Successful percutaneous endovascular treatment of symptomatic infrarenal aortic stenosis caused by soft-plaque with the Endurant stent-graft.

Focal stenosis or occlusion of the infrarenal aorta is a relatively rare entity. In particular, soft-plaque of atherothrombotic origin in the aortic segment is linked to high-risk for peripheral embolisation. To our knowledge, the present case report describes for first time in the literature successful percutaneous treatment of a symptomatic soft-plaque infrarenal aortic stenosis with severe calcification of the iliac vessels by stent-graft, in particular by the new Endurant. Endovascular exclusion of the thrombotic lesion by endoprosthesis covers the atherosclerotic wall treating the potential underlying cause of the thrombus formation. The radial force of the endoprosthesis seems to be sufficient achieving complete expansion. However, long-term results are warranted.

[Eccentric infrarenal aortic stenosis. Surgical and endovascular treatment]. / Exzentrische infrarenale Aortenstenose. Chirurgische und endovaskuläre Behandlung.

The management of coral reef lesions reported in this case study demonstrates the complementary and non-competing character of the open and endovascular treatment. The minimally invasive procedure of stent-optimized angioplasty seems to be advantageous as the primary therapy in selected cases. In the case of clinical deterioration the endovascular technique allows surgical reconstruction without significantly diminishing the result. Catheter-based techniques therefore remain an additional instrument for treatment in the hands of vascular surgeons which substantially broadens the range of therapy options for this disease entity.

[Long stents for long femoropopliteal lesions--first results of 128 Protégé stents]. / Lange femoro-popliteale Läsionen erfordern lange Stents--erste Erfahrungen mit 128 Protégé-Stents.

BACKGROUND: In the endovascular therapy for the superficial femoral artery (SFA) a variety of stent devices can be used. Indications for endovascular intervention are increasing, since the 2007 TASC II consensus changed. Several, also multicentric -trials, evaluated the use and effectiveness of stent devices. AIM: The present trial studied efficacy of long ev3 Protégé Everflex stents used in the treatment of long and complex occlusive lesions of the -superficial femoral artery (SFA) and the popliteal artery. MATERIALS AND METHODS: The ev3 Protégé Everflex device (ev3 Inc., Plymouth, MN, USA) is a self-expandable nitinol stent consisting of a helical structure with spiral cell interconnections, making high flexibility and low fragility possible. Using a prospective follow-up programme, 103 consecutive patients who received 128 stents (150 mm average length) were included in this study. Pre- and postinterventional parameters were walk-ing distance, ABI, Rutherford categorisation and duplex ultrasound examination. In addition, stent fracture was excluded by radiograms. The mean follow-up period was 6 months. RESULTS: 128 stents were implanted in 103 patients. The average age was 71.1 years (range: 52-90 years). 44 % of the collective suffered from TASC II C and D lesions. The technical success was 100 %. Restenosis was found in 11.8 % of the cases (n = 16) and recanalised (n = 9). 4 bypass implantations and 2 major amputations were performed. A total of 6 stent fractures was found (4.7 %). CONCLUSIONS: The Protégé stent is a safe device with favourable short-term results. Restenosis and fracture rates are low, but long-term results still have to be evaluated in the future.

Below-knee bare nitinol stent placement in high-risk patients with critical limb ischaemia and unlimited supragenicular inflow as treatment of choice.

PURPOSE: To evaluate the effectiveness of nitinol stent placement in long infrapopliteal lesions in patients with critical limb ischaemia. MATERIALS AND METHODS: Between January 2005 and January 2008, 34 high-risk patients (18 female; mean age: 73.8+/-6.1 years) with critical limb ischaemia underwent infragenicular stenting. They had serious cardiovascular co-morbidities (>3, such as chronic obstructive pulmonary disease (COPD), congestive heart failure and coronary artery occlusive disease), American Society of Anaesthesiologists score of 3 or more, previous myocardial infarction, coronary stent or bypass. The mean stenosis length was 6.5+/-0.9 cm (range: 2.2-8 cm), and the mean occlusion length was 7.5+/-2.9 cm (range: 3-9.6 cm). Primary stent implantation was performed for long stenosis or occlusion based on the TransAtlantic InterSociety Consensus (TASC) C and D classification, secondary stenting for flow-limiting dissections or elastic recoil after balloon dilatation. All patients who returned to the outpatient clinic were assessed for claudication by clinical examination, ankle-brachial index (ABI) measurements, colour flow and duplex Doppler ultrasound (US). Digital subtraction angiography was performed if restenosis or re-occlusion was identified by Doppler US or transcutaneous measurement of partial oxygen pressure (TcpO(2)) measurements, when appropriate. RESULTS: The technical success rate was 97.1% (33 of 34 cases). The crude rate of primary patency rate was 91.1% during a follow-up period of 10.4+/-7.3 months. The mean ankle-brachial index increased significantly following intervention (0.45+/-0.25-0.92+/-0.13, p<0.001). Two patients underwent successful redo angioplasty after tibioperoneal interventions due to in-stent restenosis (>70%) with relevant limitation of pain-free walking distance. In another patient, bypass surgery to the anterior tibial artery 6 months after primary intervention was necessary due to rest pain. Two patients required surgical revision of the femoral artery after antegrade access. No procedure-related death was recorded in the entire follow-up period. CONCLUSIONS: The mid-term outcome underscores infrapopliteal stent placement as a reliable treatment option in patients with critical limb ischaemia. In patients at high risk for crural bypass, with no flow-limiting supragenicular lesions, below-knee stent-supported angioplasty should be considered as a first choice of treatment.