| 1. |
- Greenberg, R, et al.
(författare)
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Aggressive treatment of acute limb ischemia due to thrombosed popliteal aneurysms
- 1998
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Ingår i: European Journal of Radiology. - 1872-7727. ; 28:3, s. 211-218
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The absence of infra-popliteal runoff in patients with acute limb ischemia and thrombosed popliteal aneurysms carries a high risk of amputation. A combined treatment method involving thrombolysis and surgery is reported. MATERIAL AND METHODS: Information regarding six patients was reviewed. Ankle brachial indices and degree of ischemia were recorded. All patients underwent digital subtraction angiography. In five patients thrombus dissolution was achieved using a combination of mechanical and pharmacologic therapy. One patient was judged incapable of withstanding any delay in reperfusion and was treated with isolated limb perfusion using a thrombolytic agent. All patients underwent surgical revascularization. Follow-up (1-3 years) consisted of duplex examinations at 6 months and yearly thereafter. RESULTS: Five patients had no measurable ankle brachial index (ABI), while one patient had an ABI of 0.4. Initial angiography noted all patients to have no runoff in continuity to the pedal arch. Following thrombolytic therapy, an adequate bypass vessel was noted in all cases, with reconstitution of the plantar arch in five patients. Distal revascularizations included one peroneal, and five below knee popliteal arterial bypasses. Fasciotomies were performed in four of the six patients. There were no amputations. One patient developed a persistent foot drop. Two patients developed bypass grafts occlusions; one of which required therapy. CONCLUSION: The pre-operative use of thrombolytic therapy is a safe and effective method to achieve limb salvage in this patient population. Patients must be capable of withstanding an additional period of ischemia allowing for reconstitution of distal runoff. Isolated limb perfusion is of use when a delay to reperfusion cannot be tolerated.
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| 2. |
- Ivancev, Krassi, et al.
(författare)
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Abdominal aortic aneurysms: experience with the Ivancev-Malmo endovascular system for aortomonoiliac stent-grafts
- 1997
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 4:3, s. 242-251
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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.
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| 3. |
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| 4. |
- Malina, Martin, et al.
(författare)
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Late aortic arch perforation by graft-anchoring stent: complication of endovascular thoracic aneurysm exclusion
- 1998
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 5:3, s. 274-277
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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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| 5. |
- Nyman, Ulf, et al.
(författare)
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Chronic aortic dissection: stenting of aortic true lumen obliteration with late dynamic variations of both lumens
- 1999
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Ingår i: Cardiovascular and Interventional Radiology. - : Springer Science and Business Media LLC. - 1432-086X .- 0174-1551. ; 22:2, s. 135-149
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Tidskriftsartikel (refereegranskat)abstract
- Percutaneous endovascular techniques were used to treat an arteriovenous fistula (AVF) associated with pancreatic transplantation. A pancreatic transplant superior mesenteric artery-to-superior mesenteric-vein AVF was successfully embolized while flow to the pancreas transplant was preserved. The embolization was aided by the use of Guglielmi detachable coils and a detachable balloon. No complications were encountered. At 23 months follow-up, the patient is doing well with no recurrence.
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| 6. |
- Nyman, Ulf, et al.
(författare)
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Kronisk mesenteriell ischemi. Endovaskulär behandling lika effektiv som öppen kirurgi
- 1998
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Ingår i: Läkartidningen. - 0023-7205. ; 95:36, s. 3785-3790
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Tidskriftsartikel (refereegranskat)abstract
- Chronic mesenteric ischaemia is a rare but serious condition, which if untreated may cause death secondary to starvation or bowel infarction. As the symptoms are sometimes unspecific, its diagnosis may be delayed or missed. Although open surgical revascularisation has been the traditional treatment, a review of published reports suggests it to be associated with operative mortality rates of 6-9 per cent, and major morbidity rates of 22-26 per cent. Reports by others, and our own experience, suggest that endovascular treatment of mesenteric atherosclerotic obstructions with PTA (percutaneous transluminal angioplasty) and stenting may yield patency rates differing little from those associated with surgery, but significantly lower mortality (1.6%) and morbidity (5.6%).
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| 7. |
- Nyman, Ulf, et al.
