Management of Immediate Post-Endovascular Aortic Aneurysm Repair Type Ia Endoleaks and Late Outcomes.

Background: Post-endovascular aortic aneurysm repair (EVAR) endoleaks and the need for reintervention are challenging. Additional endovascular treatment is advised for type Ia endoleaks detected on post-EVAR completion angiogram. This study analyzed management and late outcomes of these endoleaks.

Aortic Neck Anatomic Features and Predictors of Outcomes in Endovascular Repair of Abdominal Aortic Aneurysms Following vs Not Following Instructions for Use.

Background: A significant number of patients undergo endovascular repair of abdominal aortic aneurysms (EVAR) outside the instructions for use (IFU). This study will examine various aortic neck features and their predictors of clinical outcomes.

Study Design: We performed a retrospective analysis of prospectively collected data on EVAR patients.

Compliance of postendovascular aortic aneurysm repair imaging surveillance.

Objective: Imaging surveillance after endovascular aortic aneurysm repair (EVAR) is critical. In this study we analyzed compliance with imaging surveillance after EVAR and its effect on clinical outcomes.

Methods: Retrospective analysis of prospectively collected data of 565 EVAR patients (August 2001-November 2013), who were followed using duplex ultrasound and/or computed tomography angiography.

Prospective randomized double-blinded trial comparing 2 anti-MRSA agents with supplemental coverage of cefazolin before lower extremity revascularization.

Objective: To compare with antibiotics with methicillin-resistant microbial coverage in a prospective fashion.

Background: Current antibiotic prophylaxis for vascular procedures includes a first generation cephalosporin. No changes in recommendations have occurred despite changes in reports of incidence of MRSA related surgical site infections.

Practice patterns of carotid endarterectomy as performed by different surgical specialties at a single institution and the effect on perioperative stroke and cost of preoperative imaging.

Background: Carotid endarterectomy (CEA) is currently performed by various surgical specialties with varying outcomes. This study analyzes different surgical practice patterns and their effect on perioperative stroke and cost.

Methods: This is a retrospective analysis of prospectively collected data of 1000 consecutive CEAs performed at our institution by three different specialties: general surgeons (GS), cardiothoracic surgeons (CTS), and vascular surgeons (VS).

Prospective randomized trial of ACUSEAL versus Vascu-Guard patching in carotid endarterectomy.

Background: Multiple studies have been conducted that demonstrate the superiority of patch angioplasty over primary closure for carotid endarterectomy (CEA). Patch angioplasty with polytetrafluorethylene patches (ACUSEAL) have shown results comparable to patch angioplasty with saphenous vein and polyester patches. This is a prospective randomized study to compare the clinical outcomes of CEA using ACUSEAL versus bovine pericardium patching (Vascu-Guard).

Amyloidosis and spontaneous hepatic bleeding, transcatheter therapy for hepatic parenchymal bleeding with massive intraperitoneal hemorrhage: a case report and review of the literature.

Hepatic hemorrhage can be devastating, especially in patients with underlying hepatic pathology. This is a case report of a 50-year-old man who presented to the emergency room with Stage 3 shock as evidenced by a systolic blood pressure of 90 mmHg, a heart rate of 125 beats per minute, respiration of 32, with delayed capillary refill and agitation. At this time, he was found to have a massive spontaneous intra-abdominal hemorrhage with an advanced stage of amyloidosis with multiple organ malfunctions.

Cystic adventitial disease of the common femoral vein: a case report and review of the literature.

We report on a 52-year-old female patient who presented with a 6-month history of right lower extremity swelling and tenderness. The patient was treated as an outpatient with full anticoagulation, without any improvement. Her medical history was significant for hypertension and high cholesterol, and she had a full coagulopathy profile that was negative for any hypercoagulable syndrome.

Patency in arteriovenous grafts in hemodialysis patients.

Objective: It is difficult to maintain a working access for patients on hemodialysis. Despite current Dialysis Outcome Quality Initiatives recommendations of "Fistula First," not everyone qualifies for a fistula, and those patients undergoing the alternative treatment, a graft, can experience graft failure. This study examines factors associated with arteriovenous graft (AVG) patency.

Predictors of percutaneous access failure requiring open femoral surgical conversion during endovascular aortic aneurysm repair.

Objective: To determine predictors of percutaneous (PEVAR) access failure requiring conversion to an open approach (OEVAR) during endovascular aortic aneurysm repair (EVAR).

Methods: A single-center retrospective review of all EVAR patients from January 2009 through June 2011 with multivariate analysis of clinical and anatomic variables that could impact access outcome was conducted. Target vessel calcification was categorized as mild, moderate, or severe based on circumferential calcium arc (<⅓, ⅓ to ½, and >½ respectively), dyslipidemia (defined as low-density lipoprotein >130 mg/dL or receiving lipid lowering medication), and obesity (defined as body mass index [BMI] >30).

The effect of surgeon's specialty and volume on the perioperative outcome of carotid endarterectomy.

Background: Several studies have demonstrated better outcomes for carotid endarterectomy (CEA) at high-volume hospitals and providers. However, only a few studies have reported on the impact of surgeons' specialty and volume on the perioperative outcome of CEA.

Methods: This is a retrospective analysis of CEA during a recent 2-year period.

Endovascular repair of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery: case report and review of literature.

We report a case of a pseudoaneurysm of the popliteal artery following arthroscopic knee surgery. Endovascular repair was successfully used as the treatment for this patient and studies have shown this to be a safe alternative to surgery.

Evolving treatment of popliteal artery aneurysms.

