Multicenter Trial of the Jostent Balloon-Expandable Stent-Graft in Renal and Iliac Artery Lesions

Purpose: To report the results of a multicenter feasibility study of the Jostent balloon-expandable stent-graft in the treatment of renal and iliac artery lesions. Methods: Twenty-three patients (17 men; mean age 62 years, range 38–80) with lesions in the renal (n = 12) or iliac arteries (n = 12) were enrolled in 6 centers over a 1-year period. Preprocedural computed tomography (CT) and angiography were performed in all patients. The Jostent device was implanted in the 24 arteries to treat 11 in-stent stenoses, 2 arterial ruptures, 2 aneurysms, 2 dissections, 2 ulcerated stenoses, and 5 chronic occlusions. Follow-up included color duplex ultrasound examination on the day after the procedure and at 6 months; patients with renal artery stent-grafts were also evaluated with CT angiography. Results: Twenty-seven stent-grafts were deployed successfully in the 24 (100%) arteries. Seven (30%) patients required adjunctive procedures to address 1 acute in-stent thrombosis, 2 dissections, and 4 in-stent residual stenoses. At 6-month follow-up, 2 (8.3%) restenoses occurred in the renal arteries; these were treated successfully using balloon angioplasty. Conclusions: These data suggest that a balloon-expandable stent-graft may be safe and useful in patients with selected peripheral indications.

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Are There Long-Term Consequences of Iliac Artery Trauma during Endograft Implantation? Results of Serial Duplex Ultrasound Follow-up

Journal for Vascular Ultrasound ◽

10.1177/154431670502900203 ◽

2005 ◽

Vol 29 (2) ◽

pp. 71-73

Author(s):

Bernardo Mendoza ◽

George H. Meier ◽

Kathleen Carter ◽

Courtney Nelms ◽

Dulcie Chaler ◽

...

Keyword(s):

Iliac Artery ◽

Rare Event ◽

Duplex Ultrasound ◽

Abdominal Aortic Aneurysm Repair ◽

Main Body ◽

Iliac Arteries ◽

Intimal Medial Thickness ◽

Abdominal Aortic ◽

Duration Effect

Purpose The implantation of abdominal aortic endografts requires the insertion of large devices that have the potential to traumatize the iliac arteries, particularly on the ipsilateral side, where the main body of the endograft is introduced. The consequences of this potential trauma are unknown, but the possibility for significant injury remains. For this reason, a prospective measurement of iliac intimal medial thickness by serial duplex ultrasound was undertaken to determine the effect of endograft placement on iliac arteries. Methods A total of 117 patients had duplex evaluation of their iliac arteries after aortic endograft placement at an average follow-up of 18.8 months (range, 0 to 71 months). Ancure devices were used in 89, AneuRx in 11, Endologix in 12, Vanguard in 1, and unknown devices in 4. All endografts were scanned using Philips/ ATL HDI 5000 or ATL 3000 ultrasound machines with 7–4 MHz transducers and a standard protocol, with additional iliac artery measurements performed for the specifics of this study. Of these 117 patients, bilateral intimal medial thickness (IMT) was measured with a clearly determined ipsilateral (larger diameter sheath) implantation side defined in 66 patients. In these patients the ratio of ipsilateral (main introducer) IMT to contralateral (smaller diameter sheath) IMT was determined. Results Of the 66 patients with complete data available for review, the mean ipsilateral to contralateral IMT ratio was 1.41 (range, 0.3 to 16.4). Nonetheless, when evaluated more closely, only two patients had IMT ratios exceeding 2.0 (12.0 and 16.4). When these two patients are excluded, the IMT ratio averaged 1.01, suggesting an absence of significant intimal trauma secondary to aortic endograft implantation. If we presume that the cause of this increased intimal thickness is iliac trauma secondary to endograft placement, then the maximum incidence is 2/66 (3.0%). Analysis by follow-up intervals suggests no duration effect of significance. Conclusions Iliac artery trauma resulting in intimal hyperplasia or premature atherosclerosis appears to be a rare event after endograft abdominal aortic aneurysm repair. With current devices and current clinical selection, iliac artery pathology after endograft placement is not a significant concern.

