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1.	Danielsson, Gudmundur, et al. (författare) Venous function after restoring valve competence of the great saphenous vein. 2003 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 10:2, s. 350-355 Tidskriftsartikel (refereegranskat)
2.	Dias, Nuno, et al. (författare) Intraoperative proximal endoleaks during AAA stent-graft repair: evaluation of risk factors and treatment with Palmaz stents 2001 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 8:3, s. 268-273 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To study factors that might contribute to intraoperative proximal type I endoleak and to evaluate the placement of giant Palmaz stents as a therapeutic option. METHODS: Thirty-three patients (30 men; median age 72 years, range 50-85) with abdominal aortic aneurysms underwent implantation of fully supported Gianturco Z-stent-based endografts (12 custom-made aortomonoiliac and 21 bifurcated Zenith devices). Ten (30%) patients were treated for intraoperative proximal endoleaks. Stent-graft oversizing and neck angulation, length, and shape were compared between patients with and without leaks. RESULTS: In 9 cases, the endoleaks were successfully treated with intraoperative placement of Palmaz stents without complications. In 1 patient, a leak that was resolved intraoperatively with balloon dilation reappeared 1 month later; a Palmaz stent was deployed successfully. Stent-graft oversizing did not differ significantly between patients who developed proximal endoleaks and those who did not (median 4.0 mm in both groups, p = 0.47). Median neck length was 21.0 mm in patients with endoleak and 28.0 mm in those without (p > 0.99). Median neck angulation was 30 degrees in both groups (p = 0.33), and the presence of a conical aneurysm neck was not significantly different (2/10 versus 6/23, p > 0.99). All aneurysms remained excluded at a median follow-up of 13 months (range 6-24). CONCLUSIONS: Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.
3.	Hinchliffe, Robert J., et al. (författare) "Paving and cracking": An endovascular technique to facilitate the introduction of aortic stent-grafts through stenosed iliac arteries 2007 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 14:5, s. 630-633 Tidskriftsartikel (refereegranskat)abstract Purpose: To describe a technique that facilitates the safe introduction of aortic stent-grafts through diseased iliac arteries. Technique: The technique involves relining and dilating ("paving and cracking") stenosed iliac arteries with covered stents prior to the introduction of the main aortic stent-graft. It has been successfully used to introduce aortic stent-grafts in patients where other transfemoral endovascular measures have failed. Conclusion: This technique increases the applicability of transfemoral EVAR and prevents serious complications as a result of access-related damage to the iliac arteries.
4.	Malina, Martin, et al. (författare) Quality of life before and after endovascular and open repair of asymptomatic AAAs: a prospective study 2000 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 7:5, s. 372-379 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To assess how patients perceive health-related quality of life (HRQOL) after endovascular and open abdominal aortic aneurysm (AAA) repair. METHODS: Forty-two consecutive patients (33 men; mean age 74 years, range 46-81) were assessed prospectively before and after elective endovascular (n = 21) and open (n = 21) AAA repair. Aneurysm morphology dictated the type of repair. The two patient groups were similar regarding age, gender, comorbidities, and cardiopulmonary function. Data concerning surgical trauma were compiled. The Nottingham Health Profile (NHP) score was used to assess the perceived HRQOL (criteria: pain, mobility, sleep, emotion, energy, and isolation) preoperatively and at 5, 30, and 90 days postoperatively. Specific treatment perception questions were added. RESULTS: One patient from each group died, leaving 40 patients to complete the study. Two patients with open repair and 1 patient with endovascular repair were unfit to answer the questionnaire on day 5. The HRQOL improved at 3 months compared with the preoperative values (p < 0.05). No significant difference was found at any time between the open and endovascular groups regarding the NHP score, although the operative time, blood loss, analgesic use, and hospital stay were significantly in favor of endovascular repair. Reinterventions were required in 5 patients with endovascular and 2 patients with open repair. CONCLUSIONS: In general, 3 months after AAA repair, the perceived HRQOL seems better than before treatment. Perceived HRQOL is similar after endovascular and open AAA repair despite greater surgical trauma in open surgery. This may reflect the higher number of reinterventions following endovascular repair but also difficulties in defining HRQOL.
5.	Resch, Tim, et al. (författare) Aneurysm expansion and retroperitoneal hematoma after thrombolysis for stent-graft limb occlusion caused by distal endograft migration 2000 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 7:6, s. 446-446 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To describe a complication of thrombolytic therapy used to treat graft limb occlusion precipitated by distal migration and kinking of an abdominal aortic stent-graft. CASE REPORT: A 5.5-cm abdominal aortic aneurysm (AAA) in a 66-year-old woman was treated with Vanguard bifurcated stent-graft. At the 1-year follow-up, she complained of left leg claudication. Computed tomography (CT) showed a 36% reduction in maximum AAA diameter, but the stent-graft had migrated distally approximately 5 mm, and the left graft limb was occluded. Thrombolysis was initiated, but after approximately 8 hours, abdominal pain began. Emergent CT scanning revealed rapid aneurysm expansion and a retroperitoneal hematoma. Thrombolytic treatment was stopped; transfusions and thrombogenic drugs were given to restore hemodynamic stability. The aneurysm began to decrease in size. The occluded graft limb had been reopened by the lytic therapy, uncovering a stenosis in the native artery distal to the graft limb. Stent placement restored outflow. The retroperitoneal hematoma resolved over time, and the aneurysm sac shrank to its prelytic diameter. The patient is well with a functioning endograft 18 months after the occlusion (30 months after stent-grafting). CONCLUSIONS: Caution must be taken when using thrombolysis in patients with endovascular aortic grafts because unexpected bleeding complications might arise. Thrombectomy, femorofemoral bypass, or stent or stent-graft extensions might be safer alternatives for treating occluded stent-graft limbs.
6.	Resch, Timothy, et al. (författare) Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: Logistics and Short-term Results. 2003 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 10:3, s. 440-446 Tidskriftsartikel (refereegranskat)
7.	Resch, Tim, et al. (författare) Midterm changes in aortic aneurysm morphology after endovascular repair 2000 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 7:4, s. 279-285 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To study midterm changes in aortic aneurysm morphology after endovascular aneurysm repair. METHODS: Of 94 patients with abdominal aortic aneurysms (AAAs) treated with endografts between November 1993 and August 1998, 84 were available for follow-up. Patients were evaluated preoperatively by spiral computed tomography (CT) and aortography; in follow-up, spiral CT scanning was performed at 1, 3, and 6 months and semiannually thereafter. Measurements of the aneurysm neck diameter, maximum aneurysm diameter, and the distance from the lowermost renal artery to the aortic bifurcation were made preoperatively and in follow-up. RESULTS: Mean follow-up was 17.5 +/- 1.1 months; 56 (67%) patients were followed for 1 year and 28 (33%) for > or = 2 years. There was a median 2-mm increase (interquartile range [IQR] 0 to 3) in neck diameter at 18 months. However, a > or = 3-mm increase was seen in 18 (46%) of 39 patients examined at 18 months (median 4 mm, IQR 3 to 4, p = 0.0001). The maximum AAA diameter decreased by 9 mm (IQR 4 to 16, p = 0.0003) at 24 months, but after 18 months, no further interval decrease was seen. Aneurysms with a persistent endoleak showed either increasing or unchanged AAA diameters. There was no change in the renal artery to bifurcation distance. CONCLUSIONS: The infrarenal aortic neck appears to dilate after AAA endografting, but only in a subset of patients. Shrinkage of aneurysms after successful stent-grafting seems to stop after 18 months, implying that the only indication of late failure in the absence of endoleak might be aneurysm enlargement. Graft-related endoleaks are often associated with an increase in aneurysm diameter.
8.	Uher, Petr, et al. (författare) Long-term results of stenting for chronic iliac artery occlusion. 2002 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 9:1, s. 67-75 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To evaluate the long-term results of stent placement for chronic occlusions of the iliac arteries. METHODS: Between October 1992 and December 1997, 73 patients (40 men; median age 64 years, range 42-89) with 76 occluded iliac arteries (33 common, 34 external, and 9 both vessels) were treated with percutaneous recanalization and stenting using a variety of self-expanding and balloon-expandable devices. Median occlusion length was 7 cm (range 1-14). Follow-up consisted of clinical assessment, ankle-brachial index measurement, and arteriography or duplex ultrasound when indicated. RESULTS: Anatomical success was achieved in 74 (97%) limbs. Seven (10%) patients experienced major complications: 2 distal embolizations, 2 arterial ruptures, 1 myocardial infarction, 1 groin hematoma requiring surgery, and 1 contrast-induced nephropathy. There was no 30-day mortality. Over a median follow-up of 27 months (range 1-75), there was 1 early occlusion (< or = 30 days) and 16 late recurrent lesions (11 occlusions and 5 stenoses) at a median 6.2 months (range 1.4-30). The recurrent lesions were treated with endovascular techniques in 8 limbs and surgery in 7 limbs (5 after failed endovascular procedures); 1 patient died before retreatment, and 1 patient refrained from further intervention. Primary and secondary patencies were 79% and 87% at 1 year and 69% and 81% at 3 years, respectively. CONCLUSIONS: Stenting of chronic iliac occlusions is a safe and durable alternative to surgical treatment.
