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Hu C, Chen L, Wu M, Ye Q, Zou J, Zhao B, Li X, Wu H. Efficacy and Safety of Covered Stents Versus Bare-Metal Stents for Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. J Endovasc Ther 2024:15266028241237387. [PMID: 38491926 DOI: 10.1177/15266028241237387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024]
Abstract
PURPOSE This study aimed to assess the efficacy and safety outcome of covered stents (CSs), as compared with bare-metal stents (BMSs), for the treatment of patients with aortoiliac occlusive disease (AIOD). MATERIALS AND METHODS A systematic literature search was conducted in PubMed, Embase, and Cochrane Library up to August 2023 to identify all studies comparing efficacy and safety outcomes of CSs versus BMSs for treating AIOD. Our outcome was primary patency, secondary patency, technical success, ankle-brachial index (ABI) variation, target lesion revascularization (TLR), limb salvage, complications, and long-term survival. Dichotomous outcomes were pooled as relative risks (RR) or hazard ratio with the 95% confidence interval (CI). Continuous outcomes were pooled as weighted mean differences and 95% CI. Model selection was based on the heterogeneity of the included studies. RESULTS There were 10 studies (2 randomized controlled trials, 8 retrospective cohort studies), comprising 1676 sample size. Compared with BMSs, CSs use was associated with better primary patency of patients with a Trans-Atlantic Inter-Society Consensus II (TASC) D lesion (RR, 1.15, 95% CI, 1.04 to 1.27, p=0.007), TLR (RR, 0.39, 95% CI, 0.27 to 0.56, p<0.001), technical success (RR, 1.01, 95% CI, 1.00 to 1.02, p=0.010), and long-term survival (RR, 1.06, 95% CI, 1.01 to 1.11, p=0.020). There is no difference between CSs and BMSs regarding primary patency of all patients, secondary patency, variation in ABI, limb salvage, and complications. CONCLUSIONS Compared with BMSs, CSs used in AIOD was associated with more favorable primary patency in patients with TASC D lesions, TLR, technical success rates, and patient long-term survival. These results provide evidence of the advantages of using CSs for AIOD treatment. Future studies focusing on long-term variations in ABI, primary patency of different degrees of calcification, vascular segments, and TASC classification are warranted. CLINICAL IMPACT Although several studies evaluated the clinical efficacy of CS in the context of AIOD treatment, the significance and consistency of these findings were not determined to date. We found that CS was used in AIOD associated with better technical success rate, long-term patient survival, lower target lesion revascularization, and higher primary patency of patients with a Trans-Atlantic Inter-Society Consensus II D lesion when compared with BMSs. Our study provides evidence supporting the superiority of CSs over BMSs in the treatment of AIOD, and furnishing clinicians with guidance for treatment decisions.
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Affiliation(s)
- Chenming Hu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Lang Chen
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Min Wu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
| | - Qianling Ye
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Jun Zou
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Bin Zhao
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Xiang Li
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
| | - Huaping Wu
- School of Clinical Medicine, North Sichuan Medical College, Nanchong, China
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou, China
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Tomoi Y, Takahara M, Soga Y, Hata Y, Iida O, Yamaoka T, Hayakawa N, Fujihara M, Ando K. Clinical outcome of endovascular therapy using a VIABAHN VBX-covered stent for complex aortoiliac artery disease: the AVOCADO II study. Heart Vessels 2023; 38:1288-1297. [PMID: 37247091 DOI: 10.1007/s00380-023-02274-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 05/19/2023] [Indexed: 05/30/2023]
Abstract
Clinical trials have demonstrated the efficacy of a balloon-expandable covered stent (CS) for aortoiliac occlusive disease (AIOD). However, the real-world clinical outcomes and the underlying factors remain unclear. We assessed the clinical outcomes and factors associated with primary patency after implantation of a balloon-expandable CS for patients with complex AIOD. This prospective multicenter observational study enrolled 149 consecutive patients undergoing VIABAHN® VBX-CS (W.L. Gore & Associates, Flagstaff, AZ) implantation for complex AIOD (age, 74 ± 9 years; male, 74%; diabetes mellitus, 46%; renal failure on dialysis, 23%; chronic limb-threatening ischemia, 26%). The primary study endpoint was 1-year primary patency, and the secondary endpoints were procedural complications, freedom from occlusion, clinical-driven target lesion revascularization (CD-TLR), and surgical revision at 1 year. Risk factors for restenosis were explored using random survival forest analysis. The median follow-up period was 13.1 months (interquartile range 9.7-14.0 months). Procedural complications were observed in 6.7% of the patients. The 1-year primary patency was 94.8% (95% confidence interval 91.0-98.6%), while the 1-year freedom rate from occlusion, CD-TLR, and surgical revision rates were 96.5% (93.5-99.5%), 94.7% (90.9-98.6%), and 97.8% (95.4-100%), respectively. The presence of chronic total occlusion, aortic bifurcation lesion, the number of disease regions, and TASC-II classification was significantly associated with the restenosis risk. In contrast, the calcification severity, IVUS use, IVUS parameters were not associated with restenosis risk. We observed excellent 1-year real-world outcomes after implantation of a balloon-expandable CS for complex AIOD; only a few perioperative complications occurred.
