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OBJECTIVE To compare short-, intermediate-, and long-term results between dogs with tracheal collapse (TC) that received multimodal medical management only and those that underwent tracheal endoluminal stent placement. ANIMALS 159 dogs with TC that underwent medical management only (MM group; n = 84) or were surgically managed by stent placement (SM group; 75). PROCEDURES Medical records of dogs with TC that underwent medical management only or stent placement at a referral hospital between September 1, 2009, and August 1, 2018, were reviewed. Data regarding signalment, information relevant to TC, and outcome were extracted from the records and aggregated into short-, intermediate-, and long-term follow-up periods for analysis. Descriptive data and median survival times (MSTs) were compared between the MM and SM groups. RESULTS Clinical signs of dogs in the MM group generally improved during the short term but regressed and worsened over time. The proportion of dogs with malformation-type TC that underwent stent placement (38/43 [88%]) was significantly greater than the proportion of dogs with traditional-type TC that underwent stent placement (37/107 [35%]). The MST from TC diagnosis was 3.7 years for the MM group and 5.2 years for the SM group. For dogs with severe disease, the MST was 12 days for medically managed dogs and 1,338 days for dogs that underwent stent placement. CONCLUSIONS AND CLINICAL RELEVANCE Multimodal medical management alleviated clinical signs for months to years in dogs with mild to moderate TC disease, but stent placement should be considered for dogs with severe disease.

OBJECTIVE To evaluate outcomes following endoluminal stent placement for treatment of tracheal collapse (TC) in dogs. DESIGN Retrospective case series with nested observational study. ANIMALS 75 dogs that underwent endoluminal placement of a self-expanding metallic stent to treat TC between September 2009 and August 2015. PROCEDURES Medical records were reviewed to collect data on dog characteristics, clinical signs, TC type, diagnostic test results, peri- and postoperative complications, and outcomes. Complication rates and survival times and rates were compared between various groups. RESULTS The 75 dogs received 119 stents (56% [42/75] received 1 stent and 44% [33/75] received ≥ 2 stents). Thirty-eight (51%) dogs had a malformation type of TC, and 37 (49%) had the traditional type. Ninety-three percent (70/75) of dogs survived to hospital discharge. Median survival time was 1,005 days. Improvement in goose-honking or raspy breathing (89% [42/47]) and dyspnea (84% [43/51]) was reported at final follow-up examination. Major complications requiring additional stent placement procedures occurred in 47% (33/70) of dogs over the follow-up period; stent fracture and tissue ingrowth were the most common types. Male dogs and younger dogs had a significantly longer survival time than other dogs. Mainstem bronchial collapse at the time of stent placement had no significant association with outcome. CONCLUSIONS AND CLINICAL RELEVANCE Endoluminal stent placement provided a high survival rate for dogs with TC, even those with severe clinical signs. This information, as well as the information on potential complications, should be useful for advising owners of affected dogs.

We could observe the endoluminal stent graft (SG) following thoracic endovascular aneurysm repair (TEVAR) by a coronary artery angioscope and establish intravascular visualization of SG. The patient was a 70-year-old woman with the distal aortic arch aneurysm and the descending aortic aneurysm, and debranching TEVAR were performed. After 12 months follow up, urgent hospitalization was required for chest pain, and cardiac catheter examination with a coronary artery angioscope was performed. The endoluminal SG was observed. The observation in angioscope which is a video image is better than CT that is a still image, and observation in blood vessel or SG is possible. It may be possible to observe the endoluminal SG, allowing potential investigation of an endoleak, or the covering status of the SG with the native aortic vessel wall, or the state of intimal membrane formation in the endoluminal graft.

