Early complications and long-term outcome after open surgical treatment of popliteal artery aneurysms: is exclusion with saphenous vein bypass still the gold standard?

Background: Popliteal artery aneurysms (PAAs) are rare, but thromboembolic complications may result in limb loss. To define complications and outcomes after open surgical repairs, we reviewed our experience.

Methods: Clinical data of patients with PAA seen between 1985 and 2004 at Mayo Clinic, Rochester, Minnesota, were reviewed and outcomes in 289 patients with open revascularization were analyzed.

Aortic neck dilation after endovascular abdominal aortic aneurysm repair: should oversizing be blamed?

Long-term durability after endovascular abdominal aortic aneurysm repair (EVAR) is dependent upon the maintenance of an effective seal between the endograft and the proximal landing zone. Continuous neck dilation might lead to the loss of such a seal. This study aims at evaluating the incidence, risk factors, and clinical consequences of post-EVAR aneurysm neck dilation in patients treated with two types of endografts: AneuRx and Ancure.

Evolution from axillofemoral to in situ prosthetic reconstruction for the treatment of aortic graft infections at a single center.

Objective: The primary purpose of this study was to analyze the clinical outcome in patients treated for aortic graft infections with in situ reconstruction (ISR). As a secondary aim, the outcomes were compared between patients who had similar clinical characteristics and extent of infection, needed total graft excision, and had either ISR or axillofemoral reconstruction (AXFR).

Methods: 117 consecutive patients treated for aortic graft infection over a 20 year period from January 1981 to December 2001 were identified.

Factors affecting outcomes of open surgical repair of pararenal aortic aneurysms: a 10-year experience.

Purpose: Few large series document surgical outcomes for patients with pararenal abdominal aortic aneurysms (PAAAs), defined as aneurysms including the juxtarenal aorta or renal artery origins that require suprarenal aortic clamping. No standard endovascular alternatives presently exist; however, future endovascular branch graft repairs ultimately must be compared with the gold standard of open repair. To this end, we present a 10-year experience.

Beyond the instructions for use: pushing the limits of infrarenal device application for abdominal aortic aneurysms.

Endograft devices are used to treat 40% to 80% of patients with abdominal aortic aneurysms. A much smaller percentage of patients have ideal anatomy, for which the devices were designed. Vascular surgeons and interventionalists have become increasingly creative in endograft placement to exclude aneurysms, despite the presence of complex aortoiliac anatomy.

Takayasu's arteritis: operative results and influence of disease activity.

Objectives: To determine the short- and long-term outcomes of patients treated operatively for Takayasu's arteritis and the effect of disease activity on results.

Methods: Forty-two (17%) of the 251 patients enrolled in our Takayasu's arteritis registry between 1975 and 2002 required operation for symptomatic disease. Data were obtained from the registry, patient records, phone correspondence, and written surveys.

Prosthetic vascular graft infection: a risk factor analysis using a case-control study.

Objectives: Several factors have been anecdotally reported to increase the risk of prosthetic vascular graft infection (PVGI), a serious complication with high mortality and limb amputation rates. The goal of this study is to confirm purported risk factors using a well-designed statistical model.

Methods: Patients undergoing vascular graft placement at Mayo Clinic Rochester between January 1, 1982 and December 31, 2002 were retrospectively evaluated, excluding redo cases.

The spectrum, management and clinical outcome of Ehlers-Danlos syndrome type IV: a 30-year experience.

Purpose: Ehlers-Danlos syndrome type IV (EDS-IV) results from abnormal procollagen III synthesis and leads to arterial, intestinal, and uterine rupture. The purpose of this study was to review the spectrum, management, and clinical outcome of EDS-IV patients.

Methods: We retrospectively reviewed the clinical data of 31 patients (15 male and 16 female) with a clinical diagnosis of EDS-IV treated over a 30-year period (1971 to 2001).

AneuRx device migration: incidence, risk factors, and consequences.

Success after endovascular abdominal aortic aneurysm repair (EVAR) is dependent on device positional stability. The quest for such stability has motivated different endograft designs, and the risk factors entailed remain the subject of debate. This study aims at defining the incidence, risk factors, and clinical implications of device migration after EVAR with the AneuRx endograft.

