bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Molecular-Weight Heparin Versus Saphenofemoral Disconnection for the Treatment of Above-Knee Greater Saphenous Thrombophlebitis: A Prospective Study
Authors: Lozano Francisco S. , Almazan Arturo
Published: March 2006

The objective of this study was to assess the efficacy, safety, and cost of lowmolecularweight heparin compared to saphenofemoral disconnection for the treatment of internal saphenous proximal thrombophlebitis (SPT). Eighty-four consecutive patients diagnosed as presenting SPT alone (symptoms/echo-Doppler) were divided into 2 comparable groups treated with (1) saphenofemoral disconnection under local anesthesia with a short hospital stay (n=45) or (2) prospective enoxaparin on an outpatient basis for 4 weeks (n=39). Informed consent was obtained and inclusion, exclusion, and withdrawal criteria were established. Patients were followed up at 1, 3, and 6 months. Thirty patients per group completed the study requirements. In the disconnection group, 2 patients (6.7%) presented complications of the surgical wound, 1 (3.3%) had SPT recurrence (however, there was no deep venous thrombosis), and 2 (6.7%) had nonfatal pulmonary embolism confirmed by radionuclide scan. In the enoxaparin group, there were 2 cases (6.7%) of minor bleeding (epistaxis and rectal bleeding) and 3 (10%) recurrences of SPT. In the enoxaparin group there was no case of progression of the thrombosis to the deep venous system or pulmonary embolism. The study found no statistically significant differences between saphenofemoral disconnection and enoxaparin in the treatment of SPT, but the low-molecular-weight heparin group had socioeconomic advantages.
Duplex Imaging of the Renal Arteries with Contrast Enhancement
Authors: Blebea John , Zickler Robert , Volteas Nikolaos , Neumyer Marsha , Assadnia Shahin , Anderson Karla , Atnip Robert
Published: March 2006

Duplex ultrasound evaluation of the renal arteries is a technically challenging procedure. Its accuracy is significantly influenced by operator expertise and patient factors, such as overlying bowel gas and obesity. Intravenous microbubble contrast agents enhance vascular reflective acoustic signals and may improve ultrasound diagnostic accuracy. The clinical usefulness of such a contrast agent in the renal vasculature was examined prospectively. A total of 22 patients (16 males and 6 females) with mean age of 63 ±3 years with suspected abdominal vascular disease were studied prospectively. A complete color flow duplex imaging study of the renal vasculature was performed. This was then followed by an identical examination during which an ultrasound contrast agent (Definity™, DuPont Pharmaceutical) was infused intravenously at a rate of 2 to 4 mL/min. In addition to imaging of the vessels, the peak systolic velocity and Doppler waveforms of the aorta and renal arteries were examined. These results were independently compared to results with contrast angiography. A mean of 67 mL of contrast was used per patient. Of the total of 43 renal arteries examined, the accuracy for the detection of occlusions was 75% (3 of 4) for both standard and contrast-enhanced duplex ultrasound. The accuracy for the detection of hemodynamically significant stenosis was 50% (6 of 12) for standard and 75% (9 of 12) for contrast-enhanced duplex ultrasound. Visualization of normal or minimally diseased arteries was 94% (30 of 32) for standard and 97% (31 of 32) for contrast-enhanced ultrasound. Although overall accuracy was not enhanced by the infusion of ultrasound contrast, 5 of 7 arteries not visualized by color flow duplex were detected following the infusion of contrast agent, resulting in an additional 10% (5 of 48) of vessels visualized. Peak systolic velocities were increased by an average of 10% in normal or minimally diseased vessels and 12% in stenotic vessels following contrast administration but these differences were not statistically significant. Contrast-enhanced duplex imaging of the renal arteries is safe but not routinely required when performed by an experienced sonographer. However, it may increase visualization and accuracy in patients with stenoses or when the vessels are not initially visualized. Although increased velocities are seen when contrast agent is used, this does not appear to necessitate different Doppler criteria at this time.
Treatment of a Late-Appearing Proximal Type-1 Endoleak After Ancure Graft with an AneuRx Cuff
Authors: Stefanidis Dimitri , Chiou Andy C. , Kashyap Vikram , Toursarkissian Boulos
Published: March 2006

The authors describe the case of a patient who developed a type-1 proximal endoleak 10 months after Ancure stent graft placement, despite the lack of stent migration or measurable neck dilatation. The patient had been under observation for a persistent type-2 endoleak and was noted to have an increase in his aneurysm size. The use of an uncovered stent was unsuccessful, and he required a covered proximal extension cuff. This led to a resolution of the endoleak. Implications in terms of surveillance and possible etiologies are discussed.
Allograft Replacement of Common Iliac Artery Mycotic Aneurysm Caused by Bacteroides fragilis Vertebral Spondylitis
Authors: Tsuji Yoshihiko , Okita Yutaka , Niwaya Kazuo , Tsukube Takuro , Doita Minoru , Marui Takashi , Uematsu Masahisa , Murakami Hirohisa
Published: March 2006

Mycotic aneurysm secondary to vertebral spondylitis is a rare but life-threatening pathology with high mortality and morbidity. The authors describe a successfully treated case of mycotic aneurysm of the common iliac artery complicated with vertebral spondylitis in a 74-year-old man. Under midline laparotomy, complete debridement of the infected tissues, in-situ replacement of the common iliac artery with cryopreserved aortic allograft, and iliac bone autotransplantation and omentopexy to fill the debrided cavity were performed. The postoperative course was uneventful, and he remains well 3 years after his operation without persistent infection or allograft rejection.
Catheter-Directed Thrombolysis for Deep Venous Thrombosis
Authors: Baldwin Zachary K. , Comerota Anthony J. , Schwartz Lewis B.
Published: March 2006

