Abdominal wall hernia repair: use of the Gianturco-Helfrich-Eberbach hernia mesh.

A new polyester hernia mesh (Gianturco-Helfrich-Eberbach) is introduced for laparoscopic repair of the abdominal wall and groin hernias. The device incorporates the optional use of an internal wire to form a circular shape. A detachable carrier is used, permitting easy, accurate preperitoneal placement.

New Gianturco-Grifka vascular occlusion device. Initial studies in a canine model.

Background: Transcatheter closure of cardiovascular defects remains a challenge. Several occlusion devices are available, but each device has limitations. The purpose of this study was to evaluate the new Gianturco-Grifka vascular occlusion device (GGVOD) in a canine model.

Placement of covered self-expanding metallic stents in the common bile duct: a feasibility study.

Purpose: Gianturco self-expanding metallic stents have been useful in cases of benign biliary stenoses; however, the stents have not worked well in the presence of intraluminal tumor because of tumor growth between the wire struts. Stents were covered with polymeric membranes, which may prevent tumor ingrowth, and the feasibility of using these covered stents in the common bile duct was studied in healthy adult dogs.

Materials And Methods: Initially, stents (10 x 6 mm) covered with polycaprolactone (PCL), segmented polyether polyurethane (SPP), and silicone were placed in the common bile duct of dogs and were followed up for 3-12 months.

Occlusive effect of metallic stents on canine ureters.

A three-part study, with successive modifications based on preceding results, was conducted to evaluate ureteral placement of metallic stents. Gianturco self-expanding (10 mm and 4 mm diameter) and balloon-expanded (4 mm diameter) metallic stents were placed in normal and stenotic canine ureters. No migration or ureteral perforation occurred during the follow-up of 10 mm stents.

Treatment of experimentally induced atherosclerosis in swine iliac arteries: a comparison of self-expanding and balloon-expanded stents.

Atherosclerosis was induced in 20 Hanford miniature swine. Subsequently, one iliac artery lesion in each of 16 pigs was stented with either a self-expanding (8 pigs) or a balloon-expanded (8 pigs) stent. Immediately after stent placement, 4 animals in each group were taken off the atherogenic diet and continued on normal chow for the remainder of the study.

Use of the Gianturco self-expanding stent in stenoses of the superior and inferior venae cavae.

Twenty-eight patients with severe superior and inferior vena cava syndromes were treated with self-expandable Gianturco stents. Nineteen patients responded, seven did not respond, and two were unevaluable. Fourteen of the 19 who responded had complete or near complete resolution of their syndrome, and five had a partial remission.

Prostatic urethra dilatation with the Gianturco self-expanding metallic stent: a feasibility study in cadaver specimens and dogs.

In an effort to develop a transcatheter technique for dilatation of the prostatic urethra without the use of balloons, the feasibility of using Gianturco self-expanding stents was evaluated. Initially, eight human cadaveric prostatic urethras were stented to evaluate the ability of the stent to dilate the lumen. In all cases, the device attained its unconstrained diameter immediately on placement.

Hepatic artery infusion and chemoembolization in the management of liver metastases.

Hepatic metastases rather than the primary neoplasm usually dictate the course of the disease and patient's survival. For unresectable disease, intraarterial infusion of chemotherapy, embolization, and chemoembolization are viable alternatives. Intraarterial therapy for hepatic metastases is based on the dual blood supply of the normal liver (portal vein, 75%, and hepatic artery, 25%) and that of the tumors (hepatic artery, 90%).

A new device for transcatheter closure of the patent ductus arteriosus. A feasibility study in dogs.

A new device for transcatheter closure of the patent ductus arteriosus was developed and initially evaluated in the vasculature of adult mongrel dogs. The device consists of a nylon sack that can be made in various sizes and shapes. A small flexible crossbar attached to the distal end maintains the position of the sack while it is filled with a segment of modified guide wire.

Percutaneously placed endovascular grafts for aortic aneurysms: feasibility study.

This limited study addressed the feasibility of treating aneurysms with a new transcatheter endoprosthesis. Aortic aneurysms were experimentally created in six dogs and subsequently bridged with nylon-covered, self-expanding metallic stents. The dogs were followed up for as long as 7 months (median, 22 weeks).

Self-expanding endovascular graft: an experimental study in dogs.

An arterial endovascular graft was constructed by wrapping an expandable nylon mesh around a framework of Gianturco self-expanding metallic stents. The devices were passed through a 12-French Teflon catheter and positioned in the normal abdominal aorta of five dogs, two of which also had a device placed in an external iliac artery. At follow-up (1-6 months), all grafts remained patent, even though slight luminal narrowing due to neointimal encasement was noted.

The bird's nest inferior vena cava filter: progress report.

The bird's nest inferior vena cava filter, in clinical trial since 1982, has been placed in 568 patients at risk for pulmonary embolism. Of the 481 patients in whom the filter had been in place for 6 months or more, 440 were followed up clinically. The prevalence of clinically suspected recurrent pulmonary thromboembolism was 2.

