A Case of Primary Aortoduodenal Fistula and Abdominal Aortic Aneurysm in a Patient with Chronic Q Fever.

A 70-year-old man was successfully treated for an aortoduodenal fistula originating from a Q fever-related abdominal aortic aneurysm. He had no known history of contact with cattle or sheep. Although the combination of abdominal aortic aneurysm and aortoduodenal fistula is rare, one should be suspicious of Q fever infection as the causative agent, and additional medical treatment should be initiated.

Reduction of residual limb volume in people with transtibial amputation.

The early postoperative phase after transtibial amputation is characterized by rapid residual limb volume reduction. Accurate measurement of residual limb volume is important for the timing of fitting a prosthesis. The aim of this study is to analyze the reduction of residual limb volume in people with transtibial amputation and to correlate residual limb volume with residual limb circumference.

Cyanoacrylate skin microsealant for preventing surgical site infection after vascular surgery: a discontinued randomized clinical trial.

Background: Surgical site infections (SSI) after vascular surgery are related to substantial morbidity. Restriction of bacterial access to the site of surgery with a cyanoacrylate sealant is a new concept. We performed a randomized clinical trial to assess the effect of the sealing of skin with a cyanoacrylate preparation at the site of surgery on the incidence of SSI after arterial reconstruction.

A limited and customized follow-up seems justified after endovascular abdominal aneurysm repair in octogenarians.

Objective: The objective of this study was to determine whether long-term follow-up after endovascular aneurysm repair (EVAR) is justified in octogenarians.

Methods: Between September 1996 and October 2011, all patients, including octogenarians, treated for an abdominal aortic aneurysm (AAA) by EVAR were included in a prospective database. Patients older than 80 years and with a nonruptured infrarenal aneurysm treated electively or urgently were included in the study (study group [SG]).

Critical factors in the translation of improved antimicrobial strategies for medical implants and devices.

Biomaterials-associated infection incidence represents an increasing clinical challenge as more people gain access to medical device technologies worldwide and microbial resistance to current approaches mounts. Few reported antimicrobial approaches to implanted biomaterials ever get commercialized for physician use and patient benefit. This is not for lack of ideas since many thousands of claims to new approaches to antimicrobial efficacy are reported.

Safety and efficacy of carotid endarterectomy in octogenarians.

Background: To evaluate the outcome of carotid endarterectomy (CEA) in octogenarians.

Method: Between January 2005 and July 2010, all CEA patients were prospectively recorded. Patients were categorized into those <80 and ≥80 years of age.

Biomaterial-associated infection: locating the finish line in the race for the surface.

Biomaterial-associated infections occur on both permanent implants and temporary devices for restoration or support of human functions. Despite increasing use of biomaterials in an aging society, comparatively few biomaterials have been designed that effectively reduce the incidence of biomaterial-associated infections. This review provides design guidelines for infection-reducing strategies based on the concept that the fate of biomaterial implants or devices is a competition between host tissue cell integration and bacterial colonization at their surfaces.

The relevance of aortic endograft prosthetic infection.

Background: Vascular prosthetic graft infection is a severe complication after open aortic aneurysm repair. Reports of infected endografts are scarce. General treatment consensus with infected graft material is that it should be removed completely.

Effectiveness of treatment for octogenarians with acute abdominal aortic aneurysm.

Objective: To investigate whether advanced age may be a reason to refrain from treatment in patients with an acute abdominal aortic aneurysm (AAAA).

Methods: This was a retrospective cohort study that took place in a tertiary care university hospital with a 45-bed intensive care unit. Two hundred seventy-one patients with manifest AAAA, admitted and treated between January 2000 and February 2008, were included.

Stent fractures in the Hemobahn/Viabahn stent graft after endovascular popliteal aneurysm repair.

Objective: During the last decade, endovascular repair of popliteal artery aneurysms (PAAs) has become a valid alternative to open repair. This study analyzes the incidence and origin of stent graft fractures after endovascular repair, its impact on patency, and strategies to prevent fractures.

Methods: Data of 78 atherosclerotic PAAs in 64 patients were gathered in a prospectively-held database from 1998 to 2009.

Conservative treatment of vascular prosthetic graft infection is associated with high mortality.

Background: The aim of this study was to identify patient-related and/or disease-related factors that influence outcomes in patients with vascular prosthetic graft infections.

Methods: Through the hospital patient administration system, between January 1997 and December 2007, a total of 44 patients were diagnosed with central prosthetic graft infections. Univariate and multivariate analyses were performed to define factors predictive of mortality.

Overestimation of contralateral internal carotid artery stenosis before ipsilateral surgical endarterectomy.

Objective: The aim of this study was to investigate a possible overestimation of the degree of contralateral carotid artery stenosis by duplex in patients with significant bilateral carotid stenoses who are to undergo carotid endarterectomy (CEA).

Methods: A retrospective analysis was performed of all patients undergoing CEA in our center over a period of 11 years. Pre- and postoperative duplex ultrasonography measurements of peak systolic velocity (PSV) and end diastolic velocity (EDV) were compared and used to classify the degree of stenosis.

Conventional or endovascular treatment of ongoing mycotic aortic aneurysmal disease?

