Endovascular therapy in prevention and management of coronary-subclavian steal.

Background: The optimal management of patients undergoing coronary artery bypass grafting (CABG) who have proximal subclavian artery stenosis (SAS) is not well established. SAS may lead to flow reversal through a patent in situ internal mammary artery graft, resulting in myocardial ischemia (coronary-subclavian steal). We review our experience in prevention and management of coronary-subclavian steal.

Crossing the limbs: a useful adjunct for successful deployment of the AneuRx stent-graft.

Purpose: To describe a technique for deploying an AneuRx stent-graft in an abdominal aortic aneurysm (AAA) with an acutely angled aortic neck.

Technique: In routine cases, the AneuRx stent-graft main body is positioned with the nose cone notch facing the contralateral side. In severely angulated aortic necks, however, the main body of the AneuRx stent-graft can be positioned with the nose cone notch and iliac limb gate facing the ipsilateral side; this dramatically reduces the acuity of the angle at the aortic neck and the iliac gate.

The AneuRx stent-graft since FDA approval: single-center experience of 230 cases.

Purpose: To compare a single-center experience with the AneuRx stent-graft system before and after FDA approval to results from the multicenter phase II clinical trial.

Methods: The medical records of 230 consecutive patients (218 men; mean age 74 years) undergoing AneuRx stent-graft implantation for abdominal aortic aneurysm (AAA) exclusion since September 1999 were reviewed to collect patient characteristics, aneurysm morphology, procedure variables, perioperative morbidity, mortality, and short-term outcome. These data were compared to the 30 patients treated at our institution during the AneuRx phase II clinical trial and to the overall multicenter trial data.

Acute traumatic rupture of the thoracic aorta treated with endoluminal stent grafts.

Background: Endovascular technologies provide a new therapeutic option in the treatment for acute traumatic rupture of the thoracic aorta. We report our experience with endoluminal stent graft repair of thoracic aortic ruptures.

Methods: Five patients underwent repair of the thoracic aorta with an endoluminal stent graft for acute traumatic rupture.

Endoluminal stent graft repair of aortobronchial fistulas.

Objective: To describe our experience with endoluminal stent graft repair of aortobronchial fistulas.

Methods: We reviewed the records of patients treated with endoluminal stent grafting of aortobronchial fistulas at a private teaching hospital. All patients underwent the following diagnostic studies: computed tomography, angiography, bronchoscopy, and transesophageal echocardiography.

Impact of endovascular repair for abdominal aortic aneurysms in octogenarians.

A total of 50 consecutive patients (86% male; median age, 82 years) underwent endovascular repair of abdominal aortic aneurysms (AAAs) ranging from 4.0 to 9.0 cm (median, 5.

Postoperative morbidity of closely staged bilateral carotid endarterectomies: an intersurgical interval of 4 days or less.

The purpose of this study was to determine if there is increased morbidity and mortality with bilateral carotid endarterectomies (CEAs) done with an intersurgical period of less than 4 days compared to historical groups of unilateral CEAs, or those with a greater intersurgical delay. From January 1991 to July 1998, 1390 carotid endarterectomies were performed, of which 154 (11.1%) were closely staged bilateral CEAs.

The laryngeal mask airway: a comprehensive review for the Emergency Physician.

The Laryngeal Mask Airway (LMA) was developed in the 1980s, but has only recently begun to be used in Emergency Medicine. The LMA affords effective assisted ventilation without requiring endotracheal intubation or visualization of the glottis. In doing so, it is more efficacious than a bag-valve-mask apparatus, although the risk of aspiration of gastric contents persists, particularly if the device is not properly placed.

Transrenal fixation of aortic endografts: intermediate follow-up of a single-center experience.

Purpose: To examine the fate of the renal ostia following transrenal fixation of endovascular aortic stent-grafts.

Methods: Thirty-five patients (29 men; mean age 75 years) undergoing endovascular repair for abdominal aortic aneurysms (AAAs) had transrenal fixation of the uncovered proximal stent due to a short (< 1.5 cm long) or conical neck or a periprocedural endoleak.

Traumatic pneumomediastinum caused by isolated blunt facial trauma: a case report.

Traumatic pneumomediastinum is most often identified as an incidental finding in the setting of blunt or penetrating neck, chest, or abdominal trauma. There are only a few cases in the medical literature of a pneumomediastinum following isolated facial trauma. We present a patient who sustained fractures of the lateral and anterior walls of the right maxillary sinus, floor of the right orbit, and right zygomatic arch.

Immediate endovascular repair for descending thoracic aortic transection secondary to blunt trauma.

Purpose: To report the immediate endovascular treatment of a thoracic aortic tear secondary to blunt trauma.

Methods And Results: A 39-year-old man was injured in a motor vehicle collision. In addition to significant trauma to the head, chest, and abdomen, there were signs of a deceleration injury to the thoracic aorta.

Intraoperative subclavian artery stenting to salvage a LIMA graft.

The internal mammary artery is the preferred conduit for coronary bypass grafting; however, suboptimal flow through the internal mammary artery is sometimes found during the operation, and the conduit is abandoned. Subclavian artery stenosis, a well-recognized cause of reduced internal mammary artery flow, is easily and effectively treated with endovascular techniques. We describe a case of intraoperative primary stent deployment in a high-grade subclavian artery stenosis compromising internal mammary artery flow.

Long-term follow-up of endoluminal grafting for aneurysmal and occlusive disease in the superficial femoral artery.

Purpose: To examine the long-term outcome of patients treated with endoluminal grafts (ELGs) for aneurysmal and occlusive disease in the femoropopliteal (FP) segment.

Methods: ELGs of radially expandable polytetrafluoroethylene with terminal Palmaz stents were used to form intimal conduits to revascularize lengthy occlusive disease and exclude aneurysms in the FP segment. Patient records were reviewed retrospectively for outcome.