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Affiliation(s)
- Yusuke Tomoi
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-0001, Japan.
| | - Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yoshimitsu Soga
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-0001, Japan
| | - Yosuke Hata
- Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Osamu Iida
- Department of Cardiology, Kansai Rosai Hospital, Amagasaki, Japan
| | - Terutoshi Yamaoka
- Department of Vascular Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Naoki Hayakawa
- Department of Cardiovascular Medicine, Asahi General Hospital, Chiba, Japan
| | - Masahiko Fujihara
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-Ku, Kitakyushu, 802-0001, Japan
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3
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Ryu DS, Won DS, Kim JW, Park Y, Kim SH, Kang JM, Zeng CH, Lim D, Choi H, Park JH. Efficacy of closed cell self expandable metallic stent for peripheral arterial disease in the porcine iliac artery. Sci Rep 2023; 13:8601. [PMID: 37237009 DOI: 10.1038/s41598-023-35878-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/25/2023] [Indexed: 05/28/2023] Open
Abstract
This study aimed to investigate the efficacy of a closed-cell self-expandable metallic stent (SEMS) with or without expanded-polytetrafluoroethylene (e-PTFE)-covering membrane in a porcine iliac artery model. Twelve Yorkshire domestic pigs were divided into a bare closed-cell SEMS (B-SEMS) group (n = 6) and covered closed-cell SEMS (C-SEMS) group (n = 6). Both closed-cell SEMSs were placed in the right or left iliac artery. Thrombogenicity score in the C-SEMS group was significantly higher than that in the B-SEMS group (p = 0.004) after 4 weeks. Angiographic findings of mean luminal diameters at 4 weeks follow-up did not differ significantly between B-SEMS and C-SEMS groups. Neointimal hyperplasia thickness as well as degree of inflammatory cell infiltration and collagen deposition in the C-SEMS group was significantly greater than that in the B-SEMS group (p < 0.001). Closed-cell SEMSs successfully maintained patency for 4 weeks without stent-related complications in the porcine iliac artery. Although mild thrombus with neointimal hyperplasia was observed in the C-SEMS group, subsequent occlusion, and in-stent stenosis did not occur in any of the pigs until the end of the study. Closed-cell SEMS with or without the e-PTFE covering membrane is effective and safe for the porcine iliac artery.
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Affiliation(s)
- Dae Sung Ryu
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dong-Sung Won
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Ji Won Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yubeen Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Song Hee Kim
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jeon Min Kang
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Chu Hui Zeng
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Dohyung Lim
- Department of Mechanical Engineering, Sejong University, 209, Neungdong-ro, Gwangjin-gu, Seoul, 05006, Republic of Korea
| | - Hyun Choi
- Department of Mechanical Engineering, Sejong University, 209, Neungdong-ro, Gwangjin-gu, Seoul, 05006, Republic of Korea.
| | - Jung-Hoon Park
- Biomedical Engineering Research Center, Asan Institute for Life Sciences, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Zhu Q, Ye P, Niu H, Chang Z. Effect of expanded polytetrafluoroethylene thickness on paclitaxel release and edge stenosis in stent graft. Front Bioeng Biotechnol 2022; 10:972466. [PMID: 35935478 PMCID: PMC9354930 DOI: 10.3389/fbioe.2022.972466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Stent grafts have been widely used to treat lower extremity arterial stenosis or occlusion. However, there are major issues with edge stenosis and loss of patency over time. Paclitaxel-coated stent grafts have been proven to be effective in preventing edge stenosis, but the insufficient amounts of paclitaxel released may limit the effectiveness of drug-eluting stent grafts. In this study, we examined whether paclitaxel-coated expanded polytetrafluoroethylene (ePTFE) stent graft thickness influences paclitaxel release properties and inhibits edge stenosis. Low-, medium-, and high-thickness paclitaxel-coated stent grafts were prepared by varying the thickness of inner and outer ePTFE layers. Surface morphologies of the stent grafts were analyzed using a scanning electron microscope. The stent grafts were then implanted in the iliac arteries of 20 healthy swine. Twelve pigs were used to assess edge stenosis, and digital subtraction angiography was performed at day 30 (n = 4), 90 (n = 4), and 180 (n = 4). Histological evaluation of the treated arteries was also performed. Eight pigs were used for pharmacokinetic analysis, and the treated arteries were obtained at day 1 (n = 2), 30 (n = 2), 90 (n = 2) and 180 (n = 2). Scanning electron microscopy confirmed that the mean pore size of the stent grafts decreased with increasing thickness. The results of angiographic and histological evaluation demonstrated that low-thickness ePTFE-stent grafts resulted in edge stenosis and apparent intimal hyperplasia at 180 days, whereas for medium-thickness ePTFE-stent grafts, no obvious edge stenosis and intimal hyperplasia was noted in the similar time period. The results of pharmacokinetic evaluation showed that at 180 days, the paclitaxel concentration of treated arteries of the medium group was 36 ± 53 ng/g, while concentrations in the low group was not detectable. Stent grafts with increased ePTFE thickness appear to allow for more delayed release of paclitaxel compared to low-thickness ePTFEs.
