Effect of a novel cannulation device for vascular access on AVF maturation in a goat carotid-jugular fistula model.

Objective: The Ark is a 3-D printed titanium device designed to be implanted around the draining vein of an arteriovenous fistula (AVF) to facilitate vascular access. The purpose of this study was to assess AVF maturation after Ark implantation in a large animal model.

Methodology: End-to-side AVFs were created between the carotid artery and jugular vein in nine pygmy goats that included three control (AVF only) and six experimental (AVF and Ark device) animals.

A rare case of spontaneous carotid sheath abscess presenting as a painful neck mass.

Infections of the carotid arteries and sheath without any underlying etiology are extremely uncommon. In this article, we report the successful open repair of a right carotid sheath abscess in a 71-year-old woman with multiple comorbidities. The repair consisted of excision of the affected carotid segment and reconstruction by interposition of a reversed great saphenous vein graft.

Successful mechanical thrombectomy of an intermediate-high risk acute pulmonary embolism using the Alpha Vac aspiration catheter.

Large-bore aspiration thrombectomy is emerging as a promising alternative for thrombus removal in acute pulmonary embolism (PE). In this article, we report a successful case with the newly approved AlphaVac F18 device in a 76-year-old patient presenting with an intermediate- to high-risk acute PE. Preoperative imaging demonstrated bilateral PE with a modified miller index of 30 and an right ventricle-to-left ventricle ratio of 2.

Open thrombectomy, patch angioplasty, and retrograde stenting for isolated superior mesenteric artery dissection.

Isolated superior mesenteric artery dissection without aortic involvement is an exceptionally rare event. Nonoperative management remains the first-line therapy. However, surgical interventions can be indicated in the event of bowel ischemia.

Internal mammary artery injury complicating a Surfacer inside-out central venous catheterization.

We report the case of a near fatal arterial injury in a patient undergoing an inside-out catheter placement through an occluded central venous system using the Surfacer device (Bluegrass Vascular). The right internal mammary artery was inadvertently lacerated during the procedure, leading to cardiovascular collapse. The patient was rescued by transfusion, placement of a chest tube, and coil embolization of the right internal mammary artery.

Stem Cell Therapy: A Possible Role in the Treatment of Patients with Chronic Limb-Threatening Ischemia?

Chronic limb-threatening ischemia (CLTI) is a severe form of peripheral arterial disease that portends high morbidity and mortality. Patients may undergo various endovascular or open procedures with the goal of limb salvage. No-option CLTI patients represent a vulnerable population for whom conventional options have been exhausted, or anatomy precludes any attempts at revascularization, often resulting in amputation.

Safety of bilateral arm pressure measurements in the diagnostic workup of dialysis-associated steal syndrome.

Objective: Although bilateral brachial pressure measurement is routinely included in the diagnostic work-up of upper extremity ischemia, it is generally avoided in the presence of hemodialysis access due to fears of inducing access thrombosis. This study evaluated the safety of bilateral brachial pressure measurement in patients with clinical suspicion of dialysis-associated steal syndrome (DASS).

Methods: Patients undergoing non-invasive testing for steal syndrome between September 2015 and December 2021 were included in this study.

Midterm outcomes of arteriovenous fistula aneurysm repair with simultaneous inflow revision or outflow tract revascularization.

Objective: The aim of this study was to investigate the 2-year outcomes of extensive revisions aimed at simultaneously addressing arteriovenous fistula (AVF) aneurysms, outflow stenosis, and/or high flow volumes.

Methods: This was a retrospective cohort study in a tertiary referral center. The study population comprised hemodialysis patients with aneurysmal AVFs requiring revision.

Cardiovascular collapse during mechanical thrombectomy for acute pulmonary embolism and the role of extracorporeal membrane oxygenation in patient rescue.

Background: Driven by the ability to avoid thrombolytics and provide a one stop procedure with immediate hemodynamic improvement, there has been a dramatic increase in the use of mechanical thrombectomy (MT) devices for the treatment of intermediate-to-high risk pulmonary embolism (PE). This study investigated the incidence and outcomes of cardiovascular collapse during MT procedures and demonstrates the role of extracorporeal membrane oxygenation (ECMO) in salvaging patients.

Methods: This single-center retrospective review included patients with PE undergoing MT with the FlowTriever device between 2017 and 2022.

Surgical creation of upper extremity arteriovenous fistula and grafts: a narrative review.

Background And Objective: Surgical creation of arteriovenous fistulas (AVF) and grafts (AVG) continues to be the mainstay access for hemodialysis (HD). Avoidance of dependence on dialysis catheters continues to be a worldwide mission in dialysis access. Importantly, there is no one-size-fits-all approach to hemodialysis access and each patient should undergo access creation that is patient-centered.

Single-center surgical site infection rate after peripheral ECMO decannulation and surgical repair.

Objective: Extracorporeal membrane oxygenation (ECMO) is used to provide heart-lung bypass support in cases of acute respiratory and cardiac failure. The two main classifications of ECMO are venoarterial (VA) and venovenous (VV). After the patient recovers from an acute state, ECMO decannulation from the groin often requires femoral exploration and vessel repair.