BACKGROUND AND STUDY AIMS Gastrointestinal stents have become an important therapeutic option for several indications. However, migration in up to 40 % of cases represents a significant drawback, especially when covered prostheses are used. We hypothesized that a novel endoscopic suturing device could enable endoluminal stent fixation, which might increase attachment and thereby potentially reduce migration. PATIENTS AND METHODS In an initial ex vivo porcine model, stents were attached to the esophageal wall with either endoscopic hemoclips or by endoscopic suture stent fixation (ESSF). The distal tension force required to induce dislocation was measured in Newtons (N) by a digital force gauge and was compared with conventional stent placement. ESSF was then performed clinically in five patients, in whom self-expanding metal stents were sutured in place for endoscopic treatment of gastrointestinal fistulas or strictures. RESULTS Esophageal ESSF was achieved in all experiments and significantly increased the force needed to displace the stent (n = 12; mean force 20.4 N; 95 % confidence interval [CI]: 15.4 - 25.4; P

Self-expanding metal stents (SEMS) have been successfully used as a "bridge to surgery" or as palliation for acute malignant colorectal obstruction. Little data on the use of stents for benign obstruction exists and the results vary. The purpose of this study was to evaluate the efficacy and safety of SEMS in benign colorectal obstruction.A total of 21 patients with 23 SEMS procedures between the years 1998 and 2008 were retrospectively studied. Eight patients had an obstruction in the surgical anastomosis. In addition, there were two patients with anastomotic strictures due to Crohn's disease. In 10 patients the obstruction was caused by diverticular disease and one patient had a stricture after radiation therapy.Technical success was achieved for all the patients. Clinical success was achieved for 76% (16/21) of the patients. The anastomotic strictures were resolved with SEMS in 5 out of 8 cases (63%). Three patients with diverticular stricture (30%) were eventually resolved with SEMS. Nine (43%) patients in 10 out of 23 procedures (43%) had a complication, the majority being in patients with diverticular stricture.SEMS is a good treatment option for patients with anastomotic stricture of the colon and for patients with benign colonic stricture who are unfit for surgery. SEMS can be used as a bridge to surgery in diverticular obstruction but there seems to be a considerable risk of complications. If a SEMS is placed into a diverticular stricture, the planned bowel resection should be performed within a month.

The objective of this study was to measure the pulsatile forces acting on a symmetric, bifurcated endoluminal stent graft to validate a computational fluid dynamics (CFD) and analytic model so that they can be used for various graft dimensions. We used a load cell to measure the force owing to the movement of an acrylic model of a bifurcated stent graft under pulsatile flow. This was then simulated with a CFD and analytic model. The main features of the experimental pulsatile force data and the CFD results were consistent. The results showed that the total force was proportional to the inlet pressure cycle. The force rose from 3.32 N at 130 mm Hg systolic to 17.5 N at 250 mm Hg systolic pressure. For the more variable regions of the flow, the experimentally measured forces lagged the computational and analytic results. The CFD and analytic models provide approximate descriptions for the forces acting on a bifurcated stent graft subjected to pulsatile flow. Such models should be of assistance to designers of endoluminal stent grafts.

This article traces the evolution in management of blunt aortic injury (BAI) over the past 50 years from the time of the seminal description from Parmley in 1958. There have been major advances in both diagnostics and treatment paradigms with very rapid technologic advances occurring over the past decade. For many years, conventional aortography was the principle diagnostic tool, but it has been replaced by the progression of CT. The widespread adoption of antihypertensive therapy has sharply reduced the incidence of aortic rupture before planned reconstruction. Many patients with major associated injuries have definitive treatment of BAI managed in a delayed fashion with the use of hypertensives, which appears to improve outcomes. In the past 5 years, definitive treatment has changed with the majority of injuries being treated today with endoluminal stent grafts as opposed to open thoracotomy and traditional repair techniques. Paraplegia rates have diminished from 8 to 10 per cent down to 1 to 2 per cent in association with these therapeutic advances.

