bluuebunny/crossref_metadata_2025 huggingface dataset:
The Potential Risk for Upper Extremity Thromboembolism in Patients with Occluded Axillofemoral Bypass Grafts
Authors: Mawatari Kyotaro , Muto Yoichi , Funahashi Satoru , Ikeda Toshihiko , Komori Kimihiro , Sugimachi Keizo
Published: June 2007

Axillofemoral bypass grafts (AxFG) are widely used in the management of poor-risk patients with aortoiliac occlusive disease. On the other hand, AxFGs are associated with a variety complications to the upper extremity (UE). UE thromboembolism represents a significant and specific complication of occluded AxFGs in our series (2.6% of patients,33.3% of occluded grafts). This article describes two cases of late axillary artery thrombosis caused by the occlusion of externally-supported AxFGs. The two patients were treated by graft disconnection, a distal embolectomy, and patch angioplasty of the axillary artery. Their postoperative courses were uneventful. Based on the authors' experience and a review of the literature, they suggest that an occluded AxFG represents a high risk for use of a donor artery and that such patients must therefore be very carefully followed. To prevent late UE thromboembolism in patients with occluded grafts, the authors strongly advise that such patients undergo a surgical operation with careful followup after surgery.
Could Gut-Liver Function Derangements Cause Chronic Venous Insufficiency?
Authors: Cordts Paul R. , Kaminski Mitchell V. , Raju Seshadri , Clark Melanie R. , Woo Katharine M. S.
Published: June 2007

Upregulation of adhesion molecules and neutrophil infiltration of venous valve cusps may be risk factors for chronic venous insufficiency. But studies that focus on the target organ (vein) fail to consider the influence of systemic inflammation on WBC behavior in the microcirculation. This study probes the gut-liver axis as a potential source of gut-derived oxidative stress and free radical production leading to white blood cell activation in chronic venous insufficiency.

Venous hemodynamics (ambulatory venous pressure, air plethysmography, duplex) and gut-derived oxidative stress markers were studied in nine patients with chronic venous insufficiency (group I) and nine age and sex-matched control subjects with no venous disease (group II). Group I had healed venous ulcers (class 5, CEAP) but near-normal ambulatory venous pressure, to eliminate high ambulatory venous pressure as a chronic venous insufficiency risk factor. Markers of gut-derived oxidative stress included: stool analysis; intestinal permeability; hepatic detoxification challenges with caffeine, salicylate, and acetaminophen; and urine lipid peroxides.

Ambulatory venous pressure did not significantly differ (group I, 42.5 ±5.3 mm Hg; group II, 35.5 ±5.5 mm Hg; p = NS). Candida overgrowth in stool distinguished group I from group II (7/9 pts vs 1/9 pts, respectively; p=0.015). Increased intestinal permeability (lactulose/mannitol ratio) was prevalent in both groups (group I 0.07 ±0.02, group II 0.17 ±0.08, p=NS; normal range, 0.01-0.03). Both groups showed similar incidence of elevated urine lipid peroxides (5/9 pts vs 6/9 pts, respectively; p = NS), yet group I exhibited underfunction of both sulfation (group I 16.8 ±2.9%, group II 43.3 ±11%, p<0.03; normal acetaminophen recovery 16-36%) and glucuronidation (group I 30.4 ±4.1%, group II 64.1 ±14.4%, p<0.04; normal acetaminophen recovery 27%-56%) relative to oxidative stress, perhaps an indicator of diminished antioxidant capacity in patients with chronic venous insufficiency.

Gut dysbiosis (as indicated by stool yeast) and hepatic detoxification challenge pathway exhaustion may lead to subclinical, systemic inflammation and peripheral white blood cell adhesion in chronic venous insufficiency. Further exploration of the relationship between oxidative stress and venous disease is needed.
Hypothenar Hammer Syndrome
Authors: Wong Granger B. , Whetzel Thomas P.
Published: June 2007

Ulnar artery aneurysms distal to the carpal ligament represent an uncommon but uniquely characteristic disease entity. As a result of repetitive palmar trauma, the hypothenar hammer syndrome should be suspected in males with this history and unilateral digital ischemia which spares the thumb. The pathophysiology of this syndrome and its management is reviewed with presentation of an index case.
Aortic Nonanastomotic Pseudoaneurysm Eroding Lumbar Vertebra
Authors: Choi Su , Harris Linda
Published: June 2007

Nonanastomotic pseudoaneurysms are uncommon complications of prosthetic grafts, which are mostly associated with axillofemoral grafts. The case presented describes a pseudoaneurysm secondary to a previously placed end-to-side aortobifemoral bypass. Back pain developed 3 years after the original bypass and was not relieved with narcotics and muscle relaxants. The patient also complained of a 20-pound weight loss, night sweats, and frequent emesis. Approximately 1 year after the onset of back pain, left leg claudication developed. He eventually underwent magnetic resonance imaging of the lumbosacral spine, which depicted a tumorlike mass eroding the vertebral bodies of L2 and L3. Full oncologic workup was pursued preoperatively. The patient also underwent aortography, computed tomography of the abdomen and pelvis, and an inferior venacavogram to elucidate the relationships between the mass and the major vascular structures. On exploration, no malignancy was present. A hole in the native aorta approximately 2 cm above the level of the end-to-side aortic anastomosis was discovered. This was contiguous with the vertebral bodies and the left psoas muscle. The pseudoaneurysm was repaired by conversion of the proximal anastomosis to an end-to-end aorto right iliac and left femoral bypass. All of the preoperative symptoms resolved after repair of the pseudoaneurysm. Chronic aortic rupture or pseudoaneurysms are difficult to diagnose due to the unusual clinical presentations. Despite complete radiologic evaluation, preoperative diagnosis may be difficult or impossible without a high degree of suspicion. Surgical repair will depend on the cause of the pseudoaneurysm-all but infected aneurysms may be repaired in line by creating a proximal anastomosis above the level of the pseudoaneurysm. Atypical back pain in patients with previous aortic reconstructions should alert the clinician to the possibility of vascular involvement. Patients with aortic pseudoaneurysms should undergo prompt repair to avert the potential risk for rupture when the surrounding structures are no longer able to contain the pulsatile flow.
Carotid Arteriography Impacts Carotid Stenosis Management
Authors: Long Stewart M. , Kern John A. , Fiser Steven M. , Kaza Aditya K. , Cassada David C. , Miller Brian T. , Claridge Jeffrey A. , Kron Irving L. , Tribble Curtis G.
Published: June 2007