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Affiliation(s)
- Qing Zhu
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai MicroPort Endovascular MedTech (group) Co., Ltd, Shanghai, China
| | - Ping Ye
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Haifeng Niu
- Shanghai MicroPort Endovascular MedTech (group) Co., Ltd, Shanghai, China
| | - Zhaohua Chang
- Shanghai Institute for Minimally Invasive Therapy, School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Shanghai MicroPort Endovascular MedTech (group) Co., Ltd, Shanghai, China
- *Correspondence: Zhaohua Chang,
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Bekken JA, Geensen R, Kok R, Kuijper M, de Vries JPPM, Fioole B. Covered Stents vs. Angioplasty for Common Iliac Artery In Stent Restenosis: A Retrospective Comparison. Eur J Vasc Endovasc Surg 2021; 63:315-322. [PMID: 34824011 DOI: 10.1016/j.ejvs.2021.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 09/20/2021] [Accepted: 10/09/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The optimal endovascular treatment for common iliac artery in stent re-stenosis has yet to be assessed. Treatment options include, among others, angioplasty alone and repeated stenting with covered stents. METHODS This study retrospectively compared patency and target lesion revascularisation of these treatments. All patients who underwent endovascular treatment of common iliac artery in stent re-stenosis between 2007 and 2017 were included retrospectively. The primary end point was freedom from re-stenosis. Secondary endpoints were target lesion revascularisation rate (TLR) and freedom from occlusion during follow up. RESULTS Seventy-four interventions were included, consisting of 37 angioplasties and 37 covered stent placements in 57 patients. Freedom from re-stenosis at four years was 72.6% (95% confidence interval [CI] 51.8% - 88.7%) in the covered stent group vs. 43.5% (95% CI 25.9% - 59.8%) in the percutaneous transluminal angioplasty (PTA) group (p = .003). The target lesion revascularisation (TLR) rate was 16.4% (95% CI 7.1% - 35.6%) and 43.6% (95% CI 28.0% - 63.2%) respectively (p = .020). There was no difference in freedom from occlusion; this was 90.8% (95% CI 73.9% - 97.0%) in the covered stent group and 79.1% (95% CI 58.4% - 90.3%) in the PTA group (p = .49). The difference in freedom from re-stenosis and TLR remained significant after sensitivity and multivariable analyses. CONCLUSION Covered stents offer better outcomes for common iliac artery in stent re-stenosis than angioplasty alone.
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Affiliation(s)
- Joost A Bekken
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
| | - Roos Geensen
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Rosemarijn Kok
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Martijn Kuijper
- Department of Biostatistics, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Jean-Paul P M de Vries
- Department of Vascular Surgery, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands; Department of Surgery, University Medical Centre, Groningen, The Netherlands
| | - Bram Fioole
- Department of Vascular Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands
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6
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Mallory A, Giannopoulos S, Lee P, Kokkinidis DG, Armstrong EJ. Covered Stents for Endovascular Treatment of Aortoiliac Occlusive Disease: A Systematic Review and Meta-Analysis. Vasc Endovascular Surg 2021; 55:560-570. [PMID: 33902342 DOI: 10.1177/15385744211010381] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The treatment of aortoiliac occlusive disease (AIOD) has largely shifted to endovascular techniques, with primary stenting constituting the preferred treatment approach. The goal of the current study was to summarize available literature and to determine whether covered stents are superior to bare metal stents for the treatment of AIOD, in terms of both periprocedural and long-term outcomes. METHODS A meta-analysis of 47 studies was conducted with the use of random effects modeling. The incidence of adverse events during follow up among the individual included studies was synthesized. RESULTS Most of the lesions were located at the common iliac arteries and were chronic total occlusions. The procedure was technically successful in almost all cases in both groups, with a low rate of periprocedural complications observed in both groups. The reported primary patency rates for the non-covered and covered stent group during an average follow up of 24.3 months among the individual studies, were 84% and 92% respectively, while surgical or endovascular re-intervention was required in 10% of non-covered stent cases and in 6% of covered stent cases. Eight studies comparing covered vs non-covered stents in terms of patency demonstrated superiority of covered stents (OR: 2.47; 95% CI: 1.01-6.01; p = 0.047 Combining TASC C/D lesions together 12 studies reported 92% (95%CI:89%-95%) primary patency in the covered stent group, while 7 studies reported 75% (95%CI: 60%-88%) primary patency for cases treated with non-covered stents. CONCLUSION This study demonstrated that covered stents are safe and effective when utilized for the treatment of AIOD. Covered stents were associated with a statistically significant higher odds of primary patency in both the overall cohort and in more complex TASC C/D lesions. However, additional high-quality comparative analyses between covered vs bare metal stents and between several types of covered stents are needed to determine the most optimal treatment modality for AIOD.
