Multilayer stent in the treatment of popliteal artery aneurysms

Endovascular repair of popliteal artery aneurysms is an emerging treatment in high risk surgical patients. The location in a functionally demanding anatomical area creates limitations in terms of endograft patency. Technological advancements have been conscripted in an effort to circumvent such constraints. The multilayer stent technology effects through haemodynamic modulation. We used the multilayer stent to treat 6 asymptomatic popliteal artery aneurysms in 3 patients. All procedures were successfully accomplished without any complications. Over a mean follow up period of 9 months, thrombosis occurred in two limbs, and blood flow was restored with thrombolysis, achieving a primary and secondary patency rate at 6 months of 67 % and 100 %, respectively. Partial or complete thrombosis of the aneurysm sac was achieved in all aneurysms. Even though the use of the multilayer stent in popliteal artery aneurysms was safe in the short term, our experience showed that close surveillance is required.

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Retrograde Popliteal Access to Percutaneous Peripheral Intervention for Chronic Total Occlusion of Superficial Femoral Arteries

Vascular and Endovascular Surgery ◽

10.1177/1538574417698902 ◽

2017 ◽

Vol 51 (5) ◽

pp. 240-246 ◽

Cited By ~ 3

Author(s):

Mert Dumantepe

Keyword(s):

Popliteal Artery ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Stent Fracture ◽

Secondary Patency ◽

Total Occlusion ◽

Chronic Total Occlusions ◽

Type D ◽

Secondary Patency Rate

Objective: The aim of this study is to present our initial experience with the use of the retrograde popliteal artery access in patients with chronic total occlusions of superficial femoral artery (SFA). Method: From July 2012 to May 2014, a total of 28 patients (20 men, mean age 61.2 ± 11.5 years) with total occlusion of the SFA and good distal runoff were treated with percutaneous atherectomy, balloon angioplasty, and stenting (mean length 165.3 ± 57.5 mm, range 72-336 mm). All patients had severe claudication or critical limb ischemia, and most of the lesions were TransAtlantic Inter-Society Consensus classification type D (n = 21). Results: Technical success was achieved in all cases. In majority (26, 92.8%) of the patients, endoluminal recanalization was possible from the popliteal access; SFA recanalization in the other 2 cases was obtained through the subintimal space. During a mean follow-up of 12.9 ± 2.5 months, claudication, severity, rest pain, and toe ulcers improved significantly. Ankle–brachial index changed from 0.54 ± 0.11 to 0.91 ± 0.2 at 1 year after intervention ( P < .001), and patency rates at 1, 6, and 12 months after interventions were 100%, 92.8%, and 85.7%, respectively. One pseudoaneurysm and 1 arteriovenous fistula were found in the popliteal region on duplex examinations. There were 2 in-stent restenosis and 3 occlusions during the 12-month follow-up. These occlusions were treated with reendovascular procedures. Our secondary patency rate was 96.4%. No stent fracture was observed. Conclusion: The retrograde popliteal artery approach under duplex guidance can be considered as safe, efficient, and the primary SFA recanalization strategy in carefully selected patients, with competitive immediate and mid-term results.

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Surgical Treatment of Buerger's Disease

Vascular ◽

10.1258/rsmvasc.12.3.192 ◽

2004 ◽

Vol 12 (3) ◽

pp. 192-197 ◽

Cited By ~ 31

Author(s):

A. Kürşat Bozkurt ◽

Kazim Beşirli ◽

Cengiz Köksal ◽

Gökce Şirin ◽

Lale Yüceyar ◽

...

Keyword(s):

Bypass Surgery ◽

Secondary Patency ◽

Limb Salvage Rate ◽

Buerger’S Disease ◽

Buerger's Disease ◽

Secondary Patency Rate ◽

Severe Ischemia ◽

Salvage Rate ◽

Distal Flow

We aimed to evaluate the characteristics of 198 new patients with Buerger's disease treated surgically in the last decade. We also compared these results with our former series reported in 1993. The records of patients with Buerger's disease who were enrolled in an ongoing investigational protocol between 1991 and 2001 were reviewed. Sympathectomy was carried out in 161 patients and revascularization in 19 patients. The cumulative secondary patency rate was 57.9% for bypass grafts at a mean follow-up of 5.4 years. Clinical outcome following sympathectomy was considered improved in 52.3% of patients, stable in 27.8%, and worse in 19.8%. Seven major and 36 minor amputations were performed, with a limb salvage rate of 95.6%. The aggressiveness of the disease has increased compared with previous series, parallel to the expansion of cigarette consumption. Bypass surgery should be considered for patients with severe ischemia who have target vessels. Sympathectomy still has a role to improve distal flow.

