No abstract available.
Child* ; Humans ; Tuberculosis, Renal*

In this case, we describe a case of a 76-year-old male with extensive aortoiliac aneurysms treated by endovascular aneurysm repair using the sandwich technique in order to preserve left internal iliac artery perfusion. The sandwich technique refers to the deployment of multiple paralleled stent grafts into main distal and side branches in overlapping with a single proximal stent graft. The procedure was successfully performed without complications. Post-procedural CT angiography demonstrated patent stent grafts without any endoleak. The strengths and limitations of the sandwich technique need to be investigated in large-scale, long-term clinical trials.
Aged ; Aneurysm ; Angiography ; Aortic Aneurysm ; Endoleak ; Endovascular Procedures ; Humans ; Iliac Artery ; Male ; Perfusion ; Stents ; Transplants

BACKGROUND AND OBJECTIVES: Percutaneous intervention has become an established technique in the treatment of peripheral arterial obstructive disease. This study was performed to evaluate the procedural success and long-term outcome of percutaneous intervention of the superficial femoral artery (SFA), and to determine the factors that influence the long-term outcome. SUBJECTS AND MEHTODS: Eighty-eight consecutive lesions, in 76 subjects (mean age 65) with chronic lower limb ischemia and SFA obstruction, diagnosed with angiography were included in this study. The angiographic success was defined as residual stenosis <30% and the clinical success as an improvement by at least one clinical category. The clinical patency was defined as an absence of symptom recurrence and target lesion revascularization during the follow up period. The predictors of the outcome were also determined. RESULTS: Balloon angioplasty only was performed in 39 lesions and thrombolysis only in 2, whereas stenting was performed in 47 lesions. Seventy four of the 88 attempts (84%) at recanalization were angiographically successful, while 73 (83%) experienced clinical improvement. The twelve month patency was 67%. Critical ischemia (versus intermittent claudication)(relative risk 4.2, p=0.020) and renal failure (relative risk 4.1, p=0.016) were independent negative predictors of the patency. CONCLUSION: Percutaneous intervention of the SFA yielded a high procedural success rate, with an acceptable long-term outcome. Symptoms of critical ischemia and renal failure were predictive of a low long-term patency.
Angiography ; Angioplasty ; Angioplasty, Balloon ; Arterial Occlusive Diseases ; Constriction, Pathologic ; Femoral Artery* ; Follow-Up Studies ; Ischemia ; Lower Extremity ; Outcome Assessment (Health Care) ; Recurrence ; Renal Insufficiency ; Stents

Nesidioblastosis is characterized by a diffuse proliferation of islet cells arising from pancreatic ducts and is the most common cause of hyperinsulinemic hypoglycemia in newborns and infantile. It is exceedingly rare in adults and no concensus regarding its diagnosis and management is available. We herein describe an elderly man with fasting hypoglycemia, inappropriate insulin hypersecretion. And pathologic examination of his pancreas revealed the characteristic finding of nesidioblastosis confirmed by immunohistochemical stain.
Adult ; Aged* ; Diagnosis ; Humans ; Hypoglycemia* ; Infant, Newborn ; Insulin ; Islets of Langerhans ; Nesidioblastosis* ; Pancreas ; Pancreatic Ducts

BACKGROUND AND OBJECTIVES: To evaluate the feasibility and the short- and mid-term follow-up outcomes of endovascular stent-graft implantation in patients with Stanford type B aortic dissection. SUBJECTS AND METHODS: Twenty-eight patients with Stanford type B aortic dissection were evaluated. An aortogram was performed immediately after the procedure and a follow-up computed tomography (CT) scan was performed within one week, between 3 and 6 months, and annually thereafter. Clinical status was also evaluated at the same time. RESULTS: Endovascular stent-graft implantation at the target site was successful in 27 patients (96.4%). There were primary endoleaks in 6 patients and one case of procedure failure owing to migration of the stent-graft; and no procedure-related mortality. The number of patients with early complications requiring treatment was 2 (2/27, 4%). Fourteen patients experienced postimplantation syndrome (14/27, 52%). The average follow-up period was 22.1+/-17.5 months. Complete resolution or thrombosis of the false lumen was achieved in 14 patients and partial thrombosis was achieved in 10 patients. Operative treatments were required in three patients due to a progressing dissection or new dissection. There were no deaths and no instances of aneurysm or aortic rupture during the follow-up period. CONCLUSION: Endovascular stent-graft implantation for Stanford type B aortic dissection is a feasible, safe, and effective treatment modality. All patients who underwent surgery had a persisting leak. Therefore, regular evaluation of the aortic dissection and management of endoleaks were crucial for a favorable outcome in endovascular stent-graft implantation for a Stanford type B aortic dissection.
Aneurysm ; Aortic Rupture ; Endoleak ; Follow-Up Studies ; Humans ; Mortality ; Thrombosis

