Survival and patient-centered outcome in a disease-based observational cohort study of patients with thoracoabdominal aortic aneurysm.

Background: Much of the literature describing treatment for thoracoabdominal aortic aneurysm (TAAA) consists of operative series reported by centers of excellence. These studies are limited by referral and selection bias and exclude patients who are not candidates for the reported modality of repair. Little is known about the patients who are not referred or selected for repair.

Renal duplex ultrasound findings in fenestrated endovascular aortic repair for juxtarenal aortic aneurysms.

Objective: This study characterized duplex ultrasound (DUS) findings and clinical outcomes associated with covered stent placement in renal arteries during fenestrated endovascular aortic repair (FEVAR) to determine if velocity criteria for native renal artery stenosis can be applied.

Methods: Data from a prospectively maintained database of patients who underwent FEVAR between January 2010 and August 2014 were obtained before FEVAR (preoperative or baseline) and at follow-up assessments at 30 days, 6 months, and 1, 2, and 3 years. The established DUS threshold criteria for ≥60% stenosis in native renal arteries were applied at baseline and all follow-up intervals: renal artery peak systolic velocity (PSV) ≥200 cm/s or renal-aortic velocity ratio (RAR) ≥3.

The impact of chronic renal insufficiency on vascular surgery patient outcomes.

Renal insufficiency is associated with an increased incidence of poor outcomes, including cardiovascular events and death, in the general population. Renal dysfunction appears to have a particularly negative impact in patients undergoing vascular surgery and endovascular therapy. Although the exact mechanism is unknown, increased levels of inflammatory and biochemical modulators associated with adverse cardiovascular outcomes, as well as endothelial dysfunction, appear to play a role in the association between renal insufficiency and adverse outcomes.

Use of computational fluid dynamics studies in predicting aneurysmal degeneration of acute type B aortic dissections.

Objective: Whereas uncomplicated acute type B aortic dissections are often medically managed with good outcomes, a subset develop subacute or chronic aneurysmal dilation. We hypothesized that computational fluid dynamics (CFD) simulations may be useful in identifying patients at risk for this complication.

Methods: Patients with acute type B dissection complicated by rapidly expanding aortic aneurysms (N = 7) were compared with patients with stable aortic diameters (N = 7).

Outcomes after stent graft therapy for dissection-related aneurysmal degeneration in the descending thoracic aorta.

Objective: Stent graft therapy has emerged as an alternative to open surgery in the management of chronic dissection-related aneurysmal degeneration (DRAD) in the descending thoracic aorta (DTA). The incidence of perioperative complications, need for secondary aortic intervention (SAI), and rate of aneurysmal false-lumen thrombosis have not been thoroughly described.

Methods: Perioperative and midterm outcomes in patients who underwent stent graft therapy for chronic DRAD DTA at a single institution between January 2006 and September 2013 were retrospectively analyzed.

Local wall thickness in finite element models improves prediction of abdominal aortic aneurysm growth.

Objective: Growing evidence suggests that peak wall stress (PWS) derived from finite element analysis (FEA) of abdominal aortic aneurysms (AAAs) predicts clinical outcomes better than diameter alone. Prior models assume uniform wall thickness (UWT). We hypothesize that the inclusion of locally variable wall thickness (VWT) into FEA of AAAs will improve its ability to predict clinical outcomes.

Impact of wall thickness and saccular geometry on the computational wall stress of descending thoracic aortic aneurysms.

Background: Wall stress calculated using finite element analysis has been used to predict rupture risk of aortic aneurysms. Prior models often assume uniform aortic wall thickness and fusiform geometry. We examined the effects of including local wall thickness, intraluminal thrombus, calcifications, and saccular geometry on peak wall stress (PWS) in finite element analysis of descending thoracic aortic aneurysms.

Incidence, predictors, and outcomes of hemodynamic instability following carotid angioplasty and stenting.

Objective: To explore the incidence, predictors, and outcomes of hemodynamic instability (HI) following carotid angioplasty and stenting (CAS).

