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Three recently developed stent-grafts and the Wallstent were compared directly in an ovine animal model with regard to performance and biocompatibility.Three stent-grafts, the Hemobahn (polytetrafluoroethylene [ePTFE]/nitinol), Wallgraft (polyester/Ni-Co-Ti-steel alloy), and Jostent peripheral stent-graft (balloon-expandable ePTFE/stainless steel), and the Wallstent (Ni-Co-Ti-steel alloy), were implanted in sheep iliac arteries (one type of each stent or stent-graft per animal, n = 8). Pre- and postimplantation luminal diameters were measured for each prosthesis and implantation site. Angiography, intravascular ultrasonography (IVUS), and histomorphometric, histologic, and scanning electron microscopic analyses were performed at 3 months.Early lumen gain, late lumen loss, and patent vessel diameter at angiography were not significantly different. Two stent-grafts had significantly more neointima formation (Hemobahn, 9.88 mm(2) +/- 0.94; Wallgraft, 14.98 mm(2) +/- 0.90) than the other stent-graft (Jostent, 6.52 mm(2) +/- 0.46) and the Wallstent (5.24 mm(2) +/- 0.62; P.01). Patent lumen area was not significantly different (Hemobahn, 42.57 mm(2) +/- 1.41; Jostent, 39.76 mm(2) +/- 2.04; Wallgraft, 40.22 mm(2) +/- 1.04; Wallstent, 41.64 mm(2) +/- 1.59; P =.57). The Hemobahn had significantly more inflammatory reaction (inflammation score of 0.83 +/- 0.03) than the Jostent (0.58 +/- 0.03), Wallgraft (0.55 +/- 0.04), or Wallstent (0.16 +/- 0.01). Angiography and IVUS demonstrated absence of anastomotic neointima formation. Endothelialization was incomplete and immature for all prostheses.The stent-grafts caused a greater degree of neointima formation and inflammatory vessel wall reaction than the bare stent. However, these changes did not interfere with patent lumen areas and occurred in the absence of excessive anastomotic neointima formation.

PURPOSE Because first-generation stent-grafts did not meet initial expectations, a recently designed nitinol–expanded polytetrafluoroethylene (ePTFE) stent-graft was tested for treatment of abdominal aortic aneurysms (AAAs) in a prospective clinical study. The primary study endpoints were technical success and safety. MATERIALS AND METHODS A nitinol–ePTFE self-expandable stent-graft (Excluder) was used to treat 72 patients with AAAs. The median follow-up period was 21.5 months ± 13 (range, 1–46 mo). RESULTS Primary technical success in accurate placement of the device was achieved in 70 of 72 patients (97%). Complete exclusion of the aneurysm from arterial flow was achieved in 57 of 72 patients (79.2%). Three type I leaks were observed during implantation and were immediately corrected with a proximal cuff prosthesis in two patients. Fourteen of 72 patients (19.4%) had a type II leak. Major complications were observed in three patients (4.1%), including one death in the early postinterventional period (one of 72, 1.4%). At 3 months, aneurysms were excluded in 70 of 71 patients (98.6%), and at 12 months, aneurysms were occluded in 29 of 30 patients (96.7%). The maximum diameter of the aneurysm decreased from 55 mm ± 11 (median ± SD) before intervention to 53 mm ± 13 at 6 and 12 months. None of the patients showed aneurysm growth. CONCLUSION This newly designed stent-graft proved to be effective and safe for treatment of AAAs.

The authors report the role of transjugular intrahepatic portosystemic shunts (TIPS) and consecutive interventions, including brachytherapy ( n = 2) and stent-graft placement ( n = 3), to increase secondary patency and consequently postpone orthotopic liver transplantation (OLT) in the treatment of Budd-Chiari syndrome in eight patients. Two patients (with hematologic diseases) died 2 weeks after the TIPS procedure. Median follow-up in the six survivors was 42.5 months (range, 11–79 mo). Multiple TIPS occlusions occurred in three patients (range, 2–7 revisions). Reocclusions occurred despite brachytherapy and Hemobahn stent-graft placement and necessitated OLT in one patient. Revisionfree patency was achieved in the other two patients after VIATORR stent-graft placement (16 and 32 months after TIPS creation). All patients with stable TIPS ( n = 5) are without ascites, no liver failure occurred, and no patients are currently on the transplant list.

PURPOSE To assess the potential of transarterial permanent embolization with use of a mixture of cyanoacrylate and lipiodol for treatment of unresectable primary hepatocellular carcinoma (HCC). MATERIALS AND METHODS In a retrospective study, 36 patients with histologically proven HCC were treated with transarterial embolization (TAE) of the hepatic arteries. None of these patients were candidates for surgical resection and some had advanced disease with multinodular disease or bulky tumor, thrombosis of a segmental branch of the portal vein, and/or extrahepatic spread. To induce permanent and more peripheral embolization, cyanoacrylate, an adhesive polymerizing on contact with blood, was used in TAE. From 1990 to 1998, a total of 76 embolization procedures were performed. Cumulative survival rates were calculated. RESULTS Most of the patients presented with a self-limited postembolization syndrome. Severe procedure-related complications were found after four treatment sessions (5.2%). The 30-day perioperative mortality rate was 2.7%. The mean follow-up period was 20.3 months (range, 1–68 mo), with a median survival of 26 months. The median survival was also estimated for different Okuda stages of disease: stage II ( n = 26) versus stage III ( n = 5) disease (32 vs 9 months; P n = 9) or without ( n = 27) extrahepatic metastasis (10 vs 26 months; P n = 10) or without ( n = 26) thrombosis of a segmental branch of the portal vein (7 versus 34 months [ P CONCLUSION TAE with use of cyanoacrylate and lipiodol for unresectable HCC is a feasible treatment modality. This retrospective report indicates beneficial effects on survival even in patients with advanced disease.