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Tinhinan Mezdad, Samir Henni, Mathieu Feuilloy, Pierre Chauvet, Daniel Schang, Pierre Abraham
OBJECTIVES: Mechanisms of walking limitation in arterial claudication are incompletely elucidated. We aimed to identify new variables associated to walking limitation in patients with claudication. METHODS: We retrospectively analyzed data of 1120 patients referred for transcutaneous exercise oxygen pressure recordings (TcpO2 ). The outcome measurement was the absolute walking time on treadmill (3.2 km/h, 10% slope). We used both: linear regression analysis and a non-linear analysis, combining support vector machines and genetic explanatory in 800 patients with the following resting variables: age, gender, body mass index, the presence of diabetes, minimal ankle to brachial index at rest, usual walking speed over 10 m (usual-pace), number of comorbid conditions, active smoking, resting heart rate, pre-test glycaemia and hemoglobin, beta-blocker use, and exercise-derived variables: minimal value of pulse oximetry, resting chest-TcpO2 , decrease in chest TcpO2 during exercise, presence of buttock ischemia defined as a decrease from rest of oxygen pressure index ≤15 mmHg...
November 15, 2018: Vascular
Ga-Young Suh, Brant W Ullery, Jason T Lee, Michael D Dake, Dominik Fleischmann, Christopher Cheng
OBJECTIVES: Thoracic endovascular aortic repair has become a preferred treatment strategy for thoracic aortic aneurysms and dissections. Yet, it is not well understood if the performance of endografts is affected by physiologic strain due to cyclic aortic motion during cardiac pulsation and respiration. We aim to quantify cardiac- and respiratory-induced changes of the postthoracic endovascular aortic repair thoracic aorta and endograft geometries. METHODS: Fifteen thoracic endovascular aortic repair patients (66 ± 10 years) underwent cardiac-resolved computed tomography angiographies during inspiratory/expiratory breath holds...
November 14, 2018: Vascular
Areg Grigorian, Samuel E Wilson, Christian de Virgilio, Nii-Kabu Kabutey, Roy M Fujitani, Viktor Gabriel, Sebastian D Schubl, Victor Joe, Jeffry Nahmias
OBJECTIVE: Axillosubclavian vessel injury is rare, with most cases occurring after penetrating trauma. A prior database (2002-2006) analysis demonstrated an overall limb loss rate of 2.9%, with no difference between isolated arterial axillosubclavian vessel injury and combined artery/vein axillosubclavian vessel injury. Given increases in advanced vascular surgical techniques, as well as improved multidisciplinary care and expeditious diagnosis with computed tomography angiography, we hypothesized the national rate of limb loss in patients with arterial axillosubclavian vessel injury has decreased...
November 14, 2018: Vascular
Shinsuke Kikuchi, Keisuke Miyake, Yuki Tada, Daiki Uchida, Atsuhiro Koya, Yukihiro Saito, Takehiko Ohura, Nobuyoshi Azuma
OBJECTIVES: Laser speckle flowgraphy is a new method that enables the rapid evaluation of foot blood flow without contact with the skin. We used laser speckle flowgraphy to evaluate foot blood flow in peripheral arterial disease patients before and after surgical revascularization. MATERIALS AND METHODS: A prospective single-center study. Thirty-one patients with 33 limbs that underwent surgical revascularization for peripheral arterial disease were included. Pre- and postoperative foot blood flows were measured on the plantar surface via laser speckle flowgraphy and skin perfusion pressure...
November 12, 2018: Vascular
Konstantinos P Donas, Marco V Usai, Gergana T Taneva, Frank J Criado, Giovanni B Torsello, Paul Kunilis, Salvatore Scali, Frank J Veith
OBJECTIVE: Chimney endovascular aortic aneurysm repair is gaining ever greater acceptance. However, persistent gutters leading to type IA endoleaks represent an unsolved issue. The aim of the current study was to analyze the impact of abdominal endograft oversizing to the occurrence of this phenomenon. METHODS: The PERformance of the snorkel/chImney endovascular teChnique in the treatment of compLex aortic PathologiesES registry includes the largest experience with chimney endovascular aortic aneurysm repair from 13 vascular centers in Europe and the U...
November 12, 2018: Vascular
Abdul Aziz Qazi, Arash Jaberi, Oleg Mironov, Jamil Addas, Emmad Qazi, Emidio Tarulli, Martin Simons, Kong Teng Tan
PURPOSE: Proximal type 1A endoleaks on completion intra-operative angiography are not infrequently seen following endovascular abdominal aneurysm repair (EVAR). The natural course of these leaks is not well established. We sought to determine the rate of spontaneous resolution and a conservative treatment approach to these endoleaks. METHODS: All cases involving endovascular repairs of infra-renal abdominal aortic aneurysms resulting in proximal type 1A endoleak on final intra-operative completion angiography were retrospectively reviewed from 1 April 2010 and 30 March 2015...
