Carotid artery pseudo-pseudoaneurysm after excision of carotid body tumor.

J Vasc Surg. 2010 Aug 21;

Authors: Hotze TE, Smith TA, Clagett GP

PMID: 20732785 [PubMed - as supplied by publisher]

Current Procedural Terminology (CPT) coding for endovascular intervention in the descending thoracic aorta.

J Vasc Surg. 2010 Aug 21;

Authors: Seabrook GR

PMID: 20732784 [PubMed - as supplied by publisher]

Intraprocedural imaging: Flat panel detectors, rotational angiography, FluoroCT, IVUS, or still the portable C-arm?

J Vasc Surg. 2010 Aug 21;

Authors: Eagleton MJ

PMID: 20732783 [PubMed - as supplied by publisher]

A contemporary experience of open aortic reconstruction in patients with chronic atherosclerotic occlusion of the abdominal aorta.

J Vasc Surg. 2010 Aug 21;

Authors: West CA, Johnson LW, Doucet L, Caldito G, Heldman M, Szarvas T, Speirs RD, Carson S

OBJECTIVE: To examine and report surgical results from a contemporary experience of open abdominal aortic reconstruction in patients with chronic atherosclerotic abdominal aortic occlusion (CAAAO). METHODS: Between January 1999 through May 2010, 54 patients with CAAAO were identified and retrospectively reviewed. CAAAOs were categorized into infrarenal aortic occlusions (IRAOs) and juxtarenal aortic occlusions (JRAOs) based on superior extension of thrombus and requirement for supra-renal aortic clamping to repair. Morbidity, mortality, hospital stay, and operative variables were assessed. The chi(2) or Fisher test and the Wilcoxon rank sum test were used to compare demographic and operative variables between two aortic occlusion groups (IRAO and JRAO). Univariate and multivariate analyses were performed to assess factors associated with surgical outcomes and hospital stay. The Kaplan-Meier method was used to calculate survival and patency rates. RESULTS: Fifty patients underwent aortic reconstructions with aorto-bifemoral or iliac bypass, and three underwent a remote axillo-femoral bypass procedure. There were 35 (64.8%) males, and 19 (35.2%) females. Median age was 51.9 years (range, 32-72 years). Of the two CAAAO groups, there were 20 IRAOs and 33 JRAOs. Aorto-renal thromboendartectomy was performed in 26 (49.1%) patients; 26 (75.8%) among JRAOs versus 1 (5%) of IRAOs (P < .01). Proximal aortic clamps were required in 28 (85%) of JRAOs and 3 (15%) of IRAOs (P < .01). Thirty-day and in-hospital mortality was zero. Median length of hospital stay was 7 days (range, 4 to 66 days), and median intensive care unit length of stay was 3 days (range, 1-22 days). Complications included cardiopulmonary dysfunction in four (8%), postoperative renal insufficiency in 10 (18.9%), and other postoperative complications in 15 (28.3%). All 10 with renal insufficiency recovered renal function to baseline creatinine or a creatinine value <1.1 mg/dL. Mean increases in right and left ankle-brachial indicess were 0.54 +/- 0.25 and 0.59 +/- 0.22, respectively. On univariate analysis, coronary artery disease and African American race were predictors of postoperative complications (P = .048). Age was significantly associated with total complications. Patients with postoperative complications and/or renal insufficiency were older than those without such complications (P = .02) Independent predictors of prolonged hospital stay were intraoperative blood replacement (P = .003), postoperative complications (P < .01), and postoperative renal insufficiency (P < .01). Prolonged intensive care unit stay was predicted by JRAO (P = .04), postoperative complications (P = .02), and postoperative renal insufficiency (P = .013). Survival at 3, 5, and 7 years were 86.6%, 76.5% and 50.9%, respectively. The reduced survival rates were predicted by previous myocardial infarction and existing coronary artery disease (P < .01). CONCLUSION: Abdominal aortic reconstruction is a safe method for treating CAAAO with low associated morbidity and mortality. Aorto-renal thromboendartectomy with supra-renal aortic clamping and aortic replacement remains an effective treatment for those with significant pararenal aortic disease, and can be performed without significant renal impairment.

PMID: 20732782 [PubMed - as supplied by publisher]

Description and comparison of Food and Drug Administration-approved thoracic endovascular aneurysm devices.

J Vasc Surg. 2010 Aug 21;

Authors: Lyden SP

In 1991, endovascular aortic treatment was born. Less than 15 years later, the first thoracic endovascular device was approved to treat thoracic aortic aneurysms. Three devices are currently approved to treat thoracic aneurysms in the United States. This chapter describes the current devices approved to treat thoracic aortic pathology and compares differences between devices.