Evaluation of a Novel System for RFID Intraoperative Cardiovascular Analytics.

To evaluate a novel technology for real time tracking of RF-Identified (RFID) surgical tools (Biotic System), providing intraoperative data analytics during simulated cardiovascular procedures. Ineffective asset management in the Operating Room (OR) leads to inefficient utilization of resources and contributes to prolonged operative times and increased costs. Analysis of captured data can assist in quantifying instrument utilization, procedure flow, performance and prevention of retained instruments.

Advanced intraoperative imaging guidance for inside-out central venous recanalization using a novel catheter access system.

Background: The novel Surfacer Inside-Out recanalization technique facilitates right-sided central venous access in occluded vessels but carries a risk of arterial and pleural injuries. This article demonstrates how an advanced intraoperative imaging protocol can help to avoid these potential complications.

Methods: This retrospective review included patients undergoing the Surfacer Inside-Out central venous recanalization procedure between December 2017 and October 2021.

Dynamic Computed Tomography Angiography is More Accurate in Diagnosing Endoleaks than Standard Triphasic Computed Tomography Angiography and Enables Targeted Embolization.

Background: The primary objective was to compare the accuracy of dynamic computed tomography (CT) angiography (d-CTA) with standardized triphasic contrast enhanced CT angiography (t-CTA) in diagnosing endoleak type after endovascular aortic repair (EVAR) using digital subtraction angiography (DSA) as reference standard. The secondary objective was to study the impact of d-CTA on image fusion-guided endoleak embolization.

Methods: A retrospective review of patients who underwent d-CTA imaging after EVAR between March 2019 and July 2021 was performed.

Vasculink iPhone Application and Risk Prediction Model for Groin Complication in Vascular Surgery.

Background: Postoperative groin complication is a common cause of morbidity in vascular surgery. Prophylactic wound adjuncts addressing this issue have been shown to reduce complications in high-risk patients, but their widespread implementation is limited by their high cost. This study introduces a risk prediction model for patients at a high risk for groin complication which can be accessed through the iPhone application, Vasculink.

Downregulation of the endothelial histone demethylase JMJD3 is associated with neointimal hyperplasia of arteriovenous fistulas in kidney failure.

Jumonji domain-containing protein-3 (JMJD3), a histone H3 lysine 27 (H3K27) demethylase, promotes endothelial regeneration, but its function in neointimal hyperplasia (NIH) of arteriovenous fistulas (AVFs) has not been explored. In this study, we examined the contribution of endothelial JMJD3 to NIH of AVFs and the mechanisms underlying JMJD3 expression during kidney failure. We found that endothelial JMJD3 expression was negatively associated with NIH of AVFs in patients with kidney failure.

Dynamic, Time-Resolved CT Angiography After EVAR: A Quantitative Approach to Accurately Characterize Aortic Endoleak Type and Identify Inflow Vessels.

Purpose: Our purpose was to study the accuracy of dynamic computed tomography angiography (d-CTA) in characterizing endoleak type, inflow vessels as compared with digital subtraction angiography (DSA) using qualitative and quantitative analysis.

Methods: Between March 2019 and January 2021, all patients who underwent d-CTA imaging after EVAR were retrospectively reviewed. Two blinded independent reviewers qualitatively reviewed d-CTA and DSA images.

A systematic review of management of superficial venous reflux in the setting of deep venous obstruction.

Background: Because of the fear of obliterating the collateral outflow path and thus worsening venous hypertension, many physicians believe that deep venous obstruction (DVO) is a contraindication for the treatment of superficial venous reflux (SVR). In the present review, we have described the available clinical data for this important group of patients.

Methods: A literature search was performed of PubMed, Web of Science, and Google Scholar to identify clinical research studies reported between 1991 and 2021 that had evaluated the concomitant management of SVR and DVO.

Cone-Beam CT and Image Fusion-Guided Percutaneous Recanalization of Occluded Central Venous Stent.

We describe an 81-year-old man with end-stage renal disease and central venous occlusion who was referred for dialysis access creation. This case illustrates a novel percutaneous image fusion-guided recanalization of an occluded right subclavian vein and brachiocephalic vein stent in a patient with limited remaining dialysis access sites. ().

Novel technique of stent retrieval after migration to the right heart.

Central venous obstruction in the symptomatic patient is often treated with endovascular stenting. A rare, but serious, complication of this treatment is migration of the stent from the original site of deployment. Treatment of this complication requires either open or endovascular retrieval of the displaced stent.

PATENCY-2 trial of vonapanitase to promote radiocephalic fistula use for hemodialysis and secondary patency.

Objective: Arteriovenous fistulas created for hemodialysis often fail to become usable and are frequently abandoned. This prospective trial evaluated the efficacy of vonapanitase, a recombinant human elastase, in increasing radiocephalic fistula use for hemodialysis and secondary patency.

Methods: PATENCY-2 was a randomized, double-blind, placebo-controlled trial in patients on or approaching the need for hemodialysis undergoing radiocephalic arteriovenous fistula creation.