Contemporary indications for open abdominal aortic aneurysm repair in the endovascular era.

Objective: Despite the emergence of endovascular aneurysm repair (EVAR) as the most common approach to abdominal aortic aneurysm repair, open aneurysm repair (OAR) remains an important option. This study seeks to define the indications for OAR in the EVAR era and how these indicatioxns effect outcomes.

Methods: A retrospective cohort study was performed of all OAR at a single institution from 2004 to 2019.

Emergency intraoperative vascular surgery consultations at a tertiary academic center.

Objective: Vascular surgeons are frequently called on to provide emergency assistance to surgical colleagues. Whereas previous studies have included elective preoperative vascular consultations, we sought to characterize the breadth of assistance provided during unplanned intraoperative consultations at a single tertiary academic center.

Methods: We queried our institutional billing department during a 15-year period and reviewed the records (January 1, 2002-December 31, 2016) and identified unanticipated unplanned vascular surgery intraoperative consultations from all surgical services.

High dose-rate brachytherapy for the treatment of lower extremity in-stent restenosis.

Objective: Historically, edge stenosis and late thrombosis limited the effectiveness of adjunctive endovascular brachytherapy (EVBT) for in-stent restenosis (ISR) after percutaneous transluminal angioplasty (PTA) and stenting. We evaluated an updated protocol of PTA and EVBT for ISR among patients with lower extremity occlusive disease.

Methods: This is a retrospective, single-center review of patients treated with PTA and EVBT for ISR in the iliac and femoropopliteal segments between 2004 and 2012.

Contrast inhomogeneity in CT angiography of the abdominal aortic aneurysm.

Background: If undetected, infrarenal Abdominal Aortic Aneurysm (AAA) growth can lead to rupture, a high-mortality complication. Some AAA patients exhibit inhomogeneous luminal contrast attenuation at first-pass CT angiography (CTA). This study assesses the association between this observation and aneurysm growth.

Endovascular longitudinal fenestration and stent graft placement for treatment of aneurysms developing after chronic type B aortic dissection.

The thickened intimal flap present in cases of chronic aortic dissection can present a challenge to attempts at endovascular stent graft treatment performed for subsequent aneurysmal degeneration by precluding adequate landing zones for the endograft and by constraining the endograft from full expansion. In this report we describe our technique and outcome for longitudinal endovascular fenestration of chronic aortic dissection flaps to facilitate endovascular stent graft treatment for thoracic aortic aneurysms developing after aortic dissection.

Acute dissection of the descending aorta: a case report and review of the literature.

Cardiovascular disease is the leading cause of death worldwide. Acute aortic syndromes, which include aortic dissection, intramural hematoma, and penetrating aortic ulcer, represent the most morbid presentations of aortic disease and can be difficult to diagnose. Recent advances in imaging have allowed for more rapid and accurate diagnosis of acute aortic syndromes and the options for management are expanding.

Treatment planning for peripheral arterial disease based on duplex ultrasonography and computed tomography angiography: consistency, confidence and the value of additional imaging.

Background: Duplex ultrasonography (DUS) can be used for treatment planning for lower extremity peripheral arterial disease (PAD), but has not replaced contrast-enhanced imaging such as computed tomography angiography (CTA). We assessed DUS-based treatment planning for consistency, confidence, and the value of additional CTA among multinational surgeons.

Methods: Data from 12 patients with PAD were reviewed by 2 American vascular surgeons individually and 1 Dutch vascular department by consensus.

Volumetric quantification of type II endoleaks: an indicator for aneurysm sac growth following endovascular abdominal aortic aneurysm repair.

Purpose: To test the hypothesis that type II endoleak cavity volume (ECV) and endoleak cavity diameter (ECD) measurements are accurate indicators of aneurysm sac volume (ASV) enlargement in patients who undergo endovascular aneurysm repair (EVAR) in the abdominal aorta.

Materials And Methods: The institutional review board approved and waived the need to obtain patient consent for this HIPAA-compliant retrospective study. In 72 patients who underwent EVAR, 160 computed tomographic (CT) angiography studies revealed type II endoleaks.

Upper extremity composite tissue allotransplantation imaging.

Objective: Upper extremity (UE) transplantation is the most commonly performed composite tissue allotransplantation worldwide. However, there is a lack of imaging standards for pre- and posttransplant evaluation. This study highlights the protocols and findings of UE allotransplantation toward standardization and implementation for clinical trials.

Comparative analysis of autogenous infrainguinal bypass grafts in African Americans and Caucasians: the association of race with graft function and limb salvage.

