Ruptured iliac artery may initially clinically mimic an isolated inferior limb venous involvement. It was indeed an acute iliac artery dissection complicated by contained rupture and misdiagnosed as inferior limb venous thrombosis that led Thomas Mann to death in 1955. Details of the complex case are analyzed. Read More
Objective: Ischemic colitis (IC) is a well-described complication of ruptured abdominal aortic aneurysms (rAAA). The purpose of this study was to compare the incidence of IC in patients with rAAA undergoing open (OR) vs. endovascular aneurysm repair (EVAR) at a single institution. Read More
Lambe Institute for Translational Discipline of Surgery, National University of Ireland, Galway.
Objectives: To systematically assess the difference between both procedures in terms of access maturation, patency and postoperative complications.
Background: An arteriovenous fistula (AVF) is the best modality for haemodialysis (HD) access. The end-to-side (ETS) technique has been suggested in the literature to produce superior results to the side-to-side approach; however, in the absence of a systematic review, this practice remains debatable. Read More
Thrombosis of the inferior vena cava (IVC) continues to be a rare event and there is a scarcity of evidence with regard to its etiology. One source for IVC thrombosis is external compression from adjacent structures. In this case series we present one case of IVC thrombosis caused by a severely distended bladder and a case of external iliac thrombosis caused by external compression from an abnormally enlarged uterus. Read More
IU Health Center for Aortic Disease, Indiana University School of Medicine, Division of Vascular Surgery, Indianapolis IN; VA Center for Molecular and Cellular Therapeutics in Cardiovascular Disease, Richard L. Roudebush VA Medical Center, Indianapolis IN. Electronic address:
Background: Abdominal aortic aneurysms (AAA) are a major source of morbidity and mortality despite continuing advances in surgical technique and care. Although the inciting factors for AAA development continue to be elusive, accumulating evidence suggests a significant peri-aortic inflammatory response leading to degradation and dilation of the aortic wall. Previous human trials have demonstrated safety and efficacy of mesenchymal stem cells (MSCs) in the treatment of inflammation-related pathologies such as rheumatoid arthritis, graft vs host disease, and transplant rejection. Read More
Three cases of adventitial cystic disease of popliteal artery are reported; one complicated with associated thrombosis of the popliteal artery and two uncomplicated. Operative management and follow-up is described. Read More
Department of Vascular Surgery, Rijnstate Hospital, Arnhem.
Introduction: The Nellix Endovascular Aneurysm Sealing (EVAS) System is an alternative endovascular treatment option for infrarenal aortic aneurysms (AAA) with a unique appearance on Computed Tomography Angiography (CTA). Normal evolution of post-EVAS CTA appearance follow-up is still largely unknown and important in order to timely detect eventual complications.
Objective: To assess the normal appearance of CTA images 30 days and 1 year after EVAS in 50 consecutive patients. Read More
In the setting of portal hypertension, the body responds by creating portosystemic venous shunts which may lead to the development of varices. Endoscopic treatment of these varices is often warranted to prevent catastrophic bleeding. During the course of variceal treatment, one or more portosystemic shunts may be sacrificed which may acutely exacerbate portal hypertension and reduce systemic venous return. Read More
Department of Vascular Surgery, Catharina Hospital, Eindhoven, the Netherlands; Department of Epidemiology, CAPRHI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands. Electronic address:
Introduction: Although supervised exercise therapy (SET) is generally accepted as an effective noninvasive treatment for intermittent claudication (IC), Dutch vascular surgeons were initially somewhat hesitant as reported by a 2011 questionnaire study. Later on, a nationwide multidisciplinary network for SET was introduced in the Netherlands. The aim of this questionnaire study was to determine possible trends in conceptions among Dutch vascular surgeons regarding the prescription of SET. Read More
Departement of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, The Netherlands. Electronic address:
Objectives: Smartphone apps provide novel ways of triggering lifestyle-change by coupling objective measurements of health behavior with tailored feedback. Little is known about end-user preferences regarding the content of mobile health (mHealth) interventions. The aim of this study was to assess smartphone use and preferences regarding app-content among intermittent claudication patients and their treating physical therapists. Read More
Introduction/objectives: Endovascular repair of a proximal anastomotic pseudoaneurysm of an end-to-side aortobifemoral bypass (ABF) can lead to pelvic ischemia. We present a novel application of branched aortic endograft to repair such pseudoaneurysm while preserving flow into the ABF and native aortoiliac system.