Background: Obstruction of the left colon may be the first manifestation of colorectal cancer. Resection of the colonic segment involved and the construction of an end colostomy (Hartman’s procedure) is the most frequent treatment. Alternatives to the placement of a stoma are subtotal colectomy or intraoperative lavage of the colon and primary anastomosis, but their application depends on intraoperative findings and the availability of a skilled surgeon. The use of an expandable stent (SEMS) can enhance the feasibility of laparoscopic colectomy, avoiding the need for a colostomy and offering the advantages of a combination of two minimally invasive procedures. Study Design: Between 1997 and 2004, an SEMS was placed in 11 cases of left colonic obstruction due to cancer, the obstruction being successfully resolved in each case. Seven patients were approached by laparoscopy to attempt the definitive colectomy. We evaluated the location and pathological characteristics of the tumor, effectiveness and complications of SEMS insertion, time interval between the insertion of SEMS and laparoscopic surgery, and postoperative data. Results: The tumors were situated in the recto-sigma (1 case), sigma (3 cases) and descending colon (3 cases). Immediate relief of the obstruction was achieved in all cases after SEMS insertion of the stent, and oral diet was started at 24 h. The 7 patients were operated on an average of 8 days (range 6–14) after insertion of the stent. Conversion to open surgery was necessary in one case for reasons not related to the stent. Conclusions: Preliminary results of the combination of SEMS and elective laparoscopic surgery demonstrate that the procedure is feasible and that it presents all the clinical advantages of a minimally invasive approach. The procedure is a valid alternative to traditional major urgent surgery.

The objective of this study was to describe the development of a comprehensive surveillance program for monitoring the long-term follow-up of endoluminal stent graft (ELG) patients. Despite high procedural success rates, ELG patients remain at ongoing risk for aneurysm sac expansion, rupture, and other adverse events that make long-term surveillance imperative. As they perform more ELG, practitioners face increased logistical difficulty performing appropriate patient follow-up. A computer-based data ELG registry was created using Epi Info, a program developed by the Centers for Disease Control and Prevention that enables users to design a data entry form, enter data, and perform statistical analyses. The database has been used to track 259 patients (214 men and 45 women) who underwent ELG between November 1999 and October 2003. One-year follow-up was available for 182 patients, 2-year follow-up for 104 patients, and 3-year surveillance data for 40 patients, which represent follow-up rates of 89.6%, 78.8%, and 61.5%, respectively. There were 25 late deaths. The Kaplan-Meier estimate for 1-year survival was 92.5%. Twenty-one patients underwent 24 secondary angiographic procedures at a mean 8.6 ± 10.3 months (range, 1–37.6) after stent-graft repair. No mortality was observed in association with a secondary intervention. There were no late conversions to open aneurysm repair. The Kaplan-Meier estimate for freedom from secondary intervention for all patients at 1 year was 91.0%. A computer-based registry facilitates appropriate and timely patient follow-up and may improve the long-term outcome from ELG. Catheter Cardiovasc Interv 2004;62:252–261. © 2004 Wiley-Liss, Inc.

Blunt traumatic aortic transection remains a lethal condition. Treatment requires a high index of suspicion, prompt diagnosis, and expedient operative repair. Even in the best of circumstances, morbidity and mortality associated with open surgical repair are high, particularly because of frequent occurrence of other severe associated injuries. Endoluminal aortic stent-graft repair is an accepted treatment option in patients with aneurysm degeneration, and may be an alternative means of managing contained aortic transection. We describe three cases of blunt traumatic thoracic aortic transection treated with commercially available aortic endoluminal stent grafts.

Development of endoluminal repair has substantially reduced mortality and morbidity associated with repair of the thoracic aorta. It has significant advantages over conventional surgical repair, particularly in the management of acute dissection and thoracic aortic injury. Despite these perceived advantages it is important to realize that no level 1 data are available to prove safety and/or efficacy. Because the advantages are perceived to be so great these data are unable to be accrued and it is important that clinicians involved with this procedure keep rigorous data and undertake ongoing evaluation to ensure that clinical perceptions are eventually underpinned by robust data.

Purpose:To investigate what effect, if any, the presence of a stent wire in front of a renal artery has on the volume flow rate of blood through the renal artery.Methods:Experimental, numerical, an...

