J Cardiovasc Surg (Torino)
August 2009
Endovascular aneurysm repair (EVAR) represents one of the greatest advances in vascular surgery over the past 50 years. In contrast to conventional aneurysm repair, EVAR requires accurate preoperative imaging and stringent postoperative surveillance. Duplex ultrasound (DUS), transesophageal echocardiography, intravascular ultrasound, computed tomography (CT) and magnetic resonance (MR), each provide useful information for patient selection, choice of endograft type and surveillance.
View Article and Find Full Text PDFPurpose: To review midterm results and morphological changes following endovascular treatment of acute complicated type B dissection and to study the relation between extent of dissection and treatment outcome.
Methods: Between February 2001 and March 2008, 52 patients (38 men; median age 67 years, range 40-82) received thoracic stent-grafts for acute complicated type B dissections. Outcome for those patients treated for intramural hematoma (IMH; group 1, n = 7) or type IIIa dissection (group 2, n = 17) were compared to those with type IIIb dissection (group 3, n = 28).
Objective: Aortic aneurysm size is a critical determinant of the need for intervention, yet the maximal diameter will often vary depending on the modality and method of measurement. We aimed to define the relationship between commonly used computed tomography (CT) measurement techniques and those based on current reporting standards and to compare the values obtained with diameter measured using ultrasound (US).
Methods: CT scans from patients with US-detected aneurysms were analyzed using three-dimensional reconstruction software.
Open surgical total aortic arch replacement is a demanding procedure which carries a substantial morbidity and mortality. A less invasive endovascular option is endovascular stent grafting using in situ fenestrations. After thoracic stent graft deployment in the arch, fenestrations are made for the major arch vessels.
View Article and Find Full Text PDFPurpose: To compare the outcome of endovascular aneurysm repair (EVAR) versus conventional open repair (OR) in patients with a short, angulated or otherwise challenging proximal neck.
Methods: The definition of a challenging proximal neck was based on diameter (>or=28 mm), length (
Cardiovasc Intervent Radiol
September 2009
The purpose of this study was to characterize the outcome of attempted endovascular intervention in patients with acute embolic or thrombotic superior mesenteric artery (SMA) occlusion. The records of 21 patients during a 3-year period between 2005 and 2008 were retrieved from the in-hospital registry. The first group included 10 patients (6 women and 4 men; median age 78 years) with acute embolic occlusion of the SMA.
View Article and Find Full Text PDFPurpose: A straight thoracic stent graft often complies poorly with the curvature of the aortic arch. We have previously reported an in vitro model of a modified stent graft that can be bent in situ after deployment to improve conformance to the aortic arch. We now report the first clinical experience with this technique in three consecutive patients.
View Article and Find Full Text PDFObjective: Imaging follow-up (FU) after endovascular aneurysm repair (EVAR) is usually performed by periodic contrast-enhanced computed tomography (CT) scans. This study aims to evaluate the effectiveness of CT-FU after EVAR.
Methods: In this study, 279 of 304 consecutive patients (261 male, aged 74 years (interquartile range (IQR): 70-79 years) with a median abdominal aortic aneurysm (AAA) diameter of 58 mm (IQR: 53-67 mm)) underwent at least one of the yearly CT scans and plain abdominal films after EVAR.
Objective: To evaluate the early and intermediate outcome of a consecutive series of emergency endovascular aneurysm repairs (eEVAR) of computed tomography (CT)-verified infrarenal ruptured abdominal aortic aneurysm (rAAA) at a single tertiary referral centre.
Methods: Prospectively collected data of patients operated between April 2000 and October 2007 were retrospectively reviewed and all their pre-, intra- and postoperative imaging were re-evaluated. Patient and procedural data were analysed using a Cox multiregression model.
Objective: To evaluate the outcomes after fenestrated endovascular aortic repair (f-EVAR) in a tertiary European referral center.
Methods: All patients treated with commercially available custom-made f-EVAR between September 2002 and June 2007 were prospectively enrolled in a computerized database including co-morbidities and aneurysm morphology. Patients were retrospectively analyzed.
Purpose: To report an alternative to the fenestrated stent-graft for preserving blood flow to side branches in the sealing zones of aortic stent-grafts.