Surgical management of renal fibromuscular dysplasia: challenges in the endovascular era.

Percutaneous transluminal renal angioplasty (PTRA) is the primary treatment for renal fibromuscular dysplasia (RFMD). Surgical revascularization is limited to patients who fail or are unsuitable for PTRA. All patients who were operated on with RFMD since the indications for renal PTRA were expanded in our institution were retrospectively reviewed.

Comparison of precuffed and vein-cuffed expanded polytetrafluoroethylene grafts for infragenicular arterial reconstructions: a case-matched study.

Distal vein cuff interposition is often added to prosthetic infragenicular arterial reconstruction in an attempt to improve hemodynamics and patency rates. The purpose of this study was to compare the outcome of a precuffed expanded polytetrafluroethylene (ePTFE) graft with a vein-cuffed ePTFE graft for infragenicular bypass. We reviewed the clinical outcome of 77 patients with critical limb ischemia without available autologous vein conduits who underwent arterial reconstruction of 80 limbs to below-knee popliteal or tibioperoneal vessels using either ePTFE precuffed graft (precuffed group, 38 patients 40 limbs) or ePTFE vein-cuffed graft (vein-cuffed group, 39 patient, 40 limbs).

Endovascular abdominal aortic aneurysm repair: does gender matter?

Substantial differences across genders have been documented for the natural history and clinical course of cardiovascular diseases. This study's objective is to compare preoperative characteristics, intraoperative events, and postoperative outcomes in men and women undergoing endovascular abdominal aortic aneurysm repair (EVAR). We hypothesized that despite gender anatomic specificities, EVAR may achieve similar results across genders.

Proximal type I endoleak after endovascular abdominal aortic aneurysm repair: predictive factors.

Proximal type I endoleaks after endovascular abdominal aortic aneurysm repair (EVAR) are associated with a high risk of rupture. Risk factors for developing this complication are not fully elucidated. We aimed to define preoperative predictors for proximal type I endoleak and describe its clinical outcome.

Most patients with abdominal aortic aneurysm are not suitable for endovascular repair using currently approved bifurcated stent-grafts.

Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution.

Computed tomography and ultrasound in follow-up of patients after endovascular repair of abdominal aortic aneurysm.

The purpose of this study was to compare our experience with duplex ultrasonography (US) and computed tomography (CT) for the routine follow-up of patients after endovascular repair (EVAR) of abdominal aortic aneurysm (AAA). We reviewed the electronic charts and radiologic exams of the first 125 patients (113 males, 12 females, median age of 76 years, range 48-98 years) with AAA treated by EVAR from June 1996 to November 2001. Our follow-up protocol included serial CT and US at regular intervals after the procedure (before discharge, at 1 month, and then every 6 months).

Stapled aortic anastomoses: a minimally invasive, feasible alternative to videoscopic aortic suturing?

Widespread applications of totally laparoscopic aortic reconstructions have been limited by the long cross-clamp time required to suture the aortic anastomosis despite improvement in instrumentation. The authors' hypothesis was that a "one-step anastomosis concept" using an intraluminal stapler would allow shorter cross-clamp time but similar patency and imperviousness as videoscopic suturing techniques. An intraluminal stapler (Endopath-ILS, Ethicon) with a modified anvil was used to perform videoscopic-assisted thoracic aorta-to-iliac artery bypass with a 21 mm by 8 mm polytetrafluoroethylene (PTFE) graft in 22 sheep through a minimally invasive approach using a 5 cm thoracotomy.

Hand-assisted laparoscopic aorto-aortic bypass: initial experience in a porcine model.

Videoscopic surgical techniques have been developed to reduce morbidity of open aortic reconstructions. The advantage of hand-assisted laparoscopic surgery (HALS) technique is the introduction of the surgeon's hand into the peritoneal cavity. The aims of this study were to assess the feasibility and to examine the learning curve, limitations, and pitfalls of the HALS technique to perform aortic reconstruction in a porcine model for training purposes.

Carotid endarterectomy in SAPPHIRE-eligible high-risk patients: implications for selecting patients for carotid angioplasty and stenting.