BACKGROUND: May-Thurner syndrome is an uncommon disease entity in which the left common iliac vein is compressed by the right common iliac artery, with the subsequent development of deep vein thrombosis and chronic venous insufficiency. Herein, our experience on the treatment of extensive iliofemoral deep venous thrombosis due to May-Thurner syndrome, using endovascular techniques, is reported. METHODS: Twenty-one symptomatic patients, 8 men and 13 women, with a mean age of 51 years, were referred for treatment. Eighteen of these patients were treated with catheter-guided thrombolysis, but three, with short segment involvement, did not require thrombolysis. After completion of the thrombolytic therapy, the residual venous narrowing was treated by balloon angioplasty and/or self-expandable stent placement. Patients were then followed-up by clinic visits and venography. RESULTS: The mean total dose of urokinase and duration of infusion were 4.28+/-1.89 million units and 72+/-35 hours, respectively. Eighteen of the 21 patient received stent deployments. The mean diameter of the stents was 12.9+/-2.0 mm. Initial technical success, with immediate symptom resolution, was achieved in 20 of the 21 patients (95%). Among the patients who received stent implantation, two had recurrent thrombotic occlusion during the follow-up period. (mean 10.8 months); all three patients who did not receive stent implantation had recurrent thromboses There were no major bleeding complications, with the exception of one patient who developed a retroperitoneal hematoma. CONCLUSIONS: Catheter-guided thrombolysis and angioplasty with stent implantation are safe and effective for the treatment of May-Thurner syndrome.
Ambulatory Care ; Angioplasty ; Angioplasty, Balloon ; Endovascular Procedures ; Female ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Humans ; Iliac Artery ; Iliac Vein ; Male ; May-Thurner Syndrome* ; Phlebography ; Stents* ; Thrombolytic Therapy ; Thrombosis ; Urokinase-Type Plasminogen Activator ; Venous Insufficiency ; Venous Thrombosis

Endovascular aneurysm repair (EVAR) using stent grafts has shown to be an effective alternative to surgical repair in treating an abdominal aortic aneurysm (AAA). EVAR is associated with shorter hospital stays, less blood loss, shorter operating times, and lower early morbidity and mortality compared to open surgical repair, although EVAR required a higher reintervention rate during a longer follow-up period. However, short or severely an angulated infrarenal proximal aortic neck is considered unsuitable for EVAR. The chimney graft technique is a modified procedure based on the deployment of a covered or bare-metal stent parallel to the main aortic endograft within the aneurysm, thereby creating a conduit that runs outside the aortic main endograft to preserve flow to the aortic branches. In this case report, we present a 78-year-old patient with an AAA with a short and severely angulated proximal neck who was successfully treated by EVAR using the chimney graft technique.
Aneurysm ; Aortic Aneurysm, Abdominal ; Endovascular Procedures ; Humans ; Length of Stay ; Neck ; Stents ; Transplants

PURPOSE: To evaluate the effect of combined immunosuppressive treatment with FK 506-cyclophosphamide on surgical angiogenesis in non-vascularized bone xenografts. MATERIALS AND METHODS: Twenty-seven hamster-to-rat non-vascularized bone xenografts were performed. For surgical angiogenesis, recipient origin saphenous arteriovenous bundles were implanted into the medullary canals of graft bones. Immunosuppression with FK 506-cyclophosphamide was performed in group 1, not in group 2, control group. At postoperative 4 weeks, microangiography with microfil was conducted. Decalcified bones were cleared and the area of newly formed capillary, capillary density, were quantitatively evaluated using Scion image program. Bone specimens stained with hematoxylin-eosin were evaluated histologically also. RESULTS: There was no significant difference of capillary densities between immunosuppressed group and non-immunosuppressed control group (0.37+/-0.03/0.39+/-0.02, P=0.58). On histological examination, both groups showed neoangiogenesis into the medullary canals and endosteal bones. CONCLUSION: FK 506-cyclophosphamide immunosuppression did not suppress the angiogenesis in non-vascularized bone xenografts, FK 506-cyclophosphamide combination of immunosuppression will be useful even in the condition of surgical angiogenesis.
Capillaries ; Heterografts ; Immunosuppression ; Silicone Elastomers ; Transplants

PURPOSE: To evaluate the effect of combined immunosuppressive treatment with FK 506-cyclophosphamide on surgical angiogenesis in non-vascularized bone xenografts. MATERIALS AND METHODS: Twenty-seven hamster-to-rat non-vascularized bone xenografts were performed. For surgical angiogenesis, recipient origin saphenous arteriovenous bundles were implanted into the medullary canals of graft bones. Immunosuppression with FK 506-cyclophosphamide was performed in group 1, not in group 2, control group. At postoperative 4 weeks, microangiography with microfil was conducted. Decalcified bones were cleared and the area of newly formed capillary, capillary density, were quantitatively evaluated using Scion image program. Bone specimens stained with hematoxylin-eosin were evaluated histologically also. RESULTS: There was no significant difference of capillary densities between immunosuppressed group and non-immunosuppressed control group (0.37+/-0.03/0.39+/-0.02, P=0.58). On histological examination, both groups showed neoangiogenesis into the medullary canals and endosteal bones. CONCLUSION: FK 506-cyclophosphamide immunosuppression did not suppress the angiogenesis in non-vascularized bone xenografts, FK 506-cyclophosphamide combination of immunosuppression will be useful even in the condition of surgical angiogenesis.
Capillaries ; Heterografts ; Immunosuppression ; Silicone Elastomers ; Transplants

An endovascular repair of an abdominal aortic aneurysm (AAA) is technically less invasive than open surgery, but gives results as effective as open surgery if the anatomy is adequate. Unfortunately, 20-30% of AAA patients are not suitable for endovascular repair because they lack a sufficient proximal landing zone. In an effort to broaden the applicability of endovascular repair, the chimney technique has been introduced. This refers to deployment of a covered or bare-metal stent parallel to the main aortic endograft within the aneurysm, creating a conduit that runs outside the main aortic endograft into the aortic branches. We report the case of a 75-year-old male with a juxtarenal abdominal aortic aneurysm and multiple comorbidities who was treated successfully with an endovascular aneurysm repair using a chimney graft.
Aged ; Aneurysm ; Aortic Aneurysm, Abdominal* ; Comorbidity ; Endovascular Procedures ; Humans ; Male ; Stents ; Transplants*