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Carotid artery surgery

Jiechang Zhu, Xiangchen Dai, Phasakorn Noiniyom, Yudong Luo, Hailun Fan, Zhou Feng, Yiwei Zhang, Fanguo Hu
PURPOSE: To evaluate the outcomes of fenestrated thoracic endovascular aortic repair (f-TEVAR) using physician-modified stent grafts (PMSGs) in zone 0 and zone 1 for aortic arch diseases. METHODS: f-TEVAR using PMSGs in Z0 and Z1 was performed on ten high-risk patients for open surgery from November 2015 to September 2017. Indications were complicated acute type B dissection (ABAD) with retrograde dissection involving the mid-arch (n = 1), distal arch aneurysms (n = 3), mid-arch aneurysms of the inner arch curvature (n = 3) and penetrating aortic ulcer located in the mid- or proximal arch (n = 3)...
October 11, 2018: Cardiovascular and Interventional Radiology
David P Fisher, Eric Johnson, Sebastien Haneuse, David Arterburn, Karen J Coleman, Patrick J O'Connor, Rebecca O'Brien, Andy Bogart, Mary Kay Theis, Jane Anau, Emily B Schroeder, Stephen Sidney
Importance: Macrovascular disease is a leading cause of morbidity and mortality for patients with type 2 diabetes, and medical management, including lifestyle changes, may not be successful at lowering risk. Objective: To investigate the relationship between bariatric surgery and incident macrovascular (coronary artery disease and cerebrovascular diseases) events in patients with severe obesity and type 2 diabetes. Design, Setting, and Participants: In this retrospective, matched cohort study, patients with severe obesity (body mass index ≥35) aged 19 to 79 years with diabetes who underwent bariatric surgery from 2005 to 2011 in 4 integrated health systems in the United States (n = 5301) were matched to 14 934 control patients on site, age, sex, body mass index, hemoglobin A1c, insulin use, observed diabetes duration, and prior health care utilization, with follow-up through September 2015...
October 16, 2018: JAMA: the Journal of the American Medical Association
Peter Kan, Aditya Srivatsan, Jeremiah N Johnnson, Stephen R Chen
We report an unusual case in which physiologic neck rotation impeded perfusion through the internal carotid artery. The patient had a history of prior radical neck surgery and radiation for malignancy. He presented withbow hunter's-like symptoms with transient loss of consciousness and right-sided weakness with left lateral neck rotation. A self-expanding peripheral stent was successfully used to treat the patient by preventing rotatory carotid compression. In select patients with prior neck surgery and radiation, carotid injections should be part of a dynamic cerebral angiogram if the vertebral arteries are unremarkable...
October 14, 2018: BMJ Case Reports
V V Shlomin, I G Drozhzhin, Iu P Didenko, N Iu Grebenkina, P D Puzdriak, P B Bondarenko, D G Pavlov, G A Vereshchako
Described herein is a clinical case report concerning treatment of a 32-year-old female patient with rupture of an aneurysm of the arch and descending portion of the thoracic aorta, with the bleeding having penetrated the upper lobe of the left lung. The woman was admitted to the Department of Vascular Surgery of Municipal Multimodality Hospital No 2 of Saint Petersburg, presenting with a clinical pattern of aneurysmal rupture previously diagnosed by computed tomography performed at one of the local hospitals...
2018: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Mohammad Ali Alessa, Sang Hyun Kwak, Young Woo Lee, Mi-Lan Kang, Hak-Joon Sung, Soon Hyun Ahn, Eun Chang Choi, Won Shik Kim
Live models that resemble surgical conditions of humans are needed for training free-flap harvesting and anastomosis. Animal models for training purposes have been available for years in many surgical fields. We used the female (because they are easy to handle for the procedure) Yorkshire pigs for the head and neck reconstruction by harvesting the deep inferior epigastric artery perforator or the superior epigastric artery perforator flap. The anastomosis site (neck skin defect or tracheal wall defect) was prepared via the dissection of the common carotid artery and the internal jugular vein, in which 3...
September 29, 2018: Journal of Visualized Experiments: JoVE
Atsushi Masuyama, Tomoya Mita, Kosuke Azuma, Yusuke Osonoi, Kenichi Nakajima, Hiromasa Goto, Yuya Nishida, Takeshi Miyatsuka, Masako Mitsumata, Hirotaka Watada
Autophagy is considered as an evolutionarily conserved cellular catabolic process. Defective autophagy has been implicated in various human diseases, including cardiovascular diseases. Recently, we and others demonstrated that defective autophagy in vascular smooth muscle cells (SMCs) promotes the progression of atherosclerosis. In this study, we investigated the role of autophagy in SMCs on plaque instability in vivo. We generated mice with a defect atg7in which is an essential gene for autophagy, in SMCs by crossing Atg7f/f mice with transgelin (Tagln) Cre+/0 mice (Atg7cKO)...
