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Ann Vasc surg 2012; 26(8)

Originals

1.Ann Vasc Surg . 2012 Nov;26(8):1167. doi: 10.1016/j.avsg.2012.05.008.

Reliability and repeatability of toe pressures measured withlaser Doppler and portable and stationaryphotoplethysmography devices

Sabour S.

Source

Department of Clinical Epidemiology, Shahid Beheshti University of Medical Sciences,Tehran, Iran. Electronic address: [email protected].

PMID:23068429[PubMed - in process]

Related citations

2.Ann Vasc Surg . 2012 Nov;26(8):1166-7. doi: 10.1016/j.avsg.2012.05.009.

Meta-analysis of observational studies to evaluate immediateoutcomes after endarterectomy or stenting for carotid arterystenosis

Messori A, Fadda V, Maratea D, Trippoli S.

Source

Health Technology Assessment Unit, Ente dei Servizi Tecnici di Area Vasta ToscanaCentro Regional Health Service, Firenze, Italy. Electronic address:[email protected].


Related citations

3.Ann Vasc Surg . 2012 Nov;26(8):1160-5. doi: 10.1016/j.avsg.2012.06.008.
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00331-7http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00330-5

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Tissue markers in human atherosclerotic carotid artery plaque.

Moller MJ, Qin Z, Toursarkissian B.

Source

Division of Vascular Surgery, Department of Surgery, University of Texas HealthScience Center at San Antonio, San Antonio, TX 78229.

Abstract

Carotid artery stenosis predisposes to thrombo-embolization and stroke. Establishedtissue markers such as osteopontin, nitric oxide synthases, myeloperoxidases, andmatrix metalloproteinases have been examined within stenotic plaques and theirimpact upon plaque stability discussed. However, a new generation of tissue markersis being discovered, and their role in atherosclerotic development and plaque stability isbeing debated. Prostaglandin synthase, 15-lipoxygenase-2, myeloid-related proteins 8and 14, and protease nexin-1 have recently been shown to correlate with carotid arteryatherosclerosis. These proteins highlight new areas of interest in the role ofmacrophages in atherosclerotic development, plaque formation, and rupture.Additionally, these new molecules raise the possibility of new screening and treatmenttechniques.

Copyright 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rightsreserved.

PMID:23068427

[PubMed - in process]Related citations

4.Ann Vasc Surg . 2012 Nov;26(8):1129.e1-4. doi: 10.1016/j.avsg.2012.03.014. Epub2012 Aug 27.

Internal jugular vein hemangioma

Al-Natour M, Kenmuir C, Khuder S, Kazan V,Abbas J,Nazzal M.

Source

Division of Vascular and Endovascular Surgery, University of Toledo Medical Center,Toledo, OH.

Abstract

Primary tumors of the major body veins arising intraluminally are rare clinical entities.As such, few cases have been reported in the literature. As a primary tumor,hemangiomas arising in the internal jugular vein are extremely rare, while those arising
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00336-6

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in the external jugular vein are only slightly more common. We present a case of aninternal jugular vein hemangioma that was incidentally discovered during an ultrasoundexamination performed for the evaluation of the internal carotid arteries. We believethat this is the second case of internal jugular vein hemangioma reported in the Englishliterature.



Related citations

5.Ann Vasc Surg . 2012 Nov;26(8):1114-9. doi: 10.1016/j.avsg.2012.03.012. Epub 2012Aug 28.

Isokinetic strength and endurance in proximal and distalmuscles in patients with peripheral artery disease

Cmara LC, Ritti-Dias RM, Menses AL, D'Andra Greve JM,Filho WJ, Santarm JM,Forjaz CL, Puech-Leo P, Wolosker N.

Source

Hospital das Clnicas of the School of Medicine of the University of So Paulo,University of So Paulo, So Paulo, Brazil.

Abstract

BACKGROUND:

The objective of this study was to analyze the muscle strength and endurance of theproximal and distal lower-extremity muscles in peripheral artery disease (PAD)patients.

METHODS:

Twenty patients with bilateral PAD with symptoms of intermittent claudication and ninecontrol subjects without PAD were included in the study, comprising 40 and 18 legs,respectively. All subjects performed an isokinetic muscle test to evaluate the musclestrength and endurance of the proximal (knee extension and knee flexion movements)and distal (plantar flexion and dorsiflexion movements) muscle groups in the lowerextremity.

RESULTS:

Compared with the control group, the PAD group presented lower muscle strength inknee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements

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(P < 0.05) but similar strength in knee extension movements (P > 0.05). The PADpatients presented a 13.5% lower knee flexion/extension strength ratio compared withthe control subjects (P < 0.05), as well as lower muscle endurance in dorsiflexion (-28.1%) and plantar flexion (-17.0%) movements (P < 0.05). The muscle endurance inknee flexion and knee extension movements was similar between PAD patients andthe control subjects (P > 0.05).

CONCLUSION:

PAD patients present lower proximal and distal muscle strength and lower distalmuscle endurance than control patients. Therefore, interventions to improve musclestrength and endurance should be prescribed for PAD patients.


