surgically treated patients (100%) had no signs of residual DAVF on follow-up magnetic resonance angiography (MRA) and/or angiography (mean follow-up period of 9 months). Since improvement or stabilization of symptoms may be seen even in patients with delayed diagnosis and substantial neurological deficits, either endovascular or surgical treatment is always justified. PMID:26466887

  20. Endovascular embolization of carotid-cavernous fistulas: A pioneering experience in Peru

    PubMed Central

    Plasencia, Andres R.; Santillan, Alejandro

    2012-01-01

    Background: Endovascular embolization represents the method of choice for the treatment of carotid-cavernous fistulas (CCFs). Methods: We report our experience using the endovascular technique in 24 patients harboring 25 CCFs treated between October 1994 and April 2010, with an emphasis on the role of detachable balloons for the treatment of direct CCFs. Results: Of the 16 patients who presented with direct CCFs (Barrow Type A CCFs) (age range, 7–62 years; mean age, 34.3 years), 14 were caused by traumatic injury and 2 by a ruptured internal carotid artery (ICA) aneurysm. Eight patients (age range, 32–71 years; mean age, 46.5 years) presented with nine indirect CCFs (Barrow Types B, C, and D). The clinical follow-up after endovascular treatment ranged from 2 to 108 months (mean, 35.2 months). In two cases (8%), the endovascular approach failed. Symptomatic complications related to the procedure occurred in three patients (12.5%): transient cranial nerve palsy in two patients and a permanent neurological deficit in one patient. Detachable balloons were used in 13 out of 16 (81.3%) direct CCFs and were associated with a cure rate of 92.3%. Overall, the angiographic cure rate was obtained in 22 out of 25 (88%) fistulas. Patients presenting with III nerve palsy improved gradually between 1 day and 6 months after treatment. Good clinical outcomes [modified Rankin scale (mRS) ≤ 2] were observed in 22 out of 24 (91.6%) patients at last follow-up. Conclusions: Endovascular treatment using detachable balloons still constitutes a safe and effective method to treat direct carotid-cavernous fistulas. PMID:22363900

  1. Treatment of acute limb ischemia with focus on endovascular techniques.

    PubMed

    Zeller, T; Tepe, G

    2009-05-01

    Acute limb ischemia is still the most frequent cause of major limb loss. Timely and fast revascularization is the key for limb salvage and patient survival. Large randomized trials showed equivalency of surgical and endovascular revascularization by means of local lysis with urokinase (TOPAS, STILE). New lytic agents and their modified application such as via a pulse spray catheter or combined with an ultrasound catheter and the combination with glycoprotein IIb/IIIa receptor antagonists have increased the efficacy and speed of thrombolysis. Recently, mechanical thrombectomy devices have become more widespread because intervention time and bleeding complications can be reduced. This review article summarizes the clinical presentation of and the treatment options for acute arterial occlusive disease caused either by embolism or local thrombosis. PMID:19588300

  2. Imaging diagnosis and the role of endovascular embolization treatment for vascular intraspinal tumors.

    PubMed

    dos Santos, Marlise P; Zhang, Jingwen; Ghinda, Diana; Glikstein, Rafael; Agid, Ronit; Rodesch, Georges; Tampieri, Donatella; terBrugge, Karel G

    2015-08-01

    Intraspinal tumors comprise a large spectrum of neoplasms, including hemangioblastomas, paragangliomas, and meningiomas. These tumors have several common characteristic imaging features, such as highly vascular mass appearance in angiography, hypointense rim and serpentine flow voids in MRI, and intense enhancement after intravenous contrast administration. Due to their rich vascularity, these tumors represent a special challenge for surgical treatment. More recently, the surgical treatment of intraspinal vascular tumors has benefited from the combination of endovascular techniques used to better delineate these lesions and to promote preoperative reduction of volume and tissue blood flow. Endovascular embolization has been proven to be a safe procedure that facilitates the resection of these tumors; hence, it has been proposed as part of the standard of care in their management. PMID:26235014

  3. Endovascular Treatment of AVF after Hair Transplantation

    SciTech Connect

    Dogan, Sozen; Cinar, Celal; Demirpolat, Gulen; Memis, Ahmet

    2008-07-15

    Arteriovenous fistula (AVF) of the scalp is a very rare complication of hair transplantation. Only 9 cases have been reported in nearly half a century. The diagnosis is clinical but angiography is necessary for defining the angioarchitecture of the lesion. Due to technical developments, endovascular embolization has become the primary treatment for AVF of the scalp.

  4. 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.

  5. Endovascular treatment of isolated arterial pulmonary malinosculation

    PubMed Central

    Mammen, Suraj; Keshava, Shyamkumar N; Moses, Vinu; Chiramel, George Koshy; Irodi, Aparna; Gnanamuthu, Birla Roy

    2015-01-01

    We report the endovascular management of a series of four cases of isolated systemic supply to normal lung or isolated arterial pulmonary malinosculation of the left lung. In these cases, the basal segments of the left lung lacked normal pulmonary arterial supply and instead received systemic arterial blood from the descending thoracic aorta. The relevant anatomy and literature are also reviewed. PMID:26288517

  6. Endovascular Treatment of an Aortobronchial Fistula

    SciTech Connect

    Numan, Fueruezan Arbatli, Harun; Yagan, Naci; Demirsoy, Ergun; Soenmez, Binguer

    2004-01-15

    A 67-year-old man operated on 8 years previously for type B aortic dissection presented with two episodes of massive hemoptysis. An aortobronchial fistula was suspected with spiral computed tomography angiography, and showed a small pseudoaneurysm corresponding to the distal anastomotic site. The patient underwent endovascular stent-graft implantation and is asymptomatic 8 months after the procedure.

  7. Surface charge, electroosmotic flow and DNA extension in chemically modified thermoplastic nanoslits and nanochannels.

    PubMed

    Uba, Franklin I; Pullagurla, Swathi R; Sirasunthorn, Nichanun; Wu, Jiahao; Park, Sunggook; Chantiwas, Rattikan; Cho, Yoon-Kyoung; Shin, Heungjoo; Soper, Steven A

    2015-01-01

    Thermoplastics have become attractive alternatives to glass/quartz for microfluidics, but the realization of thermoplastic nanofluidic devices has been slow in spite of the rather simple fabrication techniques that can be used to produce these devices. This slow transition has in part been attributed to insufficient understanding of surface charge effects on the transport properties of single molecules through thermoplastic nanochannels. We report the surface modification of thermoplastic nanochannels and an assessment of the associated surface charge density, zeta potential and electroosmotic flow (EOF). Mixed-scale fluidic networks were fabricated in poly(methylmethacrylate), PMMA. Oxygen plasma was used to generate surface-confined carboxylic acids with devices assembled using low temperature fusion bonding. Amination of the carboxylated surfaces using ethylenediamine (EDA) was accomplished via EDC coupling. XPS and ATR-FTIR revealed the presence of carboxyl and amine groups on the appropriately prepared surfaces. A modified conductance equation for nanochannels was developed to determine their surface conductance and was found to be in good agreement with our experimental results. The measured surface charge density and zeta potential of these devices were lower than glass nanofluidic devices and dependent on the surface modification adopted, as well as the size of the channel. This property, coupled to an apparent increase in fluid viscosity due to nanoconfinement, contributed to the suppression of the EOF in PMMA nanofluidic devices by an order of magnitude compared to the micro-scale devices. Carboxylated PMMA nanochannels were efficient for the transport and elongation of λ-DNA while these same DNA molecules were unable to translocate through aminated nanochannels. PMID:25369728

  8. Effects of fluid flow on elution of hydrophilic modifier from dialysis membrane surfaces.

    PubMed

    Matsuda, Masato; Sato, Mika; Sakata, Hiroki; Ogawa, Takahisa; Yamamoto, Ken-ichiro; Yakushiji, Taiji; Fukuda, Makoto; Miyasaka, Takehiro; Sakai, Kiyotaka

    2008-01-01

    When uremic blood flows through dialyzers during hemodialysis, dialysis membrane surfaces are exposed to shear stress and internal filtration, which may affect the surface characteristics of the dialysis membranes. In the present study, we evaluated changes in the characteristics of membrane surfaces caused by shear stress and internal filtration using blood substitutes: water purified by reverse osmosis and 6.7 wt% dextran70 solution. We focused on the levels of a hydrophilic modifier, polyvinylpyrrolidone (PVP), on the membrane surface measured by attenuated total reflectance Fourier transform infrared spectroscopy. Experiments involving 4 h dialysis, 0-144 h shear-stress loading, and 4 h dead-end filtration were performed using polyester-polymer alloy (PEPA) and polysulfone (PS) membranes. After the dialysis experiments with accompanying internal filtration, average PVP retention on the PEPA membrane surface was 93.7% in all areas, whereas that on the PS membrane surface was 98.9% in all areas. After the shear-stress loading experiments, PVP retention on the PEPA membrane surface decreased as shear-stress loading time and the magnitude of shear stress increased. However, with the PS membrane, PVP retention scarcely changed. After the dead-end filtration experiments, PVP retention decreased in all areas for both PEPA and PS membranes, but PVP retention on the PEPA membrane surface was lower than that on the PS membrane surface. PVP on the PEPA membrane surface was eluted by both shear stress and internal filtration, while that on the PS membrane surface was eluted only by internal filtration. PMID:18836876

  9. Surface Charge, Electroosmotic Flow and DNA Extension in Chemically Modified Thermoplastic Nanoslits and Nanochannels

    PubMed Central

    Uba, Franklin I.; Pullagurla, Swathi R.; Sirasunthorn, Nichanun; Wu, Jiahao; Park, Sunggook; Chantiwas, Rattikan; Cho, Yoonkyoung; Shin, Heungjoo; Soper, Steven A.

    2014-01-01

    Thermoplastics have become attractive alternatives to glass/quartz for microfluidics, but the realization of thermoplastic nanofluidic devices has been slow in spite of the rather simple fabrication techniques that can be used to produce these devices. This slow transition has in part been attributed to insufficient understanding of surface charge effects on the transport properties of single molecules through thermoplastic nanochannels. We report the surface modification of thermoplastic nanochannels and an assessment of the associated surface charge density, zeta potential and electroosmotic flow (EOF). Mixed-scale fluidic networks were fabricated in poly(methylmethacrylate), PMMA. Oxygen plasma was used to generate surface-confined carboxylic acids with devices assembled using low temperature fusion bonding. Amination of the carboxylated surfaces using ethylenediamine (EDA) was accomplished via EDC coupling. XPS and ATR-FTIR revealed the presence of carboxyl and amine groups on the appropriately prepared surfaces. A modified conductance equation for nanochannels was developed to determine their surface conductance and was found to be in good agreement with our experimental results. The measured surface charge density and zeta potential of these devices were lower than glass nanofluidic devices and dependent on the surface modification adopted, as well as the size of the channel. This property, coupled to an apparent increase in fluid viscosity due to nanoconfinement, contributed to the suppression of the EOF in PMMA nanofluidic devices by an order of magnitude compared to the micro-scale devices. Carboxylated PMMA nanochannels were efficient for the transport and elongation of λ-DNA while these same DNA molecules were unable to translocate through aminated nanochannels. PMID:25369728

  10. 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

  11. In vivo feasibility of endovascular Doppler optical coherence tomography

    PubMed Central

    Sun, Cuiru; Nolte, Felix; Cheng, Kyle H. Y.; Vuong, Barry; Lee, Kenneth K. C.; Standish, Beau A.; Courtney, Brian; Marotta, Thomas R.; Mariampillai, Adrian; Yang, Victor X. D.

    2012-01-01

    Feasibility of detecting intravascular flow using a catheter based endovascular optical coherence tomography (OCT) system is demonstrated in a porcine carotid model in vivo. The effects of A-line density, radial distance, signal-to-noise ratio, non-uniform rotational distortion (NURD), phase stability of the swept wavelength laser and interferometer system on Doppler shift detection limit were investigated in stationary and flow phantoms. Techniques for NURD induced phase shift artifact removal were developed by tracking the catheter sheath. Detection of high flow velocity (~51 cm/s) present in the porcine carotid artery was obtained by phase unwrapping techniques and compared to numerical simulation, taking into consideration flow profile distortion by the eccentrically positioned imaging catheter. Using diluted blood in saline mixture as clearing agent, simultaneous Doppler OCT imaging of intravascular flow and structural OCT imaging of the carotid artery wall was feasible. To our knowledge, this is the first in vivo demonstration of Doppler imaging and absolute measurement of intravascular flow using a rotating fiber catheter in carotid artery. PMID:23082299

  12. Endovascular therapy including thrombectomy for acute ischemic stroke: A systematic review and meta-analysis with trial sequential analysis.

    PubMed

    Phan, Kevin; Zhao, Dong Fang; Phan, Steven; Huo, Ya Ruth; Mobbs, Ralph J; Rao, Prashanth J; Mortimer, Alex M

    2016-07-01

    One of the primary strategies for the management of acute ischemic stroke is intravenous (IV) thrombolysis with tissue plasminogen activator (t-PA). Over the past decade, endovascular therapies such as the use of stent retrievers to perform mechanical thrombectomy have been found to improve functional outcomes compared to t-PA alone. We aimed to reassess the functional outcomes and complications of IV thrombolysis with and without endovascular treatment for acute ischemic stroke using conventional meta-analysis and trial sequential analysis. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated for the effect of IV thrombolysis with and without endovascular therapy on functional outcome, mortality and symptomatic intracranial hemorrhage (SICH). Trial sequential analysis was done to strengthen the meta-analysis. We analyzed six randomized controlled trials involving 1943 patients. Patients who received IV thrombolysis with endovascular treatment showed significantly higher rates of excellent functional outcomes (modified Rankin Scale [mRS] 0-1) (RR, 1.75 [95% CI, 1.29-2.39]) compared to those who received IV thrombolysis alone. A similar association was seen for good functional outcomes (mRS 0-2) (RR, 1.56 [95% CI, 1.24-1.96]). Trial sequential analysis demonstrated endovascular treatment increased the RR of a good functional outcome by at least 30% compared to IV thrombolysis alone. There was no significant difference in all-cause mortality for mechanical thrombectomy compared to IV thrombolysis alone or the incidence of SICH at 3month follow-up. Endovascular treatment is more likely to result in a better functional outcome for patients compared to IV thrombolysis alone for acute ischemic stroke. PMID:26947342

  13. Analysis of the effect of older drivers’ driving behaviors on traffic flow based on a modified CA model

    NASA Astrophysics Data System (ADS)

    Jian, Mei-Ying; Shi, Jing; Liu, Yang

    2016-09-01

    As the global population ages, there are more and more older drivers on the road. The decline in driving performance of older drivers may influence the properties of traffic flow and safety. The purpose of this paper is to investigate the effect of older drivers’ driving behaviors on traffic flow. A modified cellular automaton (CA) model which takes driving behaviors of older drivers into account is proposed. The simulation results indicate that older drivers’ driving behaviors induce a reduction in traffic flow especially when the density is higher than 15 vehicles per km per lane and an increase in Lane-changing frequency. The analysis of stability shows that a number of disturbances could frequently emerge, be propagated and eventually dissipate in this modified model. The results also reflect that with the increase of older drivers on the road, the probability of the occurrence of rear-end collisions increases greatly and obviously. Furthermore, the value of acceleration influences the traffic flow and safety significantly. These results provide the theoretical basis and reference for the traffic management departments to develop traffic management measure in the aging society.

  14. 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

  15. Accuracy of Computational Cerebral Aneurysm Hemodynamics Using Patient-Specific Endovascular Measurements

    NASA Astrophysics Data System (ADS)

    McGah, Patrick; Levitt, Michael; Barbour, Michael; Mourad, Pierre; Kim, Louis; Aliseda, Alberto

    2013-11-01

    We study the hemodynamic conditions in patients with cerebral aneurysms through endovascular measurements and computational fluid dynamics. Ten unruptured cerebral aneurysms were clinically assessed by three dimensional rotational angiography and an endovascular guidewire with dual Doppler ultrasound transducer and piezoresistive pressure sensor at multiple peri-aneurysmal locations. These measurements are used to define boundary conditions for flow simulations at and near the aneurysms. The additional in vivo measurements, which were not prescribed in the simulation, are used to assess the accuracy of the simulated flow velocity and pressure. We also performed simulations with stereotypical literature-derived boundary conditions. Simulated velocities using patient-specific boundary conditions showed good agreement with the guidewire measurements, with no systematic bias and a random scatter of about 25%. Simulated velocities using the literature-derived values showed a systematic over-prediction in velocity by 30% with a random scatter of about 40%. Computational hemodynamics using endovascularly-derived patient-specific boundary conditions have the potential to improve treatment predictions as they provide more accurate and precise results of the aneurysmal hemodynamics. Supported by an R03 grant from NIH/NINDS

  16. TEVAR: Endovascular Repair of the Thoracic Aorta

    PubMed Central

    Nation, David A.; Wang, Grace J.

    2015-01-01

    The development of thoracic endovascular aortic repair (TEVAR) has allowed a minimally invasive approach for management of an array of thoracic aortic pathologies. Initially developed specifically for exclusion of thoracic aortic aneurysms, TEVAR is now used as an alternative to open surgery for a variety of disease pathologies due to the lower morbidity of this approach. Advances in endograft technology continue to broaden the applications of this technique. PMID:26327745

  17. Endovascular treatment of frontopolar artery aneurysm.

    PubMed

    Karanam, Lakshmi S Prasanna; Alurkar, Anand; Chakka, Sivaramakrishna

    2016-08-01

    Traumatic intracranial aneurysms are rare and usually present with subarachnoid hemorrhage, intracranial hemorrhage, subdural hematoma, or intraventricular hemorrhage. These are usually not true aneurysms; hence treatment of these cases poses a therapeutic challenge. In this case report, we describe a young Asian male who presented with a ruptured pseudoaneurysm of the distal branch of the anterior cerebral artery. It was treated successfully with endovascular embolization. To our knowledge, there are few reports of this entity in the literature. PMID:27048313

  18. Endovascular Exclusion of Renal Artery Aneurysm

    SciTech Connect

    Andersen, Poul Erik Rohr, Nils

    2005-06-15

    A patient who was operated for an abdominal aortic aneurysm 7 years earlier presented with recently discovered iliac and renal artery aneurysms. The renal artery had an angulation of 90{sup o}, but the aneurysm was successfully excluded using a covered vascular stent graft placed over an extrastiff guidewire. Even in cases of complex anatomy of a renal aneurysm, endovascular treatment should be considered. With development of more flexible and low-profile endoprosthesis with accurate deployment, these have become more usable.