Recent literature advocates carotid endarterectomy on duplex alone. The authors hypothesized that carotid angiography adds information that alters clinical management in a substantial number of patients compared to the use of carotid duplex examination alone. The records of 182 consecutive patients who underwent carotid artery duplex and subsequent carotid/cerebral angiography for suspected carotid artery stenosis between January 1998 and April 1999 were reviewed retrospectively. Carotid artery duplex examinations were stratified based on stenosis: <39%, 40% to 59%, 60% to 79% (moderate), 80% to 99% (severe), 100%. Carotid stenosis on angiograms was determined by NASCET criteria. New information found at angiography included vertebral, subclavian, or arch atherosclerosis, intracranial pathosis, or a change in duplex stenosis category to a degree of stenosis not requiring surgery. Clinical importance was attributed to angiograms that altered the patients' management plan. Angiography provided additional information in 53% (97/182) of patients. Vertebral disease was found in 25.1%, subclavian disease in 16.4%, intracranial disease in 15.3%, aortic arch disease in 3.3%. Patient treatment was altered in 30% (55/182). Angiographic findings downgraded the stenosis to medical therapy in 20.9% (38/182). The surgical plan was influenced in 5.5% (10/182). Nine intracranial aneurysms were discovered. Carotid angiography was essential for vascular bypass surgery planning in 3.3% (6/182). Angioplasty was performed in 2.2% (4/182). The accurate determination of stenosis is critical in determining optimal treatment of patients with carotid artery stenosis. Routine carotid angiography remains valuable in the clinical treatment of these patients.
Correlation of Tc-99m-Red Blood Cell Phleboscintigraphy with Clinical Severity of Chronic Venous Disease
Authors: Giordano Alessandro , Calcagni Maria Lucia , Rulli Francesco , Muzi Marco , Martino Gianluigi , D'Andrea Giovanni , Galli Marco , Zanella Everardo
Published: June 2007

Equilibrium red blood cell phleboscintigraphy of the lower limbs for the diagnostic management of chronic venous disease has been proposed. The aim of this study was to verify the correlation of the phleboscintigraphic assessment of chronic venous disease with the clinical grading of the severity of the disease, since other diagnostic modalities have been recently demonstrated a poor and only partial correlation. Equilibrium Tc-99m-red blood cell phleboscintigraphy was performed in 27 patients with chronic venous disease. Scintigraphic images of 52 limbs were classified according to a four-class qualitative grading of the severity of the venous disease, and a quantitative scintigraphic index (saphena /femoral ratio) was assigned to each limb. The scintigraphic qualitative grading showed a highly significant correlation with the clinical grading (Rs=0.82, p<0.01), a good interobserver and intraobserver agreement (86.5% and 92.3%, respectively) and more than 90% sensitivity and specificity to identify the categories “minimal or no chronic venous disease“ or “more significant disease” (assessed according to the Bayes theorem). Sensitivity and specificity results for the quantitative assessment were not as good. Phleboscintigraphy correlates well with the clinical grading of the severity of chronic venous disease of the lower limbs and may have potential as a valuable diagnostic tool for the noninvasive assessment of chronic venous disease.
Clinical Experience with Temporary Vena Cava Filters
Authors: Watanabe Shun-ichi , Shimokawa Shinji , Moriyama Yukinori , Koga Masaaki , Iguro Yoshifumi , Masuda Hiroshi , Yamaoka Akihiro , Fukumoto Yoshihiro , Sakasegawa Koh-ichi , Saigenji Hideaki , Taira Akira
Published: June 2007

An experience with temporary filter placement, which seems to be safe and effective for temporarily preventing pulmonary embolism, is reported. Since October 1997, six patients had temporary filters. There were two men and four women, with a mean age of 37 years. Three filters were placed at the infrarenal inferior vena cava, two at the suprarenal inferior vena cava, and one at the superior vena cava. All filters were placed before various surgical interventions. During filter placement, anticoagulation therapy was routinely performed. There were no complications at and during filter placement. No pulmonary emboli occurred during surgical intervention. All filters were successfully removed, two of which were exchanged for permanent filters. All patients are alive and well without recurrent deep vein thrombosis and/or pulmonary emboli during a follow-up period of 11 to 25 months. Although this experience is small, temporary filter placement is safe and effective for short-term prevention of pulmonary emboli even in older patients or those with malignant disease. Veins of the upper part of the body may be more favorable than the femoral vein for insertion of a temporary filter. Temporary filters can be safely placed not only at the infrarenal inferior vena cava, but also at the suprarenal inferior vena cava or superior vena cava.
Clostridial Mycotic Aneurysm of the Thoracoabdominal Aorta
Authors: Morrison Richard C. , Dimuzio Paul J. , Kahn Mark , Carabasi R. Anthony , Bailey William , Edie Richard N.
Published: June 2007