PMID: 20732781 [PubMed - as supplied by publisher]

Regulatory TEVAR clinical trials.

J Vasc Surg. 2010 Aug 21;

Authors: Garcia-Toca M, Eskandari MK

PMID: 20732780 [PubMed - as supplied by publisher]

Prosthetic lower extremity hemodialysis access grafts have satisfactory patency despite a high incidence of infection.

J Vasc Surg. 2010 Aug 21;

Authors: Geenen IL, Nyilas L, Stephen MS, Makeham V, White GH, Verran DJ

INTRODUCTION:: Prosthetic arteriovenous grafts (AVGs) in the lower extremity represent a useful alternative for hemodialysis vascular access when all upper limb access sites have been used or in some patients when freedom of both hands is necessary during dialysis. Reported complications include an increased risk of infection and limb ischemia. This study evaluated our experience with the patency outcomes and complication rates of polytetrafluoroethylene (PTFE) AVGs placed in the thigh. METHODS:: A retrospective outcomes analysis was performed of all femoral AVGs inserted between January 1992 and July 2007. Data were obtained by review of medical records for patient demographics, comorbidities, and AVG-related outcomes. Patency, complication rates, and risk factors for infection were determined. RESULTS:: A total of 153 prosthetic AVGs were placed in 127 patients (63 men). Mean patient age was 52.7 +/- 16.3 years. Median follow-up was 25 months (range, 1-169 months). The most common underlying renal disease was glomerulonephritis in 27 (21%). Hypertension and coronary artery disease were common comorbidities, respectively, in 49 (39%) and 23 patients (18%). The primary and secondary AVG patency rates at 12 months were 53.9% and 75.3%, respectively, and 2- and 5-year patency rates were, respectively, 39.6% and 19.3% (primary) and 63.8% and 50.6% (secondary). The mean AVG survival for all cases was 31.6 months (range, 0-149 months). Surgical thrombectomy was required in 82 (54%), and 22 AVGs (14%) required surgical revision for stenosis. Infection occurred in 41 AVGs (27%), and limb ischemia occurred in 2 (1.3%). Statistical analysis did not reveal a significant risk factor for infection. CONCLUSIONS:: Femoral AVGs are a suitable alternative to upper limb vascular access, with acceptable primary and secondary patency rates. Infection occurred in approximately one-quarter of cases, whereas steal was uncommon.

PMID: 20732779 [PubMed - as supplied by publisher]

Surgical treatment of giant extracranial internal carotid artery aneurysm.

J Vasc Surg. 2010 Aug 21;

Authors: Mitrev Z, Jankulovski A, Bozinovska B, Hristov N

PMID: 20732778 [PubMed - as supplied by publisher]

The ethical hierarchy of do not resuscitate orders: Never say never.

J Vasc Surg. 2010 Aug 21;

Authors: Jones JW, McCullough LB

Mrs G. Oner, a 58-year-old woman, had a massive myocardial infarction after an aneurysmectomy being kept alive for several weeks by a left ventricular assist device. It appears that she may survive. However, Mrs Oner has become clinically depressed and is strongly considering discontinuing hemodynamic support. After a discussion about her condition during which she learned that survival could not be assured, she elected what the hospital calls "code two" do not resuscitate (DNR) status (no cardiopulmonary resuscitation, no intubation) but wants all other treatment to continue "as long as it will help her." She did not discuss this decision with her husband, an internationally acclaimed professor of law, beforehand. When he visits later that day, she unexpectedly has a stroke accompanied by respiratory difficulty and Professor Oner insists that "everything" be done. The team informs him that the patient will not be intubated, per the code two status. He insists that he is her legal surrogate and demands the DNR status be withdrawn. Which options are unethical?

PMID: 20732777 [PubMed - as supplied by publisher]

Endovascular aneurysm repair for ruptured abdominal aortic aneurysm: How I do it.

J Vasc Surg. 2010 Aug 17;

Authors: Mehta M

Improvements in endovascular technology and techniques have allowed us to treat patients in ways we never thought possible. Today, endovascular treatment of ruptured abdominal aortic aneurysms is associated with markedly decreased morbidity and mortality compared with the open surgical approach, yet there are several fundamental obstacles in our ability to offer these endovascular techniques to most patients with ruptured aneurysms. This article will focus on the technical aspects of endovascular aneurysm repair for rupture, with particular attention to developing a standardized multidisciplinary approach that will help vascular surgeons deal with not just the technical aspects of these procedures but also address some of the challenges, including the availability of preoperative computed tomography, the choice of anesthesia, the percutaneous vs femoral cutdown approach, use of aortic occlusion balloons, need for bifurcated vs aortouniiliac stent grafts, need for adjunctive procedures, diagnosis and treatment of abdominal compartment syndrome, and conversion to open surgical repair.

