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A novel method to estimate iliac tortuosity in evaluating EVAR access.

https://arctichealth.org/en/permalink/ahliterature124812
Source
J Endovasc Ther. 2012 Apr;19(2):157-64
Publication Type
Article
Date
Apr-2012
Author
Thorarinn Kristmundsson
Björn Sonesson
Timothy Resch
Author Affiliation
Vascular Center, Skåne University Hospital, Malmö, Sweden. thorark@hotmail.com
Source
J Endovasc Ther. 2012 Apr;19(2):157-64
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Aged
Analysis of Variance
Aortic Aneurysm, Abdominal - radiography - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - instrumentation
Endovascular Procedures - instrumentation
Feasibility Studies
Female
Humans
Iliac Artery - radiography - surgery
Imaging, Three-Dimensional
Male
Multidetector Computed Tomography
Observer Variation
Patient Selection
Predictive value of tests
Preoperative Care
Prosthesis Design
Radiographic Image Interpretation, Computer-Assisted
Reproducibility of Results
Retrospective Studies
Stents
Sweden
Abstract
To subjectively and objectively evaluate the methods used for preoperative assessment of iliac artery tortuosity in patients with abdominal aortic aneurysms (AAA).
Iliac artery tortuosity was assessed retrospectively in 188 patients (160 men; mean age 73 years) diagnosed with AAA at our clinic in 2006 and 2007. All patients underwent preoperative computed tomography (CT) with predominantly thin-slice acquisitions. CT data were analyzed in a dedicated 3-dimensional workstation to perform centerline-of-flow measurements on 376 iliac arteries. Iliac tortuosity was evaluated using the following methods: (1) subjective grading (none, mild, moderate, severe) by 2 experienced observers, (2) calculating the modified iliac tortuosity index based on the published reporting standards for endovascular aneurysm repair, and (3) using the shortest distance between the aortic bifurcation and the common femoral artery (CFA) on axial CT scans as a surrogate for the tortuosity index. Correlation between the objective methods was assessed, and all 3 methods were evaluated for intra- and interobserver agreement.
(1) The intra- and interobserver agreement was substantial (? = 0.71 and ? = 0.65, respectively) for subjective grading, but few variations were found in the calculated tortuosity indexes between the subjective groups. (2) Intra- and interobserver correlations when measuring the iliac tortuosity index were strong (r = 0.94 and r = 0.79, respectively), with good intra- and interobserver agreement. (3) The new method had a strong correlation with iliac tortuosity index (r = 0.78); segregating the iliac arteries into 3 length categories (15 cm), the mean iliac tortuosity indexes were 2.0 ? 0.37, 1.6 ? 0.21, and 1.1 ? 0.27, respectively (p
PubMed ID
22545879 View in PubMed
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Efficacy and durability of the chimney graft technique in urgent and complex thoracic endovascular aortic repair.

https://arctichealth.org/en/permalink/ahliterature263150
Source
J Vasc Surg. 2015 Apr;61(4):886-94.e1
Publication Type
Article
Date
Apr-2015
Author
Adel Bin Jabr
Bengt Lindblad
Nuno Dias
Timothy Resch
Martin Malina
Source
J Vasc Surg. 2015 Apr;61(4):886-94.e1
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Aged
Aorta, Thoracic - surgery
Aortic Diseases - diagnosis - mortality - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Postoperative Complications - mortality - therapy
Prosthesis Design
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
This study reports the early and midterm to long-term experience of chimney grafts (CGs) in urgent endovascular repair of complex lesions in the thoracic aorta.
Twenty-nine high-risk patients (20 men) who were unfit for open repair were treated using CG technique for ruptured (n = 14) or symptomatic (n = 15) aortic lesions engaging the aortic arch itself (n = 9), the descending aorta (n = 10), or the thoracoabdominal aorta (n = 10). Twenty-two patients (76%) were treated urgently (=24 hours) and seven were semiurgent (=3 days). Of 41 chimneys used, 24 were placed in supra-aortic branches and 17 in visceral branches. Median follow-up (interquartile range) for the entire cohort was 2 years (0.6-3.8 years), 2.5 years (1-4 years) for 30-day survivors, and 3.5 years (1.9-6.4 years) for those who were still alive.
