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Clinical outcomes and influencing factors of in-stent restenosis after stenting for symptomatic stenosis of the vertebral V1 segment

Journal of Vascular Surgery - May 19, 2018 - 00:00
The objective of this study was to evaluate 30-day and long-term clinical outcomes and influencing factors of in-stent restenosis (ISR) after stenting for symptomatic stenosis of the vertebral V1 segment.

Outcomes and cost of open versus endovascular repair of intact thoracoabdominal aortic aneurysm

Journal of Vascular Surgery - May 19, 2018 - 00:00
Many previous studies have evaluated the outcomes of open and endovascular repair of thoracoabdominal aortic aneurysms (TAAAs). However, little is known about the differences in cost of these procedures and the potential factors driving these differences. The aim of this study was to evaluate the outcomes and cost of open aortic repair (OAR) vs endovascular repair of intact TAAA.

The clinical presentation and collateral pathway development of congenital absence of the internal carotid artery

Journal of Vascular Surgery - May 19, 2018 - 00:00
The objective of this study was to investigate the clinical presentation, risks, and collateral pathway development of the congenital absence of the internal carotid artery (ICA).

Emergent carotid endarterectomy versus stenting in acute stroke patients with tandem occlusion

Journal of Vascular Surgery - May 19, 2018 - 00:00
Acute stroke due to tandem cervical internal carotid artery (ICA) and intracranial large-vessel occlusion (ILVO) has a high rate of morbidity and mortality. The most appropriate treatment strategy for the extracranial culprit lesion remains unclear. In this study, we report our institutional outcomes with two approaches: emergent carotid endarterectomy (CEA) and carotid artery stenting (CAS).

Correlation between MDCTA and Carotid Plaque Histological Heterogeneity: A Pilot Study

The aim of this pilot study was to identify multidetector computed tomography angiography (MDCTA) features that may help identify carotid atherosclerotic plaques (CAPs) with severe histological heterogeneity.

Long-term Follow up of Patients with Acute Aortic Syndromes: Relevance of both Aortic and Non-aortic Events

The aim was to assess the long-term outcome of patients diagnosed with type A and type B acute aortic syndromes (AAS) and the mortality risk predictors.

Implementation of drug-eluting stents for the treatment of femoropopliteal disease provides significant cost-to-system savings in a single-state outpatient simulation

Journal of Vascular Surgery - May 18, 2018 - 00:00
Initial data on drug-eluting stents (DES) shows that they may increase the durability of endovascular treatment of superficial femoral artery disease compared with traditional bare metal stents (BMS). Observed decreased target lesion revascularization (TLR) rates have potential for cost savings despite an increased initial cost. The purpose of this study was to run a simulation model of progressive transition from BMS to DES over 5 years evaluating the overall cost impact of that transition.

Patient satisfaction with the consent discussion is not improved by showing patients their computed tomography or angiography images before they undergo vascular surgery

Journal of Vascular Surgery - May 18, 2018 - 00:00
Patient-based decision aids and other multimedia tools have been developed to help enrich the preoperative discussion between surgeon and patient. Use of these tools, however, can be time-consuming and logistically challenging. We investigated whether simply showing patients their images from preoperative computed tomography (CT) or angiography would improve patients' satisfaction with the preoperative discussion. We also examined whether this improved the patient's understanding and trust and whether it contributed to increased preoperative anxiety.

Assessment of failure to rescue after abdominal aortic aneurysm repair using the National Surgical Quality Improvement Program procedure-targeted data set

Journal of Vascular Surgery - May 18, 2018 - 00:00
Open aortic repair (OAR) is associated with higher risk of mortality compared with endovascular aneurysm repair (EVAR). The aim of this study was to compare failure to rescue (FTR) after major predischarge complications in patients undergoing OAR and EVAR.

Preoperative point-of-care ultrasound and its impact on arteriovenous fistula maturation outcomes

Journal of Vascular Surgery - May 18, 2018 - 00:00
Duplex ultrasound as a preoperative assessment tool in the clinic may help identify anatomic factors predictive of fistula maturation. Preoperative point-of-care ultrasound (POCUS) offers surgeons an alternative to routine formal vein mapping as it can be performed by the operator during the initial clinic visit. We sought to determine the impact of POCUS as an adjunct to physical examination on arteriovenous fistula maturation.

Short-term results of left subclavian artery salvage in blunt thoracic aortic injury with short proximal landing zones

Journal of Vascular Surgery - May 18, 2018 - 00:00
Thoracic endovascular aortic repair (TEVAR) is the standard treatment of blunt thoracic aortic injury (BTAI). The concept of seal was derived from the treatment of aneurysms and has been adopted for BTAI. Given the location of injury in BTAI, left subclavian artery (LSA) coverage is sometimes necessary. In these often healthier aortas, a shorter proximal landing zone may be acceptable and beneficial in avoiding some complications. Current practice patterns vary, and long-term effects of LSA coverage remain unknown.

