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Biomedical subjects

K Ivancev

Publications and source records attributed to K Ivancev.

At least 19 recordsLinked to original sources
PubMed2006

Remodeling of the thoracic aorta after stent grafting of type B dissection: a Swedish multicenter study.

AIM: Endovascular repair of complicated type B dissections has evolved as a promising alternative to open repair. Previous studies have indicated that continued false lumen flow is a predictor of continued aortic dilatation and risk of rupture during follow-up. This multicenter study was conducted to analyze the postoperative changes of the false lumen after endografting of complicated type B dissections. METHODS: All patients treated with endovascular stent grafts for thoracic type B dissections at 5 major Vascular Centers in Sweden were identified through local databases. Review of charts and all available pre- and postoperative CT scans were performed to identify demographics, indications for repair as well as postoperative changes of the aorta and false lumen. RESULTS: A total of 129 patients treated for type B dissections between 1994 and December 2005 were identified. Median radiological follow-up was 14 months. Fourteen patients died perioperatively leaving 115 patients available for analysis. Seventy-four of these had CT imaging of sufficient quality for morphological analysis. The vast majority of acute patients were treated for rupture or end-organ ischemia whereas most chronic patients were treated for asymptomatic aneurysms. In 80% of patients, the false lumen thrombosed along the stent graft but it remained perfused distal to the stent graft fixation in 50% of patients. Only 5% of patients presented with aortic enlargement of the stent grafted area when adequate proximal sealing was achieved. The distal, uncovered aorta displayed expansion in 16% of patients. CONCLUSIONS: The stent grafted thoracic aorta after type B dissection appears to be stabilized by covering the primary entry site with a stent graft in the majority of both acute and chronic dissections. The uncovered portion of the aorta distal to the stent graft, however, remains at risk of continuous dilatation. Stent grafting for complicated type B thoracic dissections seems to be a treatment option with reasonable morbidity and mortality even though the incidence of severe complications is still significant.

Adult↗
PubMed2005

Complicated acute type B dissections--an 8-years experience of endovascular stent-graft repair in a single centre.

OBJECTIVE: To analyze the experience of a single centre using stent-grafts for treatment of complicated acute aortic type B-dissections (EVR-ABD). DESIGN: Retrospective analysis of prospectively collected data from patients undergoing EVR-ABD between January 1997 and December 2004. METHODS: EVR-ABD was performed in 31 patients (20 males, median age 74 years (IQR: 64-79)). Indications for treatment were aortic rupture (22 patients), intractable pain and hypertension (six patients), acute bowel ischemia (two patients) and transient paraplegia, lower limb and renal ischemia in one patient. Initially home-made devices (five patients) and subsequently commercially available thoracic stent-grafts were used. RESULTS: Five patients (16%) died within 30 days of EVR-ABD. Postoperative complications occurred in 15 (48%) patients, including one paraplegia converted to paraparesis after cerebrospinal fluid drainage, five strokes, three lower limb ischemia, three myocardial infarction, two pneumonia and one colitis). Re-interventions were required in nine patients (29%). Six more deaths occurred during a median follow-up of 22 (IQR: 16-34) months, two related to the stent-graft and four due to cardiac disease. CONCLUSIONS: Stent-graft repair of complicated acute type B dissections seems to provide acceptable results and, therefore, it may be considered a valuable alternative to open surgery.

Acute Disease↗
PubMed2005

Endovascular recanalisation in occlusive mesenteric ischemia--feasibility and early results.