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Wallgraft Endoprosthesis for the Percutaneous Treatment of Femoral and Popliteal Artery Aneurysms

Journal of Endovascular Therapy ◽

10.1177/152660280200900113 ◽

2002 ◽

Vol 9 (1) ◽

pp. 76-81 ◽

Cited By ~ 23

Author(s):

Marcus Howell ◽

Zvonimir Krajcer ◽

Edward B. Diethrich ◽

Amir Motarjeme ◽

Michael Bacharach ◽

...

Keyword(s):

Popliteal Artery ◽

Surgical Repair ◽

Potential Versus ◽

Percutaneous Treatment ◽

Secondary Patency ◽

Stent Grafts ◽

Femoropopliteal Artery ◽

The Mean ◽

Procedural Success

Purpose: To evaluate the safety and efficacy of the Wallgraft Endoprosthesis for the treatment of femoropopliteal artery aneurysms. Methods: From October 1997 to April 2000, 17 patients (13 men; mean age 73.5 ± 7.1 years) with 7 femoral and 13 popliteal artery aneurysms underwent percutaneous aneurysm exclusion using the Wallgraft Endoprosthesis as part of a larger clinical trial. The mean aneurysm diameters were 37.6 ± 12.9 mm and 22.3 ± 8.7 mm, respectively. Results: Acute procedural success was 100% for femoral aneurysms and 92.3% (12/13) in the popliteal artery owing to one endoleak that resolved after 1 month. There were no complications, and the mean length of stay was 2.2 ± 3.8 days. Six-month and 1-year aneurysm exclusion rates were 100% for both locations, but 4 (31%) popliteal stent-grafts thrombosed in follow-up. Three were recanalized, but the fourth underwent bypass grafting after 3 thrombotic episodes. The 1-year primary and secondary patency rates were both 100% for the femoral aneurysms and 69% and 92%, respectively, for popliteal repairs. No procedure or device-related deaths occurred. Conclusions: Treatment of aneurysms in the femoropopliteal segment appears to be safe and effective with the Wallgraft Endoprosthesis, although longer follow-up in a larger patient group will be needed to determine this technique's potential versus surgical repair.

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Endovascular treatment for chronic atherosclerotic occlusive mesenteric disease: Is stenting superior to balloon angioplasty?

VASA ◽

10.1024/0301-1526/a000056 ◽

2010 ◽

Vol 39 (4) ◽

pp. 319-324 ◽

Cited By ~ 9

Author(s):

Daliri ◽

Grunwald ◽

Jobst ◽

Szucs-Farkas ◽

Diehm ◽

...

Keyword(s):

Endovascular Treatment ◽

Patency Rate ◽

Celiac Artery ◽

Primary Patency ◽

Secondary Patency ◽

Chronic Mesenteric Ischemia ◽

Primary Patency Rate ◽

Secondary Patency Rate

Background: Endovascular treatment is an increasingly used therapeutic option in patients with chronic atherosclerotic occlusive mesenteric disease. Purpose of this study was evaluation of patency and mortality in patients treated with visceral artery percutaneous transluminal angioplasty (PTA) or stenting including follow-up. Patients and methods: A retrospective review of 17 consecutive patients (4 women, 13 men) with endovascular treatment for symptomatic chronic mesenteric ischemia from 1998 to 2004 was performed. Mean follow-up period was 42 months. Patient demographics, interventional details, primary and/or secondary patency and mortality were recorded. Cumulative mortality and patency rates were determined using Kaplan-Meier life table analysis. Results: Twenty-six interventions (PTA alone n = 13, PTA and stenting n = 13) were performed in 17 patients. Interventions were performed in the superior mesenteric artery (n = 13) and celiac artery (n = 13). The re-intervention rate was 30 % (6/26). Re-interventions were performed for the superior mesenteric artery (n = 4) and celiac artery (n = 2). Cumulative overall 1-year results were primary patency rate 81 %, secondary patency rate 94 %, and survival rate 82 %. Cumulative 10-year results were primary patency rate 73 %, secondary patency rate 94 %, and survival rate 65 %. The 10-year secondary patency rate was 100 % in patients post initial stenting and 86 % in patients post initial PTA. Conclusions: Long-term follow-up post endovascular treatment for chronic mesenteric ischemia demonstrated a considerable overall secondary patency rate of 94 %. However, the long-term secondary patency rate was higher in patients post initial stenting compared to PTA alone.