  19. Endovascular Treatment Strategies in Aortoiliac Occlusion

    SciTech Connect

    Ozkan, Ugur Oguzkurt, Levent Tercan, Fahri Gumus, Burcak

    2009-05-15

    The aim of this study was to report our experience in endovascular treatment of total aortoiliac occlusion. Five patients who underwent endovascular recanalization procedures including manual aspiration thrombectomy, balloon angioplasty, and stent placement for total aortoiliac occlusion in a 4-year period were reviewed retrospectively. The mean age of patients was 51 years (range, 43 to 58 years). All patients had abdominal aorta and bilateral common iliac artery occlusion with or without external iliac artery occlusion. All patients either had a contraindication to surgery or refused it. Initial technical success was obtained in four of five (80%) patients. Endovascular techniques were successful in four patients who had good distal runoff and short-segment aortoiliac occlusion, but failed in a patient who had the worst distal runoff and long-segment aortoiliac occlusion. We observed two major complications, one of which was bilateral rupture of the common iliac arteries treated with covered stent placement. Another patient had extension of intra-aortic thrombus into the iliac stent after primary stenting. This was successfully treated with manual aspiration thrombectomy. Aortic and iliac stents remained patent during the follow-up period (median, 18 months; range, 3 to 26 months) in four patients. Primary patency rates at 6, 12, and 24 months were all 80%. In conclusion, endovascular treatment can be an alternative for aortoiliac occlusion in selected patients. Short- to midterm follow-up so far is satisfactory. Removal of intra-aortic thrombus with manual aspiration thrombectomy before balloon angioplasty and/or stenting is possible and a good alternative to thrombolysis.

  20. Endovascular Treatment in Spinal Perimedullary Arteriovenous Fistula

    PubMed Central

    Phadke, Rajendra V; Bhattacharyya, Avik; Handique, Akash; Jain, Krishan; Kumar, Alok; Singh, Vivek; Baruah, Deb; Kumar, Tushant; Patwari, Sriram; Mohan, B.Madan

    2014-01-01

    Summary This study includes 20 patients with 21 spinal perimedullary fistulae. There were nine Type IVa (42.8%) lesions, ten Type IVb (47.6%) and two Type IVc (9.5%) lesions. The dominant arterial supply was from the anterior spinal artery (47.6%), posterior spinal artery (19%) and directly from the radiculomedullary artery (28.5%). Sixteen lesions in 15 patients were treated by endovascular route using n-butyl-2-cyanoacrylate. Endovascular treatment was not feasible in five patients. Of the ten patients with microfistulae, catheterization failed/was not attempted in 40%, complete obliteration of the lesion was seen in 60% but clinical improvement was seen in 40% of patients. Catheterization was feasible in all ten patients with macrofistulae (nine type IVb and two type IVc lesions). Complete obliteration of the lesions was seen in 60% and residue in 30%. Clinical improvement was seen in 80% and clinical deterioration in 10%. In conclusion, endovascular glue embolization is safe and efficacious in type IVb and IVc spinal perimedullary fistulae and should be considered the first option of treatment. It is also feasible in many of the type IVa lesions. PMID:24976100

  1. 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

  2. Photoamperometric flow injection analysis of glucose based on dehydrogenase modified quantum dots-carbon nanotube nanocomposite electrode.

    PubMed

    Ertek, Bensu; Dilgin, Yusuf

    2016-12-01

    In this work, a core-shell quantum dot (QD, ZnS-CdS) was electrodeposited onto multiwalled carbon nanotube modified glassy carbon electrode (ZnS-CdS/MWCNT/GCE) and following glucose dehydrogenase (GDH) was immobilized onto QD modified electrode. The proposed electrode (GDH/ZnS-CdS/MWCNT/GCE) was effectively used for the photoelectrochemical biosensing of glucose in flow injection analysis (FIA) system using a home-made flow cell. Results from cyclic voltammetric and FI amperometric measurements have revealed that GDH/ZnS-CdS/MWCNT/GCE is capable of signaling photoelectrocatalytic activity toward NADH when the surface of enzyme modified electrode was irradiated with a light source (250W Halogen lamp). Thus, photoelectrochemical biosensing of glucose was monitored by recording current-time curve of enzymatically produced NADH at optimized conditions. The biosensor response was found linear over the range 0.010-2.0mM glucose with detection limits of 6.0 and 4.0μM for amperometric and photoamperometric methods, respectively. The relative standard deviations (n=5) for 0.5mM glucose were 5.8% and 3.8% for photoamperometric and amperometric results, respectively. The photoelectrochemical biosensor was successfully applied to the real samples. The results with this biosensor showed good selectivity, repeatability and sensitivity for monitoring glucose in amperometric and photoamperometric FIA studies. PMID:26944347

  3. Electrochemical removal of fluoride from water by PAOA-modified carbon felt electrodes in a continuous flow reactor.

    PubMed

    Cui, Hao; Qian, Yan; An, Hao; Sun, Chencheng; Zhai, Jianping; Li, Qin

    2012-08-01

    A novel poly(aniline-co-o-aminophenol) (PAOA) modified carbon felt electrode reactor was designed and investigated for fluoride removal from aqueous solutions. This reactor design is innovative because it operates under a wider pH range because of coating with a copolymer PAOA ion exchange film. In addition, contaminant mass transfer from bulk solution to the electrode surface is enhanced by the porous carbon felt as an electron-conducting carrier material compared to other reactors. The electrically controlled anion exchange mechanism was investigated by X-ray photoelectron spectroscopy and cyclic voltammetry. The applicability of the reactor in the field was tested through a series of continuous flow experiments. When the flow rate and initial fluoride concentration were increased, the breakthrough curve became sharper, which lead to a decrease in the breakthrough time and the defluoridation capacity of the reactor. The terminal potential values largely influenced fluoride removal by the reactor and the optimal defluoridation efficiency was observed at around 1.2V. The breakthrough capacities were all >10mg/g over a wide pH range (pH 5-9) with an initial fluoride concentration of 10mg/L. Consecutive treatment-regeneration studies over a week (once each day) revealed that the PAOA-modified carbon felt electrode could be effectively regenerated for reuse. The PAOA-modified carbon felt electrode reactor is a promising system that could be made commercially available for fluoride removal from aqueous solutions in field applications. PMID:22595483

  4. 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.

  5. 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.

  6. Noninvasive cerebral oximetry during endovascular therapy for acute ischemic stroke: an observational study.

    PubMed

    Hametner, Christian; Stanarcevic, Predrag; Stampfl, Sibylle; Rohde, Stefan; Veltkamp, Roland; Bösel, Julian

    2015-11-01

    Implementing endovascular stroke care often impedes neurologic assessment in patients who need sedation or general anesthesia. Cerebral near-infrared spectroscopy (NIRS) may help physicians monitor cerebral tissue viability, but data in hyperacute stroke patients receiving endovascular treatment are sparse. In this observational study, the NIRS index regional oxygen saturation (rSO2) was measured noninvasively before, during, and after endovascular therapy via bilateral forehead NIRS optodes. During the study period, 63 patients were monitored with NIRS; 43 qualified for analysis. Before recanalization, 10 distinct rSO2 decreases occurred in 11 patients with respect to time to intubation. During recanalization, two kinds of unilateral rSO2 changes occurred in the affected hemisphere: small peaks throughout the treatment (n=14, 32.6%) and sustained increases immediately after recanalization (n=2, 4.7%). Lower area under the curve 10% below baseline was associated with better reperfusion status (thrombolysis in cerebral infarction ≥ 2b, P=0.009). At the end of the intervention, lower interhemispheric rSO2 difference predicted death within 90 days (P=0.037). After the intervention, higher rSO2 variability predicted poor outcome (modified Rankin scale > 3, P=0.032). Our findings suggest that bi-channel rSO2-NIRS has potential for guiding neuroanesthesia and predicting outcome. To better monitor local revascularization, an improved stroke-specific set-up in future studies is necessary. PMID:26243709

  7. Modeling flows over gravel beds by a drag force method and a modified S-A turbulence closure

    NASA Astrophysics Data System (ADS)

    Zeng, C.; Li, C. W.

    2012-09-01

    A double-averaged Navier-Stokes equations (DANS) model has been developed for depth-limited open channel flows over gravels. Three test cases are used to validate the model: an open-channel flow over a densely packed gravel bed with small-scale uniform roughness (D/d50 ˜ 13, d50 = median diameter of roughness elements, D = water depth), open-channel flows over large-scale sparsely distributed roughness elements (D/Δ ˜ 2.3-8.7, Δ = roughness height) and steep slope gravel-bed river flows with D/d50 ˜ 7-25. Various methods of treatment of the gravel-induced resistance effect have been investigated. The results show that the wall function approach (WFA) is successful in simulating flows over small gravels but is not appropriate for large gravels since the vertical profile of the longitudinal velocity does not follow the logarithmic-linear relationship. The drag force method (DFM) performs better but the non-logarithmic velocity distribution generated by sparsely distributed gravels cannot be simulated accurately. Noting that the turbulence length scale within the gravel layer is governed by the gravel size, the DANS model incorporating the DFM and a modified Spalart-Allmaras (S-A) turbulence closure is proposed. The turbulence length scale parameter in the S-A model is modified to address the change in the turbulence structure within the gravel layer. The computed velocity profiles agree well with the corresponding measured profiles in all cases. Particularly, the model reproduces the S-shape velocity profile for sparsely distributed large size roughness elements. The modeling methodology is robust and can be easily integrated into the existing numerical models.

  8. A new ionic liquid dimethyldinonylammonium bromide as a flow modifier for the simultaneous determination of eight carboxylates by capillary electrophoresis.

    PubMed

    Laamanen, Pirkko-Leena; Busi, Sara; Lahtinen, Manu; Matilainen, Rose

    2005-11-18

    Two new methods of capillary zone electrophoresis based on aqueous phosphate running buffers with UV spectrophotometric detection were developed and optimized for the determination of eight carboxylates as copper complexes. Metalcomplexes are negatively charged, so measurements were made as anion analyses with flow reversal in the capillary. Two flow modifiers were used: a common tetradecyltrimethylammonium bromide (TTAB) and a new ionic liquid dimethyldinonylammonium bromide (DMDNAB). The methods were compared to each other. Better separation was achieved with DMDNAB as the flow modifier. Method development was done using a fused silica capillary (61 cm x 50 microm i.d.). Optimization was done using 95 mmol L(-1) phosphate buffer with TTAB or DMDNAB in the concentration 0.5 mmol L(-1) at pH 7.1. A -20 kV voltage and direct UV detection at 254 nm was used in measurements. In both CE methods all the peaks in the electropherograms were properly separated, the calibration plots gave good correlation coefficients and all eight carboxylates were detected in less than 7.5 min. The two methods were tested with natural water samples and a paper mill sample, and proved to be feasible. PMID:16275297

  9. A modified Green-Ampt model for water infiltration and preferential flow

    NASA Astrophysics Data System (ADS)

    Liu, D.

    2015-12-01

    Preferential flow is significant for its contribution to rapid response to hydrologic inputs at the soil surface and unsaturated zone flow, which is critical for flow generation in rainfall-runoff models. In combination with the diffuse and source-responsive flow equations, a new model for water infiltration that incorporates preferential flow is proposed in this paper. Its performance in estimating soil moisture at the catchment scale was tested with observed water content data from the Elder sub-basin of the South Fork Eel River, located in northern California, USA. The case study shows that the new model can improve the accuracy of soil water content simulation even at the catchment scale. The impacts of preferential flow on rainfall-runoff simulation were tested by the MISDc lumped hydrological model for the Elder River basin. 11 significant floods events, which were defined as having flood peak magnitudes greater than 10 times average discharge during the study period, were employed to assess runoff simulation improvement. The accuracy of the runoff simulation incorporating the preferential flow at the catchment scale improved significantly even though more model parameters were expected through the likelihood ratio test.

  10. Flow injection analysis of phenolic compounds with carbon paste electrodes modified with tyrosinase purchased from different companies

    SciTech Connect

    Lindgren, A.; Emneus, J.; Csoeregi, E.; Gorton, L.; Marko-Varga, G.; Ruzgas, T.

    1996-05-01

    Tyrosinase-modified carbon paste electrodes were prepared using lyophilised powder of the enzyme purchased from different companies. The selectivity of these electrodes for nine phenolic compounds, including six substituted catechols, has been studied. The signals obtained for catechol were always higher than those found for other phenolic compounds. Cyclic voltammetry and flow injection measurements indicated that the response of the tyrosinase-modified carbon paste electrodes was limited by the rate of the enzymatic oxidation of catechols. Different approaches of past electrode preparation have been studied and compared. Direct mixing of enzyme into the graphite powder doped with the osmium based mediator, resulted in the highest sensitivity for the studied substrates. However, substrate selectivity was found to be dependent on the source of enzyme used for electrode preparation.

  11. TRACKING GENE FLOW FROM A GENETICALLY MODIFIED CREEPING BENTGRASS -- METHODS, MEASURES AND LESSONS LEARNED

    EPA Science Inventory

    Creeping bentgrass (CBG) expressing an engineered gene for resistance to glyphosate herbicide is one of the first genetically modified (GM) perennial crops to undergo regulatory review for commercial release by the US Department of Agriculture Animal Plant Health and Inspection S...

  12. A Retrospective Study of Survivors of Endovascular Coiling for Posterior and Anterior Aneurysms

    PubMed Central

    Wilson, Sarah J.; Drackford, Ruth; Holt, Michael

    2015-01-01

    Abstract This article documents the longer-term medical and psychosocial outcomes of patients referred for endovascular coiling. There is limited research investigating outcome following endovascular coiling for posterior compared to anterior circulation aneurysms, and minimal understanding of how medical outcomes relate to patient experiences of treatment and quality of life. We studied a consecutive cohort of 80 patients referred Australia wide for endovascular coiling between 1995 and 2003 (49% posterior; 76% ruptured; 69% women, mean age 51.5 years). We used a mixed methods approach, assessing medical outcome with the Modified Rankin Scale (MRS) in 61 patients (76%), and health-related quality of life and psychosocial functioning using the EuroQol questionnaire and a qualitative semistructured interview in 49 patients (61%). Despite the high proportion of posterior aneurysms, the majority of patients (80%) showed good medical outcomes as indicated by regained independence of activities of daily living (MRS score ≤3). Patients with unruptured aneurysms were significantly more likely to show good outcomes (P < 0.04), whereas aneurysm location (posterior, anterior, or mixed) showed no significant effect. In patients with good medical outcomes, greater functional disability was associated with neurological complications surrounding treatment (P < 0.05). Good outcomes correlated with higher EuroQol ratings (P < 0.001) and the experience of less change after treatment (P < 0.001), although psychosocial adjustment issues were reported by most of the patients, including those with no medical symptoms. These results support the long-term efficacy of endovascular coiling, particularly for posterior circulation aneurysms. They have implications for guiding clinicians and patients in their choice of treatment, as well as the provision of psychological counseling for patient adjustment issues posttreatment. PMID:26266373

  13. Complications of Endovascular Repair of Abdominal Aortic Aneurysms: A Review

    SciTech Connect

    Katzen, Barry T. MacLean, Alexandra A.

    2006-12-15

    The endovascular procedure for repair of abdominal aortic aneurysms has had an enormous impact on the treatment of this challenging disease. Complications, however, do occur and it is important to have a thorough understanding of the array of complications and appropriate management strategies. In this review of endovascular complications, we describe early and late complications paying particular attention to preventive, treatment and surveillance strategies.

  14. Transapical Endovascular Repair of an Ascending Aortic Pseudoaneurysm.

    PubMed

    Howell, Eric; Sweet, Matthew P; Pal, Jay D

    2016-07-01

    Proximal aortic pathology provides a technical challenge for endovascular repair. We present a case of successful transapical endovascular aortic repair in a patient with a proximal suture line pseudoaneurysm who was not a candidate for open surgical repair. doi: 10.1111/jocs.12766 (J Card Surg 2016;31:456-460). PMID:27183897

  15. Probabilistic rainfall thresholds for triggering debris flows in a human-modified landscape

    NASA Astrophysics Data System (ADS)

    Giannecchini, Roberto; Galanti, Yuri; D'Amato Avanzi, Giacomo; Barsanti, Michele

    2016-03-01

    In the Carrara Marble Basin (CMB; Apuan Alps, Italy) quarrying has accumulated widespread and thick quarry waste, lying on steep slopes and invading valley bottoms. The Apuan Alps are one of the rainiest areas in Italy and rainstorms often cause landslides and debris flows. The stability conditions of quarry waste are difficult to assess, owing to its textural, geotechnical and hydrogeological variability. Therefore, empirical rainfall thresholds may be effective in forecasting the possible occurrence of debris flows in the CMB. Three types of thresholds were defined for three rain gauges of the CMB and for the whole area: rainfall intensity-rainfall duration (ID), cumulated event rainfall-rainfall duration (ED), and cumulated event rainfall normalized by the mean annual precipitation-rainfall intensity (EMAPI). The rainfall events recorded from 1950 to 2005 was analyzed and compared with the occurrence of debris flows involving the quarry waste. They were classified in events that triggered one or more debris flows and events that did not trigger debris flows. This dataset was fitted using the logistic regression method that allows us to define a set of thresholds, corresponding to different probabilities of failure (from 10% to 90%) and therefore to different warning levels. The performance of the logistic regression in defining probabilistic thresholds was evaluated by means of contingency tables, skill scores and receiver operating characteristic (ROC) analysis. These analyses indicate that the predictive capability of the three types of threshold is acceptable for each rain gauge and for the whole CMB. The best compromise between the number of correct debris flow predictions and the number of wrong predictions is obtained for the 40% probability thresholds. The results obtained can be tested in an experimental debris flows forecasting system based on rainfall thresholds, and could have implications for the debris flow hazard and risk assessment in the CMB.

  16. [Endovascular stroke treatment following recent positive clinical trials].

    PubMed

    Thomalla, G; Fiehler, J

    2016-04-01

    Recently, five independent randomized controlled clinical trials demonstrated the efficacy and safety of endovascular stroke treatment in stroke patients with occlusion of proximal intracranial arteries. The five trials MR CLEAN, ESCAPE, EXTEND-IA, SWIFT-PRIME and REVASCAT randomized a total of 1287 stroke patients to either standard treatment, which in the majority of patients consisted of intravenous thrombolysis within 4.5 h of symptom onset or additional endovascular stroke treatment. In all the studies endovascular treatment resulted in a better clinical outcome with an odds ratio for a better clinical outcome 90 days after stroke ranging between 1.7 and 3.1 and an absolute increase in the proportion of patients with functionally independent outcome between 14 % and 31 %. The overwhelming benefit of endovascular treatment mainly results from mechanical thrombectomy using stent retriever devices and starting endovascular treatment within 6 h of symptom onset in stroke patients. PMID:26646614

  17. Flow Visualization at Cryogenic Conditions Using a Modified Pressure Sensitive Paint Approach

    NASA Technical Reports Server (NTRS)

    Watkins, A. Neal; Goad, William K.; Obara, Clifford J.; Sprinkle, Danny R.; Campbell, Richard L.; Carter, Melissa B.; Pendergraft, Odis C., Jr.; Bell, James H.; Ingram, JoAnne L.; Oglesby, Donald M.

