Results of the North American Complex Abdominal Aortic Debranching (NACAAD) Registry.

Background: Hybrid debranching repair of pararenal and thoracoabdominal aortic aneurysms was initially designed as a better alternative to standard open repair, addressing the limitations of endovascular repair involving the visceral aorta. We reviewed the collective outcomes of hybrid debranching repairs using extra-anatomic, open surgical debranching of the renal-mesenteric arteries, followed by endovascular aortic stenting.

Methods: Data from patients who underwent hybrid repair in 14 North American institutions during 10 years were retrospectively reviewed.

Midterm evaluation of perigraft arterial sac embolization in endovascular aneurysm repair.

Objective: Management of clinically significant endoleaks (ELs) remains costly, time-consuming, and morbid. Unresolved ELs can result in rupture and mortality after endovascular aneurysm repair (EVAR). Perigraft arterial sac embolization (PASE) has been used to treat ELs diagnosed at the time of EVAR or during surveillance.

Intermodality feature fusion combining unenhanced computed tomography and ferumoxytol-enhanced magnetic resonance angiography for patient-specific vascular mapping in renal impairment.

Objective: The purpose of this study was to establish the feasibility of fusing complementary, high-contrast features from unenhanced computed tomography (CT) and ferumoxytol-enhanced magnetic resonance angiography (FE-MRA) for preprocedural vascular mapping in patients with renal impairment.

Methods: In this Institutional Review Board-approved and Health Insurance Portability and Accountability Act-compliant study, 15 consecutive patients underwent both FE-MRA and unenhanced CT scanning, and the complementary high-contrast features from both modalities were fused to form an integrated, multifeature image. Source images from CT and MRA were segmented and registered.

Caval Reconstruction with Undersized Ringed Graft after Resection of Inferior Vena Cava Leiomyosarcoma.

Background: The en bloc resection of inferior vena cava (IVC) leiomyosarcoma often necessitates IVC reconstruction. The objective of this study is to examine outcomes after IVC reconstruction and determine optimal graft sizing.

Methods: A retrospective review was conducted of all IVC reconstructions after IVC leiomyosarcoma resection at a single institution.

Infrarenal aortic repair with or without false lumen intentional placement of endografts for hybrid management of complex aortic dissection.

Objective: Aortic dissection (AD) often involves the infrarenal aorta. We review our experience with open infrarenal aortic repair with or without false lumen intentional placement (FLIP) of endografts in the proximal dissected aorta as part of a hybrid strategy to treat complex AD.

Methods: A prospectively maintained database of patients undergoing intervention for AD was reviewed.

Recognition and Surgical Techniques for Management of Nonrecurrent Laryngeal Nerve during Carotid Endarterectomy.

The presence of a nonrecurrent laryngeal nerve (NRLN) during carotid endarterectomy (CEA) may significantly limit the exposure of the surgical field during this operation. Although its reported incidence is rare, NRLN typically overlies the carotid bifurcation and failure to recognize this anatomic variation increases the risk of NRLN injury. A retrospective chart review of all patients who underwent CEA for hemodynamically significant extracranial carotid stenosis between January 2005 and December 2014 was performed.

Hybrid treatment of aortic arch aneurysms.

The advent of thoracic aortic endovascular stent-grafting has drastically changed the management of thoracic aneurysms. In 1991, Volodos and colleagues performed the first hybrid aortic arch repair. The case involved an arch debranching with placement of an endograft in a patient with a previous repair for an aortic coarctation.

Intraprocedural and postprocedural perigraft arterial sac embolization (PASE) for endoleak treatment.

Intervention may be necessary in up to one-third of patients with endoleaks after endovascular aortic aneurysm repair (EVAR). Perigraft arterial sac embolization (PASE) to induce aneurysm thrombosis was performed by intrasac injection of thrombin and gelfoam slurry. Thirteen patients were treated with PASE since 2006.

Is heparin reversal required for the safe performance of percutaneous endovascular aortic aneurysm repair?

Background: Percutaneous endovascular aneurysm repair (PEVAR) can be performed with high technical success rates and low morbidity rates. Several peer-reviewed papers regarding PEVAR have routinely combined heparin reversal with protamine before sheath removal. The risks of protamine reversal are well documented and include cardiovascular collapse and anaphylaxis.

Drip, Ship, and Grip, then Slice and Dice: Comprehensive Stroke Center Management of Cervical and Intracranial Emboli.

