1
|
Severe Focal Stenosis of the Abdominal Aorta with High Risk of Occlusion. JOURNAL OF INTERDISCIPLINARY MEDICINE 2022. [DOI: 10.2478/jim-2021-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
2
|
Whitbeck MG. Treatment of focal distal abdominal aortic stenosis with the GORE VIABAHN VBX balloon expandable covered stent. Catheter Cardiovasc Interv 2019; 95:457-461. [PMID: 31478298 DOI: 10.1002/ccd.28478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/03/2019] [Accepted: 08/20/2019] [Indexed: 11/07/2022]
Abstract
The incidence of focal infrarenal stenosis of the aorta is rare. Endovascular therapy has evolved as a first-line treatment of aortoiliac occlusive disease and has been shown to substantially improve health-related quality of life. The 8 French sheath compatible, GORE VIABAHN VBX (GORE Flagstaff, AZ) balloon expandable covered stent offers the traditional benefits of a balloon expandable covered stent with a design that improves on flexibility. We report three cases with the use of this system for treatment of infrarenal stenosis of the aorta.
Collapse
|
3
|
Tatiana B, Peter K, Peter K, Anneliese B, Tina C. Aortic Stenting in Symptomatic Infrarenal Aortic Stenosis and Subtotal Aortic Occlusion. Vasc Endovascular Surg 2019; 53:303-309. [DOI: 10.1177/1538574419830825] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The aim of this study was to evaluate the long-term results of aortic stent placement in patients with infrarenal aortic occlusive disease. Methods: Between April 1996 and May 2014, 34 patients with symptomatic infrarenal atherosclerotic aortic stenosis or subtotal aortic occlusion underwent percutaneous angioplasty with primary aortic stent implantation. There were 21 patients with Fontaine stage of the peripheral arterial disease (PAD) II, 5 patients with stage III, and 8 patients with stage IV. One patient withdrew informed consent and was excluded from further analysis. Results: Patients (n = 34, mean age: 62 ± 12 years) were followed for a mean period of 81 months. There were 2 procedure-related access-related complications. Six patients died during follow-up from non-procedure-related causes. Eight patients had late recurrence of symptoms during follow-up. Only in 2 cases, symptomatic recurrences were due to aortic in-stent stenosis (77 and 132 months after the primary stent implantation). Additionally, these 2 patients required therapy for PAD progression distal to the aorta. Five patients required further surgical or endovascular reconstruction for PAD progression distal to the aorta. In another case, clinical treatment failure was due to the progression of atherosclerotic lesion in the perirenal, nonstented part of the abdominal aorta. The mean estimated primary patency rate was 185.6 months (95% confidence interval: 161.3-209.8). Conclusion: Endovascular stent implantation is a safe and long-term effective strategy for the treatment of infrarenal aortic occlusive disease. In our study, the recurrence of symptoms was observed mainly due to atherosclerosis progression by multilevel disease with associated infrainguinal occlusive lesions but not to aortic in-stent restenosis. The prognostic advantage for this relatively young cohort of patients can be the possibility to repeat a percutaneous procedure with less technical difficulties when compared to surgical revision.