PMID:

22951062[PubMed - in process]

Related citations

6.Ann Vasc Surg . 2012 Nov;26(8):1077-84. doi: 10.1016/j.avsg.2012.02.013. Epub2012 Aug 29.

A randomized prospective multicenter trial of a novel vascularsealant

Stone WM,Cull DL, Money SR.

Source

Division of Vascular Surgery, Mayo Clinic, Scottsdale, AZ. Electronic address:[email protected].

Abstract

BACKGROUND:

Increasing use of anticoagulant medications, particularly antiplatelet therapies, canincrease the difficulty in obtaining adequate suture line hemostasis. Multiple vascularsealants have been used as adjuncts to surgical procedures, but none of them havebeen universally successful. The aim of this study was to evaluate the safety andeffectiveness of a new prophylactic vascular sealant in arterial surgery.

METHODS:

A randomized prospective multi-institutional trial was undertaken comparing ArterXVascular Sealant (AVS) with Gelfoam Plus during open arterial reconstruction.

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RESULTS:

Three hundred thirty-one anastomotic sites in 217 patients were randomized. Onehundred one of 167 (60.5%) anastomotic sites in the AVS group achieved immediatehemostasis compared with 65 of 164 (39.6%) in the control group (P = 0.001). Inanastomoses with polytetrafluoroethylene grafts, 105 of 167 (62.5%) in the AVS groupachieved immediate hemostasis compared with 56 of 164 (34.0%) in the control group(P < 0.001). No significant differences were noted in morbidity or mortality. Operativetime was significantly less in the AVS group compared with the control group (3.2 vs.3.8 hours, P < 0.01).

CONCLUSION:

Use of AVS results in superior hemostatic effectiveness compared with Gelfoam Plus,with no difference in safety. Although no cost analysis was performed, cost savingslikely resulted from significantly decreased operative time.



Related citations

7.Ann Vasc Surg . 2012 Nov;26(8):1085-92. doi: 10.1016/j.avsg.2012.04.005. Epub 2012Aug 29.

Thoracic aortobifemoral bypass in treatment of juxtarenalleriche syndrome (midterm results)

Koksal C, Kocamaz O,Aksoy E, Cakalagaoglu C,Kara I, Yanartas M,Ay Y.

Source

Department of Cardiovascular Surgery, Kartal Kosuyolu Training and ResearchHospital, Istanbul, Turkey. Electronic address: [email protected].

Abstract

BACKGROUND:

The standard surgical treatment of infrarenal aortoiliac obstructive disease isabdominal aortobifemoral bypass (AABFB). However, alternative surgical proceduresmay be considered in cases of juxtarenal Leriche syndrome and previous aortofemoral

graft obstruction. We present midterm results of 20 consecutive patients whounderwent thoracic aortobifemoral bypass (TABFB) either as primary or secondaryprocedure.

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METHOD:

Between 1999 and 2010, 20 patients who were diagnosed to have juxtarenal Lerichesyndrome (n = 17) and failure of previous AABFB graft (n = 3) were enrolled. Thepatients were classified according to the Rutherford classification. Mean follow-upperiod was 60.9 38.3 months. Mean preoperative ankle-brachial index on the leftlower extremity was 0.18 and on the right lower extremity was 0.20.

RESULTS:

Seventeen patients with the diagnosis of juxtarenal Lercihe syndrome were primarilyand three patients were secondarily (for treatment of failed previous AABFB graft)treated using TABFB procedure. The mean ankle-brachial index at last follow-up was0.75 on the left lower extremity and 0.76 on the right. One-year patency rate was100%, and 5-year patency rate was 94%.

CONCLUSION:

TABFB precludes the risk of renal artery embolization in cases of juxtarenalobstruction, without adding any risk of morbidity and mortality. Its long-term patency issimilar or even superior to conventional surgical bypass techniques. We propose itsuse as an initial treatment in juxtarenal Leriche syndrome as well as a remedialprocedure in cases with previous AABFB graft occlusion.


PMID:

22938827[PubMed - in process]Related citations

8.Ann Vasc Surg . 2012 Nov;26(8):1120-6. doi: 10.1016/j.avsg.2012.02.011. Epub 2012Jul 25.

Identifying the incidence of and risk factors for reamputationamong patients who underwent foot amputation

Kono Y,Muder RR.

Source

Division of Infectious Diseases, University of Pittsburgh, VA Pittsburgh HealthcareSystem, Pittsburgh, PA.

Abstract

BACKGROUND:

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Many patients who have lower-extremity amputations secondary to peripheral vasculardisease or diabetes require reamputation eventually. This study was designed toidentify the incidence of and risk factors for ipsilateral reamputation after forefootamputation, to evaluate whether postoperative infection increases the risk ofreamputation, and to evaluate whether the risk of reamputation was reduced by theduration of antimicrobial therapy after amputation.

