Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
Despite improvements in endograft devices, operator technique, and patient selection, endovascula... more Despite improvements in endograft devices, operator technique, and patient selection, endovascular repair has not achieved the long-term durability of open surgical aneurysm repair. Persistent or recurrent aneurysm sac flow from failed proximal sealing, component failure, or branch vessel flow underpins a significant rate of reintervention after endovascular repair. The Nellix device (Endologix, Irvine, Calif) employs a unique design with deployment of polymer-filled EndoBags surrounding the endograft flow lumens, sealing the aneurysm sac space and potentially reducing complications from persistent sac flow. This retrospective analysis represents the initial experience in consecutive patients treated with the device in real-world practice. This study was performed at six clinical centers in Europe and one in New Zealand during the initial period after commercialization of the Nellix device. Patients underwent evaluation with computed tomography and other imaging modalities following...
To present novel techniques to prevent spinal ischemia during aneurysm creation and chronic bifur... more To present novel techniques to prevent spinal ischemia during aneurysm creation and chronic bifurcated stent-graft implantation in an ovine model of abdominal aortic aneurysm (AAA). Experimental AAAs were created in 38 sheep. To prevent spinal ischemia, an internal aortic shunt was used during aneurysm creation. In the animals designated to receive bifurcated stent-grafts, a left external iliac-to-internal iliac bypass was performed to revascularize the caudal artery and prevent postdeployment spinal cord ischemia. Specimens were harvested at 1 week, 1, 3, and 6 months, and 1 year. Aneurysms were successfully created without paralysis in 35 animals. Two died due to aspiration pneumonia. Of the 33 animals implanted with endografts, 16 (94%) of 17 with straight devices and 15 (94%) of 16 with bifurcated stent-grafts survived with well-functioning, patent stent-grafts. Paralysis developed in 2 animals after endografting due to technical failures. The use of an internal shunt during aneurysm creation and internal iliac-to-external iliac transposition prior to bifurcated stent-graft deployment prevented spinal ischemia in an ovine AAA model. Chronically deployed stent-grafts were well tolerated.
Summary Introduction. During the last several decades there have been many new methods introduced... more Summary Introduction. During the last several decades there have been many new methods introduced for the treatment of lower limb chronic venous insufficiency (laser, foam, subendothelial and thermal coagulation methods). Venous system of lower limbs often presents anatomic variations including venous duplications. Knowledge of venous system variations in the lower limb area is of particular importance due to correct interpretation of imaging in relation to deep vein thrombosis (DVT). There was only a small number of studies published on anatomic variations of venous system in the lower limbs. To the best of our knowledge there have been no previous studies on anatomic variations of lower limb deep venous system performed in Latvia. Aim of the study. To retrospectively review of 216 patients (432 lower limbs) phlebograms in order to establish deep venous system anatomic variations in Latvian population and compare our results to other publications. Materials and methods. Retrospecti...
Introduction. Contrast-enhanced computed tomography (CT) has become the 'gold-standard' imaging m... more Introduction. Contrast-enhanced computed tomography (CT) has become the 'gold-standard' imaging modality for surveillance following EVAR (2,. However repeated CT is related to increased cost, risk of contrast nephropathy and radiation exposure. Duplex ultrasound (DUS) is a less invasive but considered less accurate method than CT. Aim of the study. The aim of this study was to determine the diagnostic accuracy of both imaging modalities for detection of complications in post-EVAR patients where the new generation sac-sealing endograft was used and to compare cost-effectiveness and sensitivity of both imaging modalities. Methods. Analysis of 23 post-EVAR patients with implantation of new generation sac-sealing endograft device (Nellix®, Endologix, USA) was performed, making a comparison of CT and DUS. Contrast-enhanced computed tomography was taken as the 'goldstandard' investigation. DUS was compared to CT for analysis of sensitivity, post-imaging complications and cost-effectiveness. Statistical analysis of data was performed using v19.0 SPSS software (IBM). Results. Analysis of CT and DUS studies compared in 23 patients. Both imaging modalities can detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between two imaging techniques is substantial. Our results demonstrate that DUS surveillance during follow-up after EVAR where new generation sac-sealing endograft is used can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and eliminating CT related radiation and nephrotoxicity. Conclusion. CT and DUS imaging can both detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between the two imaging techniques is substantial. Our results demonstrate that in post-EVAR patients where new-generation sac-sealing endograft was deployed DUS surveillance performed by experienced radiologist can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and avoiding CT-related complications.
Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter
Despite improvements in endograft devices, operator technique, and patient selection, endovascula... more Despite improvements in endograft devices, operator technique, and patient selection, endovascular repair has not achieved the long-term durability of open surgical aneurysm repair. Persistent or recurrent aneurysm sac flow from failed proximal sealing, component failure, or branch vessel flow underpins a significant rate of reintervention after endovascular repair. The Nellix device (Endologix, Irvine, Calif) employs a unique design with deployment of polymer-filled EndoBags surrounding the endograft flow lumens, sealing the aneurysm sac space and potentially reducing complications from persistent sac flow. This retrospective analysis represents the initial experience in consecutive patients treated with the device in real-world practice. This study was performed at six clinical centers in Europe and one in New Zealand during the initial period after commercialization of the Nellix device. Patients underwent evaluation with computed tomography and other imaging modalities following...
To present novel techniques to prevent spinal ischemia during aneurysm creation and chronic bifur... more To present novel techniques to prevent spinal ischemia during aneurysm creation and chronic bifurcated stent-graft implantation in an ovine model of abdominal aortic aneurysm (AAA). Experimental AAAs were created in 38 sheep. To prevent spinal ischemia, an internal aortic shunt was used during aneurysm creation. In the animals designated to receive bifurcated stent-grafts, a left external iliac-to-internal iliac bypass was performed to revascularize the caudal artery and prevent postdeployment spinal cord ischemia. Specimens were harvested at 1 week, 1, 3, and 6 months, and 1 year. Aneurysms were successfully created without paralysis in 35 animals. Two died due to aspiration pneumonia. Of the 33 animals implanted with endografts, 16 (94%) of 17 with straight devices and 15 (94%) of 16 with bifurcated stent-grafts survived with well-functioning, patent stent-grafts. Paralysis developed in 2 animals after endografting due to technical failures. The use of an internal shunt during aneurysm creation and internal iliac-to-external iliac transposition prior to bifurcated stent-graft deployment prevented spinal ischemia in an ovine AAA model. Chronically deployed stent-grafts were well tolerated.
Summary Introduction. During the last several decades there have been many new methods introduced... more Summary Introduction. During the last several decades there have been many new methods introduced for the treatment of lower limb chronic venous insufficiency (laser, foam, subendothelial and thermal coagulation methods). Venous system of lower limbs often presents anatomic variations including venous duplications. Knowledge of venous system variations in the lower limb area is of particular importance due to correct interpretation of imaging in relation to deep vein thrombosis (DVT). There was only a small number of studies published on anatomic variations of venous system in the lower limbs. To the best of our knowledge there have been no previous studies on anatomic variations of lower limb deep venous system performed in Latvia. Aim of the study. To retrospectively review of 216 patients (432 lower limbs) phlebograms in order to establish deep venous system anatomic variations in Latvian population and compare our results to other publications. Materials and methods. Retrospecti...
Introduction. Contrast-enhanced computed tomography (CT) has become the 'gold-standard' imaging m... more Introduction. Contrast-enhanced computed tomography (CT) has become the 'gold-standard' imaging modality for surveillance following EVAR (2,. However repeated CT is related to increased cost, risk of contrast nephropathy and radiation exposure. Duplex ultrasound (DUS) is a less invasive but considered less accurate method than CT. Aim of the study. The aim of this study was to determine the diagnostic accuracy of both imaging modalities for detection of complications in post-EVAR patients where the new generation sac-sealing endograft was used and to compare cost-effectiveness and sensitivity of both imaging modalities. Methods. Analysis of 23 post-EVAR patients with implantation of new generation sac-sealing endograft device (Nellix®, Endologix, USA) was performed, making a comparison of CT and DUS. Contrast-enhanced computed tomography was taken as the 'goldstandard' investigation. DUS was compared to CT for analysis of sensitivity, post-imaging complications and cost-effectiveness. Statistical analysis of data was performed using v19.0 SPSS software (IBM). Results. Analysis of CT and DUS studies compared in 23 patients. Both imaging modalities can detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between two imaging techniques is substantial. Our results demonstrate that DUS surveillance during follow-up after EVAR where new generation sac-sealing endograft is used can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and eliminating CT related radiation and nephrotoxicity. Conclusion. CT and DUS imaging can both detect AAA sac dimensions, endoleaks, and graft patency. The cost difference between the two imaging techniques is substantial. Our results demonstrate that in post-EVAR patients where new-generation sac-sealing endograft was deployed DUS surveillance performed by experienced radiologist can accurately detect aneurysm size, endoleaks, graft deformations and stenotic or kinked graft limbs while lowering the overall costs of surveillance and avoiding CT-related complications.
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Papers by Martin Bjorck