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Surgical Reconstruction of the Iliac Arteries Prior to Endovascular Aortic Aneurysm Repair

Journal of Endovascular Therapy ◽

10.1177/152660289700400313 ◽

1997 ◽

Vol 4 (3) ◽

pp. 307-311 ◽

Cited By ~ 8

Author(s):

Timothy A.M. Chuter ◽

Linda M. Reilly

Keyword(s):

Aortic Aneurysm ◽

Stent Graft ◽

Iliac Artery ◽

Surgical Techniques ◽

Surgical Reconstruction ◽

Common Trunk ◽

Aortic Blood Flow ◽

Iliac Arteries ◽

The Right

Purpose: To explore a method of combined endovascular/conventional treatment of abdominal aortic aneurysm (AAA), in which the iliac arteries are reconstructed by conventional surgical techniques to provide the anatomic substrate for subsequent endovascular repair of the aortic aneurysm. Method: A 77-year-old patient with severe cardiac disease was found to have a 6.5-cm AAA, bilateral common iliac artery (CIA) aneurysms, and diffusely narrowed, tortuous external iliac arteries. The left internal iliac artery was occluded. At operation, the right CIA was exposed through a transverse retroperitoneal incision under epidural anesthesia. An iliobifemoral bypass was constructed using a preformed bifurcated graft. A stent-graft was delivered through the right limb of the bifurcated iliobifemoral graft. The proximal end of the stent-graft was implanted in the neck of the aneurysm, and the distal end was deployed in the common trunk of the iliobifemoral graft, thereby excluding the AAA and both native iliac arteries from prograde arterial flow. Results: Completion angiography and follow-up contrast computed tomography showed the aneurysm to be excluded from the circulation. The patient was not intubated, was never hemodynamically unstable, and had aortic blood flow interrupted for no more than 20 seconds. In addition, he was able to resume his usual diet on the first postoperative day. He continues to be well and without evidence of endoleak at 6-month follow-up. Conclusions: This case demonstrates that iliac artery stenosis, tortuosity, and aneurysmal dilatation are not impediments to endovascular AAA exclusion. Any necessary surgical modifications of pelvic arterial anatomy can be performed before stent-graft insertion to minimize aortic occlusion time.

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Treatment of Iliac Artery Aneurysms by Percutaneous Implantation of Stent Grafts

Circulation ◽

10.1161/circ.102.suppl_3.iii-253 ◽

2000 ◽

Vol 102 (suppl_3) ◽

Author(s):

D. Scheinert ◽

M. Schröder ◽

H. Steinkamp ◽

J. Ludwig ◽

G. Biamino

Keyword(s):

Treatment Option ◽

Iliac Artery ◽

Duplex Ultrasound ◽

External Iliac Artery ◽

Primary Patency ◽

Surgical Reconstruction ◽

Stent Grafts ◽

Invasive Treatment ◽

Effective Treatment Option

Background —Iliac artery aneurysms have traditionally been treated by direct surgical reconstruction. Endovascular stent grafts have been developed to provide an effective but less invasive treatment option for patients with peripheral arterial aneurysms. Methods and Results —In 48 patients, a total of 53 endoprostheses (mean length 7.3 cm, mean diameter 8.1 mm) were implanted into the iliac arteries (common iliac artery n=29, external iliac artery n=19) for percutaneous exclusion of aneurysmal lesions. The technical success of complete exclusion of the aneurysm was achieved in 47 of 48 cases (97.9%). In 1 case, persistent perfusion through a collateral branch was detected; however, this aneurysm thrombosed spontaneously within 2 weeks. In all patients, graft patency was monitored by clinical examination, which included the standardized treadmill test with calculation of the ankle-brachial Doppler index and color-coded duplex ultrasound. Forty-two of the 48 patients (87.5%) underwent follow-up angiography. According to Kaplan-Meier life-table calculations, primary patency rates were 100% after 1 year, 97.9% after 2 years, 94.9% after 3 years, and 87.6% after 4 years. Serial contrast-enhanced spiral CT scans were performed to rule out late procedural failures and to assess growth progression of the lesions. No secondary leaks were observed. Furthermore, the aneurysm diameter had reduced from 24.8±8.0 mm to 23.1±6.6 mm at the last follow-up ( P =NS). Conclusions —Stent grafts are a safe and effective treatment option for iliac artery aneurysms and provide good long-term patency of the graft.

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Modulation of carotid strain by statin therapy in atherosclerosis patients

VASA ◽

10.1024/0301-1526/a000596 ◽

2017 ◽

Vol 46 (2) ◽

pp. 108-115 ◽

Cited By ~ 3

Author(s):

Christian Alexander Schaefer ◽

Anna Katharina Blatzheim ◽

Sebastian Gorgonius Passon ◽

Kristin Solveig Pausewang ◽

Nadjib Schahab ◽

...

