Bilateral facial nerve palsy as first indication of relapsing hairy cell leukemia after 36 years.
Explore the source record for details and available documents.
2-Chloroadenosine↗
Biomedical subjects
S Thurnher
Publications and source records attributed to S Thurnher.
Inferior mesenteric artery as outflow vessel in endoleaks after abdominal aortic stent-graft implantation: 36-month follow-up CT study.
The aim of this study was to determine the role of the inferior mesenteric artery (IMA) as an outflow vessel in endoleaks after abdominal aortic stent-graft implantation. Forty consecutive patients in whom abdominal aortic aneurysms (AAA) had been treated with stent-graft implantation were evaluated retrospectively. Spiral-CT examinations and angiographies up to 36 months after implantation were analyzed. In 29 (73%) of the 40 patients the IMA was perfused prior to implantation. In 5 (17%) of these 29 cases, the artery remained perfused after stent-graft insertion. In all 5 cases, endoleaks were detected; however, in none of these cases was the IMA the sole cause. In 3 of these 5 cases, angiography showed antegrade flow in the IMA. Implantation of extension stent grafts caused thrombosis of the aneurysmal sac and the IMA. There were no secondary endoleaks caused by the IMA at the 36-month follow-up examinations. The majority of IMAs which are patent prior to intervention occlude after successful stent-graft insertion. In cases with leaks and angiographically proven antegrade flow in the IMA, implantation of extension stent grafts is a therapeutic alternative to embolization. In this study, the IMA was not responsible for secondary endoleaks.
Aged↗
PTA versus Palmaz stent placement in femoropopliteal artery obstructions: a multicenter prospective randomized study.
PURPOSE: To evaluate if stent placement is superior to percutaneous transluminal angioplasty (PTA) in the treatment of chronic symptoms in short femoropopliteal arterial lesions. MATERIALS AND METHODS: One hundred fifty-four limbs in 141 patients who ranged in age from 39 to 87 years (mean age, 67 years) were randomized to PTA (n = 77) versus PTA followed by implantation of Palmaz stents (n = 77). Inclusion criteria were patients with intermittent claudication (n = 108, Society of Vascular Surgery/International Society of Cardiovascular Surgery [SVS-ISCVS] categories 1-3) or chronic critical limb ischemia (n = 46 with either ischemic rest pain [category 4] or minor tissue loss [category 5]), short stenosis or occlusion (lesion length < or = 5 cm), and at least one patent run-off vessel at angiography. Follow-up included clinical assessment, measurement of ankle/ brachial index (ABI), color duplex ultrasound, and/or angiography at 6 or 12 months. Angiographic follow-up between 12 and 36 months was available in 46 limbs (29.9%). RESULTS: In the PTA group, initial technical success was achieved in 65 of 77 limbs (84%) versus 76 of 77 (99%) limbs in the stent group (chi2 value = 0.009). Overall, major complications occurred in 3.9% (n = 6); n = 4 in the PTA group compared to n = 2 in the stent group. There was no difference between groups of treatment: hemodynamic/clinical success at 1 and 2 years in the PTA group was 72% and 65% versus 77% and 65% in the stent group (Gehan P value = .26). The cumulative 1- and 2-year angiographic primary patency rates were 63% and 53%, respectively, for both groups. The secondary 1- and 2-year angiographic patency rates were 86% and 74% in the PTA group versus 79% and 73% in the stent group (P = .5). CONCLUSION: After stent placement, the primary success rate was significantly higher than after PTA. However, 1-year angiographic and clinical/hemodynamic success was not improved.
Adult↗
[Simon nitinol vena cava filters: effectiveness and complications].
