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Endovascular Treatment (endovascular + treatment)
Selected AbstractsThoracic Aortic Aneurysms and Dissections: Endovascular TreatmentMOUNT SINAI JOURNAL OF MEDICINE: A JOURNAL OF PERSONALIZED AND TRANSLATIONAL MEDICINE, Issue 3 2010Donald T. Baril MD Abstract The treatment of thoracic aortic disease has changed radically with the advances made in endovascular therapy since the concept of thoracic endovascular aortic repair was first described 15 years ago. Currently, there is a diverse array of endografts that are commercially available to treat the thoracic aorta. Multiple studies, including industry-sponsored and single-institution reports, have demonstrated excellent outcomes of thoracic endovascular aortic repair for the treatment of thoracic aortic aneurysms, with less reported perioperative morbidity and mortality in comparison with conventional open repair. Additionally, similar outcomes have been demonstrated for the treatment of type B dissections. However, the technology remains relatively novel, and larger studies with longer term outcomes are necessary to more fully evaluate the role of endovascular therapy for the treatment of thoracic aortic disease. This review examines the currently available thoracic endografts, preoperative planning for thoracic endovascular aortic repair, and outcomes of thoracic endovascular aortic repair for the treatment of both thoracic aortic aneurysms and type B aortic dissections. Mt Sinai J Med 77:256,269, 2010. © 2010 Mount Sinai School of Medicine [source] Haemosuccus pancreaticus: diagnostic and therapeutic challengesHPB, Issue 4 2009Velayutham Vimalraj Abstract Background:, Haemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal bleeding. The objective of our study was to highlight the challenges in the diagnosis and management of HP. Methods:, The records of 31 patients with HP diagnosed between January 1997 and June 2008 were reviewed retrospectively. Results:, Mean patient age was 34 years (11,55 years). Twelve patients had chronic alcoholic pancreatitis, 16 had tropical pancreatitis, two had acute pancreatitis and one had idiopathic pancreatitis. Selective arterial embolization was attempted in 22 of 26 (84%) patients and was successful in 11 of the 22 (50%). Twenty of 31 (64%) patients required surgery to control bleeding after the failure of arterial embolization in 11 and in an emergent setting in nine patients. Procedures included distal pancreatectomy and splenectomy, central pancreatectomy, intracystic ligation of the blood vessel, and aneurysmal ligation and bypass graft in 11, two, six and one patients, respectively. There were no deaths. Length of follow-up ranged from 6 months to 10 years. Conclusions:, Upper gastrointestinal bleeding in a patient with a history of chronic pancreatitis could be caused by HP. Diagnosis is based on investigations that should be performed in all patients, preferably during a period of active bleeding. These include upper digestive endoscopy, contrast-enhanced computed tomography (CECT) and selective arteriography of the coeliac trunk and superior mesenteric artery. Contrast-enhanced CT had a high positive yield comparable with that of selective angiography in our series. Therapeutic options consist of selective embolization and surgery. Endovascular treatment can control unstable haemodynamics and can be sufficient in some cases. However, in patients with persistent unstable haemodynamics, recurrent bleeding or failed embolization, surgery is required. [source] Endovascular treatment for bilateral vertebral arteriovenous fistulas in neurofibromatosis 1JOURNAL OF MEDICAL IMAGING AND RADIATION ONCOLOGY, Issue 4 2003W Siddhartha Summary We report a rare case of a 36-year-old woman with neurofibromatosis 1 (NF1) with bilateral vertebro-vertebral arteriovenous fistulas. The patient presented with quadriparesis and had neck pain. Angiography revealed vertebral arteriovenous fistulas bilaterally with dilated epidural venous plexuses compressing the cervical cord resulting in quadriparesis. Endovascular treatment using coils and balloons resulted in successful occlusion of both fistulas. At 6-months postembolization, the patient had improved significantly and is now able to walk with support. [source] Therapeutic embolization in the treatment of recurrent haemarthrosis following knee arthroplastyANZ JOURNAL