Keyword(s):

Statin Therapy ◽

Pulse Wave ◽

Ultrasound Examination ◽

Ankle Brachial Index ◽

Radial Strain ◽

Strain Analysis ◽

Duplex Ultrasound ◽

Strain Imaging ◽

The Common

Abstract. Background: The beneficial effect of statin therapy on the progress of atherosclerotic disease has been demonstrated by numerous studies. Vascular strain imaging is an arising method to evaluate arterial stiffness. Our study examined whether an influence of statin therapy on the vessel wall could be detected by vascular strain imaging. Patients and methods: 88 patients with recently detected atherosclerosis underwent an angiological examination including ankle-brachial index (ABI), pulse wave index (PWI), central puls ewave velocity and duplex ultrasound. Captures for vascular strain analysis were taken in B-mode during ultrasound examination of the common carotid artery and evaluated using a workstation equipped with a speckle tracking based software. A statin therapy was recommended and after six months a follow-up examination took place. Meanwhile, the non-adherence of a group of patients (N = 18) lead to a possibility to observe statin effects on the vascular strain. Results: In the statin non-adherent group the ABI decreased significantly to a still non-pathological level (1.2 ± 0.2 vs. 1.0 ± 0.2; p = 0.016) whereas it stagnated in the adherent group (1.0 ± 0.2 vs. 1.0 ± 0.2; p = 0.383). The PWI did not differ in the non-adherent group (180.5 ± 71.9 vs. 164.4 ± 75.8; p = 0.436) but under statin therapy it decreased significantly (261.8 ± 238.6 vs. 196.4 ± 137.4; p = 0.016). In comparison to the adherent group (4.2 ± 2.0 vs. 4.0 ± 1.8; p = 0.548) under statin therapy the radial strain decreased significantly in the non-adherent group (4.7 ± 2.0 vs. 3.3 ± 1.1; p = 0.014). Conclusions: Our findings reveal a beneficial influence of statin therapy on the arterial wall detected by vascular strain analysis.

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Endovenous radiofrequency powered segmental thermal ablation (Closure FAST) of great saphenous veins

Phlebologie ◽

10.1055/s-0037-1622301 ◽

2010 ◽

Vol 39 (02) ◽

pp. 69-71 ◽

Cited By ~ 6

Author(s):

T. M. Proebstle ◽

Keyword(s):

Side Effects ◽

Thermal Ablation ◽

Clinical Success ◽

Clinical Success Rate ◽

Duplex Ultrasound ◽

Multicenter Trial ◽

Saphenous Veins ◽

Clinical Control ◽

Prospective Multicenter Trial

Summary Background: Radiofrequency powered segmental thermal ablation Closure FAST has become a globally engaged technology for ablation of incompetent great saphenous veins (GSVs). Mid-term results of slowly resolving side effects are still not described. Methods: RSTA-treated GSVs (n = 295) were followed for 24 months in a prospective multicenter trial. Clinical control visits included flow and reflux analysis by duplex-ultrasound and assessment of treatment related side effects at all times. Results: 280 of 295 treated GSVs (94.9%) were available for 24 months follow-up. According to the method of Kaplan and Meier at 24 months after the intervention 98.6% of treated legs remained free of clinically relevant axial reflux. The average VCSS score improved from 3.9 ± 2.1 at screening to 0.7 ± 1.2 at 24 months follow-up (p < 0.0001). While only 41.1% of patients were free of pain before treatment, at 24 months 99.3% reported no pain and 96.4% did not experience pain during the 12 months before. At 24 months n=3 legs showed pigmentation along the inner thigh and one leg showed study-treatment related paresthesia. Conclusion: Radiofrequency powered segmental thermal ablation Closure FAST showed a very moderate side-effect profile in conjunction with a high and durable clinical success rate.

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Multicenter Trial of the Jostent Balloon-Expandable Stent-Graft in Renal and Iliac Artery Lesions

Journal of Endovascular Therapy ◽

10.1583/1545-1550(2003)010<0361:mtotjb>2.0.co;2 ◽

2003 ◽

Vol 10 (2) ◽

pp. 361-365 ◽

Cited By ~ 4

Author(s):

Virginia Gaxotte ◽

Brigitte Laurens ◽

Stéphan Haulon ◽

Christophe Lions ◽

Claire Mounier-Véhier ◽

...

Keyword(s):

Stent Graft ◽

Iliac Artery ◽

Multicenter Trial

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Internal valvuloplasty combined with sleeve wrapping in the treatment of severe deep venous incompetence: A case report

Vascular ◽

10.1177/1708538121990121 ◽

2021 ◽

pp. 170853812199012

Author(s):

Yingfeng Wu ◽

Libing Wei ◽

Xixiang Gao ◽

Yixia Qi ◽

Zhu Tong ◽

...

Keyword(s):

Lower Limb ◽

Venous Insufficiency ◽

Femoral Vein ◽

Duplex Ultrasound ◽

Vein Wall ◽

Polyester Urethane ◽

Left Lower Limb ◽

Deep Vein ◽

Color Duplex Ultrasound

Background The main cause of severe chronic venous insufficiency is deep venous incompetence. Deep venous reconstructive surgeries are reserved for cases that do not show a good response to conservative therapies. Method We present the case of a 68-year-old man presenting with swelling, pain, and pigmentation in his left lower limb for 14 years and ulcers for 10 years. Descending venography identified a Kistner’s grade IV reflux in the deep vein of the left lower limb. Internal valvuloplasty was performed following Kistner’s method. Meanwhile, external wrapping with a 1-cm-wide polyester-urethane vascular patch was performed to strengthen the vein wall in the venospasm condition. Results Symptoms were immediately relieved postoperatively. Refractory ulcers healed five months after the procedure. At the six-month follow-up, color duplex ultrasound of the deep vein of the left lower limb showed no reflux in the proximal segment of the femoral vein. Conclusion Internal valvuloplasty combined with sleeve wrapping is feasible in the treatment of severe deep venous incompetence with good short-term results.

