One-year outcomes after transcarotid artery revascularization (TCAR) in the ROADSTER 2 trial.

Objectives: Transcarotid artery revascularization (TCAR) is a carotid stenting technique that utilizes reversal of cerebral arterial flow to confer cerebral protection. Although carotid endarterectomy (CEA) remains the standard for treatment of symptomatic and asymptomatic carotid stenosis, the search for the optimal minimally invasive option for the high-risk surgical patient continues. The goal of the current study is to evaluate the 1-year safety and efficacy of TCAR in a prospective clinical trial.

Balloon dilation strategy does not affect outcomes for transcarotid artery revascularization in prospective trials.

Objectives: Strategies of balloon dilation during transfemoral carotid artery stenting include prestent dilation only (PRE), post-stent dilation only (POST), or both predilation and postdilation (PRE+POST). Concerns over higher neurological risk have been raised with POST and PRE+POST during transfemoral carotid artery stenting. Whether these concerns are applicable to transcarotid artery revascularization (TCAR), which uses proximal clamping and cerebral blood flow reversal during stent deployment and balloon angioplasty remains unknown.

Learning curve and proficiency of transcarotid artery revascularization compared to transfemoral carotid artery stenting.

Both transfemoral carotid artery stenting (TF-CAS) and transcarotid artery revascularization (TCAR) are competing endovascular alternatives to carotid endarterectomy for the treatment of atherosclerotic carotid artery stenosis. TF-CAS is an endovascular procedure associated with a long learning curve and higher periprocedural stroke and death rates during an operator's early experience. Estimates suggest that more than 50 cases are required to achieve outcomes similar to carotid endarterectomy.

Learning Curve for Surgeons Adopting Transcarotid Artery Revascularization Based on the Vascular Quality Initiative-Transcarotid Artery Revascularization Surveillance Project.

Background: Transcarotid artery revascularization (TCAR) with flow reversal was recently introduced as a novel technique for carotid artery stenting (CAS). We examined the learning curve of surgeons adopting TCAR based on data from the Vascular Quality Initiative (VQI-TCAR Surveillance Project; TSP).

Study Design: We identified all patients in the TSP who underwent TCAR from September 2016 to December 2018.

Design and Clinical Considerations for Endovascular Stent Grafts.

Endovascular treatment for aortic abnormality is an excellent alternative option for patients who are not good candidates for conventional open surgery. Although the technique of placing endovascular stent grafts has evolved since the first grafts, the basic principles remain the same. Use of endografts is limited by anatomic criteria, and advances in graft design have allowed for more widespread use for a broader patient range.

Endothelial Function Is Preserved in Veins Harvested by Either Endoscopic or Surgical Techniques.

Background: Endoscopic vein harvest for lower extremity arterial bypass grafting has been questioned due to concern for endothelial damage during procurement. We sought to compare nitric oxide (NO)-mediated endothelial-dependent relaxation (EDR) in vein segments harvested using open surgical techniques (OH) versus endoscopic vein harvest (EH) techniques.

Methods: Saphenous vein segments were harvested for lower extremity bypass, and a single, minimally handled section of saphenous vein, free of branches, was taken from the end of the graft.

Prevalence of Bovine Aortic Arch Configuration in Adult Patients with and without Thoracic Aortic Pathology.

Background: Bovine aortic arch (BA) occurs in approximately 15-35% of the US population and is regarded as a clinically insignificant, normal variant. The aim of this study was to assess the prevalence of types I (type I bovine arch [T1BA], common origin of innominate and/or left common carotid artery) and II (type II bovine arch [T2BA], left common carotid originating from innominate) bovine arch in patients with and without thoracic aortic pathology.

Methods: We retrospectively reviewed all serial computed tomography images (n = 817) performed at our institution over 4 months to determine the overall prevalence of BA.

Arteriovenous grafts have higher secondary patency in the short term compared with autologous fistulae.

Background: To estimate patency of arteriovenous fistulas (AVFs) and grafts (AVGs) for dialysis access.

Methods: Records of all adult patients who had a dialysis access placed from January 2008 to June 2011 were retrospectively reviewed.

Results: A total of 494 patients with 655 accesses (390 AVFs, 265 AVGs) were examined.

Pulse volume recording does not enhance segmental pressure readings for peripheral arterial disease stratification.

Background: Noninvasive vascular laboratory determinations for peripheral arterial disease (PAD) often combine pulse volume recordings (PVRs), segmental pressure readings (SPs), and Doppler waveform traces (DWs) into a single diagnostic report. Our objective was to assess the corresponding diagnostic values for each test when subjected to interpretation by 4 vascular specialists.

Methods: A total of 2226 non-invasive diagnostic reports were reviewed through our institutional database between January 2009 and December 2011.

Heparin bonding does not improve patency of polytetrafluoroethylene arteriovenous grafts.

Background: Heparin-bonded polytetrafluoroethylene (PTFE) grafts (hepPTFE) were developed to decrease rates of graft thrombosis. Our objective was to compare the patency of arteriovenous grafts (AVGs) for dialysis access with and without heparin bonding in a tertiary care setting.

Methods: Records of patients who had an AVG placed between January 2008 and June 2011 were retrospectively reviewed.