Stentgraft Limb Occlusion After Endovascular Aneurysm Repair: Incidence and Risk Factors.

Introduction: Stentgraft limb occlusion (SLO) is a potential complication of endovascular aneurysm repair (EVAR). The purposes of this single centre study are to report the incidence of SLO after EVAR and to detect possible risk factors.

Methods: All patients who underwent EVAR between June 2001 and February 2020 were included in this retrospective study.

Use of Intravascular Lithotripsy in Heavily Calcified Renal Artery Stenosis: A Case Report.

Heavily calcified arterial lesions are difficult to treat in an endovascular manner with conventional techniques due to limited arterial compliance. Intravascular lithotripsy offers a novel minimally invasive therapeutic option through endovascular emission of acoustic waves, fracturing calcium deposits and facilitating lesion dilation. We present the case of a successful application of the Shockwave intravascular lithotripsy system (IVL®, Shockwave Medical Inc) in a heavily calcified stenosis of the right renal artery in a patient with a coral reef aorta.

Carotid access for percutaneous coronary intervention.

Transcarotid percutaneous coronary intervention is feasible and safe and can be considered as an ultimate alternative in cases where conventional peripheral vascular access is unavailable.

Results of carotid artery stenting. Lessons learned in a Belgian 'real world' practice.

Objective/background: Carotid artery stenting (CAS) is a valuable solution for the treatment of carotid artery stenosis in a high-risk patient population for carotid endarterectomy (CEA). In literature however, there are concerns about the death and stroke rates of CAS in the 'real world' practice. Since Belgium is a small country with a broad offer of medical care, and there is no reimbursement for CAS, only small numbers of patients can be treated per vascular department.

Multiple Simple Renal Cysts and Sequential, Rapid Progressive, Aneurysmatic Aortoiliac and Femoral Artery Disease: Case Report and Review of the Literature.

Multiple simple renal cysts have been linked to aortic aneurysm and connective tissue disease by different authors. We present a case of a 64-year-old male patient with multilevel, rapid progressive aneurysmatic disease. Over a period of 11 years, he sequentially developed a symptomatic infrarenal aortic aneurysm of 100 mm, a juxtarenal progression of the aneurysm up to 61 mm, an aneurysm on the descending thoracic aorta of 73 mm, and a common iliac aneurysm of 53 mm.

Visceral Fibromuscular Dysplasia: From asymptomatic disorder to emergency.

Fibromuscular dysplasia (FMD) is an idiopathic, segmental, non-atherosclerotic and non-inflammatory disease of the musculature of arterial walls, leading to stenosis of small and medium-sized arteries, mostly involving renal and cervical arteries. As a result of better and more systematic screening, it appears that involvement of the splanchnic vascular bed is more frequent than originally assumed. We review epidemiology, pathogenesis, clinical picture as well as diagnosis and treatment of visceral artery (VA) FMD.

Treatment of a mycotic abdominal aortic aneurysm with the jailing technique.

Purpose: We explored an innovative technique in treating mycotic aortic aneurysms.

Case Report: A patient presenting with severe back pain, vague abdominal pain, weight loss and decline in general health, was diagnosed with a contained-rupture of a suprarenal mycotic aortic aneurysm, as a complication of spondylodiscitis. Since the patient's health condition was too poor to perform an open aortic repair, we choose an alternative treatment option by coiling the aneurysm with the jailing technique.

Paclitaxel-coated versus plain old balloon angioplasty for the treatment of infrainguinal arterial disease in diabetic patients: the Belgian diabetic IN.PACT Trial.

Background: Several trials have shown that drug coated balloon (DCB) angioplasty reduce the rates of restenosis in the femoropopliteal artery. This controlled, prospective, multicenter study was designed to demonstrate the efficacy of DCB to inhibit restenosis of the infrainguinal arteries in an exclusive diabetic population.

Methods: Between 2012 and 2014, 106 diabetic patients with symptomatic peripheral arterial disease (PAD) were enrolled at 11 sites in Belgium, 54 treated with DCB angioplasty and 52 treated with plain old balloon angioplasty (POBA).