Venous thromboembolism (VTE) represents a significant clinical problem, affecting patients of all age groups, nationalities, and socioeconomic strata. Despite its prevalence, the paradigms for care are largely centered around primary or secondary prophylaxis, with less emphasis on actual treatment of the thrombus. With the recent rapid development of advanced endovascular techniques, it is now feasible to dissolve many thrombi using catheter-directed thrombolysis (CDT), and favorable clinical experience has been reported in over 600 patients. If performed safely, the purported benefits of CDT for DVT include a decreased incidence of persistent phlebitic symptoms, improved quality of life and, possibly, a decreased incidence of recurrent thrombotic events.
Hypothermia is an Independent Predictor of Mortality in Ruptured Abdominal Aortic Aneurysms
Authors: Janczyk Randy J. , Howells Greg A. , Bair Holly A. , Huang Raywin , Bendick Phillip J. , Zelenock Gerald B.
Published: March 2006

Hypothermia is known to significantly increase mortality in trauma patients, but the effect of hypothermia on outcomes in ruptured abdominal aortic aneurysms (RAAA) has not been evaluated. The authors reviewed their experience from 1990 to 1999 in 100 consecutive patients who presented with RAAA and survived at least to the operating room for surgical treatment. There were 70 men and 30 women, with a mean overall age of 74 ±8 years. Overall mortality was 47%. Univariate ANOVA (analysis of variants) showed significant correlation with mortality for decreased intraoperative temperature, decreased intraoperative systolic blood pressure, increased intraoperative base deficit, increased blood volume transfused, increased crystalloid volume (all p<0.001); decreased preoperative hemoglobin (p=0.015); and increased age (p=0.026). Patient sex, initial preoperative temperature, preoperative systolic blood pressure, and operating room time were not correlated with mortality in the univariate analysis. Using these same clinical variables, multiple logistic regression analysis showed only 2 factors independently correlated with mortality: lowest intraoperative temperature (p= 0.006) and intraoperative base deficit (p= 0.009). The mean lowest temperature for survivors was 35 ±1°C and for nonsurvivors 33 ±2°C (p<0.001). When patients were grouped by lowest intraoperative temperature, those whose temperature was <32°C (n=15) had a mortality rate of 91%, whereas patients with a temperature between 32 and 35°C (n=50) had a mortality rate of 60%. In the group that remained at or >35°C (n=35) the mortality rate was only 9%. A nomogram of predicted mortality versus temperature was constructed from these data and showed that for temperatures of 36, 34, and 32°C the predicted mortality was 15%, 49%, and 84%, respectively. The authors conclude that hypothermia is a strong independent contributor to mortality in patients with ruptured abdominal aortic aneurysms and that very aggressive measures to prevent hypothermia are warranted during the resuscitation and treatment of these patients.
Survival of Ruptured Abdominal Aortic Aneurysms in the West of Ireland: Do Prognostic Indicators of Outcome Exist?
Authors: Sultan S. , Manecksha R. , O’Sullivan J. , Hynes N. , Quill D. , Courtney D.
Published: March 2006

Ruptured abdominal aortic aneurysm (RAAA) is a demanding vascular surgical problem and the cause of significant morbidity and mortality. The aim of this study was to identify prognostic factors that influence outcome. Over 6 years, 42 ruptured abdominal aortic aneurysms were operated on with a mean diameter of 7.2 cm. RAAA was defined as free intraperitoneal rupture. Data were collected retrospectively from hospital medical records. The male:female ratio was 8:1 and the mean age was 74 years (range 55–89). Fifteen were in hypovolemic shock and 27 patients were clinically stable. The perioperative mortality rate for the 15 shocked patients was 60% (9 patients) and the 1-year cumulative survival rate was 33%. The perioperative mortality rate for the 27 clinically stable patients was 40% (11 patients) and the 1-year cumulative survival rate was 56%. Survival curves were constructed for these groups to compare male versus female, age =70 versus age <70, shocked versus stable, and preoperative hemoglobin (Hb) =10 vs >10. No patient with preoperative cardiac arrest survived more than 24 hours. With VassarStats, the confidence interval for age, gender, hemodynamic status, and preoperative Hb were calculated. The standard weighted mean analysis by ANOVA gave a p value of <0.001. The overall 30-day mortality rate was 47% (20 of 42) and the 1-year mortality rate was 52% (22 of 42). Male patients over 70 years with RAAA in hypovolemic shock with low Hb have a higher 30-day mortality rate and few survive more than 1 year. The study suggests that each of these 4 parameters separately was not a strong prognostic indicator. Collectively, however, they strongly influence the prognosis of patients with RAAA. These findings strengthen the case for selective treatment for RAAA.
Correlation Between Preoperative and Postoperative Duplex Vein Measurements of the Greater Saphenous Vein Used for infrainguinal Arterial Reconstruction
Authors: Cruz Carlos P. , Eidt John F. , Brown Aliza T. , Moursi M.
Published: March 2006

