Morphology and Hemodynamics in Isolated Common Iliac Artery Aneurysms Impacts Proximal Aortic Remodeling.

Objective- Isolated common iliac artery aneurysms (CIAA) are rare. Their prognosis and influence on aortoiliac blood flow and remodeling are unclear. We evaluated the hypotheses that morphology at and distal to the aortic bifurcation, together with the associated hemodynamic changes, influence both the natural history of CIAA and proximal aortic remodeling.

Strategy of endovascular versus open repair for patients with clinical diagnosis of ruptured abdominal aortic aneurysm: the IMPROVE RCT.

Background: Ruptured abdominal aortic aneurysm (AAA) is a common vascular emergency. The mortality from emergency endovascular repair may be much lower than the 40-50% reported for open surgery.

Objective: To assess whether or not a strategy of endovascular repair compared with open repair reduces 30-day and mid-term mortality (including costs and cost-effectiveness) among patients with a suspected ruptured AAA.

Outcomes Following Bronchial Artery Embolisation for Haemoptysis in Cystic Fibrosis.

Background: Bronchial artery embolisation (BAE) is recommended for the treatment of massive haemoptysis in cystic fibrosis (CF), but there are no randomised controlled trials of this therapy and its role in sub-massive haemoptysis is unclear. This study aimed to determine the outcomes and safety of BAE in adults with CF.

Materials And Methods: All patients with CF undergoing BAE at our centre between March 2011 and January 2015 were identified at the time of the procedure.

Reintervention following endovascular abdominal aneurysm repair is uncommon after five-years: results of greater than a decade follow-up.

Background: Endovascular aneurysm repair offers improved perioperative morbidity and mortality compared to open repair, counterbalanced by a higher incidence of graft-related complications and re-interventions. Randomized studies comparing EVAR to open repair are yet to report greater than ten-year outcomes. This study reports the outcomes of patients who underwent EVAR greater than ten years ago.

Single-Center Experience Following the Introduction of a Percutaneous Endovascular Aneurysm Repair First Approach.

We evaluated our experience following the introduction of a percutaneous endovascular aneurysm repair (pEVAR) first approach using Perclose Proglide assessing efficacy, complications, and identification of factors that could predict failure. A retrospective cohort study on patients over a 2-year period following the introduction of a pEVAR first approach was performed. The primary end point was defined as successful deployment and access site hemostasis.

Multi-layer Flow-modulating Stents for Thoraco-abdominal and Peri-renal Aneurysms: The UK Pilot Study.

Objective: There remains a population of patients with aortic aneurysms that cannot be treated by conventional endovascular means. Multi-layer flow modulating stents (MFMS) are a novel approach for the treatment of aortic aneurysm; this study reports outcomes of a UK pilot study of first-generation MFMS in thoraco-abdominal (TAAA) and perirenal aneurysms (PAA) in patients who were also unfit for open surgery.

Methods: Patients with TAAA and PAA unfit for open surgery and with no conventional options for endovascular repair were recruited.

Observations from the IMPROVE trial concerning the clinical care of patients with ruptured abdominal aortic aneurysm.

Background: Single-centre series of the management of patients with ruptured abdominal aortic aneurysm (AAA) are usually too small to identify clinical factors that could improve patient outcomes.

Methods: IMPROVE is a pragmatic, multicentre randomized clinical trial in which eligible patients with a clinical diagnosis of ruptured aneurysm were allocated to a strategy of endovascular aneurysm repair (EVAR) or to open repair. The influences of time and manner of hospital presentation, fluid volume status, type of anaesthesia, type of endovascular repair and time to aneurysm repair on 30-day mortality were investigated according to a prespecified plan, for the subgroup of patients with a proven diagnosis of ruptured or symptomatic AAA.

Endovascular or open repair strategy for ruptured abdominal aortic aneurysm: 30 day outcomes from IMPROVE randomised trial.

Objective: To assess whether a strategy of endovascular repair (if aortic morphology is suitable, open repair if not) versus open repair reduces early mortality for patients with suspected ruptured abdominal aortic aneurysm.

Design: Randomised controlled trial.

Setting: 30 vascular centres (29 UK, 1 Canadian), 2009-13.

Type B aortic dissection after standard endovascular repair of abdominal aortic aneurysm.

Dissection of the aorta is a rare yet potentially serious complication following endovascular abdominal aortic aneurysm (EVAR). These can lead to visceral branch hypoperfusion, compromise of aneurysm exclusion, arterial dilation or rupture. Intimal injury and dissection in the context of EVAR may be associated with a number of risk factors that include adverse infrarenal neck morphology, device oversizing, barbed fixation and wire manipulation in the proximal aorta.

Chimney stent technique for treatment of severe abdominal aortic atherosclerotic stenosis.

Application of the "chimney" stent technique is described in a case of complex multilevel atherosclerotic disease involving the juxtarenal aorta. A patient with significant comorbidities was unsuitable for major open reconstructive surgery. He was treated with a combined procedure consisting of chimney stent placement in the juxtarenal aorta, iliac "kissing" stent placement, and right-sided common femoral artery (CFA) replacement.

Carotid stenting for restenosis after endarterectomy.