OBJECTIVE: To evaluate a single centre experience of endovascular treatment of mesenteric ischemia caused by vascular occlusion. DESIGN: Retrospective study. MATERIAL AND METHODS: Between 1995 and 2002 17 patients (12 females; mean age 61 years) with symptoms of bowel ischemia were treated endovascularly for arterial occlusion. Vessels were evaluated with angiography and pressure gradient measured. A mean gradient of > 20 mmHg or a stenosis of > 50% was considered significant. Patient data were recorded prospectively and follow-up was supplemented with retrospective chart review. Fifteen patients had follow up imaging, median 10 months (3-29 months) postoperatively. Median clinical follow up was 14 months (5-42 months). RESULTS: Recanalisation was successful in 16 patients (94%). The average number of stents used was 1.6 per patient. For one patient recanalisation failed with subsequent SMA dissection. A celiac artery stenosis was stented but symptoms remained postoperatively. Perioperative mortality was 5.8% (n = 1). 14/17 patients (82%) displayed symptom relief/improvement. Six patients required secondary endovascular intervention; PTA (n = 3); stent/stentgraft (n = 3). Two of these patients required a third procedure. 4/6 patients that underwent secondary intervention were asymptomatic and of recurrent stenosis > 75% and a gradient > 15 mmHg mean pressure gradient on imaging. Two patients were treated because of a combination of angiographic findings and/or significant pressure gradient combined with clinical symptoms. CONCLUSIONS: Endovascular treatment of mesenteric ischemia due to vessel occlusion is feasible with acceptable short-term results and limited complications. Most patients experience relief/improvement of symptoms. A significant number of patients might need endovascular re-intervention because of restenosis.

Adult↗
PubMed2005

Endovascular management of isolated infrarenal aortic occlusive disease is safe and effective in selected patients.

OBJECTIVE: To examine the safety and efficacy of endovascular management of isolated infrarenal aortic occlusive disease within our centre. DESIGN AND METHODS: Retrospective analysis of all patients who underwent endovascular treatment of occlusive disease that is confined to the infrarenal aorta between September 1993 and November 2004. RESULTS: Primary aortic stenting was carried out in 16 women and five men using self-expanding (12 patients) and balloon expanding stents to treat both occlusions (six) and stenoses (15). Indications included intermittent claudication (13), critical limb ischaemia (six), and distal embolisation (three). Significant postoperative complications within 30 days were noted in three, including one death. Fifteen patients completed 1-year follow-up with primary patency in 14 and secondary patency in the remaining patient. Clinical improvement was documented in all patients. CONCLUSION: Primary stenting for occlusive disease isolated in the infrarenal aorta is relatively safe in selected patients with encouraging early follow-up results.

Adult↗
PubMed2005

Revascularisation of renal artery stenosis caused by fibromuscular dysplasia: effects on blood pressure during 7-year follow-up are influenced by duration of hypertension and branch artery stenosis.

Fibromuscular dysplasia (FMD) mainly affects renal arteries. Percutaneous transluminal renal angioplasty (PTRA) and surgery are effective treatments, but long-time follow-up is lacking. Retrospective follow-up for 7.0+/-4.7 years of 69 consecutive patients (age 44+/-13 years) treated for hypertension due to FMD, 59 patients underwent PTRA and eight patients surgery. In two patients no PTRA was performed. Technical success was achieved in 56 (95%) patients undergoing PTRA and all eight undergoing surgery. After successful PTRA, both systolic and diastolic blood pressures (SBP and DBP) had decreased at discharge (from 174+/-33/100+/-13 to 138+/-19/80+/-15 mmHg; P<0.0001), and remained lower at 1 month, 1 year, and last follow-up after 7.0+/-4.7 years (140+/-25/83+/-12 mmHg; P<0.0001). Serum-creatinine had decreased both at 1 year (from 84+/-28 to 75+/-13 micromol/l; P=0.0030) and last follow-up (75+/-16 micromol/l; P=0.0017). The number of antihypertensive drugs decreased (from 2.3+/-1.2 before PTRA to 1.4+/-1.3 at discharge and at 1 month; P<0.0001, and 1.6+/-1.5 at last follow-up; P=0.0011). SBP decreased more after PTRA among patients with FMD only in the main renal artery than in those with branch artery involvement (43+/-29 vs 20+/-41 mmHg; P=0.0198). Beneficial effects on BP, creatinine and antihypertensive drugs also occurred after surgery. Patients on antihypertensive drugs at last follow-up had longer hypertension duration before PTRA than those without (5.9+/-7.7 vs 1.8+/-4.1 years; P=0.0349). Cure was achieved in 16 (24%), improvement in another 26(39%), and benefit in 42(63%). In conclusion, renal artery FMD, PTRA and surgery have beneficial long-term effects, negatively affected by hypertension duration and branch artery involvement.

