Chimney endografting for pararenal aortic pathologies using transfemoral access and the lift technique.

Purpose: To present a technique for transfemoral implantation of parallel grafts into the renal arteries in patients with anatomy or morphology that blocks standard antegrade chimney graft delivery.

Technique: In a totally percutaneous approach, a 5-F pigtail angiographic catheter is passed into the aorta above the renal arteries via a 0.035-inch hydrophilic guidewire, followed by an 8-F sheath.

Technical assessment of the preloaded fenestrated stent-graft in the management of pararenal aortic aneurysms.

Purpose: To assess the effectiveness of the 20-F preloaded fenestrated stent-graft (FSG) to facilitate safe and quick catheterization of both renal arteries and its impact on relevant procedure variables in the management of pararenal aortic aneurysms (PAAs).

Methods: Between June 2012 when preloaded FSG became available in our institution and February 2013, 10 patients (9 men; mean age 70±10 years) with PAAs were treated by the same surgeon with preloaded FSGs consisting of 3 fenestrations with/without a scallop for the celiac trunk. In the same time frame, 12 patients (11 men; mean age 72±8 years) received standard FSGs with the same fenestration configuration by the same surgeon and were considered as controls.

Crossing chronic total occlusions with the Ocelot system: the initial European experience.

Aims: The aim of the study was to determine the safety, efficacy and feasibility of a new chronic total occlusion (CTO) device using optical coherence tomography (OCT) technology, the Ocelot catheter (Avinger, Inc., Redwood City, CA, USA), for crossing of SFA CTOs following guidewire failure.

Methods And Results: Prospective, multicentre, market preference testing.

Outcomes of a novel technique of endovascular repair of aneurysmal internal iliac arteries using iliac branch devices.

Objective: To present midterm outcomes of a novel technique of endovascular repair of aneurysmal internal iliac arteries (AIIAs) using iliac branch devices (IBDs).

Methods: Between January 2005 and August 2012, 129 patients with aneurysms involving the iliac bifurcation underwent placement of IBDs. In particular, between April 2010 and August 2012, 16 consecutive patients with aortoiliac or solitary iliac aneurysms and coexisting AIIAs were treated with the novel suggested strategy.

Novel therapies and the best new device concepts for 2013 CAS techniques: the Mo.Ma® Proximal Occlusion System.

Recently carotid artery stenting (CAS) was upgraded in the class of recommendation among other revascularization treatments for symptomatic patients with carotid artery disease. This makes CAS potentially available to a broader range of patients. Significant evolution in CAS materials and protection devices contributed towards this improvement.

Late cerebral embolization after emboli-protected carotid artery stenting.

Carotid artery stenting (CAS) is nowadays considered as alternative therapeutic option to carotid endarterectomy for patients suffering from carotid artery disease. Recent studies and meta-analyses have demonstrated equal performance of carotid stenting to endarterectomy as regard as the overall adverse events (death/stroke rates), especially when periprocedural myocardial infarction and nerve pulses are also included. However, carotid stenting was inferior to endarterectomy when compared in terms of acute and late embolic events.

CT angiography at 24 months demonstrates durability of EVAR with the use of chimney grafts for pararenal aortic pathologies.

Purpose: To present the 24-month radiological follow-up data for patients with pararenal aortic pathologies treated with chimney and periscope grafts during endovascular repair.

Methods: Between January 2008 and December 2011, 124 high-risk patients with complex pararenal aortic pathologies were treated using the chimney technique at 2 European vascular and cardiovascular centers with advanced experience of the described technique. In particular, 50 patients were treated at Site 1 and 74 at Site 2.

One-year follow-up after total endovascular repair of a contained-ruptured thoracoabdominal aortic aneurysm with the sandwich technique.