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Affiliation(s)
- Austin Mallory
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Stefanos Giannopoulos
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Paul Lee
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Damianos G Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
| | - Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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7
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KARAHAN O, ÖCAL N, SÜMER T, HAFIZ E, KHALİL E. Investigation of the Endothelial Response of Super Elastic Braided Stent: An Experimental Evaluation. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.745576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Dolmatch BL, Hall JW, Mower WL, Rousselle SD. Evaluation of a Novel Spun Polytetrafluoroethylene Stent Graft in an Ovine External Iliac Artery Model. J Vasc Interv Radiol 2020; 31:494-502. [PMID: 31959517 DOI: 10.1016/j.jvir.2019.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 07/24/2019] [Accepted: 07/26/2019] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the patency, cellular response, and thrombogenicity of a novel vascular stent graft. MATERIALS AND METHODS Test stent grafts, incorporating luminal spun polytetrafluoroethylene and a nonpermeable fluoropolymer layer, and control stent grafts, constructed of permeable expanded polytetrafluoroethylene, were implanted in the external iliac arteries of 14 adult sheep with a median weight of 73.4 kg ranging from 60.6-86.8 kg for 30 (n = 4), 90 (n = 4), and 180 (n = 6) days. Angiographic patency and percent diameter stenosis (%DS) were assessed at termination. Excised stent grafts were fixed and stained for histopathologic analysis, including neointimal coverage (NC) assessment. RESULTS Test and control device migration occurred in 1 animal, resulting in test device thrombosis. Both devices were excluded from analysis. Mean %DS in test and control implants was 4.6% and 8.2% (P = .563), 2.0% and 10.9% (P = .363), and 2.1% and 10.3% (P = .009) at 30, 90, and 180 days, respectively. Median NC scores at 30, 90, and 180 days were significantly lower in middle test device sections (P < .05). Proximal and distal test and control sections exhibited similar median NC scores at all time periods (P > .05). When present, test and control devices exhibited no neointimal detachment from the graft surface. Except for the migrated test device, no thrombus was observed. Transgraft cellular migration was absent in test devices but present in control devices with tissue accumulation around the stent struts. CONCLUSIONS Test and control devices demonstrated excellent patency in an ovine model. Compared to the control, test devices exhibited significantly lower %DS values at 180 days and significantly lower mid-device NC scores at 30, 90, and 180 days.
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Affiliation(s)
| | - John W Hall
- Merit Medical Systems, Inc, 1600 W Merit Pkwy, South Jordan, UT, 80495.
| | - Wayne L Mower
- Merit Medical Systems, Inc, 1600 W Merit Pkwy, South Jordan, UT, 80495
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9
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iCAST Balloon-Expandable Covered Stent for Iliac Artery Lesions: 3-Year Results from the iCARUS Multicenter Study. J Vasc Interv Radiol 2019; 30:822-829.e4. [DOI: 10.1016/j.jvir.2018.12.707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/15/2018] [Accepted: 12/20/2018] [Indexed: 11/18/2022] Open
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10
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Laird JR, Zeller T, Holden A, Scheinert D, Moore E, Mendes R, Schmiedel R, Settlage R, Lansky A, Jaff MR, Elmasri F, Robinson W, Beasley R, Mego D, Marica S, Bersin R, Kujath S, Razavi M, Teßarek J, Schulte KL. Balloon-Expandable Vascular Covered Stent in the Treatment of Iliac Artery Occlusive Disease: 9-Month Results from the BOLSTER Multicenter Study. J Vasc Interv Radiol 2019; 30:836-844.e1. [DOI: 10.1016/j.jvir.2018.12.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 11/25/2022] Open
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11
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Grusova G, Lambert L, Kavan J, Lambertova A, Burgetova A, Mlcek M, Grus T. Natural remodeling of the distal anastomosis of an above-knee femoropopliteal bypass depicted by CT angiography of lower limbs improves geometry of the reconstruction. Physiol Res 2018; 67:857-862. [PMID: 30204459 DOI: 10.33549/physiolres.933911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The geometry of the distal anastomosis of a femoropopliteal bypass influences local hemodynamics and formation of intimal hyperplasia. We hypothesized that the distal anastomosis of an above-knee femoropopliteal bypass undergoes remodeling that results in displacement of the original course of the popliteal artery and change in the anastomosis angle. We identified 43 CT angiography examination with proximal femoropopliteal bypass and either a preserved contralateral popliteal artery or previous CTA before construction of the bypass for comparison. In these examinations, we measured the displacement distance and angle at the level of the distal anastomosis and compared these measurements with clinical and imaging data. The displacement distance was 8.8+/-4.9 mm (P<0.0001) and the displacement angle was -1° (IQR=44°). The angle between the inflow and outflow artery was 153+/-16° (P<0.0001). There was a negative association between the displacement angle and the angle between the bypass and the outflow artery (r=-0.318, P=0.037). Patients with reversed venous grafts had a greater displacement of the anastomosis (14.7+/-3.0 mm) than patients with prosthetic grafts (8.0+/-4.5 mm, P=0.0011). We conclude that construction of a distal anastomosis of proximal femoropopliteal bypass results in displacement of the original course of the popliteal artery towards the bypass and this effect is more pronounced in reversed venous grafts.