Adult↗
PubMed2005

Endografting of thoracic aortic aneurysms and dissections.

3D imaging and endovascular repair have greatly increased the number of interventions in the thoracic aorta. Excellent early results of endovascular repair compensate unproven long term durability. Challenging anatomy is associated with increased risk for late failure of the stent graft (SG) but the option of open repair usually remains and complications from open surgery are also more frequent in these cases. The indications for endovascular repair of the descending aorta include aneurysms larger than 5-6 cm in diameter, pseudoaneurysms and type B dissection complicated by rupture, aortic dilation or distal hypoperfusion. Traumatic transections and certain types of coarctation are also treated endovascularly. Aortic rupture is associated with a high mortality and treatment is attempted liberally. Logistics remain a limitting factor for urgent stent grafting in many centers. Adequate pre and intraoperative imaging is mandatory for correct SG implantation. The mechanical forces of aortic blood flow jeopardize durable fixation of the device. Extended fixation zones of at least 5 cm, generous overlap between SG components and SG positioning along the outer curvature of the sac improve durability. Primary complications include stroke and paraplegia in about 5% of the cases. Late complications are mainly associated with SG dislodgement and inadequate seal. Surveillance is required. Future development focuses on treatment of leasions in the aortic arch. Debranching of the arch and branched SGs are currently being investigated.

Aortic Dissection↗
PubMed2004

Percutaneous transluminal renal angioplasty (PTRA) and surgical revascularisation in renovascular disease--a retrospective comparison of results, complications, and mortality.

OBJECTIVE: To evaluate results, complications and mortality following percutaneous transluminal renal angioplasty (PTRA) and open surgical revascularisation for renovascular disease. METHODS: A retrospective evaluation of 381 renovascular patients (median age 64, range 9-99 years, 152 women) treated at Malmö University Hospital during 1987-1996. Two hundred and sixty-two (69%) of the patients were treated with PTRA, 106 (28%) with open revascularisation. RESULTS: Thirty-day mortality was 2% in the PTRA group and 9% after open surgery (p<0.001). There were no differences between groups concerning the number of re-do procedures, but first re-do was performed after seven (IQR 3-14) months in the PTRA group, and after 15 (IQR 10-44) months after open revascularisation (p<0.0001). After a median follow-up of 4 months (IQR 0-13) systolic and diastolic blood pressure (BP) had decreased (p<0.0001) in both groups. The number of antihypertensive drugs was reduced (p<0.0001) and S-creatinine levels were unchanged in both groups. Long-time survival assessed with log-rank analysis was better (p<0.01) in the PTRA group. The risk ratio for death with open revascularisation was 1.69 (p<0.01). CONCLUSIONS: In this retrospective comparison, PTRA was as effective as open revascularisation, with lower complication rate and lower early and long-time mortality, but with shorter time to first re-do.

Angioplasty, Balloon↗
PubMed2004

Pulsatile wall motion (PWM) measurements after endovascular abdominal aortic aneurysm exclusion are not useful in the classification of endoleak.

UNLABELLED: The pulsatile wall motion (PWM) of AAA is reduced after endovascular stent-graft placement. The purpose of this study was to identify whether PWM after endografting was useful in the classification of endoleak. PATIENTS AND METHODS: 162 patients treated with EVAR underwent pre- and post-operative PWM assessment with ultrasonography. Follow-up was 1-9 years. 111 patients had well-excluded aneurysms, three patients had enlarging aneurysms without any recognizable endoleak (endotension), 16 had type I, 31 had type II and 1 had type III endoleak. RESULTS: The PWM was reduced from about 1mm pre-operatively to 0.24 mm post-operatively in well-excluded aneurysms. PWM remained stable during follow-up. Type I endoleak was associated with moderately reduced PWM (proximal endoleak 0.79 mm and distal 0.32 mm). PWM in patients with type II endoleak was higher (0.32 mm) post-operatively (p=0.002) compared to well-excluded aneurysms. CONCLUSION: PWM is permanently reduced after endografting. The smallest reduction in PWM was in patients with type II endoleaks. However, the overlap between the groups does not allow reliable identification of patients having endoleak with PWM-measurements.