Gastrocnemius fascia release under local anaesthesia as a treatment for neuropathic foot ulcers in diabetic patients: a short series.

Background: Diabetic foot ulceration is the leading cause of major amputation in the developed world. Plantar neuropathic ulcers at the forefoot can be managed conservatively with off-loading, but treatment is not invariably successful. Achilles tendon lengthening procedures aim at increasing dorsiflexion and decreasing forefoot pressure but can be associated with complications and require prolonged postoperative immobilization to prevent tendon rupture.

Stenting complex aorta aneurysms with the Cardiatis multilayer flow modulator: first impressions.

Objectives: Our aim was to assess the feasibility and efficacy of the Cardiatis multilayer flow modulator in the treatment of complex aorta aneurysms.

Methods: This is a single-center prospective registry. Six patients (4 males and 2 females; mean age 74 years) with complex aorta aneurysms (unsuitable for endovascular repair with standard, fenestrated, or branched stent grafts) were treated with the Cardiatis multilayer flow modulator.

Wound morphology and topography in the diabetic foot: hurdles in implementing angiosome-guided revascularization.

Purpose. Angiosome-guided revascularization is an approach that improves wound healing but requires a surgeon to determine which angiosomes are ischemic. This process can be more difficult than anticipated because diabetic foot (DF) wounds vary greatly in quantity, morphology, and topography.

Discharge on the first postoperative day after elective carotid endarterectomy.

Background: Medical complications may prolong the hospital stay after elective carotid endarterectomy (CEA). We prospectively assessed the social and medical feasibility and safety of patient discharge on the first postoperative day after elective CEA and unplanned readmissions.

Methods: Between June 2011 and January 2012, 57 consecutive patients scheduled for elective CEA were enrolled with the aim of discharge on the first postoperative day if there were no medical contraindications and on the condition that the patient should not be left alone during the first day and night at home.

Intraluminal crossing of near-impenetrable occlusions by balloon-assisted battering ram technique.

Purpose: Subintimal crossing of total occlusions and acquiring reentry into the true lumen may be hazardous in highly calcified lesions, with or without the use of expensive reentry devices. Even when desirable, intraluminal crossing may not be feasible, because the guidewire tends to follow a path of least resistance between the intimal plaque and the adventitia.

Technique: A standard percutaneous transluminal angioplasty balloon is positioned just above the proximal cap of the occlusion and insufflated to 6 atmosphere.

BRAVISSIMO: 12-month results from a large scale prospective trial.

The BRAVISSIMO study is a prospective, non-randomized, multi-center, multi-national, monitored trial, conducted at 12 hospitals in Belgium and 11 hospitals in Italy. This manuscript reports the findings up to the 12-month follow-up time point for both the TASC A&B cohort and the TASC C&D cohort. The primary endpoint of the study is primary patency at 12 months, defined as a target lesion without a hemodynamically significant stenosis on Duplex ultrasound (>50%, systolic velocity ratio no greater than 2.

Deep venous thrombosis and pulmonary embolism caused by an intravascular synovial sarcoma of the common femoral vein.

Malignant tumors arising in deep veins of the lower extremities are very uncommon. To our best knowledge, this is the seventh case of a primary venous intravascular synovial sarcoma (SS) reported in literature. A 32-year-old woman was admitted with a second episode of deep venous thrombosis of the right lower limb and pulmonary embolism.

Treatment of lymphocutaneous fistulas after vascular procedures of the lower limb: accurate wound reclosure and 3 weeks of consistent and continuing drainage.

Background: Lymphocutaneous fistulas occurring after vascular procedures of the lower limb are a rare, but frustrating, complication. Many treatment options exist, but may lead to inconsistent results, with infection, delayed wound healing, and prolonged hospital stay. We present a simple surgical treatment of wound closure and drainage.

The surgical history of the amputated limb according to the indication for revascularization: diabetic foot, acute ischaemia, aneurysmal disease, chronic arterial occlusive disease.

