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Müller P, Kondruweit M, Harig F, Tandler R, Rösch J, Weyand M, Heim C. Prophylactic Implantation of Intra-aortic Balloon Counterpulsation in High-Risk Cardiac Surgery Patients: A Single-Center Experience. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- P. Müller
- University of Erlangen-Nuremberg, Erlangen, Deutschland
| | - M. Kondruweit
- Department of Cardiac Surgery, University Clinic Erlangen, Erlangen, Deutschland
| | - F. Harig
- Herzchirurgie des Uni-Klinikums Erlangen, Krankenhausstraße, Erlangen, Germany, Erlangen, Deutschland
| | - R. Tandler
- University Hospital Erlangen, Erlangen, Deutschland
| | - J. Rösch
- Cardiac Surgery of the University Hospital Erlangen, Erlangen, Deutschland
| | - M. Weyand
- Department of Cardiac Surgery, University Clinic Erlangen, Erlangen, Deutschland
| | - C. Heim
- Krankenhausstraße 12, Erlangen, Deutschland
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Nooh E, Rösch J, Griesbach C, Weyand M, Harig F. How to Calculate the Risk of Sternal Instability. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pathare P, Rösch J, Cesnjevar R, Weyand M, Heim C. Junctional Rhythm Disturbances after Rotational Z-Flap versus Patch Repair of Sinus Venosus Atrial Defects. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Pathare P, Rösch J, Weyand M, Harig F. Impact of the MELD Score for Risk Stratification in Cardiac Surgery. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Minabari G, Tandler R, Kondruweit M, Rösch J, Weyand M, Heim C. Endomyocardial Biopsy beyond 2 Years after Cardiac Transplantation: Clinical Implications and Cost Analysis. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Müller P, Rösch J, Griesbach C, Weyand M, Harig F. Cannulation of the Brachiocephalic Trunk Reduces Neurological Complications in Elective Thoracic Aortic Surgery and Acute Type A Aortic Dissections: A Retrospective Analysis of a 20-Year Single-Center Experience. Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lang S, Gölitz P, Struffert T, Rösch J, Rössler K, Kowarschik M, Strother C, Doerfler A. 4D DSA for Dynamic Visualization of Cerebral Vasculature: A Single-Center Experience in 26 Cases. AJNR Am J Neuroradiol 2017; 38:1169-1176. [PMID: 28408632 DOI: 10.3174/ajnr.a5161] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 01/23/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE 4D DSA allows acquisition of time-resolved 3D reconstructions of cerebral vessels by using C-arm conebeam CT systems. The aim of our study was to evaluate this new method by qualitative and quantitative means. MATERIALS AND METHODS 2D and 4D DSA datasets were acquired in patients presenting with AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA was compared with 2D DSA in a consensus reading of qualitative and quantitative parameters of AVMs (eg, location, feeder, associated aneurysms, nidus size, drainage, Martin-Spetzler Score), dural arteriovenous fistulas (eg, fistulous point, main feeder, diameter of the main feeder, drainage), and cerebral aneurysms (location, neck configuration, aneurysmal size). Identifiability of perforators and diameters of the injection vessel (ICA, vertebral artery) were analyzed in 2D and 4D DSA. Correlation coefficients and a paired t test were calculated for quantitative parameters. The effective patient dose of the 4D DSA protocol was evaluated with an anthropomorphic phantom. RESULTS In 26 patients, datasets were acquired successfully (AVM = 10, cerebral aneurysm = 10, dural arteriovenous fistula = 6). Qualitative and quantitative evaluations of 4D DSA in AVMs (nidus size: r = 0.99, P = .001), dural arteriovenous fistulas (diameter of the main feeder: r = 0.954, P = .03), and cerebral aneurysms (aneurysmal size: r = 1, P = .001) revealed nearly complete accordance with 2D DSA. Perforators were comparably visualized with 4D DSA. Measurement of the diameter of the injection vessel in 4D DSA was equivalent to that in 2D DSA (P = .039). The effective patient dose of 4D DSA was 1.2 mSv. CONCLUSIONS 4D DSA is feasible for imaging of AVMs, dural arteriovenous fistulas, and cerebral aneurysms. 4D DSA offers reliable visualization of the cerebral vasculature and may improve the understanding and treatment of AVMs and dural arteriovenous fistulas. The number of 2D DSA acquisitions required for an examination may be reduced through 4D DSA.
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Affiliation(s)
- S Lang
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - P Gölitz
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - T Struffert
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - J Rösch
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
| | - K Rössler
- Neurosurgery (K.R.), University of Erlangen-Nuremberg, Erlangen, Germany
| | - M Kowarschik
- Angiography & Interventional X-Ray Systems (M.K.), Siemens Healthcare GmbH, Forchheim, Germany
| | - C Strother
- Department of Radiology (C.S.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - A Doerfler
- From the Departments of Neuroradiology (S.L., P.G., T.S., J.R., A.D.)
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Strecker T, Rösch J, Oehrlein S, Weyand M. PS103 Experience with Veno-Venous ECMO in Patients with Severe ARDS. Glob Heart 2016. [DOI: 10.1016/j.gheart.2016.03.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Lang S, Rösch J, Gölitz P, Kloska S, Struffert T, Doerfler A. Comparison of Intracranial Aneurysms Treated by 2-D Versus 3-D Coils: A Matched-Pairs Analysis. Clin Neuroradiol 2015; 27:43-49. [PMID: 26104272 DOI: 10.1007/s00062-015-0408-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Knowledge on the influence of 2D and 3D coils to occlude intracranial aneurysms is poor. Therefore, aim of our analysis was to evaluate whether the use of 3-D versus 2-D coils alone may improve the efficacy of endovascular aneurysm treatment. PATIENTS AND METHODS We performed a matched pair analysis comparing aneurysms treated by 3-D coils as initial "framing" coils to aneurysms treated exclusively by 2-D coils. Number of coils, implanted coil length/volume, and associated packing density were calculated. Aneurysmal occlusion was assessed and monitored 6 months (DSA; magnetic resonance angiography (MRA)) and 18 months (MRA) after embolization. Periprocedural complications and retreatment rate of each group were analyzed. RESULTS Our retrospective analysis revealed 50 pairs. Concerning the 3-D group, number of coils (353 in total, median 7; p = 0.002), implanted coil length (55.69 ± 48.4 cm), implanted coil length per volume (5.92 mm/mm3), and packing density (30 %; p = 0.017) was higher than in the 2-D group (259 in total, median 5 coils; 38.52 ± 43.13 cm; 4.54 mm/mm3; 23 %). Occlusion was not significantly different immediately after treatment but at 6 and 18 months follow-up in favor of 3-D coils. Retreatment was performed in 2 cases of the 3-D group and in 3 cases of the 2-D group and therefore in a similar range (p = 0.564). CONCLUSION Initial use of 3-D coils revealed a higher packing density and a higher long-term occlusion. Therefore, we recommend initial use of 3-D coils.