Vein diameter measurements using B-mode Doppler ultrasound (US) are used to assess the greater saphenous vein (GSV) for bypass operations; a 2.5–3.0 mm diameter is suggested as a minimum. Preoperative measurements are made while the vein is in the low-pressure venous system. This may not reflect the distended diameter of a vein after placement in the arterial system. This study compares preoperative and postoperative GSV diameters to identify the degree of dilatation and the minimal size adequate for use in arterial bypass operations. The GSV of 11 patients undergoing an infrainguinal arterial bypass were assessed by utilizing Doppler US. Measurements were taken every 10 cm, for 70 cm, along the course of the GSV before and 4 weeks after operation. All segments showed a percent increase in diameter from the preoperative to postoperative time points; 10 cm, 38%; 20 cm, 31%; 30 cm, 16%; 40 cm, 26%; 50 cm, 23%; 60 cm, 28%; and 70 cm, 22%. A Bonferroni post hoc analysis between the 2 time point means showed a significant increase in means for the 2 time points of 9.49 units (Bonf p value <0.001). Preoperative vein segments were divided into 3 categories: =3.0 mm, 3.1–4.0 mm, and >4.1 mm. All showed a significant increase over time. Preoperative diameter measurements of the vein may not reflect the final distended diameter after bypass. Preoperative vein diameters =3.0 mm showed a significant increase of 33% to nearly 4.0 mm. This was the largest increase observed in any segment measured. A potential 16–33% increase in vein diameter should be considered in vein mapping. The rejection of small veins (=3.0 mm) in preoperative vein-mapping studies may not be warranted given the potential for a substantial increase in size when placed in the arterial system.
Standardizing Vascular Surgery Residency: Merger of Two Programs to Create One Model
Authors: Friedman Steven G. , Greben Craig , Scher Larry A. , Safa Toufic , Faust Glenn , Halpern Vivienne , Simms H. Hank
Published: March 2006

The practice of vascular surgery has been transformed in the last decade. It is now necessary to change the way we train vascular surgeons, to keep pace with this rapidly evolving specialty.
Mandate for Creation of a National Peripheral Arterial Disease Public Awareness Program: An Opportunity to Improve Cardiovascular Health
Authors: Hirsch Alan T. , Gloviczki Peter , Drooz Alain , Lovell Marge , Creager Mark A.
Published: March 2006

Background:There has been increasing recognition of the detrimental effect of peripheral arterial disease (PAD) on the health of Americans, and yet there is no common national program of public PAD education designed to diminish this effect.

Format:To heighten awareness of this problem, a 2-day PAD Public Education Strategy Meeting was recently attended by representatives of 17 professional societies and public health associations whose missions support the prevention, diagnosis, treatment, and rehabilitation of vascular diseases. This Public Education Strategy Meeting was intended to provide the rationale and structure to create a national PAD public awareness campaign to diminish the health effect of PAD and to improve cardiovascular outcomes in the United States. This document (1) provides the rationale for creation of a national PAD public education program; (2) reviews the development and success of national hypertension, hypercholesterolemia, and Women's Heart Health public education programs as models of educational efficacy; (3) elucidates how the work of many vascular professionals has led to a national consensus for creation of a national PAD public educational program; (4) provides an overview of the National Heart, Lung, and Blood Institute PAD education meeting; and (5) outlines the “next steps” required to accomplish these goals.

Outcome:This meeting achieved consensus that we share responsibility for developing accurate, unified messages to promote PAD awareness and improved care. Participants agreed that the creation of such messages should be linked to plans to disseminate them to all Americans at risk. A consensus was reached that such messages, when commonly created and offered to the public, are most likely to achieve the rewards in better health that all Americans deserve. The Vascular Disease Foundation, a not-for-profit foundation whose mission includes public education about the prevention, diagnosis, treatment, and rehabilitation of PAD, will devote its resources to guide a new coalition in this process and to create a national PAD awareness campaign. During 2003 and 2004, the coalition will create the organizational underpinnings and time line for what will undoubtedly be a multiyear effort.

Conclusion:Participants of the Public Education Strategy Meeting agreed to create a broad coalition to develop a National PAD Public Awareness Program, with the objectives to develop and disseminate public education messages on PAD. A successful national PAD education program will contribute to creation of a broader mandate to improve global cardiovascular health in the United States.
Ankle/Brachial Index in the Primary Care Setting
Authors: Raines Jeffrey K. , Farrar Jon , Noicely Karlene , Pena Jasmine , Davis Warren W. , Willens Howard J. , Wallace Dennis D.
Published: March 2006

Peripheral arterial disease (PAD) is an underdiagnosed circulatory problem in the primary care setting. Individuals are at increased risk for cardiovascular disease; therefore, there is the need for a technique capable of early identification and detection of patients with PAD. The focus of this study was to compare the accuracy of a new operator-independent method of measuring ankle brachial index (ABI) with the traditional Doppler ultrasound method of determining ABI. In 246 limbs the authors compared ankle systolic pressures and ABI measured by a new automated oscillatory method called the ABIgram with those measured by standard Doppler ultrasound. In phase 1, the 2 methods for measuring ankle systolic pressure had a mean difference of 2 mm Hg with a standard deviation of 6.7 mm Hg. In phase 2 the mean difference was 3.1 mm Hg with a standard deviation of 5.1 mm Hg. Further, ABI as measured by the 2 methods fell within 1% and demonstrated a 5% error in reproducibility. These numbers pass the SP-10 standard for medical devices established by the FDA. The ABIgram module of the Vasocor ®Vascular Diagnostic Center offers primary care physicians the ability to rapidly obtain ABI measurements comparable to the standard technique. Further, the ABIgram may be operated by staff commonly found in the primary care setting.
Erectile Dysfunction After Open Versus Angioplasty Aortoiliac Procedures: A Questionnaire Survey
Authors: Karkos Christos D. , Wood Angela , Bruce Iain A. , Karkos Petros D. , Baguneid Mohamed S. , Lambert Mark E.
Published: March 2006