9.	Åkesson, Michael, et al. (författare) Subintimal angioplasty of infrainguinal arterial occlusions for critical limb ischemia: Long-term patency and clinical efficacy 2007 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 14:4, s. 444-451 Tidskriftsartikel (refereegranskat)abstract Purpose: To evaluate long-term patency and clinical efficacy of subintimal angioplasty (SAP) of occluded infrainguinal arteries 3 years post procedure. Methods: One hundred eighty-one patients (92 men; median age 79 years) underwent attempted SAP in 193 limbs with occluded infrainguinal arteries during the period 1999 to 2001. Nearly half (83, 46%) of the patients had diabetes. Most (172, 95%) had critical ischemia (Fontaine classification >II). All patients surviving at least 3 years after the procedures were followed in January 2005 with questionnaires, clinical examinations, ankle-brachial index measurements, and duplex ultrasonography. All data were collected prospectively and analyzed retrospectively. Results: The primary technical success in the entire cohort was 77% (148/193). Thirty-day mortality was 10% (19/181); 113 (62%) patients died before the 3-year follow-up. In the 68 (38%) survivors (71 limbs), patency at 49.2 months (IQR 40.8-57.6) was 40% (26/65 limbs imaged by duplex). The TASC classification did not affect technical or clinical outcomes. Forty-six (68%) of the survivors presented with clinical improvement (lower Fontaine classification at postoperative follow-up versus baseline). The limb salvage at >3 years was 86% in the 58 primarily successful SAPs and 38% in the 13 procedures that failed initially. Conclusion: SAP is a minimally invasive option for patients with critical limb ischemia. A primary technical success is essential for good clinical outcome and primary technical failure is more devastating than late occlusion. TASC classification and length of the SAP are of poor predictive value. More data are needed to confirm the efficacy of SAP.
10.	Baderkhan, Hassan, et al. (författare) Challenging Anatomy Predicts Mortality and Complications After Endovascular Treatment of Ruptured Abdominal Aortic Aneurysm 2016 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 23:6, s. 919-927 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To analyze the effects of aortic anatomy and endovascular aneurysm repair (EVAR) inside and outside the instructions for use (IFU) on outcomes in patients treated for ruptured abdominal aortic aneurysms (rAAA).METHODS: All 112 patients (mean age 73 years; 102 men) treated with standard EVAR for rAAA between 2000 and 2012 in 3 European centers were included in the retrospective analysis. Patients were grouped based on aortic anatomy and whether EVAR was performed inside or outside the IFU. Data on complications, secondary interventions, and mortality were extracted from the patient records. Cox regression analysis was performed to assess predictors of mortality and complications; results are presented as the hazard ratio (HR) with 95% confidence interval (CI). Survival was analyzed using the Kaplan-Meier method.RESULTS: Of the 112 patients examined, 61 (54%) were treated inside the IFU, 43 (38%) outside the IFU, and 8 patients lacked adequate preoperative computed tomography scans for determination. Median follow-up of those surviving 30 days was 2.5 years. Mortality at 30 days was 15% (95% CI 6% to 24%) inside the IFU vs 30% (95% CI 16% to 45%) outside (p=0.087). Three-year mortality estimates were 33.8% (95% CI 20.0% to 47.5%) inside the IFU vs 56% (95% CI 39.7% to 72.2%) outside (p=0.016). At 5 years, mortality was 48% (95% CI 30% to 66%) inside the IFU vs 74% (95% CI 54% to 93%) outside (p=0.015). Graft-related complications occurred in 6% (95% CI 0% to 13%) inside the IFU and 30% (95% CI 14% to 42%) outside (p=0.015). The rate of graft-related secondary interventions was 14% (95% CI 4% to 22%) inside the IFU vs 35% (95% CI 14% to 42%) outside (p=0.072). In the multivariate analysis, neck length <15 mm (HR 8.1, 95% CI 3.0 to 21.9, p<0.001) and angulation >60° (HR 3.1, 95% CI 1.0 to 9.3, p=0.045) were independent predictors of late graft-related complications. Aneurysm neck diameter >29 mm (HR 2.5, 95% CI 1.1 to 5.9, p=0.035) was an independent predictor of overall mortality.CONCLUSION: Long-term mortality and complications after rEVAR are associated with aneurysm anatomy. The role of adjunct endovascular techniques and the outcome of open repair in cases with challenging anatomy warrant further study.
11.	BinJabr, Adel (författare) Clinical Aspects on Chimney Stent Graft Technique in Endovascular Repair of the Aorta. 2015 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Introduction: Open repair of the aorta carries a high risk for morbidity and mortality especially in the elderly population and in patients unfit for major surgery. Endovascular aortic repair is safe, durable and effective when there is adequate proximal and distal sealing zone for the aortic stent graft. Fenestrated and branched stent grafts have made the repair possible for complex but elective cases that do not have an adequate sealing zone. Urgent complex cases and patients with midaortic occlusive diseases do not have any therapeutic alternative if they are not fit for open repair. Chimney graft technique fills this gap and allows the sealing zones for aortic stent graft to be extended as required. The aim of the present thesis is to study the applicability, safety and durability of CG technique in urgent cases with complex lesions in the thoracic and abdominal aorta including the midaortic occlusive diseases. Patients and Methods: All patients who received CG were treated urgently or semi-urgently. The majority of the treated aortic lesions were aneurysms, dissections, pseudoaneurysms, infection, and accidental overstented vital aortic side branches. The median age of all patients was 75 years (IQR, 69-78), of them 32% were female except for the first study where all ten patients were female with midaortic occlusive diseases. The second study evaluated the mid to long-term efficacy and durability of the CG technique in 29 patients with urgent and complex lesions of the thoracic aorta. The third study examined the long-term results of CG in preserving the visceral flow of 51 patients with urgent complex aortic lesions. The fourth study evaluated the CTA images of 206 patients with ruptured abdominal aortic aneurysm. The study measured the applicability of CG in patients for whom standard EVAR was contraindicated because of a short aneurysmal neck. Results: The results showed that CG is applicable and safe for midaortic occlusive diseases with high technical success and patency rate without major adverse effect. The treated patients with thoracic aortic lesions had 14% 30-day mortality, 21% type I endoleak, 7% CG-related mortality, 98% secondary patency and 68% of the aortic lesions shrank significantly. Visceral CG had a 10% 30-day mortality, 6% CG-related mortality, 12% type I endoleak, 93% secondary patency and 63% of the aortic lesions shrank significantly. Twenty-two patients had one renal arteriy sacrificed, 57% of these required permanent renal dialysis. The fourth study proved that CG technique increased the overall suitability for endovascular repair from 34% to 40-46%. Conclusions: Chimney graft seems effective and safe for treating midaortic occlusive diseases in patients unfit for open surgery. The early and mid to long-term results of the CG technique for urgent and complex lesions of the thoracic and abdominal aorta in high-risk patients are promising with a low early mortality, acceptable rate of type I endoleaks and long durability of the CGs, which may justify a broader applicability of this technique. Most endoleaks could be sealed endovascularly. However, sacrificing a kidney in such elderly population was associated with permanent dialysis in 55% of patients and should be avoided whenever possible. CGs in one or both renal arteries may increase overall suitability of rAAA for EVAR by 6-12%. Key words: Chimney stent graft, snorkel technique, endovascular aortic repair, thoracic endovascular aortic repair, endoleak, patency, rupture, urgent, stent graft, aorta, computed tomography, ultrasound, stenosis, EVAR, TEVAR.
12.	Björck, Martin (författare) Abdominal Compartment Syndrome Post EVAR : New Therapies Are Keenly Needed, but is tPA-Assisted Hematoma Evacuation the Answer? 2012 Ingår i: Journal of Endovascular Therapy. - 1526-6028 .- 1545-1550. ; 19:2, s. 149-150 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
13.	Bondesson, Johan, 1991, et al. (författare) Cardiac Pulsatile Helical Deformation of the Thoracic Aorta Before and After Thoracic Endovascular Aortic Repair of Type B Dissections 2023 Ingår i: Journal of Endovascular Therapy. - 1545-1550 .- 1526-6028. ; In Press Tidskriftsartikel (refereegranskat)abstract Purpose: Type B aortic dissections propagate with either achiral (nonspiraling) or right-handed chiral (spiraling) morphology, have mobile dissection flaps, and are often treated with thoracic endovascular aortic repair (TEVAR). We aim to quantify cardiac-induced helical deformation of the true lumen of type B aortic dissections before and after TEVAR. Material and Methods: Retrospective cardiac-gated computed tomography (CT) images before and after TEVAR of type B aortic dissections were used to construct systolic and diastolic 3-dimensional (3D) surface models, including true lumen, whole lumen (true+false lumens), and branch vessels. This was followed by extraction of true lumen helicity (helical angle, twist, and radius) and cross-sectional (area, circumference, and minor/major diameter ratio) metrics. Deformations between systole and diastole were quantified, and deformations between pre- and post-TEVAR were compared. Results: Eleven TEVAR patients (59.9 +/- 4.6 years) were included in this study. Pre-TEVAR, there were no significant cardiac-induced deformations of helical metrics; however, post-TEVAR, significant deformation was observed for the true lumen proximal angular position. Pre-TEVAR, cardiac-induced deformations of all cross-sectional metrics were significant; however, only area and circumference deformations remained significant post-TEVAR. There were no significant differences of pulsatile deformation from pre- to post-TEVAR. Variance of proximal angular position and cross-sectional circumference deformation decreased after TEVAR. Conclusion: Pre-TEVAR, type B aortic dissections did not exhibit significant helical cardiac-induced deformation, indicating that the true and false lumens move in unison (do not move with respect to each other). Post-TEVAR, true lumens exhibited significant cardiac-induced deformation of proximal angular position, suggesting that exclusion of the false lumen leads to greater rotational deformations of the true lumen and lack of true lumen major/minor deformation post-TEVAR means that the endograft promotes static circularity. Population variance of deformations is muted after TEVAR, and dissection acuity influences pulsatile deformation while pre-TEVAR chirality does not. Clinical Impact Description of thoracic aortic dissection helical morphology and dynamics, and understanding the impact of thoracic endovascular aortic repair (TEVAR) on dissection helicity, are important for improving endovascular treatment. These findings provide nuance to the complex shape and motion of the true and false lumens, enabling clinicians to better stratify dissection disease. The impact of TEVAR on dissection helicity provides a description of how treatment alters morphology and motion, and may provide clues for treatment durability. Finally, the helical component to endograft deformation is important to form comprehensive boundary conditions for testing and developing new endovascular devices.
