Vibrational angioplasty in recanalization of chronic femoropopliteal arterial occlusions: single center experience.

Purpose: This prospective study aims to present the overall success rate, safety and long-term outcome of vibrational angioplasty technique, in the treatment of chronic total femoropopliteal occlusions in our institute.

Methods: Between October 2000 and December 2008, patients with chronic total femoropoliteal arterial occlusions, treated with vibrational angioplasty during the same session after a failed attempt with conventional recanalization technique, were included. Patient's follow up included serial ankle-brachial index measurements and arterial duplex ultrasound examinations at 1, 3, 6, 12, 24, 36 and 48 months.

The study of the thrombin generation mechanism and the effect of low molecular weight heparin as thromboprophylaxis in patients undergoing total knee and hip replacement.

Introduction: The recommended duration of post-operative Low-Molecular-Weight-Heparins (LMWHs) thromboprophylaxis in Total-Hip-Replacement (THR) and Total-Knee-Replacement (TKR) surgery is controversial. Our aim is to study the thrombin generation (TG) modifications induced by surgery and to evaluate the effect of LMWH on TG during and after the recommended duration.

Patients/methods: Thirty-one patients received 4000IU anti-Xa/day of enoxaparin, 8-hours post-operatively (15 THR for 30-days and 16 TKR for 15-days).

Effects of isoflurane anesthesia on aortic compliance and systemic hemodynamics in compliant and noncompliant aortas.

Objectives: To investigate the effect of general anesthesia on aortic compliance and other cardiovascular hemodynamics in chronically instrumented pigs with compliant and noncompliant (stiff) aortas.

Design: Experimental study.

Setting: University animal laboratory.

Spinal cord ischemia after endovascular embolization of a type II endoleak following endovascular aneurysm repair.

Background: We report a rare case of severe spinal cord ischemia with neurological consequences in a patient who presented after endovascular treatment of a type II endoleak following endovascular aneurysm repair.

Methods And Results: An enlarging abdominal aortic aneurysm post-endovascular aneurysm repair was detected owing to a persistent type II endoleak caused by a communication between the iliolumbar and L4 lumbar artery for which the patient underwent supraselective embolization with particles and coils. Immediately after the procedure, the patient experienced an acute onset of neurological symptoms in the right lower limb while limb arterial perfusion remained unaffected.

Studying the expansion of small abdominal aortic aneurysms: is there a role for peak wall stress?

Aim: The aim of this paper was to study the characteristics of three distending small abdominal aortic aneurysms (AAAs), with an increase in maximal diameter from 5 to 5.5 cm or above.

Methods: Peak Wall Stress (PWS) in the presence and absence of intraluminal thrombus (ILT) was evaluated in 3 cases of small AAAs (5 cm), at initial presentation and after their expansion, at maximum diameters ≥5.

Computational evaluation of aortic aneurysm rupture risk: what have we learned so far?

In current clinical practice, aneurysm diameter is one of the primary criteria used to decide when to treat a patient with an abdominal aortic aneurysm (AAA). It has been shown that simple association of aneurysm diameter with the probability of rupture is not sufficient, and other parameters may also play a role in causing or predisposing to AAA rupture. Peak wall stress (PWS), intraluminal thrombus (ILT), and AAA wall mechanics are the factors most implicated with rupture risk and have been studied by computational risk evaluation techniques.

External jugular vein aneurysm: a source of thrombotic complications.

Superficial venous aneurysms are rare and usually are uneventful. We present a case in which a 40-year old female presenting with a thrombosed external jugular vein aneurysm which previously caused an undetected pulmonary embolism. The aneurysm was excised and the external jugular vein was ligated under local anesthesia and anticoagulation was initiated.

Chronic venous disease progression and modification of predisposing factors.

Aim: This study evaluated long-term characteristics of chronic venous disease (CVD) progression and its correlation with the modification of specific risk factors.

Methods: The contralateral limb of 73 patients (95% women; mean age, 48 +/- 12 years) undergoing varicose vein surgery was prospectively evaluated using physical and color duplex examination and classified by CEAP. After 5 years of follow-up, development of new sites of reflux among the contralateral, preoperatively asymptomatic limbs and modification of predisposing factors, including prolonged orthostatism, obesity, estrogen therapy (ET), multiparity, and elastic stockings use (ESU), were assessed.

Combined simultaneous basilic and brachial vein transposition. A new technique to create an autologous vascular access.

In this report, we present a technique to extend the function of an antecubital arteriovenous fistula in which both the basilic and the brachial veins were simultaneously transposed to create an autologous graft in the arm. This procedure may particularly be applicable for patients in whom, although a brachio-cephalic fistula, anastomosing the brachial artery and the perforating antecubital vein, has been previously performed and has remained patent arterialising the deep arm veins, the cephalic vein has failed to mature or has been thrombosed after multiple punctures. Our preliminary experience in eight patients has shown satisfactory outcome.

Peak wall stress does not necessarily predict the location of rupture in abdominal aortic aneurysms.

Unlabelled: Using finite element analysis, we evaluated if the site of an aortic bleb, known to be prone to rupture, coincides with the location of peak wall stress (PWS) in a patient-specific abdominal aortic aneurysm (AAA) model.