Use of the Zenith Fenestrated platform to rescue failing endovascular and open aortic reconstructions is safe and technically feasible

Journal of Vascular Surgery - May 18, 2018 - 00:00
Proximal neck dilation is a serious long-term complication directly causing the failure of endovascular aneurysm repair (EVAR) and open surgical repair (OSR) of abdominal aortic aneurysms. However, the implantation of a fenestrated device presents the opportunity for proximal extension of the aortic reconstruction into a healthy segment while maintaining patency of the visceral vessels. The objective of this investigation was to report perioperative and follow-up outcomes using the Zenith Fenestrated (ZFEN; Cook Medical, Bloomington, Ind) aortic stent system in salvaging previous aortic repairs undergoing type IA endoleak or aneurysmal degeneration of the proximal neck.

Spontaneous Non-Anastomotic Rupture of Axillo-femoral Bypass

A 49 year old, ex-intravenous drug user was admitted with gangrenous ulcers of the lower limbs. CTA showed infrarenal aortic occlusion with thrombus. The patient had a concomitant Takotsubu cardiomyopathy (EF 15%), which delayed surgery. He subsequently underwent bilateral axillo-femoral bypasses using 6 × 80 mm ePTFE grafts (Impra, Bard Peripheral Vascular, Tempe, USA). Recovery was uneventful until 4 weeks post-operatively when he presented with a “lump” on his lateral chest wall at the nipple level.

Comparison of hemodialysis arteriovenous fistula blood flow rates measured by Doppler ultrasound and phase-contrast magnetic resonance imaging

Journal of Vascular Surgery - May 17, 2018 - 00:00
The objective of this study was to compare blood flow rates measured by Doppler ultrasound (DUS) and phase-contrast magnetic resonance imaging (MRI) in patients having a hemodialysis arteriovenous fistula (AVF) and to identify scenarios in which there was significant discordance between these two approaches.

Acral Melanoma Mimicking Toe Gangrene in Diabetic Foot

A 71 year old man with a 20 year history of type 2 diabetes mellitus and 3 month history of intermittent claudication presented with toe gangrene on the right foot. Physical examination revealed cold skin of the right leg with gangrene of the fourth toe (ankle brachial index 0.57). Local excision was undertaken; biopsy and immunohistochemical examination revealed an acral melanoma. Wide local excision with 2 cm margins was performed. Acral melanoma is an uncommon variant typically occurring on the palms and soles that can be confused with toe gangrene in the diabetic foot.

Best medical treatment alone may not be adequate for all patients with asymptomatic carotid artery stenosis

Journal of Vascular Surgery - May 14, 2018 - 00:00
Stroke is the fifth leading cause of death in the United States, with >130,000 deaths/y.1 Every year, about 795,000 people in the United States sustain a stroke.1 About 610,000 of these are first strokes and 185,000 are recurrent strokes.1 Three landmark randomized controlled trials (RCTs) demonstrated that in patients with 60% to 99% asymptomatic carotid stenosis (ACS), carotid endarterectomy (CEA) conferred a 50% relative risk reduction in the 5-year stroke risk compared with medical treatment (MT) alone (absolute risk reduction of ≈1%/y).

Preoperative frailty assessment predicts loss of independence after vascular surgery

Journal of Vascular Surgery - May 14, 2018 - 00:00
Frailty, a clinical syndrome associated with loss of metabolic reserves, is prevalent among patients who present to vascular surgery clinics for evaluation. The Clinical Frailty Scale (CFS) is a rapid assessment method shown to be highly specific for identifying frail patients. In this study, we sought to evaluate whether the preoperative CFS score could be used to predict loss of independence after major vascular procedures.

Influence of Proximal Aortic Neck Diameter on Durability of Aneurysm Sealing and Overall Survival in Patients Undergoing Endovascular Aneurysm Repair. Real World Data from the Gore Global Registry for Endovascular Aortic Treatment (GREAT)

Aortic neck diameter is an independent anatomical feature that is poorly understood, yet potentially linked to proximal seal failure and adverse outcome following standard EVAR. The aim of this study was to assess whether large proximal aortic neck (LAN) diameter is associated with adverse outcome using prospectively collected individual patient data from The Global Registry for Endovascular Aortic Treatment (GREAT).

Massive Buttock Necrosis Following Aortobifemoral Bypass Surgery

A 77 year old male with a history of myocardial infarction received a left to right femoro-femoral bypass graft for right leg ischaemia. Angiography during subsequent external iliac artery stenting revealed a patent inferior mesenteric artery (IMA) with bilateral occluded internal iliac arteries (IIA) (A). Seven months later he developed bilateral critical leg ischaemia. As urgent endovascular treatment was unsuccessful, an aortobifemoral bypass graft was constructed. Two days later, he developed sepsis caused by massive buttock necrosis (B).

The Pac-Man Sign

A 60 year old female presented with a thoraco-abdominal aortic aneurysm (Crawford Type IV). The patient underwent endovascular repair with a fenestrated device (Cook Medical, Bloomington, IN, USA). However, the one month computed tomography angiogram (CTA) showed an infolding collapse of the proximal stent (with a Type I endoleak) forming the ‘Pac-Man’ sign, as we have named it (A). Re-intervention was undertaken using a Palmaz XL unmounted stent (P4014, Cordis, Switzerland) unfolding the proximal part of the stent graft.
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