Modified eversion carotid endarterectomy.

Background: Eversion carotid endarterectomy is a well-described technique for carotid endarterectomy (CEA). The advantage of this technique is a completely autogenous repair. We describe a modification of eversion endarterectomy (MEE) that expeditiously extracts the plaque through a linear incision over the common carotid artery and the proximal bulbous internal carotid artery (ICA) only, allowing primary closure.

Mycotic aneurysm and aortic graft infection presenting with vertebral body destruction requiring debridement and stabilization--a report of two cases.

Vertebral osteomyelitis may occur with mycotic aneurysms or infected aortic grafts. A high index of suspicion for these concurrent processes as well as appropriate preoperative evaluation and interspecialty communication is critical for appropriate diagnosis and treatment. Extraanatomic bypass, wide debridement of necrotic soft tissue and bony structures, and concurrent bony stabilization are important aspects of treatment.

Endovascular repair of carotid artery aneurysms following carotid endarterectomy.

Aneurysm of the carotid artery following endarterectomy is a rare entity that historically has required reoperation. Endovascular deployment of a covered stent can theoretically exclude an aneurysm while minimizing the risks seen with reoperation. Herein, we review the scientific literature on this evolving technique and report an additional case involving successful treatment of an aneurysm that developed following remote endarterectomy.

Decellularized vein as a potential scaffold for vascular tissue engineering.

Purpose: Current strategies to create small-diameter vascular grafts involve seeding biocompatible, compliant scaffolds with autologous vascular cells. Our purpose was to study the composition and strength of decellularized vein to determine its potential as a vascular tissue-engineering scaffold.

Methods: Intact human greater saphenous vein specimens were decellularized by using sodium dodecyl sulfate (SDS).

Ischemic jejunal stricture following endovascular abdominal aortic aneurysm repair -- a case report.

Endograft repair has rapidly become an alternative to conventional open repair of abdominal aortic aneurysms. Various trials continue to show decreased morbidity when compared to open repair. However, as with any new procedure, complications specifically related to this technique are being described.

Superior mesenteric artery pseudoaneurysm successfully treated with polytetrafluoroethylene covered stent.

A postoperative superior mesenteric artery pseudoaneurysm that communicates with a pancreatic pseudocyst after aortic surgery is a difficult management problem. Untreated, this condition can lead to exsanguination. Traditional surgical treatment has many potential complications.

Tibia fracture after fibula resection for distal peroneal bypass.

The lateral approach to the distal peroneal artery has been used by vascular surgeons for 25 years. No complications specifically related to this approach have previously been reported. We reviewed 18 cases of peroneal bypass for limb salvage using the lateral approach with fibula resection and found that two of these cases had ipsilateral tibia fractures within 1 year of the bypass.

Clostridial mycotic aneurysm of the thoracoabdominal aorta--a case report.

Clostridial infection of the aorta is a rare and life-threatening condition. The management of a mycotic aneurysm involving the thoracoabdominal aorta due to Clostridium septicum infection is presented. Successful surgical management of the aortic infection involved arterial resection, wide debridement of the surrounding tissues, and in situ graft replacement.

Long-term follow-up of reoperative carotid surgery.

Background: We examined our long-term results of carotid reoperation to identify risk factors for morbidity and secondary recurrence.

Methods: Medical record review revealed 27 patients had reoperative surgery for recurrent stenosis. Demographics, operative details, pathology, clinical outcome, and follow-up imaging results were reviewed.

Early carotid endarterectomy in selected stroke patients.

Although there are several reports suggesting the safety of performing carotid endarterectomy (CE) within 4 weeks (early) of a nondisabling stroke, at many institutions it is not standard practice. Benefits of early surgery may include reduction in the number of strokes or carotid occlusions during the time between stroke and surgery, as well as a reduction in the cost of medical care due to the elimination of interval anticoagulation and close follow-up. This review examines the outcomes of early CE in selected patients after a nondisabling stroke.

Comparison of Doppler US and CT angiography for evaluation of renal artery stenosis.

Rationale And Objectives: The authors compared Doppler ultrasound (US) with computed tomographic (CT) angiography in the evaluation of stenosis of the main renal artery.

Materials And Methods: Fifty-six patients who had undergone conventional angiography of the renal arteries participated in a prospective comparison of Doppler US (45 patients) and CT angiography (52 patients). US evaluation included both the main renal artery and segmental renal arteries.

Role of thrombin in endothelial cell monolayer repair in vitro.

Purpose: We examined the effect of thrombin on human iliac artery endothelial cell monolayer repair and proliferation after denuding vascular injury.