Erectile dysfunction (ED) is a common complication after aortoiliac surgery. The aims of this study were to determine the incidence of ED in patients with aortoiliac occlusive disease or aneurysm and evaluate the effect of revascularization by means of open surgery or iliac angioplasty/stenting upon erectile function by using the new International Index of Erectile Function (IIEF) questionnaire. All male patients who had previously undergone open aortoiliac reconstruction or iliac angioplasty/stenting and who were alive at the time of this study were first contacted by telephone. Those who agreed to take part in the study were sent anonymous IIEF questionnaires. Patients were asked to recall their sexual function before and 3 months after the procedure. ED was defined as IIEF score of <11. After telephone interview, a total of 116 patients agreed to take part in the study. The response rate was 61%. Two patients, one in each group, had ED preoperatively. The preoperative IIEF scores were no different in surgery and angioplasty/stenting groups (p=0.3). Overall, 46/63 patients reported worsening erectile function postoperatively. In the surgery group (n=37), 32 patients reported deterioration of their sexual function, 3 no change, and 2 improvement, while in the angioplasty/stenting group (n=26), 14 patients had deterioration, 11 no change, and 1 improvement. In both groups, the IIEF score decreased significantly postintervention; however, the deterioration was much more pronounced after open surgery (p<0.001). Of the 61 patients with “normal” erectile function (IIEF= 11), 10 patients (28%) developed ED following surgery, but none after angioplasty/ stenting (p=0.003). As judged by the IIEF, a significant proportion of patients undergoing open and endovascular procedures experience worsening sexual function.
Evaluation of Setpoint Temperature and Pullback Speed on Vein Adventitial Temperature During Endovenous Radiofrequency Energy Delivery in an In-Vitro Model
Authors: Zikorus Arthur W. , Mirizzi Michael S.
Published: March 2006

Endovenous occlusion of the greater saphenous vein with radiofrequency (RF) energy has been shown to be a safe and effective treatment for saphenofemoral reflux. Operating parameters initially developed for the VNUS ®Closure ®system were selected in order to provide sufficient energy to controllably and transmurally heat the vein wall to cause collagen contraction and destruction of the vein wall while limiting the degree of perivascular heating. Procedural advances, such as ultrasound-guided tumescent infiltration along the course of the vein to be treated, have provided an added level of thermal protection to the perivenous tissue during the application of RF energy. The purpose of this study was to evaluate the effect of raising the setpoint temperature from 85°C to 90°C while doubling the pullback speed from 3 to 6 cm/minute on vein adventitial temperature. An in vitro simulation of a peripheral vein surrounded by body tissue was created by fixing freshly excised bovine veins in beefsteak kept moist by normal saline. A VNUS RF generator, in conjunction with a VNUS Closure catheter, delivered temperature-controlled RF energy to the bovine vein intima. Adventitial temperatures were recorded as the catheter was withdrawn and peak temperatures from 4 treatment groups were analyzed. The mean peak adventitial temperatures for the groups in which the adventitia was lightly bathed in saline were 64.4°C and 64.9°C with a setpoint temperature of 85°C at a pullback speed of 3 cm/minute and 90°C at a pullback speed of 6 cm/minute, respectively. The mean peak adventitial temperatures for the groups in which the adventitia was bathed in a 2.0 mm layer of saline were 51.3°C and 47.7°C with a setpoint temperature of 85°C at a pullback speed of 3 cm/minute and 90°C at a pullback speed of 6 cm/minute, respectively. Temperature-controlled radiofrequency occlusion of the saphenous vein, performed using an intimal setpoint temperature of 90°C and double the pullback speed of the historical VNUS Closure treatment (6 vs 3 cm/minute), produced comparable temperatures at the adventitial surface in an in vitro model. The addition of a 2.0 mm layer of saline significantly reduced the peak adventitial temperatures.
Surgical Options for the Treatment of Venous Ulcers
Authors: Welch Harold J.
Published: March 2006

Venous ulcers are a difficult problem for both patient and physician. Healing of venous ulcers with compression therapy and elevation, although usually successful, often takes months. Some venous ulcers do not heal with conservative therapy, or if they do, can often recur. Proper evaluation of the lower extremity venous system, usually with noninvasive imaging, is essential in planning any surgical intervention. In the appropriate patient, a number of surgical options are available to achieve ulcer healing and/or to prevent recurrence. These options include ablation of superficial reflux, perforator interruption, deep venous reconstruction, and endovenous procedures.
Reflux from Thigh to Calf, the Major Pathology in Chronic Venous Ulcer Disease: Surgery Indicated in the Majority of Patients
Authors: Danielsson Gudmundur , Arfvidsson Berndt , Eklof Bo , Kistner Robert L. , Masuda Elna M. , Sato Dean T.
Published: March 2006

