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Endovascular therapy

Mehmet Akif Cakar, Ersun Tatli, Alptug Tokatli, Harun Kilic, Huseyin Gunduz, Ramazan Akdemir
INTRODUCTION: Percutaneous endovascular therapy is an accepted and preferred procedure for symptomatic subclavian artery disease. However, the technical feasibility and effectiveness of treating chronic total occlusion of the subclavian artery with this approach is uncertain. We aimed to evaluate the initial and mid-term results of endovascular therapy for patients with symptomatic chronic total occlusion of the left subclavian artery. METHODS: Consecutive patients who underwent balloon angioplasty and stenting for chronic total occlusion of the left subclavian artery between January 2010 and February 2014 were included...
March 16, 2018: Singapore Medical Journal
Jun Zhang, Xiao Zhang, Jin-Ping Zhang, Ju Han
The optimal treatment for patients with chronic symptomatic middle cerebral artery (MCA) total occlusion is not well established. In addition to medical therapy, vessel recanalisation with stenting has shown much promise, especially for patients with recurrent ischemic symptoms. Nevertheless, the incidence of symptomatic in-stent restenosis (ISR) is high, and is associated with an unfavorable prognosis. Drug coated balloons (DCBs) have been proven to be effective in treating and preventing ISR. However, the feasibility of DCBs for de novo intracranial atherothrombotic stenosis has not been previously described, especially for total occlusion lesions...
March 15, 2018: BMJ Case Reports
Anat Rabinovich, Susan R Kahn
The post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that imposes significant morbidity, reduces quality of life and is costly. After DVT, 20-50% of patients will develop PTS, and up to 5% will develop severe PTS. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, obesity and older age. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will reduce the occurrence of PTS. The effectiveness of elastic compression stockings (ECS) for PTS prevention is controversial...
March 15, 2018: Blood
Anthony H Chau, Haidar Abdul-Muhsin, Xin Peng, Victor J Davila, Erik P Castle, Samuel R Money
Renal nutcracker syndrome is an anatomic anomaly characterized by the compression of the left renal vein between the superior mesenteric artery and the aorta or between the aorta and the vertebral body. Diagnosis is often challenging. Common presenting symptoms include hematuria, abdominal pain, and pelvic congestion. Several open and endovascular techniques have been described to treat this syndrome. We report a novel surgical technique with robotic-assisted left renal vein transposition to treat a 19-year-old woman with renal nutcracker syndrome...
March 2018: Journal of Vascular Surgery Cases and Innovative Techniques
Mardjono Tjahjadi, Joseph Serrone, Juha Hernesniemi
Background: Basilar apex aneurysms constitute 5-8% of all intracranial aneurysms, and their treatment remains challenging for both microsurgical and endovascular approaches. The perceived drawback of the microsurgical approach is its invasiveness leading to increased surgical morbidity. However, many high-volume centers have shown excellent clinical results with better occlusion rates compared to endovascular treatment. With endovascular therapy taking a larger role in the management of cerebral aneurysms, the future role of microsurgery for basilar apex aneurysm treatment is unclear...
2018: Surgical Neurology International
Wataro Tsuruta, Tetsuya Yamamoto, Go Ikeda, Masayuki Sato, Yoshiro Ito, Tomoji Takigawa, Aiki Marushima, Yasunobu Nakai, Yuji Matsumaru, Akira Matsumura
BACKGROUND: Endovascular surgery for vertebral artery dissections (VADs) carries the risk of spinal cord infarction (SCI). Although SCI in the region of the anterior spinal artery (ASA) has been reported, SCI in the region of the posterior spinal artery (PSA) is rare. OBJECTIVE: To investigate PSA infarction after endovascular surgery for VAD. METHODS: Infarction in the region of the PSA after endovascular surgery for VADs carried out in consecutive 21 cases was investigated...
March 9, 2018: Operative Neurosurgery (Hagerstown, Md.)
Han-Gil Jeong, Beom Joon Kim, Jay Chol Choi, Keun-Sik Hong, Mi Hwa Yang, Cheolkyu Jung, Moon-Ku Han, Hee-Joon Bae
BACKGROUND AND PURPOSE: The majority of ischemic stroke patients receiving endovascular recanalization therapy (EVT) experience variable changes of neurological severities during the hyperacute period. We hypothesized that the National Institutes of Health Stroke Scale (NIHSS) score after EVT is a better prognostic factor compared with the initial NIHSS score or revascularization status. METHODS: We identified 566 stroke patients who received EVT at Seoul National University Bundang Hospital between April 2008 and December 2015...
March 13, 2018: Stroke; a Journal of Cerebral Circulation
Matthew C Bunte, Mehdi H Shishehbor
Endovascular therapy (EVT) of symptomatic peripheral artery disease (PAD) offers relief of symptoms and enhanced quality of life. Advancements in technique and technology have increased the feasibility and practicality of EVT, which now represents the preferred mode of revascularization over surgical procedures in many centers across the world. In this review, we consider the future of EVT in context of a rapidly expanding population of patients with symptomatic PAD.