Clostridial infection of the aorta is a rare and life-threatening condition. The management of a mycotic aneurysm involving the thoracoabdominal aorta due to Clostridium septicum infection is presented. Successful surgical management of the aortic infection involved arterial resection, wide debridement of the surrounding tissues, and in situ graft replacement. Sixteen additional cases of clostridial infection of the aortoiliac segment reported in the literature are also summarized. In ten of these 17 cases, an associated colonic adenocarcinoma was documented.
Horner's Syndrome After Carotid Endarterectomy
Authors: Perry Charles , James Donavan , Wixon Christopher , Mills Joseph , Ericksen Curtis
Published: June 2007

Horner's syndrome is described in a patient with anisocoria and unilateral lid ptosis 48 hours after an ipsilateral carotid endarterectomy. This case illustrates a rare iatrogenic complication of sympathetic nerve dysfunction following elective surgery.
Mesocaval Shunt: Patency After 22 Years
Authors: Abu-Judeh Hani , Bahramipour Phillip , Swan Kenneth G.
Published: June 2007

A case of a mesocaval shunt placed urgently in a 52-year-old man to control life-threatening hemorrhage from esophageal varices is reported. The latter resulted from portal hypertension secondary to Laennec's cirrhosis. The patient suffered from acute and chronic alcoholism, but not alcoholic hepatitis. Twenty-three years later, the shunt is angiographically patent; the patient is alive and well. He has been free from encephalopathy with the exception of three episodes of gastrointestinal hemorrhage secondary to peptic ulcer disease. In each case, hepatic coma responded promptly to cathartics, enemas, and lactulose once bleeding ceased.
Simultaneous Bilateral Upper Extremity Venous Thrombosis in a Factor V Leiden Heterozygote
Authors: Sullivan Vita V. , Wolk Seth W. , Whitehouse Walter M.
Published: June 2007

Primary upper extremity deep venous thrombosis (DVT), or effort thrombosis, typically occurs in young, healthy individuals with a history of repetitive upper extremity movement while secondary upper extremity DVT is associated with a number of predisposing factors. The role of factors such as hypercoagulability in the development of effort thrombosis is less well described. This report describes a previously healthy 21-year-old man who presented with simultaneous bilateral upper extremity DVT after hours of pushing and lifting a heavy wheelbarrow. Treatment included thrombolytic therapy followed by delayed venolysis and vein patch angioplasty. Hypercoagulable screening revealed factor V Leiden heterozygous characteristics.
Durability of Percutaneous Angioplasty and Stent Implantation for the Treatment of Abdominal Aortic Coarctation
Authors: Eliason Jonathan L. , Passman Marc A. , Guzman Raul J. , Naslund Thomas C.
Published: June 2007

Abdominal aortic coarctation (AAC) is an uncommon vascular lesion with serious sequelae related to uncontrolled hypertension. Balloon-expandable stents have recently been utilized in the treatment of AAC as an alternative to surgical intervention. A 17-year-old female presented with hypertension uncontrolled by beta blockade. She underwent angiography, which revealed an isolated supraceliac aortic coarctation without visceral or renal artery involvement. Balloon angioplasty with stent placement was performed. At 2-year follow-up, a restenosis was identified and was treated with repeat balloon-expandable stent placement. Implantation of balloon-expandable stents is a safe and technically feasible treatment modality for abdominal aortic coarctation not involving the renal and mesenteric arteries. However, it is currently unknown whether the long-term durability of this approach may limit its effectiveness when compared to traditional surgical interventions.
Mesenteric Revascularization in a Contaminated Abdomen
Authors: Young Richard M. , Hoballah Jamal J. , Sharp William J. , Corson John D.
Published: June 2007

The management of acute mesenteric ischemia in the contaminated abdomen may require the use of an autogenous graft to achieve mesenteric revascularization. The authors present a case of an ischemic small bowel perforation in a 62-year-old-woman whose preoperative angiogram demonstrated occlusion of the celiac, superior mesenteric, and inferior mesenteric arteries. Vein mapping of the right greater saphenous vein demonstrated a dual saphenous system whose individual diameters were more than 4 millimeters. Exploratory laparotomy revealed a diffusely ischemic small bowel and liver, as well as abdominal sepsis from the perforated small bowel. Revascularization was accomplished by using saphenous vein in a nonreversed orientation as a bifurcated conduit from the supraceliac aorta to the hepatic and superior mesenteric arteries. Following revascularization, the liver and small bowel immediately regained a normal perfused appearance and the perforated segment of small bowel was resected and reanastomosed. She returned for a follow-up clinic visit 5 months later and was found to have an asymptomatic 6 cm aneurysm involving the proximal mesenteric vein bypass. The aneurysmal aspect of the vein bypass was replaced with a polytetrafluoroethylene interposition graft originating from the supraceliac aorta. On follow-up 3 months later, her aortomesenteric bypass is patent without aneurysmal recurrence, and she is clinically asymptomatic from any symptoms of mesenteric ischemia.
Selection of Patients with Lower Limb Arterial Occlusive Disease for Endovascular Treatment of the Iliac Arteries with Duplex Scanning
Authors: Bostrdm Annika , Karacagil Sadettin , Löfberg Ann-Marie , Ljungman Christer , Nyman Rickard , Logason Karl , Hellberg Anders
Published: June 2007