PMID: 20724101 [PubMed - as supplied by publisher]

Discussion.

J Vasc Surg. 2010 Aug 17;

Authors:

PMID: 20724100 [PubMed - as supplied by publisher]

Long-term outcomes of secondary procedures after endovascular aneurysm repair.

J Vasc Surg. 2010 Aug 17;

Authors: Mehta M, Sternbach Y, Taggert JB, Kreienberg PB, Roddy SP, Paty PS, Ozsvath KJ, Darling RC

PURPOSE:: This study evaluated the outcomes of secondary procedures after endovascular aneurysm repair (EVAR). METHODS:: From 2002 to 2009, 1768 patients underwent EVAR for treatment of 1662 elective (94%) and 106 emergent (6%) infrarenal AAA with a variety of Food and Drug Administration-approved and commercially available stent grafts. Postoperative follow-up included clinical examination, pulse volume recording, duplex ultrasound imaging, and computed tomography and magnetic resonance angiography at 1, 6, and 12 months, and yearly thereafter. Patients with type I and III endoleaks, unexplained endotension, limb occlusion, stent graft migration, with and without type I endoleak, and aneurysm rupture underwent secondary interventions. Type II endoleak at >6 months without a decrease in the aneurysm sac underwent translumbar embolization. Data were prospectively collected. RESULTS:: EVAR was performed in 1768 patients. During a mean follow-up of 34 (SD, 30.03) months, 339 patients (19.2%) required additional secondary procedures for aneurysm-related complications, including type I (n = 51, 15.0%), type II (n = 136, 40.1%), and type III (n = 5, 1.5%) endoleaks; endotension (n = 8, 2.4%), stent graft migration proximal fixation site (n = 46, 13.6%), stent graft iliac limb thrombosis or stenosis (n = 25, 7.4%), subsequent iliac aneurysm formation (n = 39, 11.5%), or aneurysm rupture after EVAR (n = 29, 8.6%). The mean age was 74 (SD, 9.15) years. Mean AAA size was 5.7 (SD 3.24) cm. Compared with secondary procedures for AAA rupture, the nonrupture patients had a significantly lower mortality (1.6% vs 17.2%, P < .05) and a higher likelihood of being managed by endovascular means (98.8% vs 44.8%, P < .05). When nonruptured EVAR patients required urgent secondary procedures for type I endoleaks and stent graft migration or limb thrombosis, the mortality was 6.0% vs 0.5% for elective procedures (P < .05). CONCLUSIONS:: Our long-term EVAR experience indicates that 18% of patients require additional secondary procedures, and most of these patients can be managed by endovascular means with an acceptable overall mortality of 2.9%. Most type I and II endoleaks can be successfully treated by transluminal embolization, and most patients with delayed aneurysm rupture after EVAR can be successfully managed by endovascular or open surgical repair.

PMID: 20724099 [PubMed - as supplied by publisher]

Endovascular techniques for arch vessel reconstruction.

J Vasc Surg. 2010 Aug 17;

Authors: Longo GM, Pipinos II

PMID: 20724098 [PubMed - as supplied by publisher]

Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms.

J Vasc Surg. 2010 Aug 17;

Authors: Ricotta JJ

Thoracic endovascular aortic repair (TEVAR) has evolved rapidly and has become an accepted, less invasive alternative to open surgical repair for the treatment of thoracic aortic aneurysms. Patients undergoing TEVAR require lifelong postoperative surveillance to detect some of the unique complications associated with endovascular thoracic aortic aneurysm repair, such as endograft migration and endoleak formation. Failure to achieve a proximal seal in the aortic arch resulting in a proximal type I endoleak remains an Achilles' heel of the TEVAR procedure. This article addresses strategies for postoperative surveillance imaging and endoleak management in patients after endovascular repair of thoracic aortic aneurysms.

PMID: 20724097 [PubMed - as supplied by publisher]

Open techniques for arch vessel reconstruction during thoracic endovascular aneurysm repair (TEVAR).

J Vasc Surg. 2010 Aug 17;

Authors: Vallabhaneni R, Sanchez LA

PMID: 20724096 [PubMed - as supplied by publisher]

Reducing venous stasis ulcers by fifty percent in 10 years: The next steps.

