vascular aneurysm bypass carotid

OBJECTIVE: Cryopreserved human arterial allografts are a recognized acceptable alternative for vascular reconstruction when other traditional conduits are either unavailable or contraindicated. We reviewed our experience using cryopreserved arterial allografts for peripheral artery reconstructions in contaminated and infected surgical fields. METHODS: A single-center, retrospective review was conducted of 57 patients who underwent a peripheral vascular reconstruction using a cryopreserved arterial allograft from January 2002 through July 2017...

INTRODUCTION: The aim of this study was to analyze practice trends in specific intracranial bypass types in a large, consecutuve bypass experience. METHODS: This retrospective review of a prospectively maintained database included all intracranial bypasses performed by a single surgeon over 21 years. Bypass types were grouped into 7 categories and analyzed in seven 3-year time intervals: type 1 = extracranial-to-intracranial (EC-IC) bypass with scalp arteries as donors; type 2 = EC-IC bypass with interposition graft to cervical carotid arteries; type 3 = arterial reimplantation; type 4 = in situ bypass; type 5 = reanastomosis; type 6 = intracranial-to-intracranial (IC-IC) bypass with interposition graft; and type 7= combination bypass...

OBJECTIVE: We aimed to summarize our microsurgical treatment results for large (10-25 mm) and giant (≥25 mm) intradural internal carotid artery (ICA) aneurysms over a 7-year period at a single institution and to describe our detailed strategy. PATIENTS AND METHODS: We reviewed the records of 68 patients with 69 aneurysms, including large and giant intradural ICA aneurysms, treated using microsurgical techniques from January 2008 to December 2014. We used adenosine-induced cardiac standstill or retrograde suction decompression for some aneurysm clipping cases and performed bypass surgery if needed...

INTRODUCTION: Takayasu arteritis is a large-vessel vasculitis that may cause oculo-cerebral ischemia. We report a patient with visual loss as initial manifestation, and discuss transcranial Doppler (TCD) findings before and after surgical revascularization. CASE DESCRIPTION: A 19-year-old female developed episodes of transient positional right vision loss, progressing to permanent right vision loss and bright light-induced left amaurosis. Examination demonstrated subclavian bruits, palpable epigastrium aortic pulsation, faint radial pulses, right retinal pallor, arteriolar narrowing, and bilateral boxcarring...

OBJECTIVE: Head and neck cancer can involve the surrounding vasculature and require technically challenging vascular interventions. These interventions can be complicated by tumor invasion, history of prior surgery, and history of radiation therapy. Our aim was to examine patients with vascular interventions in association with head and neck cancer to determine outcomes and best practice. METHODS: We performed a retrospective review of cancer patients treated by head and neck surgery and vascular surgery between 2007 and 2014...

OBJECTIVE: Hyperglycemia is a common occurrence in patients undergoing cardiovascular surgery. It has been identified in several surgical cohorts that improved perioperative glycemic control reduced postoperative morbidity and mortality. A significant portion of the population with peripheral arterial disease suffers from the sequelae of diabetes or metabolic syndrome. A paucity of data exists regarding the relationship between perioperative glycemic control and postoperative outcomes in vascular surgery patients...

The answer to the question of whether endovascular techniques extend the barriers to treatment in multimorbid vascular patients depends on the localization of the vascular disease and its stage. In multimorbid vascular patients with limited life expectancy and asymptomatic carotid stenosis, neither an endovascular nor an open procedure is indicated but a conservative best medicinal treatment is to be preferred. In symptomatic carotid stenosis the endovascular procedure is indicated for special anatomical conditions, such as contralateral carotid artery occlusion, contralateral recurrent nerve palsy, recurrent stenosis following endarterectomy, radical neck dissection and radiotherapy in the cervical region...

Described herein is a clinical case report concerning treatment of a 32-year-old female patient with rupture of an aneurysm of the arch and descending portion of the thoracic aorta, with the bleeding having penetrated the upper lobe of the left lung. The woman was admitted to the Department of Vascular Surgery of Municipal Multimodality Hospital No 2 of Saint Petersburg, presenting with a clinical pattern of aneurysmal rupture previously diagnosed by computed tomography performed at one of the local hospitals...

BACKGROUND: Surgical management of aortic arch pathologies is complex, and endovascular developments have now enabled total or hybrid endovascular aortic arch repair. We present our early experience with fenestrated aortic arch repairs in Ishimaru zones 1 and 2 pathologies. METHODS: In a single tertiary institution, all consecutive endovascular aortic arch repairs were reviewed. A preoperative computed tomography aortogram was performed to assess anatomic suitability, which we defined as having a proximal sealing zone with a maximum diameter of 38 mm and minimum length of 20 mm, absence of significant aortic tortuosity, and suitable sealing zones in target vessels...