The aim of this study was to evaluate the role of duplex scanning in selection of patients with lower limb arterial occlusive disease for endovascular treatment of the iliac arteries. From January 1995 through May 2000, 183 patients having chronic lower limb arterial insufficiency who underwent duplex scanning of the lower extremity arteries with available aortoiliac scans within 3 months before conventional aortoiliac diagnostic angiography and/or endovascular intervention of the iliac arteries were studied retrospectively. The findings obtained from duplex scanning and angiography were analyzed in a blinded manner by 2 investigators. Limbs having category 1, 2, and 3 lesions according to duplex scan findings were interpreted as being suitable for endovascular intervention. The comparison between duplex scan findings and angiography was analyzed by the third investigator.

During 93 percutaneous transluminal angioplasty (PTA) procedures, 133 arterial segments, common or external iliac, were dilated with stent placement in 70. Bilateral interventions were performed in 25 cases, and of 68 unilateral interventions, 57 were at only 1 arterial segment. The accuracy, sensitivity, specificity, and negative and positive predictive values of duplex scanning to appropriately categorize the iliac artery lesions into suitable or unsuitable for endovascular intervention were 90%, 95%, 83%, 90%, and 92%, respectively when the inconclusive duplex scans were excluded (11%). In 6 patients with lesions suitable for PTA according to duplex scanning and angiography, PTA was not performed owing to clinical reasons. The accuracy of duplex scanning in predicting the performance of endovascular intervention was 88%.

It is concluded that iliac artery endovascular procedures in limbs with chronic occlusive disease can be reliably planned according to duplex scan findings.
Late Infection of a Dacron Carotid Endarterectomy Patch
Authors: Byer Arnold , Keys R. C. , Panush D. , Frank E.
Published: June 2007

This unique case reports the nonsurgical management of a late (2 years) methicillin-resistant Staphylococcus aureus neck infection around a Dacron-patched carotid endarterectomy. Because the patient was elderly with multiple serious risk factors and no drainable material, IV and oral antibiotics were selected as initial management. Follow-up computed tomography of the neck, however, documented complete resolution of the phlegmon. While the authors remain uncertain of the long-term outcome the patient is free of local infection 2 years after diagnosis and nonoperative treatment.
Intraoperative Graft Verification in Renal Transplants
Authors: Bhatt Kirit A. , Karamanoukian Hratch L. , Bergsland Jacob , D'Ancona Giuseppe , Stephan Rabie
Published: June 2007

The success of an arterial reconstruction is dependent on multiple factors, including patient selection, quality of the vessels, type of vascular conduit employed, and the surgical technique adopted. Transit time flow measurement is a technique that is now the standard of care for immediate graft patency verification following coronary artery bypass graft surgery. This study demonstrates that transit time flow measurement can be successfully used to evaluate renal transplant anastomoses: accurate intraoperative measurements provide a rapid objective assessment of renal graft patency.
Heparin-Induced Thrombocytopenia: Pathophysiology and Management
Authors: Mureebe Leila , Silver Donald
Published: June 2007

Immune-mediated heparin-induced thrombocytopenia (HIT) is a well-defined syndrome. Clinical criteria (thrombocytopenia, resistance to heparin anticoagulation, or thromboses during heparin therapy) are defined, and serologic diagnostic tests are available. Earlier recognition of HIT syndrome has allowed for significant advances in therapy, leading to marked reductions in morbidity and mortality from HIT syndrome. This review addresses the epidemiology, pathobiology, and management of HIT syndrome
Aneurysm of the Dorsalis Pedis Artery
Authors: Taylor David T. , Mansour M. Ashraf , Bergin James T. , Reyes Cesar V. , Stuck Rodney M.
Published: June 2007

Aneurysms of the pedal arteries are uncommon; however, they can be identified upon clinical exam and confirmed by angiogram and color-flow duplex scan. Surgical treatment options include ligation or primary repair. The authors present a case of an aneurysm of the dorsalis pedis artery in a diabetic patient. Primary repair of the aneurysm was accomplished using a venous autograft patch. The postoperative course was uneventful and the artery remains patent in follow-up.
Cerebral Hyperperfusion Syndrome
Authors: Rippy Elisabeth E. , Wolfe John H. N.
Published: June 2007

Cerebral reperfusion following carotid endarterectomy occasionally causes cerebral hyperperfusion syndrome. This is a rare but important complication and this case report acted as a stimulus for a literature review of this problem.

A 60-year-old businessman had a right carotid endarterectomy for a severe stenosis which had caused recurrent attacks of amaurosis fugax. The left internal carotid artery had occluded asymptomatically. The operation and his immediate postoperative recovery were entirely uneventful but he developed right-sided headaches and focal sensory motor seizures. He subsequently recovered.