UNLABELLED: Simon nitinol vena cava filters: effectiveness and complications. PURPOSE: The aim of this retrospective analysis was to evaluate the clinical safety and effectiveness of the Simon Nitinol inferior vena cava filter (SNF) for prevention of pulmonary embolism. PATIENTS AND METHODS: 117 patients (63 male, 54 female; aged 58.38 +/- 14.59 years) underwent percutaneous implantation of an SNF from 1993 through 1999. Patient reports were retrospectively analysed for complications during and after implantation and deep venous thrombosis (DVT) and pulmonary embolism before and after implantation. Helical-CT with contrast media and plain abdominal radiography were performed on 35 patients, helical-CT alone on two patients. We checked the position and configuration of the SNF and looked for a perforation of the filter legs through the wall of the inferior vena cava (IVC). The IVC and deep pelvic veins were analysed for patency. RESULTS: During implantation 10 of 117 (9 %) patients had minor complications, major complications were reported in 0.9 % (1/117). There was no significant increase in thrombosis of the deep pelvic veins and the IVC after implantation. Pulmonary re-embolism (PE) was documented in 9 out of 117 patients (7.7 %). One out of the 35 examined patients (2.9 %) showed a single strut fracture of the SNF. Tilting more than 15 degrees was seen in 7 out of 37 patients (19 %). Dislocation of the SNF more than 10 mm occurred in one out of 35 patients (2.9 %), perforation through the wall of the IVC in all 37 patients. We found no occlusion of the IVC. CONCLUSION: The SNF is easy and safe to implant and successfully prevents pulmonary embolism. In our study the rate of well documented pulmonary re-embolism (7.7 %) is satisfactory. Except for the high perforation rate through the wall of the IVC (100 %, but without clinical relevance), complication rates during and after implantation of the SNF are low compared with other filter types.
Adult↗
Midterm durability of abdominal aortic aneurysm endograft repair: a word of caution.
PURPOSE: Endograft technology for abdominal aortic aneurysm (AAA) repair is being applied more liberally. There is little information about the midterm performance of these grafts. This study is focused on follow-up interventions after endograft repair for AAA. METHODS: Prospective follow-up analysis of a consecutive patient series (n = 173 patients) at a single center who underwent endovascular AAA repair up to 50 months after operation. Seventeen percent of the patients were regarded unfit for open surgery. Four types of commercially available grafts were used. The Society for Vascular Surgery/International Society for Cardiovascular Surgery guidelines were applied for endograft implantation and data preparation. RESULTS: In two patients, the procedure was converted to open surgery. In one procedure, emergency repair for iliac artery rupture was performed. The 30-day mortality rate was 2.8% (n = 5 patients). An early second procedure to correct type I endoleaks was necessary in 8 cases (4.6%; 3-10 days). The following midterm results were obtained: median follow-up of the 166 remaining patients was 18 months (range, 1-50 months); 50 additional procedures were necessary in 37 patients (22.3%) for the treatment of leaks (n = 45 interventions) or to maintain graft patency (n = 5 grafts; four patients with concomitant graft segment disconnection); and 46% of the reinterventions were performed within the first year of follow-up and 74% of the reinterventions were performed within the second year of follow-up. One patient died after emergency surgery for rupture as the result of a secondary endoleak at 1 year. Although seven interventions (14%) were performed for type II endoleak, no serious complications were related to patent sidebranches. There was no statistically significant difference between the need for maintenance in different graft configurations (tubular, bifurcated, aorto-uniiliac), or number of graft segments (1, 2, 3-4, > or = 5 segments). New generation grafts (after 1996) performed better than early generation grafts (P = 0.04, chi-squared test) with regard to endoleak development. CONCLUSION: Endograft repair for AAA is safe but, with current technology, not as durable as open repair. Our data suggest that the use of endograft repair for AAA is becoming safer as endograft design improves. Nevertheless in 26.6% of the patients, there is need for reintervention within midterm follow-up. Close follow-up is crucial because late leaks may develop after more than 2 years after the initial procedure. Endoluminal repair should therefore be applied with caution, strict indication, and only if a tight follow-up is warranted. These findings may also affect health care reimbursement policies.
Aged↗
Internal iliac artery embolization before endovascular repair of abdominal aortic aneurysms: frequency, efficacy, and clinical results.
