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Seminars in Vascular Surgery

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https://www.readbyqxmd.com/read/29248127/how-to-best-treat-infectious-complications-of-open-and-endovascular-thoracic-aortic-repairs
#1
REVIEW
Andrea Kahlberg, Germano Melissano, Daniele Mascia, Diletta Loschi, Alessandro Grandi, Roberto Chiesa
Infectious complications of open and endovascular procedures for descending thoracic aortic disease are relatively rare, affecting 1% to 6% of treated patients. However, the number of thoracic aortic procedures, especially endovascular, is increasing continuously, and infectious complications involving the graft or endograft have been observed more frequently in recent years. Several causative factors may play a role in thoracic aortic prosthetic infections, including hematogenous seeding, local bacterial translocation, and iatrogenous contamination...
June 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/29248126/management-of-the-infected-aortic-endograft
#2
REVIEW
Kamphol Laohapensang, Supapong Arworn, Saranat Orrapin, Termpong Reanpang, Saritphat Orrapin
Although the incidence of abdominal and thoracic aortic endograft infection is infrequent, ranging between 0.2% and 5%, stent-graft infection carries significant morbidity and mortality and exemplifies a formidable therapeutic challenge. The treatment goal is to eradicate the infectious process by endograft explantation, regional tissue debridement, and arterial reconstruction by either an extra-anatomic or in situ grafting procedure using autologous vein, cryopreserved allograft, or antibiotic-soaked prosthetic grafts...
June 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/29248125/aortobronchial-and-aortoenteric-fistula
#3
REVIEW
M Libby Weaver, James H Black
Pathologic communication between the thoracic aorta and esophagus or tracheobronchial tree is a rare vascular condition and most commonly develops after open or endovascular aortic repair complicated by infection. Patients with aortoesophageal or tracheobronchial fistula often present with systemic infection and are at risk for major hemorrhage. Medical management is uniformly fatal. Expeditious definitive management requires operative repair by open repair or a combination of endovascular and open procedures...
June 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/29248124/current-status-of-endovascular-treatment-of-aortoenteric-fistula
#4
REVIEW
Konstantinos Spanos, George Kouvelos, Christos Karathanos, Miltiadis Matsagkas, Athanasios D Giannoukas
Aortoenteric fistula (AEF) is one of the most challenging diagnostic and therapeutic entities in vascular surgery. AEF can occur either primarily involving the aorta and the gastrointestinal tract or, more commonly, secondary to previous aortic reconstructive surgery. Traditionally, the treatment of AEF includes graft excision and extra-anatomic bypass surgery or in situ graft replacement. However, recently endovascular repair has emerged as an alternative therapeutic option. In this article, we present published and current evidence for endovascular repair of primary and secondary AEF...
June 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/29248123/current-management-of-infected-aortic-grafts-in-patients-with-connective-tissue-disorders
#5
REVIEW
Natalia O Glebova, James H Black
Patients with connective tissue disorder present a particular clinical challenge in the treatment of aortic graft infections. Specific complexities arise in patients with connective tissue disorders when reoperation for aortic graft infection is required. Herein we describe current management of infected aortic grafts in patients with connective tissue disorders using homograft and rifampin-coated graft replacements using in situ replacement therapy, which is associated with improved outcome compared to graft excision and extra-anatomic bypass...
June 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/29248122/pathology-of-graft-and-stent-graft-infections-lessons-learned-from-examination-of-explant-materials
#6
REVIEW
Anne Lejay, Antoine Monnot, Yannick Georg, Benjamin Colvard, Fabien Thaveau, Bernard Geny, Nabil Chakfé
Due to the aging population, the number of patients treated with aortic grafts or endografts continues to increase. Although infection after these procedures is uncommon, aortic graft infection is a life-threatening condition, and refinement of management guidelines based on implant pathophysiology is appropriate. In the early 1990s, our European collaborative retrieval program, European Group for Research on Prostheses Applied for Vascular Surgery (GEPROVAS) was commissioned to analyze the degenerative phenomenon occurring on explanted grafts or endografts...
June 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/29248121/percutaneous-drug-eluting-balloon-angioplasty-to-treat-dialysis-access-stenosis
#7
Mafalda Massara, Pietro Finocchiaro, Alberto Volpe, Antonino Alberti, Pietro Volpe
A common complication of arteriovenous fistula for hemodialysis is development of conduit stenosis, which compromises function and can result in access thrombosis. Possible treatment options include open repair and endovascular therapy, with the latter preferred due to lower morbidity and similar outcomes. Recurrence of conduit stenosis is common and, based on the pathophysiology of this lesion, the application of drug-coated balloon angioplasty is attractive. In this report, the application of drug-eluting balloon angioplasty for dialysis access stenosis in 18 consecutive patients is detailed and primary patency rates of 82% at 1 year and 68% at 2 years were calculated...
