Factors associated with abdominal compartment syndrome complicating endovascular repair of ruptured abdominal aortic aneurysms.

Background: Endovascular treatment of ruptured abdominal aortic aneurysms (r-AAAs) has the potential to offer improved outcomes. As our experience with endovascular repair of r-AAA evolved, we recognized that the development of abdominal compartment syndrome (ACS) led to an increase in morbidity and mortality. We therefore reviewed our experience to identify risk factors associated with the development of ACS.

Safety and efficacy of eversion carotid endarterectomy for the treatment of recurrent stenosis: 20-year experience.

Current options for treating recurrent carotid stenosis (RCS) include standard longitudinal arteriotomy and patch angioplasty with or without carotid endarterectomy (s-PCEA), carotid-carotid bypass, or carotid angioplasty and stent (CAS). Eversion carotid endarterectomy (e-CEA) is an effective procedure for treating primary carotid stenosis, yet it has not been reported for treating RCS. We evaluated the feasibility and outcome of e-CEA for treating of RCS in comparison to s-PCEA.

Hemodynamic changes associated with bypass stenosis regression.

Objective: Ultrasound scanning is used to detect velocity increases indicative of a bypass stenosis. Subsequent examinations have shown regression of some stenotic lesions. This study examined hemodynamic changes that coincided with stenosis regression.

Outcome of concomitant renal artery reconstructions in patients with aortic aneurysm and occlusive disease.

The question remains as to whether patients presenting with aortoiliac occlusive disease (AIOD) or abdominal aortic aneurysms (AAAs) have similar outcomes when concomitant renal artery reconstructions are performed. In this study, we analyzed our experience with simultaneous aortic and renal reconstructions using a retroperitoneal approach. Over a 5-year period, all patients with either AAAs > 5 cm or symptomatic AIOD who were found to have high-grade renal artery stenosis and who underwent aortic reconstructions with concomitant renal revascularization were analyzed through our vascular surgery registry.

Does sac size matter? Findings based on surgical exploration of excluded abdominal aortic aneurysms.

Purpose: To prospectively examine the outcomes of excluded abdominal aortic aneurysms (AAA) that continue to expand without evidence of endoleak.

Methods: From 1984 to 1998, 1218 patients underwent operative retroperitoneal exclusion of AAA and aortoiliac reconstructions. During the procedure, the aneurysm sac was ligated proximally, as well as distally, which created an ideal in-vivo model of excluded AAA sacs with or without endoleaks.

Infrarenal abdominal aortic aneurysm repair via endovascular versus open retroperitoneal approach.

The beneficial effects of open surgical abdominal aortic aneurysm (AAA) repair via a left retroperitoneal approach have been established. We compared the short-term outcome of infrarenal AAA repair via an endovascular approach with that of an open retroperitoneal approach. From October 2001 to April 2003, patients with infrarenal AAA >5 cm were offered repair via an endovascular approach (group I) with a variety of industry-made stent grafts or with an open retroperitoneal surgical approach (group II).

Outcome of popliteal artery aneurysms after exclusion and bypass: significance of residual patent branches mimicking type II endoleaks.

Purpose: Popliteal aneurysms (PAs) often are treated with exclusion and bypass. However, excluded aneurysms can transmit systemic pressure from persistent flow through collateral arteries (endoleak), resulting in aneurysm growth and rupture. We used duplex ultrasound scanning for postoperative surveillance more than 2 years after PA repair with exclusion and bypass, to determine the presence of flow and aneurysm growth.

Effects of bilateral hypogastric artery interruption during endovascular and open aortoiliac aneurysm repair.

Purpose: Hypogastric artery interruption is sometimes required during aortoiliac aneurysm repair. We have not experienced some of the life-threatening complications of pelvic ischemia reported by others. Therefore we analyzed our experience to identify factors that help minimize pelvic ischemia with unilateral and bilateral hypogastric artery interruption.

Analysis of factors contributing to improved outcome for carotid endarterectomy.

Since carotid endarterectomy was revitalized following the North American Symptomatic Carotid Endarterectomy Trial and Asymptomatic Carotid Atherosclerosis Study, results have improved. However, types of carotid endarterectomy, indications, risk factors, surgical factors, techniques, and other treatment modalities may be associated with outcomes of carotid endarterectomy. The purpose of this study was to identify those factors in a broad-based carotid endarterectomy patient.

Outcome of aggressive surveillance colonoscopy in ruptured abdominal aortic aneurysm.

Purpose: Emergent repair of ruptured abdominal aortic aneurysms (rAAAs) is associated with high perioperative morbidity and mortality. One of the significant complications of this surgery is bowel ischemia. Reports detail mortality as high as 80% when this condition is realized.

Early carotid endarterectomy after acute stroke.

Purpose: Carotid endarterectomy (CEA) after acute stroke is generally delayed 6 to 8 weeks because of fear of stroke progression. This delay can result in an interval stroke rate of 9% to 15%. We analyzed our results with CEA performed within 1 to 4 weeks of stroke.

Upper extremity bypass grafting for limb salvage in end-stage renal failure.

Objective: Patients with end-stage renal failure and upper-extremity arterial occlusive disease sometimes have painful digital ulceration. We evaluated the efficacy of distal bypass grafting from the brachial artery for limb salvage in this setting.

Methods: All patients with end-stage renal disease with painful digital ulceration or gangrene of the hand seen from 1992 to 2002 were evaluated with clinical examination and noninvasive studies.

