Acute Aortocaval Fistula Secondary to Chronic Type 1 B Abdominal Aortic Aneurysm Endoleak.

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysms (AAA), involving less than 1% of all AAA and is associated with high morbidity and mortality; it is even more uncommon, following endovascular aneurysm repair. The clinical presentation can be variable and making the diagnosis can be difficult. It can present with symptoms and signs of an abdominal emergency or systemic hypoperfusion.

Variability in Noninvasive Vascular Laboratory Experience of Vascular Surgery Training Programs Based on Survey of Trainees Suggests the Need for a Standardized Curriculum.

Background: Although a Registered Physician in Vascular Interpretation certification is required for vascular surgery board certification, no standardized noninvasive vascular laboratory (NIVL) curriculum for vascular surgery trainees exists. The purpose of this study is to investigate the NIVL experience of trainees and understand what helps them feel well prepared.

Methods: Current trainees in all 0 + 5 and 5 + 2 vascular surgery training programs (114) were surveyed.

Ultrasound-Guided Thrombin Injection Is a Safe and Effective Treatment for Femoral Artery Pseudoaneurysm in the Morbidly Obese.

Introduction: Ultrasound-guided thrombin injection (UGTI) is a well-established practice for the treatment of femoral artery pseudoaneurysm. This procedure is highly successful but dependent on appropriate pseudoaneurysm anatomy and adequate ultrasound visualization. Morbid obesity can present a significant technical challenge due to increased groin adiposity, resulting in poor visualization of critical structures needed to safely perform the procedure.

Preoperative antiplatelet use does not increase incidence of bleeding after major operations.

Background: This study examined the outcomes of patients holding or continuing clopidogrel during the preoperative period.

Methods: We reviewed all patients taking clopidogrel who underwent one of 72 different Current Procedural Terminology code procedures, representing major emergency and elective general thoracic and vascular operations from 2009-2012 at a single institution. Demographics, comorbidities, aspirin use, details of coronary stents, and perioperative events were collected.

Quantification of abdominal aortic aneurysm stiffness using magnetic resonance elastography and its comparison to aneurysm diameter.

Objective: Abdominal aortic aneurysm (AAA) wall stiffness has been suggested to be an important factor in the overall rupture risk assessment compared with anatomic measure. We hypothesize that AAA diameter will have no correlation to AAA wall stiffness. The aim of this study is to (1) determine magnetic resonance elastography (MRE)-derived aortic wall stiffness in AAA patients and its correlation to AAA diameter; (2) determine the correlation between AAA stiffness and amount of thrombus and calcium; and (3) compare the AAA stiffness measurements against age-matched healthy individuals.

Can the Anesthesiologist Use the Radial Artery for Monitoring After Transradial Artery Catheterization?

The use of transradial coronary angiography and intervention is growing because of its advantages over the femoral approach. However, the small size of the radial artery can contribute to complications. We present a case of an in situ access complication of transradial coronary artery catheterization.

The EPIC nitinol stent system in the treatment of iliac artery lesions: one-year results from the ORION clinical trial.

Purpose: To report the 1-year results of a pivotal study for a new-generation nitinol stent for the treatment of iliac atherosclerotic lesions.

Methods: The ORION trial (ClinicalTrials.gov identifier NCT00896337) was a single-arm, non-randomized, prospective, multicenter clinical trial that enrolled 125 patients (81 men; mean age 61.

Essentials of negotiating for employment in a changing environment.

Evolving changes in health care in the United States are causing new graduates and self-employed physicians to consider employment with large groups and health systems. Familiarity with the principles, proper conduct, and mechanics of negotiating an employment agreement will be important for vascular surgeons making such a decision. The various components of compensation packages and contract language need to be critically evaluated.

Endovascular abdominal aortic aneurysm repair in patients with ventricular assist devices.

Long-term mechanical circulatory support devices are currently an established therapy for the management of end-stage heart failure, and current evidence supports their superiority in comparison to maximal medical therapy in these patients. Screening for peripheral arterial disease and abdominal aortic aneurysm (AAA) before left ventricular assist device (LVAD) implantation is recommended. Although repair of AAA before or during LVAD placement has been reported, management of patients with AAA after LVAD implantation needs to be further investigated.

Penetration of the inferior vena cava and adjacent organs after filter placement is associated with retrievable filter type and length of time in place.

Objective: Concern over local complications of inferior vena cava (IVC) filters exists, but little long-term data are available. Referrals for filter penetrations on computed tomography (CT) have increased with no standards for management. We reviewed postfilter CT findings in our institution.

Advanced malignant mesothelioma mimicking acute contained thoracic aortic rupture.

In the emergent setting, patients presenting with acute interscapular pain along with haemodynamic instability require immediate evaluation. We describe the case of a patient in which computed tomographic scanning demonstrated a large hyper-dense, periaortic collection on post-contrast imaging. Urgent endovascular repair was performed for descending thoracic aortic rupture.

Abdominal aortic aneurysms in women.

Abdominal aortic aneurysms have an incidence that is approximately four to six times higher in men than in women. However, the incidence in women also rises with older age, although starting later in life than in men. There are also sex differences in the risk of rupture and in outcomes after endovascular and open abdominal aortic aneurysm repair.

Diseases of the thoracic aorta in women.

Women have now equaled or surpassed men in the number of cardiovascular deaths per year in published statistics. In 2006, according to the National Center for Health Statistics and the Center for Disease Control, cardiovascular disease was the cause of death in 428,906 women (35% of all deaths in women) and in 394,840 men (33% of all deaths in men). Of those numbers, it was estimated that 5506 women (0.

External iliac artery stenting: high incidence of concomitant revascularization procedures.

Objectives: To review immediate results, patency rates, hemodynamic success, and incidence of concomitant procedures with external iliac artery stenting (EIAS).

Methods: Demographic features, category and clinical grade, Trans-Atlantic Inter-Society Consensus II classification lesion type, pre- and postprocedure ankle-brachial indices, and primary patency were compared between group 1 (EIAS without distal revascularization) and group 2 (EIAS with concomitant distal revascularization).

Results: No mortality and a 100% immediate technical success rate was recorded in group 1 (n = 12) and group 2 (n = 24).

On the horizon: what's coming next for lower extremity interventions.

Multiple endovascular interventions exist for the treatment of lower extremity peripheral arterial disease (PAD), with some exhibiting better outcomes than others. As these procedures become more numerous and accepted, the type of interventionalist providing the care is changing. Despite advances in technology and techniques, there are many obstacles to overcome in order to improve the treatment of patients with vascular disease.

Endograft infection presenting as a ruptured aortic aneurysm.

Aortic endograft procedures have become commonplace. Fortunately, infection of endografts remains rare, with an incidence <0.5%.

Economic evaluation of carotid artery stenting versus carotid endarterectomy for the treatment of carotid artery stenosis.

Background: The clinical effectiveness of carotid endarterectomy (CEA) is well established. But the economic impact of CEA and carotid artery stenting (CAS) is still uncertain. The objective of this study was to compare hospital costs and reimbursement for CAS and CEA.

Use of an endovascular occlusion balloon for control of unremitting venous hemorrhage.

This report describes a new approach for management of iliac vein injury. These injuries are often difficult to expose, and the associated hemorrhage further hinders visualization and subsequent repair. In this case, the use of an endovascular balloon from groin access controlled venous hemorrhage and permitted a primary repair of a torn left iliac vein.