    2005-01-01

    A modification to the Pressure Sensitive Paint (PSP) method was used to visualize streamlines on a Blended Wing Body (BWB) model at full-scale flight Reynolds numbers. In order to achieve these conditions, the tests were carried out in the National Transonic Facility operating under cryogenic conditions in a nitrogen environment. Oxygen is required for conventional PSP measurements, and several tests have been successfully completed in nitrogen environments by injecting small amounts (typically < 3000 ppm) of oxygen into the flow. A similar technique was employed here, except that air was purged through pressure tap orifices already existent on the model surface, resulting in changes in the PSP wherever oxygen was present. The results agree quite well with predicted results obtained through computational fluid dynamics analysis (CFD), which show this to be a viable technique for visualizing flows without resorting to more invasive procedures such as oil flow or minitufts.

  18. A modified Dodge algorithm for the parabolized Navier-Stokes equation and compressible duct flows

    NASA Technical Reports Server (NTRS)

    Cooke, C. H.

    1981-01-01

    A revised version of Dodge's split-velocity method for numerical calculation of compressible duct flow was developed. The revision incorporates balancing of mass flow rates on each marching step in order to maintain front-to-back continuity during the calculation. The (checkerboard) zebra algorithm is applied to solution of the three dimensional continuity equation in conservative form. A second-order A-stable linear multistep method is employed in effecting a marching solution of the parabolized momentum equations. A checkerboard iteration is used to solve the resulting implicit nonlinear systems of finite-difference equations which govern stepwise transition. Qualitive agreement with analytical predictions and experimental results was obtained for some flows with well-known solutions.

  19. A modified Dodge algorithm for the parabolized Navier-Stokes equations and compressible duct flows

    NASA Technical Reports Server (NTRS)

    Cooke, C. H.; Dwoyer, D. M.

    1983-01-01

    A revised version of Dodge's split-velocity method for numerical calculation of compressible duct flow was developed. The revision incorporates balancing of mass flow rates on each marching step in order to maintain front-to-back continuity during the calculation. The (checkerboard) zebra algorithm is applied to solution of the three dimensional continuity equation in conservative form. A second-order A-stable linear multistep method is employed in effecting a marching solution of the parabolized momentum equations. A checkerboard iteration is used to solve the resulting implicit nonlinear systems of finite-difference equations which govern stepwise transition. Qualitative agreement with analytical predictions and experimental results was obtained for some flows with well-known solutions. Previously announced in STAR as N82-16363

  20. A modified Rusanov scheme for shallow water equations with topography and two phase flows

    NASA Astrophysics Data System (ADS)

    Mohamed, Kamel; Benkhaldoun, F.

    2016-06-01

    In this work, we introduce a finite volume method for numerical simulation of shallow water equations with source terms in one and two space dimensions, and one-pressure model of two-phase flows in one space dimension. The proposed method is composed of two steps. The first, called predictor step, depends on a local parameter allowing to control the numerical diffusion. A strategy based on limiters theory enables to control this parameter. The second step recovers the conservation equation. The scheme can thus be turned to order 1 in the regions where the flow has a strong variation, and order 2 in the regions where the flow is regular. The numerical scheme is applied to several test cases in one and two space dimensions. This scheme demonstrates its well-balanced property, and that it is an efficient and accurate approach for solving shallow water equations with and without source terms, and water faucet problem.

  1. A modified dodge algorithm for the parabolized Navier-Stokes equations and compressible duct flows

    NASA Technical Reports Server (NTRS)

    Cooke, C. H.

    1981-01-01

    A revised version of a split-velocity method for numerical calculation of compressible duct flow was developed. The revision incorporates balancing of mass flow rates on each marching step in order to maintain front-to-back continuity during the calculation. The (checkerboard) zebra algorithm is applied to solution of the three-dimensional continuity equation in conservative form. A second-order A-stable linear multistep method is employed in effecting a marching solution of the parabolized momentum equations. A checkerboard successive overrelaxation iteration is used to solve the resulting implicit nonlinear systems of finite-difference equations which govern stepwise transition.

  2. The imaging assessment and specific endograft design for the endovascular repair of ascending aortic dissection

    PubMed Central

    Zhang, Yepeng; Tang, Hanfei; Zhou, JianPing; Liu, Zhao; Liu, Changjian; Qiao, Tong; Zhou, Min

    2016-01-01

    Background Endovascular option has been proposed for a very limited and selected number of Stanford type A aortic dissection (TAAD) patients. We have performed a computed tomography (CT)-based TAAD study to explore appropriate endograft configurations for the ascending aortic pathology. Methods TAAD patients treated with optimal CT scans were retrospectively reviewed, and their entry tears (ETs) were identified using three-dimensional and multiplanar reconstructions in an EndoSize workstation. After generating a centerline of flow, measurements, including numerous morphologic characteristics of anatomy, were evaluated and a selected subset of patients were determined to be suitable for endovascular treatments. Proximal diameter and distal diameter of endograft were selected based on diameters measured at the ET level and at the innominate artery (IA) level, with 10% oversizing with respect to the true lumen, but not exceeding the original aortic diameter. The length of the endograft was determined by the distance from the sinotubular junction to IA. Results This study covered 126 TAAD patients with primary ET in ascending aorta, among which, according to the assumed criteria, 48 (38.1%) patients were deemed to be suitable for endovascular treatment. The diameters of ascending aorta from the sinotubular junction to the IA level presented a downward trend, and the proximal diameters differed significantly from distal diameters of the endograft for TAAD (39.9 versus 36.2 mm, P<0.01), implying that the conical endograft might be compatible with the ascending pathology. In the ascending aorta, lengths of the endograft should be 50, 60, 70, 80, and 90 mm in five (10.4%), 22 (45.9%), 13 (27.1%), six (12.5%), and two (4.2%) patients, respectively. Conclusion In this selected number of Chinese patients, the suitability of endovascular repair has been demonstrated based on the CT imaging. Shorter, larger, and bare spring-free conical endografts were preferred in the

  3. 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

  4. Endovascular Laser Therapy for Varicose Veins

    PubMed Central

    2010-01-01

    back pain and arthritis. Lower limb VV is a common disease affecting adults and estimated to be the seventh most common reason for physician referral in the US. There is a strong familial predisposition to VV with the risk in offspring being 90% if both parents affected, 20% when neither is affected, and 45% (25% boys, 62% girls) if one parent is affected. Globally, the prevalence of VV ranges from 5% to 15% among men and 3% to 29% among women varying by the age, gender and ethnicity of the study population, survey methods and disease definition and measurement. The annual incidence of VV estimated from the Framingham Study was reported to be 2.6% among women and 1.9% among men and did not vary within the age range (40-89 years) studied. Approximately 1% of the adult population has a stasis ulcer of venous origin at any one time with 4% at risk. The majority of leg ulcer patients are elderly with simple superficial vein reflux. Stasis ulcers are often lengthy medical problems and can last for several years and, despite effective compression therapy and multilayer bandaging are associated with high recurrence rates. Recent trials involving surgical treatment of superficial vein reflux have resulted in healing and significantly reduced recurrence rates. Endovascular Laser Therapy for VV ELT is an image-guided, minimally invasive treatment alternative to surgical stripping of superficial venous reflux. It does not require an operating room or general anesthesia and has been performed in outpatient settings by a variety of medical specialties including surgeons (vascular or general), interventional radiologists and phlebologists. Rather than surgically removing the vein, ELT works by destroying, cauterizing or ablating the refluxing vein segment using heat energy delivered via laser fibre. Prior to ELT, colour-flow Doppler ultrasonography is used to confirm and map all areas of venous reflux to devise a safe and effective treatment plan. The ELT procedure involves the

  5. Wake flow pattern modified by small control cylinders at low Reynolds number

    NASA Astrophysics Data System (ADS)

    Kuo, C.-H.; Chiou, L.-C.; Chen, C.-C.

    2007-08-01

    Passive wake control behind a circular cylinder in uniform flow is studied by numerical simulation for ReD ranging from 80 to 300. Two small control cylinders, with diameter d/D=1/8, are placed at x/D=0.5 and y/D=±0.6. Unlike the 1990 results of Strykowski and Sreenivasan, in the present study, the vortex street behind the main cylinder still exists but the fluctuating lift and the form drag on the main cylinder reduces significantly and monotonously as the Reynolds number increases from 80 to 300. Obstruction of the control cylinders to the incoming flow deflects part of the fluid to pass through the gap between the main and control cylinders, forming two symmetric streams. These streams not only eliminate the flow separation along the rear surface of the main cylinder, they also merge toward the wake centerline to create an advancing momentum in the immediate near-wake region. These two effects significantly reduce the wake width behind the main cylinder and lead to monotonous decrease of the form drag as the Reynolds number increases. As the Reynolds number gets higher, a large amount of the downstream advancing momentum significantly delays the vortex formation farther downstream, leading to a more symmetric flow structure in the near-wake region of the main cylinder. As the Reynolds number increases from 80 to 300, both increasing symmetry of the flow structure in the near-wake and significant delay of the vortex formation are the main reasons for the fluctuating lift to decrease monotonously.

  6. Total endovascular repair of aberrant left subclavian artery with Kommerell's diverticulum using a customized branched device.

    PubMed

    Silveira, Pierre Galvagni; Franklin, Rafael Narciso; Cunha, Josué Rafael Ferreira; Neves, Thais Torres; Nascimento, Gilberto Galego; Bortoluzzi, Cristiano Torres

    2013-04-01

    We describe a case of Kommerell's diverticulum involving the distal portion of a right-sided aortic arch and the origin of an aberrant left subclavian artery (LSA). The patient underwent a total endovascular repair with the use of a modified Valiant endograft (Medtronic, Minneapolis, Minn) to which a branch was attached to keep LSA patency. Postoperative computed tomography showed complete exclusion of the lesion, without endoleaks. The use of "customized off-label" devices to treat special conditions was feasible in this case, keeping patency of the LSA without risk of arm claudication or the requirement for a complementary surgical bypass. PMID:23312832

  7. Radiological Evaluation and Endovascular Treatment of Hemoptysis.

    PubMed

    Ramírez Mejía, Alex Roberto; Méndez Montero, José Vicente; Vásquez-Caicedo, Marco Leyva; Bustos García de Castro, Ana; Cabeza Martínez, Beatriz; Ferreirós Domínguez, Joaquín

    2016-01-01

    Hemoptysis can be a life-threatening condition that warrants urgent investigation and intervention. Common causes include bronchiectasis, chronic obstructive pulmonary disease, tuberculosis, and malignancy. Computed tomography angiography is an accurate imaging modality for assessment of hemoptysis. The bronchial arteries are the source of bleeding in most cases of hemoptysis, and bronchial artery embolization is the treatment of choice. The aim of this article is to summarize the pathophysiology, causes, initial management, and diagnostic approach of hemoptysis. Endovascular treatment of hemoptysis, technique, embolic materials, outcomes, complications, and follow-up of patients are discussed. PMID:26293972

  8. Endovascular revascularization for aortoiliac atherosclerotic disease

    PubMed Central

    Aggarwal, Vikas; Waldo, Stephen W; Armstrong, Ehrin J

    2016-01-01

    Atherosclerotic iliac artery disease is increasingly being treated with endovascular techniques. A number of new stent technologies can be utilized with high long-term patency, including self-expanding stents, balloon-expandable stents, and covered stents, but comparative data on these stent types and in more complex lesions are lacking. This article provides a review of currently available iliac stent technologies, as well as complex procedural aspects of iliac artery interventions, including approaches to the treatment of iliac bifurcation disease, long segment occlusions, choice of stent type, and treatment of iliac artery in-stent restenosis. PMID:27099509

  9. Endovascular Techniques in Limb Salvage: Stents

    PubMed Central

    El-Sayed, Hosam F.

    2013-01-01

    In patients with critical limb ischemia, the first-line approach for limb salvage has shifted over the past decade from bypass surgery to endovascular intervention. Stenting for the treatment of lower-extremity arterial occlusive disease is an important tool and continues to evolve, with new stent designs and technologies that have been developed to provide superior patency rates and limb salvage. In this article, we discuss the role of peripheral stenting in the treatment of patients with critical limb ischemia, including a review of the relevant current literature and the future directions of such interventions. PMID:23805339

  10. An efficient modified Gabriel method for triangulating complex fractured media for multiphase flow simulations

    NASA Astrophysics Data System (ADS)

    Mustapha, Hussein; Rouxel-Labbé, Mael; Abbas, Hicham

    2013-10-01

    Fractured reservoirs and aquifers are complex domains where discrete fractures are internal constraining boundaries. The Delaunay triangulation of a fractured medium generally does not conform to the fracture boundaries and recovering the fracture elements may violate the Delaunay empty-circle (2D) criterion, which may lead to a low-quality triangulation. This paper presents a new approach based on the combined Gabriel and Delaunay methods. A modified Gabriel condition of edge-empty-circle is introduced. In a first stage, the fracture edges violating the modified Gabriel criterion are released and then followed by a Delaunay triangulation with the rest of the fracture constraints. The released fracture edges are approximated by the edges of the Delaunay triangles in a postprocessing stage. The final representation of the fractures might be slightly different, but a very accurate solution is always maintained. The method has the capability to generate fine grids and to offer an accurate and good-quality grid. Numerical examples are presented to assess the efficiency of the proposed method.

  11. Modified hydrodynamics in canopies with longitudinal gaps exposed to oscillatory flows

    NASA Astrophysics Data System (ADS)

    El Allaoui, Nazha; Serra, Teresa; Soler, Marianna; Colomer, Jordi; Pujol, Dolors; Oldham, Carolyn

    2015-12-01

    Longitudinal gaps are commonly found in aquatic canopies. While the ecological significance of gaps may be large, we know little about their impact on the hydrodynamics within the canopy. We used laboratory experiments to investigate the effect of longitudinal gaps within canopies exposed to a wave field. In rigid submerged and emergent vegetation, wave velocities were reduced compared to the case without vegetation. Flexible canopies also attenuated waves, but this attenuation was lower than for rigid canopies. The presence of the gap modified the mean current associated with the waves in both the gap and the lateral vegetation. A gap within a canopy of 5% solid plant fraction did not show differences in the wave attenuation between the gap and the lateral vegetation. In contrast, gaps within canopies of 10% solid plant fraction resulted in large differences between the gap and the lateral vegetation. In all the experiments, the effect of a gap within a canopy reduced the wave attenuation within the lateral vegetation adjacent to the gap when compared with a canopy without a gap. In canopies with rigid plants, the lateral vegetation modified the wave attenuation in the nearby gap. In contrast, the lateral flexible vegetation did not produce any effect on the wave attenuation of the adjacent gap. Canopy density, plant height and plant flexibility were critical for determining the hydrodynamics throughout the canopy and in the gap.

  12. Enhanced capabilities and modified users manual for axial-flow compressor conceptual design code CSPAN

    NASA Technical Reports Server (NTRS)

    Glassman, Arthur J.; Lavelle, Thomas M.

    1995-01-01

    Modifications made to the axial-flow compressor conceptual design code CSPAN are documented in this report. Endwall blockage and stall margin predictions were added. The loss-coefficient model was upgraded. Default correlations for rotor and stator solidity and aspect-ratio inputs and for stator-exit tangential velocity inputs were included in the code along with defaults for aerodynamic design limits. A complete description of input and output along with sample cases are included.

  13. MODIFIED CHOKE FLOW CRITERION FOR THE TWO-PHASE TWO-FLUID MODEL

    SciTech Connect

    Suneet Singh; Vincent A. Mousseau

    2009-05-01

    A choked condition exists when mass flow rate becomes independent of the downstream conditions. In other words, no information can propagate in the upstream direction under this condition. The real part of the solution of the characteristic equation for the model represents velocity of the signal propagation and the imaginary part is the growth (or decay) rate of that signal. Therefore, if the real part of these eigenvalues is positive then no signal propagates in the upstream direction (choosing downstream direction to be the positive direction) resulting in the choke flow. In order to develop the choke criterion, a non-dimensional form of the characteristic equation is derived for the standard two-phase two-fluid model. The equation is in the terms of a slip Mach number Ms. It can be shown that the slip Mach number is small for many applications including nuclear reactor safety simulations. The eigenvalues of the characteristic equation are obtained as a power series expansion about the point Ms = 0. These eigenvalues are used to develop a choking criterion for the compressible two-phase flows.

  14. Pressure- and flow-controlled media perfusion differently modify vascular mechanics in lung decellularization.

    PubMed

    da Palma, Renata K; Campillo, Noelia; Uriarte, Juan J; Oliveira, Luis V F; Navajas, Daniel; Farré, Ramon

    2015-09-01

    Organ biofabrication is a potential future alternative for obtaining viable organs for transplantation. Achieving intact scaffolds to be recellularized is a key step in lung bioengineering. Perfusion of decellularizing media through the pulmonary artery has shown to be effective. How vascular perfusion pressure and flow vary throughout lung decellularization, which is not well known, is important for optimizing the process (minimizing time) while ensuring scaffold integrity (no barotrauma). This work was aimed at characterizing the pressure/flow relationship at the pulmonary vasculature and at how effective vascular resistance depends on pressure- and flow-controlled variables when applying different methods of media perfusion for lung decellularization. Lungs from 43 healthy mice (C57BL/6; 7-8 weeks old) were investigated. After excision and tracheal cannulation, lungs were inflated at 10 cmH2O airway pressure and subjected to conventional decellularization with a solution of 1% sodium dodecyl sulfate (SDS). Pressure (PPA) and flow (V'PA) at the pulmonary artery were continuously measured. Decellularization media was perfused through the pulmonary artery: (a) at constant PPA=20 cmH2O or (b) at constant V'PA=0.5 and 0.2 ml/min. Effective vascular resistance was computed as Rv=PPA/V'PA. Rv (in cmH2O/(ml/min)); mean±SE) considerably varied throughout lung decellularization, particularly for pressure-controlled perfusion (from 29.1±3.0 in baseline to a maximum of 664.1±164.3 (p<0.05), as compared with flow-controlled perfusion (from 49.9±3.3 and 79.5±5.1 in baseline to a maximum of 114.4±13.9 and 211.7±70.5 (p<0.05, both), for V'PA of 0.5 and 0.2 ml/min respectively. Most of the media infused to the pulmonary artery throughout decellularization circulated to the airways compartment across the alveolar-capillary membrane. This study shows that monitoring perfusion mechanics throughout decellularization provides information relevant for optimizing the process

  15. Computational method to predict thermodynamic, transport, and flow properties for the modified Langley 8-foot high-temperature tunnel

    NASA Technical Reports Server (NTRS)

    Venkateswaran, S.; Hunt, L. Roane; Prabhu, Ramadas K.