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Affiliation(s)
- S Lang
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany.
| | - J Rösch
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - P Gölitz
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - S Kloska
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - T Struffert
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
| | - A Doerfler
- Department of Neuroradiology, University of Erlangen-Nuremberg, Schwabachanlage 6, 91054, Erlangen, Germany
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Lang S, Gölitz P, Struffert T, Dietzel M, Rösch J, Kowarschik M, Dörfler A. Visualisierung von cerebralen arteriovenösen Malformationen (AVM) mit der zeitaufgelösten 3-D DSA (4-D DSA). ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Heim C, Catellanos I, Rösch J, Tandler R, Weyand M, Kondruweit M. Catecholamine- refractory vasoplegia after cardiac surgery: The safe use of methylene blue to reduce morbidity and mortality? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Heim C, Rösch J, Kondruweit M, Weyand M, Tandler R. Destination therapy with magnetically levitated pumps – the next major widespread advance in heart failure therapy? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kondruweit M, Tandler R, Rösch J, Weyand M, Heim C. Prophylactic implantation of intra-aortic balloon counter-pulsation improves outcome in high-risk cardiac surgery patients – fact or fantasy? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Garcia M, Naraghi R, Zumbrunn T, Rösch J, Hastreiter P, Dörfler A. High-resolution 3D-constructive interference in steady-state MR imaging and 3D time-of-flight MR angiography in neurovascular compression: a comparison between 3T and 1.5T. AJNR Am J Neuroradiol 2012; 33:1251-6. [PMID: 22403774 DOI: 10.3174/ajnr.a2974] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE High-resolution MR imaging is useful for diagnosis and preoperative planning in patients with NVC. Because high-field MR imaging promises higher SNR and resolution, the aim of this study was to determine the value of high-resolution 3D-CISS and 3D-TOF MRA at 3T compared with 1.5T in patients with NVC. MATERIALS AND METHODS Forty-seven patients with NVC, trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia were examined at 1.5T and 3T, including high-resolution 3D-CISS and 3D-TOF MRA sequences. Delineation of anatomic structures, overall image quality, severity of artifacts, visibility of NVC, and assessment of the SNR and CNR were compared between field strengths. RESULTS SNR and CNR were significantly higher at 3T (P < .001). Significantly better anatomic conspicuity, including delineation of CNs, nerve branches, and assessment of small vessels, was obtained at 3T (P < .02). Severity of artifacts was significantly lower at 3T (P < .001). Consequently, overall image quality was significantly higher at 3T. NVC was significantly better delineated at 3T (P < .001). Six patients in whom NVC was not with certainty identifiable at 1.5T were correctly diagnosed at 3T. CONCLUSIONS Patients with NVC may benefit from the higher resolution and greater sensitivity of 3T for preoperative assessment of NVC, and 3T may be of particular value when 1.5T is equivocal.
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Affiliation(s)
- M Garcia
- Department of Neuroradiology, Friedrich-Alexander-University of Erlangen-Nuremberg, Erlangen, Germany.
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Rösch J. Die „superselektive“ viszerale Arteriographie*. ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1229228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hiraki T, Pavcnik D, Uchida BT, Timmermans HA, Wu RH, Niyyati M, Keller FS, Rösch J. Small intestinal submucosa sandwich Zilver stent-grafts for TIPS: experimental pilot study in swine. MINIM INVASIV THER 2007; 14:32-8. [PMID: 16754151 DOI: 10.1080/13645700510010818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this study was the evaluation of preliminary suitability of the piglet small intestinal submucosa (SIS) sandwich Zilver endograft for experimental transjugular intrahepatic portosystemic shunt (TIPS) creation. TIPS was created in six swine. The five surviving animals underwent the follow-up portogram and were sacrificed at four weeks after TIPS creation. Gross and histologic examination was performed in all animals. TIPS creation was successful in all animals. One animal died four days after TIPS creation. In the five surviving animals, one shunt was occluded and four shunts were stenosed on the follow-up portogram. The mean percentage narrowing of the most advanced stenoses was 72% (range, 60%-100%). The most advanced stenosis was located in the parenchymal tract in three shunts and in the hepatic vein portion in one shunt. Gross and histologic examination showed abundant neointimal formation composed mainly of fibroblasts leading to the significant shunt stenoses. The piglet SIS sandwich Zilver stent-graft was found to offer only limited TIPS patency and should not be used for the definitive long-term TIPS study.
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Affiliation(s)
- T Hiraki
- Dotter Interventional Institute, Oregon Health and Science University, Portland, Oregon 97239, USA
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Harig F, Rösch J, Mahmoud FO, Weyand M, Feyrer R. Cost effectiveness of routine antifibrinolytic therapy in cardiac surgery: Tranexamic acid shows equivalent effects and reduces costs compared to aprotinin. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Strecker T, Rösch J, Horch RE, Kneser U, Weyand M. Management of sternal wound infections using the vacuum-assisted therapy in combination with the pectoralis major and the rectus abdominis myocutaneous flap in heart surgery patients. Thorac Cardiovasc Surg 2007. [DOI: 10.1055/s-2007-967654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Setting up a reliable cost unit accounting system in a hospital is a fundamental necessity for economic survival, given the current general conditions in the healthcare system. Definition of a suitable cost unit is a crucial factor for success. We present here the development and use of a clinical pathway as a cost unit as an alternative to the DRG. Elective coronary artery bypass grafting was selected as an example. Development of the clinical pathway was conducted according to a modular concept that mirrored all the treatment processes across various levels and modules. Using service records and analyses the process algorithms of the clinical pathway were developed and visualized with CorelTM iGrafix Process 2003. A detailed process cost record constituted the basis of the pathway costing, in which financial evaluation of the treatment processes was performed. The result of this study was a structured clinical pathway for coronary artery bypass grafting together with a cost calculation in the form of cost unit accounting. The use of a clinical pathway as a cost unit offers considerable advantages compared to the DRG or clinical case. The variance in the diagnoses and procedures within a pathway is minimal, so the consumption of resources is homogeneous. This leads to a considerable improvement in the value of cost unit accounting as a strategic control instrument in hospitals.