Aortoiliac reconstruction: the retroperitoneal approach and splenic injury.

Exposure of the abdominal aorta through the left retroperitoneum is a well-accepted technique. Unfortunately, splenic injury is a complication of this approach that rarely occurs through a mid-line transabdominal incision. In this series we evaluate the occurrence of splenic injury during left retroperitoneal aortic surgery.

Eversion carotid endarterectomy: a technical alternative that may obviate patch closure in women.

Purpose: Recurrent carotid stenosis following standard longitudinal carotid endarterectomy (s- CEA), with and without patch angioplasty, effects the durability of the procedure and can lead to reintervention. The purpose of this study is to evaluate the incidence of restenosis following eversion carotid endarterectomy (e-CEA) in women.

Methods: The records of all patients undergoing elective carotid endarterectomy (CEA) for symptomatic and asymptomatic high-grade carotid stenosis over a 5-year period from July 1994 to June 1999 were reviewed.

Should ruptured abdominal aortic aneurysms be repaired in the octogenarian?

Purpose: Several investigators have suggested a dismal prognosis of ruptured abdominal aortic aneurysm (rAAA) repair in the elderly. The purpose of this study is to evaluate the morbidity and mortality of rAAA repair in octogenarians and compare it to that of a younger population.

Methods: From 1980 to 2000, all patients undergoing emergent rAAA repair were divided into two groups based on their age; Group I: age <80, Group II: > or =80 years.

Surgical treatment of internal carotid artery occlusion.

Purpose: Nonoperative treatment of recent internal carotid artery (ICA) occlusion is associated with increased recurrent stroke rates. We analyzed our results of carotid endarterectomy (CEA) for treatment of symptomatic recent ICA occlusion to evaluate its feasibility, safety, and outcomes.

Methods: From 1990 to 2002, all patients with transient ischemic attack (TIA), amaurosis fugax, and minor stroke underwent duplex ultrasound (US) scanning and arteriography to confirm the diagnosis of ICA occlusion.

Carotid-carotid crossover bypass: is it a durable procedure?

Purpose: Reconstruction of a diseased common carotid artery may necessitate direct repair via aortic artery-based revascularization. However, carotid-carotid artery crossover grafting is an alternative extra-anatomic option that obviates the need for median sternotomy. We analyzed our results with carotid-carotid artery crossover bypass surgery.

Gender-related differences in outcome: an analysis of 5880 infrainguinal arterial reconstructions.

Objective: Few will debate that infrainguinal arterial reconstruction increases limb salvage. However, numerous reports describe a difference in results in coronary and peripheral arterial reconstructions between men and women. In this study, we analyze the outcome of infrainguinal bypasses performed over 30 years and stratify the results by gender.

Pathologic evaluation of a spherical polyvinyl alcohol embolic agent in a porcine renal model.

Purpose: To evaluate the effects of a spherical embolic agent consisting of polyvinyl alcohol (PVA) and to compare this agent with commercially available embolization agents.

Materials And Methods: Eleven miniature pigs were included in the study population. The upper poles of both kidneys were selected as the target organs for embolization.

Surgical treatment of coronary subclavian steal syndrome with carotid subclavian bypass.

Coronary subclavian steal syndrome (CSS) results from proximal subclavian artery occlusive disease causing reversal of flow in an internal mammary artery used as conduit for coronary artery bypass leading to myocardial ischemia. Although percutaneous transluminal angioplasty and stent (PTAS) for subclavian lesions has been successful, it is not always feasible. In this study, the results of carotid subclavian bypass (CSB) for symptomatic CSS due to subclavian occlusion and stenosis not amenable to PTAS were analyzed.

Carotid endarterectomy in the elderly: does gender effect outcome?

Objectives: Carotid endarterectomy (CEA) has a positive effect on stroke free survival in patients with either symptomatic or asymptomatic severe carotid bifurcation stenosis. However, most trials have excluded octogenarians. In addition, concerns have arisen regarding the benefits of CEA in the elderly population, especially in women.

Early ambulation after diagnostic angiography using 4-f catheters and sheaths: a feasibility study.

Purpose: To assess the feasibility and safety of early ambulation in patients undergoing transfemoral diagnostic angiography using 4-F catheters or sheaths.

Methods: In this prospective study approved by the institutional review board, patients undergoing diagnostic angiography were randomized to ambulate 3 or 6 hours after catheter or sheath removal. All patients were assessed for hematoma formation, pseudoaneurysm development, and other groin complications during the in-hospital recovery period and after 30 days.

Supermarket model for vascular disease care.

A supermarket model for vascular patient care proposes an interdisciplinary group of health care teams such as vascular nurses, interventional radiologists, vascular surgeons, angiologists, internists, cardiologists, and neurologists and facilities such as diagnostic testing laboratories, subcenters such as wound care and foot care centers, atherosclerotic risk prevention centers, rehabilitation centers, vein centers, and socioeconomic follow-up centers that would provide health care of vascular disease in a comprehensive manner in terms of quality care, convenience for patients, 1-stop shopping, education and training, and research and development.

Combined coronary artery bypass with carotid endarterectomy: do women have worse outcomes?

Objective: Women undergoing coronary artery bypass grafting (CABG) have higher mortality and morbidity in numerous studies. Although controversial, similar results have been seen in women undergoing carotid endarterectomy. We examined the results of combined eversion CEA/CABG by one group to analyze if the outcome is different between men and women in this setting.