Midterm outcome after the distal revascularization and interval ligation (DRIL) procedure.

Background: The distal revascularization and interval ligation (DRIL) procedure has evolved as the optimal treatment for access-related hand ischemia despite concerns about its durability. This study was designed to review our institutional experience and objectively define its mid-term outcome.

Methods: A retrospective review of all patients undergoing the DRIL procedure was performed.

Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the Preclose technique.

Objective: Percutaneous access during endovascular aortic repair has been shown to be feasible and safe using a suture-mediated closure device ("Preclose" technique) for closure of up to 24F introducer sheaths. The purpose of this study is to examine the late outcomes of those femoral arteries repaired in this manner.

Methods: The Preclose technique has been previously described.

Impact of endograft design and product line on the device cost of endovascular aneurysm repair.

Objective: Device cost is a substantial component of the overall cost of endovascular abdominal aneurysm repair (EVAR), and the four commercially available devices differ significantly in the cost of their basic configuration. This study examined the impact of three different endografts and their product lines on the overall cost of repair.

Methods: Implant records of 467 EVAR procedures performed during 2000 through 2006 were reviewed.

Early results after staged hybrid repair of thoracoabdominal aortic aneurysms.

Background: The morbidity and mortality rates associated with open thoracoabdominal aortic aneurysm (TAAA) repair are substantial. This study was designed to review our early experience with the hybrid endovascular and, or open approach for TAAA repair.

Study Design: Patients undergoing elective hybrid repair of their TAAAs were retrospectively reviewed.

Risk factors for perioperative stroke during thoracic endovascular aortic repairs (TEVAR).

Purpose: To determine the clinical and anatomical risk factors for cerebrovascular accidents (CVA) in patients undergoing thoracic endovascular aortic repair (TEVAR).

Methods: Between September 2000 and December 2006, 196 patients (135 men; mean age 68.6+/-13.

Genomic and proteomic determinants of lower extremity revascularization failure: rationale and study design.

This translational research program applies a working model of advanced functional genomics/proteomics and bioinformatics to human peripheral arterial occlusive disease (PAOD). It is a multidisciplinary collaborative effort of clinicians, scientists, and statisticians with an advisory panel consisting of experts in inflammation biology, vascular biology, molecular genetics, bioinformatics, clinical trial design, and epidemiology. The proposed human initiative is designed to study 300 symptomatic patients with PAOD undergoing medical management with or without vascular intervention by lower extremity angioplasty/stenting or vein graft bypass.

Perioperative differences between endovascular repair of thoracic and abdominal aortic diseases.

Background: With the US Food and Drug Administration approval of the TAG thoracic device, more thoracic pathologies are being treated using endovascular techniques. Although endovascular abdominal and thoracic aortic repairs have some apparent similarities, there are substantive anatomic, pathologic, and technical differences that could impact perioperative outcomes. The purpose of this study is to identify these differences.

Outcome after hypogastric artery bypass and embolization during endovascular aneurysm repair.

Background: Multiple strategies have been devised to extend the applicability of endovascular aneurysm repair (EVAR) in patients with common iliac artery (CIA) aneurysms. This study was designed to examine outcome in patients undergoing EVAR with either hypogastric artery embolization or common iliac artery bifurcation advancement by hypogastric bypass.

Methods: A retrospective review of all patients undergoing EVAR since the inception of our program (1997-2006) was performed.

Late type III endoleak from graft erosion of an Excluder stent graft: a case report.

We report a case of a late type III endoleak from a hole in the expanded polytetrafluoroethylene graft material of an Excluder bifurcated stent-graft approximately 12 months after implantation. The endoleak was successfully repaired by relining the defect site with an Excluder iliac limb. To our knowledge, this is the first reported case of late graft-material related Type III endoleak involving the Excluder device.

Outcome after autogenous brachial-axillary translocated superficial femoropopliteal vein hemodialysis access.

Objective: The optimal configuration for patients with "complex" or "tertiary" hemodialysis access needs remains undefined. This study was designed to examine the utility of the autogenous brachial-axillary translocated superficial femoropopliteal vein access (SFV ACCESS) in this subset of patients.

Methods: Patients presenting for permanent hemodialysis access without a suitable upper extremity vein for autogenous access identified by duplex ultrasound mapping and those with repeated prosthetic access failures were considered candidates for SFV ACCESS.

Impact of endovascular repair on early outcomes of ruptured abdominal aortic aneurysms.

Objective: Our purpose was to examine the impact of the introduction of endovascular treatment on the early outcomes of ruptured abdominal aortic aneurysms (AAAs) during 2 consecutive time periods at a single institution.

Methods: The hospital records of a single tertiary care center from 1997 to 2004 were retrospectively reviewed, and 36 consecutive patients who underwent treatment for acute ruptured AAA were identified. They were divided into 19 (53%) patients who were all treated with conventional open surgery from 1997 to 2001 (early) and 17 (47%) patients who were treated either with open (n = 4, 24%) or endovascular (n = 13, 76%) methods from 2002 to 2004 (late).

Twenty-one cases of aortoenteric fistula: lessons for the general surgeon.

We retrospectively reviewed our experience from 1984 to 2001 with 21 cases of aortoenteric fistula (AEF) in 19 patients. The majority of cases were in men (13 of 19, 68%). One AEF was spontaneous, the other 20 developed after prior vascular reconstruction (95%).