    1992-01-01

    The Langley 8 foot high temperature tunnel (8 ft HTT) is used to test components of hypersonic vehicles for aerothermal loads definition and structural component verification. The test medium of the 8 ft HTT is obtained by burning a mixture of methane and air under high pressure; the combustion products are expanded through an axisymmetric conical contoured nozzle to simulate atmospheric flight at Mach 7. This facility was modified to raise the oxygen content of the test medium to match that of air and to include Mach 4 and Mach 5 capabilities. These modifications will facilitate the testing of hypersonic air breathing propulsion systems for a wide range of flight conditions. A computational method to predict the thermodynamic, transport, and flow properties of the equilibrium chemically reacting oxygen enriched methane-air combustion products was implemented in a computer code. This code calculates the fuel, air, and oxygen mass flow rates and test section flow properties for Mach 7, 5, and 4 nozzle configurations for given combustor and mixer conditions. Salient features of the 8 ft HTT are described, and some of the predicted tunnel operational characteristics are presented in the carpet plots to assist users in preparing test plans.

  16. Computational method to predict thermodynamic, transport, and flow properties for the modified Langley 8-foot high-temperature tunnel

    NASA Astrophysics Data System (ADS)

    Venkateswaran, S.; Hunt, L. Roane; Prabhu, Ramadas K.

    1992-07-01

    The Langley 8 foot high temperature tunnel (8 ft HTT) is used to test components of hypersonic vehicles for aerothermal loads definition and structural component verification. The test medium of the 8 ft HTT is obtained by burning a mixture of methane and air under high pressure; the combustion products are expanded through an axisymmetric conical contoured nozzle to simulate atmospheric flight at Mach 7. This facility was modified to raise the oxygen content of the test medium to match that of air and to include Mach 4 and Mach 5 capabilities. These modifications will facilitate the testing of hypersonic air breathing propulsion systems for a wide range of flight conditions. A computational method to predict the thermodynamic, transport, and flow properties of the equilibrium chemically reacting oxygen enriched methane-air combustion products was implemented in a computer code. This code calculates the fuel, air, and oxygen mass flow rates and test section flow properties for Mach 7, 5, and 4 nozzle configurations for given combustor and mixer conditions. Salient features of the 8 ft HTT are described, and some of the predicted tunnel operational characteristics are presented in the carpet plots to assist users in preparing test plans.

  17. Modified reaction mechanism of aerated n-dodecane liquid flowing over heated metal tubes

    NASA Technical Reports Server (NTRS)

    Reddy, K. T.; Cernansky, N. P.; Cohen, R. S.

    1988-01-01

    The degradation mechanism of the n-dodecane was studied using a modified jet fuel thermal oxidation tester containing a sample withdrawal system as a reaction vessel. The reaction products were identified using gas chromatography and mass spectorometry. The soluble products were found to consist mainly of C5-C10 n-alkanes and 1-alkenes, C7-C10 aldehydes, tetrahydrofuran derivatives, dodecanol and dodecanone isomers, dodecyl hydroperoxide (ROOH) decomposition products, and C24 alkane isomers. The data from the experiments agreed with those of Hazlett et al. (1977). It was found that alkyl peroxide radical reactions dominate in the autooxidation temperature regime (at T not above 300 C); the dominant path is for the alkyl peroxyl radical to react bimolecularly with fuel to yield primarily alkyl hydroperoxides. The alkyl peroxide radical also undergoes self-termination and unimolecular isomerization and decomposition reactions, to yield smaller amounts of C12 alcohol plus ketone products and tetrahydrofuran derivatives, respectively.

  18. A mathematical representation of a modified stagnation flow reactor for MOCVD applications

    NASA Astrophysics Data System (ADS)

    Dilawari, A. H.; Szekely, J.

    1991-02-01

    Computed results are presented describing the behavior of a modified stagnation point reactor for an MOCVD system, employing a showerhead type gas distributor. The principal findings of the work are the following: (a) By this arrangement, it is possible to obtain a very high spatial uniformity in the deposition rate, in cases better than 0.35% for a five inch diameter wafer. (b) Both the absolute values of the gas velocity and the standoff distance were found to play a critical role in affecting the uniformity of the deposition rate. Indeed a small standoff distance was found to be an essential ingredient in obtaining a good spatial uniformity of the deposit. (c) "An upside down" orientation was found to be helpful in minimizing thermal natural convection and a further refinement was found to be possible by imposing a desired radial distribution on the gas inlet velocity profile.

  19. Nanoscale Poiseuille flow and effects of modified Lennard-Jones potential function

    NASA Astrophysics Data System (ADS)

    Toghraie Semiromi, D.; Azimian, A. R.

    2010-08-01

    Numerical simulation of Poiseuille flow of liquid Argon in a nanochannel using the non-equilibrium molecular dynamics simulation (NEMD) is performed. The nanochannel is a three-dimensional rectangular prism geometry where the concerned numbers of Argon atoms are 2,700, 2,550 and 2,400 at 102, 108 and 120 K. Poiseuille flow is simulated by embedding the fluid particles in a uniform force field. An external driving force, ranging from 1 to 11 PN (Pico Newton), is applied along the flow direction to inlet fluid particles during the simulation. To obtain a more uniform temperature distribution across the channel, local thermostating near the wall are used. Also, the effect of other mixing rules (Lorenthz-Berthelot and Waldman-Kugler rules) on the interface structure are examined by comparing the density profiles near the liquid/solid interfaces for wall temperatures 108 and 133 K for an external force of 7 PN. Using Kong and Waldman-Kugler rules, the molecules near the solid walls were more randomly distributed compared to Lorenthz-Berthelot rule. These mean that the attraction between solid-fluid atoms was weakened by using Kong rule and Waldman-Kugler rule rather than the Lorenthz-Berthelot rule. Also, results show that the mean axial velocity has symmetrical distribution near the channel centerline and an increase in external driving force can increase maximum and average velocity values of fluid. Furthermore, the slip length and slip velocity are functions of the driving forces and they show an arising trend with an increase in inlet driving force and no slip boundary condition is satisfied at very low external force (<1 PN).

  20. Interaction of droplet and sidewalls with modified surfaces in a PEMFC gas flow channel

    NASA Astrophysics Data System (ADS)

    Shah, Mihir M.

    A Proton Exchange Membrane Fuel Cell (PEMFC) is a clean and highly efficient way of power generation used primarily for transportation applications. Hydrogen and air are supplied to the fuel cell through gas channels, which also remove liquid water generated in the fuel cell. The clogged channels prevent reactant transport to the electrochemically active sites which comprise one of the channel walls and thus, degrading the performance of the cell. Proper management of the product water is a current topic of research interest in commercialization of fuel cell vehicles. Liquid water, produced as by-product of the fuel cell reaction, can clog the gas channels easily since surface tension of water is significant at this length scale. In a PEMFC channel cross-section, water is assumed to be produced in the channel at the center along the flow axis. This assumption is primarily valid and extensively used for experimental purposes. However in a real PEMFC, the water entry is not constrained at the channel center. Hence, more investigations are made using water entry at channel corner (land region) which resulted in contradicting prior results for the water feature behavior for all relevant PEMFC operating conditions, leading to adverse two-phase flow behavior- including slug blockage and fluctuations at channel end. Very limited research is available to study the effect of gas channel surface modifications on the two-phase flow behavior and local PEMFC performance. In this study, the droplet--sidewall dynamic interactions and two--phase local pressure drop across the water droplet present in a PEMFC channel with trapezoidal geometries with surface modifications are studied. These surface modifications include micro-grooves that possess a hybrid wetting regime that will initiate and guide the water feature at channel ends to eject with general ease. Slugs are reduced to films after ejection and thus channel blockage is avoided overcoming the problems caused by water influx

  1. Experimental Subarachnoid Hemorrhage in Rats: Comparison of Two Endovascular Perforation Techniques with Respect to Success Rate, Confounding Pathologies and Early Hippocampal Tissue Lesion Pattern

    PubMed Central

    Höllig, Anke; Weinandy, Agnieszka; Nolte, Kay; Clusmann, Hans; Rossaint, Rolf; Coburn, Mark

    2015-01-01

    Recently aside from the “classic” endovascular monofilament perforation technique to induce experimental subarachnoid hemorrhage (SAH) a modification using a tungsten wire advanced through a guide tube has been described. We aim to assess both techniques for their success rate (induction of SAH without confounding pathologies) as primary endpoint. Further, the early tissue lesion pattern as evidence for early brain injury will be analyzed as secondary endpoint. Sprague Dawley rats (n=39) were randomly assigned to receive either Sham surgery (n=4), SAH using the “classic” technique (n=18) or using a modified technique (n=17). Course of intracranial pressure (ICP) and regional cerebral blood flow (rCBF) was analyzed; subsequent pathologies were documented either 6 or 24 h after SAH. Hippocampal tissue samples were analyzed via immunohistochemistry and western blotting. SAH-induction, regardless of confounding pathologies, was independent from type of technique (p=0.679). There was no significant difference concerning case fatality rate (classic: 40%; modified: 20%; p=0.213). Successful induction of SAH without collateral ICH or SDH was possible in 40% with the classic and in 86.7% with the modified technique (p=0.008). Peak ICP levels differed significantly between the two groups (classic: 94 +/- 23 mmHg; modified: 68 +/- 19 mmHg; p=0.003). Evidence of early cellular stress response and activation of apoptotic pathways 6 h after SAH was demonstrated. The extent of stress response is not dependent on type of technique. Both tested techniques successfully produce SAH including activation of an early stress response and apoptotic pathways in the hippocampal tissue. However, the induction of SAH with less confounding pathologies was more frequently achieved with the modified tungsten wire technique. PMID:25867893

  2. Triamine-Modified Polyimides Having Improved Processability and Low Melt Flow Viscosity

    NASA Technical Reports Server (NTRS)

    Meador, Michael A. (Inventor); Nguyen, Baochan N. (Inventor); Eby, Ronald K. (Inventor)

    2001-01-01

    Addition-cured polyimides that contain the reaction product of an aromatic triamine or trianhydride analogue thereof, a reactive end group such as 5-norbornene-2, 3-dicarboxylic acid, ester derivatives of 5-norbornene-2, 3-dicarboxylic acid, anhydride derivatives of 5-norbornene-2, 3-dicarboxylic acid, or 4-phenylethynylphthalic anhydride, an aromatic diamine, and a dialkyl ester of an aromatic tetracarboxylic acid. The resultant starlike polyimides; exhibit lower melt flow viscosity than its linear counterparts, providing for improved processability of the polyimide. Also disclosed are methods for the synthesis of these polyimides as well as composite structures formed using these polyimides.

  3. [Endovascular repair for coarctation of the aorta in an adult].

    PubMed

    Hayashi, Jun; Abe, Kazuo; Hata, Masaki; Nagano, Naoko; Hamasaki, Azumi; Suzuki, Kenji

    2013-09-01

    A 27-year-old woman with Turner's syndrome who underwent successful endovascular treatment for coarctation of the aorta is presented. She was admitted to our hospital complaining of upper extremity hypertension. Computed tomography revealed discrete stenosis of the proximal descending aorta and developed collateral circulation. After endovascular repair with a balloon expandable stent, her transcoarctation gradient fell from 44 mmHg preoperatively to less than 10 mmHg. She was discharged with no complications on the 7th postoperative day. Coarctation of the aorta in an adult patient could be safely and effectively managed by endovascular treatment. PMID:24008641

  4. General technical considerations for the endovascular management of cerebral aneurysms.

    PubMed

    Eboli, Paula; Ryan, Robert W; Alexander, Michael J

    2014-07-01

    Cerebral aneurysms pose a threat to patients because of their risk of rupture causing subarachnoid hemorrhage, and the goal of treatment is the exclusion of the aneurysm from the circulation to prevent bleeding (in the case of unruptured aneurysms) or rebleeding. This article analyzes the general technical factors associated with the endovascular treatment of cerebral aneurysms. It discusses issues with transarterial access; imaging of aneurysm size, morphology, and regional anatomy to determine the endovascular plan; the techniques for the major endovascular aneurysm devices; and periprocedural management issues to reduce potential treatment-related complications. PMID:24994079

  5. 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

  6. Endovascular aortic repair: first twenty years.

    PubMed

    Koncar, Igor; Tolić, Momcilo; Ilić, Nikola; Cvetković, Slobodan; Dragas, Marko; Cinara, Ilijas; Kostić, Dusan; Davidović, Lazar

    2012-01-01

    Endovascular aortic/aneurysm repair (EVAR) was introduced into clinical practice at the beginning of the nineties. Its fast development had a great influence on clinicians, vascular surgeons and interventional radiologists, educational curriculums, patients, industry and medical insurance. The aim of this paper is to present the contribution of clinicians and industry to the development and advancement of endovascular aortic repair over the last 20 years. This review article presents the development of EVAR by focusing on the contribution of physicians, surgeons and interventional radiologists in the creation of the new field of vascular surgery termed hybrid vascular surgery, and also the contribution of technological advancement by a significant help of industrial representatives--engineers and their counselors. This article also analyzes studies conducted in order to compare the successfulness of EVAR with up-to-now applied open surgical repair of aortic aneurysms, and some treatment techniques of other aortic diseases. During the first two decades of its development the EVAR method was rapidly progressing and was adopted concurrently with the expansion of technology. Owing to large randomized studies, early and long-term results indicate specific complications of this method, thus influencing further technological improvement and defining risk patients groups in whom the use of the technique should be avoided. Good results are insured only in centers, specialized in vascular surgery, which have on their disposal adequate conditions for solving all complications associated with this method. PMID:23350259

  7. The Endovascular Management of Iliac Artery Aneurysms

    SciTech Connect

    Stroumpouli, Evangelia; Nassef, Ahmed; Loosemore, Tom; Thompson, Matt; Morgan, Robert; Belli, Anna-Maria

    2007-11-15

    Background: Isolated aneurysms of the iliac arteries are uncommon. Previously treated by conventional surgery, there is increasing use of endografts to treat these lesions. Purpose: The purpose of this study was to assess the efficacy, safety, and durability of the stent-grafts for treatment of iliac artery aneurysms (IAAs). The results of endografting for isolated IAAs over a 10-year period were analyzed retrospectively. The treatment methods differed depending on the anatomic location of the aneurysms. Twenty-one patients (1 woman, 20 men) underwent endovascular stent-graft repair, with one procedure carried out under emergency conditions after acute rupture. The mean aneurysm diameter was 4.6 cm.Results:The procedural technical success was 100%. There was zero 30-day mortality. Follow-up was by interval CT scans. At a mean follow-up of 51.2 months, the stent-graft patency rate was 100%. Reintervention was performed in four patients (19%): one patient (4.7%) with a type I endoleak and three patients (14.3%) with type II endoleaks.Conclusion:We conclude that endovascular repair of isolated IAAs is a safe, minimally invasive technique with low morbidity rates. Follow-up results up to 10 years suggest that this approach is durable and should be regarded as a first treatment option for appropriate candidates.

  8. Accuracy of Computational Cerebral Aneurysm Hemodynamics Using Patient-Specific Endovascular Measurements

    PubMed Central

    McGah, Patrick M.; Levitt, Michael R.; Barbour, Michael C.; Morton, Ryan P.; Nerva, John D.; Mourad, Pierre D.; Ghodke, Basavaraj V.; Hallam, Danial K.; Sekhar, Laligam N.; Kim, Louis J.; Aliseda, Alberto

    2013-01-01

    Computational hemodynamic simulations of cerebral aneurysms have traditionally relied on stereotypical boundary conditions (such as blood flow velocity and blood pressure) derived from published values as patient-specific measurements are unavailable or difficult to collect. However, controversy persists over the necessity of incorporating such patient specific conditions into computational analyses. We perform simulations using both endovascular-derived patient-specific and typical literature-derived inflow and outflow boundary conditions. Detailed three-dimensional anatomical models of the cerebral vasculature are developed from rotational angiography data, and blood flow velocity and pressure are measured in situ by a dual-sensor pressure and velocity endovascular guidewire at multiple peri-aneurysmal locations in ten unruptured cerebral aneurysms. These measurements are used to define inflow and outflow boundary conditions for computational hemodynamic models of the aneurysms. The additional in situ measurements which are not prescribed in the simulation are then used to assess the accuracy of the simulated flow velocity and pressure drop. Simulated velocities using patient-specific boundary conditions show good agreement with the guidewire measurements at measurement locations inside the domain, with no bias in the agreement and a random scatter of ≈25%. Simulated velocities using the simplified, literature-derived values show a systematic bias and over-predicted velocity by ≈30% with a random scatter of ≈40%. Computational hemodynamics using endovascularly measured patient-specific boundary conditions have the potential to improve treatment predictions as they provide more accurate and precise results of the aneurysmal hemodynamics than those based on commonly accepted reference values for boundary conditions. PMID:24162859

  9. Reaction-Diffusion Model Simulations relevant to Modified Taylor-Couette Flow in Systems of Varying Length

    NASA Astrophysics Data System (ADS)

    Halmstad, Andrew; Olsen, Thomas; Wiener, Richard

    2006-11-01

    Previously, we have observed a period-doubling cascade to chaos in Modified Taylor-Couette Flow with Hourglass Geometry. Such behavior had been predicted by The Reaction-Diffusion model simulations. The chaotic formation of Taylor-Vortex pair formation was restricted to a very narrow band about the waist of the hourglass. It was suggested that with increasing lengths of systems, the chaotic region would expand. We present a battery of simulations to determine the variation of the size of the chaotic region with length, seeking the transition to spatio- temporal chaos. Richard J. Wiener et al, Phys. Rev. E 55, 5489 (1997). H. Riecke and H.-G. Paap, Europhys. Lett. 14, 1235 (1991).

