Outpatient Endovascular Tibial Artery Intervention in an Office-Based Setting Is as Safe and Effective as in a Hospital Setting.

Purpose: To compare outcomes of outpatient tibial artery procedures between an office endovascular center and a hospital angiography suite.

Methods: A retrospective review was conducted of 204 outpatient tibial interventions performed on 161 patients (mean age 72±11.5 years; 81 men) in either an office (n=100) or hospital (n=104) angiography suite from April 2011 through September 2013.

Determining patient risk factors associated with accelerated growth of popliteal artery aneurysms.

Objective: The objective of this study was to determine the natural progression of popliteal artery aneurysms (PAAs) and clinical variables associated with their accelerated growth.

Methods: Retrospective chart review of 224 patients with encounters between January 2008 and May 2016 and with at least one PAA was conducted. From this group, 65 asymptomatic patients had either unilateral (n = 43) or bilateral (n = 22) PAAs that were observed for at least 1 year of medical management before intervention.

A novel anatomic severity grading score for acute Type B aortic dissections and correlation to aortic reinterventions after thoracic endovascular aortic repair.

Background: We introduce a novel preoperative anatomic severity grading system for acute type B aortic dissections and validate the system in a cohort of patients who underwent thoracic endovascular aortic repair.

Methods: We identified a cohort of patients who received thoracic endovascular aortic repair (TEVAR) for acute type B aortic dissection from 2008 to 2014. We developed an anatomic severity grading score (ASG) to measure attributes of aortic anatomy that we hypothesized may affect difficulty or durability of repair.

Anatomic severity grading score for primary descending thoracic aneurysms predicts procedural difficulty and aortic-related reinterventions after thoracic endovascular aortic repair.

Background: An anatomic severity grading (ASG) score for primary descending thoracic aortic aneurysms (DTAs) was developed. The objective of this study was to determine if an ASG score cutoff value for DTAs is predictive of procedural complexity, aortic-related reinterventions, and mortality in patients who undergo thoracic endovascular aortic repair (TEVAR).

Methods: A retrospective review from 2008 to 2013 of patient records was conducted of all consecutive patients who underwent TEVAR for a primary DTA.

Abdominal aortic aneurysm anatomic severity grading score predicts implant-related complications, systemic complications, and mortality.

Objective: The aim of our study was to examine the predictive value of the anatomic severity grading (ASG) score for abdominal aortic aneurysms (AAAs) on implant-related complications, systemic complications, and mortality at 30-day and midterm, defined as 2 years, follow-up assessments.

Methods: Patients who underwent endovascular aneurysm repair for infrarenal AAAs between 2009 and 2012 were retrospectively reviewed, and ASG scores were calculated from three-dimensonal computed tomography reconstructions. Two independent patient groups were created: those with a low ASG score (score <14) and those with a high ASG score (score ≥14).

Volumetric analysis of the initial index computed tomography scan can predict the natural history of acute uncomplicated type B dissections.

Objective: Our objective was to characterize the predictive impact of computed tomography (CT) scan volumetric analysis on the natural history of acute uncomplicated type B aortic dissections (ADs).

Methods: We conducted a retrospective review of patients with acute type B ADs from 2009 to 2014. On an iNtuition workstation (TeraRecon, Foster City, Calif), volume measurements were obtained using the true lumen volume (TLV), false lumen volume (FLV), and total aortic volume from the left subclavian artery to the celiac artery.

The effect of demographic factors and lesion severity on iliac stent patency.

Objective: The aim of our study was to perform a large multivariate analysis to identify demographic, anatomic, or procedural factors that affect iliac artery stent primary patency (PP).

Methods: Patients receiving iliac stents from 2007 to 2013 were retrospectively reviewed. Univariate analysis assessed cohort characteristics and their effect on PP.

Analysis of vascular closure devices after transbrachial artery access.

Introduction: We seek to determine whether vascular closure devices (VCDs) are safe and effective for brachial artery access.

Methods: A retrospective review of brachial artery access using either manual compression (MC) or a VCD for hemostasis from November 2005 to February 2011 was performed.

