| 1. |
- Syk, Ingvar, et al.
(författare)
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Postoperative fever, bowel ischaemia and cytokine response to abdominal aortic aneurysm repair--a comparison between endovascular and open surgery
- 1998
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 15:5, s. 398-405
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To study bowel ischaemia in transfemorally placed endoluminal grafting (TPEG) for abdominal aortic aneurysms, and any relation to cytokine response or postoperative fever. DESIGN: Prospective not randomised. University hospital setting. MATERIAL: Fourteen cases of conventional surgery and 23 cases of endovascular technique for infrarenal abdominal aortic aneurysm repair. METHODS: Tonometry was used for sigmoid colon pH, and ELISAs for serum IL-6. RESULTS: Mucosal pH in the sigmoid colon fell significantly during clamping and reperfusion in both groups. Lowest measured sigmoid colon pH was 7.10 in the open group, compared to 7.22 in the TPEG group (p < 0.05). The IL-6 levels in serum peaked after 4 h of reperfusion; 249 pg/ml in the open group, compared to 89 pg/ml in the TPEG group (p < 0.05). High levels of IL-6 in the postoperative period and persisting low sigmoidal pH were associated with serious complications. Postoperative temperature did not differ significantly between the groups, and no significant correlation could be found with sigmoid colon pH or IL-6 levels. CONCLUSIONS: The less pronounced perioperative bowel ischaemia in TPEG patients indicates an advantage of the TPEG technique. Splanchnic ischaemia was not related to postoperative fever, nor the IL-6 or TNF response.
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| 6. |
- Elmstahl, S., et al.
(författare)
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Hydrotherapy of patients with intermittent claudication : A novel approach to improve systolic ankle pressure and reduce symptoms
- 1995
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Ingår i: International Angiology. - 0392-9590. ; 14:4, s. 389-394
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To study the effects of alternating cold and hot water therapy on walking ability and systolic blood pressure in claudicants. Experimental design. A prospective case study with repeated measurements before and 1, 4 and 12 months after treatment. The systolic blood pressure levels were measured with an occlusion cuff for brachial and ankle and with a strain gauge for the first toe. Study population. Twenty consecutively included patients, 11 women and 9 men; mean age 73.9 yrs, with intermittent claudication according to clinical examination and ankle-arm systolic blood pressure (AAI) below 0.90. Intervention. Alternate hot and cold hydrotherapy of the legs were given at ten 25-minute treatments during a three-week period. The outcome measures were maximal walking ability (MW), walking ability before pain (PW) and systolic blood pressures of toe, ankle, arm and AAI. Results. Fourtheen patients (70%) reported reduced pain after treatment and their PW increased from 134 ± 29 m to 415 ± 119 m 12 months later (p < 0.05) and the MW in the total group increased form 348 ± 75 m to 523 ± 103 m. Systolic blood pressure increased in right ankle and toe one month after treatment in the total group. Among those who reported improved walking ability one year after treatment, systolic blood pressure in both right and left ankles and toes increased; e.g. right toe increasing from 72 ± 7 to 86 ± 2 (p < 0.001). Improvements of systolic blood pressure in left and right leg and changes of walking ability were correlated, in the order of 0.60 to 0.81, p < 0.05. Conclusions. Showering the legs of claudicants improved walking ability and blood pressures which sustained up to 1-year later. This therapy might be an additional alternative to conservative treatment of intermittent claudication.
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| 8. |
- Ivancev, Krassi, et al.
(författare)
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Options for treatment of persistent aneurysm perfusion after endovascular repair
- 1996
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Ingår i: World Journal of Surgery. - : Springer Science and Business Media LLC. - 1432-2323 .- 0364-2313. ; 20:6, s. 673-678
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Tidskriftsartikel (refereegranskat)abstract
- Persistent aneurysm perfusion represents failure of endovascular repair. The leak may occur around either end of the prosthesis or through a collateral route. Most cases can be treated by endovascular means. Stents can be rotated, the prosthesis can be lengthened at either end, and collateral pathways can be occluded, all without recourse to open repair. This report describes the management of persistent aneurysm perfusion in five patients from a total experience of 32 cases of endovascular aneurysm repair.
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| 9. |
- Jensen, N, et al.
