REHEARSAL Using Patient-Specific Simulation to Improve Endovascular Efficiency.

Objective: To determine whether rehearsal using patient-specific information loaded onto an endovascular simulator prior to carotid stenting improves procedural efficiency and outcomes.

Methods: Patients scheduled for carotid artery stenting who had adequate preoperative computed tomography (CT) imaging were considered for enrollment. After obtaining informed consent, patients were randomized to control versus rehearsal groups.

Successful Use of Nellix and Endovascular Aortic Sealing Technology for Treatment of Aortic Rupture in a Porcine Model.

Background: Endovascular aortic sealing (EVAS) represents a recent transformation in approach for treatment of aortic aneurysms. Initial reporting has shown that EVAS using the Nellix device is safe with similar complication rates to standard endovascular aortic repair (EVAR). What remains unknown is how EVAS technology will behave in the ruptured setting.

A diagnostic evolution: surgical experience with popliteal artery entrapment syndrome at a military tertiary referral center.

Background: Popliteal artery entrapment syndrome (PAES) is an increasingly encountered disorder that typically presents as claudication in young and active individuals. However, despite the increased recognition, accurate preoperative diagnosis can be difficult. The objective of this study was to describe the surgical assessment and outcomes of patients treated for PAES.

A technique for endograft relining of a type IV endoleak using a surgeon-modified internal gate.

Type IV endoleaks represent a rare etiology of late endograft failure; however, depending on the location, they can be extremely challenging to repair with endovascular solutions. We present a method of endograft relining that preserves antegrade limb perfusion, avoids extra-anatomic reconstructions, and ensures complete endograft exclusion.

Mechanism of stent failure in a patient with fibromuscular dysplasia following renal artery stenting.

Endovascular techniques used in the management of renal artery stenosis (RAS) have unique complications, to include stent facture, thrombosis, aneurysm formation, migration, and in-stent restenosis. Described here is an unusual complication of renal artery obstruction and recurrent hypertension without progressive loss of renal function, secondary to intermittent arterial kinking with respiratory and cardiac motion in a patient with fibromuscular dysplasia. This mechanical complication has implication not only in successful endovascular treatment of RAS, but raises questions regarding the alterations in dynamic motion with the cardio-respiratory cycle in stented visceral arteries in other vascular pathologies requiring renal artery stenting (i.

Magnetic resonance imaging: occult popliteal artery entrapment syndrome in a young soldier.

Background: Popliteal artery entrapment syndrome (PAES) is frequently misdiagnosed because of symptom overlap with other conditions and lack of a definitive diagnostic modality. The incidence is widely variable, although it should be considered in all patients under 50 years with symptoms of lower extremity claudication. Long-term sequelae of PAES include critical limb ischemia, arterial occlusion, and aneurysm formation caused by repetitive external compression.

Endovascular aortoiliac reconstruction to allow excision of an infected axillobifemoral bypass.

Axillofemoral graft reconstructions were initially intended to restore lower extremity perfusion in high-risk patients with symptomatic aortoiliac atherosclerotic occlusive disease. However, these reconstructions are now relegated to "bailout" procedures for infected grafts or high-risk critical limb ischemia patients that fail endovascular therapy. Infection of an extra-anatomic bypass graft is a challenging complication as it occurs in poor operative candidates with limited revascularization options and failure has a high rate of amputation and mortality.

Correlation of intravascular ultrasound and computed tomography scan measurements for placement of intravascular ultrasound-guided inferior vena cava filters.

Objective: The single puncture intravascular ultrasound (IVUS)-guided bedside placement of inferior vena cava (IVC) filters has been shown to be an effective technique. The major disadvantage of this procedure is a steep learning curve that can lead to an increased risk of filter malposition. In an effort to increase the safety and efficacy of IVUS-guided bedside IVC filter placement, we proposed that preoperative planning could reduce the incidence of IVUS-guided filter malpositions.

The influence of aneurysm size on anatomic suitability for endovascular repair.

Objectives: It has been proposed that the threshold for repair of abdominal aortic aneurysms (AAAs) suitable for endovascular repair (EVAR) be lowered. A critical step in this pathway is determining whether smaller AAAs are more likely to be anatomically suitable for EVAR; that is, whether suitability is lost as the AAA grows.

Methods: Patients who underwent ultrasound (US) imaging for asymptomatic AAAs at the University of Rochester Medical Center between January 1, 2003, and January 31, 2007, were identified.

Therapy of renal artery aneurysms in New York State: outcomes of patients undergoing open and endovascular repair.

The purpose of this study was to evaluate changing trends in therapy and determinants of outcomes among patients with a renal artery aneurysm (RAA) undergoing surgical or endovascular repair in New York State (NYS). A retrospective cohort study of patients who underwent therapy for RAA in NYS from October 1, 2000, to December 31, 2006, was identified from the Statewide Planning and Research Cooperative System database. Regression models which included hospital and patient characteristics were created to identify predictors of untoward events following surgical or endovascular intervention.

Subcapsular hepatic hematoma with right hepatic vein thrombosis: a complication of shock wave lithotripsy.

Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe and effective therapeutic modality for surgical treatment of urolithiasis. Hematoma is a rare complication of ESWL and, when it occurs, typically involves the kidney. We report the case of a 71-year-old woman who developed severe, persistent abdominal pain after ESWL for a 9-mm stone at the ureteropelvic junction.

Simulator assessment of innate endovascular aptitude versus empirically correct performance.

Objective: Prior work has established that performance on an endovascular simulator incorporating tactile feedback (haptics) correlates with previous endovascular experience and can be improved by training. This study was designed to test the ability to define and measure innate endovascular aptitude and empirically correct performance and to determine whether these are two different things.

Methods: Subjects ranging in endovascular skill level from novice to expert were surveyed to determine video game experience and skill, endovascular level of training, and endovascular experience.