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Vascular, surgery, endovascular

Linda J Wang, Emel A Ergul, Mark F Conrad, Mahmoud B Malas, Vikram S Kashyap, Philip P Goodney, Virendra I Patel, W Darrin Clouse
OBJECTIVE: Adding ipsilateral, proximal endovascular (IPE) intervention to carotid endarterectomy (CEA) for the treatment of tandem bifurcation and supra-aortic trunk disease is controversial. Some suggest that this combined strategy (CEA + IPE) confers no risk over isolated CEA (ICEA). Others disagree, reserving CEA + IPE for symptomatic patients. Using the Vascular Quality Initiative (VQI), this study assessed the effect of adding IPE to CEA on stroke and death risk. We further weighed CEA + IPE outcomes in the context of symptomatic status and Society for Vascular Surgery guidelines...
December 12, 2018: Journal of Vascular Surgery
Jung Hee Kim, Jong Hyun Baek
RATIONALE: Patent ductus arteriosus (PDA) ligation by open surgery is more difficult and dangerous in elderly patients than in infants. Nowadays, simple and safe interventional catheterization technology is used for the closure of uncomplicated isolated PDAs. Therefore, an alternative less invasive therapeutic option must be developed to treat complicated PDA. PATIENT CONCERNS: A 53-year-old woman presented with gradually exacerbated dyspnea on effort and continuous cardiac murmurs...
December 2018: Medicine (Baltimore)
Zaiqiang Yu, Masahito Minakawa, Norihiro Kondo, Kazuyuki Daitoku, Ikuo Fukuda
INTRODUCTION: Middle aortic syndrome (MAS) combined with thoracic aortic aneurysm (TAA) is a rare vascular disease. One stage open surgery to treat this condition, becomes a challenge for our cardiovascular surgery. PRESENTATION OF CASE: A 69-year-old man presented with a saccular type aortic arch aneurysm, shaggy aorta and severe atherosclerotic stenosis of the thoracoabdominal aorta with middle aortic syndrome and aberrant right subclavian artery, renovascular hypertension, renal dysfunction, and intermittent claudication of both legs...
November 24, 2018: International Journal of Surgery Case Reports
Vasileios Rafailidis, Konstantinos Notas, Evangelos Destanis, Konstantinos Kouskouras, Ioannis Chryssogonidis, Chrysostomos Xerras, Afroditi Charitanti-Kouridou, Thomas Tegos
BACKGROUND: Carotid dissection is a rare disease, mainly affecting young and middle-aged patients potentially ending up in stroke. Multimodality imaging plays an essential role, both in terms of prompt and accurate diagnosis and follow-up of this entity. PATIENTS AND METHODS: We herein present a case series of patients with internal carotid artery dissection and compare the various imaging findings of ultrasonography, multidetector computed tomography angiography and magnetic resonance angiography, with a purpose to illustrate the value of multimodality imaging in the diagnosis of carotid dissection...
December 12, 2018: VASA. Zeitschrift Für Gefässkrankheiten
Michael Sawang, Sharath C V Paravastu, Zhixin Liu, Shannon D Thomas, C Barry Beiles, Bibombe P Mwipatayi, Hence J M Verhagen, Eric L G Verhoeven, Ramon L Varcoe
OBJECTIVES: Operative caseload is thought to be associated with peri-operative mortality following intact aortic aneurysm repair. The aim was to study that association in the Australian setting, which has a unique healthcare provision system and geographical population distribution. METHODS: The Australasian Vascular Audit database was used to capture volume measurements for both individual surgeon and hospital and to separate it into quintiles (1, lowest, to 5, highest) for endovascular (EVAR), open surgical repair (OSR), and subgroups of repair types between 2010 and 2016...
October 24, 2018: European Journal of Vascular and Endovascular Surgery
Soraya L Voigt, Muath Bishawi, David Ranney, Babatunde Yerokun, Richard L McCann, G Chad Hughes
BACKGROUND: Subclavian artery revascularization is frequently performed in the setting of thoracic endovascular aortic repair (TEVAR). However, there is little information on the short- and long-term outcomes of patients undergoing carotid to subclavian artery bypass in this clinical setting. As such, this study sought to define the early and late outcomes associated with this procedure. METHODS: Patients undergoing carotid-subclavian bypass in conjunction with TEVAR between June 2005 and September 2016 were retrospectively identified from a prospectively maintained, single-center aortic surgery database...
