Lady With the Blue Hair: An Atypical Cause of Myasthenic Crisis.

A myasthenic crisis denotes a severe exacerbation of myasthenia gravis, leading a patient to enter a life-threatening state due to progressing muscle weakness that ultimately results in respiratory failure. A crisis can require intubation, mechanical ventilation, and additional critical care to prevent further decompensation and potentially death. Numerous well-documented precipitating factors exist, such as infections, surgery, stress, and various medications.

Heparin-bonded versus standard polytetrafluoroethylene arteriovenous grafts: A Bayesian perspective on a randomized controlled trial for comparative effectiveness.

Background: Heparin-bonded polytetrafluoroethylene grafts were marketed to improve hemodialysis access outcomes but are twice the cost of standard polytetrafluoroethylene. We launched a randomized trial of heparin-bonded polytetrafluoroethylene versus standard polytetrafluoroethylene for hemodialysis access to compare patency. Since the trial began, additional studies were published with heterogeneous findings.

Complications after endovascular treatment of hepatic artery stenosis after liver transplantation.

Background: Hepatic artery stenosis (HAS) after liver transplantation can progress to hepatic artery thrombosis (HAT) and a subsequent 30% to 50% risk of graft loss. Although endovascular treatment of severe HAS after liver transplantation has emerged as the dominant method of treatment, the potential risks of these interventions are poorly described.

Methods: A retrospective review of all endovascular interventions for HAS after liver transplantation between August 2009 and March 2016 was performed at a single institution, which has the largest volume of liver transplants in the United States.

Axillary Block-Induced Chemical Sympathectomy in the Setting of Digital Ischemia.

Background: Digital ischemia is associated with several rheumatologic disorders and is often difficult to treat. Symptoms and sequelae can include pain, disability, need for amputation, and poor quality of life.

Methods: Patients diagnosed with digital ischemia were referred for an ultrasound-guided axillary nerve block using liposomal bupivacaine (Exparel, Pacira Pharmaceuticals).

Urgent carotid intervention is safe after thrombolysis for minor to moderate acute ischemic stroke.

Objective: Carotid intervention shortly after an acute neurologic ischemic event is being performed more frequently in stroke centers to reduce the risk of recurrent stroke. Thrombolysis with recombinant tissue plasminogen activator (tPA) is offered to select patients with ischemic stroke symptoms who present within 4.5 hours.

Heparin-Bonded Polytetrafluorethylene Does Not Improve Hemodialysis Arteriovenous Graft Function.

Background: Heparin-bonded polytetrafluorethylene (hep PTFE), when compared with standard PTFE, has been shown to have a modest improvement in distal extremity bypass grafts. The data supporting its usage for dialysis access are less clear. We compared the patency rates, number of interventions, and complications between hep PTFE grafts and nonheparin-bonded PTFE (nonhep PTFE) grafts placed for dialysis access.

Primary stent placement for hepatic artery stenosis after liver transplantation.

Objective: Significant hepatic artery stenosis (HAS) after orthotopic liver transplantation (OLT) can lead to thrombosis, with subsequent liver failure in 30% of patients. Although operative intervention or retransplantation has been the traditional solution, endovascular therapy has emerged as a less invasive treatment strategy. Prior smaller studies have been conflicting in the relative efficacy of percutaneous transluminal angioplasty (PTA) vs primary stent placement for HAS.

Future management of carotid stenosis: role of urgent carotid interventions in the acutely symptomatic carotid patient and best medical therapy for asymptomatic carotid disease.

Background: Stroke is the fourth leading cause of death in the United States, leading to devastating disability. Most strokes are ischemic, and nearly one-third of these are caused by carotid disease. The primary mechanism of carotid-related stroke is an atheroembolic event from an unstable atherosclerotic plaque rupture.

Transradial approach for percutaneous intervention of malfunctioning arteriovenous accesses.