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Affiliation(s)
- R Feyrer
- Center of Cardiac Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Knapp A, Kheifets A, Bray I, Weber T, Landers AL, Schössler S, Jahnke T, Nickles J, Kammer S, Jagutzki O, Schmidt LPH, Osipov T, Rösch J, Prior MH, Schmidt-Böcking H, Cocke CL, Dörner R. Mechanisms of photo double ionization of helium by 530 eV photons. Phys Rev Lett 2002; 89:033004. [PMID: 12144390 DOI: 10.1103/physrevlett.89.033004] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2001] [Indexed: 05/23/2023]
Abstract
We have measured fully differential cross sections for photo double ionization of helium 450 eV above the threshold. We have found an extremely asymmetric energy sharing between the photoelectrons and an angular asymmetry parameter beta approximately 2 and beta approximately 0 for the fast and slow electrons, respectively. The electron angular distributions show a dominance of the shakeoff for 2 eV electrons and clear evidence of an inelastic electron-electron scattering at an electron energy of 30 eV. The data are in excellent agreement with convergent close-coupling calculations.
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Affiliation(s)
- A Knapp
- Institut für Kernphysik, Universität Frankfurt, August-Euler-Strasse 6, D-60486 Frankfurt, Germany
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Jahnke T, Weber T, Landers AL, Knapp A, Schössler S, Nickles J, Kammer S, Jagutzki O, Schmidt L, Czasch A, Osipov T, Arenholz E, Young AT, Díez Muiño R, Rolles D, García de Abajo FJ, Fadley CS, Van Hove MA, Semenov SK, Cherepkov NA, Rösch J, Prior MH, Schmidt-Böcking H, Cocke CL, Dörner R. Circular dichroism in K-shell ionization from fixed-in-space CO and N2 molecules. Phys Rev Lett 2002; 88:073002. [PMID: 11863892 DOI: 10.1103/physrevlett.88.073002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2001] [Indexed: 05/23/2023]
Abstract
We have measured the angular distributions of 1s photoelectrons excited by circularly and linearly polarized light from fixed-in-space CO and N2 molecules, in the vicinity of their shape resonances. A strong circular dichroism, i.e., a strong dependence on the sense of rotation of the polarization vector of the photons, is found for both molecules. State-of-the-art one-electron multiple scattering and partially correlated random phase approximation calculations are in good agreement with many, but not all, aspects of the experimental data.
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Affiliation(s)
- T Jahnke
- Institut für Kernphysik, University Frankfurt, August-Euler Strasse 6, D-60486 Frankfurt, Germany
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Hájek M, Rösch J, Uchida BT, Keller FS, Peregrin J, Svarz R, Válek J, Köcher M, Krajina A, Hausegger K, Simonic K. Multi-site interventional real-time procedure demonstrations with the use of integrated services digital network connections. Cardiovasc Intervent Radiol 2001; 24:332-5. [PMID: 11815840 DOI: 10.1007/s00270-001-0019-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effectiveness and cost of commercially available video conferencing units and standard Integrated Services Digital Network (ISDN) connections for real-time multi-site transmissions of interventional procedures. METHODS A network of five separate interventional radiology departments-three in the Czech Republic and one each in Austria and the USA-was established using Polyspan (Polycom in the USA) View Stations and ISDN connections. This network was used for transmissions of 16 live interventional procedures to the Sixth International Workshop on Interventional Radiology in Prague, Czech Republic in June 2000. RESULTS The transmissions were successful and of sufficient quality to contribute to the educational success of the workshop. The cost of the ISDN transmissions was a fraction of satellite transmission costs. CONCLUSION Multi-site real-time interventional procedure transmissions using video conferencing Polyspan (Polycom) View Stations and ISDN connections are a promising means of improving interventional tele-education and decreasing its cost.
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Affiliation(s)
- M Hájek
- MR Spectroscopy, MR Unit, Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídenská 800, 140 00 Prague 4, Czech Republic.
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Abstract
The square stent is a new, simply constructed, self-expanding device that has recently been described. Compared with other stents, the square stent has a minimal amount of metal and thus requires a smaller-diameter catheter for introduction. Despite the small amount of metal present, the square stent has adequate expansile force. We have been evaluating the square stent for various interventional applications. In addition to the basic square stent, combinations of square stents and coverings for square stents were developed and evaluated to expand its uses and indications. One of the coverings tested is a new biomaterial: small intestinal submucosa (SIS). This paper will discuss the various applications of the square stent, which include a retrievable inferior vena cava filter, vascular occluder, graft adapter, and venous and aortic valves. In addition, we will review the important properties of SIS as a covering for the square stent.
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Affiliation(s)
- D Pavcnik
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA.
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Burdick TR, Rösch J, Keller FS. SCVIR annual meeting film panel session: diagnosis and discussion of case 8. J Vasc Interv Radiol 2001; 12:664-5. [PMID: 11340152 DOI: 10.1016/s1051-0443(07)61497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- T R Burdick
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA
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Abstract
Primary hyperaldosteronism is a potential cause of hypertension. Unilateral adrenal adenoma and bilateral adrenal cortical hyperplasia are the most common causes of primary hyperaldosteronism. Adrenal venous sampling is employed as the gold standard test to differentiate between these two different causes when the results of other studies in the work-up protocol are non-diagnostic or ambiguous. Adrenal venous sampling can be a challenging procedure, especially in the presence of anomalous venous drainage patterns. Knowledge of normal adrenal venous anatomy, as well as possible variants, is therefore important to ensure a successful procedure. The authors describe an unusual variant of left adrenal venous drainage directly into the IVC.
