Endovascular recanalization of total occlusions of the mesenteric and celiac arteries.

Objective: To evaluate our experience with the endovascular treatment of total occlusions of the mesenteric and celiac arteries.

Methods: We performed a retrospective review of endovascular stenting of 27 nonembolic total occlusions of the superior mesenteric artery (SMA) and celiac artery (CA) between July 2004 and July 2011 (26 patients, 16 females; mean age, 62 ± 13 years). A variety of demographic, lesion-related and procedure-related variables were evaluated for potential impact of technical success and patency.

Anatomic bifurcated reconstruction of chronic bilateral innominate-superior vena cava occlusion using the Y-stenting technique.

This article presents the case of a 42-year-old man who presented with superior vena cava (SVC) syndrome due to fibrosing mediastinitis with multiple failed attempts at recanalization. We initially treated him with unilateral sharp needle recanalization of the right innominate vein into the SVC stump followed by stenting. Although his symptoms improved immediately, they did not completely resolve.

A natural history of aortic aneurysm hygroma.

A 56-year-old man with a family history of aortic aneurysm underwent routine repair in 2003. A postoperative computed tomography scan showed a 6-cm perigraft hygroma. Sudden onset of abdominal pain 12 months later revealed a larger hygroma, with an additional anterior fluid collection suggestive of contained rupture.

Combined direct repair and inline inflow stenting in the management of aortoiliac disease extending into the common femoral artery.

Purpose: Describe a hybrid approach to simplify management of complex aortoiliac occlusive disease (AIOD) extending into the common femoral artery (CFA).

Methods: Retrospective review of 56 patients who underwent hybrid management of AIOD extending into CFA between January 2003 and February 2007. Two distinct hybrid approaches were compared: Inline (iliac stenting continuous with an open CFA reconstruction, 38 limbs in 37 patients) and tandem (noncontiguous stenting of an upstream iliac segment, 20 limbs in 19 patients).

Impact of aggressive endovascular recanalization techniques on success rate in chronic total arterial occlusions (CTOs).

Purpose: To report experience with aggressive recanalization approaches in chronic total arterial occlusion (CTO).

Methods: Chronic total arterial occlusion recanalization was attempted on 112 limbs in 99 consecutive patients between January 1999 and December 2006.

Results: There were 63 iliac arteries, 45 femoropopliteal arteries, and 4 occluded stents.

Long-term outcome following stent reconstruction of the aortic bifurcation and the role of geometric determinants.

We assessed the long-term patency of kissing stent reconstruction of the aortoiliac bifurcation and identified variables that may influence it. We retrospectively reviewed our experience with stent-reconstruction procedures of the aortoiliac bifurcation from January 1998 through June 2005. The impact of demographic variables, vascular risk factors, disease location and characteristics, stent material and design, and stenting configuration on stent patency was assessed using univariate and multivariate analysis.

Kissing stent reconstruction of the aortoiliac bifurcation.

Kissing stent reconstruction of the aortoiliac bifurcation is a widely used technique for the management of aortoiliac occlusive disease involving the aortic bifurcation or proximal common iliac arteries. New advances in delivery systems and stent design have enabled better anatomic results with kissing stenting. Long-term patency is generally excellent, although several factors may adversely affect patency and should be taken into account when devising the stenting configuration and selecting the device to be used.

Development of a contemporary bleeding risk model for elderly warfarin recipients.

Background And Purpose: Develop and validate a contemporary bleeding risk model to guide the clinical use of warfarin in the elderly atrial fibrillation (AF) population.

Methods: Chart-abstracted data from the National Registry of Atrial Fibrillation was combined with Medicare part A claims to identify major bleeding events requiring hospitalization. Using a split-sample technique, candidate variables that provided statistically stable relationships with major bleeding events were selected for model development.

Can randomized trial outcomes for carotid endarterectomy be achieved in community-wide practice?

The benefit of carotid endarterectomy (CEA) is dependent upon achieving procedural outcomes comparable to those observed in randomized trials. We have extensively examined outcomes of the procedure in the community with a complete medical record (hospital chart) review of over 20,000 Medicare patients undergoing CEA in 10 states. In patients with comparable indications, overall risk of stroke or death of 6.

Combined anticoagulant-antiplatelet use and major bleeding events in elderly atrial fibrillation patients.

Background And Purpose: Bleeding risks from combined antiplatelet-warfarin therapy have not been well-described in clinical practice. We examined antiplatelet therapy among warfarin users and the impact on major bleeding rates.

Methods: Retrospective cohort analysis of persons discharged on warfarin after an atrial fibrillation admission using data from Medicare's National Stroke Project.

Balloon angioplasty as a treatment of failing infrainguinal autologous vein bypass grafts.

Purpose: The purpose of this study was to evaluate the role of balloon angioplasty in the treatment of failing infrainguinal vein bypass (IVB) grafts.

Methods: A retrospective chart review of patients undergoing revision of a failing IVB graft by vascular surgeons at a tertiary care center from 1990 to 2001 was performed. Failing bypass grafts were identified by routine duplex scan surveillance and physical examination.

Multistate improvement in process and outcomes of carotid endarterectomy.

Objectives: The purpose of this study was to assess the effect of community-wide performance measurement and feedback on key processes and outcomes of carotid endarterectomy (CEA).

Methods: Complete medical record (hospital chart) review for indications, care processes, and outcomes was performed on a random sample of Medicare patients undergoing CEA in 10 states (Arkansas, Georgia, Illinois, Indiana, Iowa, Kentucky, Michigan, Nebraska, Ohio, Oklahoma) during baseline (Jun 1, 1995 to May 31, 1996) and remeasurement (Jun 1, 1998 to May 31, 1999) periods. In addition to review of the index hospital stay, hospital admissions within 30 days of the procedure were reviewed and the Medicare enrollment database queried to identify out-of-hospital deaths, to determine 30-day outcome results.

Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results.

Purpose: To evaluate the safety and assess the role of endovascular therapy in a variety of conditions related to celiac and mesenteric vascular occlusive disease. Patients and methods Our retrospective study population included 25 consecutive patients (mean age, 66 years), in whom 28 procedures were performed on 26 stenosed or occluded mesenteric vessels (superior mesenteric artery [SMA] or celiac artery [CA]). Indications included chronic mesenteric ischemia (21 patients), including 2 patients who underwent stenting prior to a planned operative repair of a juxtamesenteric AAA.

Multistate population-based outcomes of combined carotid endarterectomy and coronary artery bypass.

Objectives: The management of combined carotid and coronary disease is controversial, and the outcomes of combined carotid endarterectomy (CEA) and coronary artery bypass grafting (CABG) have not been determined on a community-wide basis. This study was undertaken to evaluate the community-wide outcomes of combined CEA and CABG and to evaluate the risk for adverse events.

Methods: A complete medical record review of 10,561 CEA procedures randomly selected from Medicare patients undergoing CEA in 10 states was performed.