Genomic and proteomic determinants of outcome in patients undergoing thoracoabdominal aortic aneurysm repair.

Thoracoabdominal aortic aneurysm repair, with its requisite intraoperative mesenteric ischemia-reperfusion, often results in the development of systemic inflammatory response syndrome, multiorgan dysfunction syndrome (MODS), and death. In the present study, an adverse clinical outcome following thoracoabdominal aortic aneurysm repair was identified by blood leukocyte genomic and plasma proteomic responses. Time-dependent changes in the expression of 146 genes from blood leukocytes were observed (p < 0.

Evidence-based data for the hemodialysis access surgeon.

The National Kidney Foundation Dialysis Outcomes Quality Initiative Clinical Practice Guidelines for Vascular Access (DOQI) have defined the access-related care for patients with end-stage renal disease (ESRD). However, the standard of care across the country has fallen short of the DOQI targets. One potential explanation for these shortcomings is the lack of compelling evidence in the literature to support the recommendations.

Perioperative outcomes after open and endovascular repair of intact abdominal aortic aneurysms in the United States during 2001.

Objective: Small patient numbers, mixed data from clinical trials, and longitudinal series representing institutional learning curves have characterized previous studies of early outcomes after endovascular abdominal aortic aneurysm (AAA) repair. We compared the perioperative outcomes of endovascular and open surgical AAA repair in an unselected sample of patients in a single calendar year using a national administrative database.

Methods: The 2001 National Inpatient Sample database was retrospectively reviewed.

Patency of autogenous and polytetrafluoroethylene upper extremity arteriovenous hemodialysis accesses: a systematic review.

Objective: Patency rates for autogenous accesses are presumed to be better than for polytetrafluoroethylene (PTFE) accesses, although the strength of the supporting evidence is limited. We undertook this study to test the hypothesis that patency rates for upper extremity autogenous hemodialysis arteriovenous accesses in adults are superior to those for PTFE counterparts.

Methods: A systematic review of relevant literature and meta-analysis of the patency data were performed.

Morbidity with retroperitoneal procedures during endovascular abdominal aortic aneurysm repair.

Purpose: Retroperitoneal iliac procedures can enable successful endovascular repair of abdominal aortic aneurysm (AAA) in patients who otherwise would not be anatomically eligible. The purpose of this study was to determine perioperative outcome with adjunctive retroperitoneal procedures compared with standard bilateral femoral exposure.

Methods: Between August 1997 and November 2002, 164 patients underwent elective endovascular AAA repair at a single university medical center.

Role of endogenous interleukin-10 in local and distant organ injury after visceral ischemia-reperfusion.

The anti-inflammatory cytokine interleukin (IL)-10 has been detected in serum after visceral ischemia-reperfusion injury and exogenous IL-10 administration has been shown to attenuate the associated distant organ injury. This study was designed to examine the role that endogenous IL-10 production plays on both local and distant organ injury after visceral ischemia-reperfusion injury. Wild-type and IL-10(-/-)-null C57BL/6 mice were subjected to 20 min of supraceliac aortic occlusion or sham laparotomy.

Approach to patients with "complex" hemodialysis access problems.

The approach to patients with "complex" permanent hemodialysis (HD) access problems remains poorly defined. The purpose of this review is to outline our current algorithm for patients presenting for dialysis access and to address the management of specific problems that complicate this objective of establishing permanent access. The key components of the algorithm include noninvasive imaging in the diagnostic vascular laboratory to determine all the possible access configurations and invasive imaging with both venography and arteriography to confirm the optimal choice.

Eligibility rates of ruptured and symptomatic AAA for endovascular repair.

Purpose: To determine the anatomical eligibility rate for endovascular repair of ruptured and symptomatic abdominal aortic aneurysms (AAA) using commercially available endografts.

Methods: In a retrospective review, 28 preoperative computed tomographic (CT) scans were examined from among 83 patients who underwent surgical repair of a ruptured or acutely symptomatic AAA at a university-based tertiary care center during the past 10 years. The proximal aortic neck, aneurysm, and iliac dimensions were compared to corresponding measurements from 100 preoperative CT scans from patients who underwent elective repair of asymptomatic AAA.

Prospective validation of an algorithm to maximize native arteriovenous fistulae for chronic hemodialysis access.

Objective: The purpose of this study was to evaluate an algorithm to maximize native arteriovenous fistulae (AVF) for hemodialysis access.

Methods: The prospective study design was set in an academic, tertiary care medical center. The study subjects were adults referred for permanent, upper extremity hemodialysis access between April 1999 and May 2001.

A technique for combined hypogastric artery bypass and endovascular repair of complex aortoiliac aneurysms.

Endovascular repair of complex aortoiliac aneurysms may necessitate distal fixation of the endograft to the external iliac artery and percutaneous embolization of the hypogastric artery for prevention of a retrograde endoleak. However, acute interruption of hypogastric perfusion can result in symptoms of pelvic ischemia. We describe a technique in which a prosthetic graft is used as an external iliac artery conduit to facilitate the passage of the endograft delivery catheter/sheath and after completion of the endovascular portion of the procedure, a surgical bypass is completed with anastomosis of the graft to the hypogastric artery.