OF SURGERY, Issue 4 2010Michael Tat-Sing Law Abstract Recurrent spontaneous haemarthrosis after knee arthroplasty occurs in less than 1% of cases, commonly thought to be the result of impingement of hypertrophic vascular synovium or fat pads, and exacerbated by anti-coagulation or anti-platelet therapy. Traditional treatment comprises an initial period of rest followed by open or arthroscopic washout, and by synovectomy if bleeding recurs or fails to settle. We present three cases of recurrent haemarthrosis following knee arthroplasty, which were successfully treated by angiography and feeding vessel coil embolization. An injury to one of the genicular arteries was identified as the cause of bleeding in all three cases; one manifest as a traumatic arteriovenous fistula. Bleeding ceased in all cases without recurrence (follow-up period 6 months , 5 years, median of 2 years). Endovascular treatment offers a minimally invasive treatment option in selected cases of recurrent post-operative haemarthrosis. [source] ENDOVASCULAR REPAIR OF POPLITEAL ARTERY ANEURYSMS: TECHNIQUES, CURRENT EVIDENCE AND RECENT EXPERIENCEANZ JOURNAL OF SURGERY, Issue 6 2006Ray Siauw Endovascular repair of popliteal artery aneurysms is a new technique, which has emerged as an alternative to open surgical bypass. However, evidence to support its use is limited. We present a review of current literature relevant to this technique. The MEDLINE search terms were popliteal artery, aneurysm, endovascular, endoluminal and stent. Fifty-eight articles were yielded, of which 21 were studies of endovascular repair by implantation of stent or stent graft of true aneurysms of the popliteal artery. There was only one randomized study. Small numbers of endovascular interventions are reported, with variations in study design and endovascular techniques. Long-term follow-up data is lacking; however, early results have been promising with high rates of initial treatment success. Early thrombosis of stent grafts occurs in approximately 10%, but this does not herald limb loss. Endovascular treatment offers potential benefits over traditional surgery, but needs to be studied further with a large-scale multicentre randomized trial. [source] Mid-term outcome of endovascular revascularization for chronic mesenteric ischaemia,BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 2 2010N. V. Dias Background: This study aimed to assess mid-term outcome after endovascular revascularization of chronic occlusive mesenteric ischaemia (CMI) and to identify possible predictors of mortality. Methods: Consecutive patients undergoing primary elective stenting for CMI between 1995 and 2007 were registered prospectively in a database. Patients with acute ischaemia were excluded. Retrospective case-note review and data analysis were performed. Results: Forty-three patients (10 men) were treated for stable (n = 30) or exacerbated (n = 13) CMI. Their median (interquartile range (i.q.r.)) age was 70 (60,79) years. Revascularization was successful in 47 of 49 vessels. The superior mesenteric artery (SMA), either alone (n = 34) or in combination with the coeliac trunk (n = 6), was the predominant target vessel. No patient died within 30 days. Median follow-up was 43 (i.q.r. 25,63) months and the estimated (s.e.) 3-year overall survival rate was 76(7) per cent. Two patients died from distal SMA occlusive disease and intestinal infarction after 6 and 18 months respectively. Previous stroke (P = 0·016), male sex (P = 0·057) and age (P = 0·066) were associated with mid-term mortality on univariable, but not multivariable analysis. Reintervention was needed in 14 patients, achieving a 3-year cumulative rate of freedom from recurrent symptoms of 88(5) per cent. Conclusion: Endovascular treatment provided high early and mid-term survival rates in this series of patients with CMI, with low complication rates. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Endovascular treatment of abdominal aortic aneurysm: a failed experiment (Br J Surg 2001; 88: 1281-2) Letter 1BRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 4 2002T. A. A. van den Broek No abstract is available for this article. [source] Endovascular treatment of Angio-SealÔ-related limb ischemia,Primary results and long-term follow-up,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2010Christoph Thalhammer MD Abstract Objectives: To investigate primary success rates and long term follow-up of endovascular treatment of AngioSealÔ-related limb ischemia. Background: Current knowledge on optimal therapy of ischemic complications following application of AngioSealÔ is limited. Methods: A single-center prospectively maintained database was retrospectively interrogated and AngioSealÔ,related complications requiring endovascular treatment over an 8-year-time period was identified. Results: Fifteen patients fulfilling the inclusion criteria were identified, resulting in an approximated incidence of 0.26% of all devices implanted at our institution. In all cases, the complication was managed successfully in the absence of complications. Eleven patients were treated with balloon angioplasty (PTA) and four with stent implantation because of suboptimal PTA results. Twelve patients were available for noninvasive vascular follow-up examination for a median time of 40 months postinterventionally. Only two patients needed a second intervention consisting of balloon angioplasty due to symptomatic restenosis. At final follow-up all patients were asymptomatic with no relevant restenosis. Conclusion: Endovascular treatment for AngioSealÔ-related limb ischemia with or without stent implantation results in an excellent immediate and long-term clinical and hemodynamic outcome. © 2009 Wiley-Liss, Inc. [source] Angioplasty and stenting of symptomatic and asymptomatic vertebral artery stenosis: to treat or not to treatEUROPEAN JOURNAL OF NEUROLOGY, Issue 2 2010V. Parkhutik Background and purpose:, Comprehensive indications for treatment of symptomatic vertebral stenosis remain unavailable. Even less is known about endovascular treatment of asymptomatic cases. We treated symptomatic and asymptomatic vertebral ostium stenosis with angioplasty and stenting and investigated the long term outcome. Methods:, Consecutive patients with two different indications were included. Group 1 (G1) had symptomatic >50% stenosis. Group 2 (G2) had asymptomatic >50% stenosis and severe lesions of anterior circulation and were expected to benefit from additional cerebral blood supply. Results:, Twenty nine vertebral origin stenoses in 28 patients (75% men, mean age 64 ± 9 years) were treated. There were 16 G1 and 13 G2 cases. Technical success rate was 100%. Immediate neurological complications rate was 3.4% (one G1 patient with vertebral TIA due to release of emboli). Two further strokes were seen during follow up (32 ± 24 months): vertebrobasilar stroke in a G2 patient with permeable stent in V1 segment, new ipsilateral V3 occlusion and high-risk cardioembolic source, and carotid stroke in a G1 patient who had had ipsilateral carotid stenting. There were no deaths of any cause. Asymptomatic restenosis was observed in one out of 19 patients from both groups who underwent a follow up angiography. Conclusions:, Angioplasty and stenting appears to be technically feasible and safe in asymptomatic and symptomatic vertebral stenosis. More studies are needed in order to clarify its role in primary and secondary prevention of vertebrobasilar stroke. High risk anterior circulation lesions should be taken into account as a possible indication in patients with asymptomatic vertebral stenosis. [source] Cerebral vasospasm and ischaemic infarction in clipped and coiled intracranial aneurysm patientsEUROPEAN JOURNAL OF NEUROLOGY, Issue 4 2002M. Hohlrieder The influence of the treatment modalities (clipping/coiling) on the incidence of vasospasm and ischaemic infarction in aneurysm patients is still judged controversially. The purpose of this study was to analyse and compare retrospectively cerebral vasospasm and ischaemic infarction, as well as neurological deficits and outcome within a large population of clipped and coiled patients with ruptured and unruptured aneurysms. Within a 2-year period, a total of 144 interventions (53 clipping/91 coiling) entered the study. Daily bilateral transcranial Doppler sonographic monitoring was performed to observe vasospasm development. All cerebral computed tomography (cCT) and magnetic resonance imaging (MRI) scans were reviewed with respect to occurrence and localization of ischaemic infarctions. Focal neurological deficits were recorded and clinical outcome was evaluated using the Glasgow Outcome Scale. Statistical analysis included the use of multivariate logistic regression models to find determinants of