Evolving Management of Distal Anastomotic Technical Issues During Open Aortic Aneurysm Repair.

Background: Thrombosis of the iliac anastomosis is an important complication of open aortic aneurysm repair. We evaluated our evolving management of this complication to an endovascular approach and compared it with open revision to the common femoral artery.

Methods: Consecutive patients undergoing open aortic aneurysm repair from January 2009 through November 2016 at our institution were reviewed.

Guidelines for hospital privileges in vascular surgery and endovascular interventions: Recommendations of the Society for Vascular Surgery.

The Hospital Privileges Practice Guideline Writing Group of the Society for Vascular Surgery is making the following five recommendations concerning guidelines for hospital privileges for vascular surgery and endovascular therapy. Advanced endovascular procedures are currently entrenched in the everyday practice of specialized vascular interventionalists, including vascular surgeons, but open vascular surgery remains uniquely essential to the specialty. First, we endorse the Residency Review Committee for Surgery recommendations regarding open and endovascular cases during vascular residency and fellowship training.

An update on the role of proximal occlusion devices in carotid artery stenting.

Carotid artery stenting performed with distal embolic protection devices continues to show elevated rates of periprocedural stroke, in particular with high-risk groups. This article discusses the factors associated with protection devices that may contribute to this complication, performs a literature review to assess outcomes of carotid stenting with proximal occlusion devices, and assesses the role of proximal occlusion devices in the management of patients with carotid artery stenosis.

Repair of a disconnected stent-graft limb facilitated by in situ fenestration.

Purpose: To describe the use of in situ fenestration to facilitate management of a disconnected iliac stent-graft limb that could not be repaired by conventional endovascular techniques.

Technique: An 85-year-old man who had a Zenith endovascular graft deployed 3 years earlier for a 10-cm infrarenal abdominal aortic aneurysm presented with separation of the right iliac stent-graft limb from the main body, resulting in type III endoleak and sac enlargement. The disconnected limb occluded the ostium of the main stent-graft body, blocking all conventional endovascular techniques to traverse the graft limb-main body intersection.

Initial systolic blood pressure and ongoing internal bleeding following torso trauma.

Objective: Recent studies have suggested that an initial systolic blood pressure (SBP) in the range of 90-110 mmHg in a trauma patient may be indicative of hypoperfusion and is associated with poor patient outcome. However, the use of initial SBP as a surrogate for predicting internal bleeding is yet to be validated. The purpose of this study was to assess the presenting SBPs in patients with torso trauma and evidence of ongoing internal hemorrhage.

Surgical site infections: incidence and trends at a community teaching hospital.

Background: There has been increased national attention on methicillin-resistant Staphylococcus aureus (MRSA) and surgical site infections (SSIs) highlighted by the media, the public, and federal agencies. It was therefore considered important to analyze the trends and incidence of inpatient detected SSIs and associated resistant organisms at our own institution.

Methods: The analysis reflects the cultures and sensitivities of SSI on the surgical services at Monmouth Medical Center, a 527-bed community teaching hospital, from January 2003 through December 2007.

The transition to IVUS-guided IVC filter deployment in the nontrauma patient.

While prior reports have demonstrated intravascular ultrasound (IVUS)-guided inferior vena cava filter (IVCF) deployment to be feasible, larger reviews using the latest generation of filters in the nontrauma setting are absent. We review our experience with the deployment of 104 IVCFs using IVUS, whereby we transition from a combined use of IVUS with traditional road mapping techniques (venography and/or renal vein cannulation) to the sole use of the IVUS as the road mapping tool for IVCF insertion. The use of IVUS for IVCF deployment minimizes radiation exposure to patients and staff, minimizes patient contrast exposure, and minimizes dependency on auxiliary staff for fluoroscopy.