A Review: Single and MultiBranch Devices for the Treatment of Aortic Arch Pathologies with Proximal Sealing in Ishimaru Zone 0.

Recently published experience has shown that endovascular management of the aortic arch, including sealing in the proximal zones, can be a viable option for patients considered unfit for conventional open repair. Endograft designs vary and include single or multibranch devices, with or without the addition of surgical debranching. Initial reports show that both techniques can be performed with high technical success and acceptable perioperative morbidity and mortality rates in high volume centers.

"First in Man" Total Percutaneous Aortic Arch Repair With 3-Inner-branch Endografts: A Report of Two Cases.

Summary Background Data: Aneurysms of the arch are a complex clinical problem and a technical challenge. Currently, over 40% of patients are considered unfit for conventional open surgery, requiring a cardiopulmonary bypass and hypothermic circulatory arrest. In experienced hands and appropriate anatomic conditions, arch-branched graft technology has shown to be a safe and effective alternative to open conventional surgery to patients that historically have had no surgical options.

Endovascular management of chronic post-dissection aneurysms of the aortic arch.

This article reviews endovascular management of chronic post-dissection aneurysms of the aortic arch. Therapeutic strategies intended for this complex aortic condition are evolving rapidly to allow the treatment of various hostile aortic anatomy and frail patients. Principles, technical considerations, devices and outcomes of each technique are reviewed and summarized.

A Staged Hybrid Procedure to Manage Complex Cerebral Hypoperfusion in Aortic Arch Aneurysm.

We report the management of a patient who had an open-surgical repair following traumatic avulsion of the supra-aortic trunks (SAT) 30 years prior to presentation with a large arch aneurysm and poor cerebral collaterals. "Simple" thoracic endovascular aneurysm repair (TEVAR) was not an option because it would have excluded the collateral circulation to the carotid and vertebral arteries. We devised a two-stage hybrid procedure to repair this challenging aneurysm.

Successful endovascular correction of an endograft connected with the false lumen of a type B aortic dissection.

Thoracic endografting is widely used in the treatment of complicated acute type B aortic dissections to redirect the entire aortic flow toward the true lumen by covering the proximal entry tear. This procedure is challenging because endovascular navigation, maintaining position in the true lumen, can be difficult as there are frequently numerous reentry tears. There is obvious potential for complications such as malpositioning of the distal part of the endograft within the false lumen.

Carotid endarterectomy: where do we stand at present?

Purpose Of Review: The introduction of endovascular techniques and improvements in the medical management of atherosclerotic carotid lesions have led to changes in the modern management of stroke. The purpose of this review is to summarize the latest developments in surgical carotid intervention and highlight the current controversies.

Recent Findings: The predominant controversies that dominate the correct surgical management of carotid atherosclerotic disease are: Notwithstanding the results of the Carotid Revascularisation Endarterectomy versus Stenting Trial, does carotid artery stenting produce equivalent outcomes to surgical carotid endarterectomy? Should recent developments in best medical management of these lesions and changing socioeconomic factors restrict the indication for surgical intervention for asymptomatic lesions? What is the ideal time frame for carotid interventions in symptomatic patients?

Summary: There is insufficient current or historic evidence to resolve these controversies and further large randomized controlled trials are therefore required.

The current management of carotid atherosclerotic disease: who, when and how?

Ischaemic stroke represents a major health hazard in the western world, which has a severe impact on society and the health-care system. Roughly, 10% of all first ischaemic strokes can be attributed to significant atherosclerotic disease of the carotid arteries. Correct management of these lesions is essential in the prevention and treatment of carotid disease-related ischaemic events.

Persistent popliteal fossa reflux following saphenopopliteal disconnection.

Background: This was a retrospective assessment of the technical adequacy of saphenopopliteal disconnection (SPD).

Methods: Patients scheduled for SPD underwent preoperative colour-coded duplex imaging to localize the saphenopopliteal junction (SPJ). Operations were conducted with the patients under general anaesthesia in the prone position with planned full popliteal fossa exposure.