March 10, 2018: Progress in Cardiovascular Diseases
Elliot M Ross, Theodore T Redman
BACKGROUND: Noncompressible junctional and truncal hemorrhage remains a significant cause of combat casualty death. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an effective treatment for many junctional and noncompressible hemorrhages. The current hospital standard for time of placement of REBOA is approximately 6 minutes. This study examined the training process and the ability of nonsurgical physicians to apply REBOA therapy in an austere field environment. METHODS: This was a skill acquisition and feasibility study...
2018: Journal of Special Operations Medicine: a Peer Reviewed Journal for SOF Medical Professionals
Qi Liu, Tian-Jia Li, Rong Zeng, Yue-Xin Chen, Wei Ye, Bao Liu, Chang-Wei Liu
Objective To investigate the optimal treatment strategy of spontaneous isolated dissection of superior mesenteric artery (SIDSMA) and the effect of anticoagulation therapy on the prognosis of SIDSMA. Methods The clinical data of 29 patients presented with acute or subacute mesenteric ischemia (a history of less than 14 days) due to SIDSMA admitted to the Department of Vascular Surgery of Peking Union Medical College Hospital from January 1st 2003 to December 31th 2016 were retrospectively analyzed. Results In this study,28 cases were male and the remaining one was female,with an average age of (49...
February 28, 2018: Zhongguo Yi Xue Ke Xue Yuan Xue Bao. Acta Academiae Medicinae Sinicae
Jan Raupach, Jan Vales, Jan Vojacek, Petr Hoffmann, Miroslav Lojik, Katerina Kamaradova, Pavla Cabelkova, Vendelin Chovanec, Ondrej Renc, Antonin Krajina, Radovan Maly
An aggressive periaortic lymphoma could very rarely invade the aortic wall. We present a unique case of a patient with symptomatic thoracic aneurysm and imminent rupture due to the periaortic lymphoma, in which endovascular treatment using stent graft was applied. After stabilization of the aorta and histological confirmation of aggressive B-cell lymphoma by computed tomography-guided biopsy, the antilymphoma therapy was initiated. Despite the full treatment, the patient died 12 months later.
January 1, 2018: Vascular and Endovascular Surgery
Stephan A Munich, Marshall C Cress, Leonardo Rangel-Castilla, Ashish Sonig, Christopher S Ogilvy, Giuseppe Lanzino, Ondra Petr, J Mocco, Peter J Morone, Kenneth V Snyder, L Nelson Hopkins, Adnan H Siddiqui, Elad I Levy
BACKGROUND: Neck remnants are not uncommon after endovascular treatment of cerebral aneurysms. Critics of endovascular treatments for cerebral aneurysms cite neck remnants as evidence in favor of microsurgical clipping. However, studies have failed to evaluate the true clinical significance of aneurysm neck remnants following endovascular therapies. OBJECTIVE: To assess the clinical significance of residual aneurysm necks and to determine the rate of subsequent rupture following coiling or stent-assisted coiling of cerebral aneurysms...
March 8, 2018: Neurosurgery
Ali Abdul Jabaar, J Stephen Jenkins
BACKGROUND: Beyond medical therapy, the role of endovascular approach for the management of chronic Venous Thromboembolic (VTE) disease is yet to be defined. To our knowledge, no systematic reviews or guidelines are available that provide information on how to manage this chronic condition. This paper represents the first systematic review of published reports on the use of vacuum-assisted thrombectomy (AngioVac) in treating chronic VTE disease. METHODS: A systematic review of published case-series, individual case-reports, and review articles in MEDLINE, PubMed, and Google Scholar was conducted...
February 15, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Benjamin D Fellows, Nardine Ghobrial, Elliot Mappus, Andrew Hargett, Mark Bolding, Delphine Dean, Olin Thompson Mefford
Restenosis by neointimal hyperplasia is still an ongoing concern in endovascular surgery. Slowing vascular smooth muscle cell (VSMC) proliferation by reversing the phenotype change, would allow vessel healing and re-endotheliazation. To accomplish this, we have developed heparin-coated magnetic nanoparticles for targeted drug therapy of neointimal hyperplasia. Iron oxide nanoparticles were modified with a poly (ethylene oxide) based coating and then further functionalized with heparin. In vitro experiments were conducted to observe changes in phenotype, metabolic activity, and viability of three relevant cell lines including VSMC, endothelial cells and fibroblasts...