The aim of this study was to define the underlying anatomical and pathophysiological conditions in limbs with venous ulcers in order to get information for the most appropriate treatment selection. Ninety-eight limbs (83 patients, 59 men), with active chronic venous ulcers, were analyzed retrospectively and classified according to the CEAP (clinical, etiological, anatomical, and pathophysiological) classification. Duplex-ultrasound was performed in all patients, while air-plethysmography and venography were performed selectively on potential candidates for deep venous reconstruction. Sixty-six ulcers were primary in origin and 32 were secondary. Reflux was present in all limbs except 1. Isolated reflux in 1 system (superficial = 3, deep = 4, perforator = 3) was seen in 10 legs (10%), while incompetence in all 3 systems was seen in 51 legs (52%). Superficial reflux with or without involvement of other systems was seen in 84 legs (86%), 72 legs (73%) had deep reflux with or without involvement of other systems, and incompetent perforator veins were identified in 79 limbs (81%). Axial reflux (continuous reverse flow from the groin region to below knee) was found in 77 limbs (79%). The femoral vein was the single most common deep venous segment in which either reflux or obstruction was found. Axial distribution of disease was found in the majority of cases and no patient had isolated deep venous incompetence below knee. Primary disease was the predominant etiologic cause and reflux was the main pathophysiological finding. Practically all patients were found to have 1 or more sites of reflux or obstruction that could benefit from operative treatment.
Percutaneous Venous Valve Bioprosthesis: Initial Observations
Authors: Gale Steven S. , Shuman Susan , Beebe Hugh G. , Pigott John P. , Comerota Anthony J.
Published: March 2006

Chronic deep venous insufficiency remains a major health problem in the United States and worldwide. Selected patients benefit from direct deep vein valve repair or valve transplantation; however, most are not candidates for these procedures. Experience with the bovine monocusp venous valve surgically inserted into the common femoral vein (CFV) demonstrates potential benefit and good long-term patency. A venous valve placed distal to the CFV via percutaneous access has great appeal and potential for further improving venous hemodynamics, as well as reducing ambulatory venous hypertension and ulceration. Two patients were treated with a percutaneous venous valve bioprosthesis as part of a Phase I trial. The primary objective was to evaluate the safety, patency, and efficacy of the percutaneous venous valve bioprosthesis to restore competency to the deep venous system. Introduction
Reevaluation of Temporary Transvenous Cardiac Pacemaker Usage During Carotid Angioplasty and Stenting: A Safe and Valuable Adjunct
Authors: Bush Ruth L. , Lin Peter H. , Bianco Charles C. , Hurt Julian E. , Lawhorn Thomas I. , Lumsden Alan B.
Published: March 2006

Although many current series document the safety of carotid angioplasty and stenting procedures (CAS), several acknowledge clinically significant hemodynamic disturbances in 25–71% of patients. We report herein the safety and efficacy of prophylactic percutaneous temporary transvenous cardiac pacemaker insertion during CAS for the prevention of hemodynamic changes. At a community-based institution, 48 patients undergoing 51 attempted CAS procedures from March 1999 to August 2002 for carotid artery occlusive disease were retrospectively reviewed. Thirty-one percent of patients had procedures performed for either recurrent disease or a history of neck radiation; 62.5% had significant coronary disease. Temporary transvenous pacemakers were inserted as an adjunctive procedure in the authors’ CAS protocol. The pacers were set to capture a heart rate decrease below 60 beats per minute. Demographics, cardiac risk, and outcomes were analyzed. CAS was successfully performed in 96% (49 lesions). In the intent-to-treat group, the patients had a mean age of 71 ±9 years and angiographic stenoses of 88 ±8%, with 29% having symptomatic lesions. Significant bradycardia or asystole to trigger ventricular pacing occurred in 11 (22%) procedures, thus, triggering ventricular pacing. Pharmacologic support for concomitant hypotension was temporarily necessary in only 4 (8%) cases. No patient required prolonged pacing or medication therapy following CAS. Neither presence of carotid-related symptoms nor disease etiology was related to need for intraprocedural pacing. Furthermore, there was no occurrence of pacemaker failure or other complication secondary to venous catheterization. Hemodynamic changes may occur during mechanical dilation of the carotid artery and bulb, with reports in the literature of the need for prolonged pharmacologic support. In selected patients, the prophylactic placement of a transvenous pacemaker is a safe, feasible, and expeditious method to treat periprocedural hemodynamic changes with a decrease in additional pharmacologic support during CAS.
Abdominal Wall Hernias After Open Abdominal Aortic Aneurysm Repair: Prospective Radiographic Detection and Clinical Implications
Authors: Rodriguez Heron E. , Matsumura Jon S. , Morasch Mark D. , Greenberg Roy K. , Pearce William H.
Published: March 2006

The purpose of this study was to evaluate the prevalence of radiographically detected abdominal wall defects (AWD) after open abdominal aortic aneurysm (AAA) repair and to correlate it with prospectively gathered clinical information. Fine collimation, high-resolution, serial follow-up computed tomography (CT) scans for 99 patients in the control group of the Guidant Ancure device trial were reviewed. CT scans were obtained at 12, 24, 36, 48, and 60 months. AWDs, defined as discontinuity of the fascial layer with protrusion of abdominal contents, were identified. Clinical information regarding AWDs was retrieved from the study registry. The prevalence of AWD exceeds 20% and plateaus at 24 months. Eight patients (8%) had clinical evidence of ventral incisional hernias. One patient underwent repair, but no other patient developed hernia incarceration or intestinal obstruction or required additional procedures related to the AWD. AWDs are radiographic findings occurring frequently after open AAA repair. Radiographic evaluation is more sensitive than clinical observation for detection of ventral hernias. Clinical events and reinterventions related to these radiographic abnormalities are rare.
Endovascular Treatment of an Endoleak Causing Rupture of a Previously Bypassed Popliteal Aneurysm
Authors: Bush Ruth L. , Bianco Charles C. , Lin Peter H. , Lumsden Alan B.
Published: March 2006