October 24, 2018: Journal of Vascular Surgery
Justin C Mason
Vascular surgery remains an important option in the management of Takayasu arteritis (TA). Its use is predominantly confined to the treatment of symptomatic organ ischaemia or life-threatening aneurysm formation. In most cases, this follows the failure of medical therapy to prevent arterial injury. Open surgery and endovascular approaches are used. The choice between them, at least in part, is determined by the site and nature of the lesion. Open surgery, although more invasive, offers enhanced duration of arterial patency, whereas for endovascular intervention, primary angioplasty without stenting is preferred, with stenting reserved for primary or secondary angioplasty failures...
February 2018: Best Practice & Research. Clinical Rheumatology
V Goshchynsky, O Lugoviy, P Goshchynsky, S Lugoviy, U Lugoviy
A retrospective analysis of the results of endovascular operations on the arteries of the lower extremities was performed in 209 patients, of which 45 (21.5%) were patients with chronic ischemia of the 2nd stage, category 4, 138 (66.1%) of patients with ischemia of the lower extremities of the third stag, category 5 and 26 (12.4%) of patients with IV stage, category 6 (by classification Rutherford et al., 1997) 17, 187 men, 22 women. The average age of patients was 63.7±9.3 years. Based on clinical and angiographic data, several variants of endovascular revascularization of the lower extremities were used: the vasoballoone segmentation followed by its stenting with a self-expanding stent of Terumo Misago (Japan) or a stent of Palmas Cordis (USA), one stent or two end-to-end stents (the stenting of the artery was supplemented by vasoballoone dilatation of the segment over the stents, between stents or under stents), sub intimal angioplasty was performed under the condition of Re-Entry Outback (Cordis, USA), balloon angioplasty was used using IN cylinders...
October 2018: Georgian Medical News
Owen S Glotzer, Kathryn Bowser, F Todd Harad, Sandra Weiss
Middle Aortic Syndrome is a rare vascular disorder consisting of narrowing or stenosis of the distal thoracic or abdominal aorta. It is described in the literature in the form of case studies and case series. The authors present an unusual case of Middle Aortic Syndrome attributed to Takayasu's arteritis in a 60-year-old female who presented to the emergency department with uncontrolled hypertension. Traditional intervention involves open surgical bypass. This case study reviews the published literature on this rare syndrome and illustrates a successful alternative to open surgery through an endovascular approach...
2018: Case Reports in Vascular Medicine
Joel Sousa, Ana-Teresa Vilares, Armando Mansilha
INTRODUCTION: Only a minority of vascular surgeons have personal experience on thoracoabdominal aneurysm (TAA) repair, and even less have performed surgery on these formidable lesions for rupture. Unsurprisingly, when open surgery was the only treatment option available, these impressive pathologies were frequently deemed inoperable and managed conservatively. Endovascular techniques brought new hope in these scenarios, but despite current advances, morbidity and mortality remains high, even in experienced centres...
November 27, 2018: Annals of Vascular Surgery
Yana Etkin, Benjamin M Jackson, Joanna S Fishbein, Krisiva Shyta, Amit Rao, Hana Baig, Gregg S Landis
OBJECTIVES: Prosthetic grafts are often used as alternative conduits in patients with peripheral vascular disease who do not have an adequate autologous vein for bypass. Prosthetic grafts, unfortunately, carry an increased risk of infection and are associated with increased morbidity and mortality. The goal of this study was to identify potential risk factors and subsequent outcomes associated with lower extremity prosthetic graft infections. METHODS: 272 lower extremity prosthetic bypasses and patches were performed at an academic medical center between 2014 and 2016...
November 27, 2018: Annals of Vascular Surgery
Brycen D Bodell, Amy C Taylor, Parag J Patel
Thoracic endovascular aortic repair is a minimally invasive approach to repairing a number of mechanical defects of the thoracic aorta utilizing an intraluminally deployed stent graft, usually without the need for open surgery. A number of manufacturers have developed endograft systems, utilizing various stent materials (ie stainless steel vs nickel titanium [nitinol]), cover material (ie polytetrafluoroethylene vs woven polyester), radial force, flexibility, and seal zone attachment methods. The purpose of this review is to evaluate the four FDA-approved endografts currently used in the United States for descending thoracic aortic pathologies and compare their most salient features...
September 2018: Techniques in Vascular and Interventional Radiology
Dilsad Amanvermez Senarslan, Funda Yildirim, Omer Tetik
Aneurysms of the upper extremity mostly originate from trauma, mycotic lesions, thoracic outlet syndrome, previous arteriovenous fistulae and atherosclerosis. True aneurysms of the brachial and axillary artery are encountered rarely. They can be diagnosed by simple physical examination as a pulsatile mass. However, most of these aneurysms remain asymptomatic until a complication occurs. The primary complication seen with the axillary or brachial artery is embolization. We report three large diameter true brachial artery aneurysms extending to the axillary zone...