Results: Brachial artery access was performed on 154 limbs: MC on 134 limbs and VCD on 20 limbs.

Patient compliance limits the efforts of quality improvement initiatives on arteriovenous fistula maturation.

Objective: Our institutional quality-improvement (QI) initiative instituted a well-defined office follow-up schedule after arteriovenous fistula (AVF) creation, including an office visit within 30 days, fistulogram within 40 days, if indicated, and a second office visit within 55 days. In addition, a patient liaison contacted patients and dialysis units to improve follow-up. The purpose of this study was to determine the effect of the QI initiative on patient compliance and overall time to AVF permission to cannulate.

Aortic remodeling after thoracic endovascular aortic repair for intramural hematoma.

Background: Intramural hematoma (IMH), penetrating atherosclerotic ulcer (PAU), and aortic dissection comprise a spectrum of acute aortic pathologies. Although thoracic endovascular aortic repair (TEVAR) has increasingly been applied to aortic dissection, there is a paucity of data on the anatomic effect of TEVAR for IMH. Our goal was to investigate the extent of aortic remodeling after TEVAR.

A case-matched validation study of anatomic severity grade score in predicting reinterventions after endovascular aortic aneurysm repair.

Background: In 2002, the Society for Vascular Surgery created the anatomic severity grading (ASG) score to classify abdominal aortic aneurysms (AAAs). Our objective was to identify the predictive capability and cutoff value of preoperative ASG score for reintervention after endovascular aneurysm repair (EVAR).

Methods: We completed a retrospective review of AAA patients treated with elective EVAR from 2007 through 2011.

Atherectomy offers no benefits over balloon angioplasty in tibial interventions for critical limb ischemia.

Background: Endovascular adjuncts, like atherectomy, were developed to improve outcomes of endovascular arterial interventions. The true impact of atherectomy on endovascular outcomes remains to be determined, and little data exist on the influence of atherectomy on tibial interventions. Our study compares early and late outcomes of tibial intervention with angioplasty vs atherectomy-assisted interventions.

In situ laser fenestration during emergent thoracic endovascular aortic repair is an effective method for left subclavian artery revascularization.

Background: Retrograde laser fenestration of the left subclavian artery (LSA) during emergent thoracic endovascular aortic repair (TEVAR) uses a relatively simple intraoperative method of endograft modification to revascularize aortic branches for a variety of acute thoracic aortic pathologies. This study presents our expanded experience and midterm outcomes of TEVAR with laser fenestration to revascularize the LSA as an alternative to debranching.

Methods: Patients who underwent TEVAR with LSA revascularization by laser graft fenestration from September 2009 through August 2012 were retrospectively reviewed.

Nitric oxide differentially affects ERK and Akt in type 1 and type 2 diabetic rats.

Background: We have shown that nitric oxide (NO) is more effective at inhibiting neointimal hyperplasia in type 2 diabetic rats than in nondiabetic rats, but is not effective in type 1 diabetic rats. Insulin signaling is mediated by the ERK and Akt pathways, and thus we hypothesized that NO differentially affects ERK and Akt activity in type 1 versus type 2 diabetic rats.

Materials And Methods: To investigate this hypothesis, we induced type 2 diabetes in Zucker diabetic fatty (ZDF) rats by feeding them Purina 5008 chow.

Distal revascularization and interval ligation procedure for radial-basilic forearm transposition arteriovenous fistula.

The distal revascularization and interval ligation procedure is commonly performed for steal syndrome in upper arm arteriovenous accesses and is rarely performed in the forearm. We present a case of distal revascularization and interval ligation procedure performed for a 60-year-old male who presented with a 3-month history of a nonhealing ulcer of his left middle finger as a result of ischemic steal syndrome 4 years after having a left radial-basilic forearm transposition arteriovenous fistula.

Comparative analysis of celiac versus mesenteric artery outcomes after angioplasty and stenting.