vasospasm, ischaemic infarction and neurological deficits. Altogether, vasospasm was detected after 77 (53.5%) interventions, 61.8% in females (P < 0.01). Clipped patients significantly more often exhibited vasospasms (69.8 vs. 44.0%, P < 0.005) and were treated 1 week longer at the intensive care unit (P < 0.005). Seventy-seven patients (53.5%) developed ischaemic infarctions, 62.3% after clipping and 48.4% after coiling (P > 0.05). In the multivariate analysis, aneurysm-rupture was the strongest predictor for vasospasm and vasospasm was the strongest predictor for infarction. Neurological deficits at discharge (46.5%) were independent of treatment modality, the same applied for the mean Glasgow Outcome Scores. There was no significant difference in mortality between surgical and endovascular treatment (9.4 vs. 12.1%). Whilst the vasospasm incidence was significantly higher after surgical treatment, ischaemic infarctions were only slightly more frequent. The incidence of neurological deficits and clinical outcome was similar in both treatment groups. [source] Glossal angiomyoma: Imaging findings and endovascular treatmentHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2004Franklin A. Marden MD Abstract Background. An angiomyoma is an uncommon, benign tumor characterized by numerous vascular channels intermixed with bundles of smooth muscle cells. Oral manifestations are quite rare. We describe for the first time the CT, MRI, and angiographic imaging features and successful preoperative endovascular embolization of an angiomyoma of the tongue. The pathologic findings before and after embolization are also described. Methods and Results. A 25-year-old man was seen with a rapidly enlarging tongue mass. Imaging studies revealed the extent and hypervascular nature of this tumor. The diagnosis of angiomyoma was confirmed by histologic examination. Preoperative embolization proved to be helpful in the surgical management of this lesion. Conclusions. Angiomyoma should be considered in the differential diagnosis of any well-circumscribed, hypervascular, soft tissue tumor in the mouth. In addition, endovascular embolization may be a useful adjunct that facilitates resection. © 2004 Wiley Periodicals, Inc. Head Neck26: 1084,1088, 2004 [source] Incidence and Treatment of Arterial Access Dissections Occurring during Cardiac CatheterizationJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 1 2008AMIT PRASAD M.D. Background: Arterial access dissections may complicate cardiac catheterization and can often be treated percutaneously. The goal of this study was to examine the incidence, consequences, and the treatment of arterial access dissections at a tertiary referral hospital with an active training program. Methods: Patients experiencing arterial access dissection during coronary angiography or intervention at our institution between October 1, 2004, and January 31, 2007, were identified and their records were retrospectively reviewed. Results: Thirteen of the 3,062 consecutive patients (0.42%) had arterial access dissection during the study period. The location of the dissection was in the common femoral artery (CFA) (n = 6), the external iliac artery (EIA) (n = 6), or in an aortobifemoral graft (n = 1). Three of the six patients with CFA dissection were diagnosed during coronary angiography, and because of significant comorbidities were treated with self-expanding stents. After a mean follow-up of 7 months, they experienced no stent fracture or other complication. Six patients had EIA dissections. In one such patient, the dissection was not flow limiting and was treated conservatively. The remaining five patients underwent successful implantation of self-expanding stents, and during a mean follow-up of 9.6 months, no patient had any symptoms or events related to lower extremity ischemia. Finally, one patient had an aortobifemoral graft dissection. Due to the patient's critical condition, secondary to sepsis, his family elected to withdraw care, and he subsequently expired. Conclusions: Arterial access dissections occur infrequently during cardiac catheterization. Routine femoral artery angiography may help identify vascular access complications, often allowing simultaneous endovascular treatment, with excellent short-term outcomes. [source] Ear Necrosis Resulting from the Endovascular Onyx-18 Embolization of a Dural Arteriovenous Fistula Fed by the