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Percutaneous Transluminal Laser Angioplasty versus Balloon Dilation for Treatment of Popliteal Artery Occlusions

Journal of Endovascular Therapy ◽

10.1177/152660280200900623 ◽

2002 ◽

Vol 9 (6) ◽

pp. 882-888 ◽

Cited By ~ 10

Author(s):

Hermann J. Steinkamp ◽

Jürgen Rademaker ◽

Christian Wissgott ◽

Dierk Scheinert ◽

Michael Werk ◽

...

Keyword(s):

Popliteal Artery ◽

Balloon Dilation ◽

Laser Angioplasty ◽

Secondary Patency ◽

Complication Rates ◽

Long Term Outcomes ◽

Percutaneous Transluminal ◽

Term Benefit

Purpose: To compare the immediate results, complication rates, and long-term outcomes of percutaneous transluminal laser angioplasty (PTLA) versus balloon dilation alone in the treatment of popliteal artery occlusions. Methods: In a prospective nonrandomized study conducted between December 1994 and June 2000, 215 symptomatic patients with unilateral popliteal occlusions were treated with either dilation alone (88 patients: 52 men; mean age 62 years, range 48–83) or PTLA (127 patients: 70 men; mean age 64 years, range 49–86) using a 308-nm excimer laser followed by dilation. The average occlusion length was 10.4 cm (range 3–14). Results: PTLA was successful in recanalizing 105 (82.7%) arteries, while the recanalization rate for dilation alone was only 70.4% (62/88; p=0.045). After a mean follow-up of 36 months (range 6–52), the primary and secondary patency rates were 21.7% and 50.8%, respectively, in patients with PTLA and 16.3% and 35.2% in the angioplasty group (p=0.762). The complication rates associated with both techniques were similar. Conclusions: Although initial recanalization may be better with PTLA, it does not appear to add any long-term benefit over balloon dilation alone.

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Early and mid-term results in the endovascular treatment of popliteal aneurysms with the multilayer flow modulator

Vascular ◽

10.1177/1708538118771258 ◽

2018 ◽

Vol 26 (5) ◽

pp. 556-563 ◽

Cited By ~ 5

Author(s):

Alessandro Ucci ◽

Ruggiero Curci ◽

Matteo Azzarone ◽

Claudio Bianchini Massoni ◽

Antonio Bozzani ◽

...

Keyword(s):

Endovascular Treatment ◽

Limb Salvage ◽

Popliteal Artery ◽

Artery Aneurysm ◽

Secondary Patency ◽

Technical Success ◽

Popliteal Artery Aneurysm ◽

Asymptomatic Patients ◽

Collateral Vessels

Background The endovascular approach became an alternative to open surgical treatment of popliteal artery aneurysm over the last few years. Heparin-bonded stent-grafts have been employed for endovascular popliteal artery aneurysm repair, showing good and stable results. Only few reports about the use of multilayer flow modulator are available in literature, providing small patient series and short follow-up. The aim of this study is to report the outcomes of patients with popliteal artery aneurysm treated with the multilayer flow modulator in three Italian centres. Methods We retrospectively analysed a series of both symptomatic and asymptomatic patients with popliteal artery aneurysm treated with the multilayer flow modulator from 2009 to 2015. Follow-up was undertaken with clinical and contrast-enhanced ultrasound examinations at 1, 6 and 12 months, and yearly thereafter. Computed tomography angiography was performed in selected cases. Primary endpoints were aneurysm sac thrombosis; freedom from sac enlargement and primary, primary-assisted and secondary patency during follow-up. Secondary endpoints were technical success, collateral vessels patency, limb salvage and aneurysm-related complications. Results Twenty-three consecutive patients (19 males, age 72 ± 11) with 25 popliteal artery aneurysms (mean diameter 23 mm ± 1, 3 symptomatic patients) were treated with 40 multilayer flow modulators during the period of the study. Median follow-up was 22.6 ± 16.7 months. Complete aneurysm thrombosis occurred in 92.9% of cases (23/25 cases) at 18 months. Freedom from sac enlargement was 100% (25/25 cases) with 17 cases of aneurysm sac shrinkage (68%). At 1, 6, 12 and 24 months, estimated primary patency was 95.7%, 87.3%, 77% and 70.1%, respectively. At the same intervals, primary-assisted patency was 95.7%, 91.3%, 86% and 86%, respectively, and secondary patency was 100%, 95.7%, 90.3% and 90.3%, respectively. Technical success was 100%. The collateral vessels patency was 72.4%. Limb salvage was 91.4% at 24-month follow-up. One multilayer flow modulator fracture was reported in an asymptomatic patient. Conclusions Multilayer flow modulator seems a feasible and safe solution for endovascular treatment of popliteal artery aneurysms in selected patients.