Background: Open bypass is the gold standard for treatment of mesenteric ischemia. With the refinement of endovascular therapy, visceral stenting is an attractive minimally invasive alternative, but the data are limited and which vessel responds best to stenting has not been addressed. This study compares the outcomes of superior mesenteric artery (SMA) and celiac artery (CA) stenting.

Identifying the target lesions for 245 laser angioplasty cases and a review of the literature.

Objective: To provide a detailed report of our experience with laser atherectomy in a large patient population with an extensive follow-up period.

Method: A retrospective chart review was conducted on 222 patients who underwent laser atherectomy.

Results: Overall primary patency rates at 1 and 3 years were 48% and 37%, primary-assisted rates were 53% and 40%, and secondary patency rates were 69% and 51%, respectively.

Endovascular foreign body retrieval.

Objective: The number of endovascular procedures performed is increasing exponentially as technology improves. A serious complication of endovascular therapy is loss of a foreign body in the vasculature. We reviewed our experience and evaluated the cause, management, and outcomes of intravascular foreign body (IVFB) misplacement.

A hybrid approach to recanalization of a chronic iliofemoral occlusion.

The Viabahn covered stent (W. L. Gore and Associates Inc, Flagstaff, Ariz) is made of expanded polytetrafluoroethylene attached to an external nitinol stent and is primarily used in the endovascular treatment of lower extremity arterial occlusive disease.

In situ laser fenestration for revascularization of the left subclavian artery during emergent thoracic endovascular aortic repair.

Purpose: To present midterm outcomes of thoracic endovascular aortic repair (TEVAR) with laser fenestration to revascularize the left subclavian artery (LSA) as an alternative to debranching.

Methods: Six symptomatic patients (3 men; mean age of 50 years) underwent emergent TEVAR with LSA revascularization via laser graft fenestration. Three patients had large thoracic aortic aneurysms (2 secondary to chronic dissection); 1 patient had an acute symptomatic type B aortic dissection, and 2 patients had intramural hematomas.

Anatomic severity grading score predicts technical difficulty, early outcomes, and hospital resource utilization of endovascular aortic aneurysm repair.

Background: In 2002, a system for the grading of abdominal aortic aneurysms (AAAs) was developed by the Society for Vascular Surgery (SVS). Because the correlation of the anatomic severity grading (ASG) score to patient outcomes has yet to be validated, we provide our experience with calculating the ASG score using three-dimensional (3-D) image-rendering software and provide the practical translation of this score into early outcomes and hospital charges.

Methods: All patients who underwent an endovascular aneurysm repair (EVAR) for infrarenal AAAs between 2009 and 2010 were retrospectively reviewed for demographics, intraoperative data, and 30-day outcomes.

Isopropylamine NONOate (IPA/NO) moderates neointimal hyperplasia following vascular injury.

Objective: Isopropylamine NONOate (IPA/NO) is a nitroxyl (HNO) donor at physiologic pH. HNO is a positive inotrope and vasodilator, but little is known about its effect on neointimal hyperplasia. The aims of this study are to determine the effect of IPA/NO on endothelial and vascular smooth muscle cells (VSMC) in vitro and to determine if IPA/NO inhibits neointimal hyperplasia in vivo.

Citric acid-based elastomers provide a biocompatible interface for vascular grafts.

Prosthetic vascular bypass grafting is associated with poor long-term patency rates. Herein, we report on the mid-term performance of expanded polytetrafluoroethylene (ePTFE) vascular grafts modified with a citric acid-based biodegradable elastomer. Through a spin-shearing method, ePTFE grafts were modified by mechanically coating a layer of poly(1,8 octanediol citrate) (POC) onto the luminal nodes and fibrils of the ePTFE.

Heightened efficacy of nitric oxide-based therapies in type II diabetes mellitus and metabolic syndrome.

Type II diabetes mellitus (DM) and metabolic syndrome are associated with accelerated restenosis following vascular interventions due to neointimal hyperplasia. The efficacy of nitric oxide (NO)-based therapies is unknown in these environments. Therefore, the aim of this study is to examine the efficacy of NO in preventing neointimal hyperplasia in animal models of type II DM and metabolic syndrome and examine possible mechanisms for differences in outcomes.