Collapse
Affiliation(s)
- Belyavskaya Tatiana
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
- Department of Vascular Surgery, Brandenburg State Hospital, Brandenburg an der Havel, Germany
| | - Kalmar Peter
- Division of Neuroradiology, Vascular and Interventional Radiology, University Hospital of Graz, Medical University Graz, Graz, Austria
| | - Konstantiniuk Peter
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
| | - Baumann Anneliese
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
| | - Cohnert Tina
- Department of Vascular Surgery, University Hospital Graz, Medical University Graz, Graz, Austria
| |
Collapse
|
4
|
Shi C, Tercero C, Wu X, Ikeda S, Komori K, Yamamoto K, Arai F, Fukuda T. Real-time in vitro intravascular reconstruction and navigation for endovascular aortic stent grafting. Int J Med Robot 2016; 12:648-657. [PMID: 26858168 DOI: 10.1002/rcs.1736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 01/11/2016] [Accepted: 01/12/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Trans-catheter endovascular stent grafting minimizes trauma and increases the benefitting patient population. However, the alignment between stent graft branches and vasculature branches remains time-consuming and challenging, and such techniques require a significant amount of contrast agent for imaging. METHODS A new framework for intravascular reconstruction based on sensor fusion between intravascular ultrasound (IVUS) imaging and electromagnetic (EM) tracking was proposed. A new image processing method was presented to realize fully automatic processing of IVUS imaging and 3D reconstruction in real time, as well as branch detection for alignment and deployment. Complementary navigation using CT data allows for efficient catheter advancement and assistant clinical judgement. RESULTS The reconstruction of an in vitro descending aorta phantom with branches was realized at 35 Hz, with cross-section radius average error of 0.64 mm. CONCLUSION The proposed method demonstrates significant potential for clinical applications, enables navigation for precise alignment and placement for stent grafting to reduce surgical time, and decreases hemorrhagic collisions and the use of contrast agent. Copyright © 2016 John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
| | - Carlos Tercero
- Department of Micro-nano Systems Engineering, Nagoya University, Nagoya, Japan
| | | | - Seiichi Ikeda
- Department of Micro-nano Systems Engineering, Nagoya University, Nagoya, Japan
| | - Kimihiro Komori
- Division of Vascular Surgery, Graduate School of Medicine, Nagoya University
| | - Kiyohito Yamamoto
- Division of Vascular Surgery, Graduate School of Medicine, Nagoya University
| | - Fumihito Arai
- Department of Micro-nano Systems Engineering, Nagoya University, Nagoya, Japan
| | - Toshio Fukuda
- Department of Micro-nano Systems Engineering, Nagoya University, Nagoya, Japan
| |
Collapse
|
5
|
Tapping CR, Uberoi R. Iliac arteries: how registries can help improve outcomes. Semin Intervent Radiol 2014; 31:338-44. [PMID: 25435659 DOI: 10.1055/s-0034-1393970] [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: 10/24/2022]
Abstract
There are many publications reporting excellent short and long-term results with endovascular techniques. Patients included in trials are often highly selected and may not represent real world practice. Registries are important to interventional radiologists for several reasons; they reflect prevailing practice and can be used to establish real world standards of care and safety profiles. This information allows individuals and centers to evaluate their outcomes compared with national norms. The British Iliac Angioplasty and Stenting (BIAS) registry is an example of a mature registry that has been collecting data since 2000 and has been reporting outcomes since 2001. This article discusses the evidence to support both endovascular and surgical intervention for aortoiliac occlusive disease, the role of registries, and optimal techniques for aortoiliac intervention.
Collapse
Affiliation(s)
- Charles Ross Tapping
- Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom ; Department of Radiology, Churchill Hospital, Oxford, United Kingdom
| | - Raman Uberoi
- Department of Radiology, John Radcliffe Hospital, Oxford, United Kingdom
| |
Collapse
|
6
|
Klonaris C, Katsargyris A, Papapetrou A, Chatziioannou A, Georgopoulos S. Unilateral Iliac Artery Stenting Improves Perfusion and Symptoms in Both Limbs in Patients With Bilateral Iliac Lesions. J Endovasc Ther 2013; 20:106-12. [DOI: 10.1583/12-4071.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
7
|
Chung TL, Mukherjee D. Successful endovascular management of an aortic rupture following stent placement for severe atherosclerotic stenosis: A case report. Int J Angiol 2012; 16:73-6. [PMID: 22477277 DOI: 10.1055/s-0031-1278253] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Aortic rupture during endovascular procedures is a devastating complication that mandates expedient intervention. The present report describes a case in which endovascular treatment was used to successfully manage an aortic rupture following placement of a covered stent graft for severe infrarenal aortic stenosis. Successful management of this case was the result of the procedure being performed in an operating room under appropriate anesthesia and close hemodynamic monitoring. Bilateral common femoral arterial access and use of covered aortic stent grafts also contributed to a favourable outcome.