Hemodynamically compromised patients appear to be at greater risk and as the mortality of the operation is reduced and more complex patients are treated, it is likely that this unusual complication will increase in incidence.
Combined Endovascular Treatment of a Descending Thoracic Aortic Aneurysm and Off-Pump Myocardial Revascularization
Authors: Moura Marcelo R. L. , Melissano Germano , Maisano Francesco , Marone Enrico M. , Civilini Efrem , Alfieri Ottavio , Chiesa Roberto
Published: June 2007

Endovascular intervention is an alternative form of treatment for patients with thoracic aortic aneurysms. Coexistent cardiovascular diseases may adversely influence the postoperative course and affect the long-term prognosis. The case of a 76-year-old man with severe coronary artery disease and a thoracic aortic aneurysm is reported. A single-stage procedure of offpump coronary artery revascularization and endoluminal exclusion of the descending thoracic aortic aneurysm was performed. The patient was treated first with off-pump coronary artery bypass graft (left internal mammary artery on the left anterior descending coronary artery and two single venous grafts from ascending aorta to obtuse marginal artery and posterior descending artery). After heart revascularization, two Thoracic Excluder endovascular grafts (34 X 100 and 37 X 100 mm) were implanted to treat the descending thoracic aortic aneurysm. Follow-up with computed tomography angiography showed successful exclusion of the thoracic aneurysm 12 months after the procedure. The patient is well and free of symptoms 18 months later.
Aortoiliac Thrombosis in Antiphospholipid Syndrome
Authors: Alfayate Jesús M. , Aciń Francisco , Bueno Alicia , March José R. , López-Quintana Alfonso , Cancer Susana , Ros Rafael
Published: June 2007

Antiphospholipid syndrome is accepted as one of the most important causes of hypercoagulable states. Thrombotic events in patients with antiphospholipid syndrome, predominantly women, occur at a younger age than in those suffering from atherosclerotic disease. The majority of the thrombotic events affect the deep venous system of the lower limbs and arterial thrombosis predominates in the cerebral territory. The use of anticoagulant therapy prevents recurrent thrombosis but the duration and intensity of treatment remain controversial. Aortic disease is an anecdotal fact in the literature. A case of infrarenal aortic occlusion involving both iliac arteries associated with primary antiphospholipid syndrome is presented.
Transaortc Endarterectomy for Primary Mesenteric Revascularization
Authors: Lau Hung , Chew David K. , Whittemore Anthony D. , Belkin Michael , Conte Michael S. , Donaldson Magruder C.
Published: June 2007

The optimal approach to revascularization for chronic mesenteric ischemia has not been firmly established during the past three decades. The present study was undertaken to evaluate the safety and results of primary mesenteric revascularization for chronic mesenteric ischemia by transaortic endarterectomy. A descriptive retrospective analysis of 14 patients who underwent trap-door transaortic endarterectomy for primary mesenteric revascularization was performed. Clinical presentations of the patients included abdominal pain (n = 13) and weight loss (n = 7). All patients underwent preoperative aortography and subsequent elective reconstruction. Demographic features, perioperative, and long-term outcomes were analyzed. The study population consisted of 12 females and two males with a mean age of 67 years. The mean operative duration was 3 hours with an ischemic time of 33 minutes. The initial success rate of mesenteric revascularization was 93%. One early graft failure was salvaged with urgent embolectomy without bowel resection. There was no hospital mortality, but the overall postoperative morbidity rate was 50% (n = 7). Thirteen patients (93%) were discharged within 2 weeks. Late recurrent ischemia and intestinal infarction developed in one patient, requiring emergency bowel resection. Sustained relief of symptoms was achieved in 13 of 14 patients (93%). The overall survival rates were 85% ± 10.0% and 77% ± 11.7% at 1 and 3 years, respectively. Transaortic endarterectomy is a safe and effective technique for elective primary mesenteric revascularization for patients with chronic mesenteric ischemia. This approach allows simultaneous revascularization of multiple visceral arteries and achieves durable relief of symptoms.
Complication Rates of Diagnostic Angiography Performed by Vascular Surgeons
Authors: Balduf Lisa M. , Langsfeld Mark , Marek John M. , Tullis Michael J. , Kasirajan Karthikeshwar , Matteson Brian
Published: June 2007

The objective of this study was to compare the complication rates of diagnostic angiography performed by vascular surgeons to those previously published by interventional radiologists. From May 1999 through August 2000, 3 board-certified vascular surgeons performed 224 endovascular procedures in a modern endovascular suite. Of these 224 procedures, 144 were diagnostic angiographies. A retrospective chart review was conducted to identify periprocedural complications of these angiographies. The patients were classified into 3 groups according to the indication for angiography, and the major and overall complication rates were tabulated. The complication rates for the initial 25 and subsequent 119 arteriographies were compared to evaluate the presence of a learning curve. Thirty-eight percent of angiographies were performed to define aneurysmal anatomy (type I), 51% to define peripheral arterial stenosis or occlusion (type II), and 12% to assess symptomatic carotid artery disease or mesenteric ischemia (type III). The major complication rates for these 3 types were 0%, 2.7%, and 5.9%, respectively, and showed no statistical difference (Fischer's exact test) compared to published rates of 0.7%, 2.9%, and 9.1%. Major complications included an external iliac artery dissection, a cerebral air embolus, and a deep venous thrombosis. The overall major complication rate was 2.1%, which compares to published rates of 1.9-2.9%. The major complication rates for the initial 25 and final 119 were 8% and 0.8%, respectively. Vascular surgeons can perform diagnostic angiography with acceptable complication rates. The complication rate is reduced with angiographic experience.
Congenital Absence of Internal Carotid Artery Associated with Hypogonadotropic Hypogonadism
Authors: Baysefer Alper , Akay Kamil Melih , Tasar Mustafa , Izci Yusuf
Published: June 2007