Technique: A covered stent is deployed parallel to the main aortic stent-graft, protruding somewhat proximally, like a chimney, to preserve flow to a vital side branch covered by the aortic stent-graft. Use of a chimney graft makes it possible to use standard off-the-shelf stent-grafts to instantly treat lesions with inadequate fixation zones, providing an alternative to fenestrated stent-grafts in urgent cases, in aneurysms with challenging neck morphology, and for reconstituting an aortic side branch unintentionally compromised during endovascular repair.
Objective: To evaluate outcome and patency predicting factors of kissingstent treatment for aorto iliac occlusive disease (AIOD).
Methods: Patients treated with kissingstents for AOID between 1995 and 2004 at a tertiary referral center were identified through local databases. Chart review and preoperative images were used for TASC and Fontaine classification.
Scand J Surg
October 2008
Endovascular aneurysm repair (EVAR) offers a minimally invasive treatment to patients with improved short-term and similar mid-term results compared to conventional, open repair (OR). EVAR is preferred by patients due to the reduction of surgical trauma. Approximately 20% of patients have aneurysm neck morphology which is inadequate for a standard stent graft and requires the endograft to cross vital aortic side branches to achieve a seal.
View Article and Find Full Text PDFIntroduction: Branched iliac stent-grafts (bSG) have recently been developed in order to preserve internal iliac artery (IIA) flow in patients with aneurysmal or short common iliac arteries. The aim of this study is to evaluate a single-center experience with bSG for the IIA.
Methods: Twenty-two male patients (70 (IQR 65-79) years old) underwent EVAR with 23 bSG (1 bilateral repair) between September 2002 and August 2007.
Acute dissection of the descending thoracic aorta is often a life threatening disease. If complicated by rupture or organ malperfusion, immediate invasive treatment is mandatory to prevent death. Open surgery by interposition grafting or visceral fenestration is complex and associated with high morbidity and mortality.
View Article and Find Full Text PDFPurpose: To demonstrate the feasibility of a novel technique that modifies the configuration of a thoracic stent-graft after deployment to comply with the arch curvature.
Technique: The principle of a Bowden cable has been applied to direct a conventional thoracic stent-graft in situ after deployment. A suture placed at the proximal inner curve of a conventional thoracic stent-graft is fitted with a sliding, self-locking knot attached to a line that runs inside a catheter through the central rod of the stent-graft.
Purpose: To describe an alternative hybrid endovascular/open approach to revascularizing the occluded superior mesenteric artery (SMA) in patients with acute ischemia.
Technique: A laparotomy is performed to assess any visceral ischemia. The SMA is exposed, clamped distally, and cannulated proximally.
The purpose of this article is to describe three cases of kissing stent placement in the common femoral artery bifurcation in patients unsuitable for open endarterectomy and patch plasty. In three patients with critical limb ischemia, caused by primary atherosclerotic disease or dissection-related injury when performing a lower extremity intervention, a technique of kissing stents was used to treat the flow-obstructing lesion in the common femoral artery bifurcation. Technical success was uniform, and during follow-up (4.
View Article and Find Full Text PDFObjective: This was a study of intra-aneurysm sac pressures in patients who presented with endoleaks after endovascular repair (EVAR) of abdominal aortic aneurysms (AAA).
Methods: Twenty-five patients (18 men, 7 women) with endoleaks, age (IQR 68 to 80), underwent 31 direct intra-aneurysm sac pressure measurements, DISP at 16 months after EVAR (IQR, 14 to 26 months). Diameter of AAA was 59 mm (IQR, 52 to 67 mm).
Reversible male sterility and doubled haploid plant production are two valuable technologies in F(1)-hybrid breeding. F(1)-hybrids combine uniformity with high yield and improved agronomic traits, and provide self-acting intellectual property protection. We have developed an F(1)-hybrid seed technology based on the metabolic engineering of glutamine in developing tobacco anthers and pollen.
View Article and Find Full Text PDFEur J Vasc Endovasc Surg
April 2007
J Cardiovasc Surg (Torino)
October 2006
Aim: Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections.
View Article and Find Full Text PDFCarotid artery stenting (CAS) may be impossible, or associated with a high risk, in patients with severe vessel tortuosity. A novel method of catheterization of the carotid artery intended to facilitate CAS is described. It involves the placement of a microcatheter and a coronary wire through a dissected superficial temporal artery (STA), and then advanced to the ascending aorta.
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