Publications by authors named "Geoffrey Gilling-Smith"
Purpose: To determine whether the introduction of a policy of adjunctive stent insertion based on preoperative CT assessment or completion angiography reduced the incidence of limb occlusion after stent-graft implantation for endovascular aneurysm repair (EVAR).
Methods: A tertiary referral unit's endovascular database was retrospectively interrogated to compare the incidence of endograft limb occlusion in Zenith grafts following the introduction of a policy of selective adjunctive stent insertion. Group A included 288 limbs at risk in 146 patients (134 men; mean age 74+/-8 years) treated prior to August 2005 in whom adjunctive stents were inserted on an ad hoc basis only.
Purpose: To investigate in an in vitro model the ability of different covered and uncovered stents to resist displacement/migration of a fenestrated stent-graft.
Methods: Three different types (2 covered, 1 bare) of commonly used 7-mm balloon-expandable stainless steel stents (Jostent, Advanta V12, and Palmaz Genesis) were investigated in a testing rig consisting of 2 overlapping tubes with 2 sets of 7-mm holes representing bilateral renal artery fenestrations and ostia. The rig was attached to a tensile tester via pneumatic clamps.
Purpose: To determine whether fenestrated stent-grafts provide better stability to resist migration than standard non-fenestrated stent-grafts.
Methods: Truncated fenestrated stent-grafts with a single fenestration were deployed in bovine aortic segments with a side branch. Balloon-expandable stents were then delivered into the branches.
This article reports the investigation and treatment of 24 women presenting with recurrent lower limb varicosities secondary to reflux within the pelvic venous circulation. Diagnosis based on selective retrograde pelvic phlebography enabled precise identification and classification of sites of incompetence. A total of 74 veins were treated by embolization with platinum coils and glue prior to repeat surgery to the lower limb veins.
View Article and Find Full Text PDFPurpose: To measure the tensile strength of the aneurysm wall and the matrix metalloproteinase (MMP) activity in similar samples of aortic tissue.
Methods: Detailed mechanical testing was conducted on 124 standardized specimens of aneurysm wall harvested from 24 patients undergoing elective aneurysm repair. The intrasac pressure required to cause aneurysm rupture was calculated based upon the Law of Laplace.
Purpose: To demonstrate the influence of radiographic positioning on the assessment of stent-graft migration using plain radiographs following endovascular abdominal aortic aneurysm repair.
Methods: Equations were derived to correct for artifactual stent-graft migration introduced by geometric distortion due to variations in positioning between radiographs acquired at different times. A phantom system was used to validate the equations.
Purpose: To determine if pressure measured at a single location within aneurysm sac thrombus accurately reflects the force applied to the aneurysm wall and the risk of rupture by examining (1) if pressure is distributed uniformly within aneurysm thrombus, (2) the pressure transmission through aneurysm thrombus, and (3) the microstructural basis for pressure transmission.
Methods: Pressure within aneurysm thrombus was measured by direct puncture through the aneurysm wall at 121 sites in 26 patients during open abdominal aortic aneurysm repair. Measurements were taken prior to cross clamping and compared with intrasac pressure measured at 30 sites in 6 patients without aneurysm thrombus (controls).
Purpose: To investigate the effect on intrasac pressure of stent-graft deployment within a life-size silicone rubber model of an abdominal aortic aneurysm (AAA) maintained under physiological conditions of pressure and flow.
Methods: A commercial bifurcated device with the polyester fabric preclotted with gelatin was deployed in the AAA model. A pump system generated physiological flow.
Purpose: To determine aneurysm neck diameter change after endovascular repair (EVR) of abdominal aortic aneurysm (AAA) and its relationship to stent-graft diameter.
Materials And Methods: The cases of 73 patients with AAAs who underwent EVR were reviewed retrospectively: 68 had preoperative imaging available. Neck diameter was reviewed by a single observer (M.
Objective: Endoleaks and endotension are critically important complications of some endovascular aortic aneurysm repairs (EVARs). For the resolution of controversial issues and the determination of areas of uncertainty relating to these complications, a conference of 27 interested leaders was held on November 20, 2000.
Methods: These 27 participants (21 vascular surgeons, five interventional radiologists, one cardiologist) had previously answered 40 key questions on endoleaks and endotension.
Purpose: To compare unenhanced and enhanced ultrasound imaging to biphasic computed tomography (CT) in the detection of endoleak after endovascular abdominal aortic aneurysm (AAA) repair.
Methods: Fifty-three patients (44 men; mean age 70 years) were examined during 96 follow-up visits after endovascular AAA repair. All patients had color Doppler and power Doppler ultrasound studies performed before and after the administration of an ultrasound contrast agent.