Perspectives in Vascular Surgery and Endovascular Therapy

Unilateral paresis of cranial nerves IX to XI is defined as Vernet's syndrome. We retrospectively assessed cranial nerve symptoms from the clinical records of 143 carotid endarterectomy patients. A flexible nasolaryngoscope was used to examine vocal fold movements in 73 patients. If vocal fold paresis (VFP) was confirmed, the patient also underwent magnifying laryngoscopy (for correct diagnosis of injury to the glossopharyngeal and vagus nerves). It was found from clinical records that 8 patients (6%) were confirmed to have cranial nerve symptoms corresponding to Vernet's syndrome; 7 patients (9 %) had VFP on nasolaryngoscopy...

No abstract text is available yet for this article.

A relationship between decreased carotid arterial flow and apoplectic manifestations was already suspected by the ancient Greeks. Early attempts at carotid surgery, however, were limited to emergency arterial ligation in patients with neck trauma. Attempts to suture arterial stumps together to restore blood flow paved the way for Carrel's revolutionary idea of reconstructing the resected or injured arterial segment with an interposition vein graft. DeBakey and Eastcott were the first to perform carotid endarterectomy in North America and the United Kingdom, respectively...

INTRODUCTION: Vascular injuries to hepatic arterial blood flow present a challenge in reconstruction. The location and extent of the injury dictate intraoperative decision making, with repair being performed expeditiously to preserve hepatic function. Formal arterial repair either primarily or with interposition or transposition grafts is indicated in the majority of patients. Special consideration should be made in patients with underlying liver disease and those undergoing biliary reconstructions...

Mycotic aneurysms resulting from intravesical bacillus Calmette-Guérin (BCG) treatment are exceptionally rare. We report on the case of a 73-year-old man who underwent intravesical therapy of BCG for bladder carcinoma and developed a right neck mass. A carotid pseudoaneurysm within a fibrotic mass was noted on surgical exploration. Radical resection was performed followed by a polytetrafluoroethylene interposition graft. Final pathology revealed necrotizing granulomas and multinucleated giant cells concerning for tuberculoma...

The increased operating cost of running a practice, decreasing reimbursement, and general pessimism is leading to increasing number of physicians choosing employment by hospitals and large physician groups. Although over 50% of members of the Society for Vascular Surgery are currently in a practice of less than 3 surgeons and over half of all private practitioners are employed by physician groups, the landscape is shifting quickly. Younger physicians finishing training are increasingly opting for employment...

Endovascular repair of complex aneurysms involving the visceral arteries has become a reality. Fenestrated endovascular aortic repair (FEVAR) has been used with increasing frequency to treat complex aortic aneurysms. The Zenith fenestrated stent-graft system (Cook Medical Inc, Brisbane, Australia) was approved for commercial use in the United States in April 2012, offering a custom-made design with up to 3 fenestrations to treat short-neck infrarenal and juxtarenal abdominal aortic aneurysms. Nevertheless, FEVAR is a complex procedure that demands accurate planning, advanced endovascular skills, and excellent perioperative patient care to achieve optimal outcomes...

OBJECTIVES: To summarize available evidence regarding stent fracture in the femoropopliteal region. METHODS: We searched PubMed, 2000-2011, using MeSH search terms "stents," "popliteal artery," and "femoral artery." RESULTS: We identified 29 original studies reporting 0% to 65% incidence of stent fracture. Fracture-related repeat revascularization could be avoided in the absence of device failure. Recently published data suggest that even a 5% rate of fracture-related reintervention would generate $118...

INTRODUCTION: This study aimed to compare management patterns of patients with superficial venous thrombophlebitis (SVT) among phlebologists and vascular surgeons. METHODS: A survey was provided to practitioners who attended the American Venous Forum meeting in 2011. Statistical analysis included descriptive statistics, unpaired t tests, and Friedman's test for correlation. RESULTS: There were 354 US or Canadian health care providers of whom 169 were phlebologists and 185 were vascular surgeons...

OBJECTIVE: To compare outcomes of abdominal aortic aneurysm repairs before and after the endovascular era. METHODS: Group A (1997-1998) included 331 patients, 321 (97%) with open repair (OR) and 10 (3%) with endovascular aneurysm repair (EVAR). Group B (2007-2008) included 330 patients, 136 (41%) with OR and 194 (59%) with EVAR. RESULTS: Patients in Group B were older (74 ± 8.5 vs 73 ± 7.0 years, P = .02), had higher comorbidity scores (8...

