Perspectives in Vascular Surgery and Endovascular Therapy

Acute mesenteric ischemia is an uncommon but highly complex clinical problem and carries a high mortality. Traditional treatment has yielded only modest improvements in mortality and an endovascular first treatment paradigm has been adopted by selected centers over the past decade. However, the technique does not allow for immediate assessment of intestinal viability and availability of the expertise and equipment is mostly limited to tertiary referral centers. Experience gained with endovascular treatment thus far suggests that careful patient selection, procedure planning, and meticulous technique are the key to further improving results...

We present an unusual case of a 23-year-old man who had symptomatic lower extremity varicosities that have been present since birth. He was complaining of pain and swelling of several years duration. Evaluation revealed Klippel-Trenaunay syndrome with associated compression of the left common iliac vein by the overriding left common iliac artery (May-Thurner syndrome). The patient was treated with left common iliac vein stenting followed by high ligation and inversion stripping of his grossly incompetent left small saphenous vein, stripping of his aberrant left lateral embryonic veins, and also by multiple stab phlebectomies, with excellent early result...

We report a case of a fistula between the vertebral artery and the internal jugular vein that occurred after the erroneous placement of a central venous catheter. The patient was presented with tinnitus. Endovascular treatment with a balloon expandable covered stent placed into the vertebral artery was performed. One year follow-up showed satisfactory exclusion of the fistula, patency of the stented vertebral artery, and resolution of the symptoms. Only few other similar cases are reported in the literature with the use of different types of stents...

A 75-year-old man with invasive thymoma encasing the aortic arch and pulmonary arteries was referred to our institution with a 1-year history of dyspnea and worsening right heart failure. Pulmonary angiogram demonstrated greater than 90% stenosis of the right pulmonary artery. Balloon angioplasty and stent placement were performed with immediate improvement in his shortness of breath and peripheral edema. Improved lung opacification was noted on completion arteriography, and the stents remained patent until the patient expired from complications related to his cancer 2 years later...

INTRODUCTION: We used the National Trauma Data Bank (NTDB) to examine the incidence of blunt thoracic and carotid trauma nationally and survival outcomes based on treatment approach. METHODS: All vascular traumas were identified from the 2008 NTDB. International Classification of Diseases, 9th Revision (ICD-9) diagnosis coding was used to identify 178 blunt thoracic aortic injuries and 313 traumatic blunt carotid injuries. RESULTS: In all, 2089 vascular traumas were identified...

The treatment of occlusive vascular disease has evolved considerably over the past decades, with management strategies shifting from open surgical approaches toward less-invasive endovascular solutions or hybrid open and endovascular therapies. The treatment of aortoiliac occlusive disease has followed a similar pattern, with a more aggressive, minimally invasive approach being used even for long-segment iliac artery occlusions. Regardless of the type of treatment, however, optimal results are still limited by restenosis...

To determine the causes and site(s) of nerve injury and to identify potential predictors of vocal fold paralysis (VFP) after carotid endarterectomy (CEA) by application of intraoperative neuromonitoring (IONM). A total of 68 CEA patients were enrolled in this study. A 3-step IONM procedure was designed to obtain vocal fold EMG data at V1 (just after identification of the vagus nerve [VN]), V2 (just before arteriotomy), and V3 (just before wound closure). We also performed IONM before/after hemostasis near the VN using bipolar forceps and before/after dissection of the VN...

This article will review recent advances in computed tomography (CT) and magnetic resonance (MR) hardware and software techniques that have dramatically changed the use of CT and MR angiography. For CT angiography, technology has increased the speed of acquisition, reduced the radiation dose necessary to diagnose disease, and simplified the ability to characterize disease. Similarly, advances in MR angiography have focused on safer techniques that do not require the use of intravenous contrast agents, increased the speed of acquisition, and improved spatial resolution...

Ileocolic pseudoaneurysmal disease is a rare splanchnic aneurysm that affects 3 out of 100 000 patients, and only 7 cases have been described in the past 40 years in patients without preexisting connective tissue disorders. Abdominal pain is the most common presenting symptom and nearly 30% of patients present with hemorrhage. Ileocolic pseudoaneurysms are diagnosed by contrasted computed tomography scans and verified by arteriography. We present a case report and review of the literature in which a patient was initially managed by coil embolization, followed by laparotomy and suture ligation due to pseudoaneurysm rupture...

BACKGROUND: Synovial sarcoma primarily arises in para-articular locations of the extremities. However, numerous unique sites of origin have been reported. There are only 5 known cases of primary intravascular synovial sarcoma. METHODS: We present the second reported case of synovial sarcoma arising from the inferior vena cava (IVC) in a 41-year-old woman with progressive fatigue, abdominal distension, and lower-extremity swelling. This is the first known case with a monophasic histological subtype...