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Affiliation(s)
- G Grusova
- Fourth Department of Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic, Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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12
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Schmidli J, Widmer MK, Basile C, de Donato G, Gallieni M, Gibbons CP, Haage P, Hamilton G, Hedin U, Kamper L, Lazarides MK, Lindsey B, Mestres G, Pegoraro M, Roy J, Setacci C, Shemesh D, Tordoir JH, van Loon M, ESVS Guidelines Committee, Kolh P, de Borst GJ, Chakfe N, Debus S, Hinchliffe R, Kakkos S, Koncar I, Lindholt J, Naylor R, Vega de Ceniga M, Vermassen F, Verzini F, ESVS Guidelines Reviewers, Mohaupt M, Ricco JB, Roca-Tey R. Editor's Choice – Vascular Access: 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55:757-818. [DOI: 10.1016/j.ejvs.2018.02.001] [Citation(s) in RCA: 346] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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13
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Stent Graft versus Balloon Angioplasty for Failing Dialysis Access Grafts: A Long-Awaited Advance in the Treatment of Permanent Hemodialysis Access. J Vasc Access 2018; 11:89-91. [DOI: 10.1177/112972981001100201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Arteriovenous grafts (AVGs) for hemodialysis have a high failure rate, often due to the development of stenosis at the graft-to-vein anastomosis. Angioplasty (PTA) has been used for over two decades to treat AVG stenosis, with good technical success but limited AVG patency. Results of a prospective multi-center randomized trial, comparing stent graft to PTA in AVGs, has demonstrated superior access circuit patency for the stent graft group. Recent publication of this clinical study brings us into an exciting new era of dialysis access management using covered stents to improve durability of catheter-based therapy.
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Steinvil A, Bernardo N, Rogers T, Koifman E, Buchanan K, Alraies MC, Shults C, Torguson R, Okubagzi PG, Pichard AD, Satler LF, Ben-Dor I, Waksman R. Use of an ePTFE-covered nitinol self-expanding stent graft for the treatment off pre-closure device failure during transcatheter aortic valve replacement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:128-132. [DOI: 10.1016/j.carrev.2016.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 10/18/2016] [Indexed: 12/17/2022]
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15
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Chun Y, Kealey CP, Levi DS, Rigberg DA, Chen Y, Tillman BW, Mohanchandra KP, Shayan M, Carman GP. An in vivo pilot study of a microporous thin film nitinol-covered stent to assess the effect of porosity and pore geometry on device interaction with the vessel wall. J Biomater Appl 2016; 31:1196-1202. [DOI: 10.1177/0885328216682691] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Sputter-deposited thin film nitinol constructs with various micropatterns were fabricated to evaluate their effect on the vessel wall in vivo when used as a covering for commercially available stents. Thin film nitinol constructs were used to cover stents and deployed in non-diseased swine arteries. Swine were sacrificed after approximately four weeks and the thin film nitinol-covered stents were removed for histopathologic evaluation. Histopathology revealed differences in neointimal thickness that correlated with the thin film nitinol micropattern. Devices covered with thin film nitinol with a lateral × vertical length = 20 × 40 µm diamond pattern had minimal neointimal growth with well-organized cell architecture and little evidence of ongoing inflammation. Devices covered with thin film nitinol with smaller fenestrations exhibited a relatively thick neointimal layer with inflammation and larger fenestrations showed migration of inflammatory and smooth muscle cells through the micro fenestrations. This “proof-of-concept” study suggests that there may be an ideal thin film nitinol porosity and pore geometry to encourage endothelialization and incorporation of the device into the vessel wall. Future work will be needed to determine the optimal pore size and geometry to minimize neointimal proliferation and in-stent stenosis.
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Affiliation(s)
- Youngjae Chun
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Bioengineering, McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Colin P Kealey
- Advanced Development & Medical Affairs, NeuroSigma, Inc., Los Angeles, CA, USA
| | - Daniel S Levi
- Pediatric Cardiology, Mattel Children’s Hospital, University of California, Los Angeles, CA, USA
| | - David A Rigberg
- Division of Vascular Surgery, Ronald Reagan UCLA Medical Center, UCLA Surg-Vascular, Los Angeles, CA, USA
| | - Yanfei Chen
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryan W Tillman
- Division of Vascular Surgery, Ronald Reagan UCLA Medical Center, UCLA Surg-Vascular, Los Angeles, CA, USA
| | - KP Mohanchandra
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, CA, USA
| | - Mahdis Shayan
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Gregory P Carman
- Department of Mechanical and Aerospace Engineering, University of California, Los Angeles, CA, USA
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16
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Influence of drugs on arteriovenous vascular access dysfunction. J Vasc Access 2015; 16 Suppl 9:S61-5. [PMID: 25751553 DOI: 10.5301/jva.5000365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 01/04/2023] Open
Abstract
Vascular access dysfunction, due to venous stenosis at the vein-artery anastomosis in arteriovenous fistulas and vein-graft anastomosis in synthetic arteriovenous grafts, is a major cause of morbidity and mortality in dialysis patients. The two overarching approaches to prevent and treat vascular access dysfunction are from systemic or local (including endovascular and perivascular) routes. However, there are currently very few effective therapies to treat vascular access dysfunction. This article will review major studies evaluating systemic, endovascular, and perivascular therapies for vascular access dysfunction. Ongoing research to evaluate novel innovations to prevent and/or manage vascular access dysfunction appears promising.
