Polytetrafluoroethylene Covered Stent Placement for Focal Occlusive Disease of the Infrarenal Aorta

Regenerating Critical Size Rat Segmental Bone Defects with a Self-Healing Hybrid Nanocomposite Hydrogel: Effect of Bone Condition and BMP-2 Incorporation

The aim of the current study is to assess the biological performance of self-healing hydrogels based on calcium phosphate (CaP) nanoparticles and bisphosphonate (BP) conjugated hyaluronan (HA) in a critical size segmental femoral bone defect model in rats. Additionally, these hydrogels are loaded with bone morphogenetic protein 2 (BMP-2) and their performance is compared in healthy and osteoporotic bone conditions. Treatment groups comprise internal plate fixation and placement of a PTFE tube containing hydrogel (HA_BP -CaP) or hydrogel loaded with BMP-2 in two dosages (HA_BP -CaP-lowBMP2 or HA_BP -CaP-highBMP2). Twelve weeks after bone defect surgery, bone formation is analyzed by X-ray examination, micro-CT analysis, and histomorphometry. The data show that critical size, segmental femoral bone defects cannot be healed with HA_BP -CaP gel alone. Loading of the HA_BP -CaP gel with low dose BMP-2 significantly improve bone formation and resulted in defect bridging in 100% of the defects. Alternatively, high dose BMP-2 loading of the HA_BP -CaP gel does not improve bone formation within the defect area, but leads to excessive bone formation outside the defect area. Bone defect healing is not affected by osteoporotic bone conditions.

Midterm Results of the Treatment of Penetrating Abdominal Aortic or Iliac Artery Ulcer with the BeGraft Balloon-Expandable Covered Stent-A Single-Center Experience

BACKGROUND

The purpose of the study was to evaluate the feasibility and efficacy of the novel BeGraft covered stent for the treatment of abdominal penetrating aortic ulcer (PAU) or penetrating ulcers of the iliac arteries (PUIAs).

METHODS

This was a single-center observational study, which included 24 consecutive patients who underwent endovascular surgery due to abdominal PAU or PUIA between June 2017 and September 2019. Demographics of patients, lesion characteristics, diameter and length of the BeGraft stents, and postoperative events were prospectively collected and retrospectively analyzed. Follow-up examinations were performed at 1, 6, 12, and 24 months with clinical and hemodynamic evaluation. Outcome measures included technical success, perioperative complications, and stent patency.

RESULTS

A total of 24 patients (13 men and 11 women), with a median age of 67 years (range, 42-81 years), were analyzed. Among them, 20 patients were symptomatic, and 4 patients underwent elective surgery because of the size of PAU. A total of 54 BeGraft stents (26 aortic and 28 peripheral) were successfully delivered and deployed to cover 13 aortic and 13 common iliac artery ulcer lesions. The technical success rate was 100%. The average procedural time was 53.8 ± 12.8 min. Complications included one case of the access-site pseudoaneurysm, which was successfully treated by thrombin injection. During a median follow-up of 20.5 months (range, 6-33 months), all stents remained patent, without endoleak or ulcer recurrence.

CONCLUSIONS

BeGraft stents used during endovascular treatment of abdominal PAU and PUIA lesions are associated with favorable outcomes regarding technical success and patency. The primary use of BeGraft covered stents provides a valid option for patients with abdominal PAU. Long-term follow-up is required to confirm these promising results.

Treatment of focal distal abdominal aortic stenosis with the GORE VIABAHN VBX balloon expandable covered stent

The incidence of focal infrarenal stenosis of the aorta is rare. Endovascular therapy has evolved as a first-line treatment of aortoiliac occlusive disease and has been shown to substantially improve health-related quality of life. The 8 French sheath compatible, GORE VIABAHN VBX (GORE Flagstaff, AZ) balloon expandable covered stent offers the traditional benefits of a balloon expandable covered stent with a design that improves on flexibility. We report three cases with the use of this system for treatment of infrarenal stenosis of the aorta.

Successful Endovascular Therapy for Isolated Abdominal Aortic Dissection Involving Bilateral Common Iliac Arteries

A 69-year-old male patient was admitted to our hospital due to sudden right leg pain and paralysis when walking, which was suspected to be acute limb ischemia. Computed tomography and aortography revealed isolated abdominal aortic dissection with bilateral common iliac artery (CIA) stenosis. Endovascular therapy was performed. A Palmaz XL stent (20×40 mm) was deployed on the aortic dissection with intravascular ultrasound assistance. Subsequently, CIA lesions disappeared. Stent deployment at the aortic dissection primary tear resulted in occlusion of the false lumen of the distal dissection of the bilateral CIAs. Postoperatively, his symptoms disappeared, with no recurrence during 14 months of follow-up.