Intraluminal abdominal aortic aneurysm thrombus is associated with disruption of wall integrity.

Objective: An association of intraluminal thrombus (ILT) with abdominal aortic aneurysm (AAA) growth has been suggested. Previous in vitro experiments have demonstrated that aneurysm-associated thrombus may secrete proteolytic enzymes and may develop local hypoxia that might lead to the formation of tissue-damaging reactive oxygen species. In this study, we assessed the hypothesis that ventral ILT thickness is associated with markers of proteolysis and with lipid oxidation in the underlying AAA vessel wall.

Platelets enter atherosclerotic plaque via intraplaque microvascular leakage and intraplaque hemorrhage: a histopathological study in carotid plaques.

Background: Platelets foster an inflammatory environment that influences atherosclerotic lesion progression and facilitates plaque rupture, in addition to their role in acute thrombus formation. The route of entry of platelets into the atherosclerotic plaque and their exact location inside the plaque are however not completely understood.

Methods And Results: 188 carotid plaques were examined for the presence of platelets using immunohistochemistry (CD42b), and 76/188 (40.

Clinical prediction rule to estimate the absolute 3-year risk of major cardiovascular events after carotid endarterectomy.

Background And Purpose: Prognosis after carotid endarterectomy is mainly determined by the occurrence of major adverse cardiovascular events (MACEs). Optimal medical treatment to reduce risk is the mainstay of MACE prevention. The level of risk of MACE may determine the initiation and aggressiveness of medical treatment, yet a prediction rule to assess that absolute MACE risk after carotid endarterectomy is currently unavailable.

Atherosclerotic plaque biomarkers: beyond the horizon of the vulnerable plaque.

Cardiovascular disease (CVD) is the number one cause of death globally, and the majority of CVD is caused by atherosclerosis. Atherosclerosis is a systemic inflammatory disease that leads to myocardial infarction, stroke and lower limb ischemia. Pathological studies have given insight to development of atherosclerosis and the importance of local plaque vulnerability, leading to thrombus formation and cardiovascular events.

Endovascular retrieval of a dislodged femoral arterial closure device with Alligator forceps.

The Angio-Seal (St. Jude Medical, Minnetonka, Minn) is a frequently used percutaneous femoral artery closure device to obtain hemostasis after arterial catheterization. Separation and migration of the device, leading to distal embolization and limb-threatening ischemia necessitating emergency surgery, is reported but extremely rare.

Sideways displacement of the endograft within the aneurysm sac is associated with late adverse events after endovascular aneurysm repair.

Objective: Previous studies have shown the importance of proximal and distal endograft fixation. There is little information on the middle, unsupported section of endograft within the aneurysm sac. We quantified sideways movement of the endograft within the aneurysm sac and correlated it to late adverse events.

Fenestrated endograft repair of suprarenal aortic patch aneurysm in a patient with Marfan syndrome.

We present a case of a 4-fenestrated endograft repair of a suprarenal aortic patch aneurysm as useful alternative for complex open reoperation in a patient with Marfan syndrome.

Superior mesenteric artery stent fracture leading to recurrent mesenteric ischemia.

We report 2 cases of patients with recurrent symptoms of mesenteric ischemic disease after percutaneous transluminal angioplasty (PTA) and stenting due to superior mesenteric artery stent fracture. Both patients were treated by redo PTA and stenting successfully. Stent fractures, their complications, and management are discussed.

The durability of endovascular repair of para-anastomotic aneurysms after previous open aortic reconstruction.

Introduction: Anastomotic pseudoaneurysms and true para-anastomotic aneurysms after initial open abdominal aortic prosthetic reconstruction often need reintervention because they are at risk for rupture. However, open surgical reinterventions are technically challenging procedures with high mortality and morbidity rates. In the present multicenter study, we describe the long-term clinical course in an expanded number of patients who underwent endovascular repair of para-anastomotic aneurysms after previous open reconstruction.

Circumferential heterogeneity in the abdominal aortic aneurysm wall composition suggests lateral sides to be more rupture prone.

Objective: The purpose of this study was to identify local differences in inflammation and tissue degradation within the circumference of the abdominal aortic aneurysm (AAA).

Background: AAAs have the potential to rupture, and it is unknown why this predominantly occurs at the posterolateral wall. Blood flow dynamics likely influence rupture location but do not explain the whole picture, suggesting that other factors inside the AAA wall have a prominent role.

Different stages of intraplaque hemorrhage are associated with different plaque phenotypes: a large histopathological study in 794 carotid and 276 femoral endarterectomy specimens.

Background And Purpose: Intraplaque hemorrhage (IPH) is an important determinant of progression and destabilization of atherosclerotic plaque. We recently demonstrated that IPH is an independent predictor of cardiovascular events. IPH has become more clinically relevant since magnetic resonance imaging (MRI) technique is able to visualize IPH in vivo.

[Endovenous mechanochemical ablation for varicose veins--a new endovenous technique without tumescent anaesthesia].

In the past decades, endovenous techniques have played an increasingly important role in the treatment of varicose veins. The method of action of these techniques is based on heat, making tumescent anesthesia necessary. Despite this anesthesia, heat-induced complications such as skin burns, nerve damage and prolonged pain may occur.