Methods: A 71 year old male with history of aortoiliac occlusive disease resulting in lifestyle limiting claudication was treated with an aortobifemoral bypass in 1999. Read More
Division of Vascular Surgery and Endovascular Surgery, Detroit Medical Center of WSUSOM, Wayne State University School of Medicine, Detroit, Michigan. Electronic address:
Renal artery aneurysms (RAAs) are an uncommon finding but are more often associated with other congenital disorders. The complex (hilar) RAAs constitute a subset of RAAs that present a therapeutic dilemma for the vascular surgeon; because of their anatomic location. This dilemma worsens when hilar RAAs occur with a solitary kidney where organ preservation is vital. Read More
Division of Vascular and Endovascular Surgery, University of Miami & Bruce W. Carter Miami VAMC. Electronic address:
Treatment of chronic peripheral ischemic wounds in patients with spinal cord injury (SCI) can be technically challenging, especially if they have significant hip contracture. This paper describes the endovascular aorto-iliac revascularization of a paraplegic patient with hip contracture and a hostile abdomen. It also reviews the particularity of the peripheral arterial system in SCI patients. Read More
Department of General Surgery, Surgical Specialties and Organ, Transplantation "Paride Stefanini", Policlinico "Umberto I" Hospital, "Sapienza" University, Rome; PhD programme in FISIOPATOLOGIA ED IMAGING CARDIO-TORACO- VASCOLARE (31° ciclo).
TEVAR is a less invasive option for managing traumatic injuries of the descending aorta in polytraumatized patients. Concerns arise when treating young patients with TEVAR. A 22-year old male was admitted to the Emergency Department following a high-impact road traffic collision. Read More
Background: The objective was to evaluate the safety and feasibility of temporary superior vena cava (SVC) filter combined with balloon dilatation and catheter-directed thrombolysis for the treatment of catheter related thrombosis (CRT) caused by implanted ports.
Methods: Between February 2014 and October 2016, thirteen patients with implanted port-related CRT in internal jugular vein, brachiocephalic vein and/or subclavian vein were treated by temporary SVC filter, balloon dilatation and catheter-directed thrombolysis. Clinical data were retrospectively analyzed with respect to clinical characteristics, SVC filter placement and retrieval, balloon dilatation and catheter-directed thrombolysis. Read More
Background: We would like to evaluate causes of Thoracic Endovascular Aortic Repair (TEVAR) failure and conversion to open surgery (COS) in high volume vascular center for open surgery, with low volume TEVAR procedures.
Methods: A total of 8 patients (6 males, mean aged 55.14 years) underwent COS after TEVAR. Read More
Department of Vascular Surgery, Maastricht University Medical Center MUMC.
The axillary artery aneurysm (AxAAs) is a rare entity, with a diverse range of proposed etiologic mechanisms. Although usually asymptomatic, thrombo-embolic or haemorrhagic complications leave many with vascular and neurologic compromise. Both open and endovascular approaches have been reported. Read More
Section of Vascular Surgery, University of Michigan.
Background: Among patients undergoing non-cardiac surgery, major vascular surgery is associated with a high risk of perioperative myocardial infarction (MI). Currently there are no perioperative MI risk calculators accounting for intraoperative and postoperative risk factors in vascular surgery patients. We aimed to investigate specific risk factors for perioperative MI after major open vascular surgery to determine which patients are at highest risk of MI, and the association of perioperative MI with perioperative transfusion. Read More
Nantes University Hospital, Thorax Institute, Vascular Surgery Department, Nantes, F-44093 France; Laboratory of Pathophysiology of Bone Resorption, UMR-957, Nantes, F-44000 France; University of Nantes, Nantes, F-44000 France.
Objective: Vascular calcifications (VCs) may be a prognostic factor for outcome after endovascular treatment of peripheral arterial disease (PAD). Semi-quantitative analysis with X-ray imaging is the main limiting factor for assessing VCs. The aim of the present study was to find a correlation between the amount of VC with a CT scan quantification and mid-term results of endovascular treatment of TASC C/D femoropopliteal (FP) lesions. Read More
Rennes University Hospital, Center of Cardiothoracic and Vascular Surgery, F-35033 Rennes, France; (I)NSERM, U1099, F-35000 Rennes, France; University Rennes 1, Signal and Image Processing Laboratory (LTSI), F-35000 Rennes, France. Electronic address:
Purpose: Flat-panel detectors on mobile C-arm (MC-arm) systems are currently challenging fixed C-arm (FC-arm) systems used in hybrid operating rooms. MC-arm systems offer an alternative to FC-arm systems in the endovascular treatment of peripheral arterial disease (PAD) but their efficiency has not been evaluated comparatively.
