bluuebunny/crossref_metadata_2025 huggingface dataset:
Carotid Artery Stenosis: Does the World Wide Web Provide Sufficient Information to These Patients?
Authors: Sadat Umar , Chang Guohao , Sorani Alan , Walsh Stewart , Gaunt Michael
Published: May 2011

As the use of the Internet is at its highest at present, it is reasonable to assume that patients suffering from carotid artery stenosis and its complications may use this as a potential source of information prior to hospital attendance. The relevant Web sites were initially identified and the quality of information therein was assessed independently by two assessors on the author panel. We also tested whether established Web site scoring systems (HON and DISCERN score) could predict the quality of information included on the medical Web sites.

The overall quality of relevant information for these patients was found to be poor. The Spearman rank correlation between the two scoring systems was /0.64 (95% confidence interval [CI] 0.53–0.74, p < .0001). There was a good correlation between the assessors' scores for each scoring system, with a Spearman rank correlation for the DISCERN score of 0.99 (95% CI 0.99–0.99, p < .0001) and for the HON score of 0.98 (95% CI 0.97–0.98, p < .0001). We also found a good correlation between these scores and guidelines set by the assessors.

Available scoring systems provide a good means of assessment. However, significant improvement is required to enhance the overall quality of health-related Web sites.
New Technique to Facilitate Renal Revascularization with Use of Telescoping Self-Expanding Stent Grafts: VORTEC
Authors: Lachat Mario , Mayer Dieter , Criado Frank J. , Pfammatter Thomas , Rancic Zoran , Genoni Michele , Veith Frank J.
Published: May 2011

This article describes a new, less invasive prosthetic graft anastomotic technique that uses self-expanding stent grafts that are “telescoped” into aortic branches. This method, the VORTEC (Viabahn Open Revascularization TEChnique), obviates the need for potentially difficult complete vessel exposure and graft anastomoses, thereby reducing the duration of flow interruption and simplifying the performance of complex aortic reconstructions and so-called debranching procedures requiring reconstruction of major branches such as renal arteries. Minimal exposure of one surface of the renal artery allowed introduction and deployment of a self-expanding Viabahn (W.L. Gore & Associates, Flagstaff, AZ) device using the Seldinger technique. The Viabahn devices used were 5 to 8 mm in diameter and 5 to 15 cm in length depending on individual anatomy (assessed by preoperative computed tomographic angiography). Overall, 82 renal arteries have been revascularized in 58 patients using the VORTEC. The technical success rate was 100%, with all of the stent grafts implanted as intended with maintenance of flow. The patency rates were 97% after 30 days and 96% after a mean follow-up of 18 months (range 1–38 months). The VORTEC allows performance of safe and expeditious revascularization of renal arteries. This new technique may represent significant improvement over the standard approach of surgical exposure and sutured anastomosis.
Patients Requiring Dialysis are not at Risk of Greater Complication after Carotid Endarterectomy
Authors: Amin Asna , Golarz Scott , Scanlan Bradford , Hashemi Homayoun , Mukherjee Dipanker
Published: May 2011

Stroke is a leading cause of disability and the third leading cause of death. Landmark studies have demonstrated that carotid endarterectomy (CEA) reduced the risk of stroke among selected patients with carotid stenosis. Renal insufficiency is a known risk factor for stroke and appears to be an independent risk factor for poor outcome after CEA. Studies have reported high morbidity and mortality after CEA in patients on dialysis. However, our experience has been that patients undergoing dialysis have no greater risk for a poor outcome. This study was a retrospective review of our CEA patients to ascertain our morbidity and mortality results in dialysis patients versus patients not on dialysis. An institutional retrospective chart review of CEAs from January 1999 to December 2007 was conducted. Patients on dialysis at the time of CEA were identified. Their charts were reviewed for complications 30 days after surgery. This was compared with our total experience with CEAs from January 1999 to December 2007. Of the 28 patients undergoing CEA while dialysis dependent, none had complications in the 30-day postoperative period. This compares favorably with the cohort of all CEAs by the same surgeons. In that group, 13 complications were identified (13 of 1,141). Patients undergoing dialysis are at no greater risk for complications when undergoing carotid endarterectomy than the general population.
Five Years' Experience of Transverse Groin Incision for Femoral Artery Access in Arterial Reconstructive Surgery: Parallel Observational Longitudinal Group Comparison Study
Authors: Beirne Christopher , Martin Fiachra , Hynes Niamh , Sultan Sherif
Published: May 2011

Vertical groin incisions (VGIs) have been used to access femoral vessels, but reports allude to wound complications. Our aim was to compare VGI with transverse groin incision (TGI) for femoral artery exposure. Over a 5-year interval, 196 patients with 284 femoral artery exposures for supra- and infrainguinal procedures were studied. Primary endpoints were surgical skin site wound infection, seroma, haematoma formation, and major lower limb amputation. Secondary endpoints were graft patency, wound paresthesias, and length of hospital stay. There were 160 TGIs and 124 VGIs. The demographics and risk factor profile were not statistically different between groups. Seroma developed in 4.4% of TGIs and 13.7% of VGIs ( p = .005). The complicated skin and soft tissue infection rate was five times greater with VGI ( p = .001). The VGI group had a significantly higher rate of major amputation ( p = .0005). Significantly higher graft failure rates were observed in the VGI group ( p = .011). No paresthesia was reported in any TGI wound. The mean hospital stay was also significantly shorter in the TGI group ( p = .006). The study data support and expound on the theory that an alternative incision to VGI offers lower short- and long-term morbidity. Our findings sustain the selection of the TGI in femoral artery surgery for both supra- and infrainguinal procedures without compromise of vessel exposure.
Endovascular Repair of Ruptured Abdominal Aortic Aneurysms: Systematic Literature Review
Authors: Azizzadeh Ali , Villa Martin A. , Miller Charles C. , Estrera Anthony L. , Coogan Sheila M. , Safi Hazim J.
Published: May 2011