Congenital absence of internal carotid artery is a relatively rare disorder. It may be an isolated entity or combined with other organ or system anomalies. Investigations of a 19-year-old male patient with hypogonadotropic hypogonadism and hypothyroidism suffering from intracerebral and subarachnoid hemorrhages showed absence of the left internal carotid artery. The association of endocrinologic disorders and congenital absence of internal carotid artery is discussed with the pertinent literature. In conclusion, association of the absence of internal carotid artery and hypogonadism is extremely rare. Patients with absence of internal carotid artery may also have intracerebral and subarachnoid hemorrhages and should be followed up closely.
Fractured Aorta
Authors: Rosengart Matthew R. , Zierler R. Eugene
Published: June 2007

A 66-year-old, restrained driver involved in a high-speed motor vehicle crash sustained a transmural infrarenal fracture of a circumferentially calcified aorta. Blunt abdominal aortic injury is exceedingly rare, about twenty times less common than its thoracic counterpart, and the current case report is therefore unusual. A high index of suspicion in combination with a suggestive clinical history or examination should prompt diagnostic intervention, as both morbidity and mortality are high.
Endovascular Repair of an Arteriovenous Fistula from a Ruptured Hypogastric Artery Aneurysm
Authors: Char Daniel , Ricotta John J. , Ferretti John
Published: June 2007

A spontaneous ilioiliac arteriovenous fistula secondary to rupture of a hypogastric artery aneurysm is an unusual occurrence. A case of an endovascular repair of this challenging problem is reported.
Femoral Incision Morbidity Following Endovascular Aortic Aneurysm Repair
Authors: Jackson Slappy A. L. , Hakaim Albert G. , Oldenburg W. Andrew , Paz-Fumagalli Ricardo , McKinney J. Mark
Published: June 2007

Currently available aortic stent-grafts require bilateral femoral incisions for device deployment. The incidence of morbidity (infection, lymphatic complications, breakdown) of vertical, infrainguinal incisions used in endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms (AAAs) was assessed, and the natural history of asymptomatic groin fluid collections following such procedures was determined. Between June 1999 and February 2001, 77 consecutive patients underwent EVAR for AAAs utilizing bilateral vertical femoral incisions. Fifty-nine (77%) bifurcated stent-grafts (BSGs), and 18 (23%) aortouniiliac (AUI) devices, with femorofemoral bypass were performed. Patients returned at 2 weeks, 1 month, and 6 months for physical examination, and 1 month and 6 months for abdominal and pelvic computed tomography (CT) scans. The presence of fluid collections was determined from the dictation report of the attending radiologist. Data are reported as (n) mean ± SE. Patient characteristics were compared using Fisher's exact test; p <0.05 considered significant. There were 72 males and 5 females, age 75 ±6.4 years and aneurysm size (77) 5.6 ±0.8 cm. There were no cases of wound breakdown or lymph fistula. Wound infections occurred in 3/150 incisions (2%), 2/34 AUI incisions (6%), and 1/1 16 BSG incisions (0.86%). There was no statistical difference (p =0.13) between graft types (BSG vs AUI). All infections were diagnosed clinically before the 1-month CT scan, treated without operative intervention or hospitalization, and resolved. There was a significant decrease in the BSG group and overall in asymptomatic wound fluid collections from 1 to 6 months postoperatively. At 1 and 6 months, respectively, the BSG group had 17 (14.6%) and 3 (2.6%) fluid collections out of 116 incisions (p = 0.003); the AUI group had 6 (17.6%) and 1 (2.9%) fluid collection(s) out of 34 incisions (p = 0. 13); and overall 23 (15.3%) and 4 (2.6%) out of 150 incisions (p = 0.004). The present study demonstrates that bilateral vertical femoral incisions used in EVAR have a wound infection rate of 2.0%. Infections are usually detected and treated clinically and empirically without the need for hospitalization or surgery. Asymptomatic groin wound fluid collections resolve significantly within 6 months without intervention. Therefore, surgical femoral artery exposure adds little morbidity to the endovascular repair of abdominal aortic aneurysms.
Rapidly Enlarging Iliac Aneurysm Secondary to Listeria Monotogenes Infection
Authors: Clouse W. Darrin , DeWitt Caroline C. , Hagino Ryan T. , DeCaprio Jeffrey , Kashyap Vikram S.
Published: June 2007

Infected aneurysms caused by Listeria monocytogenes are rare. Worldwide, 16 cases have been reported, none in the iliac system. The authors report the case of an 80-year-old man being followed for small aortic and right common iliac artery (RCIA) aneurysms who presented with progressive gastrointestinal symptoms. Serial computed tomography demonstrated a 200% increase in RCIA diameter with development of infection over 1 month. Right axillobifemoral bypass and aneurysm resection were performed. The authors believe this case represents the first description of bacteremic seeding of an iliac degenerative aneurysm by Listeria monocytogenes. The natural history and aggressive course of vascular infection with this organism are documented.
Open Aneurysm Repair in Elderly Patients Not Candidates for Endovascular Repair (EVAR): Comparison with Patients Undergoing EVAR or Preferential Open Repair
Authors: Manis George , Feuerman Martin , Hines George L.
Published: June 2007