OBJECTIVE: The aim of our study was to assess the frequency, efficacy, and incidence of adverse effects of internal iliac artery embolization. MATERIALS AND METHODS: Of 343 patients examined for stent-graft repair, 147 were suitable for endovascular treatment. Fifty-five patients underwent preprocedural embolization of the internal iliac artery either unilaterally (46 patients) or bilaterally (nine patients). Successful embolization was assessed angiographically and with helical CT follow-up examinations. Colonic ischemia was ruled out clinically or colonoscopically. Buttock claudication, and sexual dysfunction in men, were evaluated through a questionnaire. RESULTS: Embolization of the internal iliac artery increased by 16% the percentage of patients for whom endovascular repair was suitable. After successful embolization in all patients, routine CT follow-up examinations after a mean time of 16.7 months showed no evidence of endoleaks related to retrograde perfusion via embolized internal iliac arteries. Nevertheless, in all patients who had undergone embolization, a primary endoleak was detected in 43.4% at the first postoperative CT examination. None of our patients had evidence of colonic ischemia. Clinical follow-up data of 46 patients were available. Of these patients, mild to severe new onset buttock claudication was found in 13 (36.1%) of 36 patients with unilateral, and in eight (80%) of 10 patients with bilateral, internal iliac artery embolization (p = 0.03). Five (25%) of 20 men had an erectile dysfunction after the procedure. CONCLUSION: Embolization of the internal iliac artery is a safe and efficient procedure that increases the applicability for endovascular repair of aortoiliac aneurysms. However, buttock claudication and erectile dysfunction are a drawback in a substantial number of patients.
Aged↗
Endovascular treatment of aortic type B dissection and penetrating ulcer using commercially available stent-grafts.
OBJECTIVE: The purpose of our study was to investigate the clinical experience and efficiency of translumenl endovascular stent-graft insertion using commercially available vascular endoprotheses. We studied seven patients with descending aortic dissection (type B) and four patients with penetrating aortic ulcer over a median follow-up period of 254 days during the years 1997-2000, using cross-sectional CT to evaluate the extent of the dissection, the distance between the entry tear and the left subclavian artery, and the diameter of the true lumen and the false lumen. CONCLUSION: Endovascular treatment of acute and chronic aortic type B dissections and penetrating ulcer is a minimally invasive method with a low complication rate that could be considered a feasible alternative to surgical repair. Depending on the length of the dissection, we recommend the placement of two overlapping stent-grafts in the thoracic aorta to stabilize the affected thoracic aorta over a longer distance. This might provide a reliable sealing of the entry tear and should prevent further communication between the true lumen and the false lumen.
Aged↗
[Endovascular (transfemoral endoluminal aneurysm management; TEAM) versus conventional open therapy in abdominal aortic aneurysms (AAA): analysis of a clinical series].
All patients (n = 826) treated electively at the Department of Vascular Surgery University of Vienna, Austria, for their AAA during the years 1965-2000 were analysed with particular emphasis on endoluminal repair. Data collection was carried out in retrospect. The operative mortality or within 30 days was considered the primary endpoint of the study. Since 1995 the TEAM approach was available. From that point in time 45.5% of the AAA were treated electively in the endoluminal way. An exploratory analysis of the clinical series revealed a statistically significant difference in the incidence of various risk factors between groups in favor of open repair. Consequently a conditional regression analysis demonstrated the operative method, median patient's age (above versus below 72 years of age), reduced renal and/or pulmonary function to be of significant influence.
Aged↗
[Carotid stenosis: the technic for PTA and stent implantation].
Percutaneous transluminal angioplasty and stenting of carotid artery stenosis represents an innovative experimental modality which has been increasingly employed in high-risk patients. Currently, results from prospective randomized trials are not available; thus, guidelines with regard to indications and technique are preliminary. Numerous technical innovations to avoid associated complications have evolved in neurointerventional procedures. Dedicated guiding catheters and stents using a transfemoral approach have been introduced for treatment of carotid artery disease. Low-profile stent delivery systems may decrease risk of releasing embolic load when crossing high-grade stenosis or kinking of the vessel. The introduction of a cerebral protection with the use of temporary occlusion balloons or filter systems has resulted in a reduction of procedure-related neurological complications, and is strongly recommended by leading experts in the field.