14.	Börner, Gabriel, et al. (författare) Percutaneous AAA Repair: Is It Safe? 2004 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 11:6, s. 621-626 Tidskriftsartikel (refereegranskat)
15.	Chisci, Emiliano, et al. (författare) The AAA With a Challenging Neck: Outcome of Open Versus Endovascular Repair With Standard and Fenestrated Stent-Grafts 2009 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 16:2, s. 137-146 Tidskriftsartikel (refereegranskat)abstract Purpose: 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 (>= 28 mm), length (<= 115 mm), angulation (>= 60 degrees), shape (reverse tapered or bulging), and thrombus lining (>50%). Between January 2005 and December 2007, 187 consecutive patients (159 men; mean age 73 years, range 48-92) operated for asymptomatic abdominal aortic aneurysm (AAA) were identified as having challenging proximal neck morphology. Of these, 61 patients were treated with OR at center I (group A), 71 with standard EVAR (group B; 45 center I, 29 center II) and 52 with fenestrated EVAR (group C) at center II. Clinical examination and computed tomography were performed at 1 month and yearly thereafter. Results: There was no statistically significant difference between groups A, B, and C regarding primary technical success rate, 30-day mortality, or late AAA-related mortality. The mean length of follow-up was 19.5 months (range 0-40). Freedom from reintervention at 3 years was 91.8%, 79.7%, and 82.7% for groups A, B, and C, respectively (p=0.042). The only statistically significant difference between standard and fenestrated EVAR was a higher incidence of late sac expansion [9 (12.2%) versus 1 (1.9%), p=0.036] in the standard stent-graft group. Reinterventions were more frequent after EVAR (p=NS), but open reinterventions were more common after OR. Reinterventions after EVAR were related to the presence of an angulated (p=0.039) or short neck (p=0.024). Conclusion:The results of EVAR and OR were similar for AAAs with a challenging proximal neck. Endovascular reinterventions were more frequent after EVAR, particularly in patients with an angulated or short neck. Open reinterventions were more common after OR. More patients and long-term data are needed to confirm these findings. J Endovasc Ther. 2009;16:137-146
16.	Courtois, A, et al. (författare) Positron Emission Tomography/Computed Tomography Predicts and Detects Complications After Endovascular Repair of Abdominal Aortic Aneurysms 2019 Ingår i: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. - : SAGE Publications. - 1545-1550. ; 26:4, s. 520-528 Tidskriftsartikel (refereegranskat)abstract Purpose: To assess if aortic 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography/computed tomography (PET/CT) could play a role in predicting complications after endovascular aneurysm repair (EVAR). Materials and Methods: This study involved 2 cohorts of men with abdominal aortic aneurysm treated by EVAR: those who underwent a PET/CT scan before EVAR (n=17) and those who had a PET/CT during follow-up (n=34). Uptake of FDG was measured as the standardized uptake value (SUV). D-dimer, a marker of fibrinolysis, was measured in blood drawn concomitantly with the PET/CT. Results: A significant uptake of FDG in the aneurysm wall was detected by PET/CT before EVAR in 6 of 17 patients. During the first year after EVAR, type II endoleaks developed in 5 of these FDG+ patients vs 3 of 11 FDG– patients (p=0.04). Two of the FDG+ patients had continued sac growth and required conversion to open repair. A significant association between sac growth rate, SUV, and the presence of endoleak was found in the 34 patients who underwent PET/CT after EVAR. Finally, D-dimer was significantly increased in patients with both endoleak and positive PET/CT in the post-EVAR group. Conclusion: This study suggests that the presence of FDG uptake in the aortic wall might be a useful tool to predict patients at high risk of developing post-EVAR complications.
17.	de Cort, Boris A., et al. (författare) Long-Term Outcome for Covered Endovascular Reconstruction of Aortic Bifurcation for Aortoiliac Disease: A Single-Center Experience 2021 Ingår i: Journal of Endovascular Therapy. - : SAGE PUBLICATIONS INC. - 1526-6028 .- 1545-1550. ; 28:6, s. 906-913 Tidskriftsartikel (refereegranskat)abstract Purpose The gold standard for the treatment of complex (TASC II C and D) atherosclerotic aortoiliac lesions is still open surgical repair. Endovascular techniques have a lower mortality and morbidity rate but this comes at the cost of worse patency rates when compared with open repair. Improved short- and mid-term results have been reported using the covered endovascular reconstruction of aortic bifurcation (CERAB) technique. The aim of this study was to report our initial experience with the CERAB technique and report long-term patency rates. Materials and Methods All patients treated with the CERAB technique between 2012 and 2018 were prospectively registered in an institutional database and included in this study. Patient demographics, characteristics, symptoms, procedural, and follow-up details were collected and analyzed retrospectively. Perioperative complications and reinterventions were also identified. The Kaplan-Meier survival method was used to assess cumulative rates of patency. Results A total of 44 patients were treated with the CERAB technique and included in this study. The majority of the treated aortoiliac occlusions were classified as complex: TASC II C (n=7; 15.9%) or TASC II D (n=25; 56.8%). Primary patency rate at 60 months was 83.3%, assisted primary patency was 90.9% and secondary patency 95%. No significant differences were found in patency rates comparing noncomplex (TASC II A and B) and complex (TASC II C and D) aortoiliac lesions. Seven patients (15.9%) required at least one additional procedure to maintain either assisted primary patency or secondary patency during follow-up. The 30-day complication rate in this series was 20.5% (n=9), of which 55.6% (n=5) were minor complications. All major 30-day complications (n=4) occurred during or directly after the CERAB procedure. Thirty-day mortality was 0%. No limb occlusions occurred within 30 days of the procedure. Conclusion Good long-term patency rates can be achieved with the CERAB technique to treat aortoiliac stenosis or occlusions while maintaining advantages associated with endovascular interventions. This remains true even when a CERAB is used to treat complex aortoiliac lesions. An endo-first approach to treat complex aortoiliac lesions seems viable.
18.	Dias, Nuno (författare) Commentary: An Ingenious Strategy Pays Off: Predilating Transrenal Palmaz Stents to Facilitate Fenestrated EVAR for Type Ia Endoleak. 2012 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 19:5, s. 677-678 Tidskriftsartikel (refereegranskat)
19.	Dias, Nuno, et al. (författare) Impact of renal chimney grafts on anatomical suitability for endovascular repair in ruptured abdominal aortic aneurysm. 2015 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1545-1550 .- 1526-6028. ; 22:1, s. 105-109 Tidskriftsartikel (refereegranskat)abstract To evaluate the impact of renal chimney grafts on anatomical suitability for endovascular aneurysm repair (EVAR) in ruptured abdominal aortic aneurysm (rAAA).
20.	Dias, Nuno, et al. (författare) Single superior mesenteric artery periscope grafts to facilitate urgent endovascular repair of acute thoracoabdominal aortic pathology. 2011 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 18:5, s. 656-660 Tidskriftsartikel (refereegranskat)abstract Abstract Purpose: To assess the use of periscope grafts to the superior mesenteric artery (SMA) in extending the distal sealing zone of thoracic stent-grafts. Case Reports: Three patients with ruptured Crawford type I thoracoabdominal aortic aneurysms (TAAA) and 1 patient with a symptomatic type B dissection underwent endovascular repair; the celiac trunk was intraoperatively occluded in all patients. The thoracic stent-graft was extended to immediately above the most cranial renal artery, and the SMA was simultaneously stented from a femoral approach (periscope graft). All 4 periscope grafts were successfully implanted. One patient with rTAAA and intraoperative hemodynamic instability died in the perioperative period with a patent SMA. The other 3 patients had patent SMA periscope grafts and were free from abdominal symptoms at 14, 12, and 7 months; follow-up CT scans showed excluded aneurysms in the 2 TAAAs. The patient with type B dissection became asymptomatic but had persistent retrograde perfusion and expansion of the false lumen. Conclusion: Periscope grafts are a viable option for urgent endovascular repair of acute Crawford type I TAAA. In type B dissections, however, they are at most a bridging solution until more definitive exclusion of the false lumen is achieved.
