Revascularization for claudication: Changing the natural history of a benign disease!

Objective: The benign natural history of intermittent claudication was first documented in 1960 and has been reconfirmed in several subsequent studies. Excellent outcomes in patients with intermittent claudication can be achieved with exercise therapy and optimal medical management. Professional society guidelines have clearly stated that revascularization procedures should be performed only in patients with incapacitating claudication who have failed conservative therapy.

Spontaneous iliac vein rupture: An uncommon, but frequently lethal, event.

Spontaneous rupture of the iliac veins is a distinctly uncommon problem often misdiagnosed as an arterial rupture because of significant retroperitoneal bleeding. It often occurs with acute left-sided deep vein thrombosis and physical activities that exacerbate acute venous hypertension. A significant number of these patients will have anatomy associated with May-Thurner syndrome.

Long-term Results With CorMatrix Extracellular Matrix Patches After Carotid Endarterectomy.

Background: Previous reports of extracellular matrix (ECM) patch use after carotid endarterectomy (CEA) have noted an approximately 10% rate of pseudoaneurysm (PSA) formation. PSA-related rupture of ECM patches has also been described after femoral artery repair. In these studies, different thicknesses (4-ply versus 6-ply) and no standard length of soaking the patch in saline before implantation were used.

TSG-6 is highly expressed in human abdominal aortic aneurysms.

Background: The formation of abdominal aortic aneurysms (AAA) is characterized by a dominance of proinflammatory forces that result in smooth muscle cell apoptosis, extracellular matrix degradation, and progressive diameter expansion. Additional defects in the antiinflammatory response may also play a role but have yet to be fully characterized. TSG-6 (TNF-stimulated gene-6) is a potent antiinflammatory protein involved in extracellular matrix stabilization and cell migration active in many pathological conditions.

The use of cryopreserved aortoiliac allograft for aortic reconstruction in the United States.

Background: Aortic infections, even with treatment, have a high mortality and risk of recurrent infection and limb loss. Cryopreserved aortoiliac allograft (CAA) has been proposed for aortic reconstruction to improve outcomes in this high-risk population.

Methods: A multicenter study using a standardized database was performed at 14 of the 20 highest volume institutions that used CAA for aortic reconstruction in the setting of infection or those at high risk for prosthetic graft infection.

Long-term results with cryopreserved arterial allografts (CPAs) in the treatment of graft or primary arterial infections.

Objective: Our purpose was to evaluate our results with CPAs in patients with infected grafts or primary arterial infection with emphasis on long-term durability of these grafts.

Methods: To evaluate the long-term durability of CPAs, clinical outcomes were analyzed following their use for either graft or primary arterial infections at a single institution over a 9-y period (2000-2009). The 30-d mortality rate, 90-d mortality rate, and the cause of early mortality were determined in each case.

Complete endograft collapse 91/2 years following endograft repair of an abdominal aortic aneurysm.

Endografts are a common method of treating abdominal aortic aneurysms (AAA) because of the short-term benefits of endovascular aneurysm repair (EVAR). However, the short-term benefits of endovascular repair must be balanced against long-term complications, such as the need for conversion to open repair, device migration, persistent or de novo endoleaks, and most concerning the potential for subsequent rupture of the aneurysm. Lifelong postimplantation surveillance is mandatory because the incidence of some complications increases over time.

Erosion of elephant trunk Dacron graft limb by thoracic endograft causing acute aneurysm expansion.

We recently treated a patient in whom a Gore TAG thoracic endograft (W.L. Gore and Assoc, Flagstaff, Arix) had been used to repair a descending thoracic aneurysm as the second stage of a hybrid procedure.

Case study: chronic femoropopliteal prosthetic graft infection with exposed graft.

One of the most feared complications following vascular reconstruction is infection due to the attendant risks of limb loss, sepsis, or death. The reported incidence of infection following infrainguinal prosthetic graft infection is 2.5% with associated mortality rates and amputation rates of 18% and 41%, respectively.

Combined thenar and hypothenar hammer syndromes: case report and review of the literature.

Patients who use the palms of their hands as a hammer may cause irreversible damage to the radial or ulnar arteries. Damage to the intima may lead to arterial thrombosis, whereas damage to the media may cause aneurysm formation with embolization to the digital arteries, causing symptoms of ischemia. These patients may have symptoms of Raynaud syndrome, or they may have ischemic ulcerations of their fingers.

Subclavian venous aneurysm: case report and review of the literature.

A case of a symptomatic 5.1-cm left subclavian venous aneurysm, which was treated with surgical excision, is presented. Most venous aneurysms in the head and neck region involve the internal or external jugular veins and are asymptomatic.

Infected splenic artery aneurysm with associated splenic abscess formation secondary to bacterial endocarditis: case report and review of the literature.

Infected aneurysms are rare and may present with rupture or sepsis. Surgical treatment is often required to prevent catastrophic sequelae. Bacterial endocarditis is one of the classic causes of infected aneurysm.