Angioplasty, Balloon↗
Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts.
BACKGROUND: This study was performed to evaluate the safety and feasibility of endovascular stent graft placement in the treatment of descending thoracic aortic aneurysms. METHODS: Between November 1996 and February 1999, endovascular stent graft repair was used in 21 patients. There were 5 women and 16 men with a mean age of 67 years (range, 41 to 87 years). An atherosclerotic aneurysm with a diameter of more than 6 cm was the indication for intervention in 19 patients (90.5%). In 2 patients (9.5%), a localized aortic dissection with a diameter of more than 6 cm was treated. In 71.4% (15 of 21) of patients, multiple stents were necessary for aneurysm exclusion. To allow safe deployment of the stent graft, preliminary subclavian-carotid artery transposition was performed in 9 patients (42.9%). Vascular access was achieved through a small incision in the abdominal aorta (n = 6), an iliac artery (n = 8), or a femoral artery (n = 7). Talent and Prograft stent grafts were used. RESULTS: Successful deployment of the endovascular stent grafts was achieved in all patients. Two patients died postoperatively (mortality rate, 9.5%), 1 of aneurysmal rupture and the other of impaired perfusion of the celiac axis. Repeat stenting was done in 3 patients because of intraoperative leakage. CONCLUSIONS: Endovascular stent graft repair is a promising and less invasive alternative to exclude the aneurysm from blood flow. This technique allows treatment of patients who are unsuitable for conventional surgical procedures. An exact definition of inclusion criteria and technical development of stent grafts should contribute to further improvements in clinical results.
Adult↗
Endovascular repair of thoracic aortic aneurysms.
The standard technique for the treatment of descending thoracic aortic aneurysms is elective open surgical repair with graft interposition. This standard approach, although steadily improving, is associated with high morbidity and substantial mortality rates and implies a major surgical procedure with lateral thoracotomy, use of cardiopulmonary bypass, long operation times and a variety of peri- and postoperative complications. This and the success of the first endoluminal treatment of abdominal aortic aneurysms by Parodi et al. prompted the attention to be thrown on the treatment of descending thoracic aortic aneurysms with endoluminal stent-grafts in many large centres. The aim of this new minimally invasive technique is to exclude the aneurysm from blood flow and in consequence to avoid pressure stress on the aneurysmatic aortic wall, by avoiding a large open operation with significant perioperative morbidity. The potentially beneficial effect of this new treatment approach was evaluated in the course of this study.
Adult↗
[Management of abdominal aortic and peripheral aneurysm using stent grafts].
The implantation of stent grafts is a relatively new method for the treatment of aneurysms of the aorta or peripheral aneurysms. Before the implantation precise measurements are mandatory to obtain the necessary information about the aneurysm. The numerous contraindications must be observed strictly to successfully exclude the aneurysmal sac. The stent graft is inserted via a percutaneous puncture or, in the case of an aortic graft, through a surgical arteriotomy. After the implantation rigorous follow-up is mandatory to detect complications such as leaks or thrombi: Spiral CT angiography is the method of choice. Some of the complications require secondary interventions such as the implantation of additional stent grafts. The results are encouraging, with a secondary exclusion rate of the aneurysm of up to more than 95%; however, long-term results are not available.
Angiography↗
Endovascular stent graft repair for aneurysms on the descending thoracic aorta.