21.	Dias, Nuno V., et al. (författare) Double-Cuff Bidirectional Branch in Endovascular Aortic Repair : A New Way of Increasing the Flexibility of Inner Branch Endografting 2022 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. Tidskriftsartikel (refereegranskat)abstract Purpose: The purpose of the study was to describe the design and implantation of a branched stent-graft during endovascular aortic repair incorporating double-cuff bidirectional inner branch. Technique: A new double-cuff bidirectional antegrade and retrograde inner branched stent-graft with large diamond-shaped fenestration was designed for incorporation of a splenic artery. The inner cuffs of the branch were accessible using brachial and/or femoral access. The splenic artery was originating from an aortic segment with narrow inner aortic luminal diameter in a patient with extent IV thoracoabdominal aortic aneurysm with bilobed configuration. The retrograde, more distal inner cuff of the branch was extended into the splenic artery using a self-expandable bridging stent-graft from the femoral approach, whereas the antegrade, more proximal inner cuff of the branch was intentionally occluded using an endovascular plug. The recovery was uneventful and a computed tomography angiography 30 days postoperatively showed patency of all the target vessels without signs of endoleaks. Conclusion: This is the first design of a double-cuff bidirectional inner branched stent-graft. The technique can potentially expand the applications of directional branches to patients with more difficult anatomy in the thoracoabdominal or aortic arch segments. Potential indications are patients with target arteries that are not ideally suited for caudally-oriented branches, patients with accessory vessels, or targets with early branch bifurcations. Clinical Impact: This report describes the use of a branched endograft with a new double-cuff bidirectional branch that can potentially address many of the limitations of current BEVAR solutions, such as early bifurcations, double arteries with adjacent origins and arteries with less favorable trajectories for the traditional caudally-oriented branches.
22.	D'Oria, Mario, et al. (författare) An International Expert-Based CONsensus on Indications and Techniques for aoRtic balloOn occLusion in the Management of Ruptured Abdominal Aortic Aneurysms (CONTROL-RAAA) 2023 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To report on the recommendations of an expert-based consensus on the indications, timing, and techniques of aortic balloon occlusion (ABO) in the management of ruptured abdominal aortic aneurysms (rAAA).METHODS: Eleven facilitators created appropriate statements regarding the study issues that were voted on using a 4-point Likert scale with open-comment fields, by a selected panel of international experts (vascular surgeons and interventional radiologists) using a 3-round modified Delphi consensus procedure (study period: January-April 2023). Based on the experts' responses, only the statements reaching grade A (full agreement ≥75%) or B (overall agreement ≥80% and full disagreement <5%) were included in the final study report. The consistency of each round's answers was also graded using Cohen's kappa, the intraclass correlation coefficient, and, in case of double resubmission, Fleiss kappa.RESULTS: Sixty-three experts were included in the final analysis and voted on 25 statements related to indication and timing (n=6), and techniques (n=19) of ABO in the setting of rAAA. Femoral sheath or ABO should be preferably placed in the operating room, via a percutaneous transfemoral access, on a stiff wire (grade B, consistency I), ABO placement should be suprarenal and last less than 30 minutes (grade B, consistency II), postoperative peripheral vascular status (grade A, consistency II) and laboratory testing every 6 to 12 hours (grade B, consistency) should be assessed to detect complications. Formal training for ABO should be implemented (grade B, consistency I). Most of the statements in this international expert-based Delphi consensus study might guide current choices for indications, timing, and techniques of ABO in the management of rAAA. Clinical practice guidelines should incorporate dedicated statements that can guide clinicians in decision-making.CONCLUSIONS: At arrival and during both open or endovascular procedures for rAAA, selective use of intra-aortic balloon occlusion is recommended, and it should be performed preferably by the treating physician in aortic pathology.CLINICAL IMPACT: This is the first consensus study of international vascular experts aimed at defining the indications, timing, and techniques of optimal use of ABO in the clinical setting of rAAA. Aortic occlusion by endovascular means (or ABO) is a quick procedure in properly trained hands that may play an important role as a temporizing measure until the definitive aortic repair is achieved, whether by endovascular or open means. Since data on its use in hemodynamically unstable patients are limited in the literature, owing to practical challenges in the performance of well-conducted prospective studies, understanding real-world use by experts is of importance in addressing critical issues and identifying main gaps in knowledge.
23.	D'Oria, Mario, et al. (författare) Comparison of early and mid-term outcomes after fenestrated-branched endovascular aortic repair in patients with or without prior infrarenal repair 2021 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. ; 29:4, s. 544-554 Tidskriftsartikel (refereegranskat)abstract Objective: The purpose of this study was to compare short- and mid-term outcomes of fenestrated-branched endovascular repair (F-BEVAR) of pararenal (PRAA)/thoracoabdominal (TAAA) aortic aneurysms in patients with or without prior endovascular/open (EVAR/OAR) infrarenal aortic repair.Methods: Data from consecutive F-BEVAR (2010-2019) at two high-volume aortic centers were retrospectively reviewed. Primary endpoints were technical success, 30-day mortality, and overall survival. Secondary endpoints included 30-day major adverse events (MAE), freedom from type I/III endoleaks, reinterventions, sac expansion, and target vessel (TV) primary patency.Results: A total of 222 consecutive patients were included for analysis; of these 58 (26.1%) had prior infrarenal repair (EVAR=33, OAR=25) and 164 (73.9%) had native PRAA/TAAA. At baseline, patients with prior infrarenal repair were older (mean age=75.1 vs 71.6 years, p=.005) and the proportion of females was lower (8.6% vs 29.3%, p=.002). Technical success was 97.8% (n=217) in the entire cohort, without any significant differences between study groups (94.8% vs 98.8%, p=.08). At 30 days, there were no significant differences between patients with prior infrarenal repair as compared with those without in rate of MAE (44.8% vs 54.9%, p=.59). The 5-year estimate of survival for those who underwent native aortic repair was 61.6%, versus 61.3% for those who had a previous repair (p=.67). The 5-year freedom from endoleaks I/III estimates were significantly lower in patients who had prior infrarenal repair as compared with patients undergoing treatment of native aneurysms (57.1% vs 66.1%, p=.03), mainly owing to TV-related endoleaks (ie, type IC and/or IIIC endoleaks). No significant differences were found between study groups in rates of reinterventions and TV primary patency. Five-year estimates of freedom from sac increase >5mm were significantly lower in patients who received F-BEVAR after previous infrarenal repair as compared with those who underwent treatment of native aneurysms (48.6% vs 77.5%, p=.002).Conclusions: F-BEVAR is equally safe and feasible for treatment of patients with prior infrarenal repair as compared with those undergoing treatment for native aneurysms. Increased rates of TV-related endoleaks were observed which could lead to lower freedom from aneurysm sac shrinkage during follow-up. Nevertheless, the 5-year rates of reinterventions and TV patency were similar, thereby indicating that overall effectiveness of treatment remained satisfactory at mid-term.
24.	D'Oria, Mario, et al. (författare) Outcomes of "Anterior Versus Posterior Divisional Branches of the Hypogastric Artery as Distal Landing Zone for Iliac Branch Devices" : The International Multicentric R3OYAL Registry 2024 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. ; 31:2, s. 282-294 Tidskriftsartikel (refereegranskat)abstract Objective: The aim of this multicentric registry was to assess the outcomes of "anteRior versus posteRior divisional bRanches Of the hYpogastric artery as distAl landing zone for iLiac branch devices (R3OYAL)."Methods: The main exposure of interest for the purpose of this study was the internal iliac artery (IIA) divisional branch (anterior vs posterior) that was used as distal landing zone. Early endpoints included technical success and adverse events. Late endpoints included survival, primary/secondary IIA patency, and IIA branch instability.Results: A total of 171 patients were included in the study, of which 50 received bilateral implantation of iliac branch devices (IBDs). This resulted in a total of 221 incorporated IIAs included in the final analysis, of which 40 were anterior divisional branches and 181 were posterior divisional branches. Technical success was high in both groups (anterior division: 98% vs posterior division: 100%, P = .18). Occurrence of any adverse event was noted in 14% of patients in both groups (P = 1.0). The overall rate of freedom from the composite IBD branch instability did not show significant differences between patients receiving distal landing in the anterior or posterior division of the IIA at 3 years (79% vs 87%, log-rank test = .215). The 3-year estimates of IBD patency were significantly lower in patients who received distal landing in the anterior divisional branch than those who received distal landing in the posterior divisional branch (primary patency: 81% vs 96%, log-rank test = .009; secondary patency: 81% vs 97%, log-rank test < .001).Conclusions: The use of the anterior or posterior divisional branches of the IIA as distal landing zone for IBD implantation shows comparable profiles in terms of immediate technical success, perioperative safety, and side-branch instability up to 3 years. However, IBD patency at 3 years was higher when the distal landing zone was achieved within the posterior divisional branch of the IIA.Clinical Impact: The results from this large multicentric registry confirm that use of the anterior or posterior divisional branches of the internal iliac artery (IIA) as distal landing zone for implantation of iliac branch devices (IBD) shows comparable profiles of safety and feasibility, thereby allowing to extend the indications for endovascular repair of aorto-iliac aneurysms to cases with unsuitable anatomy within the IIA main trunk. Although mid-term rates of device durability and branch instability seem to be similar, the rates of primary and secondary IBD patency at three years was favored when the distal landing zone was achieved in the posterior divisional branch of the IIA.