We report the case of a 68-year-old woman who was referred to our clinic due to a contained-ruptured type III thoracoabdominal aortic aneurysm 9 cm in diameter. The patient was not a candidate for an open repair because of her comorbid conditions, including dialysis, heart insufficiency requiring pacemaker support, chronic obstructive pulmonary disease, coronary artery disease, and previous abdominal aortic repair. Owing to her hemodynamic instability, we performed a totally endovascular repair with off-the-shelf devices by means of the sandwich technique.

First-in-human study of the INCRAFT endograft in patients with infrarenal abdominal aortic aneurysms in the INNOVATION trial.

Objective: This multicenter, prospective, nonrandomized trial was undertaken to evaluate the first-in-human experience with the INCRAFT endograft (Cordis Corporation, Bridgewater, NJ), an ultralow-profile trimodular bifurcate device for the repair of abdominal aortic aneurysms.

Methods: Patients with asymptomatic infrarenal abdominal aortic aneurysms were eligible for enrollment in the trial. Anatomic eligibility criteria included a proximal aortic neck at least 15 mm in length and up to 27 mm in diameter, and an aortic bifurcation ≥18 mm in diameter.

Early outcomes for fenestrated and chimney endografts in the treatment of pararenal aortic pathologies are not significantly different: a systematic review with pooled data analysis.

Purpose: To compare short-term outcomes between fenestrated and chimney endografts for pararenal aortic pathologies.

Methods: An English-language literature search up to January 2012 found 129 articles evaluating the immediate outcomes of endovascular repair of degenerative juxta-/suprarenal aortic aneurysms, type I endoleaks, and para-anastomotic aneurysms using the chimney technique or fenestrated endografts. Data concerning thoracoabdominal aortic aneurysms, ruptured aneurysms, and reports with <5 cases were excluded (n=84).

[Segmental arterial mediolysis: pathogenesis of aneurysms and dissections in patients younger than 60 years].

Background: Complications deriving from arterial aneurysm and dissection without signs of atherosclerosis are rare clinical entities. In recent literature case reports show a descriptive similarity of pathological findings summarized as segmental arterial mediolysis (SAM).

Objective: The purpose of this study was to answer the question whether, among 16 patients suffering from SAM histological findings corresponded and assess causality.

Drug-eluting stents and perioperative risk - more than matters of the heart?

The introduction of drug-eluting stents (DES) to interventional cardiology has been a breakthrough in the treatment of in-stent restenosis. However, the downside of reduced restenosis is a significantly prolonged and practically incalculable time to reendothelialization of thrombogenic stent-surfaces with an increased risk for coronary thrombosis. As the use of DES in non-coronary arteries (e.

Technical considerations and performance of bridging stent-grafts for iliac side branched devices based on a pooled analysis of single-center experiences.

Purpose: To report a pooled analysis of single-center experiences designed to determine the performance of self-expanding vs. balloon-expandable bridging stent-grafts used in iliac branch devices (IBDs) for the repair of iliac artery aneurysms.

Methods: The English-language literature in the MEDLINE and EMBASE databases was searched for articles published between 2006 and 1 March 2012 on the performance of bridging stent-grafts in the internal iliac artery.

New EVAR devices: pros and cons.

The first randomized controlled trials comparing the two procedures (EVAR versus open repair) for the treatment of abdominal aortic aneurysms showed considerably better short-term outcomes and on the other side higher rates of device-associated reinterventions and remarkable financial burden in the endovascular arm. In the meantime, specialists experience and expertise have been improved significantly. To solve the reported drawbacks and to prevent endografts-associated complications, safer fixation features, lower profile, more flexible design and new revolutionary release and deployment mechanisms of stent-grafts have been also developed and established over the last years.

Perioperative use of aspirin for patients undergoing carotid endarterectomy.

Background: This study was initiated to evaluate the cardiovascular benefit of perioperative use of acetylsalicylic acid (ASA) in patients undergoing carotid surgery.