Background: Over the past decade, the treatment of popliteal aneurysms has evolved at our institution from sole operative intervention during the initial part of the study period, to combined surgical and endovascular treatment, and finally to endovascular-centered management in more recent years.

Methods: This is a retrospective review of all patients with popliteal aneurysms treated at our institution from 2001 to 2011. Data collection included the indication for intervention, treatment details, interventional patency, limb salvage, perioperative outcome, and midterm survival.

Perioperative and late clinical outcomes of percutaneous transluminal stentings of the celiac and superior mesenteric arteries over the past decade.

Background: Several authorities have proposed stenting of the superior mesenteric artery (SMA)/celiac artery (CA) as the primary treatment for patients with chronic mesenteric ischemia. However, most of these reports had small samples and short follow-up periods.

Methods: Eighty-three patients were treated over a 10-year period.

Critical analysis of renal duplex ultrasound parameters in detecting significant renal artery stenosis.

Background: Several published studies have reported differing results of renal duplex ultrasound (RDU) imaging in detecting significant renal artery stenosis (RAS) using different Doppler parameters. This study is the largest to date to compare RDU imaging vs angiography and assess various published Doppler criteria.

Methods: RDU imaging and angiography were both done in 313 patients (606 renal arteries).

Antibiotic-loaded polymethylmethacrylate beads for the treatment of extracavitary vascular surgical site infections.

Objective: This study assessed the efficacy of antibiotic-loaded polymethylmethacrylate (PMMA) beads in the treatment of lower extremity vascular surgical site infections (VSSIs).

Methods: This was a retrospective review of all patients with a VSSI of a lower extremity bypass treated with antibiotic-loaded PMMA beads and culture-specific antibiotics during a 4.5-year period.

Malposition of a central venous catheter into the right internal mammary vein: review of complications of catheter misplacement.

Central venous catheters are commonly utilized to gain vascular access for varied clinical indications. Successful catheter placement requires not only technical expertise but also awareness of the potential complications. In this article, we report a malposition of a central venous catheter in a hemodialysis patient.

Duplex velocity criteria for native celiac/superior mesenteric artery stenosis vs in-stent stenosis.

Background: Duplex velocity criteria (DVC) to identify in-stent celiac artery (CA) and superior mesenteric artery (SMA) stenosis is not well defined. Only one study has been published which concluded that DVC for native SMA stenosis overestimated stenosis in stented SMAs. The purpose of this study was to analyze DVC in detecting CA/SMA in-stent stenosis (ISS).

Mesenteric/celiac duplex ultrasound interpretation criteria revisited.

Background: Several published studies with a small sample size have reported differing results of duplex ultrasound (DUS) utilizing different threshold velocities in detecting significant stenosis of superior mesenteric (SMA) or celiac arteries (CA). The present study is based on the largest number of mesenteric duplex/angiography correlations reported to date for the diagnosis of SMA/CA stenosis.

Methods: One hundred fifty-three patients (151 SMA and 150 CA) had both DUS and arteriography.

Correlation of intraoperative collateral perfusion pressure during carotid endarterectomy and status of the contralateral carotid artery and collateral cerebral blood flow.

Background: The optimal method for predicting when carotid shunting is not necessary during carotid endarterectomy (CEA) is controversial. This study will analyze the correlation of collateral perfusion pressure and the status of contralateral carotid/cerebral collaterals and determine whether preoperative duplex ultrasound/cerebral angiography can predict when CEA can be done without shunting.

Methods: Ninety-eight patients were randomized into routine shunting and 102 into selective shunting when the collateral perfusion pressure (systolic carotid stump pressure) was <40 mm Hg during CEA.

The relationship of preoperative thrombus load and location to the development of type II endoleak and sac regression.

Background: Few studies have specifically correlated the amount of thrombus in the aneurysm sac and the presence of type II endoleaks (TIIE). This study examined the correlation of preoperative thrombus load and location to the incidence of TIIE and late sac regression.

Methods: Prospectively collected data from 266 endovascular aneurysm repair (EVAR) patients were analyzed.

Kissing iliac artery stent technique for salvage of hypogastric artery occlusion secondary to iliac artery dissection during endovascular aneurysm repair.

While undergoing endovascular aneurysm repair (EVAR), dissection occurred in bilateral common and external iliac arteries resulting in acute bilateral hypogastric artery occlusion. Attempts were made to reestablish flow to the left internal iliac artery via retrograde ipsilateral approach without success. A left brachial approach was used to gain access to the left internal iliac artery and kissing angioplasty and subsequent stent placement with 2 self-expanding stents was performed raising the iliac bifurcation to the level of the stent graft to salvage the internal iliac artery.

Clinical outcomes for hostile versus favorable aortic neck anatomy in endovascular aortic aneurysm repair using modular devices.

Background: Endovascular aneurysm repair (EVAR) is not generally recommended for patients with hostile neck anatomy. This study analyzed the clinical implications of various clinical features of proximal aortic neck anatomy.

Methods: Prospectively collected data from 258 EVAR patients using modular devices were analyzed.

Carotid artery stenting outcomes are equivalent to carotid endarterectomy outcomes for patients with post-carotid endarterectomy stenosis.

Background: Carotid artery stenting (CAS) has been advocated as an alternative to redo surgery for patients with post-carotid endarterectomy (CEA) stenosis. This study compares early and late clinical outcomes for both groups.

Methods: This study analyzes 192 patients: 72 had reoperation (Group A) and 120 had CAS for post-CEA stenosis (Group B).