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Vascular, surgery, endovascular

Tyler Lazaro, Visish M Srinivasan, Phillip Cooper, Michael Phillips, Robert Garcia, Stephen R Chen, Jeremiah Johnson, Dalis E Collins, Peter Kan
BACKGROUND: Endovascular technological advances have revolutionized the field of neurovascular surgery and have become the mainstay of treatment for many cerebrovascular pathologies. Digital subtraction angiography (DSA) is the 'gold standard' for visualization of the vasculature and deployment of endovascular devices. Nonetheless, with recent technological advances in optics, angioscopy has emerged as a potentially important adjunct to DSA. Angioscopy can offer direct visualization of the intracranial vasculature, and direct observation and inspection of device deployment...
March 16, 2019: Journal of Neurointerventional Surgery
Kosmas I Paraskevas, Gert J de Borst, Frank J Veith
OBJECTIVE: Randomized controlled trials (RCTs) constitute level I evidence and are used as the backbone of guidelines and recommendations for treatment. Although RCTs are theoretically the studies of choice for the assessment of the effectiveness of health care interventions, these trials (and their interpretation) may sometimes result in erroneous conclusions, erroneous therapeutic decisions, and incorrect recommendations. We aimed to check the applicability of the results of RCTs to everyday practice...
March 13, 2019: Journal of Vascular Surgery
Gianmarco de Donato, Edoardo Pasqui, Francesco Setacci, Giancarlo Palasciano, Laura Nigi, Cecilia Fondelli, Antonio Sterpetti, Francesco Dotta, George Weber, Carlo Setacci
After the invention of the balloon catheter by Fogarty in 1963, surgical thromboembolectomy was considered the gold standard treatment for many years in patients with acute lower limb ischemia (ALLI). ALLI is a dramatic event, carrying a high risk of amputation and perioperative morbidity and mortality. The evolution of endovascular technologies has resulted in a variety of therapeutic options to establish arterial patency. In the 1970s, Dotter first introduced the idea of clot lysis in the treatment of ALLI, which was modified to catheter-directed thrombolysis, and now clot aspiration techniques...
June 2018: Seminars in Vascular Surgery
Otto Stackelberg, David Lindström, Kevin Mani, Göran Lundberg, Anneli Linné, Martin Delle, Martin Berger, Anders Wanhainen, Peter Gillgren
OBJECTIVES: To evaluate outcomes after endovascular treatment of abdominal aortic aneurysms (AAA) involving the renovisceral arteries and to compare outcomes after fenestrated/branched endovascular aortic repair (f/b-EVAR), chimney/periscope EVAR (ch-EVAR), and bailout ch-EVAR. METHODS: A retrospective multicenter study including all patients with AAA involving the renovisceral segment, treated with f/b-EVAR, ch-EVAR, or bailout ch-EVAR, between 1 January 2005 and 30 June 2015, in three Swedish vascular centers...
March 14, 2019: Vascular
Florian Präve, Kerstin Hoffmann
In case of an acute leg swelling a deep leg vein thrombosis needs to be excluded. In order to do this, compression sonography and the D-dimer-test are applied in the framework of an established diagnostic algorithm. The ensuing therapy consists in anticoagulation and compression.In case of a chronic leg swelling anamnesis and a clinical check-up often lead to a differential diagnosis. Chronic venous insufficiency is a generic term for a disturbed venous backflow. It is caused by an obstruction or an antegrade or retrograde flow insufficiency...
March 2019: Deutsche Medizinische Wochenschrift
Hussam Abou-Al-Shaar, Yair M Gozal, Philipp Taussky, William T Couldwell
Petrous internal carotid artery (ICA) aneurysms are rare, complicated lesions to treat. The management paradigms include observation, endovascular exclusion, or surgical trapping with or without revascularization. The case described in this video involved a 67-yr-old woman with a known history of chronic lymphocytic leukemia, who presented after a mechanical ground-level fall. Clinically, she had a nasal deformity and resolving epistaxis consistent with mild facial trauma. Computed tomography (CT) revealed a comminuted nasal bone fracture and an incidental 3-cm right petrous ICA aneurysm...
March 14, 2019: Operative Neurosurgery (Hagerstown, Md.)
Jesse Chait, Pavel Kibrik, Ahmad Alsheekh, Natalie Marks, Sareh Rajaee, Anil Hingorani, Enrico Ascher
OBJECTIVE: Descending thoracic endovascular aneurysm repair (D-TEVAR) is often performed by vascular surgeons. At many institutions, cardiothoracic surgery support is required for an elective TEVAR to take place. Oftentimes, this means a dedicated cardiopulmonary bypass team must be available. This study aims to investigate that TEVAR is a safe procedure that does not require such a resource-intensive "back-up plan." METHODS: This is a retrospective analysis of data collected from March 2014 to January 2018 of 18 patients who underwent TEVAR at a tertiary care facility with a level I trauma center...