  10. Protein Adsorption on Chemically Modified Block Copolymer Nanodomains: Influence of Charge and Flow.

    PubMed

    Silverstein, Joshua S; Casey, Brendan J; Kofinas, Peter; Dair, Benita J

    2016-02-01

    Understanding the interactions of biomacromolecules with nanoengineered surfaces is vital for assessing material biocompatibility. This study focuses on the dynamics of protein adsorption on nanopatterned block copolymers (BCPs). Poly(styrene)-block-poly(1,2-butadiene) BCPs functionalized with an acid, amine, amide, or captopril moieties were processed to produce nanopatterned films. These films were characterized using water contact angle measurements and atomic force microscopy in air and liquid to determine how the modification process affected. wettability and swelling. Protein adsorption experiments were conducted under static and dynamic conditions via a quartz crystal microbalance with dissipation. Proteins of various size, charge, and stability were investigated to determine whether their physical characteristics affected adsorption. Significantly decreased contact angles were caused by selective swelling of modified BCP domains. The results indicate that nanopatterned chemistry and experimental conditions strongly impact adsorption dynamics. Depending on the structural stability of the protein, polyelectrolyte surfaces significantly increased adsorption over controls. Further analysis suggested that protein stability may correlate with dissipation versus frequency plots. PMID:27433605

  11. Particle Acceleration in a High Enthalpy Nozzle Flow with a Modified Detonation Gun

    NASA Astrophysics Data System (ADS)

    Henkes, C.; Olivier, H.

    2014-04-01

    The quality of thermal sprayed coatings depends on many factors which have been investigated and are still in scientific focus. Mostly, the coating material is inserted into the spray device as solid powder. The particle condition during the spray process has a strong effect on coating quality. In some cases, higher particle impact energy leads to improved coating quality. Therefore, a computer-controlled detonation gun based spraying device has been designed and tested to obtain particle velocities over 1200 m/s. The device is able to be operated in two modes based on different flow-physical principles. In one mode, the device functions like a conventional detonation gun in which the powder is accelerated in a blast wave. In the other mode, an extension with a nozzle transforms the detonation gun process into an intermittent shock tunnel process in which the particles are accelerated in a high enthalpy nozzle flow with high reservoir conditions. Presented are experimental results of the operation with nozzle in which the device generates very high particle velocities up to a frequency of 5 Hz. A variable particle injection system allows injection of the powder at any point along the nozzle axis to control particle temperature and velocity. A hydrogen/oxygen mixture is used in the experiments. Operation performance and nozzle outflow are characterized by time resolved pressure measurements. The particle conditions inside the nozzle and in the nozzle exit plane are calculated with a quasi-one-dimensional WENO-code of high order. For the experiments, particle velocity is obtained by particle image velocimetry, and particle concentration is qualitatively determined by a laser extinction method. The powders used are WC-Co(88/12), NiCr(80/20), Al2O3, and Cu. Different substrate/powder combinations for varying particle injection positions have been investigated by light microscopy and measurements of microhardness.

  12. Corticosteroid administration modifies ozone-induced increases in sheep airway blood flow

    SciTech Connect

    Gunther, R.A.; Yousef, M.A.; Schelegle, E.S.; Cross, C.E. )

    1992-09-01

    Recently, we have shown that exposure of intubated conscious sheep to 3 to 4 ppm ozone (O3) for 3 h increases bronchial blood flow (Qbr). The purpose of the present study was to assess the potential role of corticosteroids in modulating this increase. Six nasally intubated sheep were exposed to filtered room air, 3.5 ppm O3 on two separate occasions, and 3.5 ppm O3 plus methyl-prednisone, for 3 h. Qbr was measured using a chronically implanted 20 MHz pulsed Doppler flow probe. Qbr, mean aortic pressure, cardiac output, pulmonary artery pressure, arterial blood gases, and core temperature were monitored. After 3 h of 3.5 ppm O3, Qbr increased from 3.2 +/- 0.5 (mean +/- SEM) to 8.5 +/- 1.6 KHz, whereas bronchial vascular resistance (BVR) decreased from the baseline value of 43.6 +/- 8.0 to 15.0 +/- 3 mm Hg/KHz. With corticosteroids, baseline Qbr was 3.2 +/- 0.6 and BVR was 44.2 +/- 9.7; after 3 h of 3.5 ppm O3, Qbr was 3.3 +/- 0.5 KHz and BVR was 39.0 +/- 8.0 mm Hg/KHz. The two 3.5-ppm O3 exposures without corticosteroids were impressively reproducible. Except for Qbr and BVR, no other measured cardiovascular parameters were affected by O3. The results indicate that corticosteroids are capable of interfering with mediator, neurohumoral, or inflammatory cell mechanisms responsible for vasodilation of the airway microcirculation after O3 exposure, but do not specifically address the specific processes whereby this attenuation occurs.

  13. Hyperdynamic sepsis modifies a PEEP-mediated redistribution in organ blood flows

    SciTech Connect

    Bersten, A.D.; Gnidec, A.A.; Rutledge, F.S.; Sibbald, W.J. )

    1990-05-01

    Changes in organ blood flow (Q) produced by 20 cm H2O positive end-expiratory pressure (PEEP) were measured before and after the induction of hyperdynamic sepsis in nine unanesthetized sheep. During the baseline nonseptic study, PEEP was associated with a 9% fall in thermodilution-measured systemic Q, although arterial perfusing pressures were unaffected. Concurrently, microsphere-derived Q was maintained to the brain and heart, but fell to liver, spleen, pancreas, kidney, large intestine, and gastrocnemius. Twenty-four to 36 h after cecal ligation and perforation, a pre-PEEP septic study demonstrated an increase in all of the cardiac index (CI) and systemic O2 delivery when compared with the nonseptic study, whereas whole-body O2 extraction was depressed. Although PEEP depressed systemic Q during the septic study to a greater extent than during the nonseptic study (p less than 0.02), absolute organ Q fell only to pancreas, liver, and spleen. Relative to the simultaneous fall in the CI, Q to some splanchnic organs was not depressed by PEEP to the same magnitude in the septic as in the nonseptic study. When an infusion of Ringer's lactate subsequently restored systemic Q to pre-PEEP septic levels, individual flows that had been depressed by PEEP were not restored. Furthermore, Q-kidney continued to fall, such that the postfluid Q-kidney (-19%) was significantly less than was demonstrated in the pre-PEEP septic study. We postulate that differences noted in the distribution of organ Q between the nonseptic and hyperdynamic septic studies after the application of PEEP were secondary to the vasculopathy of sepsis and/or an alteration in the function of specific organ microcirculations. However, these data do not address whether the changes in organ Q distribution after a PEEP-mediated depression in systemic Q during sepsis significantly restricted tissue DO2.

  14. Determination of Diclofenac on a Dysprosium Nanowire- Modified Carbon Paste Electrode Accomplished in a Flow Injection System by Advanced Filtering

    PubMed Central

    Daneshgar, Parandis; Norouzi, Parviz; Ganjali, Mohammad Reza; Dinarvand, Rasoul; Moosavi-Movahedi, Ali Akbar

    2009-01-01

    A new detection technique called Fast Fourier Transform Square-Wave Voltammetry (FFT SWV) is based on measurements of electrode admittance as a function of potential. The response of the detector (microelectrode), which is generated by a redox processes, is fast, which makes the method suitable for most applications involving flowing electrolytes. The carbon paste electrode was modified by nanostructures to improve sensitivity. Synthesized dysprosium nanowires provide a more effective nanotube-like surface [1-4] so they are good candidates for use as a modifier for electrochemical reactions. The redox properties of diclofenac were used for its determination in human serum and urine samples. The support electrolyte that provided a more defined and intense peak current for diclofenac determination was a 0.05 mol L−1 acetate buffer pH = 4.0. The drug presented an irreversible oxidation peak at 850 mV vs. Ag/AgCl on a modified nanowire carbon paste electrode which produced high current and reduced the oxidation potential by about 100 mV. Furthermore, the signal-to-noise ratio was significantly increased by application of a discrete Fast Fourier Transform (FFT) method, background subtraction and two-dimensional integration of the electrode response over a selected potential range and time window. To obtain the much sensivity the effective parameters such as frequency, amplitude and pH was optimized. As a result, CDL of 2.0 × 10−9 M and an LOQ of 5.0 × 10−9 M were found for the determination for diclofenac. A good recovery was obtained for assay spiked urine samples and a good quantification of diclofenac was achieved in a commercial formulation. PMID:22408485

  15. Instability of electrically-driven MHD flow in a modified cylindrical annulus filled with liquid GaInSn

    NASA Astrophysics Data System (ADS)

    Stelzer, Zacharias; Miralles, Sophie; Cébron, David; Vantieghem, Stijn; Noir, Jérôme; Jackson, Andrew

    2014-05-01

    Planetary magnetic fields such as that of the Earth are thought to be generated by motions of electrically conducting fluids and can be described by the theory of magnetohydrodynamics (MHD). Liquid cores of such astrophysical bodies are dominated by Coriolis and Lorentz forces. Instabilities developing in this magnetostrophic regime are poorly known, numerical studies being far from the actual parameters. We study the destabilization of a flow of liquid GaInSn in a modified cylindrical annulus experimentally and numerically. The flow is driven by the Lorentz force resulting from the injection of a radial electrical current under an imposed axial magnetic field. The novel feature compared to previous studies with similar geometry [Moresco and Alboussière, JFM, 2004] is the form of the electrodes, the inner one being a disk electrode, the outer one a ring electrode. A shear layer, termed the Shercliff layer, develops at the edge of the disk electrode. Using magnetic fields up to 1 T and forcing currents up to 150 A, we reach Hartmann numbers up to 2000 and Reynolds numbers of the order of 10 ^ 5 which are hardly accessible in numerical simulations. We measure the liquid-metal motions by ultrasonic Doppler velocimetry and potential differences. We characterize the flow in terms of a mean flow and fluctuations. Initiating from the Shercliff layer at low forcing currents, we observe mainly monochromatic oscillations that grow in frequency and space with increasing forcing current and magnetic field strength. The threshold of instabilities is dependent on the field strength. For the regime of low Hartmann and Reynolds numbers, we also perform numerical simulations of the flow in our setup using the quasi-static approximation. With 2.5 D finite element modelling, we are able to track the threshold of linear stability for the base flow. First results coincide well with the observations from the lab experiment. Future experiments are currently developed to further

  16. 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.

  17. 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

  18. Rupture and Migration of an Endovascular Stent in the Brachiocephalic Trunk Causing a Vertebral Steal Syndrome

    SciTech Connect

    Periard, D. Haesler, E.; Hayoz, D.; Von Segesser, L. K.; Qanadli, S. D.

    2008-07-15

    Delayed stent fracture has been observed in many different arteries and may represent a risk factor for restenosis. We describe the case of a delayed rupture of an endovascular brachiocephalic trunk stent. The complete fracture allowed a fragment to migrate distally and tilt, resulting in a hemodynamic pattern similar to that of a prevertebral stenosis with complete inversion of the homolateral vertebral blood flow. The induced vertebral steal syndrome as well as the risk of cerebral embolism was corrected by an aortobrachiocephalic bypass and resection of the ruptured stent.

  19. A modified hood infiltrometer to estimate the soil hydraulic properties from the transient water flow measurements

    NASA Astrophysics Data System (ADS)

    Moret-Fernández, D.; González-Cebollada, C.; Latorre, B.; Pérez, V.

    2015-11-01

    In-situ measurements of soil hydraulic properties on covered soil surfaces (i.e. vegetated or residue covered surfaces) are of paramount importance in many agronomic or hydrological researches. These soil parameters are commonly estimated with the tension infiltrometry technique. This paper presents a portable and modified design of the hood infiltrometer (MHI) that, unlike to the original hood infiltrometer, allows estimating the soil hydraulic properties from the transient cumulative infiltration curve. The MHI consists of a water-supply reservoir attaches to a hat-shaped base placed on the soil surface. The base of the hat is closed by a system of sticks and a malleable material ring. To test the viability of this new design, the hydraulic conductivity (Ks) estimated with MHI in a loam soil using the multiple head approach was compared to the corresponding values calculated from the transient infiltration curve analysis. Next, the MHI was tested on three different soils at saturated conditions, and the sorptivity (S) and Ks estimated by the transient infiltration curve analysis were compared to the corresponding values obtained with a disc infiltrometer (DI). An additional field experiment was performed to compare the hydraulic properties measured with MHI on a bare soil and a soil covered with plants. Results demonstrated that this design allows hermetically closing the base of the hat without disturbing the soil surface. The Ks estimated with the multiple head approach was not statistically different (p = 0.61) to that obtained with the transient infiltration curve analysis. No significant differences between the Ks (p = 0.66) and S (p = 0.50) values estimated with DI and MHI were observed. The S values measured with MHI on the covered soil surface were significantly higher than that measured on the adjacent bare soil. These results indicate that MHI can be a viable alternative to estimate the hydraulic properties of covered soils from the measured transient

  20. The evolution of endovascular electroencephalography: historical perspective and future applications.

    PubMed

    Sefcik, Roberta K; Opie, Nicholas L; John, Sam E; Kellner, Christopher P; Mocco, J; Oxley, Thomas J

    2016-05-01

    Current standard practice requires an invasive approach to the recording of electroencephalography (EEG) for epilepsy surgery, deep brain stimulation (DBS), and brain-machine interfaces (BMIs). The development of endovascular techniques offers a minimally invasive route to recording EEG from deep brain structures. This historical perspective aims to describe the technical progress in endovascular EEG by reviewing the first endovascular recordings made using a wire electrode, which was followed by the development of nanowire and catheter recordings and, finally, the most recent progress in stent-electrode recordings. The technical progress in device technology over time and the development of the ability to record chronic intravenous EEG from electrode arrays is described. Future applications for the use of endovascular EEG in the preoperative and operative management of epilepsy surgery are then discussed, followed by the possibility of the technique's future application in minimally invasive operative approaches to DBS and BMI. PMID:27132528

  1. Endovascular Management of an Infected Superficial Femoral Artery Pseudoaneurysm

    SciTech Connect

    Damodharan, Karthik Beckett, David

    2013-10-15

    This article describes an endovascular technique of treating an infected pseudoaneurysm by direct thrombin injection via a catheter placed inside the aneurysm sac while maintaining temporary balloon occlusion of the neck of the false aneurysm.

  2. 21 CFR 870.3460 - Endovascular Suturing System.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... prescription use in accordance with 21 CFR 801.109 of this chapter; and (7) Labeling must bear all information... fixation and sealing between an endovascular graft and the native artery. The system is comprised of...

  3. 21 CFR 870.3460 - Endovascular Suturing System.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... prescription use in accordance with 21 CFR 801.109 of this chapter; and (7) Labeling must bear all information... fixation and sealing between an endovascular graft and the native artery. The system is comprised of...

  4. 21 CFR 870.3460 - Endovascular Suturing System.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... prescription use in accordance with 21 CFR 801.109 of this chapter; and (7) Labeling must bear all information... fixation and sealing between an endovascular graft and the native artery. The system is comprised of...

  5. Endovascular surgery for peripheral arterial occlusive disease. A critical review.

    PubMed Central

    Ahn, S S; Eton, D; Moore, W S

    1992-01-01

    Endovascular surgery is a new multidisciplinary field that applies the recently innovated techniques of angioscopy, intraluminal ultrasound, balloon angioplasty, laser, mechanical atherectomy, and stents. This field can be defined as a diagnostic and therapeutic discipline that uses catheter-based systems to treat vascular disease. As such, it integrates the subspecialties of vascular surgery, interventional radiology, interventional cardiology, and biomedical engineering for the common purpose of improving arterial hemodynamics. Endovascular surgery offers many potential benefits: long incisions are replaced with a puncture wound, the need for postoperative intensive care is significantly reduced, major cardiac and pulmonary complications from general anesthesia are side stepped, and the dollar savings could be dramatic as the need for intensive care unit and in-hospital stay diminishes. Despite these technological advancements, endovascular surgery is still in its infancy and currently has limited applications. This review provides an updated summary of endovascular surgery today and addresses some of the obstacles still preventing its widespread use. PMID:1385944

  6. Biosensing of glucose in flow injection analysis system based on glucose oxidase-quantum dot modified pencil graphite electrode.

    PubMed

    Sağlam, Özlem; Kızılkaya, Bayram; Uysal, Hüseyin; Dilgin, Yusuf

    2016-01-15

    A novel amperometric glucose biosensor was proposed in flow injection analysis (FIA) system using glucose oxidase (GOD) and Quantum dot (ZnS-CdS) modified Pencil Graphite Electrode (PGE). After ZnS-CdS film was electrochemically deposited onto PGE surface, GOD was immobilized on the surface of ZnS-CdS/PGE through crosslinking with chitosan (CT). A pair of well-defined reversible redox peak of GOD was observed at GOD/CT/ZnS-CdS/PGE based on enzyme electrode by direct electron transfer between the protein and electrode. Further, obtained GOD/CT/ZnS-CdS/PGE offers a disposable, low cost, selective and sensitive electrochemical biosensing of glucose in FIA system based on the decrease of the electrocatalytic response of the reduced form of GOD to dissolved oxygen. Under optimum conditions (flow rate, 1.3mL min(-1); transmission tubing length, 10cm; injection volume, 100μL; and constant applied potential, -500mV vs. Ag/AgCl), the proposed method displayed a linear response to glucose in the range of 0.01-1.0mM with detection limit of 3.0µM. The results obtained from this study would provide the basis for further development of the biosensing using PGE based FIA systems. PMID:26592613

  7. Considerations for patients undergoing endovascular abdominal aortic aneurysm repair.

    PubMed

    Ullery, Brant W; Lee, Jason T

    2014-09-01

    Endovascular aneurysm repair has taken over open surgery as the primary strategy for treatment of patients with abdominal and thoracic aneurysms. The minimally invasive nature of these techniques requires alterations in preoperative workup, intraoperative management, and familiarity with unique complications that can occur. Familiarity from the anesthetic standpoint of endovascular techniques, including treatment of patients with fenestrated, chimney, snorkel, and periscope grafts, is necessary for the contemporary cardiac anesthesiologist. PMID:25113729

  8. Detection of thrombosis and restenosis in an endovascular stent

    NASA Astrophysics Data System (ADS)

    Wu, Junru; Weissman, Eric

    2002-05-01

    Endovascular stents that are implanted in an artery are often used in the interventional treatment of coronary artery disease. Its widespread applications are, however, limited by the development of subacute thrombosis (clot forming inside of the stent). Ex vivo experiments with pigs have shown that the broadband A-mode ultrasound is quite effective in detection thrombosis and restenosis in an endovascular stent. [Work supported by BFGoodrich and Noveon, Inc.

  9. Angiographic outcome of endovascular stroke therapy correlated with MR findings, infarct growth, and clinical outcome in the DEFUSE 2 trial

    PubMed Central

    Marks, Michael P.; Lansberg, Maarten G.; Mlynash, Michael; Kemp, Stephanie; McTaggart, Ryan A.; Zaharchuk, Greg; Bammer, Roland; Albers, Gregory W.