BACKGROUND: The side-to-side anastomosis is one of the difficult bypass configurations that may be used in various complex cerebral vascular and neoplastic cases. Few pure arterial models exist for practicing this bypass subtype. OBJECTIVE: To provide an optimized side-to-side anastomosis training model using rat common carotid arteries (CCA). METHODS: Bilateral CCAs were exposed in the neck of 10 anesthetized Sprague-Dawley rats. The arteries were juxtaposed in parallel, using temporary aneurysm clips applied proximally and distally...

BACKGROUND: Renal artery anomalies occur at a rate of 1-2% and present a challenge to vascular surgeons performing aortic surgery. We describe adjuncts used to manage such anatomic variants. METHODS: A single surgeon registry of all abdominal aortic aneurysms repaired in an academic center was retrospectively reviewed. Patients with prior renal transplants, congenital pelvic kidneys, or horseshoe kidneys were included. Open repair was reserved for patients with no endovascular or hybrid repair options...

BACKGROUND: We report a case of a ruptured fusiform aneurysm of the distal internal carotid artery (ICA) involving the anterior choroidal artery and posterior communicating artery, treated with selective coil embolization. CASE DESCRIPTION: An 86-year-old woman was admitted with subarachnoid hemorrhage. Computed tomography and computed tomography angiography showed diffuse subarachnoid hemorrhage with a fusiform aneurysm, as well as severe atherosclerotic change in the distal ICA...

OBJECTIVE Pathology in the region of the basilar quadrifurcation, anterolateral midbrain, medial tentorium, and interpeduncular and ambient cisterns may be accessed anteriorly via an orbitozygomatic (OZ) craniotomy. In Part 1 of this series, the authors explored the anatomy of the oculomotor-tentorial triangle (OTT). In Part 2, the versatility of the OTT as a surgical workspace for treating vascular pathology is demonstrated. METHODS Sixty patients with 61 vascular pathologies treated within or via the OTT from 1998 to 2017 by the senior author were retrospectively reviewed...

OBJECTIVE: Although endovascular repair of abdominal aortic aneurysms (AAAs) has been demonstrated to have favorable outcomes, not all cohorts of patients with AAA fare equally well. Our goal was to investigate perioperative and 1-year outcomes in patients with end-stage renal disease (ESRD) on dialysis, who have traditionally fared worse after vascular interventions, to assess how ESRD affects outcomes in a large modern cohort of endovascular aneurysm repair (EVAR) patients. METHODS: The Vascular Quality Initiative database was queried for all patients undergoing EVAR from 2010 to 2017...

BACKGROUND: Giant ruptured paraclinoid aneurysm with concomitant bilateral internal carotid artery dissection (CAD) can be a difficult condition to treat with current surgical and endovascular techniques. Paraclinoid internal carotid artery (ICA) aneurysms remain a major challenge for vascular neurosurgeons. There are still controversies in the management of carotid artery (CA) dissections. Surgical and endovascular treatment is recommended in cases with multivessel dissections or those complicated by subarachnoid hemorrhage (SAH)...

BACKGROUND: Surgical innovation is critical for the management of challenging cerebrovascular pathology. Flow-through free flaps are versatile composite grafts that combine viable tissue with a revascularization source. Neurosurgical experience with these flaps is limited. OBJECTIVE: To provide an in-depth technical description of the radial artery fascial (and fasciocutaneous) flow-through free flap (RAFF and RAFCF, respectively) for complex cerebral revascularizations...

OBJECTIVE: 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. METHODS: We identified all patients living independently at home who were prospectively assessed using the CFS before undergoing an elective major vascular surgery procedure (admitted for >24 hours) at an academic medical center between December 2015 and December 2017...

OBJECTIVE Cerebrovascular bypass surgery is a challenging yet important neurosurgical procedure that is performed to restore circulation in the treatment of carotid occlusive diseases, giant/complex aneurysms, and skull base tumors. It requires advanced microsurgical skills and dedicated training in microsurgical techniques. Most available training tools, however, either lack the realism of the actual bypass surgery (e.g., artificial vessel, chicken wing models) or require special facilities and regulations (e...

BACKGROUND: Access to medical care, by adequate insurance coverage, has a direct impact on outcomes for patients undergoing vascular procedures. We evaluated in-hospital mortality for patients undergoing index vascular procedures before and after the Massachusetts Healthcare Reform Law (MHRL) in 2006, which mandated insurance for all Massachusetts residents, both in Massachusetts and throughout the United States. METHODS: The National Inpatient Sample was queried to identify patients undergoing interventions for peripheral arterial disease, carotid artery stenosis, and abdominal aortic aneurysms based on International Classification of Diseases, Ninth Revision, Clinical Modification procedural and diagnostic codes...

OBJECTIVE: Dementia represents a major risk factor for medical complications and has been linked to higher rates of complication after surgery. Given the systemic nature of vascular disease, medical comorbidities significantly increase cost and complications after vascular surgery. We hypothesize that the presence of dementia is an independent predictor of increased postoperative complications and higher health care costs after vascular surgery. METHODS: The Vascular Quality Initiative database was queried for all patients undergoing vascular surgery at a single academic medical center from 2012 to 2017...