Methods: We retrospectively evaluated data on 257 CAS procedures performed in 245 patients from 2002 to 2011 at a single institution. The presence of periprocedural HI, as defined by hypertension (systolic blood pressure >160 mm Hg), hypotension (systolic blood pressure <90 mm Hg), and/or bradycardia (heart rate <60 beats per minute), was recorded.

Thoracic endografting reduces morbidity and remodels the thoracic aorta in DeBakey III aneurysms.

Background: The efficacy of endovascular treatment of aneurysms secondary to chronic DeBakey type III aortic dissection (CD3) remains controversial. The objective of this study was to compare outcomes from open and endovascular treatment of CD3 aneurysms, and to determine the efficacy of thoracic endovascular aortic repair (TEVAR) in remodeling the chronically dissected thoracoabdominal aorta.

Methods: From 2005 to 2012, 58 patients underwent open aortic replacement (open) and 31 patients underwent endovascular therapy (TEVAR) for the treatment of CD3 aneurysms.

Peak wall stress predicts expansion rate in descending thoracic aortic aneurysms.

Background: Aortic diseases, including aortic aneurysms, are the 12th leading cause of death in the United States. The incidence of descending thoracic aortic aneurysms is estimated at 10.4 per 100,000 patient-years.

A modern experience with saccular aortic aneurysms.

Objective: Repair of saccular aortic aneurysms (SAAs) is frequently recommended based on a perceived predisposition to rupture, despite little evidence that these aneurysms have a more malignant natural history than fusiform aortic aneurysms.

Methods: The radiology database at a single university hospital was searched for the computed tomographic (CT) diagnosis of SAA between 2003 and 2011. Patient characteristics and clinical course, including the need for surgical intervention, were recorded.

A "fall-back" technique for difficult inferior vena cava filter retrieval.

Objective: The purpose of this study was to describe the results of an alternative technique for inferior vena cava filter (IVCF) retrieval that can be used when the retrieval hook cannot be snared.

Methods: Retrospective review of all patients undergoing attempted IVCF retrieval by a single surgeon between March 2009 and March 2011 was undertaken. After December 2009, in cases where the retrieval hook could not be snared, an 18F/85 cm sheath was inserted into the internal jugular vein and a Bentson wire (Cook Medical, Bloomington, Ind) and snare were advanced across separate interstices of the filter.

Augmented mitral valve leaflet area decreases leaflet stress: a finite element simulation.

Background: Using human mitral valve (MV) models derived from three-dimensional echocardiography, finite element analysis was used to predict mechanical leaflet and chordal stress. Subsequently, valve geometries were altered to examine the effects on stresses of the following: (1) varying coaptation area; (2) varying noncoapted leaflet tissue area; and (3) varying interleaflet coefficient of friction (μ).

Methods: Three human MV models were loaded with a transvalvular pressure of 80 mm Hg using finite element analysis.

Qualitative impact of the endovascular era on vascular surgeons' comfort level and enjoyment with open and endovascular AAA repairs.

Objective: To evaluate the qualitative impact of training in the endovascular era (post-2000) on vascular surgeons' comfort level and enjoyment with abdominal aortic aneurysm (AAA) repairs.

Methods: A sample of vascular surgeons (n = 1754) were sent a survey pertaining to their fellowship training and practice of AAA repair. The influence of training- and practice-related variables on qualitative outcomes was assessed.

Stent grafting for aneurysmal degeneration of chronic descending thoracic aortic dissections.

Objective: The objective of this study was to examine the results of thoracic endovascular aneurysm repair (TEVAR) for chronic descending thoracic aortic (DTA) dissections with aneurysmal degeneration.

Methods: Over 70 months at a single institution, 27 patients underwent TEVAR for aneurysms related to chronic (>6 weeks) DTA dissections.

Results: Mean patient age was 67.

Presentation, complications, and natural history of penetrating atherosclerotic ulcer disease.

Objectives: Increased utilization of computed tomography angiography (CTA) has increased the radiologic diagnosis of penetrating atherosclerotic ulcers (PAUs), which are defined as the ulceration of atherosclerotic plaque through the internal elastic lamina into the aortic media. However, the presentation, treatment indications, and natural history of this disease process remain unclear.