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Affiliation(s)
- S P Stack
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA
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Yamada K, Pavcnik D, Uchida BT, Timmermans HA, Corless CL, Yin Q, Yamakado K, Park JW, Rösch J, Keller FS, Sato M, Yamada R. Endoluminal treatment of ruptured abdominal aortic aneurysm with small intestinal submucosa sandwich endografts: a pilot study in sheep. Cardiovasc Intervent Radiol 2001; 24:99-105. [PMID: 11443394 DOI: 10.1007/s002700000400] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate efficacy of small intestinal submucosa (SIS) Sandwich endografts for the treatment of acute rupture of abdominal aortic aneurysms (AAA) and to explore the short-term reaction of the aorta to this material. METHODS In eight adult sheep, an infrarenal AAA was created transluminally by dilation of a short Palmaz stent. In six sheep, the aneurysm was then ruptured by overdilation of the stent with a large angioplasty balloon. Two sheep with AAAs that were not ruptured served as controls. A SIS Sandwich endograft, consisting of a Z stent frame with 5 bodies and covered inside and out with SIS, was used to exclude the ruptured and non-ruptured AAAs. Follow-up aortography was done immediately after the procedure and before sacrifice at 4, 8, or 12 weeks. Autopsy and histologic studies followed. RESULTS Endograft placement was successful in all eight sheep. Both ruptured and non-ruptured AAAs were successfully excluded. Three animals with AAA rupture developed hind leg paralysis due to compromise of the arterial supply to the lower spinal cord and were sacrificed 1 day after the procedure. In five animals, three with rupture and two controls, follow-up aortograms revealed no aortic stenoses and no perigraft leaks. Gross and histologic studies revealed incorporation of the endografts into the aortic wall with replacement of SIS by dense neointima that was completely endothelialized in areas where the endograft was in direct contact with the aortic wall. In central portions of the endograft, in contact with the thrombosed aneurysm, endothelialization was incomplete even at 12 weeks. CONCLUSION The SIS Sandwich endografts effectively excluded simple AAAs and ruptured AAAs. They were rapidly incorporated into the aortic wall. A detailed long-term study is warranted.
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Affiliation(s)
- K Yamada
- Dotter Interventional Institute, Oregon Health Sciences University, L342, 3181 SW Sam Jackson Park Road, Portland, OR 97201, USA
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Pavcnik D, Uchida BT, Timmermans H, Petersen B, Loriaux M, Yamakado K, Voda J, Yin Q, Keller FS, Rösch J. Bifurcated drum occluder endograft for treatment of abdominal aortic aneurysm: an experimental study in dogs. J Vasc Interv Radiol 2001; 12:359-64. [PMID: 11287515 DOI: 10.1016/s1051-0443(07)61917-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To evaluate a new, low profile, home-made, bifurcated drum occluder endograft (BDOEG), designed for percutaneous, transcatheter treatment of abdominal aortic aneurysm (AAA). MATERIALS AND METHODS AAA was created in 10 dogs with over-dilated Palmaz stents. To prevent back filling, the lumbar arteries, inferior mesenteric artery, and common internal iliac arteries were embolized. The BDOEG was constructed of a drum occluder device and two PTFE endografts. The drum device consisted of a modified Z stent with Dacron stretched across and held within the ends of the stent, each with two 8 x 6-mm slits through which PTFE endografts were delivered. The PTFE endografts were 8 mm in diameter and 9.5 cm in length. Preloaded, the BDOEG was delivered through a 10-F sheath from both femoral arteries in a three-step procedure. All 10 animals were treated with BDOEG. Aortography was performed immediately, 6 weeks, and 12 weeks after stent-graft placement. Five animals were killed at 6 weeks and five were killed at 3 months. Gross and histologic evaluation was performed. RESULTS The infrarenal aortic diameters and both external iliac arteries ranged from 8.0 mm to 10.3 mm (mean, 9.4 mm +/- 0.6) and from 5.2 mm to 6.8 mm (mean, 5.8 mm +/- 0.5), respectively. Creation of the AAA was successful in all 10 dogs. AAA diameters ranged from 13.7 mm to 15.9 mm (mean, 14.9 mm +/- 0.7). Complete exclusion of the AAA was achieved immediately after BDOEG placement and aneurysms remained excluded without perigraft leak to the time of killing in all 10 animals. There was a high incidence of aortoiliac limb occlusion. Occlusion of 12 aortoiliac limbs (60%) caused by intimal hyperplasia at the distal end of the endografts in iliac arteries developed in nine animals (90%). In six animals (60%), one limb occluded and, in three animals (30%), there was occlusion of both limbs. CONCLUSION This study suggests a new approach for treatment of AAA. BDOEG use reduces sheath size for endograft delivery and may eliminate the need for a surgical cut down on femoral arteries. Tapering of the iliac ends of endografts to the size of the artery will be needed to prevent distal intimal hyperplasia.
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Affiliation(s)
- D Pavcnik
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA.
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Rösch J, Keller FS. Transjugular intrahepatic portosystemic shunt: present status, comparison with endoscopic therapy and shunt surgery, and future prospectives. World J Surg 2001; 25:337-45; discussion 345-6. [PMID: 11343189 DOI: 10.1007/s002680020380] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During the 13 years since its introduction into clinical practice, transjugular intrahepatic portosystemic shunt (TIPS) has become widely accepted worldwide as a percutaneous, interventional procedure for treating complications of portal hypertension. An experienced, skillful team, however, is necessary to ensure the high technical success of TIPS and to avoid its potential procedural complications. Presently, TIPS is used mainly for treatment of acute or recurrent hemorrhage from gastroesophageal varices refractory to endoscopic therapy. Randomized studies have shown that it is more effective than endoscopic treatment for preventing rebleeding; however, it is associated with a higher incidence of encephalopathy. Both treatments produce comparable survival rates. TIPS is also effective in the treatment of hepatogenic ascites and hydrothorax and hepatorenal syndrome. In comparison with surgical shunts, TIPS is a significantly less invasive procedure that can be done in poor surgical candidates with advanced cirrhosis. The high rate of shunt obstructions seen with TIPS mandates close surveillance and maintenance, rendering TIPS a multistage procedure. This is a major disadvantage of TIPS compared to surgery. Presently, both TIPS and surgical shunts have their place in the treatment of gastroesophageal variceal hemorrhage unresponsive to endoscopic therapy. TIPS is most suited for class B and C patients, particularly those who are candidates for liver transplantation. Surgical shunts should be considered for patients with well preserved liver function. Large, randomized controlled studies should be done to compare these treatment methods. Animal experimental and early clinical studies using covered stents (stent-grafts) are promising for the prevention of shunt obstructions and thus converting TIPS from a multistage to a one-stage procedure.
