Vibrational angioplasty in recanalization of chronic femoropopliteal arterial occlusions: single center experience.

Purpose: This prospective study aims to present the overall success rate, safety and long-term outcome of vibrational angioplasty technique, in the treatment of chronic total femoropopliteal occlusions in our institute.

Methods: Between October 2000 and December 2008, patients with chronic total femoropoliteal arterial occlusions, treated with vibrational angioplasty during the same session after a failed attempt with conventional recanalization technique, were included. Patient's follow up included serial ankle-brachial index measurements and arterial duplex ultrasound examinations at 1, 3, 6, 12, 24, 36 and 48 months.

The study of the thrombin generation mechanism and the effect of low molecular weight heparin as thromboprophylaxis in patients undergoing total knee and hip replacement.

Introduction: The recommended duration of post-operative Low-Molecular-Weight-Heparins (LMWHs) thromboprophylaxis in Total-Hip-Replacement (THR) and Total-Knee-Replacement (TKR) surgery is controversial. Our aim is to study the thrombin generation (TG) modifications induced by surgery and to evaluate the effect of LMWH on TG during and after the recommended duration.

Patients/methods: Thirty-one patients received 4000IU anti-Xa/day of enoxaparin, 8-hours post-operatively (15 THR for 30-days and 16 TKR for 15-days).

Effects of isoflurane anesthesia on aortic compliance and systemic hemodynamics in compliant and noncompliant aortas.

Objectives: To investigate the effect of general anesthesia on aortic compliance and other cardiovascular hemodynamics in chronically instrumented pigs with compliant and noncompliant (stiff) aortas.

Design: Experimental study.

Setting: University animal laboratory.

Spinal cord ischemia after endovascular embolization of a type II endoleak following endovascular aneurysm repair.

Background: We report a rare case of severe spinal cord ischemia with neurological consequences in a patient who presented after endovascular treatment of a type II endoleak following endovascular aneurysm repair.

Methods And Results: An enlarging abdominal aortic aneurysm post-endovascular aneurysm repair was detected owing to a persistent type II endoleak caused by a communication between the iliolumbar and L4 lumbar artery for which the patient underwent supraselective embolization with particles and coils. Immediately after the procedure, the patient experienced an acute onset of neurological symptoms in the right lower limb while limb arterial perfusion remained unaffected.

Computational evaluation of aortic aneurysm rupture risk: what have we learned so far?

In current clinical practice, aneurysm diameter is one of the primary criteria used to decide when to treat a patient with an abdominal aortic aneurysm (AAA). It has been shown that simple association of aneurysm diameter with the probability of rupture is not sufficient, and other parameters may also play a role in causing or predisposing to AAA rupture. Peak wall stress (PWS), intraluminal thrombus (ILT), and AAA wall mechanics are the factors most implicated with rupture risk and have been studied by computational risk evaluation techniques.

Chronic venous disease progression and modification of predisposing factors.

Aim: This study evaluated long-term characteristics of chronic venous disease (CVD) progression and its correlation with the modification of specific risk factors.

Methods: The contralateral limb of 73 patients (95% women; mean age, 48 +/- 12 years) undergoing varicose vein surgery was prospectively evaluated using physical and color duplex examination and classified by CEAP. After 5 years of follow-up, development of new sites of reflux among the contralateral, preoperatively asymptomatic limbs and modification of predisposing factors, including prolonged orthostatism, obesity, estrogen therapy (ET), multiparity, and elastic stockings use (ESU), were assessed.

Endovascular treatment of a ruptured profunda femoral artery branch after fogarty thrombectomy of a femoro-femoral crossover arterial graft: a case report and review of the literature.

We present a very rare case of a life-threatening rupture of a profunda femoral artery distal branch after a Fogarty thrombectomy of a thrombosed crossover synthetic graft between the ipsilateral common femoral artery and a contralateral iliac-popliteal graft; the bleeding profunda femoral artery branch was successfully embolized with metallic coils through the axillary artery approach.

Left ventricular hypertrophy induced by reduced aortic compliance.

Aim: It was the aim of this study to investigate the long- term effects of reduced aortic compliance on cardiovascular hemodynamics and cardiac remodeling.

Method: Sixteen swine, divided into 2 groups, a control and a banding group, were instrumented for pressure and flow measurement in the ascending aorta. Teflon prosthesis was wrapped around the aortic arch in order to limit wall compliance in the banding group.

Preliminary experience with cutting balloon angioplasty for iliac artery in-stent restenosis.

Purpose: To report our preliminary experience using cutting balloon angioplasty (CBA) in symptomatic iliac artery in-stent restenosis (ISR).

Methods: Fourteen cases of hemodynamically significant iliac artery ISR (4 common and 10 external) were treated in 12 men (mean age 64 years, range 55-75). Of the 14 stents involved, 8 were balloon-expandable models and 6 were self-expanding.

Total occlusion of the common carotid artery: a modified classification and its relation to clinical status.

To investigate the hemodynamics and clinical presentation of common carotid artery occlusion (CCAO), we reviewed 6,415 patients with suspected carotid artery disease in whom a color Duplex imaging (CDI) examination was performed. According to distal vessel patency, the following CDI classification of CCAO was adopted: type I (patent both distal vessels); type II (isolated patency of external carotid artery); type III (isolated patency of internal carotid artery); and type IV (both distal vessels occluded). Thirty-five (0.

The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury.

Objective: To investigate the effect of stripping the below knee great saphenous vein (GSV) segment on varicose vein recurrence as well as any disability induced after saphenous nerve injury (SNI) during a 5-year period.

