Optimizing the diagnostic approach of functional popliteal artery entrapment syndrome.

Objective: Functional popliteal artery entrapment syndrome (fPAES) is an underdiagnosed and undertreated etiology of atypical claudication. Symptoms of fPAES include deep posterior muscle cramping and pain with exercise and, unlike anatomic PAES, there are seldom vascular complications. Common noninvasive diagnostic modalities include ankle-brachial index, arterial duplex Doppler ultrasound (DUS) examination, and cross-sectional imaging such as magnetic resonance angiography (MRA).

Chronic compartment syndrome secondary to venous hypertension: fasciectomy for symptom relief.

Chronic compartment syndrome (CCS) from venous hypertension following lower leg deep venous thrombosis or severe venous insufficiency is rare and often difficult to diagnose. Although ileocaval stenting and thrombolysis have improved claudication symptoms related to outflow venous disease, chronic calf claudication from distal vein thrombosis and venous insufficiency have historically been managed with rest, compression, and elevation. Often, conservative options give inadequate symptom relief and active individuals are rarely compliant.

The social media: its impact on a vascular surgery practice.

Objectives: Social media has revolutionized interpersonal communication and has become a commonly used public informational resource. This study evaluates the impact of intranet informatics on a specialty practice of vascular surgery.

Methods: Referral patterns for patients with chronic compartment syndrome (CCS) and popliteal entrapment syndrome (PAES) between 2008 and 2011 were analyzed.

Foot claudication with plantar flexion as a result of dorsalis pedis artery impingement in an Irish dancer.

Dorsalis pedis artery impingement is an extremely rare cause of foot claudication, with a single case reported in the literature. In this report, we describe the case of a 17-year-old female Irish dancer who presented with intermittent bilateral foot pain and discoloration during active plantar flexion.

Effect of early plasma transfusion on mortality in patients with ruptured abdominal aortic aneurysm.

Background: The ratio of red blood cell (PRBC) transfusion to plasma (FFP) transfusion (PRBC:FFP ratio) has been shown to impact survival in trauma patients with massive hemorrhage. The purpose of this study was to determine the effect of the PRBC:FFP ratio on mortality for patients with massive hemorrhage after ruptured abdominal aortic aneurysm (RAAA).

Methods: A retrospective review was performed of patients undergoing emergent open RAAA repair from January 1987 to December 2007.

Impact of intraoperative arteriography on limb salvage for traumatic popliteal artery injury.

Background: Time to revascularization is speculated to be a major determinant of limb salvage for traumatic popliteal injuries. The purpose of this study was to determine whether location of diagnostic arteriography affected outcome.

Methods: From 1996 to 2006, patients with popliteal injuries were identified from our trauma database.

Functional popliteal artery entrapment syndrome: A poorly understood and often missed diagnosis that is frequently mistreated.

Objectives: Functional popliteal artery entrapment syndrome (FPAES) is an uncommon overuse injury in young physically active adults manifest by neuromuscular symptoms (gastroc/soleus cramping, plantar paresthesias). It is commonly confused with chronic recurrent exertional compartment syndrome (CRECS). This study evaluated the diagnostic testing, mechanism of injury, and treatment differences between FPAES and CRECS.

Outcomes after endarterectomy for chronic mesenteric ischemia.

Objectives: A retrospective study was performed to identify optimal factors affecting outcomes after open revascularization for chronic mesenteric ischemia.

Methods: All patients who underwent open surgery for chronic mesenteric ischemia from 1987 to 2006 were reviewed. Patients with acute mesenteric ischemia or median arcuate ligament syndrome were excluded.

Product line development: a strategy for clinical success in academic centers.

Objective: Academic medical centers, which have traditionally been relatively inefficient, have increasing difficulty in meeting the missions of patient care, teaching, and research in a progressively competitive medical marketplace. One strategy for improved efficiency in patient care while keeping quality high is utilization of a product line matrix. This study addresses the outcome of utilizing a product line strategy consisting of 3 service lines during the past 5 years at the University of Wisconsin Hospital and Clinics (UWHC).

Cardiovascular service line development: what is it, who benefits and is it worthwhile?

This article describes the creation and function of a cardiovascular service line in a university healthcare-based system. In 2001, an organizational structure (service line) was created to establish accountability between vascular surgeons, cardiologists and hospital administrators. The purpose of this merger was to provide focused, efficient care of cardiovascular patients at a reduced cost.

Effectiveness of intensive medical therapy in type B aortic dissection: a single-center experience.

Objective: Although the mainstay of managing acute descending thoracic aortic dissection (ADTAD) remains medical, certain patients will require emergency surgery for complications of rupture or ischemia. This study evaluates factors that affect outcome and determines which patients previously treated surgically would have been eligible for endovascular repair.

Methods: A single-institution retrospective study was conducted of patients who presented with clinical signs of ADTAD that was confirmed by magnetic resonance angiography (MRA) or computed tomography (CT).

Clinical utility of time-resolved imaging of contrast kinetics (TRICKS) magnetic resonance angiography for infrageniculate arterial occlusive disease.

