Ex vivo repair of renal artery aneurysms.

Objective: Renal artery aneurysms (RAAs) are rare but remain challenging lesions when treatment is required. Endovascular techniques may be useful in selected, more proximal lesions with amenable morphology, but open surgical repair is often required for more distal, anatomically complex hilar RAAs that often have several branches and unfavorable anatomy. This study reviewed a single-center experience with ex vivo repair of 14 of these more complex, distal RAAs.

Traumatic arteriovenous fistula 52 years after injury.

Untreated traumatic arteriovenous fistulae (AVF) have been associated with aneurysmal dilatation of the involved artery and vein, congestive heart failure, and limb ischemia. Open surgical repair of these lesions can be challenging due to the elevated venous pressure and surrounding inflammation. This case report describes a hybrid open and endovascular approach to treatment of a traumatic AVF in the right groin, presenting with aneurysmal ileo-femoral arteries and veins and pulmonary hypertension.

Endograft repair of traumatic aortic injury-a technique in evolution: a single institution's experience.

Objective: We evaluated a large single center experience of endograft repair of blunt traumatic injury of the thoracic aorta.

Summary Background Data: Traumatic aortic transection is a devastating injury with high morbidity and mortality. Endograft repair of these injuries has reduced the rates of death and paraplegia seen with open surgical treatment in the past.

Endovascular embolization of a giant renal artery aneurysm with preservation of renal parenchyma.

Renal artery aneurysm is a rare condition that has an unclear etiology. Although some patients present with symptoms of hypertension, pain, hematuria, or rupture, the majority are asymptomatic. Traditional surgical repair of renal artery aneurysms is often complex and may require ex vivo repair and reimplantation of the kidney if branch vessels are involved.

Intraoperative coil embolization reduces transplant nephrectomy transfusion requirement.

Transplant nephrectomy for failed renal transplants can be challenging. Patients often have numerous comorbidities, and the procedure may be associated with considerable blood loss. This study was performed to determine if intraoperative coil embolization of the transplant renal artery reduces blood loss associated with transplant nephrectomy.

The bedside insertion of inferior vena cava filters using ultrasound guidance.

Since the introduction of inferior vena cava (IVC) filters more than 30 years ago, there has been a steady improvement in the design, ease, and safety of the delivery systems. Today, all of the commonly used filters can be placed via a peripheral vein by using standard percutaneous Seldinger technique. However, this typically requires fluoroscopy, intravenous contrast agents, radiation exposure, and transport of the patient to the interventional or operating suite.

Twenty consecutive cases of endograft repair of traumatic aortic disruption: lessons learned.

Objectives: Endograft repair holds considerable promise in the treatment of traumatic disruption of the thoracic aorta because patients often have multiple coexisting injuries further complicating traditional open repair. In addition, patients are often young, with an aortic anatomy dissimilar to those with atherosclerotic aneurysms. As a result, techniques for endograft repair have to be refined accordingly.

Results of the national pilot screening program for venous disease by the American Venous Forum.

Objective: This report describes the pilot of a free comprehensive national screening program for venous disease.

Methods: The screening process consisted of a venous thromboembolism (VTE) risk assessment, abbreviated duplex examination for venous obstruction and reflux, inspection for signs of chronic venous insufficiency (CVI), and an exit interview. Physicians coordinating the screenings were members of the American Venous Forum.

Lemierre's syndrome: a potentially fatal complication that may require vascular surgical intervention.

Septic phlebitis of the internal jugular vein, Lemierre's syndrome, is extremely rare. However, Lemierre's syndrome may cause septic pulmonary emboli or result in fatal systemic sepsis, or both, if a timely diagnosis and appropriate treatment are not provided. We present a case of Lemierre's syndrome that occurred in an otherwise healthy young man.

The effect of exercise intensity on the response to exercise rehabilitation in patients with intermittent claudication.

Purpose: The purpose of this randomized trial was to compare the efficacy of a low-intensity exercise rehabilitation program vs a high-intensity program in changing physical function, peripheral circulation, and health-related quality of life in peripheral arterial disease (PAD) patients limited by intermittent claudication.

Methods: Thirty-one patients randomized to low-intensity exercise rehabilitation and 33 patients randomized to high-intensity exercise rehabilitation completed the study. The 6-month exercise rehabilitation programs consisted of intermittent treadmill walking to near maximal claudication pain 3 days per week at either 40% (low-intensity group) or 80% (high-intensity group) of maximal exercise capacity.

Exteriorization and control of a retained embolization coil in the carotid artery--a case report.

Advances in endovascular technology have enabled the development of complex techniques for the treatment of vascular conditions. Not surprisingly, the modern vascular surgeon will likely encounter unusual complications and will need to formulate plans for their management. In the current case report, the vascular surgery service was consulted to assist in the management of a retained embolization coil in the carotid artery.

Combined endovascular and surgical repair of a large traumatic pseudoaneurysm of the thigh-a case report.

Thigh pseudoaneurysms are rare compared to pseudoaneurysms of the groin, and usually result from direct injury to an arterial branch. Direct open repair can be associated with a large volume blood loss. The authors describe a combined endovascular and surgical approach to a large, traumatic, pseudoaneurysm of the thigh.

Surgical thrombectomy and transluminal balloon angioplasty for failed above-knee femoropopliteal polytetrafluoroethylene bypass grafts.

Endovascular therapy offers an alternative to redo bypass or surgical graft revision for failed above-knee femoropopliteal PTFE bypass grafts. We evaluated the outcome of surgical thrombectomy and balloon angioplasty for the treatment of thrombosed bypass grafts. Thirty selected patients with thrombosed above-knee femoropopliteal PTFE bypass grafts were treated.

The role of arteriography in assessing popliteal artery injury in knee dislocations.

Background: This study aimed to review the need for angiography among patients with traumatic knee dislocations, and to evaluate any adverse consequences associated with the clinical decision to pursue or defer angiography.

Methods: A retrospective analysis was performed for 55 patients (57 knees) with traumatic knee dislocation during a 7-year period. The presence or absence of arterial injury was assessed via physical examination (to determine presence of foot pulses and ankle-brachial index > or = 0.

Endovascular repair of a penetrating thoracic aortic ulcer by way of the carotid artery.

Introduction: Endovascular repair of thoracic aortic lesions offers an attractive alternative to traditional open repair. Access to the thoracic aorta can occasionally be challenging because of large device size and vessel tortuosity. Traditional access by way of the femoroiliac vessels might not be possible in the setting of synchronous iliac occlusive disease.

Coagulopathy as a result of factor V inhibitor after exposure to bovine topical thrombin.

We describe a case of severe coagulopathy after mesenteric revascularization. Laboratory investigation results revealed the presence of plasma inhibitors of factor V believed to result from exposure to bovine thrombin used for intraoperative hemostasis. Vascular and cardiothoracic surgeons commonly use topical thrombin for surgical hemostasis, and many patients undergo multiple exposure.