    2015-01-01

    Background DEFUSE 2 demonstrated that patients with magnetic resonance imaging mismatch had a favorable clinical response to tissue reperfusion assessed by magnetic resonance imaging. This study reports the endovascular results and correlates angiographic reperfusion with clinical and imaging outcomes. Methods Prospectively enrolled ischemic stroke patients underwent baseline magnetic resonance imaging and started endovascular therapy within 12 h of onset. Patients were classified as either target mismatch or no target mismatch using magnetic resonance imaging. The pre- and postprocedure angiogram was evaluated to determine thrombolysis in cerebral infarction scores. Favorable clinical response was determined at day 30, and good functional outcome was defined as a modified Rankin Scale 0–2 at day 90. Results One-hundred patients had attempted endovascular treatment. At procedure end, 23% were thrombolysis in cerebral infarction 0–1, 31% thrombolysis in cerebral infarction 2A, 28% thrombolysis in cerebral infarction 2B, and 18% thrombolysis in cerebral infarction 3. More favorable thrombolysis in cerebral infarction-reperfusion scores were associated with greater magnetic resonance imaging reperfusion (P < 0·001). thrombolysis in cerebral infarction scores correlated with 30-day favorable clinical response (P = 0·041) and 90-day modified Rankin Scale 0–2 (P = 0·008). These correlations were significant for target mismatch patients at 30 days (P = 0·034) and 90 days (P = 0·003). Infarct growth was strongly associated with poorer thrombolysis in cerebral infarction scores in target mismatch patients (P < 0·001). Patients with thrombolysis in cerebral infarctionnfarction 2A reperfusion had less magnetic resonance imaging reperfusion (P = 0·004) and poorer clinical outcome at 90 days (P = 0·01) compared with thrombolysis in cerebral infarction 2B-3 patients. Conclusion Thrombolysis in cerebral infarction reperfusion following endovascular therapy for

  10. Amino-silica modified Nafion membrane for vanadium redox flow battery

    NASA Astrophysics Data System (ADS)

    Lin, Chien-Hong; Yang, Ming-Chien; Wei, Hwa-Jou

    2015-05-01

    A hybrid membrane of Nafion/amino-silica (amino-SiO2) for vanadium redox flow battery (VRB) systems is prepared via the sol-gel method to improve the selectivity of the Nafion membrane, to reduce the crossover of vanadium ions, and to decrease water transfer across the membranes. The sulfonated pores of the pristine Nafion membrane are filled with amino-SiO2 nanoparticles localized by electrostatic interaction. The permeability of vanadium ions through the Nafion/amino-SiO2 hybrid membrane is determined by electrometric titration. The results indicate the crossover of vanadium ions through the hybrid membrane is 26.8% of the pristine Nafion membrane. The presence of amino-SiO2 in the hybrid membrane is verified by X-ray photoelectron spectroscopy (XPS). Nafion/amino-SiO2 hybrid membrane exhibits through plane conductivity about the same as the pristine Nafion membrane. The ion exchange capacity (IEC) of the hybrid membrane is 9.4% higher than that of the pristine Nafion membrane. In addition, Nafion/amino-SiO2 hybrid membrane exhibits a higher coulombic efficiency (CE), voltage efficiency (VE), and energy efficiency (EE) over a range of current densities from 20 to 80 mA cm-2. The performance of VRB with Nafion/amino-SiO2 hybrid membrane varies little around a charge-discharge current density of 80 mA cm-2 for 150 cycles. Thus, the Nafion/amino-SiO2 hybrid membrane can suppress the vanadium ions crossover in VRB.

  11. Sensor Fish Characterization of Fish Passage Conditions through John Day Dam Spillbay 20 with a Modified Flow Deflector

    SciTech Connect

    Duncan, Joanne P.

    2011-04-29

    Fish passage conditions over a modified deflector in Spillbay 20 at John Day Dam were evaluated by Pacific Northwest National Laboratory for the U.S. Army Corps of Engineers (USACE), Portland District, using Sensor Fish devices. The objectives of the study were to describe and compare passage exposure conditions at two spill discharges, 2.4 and 4.0 thousand cubic feet per second (kcfs), identifying potential fish injury regions within the routes, and to evaluate a low-tailwater condition at the 2.4-kcfs discharge. The study was performed in April 2010 concurrent with HI-Z balloon-tag studies by Normandeau Associates, Inc. Sensor Fish data were analyzed to estimate 1) exposure conditions, particularly exposure to severe collision and shear events; 2) differences in passage conditions between treatments; and 3) relationships to live-fish injury and mortality data estimates. Nearly all Sensor Fish significant events were classified as collisions; the most severe occurred at the gate, on the spillbay chute, or at the deflector transition. Collisions in the gate region were observed only during the 2.4-kcfs discharge, when the tainter gate was open 1.2 ft. One shear event was observed during the evaluation, occurring at the deflector transition during passage at the 2.4-kcfs discharge at low tailwater. Flow quality, computed using the Sensor Fish turbulence index, was best for passage at the low-flow low-tailwater condition as well. The worst flow quality was observed for the 4.0-kcfs test condition. Contrasting the passage exposure conditions, the 2.4-kcfs low-tailwater treatment would be most deleterious to fish survival and well-being.

  12. Endovascular treatment versus medical care alone for ischaemic stroke: systematic review and meta-analysis

    PubMed Central

    Neves, Joana Briosa; Caldeira, Daniel; Ferro, José M; Ferreira, Joaquim J; Costa, João

    2016-01-01

    Objectives To evaluate the efficacy and safety of endovascular treatment, particularly adjunctive intra-arterial mechanical thrombectomy, in patients with ischaemic stroke. Design Systematic review and meta-analysis. Data sources Medline, Embase, Cochrane Central Register of Controlled Trials, Web of Science, SciELO, LILACS, and clinical trial registries from inception to December 2015. Reference lists were crosschecked. Eligibility criteria for selecting studies Randomised controlled trials in adults aged 18 or more with ischaemic stroke comparing endovascular treatment, including thrombectomy, with medical care alone, including intravenous recombinant tissue plasminogen activator (rt-PA). Trial endpoints were functional outcome (modified Rankin scale scores of ≤2) and mortality at 90 days after onset of symptoms. No language or time restrictions applied. Results 10 randomised controlled trials (n=2925) were included. In pooled analysis endovascular treatment, including thrombectomy, was associated with a higher proportion of patients experiencing good (modified Rankin scale scores ≤2) and excellent (scores ≤1) outcomes 90 days after stroke, without differences in mortality or rates for symptomatic intracranial haemorrhage, compared with patients randomised to medical care alone, including intravenous rt-PA. Heterogeneity was high among studies. The more recent studies (seven randomised controlled trials, published or presented in 2015) proved better suited to evaluate the effect of adjunctive intra-arterial mechanical thrombectomy on its index disease owing to more accurate patient selection, intravenous rt-PA being administered at a higher rate and earlier, and the use of more efficient thrombectomy devices. In most of these studies, more than 86% of the patients were treated with stent retrievers, and rates of recanalisation were higher (>58%) than previously reported. Subgroup analysis of these seven studies yielded a risk ratio of 1.56 (95

  13. Characterization of aggregates of surface modified fullerenes by asymmetrical flow field-flow fractionation with multi-angle light scattering detection.

    PubMed

    Astefanei, Alina; Kok, Wim Th; Bäuerlein, Patrick; Núñez, Oscar; Galceran, Maria Teresa; de Voogt, Pim; Schoenmakers, Peter J

    2015-08-21

    Fullerenes are carbon nanoparticles with widespread biomedical, commercial and industrial applications. Attributes such as their tendency to aggregate and aggregate size and shape impact their ability to be transported into and through the environment and living tissues. Knowledge of these properties is therefore valuable for their human and environmental risk assessment as well as to control their synthesis and manufacture. In this work, asymmetrical flow-field flow fractionation (AF4) coupled to multi-angle light scattering (MALS) was used for the first time to study the size distribution of surface modified fullerenes with both polyhydroxyl and carboxyl functional groups in aqueous solutions having different pH (6.5-11) and ionic strength values (0-200mM) of environmental relevance. Fractionation key parameters such as flow rates, flow programming, and membrane material were optimized for the selected fullerenes. The aggregation of the compounds studied appeared to be indifferent to changes in solution pH, but was affected by changes in the ionic strength. Polyhydroxy-fullerenes were found to be present mostly as 4nm aggregates in water without added salt, but showed more aggregation at high ionic strength, with an up to 10-fold increase in their mean hydrodynamic radii (200mM), due to a decrease in the electrostatic repulsion between the nanoparticles. Carboxy-fullerenes showed a much stronger aggregation degree in water (50-100nm). Their average size and recoveries decreased with the increase in the salt concentration. This behavior can be due to enhanced adsorption of the large particles to the membrane at high ionic strength, because of their higher hydrophobicity and much larger particle sizes compared to polyhydroxy-fullerenes. The method performance was evaluated by calculating the run-to-run precision of the retention time (hydrodynamic radii), and the obtained RSD values were lower than 1%. MALS measurements showed aggregate sizes that were in good

  14. Endovascular Management of Sigmoid Sinus Diverticulum

    PubMed Central

    Paramasivam, Srinivasan; Furtado, Sunil; Shigamatsu, Tomoyoshi; Smouha, Eric

    2016-01-01

    Sigmoid sinus diverticulum (SSD) is a rare vascular disorder due to dehiscence of the sigmoid plate. It may be associated with prediverticular venous sinus stenosis (SS) and usually presents as pulsatile tinnitus. The mechanism of development of the SSD and tinnitus from a sinus diverticulum and associated SS is unclear. Previous case reports have suggested that remodeling of the venous system targeting the stenosis, elimination of the diverticulum, or both, have resulted in symptom relief. We present a case of SSD with SS, treated by stenting of the stenosis along with coil embolization of the diverticulum, resulting in complete relief of symptoms. We have also reviewed the literature and discussed the evolution of management from open surgical treatment to endovascular treatment. PMID:27610124

  15. Endovascular approach for ruptured abdominal aortic aneursyms.

    PubMed

    Setacci, F; Sirignano, P; De Donato, G; Chisci, E; Galzerano, G; Cappelli, A; Palasciano, G; Setacci, C

    2010-06-01

    The rupture of an abdominal aortic aneurysm (rAAA) causes about 15000 deaths/year in the USA alone. Even though over the last 50 years progress in surgical techniques and in postoperative intensive care have been outstanding, the analysis of registries has shown either no decrease in the mortality rate for surgically treated rAAAs. Some reports asserted better out come for endovascular repair (EVAR) compared with surgery in case of rAAA. Despite this evidence, EVAR for rAAA remains prerogative of few centers worldwide. In conclusion only larger study or registry could assest the real role of EVAR in the management of rAAA. PMID:20523280

  16. Endovascular Management of Sigmoid Sinus Diverticulum.

    PubMed

    Paramasivam, Srinivasan; Furtado, Sunil; Shigamatsu, Tomoyoshi; Smouha, Eric

    2016-06-01

    Sigmoid sinus diverticulum (SSD) is a rare vascular disorder due to dehiscence of the sigmoid plate. It may be associated with prediverticular venous sinus stenosis (SS) and usually presents as pulsatile tinnitus. The mechanism of development of the SSD and tinnitus from a sinus diverticulum and associated SS is unclear. Previous case reports have suggested that remodeling of the venous system targeting the stenosis, elimination of the diverticulum, or both, have resulted in symptom relief. We present a case of SSD with SS, treated by stenting of the stenosis along with coil embolization of the diverticulum, resulting in complete relief of symptoms. We have also reviewed the literature and discussed the evolution of management from open surgical treatment to endovascular treatment. PMID:27610124

  17. Endovascular image-guided interventions (EIGIs)

    PubMed Central

    Rudin, Stephen; Bednarek, Daniel R.; Hoffmann, Kenneth R.

    2009-01-01

    Minimally invasive interventions are rapidly replacing invasive surgical procedures for the most prevalent human disease conditions. X-ray image-guided interventions carried out using the insertion and navigation of catheters through the vasculature are increasing in number and sophistication. In this article, we offer our vision for the future of this dynamic field of endovascular image-guided interventions in the form of predictions about (1) improvements in high-resolution detectors for more accurate guidance, (2) the implementation of high-resolution region of interest computed tomography for evaluation and planning, (3) the implementation of dose tracking systems to control patient radiation risk, (4) the development of increasingly sophisticated interventional devices, (5) the use of quantitative treatment planning with patient-specific computer fluid dynamic simulations, and (6) the new expanding role of the medical physicist. We discuss how we envision our predictions will come to fruition and result in the universal goal of improved patient care. PMID:18293585

  18. Endovascular Treatment of an Aortoiliac Tuberculous Pseudoaneurysm

    SciTech Connect

    Villegas, Miguel O.; Mereles, Alberto Perez; Tamashiro, Gustavo A.; Dini, Andres E.; Mollon, Ana P.; De Candido, Laura V.; Zelaya, Denis A.; Soledispa-Suarez, Carlos I.; Denato, Sergio; Tamashiro, Alberto; Diaz, Jose A.

    2013-04-15

    We report a rare case of a tuberculous mycotic aortoiliac pseudoaneurysm treated with an endovascular procedure and follow-up of 36 months. The patient was a white 72-year-old man with pulmonary tuberculosis and a former smoker with hypertension, chronic renal failure, and dyslipidemia. A computed tomographic scan of the abdomen and pelvis revealed a left paravertebral cavity with fluid content and involvement of vertebrae L2-L4. After a surgical repair attempt, the patient was treated with the implant of a bifurcated endoprosthesis. Because it is unlikely that any center has extensive experience in the management of this rare manifestation of the disease, we reviewed the literature for similar cases.

  19. Novel temporary endovascular shunt technique to assist in situ fenestration for endovascular reconstruction of the distal aortic arch.

    PubMed

    Xiong, Jiang; Guo, Wei; Liu, Xiaoping; Jia, Xin; Ma, Xiaohui; Wang, Lijun

    2015-07-01

    Thoracic endovascular aortic repair (TEVAR) of arch pathology presents special challenges for revascularization. To obtain an anatomic reconstruction of the arch arteries, in situ fenestration with extra-anatomic bypass has been increasingly used in TEVAR. We report a case involving TEVAR for a pseudoaneurysm at zone 2 of the thoracic aorta in a 37-year-old man with the use of in situ fenestration assisted by a temporary endovascular shunt technique. PMID:24560242

  20. Comparative outcome analysis of anterior choroidal artery aneurysms treated with endovascular coiling or surgical clipping

    PubMed Central

    Aoki, Takachika; Hirohata, Masaru; Noguchi, Kei; Komaki, Satoru; Orito, Kimihiko; Morioka, Motohiro

    2016-01-01

    Background: Treatment of anterior choroidal artery (AChA) aneurysms with endovascular coiling or surgical clipping may increase the risk of ischemic complications owing to the critical territory supplied by the AChA. We analyzed the surgical results of endovascular coiling and surgical clipping for AChA aneurysms performed in a single institution, as well as the role of indocyanine green-videoangiography (ICG-VAG) and motor-evoked potential (MEP). Methods: We analyzed 50 patients (51 aneurysms; 21 men, 29 women; mean age: 58 years) including 25 with subarachnoid hemorrhage treated with endovascular coiling or surgical clipping between April 1990 and October 2013. The complication rates and clinical outcomes of the coil group (mean follow-up: 61 months) and the clip group (mean follow-up: 121 months) were analyzed with a modified Rankin scale. Results: The overall clinical outcome of the coil group (95%) was better than that of the clip group (85%). Especially, the outcomes in the coil group were better in the first investigated period (1990–2007) (P < 0.05). However, after the introduction of ICG-VAG and MEP, the outcomes in the clip group improved significantly (P = 0.005), and treatment-related complications decreased from 20 to 4.7%. Eleven aneurysms (coil group: 8, clip group: 3) showed small neck remnants but no remarkable regrowth, except for 1 case during the mean follow-up period of 91 months. Conclusions: Surgical clipping of AChA aneurysms has become safer because of ICG-VAG and MEP monitoring. Coiling and clipping of AChA aneurysms showed good and comparable outcomes with these monitoring methods.

  1. Endovascular Coil Embolization of Segmental Arteries Prevents Paraplegia After Subsequent TAAA Repair – An Experimental Model

    PubMed Central

    Geisbüsch, S; Stefanovic, A; Koruth, JS; Lin, HM; Morgello, S; Weisz, DJ; Griepp, RB; Di Luozzo, G

    2013-01-01

    Objective To test a strategy for minimizing ischemic spinal cord injury (SCI) following extensive thoracoabdominal aneurysm (TAAA) repair, we occluded a small number of segmental arteries (SAs) endovascularly one week before simulated aneurysm repair in an experimental model. Methods 30 juvenile Yorkshire pigs (25.2±1.7kg) were randomized into three groups. All SAs—intercostal and lumbar—were sacrificed by a combination of surgical ligation of the lumbar SAs and occlusion of intercostal SAs with thoracic endovascular stent grafting (TEVAR). 7–10 days before this simulated TAAA replacement, SAs in the lower thoracic/upper lumbar region were occluded using embolization coils: 1.5±0.5 SAs in Group 1 (T13/L1), and 4.5±0.5 in Group 2 (T11-L3). No SAs were coiled in the controls. Hind limb function was evaluated blindly from daily videotapes using a modified Tarlov score: 0=paraplegia; 9=full recovery. After sacrifice, each segment of spinal cord was graded histologically using the 9-point Kleinman score: 0=normal, 8=complete necrosis. Results Hind limb function remained normal after coil embolization. After simulated TAAA repair, paraplegia occurred in 6/10 control pigs, but only 2/10 pigs in Group 1: no pigs in Group 2 had SCI. Tarlov scores were significantly better in Group 2 (Control vs 1 p=0.06; Control vs 2 p= 0.0002; 1 vs 2 p=0.05). A dramatic reduction in histologic damage—most prominently in the coiled region—was seen when SAs were embolized before simulated TAAA repair. Conclusions Endovascular coiling of 2–4 SAs prevents paraplegia in an experimental model of extensive hybrid TAAA repair, and helps protect the spinal cord from ischemic histopathological injury. A clinical trial in a selected patient population at high risk for postoperative SCI may be appropriate. PMID:24220154

  2. 77 FR 8117 - Medical Devices; Cardiovascular Devices; Classification of the Endovascular Suturing System

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-02-14

    ... fixation and sealing between an endovascular graft and the native artery. The system is comprised of the... provide fixation and sealing between an endovascular graft and the native artery. The system is...

  3. Endovascular Repair of Abdominal Aortic Aneurysm in a Patient with Renal Transplant

    SciTech Connect

    Rao, M.; Arya, N. Lee, B.; Hannon, R.J.; Loan, W.; Soong, C.V.