Objective: The diagnostic accuracy of magnetic resonance angiography (MRA) in the infrapopliteal arterial segment is not well defined. This study evaluated the clinical utility and diagnostic accuracy of time-resolved imaging of contrast kinetics (TRICKS) MRA compared with digital subtraction contrast angiography (DSA) in planning for percutaneous interventions of popliteal and infrapopliteal arterial occlusive disease.

Methods: Patients who underwent percutaneous lower extremity interventions for popliteal or tibial occlusive disease were identified for this study.

Absence of buttock claudication following stent-graft coverage of the hypogastric artery without coil embolization in endovascular aneurysm repair.

Purpose: To evaluate the safety and efficacy of stent-graft coverage of the hypogastric artery origin without coil embolization during endovascular treatment of aortoiliac or iliac aneurysms.

Methods: A retrospective study was conducted of patients who underwent endovascular aneurysm repair with endograft coverage of the hypogastric artery between September 2001 and September 2005. Among the 88 patients who underwent EVAR during the study period, 21 patients (19 men; mean age 77+/-6 years, range 67-86) had unilateral hypogastric artery coverage without coil embolization.

Vertebral artery embolic protection via ipsilateral brachial approach during left subclavian artery angioplasty and stenting--a case report.

The purpose of this report is to explore angioplasty and stenting with cerebral embolic protection as a salvage procedure for a compromised carotid-subclavian bypass in the presence of antegrade vertebral artery flow. A 76-year-old woman with a carotid-subclavian bypass presented with graft infection. Failure of medical therapy to treat the infection prompted surgical removal of the graft.

Limb-salvage angioplasty in vascular surgery practice.

Objective: To assess outcomes of percutaneous infrainguinal arterial angioplasty for treatment of chronic limb-threatening ischemia (CLI) in poor surgical candidates.

Methods: A retrospective clinical analysis of 67 consecutively treated patients (76 limbs) with CLI over a 33-month period was performed. Patients were considered poor surgical candidates because of absent distal target vessels (31 limbs), severe comorbid conditions (36 limbs), or lack of an autologous vein for distal bypass (9 limbs).

Endovascular aortic repair or minimal incision aortic surgery: Which procedure to choose for treatment of high-risk aneurysms?

Background: This study evaluates use of endovascular aortic repair (EVAR) and minimal incision aortic surgery (MIAS) for treatment of high-risk patients with infrarenal aneurysms.

Methods: A retrospective review of patients treated with EVAR or MIAS between 2000 and 2002 was performed. High-risk criteria included age older than 80 years, creatinine level greater than 3.

Chronic abdominal pain and upper gastrointestinal bleeding due to duodenal perforation caused by migrated inferior vena cava filter--a case report.

The authors describe an unusual case of a 41-year-old man presenting with chronic abdominal pain and gastrointestinal bleeding caused by a migrated inferior vena cava filter eroding into the duodenum.

Is coil embolization of hypogastric artery necessary during endovascular treatment of aortoiliac aneurysms?

The aim of this study was to evaluate the safety and efficacy of stent graft coverage of hypogastric artery in the management of aortoiliac aneurysms. Between January 2000 and December 2002, 98 patients underwent endovascular repair of aortoiliac aneurysms (EVAR). Of these, 24 (24.

Clinical review of patients treated for atypical claudication: a 28-year experience.

Purpose: This article describes patient demographic data, as well as diagnosis and treatment of symptomatic lower extremity claudication that has no apparent vascular or orthopedic cause.

Methods: A retrospective review was performed of records for 843 patients who received surgical treatment between 1975 and 2003. All patients had a detailed history, and underwent physical examination and selected noninvasive vascular testing.

Comparison of minimal incision aortic surgery with endovascular aortic repair.

Background: Enthusiasm for endovascular aortic repair (EVAR) has been tempered by midterm outcomes that raise valid concern about long-term durability.

Methods: This article compares outcome data from a prospective nonrandomized comparison of a less-invasive open surgical repair technique-minimal incision aortic surgery (MIAS)-and EVAR.

Results: MIAS and EVAR had comparable intensive care unit stays (1 day or less), quick return to general dietary feeding (2 days), and comparable hospital length of stay (4.

Limb salvage angioplasty in poor surgical candidates.

This study was conducted to evaluate the potential for percutaneous catheter based limb salvage angioplasty in patients who have no surgical bypass option. Twenty patients, 12 males and 8 females, with end-stage limb ischemia (Rutherford category 4 and 5) were treated with balloon angioplasty. Antegrade femoral access, coronary guidewire, and balloons were used.

Minimal incision aortic surgery (MIAS).

This study evaluates the clinical and economic impact of using less extensive minimal invasive aortic surgery (MIAS) for elective treatment of infrarenal aortic aneurysms (AAA) and aortoiliac occlusive disease (AIOD) in two independent surgical departments. Surgeons from two institutions conducted a prospective consecutive, nonrandomized analysis of MIAS electively performed in 80 patients. MIAS outcomes were compared with 80 consecutive elective standard open aortic procedures (40 from each institution), which were performed during the same time period.