June 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818261/contemporary-medical-therapies-of-atherosclerotic-carotid-artery-disease
#8
REVIEW
Suk F Cheng, Martin M Brown
Contemporary medical therapy consists of identification and treatment of all patient-modifiable vascular risk factors. Specific atherosclerotic disease therapies are designed to reduce the risk of thrombosis, and the disease progression in order to reduce the risk of future cardiovascular events. Contemporary medical management emphasizes the need to support the patient in achieving lifestyle modifications and to adjust medication to achieve individualized target values for specific quantifiable risk factors...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818260/transcranial-doppler-monitoring-for-microemboli-a-marker-of-a-high-risk-carotid-plaque
#9
REVIEW
J David Spence
In the United States, 90% of carotid intervention is being performed for asymptomatic carotid stenosis, even though 90% of patients would be better treated with intensive medical therapy. This is being justified by comparing risks of stroke or death with medical therapy during clinical trials completed decades ago (approximately 2% per year) with risks of intervention with carotid artery stenting (CAS) versus carotid endarterectomy in recent trials that did not have a medical arm. Such extrapolations are, simply put, invalid...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818259/imaging-of-the-high-risk-carotid-plaque-magnetic-resonance-imaging
#10
REVIEW
William S Kerwin, Zach Miller, Chun Yuan
The emergence of the concept of high-risk atherosclerotic plaque has led to considerable interest in noninvasive imaging techniques to identify high-risk features before clinical sequelae. For plaques in the carotid arteries, magnetic resonance imaging has undergone considerable histologic validation to link imaging features to indicators of plaque instability, including plaque burden, intraplaque hemorrhage, fibrous cap disruption, lipid rich necrotic core, and calcification. Recently introduced imaging technologies, especially those focused on three-dimensional imaging sequences, are now poised for integration into the clinical workup of patients with suspected carotid atherosclerosis...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818258/imaging-of-high-risk-carotid-plaques-ultrasound
#11
REVIEW
Rafael S Cires-Drouet, Mahvash Mozafarian, Amir Ali, Siddhartha Sikdar, Brajesh K Lal
Duplex ultrasonography has a well-established role in the assessment of the degree of stenosis caused by carotid atherosclerosis. This assessment is derived from Doppler velocity changes induced by the narrowing lumen of the artery. New research into the mechanisms for plaque rupture and atheroembolic stroke indicates that the degree of narrowing is an imperfect predictor of stroke risk, and that other factors, such as plaque composition and remodeling and biomechanical forces acting on the plaque, can play a role...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818257/high-risk-carotid-plaque-lessons-learned-from-histopathology
#12
REVIEW
Frank D Kolodgie, Kazuyuki Yahagi, Hiroyoshi Mori, Maria E Romero, Hugh H Trout, Aloke V Finn, Renu Virmani
The pathophysiology and natural history of atherosclerotic carotid disease is predicated on a more extensive knowledge of lesion progression gained in the studies conducted in the coronary arteries, and these will be reviewed. While the precise sequence of lesion progression leading to carotid plaque vulnerability and cerebrovascular events remain less well understood, specific early and more advanced progressive lesion morphologies associated with stroke risk have been characterized. Of late, there has been a conscious effort for stroke prevention in symptomatic and asymptomatic patients to move beyond luminal stenosis as the only guidance to predict future cerebrovascular events...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818256/will-mesh-covered-stents-help-reduce-stroke-associated-with-carotid-stent-angioplasty
#13
REVIEW
Carly N Richards, Peter A Schneider
Carotid stent angioplasty (CAS) has been shown to protect patient from future stroke long-term efficacy similar to carotid endarterectomy (CEA). The risk of minor stroke in the perioperative period is higher than with CEA and not related to cerebral protection during the CAS procedure since a significant portion of the neurologic events occur between 1 and 30 days following stent deployment. This observation suggests mechanisms integral to the stent itself may be pertinent such as plaque embolization thru the stent struts may occur...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818255/clinical-need-design-and-goals-for-the-carotid-revascularization-and-medical-management-for-asymptomatic-carotid-stenosis-trial
#14
RANDOMIZED CONTROLLED TRIAL
Brajesh K Lal, James F Meschia, Thomas G Brott