Endovascular repair is increasingly used for ruptured abdominal aortic aneurysms (RAAAs). This study estimated the mortality rate for this approach. A review of 307 publications in English was performed. Thirty-four publications representing 1,200 patients with RAAA were deemed appropriate for analysis by weighted least squares regression. Of the 1,200 patients, 531 (44.3%) underwent endovascular aneurysm repair (EVAR). The average age was 74 years, and 13% were female. Aortouni-iliac grafts were used in 49.4% of patients, and 50.6% received bifurcated grafts. The technical success rate was 94.9%, with a mortality rate of 30.2%. The ratio of endovascular cases to the total number of cases strongly predicted the mortality rate (weighted coefficient −0.378, p < .0003). The mortality rate following EVAR of RAAA is 30%. A 3.8% reduction in mortality was found for each 10% increase in the percentage of ruptures repaired endovascularly at each center. These results are suggestive of a learning curve.
Chylous Ascites Following Abdominal Aortic Aneurysm Repair
Authors: Roche-Nagle Graham , Walsh Simon , Barry Mary C.
Published: May 2011

A woman aged 75 years developed chylous ascites day 5 after emergency abdominal aortic aneurysm repair. She was still on artificial ventilation at the time of diagnosis. The first symptoms were high ventilation pressure, an elevated diaphragm, and abdominal distention. The patient was treated conservatively with drainage and total parenteral nutrition and given tube feeding without long-chain triglycerides. Unfortunately, the patient died of sepsis on day 25. Chylous ascites is an unusual complication of retroperitoneal surgery. Abdominal paracentesis is a simple means to confirm the diagnosis. Initial treatment consists of draining the chylus and a medium-chain triglyceride diet or total parenteral nutrition. When this fails, more invasive treatment is required, consisting of direct lymphatic repair or peritoneovenous shunting. In mechanically ventilated patients, gradually progressive symptoms of abdominal hypertension after surgery in the retroperitoneal space should arouse suspicion of this complication.
Use of an Amplatzer Vascular Plug for Transcatheter Embolization of a Renal Arteriovenous Fistula
Authors: Campbell John E. , Davis Cordell , DeFade Brian P. , Tierney James P. , Stone Patrick A.
Published: May 2011

Renal arteriovenous fistulae (AVF) are a rare condition that can be acquired, congenital, or idiopathic. Idiopathic AVF are the rarest type of renal AVF. Traditionally, renal AVF were treated with surgery, but the mainstay of treatment has shifted to an endovascular approach by coil embolization. Embolization procedures are often difficult secondary to the “high flow” of the AVF, and there is the substantial risk of distal embolization of coils. We present a case in which an idiopathic renal AVF was successfully embolized with an Amplatzer vascular plug.
Glue Embolization of a Ruptured Celiac Trunk Aneurysm
Authors: Park Sun Jin , Kwon Se Whan , Oh Ju Hyung , Park Ho Chul
Published: May 2011

The purpose of this article is to report a case of ruptured celiac trunk aneurysm treated with glue embolization. A 39-year-old man presented with abdominal pain. Abdominal computed tomography (CT) depicted the presence of hemoperitoneum, and CT angiography revealed an aneurysm in the celiac trunk. The endovascular access into the aneurysm's outflow vessel was unattainable. N-butyl cyanoacrylate (NBCA) embolization was performed. However, untargeted distal embolizations via the left gastric, splenic, and common hepatic arteries formed. Postembolization angiography showed total occlusion of the aneurysmal cavity and left gastric artery but regular retrograde filling of the stomach, liver, and spleen by branches originating from the superior mesenteric artery. After discharge on day 6, the patient was doing well, without complications at the 11-month follow-up. The operative mortality of ruptured celiac trunk aneurysm is very high. Glue embolization was successfully used as a treatment option and should be considered when there are no other options.
Polymeric Materials for Tissue Engineering of Arterial Substitutes
Authors: Ravi Swathi , Qu Zheng , Chaikof Elliot L.
Published: May 2011

Cardiovascular disease is the leading cause of mortality in the United States. The limited availability of healthy autologous vessels for bypass grafting procedures has led to the fabrication of prosthetic vascular conduits. Synthetic polymeric materials, while providing the appropriate mechanical strength, lack the compliance and biocompatibility that bioresorbable and naturally occurring protein polymers offer. Vascular tissue engineering approaches have emerged in order to meet the challenges of designing a vascular graft with long-term patency. In vitro culture techniques that have been explored with vascular cell seeding of polymeric scaffolds and the use of bioactive polymers for in situ arterial regeneration have yielded promising results. This review describes the development of polymeric materials in various tissue engineering strategies for the improvement in the mechanical and biological performance of an arterial substitute.
Digging in the “Soil” of the Aorta to Understand the Growth of Abdominal Aortic Aneurysms
Authors: Curci John A.
Published: May 2011