Report: PWS was not located at the bleb site, even when stress values were estimated for different bleb wall thicknesses (0.5-2.

Caval migration of a ureteral J-stent after simultaneous ureter and iliac vein perforation during its placement for obstructive pyelonephritis.

A variety of indications have made the use of double pigtail ureteral catheters routine in urological practice. Although side effects are frequent they are usually mild. We report a case of intravenous stent migration after simultaneous perforation of the left ureter and left common iliac vein during retrograde J-stent placement.

The role of geometric parameters in the prediction of abdominal aortic aneurysm wall stress.

Objective: To study the correlation between peak wall stress (PWS) and abdominal aorta aneurysm (AAA) geometric parameters in the presence of intraluminal thrombus (ILT).

Design: Computational study using finite element analysis.

Material: AAA models were created by three-dimensional (3D) reconstruction of in vivo acquired computed tomography (CT) images from 19 patients.

The influence of intraluminal thrombus on abdominal aortic aneurysm wall stress.

Aim: The aim of this study was to examine the effect of intraluminal thrombus (ILT) on the peak wall stress (PWS) in abdominal aorta aneurysm models (AAA).

Methods: Anatomically correct patient specific AAA models were created by 3D reconstruction of in vivo acquired computed tomography images from 19 male patients. Patients were divided in two groups according to aneurysm peak transverse diameter, 5-7 cm (10 patients, ''intermediate'' group) and >7 cm (9 patients, ''large'' group), respectively.

Endovascular treatment of a ruptured profunda femoral artery branch after fogarty thrombectomy of a femoro-femoral crossover arterial graft: a case report and review of the literature.

We present a very rare case of a life-threatening rupture of a profunda femoral artery distal branch after a Fogarty thrombectomy of a thrombosed crossover synthetic graft between the ipsilateral common femoral artery and a contralateral iliac-popliteal graft; the bleeding profunda femoral artery branch was successfully embolized with metallic coils through the axillary artery approach.

Left ventricular hypertrophy induced by reduced aortic compliance.

Aim: It was the aim of this study to investigate the long- term effects of reduced aortic compliance on cardiovascular hemodynamics and cardiac remodeling.

Method: Sixteen swine, divided into 2 groups, a control and a banding group, were instrumented for pressure and flow measurement in the ascending aorta. Teflon prosthesis was wrapped around the aortic arch in order to limit wall compliance in the banding group.

Preliminary experience with cutting balloon angioplasty for iliac artery in-stent restenosis.

Purpose: To report our preliminary experience using cutting balloon angioplasty (CBA) in symptomatic iliac artery in-stent restenosis (ISR).

Methods: Fourteen cases of hemodynamically significant iliac artery ISR (4 common and 10 external) were treated in 12 men (mean age 64 years, range 55-75). Of the 14 stents involved, 8 were balloon-expandable models and 6 were self-expanding.

Total occlusion of the common carotid artery: a modified classification and its relation to clinical status.

To investigate the hemodynamics and clinical presentation of common carotid artery occlusion (CCAO), we reviewed 6,415 patients with suspected carotid artery disease in whom a color Duplex imaging (CDI) examination was performed. According to distal vessel patency, the following CDI classification of CCAO was adopted: type I (patent both distal vessels); type II (isolated patency of external carotid artery); type III (isolated patency of internal carotid artery); and type IV (both distal vessels occluded). Thirty-five (0.

The appropriate length of great saphenous vein stripping should be based on the extent of reflux and not on the intent to avoid saphenous nerve injury.

Objective: To investigate the effect of stripping the below knee great saphenous vein (GSV) segment on varicose vein recurrence as well as any disability induced after saphenous nerve injury (SNI) during a 5-year period.

Methods: One hundred and six limbs (86 patients, 64 female, mean age 46 years), that underwent GSV stripping, to the knee or ankle level, were prospectively followed up at 1 month and 5 years postoperatively with clinical examination and color duplex imaging (CDI), in order to evaluate SNI and the development of recurrence. The extent of GSV stripping complied with preoperative CDI in 84 limbs (79%) that were subjected to GSV stripping to the ankle and full abolishment of duplex-confirmed reflux.

Acute lower limb ischemia as the initial symptom of acute myeloid leukemia.

Although coagulatory system disorders are well recognized in patients with acute leukemia, these usually present with either hemorrhagic complications or thrombosis of small vessels. Large vessel thrombosis is a very rare clinical presentation. We present a patient with previously undiagnosed acute myeloid leukemia (M5), who was referred to our hospital with symptoms of acute ischemia of his right lower limb.

Flow dynamics in expansions characterizing abdominal aorta aneurysms.

Our purpose was to identify and quantify hemodynamic factors contributing to the generation, proliferation, and rupturing of abdominal aorta aneurysms (AAAs) using a computational investigation of steady laminar and turbulent flow in AAA models. Steady laminar and turbulent flows were computed using the incompressible Navier-Stokes equations. Flow fields in symmetric shapes of different extents and degrees of expansion are presented first.