Increasing use of open conversion for late complications after endovascular aortic aneurysm repair.

Objective: Open procedures are often required for late complications after endovascular aneurysm repair (EVAR). Our aim was to describe the indications for open interventions and their postoperative outcomes and to specifically examine our experience with limited conversions in which problem endoleaks are targeted without endograft explantation.

Methods: We reviewed patients from 2002 to 2017 who underwent any surgical abdominal aortic operation after a previous EVAR.

Peroneal bypass versus endovascular peroneal intervention for critical limb ischemia.

Objective: The peroneal artery is a well-established target for bypass in patients with critical limb ischemia (CLI). The objective of this study was to evaluate the outcomes of peroneal artery revascularization in terms of wound healing and limb salvage in patients with CLI.

Methods: Patients presenting between 2006 and 2013 with CLI (Rutherford 4-6) and isolated peroneal runoff were included in the study.

Heel Wounds Predict Mortality but Not Amputation after Infrapopliteal Revascularization.

Background: Ischemic heel ulcerations are generally thought to carry a poor prognosis for limb salvage. We hypothesized that patients undergoing infrapopliteal revascularization for heel wounds, either bypass or endovascular intervention, would have lower wound healing rates and amputation-free survival (AFS) than patients with forefoot wounds.

Methods: A retrospective chart review was performed on patients who presented between 2006 and 2013 to our institution with ischemic foot wounds and infrapopliteal arterial disease and underwent either pedal bypass or endovascular tibial artery intervention.

Prior Endovascular Intervention Is Not Detrimental to Pedal Bypasses for Ischemic Wounds.

Background: Endovascular strategies are often preferred for revascularization of ischemic foot wounds secondary to infrapopliteal disease because of the less invasive technique and faster recovery. Bypass is typically reserved for failures or lesions not amenable to balloon angioplasty. However, the effects of an endovascular-first approach on subsequent bypass grafts are largely unknown.

Bypass versus endovascular intervention for healing ischemic foot wounds secondary to tibial arterial disease.

Objective: Pedal (inframalleolar) bypass is a long-standing therapy for tibial arterial disease in patients with ischemic tissue loss. Endovascular tibial intervention is an appealing alternative with lower risks of perioperative mortality or complications. Our objective was to compare the effectiveness of these two treatment modalities with respect to patency and limb-related clinical outcomes.

Serum VEGF and bFGF in patients with inflammatory bowel diseases.

Aim: The role of angiogenesis in inflammatory bowel diseases (IBD) remains controversial. We investigated the role of serum concentration levels of VEGF and bFGF in IBD patients and assessed their potential association to disease activity.

Patients And Methods: Blood samples were obtained from 40 IBD patients with moderate to severe attack of the disease and 40 healthy controls.

Percutaneous endovascular treatment of aortic aneurysms: clinical evaluation and literature results.

In this study we aimed to evaluate the efficiency of percutaneous endovascular aortic aneurysm repair (p-EVAR). Anatomically selected patients treated with a single 10Fr Perclose Prostar XL vascular closure device (VCD) were examined. Primary success rate and common femoral artery (CFA) open conversion (OC) requirement per sheath size used were recorded.

Hybrid open endovascular technique for aortic thoracoabdominal pathologies.

Background: Many authors using a hybrid debranching strategy for the treatment of thoracoabdominal pathologies have reported disappointing results and the initial enthusiasm for the technique has given way to criticism and ambiguity. The aim of the present meta-analysis study was to assess the safety and efficacy of the technique in patients with thoracoabdominal aortic aneurysms or other aortic pathologies.

Methods And Results: A multiple electronic search was performed on all articles describing hybrid open endovascular repair.

Retrograde transpopliteal approach of iliofemoral lesions.

Purpose: Aim of this study is to present our initial experience with the use of the retrograde popliteal artery access in patients with certain anatomic lesions.

Methods: Between September 2008 and September 2010, 24 patients underwent a transpopliteal retrograde subintimal recanalization. Instead of its usage when antegrade recanalization failed, the "facedown" technique was preferred as a first choice in patients with common femoral artery stenosis or occlusion, proximal lesions of the superficial femoral artery (SFA) with no stump, severe obesity, tandem iliac, and SFA lesions.

Endograft accommodation on the aortic bifurcation: an overview of anatomical fixation and implications for long-term stent-graft stability.

In light of the results of randomized trials, it seems that despite the favorable short and midterm outcomes of standard endografts, concern over endograft migration has escalated, as this event will be responsible for almost all late complications in endovascular aneurysm repair (EVAR). Migration forces, both caudal and sideways, depend heavily on blood pressure, inlet diameter, and angulation of the stent-graft, while the bifurcation generates more force than any other segment of the stent-graft. It thus seems that the position of the endograft's flow divider influences force distribution and migration risk.

Advances in assessment and management of carotid body tumors.

Evolving technology has the potential to alter the overall management of carotid body tumors (CBTs). We review our 35-year experience emphasizing on novel modalities available in the evaluation and treatment of CBTs. Medical records of 27 CBT patients between 1975 and 2009 were retrospectively reviewed.