Extensive studies into the etiology of aortic aneurysm disease have focused on the characteristic and unique inflammatory infiltration and elaboration of products of inflammatory cells which can result in matrix degradation. While these changes clearly have a significant impact on the development of aneurysm disease, little attention has been paid to the changes in the parenchymal cells of the aorta. Under normal conditions, the vascular smooth muscle cells which populate the aortic wall are responsible for the maintenance of the matrix components of the media, particularly the elastic fibers. As our understanding of the mechanisms of aneurysm formation and normal arterial anatomy become more sophisticated, it is clear that specific changes to these smooth muscle cells make them active participants in the medial matrix destruction characteristic of aneurysm disease. As others have described for intimal arterial disease, this is the “soil” from which aortic aneurysms grow.
Matrix Metalloproteinases in Medial Arterial Calcification: Potential Mechanisms and Actions
Authors: Irwin Chance L. , Guzman Raul J.
Published: May 2011

Arterial calcification is now understood to be an actively regulated process with promoters and inhibitors similar to those seen remodeling bone. It occurs in two distinct forms involving either the atherosclerotic intimal or the media. The amount of calcification found in the tibial arteries of the lower extremity is a better predictor of amputation than atherosclerosis risk factors and the ankle brachial index. We and others have recently demonstrated that matrix metalloproteinases (MMPs) play a critical role in the development of experimental arterial calcification in rodent models. The mechanisms by which MMPs may regulate arterial calcification, however, are not completely understood. While MMPs have traditionally been thought to function primarily in the degradation of extracellular matrix molecules, recent data suggest that MMPs may also function as important regulators of matrix biology, inflammation, and osteogenesis. In this review, we will examine recent data on the potential mechanisms by which MMPs may function in the control of arterial calcification.
Signaling Pathways Regulating Vascular Smooth Muscle Cell Differentiation
Authors: Rzucidlo Eva M.
Published: May 2011

Vascular smooth muscle cell (VSMC) differentiation is an essential component of vascular development. These cells perform biosynthetic, proliferative, and contractile roles in the vessel wall. VSMCs are not terminally differentiated and are able to modulate their phenotype in response to changing local environmental cues. There is clear evidence that alterations in the differentiated state of the VSMC play a critical role in the pathogenesis of atherosclerosis and intimal hyperplasia, as well as in a variety of other major human diseases, including hypertension, asthma, atherosclerosis and vascular aneurysms. The focus of this review is to provide an overview of the current state of knowledge of molecular mechanisms involved in controlling phenotypic switching of VSMCs, with particular focus on examination of the signaling pathways that regulate this process.
Carbon Monoxide: Vascular Therapeutic for the Future
Authors: Tzeng Edith
Published: May 2011

In the past decade, carbon monoxide has lost its reputation as a toxic gas and has gained a following of scientists who now appreciate its potential therapeutic utility as an anti-inflammatory and cytoprotective agent. Its vasoprotective properties have also gained a tremendous amount of attention, especially its ability to inhibit intimal hyperplasia. This review will provide a historical perspective of carbon monoxide biology and summarize its function in disease modulation with a special focus on its potential role as a vascular therapeutic.
Use of the Angiosculpt Scoring Balloon for Infrapopliteal Lesions in Patients with Critical Limb Ischemia: 1-Year Outcome
Authors: Bosiers Marc , Deloose Koen , Cagiannos Catherine , Verbist Jürgen , Peeters Patrick
Published: May 2011

The AngioSculpt Scoring Balloon Catheter (AngioScore, Inc., Fremont, CA) is composed of a semicompliant balloon encircled by three nitinol spiral struts providing targeted lesion scoring on balloon inflation. Between April 2005 and April 2006, procedural and follow-up data on 31 patients (mean age 76 years; 54.8% males) endovascularly treated for severe infrapopliteal disease were collected. The AngioSculpt catheter was used to treat 36 complex, tibioperoneal, atherosclerotic lesions. All patients had symptomatic critical limb ischemia (Rutherford 4–5) and single-vessel runoff to the ankle. Complication-free survival at 1 month was the safety end point, whereas primary patency and limb salvage were the efficacy end points evaluated at 1 year. The AngioSculpt balloon was successfully inflated in all 36 target lesions. Eleven patients (35.5%) required additional stenting for minor dissections or suboptimal stenosis reduction. The 1-month complication-free survival was 96.8%. One-year survival, primary patency, and limb salvage rates were 83.9 ± 6.6%, 61.0 ± 9.3%, and 86.3 ± 6.4%, respectively. The 1-year data show the AngioSculpt Scoring Balloon Catheter to be an effective and safe treatment for infrapopliteal, atherosclerotic lesions in patients with critical limb ischemia. However, more patients, a longer follow-up, and randomized studies comparing it with conventional balloon angioplasty and stenting in the infrapopliteal region are required.
Two-Year Outcome after Xpert Stent Implantation for Treating Below the Knee Lesions in Critical Limb Ischemia
Authors: Bosiers Marc , Lioupis Christos , Deloose Koen , Verbist Jürgen , Peeters Patrick
Published: May 2011

We investigated the efficacy of Xpert (Abbott Vascular, Abbott Park, IL) nitinol stents for the treatment of infrapopliteal lesions in patients with Critical Limb Ischemia (CLI). Between May 2005 and November 2007, 94 CLI patients (70 male, mean age 73.5 years) received 134 Xpert stents in 102 limbs. Seventy-nine patients (71.2%) were scored as Rutherford Category 4, 31 patients (27.9%) as Category 5 and 1 patient (0.9%) as Category 6. Primary endpoint of this study was defined as 2-year duplex derived primary patency. Secondary endpoints were 2-year limb salvage rate and the absence of reintervention after the index procedure. Kaplan Meier analysis reported 2-year primary patency and limb salvage rates of 54.4% and 90.8%, respectively. Stratification by lesion location did not reveal any significant differences in 2-year primary patency rates in proximal and distal below the knee lesions. Our results suggest that treatment with nitinol Xpert stents can be considered effective for treating CLI patients, with satisfying patency outcome.
Anaconda Endovascular Limbs for the Treatment of Isolated Iliac Artery Aneurysms
Authors: Power Adam H. , Rapanos Theodore , Moore Randy , Cina Claudio S.
Published: May 2011