Methods: Human iliac artery endothelial cell monolayer repair was determined by scrape wounding confluent monolayers and measuring the advancement of the cells into the wounded area for 3 days. Proliferation studies involved plating human iliac artery endothelial cells at one tenth confluence and counting the increase in cell number every 2 days for a 2-week period.

Role of selective arteriography in the diagnosis of a ruptured middle colic artery aneurysm.

A case of a ruptured middle colic artery is reported. The diagnosis was initially overlooked and eventually made by selective arteriography. Aneurysms of visceral arteries are rare and rupture of them even more infrequent.

Treatment of iatrogenic femoral artery injuries with ultrasound-guided compression.

Iatrogenic injuries of the groin are becoming more common after increasingly sophisticated vascular intervention. These injuries are accurately detected by duplex and color Doppler ultrasonography. Recent treatment of these lesions by ultrasound-guided compression repair (UGCR) has been described.

Cultured and immediately procured endothelial cells: current and future clinical applications.

Great progress has been made in the last several years in our ability to culture human endothelial cells. In addition, techniques to immediately procure and utilize these cells have also been developed. The purpose of this paper is to present an overview of the current and potential uses of these cells in both vascular and nonvascular conditions.

Origin of cells that line damaged native blood vessels following endothelial cell transplantation.

Endothelial cell (EC) transplantation has been proposed as a method to reduce the thrombogenicity of both vascular grafts as well as injured native blood vessels. While techniques have been developed to establish EC monolayers on these surfaces, a major question that remains is whether the cells that exist on the blood flow surface are the same cells placed on the surface at the time of transplantation. We have developed an intravital fluorescent staining technique that permits isolated, autologous, fat-derived microvascular endothelial cells (MVEC) to be labeled and subsequently detected following their transplantation.

Efficacy of thrombolysis in infrainguinal bypass grafts.

The initial outcome of a consecutive series of 43 intra-arterial urokinase infusions for thrombosed infrainguinal grafts in 37 patients was analyzed. There was an 88% (38/43) technical success rate (complete clot lysis) and a 74% (32/43) clinical success rate. Complications occurred in 10 patients (23%) and were related to bleeding in four patients (9%).

Thrombus-free, human endothelial surface in the midregion of a Dacron vascular graft in the splanchnic venous circuit--observations after nine months of implantation.

The addition of an endothelial cell lining to a prosthetic vascular graft may reduce the thrombogenicity of the blood-contacting surface. An endothelialized mesoatrial graft was implanted in a patient with Budd-Chiari syndrome caused by a primary inferior vena caval leiomyosarcoma. During the initial surgery a Dacron vascular graft was preclotted with plasma and then lined with microvascular endothelial cells derived from the patient's subcutaneous adipose tissue.

Insertion and recovery of a new retrievable vena caval filter. Work in progress.

A new retrievable inferior vena cava (IVC) filter was tested in nine pigs. Insertion was through a 14 French sheath using both the femoral and jugular approaches. All insertions were successful, and there was a 100% postinsertion IVC patency rate (8/8 pigs at one week and 1/1 pig at one month).

Kinetics of endothelial cell-surface attachment forces.

Physical and biochemical forces exist that are necessary for the persistent attachment and function of ECs on native and prosthetic blood vessels. The optimization of conditions that permit regeneration of these attachment forces may allow rapid establishment of a durable, biocompatible EC monolayer. We examined the effects of three major factors, protein substrate, EC incubation time, and shear stress, on the attachment kinetics of human adult ECs to two different polymers.

Complications encountered with the use of the Greenfield filter.

The Greenfield filter can be used with a low complication rate provided one adheres to certain principles. First, preoperative venography to define the inferior vena caval anatomy will help avoid difficulties associated with anatomic variations. At the time the study is carried out, it would be extremely useful if the radiologist places a radiopaque marker at the level of the renal veins.

Use of the isolated perfused kidney model to assess the acute pharmacologic effects of cyclosporine and its vehicle, cremophor EL.

"Nephrotoxicity" secondary to cyclosporine and its clinically used vehicle, Cremophor EL, was examined in the isolated perfused rat kidney model. This model allows the serial determination of renal hemodynamic and tubular functional studies over a 3-hr duration using a normothermic, low hematocrit (13-15%) perfusion system. Initial studies indicated that the addition of small quantities of Cremophor EL resulted in marked renal vasoconstriction with decreased renal blood flow and deterioration in renal tubular function.

Renal autotransplantation and extracorporeal reconstruction for complicated benign and malignant diseases of the urinary tract.

Renal autotransplantation was performed in five patients and extracorporeal vascular reconstruction was required in two of these cases. One had a carcinoma of the mid-ureter with a solitary kidney. Two patients had ureteral injury.