Current role of biomarkers in carotid disease: a systematic review.

Background And Purpose: Accumulating evidence suggests that carotid plaque vulnerability can be used as a determinant of ischemic stroke risk stratification and carotid intervention. Novel markers of high-risk carotid plaque in patients are needed.

Summary Of Review: Advances in cellular and molecular pathophysiology, the demand for accurately predicting carotid risk, and choosing the optimal prevention strategy are stimulating great interest in the development of novel surrogate markers.

Conversion to open repair after endografting for abdominal aortic aneurysm: a review of causes, incidence, results, and surgical techniques of reconstruction.

Purpose: To review the incidence, causes, and mortality rates of early and late conversion to open surgery after endovascular aneurysm repair (EVAR) of abdominal aortic aneurysm (AAA).

Methods: A systematic search of the English-language literature from 2002 to 2009 was performed by interrogation of the PubMed, MEDLINE, and EMBASE databases. Studies were included if they: (1) had >100 patients treated with EVAR and (2) provided adequate data to calculate incidence and associated mortality rates.

Should the size threshold for elective abdominal aortic aneurysm repair be lowered in the endovascular era? No.

According to the current international guidelines, patients with infrarenal or juxtarenal abdominal aortic aneurysms (AAAs) measuring > or = 5.5 cm should undergo repair to reduce the risk of rupture. The 5.

An update on markers of carotid atherosclerosis in patients with Type 2 diabetes.

Carotid atherosclerosis constitutes an important cause of ischemic brain attack and stroke, accounting for up to 40% of cases of ischemic cerebrovascular disease. Type 2 diabetes mellitus is an independent risk factor for stroke and its recurrence. Thus, identifying diabetic patients who are at high risk of developing stroke is of great clinical importance.

Are symptomatic patients currently appropriate candidates for carotid artery stenting? Yes.

Most of the currently published randomized trials (RCTs) for carotid artery stenting (CAS) versus carotid endarterectomy (CEA) on symptomatic patients have concluded that CAS is associated with outcomes that are inferior to those of CEA. However, before final decision making on the future of CAS, there are some major issues of concern. Randomized controlled trials condemning CAS suffer from major study flaws, rendering comparison with CEA ineffective.

Endovascular repair of a persistent sciatic artery aneurysm.

Persistent sciatic artery (PSA), a persistent embryologic continuation of the internal iliac artery, represents a rare yet clinically important vascular anomaly. PSA is prone to aneurysmal change, which can subsequently lead to distal embolization, sciatic neuropathy, or rupture. The conventional surgical treatment of PSA aneurysms is commonly complex and carries the risk for sciatic nerve damage.

The hypothesis regarding the benefit of carotid endarterectomy under locoregional anesthesia in prevention of stroke may be unanswered.

A recent trial attempted to investigate the role of locoregional anesthesia (LA) in carotid endarterectomy (CEA) compared with general anesthesia. The hypothesis regarding the advantage of LA is based on the intraprocedural neurologic evaluation and the early identification of neurologic deficit. The trial has not demonstrated the superiority of the rocoregional anesthesia versus general anesthesia and revealed equal results concerning the prevention of stroke.

Medical students' perceptions on factors influencing a surgical career: the fate of general surgery in Greece.

Background: A decline of medical students' interest in a general surgery career is occurring in the Western medical world. We sought data on the mentality of Greek students toward specialty selection, and we determined whether trends indicated a decline in interest for general surgery in Greece.

Methods: A structured questionnaire was distributed to 3 groups of medical students: to pre-4th-year (group 1) surgical clerkship, post-4th-year (group 2) surgical clerkship, and post-6th-year internship students in surgery (group 3).

Protective effect of NAC preconditioning against ischemia-reperfusion injury in piglet small bowel transplantation: effects on plasma TNF, IL-8, hyaluronic acid, and NO.

Background: Ischemia-reperfusion (I/R) injury is one of the main factors affecting the function and structure of small bowel transplantation (SBT), by generation of proinflammatory mediators such as reactive oxygen species, reactive nitrogen species, cytokines, and endotoxin. Experimental data have demonstrated that N-acetylcysteine (NAC) attenuates intestinal I/R injury. The objective of this study was to determine the effect of NAC preconditioning on the SBT-I/R induced inflammatory cascade, with particular focus on TNF, IL-8, hyaluronic acid, and NO.

The Aorfix stent-graft to treat infrarenal abdominal aortic aneurysms with angulated necks and/or tortuous iliac arteries: midterm results.

Purpose: To present performance data on the use of the Aorfix stent-graft in patients with hostile infrarenal abdominal aortic aneurysm (AAA) anatomy.

Methods: A study protocol was designed to examine the safety and efficacy of the Aorfix endovascular stent-graft in AAA patients who had a proximal neck diameter between 18 and 30 mm, neck angulation between 60 degrees and 90 degrees , and/or severe iliac artery angulation/tortuosity. Between September 2005 and April 2009, 20 men (mean age 72.