November 5, 2018: Vascular
Mohammed Adil A Turki, Alexander Zargaran, Aasim Murtaza, Amal Thomas, Harry Spiers, Moneet Gill, Shaurya Aggarwal, Sarah Turki, David Zargaran
OBJECTIVES: Vascular surgery is in increasing demand due to the higher prevalence of cardiovascular disease in the general population. Meanwhile, applications to join the speciality have been in decline in the last few years. St George's Surgical Society held a one-day conference to expose undergraduates to the speciality in the hope that this will inspire more undergraduates to pursue it as a career. METHODS: The conference consisted of introductory lectures delivered by a consultant vascular surgeon, followed by practical skills workshops simulating aortic anastomosis on porcine aortas...
October 26, 2018: Vascular
Jeeeun Park, Jinhae Kim, Subin Hwang, Mi Kyoung Lee, Hye Ryoun Jang, Jung Eun Lee, Yang-Jin Park, Wooseong Huh, Yoon-Goo Kim, Ha Young Oh, Dae Joong Kim
OBJECTIVES: Arteriovenous graft for hemodialysis shows poorer outcomes than arteriovenous fistula, due to frequent stenosis and thrombosis. We investigated arteriovenous graft patency outcomes and prognostic factors for these outcomes. METHODS: We included a single-center cohort of patients receiving arteriovenous graft for hemodialysis access from 2010 to 2014. Demographics, laboratory data, comorbidities, and medications were collected from medical records. Surgical factors related to graft operation including the type and diameter of connected vessels, graft location, and type of operation (elective or emergency) were also recorded...
October 26, 2018: Vascular
Saygin Turkyilmaz, Ali Aycan Kavala
OBJECTIVES: To evaluate access success according to plaque cap morphology in subjects with lower limb chronic total occlusion. METHODS: A retrospective study was performed for a three-year period. Subjects with lower extremity chronic total occlusion (Rutherford category 3-6, ischaemia) were included in the study. Cap morphology was classified according to The chronic total occlusion crossing approach based on plaque cap morphology (CTOP) classification system. When describing the classification by a traditional antegrade approach, Types I, II, III and IV were defined as follows: Type I: concave proximal and distal caps; Type II: concave proximal and convex distal caps; Type III: convex proximal and concave distal caps; Type IV: convex proximal and distal caps...
October 23, 2018: Vascular
Sharon C Kiang, Khwaja A Ahmed, Victoria J Cha, Donald V Farley, Udochukwu E Oyoyo, Ahmed M Abou-Zamzam, Roger T Tomihama
Objectives There is paucity in the literature reporting radiation usage analysis in vascular surgery. In the era of endovascular surgeries, analyzing the surgeons' use of radiation in vascular procedures can help establish quality improvement initiatives. Methods A retrospective review was undertaken of intraoperative fluoroscopic-guided vascular surgery procedures at a single institution from 2010 to 2017. Mobile C-arms were utilized to gather the six radiation usage metrics and cases were categorized into 6 anatomic surgical fields and 10 surgical procedure types...
October 18, 2018: Vascular
Ahmed Elmallah, Mohamed Elnagar, Niamh Bambury, Zeeshan Ahmed, Joseph Dowdall, Denis Mehigan, Stephen Sheehan, Mary Barry
BACKGROUND: The current advancement and increasing use of diagnostic imaging has led to increased detection of abdominal aortic aneurysms (AAA). Many of these patients are unfit for elective AAA surgery. AIM: To investigate the outcome of conservative management of unfit patients with large AAA (>5.5 cm) who are turned down for elective surgical intervention. PATIENTS AND METHODS: Between January 2006 and April 2017, 457 patients presented with AAA >5...
October 14, 2018: Vascular
Ma XiaoHui, Wei Li, Guo Wei, Liu XiaoPing, Jia Xin, Zhang Hongpeng, Wang Lijun
Introduction Endovascular intervention involving the aortic arch, particularly in thoracic aortic dissection, remains challenging and controversial at current time when there is no commercially suitable grafts on most of the international markets. This study compared two endovascular treatments that maintain left subclavian artery perfusion using two modified techniques for type-B aortic dissection patients. Methods Consecutive cases utilizing chimney or in situ fenestration techniques to preserve left subclavian artery in type B AD from 2006 to 2015 in our single institution were retrospectively reviewed...