25.	Edsfeldt, Andreas, et al. (författare) Validation of a New Method for 2D Fusion Imaging Registration in a System Prepared Only for 3D 2020 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 27:3, s. 468-472 Tidskriftsartikel (refereegranskat)abstract Purpose: To validate a new 2D-3D registration method of fusion imaging during aortic repair in a system prepared only for 3D-3D registration and to compare radiation doses and accuracy. Materials and Methods: The study involved 189 patients, including 94 patients (median age 70 years; 85 men) who underwent abdominal endovascular aneurysm repair (EVAR) with 2D-3D fusion on an Artis zee imaging system and 95 EVAR patients (median age 70 years; 81 men) from a prior study who had 3D-3D registration done using cone beam computed tomography (CBCT). For the 2D-3D registration, an offline CBCT of the empty operating table was imported into the intraoperative dataset and superimposed on the preoperative computed tomography angiogram (CTA). Then 2 intraoperative single-frame 2D images of the skeleton were aligned with the patient’s skeleton on the preoperative CTA to complete the registration process. A digital subtraction angiogram was done to correct any misalignment of the aortic CTA volume. Values are given as the median [interquartile range (IQR) Q1, Q3]. Results: The 2D-3D registration had an accuracy of 4.0 mm (IQR 3.0, 5.0) after bone matching compared with the final correction with DSA (78% within 5 mm). By applying the 2D-3D protocol the radiation exposure (dose area product) from the registration of the fusion image was significantly reduced compared with the 3D-3D registration [1.12 Gy∙cm2 (IQR 0.41, 2.14) vs 43.4 Gy∙cm2 (IQR 37.1, 49.0), respectively; p<0.001). Conclusion: The new 2D-3D registration protocol based on 2 single-frame images avoids an intraoperative CBCT and can be used for fusion imaging registration in a system originally designed for 3D-3D only. This 2D-3D registration protocol is accurate and leads to a significant reduction in radiation exposure.
26.	Erhart, P, et al. (författare) Prediction of Rupture Sites in Abdominal Aortic Aneurysms After Finite Element Analysis 2016 Ingår i: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. - : SAGE Publications. - 1545-1550. ; 23:1, s. 115-120 Tidskriftsartikel (refereegranskat)abstract Purpose: To associate regions of highest local rupture risk from finite element analysis (FEA) to subsequent rupture sites in abdominal aortic aneurysms (AAA). Methods: This retrospective multicenter study analyzed computed tomography angiography (CTA) data from 13 asymptomatic AAA patients (mean age 76 years; 8 men) experiencing rupture at a later point in time between 2005 and 2011. All patients had CTA scans before and during the rupture event. FEA was performed to calculate peak wall stress (PWS), peak wall rupture risk (PWRR), rupture risk equivalent diameters (RRED), and the intraluminal thrombus volume (ILTV). PWS and PWRR locations in the prerupture state were compared with subsequent CTA rupture findings. Visible contrast extravasation was considered a definite (n=5) rupture sign, while a periaortic hematoma was an indefinite (n=8) sign. A statistical comparison was performed between the 13-patient asymptomatic AAA group before and during rupture and a 23-patient diameter-matched asymptomatic AAA control group that underwent elective surgery. Results: The asymptomatic AAAs before rupture showed significantly higher PWRR and RRED values compared to the matched asymptomatic AAA control group (median values 0.74 vs 0.52 and 77 vs 59 mm, respectively; p<0.0001 for both). No statistical differences could be found for PWS and ILTV. Ruptured AAAs showed the highest maximum diameters, PWRR, and RRED values. In 7 of the ruptured AAAs (2 definite and 5 indefinite rupture signs), CTA rupture sites correlated with prerupture PWRR locations. Conclusion: The location of the PWRR in unruptured AAAs predicted future rupture sites in several cases. Asymptomatic AAA patients with high PWRR and RRED values have an increased rupture risk.
27.	Friesen, Lia, et al. (författare) Bilateral Implantation of Double-Branched Iliac Branch Devices for Endovascular Repair of Aorto-Bi-Iliac Aneurysm With Concomitant Hypogastric Aneurysms : The Quadruple Branch 2023 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. ; 30:4, s. 520-524 Tidskriftsartikel (refereegranskat)abstract Purpose: The purpose of this report is to describe the use of a double-branched custom-made iliac branch device (IBD) for the endovascular repair of an aorto-bi-iliac aneurysm with concomitant bilateral hypogastric aneurysms. Technique: A 61-year-old man on peritoneal dialysis underwent a computed tomography (CT) of the infrarenal aorta before planned kidney transplantation. The CT showed an asymptomatic aorto-bi-iliac aneurysm of 54 mm involving the hypogastric artery (HA) bilaterally (right HA 31 mm; left HA 40 mm). The treatment consisted of an endovascular aortic repair (EVAR) and the bilateral implantation of custom-manufactured IBDs with double inner branches to preserve both superior and inferior gluteal arteries. At 1 year follow-up, the patient remains free of symptoms and the postoperative CT showed a successfully excluded aneurysm with patent bridging stent grafts to all HA branches. Conclusion: The bilateral implantation of double-branched IBDs is a feasible technique. Preservation of both hypogastric arteries and its branches can be achieved with this technique and therefore decrease the risk of buttock claudication and other ischemic complications.
28.	Fujita, Satoko, et al. (författare) Impact of intrasac thrombus and a patent inferior mesenteric artery on EVAR outcome. 2010 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 17:4, s. 534-539 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To assess the significance of a patent inferior mesenteric artery (IMA) and presence of intrasac thrombus on the outcome of endovascular aneurysm repair (EVAR) for infrarenal abdominal aortic aneurysm (AAA). METHODS: Between June 2004 and June 2007, 114 AAA patients (100 men; mean age 75 years, range 56-87) treated electively with a bifurcated stent-graft were assessed with computed tomography pre- and postoperatively. Incidences of type II endoleaks and reinterventions were compared with preoperative intrasac thrombus and IMA patency. RESULTS: Over a mean follow-up of 19 months (range 6-38), there was no aneurysm rupture. Eleven (11%) of 101 patients with and 7 (54%) of 13 patients without preoperative intrasac thrombus presented with a type II endoleak (p<0.01). The postoperative change in aneurysm diameter was 0 mm (-20 to 16) in 18 patients with type II endoleak and -9 mm (-30 to 18) in sealed aneurysms (p<0.001). Fourteen (78%) type II endoleaks originated from lumbar arteries and 4 (22%) from the IMA in spite of the fact that most patients (69%) had a patent IMA. There were 5 reinterventions for type II endoleak with expansion of the sac. The reinterventions did not seem related to intrasac thrombus or a patent IMA. Prophylactic embolization of the IMA was unsuccessful in 4 (33%) cases. CONCLUSION: In this series, type II endoleaks inhibited sac shrinkage and occurred more frequently in aneurysms without intrasac thrombus. Most type II endoleaks originated from lumbar arteries and not from the IMA. Prophylactic embolization of the IMA does not seem justified and is not always technically successful.
29.	Gavali, Hamid, et al. (författare) Branched Endovascular Aortic Plug in Patients With Infrarenal Aortic Graft Infection and Hostile Anatomy 2020 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 27:2, s. 328-333 Tidskriftsartikel (refereegranskat)abstract Purpose: To present a novel 4-branched endovascular aortic plug (BEVAP) for treatment of patients with infrarenal aortic graft infection.Case Reports: Two polymorbid male patients with aortic graft infections and an unsuturable diseased paravisceral aorta were treated under compassionate use with a custom-made stent-graft. The BEVAP is a factory-modified Zenith t-Branch thoracoabdominal endovascular graft with the distal tubular main graft portion removed, creating an aortic plug that excludes the abdominal aorta while maintaining perfusion to the visceral organs. The BEVAP device is deployed using a femoral approach, and the branches are accessed through an axillary approach. A standard axillobifemoral bypass is created to perfuse the lower body. One to 2 days later, the infected infrarenal graft is resected without the need of aortic clamping or closure of the aortic stump. The BEVAP device in these 2 cases resulted in thrombosis of the abdominal aorta and the infected graft prior to explantation.Conclusion: Using the BEVAP enables radical treatment of selected patients with hostile anatomy and infrarenal aortic graft infections who have an aneurysmal paravisceral aortic segment that prevents traditional radical surgical treatment with in situ reconstruction or extra-anatomical bypass.
30.	Georgakarakos, Efstratios, et al. (författare) Applying Findings of Computational Studies in Vascular Clinical Practice : Fact, Fiction, or Misunderstanding? 2014 Ingår i: Journal of Endovascular Therapy. - 1526-6028 .- 1545-1550. ; 21:3, s. 434-438 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
31.	Grima, Matthew Joe, et al. (författare) In situ laser fenestration technique : bench-testing of aortic endograft to guide clinical practice 2024 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. ; 31:1, s. 126-131 Tidskriftsartikel (refereegranskat)abstract Purpose: In situ laser fenestration (ISLF) is a recently introduced technology that offers the potential to perform total endovascular treatment of aortic arch and thoracoabdominal aortic pathologies in the acute setting. This experiment’s aim was to assess ISLF in some currently common aortic endografts and bridging stent-grafts.Materials and Methods: Three different aortic endografts were evaluated: (1) Zenith Alpha, (2) Zenith TX2, and (3) Conformable GORE TAG. Each endograft was submerged in 37°C saline to create fenestrations using the 308 nm CVX-300 Excimer Laser System fitted with a 2.3 mm diameter Turbo-Elite laser atherectomy catheter compatible with a 0.018″ guidewire. Three different 8 mm bridging stent-grafts were evaluated: (1) BeGraft peripheral, (2) BeGraft peripheral plus, and (3) GORE VIABAHN VBX Balloon Expandable. All bridging stent-grafts were deployed and exposed to different balloon sizes and pressures. The ISLFs and bridging stent-grafts were then evaluated for any tears, stenoses, and seal.Results: A laser fenestration was consistently rapidly obtained in the Zenith Alpha and the Zenith TX2 endografts while it proved difficult to achieve a timely fenestration in the C-TAG. No fabric tears were noted in the Zenith Alpha and Zenith TX2 when inflating Armada (Abbott) 8 mm balloon in the fenestrations with pressures up to 15 atmospheres (rated burst pressure) nor when flaring bridging stent-grafts with balloons up to 12 mm in diameter at 10 atmospheres, while major tears were frequently noted in the C-TAG when the Armada 8 mm balloons were inflated. BeGraft Peripheral and BeGraft Peripheral Plus were all firmly attached to the fenestrations showing good seal on manual testing, while every sixth VBX bridging stent-graft displayed poorer attachment to the fenestration before dilatation at high pressure. Commonly, significant stenoses remained in the bridging stent-grafts after dilatation at nominal pressure, which could only be eradicated with high-pressure balloons.Conclusion: In this limited bench-test, Dacron endografts responded well to the ISLF technology. Satisfactory deployment of the bridging stent was noted only after inflation and/or flaring with high-pressure balloons. Further work with different types of commercially-available bridging stent-grafts and endografts to assess the durability of in situ fenestration (ISF) and bridging stents in ISF is recommended.Clinical Impact: This report on experimental in situ laser fenestration provide important insights for clinicians considering using in situ laser fenestration of aortic stentgrafts in vivo. In particular, different laser settings were tested together with a selection of aortic stentgrafts. Also, the target pressure needed in PTA balloons to dilate the fenestrations and any subsequent tears in the fabric were noted. This was followed by deployment of assorted balloon-expandable stentgrafts with estimation of residual stenosis and seal.