Endovascular repair of aortic aneurysms (EVAR) has gained widespread acceptance in the treatment of abdominal aortic aneurysms (AAAs). Prospective studies have shown advantages compared with open surgical repair, including decreased blood loss, operating time, hospital stay, morbidity, and mortality. Approximately 30% of patients treated by EVAR have ectatic or aneurysmal common iliac arteries not suitable for distal sealing zones. In these patients, one of the most commonly utilized options is exclusion of the internal iliac artery (IIA)...

PURPOSE: To compare immediate outcomes for patients who receive and those who do not receive heparin during lower limb endovascular intervention. METHODS: A retrospective case series of 330 procedures for lower limb peripheral arterial occlusive disease. Patient records were interrogated for bleeding or thrombotic/embolic complications during or immediately after endovascular intervention for peripheral arterial occlusive disease. RESULTS: Of the 220 patients who received heparin, 21 (9...

INTRODUCTION: We report our experience about carotid artery stenting (CAS) in patients 80 years and older. MATERIALS AND METHODS: Out of 582 patients who underwent CAS at our institution from January 1999 to June 2010, 102 patients (group A) were 80 years or older. The clinical data of these patients were retrospectively reviewed, outcomes analyzed, and compared with those of younger patients who underwent CAS during the same period (group B). RESULTS: Outcomes of group B were similar to those of group A, both at 30 days and at long term...

In this study, the authors present an analysis of the outcomes of 105 low-flow vascular malformation patients treated over a 6-year period and report specific lesion characteristics that correlate with those vascular malformations that will benefit from sodium tetradecyl sulfate foam sclerotherapy (STS FS) versus surgical resection as well as morphological characteristics of vascular malformations that are associated with a poor response to FS treatment. Improvement in symptoms was documented in 92.9% of patients treated with STS FS...

Spontaneous intrahepatic portal-systemic shunts are rare and can lead to significant encephalopathy. If intervention is recommended, transcatheter embolization is preferred. Various embolization techniques have been described using a wide range of embolization materials. In this report, the authors describe a useful embolization technique for managing a complex, large type 3 spontaneous intrahepatic portal-systemic shunt using Nester coils and Amplatzer vascular plugs through both percutaneous systemic and transhepatic approaches...

INTRODUCTION: Hepatic artery transection presents a technical challenge in vascular reconstruction. Formal arterial repair is indicated in patients with underlying liver disease and those undergoing bile duct reconstructions because of a higher risk of complication following hepatic artery injury. This report highlights a novel approach to hepatic artery transection with splenic artery transposition. METHODS: A case of hepatic artery transection repaired with splenic artery transposition is presented with an accompanying literature review...

OBJECTIVE: It is not clear whether patients undergoing varicose veins operations should receive thromboprophylaxis. A nationwide survey was conducted to assess thromboprophylaxis practice patterns in patients undergoing conventional vein surgery or endovenous procedures. METHODS: A questionnaire was e-mailed to all members of the Greek Society of Vascular and Endovascular Surgery (n = 163). RESULTS: In all, 68 members (42%) returned the survey, and 53% reported that they were not performing endovenous procedures...

Hybrid procedures were introduced as a less invasive alternative to open conventional repair, avoiding thoracotomy, single-lung ventilation, and in many patients, aortic cross-clamping. Despite these potential advantages over open repair, results of hybrid repair have varied in the literature, with several reports indicating high morbidity and mortality rates. It is likely that once fenestrated and branched endografts receive approval from the Food and Drug Administration for clinical use, indications for hybrid repair of complex aortic aneurysms will further diminish...

Computer-aided surgery makes use of a variety of technologies and information sources. The challenge over the past 10 years has been to apply these methods to tissues that deform, as do vessels when relatively rigid flexible objects are introduced into them (Lunderquist rigid guide wire, aortic prosthesis, etc) Three stages of computer-aided endovascular surgery are examined: sizing, planning, and intraoperative assistance. The authors' work shows that an approach based on optimized use of the imaging data acquired during the various observation phases (pre- and intraoperative), involving only lightweight computer equipment that is relatively transparent for the user, makes it possible to provide useful (ie, necessary and sufficient) information at the appropriate moment, in order to aid decision making and enhance the security of endovascular procedures...

Management of diabetic foot ulcers remains a rather challenging task. Epidermal growth factor (EGF) plays a central role in wound healing. It acts on epithelial cells and fibroblasts promoting restoration of damaged epithelium. However, its bioavailability is impaired in chronic diabetic foot ulcers. Current evidence suggests that application of human recombinant EGF in addition to standard treatment is able to achieve both partial and complete healing and to prevent foot amputations. Its efficacy has been tested at various concentrations and by various administration routes (topical application and intralesional injection)...