Background And Purpose: Tandem acute thrombotic emboli in the cervical and intracranial arteries are an unusual cause of stroke presenting unique management challenges. In regional systems of acute stroke care anchored by Comprehensive Stroke Centers (CSC), combined fibrinolytic, endovascular, and open surgical intervention is a new therapeutic option.

Summary Of Case: A 28-year-old male underwent retinal surgery, including post-operative neck compression and the next day presented to a primary stroke center with aphasia and right hemiplegia.

Prospective, multicenter experience with the Ventana Fenestrated System for juxtarenal and pararenal aortic aneurysm endovascular repair.

Objective: This study assessed preliminary results of the Ventana Fenestrated System (Endologix, Irvine, Calif) as an off-the-shelf integrated device for juxtarenal aortic aneurysm (JAA) or pararenal aortic aneurysm (PAA) endovascular repair.

Methods: From November 2010 to April 2012, seven centers enrolled 31 patients with JAAs or PAAs in an international clinical trial of the Ventana Fenestrated System. Clinical and laboratory evaluations were done predischarge and at 1 month, with continuing follow-up through 5 years.

Techniques for inferior vena cava resection and reconstruction for retroperitoneal tumor excision.

Management of the inferior vena cava (IVC) after resection for treatment of retroperitoneal sarcomas is controversial. Ligation is well tolerated if collateral circulation is preserved. These pathways, however, are often interrupted or resected during tumor excision, and up to 50% of these patients will experience lower extremity edema with IVC ligation.

Results of a double-barrel technique with commercially available devices for hypogastric preservation during aortoilac endovascular abdominal aortic aneurysm repair.

Objective: To assess technical feasibility and short-term outcome of a novel hypogastric preservation technique in patients with aortoiliac aneurysms using commercially available endografts without device modification.

Methods: Multi-institution review of prospectively acquired database of patients undergoing double-barrel endograft repair of aortoiliac aneurysms.

Results: Twenty-two patients underwent endovascular aneurysm repair for aortoiliac aneurysms from 2010 to 2011, with 23 double-barrel hypogastric preservation procedures successfully completed in 21 patients.

Retroperitoneal trapdoor endarterectomy for paravisceral "coral-reef" aortic plaque.

A 67-year-old woman presented to the emergency room with progressive claudication, chest pain, and flash-pulmonary edema. Her past medical history was significant for poorly controlled hypertension requiring multiple antihypertensive medications, renal insufficiency, and tobacco abuse. Diagnostic evaluation revealed an extensive exophytic plaque localized to the paravisceral aorta resulting in high-grade stenoses of the proximal aorta as well as the celiac, superior mesenteric, and left renal arteries.

Inferior vena cava resection and reconstruction for retroperitoneal tumor excision.

Objective: This study reviews the results of en bloc resection of the inferior vena cava (IVC) for malignant tumor excision and reconstruction.

Methods: A prospective database was reviewed. IVC resection was categorized as suprarenal, perirenal, infrarenal, or extensive (>one segment resected).

A retrospective review of Palmaz stenting of the aortic neck for endovascular aneurysm repair.

Background: To review the aortic neck characteristics, graft types, and technical results of Palmaz stent placement as an adjunct to endovascular aneurysm repair (EVAR).

Methods: A retrospective review of 110 consecutive EVAR cases identified 18 cases in which Palmaz stents were placed as an adjunct to EVAR. Graft types, hostile aortic neck features (neck diameter: >26 mm, length: <15 mm, angulation: >60°, reverse taper necks), and treatment success were identified.

Technical modifications for endovascular infrarenal AAA repair for the angulated and dumbbell-shaped neck: the precuff Kilt technique.

Background: High risk surgical patients with abdominal aortic aneurysms and difficult infrarenal necks continue to be challenged when performing endovascular repair. Although fenestrated and branched endografts may ultimately be the main method of repair for these patients, their current limited availability has prompted the use of alternative endovascular techniques to enhance success of endovascular aortic aneurysm repair in patients with "dumbbell" shaped and angulated necks.

Methods: A retrospective review of all patients who underwent endovascular abdominal aneurysm repair with a predeployed aortic cuff (Kilt) at University of California, Los Angeles between January 2009 and April 2010 was performed.

Laparoscopic versus open celiac ganglionectomy in patients with median arcuate ligament syndrome.

Objective: Median arcuate ligament syndrome (MALS) is a rare disorder characterized by abdominal pain and compression of the celiac artery. Traditional management consists of open MAL division, with or without arterial reconstruction. We present our outcomes using a laparoscopic approach and compare them to patients treated with open MAL division during the same period.