Prior clinical trials produced evidence-based treatment recommendations for patients with asymptomatic carotid stenosis that may not be appropriate for clinical decision-making today. High-quality patient outcomes data to allow informed decision making regarding the optimal management of high-grade asymptomatic internal carotid artery stenosis is lacking. The results of the Asymptomatic Carotid Atherosclerosis Study were published in 1995 based on a randomized patient enrollment in the 1990s. Outcomes after endarterectomy, stenting, and medical treatment for these patients have all improved in the subsequent 2 decades...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818254/medical-treatment-strategies-to-reduce-perioperative-morbidity-and-mortality-after-carotid-surgery
#15
REVIEW
A Ross Naylor
There is a paucity of high-quality evidence regarding what constitutes "optimal medical therapy" for the purposes of reducing morbidity/mortality after carotid endarterectomy (CEA). All patients should be prescribed antiplatelet therapy. Low-dose aspirin (75 to 325 mg) should be continued throughout the perioperative period and there is no evidence that higher doses confer additional benefit. There is emerging evidence that early implementation of dual antiplatelet therapy in recently symptomatic patients (aspirin 75 mg plus clopidogrel 75 mg) can reduce recurrent cerebral events before CEA and that dual antiplatelet therapy will significantly reduce stroke due to early postoperative carotid thrombosis...
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28818253/introduction-evolution-of-carotid-atherosclerotic-disease-therapies
#16
EDITORIAL
Thomas S Hatsukami
No abstract text is available yet for this article.
March 2017: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28779790/management-of-renal-dysfunction-in-patients-with-liver-cirrhosis-role-of-pretransplantation-hemodialysis-and-outcomes-after-liver-transplantation
#17
REVIEW
Ashok Thorat, Long-Bin Jeng
Patients with end-stage liver disease (ESLD) who develop hepatorenal syndrome (HRS) have very high mortality rates. For patients with HRS type I, median survival without specific therapy is only 2 weeks. Due to worsening clinical condition in such patients secondary to uremia and hepatic disease, some form of renal replacement therapy (RRT), either intermittent hemodialysis IHD or continuous veno-venous hemodialysis (CVVHD), must be instituted. However, the literature regarding the survival benefits of the hemodialysis for the worsening renal failure in liver cirrhotic patients remains limited...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28779789/dialysis-access-associated-steal-syndromes
#18
REVIEW
Indrani Sen, Ramesh K Tripathi
Symptomatic hand ischemia has been reported in occur in up to 20% of patients undergoing upper-extremity dialysis access procedures, and is a common cause of postoperative steal in the patient with end-stage renal disease. The majority of dialysis access steal syndromes do not require operative intervention, but severe ischemia associated with muscle paralysis can progress to limb amputation if left untreated. In this review, patient risk factors, clinical presentation, diagnostic techniques, and management options for patients with dialysis access steal syndromes are discussed...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28779788/transjugular-venous-approach-for-endovascular-intervention-in-upper-extremity-dialysis-access-fistulae-and-grafts
#19
REVIEW
Hector Ferral, Marc J Alonzo
A transjugular venous access is an alternative approach for endovascular intervention in upper-extremity dialysis arteriovenous fistulae and grafts. The transjugular access is recommended for patients who have an unfavorable anatomy for the direct arm access approach. Ultrasound evaluation of the arteriovenous access is essential before intervention and includes evaluation of the inflow artery and outflow vein diameters, arteriovenous anastomosis, and the entire outflow vein, specifically looking into potential problem areas...
December 2016: Seminars in Vascular Surgery
https://www.readbyqxmd.com/read/28779787/effect-of-statins-on-survival-in-patients-undergoing-dialysis-access-for-end-stage-renal-disease
#20
Paola De Rango, Basso Parente, Luca Farchioni, Enrico Cieri, Beatrice Fiorucci, Selena Pelliccia, Alessandra Manzone, Gioele Simonte, Massimo Lenti
The benefit of statin therapy in patients with advanced chronic kidney disease remains uncertain. Randomized trials have questioned the efficacy of the drug in improving outcomes for on-dialysis populations, and many patients with end-stage renal disease are not currently taking statins. This study aimed to investigate the impact of statin use on survival of patients with vascular access performed at a vascular center for chronic dialysis. Consecutive end-stage renal disease patients admitted for vascular access surgery in 2006 to 2013 were reviewed...
December 2016: Seminars in Vascular Surgery
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