Collapse
|
8
|
Tapping CR, Ahmed M, Scott PM, Lakshminarayan R, Robinson GJ, Ettles DF, Shrivastava V. Primary infrarenal aortic stenting with or without iliac stenting for isolated and aortoiliac stenoses: single-centre experience with long-term follow-up. Cardiovasc Intervent Radiol 2012; 36:62-8. [PMID: 22456847 DOI: 10.1007/s00270-012-0372-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Accepted: 03/07/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the technical success, complications, long-term clinical outcome, and patency after primary infrarenal aortic stenting for aortic and aortoiliac stenosis. Between January 1999 and January 2006, 22 consecutive patients underwent endovascular treatment because of infrarenal aortic stenosis with and without common iliac stenosis (10 men; mean age 64 ± 14 years). Eleven (11 of 22) patients had an isolated aortic stenosis, whereas 11 of 22 had aortic stenosis that extended into the common iliac arteries (CIAs). Thirteen patients were Rutherford classification type 3, and 9 patients were type 4. Statistical analysis included paired Student t test and Kaplan-Meier life table analysis; p < 0.05 was considered significant. Technical and initial clinical success was achieved in all patients. There were three (14 %) procedure-related complications, which included two access-point pseudoaneurysms and one non-flow-limiting left external iliac dissection. Patients were followed-up for a mean period of 88 months (range 60-132). Mean preprocedure ankle brachial pressure indexes (ABPI) were 0.60 ± -0.15 (right) and 0.61 ± -0.16 (left). After the procedure they were 0.86 ± -0.07 (right) and 0.90 ± -0.09 (left). The increase in ABPI was significant (p < 0.05), and this continued throughout follow-up. Four (18 %) patients had recurrence of symptoms during follow-up. These occurred at 36, 48, 48, and 50 months after the original procedure. All four patients were successfully treated with repeat angioplasty procedures. There was a significant difference in primary patency between isolated aortic stenosis (100 %) and aortoiliac stenosis (60 %) (p = 0.031). Cumulative follow-up was 1920 months yielding a reintervention rate of 0.025/events/year. CONCLUSION Primary stenting of infrarenal stenosis is safe and successful with a low reintervention rate. It should be considered as first-line treatment for patients with infrarenal aortic stenotic disease.
Collapse
Affiliation(s)
- C R Tapping
- Department of Radiology, Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull, HU3 2JZ, UK
| | | | | | | | | | | | | |
Collapse
|
9
|
Önder H, Oğuzkurt L, Gür S, Tekbaş G, Gürel K, Coşkun I, Ozkan U. Endovascular treatment of infrarenal abdominal aortic lesions with or without common iliac artery involvement. Cardiovasc Intervent Radiol 2012; 36:56-61. [PMID: 22318446 DOI: 10.1007/s00270-012-0357-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 01/16/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the results of stent placement for obstructive atherosclerotic aortic disease with or without involvement of the common iliac artery. MATERIALS AND METHODS Forty patients had self-expanding stents primarily or after balloon dilatation in the abdominal aorta between January 2005 and May 2011. All patients had trouble walking. Follow-up examinations were performed with clinical visits; these included color Doppler ultrasonography and computed tomographic angiography. RESULTS Technical, clinical, and hemodynamic success was achieved in all patients. None of the patients underwent reintervention during the follow-up period, which ranged from 3 months to 6 years (median 24 months). Nine complications occurred in six patients. Of the nine complications, four were distal thromboembolisms, which were successfully treated with catheter-directed thrombolysis or anticoagulation therapy. CONCLUSION Endovascular treatment of the obstructive aortic disease using self-expanding stents was safe and effective, with high technical success and long-term patency. Thromboembolic complications were high even though direct stenting was considered protective for thromboembolism formation. Particularly for infrarenal aortic stenosis, it can be recommended as the first-line treatment option for patients with obstructive atherosclerotic aortic disease.
Collapse
Affiliation(s)
- Hakan Önder
- Department of Radiology, Dicle University Medical Faculty, Diyarbakir, Turkey.
| | | | | | | | | | | | | |
Collapse
|
10
|
Schwindt AG, Panuccio G, Donas KP, Ferretto L, Austermann M, Torsello G. Endovascular treatment as first line approach for infrarenal aortic occlusive disease. J Vasc Surg 2011; 53:1550-6.e1. [DOI: 10.1016/j.jvs.2011.02.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/08/2011] [Accepted: 02/09/2011] [Indexed: 11/24/2022]
|
11
|
Haap M, Haas CS. Acute Leriche syndrome following percutaneous transluminal angioplasty. J Cardiovasc Med (Hagerstown) 2011; 12:524-6. [PMID: 21415763 DOI: 10.2459/jcm.0b013e3283451f3d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Michael Haap
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Nephrology and Vascular Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | | |
Collapse
|
12
|
[Eccentric infrarenal aortic stenosis. Surgical and endovascular treatment]. Chirurg 2010; 82:367-9. [PMID: 20842327 DOI: 10.1007/s00104-010-1979-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The management of coral reef lesions reported in this case study demonstrates the complementary and non-competing character of the open and endovascular treatment. The minimally invasive procedure of stent-optimized angioplasty seems to be advantageous as the primary therapy in selected cases. In the case of clinical deterioration the endovascular technique allows surgical reconstruction without significantly diminishing the result. Catheter-based techniques therefore remain an additional instrument for treatment in the hands of vascular surgeons which substantially broadens the range of therapy options for this disease entity.