Enlargement of a previously bypassed popliteal aneurysm is rare. However, the possibility exists for persistent aneurysm expansion via geniculate collaterals. The authors report herein a patient who underwent successful endovascular treatment of a ruptured popliteal aneurysm that had been previously bypassed and presumably excluded.
Spontaneous Dissection of Common Iliac Artery
Authors: Savolainen H. , Heller G. , Fleischmann A. , Widmer M. K. , Carrel T. P. , Schmidli J.
Published: March 2006

Spontaneous dissection of the iliac artery is very rare but known as a complication of highenergy traumatic injuries and has been reported in connection with pregnancy, collagen diseases, and alpha-1-antitrypsin deficiency. The authors report a 42-year-old man with an acute dissection of the common iliac artery during exercise. Groin pain and claudication were the early symptoms. Computerized angiotomography was diagnostic. Operative iliac artery reconstruction was performed. A prerelease control computed tomography examination showed a dissection of the distal aorta and left iliac artery. To their knowledge, the combination of the 2 dissections has not been previously published.
Adventitial Cystic Disease of the External Iliac Vein Presenting with Deep Venous Thrombosis
Authors: Gasparis Antonios P. , Wall Philip , Ricotta John J.
Published: March 2006

Adventitial cystic disease of the venous system is a rare occurrence with only 8 reported cases in the world literature. The most commonly involved segment has been the common femoral vein, resulting in luminal compromise and presenting with extremity swelling. Painless swelling of the right lower extremity in a 37-year-old man was diagnosed as iliofemoral thrombosis by duplex examination. Thrombolysis revealed smooth luminal defects of the external iliac vein, which prompted surgical exploration. Iliofemoral thrombectomy exposed multiloculated adventitial cysts of the distal external iliac vein. The preferred surgical intervention in the literature has been transadventitial or transluminal evacuation of the mucoid cysts with removal of cystic wall. These are excellent options when there is no associated venous thrombosis, wall thickening, or persistent venous stenosis after drainage. This is the first reported case associated with deep venous thrombosis. In this situation resection of the involved segment followed by venous reconstruction might be the preferred option.
Primary Aorto/Iliac-Enteric Fistula: Report of 6 New Cases
Authors: Lawlor D. K. , DeRose G. , Harris K. A. , Forbes T. L.
Published: March 2006

The management of patients with vascular-enteric fistulas remains a challenging diagnostic and therapeutic problem for the vascular surgeon. Although fortunately quite a rare cause of gastrointestinal bleeding, reported mortality and amputation rates are very high. Fistulas between major vascular structures and the gastrointestinal tract are classified as either primary or secondary. Primary fistulas occur most commonly between an aortic aneurysm and the distal duodenum, while secondary fistulas occur following erosion of prosthetic material into the bowel following aortic reconstruction. The authors report 6 new cases of primary aortoenteric fistula: A malignant aortoenteric fistula in a patient with advanced metastatic squamous cell carcinoma involving the infrarenal aorta and duodenum, 4 cases of primary aortoenteric fistulas in patients with abdominal aortic aneurysms, and 1 iliac-enteric fistula secondary to a common iliac aneurysm. The diagnosis is often difficult to make, and although it was considered in 4 patients preoperatively, the diagnosis was not made until the time of laparotomy in all of these patients. Three patients were treated with an in-situ vascular graft, 2 others had the distal abdominal aorta oversewn and axillobilateral femoral bypass performed, and in the case involving the malignancy, the patient underwent primary aortic repair owing to the extent of the tumor process prohibiting aortic reconstruction. Three patients had primary closure of the intestine performed, and 3 required bowel resection and primary anastomosis. The overall 30-day mortality rate was 50% as 3 patients died in the early postoperative period and the remaining 3 patients survived to be discharged from hospital. One patient (17%) required bilateral above-knee amputations. Treatment of patients with vascular-enteric fistulas is a difficult problem, often associated with delayed diagnosis and high morbidity and mortality rates. Successful surgical management can be achieved with primary closure of the intestinal tract and an in-situ vascular graft or extraanatomic bypass.
Collateral Growth in the Peripheral Circulation: A Review
Authors: Unthank Joseph L. , Sheridan Kevin M. , Dalsing Michael C.
Published: March 2006

Arterial occlusive diseases are a major cause of morbidity and death in the United States. The enlargement of pre-existing vessels, which bypass the site of arterial occlusion, provide a natural way for the body to compensate for such obstructions. Individuals differ in their capacity to develop collateral vessels. In recent years much attention has been focused upon therapy to promote collateral development, primarily using individual growth factors. Such studies have had mixed results. Persistent controversies exist regarding the initiating stimuli, the processes involved in enlargement, the specific vessels that should be targeted, and the most appropriate terminology. Consequently, it is now recognized that more research is needed to extend our knowledge of the complex process of collateral growth. This basic science review addresses five questions essential in understanding current problems in collateral growth research and the development of therapeutic interventions.
Outcomes After Redo Procedures for Failed Mesenteric Revascularization
Authors: Giswold Mary E. , Landry Gregory J. , Taylor Lloyd M. , Moneta Gregory L.
Published: March 2006