Methods: Two series of patients undergoing arteriography with intention to treat were included. Read More
Objective: After an infrapopliteal reconstruction, minor amputations are frequently required, but even in the case of successful revascularization, wound healing is a major concern. We studied the role of iliac artery inflow correction in patients undergoing infrapopliteal vein grafts to improve the heal of midfoot amputation.
Methods: Thirty-eight patients affected with Rutherford Grade III Category 5 PAD, who underwent successful simultaneous iliac endovascular procedure, infrapopliteal reversed vein bypass graft, and minor amputation, were enrolled in this retrospective study. Read More
Thyroid cancer causing superior vena cava (SVC) syndrome is a very rare clinical entity with only 26 cases reported worldwide. Metastatic thyroid cancer causing SVC syndrome several years following resection of the primary tumor is extremely rare with only two cases reported; one of them was of the papillary variety. We report the second case worldwide of metastatic papillary thyroid cancer causing SVC syndrome two years after total thyroidectomy of the original tumor in a 62-year-old Indian female pilgrim. Read More
Background: Thoracic endovascular aortic repair (TEVAR) has become lately the procedure of choice in the treatment of most pathologies of descending thoracic aorta. Aortic arch aneurysms also came to be treated by TEVAR with various hybrid techniques or custom made scalloped/fenestrated stent-grafts. Zone 0; ascending TEVAR is more challenging than TEVAR of the descending thoracic aorta or aortic arch because of the more complex pathology, hemodynamics, and anatomy. Read More
Background: Increased renal complications have been suggested with suprarenal stent grafts, but long-term analyses have been limited. Therefore, the purpose of this study was to evaluate the effect of endograft choice on perioperative and long-term outcomes.
Methods: We compared Medicare beneficiaries undergoing endovascular AAA repair from 2005-2008 with endografts with infrarenal fixation and a single docking limb (AneuRx, Excluder) to those with suprarenal fixation and two docking limbs (Zenith), or a unibody configuration (Powerlink). Read More
Background: The lack of evidence-based guidelines on the use of prophylactic inferior vena cava filters (IVCF) in patients after trauma has led to variation of its application. We seek to understand the national trend of the use of prophylactic IVCF in a trauma population. METHODS: A retrospective review of the National Trauma Databank (2002-2014) was performed to identify patients who received an IVCF after trauma. Read More
Introduction: Carotid endarterectomy (CEA) intervention needs a specific training and a sufficient learning curve to obtain optimal results in terms of outcome. A formative program was settled up in a single academic center in order to optimize training of standard CEA procedures. This study aims to evaluate the 11-year results of the teaching CEA program. Read More
Division of Vascular and Endovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA, USA. Electronic address:
Background: Redo Lower extremity bypass (LEB) and infrainguinal endovascular intervention (IEI) are options to treat critical limb ischemia after a failed prior lower extremity bypass but the utilization and outcomes of each are poorly described. The purpose of this study was to compare 30-day Major Adverse Limb Events (MALE) and Major Adverse Cardiovascular Events (MACE) after LEB and IEI in patients with a failed prior ipsilateral LEB and determine risk factors for each composite outcome.
Methods: Patients with prior failed ipsilateral LEB who underwent LEB or IEI involving the same arterial segment for critical limb ischemia were identified in The National Surgical Quality Improvement Program (NSQIP) Vascular Targeted File (2011-2014). Read More
Atherosclerosis is a systemic disease and multi-arterial involvement is common. Involvement of all of the supra-aortic arteries may occur in the same patient making cerebral revascularization challenging. In this report, we present complete supra-aortic revascularization, i. Read More
Objective: This study evaluates differences in wound complication rate when transverse versus longitudinal incision is utilized to expose femoral vessels in managing patients with peripheral vascular disease.
