Lessons Learned from Open Surgical Conversion after Failed Previous EVAR.

Background: Delayed open conversion (OpC) after endovascular aortic aneurysm repair (EVAR) is becoming increasingly common worldwide. We reviewed our experience to characterize the perioperative spectrum of OpC repairs.

Materials And Methods: A retrospective analysis of a prospectively maintained institutional database to identify patients who underwent late OpC after failed EVAR was performed.

A computational study of the factors influencing pressure in arteriovenous fistulae venous aneurysms.

Purpose: To investigate the factors influencing the hydrostatic pressure exerted within the venous aneurysms (VA) of an arteriovenous fistula (AVF).

Methods: Ideal models of a side-to-end brachial-cephalic AVF were computationally constructed and typical values for the length and the local diameters were considered for both the artery and vein sections of the models. Three VA configurations were reconstructed (spherical, fusiform and curved) and hydrostatic pressure was assessed with respect to different degrees of the outflow vein stenosis, ranging from 25% to 95%, and VA maximum diameters, using validated, commercially available software.

Aneurysm sac shrinkage after endovascular treatment of the aorta: beyond sac pressure and endoleaks.

The isolation of the aneurysm sac from systemic pressure and its consequent shrinkage are considered criteria of success after endovascular repair (EVAR). However, the process of shrinkage does not solely depend on the intrasac pressure, the predictive role of which remains ambiguous. This brief review summarizes the additional pathophysiological mechanisms that regulate the biomechanical properties of the aneurysm wall and may interfere with the process of aneurysm sac shrinkage.

Application of bioengineering modalities in vascular research: evaluating the clinical gain.

Using knowledge gained from bioengineering studies, current vascular research focuses on the delineation of the natural history and risk assessment of clinical vascular entities with significant morbidity and mortality, making the development of new, more accurate predictive criteria a great challenge. Additionally, conclusions derived from computational simulation studies have enabled the improvement and modification of many biotechnology products that are used routinely in the treatment of vascular diseases. This review highlights the promising role of the bioengineering applications in the vascular field.

An overview of the hemodynamic aspects of the blood flow in the venous outflow tract of the arteriovenous fistula.

Upper limb vein aneurysms complicate all types of autogenous arteriovenous fistulae (AVF) and comprise false aneurysms secondary to venipuncture trauma as well as true aneurysms, characterized by dilatation of native veins. The dilatation of a normal vein and the development of a true aneurysm are strongly influenced by local hemodynamic factors affecting the flow in the drainage venous system and are also the target of operative interventions. This review article focuses on the description of these hemodynamic aspects which all physicians involved in the management of dialysis patients should be aware of.

Modification of the trap door technique to treat venous aneurysms in arteriovenous fistulae.

We present a modification of the "trap door" technique to treat true venous aneurysms which complicate vascular access arteriovenous fistula. The technique provides wide exposure of the aneurysm, facilitating aneurysmoraphy and permitting the exploitation of any adequate venous length for autologous reconstruction of the venous outflow. Furthermore, by precluding the proximity of the newly-reconstructed venous segments to the incised skin, their level of compromise from tissue scarring or infection is prevented.

Early results of the Endurant endograft system in patients with friendly and hostile infrarenal abdominal aortic aneurysm anatomy.

Objective: To evaluate and compare the outcome after endovascular abdominal aortic aneurysm repair (EVAR) with the newly released Endurant endograft system in patients with different aortoiliac anatomic characteristics.

Methods: We conducted a prospective observational study assigning patients with infrarenal abdominal aortic aneurysm (AAA) treated with the Endurant endoprosthesis from February 2009 to March 2010. Two groups were studied, according to the presence of a friendly (group I [GI] = 43) or hostile (group II [GII] = 34) infrarenal aortoiliac anatomy.

Composite PTFE-transposed superficial femoral vein for lower limb arteriovenous access.

Purpose: We report our experience in creating a composite loop of transposed superficial femoral vein (tSFV) and polytetrafluoroethylene (PTFE) synthetic graft for lower limb access. The indication for surgery was exhaustion of access sites in both upper limbs.

Methods: Surgery was performed on 3 male patients.

Emergency endovascular treatment of early spontaneous nonaneurysmal popliteal artery rupture in a patient with Salmonella bacteremia.

Rupture of a nonaneurysmal popliteal artery and subsequent pseudoaneurysm formation is an exceedingly rare event after bacteremia caused by Salmonella spp. Only a few cases have been reported in the literature. Moreover, spontaneous popliteal artery rupture resulting from this pathology, to our knowledge, has not been reported.