METHODS:

A retrospective analysis of patients who underwent foot amputation for nontraumaticreason from January 2002 to December 2004 at the Veterans Affairs PittsburghHealthcare System was performed.

RESULTS:

Among 116 patients, 57 (49.1%) had ipsilateral reamputation within 3 years after theirfirst surgeries; 78.9% received reamputation in the first 6 months; 53 (45.7%) died

within 3 years; and 16 (13.8%) developed postoperative infections. Upper level ofamputation, long duration of hospitalization, insulin-dependent diabetes, and gangreneon physical examination on admission were risk factors for reamputation in univariateanalysis. Gangrene (odds ratio: 3.81, 95% confidence interval: 1.60-9.12, P = 0.003)and insulin-dependent diabetes (odds ratio: 2.93, 95% confidence interval: 1.26-6.78, P= 0.012) were risk factors in multivariate analysis. Postoperative infection did notincrease the risk of reamputation. Longer than 2-week course of antibiotic use afteramputation did not prevent reamputation.

CONCLUSIONS:

Approximately one-half of patients required ipsilateral reamputation and died in 3years. Gangrene on admission and history of insulin-dependent diabetes weresignificant risk factors (P = 0.003, P = 0.028). Long duration of antibiotic use afteramputation and postoperative infection did not change the risk of reamputation.

Published by Elsevier Inc.


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Role of ultrasound arterial mapping in planning therapeuticoptions for critical ischemia of lower limbs in diabeticpatients

Mart X,Romera A, Vila R, Cairols MA.

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Source

Vascular Surgery Department, Hospital Universitari de Bellvitge, L'Hospitalet deLlobregat, Spain. Electronic address: [email protected].

Abstract

BACKGROUND:

To assess the role of ultrasound arterial mapping in planning therapeutic options forcritical limb ischemia (CLI) in diabetic patients.

METHODS:

This observational and comparative study included 244 patients with CLI. Allparticipants (64% were diabetic) underwent ultrasound arterial mapping beforeplanning surgical treatment. We established two groups: diabetic (n = 156) and

nondiabetic (n = 88). Arterial mapping was divided into segments. We studied 2,021individual segments and used arteriography when ultrasound arterial mapping was notconclusive. We compared the degree of pathology between the groups, agreementbetween the treatment decision made after ultrasound mapping and the final surgicaldecision in both groups, and agreement between ultrasound mapping andarteriography in patients who underwent both procedures.

RESULTS:

Diabetic patients had a significantly higher degree of pathology in all segments, exceptthe common iliac artery. Decisions made after ultrasound mapping matched the final

surgical decision 90% and 94% of the time in diabetic patients and nondiabeticpatients, respectively. Decisions made on the basis of ultrasound arterial mappingmatched decisions made on the basis of arteriography in 86.3%.

CONCLUSIONS:

Ultrasound arterial mapping allowed for good therapeutic planning for CLI in diabeticpatients, even though these patients had more severe arterial pathology.



Related citations

10.Ann Vasc Surg . 2012 Nov;26(8):1106-13. doi: 10.1016/j.avsg.2012.02.007. Epub 2012

Jul 25.

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Maximal venous outflow velocity: an index for iliac veinobstruction

Jones TM, Cassada DC, Heidel RE, Grandas OG, Stevens SL, Freeman MB,Edmondson JD,Goldman MH.

Source

Division of Vascular Surgery, Department of Surgery, University of Tennessee MedicalCenter, Knoxville, TN. Electronic address: [email protected].

Abstract

Leg swelling is a common cause for vascular surgical evaluation, and iliocavalobstruction due to May-Thurner syndrome (MTS) can be difficult to diagnose. Physicalexamination and planar radiographic imaging give anatomic information but may miss

the fundamental pathophysiology of MTS. Similarly, duplex ultrasonographicexamination of the legs gives little information about central impedance of venousreturn above the inguinal ligament. We have modified the technique of duplexultrasonography to evaluate the flow characteristics of the leg after tourniquet-inducedvenous engorgement, with the objective of revealing iliocaval obstruction characteristicof MTS. Twelve patients with signs and symptoms of MTS were compared with healthycontrol subjects for duplex-derived maximal venous outflow velocity (MVOV) aftertourniquet-induced venous engorgement of the leg. The data for healthy controlsubjects were obtained from a previous study of asymptomatic volunteers using thesame MVOV maneuvers. The tourniquet-induced venous engorgement mimics thatcaused during vigorous exercise. A right-to-left ratio of MVOV was generated forpatient comparisons. Patients with clinical evidence of MTS had a mean right-to-left

MVOV ratio of 2.0, asymptomatic control subjects had a mean ratio of 1.3, and MTSpatients who had undergone endovascular treatment had a poststent mean ratio of 1.2(P = 0.011). Interestingly, computed tomography and magnetic resonance imagingresults, when available, were interpreted as positive in only 53% of the patients withMTS according to both our MVOV criteria and confirmatory venography. Afterintervention, the right-to-left MVOV ratio in the MTS patients was found to be reducedsimilar to asymptomatic control subjects, indicating a relief of central venousobstruction by stenting the compressive MTS anatomy. Duplex-derived MVOVmeasurements are helpful for detection of iliocaval venous obstruction, such as MTS.Right-to-left MVOV ratios and postengorgement spectral analysis are helpful adjunctsto duplex imaging for leg swelling. The MVOV maneuvers are well tolerated by patientsand yields physiological data regarding central venous obstruction that computed

tomography and magnetic resonance imaging fail to detect.



