Treatment of abdominal aortic aneurysms: the role of endovascular repair.

Rupture of an abdominal aortic aneurysm (AAA) is a significant cause of mortality in the United States. Often asymptomatic, AAA is considered a silent killer because it frequently remains undiagnosed until the time of rupture or the patient's death. Major risk factors, such as smoking, age, sex, race, and family history of aortic aneurysm, affect the formation of AAAs.

Tissue markers in human atherosclerotic carotid artery plaque.

Carotid artery stenosis predisposes to thrombo-embolization and stroke. Established tissue markers such as osteopontin, nitric oxide synthases, myeloperoxidases, and matrix metalloproteinases have been examined within stenotic plaques and their impact upon plaque stability discussed. However, a new generation of tissue markers is being discovered, and their role in atherosclerotic development and plaque stability is being debated.

The current role of endovascular intervention in the management of diabetic peripheral arterial disease.

Poor arterial inflow continues to be a major contributing factor in the failure to heal diabetic foot wounds. Options for revascularization have significantly increased with the development of sophisticated endovascular techniques. However, the application of this technology is variable due to relatively little prospective, randomized data on newer techniques.

Synchrotron radiation X-ray fluorescence microscopy reveals a spatial association of copper on elastic laminae in rat aortic media.

Copper, an essential trace metal in humans, plays an important role in elastic formation. However, little is known about the spatial association between copper, elastin, and elastin producing cells. The aorta is the largest artery; the aortic media is primarily composed of the elastic lamellae and vascular smooth muscle cells, which makes it a good model to address this issue.

Inferior mesenteric artery aneurysm in the setting of chronic colonic vascular ectasia.

Colonic vascular ectasia is a condition characterized by dilated submucosal veins, venules, or capillaries found commonly in patients with lower gastrointestinal hemorrhage. We present a case of colorectal ectasia associated with ischemia and an inferior mesenteric artery aneurysm. These pathologic findings may be the result of the vascular ectasia and may add to the natural history of this condition.

Role of negative pressure wound therapy in treating peripheral vascular graft infections.

Wound complications involving large subcutaneous vessels can cause significant challenges for surgeons. Negative pressure wound therapy (NPWT) has been increasingly used for treating complex wounds in vascular surgery, including groin infections, either as a bridge to surgical closure or as a primary wound treatment modality. Although a growing body of evidence exists for managing various problematic wounds, such as diabetic foot ulcers and open abdominal wounds, the role of NPWT in wounds involving large blood vessels or wounds complicating infected vascular grafts has not been well defined.

Multidetector CT angiography of infrainguinal arterial bypass.

Infrainguinal arterial bypass (IGAB) surgery is commonly performed in patients with claudication, critical limb ischemia, or other arterial problems in the lower extremities. An IGAB is constructed from different materials depending on the anatomy of the lesion and the availability of an autogenous vein. The ideal material for IGAB is the greater saphenous vein, especially for distal below-knee bypass.

Commentary: risk factors for progression of peripheral arterial disease in large and small vessels. Aboyans V, Criqui MH, Denenberg JO, Knoke JD, Ridker PM, Fronek A. Circulation. 2006;113:2623-2629.

available at http://www.circ.ahajournals.

Guidelines for hospital privileges in vascular and endovascular surgery: recommendations of the Society for Vascular Surgery.

The Clinical Practice Council of the Society for Vascular Surgery (SVS) was charged with providing an updated consensus on guidelines for hospital privileges in vascular and endovascular surgery. One compelling reason to update these recommendations is that vascular surgery as a specialty has continued to evolve with a significant shift towards endovascular therapies. The Society for Vascular Surgery is making the following four recommendations concerning guidelines for hospital privileges for vascular and endovascular surgery.

Lateral plantar artery aneurysm: a case report.

We report a case of a true plantar artery aneurysm in an adult. True aneurysms of the inframalleolar vessels are rare. The limited literature on the subject is reviewed, including differential diagnosis and suggested treatment.

Target lesion characteristics in failing vein grafts predict the success of endovascular and open revision.