Methods: One hundred and six limbs (86 patients, 64 female, mean age 46 years), that underwent GSV stripping, to the knee or ankle level, were prospectively followed up at 1 month and 5 years postoperatively with clinical examination and color duplex imaging (CDI), in order to evaluate SNI and the development of recurrence. The extent of GSV stripping complied with preoperative CDI in 84 limbs (79%) that were subjected to GSV stripping to the ankle and full abolishment of duplex-confirmed reflux.

Acute lower limb ischemia as the initial symptom of acute myeloid leukemia.

Although coagulatory system disorders are well recognized in patients with acute leukemia, these usually present with either hemorrhagic complications or thrombosis of small vessels. Large vessel thrombosis is a very rare clinical presentation. We present a patient with previously undiagnosed acute myeloid leukemia (M5), who was referred to our hospital with symptoms of acute ischemia of his right lower limb.

Flow dynamics in expansions characterizing abdominal aorta aneurysms.

Our purpose was to identify and quantify hemodynamic factors contributing to the generation, proliferation, and rupturing of abdominal aorta aneurysms (AAAs) using a computational investigation of steady laminar and turbulent flow in AAA models. Steady laminar and turbulent flows were computed using the incompressible Navier-Stokes equations. Flow fields in symmetric shapes of different extents and degrees of expansion are presented first.

A decoupled fluid structure approach for estimating wall stress in abdominal aortic aneurysms.

Abdominal aortic aneurysm (AAA) is a localized dilatation of the aortic wall. The lack of an accurate AAA rupture risk index remains an important problem in the clinical management of the disease. To accurately estimate AAA rupture risk, detailed information on patient-specific wall stress distribution and aortic wall tissue yield stress is required.

Association of subclinical wall changes of carotid, femoral, and popliteal arteries with obstructive coronary artery disease in patients undergoing coronary angiography.

Study Objectives: To examine the association of occult atherosclerosis of carotid, femoral, and popliteal arteries with the presence and severity of obstructive coronary artery disease (CAD) in patients without a history or presence of cerebrovascular or peripheral arterial disease using ultrasound examination of peripheral arteries.

Patients/methods: One hundred eighty-four such individuals underwent routine coronary angiography. Obstructive CAD was found in 103 cases, which comprised the patient group.

Peripheral arterial embolism due to a left ventricular diverticulum in a young adult.

A 32-year-old man was admitted to the emergency department of our hospital after experiencing a peripheral arterial embolism. Investigation of the possible embolic sources in an otherwise asymptomatic patient revealed the existence of a left ventricular diverticulum. The left ventricular diverticulum is a rare congenital anomaly, either isolated or as a part of a syndrome including other congenital malformations.

Use of the Trellis Peripheral Infusion System for enhancement of rt-PA thrombolysis in acute lower limb ischemia.

The Trellis Peripheral Infusion System is an over-the-wire 0.035" guidewire compatible device, designed to isolate a region of the peripheral vasculature to allow for lytic drug infusion and dispersion. We used it successfully through a percutaneous approach in two cases of acute thrombosis of a native lower limb artery.

Abnormal mitochondrial respiration in skeletal muscle in patients with peripheral arterial disease.

Objective: Discrete morphologic, enzymatic and functional changes in skeletal muscle mitochondria have been demonstrated in patients with peripheral arterial disease (PAD). We examined mitochondrial respiration in the gastrocnemius muscle of nine patients (10 legs) with advanced PAD and in nine control patients (nine legs) without evidence of PAD.

Methods: Mitochondrial respiratory rates were determined with a Clark electrode in an oxygraph cell containing saponin-skinned muscle bundles.

Laparoscopic surgery for gastroesophageal reflux disease patients with impaired esophageal peristalsis: total or partial fundoplication?

Background: It has been proposed that partial fundoplication is associated with less incidence of postoperative dysphagia and consequently is more suitable for patients with gastroesophageal reflux disease (GERD) and impaired esophageal body motility. The aim of this study was to assess whether outcomes of Toupet fundoplication (TF) are better than those of Nissen-Rossetti fundoplication (NF) in patients with GERD and low-amplitude esophageal peristalsis.

Study Design: Thirty-three consecutive patients with proved GERD and amplitude of peristalsis at 5 cm proximal to lower esophageal sphincter (LES) less than 30 mmHg were randomly allocated to undergo either TF (19 patients: 11 men, 8 women; mean age: 61.

Duodenogastric reflux after biliary surgery: scintigraphic quantification and improvement with erythromycin.

Background: Persistence of dyspeptic symptoms after cholecystectomy or choledochoduodenostomy is common. There is -evidence that at least some of these symptoms may be attributed to duodenogastric reflux (DGR). The aim of the study was to quantify DGR before and after cholecystectomy, with or without choledochoduodenostomy, and endoscopic sphincterotomy for common bile duct stones, and to assess the effect of erythromycin on the increased DGR.

Suspected acute deep vein thrombosis of the lower limb in outpatients: considerations for optimal diagnostic approach.

The objective of this study was to review our diagnostic approach using color duplex scanning (CDS) in the management of symptomatic outpatients with suspected lower limb deep venous thrombosis (DVT). CDS was carried out in 315 consecutive outpatients with unilateral symptoms consistent with DVT. Both limbs were assessed in 205 patients.

Vibrational angioplasty in the treatment of chronic infrapopliteal arterial occlusions: preliminary experience.

Purpose: To evaluate the safety and efficacy of vibrational angioplasty in chronic infrapopliteal arterial occlusions.

Methods: Twelve patients (9 men, aged 54 to 90 years) with 13 below-knee arterial chronic total occlusions were treated percutaneously using vibrational angioplasty. The occlusions were located in the anterior tibial artery (n=5), the tibioperoneal trunk (n=4), the peroneal artery (n=1), the posterior tibial artery (n=1), and in both the tibioperoneal trunk and peroneal artery (n=2).