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17
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Nakayama T, Suda H, Yamada T, Miyata Y. Pre-operative endostent placement to allow the complete and safe resection of a recurrent tumor that had tightly adhered to the subclavian artery: A case report. SAGE Open Med Case Rep 2015; 3:2050313X15583209. [PMID: 27489688 PMCID: PMC4857311 DOI: 10.1177/2050313x15583209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 03/26/2015] [Indexed: 11/16/2022] Open
Abstract
Radiation and tumor infiltration confer a high risk of bleeding on surgical removal of tumor. We report on the case of a 42-year-old woman with a recurrent occult subclavian tumor in her right breast. Computed tomography revealed enhanced tumor adhesion to the subclavian artery at the infraclavicular lymph node. No other metastases were detected. We pre-operatively performed stenting of the right subclavian artery, and the tumor was resected completely and safely.
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Affiliation(s)
- Takuya Nakayama
- Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Hisao Suda
- Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Toshiuki Yamada
- Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
| | - Yosuke Miyata
- Department of Cardiovascular Surgery, Nagoya City East Medical Center, Nagoya, Japan
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18
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Chan MG, Miller FJ, Valji K, Kuo MD. Drs. Chan et al respond. J Vasc Interv Radiol 2014; 25:1315-6. [PMID: 25085071 DOI: 10.1016/j.jvir.2014.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 04/09/2014] [Indexed: 11/28/2022] Open
Affiliation(s)
- Michael G Chan
- Department of Radiology, University of California, Los Angeles, Los Angeles, California; Department of Radiology, University of California, San Diego, San Diego, California
| | - Franklin J Miller
- Department of Radiology, University of California, San Diego, San Diego, California
| | - Karim Valji
- Department of Radiology, University of Washington, Seattle, Washington
| | - Michael D Kuo
- Department of Radiology, University of California, Los Angeles, Los Angeles, California
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19
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Dolmatch B. Re: "Evaluating patency rates of an ultralow-porosity expanded polytetrafluoroethylene-covered stent in the treatment of venous stenosis in arteriovenous dialysis circuits". J Vasc Interv Radiol 2014; 25:1315. [PMID: 25085070 DOI: 10.1016/j.jvir.2014.03.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/12/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Bart Dolmatch
- Department of Interventional Radiology, Palo Alto Medical Foundation, 701 E. El Camino Real, Mountain View, CA 94040
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20
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Bekken JA, Jongsma H, de Vries JPP, Fioole B. Self-expanding stents and aortoiliac occlusive disease: a review of the literature. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2014; 7:99-105. [PMID: 24833925 PMCID: PMC4014367 DOI: 10.2147/mder.s60594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The treatment of symptomatic aortoiliac occlusive disease has shifted from open to endovascular repair. Both short- and long-term outcomes after percutaneous angioplasty and stenting rival those after open repair and justify an endovascular-first approach. In this article, we review the current endovascular treatment strategies in patients with aortoiliac occlusive disease, indications for primary and selective stenting in the iliac artery, and physical properties and future perspectives of self-expanding stents.
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Affiliation(s)
- Joost A Bekken
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | - Hidde Jongsma
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
| | | | - Bram Fioole
- Department of Vascular Surgery, Maasstad Hospital, Rotterdam, the Netherlands
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21
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Chan MG, Miller FJ, Valji K, Bansal A, Kuo MD. Evaluating Patency Rates of an Ultralow-Porosity Expanded Polytetrafluoroethylene Covered Stent in the Treatment of Venous Stenosis in Arteriovenous Dialysis Circuits. J Vasc Interv Radiol 2014; 25:183-9. [DOI: 10.1016/j.jvir.2013.10.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 10/02/2013] [Accepted: 10/03/2013] [Indexed: 11/17/2022] Open
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22
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Ulloa JG, Kirkpatrick VE, Wilson SE, Williams RA. Stent salvage of arteriovenous fistulas and grafts. Vasc Endovascular Surg 2014; 48:234-8. [PMID: 24424661 DOI: 10.1177/1538574413518609] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES This study analyzes our experience using stents to salvage dysfunctional hemodialysis access sites at a single institution. METHODS We examined the outcomes of 42 consecutive patients who had covered (36 patients) or bare-metal (9 patients) stent intervention for hemodialysis access salvage. RESULTS Of our 42 male patients, 11 had stent salvage of an arteriovenous fistula, which yielded postintervention primary and secondary 6-month patencies of 27% and 55%, respectively. For 31 patients with arteriovenous grafts, the postintervention primary and secondary 6-month patencies were 26% and 29%, respectively. Patency rates were superior for stents placed in patent access sites, in fistulas compared to grafts, and when stents were placed in forearm sites although only the latter achieved statistical significance. CONCLUSIONS Stents can extend patency for the thrombosed or failing arteriovenous access, but results are poor once thrombosis has occurred. Stent placement appears to be more effective in fistulas compared to grafts.
