Endovascular Therapy Research Papers - Academia.edu (original) (raw)

To evaluate the displacement forces acting on an aortic endograft when the iliac limbs are crossed... more

To evaluate the displacement forces acting on an aortic endograft when the iliac limbs are crossed ("ballerina" position). An endograft model was computationally reconstructed based on data from a patient whose infrarenal aortic aneurysm had an endovascular stent-graft implanted with the iliac limbs crossed. Computational fluid dynamics analysis determined the maximum displacement force on the endograft and separately on the bifurcation and iliac limbs. Its analogue model was reconstructed for comparison, assuming the neck, main body, and total length constant but considering the iliac limbs to be deployed in the usual bifurcated mode. Calculations were repeated after developing "idealized" models of both the bifurcated and crossed-limbs endografts with straight main bodies and no neck angulation or curved iliac segments. The vector of the total force was directed anterocaudal for both the typical bifurcated and the crossed-limbs configurations, with the forces in the latter slightly reduced and the vertical component accounting for most of the force in both configurations. Idealized crossed-limbs and bifurcated configurations differed only in the force on the iliac limbs, but this difference disappeared in the realistic models. Crossing of the iliac limbs can slightly affect the direction of the displacement forces. Although this configuration can exert larger forces on the limbs than in the bifurcated mode, this effect can be blunted by concomitant modifications in the geometry of the main body and other parts of the endograft, making its hemodynamic behavior resemble that of a typically positioned endograft.

Compared with the coronary setting, knowledge about antithrombotic therapies after endovascular treatment (EVT) is inadequate in patients with peripheral artery disease (PAD). Based on a review of trials and guidelines, which is... more

Compared with the coronary setting, knowledge about antithrombotic therapies after endovascular treatment (EVT) is inadequate in patients with peripheral artery disease (PAD). Based on a review of trials and guidelines, which is summarized in this article, there is scant evidence that antithrombotic drugs improve outcome after peripheral EVT. To address this knowledge gap, the randomized, open-label, multinational edoxaban in patients with Peripheral Artery Disease (ePAD) study (ClinicalTrials.gov identifier NCT01802775) was designed to explore the safety and efficacy of a combined regimen of antiplatelet therapy with clopidogrel and anticoagulation with edoxaban, a selective and direct factor Xa inhibitor, both combined with aspirin. As of July 2014, 203 patients (144 men; mean age 67 years) from 7 countries have been enrolled. These patients have been allocated to once-daily edoxaban [60 mg for 3 months (or 30 mg in the presence of factors associated with increased exposure)] or c...

To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. A retrospective... more

To determine which patient and C-arm characteristics are the strongest predictors of intraoperative patient radiation dose rates (DRs) during endovascular aneurysm repair (EVAR) procedures and create a patient risk chart. A retrospective analysis was performed of 74 EVAR procedures, including 16,889 X-ray runs using fixed C-arm imaging equipment. Four multivariate log-linear mixed models (with patient as a random effect) were constructed. Mean air kerma DR (DRAK, mGy/s) and the mean dose area product DR (DRDAP, mGycm(2)/s) were the outcome variables utilized for fluoroscopy as differentiated from digital subtraction angiography (DSA). These models were used to predict the maximum radiation duration allowed before a 2-Gy skin threshold (for DRAK) or a 500-Gycm(2) threshold (for DRDAP) was reached. The strongest predictor of DRAK and DRDAP for fluoroscopy imaging was the radiation protocol, with an increase of 200% when changing from "low" to "medium" and 410% from...

Endovascular treatment of brain aneurysms with flow diverter device can be technically difficult. Obtaining distal access through the wide neck of a large or giant aneurysm may be challenging and sometimes the microcatheter needs to be... more

Endovascular treatment of brain aneurysms with flow diverter device can be technically difficult. Obtaining distal access through the wide neck of a large or giant aneurysm may be challenging and sometimes the microcatheter needs to be looped inside the aneurysm. However, the inability to resolve this loop and to straighten the microcatheter can preclude flow diverter placement. This brief report presents four cases of large/giant aneurysms treated with flow diverter device, in which our innovative stent-retriever anchor technique was used to obtain the distal access of the parent artery. All procedures were technically successful, and no complications were recorded.