Related citations

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The ongoing battle between infrapopliteal angioplasty andbypass surgery for critical limb ischemia

Schamp KB,Meerwaldt R, Reijnen MM, Geelkerken RH, Zeebregts CJ.

Source

Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.

Abstract

BACKGROUND:

Critical limb ischemia (CLI) represents the extreme of the peripheral arterial occlusivedisease spectrum and is associated with high mortality. Limb salvage often requiresinfrapopliteal revascularization by either angioplasty or bypass surgery. The pastdecade has witnessed a paradigm shift in CLI management toward endovasculartreatment. This narrative review describes the clinical outcome, treatment strategy, andlimitations of both modalities.

METHOD:

A literature search was performed of the PubMed and Cochrane databases. All articles,

published until September 2011, describing treatment by infrapopliteal arterialrevascularization were included.

RESULTS:

Angioplasty and bypass surgery are both related to a limb salvage rate ofapproximately 80% at 3-year follow-up. Patency rates appear to be higher aftersurgery. A reliable comparison of the two modalities, however, is complicated byvarious confounders, including patient selection, lesion characteristics, andcomplication rates. Additionally, most studies did not describe the standard use of bestmedical treatment or outcome for relief of ischemic pain, wound healing, or functionalimprovement.

CONCLUSION:

Infrapopliteal angioplasty and bypass surgery both provide an acceptable limb salvagerate, but patency appears to be better after bypass surgery. Both modalities are likelyto be complementary. Additional randomized trials are indicated to provide a treatmentalgorithm for patients with CLI and infrapopliteal arterial occlusive disease.


PMID:22835563

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Vascular surgeons in france: an endangered species?

Berger L,Mace JM.

Source

Vascular Surgery Department, University Hospital of Caen, Caen, France. Electronicaddress: [email protected].

Abstract

BACKGROUND:

In France, in the next 10 years, a large number of vascular surgeons will retire, and therisk of them not being replaced has raised the question of our capability to predictfuture activity in this discipline. Otherwise, the French population is expanding andaging. It will increase by 2.7% in 2020, and the number of individuals aged >65 years is

expected to increase by 3.3 million, which represents a 33% rise between 2005 and2020. As the number of vascular surgery procedures is closely associated with agingpopulation, we can expect a significant increase in vascular surgery workload. Wepresent a model to predict changes in vascular surgery activity according to populationaging, including other parameters that could affect workload evolution.

METHODS:

To meet vascular surgeons' needs in the coming years, we initially performed anoverview of the demographics of practitioners and estimated the retirements. Thesecond part of our work consisted in studying three groups of arterial surgical and

endovascular procedures used in the treatment of infrarenal abdominal aorticaneurysm, peripheral arterial occlusive disease (PAOD), and carotid artery occlusivedisease. Data were selected and extracted from the national Medical InformationSystem Program database. Our predictive model is based on the OMPHALE methoddeveloped by the National Institute for Statistics and Economic Studies, and we appliedit from the year 2000 to 2030. To integrate other parameters affecting workload, weestablished, from year 2000 data, a prediction based on aging population for the year2008. Based on this model, we defined a weighted index for each group by comparingexpected and observed workloads. This index has been applied to validate ourweighted predictive model for year 2009.

RESULTS:

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Among the 611 vascular surgeons in activity in 2011, nearly two-thirds will retire in thenext 15 years. Compared with the number of surgeons in formation, there will be a lackof four surgeons per year in the same period. Our predictive model reported anincrease by 61% for the three groups for the period 2000 to 2030. Between 2009 and2030, nearly 22,700 additional acts are expected, representing a 38% increase.According to the model, between 2000 and 2008 only, vascular procedures increasedin total by 52.2%, with an increase of 89% in the PAOD group. Between 2000 and2009, the global increase was 58.0%, with 3.9% for abdominal aortic aneurysm,101.7% for PAOD, and +13.2% for carotid artery occlusive disease. Our weightedmodel based on aging population and corrected by a weighted factor predicted thisincrease. If the activity for each surgeon remained constant, 183 additional surgeonswould be needed according to our refined model.

CONCLUSION:

In addition to the replacement of numerous retired surgeons, aging populationand other factors could result in a significant increase in the demand for vascular

surgical services.



Related citations

13.Ann Vasc Surg . 2012 Nov;26(8):1100-5. doi: 10.1016/j.avsg.2011.12.014. Epub 2012Jun 28.

Increased expression of hypoxia-inducible factor-1alpha andbcl-2 in varicocele and varicose veins

Lee JD, Yang WK,Lee TH.