The purpose of this article is to report the feasibility and preliminary results of the treatment of isolated iliac artery aneurysms (IAAs) with Anaconda limbs (Vascutek Ltd., Inchinnan, Renfrewshire, Scotland). A prospective cohort is reported of consecutive IAAs treated by two senior surgeons from May to December 2006. One or more Anaconda limbs were used, and internal iliac arteries were embolized if necessary. Twelve IAAs in 11 patients were treated. The average IAA diameter was 4.3 ± 1.1 cm, and the average diameter of stent used was 14 ± 2.5 mm, with an average total length of 97 ± 25 mm. At a mean follow-up of 12 ± 4 months, there were no graft-related complications, graft occlusions, or requirements for reintervention. Endovascular treatment for isolated IAAs under local anesthesia using Anaconda limbs is feasible, safe, and effective. However, as with all new technology, longer follow-up data are necessary.
Secondary Endovascular and Conversion Procedures for Failed Endovascular Abdominal Aortic Aneurysm Repair: Can We Still Be Optimistic?
Authors: Pitoulias Georgios A. , Schulte Stefan , Donas Konstantinos P. , Horsch Svante
Published: May 2011

The purpose of this study was to evaluate the incidence, etiology, and outcome of secondary endovascular and “open” conversion procedures after failed endovascular abdominal aortic aneurysm repair (EVAR). From January 1997 until December 2005, 625 patients with an infrarenal abdominal aortic aneurysm were treated by elective EVAR, with 98.7% ( n = 617) primary EVAR success. The mean follow-up of the 617 patients was 46.7 ± 11.2 months. One hundred of these patients (16.2%) required secondary endovascular or peripheral procedures, and 39 (6.3%) patients underwent a secondary abdominal conversion. There were 5 acute conversions (0.8%) and 34 elective conversions (5.5%). The pre-EVAR anatomic suitability data, the main cause of the secondary procedure, and stent graft type were compared between patients with primary EVAR success, patients in need of a secondary endovascular or peripheral procedure, and patients with abdominal conversion. The overall main causes for reinterventions were proximal migration ( n = 60; 9.7%), progressive kinking of the stent graft ( n = 59; 9.6%), and late type III endoleak ( n = 12; 1.9%). Multivariate logistic regression analysis showed that factors significantly correlated with secondary procedures were the abdominal aortic aneurysm's maximum diameter, the proximal neck's width and length, and particularly the commercial withdrawal of the stent graft ( p < .001). The morbidity and mortality rates of secondary endovascular or peripheral interventions were 0%. The mortality rate of acute secondary conversions was 20% ( n = 1) and of elective secondary conversions was 8.8% ( n = 3). The morbidity rates for acute and elective conversions were 0% and 65%, respectively. The aneurysm-related mortality rate in our series was below 1%. Abdominal conversion surgery still carries a high mortality rate, but the overall EVAR-related mortality rate remains low. Early pitfall detection and proper reintervention are crucial to long-term EVAR success.
Supervised Exercise in Intermittent Claudication: A Sedentary Notion?
Authors: Shalhoub Joseph , Qureshi Mahim , Davies Alun
Published: May 2011

The benefit of exercise in the management of intermittent claudication has been explored through extensive research in the preceding decades. Within the clinical setting, there is often little differentiation between home-based and supervised exercise regimens. We examined the history and qualification of supervised exercise as a distinct treatment modality from nonsupervised exercise in intermittent claudication. A Medline, Embase, Ovid, Cochrane Database, and Google Scholar search was performed on all studies published until December 31, 2007, investigating the use of supervised exercise in peripheral arterial disease. Supervised exercise is well grounded in evidence to support its superiority over nonsupervised exercise in the management of intermittent claudication, conveying marked improvement in symptomatology, function, and quality of life. Further research is required to determine the nature of the advantage that supervision affords.
Preoperative Evaluation for Vascular Access Creation
Authors: Lampropoulos George , Papadoulas Spyros , Katsimperis George , Ieronimaki Argiro-Ioanna , Karakantza Marina , Kakkos Stavros K. , Tsolakis Ioannis
Published: May 2011

