Journal of Vascular Surgery

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Late Renal Salvage After Complex Endovascular Aneurysm Repair Complicated by Acute Renal Thrombosis

August 1, 2018 - 00:00
A devastating complication of complex aortic repair is acute renal thrombosis secondary to inadvertent coverage of the renal vessels. Renal graft occlusion after open bypass generally is associated with a warm ischemia time of approximately 1 hour before irreversible renal ischemia occurs. We would like to see if there is an opportunity for late renal salvage after inadvertent renal artery stent graft occlusion after endovascular repair of aortic aneurysms.

The Impact on Wound Healing and Major Amputation-free Survival in Patients With Isolated Below-the-Knee Arterial Disease After Angiosome-Directed Endovascular Revascularization

August 1, 2018 - 00:00
Revascularization of the specific anatomic area of the ischemic wound of the lower extremity is essential to achieve healing and limb salvage. In certain circumstances, it may not be possible to revascularize the source artery directly. If the arterial-arterial connections can revascularize the source artery of target angiosome, the healing rate may be similar. If no revascularization of the source artery is feasible, the result may be worse. Our objective was to analyze the influence of these arterial-arterial connections on ischemic wound healing and limb salvage after successful endovascular intervention of the isolated below the knee vessel.

First Report of Thoracic Endovascular Aortic Repair With Chimney to Free Vein Coronary Bypass for Ruptured Type A Thoracic Aortic Dissection

August 1, 2018 - 00:00
An 85-year-old patient with a history of oxygen-dependent chronic obstructive pulmonary disease and coronary artery bypass grafting (LIMA-LAD, free vein-circumflex) presented to the emergency department with chest and back pain. Computed tomography angiography (CTA) confirmed acute type a thoracic aortic dissection limited to the ascending thoracic aorta. Aneurysm size is 10 cm. This patient was evaluated by cardiovascular surgeons who offered the patient palliative care secondary to perioperative risk and sent home.

Aortic Septotomy For Management of Transient Ischemic Cauda Equina Syndrome in Patients With Complicated Type B Thoracic Aortic Dissection

August 1, 2018 - 00:00
Transient cauda equina syndrome is believed to occur secondary to temporary cauda equina compression. This syndrome has not been reported to occur secondary to malperfusion from complicated type B thoracic aortic dissection (TAD). We present diagnosis and endovascular treatment strategies for managing transient ischemic cauda equine syndrome.

Secondary Interventions after Vein Stent Placements: Why Do Venous Stents Fail?

August 1, 2018 - 00:00
This study was undertaken to better characterize the secondary interventions after venous stenting for chronic, proximal venous outflow obstruction.

Drug-Coated Balloon Angioplasty Confers No Advantage in the Treatment of Femoropopliteal Disease When Stenting Is Required

August 1, 2018 - 00:00
Drug-coated balloons (DCB) have become ubiquitous in the treatment of femoropopliteal atherosclerotic disease. Given their widespread use based on IDE trial data, we sought to evaluate the usefulness of DCB in a real-world, high-volume single center.

The Selection of Patients for Ambulatory Endovascular Aneurysm Repair

August 1, 2018 - 00:00
To identify candidates undergoing elective endovascular aneurysm repair (EVAR) of asymptomatic infrarenal abdominal aortic aneurysm who are eligible for early (≤6 hours) hospital discharge or to have EVAR performed in free-standing ambulatory surgery centers.

Operative Time Affects Outcomes After Lower Extremity Endovascular Revascularization

August 1, 2018 - 00:00
Longer operative times for infrainguinal revascularization have been associated with higher perioperative complication rates particularly with respect to surgical site infections and extended durations of stay. We sought to determine if prolonged procedure times after minimally invasive, endovascular interventions were also associated with increased morbidity and or mortality.

Impact of Goal-Directed Statin Therapy on Open and Endovascular Interventions for Claudication Owing to Superficial Femoral Artery Disease

August 1, 2018 - 00:00
Controlling lipids, in particular cholesterol and low-density lipoprotein cholesterol, has been identified as a key intervention to prevent adverse systemic events in patients with a high atherosclerotic burden and claudication. It is unclear if goal-directed therapy of to achieve a decrease in cholesterol (<200 mg/dL) and in low-density lipoprotein (<100 mg/dL) will influence outcomes. The aim of study was to determine the incidence and effectiveness of statin therapy on patient and procedural outcomes after SFA interventions for claudication.

Influence of Heel Ulceration on Limb Salvage After Open and Endovascular Intervention for Limb-Threatening Critical Ischemia

August 1, 2018 - 00:00
Infrapopliteal disease is documented in 50% of patients presenting with tissue loss. The implications of heel ulceration on index limb outcomes is still unclear. The aim of this study was to impact the outcomes of heel ulceration after endovascular and open intervention for limb-threatening critical ischemia

Basilic Vein Superficialization Is an Effective Alternative to Transposition in Patients Requiring Brachiobasilic Arteriovenous Fistula

August 1, 2018 - 00:00
The goal of this study was to compare outcomes for techniques in the creation of brachiobasilic arteriovenous fistulas, namely in the second stage basilic vein transposition or the second stage basilic vein superficialization.