Source

Department of Surgery, Taichung Armed Forces General Hospital, Taiwan, Republic ofChina; Central Taiwan University of Science and Technology, Taiwan, Republic ofChina. Electronic address: [email protected].

Abstract

BACKGROUND:

Primary vein wall abnormalities leading to secondary blood stasis and increasedvenous pressure that cause tissue hypoxia are observed in varicocele and varicoseveins. Both types of diseased vessels are characterized by dilated thickened vein walls.
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00204-X

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Hypoxia upregulates Bcl-2 (antiapoptosis protein) expression in different human celltypes. We studied the expression of hypoxia-inducible factor-1alpha (HIF-1) and Bcl-2in both venous diseases.

METHODS:

All vascular specimens, including the saphenous and internal spermatic veins, frompatients with either varicocele or left inguinal herniorrhaphy (control group) werestudied using immunoblotting, immunohistochemical staining, and doubleimmunofluorescence staining. The data were analyzed using 1-way analysis ofvariance with Tukey comparison test.

RESULTS:

Protein analysis revealed that both venous diseases had a higher expression of HIF-1and Bcl-2 compared with the control group (P < 0.05). Immunohistochemical stainingand double immunofluorescence staining revealed that the greatest degree of HIF-1

and Bcl-2 colocalization occurred in the muscle layer of both diseased vessels.Moreover, under confocal microscopy, elevated Bcl-2 expression was found in theendothelium of both study groups compared with the control group.

CONCLUSIONS:

Our findings revealed increased expression of HIF-1 and Bcl-2 in varicocele andvaricose veins and increased Bcl-2 expression especially in the endothelium underhypoxia. Thus, Bcl-2 overexpression may protect cells against apoptosis and contributeto the dilated thickened walls seen in both types of diseased vessels.



Related citations


Does routine completion angiogram during embolectomy foracute upper-limb ischemia improve outcomes?

Zaraca F, Ponzoni A,Sbraga P,Stringari C,Ebner JA, Ebner H.

Source

Department of Vascular and Thoracic Surgery, Regional Hospital Bolzano, Bolzano,Italy. Electronic address: [email protected].

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Abstract

BACKGROUND:

Since 1963, Fogarty balloon catheter thromboembolectomy is usually adopted as the

gold standard treatment for acute limb ischemia. As the success of the proceduredepends on complete removal of all thromboembolic material, intraoperativearteriography can be used after arterial thromboembolectomy as a guide for extensionof the procedure. It is still a matter of debate whether intraoperative angiographyshould be routinely performed in all cases or only in selected cases, depending onintraoperative findings, when the surgeon suspects an incomplete disobstruction. Mostpublished evidence derives from analysis of lower-limb thromboembolectomies. Theaim of our retrospective study was to elucidate the value of routine completionangiogram in acute arterial embolism of the upper limb.

METHODS:

Clinical and demographic data of 100 patients with acute embolic upper-limb ischemiawere prospectively recorded during an 18-year period in a central hospital vascular unitsetting. The relevance of intraoperative angiography was retrospectively analyzed. Theprocedures were divided into two groups: group A, when intraoperative angiographywas performed in selected cases (selective angiography); and group B, whenangiography was performed as a routine procedure in all cases (routine angiography).All factors associated with reocclusion and mortality were investigated to producemeaningful information that could assist the surgeon to predict outcomes.

RESULTS:

Cumulative reocclusion and mortality rates at 24 months were 14.0% and 70.0%,respectively. After upper-limb arterial embolectomy, the rate of extension of theprocedure was significantly higher in group B than in group A (26.0% vs. 4.0%, P =0.002). At 24 months after embolectomy, group B resulted in a lower incidence ofreocclusion compared with group A (12.0% vs. 2.0%, P = 0.05), whereas there was nostatistical difference between the two groups in terms of mortality (P > 0.05). Onunivariate analysis, the factor associated with increased 2-year reocclusion rate wasonly the avoidance of completion angiography, although it lost some of its predictivevalue on multivariate analysis. Factors associated with increased 2-year mortality rateon univariate analysis included age >80 years, diabetes mellitus [DM], and antiplateletdrug use. Only DM was significantly associated on multivariate analysis.

CONCLUSION:

Routine use of intraoperative angiography influences outcome after embolectomy forupper-limb acute arterial occlusion. Routine use of intraoperative angiography,compared with selective use, results in a higher rate of extension of the procedure forresidual lesion and in a lower rate of reocclusion at 24 months. In prevention ofreocclusion, completion angiogram has a hazard ratio of 5.44 on multivariate analysis.Postoperative late mortality is mainly affected by old age and DM.


PMID:22743219

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Spiral laminar flow prosthetic bypass graft: medium-termresults from a first-in-man structured registry study

Stonebridge PA, Vermassen F, Dick J, Belch JJ,Houston G.

Source

Division of Cardiovascular Research, Ninewells Hospital and Medical School,University of Dundee, Dundee, Scotland; and Division of Vascular and ThoracicSurgery, University of Ghent, Ghent, Belgium. Electronic address:[email protected].