In an effort to increase the prevalence of arteriovenous fistulae (AVF), ultrasound vessel mapping (USVM) and upper extremity venography (UEV) have been suggested; however, the effectiveness of their combined use remains unknown. We studied the effect of such a combined protocol on arteriovenous (AV) access type change compared with physical examination alone. Consecutive patients with chronic kidney disease ( n = 137) after an initial estimation of the AV access type, based on physical examination, had USVM and UEV to detect vascular pathology that could potentially alter the original plan. USVM changed the preoperative plan in 31 (22.6%) patients; this was 36.7% ( n = 18) in diabetics compared with 14.8% ( n = 13) in nondiabetics ( p < .001). Patients for whom USVM changed the type of planned AV access had been on hemodialysis significantly longer (2.7 years vs 0.9 years; p < .001). Venography identified 18 patients with central vein stenosis that led to a site change in 12 of them. Significant venous stenosis in patients with a history of two or more central catheters placed and patients without such a history was 93% and 1%, respectively. In eight patients, intraoperative findings dictated AV graft placement or creation of a central AVF. The original plan was revised in 31%, and this rate was similar for distal AVF, central AVF, and AV grafts (38%, 26%, and 43%, respectively; all p > .05). The 30-day patency rate was 92.2%. A significant proportion of patients have vascular pathology severe enough to alter the access type as suggested by physical examination alone. USVM should be routinely performed, whereas UEV should be selectively performed in patients with a history of surgery or instrumentation of their central veins.
Inferior Caval Vein Thrombosis Owing to Compression of Focal Nodular Hyperplasia: Surgical Resection after Shrinkage by Hepatic Artery Embolization
Authors: Arts Cora H.P. , van Hillegersberg Richard , de Kort Gerard A.P. , Moll Frans L.
Published: May 2011

The purpose of this study was to investigate the results of a staged treatment of symptomatic focal nodular hyperplasia (FNH), consisting of first embolization and then resection. A 36-year-old woman presented with pulmonary embolism caused by an inferior caval vein thrombosis owing to external compression by FNH in liver segment I (5.2 × 6.7 cm). She was treated with anticoagulants. The FNH lesion was first reduced by radiologic embolization of the feeding branch of the right hepatic artery. A 41% size reduction was obtained, and the symptoms disappeared. FNH resection was performed 5½ months later. The thrombus had disappeared, and the anticoagulant therapy could be stopped perioperatively. A symptomatic FNH lesion was treated successfully in two stages.
Diastasis Recti and Abdominal Aortic Aneurysm
Authors: Moesbergen Todd , Law Alice , Roake Justin , Lewis David R.
Published: May 2011

An association between abdominal aortic aneurysm (AAA) and abdominal wall hernia has been suggested, possibly reflecting a common collagen disorder. The same mechanism may also cause a greater frequency of diastasis recti among patients at risk of developing AAA. Diastasis recti could be used to identify patients at risk of AAA, with implications for AAA screening. The aim of this study was to determine whether an association between diastasis recti and AAA could be demonstrated.

The preoperative computed tomographic (CT) scans of 75 male patients undergoing elective AAA repair were retrospectively examined and linea alba width recorded at supraumbilical and subumbilical levels. Measurements were compared with controls frequency matched for age.

Fifty patients with AAA were observed to have supraumbilical diastasis recti on preoperative CT compared with 47 controls. Mean linea alba width was not significantly different between the two groups at either the supraumbilical (19.3 mm vs 20.7 mm, p = .45) or subumbilical (3.6 mm vs 4.3 mm, p = .43) level.

The findings do not support the hypothesis that the presence of diastasis recti can serve as an indication to select male patients for screening for AAA.
Monolateral Sialadenitis Following Iodinated Contrast Media Administration for Carotid Artery Stenting
Authors: Capoccia Laura , Sbarigia Enrico , Speziale Francesco
Published: May 2011

We describe the occurrence of monolateral aseptic sialadenitis following non-iodinated contrast medium (ICM) administration for a carotid artery stenting procedure in a 71-year-old man. The mechanism for iodide-induced sialadenitis may be idiosyncratic or related to toxic accumulation of iodide. The risk for sialadenitis is directly related to serum iodide levels (> 10 mg/100 mL) and inversely related to normal renal function so that in renal impairment, ICM can be eliminated through alternative pathways such as the salivary glands and other excretory organs.
Infrarenal Abdominal Aortic Aneurysm with Concomitant Urologic Malignancy: Treatment Results in the Era of Endovascular Aneurysm Repair
Authors: Habets Jesse , Buth Jaap , Cuypers Philippe W.M. , Nienhuijs Simon W. , de Hingh Ignace H.J.T.
Published: May 2011

During diagnostic workup for urologic malignancies, an abdominal aortic aneurysm (AAA) is identified in a proportion of patients. In the era of open AAA repair, these patients presented a surgical dilemma with regard to the sequence of the operations: cancer treatment first or AAA repair first? Previous assessments have concluded that irrespective of the followed strategy, the early and mediumterm mortality from the two operative procedures in this patient category was significant. With the introduction of endovascular aneurysm repair (EVAR), the mortality and morbidity associated with the treatment of both pathologic conditions may be more favorable than with open aneurysm repair. The objective of this study was to assess, in an institutional series of patients receiving EVAR, the early and long-term survival and complication rates in patients with urologic malignancies. In a series of 385 patients receiving EVAR, 14 had a concomitant urologic malignancy: renal cell carcinoma (5 patients), prostate carcinoma (6 patients), and carcinoma of the bladder (3 patients). The first-month mortality was nil. Long-term survival was 80%, 83%, and 67% for the three tumor types, respectively. EVAR offers improved treatment in patients with concomitant AAA and urologic malignancy and should be considered the first choice for these patients.
Branched Endograft for Aortoiliac Artery Aneurysms
Authors: Lee W. Anthony
Published: May 2011

