Free-floating thrombus of the carotid artery: literature review and case reports.

Background: Free-floating thrombus (FFT) of the carotid artery is an uncommon entity that usually presents as an acute emergency. Management is based on case reports and series because the natural history and optimal treatment are unknown. This study was conducted to systematically review the world literature in an attempt to better understand FFT, its presentation, distribution, management, and outcome.

Infrainguinal endovascular procedures should be reserved for patients who do not have good open surgical options.

This article is the result of a debate. The motion proposed was "Infrainguinal endovascular procedures should be reserved for patients who do not have good open surgical options.'' Arguments in favor of the motion were offered by Daniel J.

Arteriovenous access: managing common problems.

The creation and maintenance of hemoaccess occupies a significant portion of most vascular and general surgery practices. In this article, the methods used to detect hemoaccess at risk for failure and the endovascular and surgical techniques used to prolong or restore their patency are reviewed. Also, the management of hemoaccess infection, aneurysmal degeneration, false aneurysm formation, and symptomatic arterial steal syndrome are described.

The vascular surgeon's role in risk factor modification: results of a survey.

Purpose: Comprehensive care of vascular patients includes attention to atherosclerotic risk factor management. We surveyed members of the Midwestern Vascular Surgical Society (MVSS) with the following objectives: (1) to determine the usual practice pattern with respect to risk factor inquiry, screening, and intervention, (2) to determine which risk factors vascular surgeons believe are important for patients with peripheral arterial disease, and (3) to determine the vascular surgeon's confidence for management of each risk factor.

Methods: A survey was mailed to all MVSS members and two additional notifications were sent for initial nonresponders.

To what extent has endovascular aneurysm repair influenced abdominal aortic aneurysm management in the state of Illinois?

Purpose: This study was performed using population-based data to determine the changing trends in the techniques for abdominal aortic aneurysm (AAA) repair in the state of Illinois during the past 9 years and to examine the extent to which endovascular aneurysm repair (EVAR) has influenced overall AAA management.

Methods: All records of patients who underwent AAA repair (1995 to 2003 inclusive) were retrieved from the Illinois Hospital Association COMPdata database. The outcome as determined by in-hospital mortality was analyzed according to intervention type (open vs EVAR) and indication (elective repair vs ruptured AAA).

Inferior vena cava endograft to control surgically inaccessible hemorrhage.

Open surgical repair of retrohepatic inferior vena cava (IVC) injuries can be technically difficult, usually requiring extensive hepatic mobilization and associated with significant morbidity. We report a case of uncontrolled hemorrhage from the retrohepatic inferior vena cava (IVC), which occurred during attempted resection of a large retroperitoneal leiomyosarcoma, and was successfully managed using an endoluminal stent-graft. This case demonstrates that endoluminal grafts can be successfully applied to control life-threatening hemorrhage arising from lesions in the retrohepatic IVC that are otherwise extremely difficult or inaccessible to direct surgical repair.

What are the long-term results of conventional open surgical repair of abdominal aortic aneurysms?

Purpose: To determine the long-term results of conventional open surgical repair of abdominal aortic aneurysms (AAAs) and the prevalence of late arterial abnormalities.

Methods: CT scan follow-up was obtained between 8 and 9 years after elective AAA repair on a cohort of patients enrolled in the Canadian Aneurysm Study, a registry that originally consisted of 680 patients. A request for CT follow-up was sent to the responsible surgeon in 1994 when 251 patients were alive and available.

How do vascular surgeons perceive atherosclerotic risk factor management?

The specific objectives of this report were to determine (1) the usual practice of vascular surgeons with respect to risk factor inquiry and intervention, (2) which risk factors are endorsed by vascular surgeons as being very important in the management of patients with PAD, and, finally, (3) which risk factors vascular surgeons are confident in managing.

Long-term follow-up of management of failing in situ saphenous vein bypass grafts using endovascular intervention techniques.

Purpose: To report the long-term follow-up of previously reported cases of salvaging failing or failed in situ bypass grafts using endovascular techniques, to include previously unreported cases, and to include the results of thrombolysis for the salvage of occluded in situ venous bypass grafts.

Materials And Methods: Between 1985 and 1995, 352 patients underwent distal bypass via the in situ saphenous vein. Seventy-three of these patients underwent endovascular interventions for (i) graft stenoses (65 lesions in 40 patients) treated by balloon angioplasty (PTA), (ii) AV residual fistulas to veins (AVF) (23 patients) occluded by coil embolotherapy, (iii) graft occlusion (21 occluded grafts in 19 patients) treated by catheter-directed high-dose thrombolytic infusion and PTA or surgical revision of uncovered stenoses, and (iv) retained valve leaflets causing stenoses (five patients) treated by valvectomy and/or PTA.

Thoracofemoral bypass: proximal exposure and tunneling.

Although axillobifemoral bypass is the usual alternative to the standard aortobifemoral bypass (ABF) when the latter is contraindicated because of comorbid operative risk or when the transabdominal approach is considered hazardous, a more proximal aortic inflow source is desirable in selected low-risk patients. The results with these more proximal aortic procedures are more durable than with axillobifemoral bypass and approach those that can be achieved with an ABF. This article reviews some of the specific technical details of descending thoracofemoral bypass, specifically, the techniques for proximal exposure and tunneling.

Saccular aortic aneurysms.