Background: To investigate whether the indication for the first revascularization (diabetic foot, acute ischaemia, aneurysmal disease, chronic occlusive disease) determines the surgical history and survival time in amputated limbs.

Methods: The surgical history of lower extremities amputated between 2002 and 2009 was reviewed for the number of (endo)vascular procedures, minor amputations, wound debridements, complications requiring surgery (acute ischaemia, bleeding, graft infection) and limb survival time (LST).

Results: 100 limbs were included in the study.

Establishing the learning curve for a tunneled dialysis catheter placement.

Purpose: To determine how many procedures a surgical trainee requires before they are able to place a tunneled double-lumen dialysis catheter safely on their own.

Methods: Surgical trainees unfamiliar with the procedure received a pre-operative briefing in which we explained 1) why, how, and in what particular order each operational step should be executed and 2) what the possible pitfalls/complications are. Next, an experienced surgeon demonstrated the procedure with the trainee scrubbed-in as their assistant.

The ankle--brachial index and the diabetic foot: a troublesome marriage.

Background: The ankle--brachial index (ABI) is a simple, noninvasive, widely used test that detects peripheral arterial disease (PAD). In patients with diabetes, the ABI is notoriously unreliable and this is usually attributed to medial calcinosis, which stiffens the arteries and renders them poorly compressible. However, the distribution of atherosclerotic lesions in those with diabetes is different as well: lesions predominantly reside in below-the-knee (BTK) arteries.

Diabetes mellitus is a predictor for early adverse outcome after carotid endarterectomy.

Purpose: The aim of the study was to compare the outcome after carotid endarterectomy (CEA) in patients with and without diabetes mellitus.

Methods: We prospectively recorded the data from patients who underwent CEA. A patient was considered diabetic when he reported the use of antidiabetic medication.

Fatal intracerebral haemorrhage following carotid endarterectomy in a patient with cerebral amyloid angiopathy.

A 68-year-old man underwent carotid endarterectomy for symptomatic carotid artery stenosis. Immediately after surgery the patient suffered dramatic neurological deterioration, due to massive cerebral bleeding. Pathological examination revealed cerebral amyloid angiopathy.

From retroperitoneoscopic lumbar sympathectomy to total laparoscopic abdominal aorta surgery: how to learn.

The aim of this report is to describe the steps we followed to build up laparoscopic experience progressively towards total laparoscopic aorta surgery. The techniques of retroperitoneoscopic lumbar sympathectomy, hand-assisted laparoscopic aorta surgery and total laparoscopic aorta surgery are discussed and illustrated. Surgical tips and tricks and advice concerning selection of patients and surgical techniques are proposed.

Men with atherosclerotic stenosis of the carotid artery have lower testosterone levels compared with controls.

Aim: There is evidence to suggest an inverse association between serum levels of testosterone and coronary heart disease. The aim of this study was to compare endogenous sex hormone levels of men with severe internal carotid artery (ICA) atherosclerosis with age-matched controls.

Methods: Metabolic parameters and sex hormones were measured or calculated in 124 male patients undergoing carotid endarterectomy for high grade ICA stenosis and in 124 age-matched male controls.

Markers of inflammation in patients with symptomatic and asymptomatic carotid artery stenosis: a case-control study.

Objectives: There is evidence that inflammation plays a role in the pathogenesis of atherosclerosis. We compared levels of inflammatory markers between patients undergoing carotid endarterectomy (CEA) and controls, and between patients with symptomatic and asymptomatic internal carotid artery (ICA) stenosis.

Materials And Methods: A total of 180 patients with ICA stenosis were compared with 180 age-matched and sex-matched controls.

Endogenous sex hormone levels in postmenopausal women undergoing carotid artery endarterectomy.

Objective: To study the endogenous sex hormone levels in natural postmenopausal women and their association with the presence of internal carotid artery (ICA) atherosclerosis.

Design: Case-control study

Methods: We compared 56 patients with severe ICA atherosclerosis referred for carotid artery endarterectomy (CEA) with 56 age-matched control subjects free of severe atherosclerotic disease. The presence of atherosclerosis was determined by high-resolution B-mode ultrasound.