    2004-09-15

    Patients with functioning renal transplant who develop abdominal aortic aneurysm can safely be treated with endovascular repair. Endovascular repair of aneurysm avoids renal ischemia associated with cross-clamping of aorta.

  4. Separation of silver nanoparticles by hollow fiber flow field-flow fractionation: Addition of tannic acid into carrier liquid as a modifier.

    PubMed

    Saenmuangchin, Rattaporn; Mettakoonpitak, Jaruwan; Shiowatana, Juwadee; Siripinyanond, Atitaya

    2015-10-01

    A homemade hollow fiber flow-field fractionation (Hf-FlFFF) coupled with inductively coupled plasma mass spectrometry (ICP-MS) was set-up for silver nanoparticles (AgNPs) separation by using polysulfone hollow fiber membrane (30,000 MW cutoff) as a separation channel. Tannic acid and citrate stabilized AgNPs were synthesized and introduced into Hf-FlFFF. The effects of carrier liquid and stabilizing agent on retention behavior of AgNPs were investigated. Different elution behaviors were observed as follows: with 0.02% (w/v) FL-70, all of AgNPs were eluted from Hf-FlFFF but differences in retention behaviors were observed for AgNPs with tannic acid and citrate stabilizing agents; and with 30mM TRIS buffer, only tannic acid stabilized AgNPs were eluted from Hf-FlFFF, whereas citrate stabilized AgNPs were not eluted. In this work, tannic acid addition into carrier liquid was proposed to modify the surface of AgNPs and the surface of the membrane, and thereby adjusting the retention behaviors of AgNPs. Various concentrations of tannic acid were added into FL-70 and TRIS buffer. With the use of 0.1mM tannic acid in 30mM TRIS buffer as the carrier liquid, retention behaviors of both tannic acid stabilized- and citrate stabilized-AgNPs were similar and with similar fractionation recovery. PMID:26341593

  5. Beyond the use of modifiers in selective alkyne hydrogenation: silver and gold nanocatalysts in flow mode for sustainable alkene production

    NASA Astrophysics Data System (ADS)

    Vilé, Gianvito; Pérez-Ramírez, Javier

    2014-10-01

    We report on the excellent stereo and chemoselectivity of nanosized silver and gold catalysts in the three-phase hydrogenation of acetylenic compounds under flow chemistry conditions. The materials featuring metal nanoparticles in the range of 2-21 nm were prepared by spray deposition or incipient wetness impregnation of silver nitrate and sol immobilisation of gold chloride on different carriers (Al2O3, SiO2, TiO2, and carbon), followed by activation in various atmospheres. The samples were characterised by ICP-OES, N2 sorption, XPS, HAADF-STEM, and HRTEM, and evaluated in a continuous-flow flooded-bed micro-reactor. Both metals display optimal activities for particles below 5 nm, enabling stable operation at T = 373 K and P = 10 bar. While the performance of the silver catalysts is less influenced by the support, the gold nanoparticles exhibit significant activity only when deposited on TiO2, likely due to the strong metal-support interaction. Hydrogenations of functionalised alkynes reveal that silver and gold match, and in some cases exceed, the selectivity of benchmark palladium-based catalysts. Furthermore, in contrast to Pd, the Ag and Au samples require no modifiers, which brings fundamental and practical simplifications for their understanding and large scale manufacture. Therefore, these materials could be advantageously used for the continuous production of olefinic intermediates in the fine chemical and pharmaceutical industries.We report on the excellent stereo and chemoselectivity of nanosized silver and gold catalysts in the three-phase hydrogenation of acetylenic compounds under flow chemistry conditions. The materials featuring metal nanoparticles in the range of 2-21 nm were prepared by spray deposition or incipient wetness impregnation of silver nitrate and sol immobilisation of gold chloride on different carriers (Al2O3, SiO2, TiO2, and carbon), followed by activation in various atmospheres. The samples were characterised by ICP-OES, N2 sorption

  6. Influence of the Modifier Type and its Concentration on Electroosmotic Flow of the Mobile Phase in Pressurized Planar Electrochromatography.

    PubMed

    Hałka-Grysińska, Aneta; Płocharz, Paweł W; Torbicz, Andrzej; Skwarek, Ewa; Janusz, Władysław; Dzido, Tadeusz H

    2014-01-01

    The aim of this work was to find a relationship between electroosmotic flow (EOF) velocity of the mobile phase in pressurized planar electrochromatography (PPEC) and physicochemical properties like zeta potential, dielectric constant, and viscosity of the mobile phase as well as its composition. The study included different types of organic modifiers (acetonitrile, methanol, ethanol, acetone, formamide, N-methylformamide and N,N-dimethylformamide) in the full concentration range. In all experiments, chromatographic glass plates HPTLC RP-18 W from Merck (Darmstadt) were used as a stationary phase. During the study we found that there is no linear correlation between EOF velocity of the mobile phase and single variables such as zeta potential or dielectric constant or viscosity. However, there is quite strong linear correlation between EOF velocity of the mobile phase and variable obtained by multiplying zeta potential of the stationary phase-mobile phase interface, by dielectric constant of the mobile phase solution and dividing by viscosity of the mobile phase. Therefore, it could be concluded that the PPEC system fulfilled the Helmholtz-Smoluchowski equation. PMID:25067847

  7. On a modified Monte-Carlo method and variable soft sphere model for rarefied binary gas mixture flow simulation

    NASA Astrophysics Data System (ADS)

    Nourazar, S. S.; Jahangiri, P.; Aboutalebi, A.; Ganjaei, A. A.; Nourazar, M.; Khadem, J.

    2011-06-01

    The effect of new terms in the improved algorithm, the modified direct simulation Monte-Carlo (MDSMC) method, is investigated by simulating a rarefied binary gas mixture flow inside a rotating cylinder. Dalton law for the partial pressures contributed by each species of the binary gas mixture is incorporated into our simulation using the MDSMC method and the direct simulation Monte-Carlo (DSMC) method. Moreover, the effect of the exponent of the cosine of deflection angle (α) in the inter-molecular collision models, the variable soft sphere (VSS) and the variable hard sphere (VHS), is investigated in our simulation. The improvement of the results of simulation is pronounced using the MDSMC method when compared with the results of the DSMC method. The results of simulation using the VSS model show some improvements on the result of simulation for the mixture temperature at radial distances close to the cylinder wall where the temperature reaches the maximum value when compared with the results using the VHS model.

  8. Endovascular Treatment of Dural Arteriovenous Fistulas: Single Center Experience

    PubMed Central

    Oh, Jae-Sang; Oh, Hyuk-Jin; Shim, Jai-Joon; Bae, Hack-Gun; Lee, Kyeong-Seok

    2016-01-01

    Objective Treatment of intracranial dural arteriovenous fistulas (dAVFs) remains a challenge. However, after introduction of Onyx, transarterial approach is the preferred treatment option in many centers. We report our experience of dAVFs embolization with special emphasis on transarterial approach. Methods Seventeen embolization procedures were performed in 13 patients with dAVFs between Jan 2009 and Oct 2014. Clinical symptoms, location and type of fistulas, embolization methods, complications, radiological and clinical outcomes were evaluated using charts and PACS images. Results All 13 patients had symptomatic lesions. The locations of fistulas were transverse-sigmoid sinus in 6, middle fossa dura in 4, cavernous sinus in 2, and superior sagittal sinus in 1 patient. Cognard types were as follows : I in 4, IIa in 2, IIa+IIb in 5, and IV in 2. Embolization procedures were performed ≥2 times in 3 patients. Nine patients were treated with transarterial Onyx embolization alone. One of these required direct surgical puncture of middle meningeal artery. Complete obliteration of fistulas was achieved in 11/13 (85%) patients. There were no complications except for 1 case of Onyx migration in cavernous dAVF. Modified Rankin scale score at post-operative 3 months were 0 in 11, and 3 in 2 patients. Conclusion Transarterial Onyx embolization can be a first line therapeutic option in patients with dAVFs. However, transvenous approach should be tried first in cavernous sinus dAVF because of the risk of intracranial migration of liquid embolic materials. Furthermore, combined surgical endovascular approach can be considered as a useful option in inaccessible route. PMID:26885282

  9. [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

  10. A Retrospective Study of Survivors of Endovascular Coiling for Posterior and Anterior Aneurysms: Medical and Patient Perspectives.

    PubMed

    Wilson, Sarah J; Drackford, Ruth; Holt, Michael

    2015-08-01

    This article documents the longer-term medical and psychosocial outcomes of patients referred for endovascular coiling.There is limited research investigating outcome following endovascular coiling for posterior compared to anterior circulation aneurysms, and minimal understanding of how medical outcomes relate to patient experiences of treatment and quality of life.We studied a consecutive cohort of 80 patients referred Australia wide for endovascular coiling between 1995 and 2003 (49% posterior; 76% ruptured; 69% women, mean age 51.5 years). We used a mixed methods approach, assessing medical outcome with the Modified Rankin Scale (MRS) in 61 patients (76%), and health-related quality of life and psychosocial functioning using the EuroQol questionnaire and a qualitative semistructured interview in 49 patients (61%).Despite the high proportion of posterior aneurysms, the majority of patients (80%) showed good medical outcomes as indicated by regained independence of activities of daily living (MRS score ≤3). Patients with unruptured aneurysms were significantly more likely to show good outcomes (P < 0.04), whereas aneurysm location (posterior, anterior, or mixed) showed no significant effect. In patients with good medical outcomes, greater functional disability was associated with neurological complications surrounding treatment (P < 0.05). Good outcomes correlated with higher EuroQol ratings (P < 0.001) and the experience of less change after treatment (P < 0.001), although psychosocial adjustment issues were reported by most of the patients, including those with no medical symptoms.These results support the long-term efficacy of endovascular coiling, particularly for posterior circulation aneurysms. They have implications for guiding clinicians and patients in their choice of treatment, as well as the provision of psychological counseling for patient adjustment issues posttreatment. PMID:26266373

  11. Treatment protocol based on assessment of clot quality during endovascular thrombectomy for acute ischemic stroke using the Trevo stent retriever

    PubMed Central

    Ishikawa, Kojiro; Ohshima, Tomotaka; Nishihori, Masahiro; Imai, Tasuku; Goto, Shunsaku; Yamamoto, Taiki; Nishizawa, Toshihisa; Shimato, Shinji; Kato, Kyozo

    2016-01-01

    ABSTRACT The optional endovascular approach for acute ischemic stroke is unclear. The Trevo stent retriever can be used as first-line treatment for fast mechanical recanalization. The authors developed a treatment protocol for acute ischemic stroke based on the assessment of clot quality during clot removal with the Trevo. This prospective single-center study included all patients admitted for acute ischemic stroke between July 2014 and February 2015, who underwent emergency endovascular treatment. According to the protocol, the Trevo was used for first-line treatment. Immediately after the Trevo was deployed, the stent delivery wire was pushed to open the stent by force (ACAPT technique). Clot quality was assessed on the basis of the perfusion status after deployment of the Trevo; continued occlusion or immediate reopening either reoccluded or maintained after the stent retriever had been in place for 5 min. If there was no obvious clot removal after the first pass with the Trevo, according to the quality of the clot, either a second pass was performed or another endovascular device was selected. Twelve consecutive patients with acute major cerebral artery occlusion were analyzed. Thrombolysis in cerebral infarction score 2b and 3 was achieved in 11 patients (91.7%) and 9 (75%) had a good clinical outcome after 90 days based on a modified Rankin scale score ≤ 2. Symptomatic intracranial hemorrhage occurred in 1 patient (8.3%). The overall mortality rate was 8.3%. Endovascular thrombectomy using the Trevo stent retriever for first-line treatment is feasible and effective. PMID:27578909

  12. Critical early thrombolytic and endovascular reperfusion therapy for acute ischemic stroke victims: a call for adjunct neuroprotection.

    PubMed

    Lapchak, Paul A

    2015-10-01

    Today, there is an enormous amount of excitement in the field of stroke victim care due to the recent success of MR. CLEAN, SWIFT PRIME, ESCAPE, EXTEND-IA, and REVASCAT endovascular trials. Successful intravenous (IV) recombinant tissue plasminogen activator (rt-PA) clinical trials [i.e., National Institute of Neurological Disorders and Stroke (NINDS) rt-PA trial, Third European Cooperative Acute Stroke Study (ECASSIII), and Third International Stroke study (IST-3)] also need to be emphasized. In the recent endovascular and thrombolytic trials, there is statistically significant improvement using both the National Institutes of Health Stroke Scale (NIHSS) and the modified Rankin Score (mRS) scale, but neither approach promotes complete recovery in patients enrolled within any particular NIHSS or mRS score tier. Absolute improvement (mRS 0-2 at 90 days) with endovascular therapy is 13.5-31 %, whereas thrombolytics alone also significantly improve patient functional independence, but to a lesser degree (NINDS rt-PA trial 13 %). This article has 3 main goals: (1) first to emphasize the utility and cost-effectiveness of rt-PA to treat stroke; (2) second to review the recent endovascular trials with respect to efficacy, safety, and cost-effectiveness as a stroke treatment; and (3) to further consider and evaluate strategies to develop novel neuroprotective drugs. A thesis will be put forth so that future stroke trials and therapy development can optimally promote recovery so that stroke victims can return to "normal" life. PMID:26314402

  13. Treatment protocol based on assessment of clot quality during endovascular thrombectomy for acute ischemic stroke using the Trevo stent retriever.

    PubMed

    Ishikawa, Kojiro; Ohshima, Tomotaka; Nishihori, Masahiro; Imai, Tasuku; Goto, Shunsaku; Yamamoto, Taiki; Nishizawa, Toshihisa; Shimato, Shinji; Kato, Kyozo

    2016-08-01

    The optional endovascular approach for acute ischemic stroke is unclear. The Trevo stent retriever can be used as first-line treatment for fast mechanical recanalization. The authors developed a treatment protocol for acute ischemic stroke based on the assessment of clot quality during clot removal with the Trevo. This prospective single-center study included all patients admitted for acute ischemic stroke between July 2014 and February 2015, who underwent emergency endovascular treatment. According to the protocol, the Trevo was used for first-line treatment. Immediately after the Trevo was deployed, the stent delivery wire was pushed to open the stent by force (ACAPT technique). Clot quality was assessed on the basis of the perfusion status after deployment of the Trevo; continued occlusion or immediate reopening either reoccluded or maintained after the stent retriever had been in place for 5 min. If there was no obvious clot removal after the first pass with the Trevo, according to the quality of the clot, either a second pass was performed or another endovascular device was selected. Twelve consecutive patients with acute major cerebral artery occlusion were analyzed. Thrombolysis in cerebral infarction score 2b and 3 was achieved in 11 patients (91.7%) and 9 (75%) had a good clinical outcome after 90 days based on a modified Rankin scale score ≤ 2. Symptomatic intracranial hemorrhage occurred in 1 patient (8.3%). The overall mortality rate was 8.3%. Endovascular thrombectomy using the Trevo stent retriever for first-line treatment is feasible and effective. PMID:27578909

  14. Have Endovascular Procedures Negatively Impacted General Surgery Training?

    PubMed Central

    Grabo, Daniel J.; DiMuzio, Paul J.; Kairys, John C.; McIlhenny, Stephen E.; Crawford, Albert G.; Yeo, Charles J.

    2007-01-01

    Objective: Technological advances in vascular surgery have changed the field dramatically over the past 10 years. Herein, we evaluate the impact of endovascular procedures on general surgery training. Methods: National operative data from the Residency Review Committee for Surgery were examined from 1997 through 2006. Total major vascular operations, traditional open vascular operations and endovascular procedures were evaluated for mean number of cases per graduating chief general surgery resident (GSR) and vascular surgery fellow (VSF). Results: As endovascular surgical therapies became widespread, GSR vascular case volume decreased 34% over 10 years, but VSF total cases increased 78%. GSR experience in open vascular operations decreased significantly, as evidenced by a 52% decrease (P < 0.0001) in elective open AAA repair. VSFs have also seen significant decreases in open vascular procedures. Experience in endovascular procedures has increased for both general surgery and vascular residents, but the increase has been much larger in absolute number for VSFs. Conclusions: GSR experience in open vascular procedures has significantly decreased as technology has advanced within the field. Unlike VSFs, this loss has not been replaced by direct experience with endovascular training. These data demonstrate the impact technology can have on how we currently train general surgeons. New educational paradigms may be necessary in which either vascular surgery as an essential component is abandoned or training in catheter-based interventions becomes required. PMID:17717451

  15. Computational modeling of an endovascular approach to deep brain stimulation

    NASA Astrophysics Data System (ADS)

    Teplitzky, Benjamin A.; Connolly, Allison T.; Bajwa, Jawad A.; Johnson, Matthew D.

    2014-04-01

    Objective. Deep brain stimulation (DBS) therapy currently relies on a transcranial neurosurgical technique to implant one or more electrode leads into the brain parenchyma. In this study, we used computational modeling to investigate the feasibility of using an endovascular approach to target DBS therapy. Approach. Image-based anatomical reconstructions of the human brain and vasculature were used to identify 17 established and hypothesized anatomical targets of DBS, of which five were found adjacent to a vein or artery with intraluminal diameter ≥1 mm. Two of these targets, the fornix and subgenual cingulate white matter (SgCwm) tracts, were further investigated using a computational modeling framework that combined segmented volumes of the vascularized brain, finite element models of the tissue voltage during DBS, and multi-compartment axon models to predict the direct electrophysiological effects of endovascular DBS. Main results. The models showed that: (1) a ring-electrode conforming to the vessel wall was more efficient at neural activation than a guidewire design, (2) increasing the length of a ring-electrode had minimal effect on neural activation thresholds, (3) large variability in neural activation occurred with suboptimal placement of a ring-electrode along the targeted vessel, and (4) activation thresholds for the fornix and SgCwm tracts were comparable for endovascular and stereotactic DBS, though endovascular DBS was able to produce significantly larger contralateral activation for a unilateral implantation. Significance. Together, these results suggest that endovascular DBS can serve as a complementary approach to stereotactic DBS in select cases.

  16. Improving patient selection for endovascular treatment of acute cerebral ischemia: a review of the literature and an external validation of the Houston IAT and THRIVE predictive scoring systems.