We report the management of a patient presenting with haemoptysis due to aortobronchial fistula. He had previously undergone emergency exclusion bypass of a ruptured pseudoaneurysm developing post-aortic coarctation repair. Computed tomography scan showed persistent filling of pseudoaneurysm sac from proximal and distal aortic ligature sites tied during previous exclusion bypass surgery. Successful exclusion of aneurysm was achieved by using 3 vascular plug devices (1 Amplatzer plug II and 2 Amender patent ductus arteriosus occluder devices)...

We describe a simple technique we use in our institution during surgery for aortic aneurysms to reduce tension on the anastomosis when there is a discrepancy between the remnant portion of the native aorta and the vascular prosthesis.

Hybrid approaches for repair of aneurysms involving the ascending aorta and the aortic arch have been developed to avoid or reduce duration of cardiopulmonary bypass and circulatory arrest and to decrease operative time, blood loss, hospital stay, morbidity, and mortality. These include ascending aorta-based debranching or cervical extra-anatomical bypasses followed by stent-grafting. In patients with associated descending aortic aneurysms, the elephant trunk technique is used followed by stent-grafting of the descending thoracic aorta...

Congenital portosystemic venous shunt is extremely rare and should be treated. Advances in treatment techniques allow for patients to be treated safely. We present a 9-year-old boy with a large congenital portosystemic venous shunt. The shunt was occluded interventionally with the Amplatzer vascular plug II. Our case was unique with its clinical manifestation, the use of a 22-mm Amplatzer vascular plug II, and the presence of the patient's 1-year follow-up.

Inferior vena cava (IVC) filters are used to treat thromboembolic disease when there is a contraindication to anticoagulation or failure of therapeutic anticoagulation therapy. Although there are retrievable IVC filters available, permanent IVC filters remain the most commonly placed IVC filters worldwide. Permanent IVC filters have been associated with long-term complications such as IVC thrombosis and obstruction, migration, and erosion into surrounding structures. Such complications may require removal of permanent IVC filters, which has been previously described with open surgery involving venotomy of the IVC...

Type B aortic dissection is a rare, but deadly, disease process. Advances in endovascular therapy have provided alternative means for the management of aortic dissection. This comprehensive review examines the incidence, pathophysiology, presentation, diagnosis, risk factors, and management of type B aortic dissection, with an emphasis on endovascular intervention. Additionally, this review provides current information regarding the procedural outcomes, complications, mortality, and overall survival of endovascular versus conventional management of type B aortic dissections...

INTRODUCTION: This study identified characteristics of patients with moderate internal carotid artery stenosis that are at increased risk for disease progression. METHODS: Patients with asymptomatic moderate internal carotid disease correlating to 50% to 75% diameter reduction were followed for 3 years. Progression to greater than 75% diameter reduction or presentation with focal neurological symptoms was documented. Descriptive statistics and χ(2) testing provided statistical analysis...

PURPOSE: To report a case of a major vascular complication during transcatheter aortic valve replacement (TAVR) and the endovascular management thereof. Additionally, we discuss a possible correlation with long-term steroid use. CASE REPORT: A 79-year-old woman with a history of critical aortic stenosis underwent elective TAVR. Her procedure was complicated by rupture of her right iliac artery, life-threatening retroperitoneal hemorrhage, and thrombus extending into the distal right lower extremity...

Osteochondromas are the most common benign tumors of the bone and are usually asymptomatic. In rare cases, they can present as a cause of lower extremity vascular injury in young patients. We report a case of a 24-year-old man who presented with an acute onset of exercise-induced lower extremity claudication and was found to have a popliteal artery occlusion secondary to a femoral exostosis. The patient underwent an excision of the exostosis and resection of the occluded segment with primary reanastomosis of the popliteal and superficial femoral arteries...

Visceral arterial aneurysm and pseudoaneurysm are uncommon forms of vascular disease that have a significant potential for rupture or erosion into an adjacent viscera, resulting in life-threatening hemorrhage. Pseudoaneurysms related to the superior mesenteric artery are a recognized complication of trauma to the vessel, and successful treatment with stenting has been previously described. Percutaneous techniques offer an alternative form of therapy, and the number of reported cases treated with embolization has been rising steadily...