This report examines results of mesenteric revascularization following a failed splanchnic revascularization. Patients undergoing repeat mesenteric revascularization from January 1985 to July 2002 were identified from a prospectively maintained registry. Data recorded included procedures performed, perioperative mortality, complications, and operative indications. Patients who had embolic events were excluded. Eighty-six patients underwent 105 mesenteric interventions in this time period; 22 patients underwent 33 repeat mesenteric revascularization procedures. There were 25 single-vessel bypasses, 3 multivessel reconstructions, 3 angioplasty procedures (1 open, 2 percutaneous), and 2 graft thrombectomies. Complications occurred in 33.3%. Perioperative mortality was 6.1%, all in patients with acute mesenteric ischemia. One-and 4-year primary patency for repeat mesenteric revascularization was 73.5% and 62.2%, respectively, and survival for repeat mesenteric revascularization was 85.9% and 75.5%, respectively. Patients surgically treated for mesenteric ischemia can require additional interventions. Repeat revascularization effectively prolongs survival when an earlier intervention fails.
Endovascular Repair of Traumatic Descending Thoracic Aortic Disruptions: Should Endovascular Therapy Become the Gold Standard?
Authors: Uzieblo Matt , Sanchez Luis A. , Rubin Brian G. , Choi Eric T. , Geraghty Patrick J. , Flye M. Wayne , Curci John A. , Moon Marc R. , Sicard Gregorio A.
Published: March 2006

Acute arterial disruptions of the thoracic aorta are rare and often lethal. They are most often due to blunt trauma and occur most commonly just distal to the left subclavian artery origin in the setting of multisystem injuries. The very proximal nature of the lesion in survivors makes open surgical repair hazardous, with mortality rates reaching over 20%. Endovascular therapy is a new and attractive option for the treatment of those challenging patients. Since March 2002, 3 patients with blunt and 1 patient with a stable iatrogenic descending aortic injury were successfully treated at this institution. Spiral computed tomography followed by angiography was used for diagnosis. No preexisting aortic pathology was present. Major associated injuries included unstable thoracic spinal fractures, abdominal solid organ injuries, and hip fractures, making the subjects poor surgical candidates. The Talent Endovascular Graft was deployed via open femoral or iliac artery access under fluoroscopic guidance. All 4 patients underwent successful exclusion of their thoracic pseudoaneurysm with use of the Talent endovascular graft. One patient required partial coverage of the left subclavian artery, and a second patient had an iliac artery stent deployed after traversal of an area of stenosis with the delivery system. There were no cardiac, neurologic, pulmonary, or peripheral vascular complications. Acute aortic disruption, with its associated high surgical morbidity and mortality, is an excellent indication for endovascular therapy to improve patient outcomes. More long-term data are needed on repair durability.
Periprocedural Hypertension: Current Concepts in Management for the Vascular Surgeon
Authors: Samson Russell H.
Published: March 2006

Periprocedural hypertension is a common finding in patients undergoing vascular surgery or endovascular procedures, and this may pose a risk for subsequent cardiovascular morbidity or mortality. Accordingly, the vascular surgeon who wishes to improve outcomes needs to be proficient not only in surgical technique but also in the medical management of the patient's associated conditions, especially hypertension. Vascular procedures need not be cancelled unless the blood pressure (BP) is more than 180 mm Hg systolic or 110 mm Hg diastolic, but attention should also be paid to evidence of end organ damage in making this decision. In most cases preoperative antihypertensive medications should be continued up till the procedure. Postoperative hypertension may require 1 of a number of intravenous medications, which are listed. Oral nifedipine should generally be avoided for fear of inducing an uncontrolled hypotensive response and cardiac ischemia.
New Discoveries in Anatomy and New Terminology of Leg Veins: Clinical Implications
Authors: Mozes Geza , Gloviczki Peter
Published: March 2006

Advances in diagnosis and in endovascular and surgical treatments of both acute and chronic venous diseases have focused attention on several, previously clinically less important, details of venous anatomy. The time has come to standardize venous nomenclature so that general practitioners and specialists in the United States and abroad speak the same language. There is a need to adopt a universal terminology for the saphenous veins, to avoid the myriad of eponyms of perforators and, most importantly, to omit once and for all, the term “superficial” femoral vein when talking about a deep vein of the thigh. New anatomic names, such as the saphenous fascia and saphenous subcompartment, have to gain better recognition. To achieve the desired consensus on venous nomenclature, an international meeting was held in Rome, Italy, in 2001, under the auspices of the International Union of Phlebology. In this review on venous anatomy, we describe the most important previously published clinical recommendations from this conference, and suggest modifications based on their clinical experience using the new terminology.
Most Patients with Abdominal Aortic Aneurysm Are Not Suitable for Endovascular Repair Using Currently Approved Bifurcated Stent-Grafts
Authors: Elkouri Stephane , Martelli Eugenio , Gloviczki Peter , McKusick Michael A. , Panneton Jean M. , Andrews James C. , Noel Audra A. , Bower Thomas C. , Sullivan Timothy M. , Rowland Charles , Hoskin Tanya L. , Cherry Kenneth J.
Published: March 2006

