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  • Ivancev, Krassi, et al. (författare)
  • Abdominal aortic aneurysms: experience with the Ivancev-Malmo endovascular system for aortomonoiliac stent-grafts
  • 1997
  • Ingår i: Journal of Endovascular Surgery. - International Society of Endovascular Specialists. - 1074-6218. ; 4:3, s. 242-251
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To describe a component-based aortomonoiliac stent-graft system and the first clinical results achieved with this device in endovascular abdominal aortic aneurysm (AAA) repair. METHODS: From November 1993 to October 1996, 45 patients aged 60 to 86 years underwent endoluminal exclusion of true AAAs (median diameter 60 mm) involving the common iliac arteries (median diameter 16 mm right and 15 mm left) using unilimb stent-grafts deployed with the Iancev-Malmo system. RESULTS: Six immediate conversions occurred in the beginning of the series due to endografts that were too short. Complications, including 2 inadvertent renal artery occlusions, 7 kinked grafts, 6 iliac artery dissections, and 3 perioccluder leaks, were prominent features in the first 15 patients. Five patients died in the postoperative period, four of whom were nonsurgical candidates. There were five significant stent-graft migrations: one 3 weeks after surgery due to mechanical injury of the proximal stent and four after 1 year owing to continuous dilation of a wide proximal neck, stent-graft placement in a conical, thrombus-lined proximal neck, and two instances of proximal extension separation from the main graft. Translumbar aneurysm perfusion required embolization in 3 patients. CONCLUSIONS: Despite early complications associated with a learning curve, exclusion of large AAAs using unilimb stent-grafts is feasible. Strict inclusion criteria are necessary in order to improve mortality among nonsurgical candidates and minimize the risk for late migration.
  • Karlsson, M K, et al. (författare)
  • Remodeling of the spinal canal deformed by trauma
  • 1997
  • Ingår i: Journal of Spinal Disorders. - Lippincott Williams & Wilkins. - 0895-0385. ; 10:2, s. 157-161
  • Tidskriftsartikel (refereegranskat)abstract
    • Computed tomography (CT) examinations and functional scores were evaluated in 28 patients with thoracolumbar fractures with intraspinal fragments, of whom 20 underwent operation. The cross-sectional area and the sagittal and frontal diameters of the spinal canal were measured after the injury, postoperatively, and at follow-up (mean, 6 years). The operative reduction significantly increased both diameter and area of the spinal canal. During follow-up, a further significant increase of the sagittal diameter and the area was noted, in both surgically and conservatively treated patients. There was no difference in remodeling between the groups. Six patients in the surgically treated group had neurologic deficits at admission, five had improved, and one remained unchanged at follow-up. The presence or absence of intraspinal fragments should not influence the treatment strategy per se in cases without neurologic signs.
  • Kölbel, Tilo, et al. (författare)
  • Extensive acute deep vein thrombosis of the iliocaval segment: midterm results of thrombolysis and stent placement.
  • 2007
  • Ingår i: Journal of Vascular and Interventional Radiology. - Society of Interventional Radiology. - 1051-0443. ; 18:2, s. 243-250
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To evaluate patency and clinical outcome in patients treated with catheter-directed thrombolysis and stent placement for acute extensive thrombosis affecting the iliocaval segment. MATERIALS AND METHODS: During a 10-year period (1994-2005), 37 patients with 44 limbs (26 female, median age 31 years) with acute extensive venous thrombosis affecting the iliocaval segment were treated with catheter-directed thrombolysis. Angioplasty and stent placement was performed in 36 limbs (82%) for underlying stenosis or residual thrombosis. A prospectively registered database was analyzed in combination with a telephone interview about clinical symptoms. RESULTS: Technical success was achieved in all 44 limbs and clinical success in 42 of 44 (96%) limbs. Primary patency after a median imaging follow-up interval of 16 months was 34 of 44 (77%) limbs, assisted primary patency was 38 of 44 (86%) limbs, and secondary patency was 39 of 44 (89%) limbs. Thirty of 44 (68%) limbs were asymptomatic after a median clinical follow-up of 27 months, eight (18%) limbs were moderately improved, two (5%) limbs were unchanged, two (5%) limbs were moderately worse, and two (5%) limbs had no clinical follow-up. Complications occurred in six (16%) patients, three (8%) of which were major complications. No patient developed symptomatic pulmonary embolism. CONCLUSIONS: Catheter-directed thrombolysis and stent placement is a safe and effective treatment for acute iliocaval thrombosis. Clinical midterm results are encouraging. Thrombolyzed and stented segments remain patent in the vast majority of patients after 16 months. Primary and aggressive stent placement in the iliocaval vein segments can prevent rethrombosis and ensure patency.