Abstract

BACKGROUND:

A number of surgical strategies and graft enhancements have been trialled to improvethe performance of prosthetic grafts. Neointimal hyperplasia may, in part, be a normalcellular response to an abnormal (turbulent) flow environment. This first-in-many studyassesses the safety and medium-term patency performance of a new graft designed toinduce stable laminar flow through the distal anastomosis.

METHOD:

Forty patients who required an infrainguinal bypass graft were recruited/registered froma number of centers in Belgium and The Netherlands. Thirty-nine received a SpiralLaminar Flow graft as part of a standard treatment protocol (23 above-the-knee and 16below-the-knee bypasses). Kaplan-Meier analyses were used to calculate primary and

secondary patency rates.

RESULTS:

The 12-, 24-, and 30-month primary patency rates were 86%, 81%, and 81% for above-the-knee bypasses and 73%, 57%, and 57% for below-the-knee bypasses,respectively. In the case of secondary patency rates, numbers were unchanged forabove-the-knee bypasses and were 86%, 64%, and 64%, respectively, for below-the-knee bypasses. There were no amputations in the study population.

CONCLUSION:

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This first-in-man series shows potential for the idea of spiral flow-enhanced prostheticgrafts. As always, randomized studies are required to explore the role of differentenhanced prosthetic grafts.



Related citations

16.

Ann Vasc Surg . 2012 Nov;26(8):1130-44. doi: 10.1016/j.avsg.2011.12.001. Epub 2012Mar 22.

Role of the Renin-Angiotensin system in the pathogenesis ofintimal hyperplasia: therapeutic potential for prevention ofvein graft failure?

Osgood MJ, Harrison DG, Sexton KW, Hocking KM,Voskresensky IV, Komalavilas P,Cheung-Flynn J, Guzman RJ, Brophy CM.

Source

Department of Surgery, Vanderbilt University Medical Center, Nashville, TN. Electronicaddress: [email protected].

Abstract

The saphenous vein remains the most widely used conduit for peripheral and coronaryrevascularization despite a high rate of vein graft failure. The most common cause ofvein graft failure is intimal hyperplasia. No agents have been proven to be successfulfor the prevention of intimal hyperplasia in human subjects. The renin-angiotensinsystem is essential in the regulation of vascular tone and blood pressure in physiologic

conditions. However, this system mediates cardiovascular remodeling inpathophysiologic states. Angiotensin II is becoming increasingly recognized as apotential mediator of intimal hyperplasia. Drugs modulating the renin-angiotensinsystem include angiotensin-converting enzyme inhibitors and angiotensin receptorblockers. These drugs are powerful inhibitors of atherosclerosis and cardiovascularremodeling, and they are first-line agents for management of several medicalconditions based on class I evidence that they delay progression of cardiovasculardisease and improve survival. Several experimental models have demonstrated thatthese agents are capable of inhibiting intimal hyperplasia. However, there are no datasupporting their role in prevention of intimal hyperplasia in patients with vein grafts.This review summarizes the physiology of the renin-angiotensin system, the role ofangiotensin II in the pathogenesis of cardiovascular remodeling, the medical indicationsfor these agents, and the experimental data supporting an important role of the renin-angiotensin system in the pathogenesis of intimal hyperplasia.

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Copyright 2012 Annals of Vascular Surgery Inc. All rights reserved.


Related citations

17.Ann Vasc Surg . 2012 Nov;26(8):1057-63. doi: 10.1016/j.avsg.2011.09.008. Epub 2012Mar 10.

Long-Term Follow-Up of Endovascular Treatment for Trans-Atlantic Inter-Society Consensus II Type B Iliac Lesions in

Patients Aged

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Endovascular treatment of TASC-II type B iliac lesions in patients aged

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Ann Vasc surg 2012; 26(8)

Case Reports

1.Ann Vasc Surg . 2012 Nov;26(8):1127.e1-7. doi: 10.1016/j.avsg.2012.02.018.

Strategies to tackle unrecognized bilateral renal arteryocclusion after endovascular aneurysm repair.

Adu J,Cheshire NJ, Riga CV, Hamady M,Bicknell CD.

Source

Imperial Vascular Unit, St Mary's Campus, Imperial College Healthcare NHS Trust,London, UK.

Abstract

BACKGROUND:

Unintentional renal artery occlusion after endovascular aortic aneurysm repair (EVAR)

is an uncommon phenomenon. The sequelae from this specific complication aresevere; consequently, the topic of renal artery coverage is a pertinent issue. Wepresent a case series of patients undergoing EVAR with unintentional renal arterycoverage, review the treatment options available, and suggest a treatment algorithm forthis scenario based on the evidence.

METHODS AND RESULTS:

We report four patients who were found to have renal artery occlusion after EVARdetected up to 5 weeks postoperatively. Renal revascularization was achieved usingendovascular renal artery stenting in two patients, and open hepato-spleno-renalbypass in the remaining two cases. Treatment strategies used led to symptomresolution and recovery of renal function in all cases.