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To Close, Observe, or Reconstruct: The Third Way of Managing Dialysis Fistula Aneurysms in Kidney Transplant Recipients

Journal of Clinical Medicine ◽

10.3390/jcm10194567 ◽

2021 ◽

Vol 10 (19) ◽

pp. 4567

Author(s):

Krzysztof Bojakowski ◽

Aneta Gziut ◽

Rafał Góra ◽

Bartosz Foroncewicz ◽

Stanisław Kaźmierczak ◽

...

Keyword(s):

Postoperative Bleeding ◽

Long Term Results ◽

Secondary Patency ◽

Renal Transplant Recipients ◽

Transplant Recipients ◽

Primary Reconstruction ◽

Secondary Patency Rate ◽

Significant Difference ◽

Dialysis Fistula

Background: The management of patent dialysis fistulas in patients after kidney transplantation (KTx) is controversial—the options that are usually considered are the fistula’s closure or observation. Many complications of dialysis fistulas occur in patients after KTx, and immunosuppression increases the risk of fistula aneurysms and hyperkinetic flow. This study aimed to evaluate the results of dialysis fistula aneurysm treatment in patients after KTx and to compare them to procedures performed in an end-stage renal disease (ESRD) dialyzed population. Methods: We enrolled 83 renal transplant recipients and 123 ESRD patients with dialysis fistula aneurysms qualified for surgical revision to this single-center, prospective study. The results of the surgical treatment of dialysis fistula aneurysms were analyzed, and the primary, assisted primary and secondary patency rate, percentage and type of complications were also assessed. Results: For the treatment of dialysis fistula aneurysms in transplant patients, we performed dialysis fistula excisions with fistula closure in 50 patients (60.2%), excision with primary fistula reconstruction (n = 10, 12.0%) or excision with PTFE bypasses (n = 23, 27.7%). Postoperative complications occurred in 11 patients (13.3%) during a follow-up (median follow-up, 36 months), mostly in distant periods (median time after correction procedure, 11.7 months). The most common complication was outflow stenosis, followed by hematoma, dialysis fistula thrombosis and the formation of a new aneurysm and postoperative bleeding, infection and lymphocele. The 12-month primary, primary assisted and secondary patency rates of fistulas corrected by aneurysm excision and primary reconstruction in the KTx group were all 100%; in the control ESRD group, the 12-month primary rate was 70%, and the primary assisted and secondary patency rates were 100%. The 12-month primary, primarily assisted and secondary patency rates after dialysis fistula aneurysm excision combined with PTFE bypass were better in the KTx group than in the control ESRD group (85% vs. 71.8%, 90% vs. 84.5% and 95% vs. 91.7%, respectively). Kaplan–Meier analysis showed a significant difference in primary patency (p = 0.018) and assisted primary (p = 0.018) rates and a strong tendency in secondary patency rates (p = 0.053) between the KTx and ESRD groups after dialysis fistula excisions combined with PTFE bypass. No statistically significant differences in patency rates between fistulas treated by primary reconstruction and reconstructed with PTFE bypass were observed in KTx patients. Conclusions: Reconstructions of dialysis fistula aneurysms give good long-term results, with a low risk of complications. The reconstruction of dialysis fistulas can be an effective treatment method. Thus, this is an attractive option in addition to fistula ligation or observation in patients after KTx. Reconstructions of dialysis fistula aneurysms enable the preservation of the dialysis fistula while reducing various complications.

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Results of different operative procedures for patients with popliteal artery aneurysms

VASA ◽

10.1024/0301-1526.35.3.185 ◽

2006 ◽

Vol 35 (3) ◽

pp. 185-190 ◽

Cited By ~ 1

Author(s):

Kopp ◽

Cascio ◽

Weidenhagen ◽

Stelter ◽

Meimarakis ◽

...