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Affiliation(s)
- Jesus G Ulloa
- Veterans Administration Long Beach Healthcare System, Department of Surgery, Long Beach, CA, USA
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23
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Porcine carotid artery replacement with biodegradable electrospun poly-e-caprolactone vascular prosthesis. J Vasc Surg 2014; 59:210-9. [DOI: 10.1016/j.jvs.2013.03.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 02/15/2013] [Accepted: 03/04/2013] [Indexed: 11/17/2022]
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24
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Verstandig AG, Berelowitz D, Zaghal I, Goldin I, Olsha O, Shamieh B, Shraibman V, Shemesh D. Stent grafts for central venous occlusive disease in patients with ipsilateral hemodialysis access. J Vasc Interv Radiol 2013; 24:1280-7; quiz 1288. [PMID: 23806382 DOI: 10.1016/j.jvir.2013.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 04/10/2013] [Accepted: 04/11/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To assess long-term outcomes of stent grafts in patients with symptomatic central venous stenoses and occlusions ipsilateral to hemodialysis grafts or fistulas. MATERIALS AND METHODS The study included 52 of 55 consecutive patients with symptomatic stenoses of the central veins draining upper limb dialysis access grafts or fistulas treated with stent grafts. Indications for stent grafts were poor angioplasty results, rapid recurrence, or total occlusion. Endpoints were lesion patency and access patency following intervention. Mean follow-up was 25 months with a median of 24 months and 1.25 additional procedures per patient year. Patency rates were calculated using Kaplan-Meier analysis. RESULTS All stent grafts were successfully deployed. The lesion patency rates at 6, 12, 24, and 36 months after intervention were 60%, 40%, 28%, and 28%. The access patency rates at 6, 12, 24, and 36 months after intervention were 96%, 94%, 85%, and 72%. There was one major complication and no minor complications. In 40 patients (77%), the internal jugular vein confluence was covered by the stent graft. In five patients, the dialysis circuits became occluded, with no clinical sequelae in four; one patient was lost to follow-up. The contralateral brachiocephalic vein was covered in three patients (6%), preventing contralateral access construction in one patient. CONCLUSIONS Central vein stent graft placement in patients with hemodialysis access is associated with prolonged access patency. Coverage of major vein confluences, which occurred in 83% of the patients in this series, can compromise future access and should be avoided whenever possible by careful technique.
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Affiliation(s)
- Anthony G Verstandig
- Department of Radiology, Shaare Zedek Medical Center, POB 3235, Jerusalem IL-91031, Israel.
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25
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Results of polytetrafluoroethylene-covered nitinol stents crossing the inguinal ligament. J Vasc Surg 2013; 57:421-6. [DOI: 10.1016/j.jvs.2012.05.112] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 05/09/2012] [Accepted: 05/27/2012] [Indexed: 11/17/2022]
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26
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Dolmatch BL, Duch JM, Winder R, Butler GM, Kershen M, Patel R, Trimmer CK, Lopera JE, Davidson IJ. Salvage of Angioplasty Failures and Complications in Hemodialysis Arteriovenous Access Using the FLUENCY Plus Stent Graft: Technical and 180-Day Patency Results. J Vasc Interv Radiol 2012; 23:479-87. [DOI: 10.1016/j.jvir.2011.12.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Revised: 12/21/2011] [Accepted: 12/26/2011] [Indexed: 10/28/2022] Open
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27
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Topographic control of the growth and function of cardiomyoblast H9c2 cells using nanodot arrays. Biomaterials 2012; 33:20-8. [DOI: 10.1016/j.biomaterials.2011.09.054] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Accepted: 09/21/2011] [Indexed: 11/20/2022]
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28
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Jones RG, Willis AP, Jones C, McCafferty IJ, Riley PL. Long-term results of stent-graft placement to treat central venous stenosis and occlusion in hemodialysis patients with arteriovenous fistulas. J Vasc Interv Radiol 2011; 22:1240-5. [PMID: 21764328 DOI: 10.1016/j.jvir.2011.06.002] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Revised: 05/29/2011] [Accepted: 06/07/2011] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To determine the effectiveness of stent-grafts for the treatment of central venous disease in hemodialysis patients with functioning arteriovenous (AV) fistulas. MATERIALS AND METHODS Between October 2004 and March 2010, 42 VIABAHN stent-grafts were deployed in central veins of 30 patients (16 men, 14 women; mean age 60 y) with functioning AV fistulas and central venous disease that did not respond to percutaneous transluminal angioplasty (PTA). Eighteen patients had central vein stenosis and 12 had occlusion. Previous PTA and/or bare metal stent placement had been performed in 23 patients (77%). Surveillance was carried out at 3, 6, 9, 12, 18, and 24 months with diagnostic fistulography. The mean follow-up was 705 days (range, 66-1,645 d). Statistical analysis included Kaplan-Meier and log-rank studies. RESULTS Technical success rate was 100%. Primary patency rates were 97%, 81%, 67%, and 45% at 3, 6, 12, and 24 months, respectively. Primary assisted patency rates were 100%, 100%, 80%, and 75% at 3, 6, 12, and 24 months, respectively. Patients without previous procedures had significantly shorter times to repeat intervention (P = .018) than those who had undergone PTA or bare metal stent placement previously. Patients with occlusive lesions had a significantly shorter primary patency interval (P = .05) than patients with stenoses. Occluded veins were more likely to require further stent-grafts (P = .02). Twelve patients required further stent-grafts to maintain patency. There was one minor complication. CONCLUSIONS Stent-graft placement to treat central venous disease in hemodialysis patients with autogenous AV fistulas is safe and effective if PTA fails to maintain luminal patency.