Inhibition of Heat Shock Protein-90 Attenuates Postangioplasty Intimal Hyperplasia

August 1, 2018 - 00:00
Peripheral arterial disease represents a disabling and potentially fatal condition in the aging population. Intimal hyperplasia (IH) is the major pathologic event that leads to restenosis after balloon angioplasty. IH is a complex process which starts immediately after endothelial injury. Growth factors and extracellular matrix proteins are released by platelets and induce vascular smooth muscle cell (VSMC) migration and proliferation. Heat shock protein 90 (HSP90) is a chaperone that binds many proteins regulating their maturation.

Distal True Lumen Compression After Thoracic Endovascular Repair for Aortic Dissection Treated With Endovascular Fenestration

August 1, 2018 - 00:00
Endovascular treatment of type B aortic dissection provides effective relief of distal malperfusion by increasing true luminal size and perfusion distally.

Experience With Eversion Endarterectomy of the Common Femoral Artery With Comparison With Standard Endarterectomy With Patch

August 1, 2018 - 00:00
Common femoral endarterectomy (CFE) is an increasingly important vascular surgical technique. Standard endarterectomy with patch (SEP) involves closure with a prosthetic, bioprosthetic, or vein patch. Eversion endarterectomy (EE) involves transection of the distal common femoral artery (CFA) just proximal to its bifurcation, EE of the CFA and proximal profunda femoris arteries, and primary end-to-end reconstruction. Over the past decade, we have increasingly used EE and herein review our outcomes with this technique and SEP outcomes during the same time period.

Carotid Plaque Characterization In A Large Randomized Trial: Results From CREST-2

August 1, 2018 - 00:00
Objective measures of plaque area and tissue composition from duplex ultrasound (DUS) images may be useful for the risk stratification of patients with a greater likelihood of future adverse events (stroke, transient ischemic attacks, or amaurosis fugax) and to assess the effect of vascular risk factor modification strategies (by measuring change in overall plaque burden and/or individual plaque tissue constituents). Clinical assessment of carotid artery plaques is most commonly performed with two-dimensional DUS imaging.

Left Subclavian Artery Coverage Association With Neurologic Events in Trauma Patients Undergoing Thoracic Endovascular Repair

August 1, 2018 - 00:00
The trauma patient population presents unique challenges to the vascular surgeon. Endovascular repair of the thoracic aorta (TEVAR) outcomes have been studied with interest in complications related to left subclavian artery (LSA) coverage in patients with atherosclerotic pathologies. The objective of this study was to evaluate outcomes after TEVAR for traumatic aortic injury based on LSA coverage.

Prepetrous Skull Base Large internal Carotid Aneurysm Reconstruction

August 1, 2018 - 00:00
A 76-year-old patient with a 6-month history of dysphagia, profound weight loss, and hoarseness presents to the emergency room. A computed tomography scan showed a 4.5-cm left internal carotid artery aneurysm beyond the carotid artery bifurcation at the C2-C3 level. The patient required resection of a prepetrous skull base large internal carotid artery aneurysm with reconstruction of the internal carotid artery.

Concomitant Carotid Endarterectomy and Retrograde Carotid Artery Stenting Is Safe and Effective for the Treatment of Tandem Carotid Artery Lesions

August 1, 2018 - 00:00
Data regarding the treatment of tandem carotid artery lesions at the bifurcation and ipsilateral, proximal common carotid artery (CCA) are limited. It has been suggested that concomitant treatment with carotid endarterectomy (CEA) and proximal retrograde carotid artery stenting (rCAS) confers a high risk of stroke and death. The objective of this study was to evaluate the technique and outcomes of this hybrid procedure at a single institution.

Removal of All Proximal Aneurysmal Aorta Is Unnecessary in the Open Treatment of Juxtarenal Aortic Aneurysms

August 1, 2018 - 00:00
For the open treatment of juxtarenal aortic aneurysms (JRAAs), some argue for the removal of all proximal aneurysmal aorta to prevent future degeneration, whereas others deem it unnecessary. This study sought to compare perioperative and long-term outcomes of two different approaches to JRAA.

Pseudocoarctation After Collapsed Thoracic Endovascular Aortic Repair

August 1, 2018 - 00:00
This presentation describes thoracic endovascular aortic repair (TEVAR) explantation for a pseudocoarctation-type physiology after discovery of a chronically collapsed TEVAR. The indication for the TEVAR was a traumatic aortic tear in a young man. The exposure involves a left thoracotomy, explantation of endograft, and descending thoracic aortic repair with Dacron graft. Important to note is the extent of the arteriotomy, which must be extended proximally and distally to the endograft for successful explantation.