October 11, 2018: Biochemical and Biophysical Research Communications
Keiichiro Kasama, Keiji Uchida, Norihisa Karube, Shigeo Takebayashi, Kiyotaka Imoto, Munetaka Masuda
BACKGROUND: In aortic surgery, a severely atherosclerotic aorta is a known risk factor for perioperative stroke. We adopted a novel procedure of selective cerebral perfusion, named isolated cerebral perfusion (ICP), for the prevention of stroke during aortic arch surgery. METHODS: Between January 2010 and June 2016, 48 patients (mean age, 80 ± 3 years) underwent total aortic arch replacement at our institute, which included nine emergency cases with rupture. ICP was routinely performed for extracorporeal circulation during total arch replacement...
October 10, 2018: Annals of Thoracic Surgery
Mario Zanaty, Edgar A Samaniego, Nahom Teferi, David K Kung, Daichi Nakagawa, Joseph Hudson, Santiago Ortega-Gutierrez, Lauren Allan, Pascal Jabbour, David M Hasan
OBJECTIVE: The management of chronic complete occlusion of ICA (COICA) has been challenging. Endovascular procedures have been performed with variable success and risks, depending on the type of occlusion and distal revascularization. We present a novel hybrid procedure to recanalize the ICA when previous endovascular interventions have failed or is deemed too risky. METHODS: Two patients presented with symptomatic COICA after maximal medical management. They were deemed high-risk for endovascular intervention and/or previous endovascular attempts have failed...
October 9, 2018: World Neurosurgery
Jamshid H Karimov, Tomislav Mihaljevic, Shengqiang Gao, Gengo Sunagawa, Patrick Grady, Martin Sinkewich, Kiyotaka Fukamachi
OBJECTIVE: With heart disease increasing worldwide, demand for new minimally invasive techniques and transcatheter technologies to treat structural heart disease is rising. Cardioscopy has long been considered desirable, as it allows direct tissue visualization and intervention to deliver therapy via a closed chest, with real-time fiber-optic imaging of intracardiac structures. Herein, the feasibility of the advanced cardioscopic platform, allowing both transapical and fully percutaneous access is reported...
October 9, 2018: Seminars in Thoracic and Cardiovascular Surgery
Sebastian Hempe, Ajay Moza, Andreas Goetzenich, Lachmandath Tewarie, Christian Bleilevens, Rüdiger Autschbach, Heike Schnoering, Rashad Zayat
BACKGROUND: The optimal treatment strategy in patients presenting with hemodynamically significant carotid artery disease who are to undergo cardiac surgery, remains controversial. In this study, we retrospectively analyzed the outcome data of patients receiving synchronous or staged coronary artery bypass graft (CABG) surgery and carotid endarterectomy (CEA). METHODS: Between 2011 and 2016, 3173 patients underwent CABG surgery in our institution, of whom 323 received CABG and CEA either as synchronous (N = 307) or as staged (N = 16) procedures...
August 17, 2018: Heart Surgery Forum
Eleni Panagouli, Gregory Tsoucalas, Theodoros Papaioannou, Aliki Fiska, Dionysios Venieratos, Panagiotis Skandalakis
The aortic arch may present a plethora of anatomical variations, which my cause a cluster of complications in interventional procedures in surgery and angiography. We present a rare case of a common origin of both the common carotids arteries from the brachiocephalic trunk (anonymous artery), with the left common carotid artery emerging from the initial portion of it, forming a small common trunk. The great importance towards an excellent knowledge of the topographical aortic arch anatomy is stressed out.
September 2018: Anatomy & Cell Biology
Tuğra Gençpınar, Gökmen Akkaya, Çağatay Bilen, Pınar Akokay, Osman Yılmaz, Hudai Çatalyürek
Introduction: Use of carbon dioxide (CO2 ) insufflation (CDI) on the surgical field during heart surgery has become widespread, and in some units routine. Aim: To assess the effects of CDI on endothelial dysfunction in a carotid artery model in rabbits. Material and methods: Twelve randomly selected rabbits were divided into two groups. Right carotid arteries of the animals were transected and sutured with running suture technique. Then, 1 l/min CO2 insufflation was initiated with a 45° angle...
September 2018: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Munehiro Saiki, Keiji Yunoki, Ikuma Shiraishi, Naoya Sakoda, Takuya Kawabata, Yuu Ohshima, Kunikazu Hisamochi, Hideo Yoshida
A 78-year-old man was hospitalized for aortic arch aneurysm concomitant with right subclavian artery aneurysm. Maximum diameter of each aneurysm was 65 mm and 40 mm, respectively. Both aneurysms clearly needed to be treated. However, simultaneous surgery of total arch replacement (TAR) and right subclavian artery grafting carries both technical difficulty of surgical exposure and considerable risk of bilateral recurrent nerve palsy. Thus, to avoid these serious problems, we chose hybrid treatment. TAR was performed as the 1st procedure, followed by stent graft placement to right subclavian artery aneurysm...