  • Lindh, Mats, et al. (författare)
  • Endovascular stent-anchored aortic grafts: a comparison between self-expanding and balloon-expandable stents in minipigs
  • 1996
  • Ingår i: Journal of Endovascular Surgery. - International Society of Endovascular Specialists. - 1074-6218. ; 3:3, s. 284-289
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To study endovascular graft attachment with self-expanding Gianturco Z-stents and balloon-expanded Palmaz stents and the effect of these devices on the renal ostia. METHODS: Ten stent-grafts were constructed, 5 with Gianturco Z-stents and 5 with Palmaz stents. The endografts were implanted under fluoroscopic guidance into the abdominal aorta of 10 pigs so that the uncovered portion of the proximal stent extended over the renal artery orifices. Distal aortic blood pressure and flow were measured before and after graft placement and 1 hour postprocedure. The aorta was then exposed surgically, and the central portion of the stent-graft was inspected through an aortotomy to assess perigraft leakage. RESULTS: Stent-graft implantation was accurate and hemostatic in all cases, despite longitudinal folding of the graft due to oversizing. However, transverse folds produced pressure gradients (> 15 mmHg) between the ends of the graft in two cases. In another case, a pressure gradient resulted from partial thrombosis of the graft. In two cases, renal artery occlusion and thrombosis occurred due to coverage by the graft material. In two other animals, one of the renal arteries was entirely uncovered by a stent. The remaining 16 renal arteries were covered by the proximal stent but not the graft, as intended. One (6.25%) of these arteries thrombosed, but the remainder were grossly patent when the animals were sacrificed at 1 hour. CONCLUSIONS: Both Palmaz and Gianturco Z-stents produced hemostatic endovascular graft attachment, even in the presence of moderate graft oversizing. The risk of acute renal artery occlusion from juxtarenal stenting does not appear to be prohibitive, but longer term observations are needed.
  • Malina, Martin, et al. (författare)
  • Changing aneurysmal morphology after endovascular grafting: relation to leakage or persistent perfusion
  • 1997
  • Ingår i: Journal of Endovascular Surgery. - International Society of Endovascular Specialists. - 1074-6218. ; 4:1, s. 23-30
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To relate changing abdominal aortic aneurysm (AAA) morphology after endovascular grafting to the presence of leakage, collateral perfusion, and other factors. METHODS: Thirty-five patients who underwent successful AAA endovascular grafting were evaluated. Self-expanding Z-stents and Dacron grafts were applied in bifurcated and aortomonoiliac systems. Postoperative diameter changes were calculated from repeated spiral computed tomographic scans, angiograms, and ultrasonic phase-locked echo-tracking scans during a median 6-month follow-up (interquartile range [IQR] 3 to 12). RESULTS: At 12 months, the diameters of completely excluded aneurysms had decreased 6 mm (IQR 2 to 11; p = 0.006). The proximal graft-anchoring stents had dilated 2 mm (IQR 0.5 to 3.3; p = 0.01). The aortic diameters immediately below the renal arteries but above the stents had not changed. Endoleakage and collateral perfusion (n = 13) were each associated with preserved aneurysm size and a 12 times higher risk of aneurysm dilation. After the leakage or the collateral perfusion had been treated, the aneurysm size decreased. Aneurysms with extensive intraluminal thrombi presented a reduced risk of leakage or perfusion. CONCLUSIONS: The diameters of endovascularly excluded AAAs decrease, except in cases of leakage or perfusion. Careful follow-up of patients with aortic endografts is necessary.
  • Malina, Martin, et al. (författare)
  • Endovascular AAA exclusion: will stents with hooks and barbs prevent stent-graft migration?