October 14, 2018: Vascular
Stefan Gh Heinen, Wouter Huberts, Daniel Af van den Heuvel, Frans N van de Vosse, Jean-Paul Pm de Vries, Tammo Delhaas
Objectives To date, the ultimate decision to treat iliac artery stenoses in patients suffering from symptomatic peripheral arterial disease is based on the patient's symptoms and on visual inspection of angiographical images. The primary aim of this study was to investigate the accuracy of geometry-based methods (i.e. visual inspection and quantitative vascular analysis (Viewforum version R7.2v1 Advanced vessel analysis, Philips Healthcare, Best, The Netherlands) of 3D rotational angiography) to identify the severity of equivocal iliac artery stenosis in peripheral arterial disease patients with intra-arterial hyperemic pressure measurements (gold standard) as a reference...
October 10, 2018: Vascular
Fehmi Kacmaz, Adnan Kaya, Muhammed Keskin, Serdar Keceoglu, Ibrahim Halil Algin, Bayram Yilmazkaya, Erdogan Ilkay
Objective Buerger's disease is one of the worst diseases causing peripheral artery occlusions (especially lower extremity) with increased morbidity and mortality. Endovascular treatment of the diseased arteries gains preference over bypass surgery nowadays. Here, we aimed to present the clinical outcomes of 16 consecutive Buerger's disease patients underwent extended endovascular recanalization which is a new technique to restore direct blood flow to at least one foot artery, with the performance of angioplasty for each tibial and foot artery obstructions...
October 10, 2018: Vascular
Georgios I Karaolanis, Marco Damiano Pipitone, Giovanni Torsello, Martin Austermann, Konstantinos P Donas
Objectives To evaluate the use of chimney grafts in the treatment of para-anastomotic aneurysms after previous abdominal aortic aneurysms open repair with short neck. Methods A retrospective analysis of prospectively collected data of consecutive patients who underwent endovascular repair for proximal aortic para-anastomotic aneurysms following previous open repair for infrarenal abdominal aortic aneurysms was performed. All included patients had a short infrarenal aortic neck (<10 mm) excluding standard endovascular aortic repair...
October 3, 2018: Vascular
Ian Wee, Andrew Mtl Choong
Background Whilst autologous vein conduits have been heralded as the first-line approach for patients undergoing lower limb bypass grafting procedures, patients with peripheral arterial occlusive disease may have exhausted venous options given prior use for cardiac surgery, varicose vein surgery, or lower limb revascularization. Hence, the use of a radial artery graft may serve as a viable alternative. Methods The systematic review was performed in accordance to the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines...
September 30, 2018: Vascular
Jordan R Stern, Adham Elmously, Matthew C Smith, Peter H Connolly, Andrew J Meltzer, Darren B Schneider, Sharif H Ellozy
Objectives Upper extremity arterial access is often required for endovascular procedures, especially for antegrade access to the visceral aortic branches. Radial arterial access has been shown previously to have low complication rates, and patients tolerate the procedure well and are able to recover quickly. However, transradial access remains relatively uncommon amongst vascular surgeons. Methods The radial artery was evaluated by ultrasound to evaluate for adequate caliber, and to identify any aberrant anatomy or arterial loops...
September 11, 2018: Vascular
José Carlos Arévalo-Lorido, Juana Carretero-Gómez, Nicolás Roberto Robles Pérez-Monteoliva
Aim The role of serum uric acid in ischemic stroke is controversial. On the one hand, it has a role as neuroprotectant in acute phase, but on the other hand, it may promote atherosclerosis in carotid arteries. Our aim is to investigate the association of serum uric acid levels at admission of acute ischemic stroke patients with carotid disease. Methods Cross-sectional study of patients admitted due to acute ischemic stroke. Clinical and laboratory variables were recorded. The carotid disease was defined based on the findings of carotid echography intima to media thickness and stenosis...
September 11, 2018: Vascular
Fadi Taher, Juergen Falkensammer, Joseph Nguyen, Miriam Uhlmann, Edda Skrinjar, Afshin Assadian
Objective Custom-made fenestrated aortic endografts allow exclusion of pararenal aortic aneurysms while maintaining blood flow to aortic branches. Meticulous device planning and precise deployment of the main body are essential to allow successful cannulation of the fenestrations. This study investigates whether a learning curve can be observed with more reliable cannulation and connection of fenestrations over time at a single department of vascular and endovascular surgery with multiple surgeons trained to use the device...
September 11, 2018: Vascular
Tian Du, Honglin Dong, Chunhong Li, Sheng Yan, Haifeng Li
Objectives Previously, we found that urinary fibrinogen (Fg) levels were positively related to contrast-induced acute renal injury degree in mice. Reduction of fibrinogen in heterozygous mice can improve renal function. Here, we prospectively observed the variation in urinary Fg levels in patients undergoing angiography to determine the relationship between serum creatinine (Scr) and serum cystatin C (Cys C) levels. Methods Serum Cys C and urinary Fg levels were evaluated by ELISA before and 2, 12, and 24 h after angiography in 115 enrolled inpatients...
September 10, 2018: Vascular
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