Aged↗
PubMed2004

Sustained beneficial effects on blood pressure during long time retrospective follow-up after endovascular treatment of renal artery occlusion.

We retrospectively evaluated short- and long-term effects of percutaneous transluminal renal angioplasty (PTRA) with or without stent placement of renal artery occlusion (RAO) upon blood pressure (BP), serum (s)-creatinine, and the need for antihypertensive treatment in 34 RAO patients who underwent PTRA during 1996-2002. In 24/34 (71%) treatment was considered technically successful, 22/24 (92%) were treated with PTRA + stent, two with only PTRA. Patients were followed for mean 2.6 (range 0-8) years, during which 14/34 (41%) patients died. In all 34 patients, systolic and diastolic BP (SBP and DBP) before treatment were 184 +/- 30/95 +/- 15 mmHg and had decreased at discharge (to 157 +/- 21/80 +/- 10 mmHg; P < 0.001 for both SBP and DBP), and remained lower after 1 year (154 +/- 20/83 +/- 7 mmHg; P < 0.001 for SBP and P < 0.01 for DBP), and at last follow-up (148 +/- 20/80 +/-12 mmHg; P < 0.001 for both SBP and DBP). No changes occurred in s-creatinine or the number of antihypertensive drugs. Similar results were seen in the subgroup of 24/34 (71%) patients in whom treatment was technically successful. Among the 24 patients undergoing technically successful PTRA, absence of nephrosclerosis (P = 0.035) and a shorter duration of hypertension (P = 0.020) predicted favourable clinical outcome. No adverse effects upon s-creatinine or the need for antihypertensive medication were seen in patients in whom treatment was considered a technical failure. Seven of these patients were treated with PTRA of another renal artery than the occluded, or with embolisation. In conclusion, RAO can be treated with endovascular techniques. Technically successful results with decreasing blood pressure levels were obtained in 71% of patients.

Adolescent↗
PubMed2003

Does the wide application of endovascular AAA repair affect the results of open surgery?

PURPOSE: to examine the effect of the adoption of endovascular aneurysm repair (EVAR) on the outcome of open repair (OR). METHODS: between May 1998 and December 2001, EVAR (Zenith) was performed in 117 patients, and OR was performed because of anatomic restrictions in 40 (group A), and because of young age in 11 patients (group B). RESULTS: EVAR patients had higher ASA classifications (p < 0.0001). EVAR was associated with a 98.3% (115 patients) technical success rate, one conversion to OR and one fatal cardiac arrest. Thirty-day mortality was 2.6% (3 patients) in EVAR, 15% (6 patients) in group A and none in group B. There was no difference in late survival between the three groups. Late reinterventions, mainly endovascular, were more frequent in EVAR. At a median follow-up of 17 months one stent-graft had migrated 5 mm distally and five stents had fractured, but without clinical consequence. CONCLUSIONS: EVAR provides good results even with inclusion of high-risk patients. The adoption of EVAR may adversely affect the results of OR offered to patients because of anatomic considerations. However, OR continues to be the first option for low-risk young patients.

Aged↗
PubMed2001

[Ruptured abdominal aortic aneurysm. Endovascular treatment under local anesthesia].

We report on endovascular repair of a ruptured abdominal aortic aneurysm. A bifurcated stent graft was inserted under local anesthesia. Aortic clamping is rapidly provided by percutaneous placement of an aortic occlusion balloon catheter. Carbon dioxide can usually replace conventional contrast in patients with renal insufficiency. This minimally invasive procedure may reduce perioperative morbidity and mortality in patients with ruptured aortic aneurysms. The advantages and limitations of this novel technique are discussed.

Aged↗
PubMed2001

Fixation of infrarenal aortic stent-grafts using laparoscopic banding -- an experimental study in pigs.