Methods: The radiology database at a single university hospital was searched retrospectively for the CTA diagnosis of PAU from January 2003 to June 2009.

Increased wall stress of saccular versus fusiform aneurysms of the descending thoracic aorta.

Background: Repair of fusiform descending thoracic aortic aneurysms (DTAs) is indicated when aneurysmal diameter exceeds a certain threshold; however, diameter-related indications for repair of saccular DTA are less well established.

Methods: Human subjects with fusiform (n = 17) and saccular (n = 17) DTAs who underwent computed tomographic angiography were identified. Patients with aneurysms related to connective tissue disease were excluded.

Increased ascending aortic wall stress in patients with bicuspid aortic valves.

Background: Patients with bicuspid aortic valves (BAV) are at increased risk of ascending aortic dilatation, dissection, and rupture. We hypothesized that ascending aortic wall stress may be increased in patients with BAV compared with patients with tricuspid aortic valves (TAV).

Methods: Twenty patients with BAV and 20 patients with TAV underwent electrocardiogram-gated computed tomographic angiography.

Predictors of decreased short- and long-term survival following open abdominal aortic aneurysm repair.

Objectives: The purpose of this study was to identify predictors of decreased survival after open abdominal aortic aneurysm (AAA) repair at a single university hospital.

Methods: Patients undergoing open AAA repair from June 2003 to June 2009 were identified. Primary outcomes were 30-day and 5-year survival.

Low rehospitalization rate for vascular surgery patients.

Objectives: Reducing rehospitalization rates has been proposed to improve care, reduce costs, and as a pay-for-performance criterion. Recent review of Medicare claims data indicates that vascular surgery patients have among the highest rates of 30-day rehospitalization at 23.9%.

Open and endovascular repair of hepatic artery aneurysm: two case reports and review of the literature.

Hepatic artery aneurysms (HAAs) represent a complex and often lethal condition. An 80-year-old woman with polyarteritis nodosa and a right hepatic lobe HAA underwent endovascular repair with coils. Her case was complicated by intraoperative HAA rupture requiring exploratory laparotomy.

Delayed complications of inferior vena cava filters: case report and literature review.

Inferior vena cava (IVC) filters are frequently placed to prevent pulmonary embolism in patients in whom anticoagulation is contraindicated or ineffective. Delayed erosion of the filter into adjacent vital structures is a rare complication. We report 3 complications of IVC filters managed with both surgical and endovascular therapies.

Pathogenesis of acute aortic dissection: a finite element stress analysis.

Background: Type A and type B aortic dissections typically result from intimal tears above the sinotubular junction and distal to the left subclavian artery (LSA) ostium, respectively. We hypothesized that this pathology results from elevated pressure-induced regional wall stress.

Methods: We identified 47 individuals with normal thoracic aortas by electrocardiogram-gated computed tomography angiography.

Predictors of early and late mortality following open extent IV thoracoabdominal aortic aneurysm repair in a large contemporary single-center experience.

Objective: The primary purpose of this study was to examine outcomes following open repair of extent IV thoracoabdominal aortic aneurysms (TAAAs) at a single university hospital. As a secondary aim, comparison was made to patients who underwent open abdominal aortic aneurysm (AAA) repair with supraceliac clamping but without left renal artery bypass to assess the effect of left renal artery bypass on outcomes.

Methods: Patients undergoing open extent IV TAAA repair from 1998 to 2008 were identified (n = 108).

Thoracoscopic total parietal pleurectomy for primary spontaneous pneumothorax.

Although the management of spontaneous pneumothorax through a thoracotomy traditionally included apical pleurectomy, thoracoscopic treatment of this problem does not generally include pleurectomy. Thoracoscopy in fact allows excellent exposure to perform total parietal pleurectomy, and we hypothesize that including total pleurectomy will reduce recurrences. We describe here the technique of thoracoscopic total parietal pleurectomy and the early outcomes afterward.