CONCLUSIONS:

Both open and endovascular techniques may be used as procedures to treat thiscondition-the choice of procedure is primarily determined by accessibility of the renalorifice.


PMID:23068430

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2.Ann Vasc Surg . 2012 Nov;26(8):1129.e9-1129.e11. doi: 10.1016/j.avsg.2012.04.010.Epub 2012 Sep 12.

Management of a challenging arteriovenous malformation ofthe scalp and orbit in a patient with polycystic kidneydisease.

Bit N, Vidyasagaran T,Amalorpavanathan J, Balakrishnan TM, Sritharan N.

Source

Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, TamilNadu, India. [email protected]

Abstract

Arteriovenous malformations are notorious for their propensity to bleed, sometimeswith fatal consequences. We describe an unusual case of a patient with polycystickidney disease and with a large arteriovenous malformation involving the orbit andscalp who presented with multiple episodes of profuse bleeding from the upper eyelid

and loss of vision in the corresponding eye.



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3.Ann Vasc Surg . 2012 Nov;26(8):1129.e13-6. doi: 10.1016/j.avsg.2012.04.012. Epub2012 Sep 12.

Endovascular repair of a left common carotid pseudoaneurysmassociated with a jugular-carotid fistula after gunshotwound to the neck.

Faure E,Canaud L, Marty-An C,Alric P.

Source
http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00268-3http://linkinghub.elsevier.com/retrieve/pii/S0890-5096(12)00221-X

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Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital,Montpellier, France. [email protected]

Abstract

The management of traumatic injury of the common carotid artery has traditionallyrequired a conventional surgical intervention, which is associated with a high mortalityrate. Endovascular procedures might offer a less invasive alternative to treat theseinjuries, with a lower rate of mortality and morbidity. We report the case of a 30-year-old man who presented after penetrating injury due to a low-velocity gunshot wound tothe neck. Angiography demonstrated a high-flow arteriovenous fistula and large falseaneurysm of the common carotid artery. A self-expanding covered stent was placedacross the injured portion of the artery, resulting in thrombosis of the aneurysm andpreservation of the parent artery, without any significant complication. Covered stentplacement is an alternative approach to treating carotid artery pseudoaneurysmsassociated with a jugular-carotid fistula.



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4.Ann Vasc Surg . 2012 Nov;26(8):1129.e5-8. doi: 10.1016/j.avsg.2012.04.011. Epub2012 Sep 12.

Inferior vena cava clip migration: unusual cause of duodenal foreign body.

Antonoff MB, Beilman GJ.

Source

Department of Surgery, University of Minnesota, Minneapolis, MN 55455, [email protected]

Abstract

Before the development of the inferior vena cava (IVC) filter, various techniques of IVCinterruption were described for the management of patients at high risk forthromboembolic events, and for whom anticoagulation was either inadequate orcontraindicated. In this report, we describe the enteric migration of a Miles IVC clip,occurring 27 years after IVC interruption. This previously undescribed complication andthe patient's prolonged follow-up period render this case of significant interest.


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Related citations


Internal jugular vein hemangioma.

Al-Natour M, Kenmuir C, Khuder S, Kazan V,Abbas J,Nazzal M.

Source

Division of Vascular and Endovascular Surgery, University of Toledo Medical Center,Toledo, OH 43614, USA.

Abstract

Primary tumors of the major body veins arising intraluminally are rare clinical entities.As such, few cases have been reported in the literature. As a primary tumor,hemangiomas arising in the internal jugular vein are extremely rare, while those arisingin the external jugular vein are only slightly more common. We present a case of aninternal jugular vein hemangioma that was incidentally discovered during an ultrasound

examination performed for the evaluation of the internal carotid arteries. We believethat this is the second case of internal jugular vein hemangioma reported in the Englishliterature.



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6.Ann Vasc Surg . 2012 Nov;26(8):1128.e7-1128.e10. doi: 10.1016/j.avsg.2012.02.019.Epub 2012 Aug 28.

Aneurysm of a 32-year-old aortorenal saphenous vein bypassgraft.

Bath J,Cho JS.

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Source

Division of Vascular Surgery, Department of Surgery, University of Pittsburgh School ofMedicine, Pittsburgh, PA 15213, USA.

Abstract

We report the case of an incidentally discovered aneurysm of a previous saphenousvein bypass graft performed 32 years earlier for a renal artery aneurysm. The patient isa 52-year-old man who initially suffered from symptoms of hypertension and left-sidedback pain. Saphenous vein bypass grafting was performed with aneurysm resection.Thirty-two years after surgery, the patient underwent a magnetic resonance imagingscan for back pain, hip pain, and anemia, discovering a 1.8-cm focal aneurysm at thesite of the previous bypass. The patient underwent a repeat aortorenal bypass with an8-mm flanged Dacron graft with excision of the existing aneurysmal saphenous veingraft.



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7.Ann Vasc Surg . 2012 Nov;26(8):1127.e9-1127.e13. doi: 10.1016/j.avsg.2012.02.025.Epub 2012 Aug 28.