(författare)
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Recovery of endothelial cells and prostanoid production in endothelial cell-seeded grafts
- 1996
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 12:1, s. 54-59
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the function and morphology of endothelial cell (EC) seeded grafts. DESIGN: Experimental, open study. CHIEF OUTCOME MEASURES: Endoluminal release of prostacyclin (6-Keto-PGF1 alpha) and thromboxane B2 (TxB2), patency, EC coverage and cell identity. MATERIALS: In 12 sheep, segments of both carotid arteries were excised. On one side a seeded and on the other an unseeded dacron graft were inserted. After 3 months the grafts were excised. In grafts and arteries, the endoluminal release of 6-keto-PGF1 alpha and TxB2 was determined in a perfusion system. Scanning electron microscopy (SEM) and light microscopy were used to determine the EC coverage and cell identity. RESULTS: Eight animals survived. Three seeded and two unseeded grafts were occluded. Prostacyclin release did not differ significantly between seeded and unseeded grafts and arteries, when the arteries were looked upon as one group. When the graft was compared with its corresponding artery, i.e. the artery it replaced, a significantly lower release was found in the unseeded group. Thromboxane release was undetectable in arteries but significantly higher in both graft groups. SEM revealed a cellular coverage of 75% in the seeded grafts and 50% in the unseeded (not significant). Light microscopy showed a patchy staining for Factor VIII-related antigen in some grafts in both groups. CONCLUSION: Prostacyclin release in unseeded and seeded dacron grafts did not differ 3 months after implantation in sheep, except when the graft was compared with its corresponding artery. The significance of this remains to be settled. Seeded grafts did not have a higher proportion of endothelial coverage than unseeded grafts.
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| 11. |
- Lind, H, et al.
(författare)
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Selective attenuation of neuropeptide-Y-mediated contractile responses in blood vessels from patients with diabetes mellitus
- 1995
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Ingår i: Clinical Autonomic Research. - 1619-1560. ; 5:4, s. 191-197
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Tidskriftsartikel (refereegranskat)abstract
- Vascular smooth muscle contractile responses to neuropeptide Y, alpha,beta-methyleneATP and noradrenaline were studied in circular segments of isolated vessels with intact endothelium in vitro from 12 patients with diabetes mellitus type 2 (NIDDM) and 12 control subjects. The dilatory effect of acetylcholine was used to test the function of the endothelium. Subcutaneous arteries and veins (diameter 0.1-1.1 mm) were obtained during surgery. There was no difference in contractile responses to noradrenaline or alpha,beta-methyleneATP between diabetic and control vessels. The contractile response to neuropeptide Y, however, was markedly reduced in the diabetic group. The maximal contractile effect (46.0 +/- 14.0%, p < 0.05) but not the sensitivity to neuropeptide Y was significantly less in diabetic veins compared to control (107.5 +/- 19.6%). Thus, the attenuation of neuropeptide Y responses was present in humans as previously observed in alloxan-induced diabetes mellitus in rabbits. There was no difference in the dilator effect of acetylcholine between the diabetic and the control group in any of the vessel types, indicating that the difference in vascular reactivity to neuropeptide Y was not endothelium-dependent. In conclusion, the present study has shown that the postjunctional effects of neuropeptide Y, a co-transmitter of the peripheral sympathetic nervous system, is selectively attenuated in diabetes mellitus.
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| 14. |
- Lindh, Mats, et al.
(författare)
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Endovascular stent-anchored aortic grafts: a comparison between self-expanding and balloon-expandable stents in minipigs
- 1996
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Ingår i: Journal of Endovascular Surgery. - 1074-6218. ; 3:3, s. 284-289
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To study endovascular graft attachment with self-expanding Gianturco Z-stents and balloon-expanded Palmaz stents and the effect of these devices on the renal ostia. METHODS: Ten stent-grafts were constructed, 5 with Gianturco Z-stents and 5 with Palmaz stents. The endografts were implanted under fluoroscopic guidance into the abdominal aorta of 10 pigs so that the uncovered portion of the proximal stent extended over the renal artery orifices. Distal aortic blood pressure and flow were measured before and after graft placement and 1 hour postprocedure. The aorta was then exposed surgically, and the central portion of the stent-graft was inspected through an aortotomy to assess perigraft leakage. RESULTS: Stent-graft implantation was accurate and hemostatic in all cases, despite longitudinal folding of the graft due to oversizing. However, transverse folds produced pressure gradients (> 15 mmHg) between the ends of the graft in two cases. In another case, a pressure gradient resulted from partial thrombosis of the graft. In two cases, renal artery occlusion and thrombosis occurred due to coverage by the graft material. In two other animals, one of the renal arteries was entirely uncovered by a stent. The remaining 16 renal arteries were covered by the proximal stent but not the graft, as intended. One (6.25%) of these arteries thrombosed, but the remainder were grossly patent when the animals were sacrificed at 1 hour. CONCLUSIONS: Both Palmaz and Gianturco Z-stents produced hemostatic endovascular graft attachment, even in the presence of moderate graft oversizing. The risk of acute renal artery occlusion from juxtarenal stenting does not appear to be prohibitive, but longer term observations are needed.
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| 15. |
- Malina, Martin, et al.
(författare)
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Endovascular management of the juxtarenal aortic aneurysm: can uncovered stents safely cross the renal arteries?