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Affiliation(s)
- Robert G Jones
- Radiology Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Trust, Edgbaston, Birmingham B15 2TH, United Kingdom.
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29
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Patrzyk M, Hoene A, Jarchow R, Wilhelm L, Walschus U, Zippel R, Schlosser M. Time course of fibronectin in the peri-implant tissue and neointima formation after functional implantation of polyester-based vascular prostheses with different porosity in pigs. Biomed Mater 2010; 5:055003. [PMID: 20826907 DOI: 10.1088/1748-6041/5/5/055003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Intima hyperplasia, resulting from extracellular matrix (ECM) secretion, can lead to vascular prosthesis occlusion and is a major problem in vascular surgery. Fibronectin might contribute to ongoing ECM secretion. However, the exact role of fibronectin and its influence on neointima formation remains unclear. This study was aimed at investigating the time course of the fibronectin area fraction and neointima formation following the functional implantation of three different polyester vascular prostheses into pigs. The infrarenal aorta from 15 animals (n = 5/group) was replaced by prosthesis segments with low, medium and high primary porosity. After 7, 14, 21, 28 and 116 days, the prostheses were morphometrically examined. Overall, the fibronectin area fraction was inversely correlated with the neointima thickness, demonstrating high fibronectin levels in the early phase (days 7 and 14) and low levels in the later phase with almost complete neointima formation (days 21-116). Throughout the study, fibronectin levels were highest at the proximal anastomosis region. The low porosity prosthesis had the highest fibronectin area fraction and a delayed neointima formation in the middle phase (days 21 and 28) but the highest neointima lining on day 116. The results indicate a relationship between fibronectin and neointima formation with the prosthesis porosity, demonstrating the importance of the textile design for tissue reactions following implantation.
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Affiliation(s)
- Maciej Patrzyk
- Department of Surgery, Ernst Moritz Arndt University Greifswald, Friedrich-Loeffler-Str. 23, D-17489 Greifswald, Germany
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30
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Bent CL, Rajan DK, Tan K, Simons ME, Jaskolka J, Kachura J, Beecroft R, Sniderman KW. Effectiveness of Stent-graft Placement for Salvage of Dysfunctional Arteriovenous Hemodialysis Fistulas. J Vasc Interv Radiol 2010; 21:496-502. [DOI: 10.1016/j.jvir.2009.12.395] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Revised: 11/26/2009] [Accepted: 12/30/2009] [Indexed: 11/28/2022] Open
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31
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Moreira SM, Kambara AM, Ajzen S, Costa Junior JDR. Quantificação volumétrica da hiperplasia neointimal em artérias ilíacas após implante de suporte intravascular metálico. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Quantificar a hiperplasia neointimal em artérias ilíacas após stent, correlacionando fatores clínicos, arteriais e materiais dos stents. MATERIAIS E MÉTODOS: De junho de 2003 a agosto de 2005, 60 pacientes realizaram angioplastia transluminal percutânea e stent. Desses, 30 foram reestudados com ultrassonografia intravascular. Os dados foram analisados no laboratório de análise quantitativa. RESULTA-DOS: Dezesseis pacientes eram do sexo masculino (53,3%) e 14 (46,7%), do sexo feminino. A média de idade foi de 60,3 anos. Apresentaram hipertensão arterial 22 pacientes (73,3%), tabagismo, 18 (62,1%), hiperlipidemia, 20 (66,7%), e diabetes, 9 (30%). Foram implantados 20 stents de nitinol (66,7%) e 10 de aço inoxidável (33,3%). Quatro pacientes eram TASC A (13,3%), 15 eram TASC B (50%) e 11, TASC C (36,7%). O volume da hiperplasia variou de 49,02 mm³ a 112,87 mm³ (média de 80,33 mm³). O percentual de obstrução intra-stent variou de 18% a 47% (média de 27,4%). Os resultados clínicos obtidos com stent se mantiveram até o reestudo. CONCLUSÃO: A hiperplasia neointimal sempre ocorre após a angioplastia transluminal percutânea e stent, porém os percentuais de obstrução não foram superiores a 50% em nenhum caso. Não houve diferença estatisticamente significante dos percentuais de obstrução intra-stent quanto aos materiais dos stents, aos fatores clínicos e aos fatores arteriais.
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Affiliation(s)
| | | | - Sergio Ajzen
- Universidade Federal de São Paulo/Escola Paulista de Medicina, Brasil
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32
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Gupta M, Rajan DK, Tan KT, Sniderman KW, Simons ME. Use of Expanded Polytetrafluoroethylene–covered Nitinol Stents for the Salvage of Dysfunctional Autogenous Hemodialysis Fistulas. J Vasc Interv Radiol 2008; 19:950-4. [DOI: 10.1016/j.jvir.2008.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 03/05/2008] [Accepted: 03/10/2008] [Indexed: 11/29/2022] Open
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