Strict morphologic criteria must be used for patient selection to achieve durable success with endovascular aortic aneurysm repair (EVAR). The goal of this study was to assess morphologic suitability (MS) of abdominal aortic aneurysms (AAAs) for 2 currently approved bifurcated stent grafts and identify reasons for exclusion from EVAR. The authors reviewed the electronic charts of 1,795 consecutive patients who were diagnosed as having AAA between January 1999 and July 2001 at their institution. Three hundred and twenty patients had an AAA with a diameter of =5.0 cm, measured on computed tomography (CT). The records of 301 patients, 254 men, 47 women, with a mean age of 74 years were available for review, and these patients constituted the study cohort. Criteria used for MS included a proximal neck length =15 mm; neck diameter between 18 and 26 mm; neck angulation =60°; common or external iliac artery (CIA or EIA) diameters of 7–16 mm and 8–13 mm, respectively, for AneuRx (Medtronic Ave, Santa Rosa, CA) and Ancure (Guidant Cardiac and Vascular Division, Menlo Park, CA) bifurcated grafts. AAAs were suitable for AneuRx device in 14% of patients (43 of 301; 95% CI = 11–19%) and for Ancure in 5% (16 of 301; 95% CI = 3.1–9%). The main reason for exclusion was an inadequate proximal aortic neck (73%). The neck was too short in 49.5%, too wide in 64% and badly angulated in 12% of the patients. Iliac artery morphology precluded EVAR with AneuRx and Ancure devices in 52% and 80%. Both CIAs were too wide for EVAR in 43% and 77%, respectively. When iliac artery diameter =20 mm was accepted, iliac suitability for AneuRx increased from 49% to 70% and overall suitability increased from 14% to 20%. When more permissive criteria were used for MS (neck length =10 mm, neck diameter =30 mm, CIA =20), 39% of patients became candidates for EVAR. More than three fourths of the patients with an AAA =5.0 cm in size, seen in a tertiary referral center, are morphologically not suitable for EVAR using 2 currently approved bifurcated endografts. The main reasons for exclusion are a short or wide proximal aortic neck. Considerable changes in size of the devices and in proximal attachment techniques have to occur before most AAAs will be suitable for EVAR.
Lower Extremity Deep Venous Thrombosis: Vascular Laboratory Quality Assurance Without Correlation Between Ultrasound and Venography
Authors: Salles-Cunha Sergio X. , Ascher Enrico , Hingorani Anil , Markevich Natalia , Yorkovich William
Published: March 2006

Venography is rarely available for comparison with ultrasonography (US) as a means for quality assurance (QA) in the detection of lower extremity venous thrombosis. New QA methods must be implemented. We compared results of multiple serial studies performed in the same extremity as a QA indicator. From a 3-year sample of close to 9,000 venous tests, we obtained a subset of 44 patients who had 331 tests in 71 lower extremities throughout the years. A positive or negative study preceded or followed by another positive or negative study was considered as a confirmed study. A negative or positive study not preceded or followed by a negative or positive study was considered as unconfirmed. Explanations were then sought to explain unconfirmed results. There were 169 (51%) and 124 (37%) confirmed positive and negative studies, respectively, and 13 (4%) and 25 (8%) unconfirmed positive and negative studies, respectively. Of the 13 unconfirmed positive tests, 2 were preceded by negative tests, 3 were preceded and followed by negative tests, and 8 were followed by negative tests. Of these 13 tests, 4 documented extensive venous thrombosis. Of the 25 unconfirmed negative tests, 11 followed treatment for venous thrombosis, 6 had recurrent thrombosis with intermittent lysis, and 8 were followed by positive tests. Considering the low probability of extensive thrombosis being a false-positive test, positive predictive value was 95% (173/182). Excluding 11 negative tests following treatment for venous thrombosis, negative predictive value was 90% (124/138) and accuracy was 93% (297/320). US versus US and literature US versus venography comparisons of these statistics were similar.
Maturation and Failure Rates in a Large Series of Arteriovenous Dialysis Access Fistulas
Authors: Schild A. Frederick , Prieto James , Glenn Maria , Livingstone Joshua , Alfieri Keith , Raines Jeff
Published: March 2006

The objective of this study was to document maturation and failure rates in a large homogeneous series of arteriovenous fistulas (AVFs). Between January 1, 1996, and December 31, 2001 (60 months), a single surgeon (AFS) in 1 academic medical center, constructed 374 AVFs. In this series, all AVFs were developed in vessels that had not undergone previous vascular access surgery. Recently, a retrospective review of these records revealed that 291 subjects had had complete follow-up for at least 3 months, and they constitute the material for this study. AVFs were considered a failure if an early occlusion/thrombosis occurred, if in 3 months the AVF had not matured on clinical examination, or if cannulation in the dialysis center was not feasible. A total of 91 AVFs did not mature, for an overall failure rate of 31%. An evaluation of failure rates indicated rates in females were higher than in males (41% versus 27%). Other risk factors, including HIV+ status, hypertension, and diabetes, demonstrated minimal failure differences (33%, 31%, and 36%, respectively).
Surgical Intervention for Isolated Dissecting Aneurysm of the Superior Mesenteric Artery
Authors: Tsuji Yoshihiko , Hino Yutaka , Sugimoto Koji , Matsuda Hitoshi , Okita Yutaka
Published: March 2006

A 44-year-old man with abdominal pain was diagnosed as having a spontaneous isolated dissection of the superior mesenteric artery. The patient was successfully treated with endoaneurysmorrhaphy 5 months after the onset and has been symptom free 15 months after surgery. In view of the excellent surgical outcome in the literatures, surgical intervention for this rare pathology should be considered.