- 1999
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Ingår i: Seminars in Vascular Surgery. - 0895-7967. ; 12:3, s. 182-192
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Tidskriftsartikel (refereegranskat)abstract
- A short or otherwise suboptimal neck precludes the use of endovascular repair in 30% to 50% of patients with abdominal aortic aneurysms. Stent-graft fixation in an unsuitable neck carries the risk of technical failure owing to development of a proximal endoleak or stent-graft migration. Furthermore, in some patients, the neck dilates postoperatively. Endovascular healing with tissue incorporation into the graft material seems in and of itself insufficient to fixate the stent-graft adequately or to prevent neck dilation. Therefore, neck dilation is often associated with detachment of the stent-graft from the aortic wall, which is followed by the development of a proximal endoleak or stent-graft migration. Fixation of stent-grafts can be improved by placing the proximal stent above one or both of the renal artery orifices. Current experimental and clinical data suggest that renal function is not impaired by suprarenal aortic stents during the first year; however, this finding may not apply to all types of stents. Fixation of stent-grafts also may be improved by using stents with barbs that pierce the aortic wall. Additionally, the force that is exerted on the anchoring device may well be reduced by fully stented grafts with an associated increase in column strength. In the future, the risk of neck dilation and stent-graft dislodgement might also be limited by novel techniques such as laparoscopic banding of the neck or endoluminal stapling devices.
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| 16. |
- Malina, Martin, et al.
(författare)
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Renal arteries covered by aortic stents: clinical experience from endovascular grafting of aortic aneurysms
- 1997
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 14:2, s. 109-113
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: During the endovascular repair of abdominal aortic aneurysms (AAAs), effective anchoring of the stent-graft is difficult in the presence of a short infrarenal aneurysm neck. The aim of this study was to investigate renal artery patency and renal function after deployment of graft anchoring stents across the renal arteries. DESIGN: Retrospective open study. PATIENTS: Twenty-five renal arteries, in 18 patients treated by endovascular exclusion of an AAA, were intentionally covered with the Gianturco Z-stent to ensure stent graft attachment. METHODS: Renal artery patency was assessed by repeated spiral computed tomography (CT) scans and angiography. Creatinine levels, blood pressure and antihypertensive medication were recorded. Follow-up was a median 6 months (2-9). RESULTS: All 25 stent-covered renal arteries remained patent. CT showed a small infarct in one kidney. Creatinine was 108 mumol/l (89-133) before intervention and 98 mumol/l (87-127) at follow-up. Blood pressure was 150/80 mmHg on both occasions. Antihypertensive therapy was intensified in one patient whose creatinine level remained stable and whose separate renin sampling was normal. CONCLUSIONS: Covering the renal arteries with the Gianturco Z-stent does not seem to affect renal function within 6 months. Further follow-up is needed before suprarenal stent deployment can be advocated.
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| 17. |
- Mangell, Peter, et al.
(författare)
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Are self-expanding stents superior to balloon-expanded in dilating aortas? An experimental study in pigs
- 1996
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Ingår i: European Journal of Vascular and Endovascular Surgery. - 1532-2165. ; 12:3, s. 287-294
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study the stent/vessel interaction and distensibility following the natural increase in vascular diameter using self-expanding and balloon-expanded stents. DESIGN: Open experimental study. SETTING: Animal laboratory, university hospital. MATERIALS AND METHODS: Eight Palmaz (P) and eight Gianturco (G) stents were transluminally placed in the infrarenal aortas of 16 pigs. Pulsatile diameter changes above, at and below the stents were non-invasively monitored with an ultrasound phase-locked echo-tracking system before and immediately after stenting and at 4 and 18 weeks. Blood pressure was registered intra-arterially and stiffness (beta) was calculated. Intravascular ultrasound (IVUS) was performed at 18 weeks. RESULTS: Median weight increased from 20 kg (19-26) to 93 kg (62-130). Diameter of the aorta increased 60%. In group P no pulsatile diameter change could be measured at the stent (beta = infinity). In group G stenting increased stiffness from beta 20.7 (9.2) to 43.2 (8.0) (p < 0.05). After 18 weeks stiffness returned to beta 20.1 (12.4). Expanded, median diameter of the P stents was 7.4 (0.8) mm, not increasing after 18 weeks. Initial diameter of the G stents was 7.8 (1.0) mm, increasing 56% to 12.2 (2.3) mm (p < 0.05). IVUS revealed the G stents to be well attached to the vascular wall, but five P stents were detached within half of the circumference. CONCLUSION: Self-expanding stents follow the pulsatile diameter change of the vessel wall, not adversely affecting distensibility after 18 weeks. They show good attachment despite 56% dilation. In contrast, the balloon-expanded stents do not show pulsatile movement and may detach during vessel diameter increase. This may be of importance when choosing stents for endovascular treatment of abdominal aortic aneurysms.
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| 18. |
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| 19. |
- 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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