BACKGROUND: The traditional treatment of aneurysms of the descending thoracic aorta includes posterolateral thoracotomy and aortic replacement with a prosthetic graft. In this study, we report our experiences and results in endovascular stent graft placement as an alternative to surgical repair. METHODS: Between January 1989 and July 1997, a total of 68 patients (24 women) underwent replacement of the thoracic aorta. Mean age at operation was 51 years. Fifty-eight patients underwent conventional surgical treatment. All of these patients were suitable candidates for endovascular stenting; however, no stent graft material was available at the time of operation. Ten patients (1 chronic dissection, 9 atherosclerotic aneurysm) received in the past 8 months the first commercially manufactured endovascular stent graft. The mean diameter of the aneurysms in this group was 7 cm (range, 6 to 8 cm). Two stent patients were operated on using only spinal cord analgesia. All stent grafts were custom designed for each of the 10 patients. RESULTS: The 30-day mortality in the conventional group was 31% versus 10% in the stent group. Mean length of intervention was 320 minutes in the conventional group versus 150 minutes in the endovascular group. Spinal cord injury occurred in 5 patients (12%) in the surgical group, whereas none of the stented patients developed any neurologic sequelae. Mean intensive care unit stay was 13 days, followed by a mean of 10 days on a ward in the first group compared to 4 days in the intensive care unit and 6 days on the ward in the stent group. One stent was required in 2 patients, two stents were required in 3 patients, and four stents were deployed in 5 patients of our series. Five patients required transposition of the left subclavian artery to achieve a sufficient neck for the proximal placement of the stent. There was complete thrombosis of the thoracic aortic aneurysm surrounding the stent graft in 8 patients (80%). Two patients required restenting as a result of leakage (20%). Stent graft placing was performed through the femoral artery in 8 patients, whereas access was only achieved through the abdominal aorta in 2 patients. CONCLUSIONS: These preliminary results demonstrate that endovascular stent graft replacement might be a promising, cheaper, and safe alternative method in selected patients with descending thoracic aneurysms.
Adult↗
Endovascular management of "endoleaks" after transluminal infrarenal abdominal aneurysm repair.
PURPOSE: To investigate the reasons for endoleaks after transluminal infrarenal abdominal aneurysm management and the potential for transluminal interventions in subsequent management. METHODS: Prospective analysis of 50 consecutive patients undergoing endovascular aneurysm repair at a single institution with Stentor and Vanguard grafts from March 1995 to March 1997. SETTING: Academic teaching hospital. RESULTS: Two procedures were converted for other reasons than leak. In the remaining 48 successful procedures endoleaks were detected in 11 (22.9%): proximal aortic leak (2.1%), distal aortic leak (8.3%), iliac leak (12.5%). Leaks were treated at the initial procedure in five patients, resulting in 87.5% excluded aneurysms. Twelve and a half per cent were discharged with a primary leak. Redo was performed on all iliac leaks within 7 weeks. All aortic leaks showed spontaneous thrombosis within 3 months, but reappeared with local aneurysm expansion. Aortic redo-procedures were performed by proximal tubular extension or converting a tube graft into a bifurcation graft. All rescue procedures were successful. Secondary leaks have been observed twice in this series, both treated by endovascular means. CONCLUSIONS: Endovascular treatment of primary and secondary endoleaks is possible, and may be a safe alternative to a difficult open procedure.
Aged↗
[Treatment of arterial aneurysms of the pelvic leg vessels using dacron covered nitinol stents].
PURPOSE: To evaluate the success rates of the implantation of stent grafts in the treatment of peripheral aneurysms. MATERIALS AND METHODS: In 13 patients with 15 aneurysms at the common iliac artery (n = 6), external iliac artery (n = 1), hypogastric artery (n = 2), femoral artery (n = 2) or popliteal artery (n = 4), implantation of dacron-covered nitinol stents was performed. The patients were followed up for three to 20 months (mean, 8.8 months) with intravenous digital subtraction angiography, CT or colour-coded Doppler sonography. RESULTS: In all cases, the aneurysm was successfully occluded after stent implantation. In one case with a popliteal aneurysm, kinking of the vessel caused thrombosis of the stent. The stent was successfully reopened. The aneurysm however, had to be surgically treated 9 months later. The primary and secondary patency rates at 6 months were 93% and 100%, respectively. CONCLUSION: The method described might be an alternative therapy to surgery. There are some limitations in respect of treatment of popliteal aneurysms.
Adult↗
Treatment of malignant biliary obstruction with polyurethane-covered Wallstents.