PURPOSE: to test whether a laparoscopically-placed external band around the infrarenal aorta could stop vessel dilatation and prevent stent-graft detachment from the aortic wall. METHODS: in 13 growing pigs Gianturco-based stent-grafts were placed in the infrarenal aorta. In eight pigs, an external PTFE band (1 cm width) was placed laparoscopically around the infrarenal aorta. The remaining five pigs served as controls. Angiographic aortic diameters were measured: (1) at the most distal renal artery; (2) 1.5 cm further distally; (3) at the middle of the stent-graft; and (4) below the stent-graft, 1 cm above the aortic bifurcation. RESULTS: at a median follow-up of 16 weeks the pigs in the control group (n =5) and in the banded group ( n =7) increased their weight from 24 kg to 107 kg and 23 to 83 kg, respectively. In the control group, aortic dimensions increased by approximately 40% at all levels. In the banded group, aortic dimensions were unchanged at levels 2 and 3, but increased significantly at levels 1 and 4 (i.e. above and below the stent-graft). In the control group all stent-grafts detached causing a proximal perigraft leakage. No detachment or proximal perigraft leak was observed in the banded group. CONCLUSION: a laparoscopically placed external band around the infrarenal aorta of growing pigs seems to counteract the vessel dilatation and thereby provides a stable fixation of self-expandable stent-grafts.

Animals↗
PubMed2001

The impact of stent-graft development on outcome of AAA repair--a 7-year experience.

OBJECTIVE: to analyse the impact of stent-graft (SG) design and operator skill on the outcome of endovascular AAA repair. DESIGN: prospective non-randomised open. MATERIAL: a total of 158 patients (mean age 71) underwent SG repair. Patients were treated with five different types of SG: first (n =58) and second ( n =17) generation Ivancev-Malmö monoiliac SG (IM I and IM II respectively) combined with femoral-femoral crossover, Chuter bifurcated SG (n =15), Vanguard SG ( n =15) and the Zenith SG ( n =53). METHODS: patients underwent DSA and contrast CT preoperatively and were then followed with CT and digital scans. Recently, one change in AAA diameter and endoleaks (EL) were recorded. Mortality, complications and secondary interventions were recorded and life-table analysis for intervention-free SG survival calculated. RESULTS: immediate and late conversions as well as 30-day mortality were reduced for 2nd (Zenith and Vanguard) compared to 1st generation SG (IM I, Im II and chuter). SG migrations occurred only with the IM I and Chuter SG. Type I EL were significantly more common in 1st generation SG. First generation SG required significantly more secondary interventions than 2nd SG up to 20 months post-operatively. The number of unplanned intraoperative adjunctive manoeuvres was increased with 2nd SG. CONCLUSIONS: enhanced SG design has improved the probability of SG success after endovascular AAA repair. Better technical skills may also have contributed to improved results.

Aged↗
PubMed2001

Changes in aneurysm morphology and stent-graft configuration after endovascular repair of aneurysms of the descending thoracic aorta.

OBJECTIVE: We sought to study changes in morphology and stent-graft configuration of descending thoracic aortic aneurysms after endovascular repair. METHODS: Twenty-three patients treated with custom-made stent-grafts were studied. The stent-graft consisted of continuous, stainless-steel Z stents mounted within a polyester graft. In the last 11 cases the stents were interconnected with 3 longitudinal wires. Contrast-enhanced spiral computed tomography was performed preoperatively and at 1, 3, and every 6 months postoperatively. Angiography was used preoperatively and at 1-year follow-up. Proximal and distal necks were assessed for diameter and length. Aneurysm diameter, endoleaks, stent-graft migration, and changes in stent-graft configuration were evaluated. RESULTS: During follow-up (median, 18 months; range, 1-48 months), excluded aneurysms decreased in diameter by 4 mm (0.5-10 mm, P =.0018). Endoleaks prevented size decrease. Five patients displayed neck dilatation, 4 at both the proximal and distal fixation sites and 1 only distally. In 7 (30%) patients there was proximal migration of the distal end of the stent-graft. Three (13%) patients displayed both distal migration of the proximal end of the stent-graft and proximal migration of the distal end of the stent-graft. There was a significant correlation between stent-graft kinking and appearance of proximal or distal stent-graft migration (P =.05 and P =.0007, respectively). In no case did the migration lead to appearance of an endoleak before intervention was performed. CONCLUSION: Excluded descending thoracic aortic aneurysms decrease in size on midterm follow-up. A subgroup of patients prone to neck dilatation might exist. A combination of neck dilatation and vector forces acting on stent-grafts in the tortuous thoracic aorta might lead to stent-graft migration.