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Endovascular Aneurysm Sealing of a Collapsed and Thrombosed Aortic Stent-Graft With Renovisceral Chimney Stent-Grafts

Journal of Endovascular Therapy ◽

10.1177/1526602818811915 ◽

2018 ◽

Vol 26 (1) ◽

pp. 72-75

Author(s):

Fabien Lareyre ◽

Claude Mialhe ◽

Carine Dommerc ◽

Juliette Raffort

Keyword(s):

Stent Graft ◽

Mesenteric Artery ◽

Endovascular Aneurysm Repair ◽

Stent Grafts ◽

Aortic Thrombosis ◽

Aortic Stent Graft ◽

Aneurysm Repair ◽

Stent Graft Implantation ◽

Graft Implantation

Purpose: To report the use of the Nellix endovascular aneurysm sealing (EVAS) system in the management of proximal stent-graft collapse associated with thrombosis following endovascular aneurysm repair (EVAR). Case Report: A 76-year-old man was admitted for proximal collapse of an aortic extension following bifurcated AFX stent-graft implantation associated with chimney grafts in both renal arteries and the superior mesenteric artery 1 month prior. Imaging identified thrombosis of the aortic stent-graft and the iliac limbs. A Nellix EVAS was placed into the AFX stent-graft to recanalize the aneurysm lumen and address the aortic thrombosis. There was no endoleak, and the renovisceral chimney stent-grafts remained patent over a follow-up of 25 months. Conclusion: While further studies are required to generalize its use, EVAS appears to be feasible in the management of aortic stent-graft collapse.

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Endovascular repair of aortic aneurysm: Preliminary results

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0902010d ◽

2009 ◽

Vol 137 (1-2) ◽

pp. 10-17 ◽

Cited By ~ 1

Author(s):

Lazar Davidovic ◽

Momcilo Colic ◽

Igor Koncar ◽

Dejan Markovic ◽

Dusan Kostic ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Stent Graft ◽

Endovascular Aneurysm Repair ◽

Aortic Aneurysms ◽

Endovascular Stent ◽

Stent Grafts ◽

Graft Thrombosis ◽

Abdominal Aortic

Introduction. Endovascular aneurysm repair (EVAR) has been introduced into clinical practice at the beginning of the 90's of the last century. Because of economic, political and social problems during the last 25 years, the introduction of this procedure in Serbia was not possible. Objective. The aim of this study was to present preliminary experiences and results of the Clinic for Vascular Surgery of the Serbian Clinical Centre in Belgrade in endovascular treatment of thoracic and abdominal aortic aneurysms. Methods. The procedure was performed in 33 patients (3 female and 30 male), aged from 42 to 83 years. Ten patients had a descending thoracic aorta aneurysm (three atherosclerotic, four traumatic - three chronic and one acute as a part of polytrauma, one dissected, two penetrated atherosclerotic ulcers), while 23 patients had the abdominal aortic aneurysm, one ruptured and two isolated iliac artery aneurysms. The indications for EVAR were isthmic aneurismal localisation, aged over 80 years and associated comorbidity (cardiac, pulmonary and cerebrovasular diseases, previous thoracotomy or multiple laparotomies associated with abdominal infection, idiopatic thrombocitopaenia). All of these patients had three or more risk factors. The diagnosis was established using duplex ultrasonography, angiography and MSCT. In the case of thoracic aneurysm, a Medtronic-Valiant? endovascular stent graft was implanted, while for the abdominal aortic aneurysm Medtronic-Talent? endovascular stent grafts with delivery systems were used. In three patients, following EVAR a surgical repair of the femoral artery aneurysm was performed, and in another three patients femoro-femoral cross over bypass followed implantation of aortouniiliac stent graft. Results. During procedure and follow-up period (mean 1.6 years), there were: one death, one conversion, one endoleak type 1, six patients with endoleak type 2 that disappeared during the follow-up period, one early graft thrombosis. No other complications, including aneurysm expansion, collapse, deformity and migration of the endovascular stent grafts, were registered. Conclusion. According to all medical and economic aspects, we recommend EVAR to treat acute traumatic thoracic aortic aneurysm, as well as in elderly and high-risk patients with abdominal or thoracic aneurysms, when open surgery is related to a significantly higher mortality and morbidity.

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