Collapse
|
13
|
Emergent thoracic aortic angioplasty and stenting for middle aortic syndrome in non-specific aortitis. Cardiovasc Interv Ther 2010; 25:117-21. [PMID: 24122472 DOI: 10.1007/s12928-010-0012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2009] [Accepted: 01/08/2010] [Indexed: 10/19/2022]
Abstract
A 61-year-old Japanese male was admitted to hospital due to severe congestive heart failure and pre-renal failure with middle aortic syndrome. The patient was successfully treated with emergent aortic angioplasty and kissing stents implantation whilst in a hemodynamically unstable state. Our experience confirms that stenosis of the descending aorta when treated with catheter intervention may be palliative, however, it was a very effective method for life threatening clinical conditions in the short and mid-term and may be an alternative to surgery.
Collapse
|
14
|
Endovascular Management of Stenosis of the Infrarenal Aorta Secondary to Blunt Abdominal Aortic Trauma in a Multiply Injured Patient. ACTA ACUST UNITED AC 2009; 66:E81-5. [DOI: 10.1097/01.ta.0000238651.56585.e4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
15
|
Schaefer PJ, Mueller-Huelsbeck S, Lukas R, Schaefer FK, Huemme TH, Heller M, Jahnke T. Low-profile primary stent placement for the treatment of focal calcified ulcerated stenosis in the infrarenal aorta. J Vasc Interv Radiol 2008; 19:182-8. [PMID: 18341946 DOI: 10.1016/j.jvir.2007.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 09/01/2007] [Accepted: 09/09/2007] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To analyze the immediate and midterm success of low-profile stent placement in calcified ulcerated lesions of the infrarenal aorta in patients with arterial occlusive disease. MATERIALS AND METHODS In this prospective case series, 13 symptomatic patients (eight men, five women; mean age, 64.8 years +/- 12.1; age range, 44-84 years) with focal calcified ulcerated stenoses of the infrarenal aorta were treated with stent placement by using a low-profile technique in a radiology intervention center during a 4-year period. Clinical examinations and duplex ultrasonography were used to evaluate the stents? patency and clinical success. Kaplan-Meier graphs were calculated to analyze the freedom-of-symptom rate. RESULTS The initial technical success rate was 92% (12 of 13 patients). Due to extended calcifications, a residual stenosis of 50%-60% remained in one patient. No peri-interventional complications occurred. The mean follow-up was 26 months (range, 5-53 months). During follow-up, one patient had a restenosis after 7 months and presented clinically with Fontaine stage IIb. Two patients had iliac and/or femoral stenoses, and both presented with Fontaine stage IIb. One patient's symptoms originated from the lumbar spine. Primary patency and primary clinical success rates were 85% and 69%, respectively. According to Kaplan-Meier tables, the freedom-from-symptom rates were 92%, 84%, 73%, and 63% at 0, 7, 12, and 21 months, respectively. CONCLUSIONS Low-profile stent placement in calcified, ulcerated lesions of the infrarenal aorta is an effective and safe treatment for symptomatic stenoses in patients with arterial occlusive disease after a mean follow-up of 26 months.
Collapse
Affiliation(s)
- Philipp J Schaefer
- Department of Diagnostic Radiology, University Hospital Schleswig-Holstein Campus Kiel, Arnold-Heller-Strasse 9, 24105 Kiel, Germany.