Introduction: Restenosis after carotid endarterectomy (CEA) has been described in 8-19% of patients, 14-23% of whom become symptomatic. This study analyzes our experience with carotid artery stenting (CAS) for post-CEA recurrent stenoses.

Method: Retrospective database and case-note review.

The Immediate Management of the Patient with Rupture: Open Versus Endovascular repair (IMPROVE) aneurysm trial--ISRCTN 48334791 IMPROVE trialists.

Background: Systematic reviews have suggested a survival advantage for patients with ruptured abdominal aortic aneurysm (AAA), who are managed by endovascular repair. These reviews are based on single centre experiences of selected patients.

Objective: To determine whether a policy of endovascular repair improves the survival of all patients with ruptured AAA.

Use of an extracorporeal femoral-carotid shunt in the management of complex supra-aortic disease.

Management of symptomatic multifocal supra-aortic atherosclerotic disease presents a complex surgical challenge. We describe a novel approach where a temporary extra-corporeal femoro-carotid shunt was used to maintain cerebral perfusion during hybrid surgical and endovascular treatment for tandem supra-aortic lesions.

Endovascular aortic aneurysm repair with the talent stent-graft: outcomes in patients with large iliac arteries.

The purpose of this study is to report outcomes following endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA) in patients with ectatic common iliac arteries (CIAs). Of 117 AAA patients treated by EVAR between 1998 and 2005, 87 (74%) had CIAs diameters <18 mm and 30 (26%) patients had one or more CIA diameters >18 but <25 mm. All patients were treated with Talent stent-grafts, 114 bifurcated and 3 AUI devices.

Preoperative embolization followed by surgical excision of an intrapericardial pheochromocytoma.

A teenager with palpitations and hypertension was found to have an intrapericardial pheochromocytoma of the left atrium with multiple feeding collaterals. Radiologic embolization was carried out on the major feeding arteries to the tumor preoperatively with good angiographic result. Surgery was carried out the following day through a median sternotomy approach and cardiopulmonary bypass.

Outpatient angioplasty and stenting facilitated by percutaneous arterial suture closure devices.

Aim: To review our practice of outpatient percutaneous vascular interventions facilitated by an arterial suture device.

Materials And Methods: A retrospective review of all patients attending this tertiary centre for iliac or femoral intervention was undertaken between February 2001 and December 2004. All patients who underwent angioplasty or stenting had their puncture sites closed using a Perclose suture.

Incidence and effect of bare suprarenal stent struts crossing renal ostia following EVAR.

Objectives: The incidence and effect of bare stent struts crossing the renal ostia following endovascular aortic aneurysm repair with the Talent stent-graft is not known. The study aims to establish the incidence in which bare stent struts cross the renal ostia and to assess any associated effects on renal function.

Methods: Fifty-five patients (51 men, mean age 73 years, range 57-90) who had endovascular repair of their abdominal aortic aneurysms with a Talent suprarenal stent-graft were included in the study.

Midterm follow-up of a single-center experience of endovascular repair of abdominal aortic aneurysms with use of the Talent stent-graft.

Purpose: To review the midterm results of endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms (AAAs) with the Talent stent-graft.

Materials And Methods: All patients who underwent EVAR of AAAs with Talent stent-grafts from February 1998 to April 2002 at a single institution were monitored for a minimum of 2 years or until an endpoint of death or rupture was reached.

Results: There were 68 eligible patients, who were monitored for a mean period of 39 months (range, 24-72 months).

Endovascular management of the carotid blowout syndrome.

Bleeding from the carotid artery or its branches ('carotid blowout') is a well recognized complication following treatment or recurrence of head and neck cancer. The traditional surgical treatment for carotid blowout is often technically difficult and is associated with an unacceptably high morbidity and mortality. The majority of such patients are currently treated conservatively with end of life supportive measures.

The impact of diabetes on current revascularisation practice and clinical outcome in patients with critical lower limb ischaemia.

Objective: To compare current revascularisation practice and outcome in diabetic and non-diabetic patients presenting with critical limb ischaemia (CLI) to a single vascular surgeon.

Methods: Data for 113 patients presenting with CLI were collected prospectively over a 3-year period. Forty-four (39%) were diabetic.

Patterns, incidence and predictive factors for pain after interventional radiology.

Aim: To evaluate prospectively the pattern, severity and predictive factors of pain after interventional radiological procedures.

Materials And Methods: All patients undergoing non-arterial radiological interventional procedures were assessed using a visual-analogue scale (VAS) for pain before and at regular intervals for 24 h after their procedure.

Results: One hundred and fifty patients (87 men, mean age 62 years, range 18-92 years) were entered into the study.

A cross-site vascular radiology on-call service: the Manchester experience.

Aim: A cross-site vascular radiology on-call service was established 5 years ago to cover two vascular centres in Manchester. We aimed to review the service.

Materials And Methods: A prospective audit of out-of hours referrals and procedures over a three month period (March-May 2003) was undertaken.

Device migration after endovascular abdominal aortic aneurysm repair: experience with a talent stent-graft.

Purpose: Device migration (DM) may cause late failure after endovascular aortic aneurysm repair (EVAR). Computed tomography (CT) scans following EVAR were reviewed to establish the frequency of DM and whether it can be predicted.

Materials And Methods: Fifty-five patients underwent EVAR with a Talent stent-graft with suprarenal fixation.