Iliac aneurysms can occur concomitantly in 15 to 20% of abdominal aortic aneurysms. The common iliac arteries serve as the distal landing zones for the iliac limbs of abdominal aortic stent grafts, and for most currently available devices, the maximum treatable iliac size is 20 mm. When the iliac artery diameter exceeds this, alternative landing zones or adjunctive techniques are required to achieve an adequate distal seal and fixation, which typically involves occlusion of the hypogastric artery origin and extension to the external iliac artery. The clinical sequelae of acute hypogastric occlusion mostly involve symptoms of hip and buttock ischemia (claudication), which can occur in up to 40% of cases. In this article, a novel method of endovascular management of common iliac artery aneurysms in the setting of endovascular aortic aneurysm repair is described using an investigational (United States only) iliac branch device that preserves antegrade perfusion to the hypogastric artery to decrease the potential risks of pelvic ischemia.
Electrical Foot Stimulation: A Potential New Method of Deep Venous Thrombosis Prophylaxis
Authors: Czyrny James J. , Kaplan Robert E. , Wilding Gregory E. , Purdy Christopher H. , Hirsh Jack
Published: May 2011

The purpose of this study was to compare venous blood flow velocity of intermittent pneumatic compression to electrical stimulation of the foot. A prospective randomized controlled study of 40 healthy volunteers was conducted. Subjects were seated for 4 hours during which they received electrical stimulation of the sole of the foot or knee-high intermittent pneumatic compression. Popliteal and femoral venous blood flow velocities were measured via Doppler ultrasonography. Blood flow velocity in the nonstimulated or noncompressed lower extremity served as a simultaneous control. For both the femoral and popliteal veins, the electrical foot stimulation group exhibited a greater increase in blood flow velocity than the intermittent pneumatic compression group. Electrical foot stimulation was noninferior relative to standard intermittent pneumatic compression. Specifically, this result of a greater increase in blood flow velocity is achieved at time = 120 minutes for the femoral vein ( t = 2.70; p = .005) and time = 120 ( t = 2.75; p = .004) and 240 ( t = 2.27; p = .014) minutes for the popliteal vein. Short-term electrical foot stimulation is at least as effective as knee-high intermittent pneumatic compression in increasing popliteal and femoral blood flow velocity. Electrical foot stimulation has the potential to be an effective method of deep venous thrombosis prophylaxis.
Sonographic Assessment of Atherosclerotic and Hypercholesterolemic Artery Using the Echo-Tracking Technique in an Animal Model
Authors: Wen Chaoyang , Zhang Lihai , Wang Yuexiang , Cheng Zhigang , Lin Qian , Wang Zhili , Tang Jie
Published: May 2011

The purpose of this study was to ascertain the utility of sonography with the echo-tracking (ET) technique to assess vascular stiffness in rabbits with hypercholesterolemia and atherosclerosis. Grayscale sonography associated with the ET technique was used to measure the elastic modulus (Ep) of the aorta in cholesterol-fed rabbits (group T1, n = 44, for 4 weeks; group T2, n = 44, for 12 weeks) and normal control rabbits (group C1, n = 44; group C2, n = 44). The aortic Ep values and blood biochemical markers between groups were compared using analysis of covariance. Light and transmission electron microscopic evaluation were used to demonstrate atherosclerotic changes in the aorta. The Ep values of the aorta in group T1 and T2 rabbits were significantly higher than those of group C1 and C2 controls (88.74 ± 27.99 and 100.96 ± 24.81 vs 64.38 ± 20.23 and 72.35 ± 18.43, p = .124). Also, the Ep values of the aorta between group T1 and T2 rabbits were significantly different ( p = .033). Light and transmission electron microscopy confirmed morphologic typical changes of aortic atherosclerosis in groups T1 and T2. Grayscale sonography with the ET method could be used to evaluate tissue elastic changes in arterial walls associated with atherosclerosis and hypercholesterolemia.
Early and Late Clinical Outcomes of Endovascular Aneurysm Repair in Patients with an Angulated Neck
Authors: AbuRahma Ali F. , Campbell John , Stone Patrick A. , Nanjundappa Aravinda , Scott Dean L. , Keiffer Tammi , Emmett Mary
Published: May 2011

This study analyzed the clinical outcome in endovascular aneurysm repair (EVAR) patients with an angulated aortic neck. Two hundred thirty-eight EVAR patients underwent postoperative duplex ultrasonography and/or computed tomographic angiography, which was repeated every 6 to 12 months. Aortic neck angle was classified into < 45° (A1, n= 129), ≥ 45 to < 60° (A2, n = 43), and ≥ 60° (A3, n = 42). The perioperative complication rates for groups A1, A2, and A3 were 13%, 5%, and 29%, respectively ( p = .006). Proximal type I early endoleaks occurred in 9%, 33%, and 38% in groups A1, A2, and A3, respectively ( p < .0001). Intraoperative proximal aortic cuffs were needed in 7%, 28%, and 33% in groups A1, A2, and A3, respectively ( p < .0001). However, the rate of late reintervention was comparable in all groups. Postoperatively, the size of abdominal aortic aneurysm decreased or remained unchanged in 97%, 95%, and 84% in A1, A2, and A3, respectively ( p = .0147). The rates of freedom from late type I endoleak at 1, 2, and 3 years were 90%, 85%, and 85% for A1; 74%, 74%, and 68% for A2; and 64%, 64%, and 53% for A3 ( p = .0013). EVAR can be used for patients with an angulated aortic neck but was associated with a higher rate of early and late type I endoleaks and early interventions.
Endovascular Repair of a Persistent Sciatic Artery Aneurysm
Authors: Verikokos Christos , Avgerinos Efthimios D. , Chatziioannou Achilleas , Katsargyris Athanasios , Klonaris Chris
Published: May 2011