  • 1998
  • Ingår i: Journal of Endovascular Surgery. - International Society of Endovascular Specialists. - 1074-6218. ; 5:4, s. 310-317
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To investigate if stents with hooks and barbs will improve stent-graft fixation in the abdominal aorta. METHODS: Sixteen- to 24-mm-diameter Dacron grafts were deployed inside cadaveric aortas. The grafts were anchored by stents as in endovascular abdominal aortic aneurysm repair. One hundred thirty-seven stent-graft deployments were carried out with modified self-expanding Z-stents with (A) no hooks and barbs (n = 75), (B) 4 5-mm-long hooks and barbs (n = 39), (C) 8 10-mm-long, strengthened hooks and barbs (n = 19), or (D) hooks only (n = 4). Increasing longitudinal traction was applied to determine the displacement force needed to extract the stent-grafts. The radial force of the stents was measured and correlated to the displacement force. RESULTS: The median (interquartile range) displacement force needed to extract grafts anchored by stent A was 2.5 N (2.0 to 3.4), stent B 7.8 N (7.4 to 10.8), and stent C 22.5 N (17.1 to 27.9), p < 0.001. Both hooks and barbs added anchoring strength. During traction, the weaker barbs were distorted or caused intimal tears. The stronger barbs engaged the entire aortic wall. The radial force of the stents had no impact on fixation, while aortic calcification and graft oversizing had marginal effects. CONCLUSIONS: Stent barbs and hooks increased the fixation of stent-grafts tenfold, while the radial force of stents had no impact. These data may prove important in future endograft development to prevent stent-graft migration after aneurysm exclusion.
  • Malina, Martin, et al. (författare)
  • Endovascular management of the juxtarenal aortic aneurysm: can uncovered stents safely cross the renal arteries?
  • 1999
  • Ingår i: Seminars in Vascular Surgery. - W B Saunders. - 0895-7967. ; 12:3, s. 182-192
  • Tidskriftsartikel (refereegranskat)abstract
    • A short or otherwise suboptimal neck precludes the use of endovascular repair in 30% to 50% of patients with abdominal aortic aneurysms. Stent-graft fixation in an unsuitable neck carries the risk of technical failure owing to development of a proximal endoleak or stent-graft migration. Furthermore, in some patients, the neck dilates postoperatively. Endovascular healing with tissue incorporation into the graft material seems in and of itself insufficient to fixate the stent-graft adequately or to prevent neck dilation. Therefore, neck dilation is often associated with detachment of the stent-graft from the aortic wall, which is followed by the development of a proximal endoleak or stent-graft migration. Fixation of stent-grafts can be improved by placing the proximal stent above one or both of the renal artery orifices. Current experimental and clinical data suggest that renal function is not impaired by suprarenal aortic stents during the first year; however, this finding may not apply to all types of stents. Fixation of stent-grafts also may be improved by using stents with barbs that pierce the aortic wall. Additionally, the force that is exerted on the anchoring device may well be reduced by fully stented grafts with an associated increase in column strength. In the future, the risk of neck dilation and stent-graft dislodgement might also be limited by novel techniques such as laparoscopic banding of the neck or endoluminal stapling devices.
  • Malina, Martin, et al. (författare)
  • Late aortic arch perforation by graft-anchoring stent: complication of endovascular thoracic aneurysm exclusion
  • 1998
  • Ingår i: Journal of Endovascular Surgery. - International Society of Endovascular Specialists. - 1074-6218. ; 5:3, s. 274-277
  • Tidskriftsartikel (refereegranskat)abstract
    • PURPOSE: To describe a fatal case of late aortic perforation by an endograft-anchoring stent. METHODS AND RESULTS: A 69-year-old woman presented 2 years after thoracoabdominal aneurysm repair with a 9-cm dilatation of the descending thoracic aorta proximal to the conventional aortic graft. A 38-mm Dacron graft with multiple Gianturco Z-stents sutured inside was placed transluminally across the aortic arch such that part of the uncovered portion of the proximal stent was partially across the left subclavian orifice. Four months later, the patient died from massive hemorrhage. Autopsy showed that the uncovered portion of the proximal stent had perforated the aortic arch. CONCLUSIONS: This case stresses the need for low-profile stent-grafts and smaller, more flexible introducer systems. Anchoring stents must be flexible, less traumatic, and strong enough to create a watertight seal even in tortuous vessels. To avoid aortic arch damage by thoracic stent-grafts, the proximal stent should be fully covered by the fabric.
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