Four patients (14%) died =30 days of cerebral infarction (n = 1), visceral ischemia secondary to the initial rupture (n = 1), multiple organ failure (n = 1), or heart failure (n = 1). There were 11 late deaths (38%); however, only two deaths were related to the CG technique. The primary and secondary technical success rates were 86% (25 of 29) and 97% (28 of 29), respectively. The secondary patency rate of CGs was 98%. Seventeen (68%) of the aortic lesions shrank significantly. Three patients (10%) had primary type I endoleak and another three (10%) had secondary type I endoleak. The endoleaks were managed with Onyx (ev3 Endovascular, Inc, Plymouth, Minn) or coil embolization (n = 2), restenting (n = 1), and conversion to open repair (n = 2). One secondary endoleak is still under observation after >20 months. All primary endoleaks and one secondary endoleak originated from CGs in the brachiocephalic trunk (4 of 6 [67%]).
The midterm to long-term results of the CG technique for urgent and complex lesions of the thoracic aorta in high-risk patients are promising, with low early mortality and long durability of the CGs. More patients with longer follow-up are still needed.
PubMed ID
25616907 View in PubMed
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Outcomes of fenestrated endovascular repair of juxtarenal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature107411
Source
J Vasc Surg. 2014 Jan;59(1):115-20
Publication Type
Article
Date
Jan-2014
Author
Thorarinn Kristmundsson
Björn Sonesson
Nuno Dias
Per Törnqvist
Martin Malina
Timothy Resch
Author Affiliation
Vascular Center, Skåne University Hospital, Malmö, Sweden. Electronic address: thorark@hotmail.com.
Source
J Vasc Surg. 2014 Jan;59(1):115-20
Date
Jan-2014
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - mortality - radiography - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Male
Postoperative Complications - mortality - physiopathology - therapy
Risk factors
Stents
Sweden
Tertiary Care Centers
Time Factors
Tomography, Spiral Computed
Treatment Outcome
Vascular Patency
Abstract
To evaluate late outcomes after fenestrated endovascular aortic repair (f-EVAR) in a tertiary European referral center.
In 2009, we published short- and midterm results after f-EVAR in the first 54 patients treated with this technique at our center between September 2002 and June 2007. In this paper, we provide long-term follow-up of the same patient cohort with the main focus on target vessel (TV) patency, renal function, reinterventions, and survival.
A total of 54 patients were included in this study. Median age was 72 years (interquartile range [IQR], 68-76 years) at primary operation, and 85% were men. Median preoperative aneurysm diameter was 60 mm (IQR, 53-66 mm). One hundred thirty-four vessels were targeted (mean, 2.5 per patient), and 96 TV stents were placed. The median clinical follow-up was 67 months (IQR, 37-90 months), and computed tomography follow-up was 60 months (IQR, 35-72 months). Aneurysm diameter decreased = 5 mm in 39% ± 7% at 12 months, 64% ± 8% at 36 months, and 71% ± 8% at 60 months. Primary TV patency was 94% ± 2% at 12 months, 91% ± 3% at 36 months, and 90% ± 3% at 60 months. Glomerular filtration rate decreased by 17% at 59 months (IQR, 26-73 months) follow-up (60 [IQR, 46-79] vs 50 [IQR, 38-72] mL/min/1.73 m(2); P
PubMed ID
24011738 View in PubMed
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Intra-aneurysm sac pressure measurements after endovascular aneurysm repair: differences between shrinking, unchanged, and expanding aneurysms with and without endoleaks.