Keyword(s):

Popliteal Artery ◽

Patency Rate ◽

Primary Patency ◽

Operative Procedures ◽

Long Term Results ◽

Acute Ischemia ◽

Secondary Patency ◽

Autologous Vein ◽

Below The Knee ◽

Secondary Patency Rate

Background: Long term results of four different operative procedures for the treatment of popliteal artery aneurysms were investigated either performed by short venous or segmental alloplastic interpositions or long femoro-popliteal below the knee bypass using alloplastic grafts or autologous vein. Patients and methods: 47 patients treated for 50 popliteal aneurysms (mean diameter ± SD: 3.5 ± 1.1 cm) were analyzed (follow-up: 40.2 ± 4.9 months). Results: Primary patency rate was 78% and secondary patency rate was 86% at 5 years. Frequency of operative reinterventions was higher in patients treated for acute ischemia and in patients treated with alloplastic interpositions or alloplastic bypass (p = 0.026). Secondary patency rates were higher in patients treated with autologous venous interpositions or venous femoro-popliteal bypass (p = 0.022). Times of secondary vascular patency were significantly shorter for patients treated with short alloplastic interpositions in comparison to long alloplastic femoro-popliteal bypass procedures, short venous interpositions or long venous bypass operations (p = 0.018). Conclusions: For the treatment of patients with popliteal aneurysms autologous venous interposition is therefore recommended or as an alternative venous or alloplastic femoro-popliteal below the knee bypass.

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Ruptured infected popliteal artery aneurysm treated with endovascular therapy: A case report

JRSM Cardiovascular Disease ◽

10.1177/20480040211027792 ◽

2021 ◽

Vol 10 ◽

pp. 204800402110277

Author(s):

Shunsuke Kojima ◽

Tatsuya Nakama ◽

Kotaro Obunai ◽

Hiroyuki Watanabe

Keyword(s):

Popliteal Artery ◽

Artery Aneurysm ◽

Surgical Patients ◽

Anterior Tibial Artery ◽

Retrograde Approach ◽

First Line ◽

Popliteal Artery Aneurysm ◽

Anterior Tibial ◽

Computed Tomography Angiogram

An 86-year-old woman was admitted for a ruptured popliteal artery aneurysm (rPAA, 26 × 28 mm). Due to the patient’s age and comorbidities, emergency endovascular repair was performed. After the failed antegrade guidewire crossing, a retrograde approach from the anterior tibial artery and snaring was performed for lesion crossing, and stentgraft (5 × 50 mm) was deployed from antegrade fashion. At the 14-month follow-up, computed tomography angiogram demonstrated stentgraft patency and reduced aneurysmal size. Although open surgery remains the first-line treatment for infected rPAA, our approach adds to the evidence and can be applied to emergency cases or high-risk surgical patients.

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The Link Between Verbal Short-Term Memory and Anomia Treatment Gains

American Journal of Speech-Language Pathology ◽

10.1044/2019_ajslp-18-0176 ◽

2019 ◽

Vol 28 (3) ◽

pp. 1039-1052

Author(s):

Reva M. Zimmerman ◽

JoAnn P. Silkes ◽

Diane L. Kendall ◽

Irene Minkina

Keyword(s):

Short Term Memory ◽

Controlled Trial ◽

Treatment Success ◽

Linear Regression Models ◽

Language Performance ◽

Short Term ◽

Term Memory ◽

Treatment Gains ◽

Post Hoc

Purpose A significant relationship between verbal short-term memory (STM) and language performance in people with aphasia has been found across studies. However, very few studies have examined the predictive value of verbal STM in treatment outcomes. This study aims to determine if verbal STM can be used as a predictor of treatment success. Method Retrospective data from 25 people with aphasia in a larger randomized controlled trial of phonomotor treatment were analyzed. Digit and word spans from immediately pretreatment were run in multiple linear regression models to determine whether they predict magnitude of change from pre- to posttreatment and follow-up naming accuracy. Pretreatment, immediately posttreatment, and 3 months posttreatment digit and word span scores were compared to determine if they changed following a novel treatment approach. Results Verbal STM, as measured by digit and word spans, did not predict magnitude of change in naming accuracy from pre- to posttreatment nor from pretreatment to 3 months posttreatment. Furthermore, digit and word spans did not change from pre- to posttreatment or from pretreatment to 3 months posttreatment in the overall analysis. A post hoc analysis revealed that only the less impaired group showed significant changes in word span scores from pretreatment to 3 months posttreatment. Discussion The results suggest that digit and word spans do not predict treatment gains. In a less severe subsample of participants, digit and word span scores can change following phonomotor treatment; however, the overall results suggest that span scores may not change significantly. The implications of these findings are discussed within the broader purview of theoretical and empirical associations between aphasic language and verbal STM processing.

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