Background: The purpose of the present paper was to review the initial experience of an endovascular aortic stent graft program at a major teaching hospital in Hong Kong. Methods: Demographics, operative details, complications and follow-up data of all the patients receiving endovascular repair for aortic disease were recorded prospectively. Results: Between July 1999 and December 2001, endovascular repairs were attempted in 39 patients with aortic disease. The procedural success rate was 97.4%. Thirty-three procedures were for abdominal aorto-iliac aneurysms. Graft configuration was bifurcated in 28 patients (85%) while an aorto-uni-iliac device with a femoro-femoral bypass was carried out in the remaining five patients. Thoracic procedures were carried out for one thoracic aortic aneurysm, two traumatic thoracic aortic injuries, one thoracic aortic dissection, and one thoracic aortic pseudoaneurysm with aorto-oesophageal fistula. There was one hospital mortality (2.6%) from a type A thoracic aortic dissection with cardiac tamponade. Postoperative complications were seen in seven patients (18%). With a mean follow-up of 11.6 ± 8.1 months, there was no open conversion or rupture. The endoleak rate was 27% at discharge, 15% at 6 months and 5% at 12 months postoperatively. For aneurysm endografts, the aneurysm sac decreased in size in 21 patients (62%), and remained static in 13 patients (38%). Conclusions: The endoluminal stent graft appears to be a promising device that can be used safely in selected patients with aortic disease. Continued follow-up is required to monitor the presence of endoleak and the size of the aneurysm sac.

Endovascular technologies provide a new therapeutic option in the treatment for acute traumatic rupture of the thoracic aorta. We report our experience with endoluminal stent graft repair of thoracic aortic ruptures.Five patients underwent repair of the thoracic aorta with an endoluminal stent graft for acute traumatic rupture. Data from patient history, the procedure, hospital course, and follow-up were analyzed.All patient were involved in motor vehicle crashes. The mean Injury Severity Score was 51.8 +/- 6.38. All procedures were technically successful. Mean operating room time was 111 minutes and mean estimated blood loss was 200 mL. There were no cases of postprocedural endoleaks or conversions. There were no procedural complications, paraplegia, or deaths. Average follow-up was 20.2 months.Five cases of successful endograft repair of thoracic aortic rupture have been demonstrated. This should encourage future studies to determine whether endovascular repair of thoracic aortic ruptures is a safe and feasible alternative to conventional open repair.

Purpose: To present a renal artery aneurysm that was treated successfully by endoluminal grafting. Case Report: A 48-year-old woman presented with a 2.5-cm saccular left renal artery aneurysm. A Jostent coronary stent-graft was placed transluminally into the left renal artery via a femoral artery cutdown. After 12 months, renal function remained normal, and computed tomography revealed normal kidney perfusion with complete resolution of the renal artery aneurysm. Conclusions: The advances in endovascular stent-grafts will allow more visceral artery aneurysms to be treated with a minimally invasive approach.

At the urologic department of the Public General Hospital in Wels between 1994 and 2000, a self-expanding permanent endoluminal stent (SPES) was implanted in 13 women and 1 man (mean age: 52.2 years) with ureteral strictures. All patients had previously been treated unsuccessfully. An open operative approach was not possible because of various contraindications or because the patient had refused surgery. During a total follow-up period of 730 months (median: 59.9 months), primary patency lasted 669.3 months (median: 47.8 months). In nine patients no further intervention was necessary, and in four patients patency could be regained by additional interventions. In one patient the kidney had to be removed because of progressive renal insufficiency. Worldwide 98 cases of a SPES implant have been published so far. The patency rate was 68 of 98 stents (69.3%). The implantation of a SPES in the ureter for benign and complicated strictures represents a serviceable alternative to other urinary diversions. Additional clinical and experimental studies and long-term results are needed to make a definitive assessment of this method.