Methods: A retrospective review from 2013-2015 was conducted of 150 patients undergoing 156 lower extremity revascularizations with femoral artery exposure through a groin incision. Patients were stratified into two groups, transverse versus longitudinal groin incision. Read More
Introduction: Stent grafts have become the preferred method for treating abdominal aortic aneurysms (AAAs), but also have utility in treating other vasculopathies. In 2005, peripheral stent grafts were approved for treating superficial femoral artery (SFA) occlusive disease. This report describes our experience using covered stent grafts to treat acquired arterial venous fistulae (aAVF). Read More
The presence of the meandering mesenteric artery, which is a non-constant tortuous arterial component unifying the peripheral intestinal circulation, is evidence of chronic occlusive disease of the main intestinal arteries. This collateral intestinal arterial pathway, when present, must be preserved in any abdominal intervention, as it is often the only remaining arterial supply of the intestine; its ligation can be accompanied by intestinal ischemia. We present herein, the case of a 42-year old man, heavy smoker, who had chronic mesenteric ischemia without particular clinical manifestations till the hospitalization for acute myocardial infarction for which he underwent balloon angioplasty and stenting of the left circumflex coronary artery. Read More
Vascular and Endovascular Surgery Unit - University Hospital of Cattinara - Strada di Fiume, 447 - Trieste - Italy.
Purpose: To report an alternative endovascular technique to exclude aneurysms of the internal iliac artery in the setting of abdominal aortic aneurysm (AAA) disease using the anterior division of the hypogastric artery (HGA) or the superior gluteal artery (SGA) as distal landing zone for the stent-graft.
Case-series: 3 patients with hypogastric artery (HGA) aneurysms in the setting of AAA that were excluded with placement of a self-expandable covered stent (SECS). In two patients the AAA had been already treated with resulting exclusion of one hypogastric artery,while in the remaining we treated the hypogastric aneurysm before the AAA. Read More
Department of Surgery, University of Oklahoma Health Sciences Center 800 Stanton L Young Blvd Suite 9000, Oklahoma City, OK. Electronic address:
Introduction: We present an interesting case of a 55 year-old male with a large left chest mass after significant cutaneous bleeding. CT angiogram of the chest revealed arteriovenous malformation with blood supply from subbranches of the left subclavian artery, left internal mammary artery and left external carotid artery. Measuring 5. Read More
Autogenous arteriovenous fistulas (AVF) are the preferred access for hemodialysis. AVF occasionally develop venous aneurysms and we report a modified staple aneurysmorrhaphy technique for treatment. Briefly, the lateral wall of the venous aneurysm is dissected and a longitudinal staple resection performed. Read More
Background: No criteria, including pre-amputation vascular diagnostic thresholds, have been established to reliably predict healing versus non-healing following minor lower extremity amputations. Thus, the goal of our study was to identify clinical factors, including non-invasive vascular laboratory measures, associated with wound healing following toe, forefoot, and midfoot amputations.
Methods: We retrospectively examined records of patients receiving elective toe, forefoot, or midfoot amputation at our institution over a 5-year span (2010-2015). Read More
Background: TEVAR has dramatically expanded treatment options for patients with thoracic aortic pathology. The interaction between endografts and the dynamic anatomy of the thoracic aorta is not well characterized for repetitive physiologic stressors and subsequent issues related to long-term durability. Through 3D modeling we sought to quantify cardiac-induced aortic deformation before and after TEVAR to assess the impact of endografts on dynamic aortic anatomy. Read More
Department of Vascular Surgery, KAT General Hospital, Athens, Greece.
Chronic totally thrombosed abdominal aortic aneurysms (AAAs) comprise a rare medical situation, with only a few cases reported in literature. Optimal management has been controversial, although an early risk for rupture is present. Therefore, we present a rare case of late rupture in a patient with a totally thrombosed AAA, and we discuss proper treatment. Read More
Background: Aneurysms of the subclavian artery are usually the result of trauma, atherosclerosis or thoracic outlet syndrome. Until the 90s, open surgical repair was considered the only therapeutic choice, exhibiting high complication rates. Since the first report of endovascular repair of subclavian aneurysms in 1991, promising results have been published. Read More
Background: Ankle brachial index (ABI) is a reliable method to evaluate extremity perfusion but can be prohibitive to obtain secondary to patient discomfort or extremity trauma. This study investigates smart phone based forward looking infrared imaging (FLIR) to assess peripheral perfusion using thermal ABI (tABI).