To compare the immediate suprarenal neck angulation change between the Ovation stent-graft, with its inflatable sealing rings, and a stent-graft with a conventional sealing mechanism. A case-control study was conducted in which 30... more

To compare the immediate suprarenal neck angulation change between the Ovation stent-graft, with its inflatable sealing rings, and a stent-graft with a conventional sealing mechanism. A case-control study was conducted in which 30 consecutive patients (mean age 67 years; all men) with abdominal aortic aneurysm (AAA) treated with the Ovation stent-graft (group O) were retrospectively compared with 24 patients (mean age 77 years; all men) contemporaneously treated with the Endurant stent-graft (group E) at 3 high-volume tertiary vascular centers. The variables recorded were the aortic neck length, preoperative and postoperative angulation, minimum and maximum diameters of the infrarenal neck, as well as the maximum AAA diameter. All patients had undergone preoperative and postoperative (within 30 days) computed tomographic angiography. Multiple regression analysis compared the relative contribution to neck angulation change of each geometric parameter and the type of endograft. Data a...

The IN.PACT Global Study is the largest prospective, multicenter, independently adjudicated trial to evaluate a paclitaxel drug-coated balloon in patients with lifestyle-limiting claudication and/or ischemic rest pain due to... more

The IN.PACT Global Study is the largest prospective, multicenter, independently adjudicated trial to evaluate a paclitaxel drug-coated balloon in patients with lifestyle-limiting claudication and/or ischemic rest pain due to atherosclerotic disease of the femoropopliteal artery and includes complex lesions beyond what are typically included in randomized controlled trials. Randomized controlled trials have demonstrated the safety and efficacy of drug-coated balloons for the treatment of Trans-Atlantic Inter-Society Consensus Document II A and B lesions, but there is a need for large-scale prospective studies to evaluate a broader range of lesions. The IN.PACT Global Study enrolled 1,535 subjects, and 1,406 (1,773 lesions) were included in the pre-defined clinical cohort analysis. Freedom from clinically driven target lesion revascularization was evaluated at 24 months. The safety composite endpoint was freedom from device- and procedure-related death through 30 days and freedom from...

To describe the short-term consequences of endovascular aortic aneurysm repair (EVAR) on renal function after infrarenal (IR) versus transrenal (TR) stent-graft fixation. Between December 1996 and January 2006, 369 consecutive patients... more

To describe the short-term consequences of endovascular aortic aneurysm repair (EVAR) on renal function after infrarenal (IR) versus transrenal (TR) stent-graft fixation. Between December 1996 and January 2006, 369 consecutive patients were treated with EVAR. All patients had an AneuRx or a Talent stent-graft implanted using IR (AneuRx) or transrenal (Talent) fixation. Post-EVAR, a standardized follow-up scheme included computed tomography (CT) scanning and serum creatinine measurements at 2 days, 3 months, and 12 months. Postoperative renal dysfunction was defined as a >20% decrease in serum creatinine clearance compared to baseline, the presence of new-onset dialysis, or both. Of the 369 patients, 309 (291 men; mean age 71+/-7 years, range 63-82) had complete 1-year follow-up and were included in this study. An IR stent-graft was placed in 190 patients, and a TR stent-graft was placed in the remaining 119 patients. At discharge, renal dysfunction occurred in 3.7% of the patients in the IR group versus 5.9% in the TR group (p = NS) and rose significantly to 13.7% in the IR group (p = 0.001) and 15.1% in the TR group (p = 0.02) at the 1-year follow-up. However, no significant difference was noted between the IR and TR groups at either time point. At the 1-year follow-up, at least 50% of renal dysfunction was caused by obstructions of (accessory) renal arteries and renal infarctions. During the follow-up interval, 3 (0.97%) of 309 patients underwent new-onset dialysis. Both infrarenal and transrenal fixation techniques in EVAR will lead to a significant rise in renal dysfunction during the first year. A few patients with dysfunction will require dialysis.