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Affiliation(s)
- J Rösch
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, L342, Portland, Oregon 97201-3098, USA
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Ferko A, Lesko M, Krajina A, Hulek P, Rösch J, Rabkin J. Intrahepatic portal vein branches after extrahepatic portal vein occlusion. Experimental study. Hepatogastroenterology 2001; 48:475-9. [PMID: 11379337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND/AIMS Prehepatic portal hypertension caused by extrahepatic portal vein occlusion is a situation in which hepatocytes are not damaged by disease despite the fact that portal blood is unable to reach them due to portal vein occlusion. We explored the patency of intrahepatic portal vein branches after extrahepatic portal vein occlusion for the possibility of revascularization by splenoportal shunt. METHODOLOGY Prehepatic portal hypertension was induced in 8 mini-pigs by external compression of the portal vein with a device consisting of an inflatable silicone balloon mounted on a silicone cuff and attached to a subcutaneous chamber. Another device consisting of cannula and a subcutaneous chamber was placed into the splenic vein for portal pressure monitoring and portal venograms. Both devices were placed during laparotomy with their chambers positioned subcutaneously. Portal vein compression was initiated one week later and was accomplished in two steps. Extrahepatic portal vein occlusion and the patency of intrahepatic portal vein branches were confirmed by direct portal venography. Alteration of the intrahepatic portal bed was examined at necropsy after 4 weeks, checking for the presence of occlusion or thrombosis. RESULTS Portal vein occlusion was achieved in 5 animals, while severe stenosis was demonstrated in the remaining three. Portal venograms demonstrated patency of the lobar portal vein branches filled by hepatopetal collaterals around the occluded portal vein. All intrahepatic branches were free of thrombus at gross examination. CONCLUSIONS In the absence of the hepatic parenchymal disease, lobar intrahepatic portal vein branches remain patent despite truncal portal vein occlusion and are supplied by rapidly developed hepatopetal collaterals.
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Affiliation(s)
- A Ferko
- Department of Surgery, University Hospital, 500 05 Hradec Králové, Czech Republic.
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Abstract
PURPOSE To evaluate the effects of catheter-directed thrombin in the peripheral arterial circulation of swine. MATERIALS AND METHODS Thrombin was injected into a single femoral artery in 20 domestic swine. Each of five animals from four dose groups received 50, 150, 250, or 1,000 U as a single dose. Bilateral femoral arterial flow was monitored for as long as 4 hours and evaluated relative to baseline and contralateral limb flow. Interval arteriographic results were evaluated by segmental patency and a numeric angiographic score. RESULTS Mean baseline flow was 136 mL/min +/- 44, with an internal arterial diameter of 3.4 mm +/- 0.5. A transient increase in blood flow after thrombin administration was followed by diminished flow and thrombosis. These findings varied directly with dose and inversely with baseline flow. Angiographic and flow abnormalities generally improved with time and recovery was generally better in swine that received 50 or 1,000 U than in other groups. However, one animal that received 1,000 U (13.2 U/mL/min) developed stable, complete limb thrombosis. The degree of recovery varied with thrombin dose and thrombus location. At doses greater than 50 U (0.33 U/mL/min +/- 0.05), abnormalities were commonly persistent. Animals receiving the 150-U dose (1.33 U/mL/min +/- 0.41) had a higher incidence of persistent distal occlusion. Distal occlusions were less likely to resolve than proximal occlusions. CONCLUSIONS The effect of intraarterial thrombin is directly related to dose and inversely related to baseline blood flow. In swine, a threshold for significant flow disruption and thrombosis exists above a dose of 50 U (0.33 U/mL/min +/- 0.05). A threshold dose for irreversible occlusion may also exist. Although small amounts of thrombin in a high-flow vessel may not cause significant complication, administration into the arterial circulation should be avoided.
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Affiliation(s)
- M E Pfister
- Dotter Interventional Institute, Oregon Health Sciences University, University Hospital South, Portland 97201-3098, USA
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Park JW, Pavcnik D, Uchida BT, Timmermans H, Corless CL, Yamakado K, Yamada K, Keller FS, Rösch J. Small intestinal submucosa covered expandable Z stents for treatment of tracheal injury: an experimental pilot study in swine. J Vasc Interv Radiol 2000; 11:1325-30. [PMID: 11099244 DOI: 10.1016/s1051-0443(07)61310-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate efficacy of small intestinal submucosa (SIS) as a stent covering in healing experimentally created tracheal defects and to explore the trachea's reaction to placement of SIS-covered stents. MATERIAL AND METHODS A tracheal defect with a diameter of approximately 10 mm was created in six swine with use of a blade or electrocauterization. A double-body, self-expandable SIS-covered Gianturco Rösch Z stent was placed into the trachea to cover the defect. The animals were observed, and were killed when they developed respiratory problems. Autopsy and histologic studies were performed. RESULTS The SIS-covered stents were accurately placed without immediate complications related to placement. All animals developed respiratory problems on follow-up. One animal died 9 days after procedure because of pneumonia, the others five were killed at 12, 17, 18, 28, and 56 days because of stridor, wheezing, and cough. At autopsy and histology, the tracheal defects were found to be completely healed, with epithelial lining and regeneration of submucosal glands. Animals whose defects were created with a blade demonstrated cartilage remodeling between 9 and 18 days, and apparent deposition of new cartilage at 28 days after SIS placement. The defects made by electrocauterization showed only fibrous tissue with no cartilage regeneration. The tracheal lumen was narrowed by overgrowth of granulation tissue, particularly at the end wires of the stents. In three animals, polypoid masses caused 60%, 70%, and 80% tracheal obstruction, respectively. CONCLUSION Placement of SIS-covered stents contributed to rapid and effective healing of large tracheal defects. Rigidity and oversizing of Gianturco Rösch Z stents led to secondary changes of the tracheal wall, causing significant airway obstructions. Smaller size and flexible stents should be selected for future work.
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Affiliation(s)
- J W Park
- Dotter Interventional Institute, Oregon Health Sciences University and Portland Veterans Administration Medical Center, 97201, USA
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Pavcnik D, Uchida BT, Timmermans H, Corless CL, Loriaux M, Keller FS, Rösch J. The square stent-based large vessel occluder: an experimental pilot study. J Vasc Interv Radiol 2000; 11:1227-34. [PMID: 11041484 DOI: 10.1016/s1051-0443(07)61369-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
PURPOSE The purpose of this study is in vitro and in vivo experimental evaluation of a square stent-based vascular occlusion device for large vessels. MATERIALS AND METHODS Square stent-based large vessel occluders (LVO) 5 mm-50 mm in size were constructed from stainless-steel square stents covered by porcine small intestine submucosa (SIS). The LVOs with two back-side barbs were delivered through a guiding catheter. The LVOs with two back-side barbs and two frontal barbs were front-loaded and delivered coaxially. A pusher with a retention mechanism at its end was used for deployment. In vitro testing for competency was performed with use of a flow model with pressure increases. In an experimental pilot study in seven pigs and five dogs, 16 LVOs were placed into the aorta (n = 4), common iliac artery (n = 2), pulmonary artery (n = 4), and medial sacral artery (n = 6). Four animals received two LVOs in different locations. Angiography was performed before and after placement of each LVO. Animals were followed for as long as 3 months with use of angiography and were then killed for gross and histologic evaluation. RESULTS In vitro LVOs with two and four barbs were easily collapsed and pushed through or front-loaded into guiding catheters (6-F for a 5-mm occluder, 10-F for a 50-mm occluder). A 20-mm LVO adapted to tubular structures 10-15 mm in diameter, forming polygons 17-18.5 mm in length. In the flow model, LVOs endured pressure increases to 300 mm Hg. In vivo, the LVOs self-expanded and adapted to the vessel without migration in all cases. The locking pusher allowed precise LVO placement and engagement of its barbs into the vessel wall before complete deployment, preventing dislodgment by blood flow. Complete arterial occlusion occurred within 10-20 minutes and arteries remained occluded until the animal was killed in all cases. After 2 months, histologic evaluation revealed replacement of SIS by host tissue and its remodeling with variable fibrocytes, fibroblasts, and some inflammatory cells. Complete endothelialization was seen on both sides of the LVO. CONCLUSION The SIS LVO is effective and reliable for acute and chronic occlusion in a high flow model in an experimental animal.