Methods: ABI's were measured by a certified vascular laboratory. Read More
Introduction: Frailty is a recognised predictor of poor outcome in patients undergoing surgical intervention. Frailty is intricately linked with body morphology, which can be evaluated using morphometric assessment via computerised tomographic (CT) imaging. We aimed to assess the predictive power of such objective assessments in a broad cohort of vascular surgical patients. Read More
A 52 year-old man presented with sudden abdominal pain and intermittent vomiting. The patient underwent contrast-enhanced computed tomography scan (CT) and was diagnosed with an acute type B aortic dissection (ABAD) involving the celiac trunk superior mesenteric artery (SMA), and extending to the renal artery. The patient was treated with thoracic endovascular aortic repair (TEVAR). Read More
Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK.
Abdominal aortic aneurysms are usually asymptomatic. The compressive effects of internal iliac aneurysms are well described in the literature, however, we report what we believe to be the first case of rupture of the renal pelvis caused by compression by an infra-renal abdominal aortic aneurysm. We describe the subsequent management and briefly review the literature. Read More
Background: Temporary hepatic ischemia is inevitable during open aortic surgery when supraceliac clamping is necessary, as in thoracoabdominal or pararenal aneurysms. Remote ischemic preconditioning (RIPC) has been described as a potential protective means against ischemia - reperfusion injury (IRI) in various tissues including the liver. The aim of this experimental study was to detect the effect of RIPC on liver IRI in a model of supraceliac aortic cross-clamping. Read More
Division of Vascular and Endovascular Surgery, Albert Einstein Hospital, São Paulo, SP, Brazil; Division of Vascular and Endovascular Surgery, Clinics Hospital of the University of São Paulo Medical School, São Paulo, SP, Brazil.
Study Objective: The purpose of this study was to compare the efficiency between two thermal blanket models: the upper blanket and the underbody blanket in patient heating and hypothermia prevention during endovascular surgery.
Design: Prospective randomized study SETTING: Operating room PATIENTS: 50 patients, ASA 2-4 physical status, receiving endovascular surgery repair of infrarenal abdominal aortic aneurysm or lower limb angioplasty by endovascular technique were studied. Primary outcome was to determine which forced-air blanket is more warming effective during the surgeries. Read More
Objective: This study aimed to investigate the patency following initial successful percutaneous transluminal angioplasty (PTA) for untreated dysfunctional hemodialysis vascular access and to identify predictors of PTA durability.
Methods: This retrospective observational study included data of 132 consecutive initial PTA of hemodialysis vascular access in 126 patients who showed immediate technical and clinical success and had at least 1 year of follow-up data.
Results: The mean duration of primary and secondary patency post-PTA was 16 and 27 months, respectively. Read More
Objective: Ultrasound-guided thrombin injection (UGTI) of femoral artery pseudoaneurysms after endovascular procedures is an effective therapy. There is controversy in the literature regarding injecting pseudoaneurysms with short and/or wide necks. This paper reports on our experience in UGTI of pseudoaneurysms in one hospital regarding the efficacy of this treatment in all pseudoaneurysms regardless of the size of the necks. Read More
Background: The natural history of abdominal aortic aneurysm (AAA) can be investigated through longitudinal evaluation of localized aneurysm characteristics exploiting clinical images. The major challenge is to identify corresponding regions between follow-ups. We have recently developed an algorithm (VascForm) based on non-rigid registration that can obtainsurface correspondence, and quantify surface growth distribution. Read More
Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth) and Memorial Hermann Hospital, Houston, TX. Electronic address:
Objective: Although the incident risk of peripheral artery disease increases in patients with metabolic syndrome, several authors report favorable outcomes in obese patients after arterial bypass surgery. We examine the effect of the so-called "obesity paradox" and metabolic syndrome on outcomes after open aortoiliac bypass surgery.
Methods: We identified patients between 2004 and 2015 who had open surgical bypass for aortoiliac occlusive disease. Read More
Background: Despite an aggressive climate of limb salvage and revascularization, 7% of patients with peripheral artery disease undergo major lower extremity amputation (LEA). The purpose of this study was to describe the current demographics and early outcomes of patients undergoing major LEA in the Vascular Quality Initiative (VQI).
Methods: The VQI amputation registry was reviewed to identify patients who underwent major LEAs. Read More