https://arctichealth.org/en/permalink/ahliterature179716
Source
J Vasc Surg. 2004 Jun;39(6):1229-35
Publication Type
Article
Date
Jun-2004
Author
Nuno V Dias
Krassi Ivancev
Martin Malina
Timothy Resch
Bengt Lindblad
Björn Sonesson
Author Affiliation
Endovascular Center, Department of Radiology, UMAS, Malmö University Hospital, S-205 02 Malmö, Sweden. nunovdias@hotmail.com
Source
J Vasc Surg. 2004 Jun;39(6):1229-35
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - physiopathology - radiography - surgery
Blood Pressure - physiology
Blood Pressure Determination
Diastole - physiology
Embolization, Therapeutic
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications - etiology - physiopathology - therapy
Reoperation
Sweden
Systole - physiology
Tomography, X-Ray Computed
Treatment Outcome
Vascular Surgical Procedures
Abstract
Our objective was to study intra-aneurysm pressure after endovascular aneurysm repair (EVAR) in shrinking, unchanged, and expanding abdominal aortic aneurysms (AAAs) with and without endoleaks.
Direct intra-aneurysm sac pressure measurement (DISP) by percutaneous translumbar puncture of the AAA under fluoroscopic guidance was performed 46 times during the follow-up of 37 patients (30 men; median age, 73 years [range, 58-82 years]; AAA diameter: median, 60 mm [range, 48-84 mm]). Three patients were included in two different groups because DISP was performed more than once with different indications. Tip-pressure sensors mounted on 0.014-inch guidewires were used for simultaneous measurement of systemic and AAA sac pressures. Mean pressure index (MPI) was calculated as the percentage of mean intra-aneurysm pressure relative to the simultaneous mean intra-aortic pressure.
Median MPI was 19% in shrinking (11 patients), 30% in unchanged (10 patients), and 59% in expanding (9 patients) aneurysms without endoleaks. Pulse pressure was also higher in expanding (10 mm Hg) compared with shrinking (2 mm Hg; P
PubMed ID
15192561 View in PubMed
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Outcome of visceral chimney grafts after urgent endovascular repair of complex aortic lesions.

https://arctichealth.org/en/permalink/ahliterature274258
Source
J Vasc Surg. 2016 Mar;63(3):625-33
Publication Type
Article
Date
Mar-2016
Author
Adel Bin Jabr
Bengt Lindblad
Thorarinn Kristmundsson
Nuno Dias
Timothy Resch
Martin Malina
Source
J Vasc Surg. 2016 Mar;63(3):625-33
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Aorta, Abdominal - physiopathology - radiography - surgery
Aortic Aneurysm, Abdominal - diagnosis - mortality - physiopathology - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Cause of Death
Emergencies
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
Humans
Kaplan-Meier Estimate
Male
Postoperative Complications - mortality - therapy
Prosthesis Design
Retreatment
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Vascular Patency
Abstract
Endovascular abdominal aortic repair requires an adequate sealing zone. The chimney graft (CG) technique may be the only option for urgent high-risk patients who are unfit for open repair and have no adequate sealing zone. This single-center experience provides long-term results of CGs with endovascular repair for urgent and complex aortic lesions.
Between July 2006 and October 2012, 51 patients (16 women) with a median age of 77 years (interquartile range, 72-81 years), were treated urgently (within 24 hours [61%]) or semiurgently (within 3 days [39%]) with endovascular aortic repair and visceral CGs (n = 73). Median follow-up was 2.3 years (interquartile range, 0.8-5.0 years) for the whole cohort, 3 years for 30-day survivors, and 4.8 years for patients who are still alive.
Five patients (10%) died within 30 days. All of them had a sacrificed kidney. All-cause mortality was 57% (n = 29), but the chimney- and procedure-related mortality was 6% (n = 3) and 16% (n = 8), respectively. Chimney-related death was due to bleeding, infection, renal failure, and multiple organ failure. There were two postoperative ruptures; both were fatal although not related to the treated disease. The primary and secondary long-term CG patencies were 89% (65 of 73) and 93% (68 of 73), respectively. Primary type I endoleak (EL-I) occurred in 10% (5 of 51) of the patients, and only one patient had recurrent EL-I (2%; 1 of 51). No secondary endoleak was observed. Chimney-related reintervention was required in 16% (8 of 51) of the patients because of EL-I (n = 3), visceral ischemia (n = 4), and bleeding (n = 2). The reinterventions included stenting (n = 5), embolization (n = 3), and laparotomy (n = 2). Thirty-one visceral branches were sacrificed (9 celiac trunks, 9 right, and 13 left renal arteries). Among the 30-day survivors, 8 of 17 patients (47%) with a sacrificed kidney required permanent dialysis; of these, seven underwent an urgent index operation. The aneurysm sac shrank in 63% (29 of 46) of cases.