32.	Hörer, Tal M., 1971-, et al. (författare) Tissue plasminogen activator-assisted hematoma evacuation to relieve abdominal compartment syndrome after endovascular repair of ruptured abdominal aortic aneurysm 2012 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. ; 19:2, s. 144-148 Tidskriftsartikel (refereegranskat)abstract Purpose: To describe our experience with a novel technique to decompress abdominal compartment syndrome after endovascular aneurysm repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA).Method: From January 2003 to April 2010, 13 patients (12 men; mean age 75 years) treated for rAAA with EVAR underwent tissue plasminogen activator (tPA)-assisted decompression for intra-abdominal hypertension. All of the patients but one had intra-abdominal pressure >20 mmHg, with signs of multiple organ failure or abdominal perfusion pressure <60 mmHg. With computed tomography guidance, a drain was inserted into the retroperitoneal hematoma, and tPA solution was injected to facilitate evacuation of the coagulated hematoma and decrease the abdominal pressure.Results: In the 13 patients, the mean intra-abdominal pressure decreased from 23.5 mmHg (range 12-35) to 16 mmHg (range 10-28.5). A mean 1520 mL (range 170-2900) of blood was evacuated. Urine production (mean 130 mL/h, range 50-270) increased in 7 patients at 24 hours after tPA-assisted decompression; among the 5 patients in which urine output did not increase, 3 underwent hemodialysis by the 30-day follow-up. One patient did not respond with clinical improvement and required laparotomy. The 30-day, 90-day, and 1-year mortality was 38% (5/13 patients); none of the deaths was related to the decompression technique.Conclusion: tPA-assisted decompression of abdominal compartment syndrome after EVAR can decrease the intra-abdominal pressure and could be useful in preventing multiple organ failure. It is a minimally invasive technique that can be used in selected cases but does not replace laparotomy or retroperitoneal surgical procedures as the gold standard treatments. J Endovasc Thor. 2012;19:144-148
33.	Jaff, Michael R., et al. (författare) An Update on Methods for Revascularization and Expansion of the TASC Lesion Classification to Include Below-the-Knee Arteries : A Supplement to the Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II) 2015 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 22:5, s. 663-677 Tidskriftsartikel (refereegranskat)abstract The Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC) guidelines were last updated in 2007 (TASC II) and represented the collaboration of international vascular specialties involved in the management of patients with peripheral arterial disease (PAD). Since the publication of TASC II, there have been innovations in endovascular revascularization strategies for patients with PAD. The intent of this publication is to provide a complete anatomic lower limb TASC lesion classification, including the infrapopliteal segment, and an updated literature review of new endovascular techniques and practice patterns employed by vascular specialists today.
34.	Jónsson, Gísli Gunnar, et al. (författare) Off-the-shelf single-fenestrated endograft for emergent juxtarenal and pararenal abdominal aortic aneurysm 2023 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. Tidskriftsartikel (refereegranskat)abstract Introduction: Endovascular solutions to emergent juxtarenal and pararenal abdominal aortic aneurysms (AAAs) are complicated. Endovascular aortic repair (EVAR) with in situ laser fenestration (ISLF) is promising but requires a period of visceral ischemia. With an off-the-shelf, single superior mesenteric artery (SMA)-fenestrated device mesenteric ischemia is avoided and renal ischemia decreased. The aim was to develop an optimized design of such an endograft suitable for >90% of juxtarenal and pararenal AAAs.Methods: Single-center analysis on 44 consecutive preoperative CTs for previously elective fenestrated EVARs for juxtarenal and pararenal aneurysms. Anatomical characteristics were analyzed to define: (1) shortest aortic coverage above SMA fenestration to achieve ≥4 cm seal; (2) feasibility of a scallop for the celiac artery; (3) shortest distance between the SMA and lowest renal, to facilitate renal ISLF in a straight endograft; (4) distance from the lowest renal to the aortic bifurcation, to allow an overlapping zone >40 mm with a bifurcated stent graft; (5) aortic diameter in the sealing zone, for optimal proximal stent graft diameter with 10% to 30% oversizing; (6) the final design was then tested on individual level.Results: (1) The stent graft needs to start 40 mm above the SMA fenestration to achieve a 4 cm sealing zone in >90% of cases. (2) A proximal sealing zone of 40 mm without a scallop covers 77% of celiac arteries. With an addition of a 20 mm deep, 20 mm wide scallop at 12:30, the stent graft still covers 27% of celiacs. This suggests that a scallop would not be practically feasible. (3) In >90% of cases, the lowest renal was <31 mm from the SMA, suggesting that the tapering should start 30 mm below the SMA. (4) The distance from the lowest renal to the aortic bifurcation ranged from 82 to 166 mm. This allows for a 20 mm tapering and 50 mm straight part in all cases. (5) The 5th and 95th percentile of the aortic diameter in the sealing zone was 22 and 31 mm, respectively. Thus, 2 different stent graft diameters (28 and 34 mm) would fit >90% of cases. (6) The final design was suitable in 91% cases.Conclusions: Two sizes of a single-fenestrated aortic stent graft without scallop cover >90% of juxtarenal and pararenal anatomies.Clinical Impact: Emergent juxta- and pararenal aortic aneurysms is a difficult clinical scenario that continuously challenges physicians. An endovascular option is in situ laser fenestrated endografts. One risk with these is the complete visceral ischemia occurring before the fenestrations are completed. An off-the-shelf single-fenestrated stent graft facilitates the treatment by removing the ischemia time for the SMA and reducing the ischemia time for the celiac and renal arteries thus decreasing the risk of visceral ischemia complications.
35.	Jonsson, Thomas, et al. (författare) Limb ischemia after EVAR : an effect of the obstructing introducer? 2008 Ingår i: Journal of Endovascular Therapy. - Phoenix, AZ : International Society of Endovascular Specialists. - 1526-6028 .- 1545-1550. ; 15:6, s. 695-701 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To evaluate the splanchnic and limb metabolic effects of open repair (OR) of abdominal aortic aneurysms (AAA) versus endovascular aneurysm repair (EVAR) in a pilot study utilizing microdialysis. METHODS: Nine AAA patients (8 men; mean age 74 years, range 61-85) were treated with EVAR and 9 had an OR (5 men; mean age 70 years, range 55-85). In the EVAR cases, which were performed percutaneously, the external iliac artery was obstructed by the introducer to a mean functional stenosis of 70% (52%-100%). Catheters for microdialysis were placed subcutaneously above the ankle of the right leg and freely in the abdominal cavity to measure the levels of lactate and pyruvate. The lactate/pyruvate ratio was calculated as a measure of ischemia. Measurements started at the end of surgery and continued for 2 days. Mean values were compared using the Mann-Whitney U test. RESULTS: The mean value of intraperitoneal lactate during the first day after EVAR was 1.5+/-0.7 mM versus 2.6+/-0.8 mM after OR (p = 0.019). The lactate/pyruvate ratio was 10.2+/-2.2 after EVAR and 12.3+/-2.6 after OR (p = 0.113). Leg lactate mean values were 4.2+/-2.0 mM after EVAR versus 1.8+/-0.6 mM after OR (p<0.001). The lactate/pyruvate ratio was 20.1+/-8.3 for EVAR and 13.7+/-3.3 for OR (p = 0.040). These differences between EVAR and OR continued for the second day. CONCLUSION: Intraperitoneally, metabolism was slightly increased after OR; however, it was not suggestive of splanchnic ischemia. Leg findings reflected a more extensive ischemia after EVAR over 48 hours, which was a somewhat unexpected finding that may be related to the introducer's impact on blood flow to the limb during the intervention. Although no clinical consequences were recorded, the finding suggests some benefit of minimizing as much as possible the time of reduced perfusion to the limb.