The authors reviewed a 2-year experience with abdominal aortic aneurysm (AAA) repair to determine if patients who were excluded from endovascular aneurysm repair (EVAR) because of anatomic criteria (Group III) represented a higher risk for subsequent open aneurysm repair than either patients undergoing EVAR (Group II) or those patients who preferentially underwent open repair (Group I). Between January 2001 and December 2003, 107 patients underwent AAA repair. Open repair was recommended in patients <70 years of age and without significant comorbidities (Group I). There were 35 patients in Group I; 72 patients were evaluated for EVAR; 29 patients underwent EVAR (Group II), and 43 were excluded and underwent open repair (Group III). Exclusion criteria were those recommended by the graft manufacturers. Patients in Group I were significantly younger than those in Groups II and III (p<0.0001). Gender, incidence of diabetes, and hypertension were similar in all groups. Patients in Group III had a greater incidence of coronary artery disease (CAD) than those in Groups I and II, trending toward statistical significance (p=0.06). Aneurysm size in Group II was statistically smaller than in Group I or III. Group III had significantly more complications (25.6% vs 5.7% and 6.9%) than either Group I or II (p<0.015). Cardiac complications were similar in all groups. Three patients in Group III required prolonged intubation and 3 in Group III developed renal insufficiency. A history of CAD was predictive of complications (21.8% vs 5.8%, p<0.024), as was inclusion in Group III. There were 2 deaths in this series, both in Group III. Length of stay was significantly less in Group II (4.17 ±2.36 days) than in Group I (6.57 ±1.84 days) or Group III (12.30 ±9.82 days) (p=0.0001). Open aneurysm repair can be safely performed in younger good-risk patients (Group I) with results equivalent to EVAR (Group II) but with slightly longer length of stay (LOS). In older patients with suitable anatomy EVAR can be performed with minimal morbidity and short LOS. Older patients not suitable for EVAR (Group III) constitute a higher risk group of patients because of increased incidence of CAD and the need for more complex repairs. However, the mortality rate in this group was only 4.6%.
Endovenous Saphenous Ablation Corrects the Hemodynamic Abnormality in Patients with CEAP Clinical Class 3–6 CVI Due to Superficial Reflux
Authors: Marston William A. , Owens Lewis V. , Davies Steven , Mendes Robert R. , Farber Mark A. , Keagy Blair A.
Published: June 2007

This investigation was designed to determine whether minimally invasive radiofrequency or laser ablation of the saphenous vein corrects the hemodynamic impact and clinical symptoms of chronic venous insufficiency (CVI) in CEAP clinical class 3–6 patients with superficial venous reflux. Patients with CEAP clinical class 3–6 CVI were evaluated with duplex ultrasound and air plethysmography (APG) to determine anatomic and hemodynamic venous abnormalities. Patients with an abnormal (>2 mL/second) venous filling index (VFI) and superficial venous reflux were included in this study. Saphenous ablation was performed utilizing radiofrequency (RF) or endovenous laser treatment (EVLT). Patients were reexamined within 3 months of ablation with duplex to determine anatomic success of the procedure, and with repeat APG to determine the degree of hemodynamic improvement. Venous clinical severity scores (VCSS) were determined before and after saphenous ablation. Eighty-nine limbs in 80 patients were treated with radiofrequency ablation (RFA) (n=58), or EVLT (n=31). The average age of patients was 55 years and 66% were women. There were no significant differences in preoperative characteristics between the groups treated with RFA or EVLT. Postoperatively, 86% of limbs demonstrated near total closure of the saphenous vein to within 5 cm of the saphenofemoral junction. Eight percent remained open for 5–10 cm from the junction, and 6% demonstrated minimal or no saphenous ablation. The VFI improved significantly after ablation in both the RF and EVLT groups. Postablation, 78% of the 89 limbs were normal, with a VFI <2 mL/second, and 17% were moderately abnormal, between 2 and 4 mL/second. VCSS scores (11.5 ±4.5 preablation) decreased significantly after ablation to 4.4 ±2.3. Minimally invasive saphenous ablation, using either RFA or EVLT, corrects or significantly improved the hemodynamic abnormality and clinical symptoms associated with superficial venous reflux in more than 90% of cases. These techniques are useful for treatment of patients with more severe clinical classes of superficial CVI.
Prospective Evaluation of Combined Upper and Lower Extremity DVT
Authors: Hingorani Anil P. , Ascher Enrico , Markevich Natalia , Schutzer Richard W. , Kallakuri Sreedhar , Mutyala Manikyam , Nahata Suresh , Yorkovich William , Jacob Theresa
Published: June 2007

The clinical importance of upper extremity deep venous thrombosis (UEDVT) has been increasingly demonstrated in recent literature. Not only has the risk of pulmonary embolism from isolated upper extremity DVT been demonstrated, but a significant associated mortality has been encountered. Examination of this group of patients has demonstrated the existence of combined upper and lower extremity deep venous thrombosis (DVT) in some patients who exhibit an even higher associated mortality. As a result of this information, it has become the standard practice at this institution to search for lower extremity DVTs in patients found to have acute thrombosis of upper extremity veins. Since January 1999, there have been a total of 227 patients diagnosed with acute UEDVT. Within this group, 211 (93%) patients had lower extremity studies; 45 of these 211 (21%) had acute lower extremity DVTs by duplex examination in addition to the upper extremity DVTs. Overall, there were 145 women, 66 men, and the average age was 70 ±1.2 (SEM); 22 of these patients had bilateral lower extremity thrombosis (LEDVT), and 8 patients were found to have chronic thrombosis of lower extremity veins. Of the patients with bilateral upper extremity DVTs, there were 3 with bilateral LE acute DVTs. Finally, 8 of the remaining 166 patients (5%) with originally negative lower extremity studies were found to develop a thrombosis at a later date. These data serve to confirm previous studies, on a larger scale, that there should be a high index of suspicion in patients with UEDVT of a coexistent LEDVT.
Total-Contact Casting as an Adjunct to Promote Healing of Pressure Ulcers in Amputees
Authors: Pua Bradley B. , Muhs Bart E. , Maldonado Thomas , Ben-Arie Eyal , Sheehan Peter , Gagne Paul J.
Published: June 2007

