Permissive hypertension during awake eversion carotid endarterectomy: a physiologic approach for cerebral protection.

Background: Carotid endarterectomy (CEA) is often completed with general anesthesia and routine shunting; however, shunting is only required in a small group of at-risk patients to maintain adequate cerebral perfusion. Selective shunting during CEA is performed to normalize cerebral hemodynamics for patients determined to be at risk. Eversion CEA with selective shunting for neurologic dysfunction in patients that are awake/sedated is described, as well as routine use of permissive hypertension (PH), which uses standard cardiovascular medications to recruit the cerebral collateral network and reduce the need for shunting.

Pharmacomechanical thrombolysis for phlegmasia cerulea dolens.

Phlegmasia cerulea dolens (PCD) is limb-threatening. Traditional treatments are very morbid. We examine the efficacy of percutaneous treatment of PCD.

Management of chronic mesenteric vascular insufficiency: an endovascular approach.

Background: In patients with chronic mesenteric insufficiency (CMI), traditional bypass surgery carries a high operative mortality. Endovascular therapy for reconstruction of the mesenteric vascular system has high technical success but poor long-term patency. Secondary procedures are often mandatory for recurrent disease.

Balloon-expandable covered stent therapy of complex endovascular pathology.

The current study was designed to investigate our hypotheses that balloon-expandable covered stents display acceptable function over longitudinal follow-up in patients with complex vascular pathology and provide a suitable alternative for the treatment of recurrent in-stent restenosis. All stents were Atrium iCast, which is a balloon-mounted, polytetrafluoroethylene-covered stent with a 6F/7F delivery system. A retrospective review was performed of 49 patients with 66 stented lesions.

Aneurysm regression after endovascular aneurysm repair: what should we expect?

This study reviewed a large national core laboratory database for the Ancure (Guidant, Menlo Park, California) phase I and II trial of overall aneurysm sac regression after endovascular aneurysm repair. Data were reviewed for aneurysm size and endoleak in follow-up. Endoleak was recorded as well as maximum major and minor axis aortic diameters.

Repair of a combined femoral pseudoaneurysm and arteriovenous fistula using a covered stent graft.

Our purpose was to demonstrate clinical efficacy of covered stent use in the peripheral vasculature. A 68-year-old man was transferred from an outlying hospital for evaluation and treatment of a pulsatile mass in his right groin after cardiac catheterization. Imaging with duplex ultrasound and diagnostic arteriogram demonstrated a 6-cm pseudoaneurysm (PSA) of the right superficial femoral artery (SFA) and an arteriovenous fistula (AVF) of the SFA and the profunda vein.

Selection of treatment for patients with carotid artery disease: medication, carotid endarterectomy, or carotid artery stenting.

Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case.

The capture of visible debris by distal cerebral protection filters during carotid artery stenting: Is it predictable?

Objectives: Neurologic complications during carotid artery stenting (CAS) are most clearly associated with embolization of visible debris. Distal filter devices may provide cerebral protection by capturing clinically significant debris. However, they increase procedural time and expense and have their own set of complications.

Are we undertreating carotid stenoses diagnosed by ultrasound alone?

Clinical management of carotid disease is primarily based on results of national trials (ACAS and NASCET) that used the distal internal carotid artery diameter as a reference. However, commonly accepted ultrasound (US) criteria for carotid stenosis were derived from the correlation of velocity measurements with angiographic bulb diameter reductions (BDR). This study was undertaken to compare the degree of carotid stenosis determined by conventional velocity criteria to the degree of stenosis measured by B-mode (gray scale) diameter at both the carotid bulb and at the distal internal carotid artery, and, second, to evaluate US imaging to derive distal diameter reductions (DDR) noninvasively.

Is three-dimensional computed tomography reconstruction justified before endovascular aortic aneurysm repair?

Objectives: The endovascular management of abdominal aortic aneurysm (AAA) relies on accurate preoperative imaging for proper patient selection and operative planning. Three-dimensional (3-D) computed tomography (CT) with reformatted images perpendicular to blood flow has gained popularity as a method of AAA assessment and image-based planning before endovascular aneurysm repair (EVAR). The current study was undertaken to determine the interobserver agreement of AAA measurements obtained with axial CT and reformatted 3-D CT and to compare the consistency of the 2 methods in selecting patients for EVAR.

Percutaneous treatment of symptomatic central venous stenosis [corrected].

Objectives: The increased use of central venous access primarily for hemodialysis has led to a significant increase in clinically relevant central venous occlusive disease (CVOD). The magnitude of and the optimal therapy for CVOD are not clearly established. The purpose of this study is to define the problem of CVOD and determine the success of percutaneous therapy for relieving symptoms and maintaining central venous patency.

Injuries in pediatric patients with seatbelt contusions.

Children restrained with lap belts may sustain severe injuries. We investigated the frequency of each type of injury associated with seatbelt contusions. The medical records of all trauma patients with ICD-9 codes for abdominal wall contusions from January 1, 1999, to December 31, 2001, were reviewed.

Comparison of abdominal aortic aneurysm diameter measurements obtained with ultrasound and computed tomography: Is there a difference?

Objectives: Accurate diameter measurements of abdominal aortic aneurysm (AAA) with both computed tomography (CT) and ultrasound (US) are essential for screening, planning surgical intervention, and follow-up after endovascular repair. Often there is a discrepancy between measurements obtained with CT and US, and neither limit of agreement (LOA) nor correlation between the two imaging methods has been clearly established. The purpose of this study was to assess the paired differences in AAA diameter measurements obtained with CT and US in a large national endograft trial.

The endovascular treatment of a renal arteriovenous fistula: Placement of a covered stent.

We describe the case of a 40-year-old man with an acquired renal arteriovenous fistula (AVF) treated with endovascular placement of a homemade polytetrafluoroethylene covered Palmaz stent (Johnson & Johnson, Warren, NJ). The patient was seen with a abdominal bruit 5 years after exploratory laparotomy for multiple knife stab wounds. An abdominal computed tomographic scan showed an atrophic right kidney and enlarged right renal vein and inferior vena cava.