March 13, 2019: Vascular
Maarten P van Wiechen, Jurgen M Ligthart, Nicolas M Van Mieghem
Endovascular aneurysm repair, transcatheter aortic valve implantation and percutaneous mechanical circulatory support systems have become valuable alternatives to conventional surgery and even preferred strategies for a wide array of clinical entities. Their adoption in everyday practice is growing. These procedures require large-bore access into the femoral artery. Their use is thus associated with clinically significant vascular bleeding complications. Meticulous access site management is crucial for safe implementation of large-bore technologies and includes accurate puncture technique and reliable percutaneous closure devices...
February 2019: Interventional Cardiology
Lewis Meecham, Matthew Popplewell, Gareth Bate, Smitaa Patel, Andrew W Bradbury
BACKGROUND: Bypass surgery (BS) remains the gold standard revascularization strategy in patients with chronic limb-threatening ischemia (CLTI) owing to infrainguinal disease. The Bypass versus Angioplasty for Severe Ischaemia of the Leg (BASIL)-1 trial showed that, in patients with CLTI who survived for 2 years or more, BS resulted in better clinical outcomes. Despite this finding, there has been an increasing trend toward an endovascular-first approach to infrainguinal CLTI. Our aim was to investigate whether changes in practice have impacted the clinical outcomes of BS in our unit 10 years after BASIL-1...
March 6, 2019: Journal of Vascular Surgery
Thomas E Brothers, Daniel J Bertges
OBJECTIVE: The purpose of this study was to validate published Society for Vascular Surgery Vascular Quality Initiative (VQI) prediction models for patients with limb-threatening ischemia (LTI) undergoing open or endovascular revascularization for infrapopliteal occlusive disease. METHODS: We sought to validate our prior VQI LTI models for major adverse limb events (MALEs) and amputation-free survival (AFS) in a VQI new cohort undergoing open or percutaneous interventions from September 2014 through August 2016...
March 6, 2019: Journal of Vascular Surgery
Michele Antonello, Francesco Squizzato, Silvia Bassini, Luca Porcellato, Franco Grego, Michele Piazza
OBJECTIVE: The aim of the present study was to compare open surgical repair (OSR) versus endovascular repair (ER) using self-expanding covered stents for complex TransAtlantic Inter-Society Consensus II (TASC) class C or D aortoiliac lesions in low-risk patients, with a specific subanalysis for younger patients. METHODS: A single-center retrospective review of TASC C/D lesions treated from January 2008 to December 2017 was conducted. Patients with associated aortic aneurysm or lesions involving the entire infrarenal aorta were excluded...
March 5, 2019: Journal of Vascular Surgery
Frank M Davis, Erin Jerzal, Jeremy Albright, Andris Kazmers, Ash Monsour, Paul Bove, Peter K Henke
OBJECTIVE: Recent vascular societal guidelines have recommended an abdominal aortic aneurysm (AAA) size threshold for elective intervention; however, limited data have documented how well these AAA diameter benchmarks are being met. The objective of this study was to analyze variation in management of AAAs based on diameter and to determine the physician's rationale for intervention on small AAAs in relation to recommended treatment guidelines. METHODS: A retrospective review of a statewide vascular surgery registry of all elective endovascular or open surgical AAA repairs from January 2012 to January 2016 was performed...
March 2, 2019: Journal of Vascular Surgery
Mark Rockley, Adnan Hadziomerovic, Carl van Walraven, Prosenjit Bose, Oonagh Scallan, Prasad Jetty
OBJECTIVE: Infrarenal aortic neck angulation is one of the most powerful predictors of endovascular aneurysm repair failure. Whereas the "gold standard" to measure this angle is three-dimensional (3D) reconstruction and centerline measurement, many surgeons rely on estimations of angulation based on two-dimensional (2D) views of computed tomography imaging. Unfortunately, these views do not accurately represent the true angle, particularly if aortic angulation is oblique to the standard views...