November 26, 2018: Annals of Vascular Surgery
Asma Yafawi, Richard G McWilliams, Robert K Fisher, Andrew England, Maria Karouki, Francesco Torella
PURPOSE: To investigate the incidence and extent of stent frame movement after endovascular aneurysm sealing (EVAS) in the abdominal aorta and its relationships to aneurysm growth and the instructions for use (IFU) of the Nellix endograft. METHODS: A retrospective single-center study was conducted to review the clinical data and computed tomography (CT) images of 75 patients (mean age 76±7.6 years; 57 men) who underwent infrarenal EVAS and had a minimum 1-year follow-up...
November 28, 2018: Journal of Endovascular Therapy
Xin Li, Chang Shu, Quan Ming Li, Kun Fang, Ming Li, Wenwu Cai
BACKGROUND: We introduce the "kissing stent-grafts technique" for a patient who suffered from a pseudoaneurysm in bifurcation of innominate artery. This technique repaired an innominate artery bifurcation pseudoaneurysm; it successfully isolated the pseudoaneurysm and preserved both right subclavian and right common carotid artery. CASE PRESENTATION: A 60-year-old Asian (Chinese) woman complained of discovering a cervical pulsatile mass. A pseudoaneurysm at the location of innominate artery bifurcation is a rare and difficult situation that should be treated by vascular surgeons...
November 27, 2018: Journal of Medical Case Reports
Wei-Long Lu, Bing Wang, Fei Wu, Meng-Yu Wang, Jin-Xuan Pan, Heng Xu
Extracranial carotid artery pseudoaneurysms (ECAPs) are rare vascular lesions that, if untreated, can lead to severe neurologic deficits and significant mortality. Although conservative therapy, surgical ligation or reconstruction, and endovascular techniques can be curative, the literature demonstrates that the best therapy remains controversial and consensus is lacking. We report a case of a 53-year-old patient who developed a giant ECAP on the left side of her neck, which had been presented for 10 years and was successfully treated by covered stent-assisted open surgery...
November 23, 2018: Annals of Vascular Surgery
Patrick Canning, Wael Tawfick, Khaled Kamel, Niamh Hynes, Sherif Sultan
OBJECTIVES: To compare the cost-effectiveness of endovascular (rEVAR) vs. open surgical repair (rOSR) for ruptured abdominal aortic aneurysm (rAAA) where rEVAR is regularly performed outside of IFU (shorter and more angulated necks). Primary endpoint is incremental-cost-effectiveness ratio (ICER) of rEVAR vs. rOSR and aneurysm-related mortality. Secondary endpoints are cost-per-Quality-Adjusted-Life-Years (QALY), perioperative morbidity and mortality, re-intervention and all-cause mortality...
November 23, 2018: Annals of Vascular Surgery
Anna Z Fashandi, J Hunter Mehaffey, Robert B Hawkins, Irving L Kron, Gilbert R Upchurch, William P Robinson
OBJECTIVE: Major adverse limb events (MALEs) and major adverse cardiovascular events (MACEs) at 30 days provide standardized metrics for comparison and have been adopted by the Society for Vascular Surgery's objective performance goals for critical limb ischemia. However, MALEs and MACEs have not been widely adopted within the claudication population, and the comparative outcomes after lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) remain unclear. The purpose of this study was to compare MALEs and MACEs after LEB and IEI in a contemporary national cohort and to determine predictors of MALEs and MACEs after revascularization for claudication...
December 2018: Journal of Vascular Surgery
Talha Butt, Erika Lilja, Hedvig Örneholm, Jan Apelqvist, Anders Gottsäter, Magnus Eneroth, Stefan Acosta
BACKGROUND: Heel ulcers in patients with diabetes mellitus (DM) and peripheral arterial disease (PAD) are hard to heal. The aim of the present study was to evaluate the difference in amputation-free survival (AFS) between open and endovascular revascularization in patients with DM, PAD, and heel ulcers. METHODS: Retrospective comparative study of results of open versus endovascular surgery in patients with DM, PAD, and heel ulcer presented at the multidisciplinary diabetes foot clinic between 1983 and 2013...
November 22, 2018: Vascular and Endovascular Surgery
Chandler A Long, Zachary B Fang, Frances Y Hu, Shipra Arya, Luke P Brewster, Elizabeth Duggan, Yazan Duwayri
OBJECTIVE: Hyperglycemia is a common occurrence in patients undergoing cardiovascular surgery. It has been identified in several surgical cohorts that improved perioperative glycemic control reduced postoperative morbidity and mortality. A significant portion of the population with peripheral arterial disease suffers from the sequelae of diabetes or metabolic syndrome. A paucity of data exists regarding the relationship between perioperative glycemic control and postoperative outcomes in vascular surgery patients...
November 17, 2018: Journal of Vascular Surgery
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