    PubMed

    Ishkanian, Amy A; McCullough-Hicks, Margy E; Appelboom, Geoffrey; Piazza, Matthew A; Hwang, Brian Y; Bruce, Samuel S; Hannan, Lindsay M; Connolly, E Sander; Lavine, Sean D; Meyers, Philip M

    2011-06-01

    Outcome after intraarterial therapy (IAT) for acute ischemic stroke remains variable, suggesting that improved patient selection is needed to better identify patients likely to benefit from treatment. The authors evaluate the predictive accuracies of the Houston IAT (HIAT) and the Totaled Health Risks in Vascular Events (THRIVE) scores in an independent cohort and review the existing literature detailing additional predictive factors to be used in patient selection for IAT. They reviewed their center's endovascular records from January 2004 to July 2010 and identified patients who had acute ischemic stroke and underwent IAT. They calculated individual HIAT and THRIVE scores using patient age, admission National Institutes of Health Stroke Scale (NIHSS) score, admission glucose level, and medical history. The scores' predictive accuracies for good outcome (discharge modified Rankin Scale score ≤ 3) were analyzed using receiver operating characteristics analysis. The THRIVE score predicts poor outcome after IAT with reasonable accuracy and may perform better than the HIAT score. Nevertheless, both measures may have significant clinical utility; further validation in larger cohorts that accounts for differences in patient demographic characteristics, variation in time-to-treatment, and center preferences with respect to IAT modalities is needed. Additional patient predictive factors have been reported but not yet incorporated into predictive scales; the authors suggest the need for additional data analysis to determine the independent predictive value of patient admission NIHSS score, age, admission hyperglycemia, patient comorbidities, thrombus burden, collateral flow, time to treatment, and baseline neuroimaging findings. PMID:21631231

  17. Endovascular Treatment of Ruptured Iliac Aneurysm Previously Treated by Endovascular Means

    SciTech Connect

    Dalainas, Ilias Nano, Giovanni; Stegher, Silvia; Bianchi, Paolo; Malacrida, Giovanni; Tealdi, Domenico G.

    2008-03-15

    A patient with a ruptured iliac aneurysm was admitted to the Emergency Department in hypovolemic shock. He had previously undergone surgical treatment for an infrarenal abdominal aortic aneurysm, which was managed with a terminal-terminal Dacron tube graft. Subsequently, he developed two iliac aneurysms, which were treated endovascularly with two wall-grafts in the right and one wall-graft in the left iliac arteries. He suffered chronic renal failure and arterial hypertension. Contrast-enhanced computed tomography showed rupture of the right iliac aneurysm and dislocation of the two wall-grafts. He was treated in an emergency situation with the implantation of an iliac endograft that bridged the two wall-grafts, which resulted in hemostasis and stabilization of his condition. Five days later, in an elective surgical situation, he was treated with the implantation of an aorto-uni-iliac endograft combined with a femoral-femoral bypass. He was discharged 5 days later in good condition. At the 4 year follow-up visit, the endoprosthesis remained in place with no evidence of an endoleak. In conclusion, overlapping of endografts should be avoided, if possible. Strict surveillance of the endovascularly treated patient remains mandatory.

  18. Laser-induced (endo)vascular photothermal effects studied by combined brightfield and fluorescence microscopy in hamster dorsal skin fold venules

    NASA Astrophysics Data System (ADS)

    Bezemer, R.; Heger, M.; van den Wijngaard, J. P. H.; Mordon, S. R.; van Gemert, M. J. C.; Beek, J. F.

    2007-07-01

    The putative features of the (endo)vascular photothermal response, characterized by laser-induced thermal denaturation of blood and vessel wall constituents, have been elucidated individually, but not simultaneously in dynamic, isolated in vivo systems. A hamster dorsal skin fold model in combination with brightfield/fluorescence intravital microscopy was used to examine the effect of laser pulse duration and blood flow velocity on the size of the thermal coagulum, its attachment behavior, and laser-mediated vasomotion. The size of the coagulum and the extent of vasoconstriction and latent vasodilation were proportional to the laser pulse duration, but pulse duration had no effect on coagulum attachment/dislodgement. Blood flow velocity exhibited no significant effect on the studied parameters. The (endo)vascular photothermal response is governed predominantly by laser energy deposition and to a marginal extent by blood flow velocity.

  19. [Endovascular treatment for dural arteriovenous fistula].

    PubMed

    Miyachi, Shigeru

    2008-08-01

    Intracranial dural arteriovenous fistulas (DAVFs) are acquired abnormal epidural arteriovenous shunts, particularly at the sinus wall. Most of the DAVFs are associated with progressive sinus occlusion. They are located in the cavernous sinus, lateral (transverse-sigmoid) sinus, superior-sagittal sinus, anterior condylar confluence, tentorial sinus, craniocervical junction, and anterior skull base (ethmoidal sinus). The treatment strategy differs based on the etiology and drainage pattern of DAVFs. The most effective treatment for DAVFs at the sinus wall is transvenous embolization (TVE) with coils. The target coil packing is effective if the sinus point is identified. Certain cases that are difficult to approach transvenously are treated with transarterial embolization (TAE) by using liquid materials like such glue. In particular cases with sinus occlusive lesion sinus reconstruction with sinoplasty is effective. The cases with failed or impossible endovascular approach should be treated with surgical interruption of shunts or by radiosurgery. The most frequent complication of TAE is brain and nerve ischemia due to the overembolization or migration, and that in TVE is the bleeding due to obstruction of the drainage route and nerve compression due to overpacking of coils. PMID:18717194

  20. Reduction of aneurysm pressure and wall stress after endovascular repair of abdominal aortic aneurysm in a canine model.

    PubMed

    Marston, W A; Criado, E; Baird, C A; Keagy, B A

    1996-03-01

    A canine model was designed to evaluate the changes in abdominal aortic aneurysm (AAA) pressure and wall stress after endovascular repair. Eight canines underwent laparotomy and creation of an AAA. The aneurysm was then excluded with a transluminally placed endovascular graft (TPEG) inserted through the right femoral artery and deployed across the AAA to exclude the infrarenal aortic branches from aortic perfusion. Blood pressure and flow data were recorded for 6 hours. The AAA blood pressure decreased from 135 +/- 9.3 mm Hg before exclusion to 45 +/- 17.6 mm Hg at 10 minutes after exclusion (p < 0.001). At 6 hours, AAA blood pressure had declined further to 26 +/- 12.5 mm Hg. Blood flow in the excluded iliac artery decreased from a baseline of 242 +/- 58 ml/min to 41 +/- 29 ml/min 10 minutes after TPEG placement (p < 0.001). At 6 hours, flow was reduced to 12 +/- 3.5 ml/min (p < 0.05 compared with that at 10 minutes). Aortic wall stress was significantly reduced by TPEG placement but was only slightly lower than baseline aortic wall stress before AAA creation. The lumbar arteries were patent with retrograde flow in all cases and were found to be the major contributors to postexclusion aneurysm pressure. Endovascular AAA exclusion results in an immediate decrease in blood pressure and wall stress within the excluded aneurysm, but the aneurysm remains perfused by retrograde flow through the lumbar arteries, which resulted in near-baseline levels of aneurysm wall stress in this canine model. Embolization of patient lumbar vessels at prosthesis placement may further reduce the risk of late rupture. PMID:8733869

  1. Endovascular recanalization of infrapopliteal occlusions in patients with critical limb ischemia

    PubMed Central

    Singh, Gagan D.; Armstrong, Ehrin J.; Yeo, Khung-Keong; Singh, Satinder; Westin, Gregory G.; Pevec, William C.; Dawson, David L.; Laird, John R.

    2014-01-01

    Background Endovascular therapies are increasingly used for treatment of critical limb ischemia (CLI). Infrapopliteal (IP) occlusions are common in CLI, and successful limb salvage may require restoration of arterial flow in the distribution of a chronically occluded vessel. We sought to describe the procedural characteristics and outcomes of patients with IP occlusions who underwent endovascular intervention for treatment of CLI. Methods All patients with IP interventions for treatment of CLI from 2006 to 2012 were included. Angiographic and procedural data were compared between patients who underwent intervention for IP occlusions vs IP stenosis. Restenosis was determined by Doppler ultrasound imaging. Limb salvage was the primary end point of the study. Additional end points included primary patency, primary assisted patency, secondary patency, occlusion crossing success, procedural success, and amputation-free survival. Results A total of 187 patients with CLI underwent interventions for 356 IP lesions, and 77 patients (41%) had interventions for an IP occlusion. Patients with an intervention for IP occlusion were more likely to have zero to one vessel runoff (83% vs 56%; P < .001) compared with interventions for stenosis. Compared with IP stenoses, IP occlusions were longer (118 ± 86 vs 73 ± 67 mm; P < .001) and had a smaller vessel diameter (2.5 ± 0.8 vs 2.7 ± 0.5 mm; P =.02). Wire crossing was achieved in 83% of IP occlusions, and the overall procedural success for IP occlusions was 79%. The overall 1-year limb salvage rate was 84%. Limb salvage was highest in the stenosis group, slightly lower in the successful occlusion group, and lowest in the failed occlusion group (92% vs 75% vs 58%, respectively; P = .02). Unsuccessfully treated IP occlusions were associated with a significantly higher likelihood of major amputation (hazard ratio, 5.79; 95% confidence interval, 1.89–17.7) and major amputation or death (hazard ratio, 2.69; 95% confidence interval

  2. Emerging Endovascular Therapies for Non-Compressible Torso Hemorrhage.

    PubMed

    Russo, Rachel M; Neff, Lucas P; Johnson, Michael Austin; Williams, Timothy K

    2016-09-01

    Management of non-compressible torso hemorrhage (NCTH) remains a challenge despite continued advancements in trauma resuscitation. Resuscitative thoracotomy with aortic cross-clamping and recent advances in endovascular aortic occlusion, including resuscitative endovascular occlusion of the aorta, have finite durations of therapy due to the inherent physiologic stressors that accompany complete occlusion. Here, we attempt to illuminate the current state of aortic occlusion for trauma resuscitation including explanation of the deleterious consequences of complete occlusion, potential methods and limitations of existing technology to overcome these consequences, and a description of innovative methods to improve the resuscitation of NCTH. By explaining the complexity and potential deleterious effects of resuscitation augmented with aortic occlusion, our goal is to provide practitioners with a real-world perspective on current endovascular technology and to encourage the continued innovation required to overcome existing obstacles. PMID:27172156

  3. Formation, characterization, and flow dynamics of nanostructure modified sensitive and selective gas sensors based on porous silicon

    NASA Astrophysics Data System (ADS)

    Ozdemir, Serdar

    Nanopore covered microporous silicon interfaces have been formed via an electrochemical etch for gas sensor applications. Rapid reversible and sensitive gas sensors have been fabricated. Both top-down and bottom-up approaches are utilized in the process. A nano-pore coated micro-porous silicon surface is modified selectively for sub-ppm detection of NH3, PH3 , NO, H2S, SO2. The selective depositions include electrolessly generated SnO2, CuxO, Au xO, NiO, and nanoparticles such as TiO2, MgO doped TiO 2, Al2O3, and ZrO2. Flow dynamics are analyzed via numerical simulations and response data. An array of sensors is formed to analyze mixed gas response. A general coating selection method for chemical sensors is established via an extrapolation on the inverse of the Hard-Soft Acid-Base concept. In Chapter 1, the current state of the porous silicon gas sensor research is reviewed. Since metal oxide thin films, and, recently, nanowires are dominantly used for sensing application, the general properties of metal oxides are also discussed in this chapter. This chapter is concluded with a discussion about commercial gas sensors and the advantages of using porous silicon as a sensing material. The PS review discussed at the beginning of this chapter is an overview of the following publication: (1) "The Potential of Porous Silicon Gas Sensors", Serdar Ozdemir, James L. Gole, Current Opinion in Solid State and Materials Science, 11, 92-100 (2007). In Chapter 2, porous silicon formation is explained in detail. Interesting results of various silicon anodization experiments are discussed. In the second part of this chapter, the microfabrication process of porous silicon conductometric gas sensors and gas testing set up are briefly introduced. In chapter 3, metal oxide nanoparticle/nanocluster formation and characterization experiments via SEM and XPS analysis are discussed. Chapter 4 is an overview of the test results for various concentrations NH3, NO, NO2 and PH3. The

  4. [Repeat endovascular interventions after transjugular intrahepatic portosystemic shunt (tips) procedures].

    PubMed

    Shipovskiĭ, V N; Tsitsiashvili, M Sh; Saakian, A M; Monakhov, D V; Khuan, Ch; Nechaev, A I

    2010-01-01

    The authors share their experience with transjugular intrahepatic portosystemic shunt (TIPS) procedures preformed in a total of fifty-nine patients diagnosed with and hence operated on for class B and C hepatocirrhosis (according to the Child-Turcotte-Pugh classification), portal hypertension, grade 3 varicosely dilated oesophageal veins, or ascites. Of these, there were 12 women and 47 men (average age 56.3 years). Three types of stents were used: matrix stents (PERICO), self-expanding (ZA-stents, OptiMedsinus-SuperFlex- Visualstents, Zilverstents, SMART), and coated self-expanding stents (Gore Viatorr TIPS Endoprosthesis). Six (11 %) TIPS procedures ended in failure. Of the remaining 53 successful TIPS attempts, thirteen patients developed an in-stent thrombosis at various terms postoperatively, with one patient having experienced it twice Within four postoperative days, thrombosis occurred in three patients, at terms varying from one month to three months in five patients, and from 6 to 12 months in a further five patients. More often thromboses were encountered with the matrix stents (n = 3) 23.0% (PERICO) and self-expanding stents (n = 8) in 61.0% (OptiMed sinus-SuperFlex-Visual). Thromboses were clinically manifested by oesophageal variceal haemorrhage. An in-stent thrombosis was confirmed by means of ultrasonographic duplex scanning (lack of arterial blood flow). The primary stent patency rate following TIPS procedures amounted to 67%. with the secondary assisted graft patency rate equalling 89%. Restoration of the stent's lumen after TIPS procedures by means of endovascular recanalization, rheolytic thrombectomy, balloon angioplasty, and a stent-in-stent technique appears to be a minimally invasive, rather efficient method and virtually the only way to preserve the stent's patency. This technique makes it possible to decrease the rate of recurrent oesophageal variceal haemorrhage. PMID:21032871

  5. Pregnancy with a ruptured renal artery aneurysm: management concerns and endovascular management.

    PubMed

    Yadav, Siddharth; Sharma, Sanjay; Singh, Prabhjot; Nayak, Brusabhanu

    2015-01-01

    Renal artery aneurysm (RAA) affects <0.01% of the general population. Rupture of RAA is a rare catastrophe that can complicate pregnancy and is associated with high maternal and fetal mortality. Presentation is usually acute with severe flank pain, with or without haematuria, and haemodynamic instability requiring exploration and nephrectomy. A 26-year-old pregnant woman had sudden onset of gross haematuria and on evaluation was found to have a left RAA with an intrapelvic rupture and thinned out renal parenchyma. In view of the high risk of surgery, she was managed with endovascular placement of an Amplatzer type II vascular plug. Immediate and complete occlusion of blood flow was achieved and nephrectomy was avoided. Follow-up Doppler ultrasound revealed a reduced 5 cm mass in the left renal fossa with no internal flow and plug in position. She is currently on follow-up with 3-6 monthly ultrasonography not requiring any intervention. PMID:26504094

  6. Endovascular management of six simultaneous intracranial dural arteriovenous fistulas in a single patient

    PubMed Central

    Gist, Taylor L; Rangel-Castilla, Leonardo; Krishna, Chandan; Roman, Gustavo C; Cech, David A; Diaz, Orlando

    2013-01-01

    A 64-year-old man with a history of traumatic brain injury 4 years previously presented with progressive cognitive decline and gait abnormality. MRI revealed diffusion restriction in the bilateral centrum semiovale and multiple serpiginous flow voids. Cerebral angiogram revealed a total of six intracranial dural arteriovenous fistulas with separate fistulas of the right and left sphenoid bones, left clival plexus, right transverse sinus, right sigmoid sinus, and superior sagittal sinus. A diffuse pseudophlebitic pattern of venous drainage indicating severe venous hypertension was also observed. The patient underwent a series of endovascular treatments over the next 10 months to achieve resolution of all arteriovenous shunting. Repeat MRI showed resolution of the diffusion restriction and marked reduction in T2 vascular flow voids. The patient's clinical status improved significantly over the course of treatment, paralleling the improvement in venous hypertension. PMID:23475992

  7. 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

  8. 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

  9. Endovascular treatments for posterior cerebral artery aneurysms and vascular insufficiency of fetal-type circulation after parent artery occlusion.

    PubMed

    Matsumura, Hideaki; Kato, Noriyuki; Fujiwara, Yusuke; Hosoo, Hisayuki; Yamazaki, Tomosato; Yasuda, Susumu; Matsumura, Akira

    2016-10-01

    We present a retrospective analysis of endovascular treatments for posterior cerebral artery (PCA) aneurysms and discuss the susceptibility of a fetal-type PCA to vascular insufficiency after parent artery occlusion. Among 1207 aneurysms treated with endovascular therapy between March 1997 and March 2013 in our institution, 10 patients (0.8%) presented PCA aneurysms. The principal strategy was to employ selective coil embolization for the aneurysm. However, in certain cases of fusiform or dissecting aneurysms, we performed parent artery occlusion with coils. Clinical and radiological data were collected from hospital charts and evaluated retrospectively. The mean age was 52.7±15.6years (range, 12-65years). Five patients (50%) were admitted with a subarachnoid hemorrhage, and one patient presented with slowly developing paralysis. The remaining four patients were diagnosed incidentally. Five patients underwent selective coil embolization, and five patients underwent parent artery occlusion. All endovascular therapies were successfully performed. However, two patients in the parent artery occlusion group suffered cerebral infarction, and both patients exhibited a fetal-type PCA. The remaining three patients in the parent artery occlusion group exhibited an adult-type PCA and did not suffer a cerebral infarction. Endovascular treatment with either selective coil embolization or parent artery occlusion is safe and effective as the long as the anatomical type of the PCA is considered. Patients with a fetal-type PCA may develop vascular insufficiency upon parent artery occlusion. Neurosurgeons should attempt to preserve the parent artery using a flow-diverting stent or stent-assisted technique for a fetal-type PCA aneurysm. PMID:27523585

  10. Anesthesia for Endovascular Approaches to Acute Ischemic Stroke.

    PubMed

    Avitsian, Rafi; Machado, Sandra B

    2016-09-01

    Involvement of the Anesthesiologist in the early stages of care for acute ischemic stroke patient undergoing endovascular treatment is essential. Anesthetic management includes the anesthetic technique (general anesthesia vs sedation), a matter of much debate and an area in need of well-designed prospective studies. The large numbers of confounding factors make the design of such studies a difficult process. A universally agreed point in the endovascular management of acute ischemic stroke is the importance of decreasing the time to revascularization. Hemodynamic and ventilatory management and implementation of neuroprotective modalities and treatment of acute procedural complications are important components of the anesthetic plan. PMID:27521194