Large bowel obstruction (LBO) is a serious and costly medical condition, indicating often emergency surgery. The main clinical issue is to determine whether the obstruction affects the small bowel or the colon since the causes and treatments are different. Delay in operative intervention may lead to an unnecessary bowel resection, increased risk of perforation, and overall worsening of patient morbidity and mortality. With the advent of colonic endoluminal stent, the treatment of distal colonic obstruction should be individually tailored to each patient. This article discussed LBO and emphasized the importance of history taking, examination, and basic imaging in the early diagnosis of its cause, thus facilitating appropriate management.

Purpose: To describe a case of secondary aortoesophageal fistula that was treated with an endoluminal stent-graft. Case Report: A 58-year-old woman presented with hematemesis and melena. In 1974 she had an interposition graft repair of an aortic transection sustained during a traffic accident. At the examination in 1998, angiography demonstrated a mechanical disruption of the proximal anastomosis forming an aortoesophageal fistula. A 28-mm × 3.75-cm AneuRx stent-graft was introduced via a right femoral arteriotomy and deployed across the defect. Follow-up CT scans at 18 months showed exclusion of the false aneurysm with no evidence of infection; the patient remains well at >2 years after stent-graft implantation. Conclusions: Endoluminal repair can be successful in achieving a satisfactory midterm outcome in cases of secondary aortoesophageal fistula.

Purpose: To demonstrate the feasibility of endovascular repair of a ruptured abdominal aortic aneurysm (AAA) previously treated with an endoluminal stent-graft. Case Report: An 84-year-old man with a 9.5-cm AAA underwent endoluminal repair with an Endologix stent-graft, but a type I endoleak was detected postprocedurally. The patient was discharged and lost to follow-up. Twenty months later, he suffered an aneurysm rupture, which was repaired using endovascular techniques. Although he had a postoperative course complicated by aspiration pneumonia and renal failure, he recovered fully and was discharged from the hospital with no evidence of endoleak on the postprocedural imaging studies. Conclusions: Late ruptures after endoluminal AAA stent-grafting can be successfully treated with endovascular techniques.

Purpose: The purpose of this phantom study was to evaluate the visualization of vascular stents by using contrast-enhanced (CE) 3D MR angiography (MRA). Methods: The measurements were performed on a Magnetom Vision operating at 1.5 T with 25 mT/m gradients by using a head coil; a 3D FISP sequence (TR/TE/FA 4.6 ms/1.8 ms/30°) was used. A phantom was designed with a length of 20 cm and consisted of a plastic cylinder filled with hydrogel. Tubes were used to install 7 different stents (Strecker, Boston Scientific; Cragg, Mintec; Wall, Schneider; Memotherm, Angiomed; St-Come, Trigon-MTS; Sinus, Optimed; Palmaz, Johnson & Johnson) with different metal components. The tubes were perfused with a solution of water and Gd-DTPA. Four radiologists evaluated the image quality. The measurements of the endoluminal stent diameters were compared with the findings obtained by digital subtraction angiography. The signal intensities were measured before (inflow), within (stent) and after (outflow) the different stent types. Results: The endoluminal diameter of the Cragg stent and the strecker graft were easily detectable. The signal loss within the lumen of the Wall stent was approx. 10% in relation to the inflow and outflow measurements. The result was an only slightly reduced image quality. The other grafts (St-Come, Sinus, Palmaz, Memotherm) showed significant signal losses ranging from 65% to 96%. A correct diagnosis was not possible within these graft lumina. Conclusion: Contrast-enhanced MR angiography can be used to evalute vascular stents. A prerequisite is the application of particular commercially available grafts.