Persistent sciatic artery (PSA), a persistent embryologic continuation of the internal iliac artery, represents a rare yet clinically important vascular anomaly. PSA is prone to aneurysmal change, which can subsequently lead to distal embolization, sciatic neuropathy, or rupture. The conventional surgical treatment of PSA aneurysms is commonly complex and carries the risk for sciatic nerve damage. We report herein the successful endovascular management of a PSA aneurysm and postaneurysmal stenosis with the use of two overlapping self-expanding stent-grafts via a contralateral transfemoral approach. Additionally, a review of the literature regarding the treatment of these unusual peripheral aneurysms is provided.
Early Neurologic Outcome after Bovine Pericardium versus Venous Patch Angioplasty in 599 Patients Undergoing Carotid Endarterectomy
Authors: Bisdas Theodosios , Pichlmaier Maximilian , Bisdas Sotirios , Haverich Axel , Teebken Omke E.
Published: May 2011

Bovine pericardium was compared to great saphenous vein patch angioplasty regarding the neurologic events after carotid endarterectomy (CEA) with or without concomitant cardiac surgery (CS). From January 1996 to December 2007, 599 patients undergoing CEA (259 with concomitant CS) were enrolled; 456 patients were treated with the great saphenous vein (GSV group) and 143 were treated with bovine pericardium (BP group). Neurologic outcome and Rankin score (RS) were recorded after 24 hours and 30 days. We found comparable rates of neurologic complications (transient ischemic attack, stroke) between the two groups. Thirty-day mortality was 4% (17 of 456 patients) in the GSV group and 0% in the BP group ( p = .12). None of the patients died as a consequence of a fatal stroke. Preoperative RS was a prognostic factor for postoperative neurologic deterioration ( p = .001). Early neurologic outcome was comparable for the two types of patch material. Preoperative RS predicted postoperative neurologic deterioration.
Are Symptomatic Patients Appropriate Candidates For Carotid Artery Stenting? No (at Least Not At Present)
Authors: Paraskevas Kosmas I. , Mikhailidis Dimitri P. , Veith Frank J.
Published: May 2011

Most symptomatic patients should not be candidates for carotid artery stenting (CAS); at least not at present. In these patients, CAS is associated with higher stroke, as well as recurrent stenosis rates compared with carotid endarterectomy (CEA). Furthermore, CAS is considerably more expensive than CEA. These facts raise the question, why perform CAS in symptomatic patients when you have CEA, which is associated with lower stroke and recurrent stenosis rates, and is also a more cost-effective option. This article supports the theory that currently most symptomatic patients are not appropriate candidates for CAS.
Hybrid Endograft Solution for Complex Iliac Anatomy: Zenith Body and Excluder Limbs
Authors: Bos Wendy T. , Tielliu Ignace F. , Sondakh Arthur O. , Vourliotakis Georgios , Bracale Umberto M. , Verhoeven Eric L.
Published: May 2011

The purpose of this study was to evaluate single-center results with selective use of Gore Excluder limbs (W.L. Gore & Associates, Flagstaff, AZ) in a Cook Zenith body (Cook Inc, Bloomington, IN) for elective endovascular abdominal aortic aneurysm (AAA) repair. A prospectively held database for patients with AAA, who were treated endovascularly between March 1999 and July 2008, was queried for patients treated with a Cook Zenith body and one or two Gore Excluder limbs. Indication, technical success, late limb occlusion, and disconnection were evaluated. From 276 patients who were treated with a Zenith body, 29 underwent repair with hybrid graft components with, in total, 41 Gore Excluder limbs. The indication was always complex iliac anatomy. The primary technical success rate in this group was 89% (26 of 29 patients), with a primary assisted technical success rate of 100%. Mortality at 30 days was 0%. The mean follow-up was 19.4 months (range 2–64 months). Late mortality was 13.8% (4 of 29), with no aneurysm-related death. No graft limb occlusion or disconnection occurred during follow-up. No reintervention was needed in the hybrid endograft group. The use of a Cook Zenith body with Gore Excluder limb(s) in case of adverse iliac anatomy is feasible and showed no adverse effects at the midterm follow-up.
Experience with a Scalloped Thoracic Stent Graft: A Good Alternative to Preserve Flow to the Celiac and Superior Mesenteric Arteries and to Improve Distal Fixation and Sealing
Authors: Da Rocha Marcio , Riambau Vicent A.
Published: May 2011

Thoracic endografting has been proposed as an effective alternative to open repair to treat several aortic pathologies. Cranial migration is one of the critical issues concerning long-term durability. The scalloped thoracic endograft was proposed to improve distal sealing and fixation crossing the diaphragm. The objective of this study was to evaluate technical feasibility and experience with a custom-made scalloped thoracic endograft using the Relay platform (Bolton Medical, Sunrise, FL) in selected cases. From January 2006 to June 2009, 57 patients (40 men) were treated in Europe with a customized distal scalloped thoracic endograft. Forty-five patients presented with thoracic aortic aneurysm, nine presented with type B dissection, and three had a pseudoaneurysm. Successful and accurate deployment was achieved in all cases except one partial rotation in an extremely tortuous anatomy. Technical success was achieved in 96.4%. Good sealing and no mortality, paraplegia, or visceral embolization were observed. At a mean follow-up of 6 months, no complications were registered. The Relay endograft with the distal scallop represents a feasible alternative for distal short necks. This approach may increase the applicability and durability of the endograft in short distal necks.
Delirium after Emergency/Elective Open and Endovascular Aortoiliac Surgery at a Surgical Ward with a High-standard Delirium Care Protocol
Authors: Koebrugge Boukje , van Wensen Remco J.A. , Bosscha Koop , Dautzenberg Paul L.J. , Koning Olivier H.J.
Published: May 2011