Atherosclerotic plaque vulnerability as an explanation for the increased risk of stroke in elderly undergoing carotid artery stenting.

Background And Purpose: Recent randomized trials showed an increased periprocedural risk for stroke with increasing age in patients undergoing carotid artery stenting. Manipulation of atherosclerotic plaques during carotid artery stenting can result in plaque rupture with subsequent superimposed thrombus formation, embolization, and cerebrovascular events. We hypothesized that atherosclerotic plaques become more unstable with increasing age and thereby might provide insight into the age-related increased risk of cerebrovascular events during carotid artery stenting.

Advancements in catheter-directed ultrasound-accelerated thrombolysis.

Purpose: To review all available literature on catheter-directed ultrasound-accelerated thrombolysis for peripheral artery occlusions, stroke, deep venous thrombosis, and pulmonary embolism.

Methods: A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. A total of 77 reports focusing on catheter-delivered ultrasound-accelerated thrombolysis were identified.

Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study.

Purpose: To evaluate the feasibility and safety of endovenous mechanochemical ablation (MOCA) for the treatment of great saphenous vein (GSV) incompetence.

Methods: The newly developed ClariVein device uses a technique that combines mechanical endothelial damage using a rotating wire with the infusion of a liquid sclerosant. Heating of the vein and tumescent anesthesia are not required; only local anesthesia is utilized at the insertion site.

Variations in anatomy of the popliteal artery and its side branches.

Knowledge of anatomic variations of the popliteal artery is essential for the management of peripheral vascular disease and in orthopedic surgery. The aim of this study was to perform an overview of the literature describing variations of the popliteal artery. To identify relevant literature, we performed a systematic search on MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews.

One-year multicenter results of 100 abdominal aortic aneurysm patients treated with the Endurant stent graft.

Objective: The Endurant (Medtronic, Minneapolis, Minn) is a new stent graft specifically designed to make more patients anatomically eligible for endovascular aneurysm (EVAR). This study presents the 1-year results of 100 consecutive patients with abdominal aortic aneurysms (AAAs) treated with the Endurant stent graft in real-life practice.

Methods: All clinical preoperative, operative, postoperative, and 1-year follow-up data of patients with the Endurant stent graft from three tertiary centers were prospectively collected.

Initial results of catheter-directed ultrasound-accelerated thrombolysis for thromboembolic obstructions of the aortofemoral arteries: a feasibility study.

Purpose: This article reports the 30-day technical and clinical outcome of ultrasound (US)-accelerated thrombolysis in patients with aortofemoral arterial thromboembolic obstructions.

Methods: A prospective cohort study was conducted from December 2008 to December 2009 of patients who were treated with US-accelerated thrombolysis for thromboembolic obstructions of aortofemoral arteries or bypasses. Urokinase was infused in a dosage of 100,000 IU per hour.

Longer time interval between carotid cross-clamping and shunting is associated with increased 30-day stroke and death rate.

Background: The benefit of carotid endarterectomy (CEA) in patients with a significant (>70%) (a)symptomatic stenosis has been proven thoroughly in major trials. It is unknown whether, after cross-clamping the carotid artery, the time interval between determination that a shunt is needed and the actual functioning of the shunt, defined as the need for shunt-to-shunt time (NST), influences 30-day morbidity and mortality rate after CEA.

Methods: Experienced vascular surgeons performed 851 CEAs with a selective shunting protocol based on perioperative transcranial Doppler measurement and electroencephalographic findings, and data were analyzed retrospectively.

Toll-like receptor 2 and 4 stimulation elicits an enhanced inflammatory response in human obese patients with atherosclerosis.

The innate immune response elicited by activation of TLRs (Toll-like receptors) plays an important role in the pathogenesis of atherosclerosis. We hypothesized that cardiovascular risk factors are associated with the activation status of the innate immune system. We therefore assessed the responsiveness of TLRs on circulating cells in two groups of patients with established atherosclerosis and related this to the presence of cardiovascular risk factors.

The effect of alcohol on atherosclerotic plaque composition and cardiovascular events in patients with arterial occlusive disease.

Objectives: This study examined the association between alcohol use, the occurrence of cardiovascular events, and plaque phenotype in patients after femoral or carotid endarterectomy for arterial occlusive disease. Alcohol has been shown to have cardiovascular protective effects in patients with cardiovascular disease as well as in healthy individuals. Whether alcohol consumption induces changes in atherosclerotic plaque composition has not been investigated.

Restenosis after carotid surgery: the importance of clinical presentation and preoperative timing.

Background And Purpose: Carotid endarterectomy (CEA) of stable atherosclerotic plaques is associated with an increased risk for restenosis. Patients with transient ischemic attack and patients with and stroke have relatively unstable atherosclerotic plaques. However, carotid plaques stabilize over time after a cerebrovascular event due to plaque repair after rupture.

Carotid endarterectomy for treatment of in-stent restenosis after carotid angioplasty and stenting.

Objective: Carotid angioplasty and stenting (CAS) has emerged as an alternative for carotid endarterectomy (CEA) in the prevention of stroke. The benefit of the procedure, however, is hampered by a suggested higher incidence of in-stent restenosis (ISR) for CAS relative to CEA during follow-up. ISR management remains a challenge for clinicians.