A 64-year-old man collapsed and was admitted to our hospital. He had a 3-month history of diarrhea with occasional rectal bleeding, and prior stool cultures had grown Salmonella . His ECG demonstrated a sinus tachycardia (Figure 1). A gastroscopy showed extrinsic compression of the esophagus, and computed tomography with contrast revealed a saccular aneurysm of the descending thoracic aorta with circumferential thrombus (Figure 2). No significant mediastinal adenopathy was noted, and no pulmonary masses were identified. A mycotic aneurysm was suspected, and an endoluminal stent graft inserted. …

The presence of a tortuous, elongated thoracic aorta and an angulated arch poses a technical challenge for the delivery of an endoluminal graft to the target site to exclude management of a thoracic aortic aneurysm. Despite the availability of a flexible delivery sheath system, adjunct techniques are necessary to deal with extremely tortuous thoracic aortas. The use of a brachio-femoral wire with tension applied at both ends is a useful technique to deliver an endoluminal graft in an angulated thoracic arch. We describe the use of a right brachio-femoral wire approach to treat a thoracic aortic aneurysm in a 75-year-old man with an elongated, tortuous and angulated arch aorta.

The literature on endoluminal stent grafting (ELG) treatment of abdominal aortic aneurysms (AAA) is primarily descriptive and anecdotal. We sought to compare the success rates of the different categories and types of AAA ELGs and find the 30-day complication rate.

O SCVIR, 1997 THE causes of internal jugular vein thrombosis are myriad. Specific etiologies previously reported include intravenous drug abuse, indwelling venous catheters, adjacent neoplasms, hypercoagulability, soft-tissue infections, and spontaneous or idiopathic thrombosis (1-4). We report a case of traumatic occlusion of the internal jugular veins that was successfully treated with percutaneous endoluminal stent placement.

Thoracic endovascular aortic repair (TEVAR) has evolved as an alternative to open repair for a range of aortic pathology. The earliest endovascular repairs were limited to descending thoracic aortic pathology, but growing experience has resulted in the use of stents in the ascending aorta and aortic arch. This review presents the current literature pertaining to thoracic endoluminal stent repair, with emphasis on the role of intravenous contrast-enhanced multidetector computed tomography, the primary cross-sectional imaging modality used in these patients. Radiologists play an integral role in patient selection, procedural planning, and postprocedural follow-up.

The case of anastomotic rupture of the subclavian artery following infection of a subclavian-to-carotid bypass grafting is reported. Emergency endoluminal stent graft repair was life saving and aided wound healing, but stent graft thrombosis occurred. Such a complication raises some concern about the safety of this procedure in an infected setting. The use of autologous saphenous vein-covered stent graft may provide some advantages in avoiding graft infection and thrombosis.

To assess mid- to long-term clinical results of stent-graft repair in patients with type B aortic dissection.Retrospective analysis was done on 72 patients (47 men; mean age 55+/-12 years) who were diagnosed with chronic type B aortic dissection and underwent stent-graft repair from June 1994 to December 2007. Two types of stent-grafts were employed. Prior to 2000, a custom-designed stent-graft composed of self-expanding Z-type stainless steel stents covered with woven polytetrafluoroethylene material was used. Thereafter, a separate-type (modular) manufactured stent-graft was used, consisting of proximal and distal nitinol stents with an unsupported Dacron tube graft in between; the unsupported graft was stented after deployment.Procedural success (completion of the stent-graft deployment at the target area without device failure) was obtained in 97% (70/72). The 2 failures were due to stent migration and tortuous anatomy, respectively. There were persistent type I endoleaks in 6 cases for a clinical success (entry tear exclusion) of 88% (64/72). There was no immediate postprocedural mortality or paraplegia. There was unintended partial left subclavian artery occlusion in 1 case, as well as postprocedural transient renal failure in 1 patient and 2 access-site pseudoaneurysms. Median follow-up was 43 months (range 5-97, mean 64.4+/-38.8) in 61 patients (3 patients lost to follow-up). Five patients died, 1 of probable aortic rupture in the setting of residual type I endoleak. Overall clinical success (no death, conversion, or endoleak) was achieved in 84% (47/56); of these, 35 (74%) showed complete resolution of the thoracic false lumen, while the other 12 (26%) had a decrease in false lumen diameter.Intermediate to long-term results of stent-graft implantation in patients with chronic type B aortic dissection seem acceptable and may justify the use of this minimally invasive approach as first line therapy in these patients.