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Remote endarterectomy

George A Antoniou, George S Georgiadis, Stavros A Antoniou, Ragai R Makar, Jonathan D Smout, Francesco Torella
BACKGROUND: Bypass surgery is one of the mainstay treatments for patients with critical lower limb ischaemia (CLI). This is the second update of the review first published in 2000. OBJECTIVES: To assess the effects of bypass surgery in patients with chronic lower limb ischaemia. SEARCH METHODS: For this update, the Cochrane Vascular Group searched its trials register (last searched October 2016) and the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (last searched Issue 9, 2016)...
April 3, 2017: Cochrane Database of Systematic Reviews
Mária Rašiová, Ľubomír Špak, Ľudmila Farkašová, Štefan Pataky, Martin Koščo, Marek Hudák, Matej Moščovič, Norbert Leško
BACKGROUND: The goal of carotid artery stenting (CAS) is to decrease the stroke risk in patients with carotid stenosis. This procedure carries an immediate risk of stroke and death and many patients do not benefit from it, especially asymptomatic patients. Patient selection for carotid procedure who benefit from procedure and who is the procedure hazardous for is important. Remote ischemic stroke is known risk factor for stroke reccurence during surgery. The aim of our study was to determine the periprocedural complication risk (within 30 days after CAS) associated with carotid stenting (stroke, death) between patients with remote pre- procedural ischemic stroke and without it; to analyse periprocedural risk in other specific patient subgroups treated with CAS and to determine the impact of observed variables on all- cause mortality during long-term follow-up...
December 1, 2016: International Angiology: a Journal of the International Union of Angiology
ZhiHui Chang, JiaHe Zheng, ZhaoYu Liu
BACKGROUND: In recent years subintimal angioplasty (SIA) has become an established percutaneous procedure for the treatment of symptomatic lower limb arterial chronic total occlusions. However, the clinical benefits of this practice remain unclear. The aim of the review was to determine the effectiveness of SIA on clinical outcomes. This is an update of a review first published in 2013. OBJECTIVES: To assess the effectiveness of SIA versus other treatment for people with lower limb arterial chronic total occlusions, determined by the effects on clinical improvement, technical success rate, patency rate, limb salvage rate, and morbidity rates...
November 18, 2016: Cochrane Database of Systematic Reviews
Mohammad Ali Husainy, Hani Slim, Hisham Rashid, Dean Y Huang
We report a novel application of balloon angioplasty to recanalise a chronically occluded remote endarterectomy superficial femoral artery. This patient previously had two occluded surgical bypass grafts in an attempt to revascularise the limb and presented with critical limb ischaemia and necrotic foot ulcerations. Following the angioplasty, the patient showed significant improvement in rest pain and healing of the ulcerations. This technique may be useful for limb salvage in patients where surgical options have been exhausted...
February 2017: Cardiovascular and Interventional Radiology
Yader Sandoval, Marina Zakharova, Thomas S Rector, Emmanouil S Brilakis, Todd Drexel, Edward O McFalls, Santiago Garcia
The utility of measuring cardiac troponins (cTn) in asymptomatic patients during the perioperative period has been controversial. In the present substudy of the Cardiac Remote Ischemic Preconditioning Prior to Elective Vascular Surgery Trial (NCT01558596), we hypothesized that surveillance of myocardial injury with cTnI in the perioperative period would lead to initiation or intensification of medical therapies for coronary artery disease. Increases in cTnI ≥0.01 μg/l in the perioperative period were considered clinically significant...
December 15, 2016: American Journal of Cardiology
Steven T W van Haelst, Saskia Haitjema, Jean-Paul P M de Vries, Frans L Moll, Gerard Pasterkamp, Hester M den Ruijter, Gert J de Borst
OBJECTIVE: Diabetes mellitus (DM) is associated with peripheral arterial disease (PAD) and leads to worse clinical outcome compared with patients without DM. The objective of this study was to determine the impact of DM on iliofemoral artery plaque characteristics and to examine secondary clinical outcomes in patients with DM and PAD undergoing surgical revascularization. METHODS: We analyzed 198 patients with and 453 patients without DM from the Athero-Express biobank, a prospective ongoing biobank study, who underwent endarterectomy of the femoral or iliac artery between 2002 and 2013...
February 2017: Journal of Vascular Surgery
Crystal M Kavanagh, Michael J Heidenreich, Jeremy J Albright, Abdulhameed Aziz
OBJECTIVE: Long or multisegmental external iliac-to-femoral arterial lesions treated by angioplasty and stenting have achieved disappointing results. Conventional, open approaches are often complicated by significant morbidity, and endovascular stenting alone typically requires additional outflow procedures. We hypothesized that a hybrid approach, combining endovascular techniques with remote selective external iliac endarterectomy, produces superior outcomes in terms of patency compared with stenting alone, with minimal associated morbidity...