J Vasc Surg. 2010 Aug 17;

Authors: Henke P, Kistner B, Wakefield TW, Eklof B, Lurie F

PMID: 20719467 [PubMed - as supplied by publisher]

Evidence for markers of hypoxia and apoptosis in explanted human carotid atherosclerotic plaques.

J Vasc Surg. 2010 Aug 17;

Authors: Bitto A, De Caridi G, Polito F, Calò M, Irrera N, Altavilla D, Spinelli F, Squadrito F

OBJECTIVE: Apoptosis and inflammation are important features of atherosclerotic plaques. We investigated whether a common signal molecule can trigger these two apparently separate pathways. Hypoxia inducible factor (HIF-1alpha) is known to participate in atherosclerosis and to stimulate apoptosis signal-regulating kinase 1 (ASK-1), one of the mitogen-activated protein kinases, which is activated by various extracellular stimuli and involved in a variety of cellular function. METHODS: We tested carotid artery specimens from 50 subjects who underwent angioplasty and five age-matched controls for either Western blot or histologic analysis. The hypoxic status was investigated by means of HIF-1alpha expression in carotid specimens. RESULTS: HIF-1alpha was significantly upregulated in carotid specimens with respect to controls (P < .05), ASK-1 was detected in plaques of any composition from lipidic to calcific, and this expression increased with the stage of the plaque and with the expression of inflammatory (p-ERK, RANK-L, OPG) and apoptotic molecules (caspase 9, p-p-38, and p-JNK). CONCLUSION: Our data suggest that hypoxia is the key regulating factor that triggers inflammation as well as apoptosis in the human atherosclerotic plaque.

PMID: 20719466 [PubMed - as supplied by publisher]

Heparin versus bivalirudin for carotid artery stenting using proximal endovascular clamping for neuroprotection: Results from a prospective randomized study.

J Vasc Surg. 2010 Aug 17;

Authors: Stabile E, Sorropago G, Tesorio T, Popusoi G, Ambrosini V, Mottola MT, Biamino G, Rubino P

BACKGROUND:: General recommendations indicate that, during a carotid artery stenting (CAS), sufficient unfractionated heparin (UFH) has to be given to maintain the activated clotting time between 250 to 300 seconds. Bivalirudin use is able to reduce postprocedural bleedings in percutaneous interventions when compared with UFH. The study purpose was to evaluate, in a randomized study, the safety and efficacy of bivalirudin versus heparin during CAS, using proximal endovascular occlusion (PEO) as a distal protection device. METHODS:: From January 2006 to December 2009, 220 patients undergoing CAS using PEO have been randomly assigned to one of the study arms (control arm: 100 UI/kg UFH or bivalirudin arm: 0.75 mg/kg intravenous bolus and intraprocedural infusion at 1.75 mg/kg/h). RESULTS:: Procedural success was achieved in all the patients. No episodes of intraprocedural thrombosis occurred. One major stroke occurred in the bivalirudin arm, and two minor strokes occurred, one in each group. A significant difference in the incidence of postprocedural bleedings was observed between the study groups; bivalirudin use was associated with reduced number of bleedings according to Thrombolysis In Myocardial Infarction criteria. CONCLUSIONS:: The use of bivalirudin should be considered a safe and effective anticoagulation regimen during CAS, using PEO as a distal protection device. Bivalirudin use is associated with a reduced incidence of bleedings.

PMID: 20719465 [PubMed - as supplied by publisher]

Advanced thoracic endovascular aortic repair data update and technical tips.

J Vasc Surg. 2010 Aug 13;

Authors: Peterson BG

PMID: 20709484 [PubMed - as supplied by publisher]

Staged total exclusion of the aorta for chronic type B aortic dissection: A case report.

J Vasc Surg. 2010 Aug 13;

Authors: Perera AD, Willis AK, Fernandez JD, Garrett HE, Wolf BA

Hybrid techniques using extra-anatomic bypass of critical aortic branches to enable endovascular treatment of complex aortic pathology have been previously described. A staged endograft repair of a complex, chronic Stanford type B aortic dissection with aneurysmal degeneration is reported in a 50-year-old man. The aneurysmal portion of the dissection extended from the distal arch to both common iliac arteries and was covered with an endograft from the ascending aorta to both external iliac arteries. Aortic arch branches, visceral, and renal arteries were bypassed using open technique. The patient had no neurologic complications. This case report illustrates the feasibility of the hybrid technique in selected high-risk patients when confronted with complex aortic pathology.

PMID: 20709483 [PubMed - as supplied by publisher]