36.	Jovanovic, K, et al. (författare) The Value of Troponin Measurement in Carotid Revascularization: A Scoping Review 2023 Ingår i: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. - 1545-1550. ; , s. 15266028231179874- Tidskriftsartikel (refereegranskat)
37.	Karelis, Angelos, et al. (författare) Iliac Branch Devices in the Repair of Ruptured Aorto-iliac Aneurysms: A Multicenter Study 2023 Ingår i: Journal of Endovascular Therapy. - : SAGE PUBLICATIONS INC. - 1526-6028 .- 1545-1550. Tidskriftsartikel (refereegranskat)abstract Purpose: To evaluate the outcomes of preserving the internal iliac artery (IIA) with iliac branched devices (IBDs) during acute endovascular repair of ruptured aortoiliac aneurysms. Material and Methods: This is a multicenter retrospective review of all consecutive patients undergoing acute endovascular repair of ruptured aortoiliac aneurysm with an IBD at 8 aortic centers between December 2012 and June 2020. A control group was used where the IIA was intentionally occluded from the same study period. The main outcome measures were 30-day mortality, major adverse events, technical success, and clinical success. Secondary outcomes were buttock claudication, primary patency, primary-assisted and secondary patency of the IBD, occurrence of endoleak types I/III, and reintervention. Values are presented as numbers and percentages or interquartile range in parenthesis. Results: Forty-eight patients were included in the study: 24 with IBD and 24 with IIA occlusion. There was no difference in demographics, cardiovascular risk factors, and aneurysm extent. Twenty (83%) of them were hemodynamically stable during the procedure as opposed to 14 (58%, p=.23) with the IIA occlusion. Technical success was achieved in all cases with a procedure time of 180 (133-254) minutes, 45 (23-65) of which were from IBD. There were 2 (8%) deaths during the first 30 days and 2 (8%) major complications unrelated to the IBD, whereas in the IIA occlusion, the figures were 10 (42%) and 7 (29%), respectively. No patient in the IBD group developed buttock claudication compared to 8 (57%, p<.0001) in the IIA occlusion group; 1 (4%) patient developed bowel ischemia on both groups, with 1 in the IIA occlusion group needing resection. The median follow-up duration was 17 months (interquartile range 2-39) for the IBD group, with a primary patency of 60 +/- 14% at 3 years that went up to 92 +/- 8% with reinterventions (8 reinterventions in 6 patients). When the first 90 days were disregarded, there were no differences in survival between the groups. Conclusion: IBD is a valid alternative for maintaining the pelvic circulation for endovascular aortic aneurysm repair of ruptured aortoiliac aneurysms. The technical success and midterm outcomes are very satisfactory but require patient selection particularly regarding hemodynamic stability. The reintervention rate is considerable, mandating continuous follow-up. Clinical Impact This multicenter study demonstrates that ruptured aortoiliac aneurysms do not necessarily require mandatory occlusion of hypogastric arteries. Iliac branch devices are shown to be a valid alternative in highly selected cases, with good midterm results, even if reinterventions are required in a significant proportion of patients.
38.	Karelis, A, et al. (författare) Multicentric Use of Commercially Available Infrarenal Endografts During Fenestrated Endovascular Aortic Repair: A Feasibility Study 2024 Ingår i: Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists. - 1545-1550. ; , s. 15266028241257090- Tidskriftsartikel (refereegranskat)
39.	Koelbel, Tilo, et al. (författare) Fenestrated TEVAR Using a Guidewire Fixator for Anchoring in Aortic Arch Target Vessels 2018 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 25:1, s. 40-46 Tidskriftsartikel (refereegranskat)abstract Purpose:To report a new facilitated method for securing target vessel access during single fenestrated and branched thoracic endovascular repair using a guidewire fixator.Technique: The Liungman Guidewire Fixator (LGF) includes a 0.035-inch guidewire that is fitted with a stopper close to the distal end and a self-expanding anchoring element that is freely movable over the guidewire to the point of the stopper. The technique of using a LGF for anchoring in a target vessel is described in a 75-year-old woman with a 53-mm saccular arch aneurysm. She was treated with a fenestrated Zenith stent-graft that had a catheter-preloaded fenestration for the left subclavian artery (LSA) and a scallop for the left common carotid artery. To avoid through-and-through wire and brachial access, the LGF was used to secure the guidewire in the LSA during stent-graft deployment.Conclusion: The use of an LGF for anchoring in the target LSA during fenestrated arch endografting was feasible and safe.
40.	Koelbel, Tilo, et al. (författare) Physician-Modified Thoracic Stent-Graft With Low Distal Radial Force to Prevent Distal Stent-Graft-Induced New Entry Tears in Patients With Genetic Aortic Syndromes and Aortic Dissection 2018 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1526-6028 .- 1545-1550. ; 25:4, s. 456-463 Tidskriftsartikel (refereegranskat)abstract Purpose: To describe a novel modification technique to lower the distal radial force of a thoracic stent-graft so as to avert stent-graft-induced new entry tears (SINE) in the fragile aorta of patients with genetic aortic disease and aortic dissection. Technique: A commercially available thoracic stent-graft is partially deployed on a back table. The most distal Z-stent is removed, the distal fabric is marked by vascular clips, and the modified stent-graft is reloaded and deployed in the true lumen of an aortic dissection. The technique is demonstrated in 3 patients with aortic dissection related to genetic aortic diseases. Conclusion: Creating a low distal radial force stent-graft is easy and can be done in a short time. Endovascular implantation appears feasible and safe.
41.	Kragsterman, Björn, et al. (författare) EndoVAC, a Novel Hybrid Technique to Treat Infected Vascular Reconstructions With an Endograft and Vacuum-Assisted Wound Closure 2011 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1526-6028 .- 1545-1550. ; 18:5, s. 666-673 Tidskriftsartikel (refereegranskat)abstract Purpose: To report an initial experience and midterm results of a novel hybrid technique (EndoVAC) combining stent-grafts, surgical revision, and vacuum-assisted wound closure (VAC). Methods: All 10 patients (5 men; mean age 62 years) treated with the EndoVAC technique for infected vascular reconstructions (5 carotid, 4 femoral) or access sites (1 femoral and 1 brachial artery) between November 2007 and June 2010 were retrospectively reviewed. Follow-up included laboratory investigations, duplex ultrasonography, and imaging. Results: VAC therapy was applied for a median 15 days (range 9-54). Three complications occurred: a watershed infarction (dysphasia), a transient hypoglossal nerve palsy, and a late stent-graft thrombosis. Two patients died during treatment but with local infection under control. Over a median follow-up of 11 months (range 1-33), no recurrent infection was noted after healing of the skin in any of the 8 survivors. Conclusion: The EndoVAC technique seems to be a promising option for treatment of infected vascular reconstructions in selected cases.
42.	Kristmundsson, Thorarinn, et al. (författare) A Novel Method to Estimate Iliac Tortuosity in Evaluating EVAR Access 2012 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 19:2, s. 157-164 Tidskriftsartikel (refereegranskat)abstract Purpose: To subjectively and objectively evaluate the methods used for preoperative assessment of iliac artery tortuosity in patients with abdominal aortic aneurysms (AAA). Methods: Iliac artery tortuosity was assessed retrospectively in 188 patients (160 men; mean age 73 years) diagnosed with AAA at our clinic in 2006 and 2007. All patients underwent preoperative computed tomography (CT) with predominantly thin-slice acquisitions. CT data were analyzed in a dedicated 3-dimensional workstation to perform centerline-of-flow measurements on 376 iliac arteries. Iliac tortuosity was evaluated using the following methods: (1) subjective grading (none, mild, moderate, severe) by 2 experienced observers, (2) calculating the modified iliac tortuosity index based on the published reporting standards for endovascular aneurysm repair, and (3) using the shortest distance between the aortic bifurcation and the common femoral artery (CFA) on axial CT scans as a surrogate for the tortuosity index. Correlation between the objective methods was assessed, and all 3 methods were evaluated for intra- and interobserver agreement. Results: (1) The intra- and interobserver agreement was substantial (κ = 0.71 and κ = 0.65, respectively) for subjective grading, but few variations were found in the calculated tortuosity indexes between the subjective groups. (2) Intra- and interobserver correlations when measuring the iliac tortuosity index were strong (r = 0.94 and r = 0.79, respectively), with good intra- and interobserver agreement. (3) The new method had a strong correlation with iliac tortuosity index (r = 0.78); segregating the iliac arteries into 3 length categories (<10 cm, 10-15 cm, >15 cm), the mean iliac tortuosity indexes were 2.0±0.37, 1.6±0.21, and 1.1±0.27, respectively (p<0.001). This strong correlation was not seen when measuring the iliac artery length in CLF reconstruction (r = 0.31), proving little variation in CLF length among patients. Conclusion: Subjective grading of iliac artery tortuosity had substantial agreement between investigators but cannot be recommended as a surrogate for the tortuosity index in access evaluation. The iliac artery tortuosity index is most accurate, but complex and time-consuming. As the CLF length varies only slightly among patients, the new method using the shortest aortic bifurcation-CFA distance on an axial CT scan is a good substitute for the iliac tortuosity index and can often replace it clinically.