November 2016: Journal of Vascular Surgery
I M Ignat'ev
AIM: The study was aimed at improving the results of carotid endarterectomy (CEA) by means of improving technical methods of performing reconstruction of the carotid bifurcation. MATERIAL AND METHODS: From January 2012 to December 2014 at the Department of Vascular Surgery we performed a total of 703 CEA operations, including 183 (26%) according to the classical technique and 520 (74%) according to the eversion technique. The average age of patients amounted to 61...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
R A Kuzhuget, A A Karpenko, O V Kamenskaya, P V Ignatenko, V B Starodubtsev, V G Postnov
The authors analysed the results of carotid endarterectomy in a total of 469 patients with the use of simultaneous assessment of the oxygen status and collateral blood flow of the brain in order to determine feasibility of placing a temporary bypass, carried out at the Centre of Vascular and Hybrid Surgery of the Novosibirsk Scientific Research Institute of Circulatory Pathology named after Academician E.N. Meshalkin in 2008-2012. It was shown that it is more appropriate to use a temporary bypass based on simultaneous assessment of the oxygen status and collateral blood flow of the brain: in synchronous decrease of the degree of cerebral oxygenation during tentative occlusion by more than 20% of the baseline level, or in absolute values of cerebral oxygenation below 40% and simultaneous decrease of retrograde pressure below 40 mm Hg...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
A V Pokrovsky, V N Tsygankov, A A Sidorov
Timely performed reconstructive operations on carotid arteries considerably decrease the incidence rate of ischaemic-type acute impairments of cerebral circulation. Nevertheless, restenoses developing in the zone of reconstruction of carotid arteries level the positive result of the primary operation in remote terms of follow up. In such cases it is more preferable to perform stenting of the damaged portions. The article deals with cases of successful use of self-expandable stent grafts in restenoses of carotid arteries after carotid endarterectomy and operations of prosthetic repair of carotid arteries...
2016: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Christos Karathanos, Konstantinos Spanos, Vassileios Saleptsis, Georgios A Antoniou, Stylianos Koutsias, Athanasios D Giannoukas
OBJECTIVES: Remote endarterectomy (RE) is a relatively minimally invasive procedure as an alternative to femoropopliteal above-knee bypass for the treatment of long-segment superficial femoral artery (SFA) occlusion. The objective of this study was to report our experience and to evaluate the long-term outcome. DESIGN: Single-center nonrandomized retrospective study with prospective collection of patients' data. METHODS: Twelve patients (11 men; mean age 72 years, range 55-81 years) with long (>10 cm) SFA occlusion underwent RE followed by stent (aSpire) placement at the distal end of the endarterectomy...
November 2015: Vascular and Endovascular Surgery
Wesley S Moore, Jeffrey J Popma, Gary S Roubin, Jenifer H Voeks, Donald E Cutlip, Michael Jones, George Howard, Thomas G Brott
OBJECTIVE: The Carotid Revascularization Endarterectomy versus Stenting Trial (CREST) demonstrated a higher periprocedural stroke and death (S+D) rate among patients randomized to carotid artery stenting (CAS) than to carotid endarterectomy (CEA). Herein, we seek factors that affect the CAS-CEA treatment differences and potentially to identify a subgroup of patients for whom CAS and CEA have equivalent periprocedural S+D risk. METHODS: Patient and arterial characteristics were assessed as effect modifiers of the CAS-CEA treatment difference in 2502 patients by the addition of factor-by-treatment interaction terms to a logistic regression model...
April 2016: Journal of Vascular Surgery
Max Wohlauer, Jesse K McKenney, Woosup Michael Park
BACKGROUND: A 68-year-old woman with a thoracoabdominal aortic aneurysm recently status after first-stage elephant trunk procedure with right brachiocephalic artery endarterectomy and reimplantation of the innominate and left carotid using a 14 × 10-mm branch graft presented to clinic with increasing pain in her right arm and shoulder for 2 weeks. She also had a remote history of radiation to the right axilla for breast cancer. On physical examination, she had a tender mass under her clavicle, numbness in shoulder and right hand weakness...