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Affiliation(s)
- D Pavcnik
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA.
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Sochman J, Peregrin JH, Pavcnik D, Timmermans H, Rösch J. Percutaneous transcatheter aortic disc valve prosthesis implantation: a feasibility study. Cardiovasc Intervent Radiol 2000; 23:384-8. [PMID: 11060369 DOI: 10.1007/s002700010060] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Over the past 30 years there have been experimental efforts at catheter-based management of aortic valve regurgitation with the idea of extending treatment to nonsurgical candidates. A new catheter-based aortic valve design is described. METHODS The new catheter-delivered valve consists of a stent-based valve cage with locking mechanism and a prosthetic flexible tilting valve disc. The valve cage is delivered first followed by deployment and locking of the disc. In acute experiments, valve implantation was done in four dogs. RESULTS Valve implantation was successful in all four animals. The implanted valve functioned well for the duration of the experiments (up to 3 hr). CONCLUSION The study showed the implantation feasibility and short-term function of the tested catheter-based aortic disc valve. Further experimental studies are warranted.
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Affiliation(s)
- J Sochman
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 140 21 Prague 4, Czech Republic
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Andrews RT, Saxon RR, Bloch RD, Petersen BD, Uchida BT, Rabkin JM, Loriaux MM, Keller FS, Rösch J. Stent-grafts for de novo TIPS: technique and early results. J Vasc Interv Radiol 1999; 10:1371-8. [PMID: 10584654 DOI: 10.1016/s1051-0443(99)70247-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To evaluate the potential benefits of placing a polytetrafluoroethylene (PTFE)-covered stent-graft during initial creation of a transjugular intrahepatic portosystemic shunt (TIPS) in clinical practice. MATERIALS AND METHODS De novo TIPS were created with a PTFE stent-graft in four male and four female patients with symptomatic portal hypertension awaiting liver transplant. Their ages ranged from 35 to 62 (mean, 47) years. Patients were followed with TIPS ultrasound (US) and/or venography until liver transplantation or death; one remains under active study. Six recovered specimens underwent gross and microscopic evaluation. RESULTS All TIPS placements were successful. Six shunts were primarily patent, with a mean patency of 289 days, through completion of the study. Five were found to be patent at transplant and one was found to be patent at autopsy. Explant evaluation revealed a smooth, thin layer of neointima and exclusion of biliary secretions. Three patients developed a total of four stenoses (one tandem lesion) during follow-up, leading to revision in two patients. Mean primary and total patency in these patients was achieved after 279 and 463 days, respectively. A previously occult moderate stenosis was detected after explant in another patient. Only one (nonsignificant) stenosis clearly developed in an area covered by PTFE. CONCLUSION Placement of a de novo PTFE stent-graft during TIPS creation is feasible and may extend primary shunt patency. Appropriate positioning of the stent-graft is critical.
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Affiliation(s)
- R T Andrews
- Dotter Interventional Institute, Portland, Oregon 97201, USA.
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Sakaguchi S, Uchida BT, Timmermans HA, Pavcnik D, Sakai Y, Keller FS, Rösch J, Yin Q, Kichikawa K, Uchida H. Twin-tube endografts for aortic aneurysms: an experimental feasibility study. J Vasc Interv Radiol 1999; 10:1092-8. [PMID: 10496713 DOI: 10.1016/s1051-0443(99)70197-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To explore feasibility of twin-tube endografts (TTEGs) for treatment of abdominal aortic aneurysm (AAA). MATERIALS AND METHODS AAAs were created in six dogs by overdilation of Palmaz stents. TTEGs made of seven 9.5-mm-diameter Gianturco Rösch Z (GRZ) stents and covered with PTFE were deployed simultaneously from both femoral arteries through 10-F sheaths to exclude the AAA. Follow-up aortography was performed immediately and at 2, 4, and 8 weeks. Two dogs were killed at 4 weeks and four were killed at 8 weeks. Gross and histologic examinations were performed. RESULTS AAA creation and TTEG placement were successful in all six dogs. TTEGs completely excluded AAAs in five dogs. Minor temporary perigraft leak was seen in one dog immediately after stent placement. Four dogs had TTEGs patent to termination at 8 weeks. In two dogs with oversized TTEGs, one of the twin endografts occluded at 2 weeks. At autopsy, TTEGs were formed in semicircular shape and histology did not show any significant inflammatory reaction. CONCLUSION TTEGs show promise for treatment of AAA, with the potential of reducing the introductory sheath size. Further experimental studies, particularly with TTEGs extended into iliac arteries, are warranted.
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Affiliation(s)
- S Sakaguchi
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA
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Abstract
PURPOSE In vitro and in vivo evaluation of a new retrievable, home-made, inferior vena cava (IVC) Square stent filter (SSF) with two trapping levels. METHODS In vitro, the SSF was compared in a flow model with the stainless steel Greenfield filter (SGF) for emboli-trapping efficiency by serially passing 300 emboli of 3 and 6 mm in diameter and 15-30 mm in length in each type of filter. Nine swine were used for the in vivo testing of the SSF for deployment and retrievability, emboli-trapping efficiency, stability, and self-centering ability and two were used (total of 11 swine) for testing repositioning and retrievability of the SSF at 2 weeks and for gross and histologic IVC changes at 2 months. RESULTS In vitro, the SSF and SGF had similar efficiency in trapping large emboli but the SSF had significantly better efficiency than the SGF for trapping all sizes of emboli (91.7% vs 81%), medium size emboli (93% vs 80%), and small emboli (86% vs 69%). Efficiency decreased in both filters from the first to the fifth embolus in each series but was still significantly better for the SSF. With the SSF, 89% of emboli were caught at the primary and 11% at the secondary filtration level. In the nine animals used for acute studies, the SSF was easily placed in all 27 attempts, assumed a central position 26 times, and was easily retrieved in 21 of 22 attempts. One tilted filter needed additional manipulation for retrieval. During emboli injection in five swine, the SSF had 97.2% emboli-trapping efficiency and demonstrated good stability. In the two animals used for longer-term evaluation, the filters were easily retrieved 2 weeks after implantation. Histologic evaluation at 2 months showed neointimal proliferation around the SSF wires in contact with the IVC wall, which was otherwise normal. CONCLUSION The SSF is a promising filter. It is easy to place and retrieve, is stable after placement, and has high efficiency for trapping emboli. Promising results justify further experimental and eventual clinical studies with a commercially manufactured SSF.