Aged↗
PubMed2001

An update of the Zenith endovascular graft for abdominal aortic aneurysms: initial implantation and mid-term follow-up data.

PURPOSE: To evaluate the initial and mid-term results of the Zenith endovascular grafting system for infrarenal abdominal aortic aneurysms. METHODS: Prospective databases at seven centers were used to assess a cohort of patients that underwent treatment for aortic, aortoiliac, or iliac aneurysms since 1995. Data were analyzed to yield descriptive characteristics that pertained to the patients, the aortic morphologic features, the graft configuration, and the complications. Follow-up imaging data were used to determine size changes of the aneurysm sac, endoleak rates, and further complications. Finally survival data were expressed with a Kaplan-Meier analysis. RESULTS: A total of 528 patients were treated with the Zenith endograft. Most of the patients (66%) were considered to be at a high physiologic risk for open repair. Successful graft implantation was accomplished in all but four patients. An overall endoleak rate of 15% was noted, of which 4% was treated urgently because they were thought to represent attachment site faults. The mean follow-up period was 18 months. A total of eight endograft migrations were detected after 2 years of follow-up with an early version of the system. There were three late conversions; two ruptures occurred during the follow-up period. CONCLUSION: This early and mid-term data support the use of the Zenith endovascular graft for the treatment of aortic and aortoiliac aneurysms in properly selected patients. The risks of significant complications or aneurysm rupture are low.

Angioplasty↗
PubMed2001

Intraoperative proximal endoleaks during AAA stent-graft repair: evaluation of risk factors and treatment with Palmaz stents.

PURPOSE: To study factors that might contribute to intraoperative proximal type I endoleak and to evaluate the placement of giant Palmaz stents as a therapeutic option. METHODS: Thirty-three patients (30 men; median age 72 years, range 50-85) with abdominal aortic aneurysms underwent implantation of fully supported Gianturco Z-stent-based endografts (12 custom-made aortomonoiliac and 21 bifurcated Zenith devices). Ten (30%) patients were treated for intraoperative proximal endoleaks. Stent-graft oversizing and neck angulation, length, and shape were compared between patients with and without leaks. RESULTS: In 9 cases, the endoleaks were successfully treated with intraoperative placement of Palmaz stents without complications. In 1 patient, a leak that was resolved intraoperatively with balloon dilation reappeared 1 month later; a Palmaz stent was deployed successfully. Stent-graft oversizing did not differ significantly between patients who developed proximal endoleaks and those who did not (median 4.0 mm in both groups, p = 0.47). Median neck length was 21.0 mm in patients with endoleak and 28.0 mm in those without (p > 0.99). Median neck angulation was 30 degrees in both groups (p = 0.33), and the presence of a conical aneurysm neck was not significantly different (2/10 versus 6/23, p > 0.99). All aneurysms remained excluded at a median follow-up of 13 months (range 6-24). CONCLUSIONS: Stent-graft oversizing and neck morphology (length, angulation, and conical shape) do not seem to correlate with the incidence of proximal type I endoleaks. Palmaz stent placement appears to be a feasible and safe treatment option for this complication.

Aged↗
PubMed2000

[Varices and venous insufficiency--therapeutic philosophy prior the 2000's].

Varicose veins represent everything from a cosmetic problem to a risk of venous leg ulcers. Predicting the risk of complications has been difficult, not least due to less than satisfactory diagnostic procedures. Recent investigations have pointed out some important new concepts: Superficial venous incompetence may give rise to an ulcer, and such an ulcer may be prevented by varicose vein surgery. Recanalization and stenting may be useful in treating chronic iliac and caval venous occlusions; however, long-term outcome is yet to be established. Venous diameter can be reduced, thus effecting valve competence. To what extent this result is long-lasting is not known. Neither has the method been attempted on deep veins. Clinical diagnosis is never sufficient in cases of suspected chronic venous incompetence. The minimum requirement is the use of a hand-held Doppler. Frequently, a more detailed ultrasonographic analysis is required, and for a global assessment of venous function, plethysmographic techniques are useful. Primary health care may contribute effectively to the care of venous leg ulcers.

Humans↗