October 2018: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Hao Ma, Zhenghua Xiao, Jun Shi, Lulu Liu, Chaoyi Qin, Yingqiang Guo
BACKGROUND: Aortic arch cannulation for an antegrade central perfusion during the surgery for Stanford type A aortic dissection can be performed within median sternotomy. We summarize the safety and convenient profile of the central cannulation strategy using the guidance of transesophageal echocardiography (TEE) in comparison to traditional femoral cannulation strategy. METHODS: Sixty-two patients with acute Stanford type A aortic dissection underwent aortic arch surgery in our hospital...
October 11, 2018: Journal of Cardiothoracic Surgery
Ryosuke Kowatari, Yasuyuki Suzuki, Kazuyuki Daitoku, Satoshi Taniguchi, Shinya Kakehata, Ikuo Fukuda
We report a simple endovascular repair for symptomatic aberrant right subclavian artery (ARSA) in an 11-year-old girl. She had undergone tracheostomy due to hypoxic encephalopathy after cardiac surgery and suffered from dyspnea. Computed tomography revealed tracheal stenosis caused by a vascular ring made with an ARSA and the right common carotid artery. Transcatheter ARSA embolization using an Amplatzer vascular plug and coils was performed. Symptoms improved within a few days after this intervention and no complications such as upper extremity ischemia were encountered...
October 10, 2018: Vascular and Endovascular Surgery
Robert Seifert, Michael T Kuhlmann, Sarah Eligehausen, Friedemann Kiefer, Sven Hermann, Michael Schäfers
PURPOSE: As atherosclerotic plaque ruptures are the primary cause of ischaemic events, their preventive identification by imaging remains a clinical challenge. Matrix metalloproteinases (MMP) are involved in plaque progression and destabilisation and are therefore promising targets to characterize rupture-prone unstable plaques. This study aims at evaluating MMP imaging to discriminate unstable from stable plaque phenotypes. METHODS: ApoE deficient mice (ApoE-/-) on a high cholesterol diet underwent implantation of a tapered cuff around the right common carotid artery (CCA) inducing a highly inflamed atherosclerotic plaque upstream (US) and a more stable plaque phenotype downstream (DS) of the cuff...
2018: PloS One
Viviana Manuel, Ryan Gouveia E Melo, Ruy Fernandes E Fernandes, Ana Rita Santos, Luís Silvestre, Emanuel Silva, Tony Soares, Luís Mendes Pedro
Introduction: There is much debate in the literature regarding the management of blunt cervical carotid injuries. This report describes a case of bilateral carotid artery dissection in the very uncommon case of a near hanging victim and the treatment controversies regarding its management. Report: A 50 year old male patient was admitted after attempted suicide through hanging, having been swiftly rescued by a bystander. On admission, six hours after the event there was no neurological deficit...
2018: EJVES Short Reports
Julia Schubert, Otto W Witte, Utz Settmacher, Thomas E Mayer, Albrecht Günther, Jürgen Zanow, Carsten M Klingner
Ischemic stroke due to an acute occlusion of the extracranial internal carotid artery (eICA) is associated with high morbidity and mortality. The best treatment option remains unclear. This study aims to increase the available therapeutic experience documented for surgical recanalization of acute eICA occlusions. We retrospectively reviewed all hospital records of the University Hospital Jena between 2006 and 2018 to identified patients with acute ischemic stroke due to an occlusion of the eICA who underwent emergent surgical recanalization...
October 9, 2018: Vascular and Endovascular Surgery
Lan Wen, Suxia Wang, Lei Liu, Lin Chen, Jia Geng, Lei Kuang, Gangzhen Qian, Junjie Su, Kangning Chen, Zhenhua Zhou
Compared to carotid endarterectomy, carotid artery stenting (CAS) is reportedly associated with higher perioperative risks in elderly patients. To verify the long-term safety and efficacy of CAS with embolic protection in elderly patients, we retrospectively reviewed the medical records of patients with carotid stenosis treated between January 2003 and March 2010 at the Department of Neurology of a large university hospital in China. We included patients with symptomatic, moderate, or severe carotid stenosis of atherosclerotic etiology (other etiologies were excluded), with a disability score ≤ 3 on the modified Rankin Scale, and who received CAS instead of carotid endarterectomy...
2018: Behavioural Neurology
Stanimir Sirakov, Adriana Panayotova, Alexander Sirakov, Krasimir Minkin, Hristo Hristov
Internal carotid artery (ICA) injury is a rare but potentially life-threatening complication of skull base and neck surgery. Although usually manifested by massive intraoperative haemorrhage, impairment of the ICA might go unnoticed and result in formation of a pseudoaneurysm, causing delayed bleeding. Often additional complications are observed such as thrombosis, spasm, embolism or carotico-cavernous fistula formation. The risk of carotid artery injury in aggressive endonasal skull base surgical interventions ranges from 1% to 9%...
October 9, 2018: Interventional Neuroradiology
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