43.	Kristmundsson, Thorarinn, et al. (författare) Association Between the SVS/AAVS Anatomical Severity Grading Score and Operative Outcomes in Fenestrated Endovascular Repair of Juxtarenal Aortic Aneurysm. 2013 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 20:3, s. 356-365 Tidskriftsartikel (refereegranskat)abstract Purpose : To evaluate the association between the Society for Vascular Surgery/American Association for Vascular Surgery (SVS/AAVS) anatomical severity grading (ASG) score and operative outcomes in fenestrated endovascular repair (f-EVAR) for juxtarenal aortic aneurysm. Methods : A review was conducted of all patients treated at our clinic with commercially available, custom-made f-EVAR devices between June 2007 and December 2011. Preoperative computed tomography (CT) scans were analyzed in a dedicated vascular 3-dimensional workstation for calculation of the ASG score. Of the 100 patients treated with f-EVAR during the study period, 88 (69 men; mean age 70 years, range 50-82) had high quality CT scans available for generating semiautomatic centerline-of-flow reconstructions needed to calculate the ASG score. The mean score was used to divide the patients into high and low score groups for comparison of operative outcomes. Results : A total ASG score ≥24 was associated with longer procedure time (357±121 vs. 298±131 minutes, p=0.03) and more frequent intraoperative adjunctive maneuvers (48% vs. 29% of patients, p=0.05). An ASG neck score ≥7 was associated with longer procedure time (365±126 vs. 288±119 minutes, p<0.01), more operative adverse events (31% vs. 14% of patients, p=0.05), higher radiation exposure (53828±37341 vs. 38788±25846 μGym (2) , p=0.04), and more frequent postoperative complications (46% vs. 18% of patients, p<0.01). An ASG aneurysm score ≥5 was associated with operative adverse events (44% vs. 19% of patients, p=0.04). No relationship was found between the ASG score and blood loss, contrast volume, fluoroscopy time, or hospital stays. Conclusion : The ASG score is associated with operative adverse events, intraoperative adjunctive maneuvers, radiation exposure, and postoperative complications in patients treated with f-EVAR for juxtarenal aortic aneurysm.
44.	Kristmundsson, Thorarinn, et al. (författare) Suitability of the Zenith p-Branch Standard Fenestrated Endovascular Graft for Treatment of Ruptured Abdominal Aortic Aneurysms. 2015 Ingår i: Journal of Endovascular Therapy. - : SAGE Publications. - 1545-1550 .- 1526-6028. ; 22:5, s. 760-764 Tidskriftsartikel (refereegranskat)abstract To evaluate the anatomic suitability of the Zenith pivot branch (p-branch) fenestrated device in ruptured abdominal aortic aneurysms (rAAA).
45.	Kölbel, Tilo, et al. (författare) Chronic iliac vein occlusion: midterm results of endovascular recanalization. 2009 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 16:4, s. 483-491 Tidskriftsartikel (refereegranskat)abstract PURPOSE:To evaluate patency and clinical outcome in patients treated with endovascular recanalization and stent placement for chronic iliac vein occlusions. METHODS:During a 14-year period (1994-2008), 59 (38 women; median age 39 years) of 62 patients with chronic occlusion of the iliac vein segment in 66 limbs were successfully treated with endovascular recanalization and stent placement. A prospectively maintained database was analyzed retrospectively to obtain information on clinical details, endovascular techniques, and outcome. RESULTS:Three (5%) procedures failed for technical reasons. Three (5%) complications occurred, 2 (3%) of which were perforations requiring transfusion and procedure termination. Initial clinical success after 6 months was achieved in 49 (83%) of the 59 patients successfully treated initially. Primary patency after a median imaging follow-up of 25 months was 67% (44/66), assisted primary patency was 75% (49/66), and secondary patency was 79% (52/66). Fifteen (23%) of 66 limbs were asymptomatic after a median clinical follow-up of 32 months, 34 (52%) limbs were improved, 13 (20%) were unchanged, and 4 (6%) were worse compared to before intervention. Actuarial primary, assisted primary, and secondary patency rates using Kaplan-Meier survival analysis were 70%, 73%, and 80%, respectively, at 5 years. CONCLUSION:Endovascular recanalization and stent placement is a safe and effective treatment for occluded iliac veins and adjacent segments. Clinical midterm results are encouraging. Recanalized and stented segments remain patent in the majority of patients after 2 years. Endovascular treatment can ease symptoms and prevent further deterioration of patients with post-thrombotic syndrome.
46.	Kölbel, Tilo, et al. (författare) In situ bending of a thoracic stent-graft: A proposed novel technique to improve thoracic endograft seal 2008 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 15:1, s. 62-66 Tidskriftsartikel (refereegranskat)abstract Purpose: 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. Traction applied to this line directs the endograft post deployment, which allows for better apposition to the aortic wall. Shortening the inner curve makes the stent-graft bend. The extent of bending is fully controlled by the surgeon and held in place with the sliding knot. A release mechanism allows removal of all luminal components of the mechanism. Conclusion: The described technique of directing a thoracic stent-graft in situ seems feasible and enables better apposition of the stent-graft in a glass model. It may improve the durability of thoracic stent-grafts in the aortic arch.
47.	Kölbel, Tilo, et al. (författare) Staged proximal deployment of the Zenith TX2 thoracic stent-graft: a novel technique to improve conformance to the aortic arch. 2009 Ingår i: Journal of Endovascular Therapy. - : International Society of Endovascular Specialists. - 1545-1550 .- 1526-6028. ; 16:5, s. 598-602 Tidskriftsartikel (refereegranskat)abstract PURPOSE: To present a modification of the Zenith TX2 thoracic stent-graft that allows staged proximal deployment to improve apposition to the aortic wall. TECHNIQUE: Three standard Zenith TX2 thoracic stent-grafts and 3 modified versions were deployed in a glass model of the aortic arch. Deployment sequences were analyzed. In a patient with a 6-cm thoracic aortic aneurysm after a type B dissection, the modified Zenith TX2 thoracic stent-graft was deployed successfully and without complications; the proximal part of the stent-graft protruded less into the arch, significantly improving wall apposition. CONCLUSION: Staged proximal deployment with a modified Zenith TX2 thoracic stent-graft can improve orientation and wall apposition of the first Z stent. A better proximal apposition may prevent early and late stent-graft complications.
48.	Kölbel, Tilo, et al. (författare) Thrombus Embolization Into IVC Filters During Catheter-Directed Thrombolysis for Proximal Deep Venous Thrombosis 2008 Ingår i: Journal of Endovascular Therapy. - 1545-1550. ; 15:5, s. 605-613 Tidskriftsartikel (refereegranskat)abstract Purpose: To assess the frequency of embolization into retrievable inferior vena cava (IVC) filters during catheter-directed thrombolysis (CDT) and stent placement for acute iliocaval deep venous thrombosis (DVT). Methods: Serial phlebograms from 40 patients (28 women; median age 32 years) consecutively treated with CDT for DVT during a 12-year period were retrospectively evaluated for visible emboli in the IVC filter. Clinical and procedural data extracted from a prospectively maintained database were evaluated to identify predictors for embolization into the filter. Results: Visible emboli were found in 18 (45%) patients. Visible embolization to the IVC filter was less frequent in patients with a hypercoagulable disorder (n=29, 31%) than in patients without a hypercoagulable disorder (n=11, 69%; OR 0.1, 95% Cl 0.02 to 0.56, p=0.006). No patient developed clinical symptomatic pulmonary embolism or a complication related to the placement or retrieval of the IVC filter. Conclusion: Thrombus embolization during CDT is a common phenomenon in patients with proximal DVT. Placement of a retrievable IVC filter during thrombolytic therapy can prevent silent and symptomatic pulmonary embolism.
49.	Lachat, Mario, et al. (författare) Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair 2013 Ingår i: Journal of Endovascular Therapy. - 1526-6028 .- 1545-1550. ; 20:6, s. 728-734 Tidskriftsartikel (refereegranskat)abstract Purpose: To present early and midterm results of the periscope endograft (PG) technique to maintain left subclavian artery (LSA) blood flow in thoracic endovascular aortic repairs (TEVAR) involving zone 3. Methods: From April 2010 to January 2013, 14 consecutive high-risk patients (11 men; mean age 70 8 years, range 56-87) underwent TEVAR with the PG technique for 10 thoracic aortic aneurysms (TAA), 2 traumatic aortic ruptures, and 2 aortic dissections without a suitable landing zone (>2 cm distal to the LSA). Five procedures were performed emergently for rupture (3 TAAs and the 2 trauma cases). Two patients had a periscope deployed in an aberrant right subclavian artery. The periscope endografts were sized 1 to 2 mm larger than the branch artery at the intended landing zone. The caudal end was extended distal to the intended distal landing site of the thoracic stent-graft, which was usually deployed after the PG. Both the PG and thoracic stent-grafts were generally molded using the kissing balloon technique. Outcomes analyzed were immediate technical success, perioperative mortality and morbidity, aneurysm diameter change, and periscope endograft patency. Results: Immediate technical success was 100%, with all procedures completed as planned. Perioperatively, one periscope occluded and one of the ruptured TAA patients died. One percutaneous access site hematoma required only conservative management. At a mean follow-up of 26 +/- 9 months (range 9-37), there was no additional PG occlusion. The Kaplan-Meier estimate of PG patency was 93% at 2 years. Conclusion: The periscope endograft is a simple technique to maintain perfusion to the LSA in cases where the aortic stent-graft crosses its ostium. The PG technique can be performed transfemorally and even percutaneously, and it can be applied to all supraaortic branches. Early and midterm results are encouraging, but more experience and long-term results are mandatory before this technique can be widely recommended.
50.	Lareyre, Fabien, et al. (författare) Artificial Intelligence–Powered Technologies for the Management of Vascular Diseases : Building Guidelines and Moving Forward Evidence Generation 2023 Ingår i: Journal of Endovascular Therapy. - : Sage Publications. - 1526-6028 .- 1545-1550. Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)

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