Elastic characteristics of the self-expanding metallic stents.

We measured elastic properties of the self-expanding metallic (Gianturco) stent using Hooke's law to characterize the stent with respect to its caliber, length, and radius by a coefficient of stiffness. Although this coefficient was independent of the radius of the stent, we found that it was directly dependent on caliber. For a stent of a particular caliber and length, the fractional change in radius determined the force exerted by the stent.

Early and late results of intracoronary arterial stenting after coronary angioplasty in dogs.

Intimal dissection with acute closure represents the major complication associated with percutaneous transluminal coronary angioplasty (PTCA). Intracoronary stent devices offer the possibility of treatment for this sequela. We developed a balloon catheter-mounted, flexible coil stent for use in such cases.

Self-expanding metallic stents: preliminary evaluation in an atherosclerotic model.

The performance of the self-expanding stainless steel (Gianturco) stent in atherosclerotic arteries was examined in a rabbit model. Atherosclerosis was induced by supplementing rabbit chow with 6% peanut oil and 2% cholesterol followed by endothelial disruption of the abdominal aorta with a balloon catheter and continuation on the atherogenic diet for the remainder of the study. Eighteen stents, 1 cm in length and 4 or 5 mm in diameter when fully expanded, were placed in atherosclerotic stenotic lesions in six rabbits.

Percutaneous endovascular graft: experimental evaluation.

An arterial endovascular graft was constructed by wrapping a Dacron cylinder around the Gianturco expandable metallic stent. The device was passed through an 11-F Teflon catheter into the normal abdominal or thoracic aortas of nine dogs. At follow-up of 7-35 weeks, all but one graft remained patent.

Self-expanding metallic stents for small vessels: an experimental evaluation.

Thirty-three self-expanding metallic stents were placed in 24 arterial segments of the hind legs and nine arteries of the abdominal viscera in seven dogs. Twelve 5-mm stents, eight 4-mm stents, and 13 3-mm stents were inserted. Follow-up ranged from 4 to 30 weeks.

Flexible balloon-expanded stent for small vessels. Work in progress.

A new type of flexible, balloon-expanded, stainless steel stent was designed for introduction into small vessels subject to motion. Four stents placed in four dogs were patent at follow-up (4-8 weeks). A fibrocellular proliferation involving the intima and media was responsible for a 20%-25% luminal narrowing observed in all vessels with stents.

Stenosis of the vena cava: preliminary assessment of treatment with expandable metallic stents.

To test the ability of Gianturco expandable metallic stents to dilate and maintain patency in stenotic venae cavae, stenosis of the inferior vena cava was created in seven mongrel dogs by the percutaneous injection of absolute ethanol into the paravascular retroperitoneal space. Gianturco stents, placed across the stenotic segment, resulted in successful dilatation with improved hemodynamics in four dogs. The stents failed to dilate an occluded vena cava in one dog; in the remaining dogs, stent placement was complicated by early migration and occlusion.

Pulsed arterial infusions. Chemotherapeutic implications.

To simulate the intra-arterial infusion of chemotherapy, ink was infused at a steady rate through a vascular catheter inserted in a transparent tube carrying water at a rate similar to that of arterial blood. The ink ran in one or two discrete streams for 10 to 15 cm before mixing with the water, and there were substantial differences in the concentrations of ink in the water collected from side holes made at various distances from the catheter tip. If the ink was delivered in short pulses, however, it mixed with the water 2 to 3 cm beyond the catheter tip, and the samples collected from the side holes showed similar concentrations of ink.

Tracheobronchial tree: expandable metallic stents used in experimental and clinical applications. Work in progress.

An expandable stainless steel stent was formulated for use in the treatment of tracheobronchial stenosis, tracheomalacia, and airway collapse following tracheal reconstruction. The stents were placed through an endotracheal tube into the trachea and bronchi of 11 healthy dogs. The stents expanded over time, substantially increasing the diameter of the lumen.

Flow-directed catheter for superselective arterial catheterization: an experimental evaluation.

A coaxial infusion catheter of 3 Fr Teflon and Gore-Tex was developed to facilitate superselective catheterization of cerebral arteries for the delivery of therapeutic agents. The catheter, technique for use, and preliminary results are described.

Expandable biliary endoprosthesis: an experimental study.

Expandable stents constructed of stainless-steel wire were inserted in the extrahepatic bile ducts of five animals to determine the effect of the endoprosthesis on the ductal wall. The stents were left in place 4-23 weeks, at which time the bile ducts were inspected. The bile ducts remained patent in all animals.

Endovascular stent for use in aortic dissection: an in vitro experiment.

Injection of normal saline and contrast material into the walls of aortic specimens from human cadavers created a narrowing of the aortic lumen, simulating aortic dissection. Endovascular stents were applied to expand the aortic lumen. Successful dilatation of the narrowed aortic lumen was demonstrated in all six specimens.

Percutaneous endovascular stents: an experimental evaluation.

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.