January 2016: Annals of Vascular Surgery
A G Edemskiĭ, A M Cherniavskiĭ, M A Cherniavskiĭ, A R Tarkova, V G Efimenko
Over the period from 2004 to 2013, a total of 146 patients presenting with chronic post-embolic pulmonary hypertension (CPEPH) underwent the operation of pulmonary thromboendarterectomy (TEE) at the Centre for Surgery of the Aorta, Coronary and Peripheral Arteries. The operation was carried out according to the conventional technique with the use of hypothermia and circulatory arrest. The dynamics of the clinical and functional state was assessed by analysing the following parameters: 6-minute walk test, mean pulmonary artery pressure, and resistance of lesser circulation vessels (according to the data of catheterization of the right parts of the heart), as well as the diameter of the pulmonary artery trunk (by data of MSCT angiography of the pulmonary artery)...
2015: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
I M Ignat'ev
The article reviews the materials of the 29th International Conference of the Russian Association of Angiologists and Vascular Surgeons "New trends and remote results of open endovascular interventions in treatment of vascular patients". Presented herein are the main results of scientific research in carotid surgery (carotid endarterectomy in the acute period of stroke, stenting), reconstructive, endovascular interventions in Leriche syndrome, pathology of lower-limb arteries, present-day technologies of treatment of aortic aneurysms (hybrid operations, endovascular prosthetic repair)...
2015: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Carola Heneweer, Markus Siggelkow, Michael Helle, Rainer Petzina, Asmus Wulff, Joost P Schaefer, Rouven Berndt, Rene Rusch, Thilo Wedel, Guenther Klaws, Magdalena Müller-Gerbl, Christoph Röcken, Olav Jansen, Georg Lutter, Joachim Cremer, Justus Groß
Stenosis and occlusion of the superficial femoral artery (SFA) are most common in arterial occlusive disease. There are numerous interventional, surgical, and combined approaches to reconstitute maximum blood supply to the lower limb; however, despite intense clinical research, the long-term success rates are still poor. We present the first results with a catheter prototype for laser-based minimal invasive endarterectomy, called laser scoop desobliteration (LSD). The tip of a glass fiber containing a catheter was modified with a spatula head design and connected to an ultraviolet laser...
February 2015: Journal of Biomedical Optics
Sachinder Singh Hans, Irina Catanescu
OBJECTIVE: Many surgeons favor routine shunting during carotid endarterectomy (CEA) in patients with recent stroke who otherwise prefer selective shunt placement for other indications of CEA. We analyzed the results of CEA in this group of patients with the strategy of selective shunting. METHODS: A retrospective review was performed of 59 patients (group A) undergoing CEA ≤8 weeks of a stroke (2000-2014) from two midsized teaching hospitals with stroke certification; of these, 38 patients had CEA ≤2 weeks and 21 other had CEA >2 weeks but <8 weeks...
April 2015: Journal of Vascular Surgery
A I Pityk, V A Prasol, V V Boĭko
AIM: The study was aimed at comparative analysis of efficacy of endovascular and surgical revascularization in patients presenting with lower limb critical ischaemia (LLCI) due to lesions of infrainguinal arteries. MATERIAL AND METHODS: The retrospective study included a total of 236 patients with LLCI undergoing revascularization of lower extremities performed at our Institute from 2007 to 2011. The patients were subdivided into two groups. Group One consisted of 135 patients subjected to transcutaneous endovascular interventions...
2014: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
I S Abramov, D A Maĭtesian, T A Lazarian, V L Baldin, A V Verigo, A G Eremenko, S A Papoian
AIM: To compare the results of semiclosed retrograde loop endarterectomy from the superficial femoral artery (SFA) and proximal femoropopliteal bypass grafting (FPBG) with a synthetic prosthesis. MATERIAL AND METHODS: From 2007 to 2011, at the Department of Vascular Surgery of Municipal Clinical Hospital No 15 named after O.M. Filatov we operated on a total of 97 patients with occlusive and stenotic lesions of the femoropopliteal segment, with 83 (86%) of them being men...
2014: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
Sh I Karimov, R D Sunnatov, A A Irnazarov, R T Muminov, A A Iulbarisov, A M Akhmatov, Kh K Alidzhanov
The work was aimed at studying the remote results of reconstructive operations performed on brachiocephalic arteries in a total of 1,483 patients presenting with chronic cerebrovascular insufficiency. The findings obtained from our experience confirmed that carotid endarterectomy up to now remains the gold standard of treatment for both symptomatic and asymptomatic patients suffering from haemodynamically significant lesions of carotid arteries, requiring, however, timely performance and consequent active follow up of the patients involved...
2014: Angiologii︠a︡ i Sosudistai︠a︡ Khirurgii︠a︡, Angiology and Vascular Surgery
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