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Affiliation(s)
- D Pavcnik
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA
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Kaminou T, Rösch J, Yamada R, Uchida BT, Pavcnik D, Timmermans HA, Sakaguchi S, Keller FS. Percutaneous retroperitoneal splenorenal shunt: an experimental study in swine. Radiology 1998; 206:799-802. [PMID: 9494504 DOI: 10.1148/radiology.206.3.9494504] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the technical possibility of creating a percutaneous retroperitoneal splenorenal shunt (PRESS) in swine as a minimally invasive treatment of portal hypertension. MATERIALS AND METHODS Five normal domestic swine underwent creation of a PRESS. A modified transjugular intrahepatic portosystemic shunt puncture set was introduced from the right femoral vein into the left renal vein. The proximal splenic vein was punctured transvenously through the retroperitoneal cavity. Noncovered metallic stents were then placed to connect both veins. The animals were sacrificed 1 hour after the procedure, after follow-up splenic venography and necropsy were performed. RESULTS Puncture of the splenic vein and stent placement were successfully completed in all cases. In four of five cases, the splenic venogram revealed good flow from the splenic vein to the left renal vein through the shunt track 1 hour after creation of the PRESS, and there was no evidence of leakage. No changes in vital signs were noticed. At necropsy, a small retroperitoneal hematoma along the stent and minimal intraperitoneal bleeding were observed. The stents were found in the retroperitoneal cavity connecting both veins in all animals. CONCLUSION Creation of a PRESS is technically possible, and further experimental studies of its efficacy are warranted.
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Affiliation(s)
- T Kaminou
- Dotter Interventional Institute, Oregon Health Sciences University, Portland, USA
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Abstract
OBJECTIVES We studied the hypothesis that in the absence of vascular pathology, coronary artery vasospasm occurs as a result of local regions of vascular muscle hyperreactivity. We aimed to explore the basis for a functional etiology of those vasospasms not explained on a structural basis. BACKGROUND Ovariectomized rhesus monkeys (Macaca mulatta) without injury or significant vascular disease were stimulated with platelet release products, and angiograms were compared with those from vasospasms induced in human patients. METHODS We used intracoronary (IC) injections of serotonin, thromboxane A2 (U46619), endothelin 1 or angiotensin II in concentrations 3 to 10 times that which reduced coronary artery diameter by 50%. RESULTS Although no agent alone caused vasospasm, the combination of pathophysiologic concentrations of serotonin and the stable thromboxane A2 mimetic, U46619, injected through an IC catheter, synergistically caused coronary vasospasm on the second or third challenge in five of seven monkeys. These drug-induced vasospasms were similar to vasospasms induced by mechanical injury followed by serotonin, and to those stimulated in human IC diagnostic tests, as judged by onset, appearance, kinetics and vasodilator reversal. CONCLUSIONS These studies in ovariectomized monkeys revealed that coronary vasospasm can be stimulated without preexisting vascular pathology, endothelial denudation or injury. Reproducible vasospasm of primate coronary arteries in response to these two endogenous pathophysiologic vasoconstrictors, which are thought to be precipitating stimuli in the etiology of vasospasm, suggests that structure-independent epicardial vasospasm can be an important element in serious cardiac ischemic events, particularly the focal, persistent vasospasms that occur without plaques or injury.
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Affiliation(s)
- K Hermsmeyer
- Oregon Regional Primate Research Center, Beaverton 97006, USA
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Abstract
Cardiovascular disease, the major cause of death in post-menopausal women, can be reduced by replacement of ovarian steroid hormones. To compare medroxyprogesterone with progesterone as the progestin in hormone replacement therapy from the standpoint of coronary artery vasospasm, we treated ovariectomized rhesus monkeys with physiological levels of estradiol-17 beta in combination with medroxyprogesterone or progesterone for four weeks. Coronary vasospasm in response to pathophysiological stimulation without injury showed that progesterone plus estradiol protected but medroxyprogesterone plus estradiol failed to protect, allowing vasospasm. We conclude that medroxyprogesterone in contrast to progesterone increases the risk of coronary vasospasm.
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Affiliation(s)
- K Miyagawa
- Oregon Regional Primate Research Center, Oregon 97006, USA
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Abstract
We report the use of a Dacron-covered Gianturco-Rösch Z (GRZ)-stent to treat malignant obstruction of the superior vena cava (SVC). Initial treatment with an uncovered GRZ-stent was suboptimal due to protrusion of tumor-thrombus through the stent struts into the SVC lumen. Placement of a coaxial Dacron-covered stent graft relieved the residual obstruction due to tumor within the SVC.
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Affiliation(s)
- D H Chin
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd., L-605, Portland, OR 97201-3098, USA
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De Gregorio BT, Kinsman K, Katon RM, Morrison K, Saxon RR, Barton RE, Keller FS, Rösch J. Treatment of esophageal obstruction from mediastinal compressive tumor with covered, self-expanding metallic Z-stents. Gastrointest Endosc 1996; 43:483-9. [PMID: 8726763 DOI: 10.1016/s0016-5107(96)70291-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Mediastinal malignancies may involve the esophagus, leading to esophageal stenosis and dysphagia. Rigid and self-expanding esophageal stents have been used for effective palliation, but their use in extrinsic, compressive lesions is controversial. METHODS A retrospective review of self-expanding Gianturco-Rösch Z-stents that were successfully placed in 13 patients with malignant esophageal obstruction due to extrinsic lesions. RESULTS All patients had an improvement in dysphagia of at least two dysphagia grades. The mean dysphagia grade fell from 3.15 to 0.62. Mean survival was 2.2 months. Early (within 48 hours) procedure-related complications occurred in 4 of 13 patients and consisted of minor, transient chest pain that resolved within 6 hours (3 patients) and endoscopic stent dislodgment into the stomach (1 patient). Late complications (> 48 hours) occurred in 2 patients and consisted of a partial proximal stent migration and the development of a benign stricture proximal to the stent. There was no procedural or stent related mortality. CONCLUSIONS Esophageal obstruction and malignant dysphagia from extrinsic, compressive mediastinal malignancies can be effectively and safely palliated with self-expanding Gianturco- Rösch Z-stents.