Objectives: This study examined the association of anatomic and temporal characteristics of graft-threatening lesions with the efficacy of percutaneous and open graft revision for failing infrainguinal vein grafts.

Methods: Consecutive open and endovascular revisions for graft threatening lesions were reviewed. We evaluated graft durability and individual target lesion response to open and endovascular treatment to determine characteristics that may influence outcomes.

The management of deep sternal wound infections using vacuum assisted closure (V.A.C.) therapy.

A group of international experts met in May 2006 to develop clinical guidelines on the practical application of vacuum assisted closure (V.A.C.

Consensus statement on negative pressure wound therapy (V.A.C. Therapy) for the management of diabetic foot wounds.

Unlabelled: In 2004, a multidisciplinary expert panel convened at the Tucson Expert Consensus Conference (TECC) to determine appropriate use of negative pressure wound therapy as delivered by a Vacuum Assisted Closure device (V.A.C.

Type 2 endoleaks after abdominal aortic aneurysm stent grafting with systematic mesenteric and lumbar coil embolization.

We evaluated the results of our policy of systematic coil embolization of the inferior mesenteric artery (IMA) and/or lumbar arteries (LAs) prior to endovascular abdominal aortic aneurysm (AAA) repair (EVAR). We retrospectively reviewed all patients undergoing EVAR over a 4-year period at one hospital. Results were analyzed using uni- and multivariate analyses.

Distal embolic protection during femoropopliteal atherectomy.

We report on a series of 10 consecutive cases of superficial femoral and popliteal artery atherectomy with the SilverHawk device, carried out for the treatment of peripheral vascular atherosclerosis. All cases were done with the use of a distal embolic protection device. Debris were retrieved in the filter in each case.

Healing of transmetatarsal amputation in the diabetic patient: is angiography predictive?

Transmetatarsal amputation (TMA) is a durable reconstruction in the diabetic patient with limited forefoot gangrene. However, predicting TMA healing remains difficult. Our goals were to (1) determine the success rate of TMA and (2) identify factors predictive of TMA healing, in particular arterial foot anatomy.

Early experience in the application of distal protection devices in treatment of peripheral vascular disease of the lower extremities.

The objectives of this study were to reduce the risk of showering distal vessels with thromboemboli created during percutaneous interventions of the arteries in the lower extremities. Distal protection devices have been used in coronary and carotid interventions. Hence, using similar techniques, these filters and occlusion balloons were advanced past the targeted lesions and distally into femoral and popliteal arteries.

Duplex screening for asymptomatic carotid artery disease in Hispanic diabetic patients undergoing lower extremity revascularization: is it a worthwhile endeavor?

Screening for carotid artery disease in patients with systemic manifestations of atherosclerosis (e.g., peripheral vascular disease or coronary artery disease) has been recommended.

Treatment of a late-appearing proximal type-1 endoleak after Ancure graft with an AneuRx cuff--a case report.

The authors describe the case of a patient who developed a type-1 proximal endoleak 10 months after Ancure stent graft placement, despite the lack of stent migration or measurable neck dilatation. The patient had been under observation for a persistent type-2 endoleak and was noted to have an increase in his aneurysm size. The use of an uncovered stent was unsuccessful, and he required a covered proximal extension cuff.

Aneurysmal degeneration of the superficial femoral artery following stenting: an uncommon infectious complication.

Infrainguinal angioplasty and stenting is becoming a more commonly performed procedure. Its durability remains a matter of debate, however. Aneurysmal degeneration following angioplasty and stenting is a complication not previously described in the literature with regard to the superficial femoral artery.

Endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta: long-term outcome.

The purpose of this multicenter study was to assess the long-term outcome of endovascular treatment of isolated atherosclerotic stenosis of the infrarenal abdominal aorta on the basis of clinical and ultrasound examination. Clinical, ultrasound, and angiographic findings from 36 women and 50 men (mean age, 53.2 years) treated for atherosclerotic stenosis of the infrarenal abdominal aorta were reviewed.