The 6% chimney-related mortality and 93% long-term patency seem promising in urgent, complex aortic lesions of a high-risk population and may justify a continued yet restrictive applicability of this technique. Most endoleaks could be sealed endovascularly. However, sacrifice of a kidney in this elderly cohort was associated with permanent dialysis in 47% of patients.
PubMed ID
26527423 View in PubMed
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Early versus late experience in fenestrated endovascular repair for abdominal aortic aneurysm.

https://arctichealth.org/en/permalink/ahliterature263151
Source
J Vasc Surg. 2015 Apr;61(4):895-901
Publication Type
Article
Date
Apr-2015
Author
Magnus Sveinsson
Jonathan Sobocinski
Timothy Resch
Björn Sonesson
Nuno Dias
Stéphan Haulon
Thorarinn Kristmundsson
Source
J Vasc Surg. 2015 Apr;61(4):895-901
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Aged
Aortic Aneurysm, Abdominal - diagnosis - surgery
Aortography - methods
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - methods
Contrast Media - diagnostic use
Endovascular Procedures - adverse effects - instrumentation - methods
Female
France
Humans
Male
Middle Aged
Operative Time
Patient Safety
Patient Selection
Predictive value of tests
Prosthesis Design
Radiation Dosage
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Abstract
The objective of this study was to evaluate operative results and 1-year outcomes in early vs late experience after fenestrated endovascular aortic repair.
All patients treated in Malmö, Sweden, and in Lille, France, with fenestrated endovascular repair for abdominal aortic aneurysm were prospectively enrolled in a computerized database. Early experience was defined as the first 50 patients treated at each center. Data from early and late experience were retrospectively analyzed and compared for differences in operative results and 1-year outcomes.
Early experience covered 4.7 years in Malmö and 4.5 years in Lille; late experience covered 5.6 years in Malmö and 3.7 years in Lille. A total of 288 patients were included. In the later phase, stent graft configuration was more complex because of increased number of fenestrations/scallops incorporated in the graft design (2.7 ± 0.8 vs 3.2 ± 0.7; P
PubMed ID
25595398 View in PubMed
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Source
Ann Vasc Surg. 2014 Aug;28(6):1396-401
Publication Type
Article
Date
Aug-2014
Author
Adrien Hertault
Jonathan Sobocinski
Thorarinn Kristmundsson
Blandine Maurel
Nuno V Dias
Richard Azzaoui
Björn Sonesson
Timothy Resch
Stéphan Haulon
Source
Ann Vasc Surg. 2014 Aug;28(6):1396-401
Date
Aug-2014
Language
English
Publication Type
Article
Keywords
Age Factors
Aged
Aged, 80 and over
Aortic Aneurysm, Abdominal - diagnosis - mortality - surgery
Blood Vessel Prosthesis
Blood Vessel Prosthesis Implantation - adverse effects - instrumentation - mortality
Databases, Factual
Endovascular Procedures - adverse effects - instrumentation - mortality
Female
France
Hospitals, High-Volume
Humans
Kaplan-Meier Estimate
Life expectancy
Male
Middle Aged
Patient Selection
Prosthesis Design
Retrospective Studies
Risk factors
Stents
Sweden
Time Factors
Treatment Outcome
Abstract
To evaluate the clinical outcomes after fenestrated endovascular aortic aneurysm repair (F-EVAR) in octogenarians.
Between 2002 and 2012, all data from patients treated with custom-made fenestrated endografts for elective juxtarenal or pararenal aortic aneurysms in 2 high-volume centers (Malmö, Sweden & Lille, France) were prospectively entered in a computer database. Demographics and perioperative and follow-up results of patients aged =80 years (group 1) and patients aged
PubMed ID
24530722 View in PubMed
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7 records – page 1 of 1.