Duplex ultrasound factors predicting persistent type II endoleak and increasing AAA sac diameter after EVAR.

Objective: While the significance of type II endoleaks (T2ELs) on the long-term outcome of endovascular abdominal aneurysm repair (EVAR) to repair abdominal aortic aneurysms (AAAs) is debatable, duplex ultrasonography (DU) parameters have been suggested to be predictive of their closure or persistence. The purpose of this study was to determine which, if any, of these variables was associated with persistent T2EL or increased AAA sac diameter.

Methods: Between 1998 and 2009, 278 patients underwent EVAR and post-operative DU surveillance during long-term follow-up (1-11 years) in our accredited non-invasive vascular laboratory by one of three experienced technologists.

Duplex ultrasound imaging alone is sufficient for midterm endovascular aneurysm repair surveillance: a cost analysis study and prospective comparison with computed tomography scan.

Objective: Early in our experience with endovascular aortic aneurysm repair (EVAR) we performed both serial computed tomography scans and duplex ultrasound (DU) imaging in our post-EVAR surveillance regimen. Later we conducted a prospective study with DU imaging as the sole surveillance study and determined cost savings and outcome using this strategy.

Methods: From September 21, 1998, to May 30, 2008, 250 patients underwent EVAR at our hospital.

Critical pathways can improve results with carotid endarterectomy.

Approximately 10 years ago, the Section of Vascular Surgery at Pennsylvania Hospital reported results of critical pathways that we developed for all major vascular operations, including carotid endarterectomy (CEA). After implementing these pathways, we then developed a specific five-step protocol to further improve results and decrease costs for elective CEA. With the advent of carotid artery balloon angioplasty and stenting (CABAS), CEA has come under increasing attack by endovascular interventionalists.

Five-step protocol for carotid endarterectomy in the managed health care era.

Background: We developed a protocol combining 5 cost-effective strategies to determine whether elective carotid endarterectomy (CEA) could be performed safely without adversely affecting well-established low morbidity and mortality rates and with significant hospital cost savings.

Methods: Between April 1, 1995, and December 31, 1996, 109 of 141 patients were prospectively enrolled as candidates into a 5-step CEA protocol: (1) duplex ultrasonography (DU) performed at an accredited vascular laboratory as the sole diagnostic carotid preoperative study, (2) admission the day of operation, (3) cervical block anesthesia to eliminate intraoperative electroencephalogram monitoring, (4) transfer from the recovery room after a 4-hour observation period to the vascular ward, and (5) discharge the first postoperative morning. The other 32 patients were excluded from analysis; 16 patients were treated by vascular surgeons not participating in the protocol, 9 were treated concomitantly for other medical problems, and 7 were admitted emergently.

Is balloon angioplasty indicated for "short" stenoses of failing vein grafts?

Previous reports have suggested "short" focal stenoses in peripheral vein grafts (PVGs), namely less than 2 cm long, can be successfully balloon dilated with good long-term patency rates. We questioned if enthusiasm for balloon angioplasty of these lesions in failing PVGs is warranted. Between August 1, 1993 and December 31, 1996, we performed balloon angioplasty of "short" stenoses in 19 PVGs in 16 patients.