Partial foot amputations have become increasingly prevalent among long-lived diabetic patients. These patients have lower extremity neuropathy and are prone to ulceration at their amputation site. These ulcers are difficult to heal, and they place a significant financial and resource burden on the healthcare system. We examined the efficacy of total-contact casts (TCC) in diabetic amputees with nonhealing partial foot amputation site neuropathic ulcers. Data were collected retrospectively on all patients with amputations who were treated with a total-contact cast between December 2000 and December 2003. Seventeen patients (13 men, 4 women) with amputation site ulceration were identified. All patients were diagnosed with neuropathy secondary to diabetes and none had wound healing compromised by ischemia. The initial ulcer averaged 1,169 mm2 with a depth of 2.77 mm. Patients were treated with an average of 7.9 cast applications over 8.4 weeks; 47% (8/17) of ulcers healed, but 29% (5/17) of patients were unable to complete their recommended treatment course secondary to complications from the TCC. Of the patients who were able to complete their treatment course, the healing rate was 66.7% (8/12). The recurrence rate for healed ulcers was 63% (5/8). Partial foot amputations with neuropathic ulcers present a very difficult problem to the vascular surgeon. Patient compliance and underlying medical comorbidities limit the success rate. In patients who can complete a TCC treatment course, good short term results can be expected. However, recurrence rates are high following discontinuation of mechanical TCC off-loading.
Interventional Techniques to Facilitate Supraaortic Angioplasty and Stenting
Authors: Criado Frank J. , Abul-Khoudoud Omran
Published: June 2007

Arterial occlusive disease involving the supra-aortic trunks (SATs) is relatively frequent. Its mere presence does not dictate the need for intervention. Revascularization options include intra and extrathoracic surgical bypasses and transpositions, and percutaneous endovascular approaches with angioplasty and stenting. This paper focuses on a description of the fundamental endovascular techniques and equipment that have proved useful in the senior author's (FJC) 15-year experience with catheter-based intervention for treatment of SAT disease. These procedures have gained in popularity over the years and become the preferred modality for management of most patients today.
Complications of Diagnostic Carotid/Cerebral Arteriography when Performed by a Vascular Surgeon
Authors: AbuRahma Ali F. , Hayes J. David , Deel John T. , Abu-Halimah Shadi , Mullins Bandy B. , Habib Joseph H. , Welch Christina A. , AbuRahma Zachary
Published: June 2007

Carotid stenting has recently been considered as an alternative treatment to carotid endarterectomy for certain patients with carotid stenosis. Hence, performing carotid arteriography with minimal morbidity and mortality is essential. The purpose of this study was to audit complications of diagnostic carotid/cerebral arteriography performed by a vascular surgeon with experience in endovascular interventions. One hundred one consecutive patients underwent 4-vessel arch aortography with selective carotid, subclavian, and/or vertebral arteriography with use of the Seldinger technique. Demographic data, indications, procedure approach (transfemoral, brachial), number of arteries punctured, type of selective injection, contrast volume, and procedure time were analyzed. Minor complications were those that do not significantly alter the health or activity of the patient or require extra hospitalization or treatment. Other complications were defined as major complications. The technical success rate was 99% (100/101 patients). These included the following: 82 patients with right carotid artery, 82 with left carotid artery, 15 with right subclavian artery, 21 with left subclavian artery, 11 with right vertebral artery, and 17 with left vertebral artery (a total of 228 selective injections). Indications for procedures included the following: transient ischemic attack (TIA)/stroke symptoms in 66%, asymptomatic carotid stenosis in 22%, upper limb claudication in 4%, and vertebrobasilar insufficiency in 4%. Right femoral puncture was used in 79%, left femoral in 12%, and left brachial in 9%. The mean amount of contrast used was 101 cc (45-250 cc) and the mean procedure time was 46 minutes (22-132 minutes). There were 5 complications in the whole series: 3 major complications (3%), including 1 minor stroke (1%) with carotid injection, 1 TIA, and 1 major retroperitoneal bleeding; and 2 (2%) minor complications. The major complication rate in this series compares favorably to published rates of 5.7% to 9.1%. There was no association between complications and specific risk factors except for a longer catheterization time (66 minutes versus 45 minutes, p= 0.011). Carotid/cerebral arteriography can be done safely by experienced vascular surgeons with minimal perioperative complications that compare favorably with what has been reported in the radiology literature.
Surgical Treatment of Ovarian Vein Thrombosis
Authors: Carr Sandra , Tefera Girma
Published: June 2007

Ovarian vein thrombosis is a rare but serious condition that may cause sepsis in the postpartum patient or may be associated with thrombosis of the inferior vena cava or renal vein. A 30-year-old woman presented 2 weeks postpartum with sudden onset of dyspnea and rightsided pleuritic chest pain. She was diagnosed with a large pulmonary embolus and thrombosis of the right ovarian vein. After failure of percutaneous embolization of the right ovarian vein, the patient underwent open surgical excision of the right ovarian vein. The management of ovarian vein thrombosis may involve systemic anticoagulation, antibiotics, thrombolysis, open surgical treatment, or a combination of these.