March 8, 2018: Nanomedicine: Nanotechnology, Biology, and Medicine
Raffaele Pesavento, Paolo Prandoni
Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon and late complication of pulmonary embolism resulting from misguided remodelling of residual pulmonary thromboembolic material and small-vessel arteriopathy. CTEPH is the only form of pulmonary hypertension (PH) potentially curable by pulmonary endarterectomy (PEA). Unfortunately, several patients have either an unacceptable risk-benefit ratio for undergoing the surgical intervention or develop persistent PH after PEA. Novel medical and endovascular therapies can be considered for them...
March 2, 2018: Thrombosis Research
Pius Kim, Suk Jung Jang
OBJECTIVE: Surgical clipping of the cerebral aenurysm is considered as a standard therapy with endovascular coil embolization. The surgical clipping is known to be superior to the endovascular coil embolization in terms of recurrent rate. However, a recurrent aneurysm which is initially treated by surgical clipping is difficult to handle. The purpose of this study was to research the management of the recurrent cerebral aneurysm after a surgical clipping and how to overcome them. METHODS: From January 1996 to December 2015, medical records and radiologic findings of 14 patients with recurrent aneurysm after surgical clipping were reviewed retrospectively...
March 2018: Journal of Korean Neurosurgical Society
Konstantinos Tigkiropoulos, Fragiska Sigala, Diamantis I Tsilimigras, Demetrios Moris, Konstantinos Filis, Nikolaos Melas, Dimitrios Karamanos, Christos Kontogiannis, Ioannis Lazaridis, Nikolaos Saratzis
BACKGROUND: Blunt thoracic aortic injury (BTAI) is the second most common cause of death in trauma patients. Nowadays, thoracic endovascular aortic repair (TEVAR) has become the treatment of choice due to lower rates of mortality, paraplegia and stroke. However, concerns have been raised whether graft implantation is related to the development of hypertension in the postoperative period. OBJECTIVES: To report short- and long-term outcomes of patients undergoing TEVAR for BTAIs at a tertiary hospital as well as investigate post-implant hypertension...
March 7, 2018: Annals of Vascular Surgery
Dale G Wilson, Sheena K Harris, Chandler Barton, Jeffrey D Crawford, Amir F Azarbal, Enjae Jung, Erica L Mitchell, Gregory J Landry, Gregory L Moneta
OBJECTIVE: The ankle-brachial index (ABI) is a well-established measure of distal perfusion in lower extremity ischemia; however, the ABI is of limited value in patients with noncompressible lower extremity arteries. We sought to demonstrate whether duplex ultrasound-determined tibial artery velocities can be used as an alternative to ABI as an objective performance measure after endovascular treatment of above-knee arterial stenosis. METHODS: Thirty-six patients undergoing above-knee endovascular intervention had preprocedure and postprocedure duplex ultrasound examination within 6 months of intervention...
March 6, 2018: Journal of Vascular Surgery
Roberta Rossini, Giuseppe Tarantini, Giuseppe Musumeci, Giulia Masiero, Emanuele Barbato, Paolo Calabrò, Davide Capodanno, Sergio Leonardi, Maddalena Lettino, Ugo Limbruno, Alberto Menozzi, U O Alfredo Marchese, Francesco Saia, Marco Valgimigli, Walter Ageno, Anna Falanga, Antonio Corcione, Alessandro Locatelli, Marco Montorsi, Diego Piazza, Andrea Stella, Antonio Bozzani, Alessandro Parolari, Roberto Carone, Dominick J Angiolillo
Perioperative management of antithrombotic therapy in patients treated with coronary stents undergoing surgery remains poorly defined. Importantly, surgery represents a common reason for premature treatment discontinuation, which is associated with an increased risk in mortality and major adverse cardiac events. However, maintaining antithrombotic therapy to minimize the incidence of perioperative ischemic complications may increase the risk of bleeding complications. Although guidelines provide some recommendations with respect to the perioperative management of antithrombotic therapy, these have been largely developed according to the thrombotic risk of the patient and a definition of the hemorrhagic risk specific to each surgical procedure, key to defining the trade-off between ischemia and bleeding, is not provided...
March 12, 2018: JACC. Cardiovascular Interventions
Gianfranco Varetto, Alessandra Trevisan, Giovanni Barile, Lorenzo Gibello, Flavia Spalla, Edoardo Frola, Daniele Pennica, Pietro Rispoli PhD
BACKGROUND: Pseudoaneurysm (PA) after carotid endarterectomy (CEA) is a rare and potentially life-threatening complication, with an incidence lower than 1%. Most of the cases described report PAs after carotid patch angioplasty and are associated with infection, often caused by Staphylococci. The management of PAs can be surgical, endovascular, or hybrid. METHODS: We herein present the case of an infected carotid PA 27 days after an eversion CEA. We performed a common to internal carotid bypass with the interposition of great saphenous vein (GSV) associated with specific polyantibiotic therapy for 4 weeks...
January 1, 2018: Vascular and Endovascular Surgery
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