Totally implanted venous access devices implanted in thesaphenous vein. Relation between the reservoir site andcomfort/discomfort of the patients.

Toro A, Mannino M, Cappello G, Celeste S,Cordio S,Di Carlo I.

Source

Department of Surgical Sciences, Organ Transplantation, and Advanced Technologies,Cannizzaro Hospital, University of Catania, Catania, Italy.

Abstract

BACKGROUND:

When a totally implantable venous access device (TIVAD) is implanted in the femoralor saphenous vein, the port can be placed in the abdominal wall, thigh, or anteroinferiorthoracic wall. This study analyzed the relationship between the position of the port and

patient comfort.

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METHODS:

All patients who underwent TIVAD implantation from 1995 to 2011 were included in thestudy. Sex, age, indication for TIVAD implantation, contraindication for implantation in avein draining into the superior vena cava, surgical technique, length of procedure,complications, difficulties recorded by nurses, and patient comfort or discomfort wererecorded.

RESULTS:

The TIVAD was implanted in the saphenous vein in 6 of 581 patients (1.3%) whoreceived a TIVAD, consisting of four male subjects and two female subjects aged 35 to56 years (mean age: 47.3 years), who all underwent TIVAD implantation for thetreatment of a solid tumor. The port was positioned in the anteroinferior thoracic wall inone patient, the abdominal wall in one patient, the anterior thigh in three patients, andthe lateral thigh in one patient. The mean procedure duration was 52 minutes (range:20-135 minutes). No immediate or early complications were recorded. The nurses had

difficulty in puncturing the port in the abdominal wall. Patient comfort levels were highwhen the port was placed in the anterior thigh.

CONCLUSION:

The anterior thigh may be the most useful and comfortable position for the port of aTIVAD implanted in the inferior vena cava. Larger studies should be undertaken toconfirm this.



Related citations


Aortoiliac thrombi in inflammatory bowel disease.

Singh K, Marco SA, Wang ML,Milone L, Deitch JS.

Source

Division of Vascular and Endovascular Surgery, Staten Island University Hospital,Staten Island, NY 10305, USA. [email protected]

Abstract

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Isolated arterial thrombi complicating inflammatory bowel disease occurs rarely. Weencountered a case of a 28-year-old man with Crohn disease who presented withabdominal pain and severe claudication and was found to have an isolated aortoiliacthrombus. Bilateral aortoiliac thromboembolectomies were performed with successfulrestoration of femoral blood flow. Long-term anticoagulation therapy was instituted afteran extensive hypercoagulable workup, which failed to reveal an etiology for thepatient's coagulopathy. We present our case and perform an extensive literature reviewon this topic.



Related citations


Recurrent acute lower-limb ischemia with multiple organinfarctions secondary to acute myeloid leukaemia M1.

Overton J, Nicklin A, Eleftheriou P, Frith D, Gravante G, Sapsford W.

Source

Department of Vascular Surgery, Barts and the London NHS Trust, London, [email protected]

Abstract

BACKGROUND:

Acute myeloid leukemia (AML) is usually associated with coagulopathy and disorders

of hemostasis, but cases of ischemic events have been reported. We present a case ofAML with recurrent acute limb ischemia and multiple organ infarctions.

METHODS AND RESULTS:

A 57-year-old woman diagnosed with AML subtype M1 developed recurrent bilateralacute lower-limb ischemia refractory to multiple thromboembolectomies and bypassgrafting. Histopathology revealed that thrombi were composed of leukemic blasts, andcomputed tomography angiogram incidentally revealed multiple infarctions. Shedemonstrated a response to chemotherapy, but died of an overwhelming sepsis 22days after her acute admission.

CONCLUSIONS:

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AML subtype M1 with acute lower-limb ischemia and multiple organ infarctions isassociated with a poor prognosis. The role of emergency chemotherapy in reducing thetumour burden and possibly improving the results of vascular interventions needs to bedefined. Limb-salvaging surgery should not be delayed but be administeredimmediately according to the degree of ischemia.



Related citations

10.Ann Vasc Surg . 2012 Nov;26(8):1128.e15-7. doi: 10.1016/j.avsg.2012.03.007. Epub2012 Jul 25.

Pasteurella multocida-infected expandedpolytetrafluoroethylene hemodialysis access graft.

Schneider JR, White GW,Dejesus EF.

Source

Vascular and Interventional Program of Cadence Healthcare, Winfield, IL 60190, [email protected]

Abstract

Infections are among the risks related to prosthetic hemodialysis access grafts.However, dialysis access graft infections caused by Pasteurella multocida have notbeen reported previously. We report a case of a P. multocida-infected nonfunctioningexpanded polytetrafluoroethylene graft in the forearm after a cat bite. At surgery, thegraft was completely unincorporated and was completely excised. Operative cultureresults were positive for P. multocida, a common oral flora found in cats and dogs. The

patient was treated with intravenous ceftriaxone, and the wounds healed with localcare.



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