Patients And Methods: A prospective two-arm comparative study was conducted and focused on cardiac, neurological and bleeding complications for patients with high-grade (> 80 %) asymptomatic or symptomatic (> 60 %), internal carotid artery stenosis based on NASCET criteria who were treated by surgery. Between March 2008 and November 2010, 540 patients underwent carotid endarterectomy in two European vascular centers.

The role of open and endovascular treatment with fenestrated and chimney endografts for patients with juxtarenal aortic aneurysms.

Objective: To present endovascular techniques in the treatment of juxtarenal aortic aneurysms (JAAAs) in relation to surgical repair; this is the "gold standard."

Methods: Between January 2008 and December 2010, 90 consecutive patients were diagnosed with primary degenerative JAAAs (≥5.0 cm) and assigned prospectively to different operative strategies on the basis of morphologic and clinical characteristics.

The role of simple renal cysts, abdominal wall hernia, and chronic obstructive pulmonary disease as predictive factors for aortoiliac aneurysmatic disease.

Background: This study was designed to investigate the possible predictive value of simple renal cysts (SRCs), abdominal wall hernia (AWH), and chronic obstructive pulmonary disease (COPD) for the presence of abdominal aortoiliac aneurysms (AAA).

Methods: Between January 2006 and January 2011, we treated 170 consecutive patients with aortoiliac pathology. Patients' data were prospectively collected and were retrospectively analyzed.

Zenith TX2LowProfile TAA Endovascular Graft: a next generation thoracic stent-graft.

Aim: The aim of the present article is to describe a new thoracic stent graft (Zenith TX2 Low-Profile TAA Endovascular Graft).

Methods: Feasibility of endovascular repair of thoracic aortic aneurysms depends on several anatomic factors. A primary limitation is an adequate arterial approach.

Mid-term outcome after endovascular therapy in the superficial femoral and popliteal artery using long stents.

Background: Peripheral artery disease (PAD) affecting the femoropopliteal artery is treated by endovascular interventions [2, 5, 13] increasingly. Aim of the study was to evaluate mid-term efficacy and patency of long stents in the superficial femoral and popliteal artery.

Patients And Methods: Between September 2006 and September 2007 103 patients received 128 stents for endovascular treatment of femoropopliteal vascular stenosis or occlusion.

Randomized comparison of everolimus-eluting versus bare-metal stents in patients with critical limb ischemia and infrapopliteal arterial occlusive disease.

Objective: Critical limb ischemia, the most severe form of peripheral arterial disease, results in extremity amputation if left untreated. Endovascular recanalization of stenotic or occluded infrapopliteal arteries has recently emerged as an effective form of therapy, although the duration of patency is typically limited by restenosis. Recently, it has been suggested that drug-eluting stents originally developed for the coronary arteries might also be effective in preventing restenosis in the infrapopliteal arteries.

Use of covered chimney stents for pararenal aortic pathologies is safe and feasible with excellent patency and low incidence of endoleaks.

Background: To present the clinical experience of consecutive series with use of balloon-expandable and self-expanding chimney endografts (balloon-expandable covered stent group [BECS] vs self-expanding covered stent group [SECS]) in the endovascular treatment of challenging aortic pathologies requiring renal and/or visceral revascularization.

Methods: Between January 2009 and May 2011, data for 37 high-risk patients from one center and 35 patients from another institution, with pararenal aortic pathologies treated by the chimney endovascular technique, were prospectively collected. The chimney-graft technique is based on the deployment of a covered or bare-metal stent parallel to the aortic endograft, thereby creating a conduit that runs outside the aortic main endograft, and has been proposed to ensure secure proximal fixation extending the sealing zones.

[Effectiveness of nephroprotection by the selection of contrast media used during vascular interventions in patients with chronic renal failure?].

Background: The increasing number of endovascular procedures made aware of a kidney disease induced by contrast media (CM). Contrast-induced nephropathy (= CIN) can develop in 0.6-44 % of the treated patients by angiography and / or endovascular intervention.