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Affiliation(s)
- B T De Gregorio
- Divisions of Gastroenterology, Oregon Health Sciences University, Portland 97201-3098, USA
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Petersen BD, Maxfield SR, Ivancev K, Uchida BT, Rabkin JM, Rösch J. Biliary strictures in hepatic transplantation: treatment with self-expanding Z stents. J Vasc Interv Radiol 1996; 7:221-8. [PMID: 9007801 DOI: 10.1016/s1051-0443(96)70765-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To determine the long-term results of Gianturco-Rösch Z (GRZ) stent placement for the treatment of recurrent, benign biliary strictures in liver transplant recipients. MATERIALS AND METHODS During a 5-year period, eight orthotopic liver transplant recipients underwent transhepatic placement of GRZ stents to treat 12 recurrent biliary strictures (six anastomotic, six intrahepatic). Prior treatment of 11 strictures with balloon dilation therapy had failed. Patients were followed up for 1-65 months. RESULTS Stent placement was successful in all patients. Stent position remained stable in all but one patient. Three patients died (1, 25, and 28 months after stent placement), all with patent stents. Four patients required no further biliary intervention. Two of the other four patients needed intermittent biliary balloon dilation with removal of bile duct debris. The third patient had a stable, nonobstructing stenosis in the stent. The fourth passed his stents and needed no further intervention. CONCLUSION GRZ stents are useful in patients who are refractory to repetitive balloon dilation of biliary strictures or who are poor surgical candidates.
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Affiliation(s)
- B D Petersen
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201, USA
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Abstract
PURPOSE To evaluate expandable metallic Gianturco-Rösch Z (GRZ) stents for treatment of benign and malignant tracheobronchial stenoses. PATIENTS AND METHODS Six patients, ages 45-73 years, were treated for severe dyspnea with placement of GRZ stents. Three patients had benign tracheal lesions (one tracheomalacia, two postoperative) and received uncovered GRZ stents. Three patients had malignant stenoses at the level of the carina; one received an uncovered stent and the other two received silicone-covered GRZ stents. RESULTS Two patients with benign lesions responded well to stent placement. One was asymptomatic for a year and then was lost to follow-up; the other improved substantially but died of end-stage lung disease 5 months after stent placement. A third patient with a benign high tracheal lesion did poorly; symptoms recurred secondary to inferior migration of a stent, which was removed surgically at 4 months. All patients with malignant lesions improved symptomatically after stent placement and remained without significant dyspnea until death (from 1 to 6 months). CONCLUSION Expandable GRZ stents are promising devices for treatment of benign lesions and offer effective palliation of malignant tracheobronchial stenoses.
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Affiliation(s)
- B D Petersen
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA
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Saxon RR, Barton RE, Katon RM, Petersen BD, Lakin PC, Timmermans H, Uchida B, Keller FS, Rösch J. Treatment of malignant esophageal obstructions with covered metallic Z stents: long-term results in 52 patients. J Vasc Interv Radiol 1995; 6:747-54. [PMID: 8541679 DOI: 10.1016/s1051-0443(95)71180-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To prospectively evaluate the clinical efficacy of silicone-covered Gianturco-Rösch self-expandable Z (GRZ) stents in the treatment of malignant esophageal obstruction. PATIENTS AND METHODS GRZ stents were placed in 52 patients (39 men, 13 women) with severe dysphagia due to high-grade malignant esophageal obstruction. RESULTS Stent placement was technically successful, and immediate relief of dysphagia was achieved in 50 of 52 patients (96%), with long-term relief in 47 patients (90%). Fifty-one patients (98%) died during follow-up (range, 1 week to 33 months; mean, 4.3 months). Late complications were most prevalent and included stent migration (n = 5), food impaction (n = 2), chest pain (n = 2), membrane disruption with tumor ingrowth (n = 1), granulomatous reaction above the stent (n = 1), esophageal perforation with mediastinitis (n = 1), and upper gastrointestinal hemorrhage (n = 4). Twelve complications were easily managed with medical, endoscopic, or radiologic intervention. Four deaths may have been related to stent placement (early mortality rate, 7.7%). CONCLUSION GRZ stents provide relatively safe and effective long-term palliation in patients with severe, malignant esophageal obstruction.
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Affiliation(s)
- R R Saxon
- Dotter Interventional Instite L-605, Oregon Health Sciences University, Portland 97201-3098, USA
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Nishimine K, Saxon RR, Kichikawa K, Mendel-Hartvig J, Timmermans HA, Shim HJ, Uchida BT, Barton RE, Keller FS, Rösch J. Improved transjugular intrahepatic portosystemic shunt patency with PTFE-covered stent-grafts: experimental results in swine. Radiology 1995; 196:341-7. [PMID: 7617843 DOI: 10.1148/radiology.196.2.7617843] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
PURPOSE To evaluate the ability of stent-grafts made with polytetrafluoroethylene (PTFE) graft material to improve transjugular intrahepatic portosystemic shunt (TIPS) patency. MATERIALS AND METHODS TIPS were created in 13 swine by using PTFE-covered stent-grafts. Uncovered TIPS were placed in 13 other swine. Twenty-one of 26 animals were followed up with portal venography for 3 months or until the shunt became severely stenotic. Five animals without severe stenosis were sacrificed before 3 months because of illness. RESULTS At 4 weeks after TIPS placement, nine of 13 stent-graft TIPS were patent (< 50% diameter narrowing) compared with only one patent stent in 13 uncovered TIPS. Six of 13 stent-graft TIPS remained patent until the animals were sacrificed. In 11 of 12 uncovered TIPS, stenosis was most prominent in the parenchymal tract. In five of seven stent-graft TIPS, stenosis was most prominent in the hepatic vein above the end of the graft material. Bile leaks were discovered in six occluded uncovered TIPS and in two of the stent-graft TIPS. CONCLUSION PTFE-covered stent-grafts significantly improved TIPS patency in swine (P < .01). However, stenosis in the hepatic vein led to late shunt malfunction in selected cases.
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Affiliation(s)
- K Nishimine
- Dotter Interventional Institute, Oregon Health Sciences University, Portland 97201-3098, USA
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