Objectives: Carotid angioplasty and stenting (CAS) has been proposed as an alternative to carotid endarterectomy (CEA) in patients excluded from the North American Symptomatic Carotid Endarterectomy Trial and the Asymptomatic Carotid Atherosclerosis Study and in those considered at high risk for CEA. In light of recently released CAS data in patients at high risk, we reviewed our experience with CEA.

Methods: The records for consecutive patients who underwent CEA between 1998 and 2002 were retrospectively reviewed, and risk was stratified according to inclusion and exclusion criteria from a "high-risk" or CAS-CEA trial, The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial.

Iatrogenic operative injuries of abdominal and pelvic veins: a potentially lethal complication.

Purpose: Epidemiologic studies of vascular injuries are usually limited to those caused by trauma. The purpose of this study was to review the management and clinical outcome in patients with operative injuries to abdominal and pelvic veins.

Methods: Clinical data and outcome in all patients with iatrogenic venous injuries during abdominal and pelvic operations between 1985 and 2002 were reviewed.

Perioperative complications and early outcome after endovascular and open surgical repair of abdominal aortic aneurysms.

Background: Open repair (OR) of abdominal aortic aneurysms (AAAs) is a major surgical procedure with elevated morbidity and a low but definite mortality. Advocates of endovascular repair (EVAR) claim decreased complication rates and outcome equal to OR.

Methods: Data of all patients with infrarenal AAA that was treated electively, both with OR and EVAR, at Mayo Clinic Rochester between December 1, 1999 and December 1, 2001 were retrospectively reviewed.

Relief of iliofemoral vein occlusion with the Palma bypass in a patient with Klippel Trenaunay syndrome.

Klippel Trenaunay syndrome is usually managed conservatively with surgery reserved for patients with symptomatic but mild cosmetic deformity or persistent venous hypertension despite nonoperative measures. Deep venous reconstruction is necessary in a small group of patients who present with significant chronic venous insufficiency due to hypoplastic, absent, or occluded deep venous outflow. Most often, venous outflow occlusion results from inadequate or surgically removed superficial collateral veins or from complications of endovascular procedures.

Intraoperative duplex ultrasound of visceral revascularizations: optimizing technical success and outcome.

Purpose: The purpose of this study was to evaluate the use of intraoperative duplex ultrasound scanning (IOUS) during visceral revascularizations and correlate its results with clinical outcome.

Methods: We studied 68 patients (15 men and 53 women, mean age 66.5 years, range 27-86 years) who underwent visceral revascularization with concomitant IOUS examination of 120 visceral arteries (52 celiac, 60 superior mesenteric, and 8 inferior mesenteric arteries) from 1992 to 2002.

Endovascular repair of abdominal aortic aneurysms: initial experience with 100 consecutive patients.

Objective: To review early results of endovascular repair of abdominal aortic aneurysms (AAAs).

Patients And Methods: The first 100 patients who underwent endovascular repair of AAA (EVAR) between June 26,1996, and October 31, 2001, at the Mayo Clinic in Rochester, Minn, were studied retrospectively to evaluate technical success, freedom from reinterventions, and early clinical outcome.

Results: A total of 89 men and 11 women (mean +/- SD age, 76 +/- 7 years; range, 47-92 years) underwent EVAR.

Open surgical and endovascular treatment of superior vena cava syndrome caused by nonmalignant disease.

Objectives: The purpose of this study was to evaluate the role of endovascular and open surgical reconstructions in patients with superior vena cava (SVC) syndrome caused by nonmalignant disease.

Methods: Clinical data from 32 consecutive patients who underwent endovascular or open surgical reconstruction of central veins because of symptomatic benign SVC syndrome between November 1983 and June 2001 were retrospectively reviewed.

Results: The study included 17 male and 15 female patients (mean age, 38 years; range, 5-69 years).

Subfascial endoscopic perforator vein surgery in patients with post-thrombotic venous insufficiency--is it justified?

Previous results following subfascial endoscopic perforator vein surgery were reported to be worse in post-thrombotic syndrome than in limbs with primary valvular incompetence. This report comprises a larger patient cohort with longer follow-up. The goal of this study was to determine if subfascial endoscopic perforator vein surgery is justified in patients with post-thrombotic venous insufficiency.