| | | | | | | | | | | | | |
Collapse
|
16
|
Primary stenting for aortic lesions: From single stenoses to total aortoiliac occlusions. J Vasc Surg 2008; 47:310-7. [DOI: 10.1016/j.jvs.2007.10.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2007] [Revised: 10/09/2007] [Accepted: 10/11/2007] [Indexed: 11/24/2022]
|
17
|
Primary Self-Expandable Nitinol Stent Placement in Focal Lesions of Infrarenal Abdominal Aorta: Long Term Results. Cardiovasc Intervent Radiol 2007; 31:43-8. [DOI: 10.1007/s00270-007-9222-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 08/20/2007] [Accepted: 09/28/2007] [Indexed: 10/22/2022]
|
18
|
Tempremant F, Hachulla AL, Negaiwi Z, Lions C, Willoteaux S, Gaxotte V, Beregi JP. [Coralliform atheroma of the abdominal aorta: diagnosis and management]. ACTA ACUST UNITED AC 2007; 88:592-4. [PMID: 17464260 DOI: 10.1016/s0221-0363(07)89861-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
19
|
Laxdal E, Wirsching J, Jenssen GL, Pedersen G, Aune S, Daryapeyma A. Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is technically feasible with acceptable long-term results. Eur J Radiol 2007; 61:541-4. [PMID: 17258418 DOI: 10.1016/j.ejrad.2006.11.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Revised: 04/04/2006] [Accepted: 11/07/2006] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To investigate the results of endovascular treatment of symptomatic, atherosclerotic lesions of the infrarenal aorta. PATIENTS AND METHOD This is a retrospective study including 30 procedures performed on 25 patients in the period from 1990 through 2003. There were 16 women (64%) and 9 men, with a mean age of 55 years (range 35-81 years). The indication was disabling intermittent claudication in all cases. Preoperative assessment was done with ankle-arm pressure measurement and angiography. The mean length of the lesions was 2.5cm (range 1-6cm). One lesion was a short occlusion and nine were >90% stenoses. The remaining 20 lesions were significant (>70%) stenoses. The procedure was done with PTA alone in 13 cases, and with additional stenting in 17. RESULTS The procedures were technically successful in 28 cases and clinically successful in all 30. In two cases, a >50% residual stenosis was not dilated further because of stretch pain. The mean observation time was 40 months (range 0-135 months). The primary 2 and 5 year patency rates calculated on basis of intention to treat were 90 and 77%. The primary assisted patency rate was 90% at 2 years and 83% at 5 years. Eight patients developed significant restenosis, of which five were treated with a new endovascular procedure. Two failures were treated conservatively and one with surgical thrombendarterectomy. CONCLUSION Endovascular treatment of isolated atherosclerotic lesions of the infrarenal aorta is feasible in patients with suitable anatomy. Clinical success rates are high and long-term patency is good. Complications are few and minor. The majority of failures are amenable to new endovascular treatment.
Collapse
Affiliation(s)
- E Laxdal
- Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway.
| | | | | | | | | | | |
Collapse
|
20
|
Wulff B, Jungbluth T, Esnaashari H, Franke C, Bruch HP. [Surgical management of peripheral arterial disease. Operative methods and results]. Radiologe 2006; 46:931-40. [PMID: 17075710 DOI: 10.1007/s00117-006-1438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Various operative and interventional methods are available to treat patients with peripheral arterial disease (PAD). The selection of the appropriate therapy should be made after a careful review of the patient's general condition, the morphology of the arterial occlusion, the risk of possible complications, and the likelihood of long-term success for each type of treatment. The different procedures complement one another in their technical possibilities and their risk profile The combination of surgical and interventional methods offers new therapeutic possibilities. The different surgical procedures and their long-term outcome are presented in this publication.
Collapse
Affiliation(s)
- B Wulff
- Klinik für Chirurgie, Universitätsklinikum Schleswig-Holstein--Campus Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | | | | | | | | |
Collapse
|
21
|
Simons PCG, Nawijn AA, Bruijninckx CMA, Knippenberg B, de Vries EH, van Overhagen H. Long-term results of primary stent placement to treat infrarenal aortic stenosis. Eur J Vasc Endovasc Surg 2006; 32:627-33. [PMID: 16859934 DOI: 10.1016/j.ejvs.2006.05.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2006] [Accepted: 05/11/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the safety and the long-term results of primary stent placement for localized distal aortic occlusive disease. DESIGN Retrospective observational study. PATIENTS AND METHODS From July 1998 to July 2005 17 patients (14 female and 3 men, mean age 57 years (39-80)) were treated for intermittent claudication. Five of these patients underwent additional endovascular treatment of focal iliac lesions. RESULTS Technical success defined as residual stenosis of less than 50% or a trans-stenotic systolic pressure gradient <10% was achieved in 14 of 17 (82%) patients. Major complications included dissection at the puncture site in one patient and thrombosis of additional iliac stents in another patient. Both of these complications were successfully treated. During a mean follow-up of 27 months (range 1-86), four patients had recurrence of symptoms due to in-stent restenoses (n=2), femoral (n=1) or iliac occlusion (n=1), respectively. By Kaplan-Meier analysis, primary aortic hemodynamic patency was 83% at 3 years. Secondary aortic hemodynamic patency was 100%. The primary clinical patency was 68% at 3 years. CONCLUSION Primary stent placement for distal aortic stenoses is an alternative to surgical treatment because of its high patency and relatively low complication rates.