Delirium is a common problem in elderly patients undergoing surgery. Standard delirium care is not available at all surgical wards. We determined the incidence, risk factors, and outcomes of postoperative delirium among patients undergoing elective/emergency aortoiliac surgery at a surgical ward with high-standard delirium care. A prospective descriptive survey in 107 patients was conducted. High-standard delirium care was given to patients above age 65, consisting of an extended focus on risk factors and intensive screening. The Delirium Observation Scale was used as a screening instrument for delirium. Patients were classified as having delirium if they met the DSM-IV criteria. The overall incidence of delirium was 23%. The incidence was 14% after elective surgery. Delirium occurred in 59% after emergency surgery and more often after open than after endovascular aneurysm repair ( p < .01). Delirium was associated with age ( p < .01) and emergency surgery ( p = .01) and is an important and frequent complication after aortoiliac surgery.
Percutaneous in Situ Oxygenated Pump Perfusion of a Transplanted Kidney during Abdominal Aortic Aneurysm Repair
Authors: Hawksworth Jason S. , Fitzgerald Dave , Speir Alan , Mukherjee Dipankar
Published: May 2011

The surgical management of aortic aneurysms in kidney transplant patients is a difficult clinical scenario where preservation of the kidney allograft during aortic cross-clamping is paramount. We describe a novel technique for renal protection during abdominal aortic aneurysm repair with in situ oxygenated pump perfusion of the transplanted kidney. A percutaneous approach is used for common femoral artery and vein cannulation and a cardiopulmonary bypass circuit to provide retrograde oxygenated pump perfusion to the transplanted kidney. This technique allows adequate kidney perfusion during warm ischemia and minimizes morbidity by using a percutaneous access technique.
Transit-Time Volume Flow Measurements in Autogenous Femorodistal Bypass Surgery for Intraoperative Quality Control
Authors: Bosma Jan , Minnee Robert C. , Erdogan Deha , Wisselink Willem , Vahl Anco C.
Published: May 2011

The aim of this study was to assess intraoperative transit-time volume flow measurements (VFMs) as a tool for intraoperative evaluation of lower extremity arterial bypass grafts and to predict their patency. We analyzed 273 consecutive patients who had an infrainguinal bypass procedure using the great saphenous vein from 1998 until 2008; 103 had an intraoperative VFM. All intraoperative revisions were recorded and analyzed. Patency and revision rates were compared between those receiving and those not receiving intraoperative VFM. Cox regression was used for analysis of predictors of patency. Primary patency at 1 and 2 years was 75 and 67%, respectively, in patients receiving intraoperative VFM versus 72 and 69% in those without VFM ( p = .79). In the VFM group, 12% had an immediate revision versus 6% without VFM ( p = .06). In the VFM group, 4% underwent revision to salvage the bypass within the first postoperative 30 days versus 6% without VFM ( p = .32). Patency was not associated with the use of VFM. Receiver operating characteristic curve was significant for occlusion at 30 days postoperatively but with a low predictive value ( p = .019,area under the curve 0.648). VFM may be helpful in selecting bypasses requiring immediate revision to prevent postoperative occlusion. The use of VFM is not significantly associated with patency.
Staged Hybrid Repair of Thoracoabdominal Aortic Aneurysm after Chronic Type B Aortic Dissection
Authors: Mangialardi Nicola , Costa Pierluigi , Bergeron Patrice , Serrao Eugenia , Ronchey Sonia
Published: May 2011

The purpose of this study was to evaluate clinical outcomes of combined endovascular and open techniques to eradicate false lumen dilatation in the visceral aortic segment after type B aortic dissection associated with aortic aneurysm. We reviewed eight patients with distal thoracic and abdominal false lumen dilatation treated with a staged procedure. These included arch debranching as needed, proximal thoracic endovascular repair, and open surgical correction with abdominal aortic replacement of the visceral and infrarenal aorta. False lumen eradication was successful in all patients. There were no operative deaths, and paraplegia or paraparesis occurred in two patients. During a mean follow-up of 30 months, no complications or secondary interventions were necessary. The thoracic false lumen remained thrombosed in all patients, with no evidence of aortic dilatation or stent graft complications. Complete thrombosis and eradication of the false lumen can be achieved through a three-stage repair of chronic type B aortic dissection with aneurysmal dilatation. A prospective randomized trial is needed to establish the viability of this approach versus standard open repair of type II thoracoabdominal aortic aneurysms.
The effect of habitat on European ash root growth in the topsoil layers
Authors: Farfał Dorota
Published: May 2011

Wpływ warunków siedliskowych na rozwój korzeni jesionu w wierzchnich warstwach gleby
What did European primeval forests under high herbivore pressure look like?
Authors: Borkowski Jakub
Published: May 2011

Jak wyglądały lasy pierwotne Europy pod presją dużych roślinożerców?
La coupe de l'oued Ahmadi (Dahar, sud tunisien) : son intérêt pour la compréhension de l'évolution climatique au Pléistocène moyen
Authors: Ballais Jean-Louis , Ben Ouezdou H. , Ghanmi M. , Regaya K.
Published: May 2011

La coupe de la terrasse du Pléistocène moyen de l'oued Ahmadi est organisée en quatre séquences sédimentaires qui pourraient traduire l'existence de quatre oscillations climatiques dans un climat restant aride dans l'ensemble. La genèse d'une croûte calcaire postérieurement à celle d'une croûte gypseuse indique un renversement épisodique de la tendance générale à l'aridification du climat pendant le Quaternaire.