Most vascular surgeons believe that saccular aortic aneurysms have a more ominous natural history than the typical fusiform aneurysm, although this is not documented in the literature. Expeditious repair is indicated for symptomatic saccular aneurysms, and intervention is usually advocated even when they are asymptomatic because of the general belief that their unique shape predisposes them to rupture. The objective of this report is to review the presentation and surgical management of this uncommon pathology.

A practical approach to vascular access for hemodialysis and predictors of success.

Purpose: The long-term results and predictors of success for vascular access at The Toronto Hospital were studied. This report describes the access program and emphasizes the role of the vascular access coordinator.

Methods: A total of 384 consecutive patients underwent 466 vascular access procedures.

The value of late computed tomographic scanning in identification of vascular abnormalities after abdominal aortic aneurysm repair.

Purpose: The purpose of this study was to determine the prevalence of late arterial abnormalities after aortic aneurysm repair and thus to suggest a routine for postoperative radiologic follow-up examination and to establish reference criteria for endovascular repair.

Methods: Computed tomographic (CT) scan follow-up examination was obtained at 8 to 9 years after abdominal aortic aneurysm (AAA) repair on a cohort of patients enrolled in the Canadian Aneurysm Study. The original registry consisted of 680 patients who underwent repair of nonruptured AAA.

Mycotic axillary artery aneurysm.

Mycotic axillary aneurysms, not commonly encountered today, are generally the consequence of arterial trauma. A case of an axillary aneurysm secondary to a septic embolus from valvular vegetations in an intravenous drug abuser was studied. The case is reminiscent of those sporadically reported cases of the preanitibiotic era.

Clinical and pathophysiological effects of active and passive smoking on the cardiovascular system.

Both passive and active cigarette smoking increase the risk of cardiovascular disease, the leading cause of death in Western industrialized nations. The prevalence of smoking as a major cardiovascular risk factor has been well characterized over the past 30 years. The two demographic groups of particular concern are women and the young.

Management of upper extremity central venous obstruction using interventional radiology.

Upper extremity central vein stenosis/occlusion is responsible for significant morbidity. The objective of this report is to review our management using interventional radiological techniques and to determine the long-term clinical results. All radiological interventions for central vein stenosis/occlusion (n = 59) between July 1991 and July 1996 at our institution were reviewed.

Flow-independent angiography for peripheral vascular disease: initial in-vivo results.

Flow-independent angiography (FIA), an approach that isolates arterial blood using MR relaxation characteristics rather than flow effects, was evaluated for application in peripheral vascular disease (PVD). First, pilot studies were conducted in which FIA coronal projection images were obtained from controls and symptomatic patients with PVD to assess clinical utility. All control images corresponded to the expected leg arterial anatomy with little interference from deep veins (one of five) and muscle (zero of five).

Predictors of long-term patient survival after in situ vein leg bypass.

Purpose: The objective was to determine the long-term survival rates of patients who undergo distal arterial bypass surgery and to identify the preoperative factors that are predictive of survival.

Methods: Three hundred fifty-eight consecutive in situ distal leg bypass procedures were performed between July 1986 and December 1995. The relationship between 13 preoperative variables and late survival were determined using both univariate (Kaplan-Meier) and multivariate (Cox regression) statistical techniques.

Aortic transgraft hemorrhage after systemic thrombolytic therapy.

Aortic transgraft hemorrhage is an unusual complication following thrombolytic therapy that can occur months to years after aortic surgery. It is critical to differentiate this from other potential causes of hemorrhage, such as an acute bleed from an anastomotic false aneurysm which is a surgical emergency. One such case that was managed conservatively with success is reported.

Indications and results of balloon angioplasty for arterial occlusive lesions.

This paper describes the current techniques for percutaneous transluminal angioplasty (PTA) of peripheral arteries, summarizes the long-term results of the procedure, and identifies the variables that are predictive of long-term success of PTA performed in the iliac and femoropopliteal segments.

Sociologic factors are major determinants of prolonged hospital stay after abdominal aneurysm repair.

Background: With increasing pressure to optimize the utilization of hospital resources, it is important to identify patients who may have prolonged hospital length of stay (LOS). The purpose of this report was to identify the preoperative variables that are predictive of prolonged postoperative hospital LOS for patients undergoing elective infrarenal abdominal aneurysm repair and to discuss strategies that might assist in minimizing LOS for these patients.

Methods: Three hundred sixty-five consecutive patients underwent elective infrarenal abdominal aneurysm repair between 1989 and 1994.

Mesenteric arterial bypass grafts: early and late results and suggested surgical approach for chronic and acute mesenteric ischemia.

Background: The purposes of this study were to determine the early and late results of placement of arterial bypass grafts in the treatment of chronic and acute intestinal ischemia and to ascertain whether multiple grafts provide better late results than a single graft.

Methods: Records of 34 patients who underwent mesenteric vascular graft placement were retrospectively reviewed.

Results: All 21 patients with chronic ischemia had a history of intestinal angina and weight loss.

Reversal of delayed-onset paraplegia after thoracic aortic surgery with cerebrospinal fluid drainage.

We report two patients who had postoperative reversal of delayed-onset paraplegia after cerebrospinal fluid (CSF) drainage after type I thoracoabdominal aneurysm repair. CSF drainage was not initiated before operation because of the urgent presentation of both patients. Decompression of the spinal canal by CSF drainage may improve spinal cord circulation in certain patients and may avoid or decrease neurologic injury.