March 2, 2019: Journal of Vascular Surgery
Fernando Motta, Jason R Crowner, Corey A Kalbaugh, Martyn Knowles, Luigi Pascarella, Katharine L McGinigle, Mark A Farber
OBJECTIVE: This study compared complications in patients undergoing fenestrated-branched endovascular aneurysm repair (F-BEVAR) without and with stenting of the superior mesenteric artery (SMA) or celiac artery (CA), with particular attention to the length of coverage above the CA. METHODS: A retrospective review was performed of a prospectively maintained database of patients treated with F-BEVAR for thoracoabdominal aortic aneurysms between July 2012 and May 2017...
March 2, 2019: Journal of Vascular Surgery
J A Mustapha, Fadi A Saab, Daniel Clair, Peter Schneider
OBJECTIVE: To investigate the feasibility, safety, and effectiveness of the LimFlow stent-graft system in performing percutaneous deep vein arterialization (pDVA) for treatment of critical limb ischemia (CLI) patients ineligible for conventional endovascular or surgical revascularization procedures. METHODS: Ten no-option CLI patients (mean age, 67 ± 11 years; 30% women) were enrolled. All patients were classified as Rutherford class 5 or 6 and were deemed by a committee of experts to be ineligible for endovascular or surgical procedures to restore blood flow...
March 2019: Journal of Invasive Cardiology
Vittorio Branchi, Carsten Meyer, Frauke Verrel, Alexander Kania, Edwin Bölke, Alexander Semaan, Arne Koscielny, Jörg C Kalff, Hanno Matthaei
BACKGROUND: Visceral artery aneurysms (VAA) are rare vascular lesions. Clinically silent VAA are increasingly detected by cross-sectional imaging but some lesions are at risk for rupture with severe bleeding. The aim of the present study was to evaluate the trends in the interdisciplinary management at a tertiary center. METHODS: Patients who underwent treatment for VAA at University Hospital of Bonn between 2005 and 2018 were enrolled in this retrospective study...
February 28, 2019: European Journal of Medical Research
Grace J Wang, Richard P Cambria, Joseph V Lombardi, Ali Azizzadeh, Rodney A White, Dorothy B Abel, Jack L Cronenwett, Adam W Beck
OBJECTIVE: The purpose of the Society for Vascular Surgery Vascular Quality Initiative thoracic endovascular aortic repair (TEVAR) for dissection project is to assess the effectiveness of TEVAR for type B dissection by evaluation in a prospective quality improvement registry. Here we describe the project cohort and 30-day outcomes of TEVAR for both acute dissection (AD) and chronic dissection (CD) patients and focus specifically on outcomes of uncomplicated AD patients based on timing of treatment...
March 2019: Journal of Vascular Surgery
M Sahinoglu, O Arun, A Orhan, A Nayman, A Calısır, Y Bocu, Y Cebeci, A Duman, H Yılmaz, E Köktekir, H Karabağlı
BACKGROUND: Vascular injury complications during lumbar discectomy are rare but potentially life-threatening. Therefore, an early diagnosis and effective treatment management is required for these complications. CASE DESCRIPTION: A 50-year-old female patient was admitted to our outpatient clinic with severe back and right leg pain. She underwent surgery for right L4-5 extruded disc herniation with general anesthesia. Sudden arterial hemorrhage occurred during discectomy performed with straight disc forceps and was controlled using hemostatic materials, with no significant decrease in blood pressure...
February 21, 2019: World Neurosurgery
Rafael de Athayde Soares, Marcelo Fernando Matielo, Francisco Cardoso Brochado Neto, Ana Paula Maia Pires, Rogério Duque de Almeida, Murilo de Jesus Martins, Roberto Sacilotto
Objectives: In this paper, we report the long-term outcomes of the endovascular treatment of femoropopliteal occlusive disease, focusing on the importance of calcification and runoff outflow on limb salvage and patency, and the factors associated with these outcomes at a single center. Methods: This retrospective cohort study included consecutive patients with femoropopliteal occlusive who underwent femoropopliteal angioplasty at the Division of Vascular and Endovascular Surgery, Hospital do Servidor Público Estadual, São Paulo, Brazil, between January 2015 and July 2017...
January 2019: JRSM Cardiovascular Disease
Davide Nasi, Mauro Dobran, Lucia di Somma, Alessandro Di Rienzo, Maurizio De Nicola, Maurizio Iacoangeli
Coil migration and extrusion outside the cranial compartment after embolization of cerebral aneurysms represents a very rare complication of the endovascular procedures and few cases are reported in the literature. Instability of the vascular malformation wall and the resolution of the intramural hematoma, especially in pseudoaneurysm, might generate extravascular migration of the coils in the first months after embolization. However, to the best of our knowledge, an extrusion of coil 10 years after embolization has never been reported...
January 2019: Case Reports in Neurology
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