Collapse
Affiliation(s)
- P C G Simons
- Department of Radiology, HAGA Hospital, Hague, The Netherlands.
| | | | | | | | | | | |
Collapse
|
22
|
Stoeckelhuber BM, Stoeckelhuber M, Gellissen J, Kueffer G. Primary Endovascular Stent Placement for Focal Infrarenal Aortic Stenosis: Long-term Results. J Vasc Interv Radiol 2006; 17:1105-9. [PMID: 16868162 DOI: 10.1097/01.rvi.0000228374.85266.64] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The objectives of this retrospective study were to determine the technical success, safety, and long-term results of primary stent implantation in infrarenal aortic stenosis. MATERIALS AND METHODS A total of eight atherosclerotic stenoses and one occlusion of the infrarenal aorta (ie, midaortic syndrome) were treated with endoluminal stent placement after balloon angioplasty. Aortoiliac lesions were excluded. Technical success and patency were assessed. RESULTS Primary technical success in percutaneous transluminal angioplasty and subsequent stent placement was achieved in all patients. No complications occurred, and no morbidity was encountered. Primary clinical patency rates were 100% on all follow-up examinations. Long-term results with a mean follow-up of 110 months (range, 99-117 months) were recorded in seven patients; one patient had died and one was lost to follow-up. CONCLUSIONS In view of the excellent initial results and promising long-term follow-up data in a small series, stent placement after predilation in properly selected patients with isolated infrarenal aortic stenosis appears to be a promising, durable treatment. It should be considered as a primary method of treatment.
Collapse
Affiliation(s)
- Beate Maria Stoeckelhuber
- Department of Radiology, Universitätsklinikum des Medizinischen Universität zu Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany.
| | | | | | | |
Collapse
|
23
|
Ruppert V, Wirth S, Rieger J, Kueffer G, Steckmeier B, Stoeckelhuber BM. Long-term Results After Primary Stenting of Distal Aortic Stenosis. J Endovasc Ther 2006; 13:229-36. [PMID: 16643078 DOI: 10.1583/05-1683mr.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To review the long-term results of primary stent placement in the distal aorta above the bifurcation. METHODS Fourteen patients (8 men; mean age 62 years, range 46-82) underwent primary stent implantation performed by an interdisciplinary radiosurgical team. In 10 patients, a long-term follow-up examination consisting of patient history, clinical examination, and duplex sonography was performed. The ankle-brachial index (ABI) for the posterior tibial artery was calculated on the basis of Doppler pressure measurements. RESULTS The clinical success rate at the first follow-up examination (mean 2.9 months, range 2.1-4.4) was 100% (n = 14). The mean baseline ABI of 0.64 +/- 0.12 had risen to 1.02 +/- 0.10 (p < 0.0001). At midterm follow-up (mean 22.8 months, range 14-42) in 12 patients, the ABI was 0.96 +/- 0.12 (p < 0.0001 versus baseline). At a mean 86 months (range 51-119) after stent treatment, the ABI in 10 patients was 0.90 +/- 0.20 (p < 0.0001 versus baseline). Over the long term, the clinical success rate was 70%. Deterioration was due to the progression of atherosclerosis distal to the aorta; duplex sonography showed no aortic restenosis or occlusion. CONCLUSION In view of the excellent long-term results in our small series, primary stent placement in focal abdominal aortic stenosis in properly selected patients is a durable treatment. In addition, the mortality and morbidity risks are markedly reduced compared with open surgery.
Collapse
Affiliation(s)
- Volker Ruppert
- Department of Vascular Surgery, Hospital of Ludwig-Maximilian University Munich-Campus Innenstadt, Munich, Germany.
| | | | | | | | | | | |
Collapse
|