(författare)
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Primary stenting in infrarenal aortic occlusive disease
- 2000
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Ingår i: Cardiovascular and Interventional Radiology. - : Springer Science and Business Media LLC. - 1432-086X .- 0174-1551. ; 23:2, s. 97-108
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate the results of primary stenting in aortic occlusive disease. METHODS: Thirty patients underwent primary stenting of focal concentric (n = 2) and complex aortic stenoses (n = 19), and aortic or aorto-iliac occlusions (n = 9). Sixteen patients underwent endovascular outflow procedures, three of whom also had distal open surgical reconstructions. Median follow-up was 16 months (range 1-60 months). RESULTS: Guidewire crossing of two aorto-biiliac occlusions failed, resulting in a 93% (28/30) technical success. Major complications included one access hematoma, one myocardial infarction, one death (recurrent thromboembolism) in a patient with widespread malignancy, and one fatal hemorrhage during thrombolysis of distal emboli from a recanalized occluded iliac artery. One patient did not improve his symptoms, resulting in a 1-month clinical success of 83% (25/30). Following restenting the 26 stented survivors changed their clinical limb status to +3 (n = 17) and +2 (n = 9). During follow-up one symptomatic aortic restenosis occurred and was successfully restented. CONCLUSIONS: Primary stenting of complex aortic stenoses and short occlusions is an attractive alternative to conventional surgery. Larger studies with longer follow-up and stratification of lesion morphology are warranted to define its role relative to balloon angioplasty. Stenting of aorto-biiliac occlusions is feasible but its role relative to bypass grafting remains to be defined.
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| 8. |
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| 9. |
- Resch, Tim, et al.
(författare)
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Abdominal aortic aneurysm morphology in candidates for endovascular repair evaluated with spiral computed tomography and digital subtraction angiography
- 1999
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 6:3, s. 227-232
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze the morphology of abdominal aortic aneurysms (AAAs) and to study the usefulness of spiral computed tomography (CT) versus digital subtraction angiography (DSA) in the evaluation of patients for endovascular repair. METHODS: Of 133 AAA patients (120 men, mean age 67 years, range 52 to 84) evaluated preoperatively with CT imaging, 77 endograft candidates (68 men) were also assessed with intra-arterial DSA. Arterial parameters were measured on axial CT scans and angiographic films for comparison. RESULTS: Mean maximum AAA diameter was 58 +/- 11 mm (range 39 to 95). Aneurysmal neck diameter was consistently smaller on DSA than on CT (20.7 +/- 3.6 mm versus 23.0 +/ 3.5 mm, p < 0.0001). The distance from the most distal renal artery to the aortic bifurcation was longer on angiography than on CT (mean difference 10.0 mm, p < 0.0001). There was a positive correlation between the maximum AAA diameter and the AAA length (r = 0.49, p < 0.0001) and an inverse relationship between the neck length and the neck diameter (r = -0.36, p < 0.0001). No correlation was found between the maximum AAA diameter and maximum iliac diameter, angulation, or length. CONCLUSIONS: AAA anatomy varies widely and independently of the aneurysm size. Therefore, the maximum size of the aneurysm is a poor predictor of whether or not an aneurysm is suitable for endovascular repair. The discrepancy between angiographic and axial CT measurements suggests that neither alone is sufficient as a preoperative imaging technique when evaluating a patient for an endovascular graft procedure.
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| 10. |
- Resch, Tim, et al.
(författare)
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Distal migration of stent-grafts after endovascular repair of abdominal aortic aneurysms
- 1999
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Ingår i: Journal of Vascular and Interventional Radiology. - 1051-0443. ; 10:3, s. 257-264
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To analyze patients after endovascular repair of abdominal aortic aneurysm (AAA) with respect to distal migration of stent-grafts and its underlying causes. MATERIALS AND METHODS: Sixty-five patients underwent endovascular repair between January 1994 and February 1997. There were seven women and 58 men, with a mean age of 71 years (range, 51-84 years). Three patients died in the perioperative period (one of myocardial infarction and two of multiorgan failure) and two patients died within 4 months of the procedure of non-procedure-related causes. In addition, two patients were followed at another hospital. The remaining 58 patients were followed up with spiral computed tomography scans at 1, 3, and 6 months, and biannually thereafter. Angiography was performed at 1 month and 1 year after the procedure and additionally when deemed clinically necessary. Mean follow-up was 29 months (range, 1-49). Migration more than 5 mm was considered significant. RESULTS: Twenty-six patients (45%) showed distal migration of stent-grafts during follow-up. Mean follow-up time at detection of migration was 13 months (range, 1-36 months). Thirteen cases of migration were ascribed to dilatation of the proximal aneurysmal neck during follow-up. Ten cases of migration were ascribed to causes other than neck dilatation or poor patient selection. In three cases, no obvious cause for the migration was found. The migration was complete in eight cases, leading to late conversion to open surgical repair. On two of these occasions, complete migration lead to aneurysm rupture. In addition, four patients received additional stent-grafts as proximal extensions. CONCLUSIONS: Distal migration of stent-grafts after endovascular AAA repair occurred frequently in this series. Dilatation of the proximal aneurysmal neck is a major cause of distal migration of stent-grafts. Improved proximal fixation is needed to secure long-term durability.
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