Objective: African Americans (AAs) are at risk for developing diabetes mellitus and atherosclerosis. Whether race influences the results of infrainguinal arterial reconstruction is unclear. The purpose of this study was to compare the results of autogenous infrainguinal bypasses in AAs and Caucasians to determine the association of race with graft function and limb salvage.

Infrainguinal vein bypass graft revision: factors affecting long-term outcome.

Objectives: We sought to determine the long-term results of revision procedures performed for repair of stenotic lesions in infrainguinal vein bypass grafts.

Methods: A retrospective review of 188 vein grafts, from a total series of 1260 bypasses, undergoing revision of stenotic lesions between January 1, 1987, and December 31, 2002, at Brigham & Women's Hospital was undertaken. Lesions were identified by recurrence of symptoms, change in examination findings, or with routine duplex ultrasound graft surveillance.

Congenital Vascular Anomalies.

Congenital vascular anomalies are rare. The cardiovascular specialist should nevertheless be aware of the more common types of vascular anomalies and understand the implications for patient treatment and the likelihood of associated morbidity. The presentation of congenital arteriovenous malformations can range from asymptomatic or cosmetic lesions, to those causing ischemia, ulceration, hemorrhage, or high-output congestive heart failure.

Endovascular repair of diffuse atherosclerotic occlusive disease using stented grafts.

Minimally invasive techniques have greatly influenced the practice of surgery in the past two decades, especially the vascular surgical specialty. Current technological advances and refinements have allowed for the application of less invasive or percutaneous endovascular techniques to the treatment of arterial aneurysms and peripheral vascular occlusive disease. While balloon angioplasty and stenting for occlusive disease have proven successful in certain vascular beds (such as common iliac arteries), infrainguinal results are generally less impressive.

Carotid stenting in the bovine arch.

We report our experience in stent-supported angioplasty of the left internal carotid artery in patients with anomalous origin of the left common carotid, the so-called bovine arch, in which the right brachiocephalic and left carotid share a common trunk from the aortic arch. The occurrence of the anatomic variant is discussed, and techniques of femoral, brachial, and radial approaches are described.

An unusual cause of claudication.

We describe a case of a patient who presented with claudication 3 months following a coronary angiogram in which the femoral arterial puncture site had been closed with an AngioSeal. The lesion was found to be due to the anchor of the AngioSeal, which embolized during attempted percutaneous revascularization and had to be snared and retrieved to the level of the sheath in the left femoral artery and was then surgically removed.

Mechanical failure of prosthetic human implants: a 10-year experience with aortic stent graft devices.

Objective: The first endovascular stent graft was implanted to treat an abdominal aortic aneurysm more than a decade ago. This technique has evolved dramatically with the growing understanding of metallurgic and fabric sciences and improved device designs. However the potential for stent graft material failure remains.

Recent advances in peripheral angioplasty and stenting.

Utilization of percutaneous interventions for arterial and venous occlusive lesions continue to increase. With the progression of the technology supporting these therapeutic measures, the results of these interventions may be expected to improve. In general, a comparison of techniques for revascularization demonstrates similar initial technical success rates for surgery and percutaneous transluminal angioplasty.

Abdominal aortic aneurysmorrhaphy and cholelithiasis in the era of endovascular surgery.

The incidence of acute cholecystitis complicating standard abdominal aortic aneurysm (AAA) repair has been reported between 0.3 and 18 per cent. This has prompted considerable debate regarding the management of cholelithiasis discovered incidentally during open aortic reconstruction.

Predicting iliac limb occlusions after bifurcated aortic stent grafting: anatomic and device-related causes.

Objective: Graft limb occlusion may complicate endovascular abdominal aortic aneurysm repair. The precise etiologic factors that contribute to the development of these graft limb thromboses have not been defined. We evaluated our experience with bifurcated aortic endografts to determine factors that may predict subsequent limb thrombosis.

A multicenter experience with the Talent endovascular graft for the treatment of abdominal aortic aneurysms.

Objective: The Talent endovascular graft has been used in the treatment of abdominal aortic aneurysms (AAAs) in more than 13,000 patients worldwide. However, information regarding the results of its use has been limited. This report describes the experience with 368 patients with AAAs who underwent treatment at four medical centers as part of an investigator-sponsored investigational device exemption trial.

Failure of endovascular aortoaortic tube grafts: a plea for preferential use of bifurcated grafts.

Objective: Aortoaortic tube graft repair was the first technique used for the endovascular treatment of abdominal aortic aneurysms (AAAs). However, progressive changes in the morphology of the distal aortic neck may be responsible for procedural failure. This study examines the use of aortoaortic tube prostheses and analyzes the factors that contributed to their failure and the methods used for their subsequent repair.