We report a case in which conventional and endovascular exclusion techniques were used to treat ongoing mycotic aortic aneurysmal disease. A 51-year-old man presented with an infrarenal mycotic aortic aneurysm that was excluded and reconstructed with a superficial femoral vein. Two years later, he developed a symptomatic mycotic aneurysm of the descending thoracic aorta, which required emergent treatment with a stent graft.

A modified technique for iliac artery branched endografting using a "tromboned" sheath.

The iliac branched device (IBD) is the only totally endovascular option to preserve flow to the internal iliac artery for the treatment of aorto-iliac or solitary iliac artery aneurysms. This technique involves the use of two parallel guide wires, including the indwelling through-and-through wire and a wire to introduce the bridging stent-graft. We describe a technique which uses "tromboned" sheaths (ie, a 7F ANL 1 inside a 10F Balkin sheath) for increased cross-over stability and avoids problems associated with the use of parallel wires inside one sheath.

Changes in laboratory values and their relationship with time after rupture of an abdominal aortic aneurysm.

Purpose: Many laboratory values are abnormal after surgery for a ruptured abdominal aortic aneurysm (RAAA). However, these changes have not been comprehensively evaluated. We analyzed the changes in routine laboratory values and how these changes related to outcome in a consecutive series of RAAA patients.

Myopathy in CRPS-I: disuse or neurogenic?

The diagnosis Complex Regional Pain Syndrome type I (CRPS-I) is based on clinical symptoms, including motor symptoms. Histological changes in muscle tissue may be present in the chronic phase of CRPS-I. Aim of this study was to analyze skeletal muscle tissue from amputated limbs of patients with CRPS-I, in order to gain more insight in factors that may play a role in changes in muscles in CRPS-I.

Long-term locoregional vascular morbidity after isolated limb perfusion and external-beam radiotherapy for soft tissue sarcoma of the extremity.

Background: Isolated limb perfusion (ILP) with tumor necrosis factor alpha (TNF-alpha) and melphalan, followed by delayed surgical resection and adjuvant external-beam radiotherapy is a limb salvage treatment strategy for locally advanced soft tissue sarcomas. The long-term vascular side effects of this combined procedure were evaluated.

Methods: Thirty-two patients were treated for a locally advanced sarcoma of the upper (n = 5) or lower limb (n = 27).

Emergency endovascular stent grafting for thoracic aortic pathology.

Our aim was to report single-center results of emergency endovascular treatment for thoracic aortic disease. From March 1998 to January 2006, 30 acute thoracic EVAR procedures were carried out in 29 patients. One patient received two procedures in different settings.

Is emergency endovascular aneurysm repair associated with higher secondary intervention risk at mid-term follow-up?

Objective: The study assessed mid-term outcome of emergency endovascular repair for acute infrarenal abdominal aortic aneurysms, with special attention to secondary interventions.

Methods: Between May 1998 and August 2005, 56 patients underwent emergent endovascular repair for a ruptured abdominal aortic aneurysm (n = 34) or an acute nonruptured abdominal aortic aneurysm (n = 22). During the same period, 322 consecutive patients underwent elective endovascular aneurysm repair and were used as control group.

HLA-DR expression on monocytes and systemic inflammation in patients with ruptured abdominal aortic aneurysms.

Introduction: Mortality from ruptured abdominal aortic aneurysms (RAAA) remains high. Severe systemic inflammation, leading to multi-organ failure, often occurs in these patients. In this study we describe the level of HLA-DR expression in a consecutive group of patients following surgery for RAAA and compare results between survivors and non-survivors.

Mid-term results of endovascular aneurysm repair with branched and fenestrated endografts.

Purpose: The technique of fenestrated and branched endovascular aneurysm repair (EVAR) has been used for the treatment a variety of aortic aneurysms. Although technically successful, longer-term results have been lacking. This article reports on the mid-term results of aneurysm repair with fenestrated and branched endografts from a European center with a large endovascular experience.

Expanding use of nonpenetrating clips in various surgical specialities.

The Anastoclip Vessel Closure System (VCS) (LeMaitre Vascular, Burlington, MA, USA), introduced primarily to facilitate microvascular anastomoses performed during neurosurgical extra-intracranial bypasses, has been used for several other applications as well. The relatively new anastomotic technique includes a clip applier, clip remover, and everting forceps. With the applier, tiny nonpenetrating titanium clips were installed on everted walls of tubular structures.

Endovascular treatment of iliac artery aneurysms with a tubular stent-graft: mid-term results.

Objective: To report the mid term results of a prospective cohort of iliac artery aneurysms (IAAs) treated with endovascular tubular stent-grafts.

Methods: All IAAs referred to the University Medical Center Groningen between June 1998 and June 2005 were evaluated for endovascular repair. Criteria for repair were a diameter of > or = 30 mm for anastomotic aneurysms and > or = 35 mm for true aneurysms.

Thoracic stent grafts with a distal fenestration for the celiac axis.

Descending thoracic aneurysms can be treated with a stent graft provided that there is sufficient proximal and distal aortic neck length above the celiac axis. One of the options for the treatment of thoracic aneurysms with a too short distal neck is described in this report. For this purpose, a stent graft was constructed with a scallop for the celiac axis.