Posterior Auricular ArteryJOURNAL OF NEUROIMAGING, Issue 3 2009Brian T. Jankowitz MD ABSTRACT BACKGROUND AND PURPOSE The treatment of a dural arteriovenous fistula (DAVF) can involve surgery, radiosurgery, or endovascular embolization. New embolization techniques and agents have expanded the role of endovascular treatment. METHODS We report the endovascular embolization with Onyx-18 of a DAVF fed by the posterior auricular artery. RESULTS The DAVF was successfully embolized; however, the patient's ear developed ischemic necrosis of the superolateral pinna. CONCLUSIONS Onyx-18 can provide high rates of success in the treatment of DAVFs in well-selected patients. Risks of end organ ischemia must be considered during endovascular embolization and when counseling patients regarding procedural risk. [source] Endovascular treatment of Angio-SealÔ-related limb ischemia,Primary results and long-term follow-up,CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 6 2010Christoph Thalhammer MD Abstract Objectives: To investigate primary success rates and long term follow-up of endovascular treatment of AngioSealÔ-related limb ischemia. Background: Current knowledge on optimal therapy of ischemic complications following application of AngioSealÔ is limited. Methods: A single-center prospectively maintained database was retrospectively interrogated and AngioSealÔ,related complications requiring endovascular treatment over an 8-year-time period was identified. Results: Fifteen patients fulfilling the inclusion criteria were identified, resulting in an approximated incidence of 0.26% of all devices implanted at our institution. In all cases, the complication was managed successfully in the absence of complications. Eleven patients were treated with balloon angioplasty (PTA) and four with stent implantation because of suboptimal PTA results. Twelve patients were available for noninvasive vascular follow-up examination for a median time of 40 months postinterventionally. Only two patients needed a second intervention consisting of balloon angioplasty due to symptomatic restenosis. At final follow-up all patients were asymptomatic with no relevant restenosis. Conclusion: Endovascular treatment for AngioSealÔ-related limb ischemia with or without stent implantation results in an excellent immediate and long-term clinical and hemodynamic outcome. © 2009 Wiley-Liss, Inc. [source] Treatment of instent restenosis following stent-supported renal artery angioplastyCATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 3 2007Thomas Zeller MD Abstract Objectives: We prospectively studied the long-term outcome of endovascular treatment of instent renal artery stenosis (IRAS). Background: Restenosis is a considerable drawback of stent-supported angioplasty of renal artery stenosis especially in small vessel diameters. The appropriate treatment strategy is not yet defined. Patients and Methods: During a 10-year period 56 consecutive patients (65 lesions) with their first IRAS were included in a prospective follow-up program (mean follow-up 53 ± 25 months, range 6,102). Primary endpoint of the study was the reoccurrence of IRAS (, 70%) after primarily successful treatment of the first IRAS determined by duplex ultrasound. Results: Primary success rate was 100%, no major complication occurred. Nineteen lesions were treated with plain balloon angioplasty (group 1, 30%), 42 lesions with stent-in-stent placement (group 2, 65%) using various bare metal balloon expandable stents, and 4 lesions with drug-eluting stent angioplasty (group 3, 6%). During follow-up, overall 21 lesions (32%) developed reoccurrence of IRAS: n = 7/19 in group 1 (37%), n = 14/42 in group 2 (33%), and n = 0/4 in group 3 (0%; P = 0.573). Reoccurrence of IRAS was more likely to occur in smaller vessel diameters than in larger ones [3,4mm: 4/7 (57%); 5 mm: 11/26 (42%); 6 mm: 5/25 (20%); 7 mm: 1/7 (14%), P = 0.088]. Multivariable analysis found bilateral IRAS and IRAS of both renal arteries of the same side in case of multiple ipsilateral renal arteries as independent predictors for reoccurrence of IRAS. Conclusion: Treatment of IRAS is feasible and safe. The data demonstrate a nonsignificant trend towards lower restenosis with restenting of IRAS versus balloon angioplasty of IRAS. Individual factors influence the likelihood of reoccurrence of IRAS. © 2007 Wiley-Liss, Inc. [source] | |||||||||||||||||||||||||