Objective: Interventions on arteriovenous (AV) access are typically performed with a direct puncture into the fistula. An alternative is the transradial approach (TRA), which offers the advantage of visualizing both the arterial and venous limbs as well as any juxta-anastomotic stenosis, all through one access.

Methods: From September 2010 to 2013, 511 fistulograms were performed on 322 patients, 55 of which were TRA procedures in 40 patients (50% male; mean age, 60.

Hospital reimbursement for carotid stenting and endarterectomy.

Purpose: To investigate the cost-effectiveness of carotid endarterectomy (CEA) vs. carotid artery stenting (CAS) in terms of hospital reimbursement.

Methods: A retrospective analysis was conducted of hospital reimbursement for patients undergoing CEA and CAS from 1 January 2008 through 30 September 2010 at a single tertiary referral institution.

Retrograde pedal access for patients with critical limb ischemia.

Objective: Retrograde pedal access may allow the treatment of tibial occlusive lesions when standard endovascular techniques fail. We aimed to analyze the outcomes in patients with chronic limb ischemia (Rutherford class IV and V) who were not surgical candidates for a tibial bypass and had undergone an unsuccessful attempt at revascularization through an antegrade access.

Methods: During a 3-year period, a retrograde pedal access was selectively chosen when a popliteal or tibial lesion could not be crossed through an antegrade approach.

A stroke/vascular neurology service increases the volume of urgent carotid endarterectomies performed in a tertiary referral center.

Background: Increasing evidence supports that urgent carotid endarterectomy (CEA), defined as CEA during the index hospitalization, may be undertaken in select patients with acute carotid-related neurologic symptoms to prevent recurrent ischemic events. We aimed to determine the effect of a stroke/vascular neurology service on the volume of urgent CEAs performed and assess perioperative outcomes.

Methods: A retrospective review from a single tertiary referral center between June 2005 through December 2011 revealed 393 patients who underwent CEA.

Laparoscopic versus robot-assisted surgery for median arcuate ligament syndrome.

Background: Median arcuate ligament syndrome (MALS) is an uncommon disorder characterized by postprandial abdominal pain, weight loss, and vomiting related to the compression of the celiac artery by the median arcuate ligament. This syndrome has been classically treated with an open surgical approach. More recently, laparoscopic and robotic approaches have been used.

Awake, percutaneous repair of a ruptured abdominal aortic aneurysm.

Background: The rupture of an abdominal aortic aneurysm is a highly lethal event, claiming approximately 15,000 lives each year. Traditionally, open surgical repair has been the mainstay for treatment. However, this surgery is associated with almost a 50% perioperative mortality rate.

Endovascular treatment of hepatic artery stenosis after liver transplantation.

Background: Hepatic artery stenosis (HAS) after orthotopic liver transplantation is a significant risk factor for subsequent hepatic artery thrombosis (HAT). HAT is associated with a 30%-50% risk of liver failure culminating in retransplantation or death. Traditional treatment of hepatic artery complications has been surgical, with hepatic artery revision or retransplantation.

Carotid endarterectomy is more cost-effective than carotid artery stenting.

Objective: Cost-effectiveness has become an important end point in comparing therapies that may be considered to have clinical equipoise. While controversial, some feel that recent multicenter randomized controlled trials have codified clinical equipoise between carotid endarterectomy (CEA) and carotid artery stenting (CAS).

Methods: A retrospective analysis of hospital cost and 30-day clinical outcomes was performed on patients undergoing CEA and CAS between January 1, 2008 and September 30, 2010 at a single tertiary referral institution.

Hybrid repair of thoracoabdominal aortic aneurysms involving the visceral vessels: comparative analysis between number of vessels reconstructed, conduit, and gender.

Background: Thoracoabdominal aortic aneurysm (TAAA) repairs are technically challenging. The advent of endovascular aneurysm repair in combination with visceral/renal artery bypasses has allowed for hybrid endovascular repair of these aneurysms. The purpose of this study was to evaluate whether outcomes were affected by the number of visceral/renal artery reconstructions, conduit, or gender.