OBJECTIVE: This study was undertaken to determine the safety, efficacy, and performance of polyurethane-covered Wallstents in the treatment of malignant biliary obstruction. SUBJECTS AND METHODS: This pilot study included 30 patients with malignant biliary obstruction. Palliative decompression of the obstructed bile duct was attempted with a polyurethane-covered Wallstent that is a prototype. Patients with hilar obstructions were excluded. All stents were inserted percutaneously. Kaplan-Meier analysis was used to determine stent patency. RESULTS: Effective biliary decompression was achieved in all patients initially. No acute stent-related complications occurred. The 30-day mortality rate was 20%. During follow-up, 11 stent occlusions occurred; therefore, the occlusion rate was 37%. The patency rates after 1, 3, 6, and 12 months were 96%, 69%, 47%, and 31%, respectively. Tumor growth through the stent covering that was proven both histologically and by biopsy observed in two patients, causing stent occlusion in one of them. Other reasons for stent occlusion were distal tumor ingrowth (n = 1) and biopsy-proven granulation tissue inside the stent (n = 2). Otherwise, the reasons for stent occlusion remained unclear. CONCLUSION: This prototype of a covered stent did not provide better results than did conventional uncovered stents in patients with malignant biliary obstruction. The covering did not effectively prevent tumor ingrowth in at least two patients. The stent also seems prone to premature occlusion.
Aged↗
Biliary Wallstent endoprosthesis in malignant hilar obstruction: long-term results with regard to the type of obstruction.
AIM: To evaluate the clinical efficacy of percutaneously placed biliary Wallstents in the management of malignant hilar obstruction with regard to the obstruction type. PATIENTS AND METHODS: Sixty-six Wallstents were inserted in 41 patients with inoperable hilar obstruction: 13 patients had a type I obstruction according to Bismuth-classification, 18 a type II, eight a type III, and two a type IV obstruction, respectively. Clinical follow-up data were obtained from all the patients and the referring physicians. RESULTS: Stent placement was technically successfully in all patients. The procedure-related death rate was 2% (one patient), but the overall 30-day mortality rate was 39%, mostly due to advanced malignant disease, cardiac failure or pneumonia. Stent occlusion was found in 11 patients (27%) after 87 days (mean; range, 8-190 days). After stent placement, the mean stent patency was 96 days and the mean survival was 131 days with no significant difference between patients with obstruction type I, II and III. Multivariate analysis revealed that patients with obstruction due to gallbladder carcinoma had a significantly shorter survival than patients with cholangio-carcinoma or hilar obstruction due to metastases. CONCLUSION: Overall, the insertion of Wallstent endoprostheses offers moderate results for palliation of hilar biliary obstruction regardless of the type of obstruction. In patients with cholangiocarcinoma, long-term results are good even for complicated strictures (type III). In patients with hilar obstruction due to gallbladder carcinoma the outcome is generally poor, regardless of the type of obstruction.
Adult↗
The first 15 months of transluminal abdominal aortic aneurysm management: a single centre experience.
OBJECTIVES: To assess the early experience with the transfemorally placed modular endovascular MinTec graft (TPEG) for abdominal aortic aneurysm (AAA). DESIGN: One single centre prospective evaluation of the endograft procedure as well as early postoperative results. SETTING: An academic teaching hospital. PATIENTS: 30 consecutive patients treated during a period of 15 months. RESULTS: Peri- and postoperative morbidity and mortality were evaluated according to the recommendations of the Ad Hoc Committee on Reporting Standards. The endograft procedure was successful in 28 patients (93.4%); two patients (6.6%) needed conversion into open conventional y-graft replacement; one patient died 36 days following intervention from multiple organ failure. Another patient died from pancreatitis unrelated to the implantation. Endoleaks were treated by "overstenting" or distal extension of the endografts, but conversions were unnecessary. Five severe adverse events were noted in four patients. CONCLUSIONS: TPEG is a feasible but technically demanding procedure, requiring both surgical techniques and catheter skills. The potential for less operative morbidity and simpler aneurysm management compared to conventional open surgery may be present. Close follow-up of patients is necessary to understand the development and treatment of endoleaks.
Aged↗